This Week in Cardiology – Détails, épisodes et analyse

Listener feedback on the PISCES trial, AHA news (including a big PCSK9i trial), beta-blockers post MI, LAAC, and post-AF ablation OAC use are the topics John Mandrola, MD, discusses in this week's podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I Listener Feedback

Why I Believe Fish Oil's Big CV Benefit in Dialysis Patients https://www.medscape.com/viewarticle/why-i-believe-fish-oils-big-cv-benefit-dialysis-patients-2025a1000uzg

• PISCES trial https://www.nejm.org/doi/full/10.1056/NEJMoa2513032

II PCSK9 Inhibitor News

In Global Trial, PCSK9 Inhibitor Provides Major Protection Against First CV Event https://www.medscape.com/viewarticle/global-trial-pcsk9-inhibitor-provides-major-protection-2025a1000uzp

• VESALIUS-CV trial https://www.nejm.org/doi/full/10.1056/NEJMoa2514428
• ODYSSEY trial https://www.nejm.org/doi/full/10.1056/NEJMoa1801174
• FOURIER https://www.nejm.org/doi/full/10.1056/NEJMoa1615664
• Anish Koka Tweet on LDL-lowering https://x.com/anish_koka/status/1987280506937909326?s=20

III Beta-Blockers After MI and John Cleland

• Beta-Blockers after MI with normal EF https://www.nejm.org/doi/full/10.1056/NEJMoa2512686
• REBOOT-CNIC trial https://www.nejm.org/doi/full/10.1056/NEJMoa2504735
• REDUCE AMI trial https://academic.oup.com/ehjcvp/article/9/2/192/6895544?login=false
• ABYSS trial https://www.nejm.org/doi/full/10.1056/NEJMoa2404204
• CAPITAL RCT trial https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0199347
• Beta-Blockers after MI with mildly reduced EF https://pubmed.ncbi.nlm.nih.gov/40897190/
• John Cleland Clinical Outlook https://www.nature.com/articles/s41569-025-01228-w

IV Left Atrial Appendage Closure – The CLOSURE-AF trial

Percutaneous LAAC in AF Falls Short Again in CLOSURE-AF https://www.medscape.com/viewarticle/percutaneous-left-atrial-appendage-closure-af-falls-short-2025a1000uzu

• Prague-17 Trial https://www.jacc.org/doi/10.1016/j.jacc.2020.04.067
• OPTION trial https://www.nejm.org/doi/full/10.1056/NEJMoa2408308

V Oral AC after AF ablation – the OCEAN Trial

Anticoagulation After AF Ablation: The OCEAN Trial Still Leaves Questions https://www.medscape.com/viewarticle/anticoagulation-after-af-ablation-ocean-trial-still-leaves-2025a1000v4t

• OCEAN Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2509688
• ALONE-AF trial https://jamanetwork.com/journals/jama/fullarticle/2838294

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Listener feedback on non-culprit PCI in STEMI, a major cardiac result in patients on hemodialysis, news on GLP-1 agonists, a dubious stroke trial, and an AHA preview are the topics John Mandrola, MD, discusses in this week's podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I Listener Feedback

• Meta-analysis of MI as a surrogate https://pubmed.ncbi.nlm.nih.gov/34694318/
• Compare Acute Trial https://www.nejm.org/doi/full/10.1056/NEJMoa1701067
• DANAMI-3–PRIMULTI 10.1016/S0140-6736(15)60648-1 External Link
• CULPRIT-SHOCK https://www.nejm.org/doi/full/10.1056/NEJMoa1710261
•  

II  Huge Cardiac News for Patients with ESRD PISCES article EMBARGOED Till 1130 AM EST

• PISCES Trial www.nejm.org/doi/full/10.1056/NEJMoa2513032
• REDUCE-IT Trial https://www.nejm.org/doi/full/10.1056/NEJMoa1812792
• STRENGTH Trial https://jamanetwork.com/journals/jama/fullarticle/2773120
• FISH trial https://jamanetwork.com/journals/jama/fullarticle/1150094

