Cardiology

Prehospital UFH improves IRA patency in STEMI without more major bleeding

This single-center randomized trial assigned 593 STEMI patients to weight-based UFH at first medical contact or only at PCI initiation. Prehospital UFH increased initial IRA TIMI 2–3 flow to 43% versus 27% with cath-lab–only UFH (RR 1.59; 95% CI, 1.27–1.98). BARC 3–5 bleeding during the index hospitalization remained low and similar (2.4% vs 2.0%; RR 1.16; 95% CI, 0.39–3.45). Symptom-to-angiography times were comparable between groups, suggesting benefit derived from earlier anticoagulation rather than system delays. 1

Sotatercept favorably alters pulmonary hemodynamics in CpcPH-HFpEF

The CADENCE phase 2 trial randomized 164 adults with CpcPH-HFpEF to sotatercept 0.3 or 0.7 mg/kg or placebo every three weeks for 24 weeks. Baseline median pulmonary vascular resistance was 5.2 Wood units, and sotatercept significantly reduced pulmonary vascular resistance versus placebo at both doses. Mean pulmonary arterial and wedge pressures also fell in sotatercept arms, indicating improvements in both pulmonary vascular load and left-sided filling pressures. Six-minute walk distance increased modestly, more with 0.3 mg/kg; increased hemoglobin and diarrhea were common adverse events. 2

Evolocumab reduces first MACE in high-risk diabetic primary prevention without known atherosclerosis

This prespecified VESALIUS-CV subgroup included 3,655 patients with diabetes, no prior MI or stroke, and no significant atherosclerosis by revascularization, stenosis, or calcium score. Patients on optimal statins were randomized to evolocumab 140 mg every two weeks or placebo, with median follow-up of 4.8 years. At 48 weeks, median LDL-C was 52 mg/dL with evolocumab versus 111 mg/dL with placebo. Evolocumab lowered 5-year 3-point MACE estimates to 5.0% versus 7.1% (HR 0.69; 95% CI, 0.52–0.91). 3

NPR1 agonist XXB750 paradoxically worsens biomarkers and outcomes in HFrEF

This phase 2 trial enrolled 136 patients with LVEF <50% on background renin-angiotensin blockade and randomized them to XXB750 60 or 120 mg, placebo, or sacubitril/valsartan. Pooled XXB750 treatment increased NT-proBNP (ratio 1.34; 95% CI, 1.07–1.66) and decreased cGMP (ratio 0.77; 95% CI, 0.65–0.91) at 16 weeks. In contrast, sacubitril/valsartan showed lower NT-proBNP and higher cGMP versus baseline, consistent with expected natriuretic pathway activation. Death or worsening heart failure events occurred in 25% of XXB750 recipients versus 8% on sacubitril/valsartan and 0% on placebo. 4