30-Second Takeaway
- CCM added to guideline therapy showed a **win ratio 2.48** versus optimal medical therapy in HFrEF in a randomized cohort.
- Vutrisiran reduced the composite of mortality and recurrent cardiovascular events in ATTR-CM with no sex interaction detected.
- Interpretable LightGBM model outperformed GRACE for 1-year cardiac death after PCI (external AUC **0.811**).
Week ending June 27, 2026
Five recent cardiovascular studies with direct clinical implications: device therapy, ATTR-CM therapy, perioperative and post-PCI risk prediction, and ARB versus ACEI outcomes
CCM produced a favorable win-ratio versus optimal medical therapy in HFrEF (FIX-HF-5C win-ratio analysis).
In 160 randomized HFrEF patients, cardiac contractility modulation (CCM) plus guideline therapy achieved an overall win ratio of 2.48 versus optimal medical therapy (95% CI 1.76–3.64; p<0.001). The win-ratio analysis integrated cardiovascular death, HF hospitalization, peak VO2, MLHFQ, 6MWD, and NYHA class to prioritize clinically relevant outcomes. Event-driven endpoints accounted for 22% of wins while patient-centered measures contributed 56.2% of wins. Authors emphasise the findings are hypothesis-generating and require validation in larger confirmatory studies.
Machine learning models generally outperform traditional scores for perioperative cardiac risk but lack external validation.
Systematic review and Bayesian network meta-analysis of 13 studies (927,113 patients) found machine learning models typically had better discrimination than the Revised Cardiac Risk Index. Automated machine learning (SUCRA 96.6) and gradient boosting ranked highest with mean discrimination improvements reported versus RCRI. None of the included ML models had external validation and most lacked calibration reporting, limiting clinical readiness. Prospective, multicentre external validation and calibration assessment are required before clinical deployment.
Vutrisiran showed consistent efficacy across sexes in HELIOS-B for transthyretin cardiac amyloidosis.
HELIOS-B randomized 654 patients with wild-type or variant ATTR-CM to vutrisiran 25 mg every 12 weeks or placebo and reduced the primary composite of all-cause mortality and recurrent cardiovascular events in both sexes. Hazard ratios were 0.59 (95% CI 0.26–1.30) in women and 0.71 (95% CI 0.54–0.94) in men, with no statistically significant sex interaction (p-interaction = 0.66). Safety profiles were comparable between sexes and functional and quality-of-life declines were attenuated with treatment. Precision was limited in women due to small subgroup size, so inference for women remains less precise.
References
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Additional Reads
Optional additional studies from this edition.