Cardiology
Intravenous nicorandil did not improve one-year outcomes after primary PCI for STEMI
A 1,503-patient blinded trial finds no benefit on its primary endpoint; IVUS guidance helped far more in East Asian trials than elsewhere; and flutter alone carried a lower stroke rate than atrial fibrillation.
Evolocumab was projected to prevent 55 first and repeat events per 1,000 over five years in patients with no prior MI or stroke
VESALIUS-CV counts first and repeat events; titrated vitamin D after MI missed its primary endpoint; and many 'raised' troponin I results in healthy people are antibody complexes, not heart injury.
Statins cut cardiovascular events after 70, but did not buy disability-free years
STAREE gives primary-prevention atorvastatin in older adults a firm yes for events and a no for disability-free survival; factor XIa inhibition failed after ACS; and a short DOAC course after TAVR traded a temporary imaging benefit for more harm.
Transcatheter tricuspid repair cuts death or heart failure admission; dropping aspirin in STEMI fails
TRIC-I-HF halved three-year death or heart failure hospitalisation in severe tricuspid regurgitation. PREMIUM could not show prasugrel alone was safe at primary PCI. Also: routine CT coronary angiography after MI rule-out, posterior wall isolation, and a lipid protocol after ACS.
Escitalopram and amitriptyline lengthened QTc most among ten antidepressants, without a rise in early cardiac events
An individual-patient BMJ analysis ranks antidepressants by QTc effect for the cardiac patient who needs one. Also: pace-and-ablate beat pulmonary vein isolation in over-75s with persistent AF, first-line evolocumab at PCI hit targets but not outcomes, and SELECT's benefit is not explained by weight alone.
A randomised answer for AF at intermediate stroke risk
SINGLE-AF found a DOAC cut the composite of stroke, embolism, major bleeding and cardiovascular death against no anticoagulation at CHA2DS2-VASc 1 in men and 2 in women. Also: CMR scar did not identify who benefits from an ICD at LVEF 36–50%, anticoagulation after TAVI, the EV-ICD in routine practice, and dexrazoxane for haemorrhagic infarction.
Tenecteplase bleeding risk is set by three numbers you already have before you give it
A pooled analysis of 15,954 lysed STEMI patients turns age, weight and systolic pressure into a usable bleeding estimate; an amiodarone infusion is in Class II recall; and physiology beats the eye for non-culprit lesions.
Four doses of dapagliflozin halved acute kidney injury after cardiac surgery
A Dutch randomised trial finds a striking perioperative kidney signal, a multicentre study rewrites how exercise echocardiography should be used in suspected HFpEF, and SMART-CHOICE 3 asks whether women do better on clopidogrel than aspirin.
Bivalirudin holds its advantage at low bleeding risk, and two familiar drugs fail their trials
A prespecified BRIGHT-4 analysis undercuts the assumption that only bleeding-prone patients benefit; nicorandil and sodium bicarbonate both miss; and an Indian stent trial reports at a scale the field rarely sees.
Counting every event, not just the first, changes what evolocumab is worth
A prespecified VESALIUS-CV analysis finds two in five events are repeats and lipid lowering prevents those too; half-dose rivaroxaban cuts silent embolism after appendage occlusion; targeted vitamin D after infarction does nothing for the composite.
Evolocumab improves survival before the first infarct, and voltage mapping earns its place
A prespecified VESALIUS-CV analysis shows a 20% lower all-cause mortality in patients with no prior myocardial infarction or stroke; adjunctive low-voltage ablation nearly doubles arrhythmia-free survival in persistent atrial fibrillation; and three months of a DOAC after TAVR buys leaflet appearance at the cost of events.
Dropping aspirin at primary PCI fails its noninferiority test, and transcatheter tricuspid repair produces an effect size that is hard to ignore
A Japanese randomised trial finds prasugrel monotherapy from the start of primary PCI does not meet noninferiority against dual antiplatelet therapy; transcatheter tricuspid repair cuts death or heart-failure hospitalisation at three years; routine CT coronary angiography after a ruled-out presentation changes nothing over three years; and a pooled analysis of 42,000 patients puts the optimal haemoglobin in heart failure well above the WHO anaemia threshold.
