Daily Cardiology Research Analysis
Three high-impact cardiology studies advance device durability and heart failure therapy. A pooled individual-patient meta-analysis clarifies that early excess events with first-generation bioresorbable scaffolds dissipate after 3 years. Long-term registry data identify predictors of hemodynamic valve deterioration after TAVR, while a prespecified analysis shows initial eGFR declines with finerenone do not portend worse outcomes and should not trigger drug discontinuation.
Summary
Three high-impact cardiology studies advance device durability and heart failure therapy. A pooled individual-patient meta-analysis clarifies that early excess events with first-generation bioresorbable scaffolds dissipate after 3 years. Long-term registry data identify predictors of hemodynamic valve deterioration after TAVR, while a prespecified analysis shows initial eGFR declines with finerenone do not portend worse outcomes and should not trigger drug discontinuation.
Research Themes
- Long-term durability and safety of coronary and transcatheter valve devices
- Optimization of heart failure pharmacotherapy despite renal function fluctuations
- Risk stratification using multicenter registries and pooled randomized evidence
Selected Articles
1. Early and Late Outcomes With the Absorb Bioresorbable Vascular Scaffold: Final Report From the ABSORB Clinical Trial Program.
Pooled individual-patient data from 5 randomized trials (n=5,988) showed higher target lesion failure and device thrombosis with Absorb BVS vs EES through 3 years, but no excess risk between 3–5 years. Spline analyses suggest the hazard becomes comparable or lower after complete bioresorption, clarifying time-dependent safety of first-generation BVS.
Impact: This resolves a key controversy around BVS by showing that excess risk is confined to the pre-bioresorption period, informing both device development and long-term follow-up strategies.
Clinical Implications: First-generation BVS should be avoided in favor of contemporary DES, but the findings support the potential of next-generation BRS if early hazards are mitigated. Long-term antithrombotic and imaging surveillance may be tailored to the time course of bioresorption.
Key Findings
- Between 0–5 years, TLF was higher with BVS vs EES (15.9% vs 13.1%; HR 1.25, 95% CI 1.08–1.43).
- From 0–3 years, device thrombosis was higher with BVS (2.0% vs 0.6%; HR 3.58, 95% CI 2.01–6.36).
- From 3–5 years, TLF was similar (HR 0.99) and device thrombosis numerically lower (HR 0.49) with BVS.
Methodological Strengths
- Individual patient data pooled from five randomized controlled trials
- Time-to-event analyses with prespecified early (0–3y) and late (3–5y) windows
Limitations
- Applies to first-generation Absorb BVS and may not generalize to newer scaffolds
- Heterogeneity in implantation techniques and trial eras may confound comparisons
Future Directions: Evaluate optimized implantation (PSP) and antithrombotic strategies for newer BRS; extend follow-up beyond 5 years; refine patient/lesion selection based on early risk mitigation.
2. Initial Decline in Glomerular Filtration Rate With Finerenone in HFmrEF/HFpEF: A Prespecified Analysis of FINEARTS-HF.
Among 5,587 patients with baseline and 1-month eGFR, a ≥15% decline occurred in 18.2% overall (23.0% finerenone vs 13.4% placebo). An early eGFR drop predicted worse outcomes on placebo (adjusted rate ratio 1.50) but not with finerenone (1.07), supporting continuation of finerenone despite initial renal dips.
Impact: Addresses a common clinical dilemma of stopping MRAs after eGFR dips and provides randomized evidence that the early decline with finerenone is not harmful.
Clinical Implications: Clinicians should anticipate a modest early eGFR decline with finerenone in HFmrEF/HFpEF and avoid premature discontinuation absent other safety concerns. Monitoring and patient counseling are essential.
Key Findings
- ≥15% eGFR decline at 1 month occurred in 23.0% with finerenone vs 13.4% with placebo (OR 1.95, 95% CI 1.69–2.24).
- Early eGFR decline predicted worse outcomes on placebo (adjusted rate ratio 1.50, 95% CI 1.20–1.89).
- The association was attenuated and not significant with finerenone (adjusted rate ratio 1.07, 95% CI 0.84–1.35).
Methodological Strengths
- Prespecified analysis within a large, randomized, placebo-controlled trial
- Robust adjustment and interaction assessment for treatment-by-eGFR decline
Limitations
- Focus on 1-month eGFR change; longer-term renal trajectories not detailed in abstract
- Mechanistic drivers of eGFR dip not directly assessed
Future Directions: Define thresholds and monitoring protocols to safely continue finerenone; evaluate similar patterns across EF spectrum and in diverse CKD phenotypes.
3. Hemodynamic Valve Deterioration After Transcatheter Aortic Valve Replacement: Incidence, Predictors, and Clinical Outcomes.
In 2,403 patients with follow-up up to 10 years, moderate or severe HVD occurred in 2.2%, 10.8%, and 25.6% at 1, 5, and 10 years, respectively. Independent predictors included higher aortic valve calcium (HR 1.81), residual aortic regurgitation (HR 1.87), and oral anticoagulant therapy (HR 1.78). HVD increased repeat valve intervention (rate ratio 4.81) without increasing mortality.
Impact: Establishes long-term incidence and actionable predictors of valve deterioration post-TAVR, guiding implantation technique, antithrombotic choices, and follow-up intensity.
Clinical Implications: Minimize residual AR and consider calcium burden during planning to reduce HVD risk. Structured surveillance is warranted, and patients with HVD need closer monitoring for potential reintervention.
Key Findings
- Cumulative incidence of moderate/severe HVD: 2.2% (1 year), 10.8% (5 years), 25.6% (10 years).
- Independent predictors: aortic valve complex calcium volume (HR 1.81), residual AR at discharge (HR 1.87), and oral anticoagulation (HR 1.78).
- HVD associated with higher repeat aortic valve intervention (rate ratio 4.81) but similar all-cause and cardiovascular mortality.
Methodological Strengths
- Prospective registry with VARC-3 definitions and long-term follow-up up to 10 years
- Case-control matching to compare outcomes in HVD vs no-HVD
Limitations
- Single-country registry; residual confounding inherent to observational design
- Median follow-up was relatively short; long-term estimates rely on cumulative incidence modeling
Future Directions: Test procedural strategies to reduce residual AR; evaluate anti-calcification or leaflet-thrombus prevention approaches; integrate predictors into personalized surveillance algorithms.