III Obesity Agents

• White House announces deal with Lilly and Novo on GLP-1 drugs https://www.reuters.com/business/healthcare-pharmaceuticals/novo-lilly-shares-rise-trump-obesity-drug-deal-nears-2025-11-06/

Amylin Agonists

• Amylin Analog Eloralintide Reduces Weight in Phase 2 Trial

https://www.medscape.com/viewarticle/amylin-analog-eloralintide-reduces-weight-phase-2-trial-2025a1000uqf

• Eloralintide Phase 2 Study https://doi.org/10.1016/S0140-6736(25)02155-5

GLP-1 Comparisons

• SURMOUNT-5 Trial https://www.nejm.org/doi/10.1056/NEJMoa2416394
• Tirzepatide vs Semaglutide in 10-year CVD Risk Reduction https://doi.org/10.1093/ehjopen/oeaf117

IV A Problematic Trial in Stroke Care

• LAMP trial https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2840370

V AHA Preview

AHA 2025: Mandrola's Four Trials to Look For https://www.medscape.com/viewarticle/aha-2025-mandrolas-four-trials-look-2025a1000u80

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The big beta-blocker story from ESC, dual pathway therapy with aspirin and OAC, stopping OAC after successful AF ablation, and DANCAVAS II trial are the topics John Mandrola, MD, discusses on this week's podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I Listener Feedback

This Week in Cardiology Podcast – August 29 https://www.medscape.com/viewarticle/1002877

II The Big Beta-blocker Story from ESC

Beta-Blockers Post-MI: A Clear Clinical Message https://www.medscape.com/viewarticle/beta-blockers-post-mi-clear-clinical-message-2025a1000mz0

• REBOOT https://www.nejm.org/doi/full/10.1056/NEJMoa2504735
• BETAMI-DANBLOCK https://www.nejm.org/doi/abs/10.1056/NEJMoa2505985

• REDUCE AMI https://www.nejm.org/doi/10.1056/NEJMoa2401479
• CAPITAL RCT https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0199347
• Post Hoc Analysis From REBOOT Trial https://eurointervention.pcronline.com/article/effect-of-beta-blocker-withholding-or-withdrawal-after-myocardial-infarction-without-reduced-ejection-fraction-on-ischaemic-events-a-post-hoc-analysis-from-the-reboot-trial
• Beta-Blockers After MI With Mildly Reduced Ejection Fraction https://doi.org/10.1016/S0140-6736(25)01592-2
• CAPRICORN 10.1016/S0140-6736(00)04560-8 External Link
• BHAT https://jamanetwork.com/journals/jama/fullarticle/370103
• ISIS 1 https://pubmed.ncbi.nlm.nih.gov/2873379/

III Aspirin and OAC Combination Clearly Dangerous

Aspirin Plus Oral Anticoagulants Raises Mortality, Bleeding https://www.medscape.com/viewarticle/aspirin-plus-oral-anticoagulants-raises-mortality-bleeding-2025a1000nam

• AQUATIC https://www.nejm.org/doi/full/10.1056/NEJMoa2507532
• AFIRE https://www.nejm.org/doi/full/10.1056/NEJMoa1904143
• EPIC CAD https://www.nejm.org/doi/10.1056/NEJMoa2407362
• OAC-ALONE  https://pubmed.ncbi.nlm.nih.gov/30586700/

IV Stop or Continue OAC after Successful AF Ablation

• ALONE-AF https://jamanetwork.com/journals/jama/fullarticle/2838294
• OCEAN trial protocol https://doi.org/10.1016/j.ahj.2017.12.007

V DANCAVAS II Trial

• DANCAVAS II https://doi.org/10.1093/eurheartj/ehaf704
• DANCAVAS I https://www.nejm.org/doi/full/10.1056/NEJMoa2208681

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Coated vs uncoated ASA, a new trial in CAD, conflicts of interest, first AF in the hospital, and changing HTN scoring and CHADSVASC are the topics John Mandrola, MD, covers in this week's podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. ASA

No Benefit of Enteric-Coated Aspirin vs Uncoated in CVD https://www.medscape.com/viewarticle/997119

-  JAMA Cardiology: Coated vs Uncoated ASA https://jamanetwork.com/journals/jamacardiology/fullarticle/2809795

