Cardiology

FFR-guided PCI before TAVI lowers MACCE versus angiography guidance

In FAITAVI, 320 very elderly TAVI candidates with intermediate coronary lesions were randomized to FFR‑guided versus angiography‑guided PCI. FFR guidance reduced 12‑month MACCE from 16.0% to 8.5% (HR 0.52; 95% CI 0.27–0.99), mainly via lower all‑cause mortality (HR 0.31; 95% CI 0.10–0.96). Other components of the composite, including MI, TVR, disabling stroke, and major bleeding, were numerically but not significantly lower with FFR. These data support physiology‑based coronary revascularization as a preferred strategy around TAVI in this frail, elderly population. 1

Sacubitril–valsartan in Chagas HFrEF improves biomarkers but not LVEF vs enalapril

ANSWER‑HF randomized 190 patients with chronic Chagas cardiomyopathy and HFrEF to sacubitril–valsartan or enalapril for 6 months. Change in LVEF was similar, with only a nonsignificant 0.9‑percentage‑point difference favoring sacubitril–valsartan (95% CI −0.9 to 2.6; P = 0.36). A hierarchical composite of cardiovascular death, HF hospitalization, NT‑proBNP change, and LVEF change favored sacubitril–valsartan (win ratio 1.80; 95% CI 1.27–2.63). NT‑proBNP was significantly lower with sacubitril–valsartan (geometric mean ratio 0.68; 95% CI 0.57–0.81), with similar safety between groups. These findings show biological activity and safety of sacubitril–valsartan in Chagas HFrEF, while definitive outcome benefits need larger, longer trials. 2

Switching from hs‑cTnI to hs‑cTnT increases admissions without outcome gains

This interrupted time‑series study followed 25 849 suspected ACS presentations across three centers switching from hs‑cTnI to hs‑cTnT. After the switch, myocardial injury diagnoses rose from 21% to 38%, and admissions increased (OR 2.24; 95% CI 1.81–2.77). Serial troponin testing increased six‑fold with hs‑cTnT (OR 6.03; 95% CI 4.85–7.49), substantially raising resource use. Subsequent MI, HF, or cardiovascular death at 1 year remained unchanged (OR 0.83; 95% CI 0.48–1.41). Centers should anticipate more admissions and testing without proven outcome benefit when moving from hs‑cTnI to hs‑cTnT. 3