Daily Cardiology Research Analysis
Analyzed 203 papers and selected 3 impactful papers.
Summary
Analyzed 203 papers and selected 3 impactful articles.
Selected Articles
1. Low-Density Lipoprotein Cholesterol Lowering With Inclisiran Plus Usual Care in Recent Acute Coronary Syndrome: VICTORION-INCEPTION, a Randomized, Controlled, Open-Label Trial.
In a pragmatic phase 3b RCT of 400 recent-ACS patients, inclisiran plus usual care led to large, rapid, and sustained LDL-C reductions versus usual care alone. At day 90, 74.6% achieved <70 mg/dL (OR 10.84) and 63.2% achieved <55 mg/dL (OR 26.58); benefits persisted to day 330 with good tolerability.
Impact: Demonstrates, for the first time post-ACS, that an siRNA-based PCSK9 therapy can operationalize guideline LDL-C targets rapidly and sustainably in routine-like settings.
Clinical Implications: Early inclisiran initiation after ACS can substantially increase attainment of LDL-C targets (<70 or <55 mg/dL), supporting integration of twice-yearly inclisiran into post-ACS lipid-lowering strategies alongside statins and ezetimibe.
Key Findings
- At day 90, 74.6% vs 26.6% achieved LDL-C <70 mg/dL (OR 10.84; 97.5% CI 6.13–19.16).
- At day 90, 63.2% vs 8.5% achieved LDL-C <55 mg/dL (OR 26.58; 95% CI 14.14–49.98).
- Mean LDL-C percentage change at day 90 was −48.9% with inclisiran vs +2.2% with usual care; goal attainment remained superior through day 330.
- Treatment was well tolerated in a pragmatic, open-label, multicenter setting.
Methodological Strengths
- Randomized, controlled, pragmatic multicenter design with clear lipid endpoints
- Consistent superiority across stringent LDL-C thresholds (<70 and <55 mg/dL)
Limitations
- Open-label design with surrogate lipid endpoints rather than cardiovascular outcomes
- Follow-up limited to 330 days without MACE assessment
Future Directions: Outcome-driven trials post-ACS evaluating whether early inclisiran initiation reduces MACE, and implementation studies optimizing care pathways for timely administration.
BACKGROUND: The low-density lipoprotein cholesterol (LDL-C)-lowering effect of inclisiran, a proprotein convertase subtilisin/kexin type 9-targeting small interfering RNA, has not been established in patients with recent acute coronary syndrome. METHODS: VICTORION-INCEPTION, a 330-day, phase 3b, open-label, multicenter trial, designed to mimic clinical practice, randomized 400 eligible participants (discharged following acute coronary syndrome ≤5 weeks of screening, with LDL-C ≥70 mg/dL [or non-high-density lipoprotein cholesterol ≥100 mg/dL], receiving statin therapy or statin intolerant) 1:1 to inclisiran sodium 300 mg (284 mg inclisiran equivalent; Days 0, 90, 270) + usual care, or usual care (clinician-directed LDL-C management). Coprimary end points at Day 330 were LDL-C <70 mg/dL attainment and LDL-C percentage change from baseline. RESULTS: At Day 90, inclisiran + usual care led to greater LDL-C goal attainment and lowering versus usual care (<70 mg/dL: 74.6% versus 26.6%, odds ratio [OR], 10.84 [97.5% CI, 6.13-19.16]; <55 mg/dL: 63.2% versus 8.5%, OR, 26.58 [95% CI, 14.14-49.98]; percentage change from baseline: -48.9% versus 2.2%); this was sustained to Day 330 (<70 mg/dL: 66.7% versus 28.1%, OR, 5.42 [97.5% CI, 3.29-8.91], CONCLUSIONS: VICTORION-INCEPTION was the first inclisiran trial in participants with recent acute coronary syndrome. Early inclisiran initiation with usual care resulted in rapid, sustained attainment of guideline-directed LDL-C goals and was well tolerated. REGISTRATION: URL: https://clinicaltrials.gov; Unique identifier: NCT04873934.
2. A deep learning ECG model for identification and localization of occlusion myocardial infarction.
Using 540,372 emergency ECGs paired with catheterization outcomes, a deep learning model accurately identified occlusion myocardial infarction (C-statistic ≥0.95) and localized the culprit vessel across the three major coronary branches. Performance was consistent across demographics and hardware, potentially enabling faster reperfusion decisions without reliance on ST-elevation criteria or troponins.
Impact: This work demonstrates state-of-the-art diagnostic accuracy for occlusion MI and adds actionable lesion localization, offering a paradigm shift in ED triage and activation for urgent reperfusion.
Clinical Implications: Integration into ECG acquisition workflows could reduce door-to-balloon times and unnecessary angiographies. Prospective RCTs should test whether model-guided care improves mortality, infarct size, and resource use.
Key Findings
- Trained/validated on 540,372 emergency ECGs paired with definitive catheterization outcomes.
- C-statistic ≥0.95 for occlusion MI and ≥0.87 for non-occlusion infarctions.
- Model localizes culprit lesions in LAD, LCx, and RCA to guide angiography.
