Robert Eidus, MD

Cardiovascular Disease

OCTOPUS: What Really Causes MI in Younger Patients

Young heart attack patients might actually be a completely different disease population than previously understood, after the OCTOPUS registry analysis revealed that the causes of early MI and the people who get them aren’t what’s expected.

• Currently the accepted most common cause of heart attacks in young people is typically coronary artery disease due to plaque buildup.
• Other accepted major factors include genetics, substance abuse, hypertension, obesity, and less commonly, spontaneous coronary artery dissection (SCAD).

The OCTOPUS registry analyzed 4k cardiac events between 2003-2018, using medical record linkage to classify MI etiologies in patients 18-65 years old, but what researchers found could challenge our usual assumptions about young MI patients…

• Atherothrombosis caused 67% of MIs overall, but supply-demand mismatch (when the heart’s oxygen demand exceeds its oxygen supply) accounted for 23%.
• Meanwhile, SCAD accounted for 4%, MINOCA-U for 3%, embolism for 2%, and vasospasm for 1% of young MIs.
• Angiographic review led to MI cause reclassification in 4% of cases, most commonly changing MINOCA-U diagnoses to SCAD and atherothrombosis to coronary embolism.

Given these distinct etiological patterns, the findings suggest young MI patients require fundamentally different diagnostic and therapeutic approaches compared to older populations with predominantly atherosclerotic disease.

• For example, takotsubo syndrome (temporary LV weakening) showed concerning long-term outcomes with 26% noncardiovascular mortality at 5 years in patients with a median age of just 54.
• Many supply-demand mismatch patients (64%) didn’t undergo angiography, meaning there could be potential for reclassification with better evaluation.

The Takeaway

The OCTOPUS analysis reveals that young MI patients represent a much more uniform population where nonatherosclerotic causes predominate. This challenges the traditional atherosclerosis-focused approach to MI management and highlights the critical importance of accurate initial diagnosis, especially for conditions like SCAD where inappropriate intervention can cause harm.

CMR Access Is Broken — Here’s How to Fix It

Cardiac MRI is one of the most powerful tools for diagnosing heart disease, yet it’s still out of reach for many patients. Download Vista AI’s new infographic to see what’s holding CMR adoption back—and how AI and automation can help make gold-standard imaging more accessible than ever.

Merge Hemo Expands to Puerto Rico

Merge partnered with Alpha Biomedical to bring Merge Hemo to Puerto Rico, marking the software’s first expansion outside the 50 U.S. states. Read more about the work Merge is doing to expand access to its award winning solutions beyond the United States.

The Wire

• AMA Releases CPT 2026 Code Set: The AMA just dropped the CPT 2026 code set, which included 418 total changes – 288 new codes, 84 deletions, and 46 revisions. Advanced lab tests and CPT III codes made up the largest share of new codes (both 27%). Notable cardiology inclusions were CCTA AI-based coronary atherosclerotic plaque assessment for coronary disease severity and perivascular fat analysis for cardiac risk and ECG AI-based detection of cardiac dysfunction.

• Medicare’s AI Rejections: A JACR study showed that most AI Medicare claims filed between 2018–2023 were rejected. Across 83k claims for 23 AI services, Medicare approved 47% of claims ($8M), while denying 53% ($16.4M). The better news: the number (1,507 to 53,586) and acceptance rate (28.1% to 31.8%) of AI claims increased. Cardiology was at both ends of the spectrum, as 90.7% of all accepted claims were for FFR-CT, while Low Ejection Fraction AI-ECG had a 98.2% denial rate.

• Genetesis MCG Acquired: “After a decade committed to biomagnetism,” Genetesis announced the sale of its key magnetocardiography assets to a strategic partner, who will continue work towards making MCG a go-to cardiac imaging modality. The CardioFlux Magnetocardiograph system measures the heart’s magnetic fields to quickly detect ischemic heart disease, and has achieved a pair of Breakthrough Designations for myocardial ischemia.

• Novartis Expands CV Portfolio: Novartis acquired Tourmaline Bio for $1.4B for the company’s Phase 3-ready anti-inflammatory antibody called pacibekitug that targets IL-6 for atherosclerotic cardiovascular disease. Pacibekitug offers quarterly dosing versus monthly for competitors Novo Nordisk’s ziltivekimab and CSL Behring’s clazakizumab, and Tourmaline’s Phase 2 results have shown significant inflammation reduction via C-reactive protein biomarker. The acquisition strengthens Novartis’s cardiovascular portfolio as the company’s earlier HF drug, Entresto, faces patent expiration and generic competition.

• TAVR vs. SAVR in Low-Risk AS: A recent meta-analysis suggests TAVR is an effective alternative to SAVR in low-to-intermediate risk severe aortic stenosis patients. The study, which examined patients across the DEDICATE, NOTION, NOTION-2, and UK TAVI trials found that TAVR significantly reduced 1-year all-cause death or stroke (HR 0.76). While researchers concluded that the combined mortality and stroke reduction might support TAVR for this lower risk patient group, longer-term follow-up data on valve deterioration and hemodynamics is needed to know for sure.

• Integration Health Goes All-In on ECMO: Integration Health acquired ECMO Advantage, merging the two leading ECMO service providers to create a single massive provider of extracorporeal membrane oxygenation services. The combined organization will serve over 55 healthcare facilities across 22 states, offering comprehensive ECMO program development, specialized staffing, transport, education, and perfusion services. This acquisition positions Integration Health for continued growth in the rapidly expanding ECMO services market by integrating one of its biggest competitors.