-  ADAPTABLE https://www.nejm.org/doi/10.1056/NEJMoa2102137

II. RECHARGE

-  Revascularization Choices Among Under-Represented Groups Evaluation (The RECHARGE Program) https://www.pcori.org/research-results/2023/revascularization-choices-among-under-represented-groups-evaluation-recharge-program

-  Gaudino/Stone: Reconsidering Coronary Revascularization Trials

III. Conflicts of Interest

-  Financial Conflicts of Interest in Public Comments on Medicare National Coverage Determinations of Medical Devices  https://jamanetwork.com/journals/jama/fullarticle/2808721

IV. First AF in the Hospital

Decoding AFib Recurrence: PCPs' Role in Personalized Care https://www.medscape.com/viewarticle/997011

-  Annals of Internal Medicine: AF Recurrence https://doi.org/10.7326/M23-1411

V. Changing CHADSVASC Score

-  JAMA Network Open: HTN Guidelines and CHADSVASC Up-Scoring  https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2809933

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Reader feedback, leadless pacing, ABIM, SGLT2 inhibitors, peri-operative MI after cardiac surgery, and. AHA late-breakers are the topics John Mandrola, MD, covers in this week's podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. Reader Feedback

Sep 22, 2023 This Week in Cardiology Podcast

https://www.medscape.com/viewarticle/996694

-   ODYSSEY OUTCOMES trial https://www.nejm.org/doi/full/10.1056/nejmoa1801174

-   FOURIER https://www.nejm.org/doi/full/10.1056/nejmoa1615664

II. Leadless Pacing

-   Leadless vs Transvenous Pacemaker Study https://doi.org/10.1093/europace/euad269

III. ABIM News

Heart Societies Ready to Split From ABIM Over Long-Standing MOC Disputes

https://www.medscape.com/viewarticle/996747

IV. SGLT2 inhibitors

Empagliflozin Gets FDA Nod for CKD Without T2D or HF

https://www.medscape.com/viewarticle/996873

-   EMPA-Kidney https://www.nejm.org/doi/full/10.1056/NEJMoa2204233

V. Peri-Op MI after Cardiac Surgery

Cardiac Troponin Predicts Mortality Post Surgery

https://www.medscape.com/viewarticle/996877

-   Austrian Perioperative MI study https://doi.org/10.1016/j.jacc.2023.07.011

-   Vision  https://www.nejm.org/doi/10.1056/NEJMoa2000803

VI. AHA Late Breakers

-   Link to Late-Breakers https://professional.heart.org/en/meetings/scientific-sessions/programming/late-breaking-science#late-breaking

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Coronary calcium, cardiac arrest survival, Factor XI drug findings, APCs and a potential new board certification in cardiology are the topics discussed by John Mandrola, MD in this week's podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I Coronary Artery Calcium

-   CONFIRM Registry - https://doi.org/10.1016/j.jcmg.2023.03.008

-   CURE -- https://www.nejm.org/doi/full/10.1056/nejmoa010746

II Cardiac Arrest

Cardiac Arrest Centers No Benefit in OHCA Without STEMI

https://www.medscape.com/viewarticle/995885

-   Cycling coverage https://velo.outsideonline.com/road/road-racing/nathan-van-hooydonck-forced-to-end-to-racing-career-due-to-heart-condition/

-   ARREST https://doi.org/10.1016/S0140-6736(23)01351-X

-   SCD in Athletes Bob Harrington and Manesh Patel https://www.medscape.com/viewarticle/995575

III Factor XI

Trial Halted for Bleeding Reduction With Abelacimab vs Rivaroxaban in AF

https://www.medscape.com/viewarticle/996587

-   Press Release - https://anthostherapeutics.com/wp-content/uploads/2023/09/2023-09-18-Anthos-Press-Release-final.pdf

-   Abelacimab, a Factor XI Inhibitor, Prevents VTE With Low Bleeding Risk in Knee Replacement

-   NEJM proof-of-concept https://www.nejm.org/doi/full/10.1056/NEJMoa2105872

-   OCEANIC-AF https://classic.clinicaltrials.gov/ct2/show/NCT05643573

-   Will Factor XI Be the Goldilocks Anticoagulant Target? https://www.medscape.com/viewarticle/979634

