Martha Gulati, MD, on the underappreciation for younger women’s heart attack risk.

Surgeries & Interventions

Aggressive LDL Reduction Strategy

An aggressive new strategy may help lower LDL levels in patients with STEMI (ST-Segment Elevation Myocardial Infarction) – the most severe type of heart attack. 

Early high-intensity statin initiation is standard after STEMI, but many patients still don’t reach their target LDL levels. Clinicians will sometimes leverage PCSK-9 inhibitors to further reduce levels when other lipid-lowering therapy is insufficient. But new research suggests starting the powerful LDL-lowering agent earlier – like, in the cath lab – may be the most effective strategy. 

A trial presented at TCT showed that the PCSK-9 inhibitor alirocumab significantly reduced LDL-C levels compared with sham-control when given acutely during the blockage-clearing PCI procedure. 

STEMI patients undergoing PCI were randomized to alirocumab 150mg injection (n=38) versus sham-control (n= 30). Patients received medication at baseline, two weeks, and four weeks. All patients received high-dose statin therapy. 

• The alirocumab group saw a 22.3% greater reduction in LDL-C levels at six weeks compared to the control group.
  
• The proportion of people meeting the LDL cholesterol target of 54 mg/dL was 92.1% with alirocumab and 56.7% with control.

The LDL cholesterol reduction will hopefully translate to reduced inflammation in these patients, and as a result, better outcomes.

The Takeaway

Aggressive in-hospital PCSK-9 therapy (plus statins) for heart attack patients undergoing PCI would likely mean fewer deaths and cardiovascular events. While the trial was not designed to assess clinical outcomes (see: small sample size, short follow-up), it did show acute PCSK-9 injections were feasible and effectively lowered LDL-C levels. 

Stress Less with AI-Powered CCTA

Stress tests are today’s go-to method for detecting coronary artery disease, but should they be? Join experts from Cleerly and George Washington University on October 6th for a discussion exploring how we can improve CAD detection with AI-enabled CCTA.

Us2.ai and EchoNous Integrate

Us2.ai’s echocardiography reporting automation solution is being integrated into the EchoNous Kosmos ultrasound platform, creating the most powerful diagnostic “power tool” ever created for the hand-carried POCUS market.

The Wire

• NIH Backs Eko Again: Eko has secured a $2.7M grant from the NIH, bringing the startup’s total funding to $128M. Armed with the fresh funding, the smart stethoscope startup will work with Lifespan Health System’s Cardiovascular Institute to collect real-world ECG and phonocardiogram data using the Eko DUO ECG + Digital Stethoscope. This data will help Eko develop an algorithm that can detect pulmonary hypertension and stratify its severity. This is the fourth small business grant Eko has received from the NIH. 

• Ultrasound-Guided Femoral Access Falls Flat: Common femoral artery access – a procedure ubiquitous in cardiac cath labs – is known for its grave bleeding risks. Surprisingly, this JAMA-published study (N= 621) found that ultrasound-guided femoral access did *not* significantly reduce femoral bleeding or vascular complications, nor did it speed up access times. It did reduce the risk of venipuncture (3.1% vs. 11.7%) and the number of puncture attempts (1.2 vs. 1.4).

• Cannabis & CV Medication Interactions: An article published in Healio’s Cardiology Today highlights the clinically relevant drug interactions between cannabinoids and common CV medications. Through various mechanisms, CBD may lead to increased levels of DOACs, warfarin, digoxin, and cilostazol, as well as decreased levels of the antiplatelet agent clopidogrel. The authors suggest physicians consider these interactions (and their patients’ cannabis use) when determining CVD drug dosages. 

• Bifurcation Lesion Solution: Medtronic has received an expanded FDA approval for its Onyx Frontier drug-eluting stent, allowing physicians to use just one stent to treat plaque that has accumulated around the junction of two coronary arteries. Medtronic’s single-wire design provides physicians with the option to open the stent cell wall to access the branching artery, without compromising stent integrity.  

• SGLT2i Lowers CKD: Information presented at the EASD annual meeting suggests the  empagliflozin SGLT2 inhibitor improves chronic kidney disease outcomes among patients with cardiovascular disease and type 2 diabetes. Among 7k patients, empagliflozin was associated with a 30% reduced risk of worsening CKD and an over 50% chance of CKD improvement after a 3-year follow-up. 

• 2021 Burnout Levels: A study of 2.4k physicians in Mayo Clinic Proceedings revealed the unfortunate yet not too surprising information that 63% of physicians experienced burnout at least once in 2021 (up from 38% in 2020). Last year saw a 39% rise in emotional exhaustion scores and a 35% decrease in work-life balance satisfaction, although the moderate 6% increase in depression scores caused the authors to conclude that “the increase in physician distress in this interval was primarily due to increased work-related distress.”

• Waist-Hip Ratio Beats BMI : New evidence underscores that BMI may not be the best metric to measure disease risk. Using genetic data from over 380k people, the authors directly compared waist-to-hip ratio (WHR), body mass index (BMI), and fat mass index (FMI), and found that WHR had the strongest relationship to all-cause death (odds ratios: 1.51 vs. 1.29 & 1.26). When the authors looked at males and females separately, they discovered the finding was only true for men. For women, all measurements predicted mortality equally. 

• EPDs from Approval to Payment: A new study in JAMA Cardiology suggests that, in the absence of clear evidence for embolic protection device (EPD) efficacy, CMS reimbursement alone did not drive device use. Among 511 institutions, EPDs were used in only 7.1% of TAVR procedures, with a history of stroke being the strongest predictor of use. There was no difference in EPD use based on hospital TAVR reimbursement, though there was more EPD use at higher-volume centers. Even more surprising, there was no uptick in EPD use after CMS approval.

• Questioning Acetaminophen Safety: Acetaminophen is widely considered a safe option for patients with cardiovascular disease or CVD risk factors, especially as an alternative to NSAIDs which are known to raise blood pressure. But a recent meta-analysis of 172 high-risk patients found a significant correlation between daily acetaminophen use and elevated systolic BP (standardized mean difference: 0.38) compared to placebo. There was no change in diastolic BP. 

• Orchestra BioMed’s Blood Pressure Device: Orchestra BioMed is celebrating promising extended study results for its BackBeat cardiac neuromodulation therapy – an implant designed to integrate with a patient’s existing pacemaker to help manage high blood pressure. When fourteen patients who were originally in the control group transitioned to BackBeat therapy, they saw a 10.33 mmHg reduction in ambulatory systolic blood pressure at six months. As per a deal inked earlier this year, Medtronic will have exclusive rights to commercialize the implant once it receives marketing authorization.

• Judge Greenlights UnitedHealth’s Change Acquisition: The big are getting bigger after a federal judge denied the DOJ’s attempt to block UnitedHealth Group’s $13B acquisition of Change Healthcare, delivering a huge victory to the healthcare giant as it continues to vertically integrate its business. As part of the decision, UHG will be required to divest Change’s ClaimsXten service line (it already has TPG Capital set to pick it up for $2B), although its cardiology-related businesses are remaining. If you’re interested in this segment and didn’t catch our full writeup in Digital Health Wire, you’re missing out.

Transformation Through Structured Reporting

Ready to realize the benefits of cardiovascular imaging structured reporting? Check out these quick and powerful Change Healthcare videos detailing the efficiency gains provided by structured reporting and what it takes to drive adoption.

Detecting CAC and Undiagnosed CAD

Do you know how many patients in your health system are at risk for coronary artery disease but are undiagnosed? This article details how Nanox AI’s CAC solution can help clinicians identify those who often go undetected.