Cardiology

Class 1C rhythm control in AF linked to lower mortality and stroke than rate control

In a multihospital AF registry of 100,748 adults, 5% received class 1C rhythm control, mostly flecainide. After propensity matching and 5±3 years of follow-up, class 1C use was associated with lower all-cause mortality than rate control (14% vs 19%; HR 0.65; 95% CI 0.57-0.74). Class 1C therapy also correlated with lower stroke hospitalization (3.6% vs 4.8%; HR 0.82; 95% CI 0.80-0.95) and, in patients aged 65-80 years, less heart failure and major bleeding. Age, CHA2DS2-VASc score, and comorbidity burden modified the survival benefit, whereas coronary artery disease status did not. 1

Negative CT-FFR in stable CAD predicts excellent 10-year prognosis

This meta-analysis reconstructed individual time-to-event data for 14,315 stable CAD patients from 15 CT-FFR studies. CT-FFR ≤0.80 was associated with a nearly threefold higher MACE risk versus CT-FFR >0.80 (HR 2.97; 95% CI 2.54-3.48). Ten-year MACE-free survival was 91.4% with CT-FFR >0.80 versus 77.1% when CT-FFR was ≤0.80. Restricted mean MACE-free survival over 10 years favored CT-FFR >0.80 by about 19 months (114.1 vs 94.8 months). 2

ApoB-based goals for primary-prevention lipid therapy appear cost-effective

This simulation modeled 250,000 US adults without ASCVD but statin-eligible, based on NHANES and guideline-directed initial statin use. Therapy was intensified with high-intensity statins or ezetimibe to LDL-C <100 mg/dL, non–HDL-C <118 mg/dL, or apoB <78.7 mg/dL, depending on strategy. Relative to LDL-C goals, non–HDL-C targeting gained quality-adjusted life-years and modestly reduced costs. Compared with non–HDL-C, apoB-based intensification gained 1,324 QALYs at an additional $40.2 million, yielding an ICER of $30,300 per QALY. 3

Isolated CTO PCI improves angina and quality of life versus medical therapy

This pooled post hoc analysis of EUROCTO and DECISION-CTO included 518 patients with a single CTO and no other significant coronary lesions. PCI success was 92.2%, and Seattle Angina Questionnaire scores were assessed at baseline and 12 months, with clinical follow-up to about three years. Intention-to-treat analysis showed greater improvements with PCI than optimal medical therapy in angina frequency, quality of life, and SAQ summary scores. Physical limitation improvement with PCI reached statistical significance but was less pronounced than other domains. 4