A randomised answer at last for atrial fibrillation with a CHA2DS2-VASc of one

The edition in brief

The lead today is SINGLE-AF, a Korean trial of 1,803 patients with atrial fibrillation and a CHA2DS2-VASc score of 1 in men or 2 in women — the group guidelines have called class IIa without randomised support. Over 24 months, DOAC therapy cut the composite of stroke, systemic embolism, major bleeding and cardiovascular death from 1.5% to 0.5% (HR 0.31, 95% CI 0.10 to 0.94), with no excess bleeding. Event rates were very low in both arms, so this is a small absolute gain in a young population. AMUNDSEN randomised 2,161 patients with high-risk acute MI to evolocumab starting before PCI or standard care. It worked biochemically — 82% versus 40% reached target LDL, median 16 versus 56 mg/dL at six weeks — but death or unplanned cardiovascular hospitalisation was unchanged at one year (14.6% versus 15.4%). No sign of an acute pleiotropic effect. ACASA-TAVI found NOAC monotherapy after TAVI reduced hypoattenuated leaflet thickening from 28.6% to 16.2% and was non-inferior on bleeding and death. ABLATE versus PACE showed that in patients over 75 with persistent AF, pacemaker plus AV-node ablation beat pulmonary vein isolation for hospitalisations and cardioversions. A Dutch trial found four doses of dapagliflozin around elective cardiac surgery cut acute kidney injury from 52% to 28%. No new regulatory action for the desk; the 2025 ACC scientific statement on peripheral artery disease in diabetes remains the most useful recent document. Today's pearl: the stress hyperglycaemia ratio, not the admission glucose, is what carries prognostic weight after PCI.