Imaging-guided left main stenting gets a consensus; targeted vitamin D after MI misses its endpoint; discordant troponins may be assay artefact

The edition in brief

A clinical consensus statement from EAPCI and the European Bifurcation Club sets out how to use intravascular ultrasound or optical coherence tomography to plan, guide and optimise left main bifurcation stenting, noting that American and European guidelines already endorse imaging for this lesion. TARGET-D, a pragmatic randomised trial of 630 patients after myocardial infarction, tested vitamin D3 titrated to a 25-hydroxyvitamin D target above 40 ng/mL: major adverse cardiovascular events were 15.7% against 18.4% (HR 0.85, 95% CI 0.58 to 1.24), not significant. A meta-analysis of 36 studies and about 2.6 million women associated iatrogenic menopause with more cardiovascular disease and stroke, with mortality excess confined to menopause before age 45. A meta-analysis of seven small trials (513 women) found no consistent effect of exercise on ejection fraction or strain during anthracycline or anti-HER2 therapy, with low-certainty evidence. In a general-population cohort of 19,499 people, about half of elevated troponin results were discordant between troponin I and T, and most discordant troponin I results were due to macrotroponin complexes; those with suspected macrotroponin did not carry the excess risk seen with true myocardial injury.