Daily Cardiology Research Analysis
Three impactful cardiology studies advance risk stratification and therapy optimization. Shortening DAPT to 1 month after EES in high-bleeding-risk diabetes appeared safe and reduced bleeding signals; automated CAC from routine oncology CTs identified cancer patients at higher ASCVD risk; and a 1.41-million-person cohort linked higher lean mass index to lower incident stroke.
Summary
Three impactful cardiology studies advance risk stratification and therapy optimization. Shortening DAPT to 1 month after EES in high-bleeding-risk diabetes appeared safe and reduced bleeding signals; automated CAC from routine oncology CTs identified cancer patients at higher ASCVD risk; and a 1.41-million-person cohort linked higher lean mass index to lower incident stroke.
Research Themes
- Antithrombotic therapy optimization after PCI in high-bleeding-risk diabetes
- Automated imaging/AI for cardiovascular risk in oncology populations
- Body composition (lean mass) and stroke prevention
Selected Articles
1. One- versus three-month DAPT after everolimus-eluting stent implantation in diabetic patients at high bleeding risk: results from the XIENCE Short DAPT programme.
In HBR patients with diabetes receiving EES, 1-month DAPT did not increase death or MI at 1 year versus 3 months and showed numerically lower BARC 2–5 bleeding. Results derive from a prospective program with propensity stratification and apply mainly to stable, low-complexity PCI cases.
Impact: Addresses a persistent clinical dilemma—DAPT duration in HBR diabetes—using large prospective data with modern stents, supporting shorter DAPT without ischemic penalty. This aligns with bleeding avoidance strategies in high-risk PCI populations.
Clinical Implications: For stable, low-complexity HBR diabetic patients post-EES, 1-month DAPT may be reasonable to reduce bleeding exposure without increasing MI or death. Applicability to ACS, complex PCI, or very high ischemic-risk cases remains uncertain.
Key Findings
- Among 3,352 PCI patients, 38.8% had diabetes; DM had higher 1-year death/MI than non-DM (10.1% vs 6.6%).
- In DM, 1-month vs 3-month DAPT showed no increase in death/MI (adjHR 0.70, 95% CI 0.47–1.05).
- BARC 2–5 bleeding was numerically lower with 1-month DAPT in DM (adjHR 0.67, 95% CI 0.45–1.01).
- Treatment effect heterogeneity by DM status was observed (interaction p=0.015).
Methodological Strengths
- Prospective multicenter program with standardized stent platform (XIENCE EES).
- Propensity score stratification to balance confounders across treatment durations.
Limitations
- Non-randomized design; residual confounding cannot be excluded.
- Predominantly stable, low-complexity PCI; limited generalizability to ACS or complex anatomies.
Future Directions: Randomized trials in HBR diabetes including ACS and complex PCI are needed to confirm noninferiority of 1-month DAPT and quantify bleeding benefit, possibly integrating risk tools and platelet function/genetics.
BACKGROUND: In patients with diabetes mellitus (DM) and high bleeding risk (HBR) undergoing percutaneous coronary intervention (PCI), the optimal duration of dual antiplatelet therapy (DAPT) remains uncertain. AIMS: We sought to compare early DAPT discontinuation in DM and non-DM patients enrolled in the prospective XIENCE Short DAPT programme. METHODS: The effects of 1- versus 3-month DAPT on ischaemic and bleeding outcomes were compared using propensity score stratification. The primary endpoint was a composite of all-cause death or myocardial infarction (MI) at 1 year. The incidence of Bleeding Academic Research Consortium (BARC) Type 2 to 5 bleeding was the key secondary endpoint. RESULTS: Out of 3,352 included patients, 1,299 (38.8%) had DM; diabetic patients had a higher 1-year incidence of death or MI (DM vs non-DM: 10.1% vs 6.6%) and similar BARC 2-5 bleeding (DM vs non-DM: 9.5% vs 9.2%). With 1- versus 3-month DAPT, the incidence of death or MI did not statistically differ in DM patients (adjusted hazard ratio [adjHR] 0.70, 95% confidence interval [CI]: 0.47-1.05) and non-DM patients (adjHR 1.26, 95% CI: 0.87-1.81), although heterogeneity by DM status was evident (p for interaction=0.015). BARC 2-5 bleeding was numerically lower with 1-month DAPT in both groups (DM: adjHR 0.67, 95% CI: 0.45-1.01; non-DM: adjHR 0.78, 95% CI: 0.56-1.07; p for interaction=0.973). CONCLUSIONS: Among HBR patients with DM undergoing PCI, 1-month DAPT, as compared to 3-month DAPT, was not associated with an excess of fatal or non-fatal MI and even reduced the occurrence of bleeding. These findings should be interpreted in the context of a predominantly stable patient population with low procedural complexity and may not be generalisable to higher-risk cases.
