Key Points

• The ESPRIT trial assessed whether the efficacy and safety of intensive blood pressure (BP) varies across frailty status compared to control.
• In this open-label trial, 11,255 patients were randomized into intensive vs standard blood pressure treatment groups. Both groups were followed over a median of 3.4 years.
• The findings support the adoption of intensive blood pressure control, targeting a systolic BP below 120 mmHg, in hypertensive patients at high cardiovascular risk, regardless of frailty status.

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Key Points: 

• In this sub analysis of the EARLY TAVR trial, the authors aim to evaluate outcomes among all patients who underwent transcatheter aortic valve replacement (TAVR), regardless of whether they were randomized to receive early TAVR versus clinical surveillance.
• Patients who underwent delayed TAVR had higher rates of periprocedural stroke (1.8% vs. 0.9%) and permanent pacemaker implantation (8.4% vs. 5.7%).
• There were significant differences in the rates of the primary outcome (death, stroke, and unplanned hospitalizations for cardiovascular causes) between the delayed TAVR with acute valve syndrome vs. delayed TAVR with progressive valve syndrome vs. early TAVR group with a rate of 14.9% vs. 8.2% vs. 6.8% respectively (log rank: p=0.008).  

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Key Points: 

• In the ARISE-ARMYDA 7 trial, 40 patients who presented with ST elevation myocardial infarction and a plan for a deferred stenting strategy were randomized to receive rivaroxaban 2.5 mg + dual-antiplatelet therapy (DAPT) or DAPT alone to evaluate the primary endpoint of OCT-derived thrombus burden reduction after six days.
• There was a significantly greater reduction in OCT-derived thrombus burden after 6 days in the rivaroxaban + DAPT group compared to the DAPT alone group.

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Key Points:

• Many patients with ASCVD are on LDL-lowering therapy, but many patients with elevated TGs remain at elevated risk
• Solbinsiran, a novel siRNA therapy, may lower cholesterol by targeting hepatic ANGPTL3 and thereby increasing hepatic clearance of triglyceride lipoprotein components
• This trial demonstrated solbinsiran 400mg had significant reduction in apoB, ANGPTL3, hepatic fat, and other cholesterol markers
• Given a favorable safety profile, though limitations are noted, the trial suggests investigation of targeting hepatic ANGPTL3 reduction in mixed hyperlipidemia patients at high ASCVD risk

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Key Points:

• Health360x.ai is an AI-powered digital health platform designed to scale access to decentralized clinical trials (DCTs) by addressing infrastructure gaps in small and medium-sized practices.
• Across 35 community-based sites, the registry enrolled 7,513 participants: 85% Black, 8% White, 58% female, and 15% from rural areas. Over half (51%) reported annual income <$25,000.
• High adoption metrics included a 95% usability score and strong engagement with chatbot tools and site team training (p<0.02 vs baseline).

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Key Points:

• Older adults have higher cardiovascular risk in conjunction with other comorbidities
• Cardiac rehab (CR) is an opportunity to improve health after major cardiovascular events, but multiple factors often limit participation
• The MACRO study investigated a coaching intervention in helping facilitate CR for older adults
• The study overall did not show increased physical function or activity, but a subgroup analysis demonstrated improved outcomes among highly compliant patients

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Key Points

• Five classic risk factors – HTN, DM, HLD, underweight/obesity, and smoking – account for 50% of the global burden of CV disease. 
• The purpose of this global epidemiological study was to estimate the effect of these risk factors on the lifetime risk of CV disease and all-cause mortality and to quantify the years of life gained by avoiding or modifying these risk factors, in order to inform prevention strategies worldwide, using harmonized individual-level data from the Global Cardiovascular Risk Consortium, which included over 2 million participants from 39 countries and 8 geographic regions.
• Absence of all five risk factors at age 50 was associated with up to 13.3 additional years free of CV disease and 14.5 additional years of life compared to having all risk factors at age 50 for women, and 10.6 and 11.8 years for men, respectively.
• Treating hypertension between ages 50-59 was associated with the largest gains in CV disease-free life years, while quitting smoking was associated with the greatest increase in overall life expectancy.

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Key Takeaways:

1. The 0/1-hour hs-cTn algorithm is safe, non-inferior to usual care, and significantly increases ED discharge rates while reducing short-term cardiac events among Asian patients presenting with chest pain.
2. Improved adherence to subsequent clinical management recommendations is crucial to fully optimize outcomes and ensure the effectiveness of rapid chest pain assessment strategies in Asian emergency care settings.

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Key Takeaways:

1. Orbital atherectomy as a routine lesion preparation strategy prior to stenting did not reduce clinical events or improve stent expansion compared to balloon angioplasty alone for severely calcified coronary lesions.
2. Use of intravascular imaging was associated with significantly improved clinical outcomes, highlighting its critical role in guiding PCI procedures in severely calcified lesions.

