Cardiology

Impella-Based LV Unloading With PCI Delay Fails to Improve Outcomes in Anterior STEMI Without Shock

In 527 anterior STEMI patients without shock, LV unloading using a microaxial pump plus 30-minute PCI delay did not reduce infarct size versus immediate PCI. Cardiac MRI showed similar infarct size indexed to LV mass between unloading and control groups (30.8% vs 31.9%; mean difference -1.1%; P = 0.50). Total ischemic time was longer and major bleeding or vascular complications at 30 days were more frequent with unloading. These findings do not support routine pre-PCI Impella-type unloading with deliberate reperfusion delay in hemodynamically stable anterior STEMI. 1

Left Bundle Branch Pacing Outperforms Right Ventricular Pacing in High-Burden Pacing Patients

In 160 high pacing burden patients at risk for cardiac dysfunction, left bundle branch pacing reduced the composite of death, HF hospitalization, or pacing-induced cardiomyopathy versus RV pacing. Over 36 months, the primary endpoint occurred in 11.6% with left bundle branch pacing vs 33.9% with RV pacing (HR 0.31; 95% CI 0.15-0.66). Benefit was driven mainly by less pacing-induced cardiomyopathy (6.5% vs 18.2%; sub-HR 0.32; 95% CI 0.12-0.88). Left bundle branch pacing produced greater LVEF improvement, smaller LV dimensions, and better NYHA class, without clear mortality or HF hospitalization differences alone. 2

Edoxaban Monotherapy Lowers Total Event Burden Versus Dual Therapy in AF With Stable CAD

This EPIC-CAD post-hoc analysis included 1,040 patients with AF and stable CAD randomized to edoxaban alone or edoxaban plus a single antiplatelet. At 12 months, edoxaban monotherapy halved total net adverse clinical events versus dual therapy (9.4 vs 19.8 per 100 person-years; IRR 0.47; 95% CI 0.34-0.67). Monotherapy reduced both first and recurrent events while maintaining similar ischemic event and mortality rates. Bleeding dominated events in both groups but was more frequent with dual therapy (85.7% vs 55.3% of events). 3

Single-Sample Rule-Out of MI With a Sixth-Generation hs-cTnT Threshold of 13 ng/L

In 987 ED patients with possible NSTEMI, a sixth-generation hs-cTnT <13 ng/L at presentation classified 61% as low risk. At this threshold, NPV for 30-day MI or cardiac death was 99.9% and sensitivity 99.4% in the derivation cohort. The early rule-out pathway using the sixth-generation assay identified more low-risk patients at presentation than the fifth-generation assay (41.0% vs 17.4%). In an external cohort of 1,721 patients, <13 ng/L identified 45.4% as low risk with NPV 99.0% and sensitivity 97.5%. 4