Daily Cardiology Research Analysis
Automation and AI are rapidly reshaping cardiology. A prospective, blinded study showed robotic process automation outperformed manual screening to identify patients needing perioperative myocardial injury surveillance while cutting costs. Deep learning on ECGs identified undiagnosed coronary artery disease and predicted adverse outcomes, and a large LAAO registry suggested single antiplatelet therapy may be a safe, bleeding-sparing alternative to dual therapy after Amulet implantation.
Summary
Automation and AI are rapidly reshaping cardiology. A prospective, blinded study showed robotic process automation outperformed manual screening to identify patients needing perioperative myocardial injury surveillance while cutting costs. Deep learning on ECGs identified undiagnosed coronary artery disease and predicted adverse outcomes, and a large LAAO registry suggested single antiplatelet therapy may be a safe, bleeding-sparing alternative to dual therapy after Amulet implantation.
Research Themes
- Automation/AI for cardiovascular risk identification
- Post-LAAO antithrombotic strategy optimization
- ECG-based deep learning for CAD detection and prognosis
Selected Articles
1. Robotic process automation to identify patients at high risk for perioperative myocardial infarction or injury: a prospective, blinded, paired reader-controlled single-centre study.
In a prospective, blinded, paired-reader study, robotic process automation outperformed manual screening to identify patients requiring perioperative myocardial infarction/injury surveillance, with higher sensitivity (0.97 vs 0.82) and markedly lower annual costs (−81%). Specificity remained high for both approaches, and the number needed to screen to gain one additional true positive with RPA was 6.
Impact: This pragmatic automation trial directly addresses a major implementation barrier to guideline-recommended perioperative myocardial injury surveillance by replacing manual screening with a scalable, higher-performing, lower-cost RPA workflow.
Clinical Implications: Hospitals can deploy RPA-driven screening to more reliably flag high-risk surgical patients for perioperative troponin monitoring and management pathways, improving compliance with recommendations while reducing personnel costs.
Key Findings
- Among 660 participants, 12% met criteria for surveillance; RPA identified 75/77 (97%) true positives vs 63/77 (82%) for manual screening.
- Relative true positive fraction favored RPA (1.19; 95% CI 1.08–1.32; P=0.004); number needed to screen to gain one additional true positive was 6.
- Sensitivity: RPA 0.97 vs manual 0.82; specificity high for both (0.98 vs 1.00).
- Estimated annual screening cost was 81% lower with RPA compared with manual screening.
Methodological Strengths
- Prospective, blinded, paired reader-controlled design with independent adjudication.
- Direct cost evaluation demonstrating substantial resource savings.
Limitations
- Single-centre study may limit generalizability.
- Did not measure downstream patient outcomes from enhanced surveillance.
Future Directions: Multicentre implementation studies assessing clinical outcomes (MI detection rates, complications, length of stay) and integration with EHRs; evaluation of model drift and governance for automated screening.
2. Electrocardiogram-Based Artificial Intelligence to Identify Coronary Artery Disease.
A deep learning model trained on 764,670 ECGs discriminated prevalent CAD across 3 cohorts (AUROC ~0.75–0.78) and provided incremental value beyond age/sex and Pooled Cohort Equations. In primary care, the highest risk quintile carried markedly higher hazards of MI, HF, and all-cause mortality, supporting ECG-based opportunistic screening for CAD and risk stratification.
Impact: This work operationalizes ECG-based AI for CAD detection with large-scale external validation and prognostic linkage, enabling practical, low-cost risk identification in primary care.
Clinical Implications: ECG2CAD could flag high-risk individuals for targeted diagnostic testing (e.g., coronary CTA) and aggressive preventive therapy, improving detection of silent CAD and guiding resource allocation.
Key Findings
- Discrimination of prevalent CAD across MGH, BWH, and UK Biobank: AUROC 0.782, 0.747, and 0.760; AUPRC 0.639, 0.588, and 0.155, respectively.
- Incremental performance beyond age/sex and Pooled Cohort Equations (P < 0.01) in MGH and BWH.
- Top ECG2CAD risk quintile associated with substantially higher hazards: MI HR 5.59, HF HR 10.49, all-cause mortality HR 2.68.
- Performance consistent across diverse primary care subgroups.
Methodological Strengths
- Very large training set with multi-cohort external validation.
- Prognostic linkage to incident MI, HF, and mortality, and benchmarking against guideline risk tools.
Limitations
- CAD labels derived from diagnostic codes may introduce misclassification.
- Retrospective design; prospective impact on clinical pathways not yet tested.
Future Directions: Prospective trials to assess clinical utility (changes in testing, therapy, and outcomes), calibration across devices/vendors, and integration with multimodal imaging biomarkers.
3. Outcomes for single antiplatelet, dual antiplatelet, or oral anticoagulation after Amulet: Insights from EMERGE LAA post-approval study.
In 11,445 Amulet LAAO patients, adjusted 6-month safety and effectiveness outcomes did not differ between DAPT, SAPT, and OAC. Despite higher baseline bleeding risk, SAPT showed numerically lower bleeding than DAPT, with similar device-related thrombus rates and >95% clinically relevant closure across groups.
Impact: These real-world data support SAPT as a reasonable alternative to DAPT after Amulet implantation, potentially reducing bleeding without compromising effectiveness, informing contemporary antithrombotic strategies in AF patients undergoing LAAO.
Clinical Implications: For high bleeding risk patients after Amulet LAAO, SAPT may be considered instead of routine DAPT, with careful individualized assessment until randomized data are available.
Key Findings
- Among 11,445 cases, discharge regimens were DAPT 81.7%, SAPT 5.3%, and OAC 13.0%.
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95% achieved clinically relevant closure (≤3 mm peri-device leak) at 45 days across all groups.
- At 6 months, adjusted analyses showed no significant differences in safety or effectiveness endpoints among DAPT, SAPT, and OAC.
- SAPT had numerically lower bleeding than DAPT (3.9% vs 4.8%) despite higher baseline bleeding risk; device-related thrombus rates were identical (0.8%).
Methodological Strengths
- Large national registry with contemporary real-world practice and adjudicated endpoints over 6 months.
- Risk-adjusted analyses comparing three clinically relevant antithrombotic strategies.
Limitations
- Nonrandomized observational design with potential residual confounding and treatment selection bias.
- Follow-up limited to 6 months; longer-term thromboembolic and bleeding outcomes are unknown.
Future Directions: Randomized trials directly comparing SAPT vs DAPT post-Amulet, extended follow-up for late device-related thrombosis and bleeding, and subgroup analyses by bleeding/thrombotic risk.