2. Association Between Automated Coronary Artery Calcium From Routine Chest Computed Tomography Scans and Cardiovascular Risk in Patients With Colorectal or Gastric Cancer.
In 3,153 colorectal/gastric cancer patients, automated CAC from routine, non-ECG-gated chest CT identified markedly higher MACE risk when CAC>400 (sHR 2.33 vs CAC=0). Lower CAC categories did not significantly differ from CAC=0, supporting a high-risk threshold approach in cardio-oncology.
Impact: Demonstrates a pragmatic, scalable AI-based method to extract CAC from ubiquitous oncology chest CTs and stratify ASCVD risk, enabling opportunistic prevention in a population with substantial noncancer cardiovascular mortality.
Clinical Implications: Consider reporting automated CAC when available on routine oncology chest CTs to prompt ASCVD risk assessment and preventive therapies, particularly when CAC>400. Integration into cardio-oncology care pathways may reduce noncancer mortality.
Key Findings
- Automated deep-learning CAC quantification applied to routine non-ECG chest CT in 3,153 cancer patients.
- MACE incidence rose from 5.28 to 29.14 per 1000 person-years across CAC categories, highest in CAC>400.
- CAC>400 associated with 2.33-fold higher MACE risk vs CAC=0 (95% CI 1.24–4.39) using Fine–Gray models.
- Lower CAC categories (0<CAC≤100, 100<CAC≤400) were not significantly different from CAC=0.
Methodological Strengths
- Use of automated deep-learning CAC on non-ECG-gated CT enhances scalability and real-world utility.
- Competing risk-adjusted Fine–Gray modeling and linked EHR-claims data across two tertiary centers.
Limitations
- Retrospective design with potential residual confounding; two-center cohort may limit generalizability.
- Non-ECG-gated CT may introduce motion artifacts affecting CAC quantification in some cases.
Future Directions: Prospective validation and integration of automated CAC reporting into oncology workflows with randomized evaluation of preventive therapy initiation triggered by CAC thresholds.
BACKGROUND: As cardiovascular disease (CVD) is the leading cause of noncancer mortality in colorectal or gastric cancer patients, it is essential to identify patients at increased CVD risk. Coronary artery calcium (CAC) is an established predictor of atherosclerotic CVD; however, its application is limited in this population. This study evaluates the association between automated CAC scoring using chest computed tomography and atherosclerotic CVD risk in colorectal or gastric cancer patients. METHODS: A retrospective cohort study was conducted using electronic health records linked to claims data of colorectal or gastric cancer patients who underwent non-ECG-gated chest computed tomography at 2 tertiary hospitals in South Korea between 2011 and 2019. CAC was automatically quantified using deep learning software and used to classify patients into 4 groups (CAC=0, 0<CAC≤100, 100<CAC≤400, CAC>400). The primary outcome was major adverse cardiovascular events (myocardial infarction, stroke, or cardiovascular mortality), and assessed using the multivariable Fine and Gray subdistribution hazard model. A meta-analysis was performed to calculate pooled subdistribution hazard ratios. RESULTS: A total of 3153 patients were included in this study (36.5% women; 36.3% CAC=0; 38.1% 0<CAC≤100; 14.1% 100<CAC≤400; 11.5% CAC>400). The mean follow-up period was 4.1 years. The incidence rate of MACE was 5.28, 8.03, 9.99, and 29.14 per 1000 person-years in CAC=0, 0<CAC≤100, 100<CAC≤400, and CAC>400. Compared with CAC=0, the risk of MACE was not significantly different in patients with 0<CAC≤100 (subdistribution hazard ratio, 1.43 [95% CI, 0.41-5.01]), and 100<CAC≤400 (subdistribution hazard ratio, 0.99 [95% CI, 0.48-2.04]). Patients with CAC>400 had 2.33 (95% CI, 1.24-4.39) times higher risk of MACE compared with those with CAC=0. CONCLUSIONS: CAC>400 was associated with an increased risk of MACE compared with CAC=0 among colorectal or gastric cancer patients. CAC quantified on routine chest computed tomography scans provides prognostic information for atherosclerotic CVD risk in this population.
