Daily Cardiology Research Analysis
Analyzed 45 papers and selected 3 impactful papers.
Summary
A randomized, sham-controlled trial showed that intraoperative adsorption of ticagrelor can safely reduce severe bleeding events in patients undergoing early cardiac surgery, with a significant benefit in isolated CABG. A nationwide cohort study found that arrhythmia risk after secundum ASD depends on timing and closure technique, with surgical closure linked to higher incident arrhythmia. A very large retrospective cohort established that the number of abnormal 100-g OGTT values in pregnancy strongly stratifies future cardiovascular risk, underscoring a window for postpartum prevention.
Research Themes
- Perioperative antiplatelet management and bleeding reduction
- Arrhythmia risk after congenital heart disease interventions
- Pregnancy glucose testing as a predictor of future cardiovascular disease
Selected Articles
1. Randomized, Sham-Controlled Trial of Intraoperative Ticagrelor Removal to Reduce Perioperative Bleeding.
In patients undergoing cardiac surgery within 2 days of ticagrelor discontinuation, intraoperative adsorption (DrugSorb-ATR) was safe and achieved significant reductions in severe bleeding in the prespecified isolated CABG cohort, although the overall primary efficacy endpoint was not met. The number needed to treat to prevent one severe bleed was 6.
Impact: This is a randomized, sham-controlled device trial addressing a common and high-risk perioperative scenario, offering a pragmatic bleeding mitigation strategy when guideline washout cannot be achieved.
Clinical Implications: For patients requiring urgent or semi-urgent CABG after ticagrelor, intraoperative adsorption may reduce severe bleeding, supporting its selective use in CABG when washout is incomplete. Surgical teams should consider device availability and protocols for high-risk cases.
Key Findings
- Primary safety endpoint met with similar 30-day adverse events between groups.
- Overall primary efficacy endpoint not met (WR 1.07; p=0.748), but prespecified isolated CABG cohort achieved supplementary efficacy (WR 1.59; 95% CI 1.02-2.46; p=0.041).
- Significant reductions in large chest tube drainage events and severe bleeding/CTD ≥1 L composite in CABG; number needed to treat to prevent one severe bleed was 6.
Methodological Strengths
- Randomized, sham-controlled design with hierarchical win ratio analysis of bleeding outcomes.
- Predefined subgroup (isolated CABG) and standardized bleeding definitions (UDPB) and objective CTD metrics.
Limitations
- Primary efficacy endpoint not met in overall population; trial size modest with predominance of isolated CABG.
- Generalizability to non-CABG cardiac surgeries and different perioperative antiplatelet strategies is uncertain.
Future Directions: Larger multicenter RCTs powered for clinical efficacy across broader cardiac surgical populations and cost-effectiveness analyses are warranted; platform refinement and timing optimization may enhance benefit.
OBJECTIVE: Patients on ticagrelor undergoing cardiac surgery before completing guideline-recommended washout are at high risk for severe bleeding. This study evaluated whether a novel drug removal device reduces bleeding in patients operated within 2 days from ticagrelor discontinuation. METHODS: Eligible patients were randomized 1:1 to intraoperative DrugSorb-ATR or sham control. Primary safety endpoint was adverse events at 30 days. Efficacy was assessed by composite endpoints comprising bleeding events using Universal Definition of Perioperative Bleeding (UDPB) and 24-hour chest tube drainage (CTD) in the overall and isolated coronary artery bypass grafting (CABG) populations with a hierarchical win ratio (WR) method. RESULTS: 140 patients were randomized, 132 had surgery and received a study device; 92% were isolated CABG. Mean age was 65±5 years, 15% females. The primary safety endpoint was met, with similar adverse events between groups. The primary efficacy endpoint was not met in the overall or CABG populations (WR 1.07, 95% CI 0.72-1.58, p=0.748; WR 1.33, 95% CI 0.86-2.04, p=0.202 respectively). The supplementary efficacy endpoint was met in the CABG population (WR 1.59, 95% CI 1.02-2.46, p=0.041) with significant reductions also shown in large CTD bleeding events (p=0.016) and the composite of severe bleeding events or CTD≥1L (p=0.041). The number needed to treat to prevent a severe bleed was 6. CONCLUSIONS: Intraoperative use of DrugSorb-ATR is safe in patients operated within 2 days of ticagrelor discontinuation. Although the primary endpoint was not met in the overall population there were significant reductions in severe bleeding events in the prespecified CABG population.
2. Closure of Secundum Atrial Septal Defect and Risk of Incident and Recurrent Arrhythmia.
In a nationwide cohort of 6,469 secundum ASD patients, arrhythmia incidence was 13.3 per 1,000 person-years, and older age at diagnosis/closure increased risk. Surgical closure was associated with higher incident arrhythmia compared with no closure, whereas percutaneous closure reduced recurrence versus no closure.
Impact: This large, decades-long, population-based study clarifies how closure modality and timing influence arrhythmia risk in ASD, informing patient selection and long-term rhythm surveillance strategies.
Clinical Implications: Percutaneous ASD closure may be preferred to mitigate arrhythmia recurrence, while surgical candidates require vigilant rhythm monitoring. Older patients at diagnosis/closure merit tailored counseling about arrhythmia risk.
Key Findings
- Arrhythmia incidence was 13.3 (95% CI 12.6-14.2) per 1,000 person-years; atrial fibrillation/flutter predominated.
- Surgical closure increased incident arrhythmia risk vs no closure (adjusted HR 1.38; 95% CI 1.19-1.60); percutaneous closure showed no increase vs no closure.