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Key Points:

• Women are underdiagnosed and undertreated for CAD, despite higher prevalence of non-obstructive CAD, leading to worse outcomes 
• Using AI-enhanced assessment of coronary artery plaque characteristics, investigators suggest better evaluation of CAD risk compared to traditional risk scores
• The CONFIRM2 registry study analyzed symptomatic patients with no prior CAD to assess for evidence of CAD with plaque characterization
• Despite a higher prevalence of plaque in men, women demonstrated incrementally higher rates of elevated risk plaque characteristics, which the study investigators suggest should be considered in future guidelines 

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Key Takeaways:

1. AI-based quantitative coronary plaque assessments significantly improve risk prediction for cardiovascular events in women compared to traditional clinical risk scores.
2. Although women had lower absolute plaque burden, the same incremental increase in plaque conferred substantially higher relative risk for adverse cardiovascular outcomes compared to men, highlighting the importance of sex-specific risk evaluation and potential intensification of preventive therapy in women.

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Key Takeaways:

1. TN-201, a first-in-class gene therapy, was well tolerated and showed stable cardiac gene expression, improved biomarkers, and symptom relief in patients with severe MYBPC3-associated hypertrophic cardiomyopathy.
2. All treated patients improved from symptomatic NYHA class II/III at baseline to asymptomatic class I after TN-201 therapy, highlighting the potential clinical impact of gene replacement strategies in this challenging condition.

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Key Takeaways:

1. AI-guided echocardiography enables novice users to obtain diagnostic-quality cardiac images comparable to expert sonographers, achieving perfect diagnostic-quality rates (100%) for primary cardiac parameters.
2. AI-assisted echocardiography shows rapid adoption by novice users, potentially broadening access to critical diagnostic imaging, especially in underserved or resource-constrained healthcare environments.

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Key Takeaways:

1. Survival from sudden cardiac arrest among young competitive athletes increased significantly from 38% to 66% over the last decade, driven by enhanced emergency preparedness and improved access to CPR and AEDs.
2. Persistent racial disparities remain a critical concern, with Black athletes having significantly lower survival rates (43%) compared to White athletes (68%), emphasizing the need for equitable emergency response resources and strategies across all athletic environments.

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Key Points

• Elevated lipoprotein(a) is associated with incident atherosclerotic cardiovascular disease and aortic stenosis
• The ALPACA trial randomized 320 patients with a serum lipoprotein(a) concentration ≥175 nmol/L in 1:2:2:2:2 ratio to receive lepodisiran 16 mg (baseline and 180 days), lepodisiran 96 mg (baseline and 180 days), lepodisiran 400 mg (baseline and 180 days), lepodisiran 400mg at baseline followed by placebo at 180 days, or placebo at both timepoints
• The placebo-adjusted time-averaged change in lipoprotein(a) from day 60 to day 180 was 94% for the pooled lepodisiran groups. 

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Key Points

• The TRILUMINATE Pivotal trial previously reported that transcatheter edge-to-edge repair (TEER) improved quality-of-life compared to medical therapy alone for severe, symptomatic tricuspid regurgitation. The trial did not observe a benefit in mortality or heart failure hospitalization at 1-year but differences may emerge with longer follow-up. 
• In this 2-year pre-specified analysis, TEER significantly decreased the annualized rate of heart failure hospitalizations through 2 years compared to the control arm (0.19 vs 0.26 events/patient year, p=0.02). No difference in all-cause mortality was observed. 

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Key Points

• The majority of ASCVD patients fail to achieve guideline endorsed LDL targets 
• The PURSUIT trial randomized 428 patients in a 1:1:1:1 ratio to receive oral AZD0780 1, 3, 10, or 30mg, or matching placebo for 12 weeks. 
• AZD0780 demonstrated robust, dose-dependent reductions in LDL-C with a favorable safety and tolerability profile supporting further development of this once daily, oral treatment. 

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Key Points: 

• In the FLAVOUR II trial, 1839 patients with angiographically-significant coronary artery disease were randomized to receive angiography-derived fractional flow reserve (AngioFFR) guided vs. intravascular ultrasound (IVUS) guided percutaneous coronary intervention (PCI).

• Fewer patients in the AngioFFR-guided group underwent PCI compared to the IVUS-guided group (73.9% vs. 83.1%; p<0.001).

• AngioFFR-guided PCI was found to be non-inferior to IVUS-guided PCI for the primary outcome, a composite of death, myocardial infarction or revascularization at 12 months. 

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Key Points: 

• In the MIGHT-y Heart Trial, 2,003 patients who were hospitalized for heart failure across 11 hospitals in New York City were randomized to receive post-discharge follow-up via a mobile integrated health (MIH) platform versus transitions of care coordinators (TOCC). 
• Although there was no significant difference in health status at 30 days between the MIH vs. TOCC arms overall, younger patients in the MIH arm had a 4.5 point higher health status score than younger patients in the TOCC arm.
• There was no significant difference in 30-day all cause hospitalizations between in the MIH vs. TOCC arms overall, but women in the MIH arm were 30% less likely to have an all-cause readmission than women in the TOCC arm.

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Key Points: 

• In the DETECT AS trial, 285 providers for 939 patients with severe aortic stenosis were randomized to receive an electronic provider notification (EPN) notifying the provider of the AHA/ACC guidelines for management vs. usual care.
• At one year, the rates of the primary outcome, aortic valve replacement within one year, were 48.2% in the EPN arm versus 37.2% in the usual care arm (OR: 1.62, 95% CI: 1.13-2.32).
• The impact of the EPN on rates of aortic valve replacement was greatest in patients >80 years of age, in women, and in patients who underwent echocardiogram in the inpatient setting.

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