Daily Cardiology Research Analysis
Analyzed 139 papers and selected 3 impactful papers.
Summary
Three impactful studies in cardiology emphasize precision care: a large RCT (HOST-BR) shows DAPT duration should be tailored by bleeding risk, an externally validated inflammation-based score (INFLAME-MI) improves in-hospital mortality risk estimation after MI, and a secondary analysis of SOUL suggests oral semaglutide reduces heart failure events in T2D patients with pre-existing HF, especially HFpEF. Together, these advance individualized antithrombotic strategies, risk stratification, and cardio-metabolic therapeutics.
Research Themes
- Personalized antithrombotic therapy after PCI
- Inflammation-driven risk stratification in acute MI
- Cardio-metabolic therapeutics influencing heart failure outcomes
Selected Articles
1. Dual antiplatelet therapy after percutaneous coronary intervention according to bleeding risk (HOST-BR): an open-label, multicentre, randomised clinical trial.
In 4,897 PCI patients stratified by ARC-HBR, 1-month DAPT did not meet non-inferiority vs 3-month DAPT for net adverse clinical events in HBR. In non-HBR, 3-month DAPT was non-inferior to 12-month for ischemic/net events and reduced bleeding.
Impact: This large randomized trial directly informs DAPT duration by bleeding risk, offering practice-ready guidance with hierarchical endpoints and prospective registration.
Clinical Implications: For non-HBR PCI patients, 3-month DAPT should be considered to reduce bleeding without compromising ischemic protection; for HBR patients, avoiding a 1-month DAPT default is prudent as it was not non-inferior to 3 months.
Key Findings
- HBR stratum: 1-month vs 3-month DAPT failed non-inferiority for NACE (18.4% vs 14.0%; HR 1.337, 95% CI 1.043–1.713; p=0.82 for non-inferiority).
- HBR stratum: MACE higher with 1-month (9.8%) vs 3-month (5.8%) DAPT; bleeding 13.8% vs 15.8%.
- Non-HBR stratum: 3-month DAPT non-inferior to 12-month for NACE (2.9% vs 4.4%; HR 0.657, 95% CI 0.455–0.949) and MACE (2.2% vs 2.3%; HR 0.984), with less bleeding (7.4% vs 11.7%; HR 0.631).
Methodological Strengths
- Large, multicentre randomized design with ARC-HBR stratification and hierarchical coprimary endpoints.
- Trial registration (KCT0005356; NCT05631769) and intention-to-treat analysis.
Limitations
- Open-label design may introduce performance or ascertainment biases.
- Population limited to East Asian centers; generalizability to other populations requires caution.
Future Directions: Head-to-head trials across diverse populations and device/lesion subsets, and pragmatic implementation studies incorporating bleeding and ischemic risk algorithms.
BACKGROUND: The optimal duration of dual antiplatelet therapy (DAPT) after coronary stenting according to bleeding risk is not well established. We aimed to evaluate the optimal duration of DAPT after coronary stenting according to bleeding risk. METHODS: In this open-label, multicentre, randomised clinical trial, patients aged 19 years and older who received percutaneous coronary intervention with a drug-eluting stent at 50 high-volume cardiology centres in South Korea were stratified into high bleeding risk (HBR) or non-HBR strata, acco
2. Oral Semaglutide and Heart Failure Outcomes in Persons With Type 2 Diabetes: A Secondary Analysis of the SOUL Randomized Clinical Trial.
Among 9,650 T2D participants (median follow-up 47.5 months), oral semaglutide reduced the composite HF outcome in those with baseline HF (HR 0.78, 95% CI 0.63–0.96) but not in those without HF (HR 1.01). Benefit appeared greater in HFpEF (HR 0.59) than HFrEF (HR 0.98). MACE reduction did not differ by HF history; serious adverse events were similar to placebo.
Impact: This secondary analysis provides clinically actionable insights on GLP-1 RA benefits in T2D patients with HF—especially HFpEF—beyond MACE, informing patient selection in cardio-metabolic care.