- Stable performance across age, sex, and ECG hardware subgroups.
- Potential to bypass reliance on ST-elevation criteria and troponins, expediting reperfusion.
Methodological Strengths
- Very large, real-world dataset with catheterization-confirmed outcomes.
- Demonstrated generalization across demographic and hardware subgroups with lesion localization.
Limitations
- Retrospective development/validation without randomized outcome testing.
- Potential selection and spectrum biases; external healthcare system validation needed.
Future Directions: Conduct cluster-randomized trials to assess time-to-reperfusion, infarct size, and mortality benefits; evaluate integration into prehospital ECG systems and global health settings.
Rapid identification and localization of an acute coronary occlusion are vital to prevent myocardial damage, yet reliance on ST-segment ECG criteria misses many acute occlusion myocardial infarctions (OMI) and triggers unnecessary acute angiographies. Here, we present a trained and validated deep learning model using 540,372 emergency ECGs paired with definitive catheterization outcomes. The model has a C-statistic of ≥0.95 for OMI and ≥0.87 for non-OMI infarctions and can localize culprit lesions in the three main coronary branches, which can guide the angiographer. Performance is similar across age, sex, and ECG hardware subgroups. Obviating dependence on ST-elevations and troponins, this model for the identification and localization of OMI has the potential to shorten the time to reperfusion of an acute coronary occlusion and save resources. Because human oversight of OMI detection on the ECG is limited, randomized clinical trials with patient-relevant outcomes are warranted.
3. Clinical Effectiveness of Sodium-Glucose Cotransporter-2 Inhibitors Among Older Patients Hospitalized for Heart Failure With Reduced Ejection Fraction.
In 8,847 Medicare HFrEF inpatients (median age 77), initiating SGLT2 inhibitors by discharge was associated with lower 1-year all-cause mortality (HR 0.76), all-cause readmission (HR 0.89), and HF readmission (HR 0.84). Benefits were consistent across demographics, diabetes, CKD status, and EF.
Impact: Extends trial evidence to a real-world, older, hospitalized HFrEF population, supporting in-hospital initiation of SGLT2 inhibitors to improve post-discharge outcomes.
Clinical Implications: Clinicians should prioritize initiating SGLT2 inhibitors before discharge in eligible older HFrEF patients to reduce 1-year mortality and readmissions, integrating with GDMT and across comorbidity profiles.
Key Findings
- Among 8,847 eligible HFrEF inpatients, 16.5% were started on SGLT2i by discharge.
- SGLT2i initiation was associated with lower 1-year all-cause mortality (HR 0.76; 95% CI 0.67–0.86).
- All-cause readmission (HR 0.89; 95% CI 0.81–0.97) and HF readmission (HR 0.84; 95% CI 0.75–0.95) were also reduced.
- Findings were consistent across age, sex, race/ethnicity, diabetes, CKD status, and EF strata.
Methodological Strengths
- Large multicenter registry linked to Medicare with overlap weighting to reduce confounding
- Clinically meaningful hard outcomes with 12-month follow-up
Limitations
- Observational design with residual confounding despite advanced adjustment
- Treatment selection biases and lack of randomization
Future Directions: Implementation research to optimize in-hospital initiation workflows, dosing, and transitions of care; pragmatic trials in very old and multimorbid populations.
BACKGROUND: SGLT2 (sodium-glucose cotransporter-2) inhibitors (SGLT2i) reduce cardiovascular events in randomized controlled trials of patients with heart failure with reduced ejection fraction (HFrEF), but these trials enrolled outpatient, relatively younger patients (median age 66-67). The effectiveness of SGLT2i in older patients hospitalized for HFrEF in routine US clinical practice is not well studied. METHODS: This study included Medicare beneficiaries aged ≥65 years hospitalized for HFrEF and eligible for SGLT2i in Get with the Guidelines-Heart Failure between July 1, 2021 and June 30, 2023. Primary outcomes were 30-day and 1-year all-cause mortality, all-cause readmission, and HF readmission. Association between SGLT2i and outcomes was assessed with Cox regression and overlap weighting using propensity score estimates. RESULTS: A total of 8847 patients were eligible for but not prescribed SGLT2i at hospital admission (Median age 77; 40% women; median left ventricular EF 28%); 1464 (16.5%) patients were initiated on SGLT2i by discharge. After overlap weighting, SGLT2i initiation was independently associated with lower all-cause mortality (adjusted hazard ratio [HR], 0.76 [95% CI, 0.67-0.86]), all-cause readmission (HR, 0.89 [95% CI, 0.81-0.97]), and HF readmission (HR, 0.84 [95% CI, 0.75-0.95]) over 12-month follow-up, compared with those not prescribed SGLT2i. Findings were consistent across subgroups based on age, sex, race, ethnicity, diabetes status, chronic kidney disease status, and left ventricular EF. CONCLUSIONS: Among older patients hospitalized for HFrEF, SGLT2i initiation by time of discharge was independently associated with reduced all-cause mortality, all-cause readmission, and HF readmission. These findings support SGLT2i use to improve postdischarge outcomes among older patients hospitalized for HFrEF in routine US practice.