Cardiology

Acoramidis improves survival and HF hospitalizations in both wild-type and variant ATTR-CM

In ATTRibute-CM, 611 patients with ATTR-CM were randomized to acoramidis 712 mg twice daily or placebo for 30 months, with open-label extension to 42 months. Acoramidis reduced all-cause death or first cardiovascular hospitalization by 31% in ATTRwt-CM and 59% in ATTRv-CM at 30 months versus placebo. All-cause mortality reductions persisted through 42 months in both wild-type and variant disease, with consistent benefit in p.Val142Ile and other variants. Secondary endpoints, including biomarkers, functional capacity, and quality of life, improved similarly in wild-type and variant subgroups with acoramidis. 1

Tendyne TMVR offers meaningful 1-year outcomes in severe MAC with mitral dysfunction

SUMMIT-MAC treated 103 high-surgical-risk patients with severe MAC and significant mitral dysfunction using the Tendyne transcatheter mitral valve system. Technical success was 94.2%, and 30-day mortality was 6.8% in this frail, predominantly inoperable cohort. Freedom from all-cause mortality or heart failure hospitalization at 12 months was 60.4%, significantly exceeding the 43% performance goal. NYHA I/II status increased from 30.6% to 87.5% at 12 months, accompanied by an 18.7-point mean improvement in KCCQ overall summary score. 2

DCB-first PCI strategy remains inferior to up-front DES at 3 years for de novo CAD

REC-CAGEFREE I randomized 2,272 patients with de novo CAD to paclitaxel-coated DCB angioplasty with provisional stenting or planned sirolimus-eluting stents. Rescue DES implantation after unsatisfactory DCB result was required in 9.4% of patients in the DCB arm. At 3 years, the device-oriented composite endpoint occurred in 8.2% of DCB-treated versus 5.0% of DES-treated patients, favoring DES (P=0.002). Excess events with DCB were greatest during the first year, with smaller but persistent differences thereafter. 3

hs-Troponin–based risk stratification safely shortens ED stay in suspected ACS

This stepped-wedge analysis included 31,492 ED patients with suspected ACS classified as low (<5 ng/L) or intermediate (5 ng/L to 99th percentile) hs-troponin risk. After implementing an early rule-out pathway, length of stay decreased by about 2 hours in low-risk and nearly 5 hours in intermediate-risk patients. Emergency department discharges increased markedly, with adjusted odds of discharge more than tripling for low-risk and doubling for intermediate-risk patients. Among discharged patients, 1-year MI or cardiac death fell after implementation in both low- and intermediate-risk strata. 4