The edition · Cardiology
CT-planned PCI matched IVUS-guided PCI at a year, and Lp(a) tracks recurrent MI in diabetes
An NEJM noninferiority trial of 1,105 patients found CCTA-guided PCI no worse than IVUS guidance for target-vessel failure. Raised Lp(a) was linked to about double the hazard of recurrent MI after ACS in diabetes, and PREVENT-HF predicts HFpEF better than HFrEF.
The edition in brief
In an open-label NEJM trial of 1,105 patients with a lesion over 70% and CT-derived FFR of 0.80 or less, PCI planned on coronary CT angiography was noninferior to IVUS-guided PCI: target-vessel failure at 12 months was 4.1% versus 4.6% (risk difference −0.42 points, 95% CI −2.82 to 1.99). It was not superior, and the trial was industry funded. A meta-analysis of seven observational studies (7,887 patients with diabetes after ACS or PCI) found raised lipoprotein(a) associated with recurrent MI (HR 2.17, 95% CI 1.02–4.62) with high heterogeneity, and no clear association with repeat revascularisation. In three US samples totalling over 190,000 adults, the PREVENT-HF equations discriminated future HFpEF (AUROC 0.82–0.90) somewhat better than HFrEF (0.79–0.83), with similar calibration; they were built for overall heart failure risk, so subtype thresholds do not yet exist. The pearl covers measuring Lp(a) once in every adult after a coronary event.
Raised Lp(a) linked to about double the hazard of recurrent MI after ACS in diabetes
In diabetes after ACS, a high Lp(a) marks higher recurrent MI risk; consider measuring it once and use it to intensify other risk-factor control.
PREVENT-HF predicts future HFpEF better than HFrEF
PREVENT-HF works for both heart failure subtypes, slightly better for HFpEF; use the overall score to target prevention.
Who gets no-reflow after primary PCI: an evidence map of 27,405 STEMI patients
Use age, diabetes, heart failure at presentation and thrombus load to anticipate no-reflow during primary PCI; the procedural links are not causal.
Measure Lp(a) once — it is the lipid test that does not need repeating
Check Lp(a) once in adults with premature or recurrent coronary disease, and use a high value to intensify other risk control.
PCI planned on coronary CT was noninferior to IVUS guidance at one year
Where high-quality coronary CT is already done, consider using it to plan PCI instead of routine IVUS for suitable lesions.
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