Daily Cardiology Research Analysis
Analyzed 50 papers and selected 3 impactful papers.
Summary
Three clinically oriented cardiology studies stand out today: a Bayesian re-analysis of the SLIM RCT shows a very high probability that complete revascularization benefits NSTEMI patients with multivessel disease; a nationwide Italian implementation study rapidly increased LDL goal attainment largely with statin plus ezetimibe; and a phenotype-stratified two-center analysis of high-risk pulmonary embolism suggests catheter-directed therapy may reduce in-hospital mortality versus systemic thrombolysis.
Research Themes
- Complete revascularization strategies in NSTEMI with multivessel disease
- Implementation science to close LDL-cholesterol treatment gaps
- Phenotype-guided reperfusion strategies in high-risk pulmonary embolism
Selected Articles
1. Probabilities of treatment effects in complete or culprit-only revascularization for NSTEMI: a Bayesian re-analysis of the SLIM trial.
This Bayesian re-analysis of the randomized SLIM trial indicates a 99.8% probability that complete revascularization benefits NSTEMI patients with multivessel disease, with an absolute risk reduction of 7.9% for the composite endpoint. The benefit was driven largely by reductions in repeat revascularization and non-fatal MI, and findings were robust across priors.
Impact: Provides probabilistic, clinically intuitive evidence supporting complete revascularization in NSTEMI, complementing frequentist results and informing patient-centered decision-making.
Clinical Implications: For NSTEMI with multivessel disease, clinicians should favor complete revascularization when feasible, discussing probabilities of benefit with patients and integrating the high likelihood of clinically meaningful absolute risk reduction.
Key Findings
- Posterior median RR for the composite endpoint was 0.41, ARD −7.9% (95%CrI −10.4% to −3.2%).
- Probability of any benefit was 99.8%; probability of meeting a 5% MCID was 91.2%.
- Repeat revascularization ARD −8.3% with >99.9% probability of clinically relevant benefit; non-fatal MI ARD −2.8% with 94.8% probability of benefit.
- Results were consistent across multiple prior specifications.
Methodological Strengths
- Bayesian framework providing probabilities of benefit and MCID attainment, enhancing clinical interpretability.
- Analysis anchored to an RCT dataset with sensitivity analyses across priors demonstrating robustness.
Limitations
- Post-hoc re-analysis; not a prospective design and not powered for individual hard endpoints independently.
- Follow-up duration and certain endpoint components were not re-specified in this abstract.
Future Directions: Prospective trials incorporating Bayesian decision frameworks and health-economic modeling could refine patient selection for complete revascularization and quantify utility across risk strata.
BACKGROUND: The completeness of revascularization in patients presenting with non-ST-elevation myocardial infarction (NSTEMI) and multivessel disease (MVD) remains understudied. The SLIM trial previously demonstrated a significant reduction in a composite endpoint of all-cause death, non-fatal myocardial infarction (MI), repeat revascularization, and stroke with complete revascularization under a frequentist framework. This post-hoc Bayesian re-analysis offers a probabilistic interpretation beyond conventional significance testing. METHODS: The primary composite endpoint was analyzed as in the original trial, while secondary endpoints of the composite were evaluated individually. Analyses under multiple priors assessed robustness. The minimal clinically important difference (MCID) was defined as 5% absolute risk difference (ARD) for the composite endpoint and 1% for individual endpoints. The primary model used a weakly informative prior on the log relative risk (RR) scale within a normal-normal Bayesian framework. RESULTS: 478 patients were randomized (complete: n=240; culprit-only: n=238). The posterior median RR for the composite endpoint was 0.41 (95% credible interval [CrI] 0.22-0.76), corresponding to an ARD of -7.9% (95%CrI -10.4% to -3.2%). The probability of any benefit was 99.8%, and the probability of meeting the MCID was 91.2%. For repeat revascularization, the ARD was -8.3% (95%CrI -10.0% to -4.5%), with a >99.9% probability of clinically relevant benefit. For non-fatal MI, the ARD was -2.8% (95%CrI -4.2% to 0.9%), with a 94.8% probability of benefit. Results were consistent across all priors. CONCLUSION: Complete revascularization provides a high probability of clinically meaningful benefit in NSTEMI patients with MVD, primarily through reductions in non-fatal MI and repeat revascularization.
