Long-Term Outcomes of Invasive vs Conservative Management in Stable Coronary Disease: Consistent Evidence From Extended Follow-Up Trials

Extended follow-up of three major trials consistently shows that an initial invasive strategy does not improve long-term survival or reduce myocardial infarction (MI) compared with initial conservative management in patients with stable coronary disease. In the COURAGE trial’s extended observational analysis of 959 US veterans (median follow-up 15 years, maximum […]

Antidepressants Differ in Efficacy and Acceptability in Long-Term Treatment of Major Depressive Disorder

Escitalopram, duloxetine, and agomelatine achieved higher sustained response rates than fluoxetine, while escitalopram and duloxetine also showed lower all-cause discontinuation, according to a systematic review and network meta-analysis of 115 double-blind randomised controlled trials (30,428 participants) comparing 21 antidepressants for long-term (>12 weeks) treatment of adult unipolar major depressive disorder. […]

Intensive BP Control Reduces Cardiovascular Events After Ischemic Stroke

Targeting a systolic blood pressure (BP) of less than 120 mm Hg lowered the incidence of major cardiovascular events compared with a target of less than 140 mm Hg among participants with elevated BP and a previous ischemic stroke or transient ischemic attack, according to a multicenter, open-label, randomized trial […]

No Significant Reduction in Major Cardiovascular Events with Intensive BP Lowering in T2D

In patients with type 2 diabetes (T2D) and high cardiovascular risk, targeting a systolic blood pressure (BP) of less than 120 mm Hg did not significantly reduce major cardiovascular events compared with a target of less than 140 mm Hg, according to a multicenter, open-label, randomized trial conducted in Brazil. […]

Stopping Statins Noninferior to Continuing Them in Older Adults without Known CVD

Among older adults with at least two chronic conditions but no known cardiovascular disease, discontinuing statin therapy was noninferior to continuing it with respect to major cardiovascular events or death from any cause at 2 years. In this international, open-label, randomized, controlled trial, 1,880 adults aged 70 years or older […]

Ziltivekimab and Pelacarsen Show No Clinical Benefit Despite Effective Biomarker Lowering

Two randomized, placebo-controlled trials of targeted therapies—ziltivekimab, a monoclonal antibody neutralizing interleukin-6, and pelacarsen, an antisense oligonucleotide lowering lipoprotein(a)—both failed to reduce major adverse cardiovascular events despite effectively lowering their respective biomarkers. In the ziltivekimab trial, 6,376 adults with established atherosclerotic cardiovascular disease, chronic kidney disease, and cardiovascular inflammation (high-sensitivity […]

Cold Drives Heart Failure Hospitalizations in Older US Adults

Among US Medicare beneficiaries, colder ambient temperatures were associated with increased heart failure hospitalizations while warmer temperatures were not, and the U-shaped temperature–cardiovascular risk association seen for cardiovascular mortality did not apply to heart failure hospitalizations, according to a time-stratified case-crossover study of 1,517,756 hospitalizations from 996,312 patients (mean age, […]

No Significant Difference Between Initial CTO-PCI and No CTO-PCI Strategies in 10-Year Follow-Up

In the 10-year extended follow-up of the DECISION-CTO trial, an initial strategy of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) was not associated with a significant difference in the primary composite endpoint of death, myocardial infarction, stroke, or any revascularization compared with a no CTO-PCI strategy (33.9% vs […]

CCTA-Guided PCI Noninferior to IVUS-Guided PCI

In a randomized, open-label, noninferiority trial, a coronary computed tomographic angiography (CCTA)–guided percutaneous coronary intervention (PCI) strategy was noninferior to intravascular ultrasound (IVUS)–guided PCI with respect to target-vessel failure at 12 months; among 1,105 randomized patients, target-vessel failure occurred in 4.1% of the CCTA-guided group versus 4.6% of the IVUS-guided […]

Left Bundle-Branch Area Pacing vs Right Ventricular Pacing in Atrioventricular Block

A randomized trial found that left bundle-branch area pacing (LBBAP) significantly reduced the risk of major clinical events, particularly heart failure (HF) events, compared with right ventricular pacing (RVP) in patients with atrioventricular block, preserved left ventricular ejection fraction (LVEF ≥50%), and an anticipated high ventricular pacing burden. The trial […]