IV APC Care

NPs and PAs Handling Increasingly More Primary Care Visits: New Studies https://www.medscape.com/viewarticle/996709

BMJ paper -- https://www.bmj.com/content/382/bmj-2022-073933

V Possible Cardiology Board Certification Changes

-   Heart Societies Ready to Split From ABIM Over MOC Disputes https://www.medscape.com/viewarticle/996747

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Reader feedback, imaging in the cath lab, AF ablation to relieve anxiety, and some possible help in hypertension are the topics John Mandrola, MD, discusses in this week's podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. Reader Feedback

Sep 08, 2023 This Week in Cardiology Podcast   https://www.medscape.com/viewarticle/996233

First Clinical Trial of CTO Procedures Fails to Deliver   https://www.medscape.com/viewarticle/877405

-   DanGerShock trial https://pubmed.ncbi.nlm.nih.gov/31176289/

II. Imaging in the Cath Lab

Should Intravascular Imaging Be Almost Routine in PCI?    https://www.medscape.com/viewarticle/996375

-   ILUMIEN IV    https://www.nejm.org/doi/full/10.1056/NEJMoa2305861

-   OCTOBER    https://www.nejm.org/doi/full/10.1056/NEJMoa2307770

III. AF Ablation to Relieve Anxiety

-   REMEDIAL Trial   https://jamanetwork.com/journals/jama/fullarticle/2809419

-   Sohaib and Francis; Meta analysis of Symptomatic Response Effect of CRT Pacing    https://pubmed.ncbi.nlm.nih.gov/24259043/

IV. HTN

'New Dawn' for Aldosterone as Drug Target in Hypertension?    https://www.medscape.com/viewarticle/996316

-   TARGET HTN -    https://jamanetwork.com/journals/jama/fullarticle/2809625

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ESC Recap Part 2: ECLS-SHOCK, FIRE, MULTISTARS-AMI, HEART FID, and DANPACE II are the trials John Mandrola, MD, discusses in this week's podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:  https://www.medscape.com/twic

I. Cardiogenic Shock

ECMO for Shock in Acute MI Won't Help, May Harm: ECLS-SHOCK  https://www.medscape.com/viewarticle/995882

-   ECLS-SHOCK trial  https://www.nejm.org/doi/full/10.1056/NEJMoa2307227

-   ECMO-CS trial  https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.062949

II. FIRE TRIAL

FIRE a Win for Physiology-Guided MI Complete Revascularization in Older Patients  https://www.medscape.com/viewarticle/995875

-   FIRE Trial  https://www.nejm.org/doi/full/10.1056/NEJMoa2300468

-   COMPLETE Trial  https://www.nejm.org/doi/full/10.1056/NEJMoa1907775

III. Immediate vs Staged Revascularization

Parity for Prompt vs Staged STEMI Complete Revascularization: MULTISTARS-AMI  https://www.medscape.com/viewarticle/995961

-   MULTISTARS AMI trial  https://www.nejm.org/doi/full/10.1056/NEJMoa2307823

-   Complete Revascularization Now Compulsory? MULTISTARS-AMI and FIRE in Context  https://www.medscape.com/viewarticle/995676

IV. Iron-Supplementation in Heart Failure

IV Iron Shows Only Modest Benefit in HF: HEART-FID  https://www.medscape.com/viewarticle/995874

-   HEART-FID   https://www.nejm.org/doi/full/10.1056/NEJMoa2304968

-   EHJ meta-analysis of Iron Supplementation   https://doi.org/10.1093/eurheartj/ehad586

V. AF Prevention with Pacing

Minimizing Atrial Pacing No Benefit in Sinus Node Disease: DANPACE II  https://www.medscape.com/viewarticle/996076

-   DANPACE II  https://doi.org/10.1093/eurheartj/ehad564

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ESC Wrap-up 1: Obesity, heart failure with preserved EF and reduced EF, AF, frailty, evidence translation, and catheter ablation are the topics John Mandrola, MD, discusses in this week's podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. FRAIL AF