2. Sustainable and Effective Lipid-Lowering Management: Prevention Strategies from the BRING-UP Prevention Study.
In a nationwide prospective implementation study across 189 cardiology centers (n=4,790), 6-month LDL-C goal attainment (<55 mg/dL) increased from 33% to 58.1%, largely via high-dose statins plus ezetimibe, with limited use of PCSK9 therapies. Follow-up was high (97%), and small gains were observed in blood pressure and smoking cessation, while glycemic and weight control remained suboptimal.
Impact: Demonstrates that large-scale, education-led implementation can rapidly close secondary prevention gaps using cost-effective lipid-lowering regimens, informing system-level quality improvement.
Clinical Implications: Scale-up of high-intensity statins with routine ezetimibe add-on and tight follow-up can markedly increase LDL-C goal attainment in secondary prevention without immediate reliance on costly agents.
Key Findings
- LDL-C <55 mg/dL increased from 33% to 58.1% at 6 months (absolute +25.1%; relative +76.1%).
- Medication profile: statins 94.9% (mostly high-dose atorvastatin/rosuvastatin); ezetimibe 84%; PCSK9 mAbs/inclisiran 8.3%.
- 97% 6-month follow-up completion; small improvements in blood pressure and smoking cessation; glycemic and weight control lagged.
Methodological Strengths
- Large multicenter prospective cohort with high follow-up completeness (97%).
- Pragmatic, education-led implementation mirrors real-world practice and scalability.
Limitations
- Non-randomized design with potential confounding and Hawthorne effects.
- Short 6-month horizon focusing on surrogate endpoints (LDL-C) rather than clinical events.
Future Directions: Cluster-randomized or stepped-wedge trials comparing implementation strategies, and longer-term linkage to cardiovascular outcomes will define durability and event reduction.
BACKGROUND AND AIMS: Adherence to guideline recommendations for secondary prevention appears to be inadequate, even in cardiology centers. To narrow the gap between guideline recommendations and what is implemented in clinical practice, we designed the BRING-UP Prevention project. METHODS: BRING-UP Prevention is a nationwide, observational, prospective, multicenter study enrolling patients with a prior atherothrombotic event. The study consists of two 3-month enrolment phases followed by a 6-month follow-up, with each phase preceded by an educational intervention. Data presented here mainly focus on the percentage of patients at goal for LDL-cholesterol (LDL-C) (<55 mg/dL) at the 6-month follow-up in the recently completed first enrollment phase. Secondary endpoints are blood pressure, glycemic and weight control and smoke cessation. RESULTS: Over 3 months, 189 cardiology centres recruited 4790 patients. Follow-up data at 6 months were available for 4643 patients (97%) and LDL-C was available for 4334 of them. The rate of patients with LDL-C <55 mg/dL increased from 33% to 58.1%, with absolute and relative increases of 25.1% and 76.1%, respectively. At 6 months 94.9% of patients were prescribed on statins. Atorvastatin and rosuvastatin were the most prescribed statins, mostly at high doses. Ezetimibe was prescribed in 84% of cases. PCSK9i monoclonal antibodies and inclisiran were prescribed in 8.3% of patients. CONCLUSIONS: BRING-UP Prevention achieved its primary goal to increase the percentage of patients at LDL-C goal, demonstrating that, in many patients, this goal can be achieved increasing the use of low-cost therapies. Many people who have already had heart problems do not fully follow medical guidelines to prevent another event. In particular, their levels of “bad” cholesterol (LDL-C) often remain too high. To help close the gap between what the guidelines recommend and what actually happens in everyday care, we created a project called BRING-UP Prevention. This project focused on educating doctors and collecting information about their patients. After the program:The number of patients who reached their target LDL-C level went up from 33% to 58%.This improvement was achieved mostly with standard, affordable medications, such as statins, often combined with ezetimibe.We also saw small improvements in blood pressure control and smoking cessation. However, blood sugar levels and weight management still need more attention in the future. Our results show that studies aimed at helping doctors follow prevention guidelines more closely can quickly lead to better cholesterol control. This is especially true when many cardiology centers—of all sizes and technological levels—take part in the initiative, as they did in the BRING-UP Prevention project across Italy.
