Cardiology

Six-year Evolut Low Risk data: similar survival for TAVR and surgery, higher reintervention with TAVR

Among 1,414 low-surgical-risk patients with severe symptomatic AS, 6-year death or disabling stroke was similar for TAVR vs surgery (23.3% vs 20.4%). All-cause mortality was also comparable (23.3% vs 20.2%), supporting TAVR as a long-term alternative in appropriately selected low-risk patients. At 6 years, reintervention was numerically higher with TAVR (5.5% vs 3.3%), becoming significantly higher by 7 years (9.8% vs 6.0%). Excess reinterventions with TAVR were driven by aortic regurgitation, whereas reinterventions for stenosis were similar between groups. 1

Early MRA after ADHF or MI with LV dysfunction reduces death and worsening HF

This meta-analysis of six RCTs (9,770 patients) examined MRA initiation during hospitalization or within 60 days of ADHF or MI with LV dysfunction. Early MRA use reduced all-cause mortality (RR 0.87) and worsening HF events (RR 0.81) versus usual care. Hyperkalaemia risk was modestly increased, while hypokalaemia risk decreased markedly (RR 0.39), without excess hypotension or worsening renal failure. These results support routine early MRA initiation in eligible post-ADHF and post-MI patients, with structured potassium and renal monitoring. 2

IV ferric carboxymaltose lowers HF events and improves capacity in iron-deficient HFrEF

Across 11 RCTs including 6,493 HF patients with iron deficiency, IV ferric carboxymaltose reduced recurrent HF hospitalizations or CV death at 1 year (RR 0.73). Benefits persisted over maximum follow-up (RR 0.80), with consistent reductions in recurrent HF hospitalizations at both 1 year and complete follow-up. There was a trend toward lower all-cause and CV mortality at 1 year, though survival effects attenuated with longer follow-up. Six-minute walk distance improved by about 30 meters, indicating clinically meaningful functional gains with therapy. 3