Cardiology

β-blockers after MI with preserved EF lower major adverse events in randomized evidence

This meta-analysis synthesized 4 randomized trials of β-blockers in post-MI patients with preserved ejection fraction. β-blocker therapy was associated with a significant reduction in major adverse cardiovascular events compared with control therapy. Clinical benefit was seen despite contemporary background management, addressing a key evidence gap in preserved-EF post-MI care. These findings support continuing guideline-level β-blocker use after MI, even when systolic function is preserved. 1

ECG-AI markedly improves incident heart failure prediction over PREVENT-HF in community cohorts

This pooled analysis included 14,126 participants from Framingham, MESA, and CHS with both ECG-AI and PREVENT-HF data. Composite ECG-AI positivity occurred in 11.9% and conferred 10- to 20-fold higher incident HF risk versus negative screens. Adding ECG-AI to PREVENT-HF improved discrimination and yielded meaningful one-directional net reclassification improvement at 10% and 20% risk thresholds. Results suggest ECG-AI could enable scalable HF risk stratification and targeted preventive interventions in general populations. 2

OPTION-STEMI: staged complete PCI favored over immediate in STEMI with heart failure

OPTION-STEMI randomized 994 STEMI patients with multivessel disease, excluding cardiogenic shock, to immediate versus staged complete revascularization. Among 329 patients with heart failure at presentation (Killip II–III), primary endpoint risk was higher than in those without heart failure (18.2% vs 8.7%). In this heart failure subgroup, immediate complete revascularization increased the 1-year composite of death, MI, or unplanned revascularization versus staged PCI (22.8% vs 13.3%; HR 1.79). No excess risk with immediate PCI was observed among patients without heart failure (8.0% vs 9.5%; HR 0.84), with significant interaction by heart failure status. 3

BRAIN-AF: low-dose rivaroxaban ineffective for preventing cognitive decline or stroke in low-risk AF

BRAIN-AF randomized AF patients with CHA2DS2-VASc 0–1 (excluding female sex) to rivaroxaban 15 mg daily or placebo. Over a median 3.7 years, the composite of cognitive decline, stroke, or disabling TIA occurred similarly with rivaroxaban and placebo (annual 7.0% vs 6.4%). The hazard ratio was 1.10 (95% CI 0.86–1.40; P = 0.46), and the trial stopped early for futility. Major bleeding was rare and not increased with rivaroxaban, but there was no efficacy signal on cognitive or ischemic outcomes. 4