Daily Cardiology Research Analysis
Three impactful cardiology studies stand out today: a Bayesian network meta-analysis suggests coronary artery bypass grafting plus optimal medical therapy likely offers the best long-term outcomes for non-acute ischemic syndromes, the Mighty-Heart randomized trial shows no added benefit of mobile integrated health on 30-day outcomes after heart failure discharge, and a large biomarker analysis from DECLARE-TIMI 58 identifies galectin-3 as a predictor of kidney disease progression and greater abs
Summary
Three impactful cardiology studies stand out today: a Bayesian network meta-analysis suggests coronary artery bypass grafting plus optimal medical therapy likely offers the best long-term outcomes for non-acute ischemic syndromes, the Mighty-Heart randomized trial shows no added benefit of mobile integrated health on 30-day outcomes after heart failure discharge, and a large biomarker analysis from DECLARE-TIMI 58 identifies galectin-3 as a predictor of kidney disease progression and greater absolute benefit with dapagliflozin.
Research Themes
- Revascularization strategy optimization in stable ischemic heart disease
- Care transition interventions after heart failure hospitalization
- Biomarker-guided risk stratification and therapy in cardio-renal-metabolic disease
Selected Articles
1. Revascularisation strategies for non-acute myocardial ischaemic syndromes.
This hierarchical Bayesian network meta-analysis of 10 RCTs (10,742 participants) found that CABG plus optimal medical therapy was most likely to yield the best long-term outcomes (all-cause mortality, myocardial infarction, re-revascularization) compared with PCI plus medical therapy or medical therapy alone, with overlapping credible intervals but high SUCRA rankings. Stroke outcomes did not clearly favor CABG.
Impact: Clarifies comparative effectiveness across strategies using modern evidence synthesis and supports multidisciplinary decision-making for stable ischemic syndromes.
Clinical Implications: For appropriate candidates with non-acute ischemia, CABG plus optimal medical therapy should be strongly considered when aiming to reduce death, MI, and repeat revascularization, while weighing stroke risk and patient-specific anatomy and comorbidities.
Key Findings
- CABG+OMT vs OMT: HR 0.84 (95% CrI 0.68–1.07) for all-cause mortality; highest SUCRA for mortality/MI/re-revascularization.
- PCI+OMT vs OMT: HR 0.93 (95% CrI 0.79–1.16) for all-cause mortality.
- CABG+OMT vs PCI+OMT: HR 0.91 (95% CrI 0.71–1.13) for all-cause mortality; CABG ranked best for MI and re-revascularization; stroke not clearly improved.
Methodological Strengths
- Hierarchical Bayesian network meta-analysis with SUCRA rankings and node-splitting checks
- Pre-registered protocol (PROSPERO CRD42024541215) and sensitivity analyses
Limitations
- Credible intervals overlapped across comparisons; uncertainty persists
- Heterogeneity in trial eras, populations, and definitions; stroke effects less certain
Future Directions: Prospective randomized trials comparing contemporary PCI (with physiology/imaging guidance) versus CABG in defined anatomic and clinical subsets; patient-level network meta-analyses incorporating stroke, quality of life, and cost-effectiveness.
2. Mobile Integrated Health vs a Transitions of Care Coordinator for Patients Discharged After Heart Failure: The Mighty-Heart Randomized Clinical Trial.
In 2,003 patients discharged after heart failure hospitalization, adding mobile integrated health (community paramedic home visits and facilitated telehealth) to a transitions-of-care coordinator did not improve 30-day health status (KCCQ-OS mean difference 1.83; P=0.16) or reduce all-cause readmissions (20.3% vs 20.4%; OR 0.99; P=0.95). Exploratory analyses suggested potential heterogeneity by age.
Impact: High-quality multicenter RCT providing definitive, practice-relevant negative evidence about a widely promoted post-discharge HF model.
Clinical Implications: Health systems should avoid broad deployment of MIH add-on for all post-HF discharges; focus resources on proven components and consider targeted subgroups (e.g., younger adults) pending confirmatory studies.
Key Findings
- No significant improvement in 30-day KCCQ-OS with MIH versus TOCC (mean difference 1.83; 95% CI -0.75 to 4.40; P=0.16).
- No reduction in 30-day all-cause readmissions (20.3% vs 20.4%; OR 0.99; 95% CI 0.83–1.19; P=0.95).
- Exploratory age-by-treatment interaction suggested greater health status improvement in younger patients receiving MIH.
Methodological Strengths
- Large, multicenter randomized design with prespecified coprimary outcomes
- Pragmatic implementation across 11 hospitals with real-world populations
Limitations
- Short follow-up window (30 days) may miss later benefits or harms
- Exploratory subgroup signals need confirmation and may be underpowered
Future Directions: Targeted trials testing MIH in phenotyped subgroups (e.g., younger age, social risk) and dismantling studies to identify effective components; longer follow-up and cost-effectiveness analyses.
3. Galectin-3 and kidney function in type 2 diabetes treated with dapagliflozin: Analysis from DECLARE-TIMI 58.
In 14,530 patients with T2DM, higher baseline galectin-3 was independently associated with increased risk of a kidney-specific composite outcome (adj HR 1.15 per 1-SD log Gal-3). Dapagliflozin reduced kidney events across galectin-3 quartiles (no interaction), with greater absolute risk reduction in the highest quartile (ARR 1.9% vs 0.6% in Q1; P trend=0.048).
Impact: Links a fibrosis biomarker to kidney risk and absolute benefit with SGLT2 inhibition, supporting biomarker-informed risk stratification while reinforcing broad effectiveness.
Clinical Implications: Galectin-3 may help identify T2DM patients at higher absolute kidney risk who stand to gain more from dapagliflozin, supporting prioritization and shared decision-making; treatment remains effective regardless of baseline galectin-3.
Key Findings
- Median baseline Gal-3 was 14.9 ng/mL; independently associated with kidney EP (adj HR 1.15 per 1-SD log Gal-3; P=0.013).
- Dapagliflozin reduced kidney events across Gal-3 quartiles (overall HR 0.45; 95% CI 0.23–0.85; P<0.0001; no interaction).
- Absolute risk reduction was greater in highest Gal-3 quartile (ARR 1.9% [0.6–3.2]) vs lowest quartile (ARR 0.6% [-0.1–1.3]; trend P=0.048).
Methodological Strengths
- Large biomarker substudy within a randomized, placebo-controlled outcome trial
- Adjusted analyses and evaluation of interaction and absolute risk differences
Limitations
- Post hoc biomarker analysis; single baseline measurement of Gal-3
- Generalizability to lower eGFR populations (<60 mL/min) not assessed in this substudy
Future Directions: Prospective validation of galectin-3-guided prioritization strategies for SGLT2 inhibitors; assessment of serial galectin-3 changes and integration with other fibrosis/renal biomarkers.