• GLP-1s Help CV Risk in Psoriasis Patients: New research presented at EADV 2025 found that psoriasis patients treated with GLP-1s (like semaglutide) could face significantly lower risk of death or major CV events. Researchers analyzed over 6k psoriasis patients and found that those on GLP-1s faced a 78% lower death risk and 44% lower major CV event risk compared to those on other non-GLP-1 diabetes/weight-loss medications. The study also showed a 65% reduced alcohol abuse risk and nearly 50% lower substance abuse.

• Thryv Gains IND for THRV-1268: The FDA approved Thryv Therapeutics IND application for its antiarrhythmic drug, THRV-1268, enabling a Phase 2/3 WAVE II clinical study in Long QT Syndrome Type 2. This marks Thryv’s second recent IND clearance, following approval for heart failure/AFib studies. THRV-1268 is an SGK1 inhibitor that could become the first approved therapy for Long QT Syndrome, a rare inherited cardiac condition that causes potentially life-threatening arrhythmias.

• Lilly’s Oral GLP-1 Beats Semaglutide: Eli Lilly’s ACHIEVE-3 Phase 3 trial showed that its oral GLP-1/GIP, orforglipron, significantly outperformed oral semaglutide in adults with type 2 diabetes. The study followed 1.7k patients for 52 weeks, and found that orforglipron delivered superior A1C reductions (1.9-2.2% vs 1.1-1.4%) and weight loss (14.6-19.7 lbs vs 7.9-11.0 lbs). The highest orforglipron dose helped nearly three times more participants achieve near-normal blood sugar compared to highest-dose oral semaglutide (37.1% vs 12.5%). 

• Noblestitch Works for PFO: A new PFO closure system called NobleStitch made by HeartStitch demonstrated exceptional long-term safety in the largest PFO closure study. Published in JACC: Advances, the study followed 703 patients over 4 years, and found zero recurrent strokes, TIAs, or device-related complications. Despite 11.7% having residual shunts, no neurological events occurred, suggesting anatomical modification rather than complete closure prevents stroke. The suture-based approach eliminates permanent metallic implants, avoiding AFib risks seen with traditional devices.

• CV Health Trends in Africa: A cross-sectional study across 22 WHO African Region countries found that roughly a quarter of each country’s citizens had ideal CV health, with the other three quarters lagging behind. Among the study’s 73k participants, 26.2% had ideal cardiovascular health, 57.9% intermediate, and 15.9% poor CVH using Life’s Simple 7 scores. Intriguingly, country-level factors like higher education rates and undernourishment prevalence correlated with better CVH scores.

5,600 Ways to Improve Your Cardiac Ultrasound Workflow

AI-powered measurements can enhance the way you acquire and interpret cardiac ultrasound. Learn how AI-powered ultrasound can help you overcome everyday limitations in echo. Read Siemens Healthineers’ white paper on how its AI software provides 5,600+ automated measurements to help improve workflow efficiency, consistency, and clinical confidence.

Cracking the Code of ECG Analysis with Monebo’s AI Genetic Algorithm

How do you teach a computer to recognize the complex patterns in an ECG signal? Discover how Monebo found the answer by blending human expertise and a little evolutionary magic in this article that breaks down the advantages of genetic algorithms in ECG analysis.

Tempus Receives FDA 510(k) Clearance for Tempus ECG-Low EF

Tempus announces the expansion of its Tempus ECG-AI portfolio with Tempus ECG-Low EF, software intended for use to analyze 12-lead ECG recordings and detect signs associated with having a low left ventricular ejection fraction (LVEF less than or equal to 40%) in patients 40 years of age or older at risk of heart failure. It is not intended as a stand-alone diagnostic and positive results may suggest the need for further clinical evaluation. For Full Indications for Use, visit here.

The Resource Wire

• Explore Vitrea Advanced Visualization: Discover Canon Medical Healthcare IT’s suite of advanced imaging workflows designed to increase efficiency in cardiovascular imaging, and facilitate the assessment, diagnosis, and treatment of cardiovascular diseases. These cutting-edge tools support the delivery of faster, more accurate care while integrating seamlessly into clinical workflow.

• The Benefits of Outsourced Post-Processing: Using an outsourced cardiac image post-processing solution doesn’t have to mean sacrificing control of the results. Discover how PIA’s customizable post-processing workflow can help you get the most out of your images.

• Heartflow Roadmap Analysis For Efficient Care: As Coronary CT scan volumes increase, your entire reading team needs to deliver efficient and consistent reads. Good thing Heartflow’s Roadmap Analysis can help you maintain accuracy and increase CCTA read speeds by up to 25%, with even level 3 readers seeing real efficiency benefits.

• GLS Analysis of Us2.ai’s Fully-Automated Software: Ten years after the first head-to-head comparison of 2D echocardiography, the latest review suggests Us2.ai is among the easiest to use and integrate. Read the study to learn about how Us2.ai’s software requires zero operator input, operates without human intervention, and leads to high agreement with traditional semi-automated speckle- tracking software solutions.

• Circle CVI’s Cardiac CT Expansion: Watch this Cardiac Wire interview with Circle Cardiovascular Imaging’s Chief Product Officer, Scott Galbari as he sheds light on Circle CVI’s history with cardiac MRI and how the company is tackling the coming demand for cardiac CT.

The Industry Wire

1. FDA issues warning letters to 100+ drug advertisers.
2. Ascension cuts operating loss by $1.3B in fiscal 2025.
3. Nurse practitioner, RN shortage to hit 362k by 2032.
4. Former Steward hospitals rebrand under single system.
5. Johns Hopkins and UnitedHealthcare end talks without new deal.
6. Are Republicans changing their minds about AI safety?
7. Medicare Advantage plans to share provider directories under CMS final rule.
8. AI in healthcare: Investors’ green and red flags.
9. University of Utah Health names first chief innovation officer.
10. New federal data shows deaths by suicide up 25%.