3. Outcomes of High-Risk Pulmonary Embolism Stratified by Clinical Phenotype: Results from Two Specialized Pulmonary Embolism Centres.
Among 137 high-risk PE patients across two PERT centers, in-hospital mortality varied by phenotype (40% cardiac arrest; 21.1% shock; 8.7% hypotension). Catheter-directed therapy was associated with substantially lower in-hospital mortality and bleeding than systemic thrombolysis, especially in shock and hypotension phenotypes, supporting phenotype-driven management and referral to expert centers.
Impact: Provides urgently relevant real-world evidence suggesting safer, more effective reperfusion with CDT in selected high-risk PE phenotypes, where randomized data are scarce.
Clinical Implications: For non–cardiac arrest high-risk PE (shock or hypotension), consider early catheter-directed therapy and referral to expert PE centers, balancing bleeding risks of systemic thrombolysis.
Key Findings
- In-hospital mortality differed by phenotype: 40.0% (cardiac arrest), 21.1% (shock), 8.7% (hypotension).
- CDT associated with lower mortality vs systemic thrombolysis overall (6.7% vs 41.1%), particularly in shock (6.3% vs 38.1%) and hypotension (0% vs 25.0%).
- CDT linked to fewer major bleeding events and lower therapy failure; expert-center management improved survival.
Methodological Strengths
- Phenotype-stratified analysis reflecting clinical heterogeneity of high-risk PE.
- Comparative outcomes across reperfusion strategies with multivariable logistic regression.
Limitations
- Observational two-center design prone to selection bias and confounding by indication.
- Modest sample size limits precision; device/technique heterogeneity not fully detailed.
Future Directions: Prospective registries and randomized trials comparing CDT modalities with systemic thrombolysis within phenotype-defined strata are needed to confirm mortality benefits.
BACKGROUND: High-risk pulmonary embolism (HR-PE) includes a heterogeneous population ranging from cardiac arrest to obstructive shock or hypotension, with high early mortality. While systemic thrombolysis (ST) remains the standard of care, its use is limited by contraindications and bleeding risk. Catheter-directed therapies (CDT) have emerged as alternatives, though data in HR-PE is limited. This study aimed to assess clinical characteristics, management, and outcomes across three HR-PE clinical phenotypes. METHODS: We analysed 137 consecutive HR-PE patients consulted by two Polish PERT centres. Based on presentation, patients were stratified into three groups: Cardiac Arrest, Shock, and Hypotension, according to the European Society of Cardiology HR-PE criteria. Reperfusion strategies included ST and CDT. The primary outcome was in-hospital mortality. Logistic regression was used to identify predictors of survival. RESULTS: In-hospital mortality differed significantly across phenotypes (Cardiac Arrest: 40.0%, Shock: 21.1%, Hypotension: 8.7%; p=0.01). CDT was associated with lower mortality than ST (6.7% vs. 41.1%, p<0.001), especially in the Shock (6.3% vs. 38.1%, p=0.009) and Hypotension groups (0% vs. 25.0%, p=0.04). CDT was also linked to fewer major bleeding events and lower therapy failure. Management at expert PE centre was associated with improved survival, particularly among Cardiac Arrest patients, while the use of CDT determined survival in HR-PE patients with Shock or Hypotension. CONCLUSIONS: HR-PE presented phenotype-specific differences in prognosis and treatment response. Our findings support a phenotype-driven approach and timely referral to expert PE centres, where CDT may be a safer and more effective alternative to systemic thrombolysis particularly in non-Cardiac-Arrest PE patients.