Cardiology

CCTA plaque burden modestly improves prediction of first coronary events beyond PCE and CAC

In this Swedish population cohort, 24,791 adults aged 50–64 without prior cardiovascular disease underwent CCTA and were followed a median 7.8 years. Higher segment involvement scores (3–4 and >4) were associated with markedly increased hazards of first coronary events vs minimal disease. Noncalcified atherosclerosis independently conferred additional risk beyond traditional factors and coronary artery calcium score. Adding CCTA-derived plaque measures to pooled cohort equations and CACS modestly improved discrimination and reclassification, especially by upgrading risk in PCE-low-risk individuals. 1

In VANISH2, catheter ablation outperforms sotalol and rivals amiodarone in post-MI VT

This VANISH2 substudy analyzed 416 patients with prior MI and VT randomized to catheter ablation vs antiarrhythmic drugs, stratified by sotalol or amiodarone eligibility. Among sotalol-eligible patients, ablation reduced the composite endpoint vs sotalol (46% vs 59%; HR 0.64; 95% CI 0.43–0.94). Ablation also greatly reduced sustained VT below ICD detection compared with sotalol, indicating superior rhythm control. In amiodarone-eligible patients, ablation and amiodarone had similar primary endpoint rates, but amiodarone increased noncardiac death, respiratory failure, and heart failure hospitalization. 2

Acoramidis reduces mortality and CV hospitalizations in both wild-type and variant ATTR-CM

ATTRibute-CM randomized 611 patients with wild-type or variant ATTR-CM to acoramidis or placebo for 30 months, with an ongoing open-label extension. In wild-type disease, acoramidis reduced all-cause mortality or first cardiovascular hospitalization by 31% vs placebo at 30 months (HR 0.69; P = .007). In variant ATTR-CM, including p.Val142Ile, the composite endpoint was reduced by 59% (HR 0.41; P = .01), with consistent benefit across variants. Mortality reductions persisted through month 42 in both wild-type and variant groups, and secondary endpoints improved concordantly. 3

Meta-analysis confirms low-dose colchicine reduces recurrent MACE, MI, and stroke in secondary prevention

This meta-analysis pooled six randomized trials including 21,774 patients with established atherosclerotic disease treated with colchicine for at least 12 months. Low-dose colchicine reduced major adverse cardiovascular events vs placebo (RR 0.74; 95% CI 0.60–0.92). Myocardial infarction and stroke risks were also significantly lowered, while cardiac death and revascularization were unaffected. Benefits accrued on top of contemporary standard therapy, reinforcing colchicine as a low-cost adjunct in secondary prevention. 4