In patients over 75 with persistent AF, pace-and-ablate halved the hospital-and-cardioversion endpoint against PVI
ABLATE versus PACE favours the older strategy, 28 trials support intracoronary imaging again, a patient-level analysis sharpens AF-PCI antithrombotic choice, and early evolocumab after MI lowered LDL without a one-year clinical gain.
Anticoagulation beat no treatment at intermediate stroke risk in atrial fibrillation
SINGLE-AF gives the class IIa recommendation its first randomised support, though on few events. Also: statins in the over-70s, ultrashort DAPT after ACS, scar-guided ICDs, and anticoagulation after TAVI.
Physiology, not the picture: guiding complete revascularisation in STEMI cut events by a third
AIR-STEMI randomised 1823 patients and found fewer events and less harm when non-culprit lesions were selected by function rather than by eye. Plus a lifetime risk model for HFpEF, and what a cyclone does to door-to-balloon time.
Ablation lost to a sham procedure, and exercise echo alone still cannot diagnose HFpEF
PVI-SHAM-AF randomised 262 patients to pulmonary vein isolation or a sham and found a 2.6-point difference in quality of life at six months, confidence interval crossing zero. Meanwhile a 482-patient study shows the non-invasive HFpEF pathway most units now use has a sensitivity of 55 to 60%.
Endocarditis guidance rewritten, and a reason to doubt a raised troponin
The AHA updates its endocarditis statement for the first time in a decade; discordant troponin I and T usually means assay interference; and IVUS-guided PCI turns out to work very differently depending on where the trial was run.
Familial hypercholesterolaemia is commoner than we teach, and three liver indices sharpen cardiovascular risk
25,431 German children screened at routine appointments, 318,308 adults followed for 14 years on non-invasive liver markers, a validated risk model for RYR2 CPVT, and what night-time light does to the ventricle.
Stress testing standards rewritten, and a heart failure risk model for the patients you already follow
ASNC replaces its 2016 stress testing guideline; a fatty liver meta-analysis argues for looking harder at HFpEF; and SMART2-HF puts a number on heart failure risk in established atherosclerotic disease.
Three months of anticoagulation after TAVI buys a CT finding and costs blood
NOTION-4 abolishes leaflet thickening at three months and loses it again by twelve, while harm accumulates; scar corridors and genotype beat ejection fraction for arrhythmic risk; and a simple protocol gets more post-ACS patients to target than good intentions do.
A tricuspid valve that finally moves hard outcomes
Transcatheter tricuspid repair cuts death and heart-failure admission in a randomised trial; voltage-guided ablation earns its extra mapping time in persistent AF; and a Copenhagen cohort argues for measuring Lp(a) in the old, not just the young.
Raise the potassium, and let the village health worker titrate the blood pressure
A 1200-patient trial says pushing plasma potassium to the high-normal range cuts atrial fibrillation events by a third; half-dose rivaroxaban beats antiplatelet therapy after appendage occlusion on silent embolic lesions; and rural China shows a nurse-led hypertension programme still working three years after the funding stopped.
Anticoagulation after TAVI halved leaflet thrombosis without costing safety
ACASA-TAVI found NOAC monotherapy cut hypoattenuated leaflet thickening from 28.6% to 16.2% and was non-inferior for bleeding and death, four doses of dapagliflozin around cardiac surgery nearly halved acute kidney injury, and evolocumab started in the cath lab hit every lipid target while changing no outcome at a year.
Statins cut events in the over-70s but do not extend disability-free survival
STAREE randomised nearly 10,000 community-dwelling adults aged 70 and over to atorvastatin 40 mg or placebo: a 30% reduction in major cardiovascular events, and no gain on the outcome older patients care about most. Plus physiology-guided complete revascularisation in STEMI, and anticoagulation at CHA2DS2-VASc 1.
A randomised answer at last for atrial fibrillation with a CHA2DS2-VASc of one
SINGLE-AF gives trial evidence for anticoagulating intermediate-risk AF, AMUNDSEN shows early evolocumab drives LDL down without a first-year clinical payoff, and NOAC monotherapy after TAVI halves leaflet thrombosis.