Daily Cardiology Research Analysis

IMPORTANCE: Several randomized clinical trials (RCTs) assessed the effect of immediate vs delayed coronary angiography in patients with out-of-hospital cardiac arrest (OHCA) without ST-segment elevations and found no difference in short-term survival. However, the association of these strategies with long-term outcomes and the identification of patient subgroups that might benefit from tailored approaches remain unclear. OBJECTIVE: To compare immediate vs delayed or selective coronary angiography treatment strategies for patients with OHCA without ST elevation and the effect on 1-year survival, and identify subgroups that may differ in treatment effect based on patient or clinical features. DATA SOURCES: Ovid MEDLINE, Embase, and Clarivate/Web of Science Core Collection were searched for relevant literature from inception to September 8, 2022. STUDY SELECTION: RCTs investigating immediate vs delayed or selective coronary angiography after OHCA without ST-segment elevations and a minimum follow-up period of 1 year. Data were combined using the 1-stage individual participant data meta-analysis (IPDMA) approach. DATA EXTRACTION AND SYNTHESIS: Individual patient data were obtained from RCTs that met the eligibility criteria: COACT (Coronary Angiography After Cardiac Arrest) and TOMAHAWK (Immediate Unselected Coronary Angiography vs Delayed Triage in Survivors of Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation). MAIN OUTCOMES AND MEASURES: The primary end point was 1-year survival. Secondary outcomes included the identification of variations in treatment effect using subgroup analysis (based on age, sex, arrest rhythm, witnessed arrest, time to basic life support, time to return of spontaneous circulation, and history of coronary artery disease, diabetes, and hypertension) and clinical outcomes (eg, myocardial infarction and heart failure) at 1 year. RESULTS: For the IPDMA, data were derived from 2 RCTs comprising a total of 1031 patients. In the immediate angiography group, 259 of 522 (49.6%) survived until 1 year vs 272 of 509 (53.4%) in the delayed or selective angiography group (stratified by randomized trial; hazard ratio, 1.15 [95% CI, 0.96-1.37). No treatment-by-subgroup interactions were identified that suggested heterogeneity between the 2 groups (P values for interaction ranged from P = .26 to P = .91 across subgroups). CONCLUSIONS AND RELEVANCE: In this IPDMA of 2 RCTs, there was no benefit of immediate coronary angiography compared with a delayed or selective strategy during 1-year follow-up in successfully resuscitated patients with OHCA without ST-segment elevations. No subgroup of patients was identified that showed a differential treatment effect. TRIAL REGISTRATION: PROSPERO Identifier: CRD42022346559; COACT Netherlands Trial Register Identifier: NTR4973; TOMAHAWK ClinicalTrials.gov Identifier: NCT02750462.

BACKGROUND: This study aimed to evaluate the prevalence of pathogenic/likely pathogenic cardiomyopathy variant carriers in a multiancestry US population and examine the risk of adverse clinical outcomes. METHODS: This retrospective cohort study included multiancestry US adults aged ≥18 years with sequencing data from the All of Us Research Program. Pathogenic/likely pathogenic variants in cardiomyopathy genes were identified using the ClinVar database. The primary outcome was heart failure. Secondary outcomes included cardiomyopathy and arrhythmia. Outcomes were identified from electronic health records. Interval-censored Cox models, taking age on the timescale, were used to assess the risk of outcomes in pathogenic/likely pathogenic variant carriers with noncarriers as the reference group. RESULTS: Among 167 435 individuals (median age, 55.2 [39.5-66.3] years; 61.7% female; 40.7% non-European ancestry) included, the prevalence of pathogenic/likely pathogenic cardiomyopathy variant carriers was 0.7% in the overall population and 0.8%, 0.8%, 0.5%, and 1.2% among European, African, East Asian, and South Asian ancestry individuals, respectively. Over their lifetime, there were 12 867 heart failure events (205 in carriers and 12 662 in noncarriers), with an incidence rate of 3.05 (95% CI, 2.66-3.49) per 1000 person-years in carriers and 1.37 (95% CI, 1.35-1.40) in noncarriers (adjusted hazard ratio, 2.30 [95% CI, 2.04-2.60]). Cardiomyopathy occurred in 5164 (161 in carriers and 5003 in noncarriers), with an incidence rate of 2.38 (95% CI, 2.04-2.78) per 1000 person-years among carriers and 0.54 (95% CI, 0.53-0.56) in noncarriers (adjusted hazard ratio, 4.31 [95% CI, 3.73-4.97]). There were 19 405 arrhythmia events (263 in carriers and 19 142 in noncarriers), with an incidence rate of 3.93 (95% CI, 3.48-4.44) per 1000 person-years among carriers and 2.09 (95% CI, 2.06-2.12) in noncarriers (adjusted hazard ratio, 2.12 [95% CI, 1.78-2.53]). CONCLUSIONS: Pathogenic/likely pathogenic cardiomyopathy variant carriers have an increased risk of heart failure, cardiomyopathy, and arrhythmias. Despite the modest overall prevalence, the associated risks suggest potential benefits of targeted genetic screening for early detection and management.

AIMS: Catheter ablation is a well-established treatment for symptomatic paroxysmal atrial fibrillation (PAF) or persistent atrial fibrillation (PsAF) refractory to antiarrhythmic agents, and current guidelines have also upgraded its role as a first-line option for recurrent PAF. However, the optimal timing to maximize rhythm outcomes remains uncertain. To address this gap, the present study sought to investigate the association between diagnosis-to-ablation time (DAT) and age-stratified atrial fibrillation (AF) recurrence and clinical outcomes. METHODS AND RESULTS: Medline, the Cochrane Library, and Scopus were searched through 18 February 2025. Triple-independent selection, extraction, and quality assessment were conducted, with evidence pooled via random-effects meta-analyses. Among the 28 studies (41 431 participants) with a median 24-month follow-up, early ablation (DAT ≤ 1 year) significantly reduced AF recurrence compared to delayed ablation [hazard ratio (HR) 0.65, 95% confidence interval (CI) 0.59-0.73]. The benefit of early ablation was consistent for both PAF (HR 0.72, 95% CI 0.67-0.77) and PsAF (HR 0.70, 95% CI 0.61-0.81). Age-stratified analysis revealed that this effect was significant regardless of age, with the greatest risk reduction observed in individuals ≤ 55 years (HR 0.49, 95% CI 0.34-0.71). Early ablation was also associated with a reduced risk of repeat ablation, new cardioversion, and cardiovascular hospitalization compared to delayed ablation. Higher CHA₂DS₂-VASc scores, heart failure prevalence, and lower mean left ventricular ejection fraction were associated with greater benefits from early ablation. CONCLUSION: Early catheter ablation within 1 year of AF diagnosis is associated with a lower risk of recurrence in both PAF and PsAF, with the strongest association observed in patients ≤ 55 years.