Dropping aspirin at primary PCI fails its noninferiority test, and transcatheter tricuspid repair produces an effect size that is hard to ignore

The edition in brief

In 2,216 patients with STEMI undergoing primary PCI in Japan, low-dose prasugrel monotherapy started before the procedure failed to meet noninferiority against 12 months of dual antiplatelet therapy for death, stroke or myocardial infarction (11.0% vs 8.5%; HR 1.34, 95% CI 1.02-1.75). Major bleeding was lower with monotherapy (5.6% vs 8.4%; HR 0.66, 95% CI 0.47-0.91). In TRIC-I-HF, 360 patients with symptomatic severe tricuspid regurgitation, mean age 80, were randomised 2:1 to transcatheter tricuspid repair plus medical therapy or medical therapy alone: win ratio 2.42 (95% CI 1.76-3.33) for the hierarchical primary endpoint, and freedom from death or heart-failure hospitalisation at three years of 52.4% versus 21.0% (HR 0.40, 95% CI 0.29-0.55). TARGET-CTCA randomised 3,170 UK emergency-department patients in whom myocardial infarction had been ruled out but high-sensitivity troponin exceeded 5 ng/L; CT coronary angiography-guided care did not reduce myocardial infarction or cardiac death over a median three years (7.1% vs 7.3%; adjusted HR 0.95, 95% CI 0.73-1.23). Pooled patient-level data from 11 heart-failure trials, 42,213 patients, located the lowest observed risk at haemoglobin around 14 g/dL in women and 15 g/dL in men, above the WHO anaemia thresholds, with excess risk even 0 to under 1 g/dL above them. The edition closes on BRIDGE, a cluster-randomised trial in which a protocol-based lipid pathway after acute coronary syndrome raised achievement of LDL-C under 70 mg/dL at six months from 73.7% to 86.4%.