Clinical Implications: In T2D with established HF—particularly HFpEF—oral semaglutide may reduce HF events without excess serious adverse events. It may be considered as part of comprehensive therapy alongside SGLT2 inhibitors and guideline-directed medical therapy.
Key Findings
- Composite HF outcome reduced with semaglutide in participants with baseline HF (HR 0.78, 95% CI 0.63–0.96), not in those without HF (HR 1.01; interaction p=0.06).
- HFpEF subgroup showed larger benefit (HR 0.59, 95% CI 0.39–0.86) than HFrEF (HR 0.98, 95% CI 0.70–1.38).
- MACE reduction consistent irrespective of HF history (HF: HR 0.83; no HF: HR 0.86; interaction p=0.77).
- Serious adverse event rates were similar between semaglutide and placebo among HF patients (53.8% vs 57.1%).
Methodological Strengths
- Large, event-driven RCT base with long follow-up and prespecified composite HF outcome.
- Subgroup analyses across HF phenotypes (HFpEF vs HFrEF) with robust hazard estimates.
Limitations
- Secondary analysis; not primarily powered for HF outcomes.
- HF phenotype was unknown in a subset; interaction p-value for HF vs non-HF was borderline.
- Concomitant background therapies could confound subgroup effects.
Future Directions: Prospective trials targeting HFpEF populations with T2D to confirm HF benefits, head-to-head and add-on designs with SGLT2 inhibitors, and biomarker-guided responder analyses.
IMPORTANCE: Heart failure (HF) is a common complication of type 2 diabetes (T2D). Oral semaglutide reduced the risk of major adverse cardiovascular (CV) events (MACE; comprising CV death, nonfatal myocardial infarction, or nonfatal stroke) in people with T2D in the SOUL trial, but the impact on HF outcomes in these participants is unknown. OBJECTIVE: To evaluate the effect of oral semaglutide on HF events, MACE, and safety among participants with or without HF at baseline. DESIGN, SETTING, AND PARTICIP
3. Development and validation of the INFLammation in Acute Myocardial diseases risk Estimation for Myocardial Infarction (INFLAME-MI) score.
Using leukocyte subpopulations from routine labs, INFLAME-MI was derived in 3,028 AMI patients and externally validated in 682 patients. It showed strong discrimination (AUC 0.88 derivation; 0.92 external) with superior calibration and reclassification vs GRACE, offering net benefit at ≤7% decision thresholds.
Impact: Introduces an inflammation-centric, externally validated tool that improves calibration and decision utility over a gold-standard risk score, potentially enhancing early triage after MI.
Clinical Implications: Incorporating leukocyte subpopulation data into early risk assessment may refine in-hospital mortality prediction and resource allocation; implementation requires prospective validation and integration into clinical pathways.
Key Findings
- Derivation AUC 0.88 and external validation AUC 0.92 for in-hospital mortality prediction.
- Non-inferior discrimination to GRACE (AUC 0.92 vs 0.94; p=0.256) with superior calibration (Hosmer–Lemeshow χ²8=6.2 vs 22.9; GRACE p<0.001).
- Improved net reclassification and higher net benefit at ≤7% risk thresholds.
Methodological Strengths
- External validation across international cohort with comparison against GRACE.
- Regularized machine-learning approach leveraging routine inflammatory indices.
Limitations
- Retrospective design; potential residual confounding and selection bias.
- Needs prospective, multi-ethnic validation and impact analysis in clinical workflow.
Future Directions: Prospective validation with decision-curve guided implementation studies, EHR integration, and testing additive value with cardiac biomarkers (e.g., troponin dynamics, NT-proBNP).
INTRODUCTION: Elevated leucocytes, particularly neutrophils, are strongly associated with poor prognosis after acute myocardial infarction (AMI). However, inflammatory indices are not included in established post-AMI risk scores. We aimed to derive a novel, inflammation-based risk score with superior performance to contemporary scores to predict in-hospital mortality after AMI. METHODS AND RESULTS: This was a retrospective, multicentre, longitudinal cohort study including a derivation cohort of consec