   -FRAIL-AF Study

   https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.066485

   -The Most Important Study From ESC: FRAIL-AF

   https://www.medscape.com/viewarticle/996063

II. STEP-HFpEF

Wegovy Scores HFpEF Benefits in People With Obesity

https://www.medscape.com/viewarticle/995844

GLP-1 Agonist Semaglutide in HFpEF Cleared Low Bar

https://www.medscape.com/viewarticle/995872

Semaglutide's Big Step in HFpEF With Obesity: Investigator Inteview

https://www.medscape.com/viewarticle/995673

   -Semaglutide in Obese Patients With  HFpEF

   https://www.nejm.org/doi/full/10.1056/NEJMoa2306963

III. NOAH AFNET 6

Anticoagulation No Benefit in Presumed AF Detected by Cardiac Devices

https://www.medscape.com/viewarticle/995861

How Much AF Warrants Anticoagulation? NOAH-AFNET 6 Provides Clues

https://www.medscape.com/viewarticle/995871

   -NOAH AFNET-6 – NEJM

   https://www.nejm.org/doi/full/10.1056/NEJMoa2303062

IV. ADVENT

Pulsed Field Ablation Challenges Conventional Devices in AF

https://www.medscape.com/viewarticle/995884

Pulsed Field Ablation Noninferior but Underwhelming in ADVENT

https://www.medscape.com/viewarticle/995898

   -PPFA vs Thermal Ablation for PAF

   https://www.nejm.org/doi/10.1056/NEJMoa2307291

V. BUDAPEST CRT

Impact of RV Pacing in Heart Failure, CRT Benefit Shown in BUDAPEST-CRT

https://www.medscape.com/viewarticle/996035

Supporting Evidence for a Common Practice: BUDAPEST CRT

https://www.medscape.com/viewarticle/995880

   -BUDAPEST CRT Study: European Heart Journal

   https://doi.org/10.1093/eurheartj/ehad591

VI. CASTLE HTx

Advanced HF No Obstacle to AF Ablation Success: CASTLE-HTx

https://www.medscape.com/viewarticle/995897

AF Ablation in End-Stage HF: Is CASTLE-HTx Too Good to Be True?

https://www.medscape.com/viewarticle/995974

   -CASTLE AF (2018)

   https://www.nejm.org/doi/full/10.1056/nejmoa1707855

   -CASTLE HTx

   https://www.nejm.org/doi/full/10.1056/NEJMoa2306037

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GLP-1 agonists in HFpEF, DOACs for subclinical AF, renal denervation, and the matter of remaining in the profession are the topics John Mandrola, MD, discusses in this week's podcast.

This podcast is intended for healthcare professionals only.

To read a partial transcript or to comment, visit:

https://www.medscape.com/twic

I. Obesity and HFpEF

GLP-1 Agonists in HFpEF With Obesity: Are We There Yet? https://www.medscape.com/viewarticle/993980

Wegovy Scores HFpEF Benefits in People With Obesity https://www.medscape.com/viewarticle/995844

- Semaglutide in Obese Patients With HFpEF https://www.nejm.org/doi/full/10.1056/NEJMoa2306963

- Rationale/Protocol Paper https://doi.org/10.1016/j.jchf.2023.05.010

II. DOAC for Subclinical AF

- NOAH-AFNET 6 Rationale/Protocol https://doi.org/10.1016/j.ahj.2017.04.015

- NOAH-AFNET 6 Trial Results https://www.nejm.org/search?q=NOAH+AFNET

III. Renal Denervation

ReCor Renal Denervation System Safe, Effective: FDA Panel https://www.medscape.com/viewarticle/995741

FDA Panel Split on Efficacy of Spyral Renal Denervation https://www.medscape.com/viewarticle/995800

SPYRAL HTN-ON MED https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00455-X/fulltext

IV. Maintenance of Certification

As MOC Debate Heats Up, Cardiology Societies Weigh In https://www.medscape.com/viewarticle/moc-debate-heated-cardiology-societies-weigh-2023a1000jju

Features

Mandrola's 5 Things to Look for at the Upcoming ESC 2023

https://www.medscape.com/viewarticle/995614

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