- Three-quarters experienced arrhythmia recurrence overall; percutaneous closure reduced recurrence vs no closure (adjusted HR 0.79; 95% CI 0.64-0.98).
Methodological Strengths
- Nationwide registry with large sample and long follow-up spanning 1977–2024.
- Time-dependent Cox modeling and stratification by closure technique.
Limitations
- Observational design susceptible to confounding by indication and era-related practice changes.
- Arrhythmia ascertainment and management strategies likely evolved over decades, potentially affecting comparisons.
Future Directions: Prospective studies to examine rhythm outcomes with standardized monitoring after closure are needed, including randomized comparisons of closure techniques in selected populations.
BACKGROUND: Atrial septal defect (ASD) is a simple defect but carries considerable morbidity, especially arrhythmias. OBJECTIVES: Data on the impact and timing of ASD closure and the risk of (recurrent) arrhythmia remain scarce and will be the focus of this study. METHODS: This Danish nationwide cohort study included all patients diagnosed with secundum ASD (1977-2024), followed until arrhythmia, death, emigration, or study end (Jan 2024). The risk of (recurrent) arrhythmias was assessed based on ASD closure status and closure technique. RESULTS: Among 6,469 patients with ASD (43.3% men), 34.6% underwent ASD closure (65.5% surgically and 34.5% percutaneously). The incidence rate of arrhythmia was 13.3 (95%CI 12.6-14.2) per 1,000 PY, with atrial fibrillation/flutter being the most prevalent. Older age at diagnosis and closure were linked to higher incidence and recurrence of arrhythmia. In time-dependent Cox regression analyses, surgical ASD closure was associated with an increased risk of arrhythmias compared to no closure (adjusted HR 1.38 [95%CI 1.19-1.60]), whereas no difference was found for percutaneous closure. Overall, three in four patients experienced arrhythmia recurrence. ASD closure was associated with a decreased risk of recurrence, yet statistical significance was observed only when comparing percutaneous closure to no closure (adjusted HR 0.79 [95%CI 0.64-0.98]). CONCLUSIONS: The incidence rate of arrhythmia among patients with ASD was 13 per 1,000 PY, with age and closure technique being pivotal factors. Surgical closure was associated with an increased risk of arrhythmias compared to no closure, while percutaneous closure was associated with a decreased risk of recurrence.
3. An oral glucose tolerance test in pregnancy and its association with future cardiovascular diseases.
Among 103,389 pregnant individuals, increasing numbers of abnormal values on the 100-g OGTT during pregnancy were associated with progressively higher future CVD risk, with four abnormal values conferring more than a twofold risk versus normal. Findings highlight a postpartum window for cardiovascular risk stratification and prevention.
Impact: This very large, contemporary cohort provides robust, graded risk estimates linking pregnancy glucose dysregulation to later CVD, informing targeted postpartum screening beyond diabetes outcomes.
Clinical Implications: Postpartum cardiovascular risk assessment and preventive strategies should be prioritized in women with multiple abnormal OGTT values, particularly those with four abnormalities, integrating blood pressure, lipid management, and lifestyle interventions early after delivery.
Key Findings
- In 103,389 individuals (median follow-up 6.8 years), 641 developed composite CVD (0.62% cumulative incidence).
- Compared with all-normal OGTT, 1–3 abnormal values were associated with adjusted HR 1.2 (95% CI 1.02–1.4) for CVD.
- Four abnormal OGTT values were associated with adjusted HR 2.41 (95% CI 1.44–4.05) for future CVD.
Methodological Strengths
- Very large sample with long follow-up and Cox proportional hazards modeling.
- Graded exposure definition (count of abnormal OGTT values) enabling dose–response assessment.
Limitations
- Retrospective design with potential residual confounding and misclassification of exposures and outcomes.
- Low absolute event rate may limit precision in subgroup analyses and generalizability to other populations.
Future Directions: Prospective validation across diverse populations and integration into postpartum cardiovascular risk tools; interventional trials testing early risk-factor modification triggered by pregnancy OGTT abnormalities.
AIMS/HYPOTHESIS: Gestational diabetes and abnormal 100-g oral glucose tolerance test (OGTT) results in pregnancy are associated with type 2 diabetes, but their relationship with cardiovascular disease (CVD) is less clear. We evaluated the risk of CVD according to the number of abnormal OGTT values during pregnancy. METHODS: This retrospective cohort study used data from a major Israeli healthcare provider. Pregnant individuals aged 20-50 years without a prior diagnosis of type 2 diabetes and CVD who had a complete 100-g OGTT during their last pregnancy between January 2000 and December 2022 were included. The primary outcome was the development of a composite of CVD by September 2024. Risk was assessed using Cox proportional hazards models based on the number of abnormal OGTT values. RESULTS: The study included 103 389 individuals with a mean age of 34 ± 5.2 years. Overall, the median follow-up was 6.8 years (IQR, 3.4-12.9), totalling 886 955 person-years. A composite of CVD developed in 641 individuals (a cumulative incidence of 0.62%). When compared to individuals with all OGTT values normal, individuals with one to three abnormal values had an adjusted hazard ratio (HR) of 1.2 (95% CI: 1.02-1.4) for CVD, reaching 2.41 (95% CI 1.44-4.05) in those with four abnormal OGTT values. CONCLUSIONS: A history of abnormal 100-gram OGTT results during pregnancy, and specifically having four abnormal values, is associated with an elevated risk of CVD. These results underscore the need for early post-partum identification and prevention strategies in this high-risk population.