Daily Cardiology Research Analysis
Three high-impact cardiology studies stand out today. A network meta-analysis of 26 RCTs in STEMI with multivessel disease found complete revascularization—especially immediate—reduces MACE versus culprit-only PCI. A large prospective registry (J-PRIDE) showed that in lesions with discordant physiology, FFR guidance outperforms NHPR for outcomes after deferral decisions. A 25-year European cohort (PREVEND) quantified sex-specific lifetime risks and modifiable contributors to HFpEF and HFrEF, sha
Summary
Three high-impact cardiology studies stand out today. A network meta-analysis of 26 RCTs in STEMI with multivessel disease found complete revascularization—especially immediate—reduces MACE versus culprit-only PCI. A large prospective registry (J-PRIDE) showed that in lesions with discordant physiology, FFR guidance outperforms NHPR for outcomes after deferral decisions. A 25-year European cohort (PREVEND) quantified sex-specific lifetime risks and modifiable contributors to HFpEF and HFrEF, sharpening prevention targets.
Research Themes
- Coronary physiology and revascularization strategies in STEMI
- Risk stratification using invasive indices (FFR vs NHPR)
- Sex-specific lifetime risk and prevention of heart failure phenotypes
Selected Articles
1. Optimal Strategy for Complete Revascularization in ST-Segment Elevation Myocardial Infarction and Multivessel Disease: A Network Meta-Analysis.
Across 26 RCTs (n=15,902), complete revascularization reduced MACE compared with culprit-only PCI. Immediate CR further reduced MACE versus staged CR (RR 0.74), largely driven by MI reduction; the advantage attenuated when excluding procedural MI. Benefits were consistent whether guidance was angiographic or physiology-based.
Impact: This synthesis unifies disparate RCTs and provides practice-directing evidence favoring immediate complete revascularization in multivessel STEMI. It clarifies the magnitude and drivers of benefit and nuances related to procedural MI.
Clinical Implications: For hemodynamically stable multivessel STEMI, prioritize complete revascularization during the index procedure when feasible, with awareness that some MI reduction reflects procedural factors. Institutional protocols should enable immediate CR with careful lesion selection and operator expertise.
Key Findings
- Complete revascularization reduced MACE vs culprit-only PCI (immediate CR RR 0.48; staged CR RR 0.65).
- Immediate CR reduced MACE vs staged CR (RR 0.74), consistent with angiographic and functional guidance.
- MI reduction with immediate CR attenuated when procedural MI was excluded (RR 0.65; 95% CI 0.36–1.16).
Methodological Strengths
- Network meta-analysis of 26 RCTs with 15,902 patients; comprehensive comparison across timing and guidance strategies
- Rigorous assessment of heterogeneity and sensitivity analyses excluding procedural MI
Limitations
- Potential trial-level heterogeneity (patient selection, operator expertise, definition of MI across trials)
- Attenuation of MI benefit after excluding procedural MI complicates interpretation of mechanism
Future Directions: Head-to-head RCTs comparing immediate vs staged CR with standardized MI definitions and patient-centered outcomes; implementation studies optimizing workflow and lesion selection.
2. Prevalence and Clinical Outcomes of Discordant Lesions Between Fractional Flow Reserve and Nonhyperemic Pressure Ratios in Clinical Practice: The J-PRIDE Registry.
In 4304 lesions, FFR–NHPR discordance occurred in 20%. Deferred discordant lesions had higher 1-year target vessel failure than concordant negative lesions. Notably, only FFR+/NHPR− lesions derived benefit from revascularization versus medical therapy, supporting FFR-guided decisions when indices disagree.
Impact: Provides high-quality prospective real-world evidence resolving a common clinical dilemma in physiology-guided PCI, with actionable guidance favoring FFR when indices disagree.
Clinical Implications: When FFR and NHPR disagree, consider revascularization for FFR-positive/NHPR-negative lesions and be cautious deferring such lesions. Concordant negative lesions remain safe to defer.
Key Findings
- FFR–NHPR discordance was present in 20% of lesions (FFR+/NHPR− 11.2%; FFR−/NHPR+ 8.8%).
- Deferred discordant lesions had higher 1-year target vessel failure vs concordant negative (7.9% and 5.5% vs 1.7%).
- Only FFR+/NHPR− lesions showed benefit from revascularization over medical therapy.
Methodological Strengths
- Prospective multicenter registry across 20 centers with lesion-level analysis
- Adjusted hazard modeling and clear physiological thresholds (FFR 0.80; NHPR 0.89)
Limitations
- Observational design with potential residual confounding and selection bias in deferral decisions
- Generalizability may vary by NHPR type and center practices
Future Directions: Randomized trials in discordant lesions testing FFR- vs NHPR-guided strategies; standardized protocols across NHPR modalities.
3. Sex-specific risk factors for new-onset heart failure: the PREVEND study at 25 years.
Over 25 years in 8,558 adults, lifetime HF risk was similar overall, but men had higher HFrEF risk and women higher HFpEF risk. Eight modifiable factors (e.g., hypertension, hypercholesterolemia, obesity, AF, CKD, MI, diabetes, smoking) explained a larger share of incident HF in women, emphasizing sex-tailored prevention.
Impact: Defines sex-specific lifetime risks and the population-level impact of modifiable risk factors for HF phenotypes in a large European cohort, informing prevention strategies and policy.
Clinical Implications: Aggressively manage hypertension and lipids to prevent HFrEF in both sexes; prioritize obesity control to prevent HFpEF, particularly in women. Sex-specific risk attribution supports tailored screening and prevention programs.
Key Findings
- Lifetime HF risk: men 24.5% vs women 23.3%; HFrEF higher in men (18.1% vs 11.9%), HFpEF higher in women (11.5% vs 6.4%).
- Eight modifiable factors accounted for 71% of incident HFrEF in women (60% in men).
- Hypertension and hypercholesterolemia were strongest for HFrEF; hypertension and obesity for HFpEF.
Methodological Strengths
- Longitudinal community cohort with 25 years of follow-up and adjudicated HF phenotypes
- Sex-specific lifetime risk and population attributable fraction analyses
Limitations
- Hospital record-based HF ascertainment may miss subclinical cases
- Cohort demographics may limit generalizability beyond European populations
Future Directions: Interventional prevention trials targeting high-PAF factors (hypertension, obesity, lipids) with sex-specific endpoints; integration with polygenic and biomarker risk to refine prediction.