Daily Cardiology Research Analysis
Three impactful cardiology studies stood out today: a 60,042-patient validation shows a multimarker calculator greatly improves 30-day mortality risk stratification in acute pulmonary embolism; a 10-year randomized follow-up (DANAMI-3-PRIMULTI) confirms FFR-guided complete revascularization in STEMI reduces repeat procedures but not myocardial infarction or death; and atrial biopsies during AF ablation revealed a 7% prevalence of early, often atrium-confined amyloidosis, highlighting a new diagn
Summary
Three impactful cardiology studies stood out today: a 60,042-patient validation shows a multimarker calculator greatly improves 30-day mortality risk stratification in acute pulmonary embolism; a 10-year randomized follow-up (DANAMI-3-PRIMULTI) confirms FFR-guided complete revascularization in STEMI reduces repeat procedures but not myocardial infarction or death; and atrial biopsies during AF ablation revealed a 7% prevalence of early, often atrium-confined amyloidosis, highlighting a new diagnostic window.
Research Themes
- Risk stratification and prognostication in acute pulmonary embolism
- Long-term strategy optimization for STEMI with multivessel disease
- Early detection of cardiac amyloidosis in atrial fibrillation care
Selected Articles
1. Acute pulmonary embolism: a multimarker calculator to predict short-term outcomes.
In 60,042 hemodynamically stable acute PE patients, a multimarker calculator using sPESI, natriuretic peptides, troponin, and DVT status markedly improved 30-day mortality prediction versus the ESC model (C-statistic 0.79 vs 0.56). Positive predictive value for mortality tripled at a >10% risk threshold. This tool enhances discrimination and calibration across subgroups.
Impact: Provides a validated, scalable risk tool that substantially improves short-term mortality prediction in acute PE, enabling better triage and resource allocation than current ESC stratification.
Clinical Implications: Adoption of the calculator can refine identification of intermediate-high risk PE, inform monitoring intensity, early reperfusion consideration, and discharge planning, potentially reducing mortality and unnecessary admissions.
Key Findings
- C-statistic for 30-day mortality improved from 0.56 (ESC model) to 0.79 with the multimarker calculator (P<0.001).
- Improved discrimination persisted in a 16,648-patient subgroup with RV data and troponin (0.78 vs 0.66) and after missing data imputation (0.79 vs 0.66).
- At a >10% estimated risk threshold, positive predictive value for mortality was 15.7% versus 5.0% for ESC (P<0.001).
Methodological Strengths
- Very large, contemporary registry cohort (n=60,042) with robust discrimination and calibration analyses.
- Direct head-to-head comparison with ESC model across subgroups and with sensitivity analyses including imputation.
Limitations
- Observational registry design limits causal inference and is susceptible to residual confounding.
- Model performance assessed for short-term (30-day) outcomes; impact on management decisions and clinical endpoints not tested prospectively.
Future Directions: Prospective impact studies to test whether calculator-guided care improves outcomes, and external validation across diverse health systems with integration into clinical pathways and EHR.
2. 10-Year Outcome of Complete or Infarct Artery-Only Revascularization in STEMI With Multivessel Disease: The DANAMI-3-PRIMULTI Study.
In 627 STEMI patients with multivessel disease randomized to FFR-guided complete revascularization versus culprit-only PCI, 10-year outcomes favored complete revascularization for the composite endpoint (HR 0.76), driven by fewer repeat revascularizations (OR 0.62) without reductions in recurrent MI or death.
Impact: Provides definitive long-term randomized evidence on complete revascularization strategy in STEMI, confirming sustained reduction in repeat procedures but no mortality or MI benefit.
Clinical Implications: Supports current practice of considering staged complete revascularization for symptom and event reduction (repeat procedures), while setting realistic expectations regarding mortality/MI outcomes in shared decision-making.
Key Findings
- Primary composite (death, MI, any revascularization) reduced with complete revascularization at 10 years (HR 0.76; 95% CI 0.60-0.94; P=0.014).
- Repeat revascularization significantly lower (OR 0.62; 95% CI 0.44-0.89).
- No difference in recurrent MI (OR 0.90; 95% CI 0.60-1.35) or all-cause mortality (24% vs 25%).
Methodological Strengths
- Randomized design with decade-long follow-up and analysis of repeated events.
- FFR guidance standardizes non-culprit lesion selection, enhancing internal validity.
Limitations
- Trial underpowered to detect modest differences in mortality or MI over 10 years.
- Evolving PCI techniques/devices over a decade may limit external generalizability.
Future Directions: Assess patient-centered outcomes and cost-effectiveness of staged complete revascularization; explore physiology/intracoronary imaging-guided algorithms to align revascularization with prognosis.
3. Atrial amyloidosis identified by biopsy in atrial fibrillation: prevalence and clinical presentation.
Among 578 AF ablation patients, atrial biopsy detected amyloid in 7% (mostly ATTR), with prevalence rising to 20–40% in older patients, those with LV hypertrophy, or left atrial low-voltage areas. Notably, half of tested abio-CA cases lacked RV involvement, supporting an atrium-confined early phenotype.
Impact: Reveals a substantial burden of early, potentially atrium-confined ATTR amyloidosis in AF ablation candidates, defining high-yield phenotypes for targeted screening and earlier diagnosis.
Clinical Implications: Consider atrial biopsy or intensified amyloid evaluation in older AF ablation candidates with LV hypertrophy or left atrial low-voltage areas; earlier recognition could influence rhythm strategy, anticoagulation, and disease-modifying therapy referral.
Key Findings
- Atrial amyloid was detected in 7% (40/578) of AF ablation patients; 25 were transthyretin (ATTR) type.
- Prevalence increased to 20–40% with advancing age, LV hypertrophy, and left atrial low-voltage areas.
- Among abio-CA patients with RV biopsy, 50% had no RV deposits, indicating confined atrial amyloidosis.
Methodological Strengths
- Large procedural biopsy cohort with standardized immunohistochemistry typing.
- Concurrent RV biopsies in a large subset enabled anatomical localization (atrial confinement) assessment.
Limitations
- Single-procedure, cross-sectional sampling in an AF ablation population limits generalizability and prognostic inference.
- No longitudinal outcomes to link biopsy findings with clinical progression or therapy response.
Future Directions: Prospective studies to evaluate outcomes and treatment impact of early/atrial-confined ATTR detected at ablation; noninvasive markers to preselect high-yield cases for biopsy.