Daily Cardiology Research Analysis
Three impactful cardiology studies stood out: a comprehensive HTA meta-analysis and decision model defines cost-effective pathways for diagnosing acute aortic syndrome using ADD-RS and D-dimer; an AI-enabled strategy using coronary calcium from CT attenuation scans can safely double stress-only SPECT-MPI workflows; and pooled randomized data show IL-1 blockade with anakinra reduces systemic inflammation and improves HF-related outcomes after STEMI irrespective of prior CAD.
Summary
Three impactful cardiology studies stood out: a comprehensive HTA meta-analysis and decision model defines cost-effective pathways for diagnosing acute aortic syndrome using ADD-RS and D-dimer; an AI-enabled strategy using coronary calcium from CT attenuation scans can safely double stress-only SPECT-MPI workflows; and pooled randomized data show IL-1 blockade with anakinra reduces systemic inflammation and improves HF-related outcomes after STEMI irrespective of prior CAD.
Research Themes
- Diagnostic pathways and cost-effectiveness in acute aortic syndrome
- AI-enabled imaging triage to streamline SPECT-MPI
- Targeting inflammation (IL-1 blockade) in STEMI
Selected Articles
1. Diagnostic strategies for suspected acute aortic syndrome: systematic review, meta-analysis, decision-analytic modelling and value of information analysis.
This HTA combined meta-analyses of ADD-RS and D-dimer with decision-analytic and value-of-information modeling to define accurate and cost-effective pathways for suspected acute aortic syndrome. Strategies using ADD-RS>1 alone were cost-effective in unselected low-prevalence settings, while combining ADD-RS with D-dimer became cost-effective when clinicians preselect higher-risk populations.
Impact: Defines evidence-based, cost-effective diagnostic algorithms that can directly inform ED triage and imaging utilization for acute aortic syndrome.
Clinical Implications: Adopt ADD-RS>1-triggered CTA in unselected populations; in clinician-enriched higher pretest probability settings, use ADD-RS with D-dimer (e.g., ADD-RS>1 or D-dimer>500 ng/mL) to safely reduce unnecessary CTA while maintaining near-perfect sensitivity.
Key Findings
- ADD-RS>0: sensitivity 94.6% (90–97.5%), specificity 34.7% (20.7–51.2%); ADD-RS>1: sensitivity 43.4% (31.2–57.1%), specificity 89.3% (80.4–94.8%).
- ADD-RS>0 or D-dimer>500 ng/mL: sensitivity 99.8% (98.7–100%), specificity 21.8% (12.1–32.6%); ADD-RS>1 or D-dimer>500 ng/mL: sensitivity 98.3% (94.9–99.5%), specificity 51.4% (38.7–64.1%).
- Decision modeling: in unselected populations (AAS prevalence 0.26%), only ADD-RS>1-to-CTA was cost-effective; in higher-prevalence cohorts (0.61%), combined ADD-RS/D-dimer strategies were cost-effective and deliverable.
- Population expected value of perfect information approximated £17.75 million at £20,000/QALY thresholds.
Methodological Strengths
- PRISMA-consistent systematic review with QUADAS-2 bias assessment and hierarchical meta-analytic models (multinomial/bivariate).
- Integrated decision-analytic and value-of-information modeling linking diagnostic accuracy to QALYs and costs.
Limitations
- Marked heterogeneity in specificity estimates across studies.
- Uncertainty in defining the suspected AAS population and in modeling delayed diagnosis effects.
Future Directions: Prospective comparative studies of ADD-RS/D-dimer combinations in real-world ED pathways and evaluation of alternative biomarkers to improve specificity.
2. Integrating perfusion with AI-derived coronary calcium on CT attenuation scans to improve selection of low-risk studies for stress-only SPECT myocardial perfusion imaging.
In 6,884 patients with stress TPD <5%, an AI-derived CAC=0 from CTAC identified a very low-risk group. Those with minimal perfusion abnormality (TPD 1–4%) and CAC=0 had lower MACE risk than TPD 0% (HR 0.58), whereas TPD 1–4% with CAC>0 had higher risk (HR 1.90). Using CAC=0 could double safe rest-scan cancellations (55% vs 25%).
Impact: Demonstrates a scalable, low-dose, AI-enabled approach to safely expand stress-only SPECT workflows, with immediate operational and radiation-sparing implications.
Clinical Implications: In patients with stress TPD <5%, integrating AI-derived CAC=0 from CTAC can guide safe rest-scan cancellation, streamline throughput, and reduce radiation, while flagging minimal perfusion defects with CAC>0 for full protocols and closer follow-up.
Key Findings
- Among 6,884 patients without known CAD and stress TPD <5%, those with TPD 1–4% and CAC=0 had lower MACE risk than TPD 0% (HR 0.58; 95% CI 0.45–0.76).
- Patients with TPD 1–4% and CAC>0 had higher MACE risk vs TPD 0% (HR 1.90; 95% CI 1.56–2.30).
- Using AI-derived CAC=0 to cancel rest scans could increase rest-scan cancelation from 25% to 55% while maintaining low event risk.
Methodological Strengths
- Large cohort with automated AI CAC quantification from routinely acquired CTAC.
- Time-to-event analyses with hazard ratios stratified by perfusion abnormality and CAC.
Limitations
- Retrospective design with potential selection and treatment biases.
- MACE definition included revascularization, which may be influenced by testing and referral patterns; follow-up duration not specified.
Future Directions: Prospective implementation trials comparing AI CAC–guided stress-only protocols vs standard workflows with patient-level outcomes and cost-effectiveness.
3. Interleukin-1 blockade in patients with ST-segment elevation myocardial infarction with and without history of coronary artery disease.
Pooled randomized data (n=139) show that anakinra, an IL-1 blocker, significantly reduces systemic inflammation (CRP-AUC) after STEMI and improves HF-related outcomes with no interaction by prior CAD status. CRP-AUC was markedly lower with anakinra vs placebo in both CAD-history and CAD-naïve patients.
Impact: Reinforces inflammation as a modifiable therapeutic target post-STEMI and supports broader evaluation of IL-1 blockade across patient subgroups.
Clinical Implications: Consider enrollment in trials or compassionate use of IL-1 blockade for selected STEMI patients at high risk of HF, as benefits appear consistent irrespective of prior CAD; prioritize monitoring inflammation (e.g., CRP) to guide therapy.
Key Findings
- Across 3 RCTs (n=139), anakinra reduced CRP-AUC vs placebo in STEMI, regardless of CAD history: CAD-history 85 vs 349 mg·day/L; no-CAD 86 vs 213 mg·day/L; no treatment-by-history interaction (p=0.27).
- Event-free survival for HF-related composite outcomes improved with anakinra, with no significant interaction by CAD history (p=0.48).
- Findings support IL-1–mediated inflammation as a cross-cutting driver of post-STEMI HF risk.
Methodological Strengths
- Pooled randomized clinical trial data spanning three studies enhances causal inference.
- Consistent biomarker (CRP-AUC) and clinical composite outcomes with interaction testing.
Limitations
- Overall sample size remains modest; heterogeneity across trials may exist.
- Not powered for mortality; long-term outcomes and optimal treatment duration remain uncertain.
Future Directions: Adequately powered multicenter RCTs to test IL-1 blockade on hard outcomes (HF hospitalization, mortality) and to define timing, dose, and duration in contemporary STEMI care.