Daily Cardiology Research Analysis
Analyzed 45 papers and selected 3 impactful papers.
Summary
Analyzed 45 papers and selected 3 impactful articles.
Selected Articles
1. Randomized, Sham-Controlled Trial of Intraoperative Ticagrelor Removal to Reduce Perioperative Bleeding.
In a sham-controlled randomized trial of patients undergoing cardiac surgery within 2 days of ticagrelor discontinuation, intraoperative DrugSorb-ATR use was safe but did not meet the overall primary efficacy endpoint. In the prespecified isolated CABG subgroup, it significantly reduced severe bleeding events and large chest tube drainage, with a number needed to treat of 6.
Impact: This is a rigorous randomized, sham-controlled evaluation of a novel intraoperative antiplatelet removal strategy addressing a common and high-risk perioperative problem. Positive subgroup signals in isolated CABG suggest a path to safer earlier surgery after ticagrelor.
Clinical Implications: For isolated CABG patients requiring surgery within 48 hours of ticagrelor cessation, intraoperative adsorption may reduce severe bleeding risk, prompting consideration of device-enabled strategies when washout is not feasible.
Key Findings
- Randomized 140 patients (132 treated); primary safety endpoint met with similar 30-day adverse events between groups.
- Primary efficacy endpoint was neutral overall (WR 1.07; p=0.748) and in CABG subset (WR 1.33; p=0.202).
- Prespecified CABG supplementary endpoint favored DrugSorb-ATR (WR 1.59; p=0.041), with fewer large chest tube drainage events (p=0.016) and fewer severe bleeding/CTD≥1L events (p=0.041); NNT to prevent a severe bleed = 6.
Methodological Strengths
- Randomized, sham-controlled design with hierarchical win ratio analysis.
- Prespecified subgroup analysis in isolated CABG with clinically meaningful endpoints (UDPB, chest tube drainage).
Limitations
- Primary efficacy endpoint not met in overall or CABG populations; study may be underpowered for broader efficacy.
- Generalisability limited by predominance of isolated CABG (92%) and single device platform.
Future Directions: Larger, adequately powered RCTs focusing on patients requiring urgent isolated CABG, with standardized bleeding definitions and cost-effectiveness, are warranted; platform optimization and timing relative to last ticagrelor dose should be explored.
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. An oral glucose tolerance test in pregnancy and its association with future cardiovascular diseases.
In a 103,389-person retrospective cohort with median 6.8 years of follow-up, the risk of composite cardiovascular disease rose with the number of abnormal 100-g OGTT values during pregnancy. Women with four abnormal values had more than double the risk (HR 2.41), supporting postpartum risk stratification and preventive care.
Impact: This very large cohort robustly quantifies the long-term cardiovascular risk signal from abnormal gestational glycemic profiles, moving beyond diabetes outcomes and informing cardiovascular prevention in postpartum women.
Clinical Implications: Abnormal 100-g OGTT results—especially four abnormal values—should trigger postpartum cardiovascular risk assessment and early preventive strategies (lifestyle, BP/lipid management) in collaboration with primary care and cardiology.
Key Findings
- Included 103,389 women (mean age 34 years) with complete 100-g OGTT; median follow-up 6.8 years, 886,955 person-years.
- Composite CVD occurred in 641 individuals (0.62% cumulative incidence).
- Adjusted hazard increased with abnormal values: HR 1.2 for 1–3 abnormal values, HR 2.41 for four abnormal values versus all normal.
Methodological Strengths
- Very large sample with long follow-up enabling precise risk estimates.
- Use of Cox models and stratification by number of abnormal OGTT values.
Limitations
- Retrospective design with potential residual confounding.
- Composite CVD outcome and possible misclassification from administrative data.
Future Directions: Prospective studies to validate risk thresholds, integrate OGTT patterns with polygenic and cardiometabolic markers, and test targeted postpartum prevention pathways.
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.
3. Hemolysis and Renal Safety of Pulsed-Field Versus Thermal Ablation for Atrial Fibrillation: A Systematic Review and Meta-Analysis.
Across 12 comparative studies (n=5,158), pulsed-field ablation caused greater increases in hemolysis biomarkers than thermal ablation but did not increase acute kidney injury risk (3.5% vs 3.1%). PFA was associated with substantially lower major bleeding and shorter procedure time, with hemolysis varying by platform.
Impact: This synthesis provides clinically actionable safety signals for a rapidly adopted AF ablation modality, balancing increased biomarker hemolysis against neutral AKI risk and reduced bleeding and procedure time.
Clinical Implications: PFA can be favored for its lower major bleeding and efficiency; periprocedural hydration, attention to energy dosing, and platform selection may mitigate hemolysis, especially in high-risk patients.
Key Findings
- PFA increased hemolysis biomarkers versus thermal ablation: LDH MD +63.79 U/L (p<0.001), haptoglobin MD -0.30 g/L (p=0.036), bilirubin MD +1.91 μmol/L (p=0.023).
- No difference in AKI risk: RR 1.14 (95% CI 0.42–3.12); absolute rates 3.5% vs 3.1%.
- PFA reduced major bleeding (RR 0.15) and shortened procedure time (MD -25.81 minutes); hemolysis magnitude varied by PFA platform.
Methodological Strengths
- PRISMA-adherent systematic review with random-effects meta-analysis and ROBINS-I risk-of-bias assessment.
- Co-primary outcomes included both objective biomarkers and clinical AKI, enhancing interpretability.
Limitations
- Observational comparative designs limit causal inference; study heterogeneity and platform differences.
- Potential variability in AKI definitions and timing across studies, despite KDIGO preference.
Future Directions: Platform-specific RCTs comparing PFA with thermal ablation focusing on hemolysis mitigation strategies, renal outcomes, and long-term safety are needed.
BACKGROUND: Pulsed-field ablation (PFA) is a non-thermal modality for atrial fibrillation (AF) ablation; concerns persist regarding intravascular hemolysis and acute kidney injury (AKI). OBJECTIVE: To compare biomarker-defined hemolysis and clinical AKI after PFA versus thermal ablation. METHODS: PRISMA-adherent systematic review and random-effects meta-analysis of comparative observational studies in adults undergoing AF ablation. Major databases and trial registries were searched. Risk of bias was assessed with ROBINS-I. Co-primary outcomes were change-from-baseline hemolysis biomarkers (lactate dehydrogenase [LDH], haptoglobin, bilirubin) and AKI incidence (preferentially KDIGO-defined). RESULTS: Twelve studies (n=5,158; AKI analysis n=4,884; 2,122 PFA, 2,762 thermal) met criteria. Versus thermal ablation, PFA produced significantly greater hemolysis: LDH mean difference (MD) +63.79 U/L (p<0.001); haptoglobin MD -0.30 g/L (p=0.036); bilirubin MD +1.91 μmol/L (p=0.023). AKI risk did not differ (risk ratio [RR] 1.14, 95% CI 0.42-3.12; p=0.80; absolute rates 3.5% vs 3.1%). PFA was associated with significantly lower major bleeding (RR 0.15, 95% CI 0.04-0.62; p=0.009) and shorter procedure time (MD -25.81 min, 95% CI -49.26 to -2.36; p=0.031). Hemolysis magnitude varied by PFA platform; AKI did not. Limitations include observational designs and heterogeneity. CONCLUSION: PFA increases biomarker-defined intravascular hemolysis relative to thermal ablation without increasing population-level AKI. Coupled with reduced major bleeding and enhanced procedural efficiency, these data support PFA use; dose discipline, hydration, and platform selection remain important for high-risk patients.