3. Association of lean mass index with a risk of incident stroke: a nationwide epidemiological cohort study.
In 1,410,568 Japanese adults free of CVD, higher lean mass index—estimated without imaging—was associated with lower incident stroke, with a monotonic inverse dose-response and consistent effects across sexes and stroke types. Findings support body composition as a modifiable prevention target.
Impact: This nationwide cohort links a simple, non-imaging LMI metric to stroke risk at population scale, offering an actionable prevention lever via physical activity/nutrition policies and individualized risk stratification.
Clinical Implications: Incorporate LMI (derived from routine anthropometrics) into risk assessment to identify individuals for muscle-preserving interventions (resistance training, protein optimization), potentially lowering stroke risk.
Key Findings
- Nationwide cohort of 1,410,568 adults without prior CVD; 35,210 stroke events over mean 1372 days.
- Restricted cubic spline showed monotonic inverse association between LMI and incident stroke.
- HRs vs middle quintile: lowest LMI quintile HR 1.23; highest LMI quintile HR 0.82.
- Associations consistent across ischemic and hemorrhagic stroke and in both men and women.
Methodological Strengths
- Very large, nationwide cohort enabling precise estimates and subgroup consistency checks.
- Use of a validated, non-imaging LMI formula derived from standard anthropometrics.
Limitations
- Observational design with potential residual confounding and measurement error in derived LMI.
- Generalizability to non-Japanese populations requires external validation.
Future Directions: Interventional studies to test whether increasing lean mass (e.g., resistance training, nutritional optimization) lowers stroke incidence; external validation across diverse populations.
BACKGROUND: Body compositions are closely related to stroke risk. Recently, lean mass index (LMI) has been demonstrated to be a precise indicator of cardiovascular disease (CVD) risk, and the newly proposed formula enabled the simple estimation of LMI without a computed tomography scan. However, little is known about its attribution to a risk of stroke. Using a large-scale epidemiological cohort, we sought to clarify the association of LMI with a subsequent risk of developing stroke. METHODS: This retrospective observational cohort study included 1,410,568 participants in Japan without a history of CVD or kidney replacement therapy from the DeSC Database between 2014 and 2022. The median age was 62 years (IQR, 48-67), and 642,343 participants (45.5 %) were men. Using age, sex, height, weight, and waist circumference, LMI was estimated, with a median of 14.9 (13.2-17.0). Participants were categorized into quintiles based on LMI. The primary endpoint was overall stroke, comprising ischemic and hemorrhagic stroke. RESULTS: During a mean follow-up period of 1372 ± 793 days, 35,210 stroke events were recorded. Cox regression analysis modeling a restricted cubic spline showed monotonously inverse correlation between LMI and stroke occurrence, with hazard ratios of 1.23 and 0.82 at the lowest and highest LMI quintile, respectively, compared to the middle quintile. This inverse association was consistent across ischemic and hemorrhagic strokes and observed in men and women. CONCLUSIONS: The high LMI was associated with a lower risk of developing stroke, suggesting the importance of maintaining adequate muscle mass from the perspective of stroke prevention.