This Week In Cardiology

Less is more after PCI, the TARGET-FIRST trial, a negative blood pressure trial that is actually positive, aspirin vs OAC for bleeding, AEDs, and Factor XI is not dead yet are the topics discussed by John Mandrola, MD, 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 Less is More: TARGET-FIRST TARGET-FIRST Trial https://www.nejm.org/doi/10.1056/NEJMoa2508808 STOPDAPT-2 ACS Trial https://jamanetwork.com/journals/jamacardiology/fullarticle/2789701 II A Negative Trial That Is Actually Positive The RETREAT-FRAIL Study https://www.nejm.org/doi/full/10.1056/NEJMoa2508157 III Major Bleeding With Aspirin vs Apixaban Subanalysis of ARTESiA https://jamanetwork.com/journals/jamacardiology/fullarticle/2841075 ARTESiA Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2310234 AVERROES Trial https://www.nejm.org/doi/full/10.1056/NEJMoa1007432 IV High Value Interventions – The AED Experts Call for AED

Listener feedback, huge news in the world of carotid disease with the CREST-2 publication, prasugrel beats ticagrelor again, and a big coffee trial 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 Complete Revascularization for Acute MI Meta-analysis  https://doi.org/10.1016/S0140-6736(25)02170-1 II A Sea Change in the Treatment of Carotid Artery Disease — CREST-2 Published ECST-2 https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(25)00107-3/fulltext SPACE-2 https://pubmed.ncbi.nlm.nih.gov/36115360/ CREST-2 Trial www.nejm.org/doi/full/10.1056/NEJMoa2508800 CREST Protocol paper https://pmc.ncbi.nlm.nih.gov/articles/PMC5987521/ III Prasugrel Beats Ticagrelor in High-Risk Patients With Diabetes After PCI https://www.medscape.com/viewarticle/prasugrel-beats-ticagrelor-high-risk-patients-diabetes-after-2025a1000wbt PLAT

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 Twe

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/1

Four pillars of cardiology today, stable coronary artery disease, severe aortic stenosis, the evaluation of chest pain, and best therapies for atrial fibrillation 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 Stable CAD Complete vs culprit-only revascularization at time of STEMI iMODERN Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2512918 PRAMI Trial https://www.nejm.org/doi/full/10.1056/NEJMoa1305520 COMPLETE Trial https://www.nejm.org/doi/full/10.1056/NEJMoa1907775 FULL REVASC Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2314149 PCI Revascularization Strategies After MI https://www.jacc.org/doi/10.1016/j.jacc.2024.04.051 CULPRIT SHOCK Trial https://www.nejm.org/doi/full/10.1056/NEJMoa1710261 How a Meta-Analysis Can Mislead https://www.sensible-med.com/p/how-a-meta-analysis-can-misleadthe   II SEVERE Aortic Senosis 7-Year PARTNER 3 Re

The PREVENT score in hypertension, GLP-1 mechanism of action in cardiovascular disease, CAD type and statin benefit, and the problem with hospitalization endpoints in HF trials 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 Is the PREVENT Calculator Best for Determining CVD Risk? Insights From a Post Hoc Analysis of SPRINT Trial https://www.medscape.com/viewarticle/prevent-calculator-best-determining-cvd-risk-insights-post-2025a1000svo PREVENT Calculator https://doi.org/10.1016/j.jacc.2025.07.037 SPRINT Trial https://www.nejm.org/doi/full/10.1056/NEJMoa1511939 II GLP-1 Mechanism of Action in CV Disease Analysis of SELECT Trial 10.1016/S0140-6736(25)01375-3 External Link SELECT trial https://www.nejm.org/doi/full/10.1056/NEJMoa2307563 III Statins and CAD Phenotype on CTA and Outcomes Interactions Between Statin Use, CAD Phenotypes on CTA  http

Another knock against the antiplatelet/anticoagulant combo, polypills in HF, the physical exam of the future, and the problem of underpowered trials that even Bayesian analyses cannot rescue 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 Trends Study https://www.heartrhythmjournal.com/article/S1547-5271(11)00496-6/fulltext II Another knock against the Antiplatelet/Anticoagulation combination “Antiplatelet Plus Oral Anticoagulant Lowers Stroke, Raises Bleeding Risk” https://www.medscape.com/viewarticle/antiplatelet-plus-oral-anticoagulant-lowers-stroke-raises-2025a1000re0 ATIS-NVAF Trial https://jamanetwork.com/journals/jamaneurology/fullarticle/2839511 AQUATIC trial https://www.nejm.org/doi/abs/10.1056/NEJMoa2507532 III Polypill for HFrEF A Multilevel Polypill for Patients With HFrEF https://www.jacc.org/doi/10.1016/j.jacadv.

GLP-1 use in HFrEF, left atrial posterior wall isolation during AF ablation, peri-device leaks for LAAO, new findings in post-cardiac surgery AF, and imaging before AF 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. Listener Feedback HYPERION trial https://www.nejm.org/doi/10.1056/NEJMoa2508170 ZENITH trial https://www.nejm.org/doi/full/10.1056/NEJMoa2415160 II GLP1 Use in HFrEF Effects of GLP-1s in Patients With HFrEF https://doi.org/10.1016/j.jchf.2025.102573 FIGHT Study https://jamanetwork.com/journals/jama/fullarticle/2540402 FIGHT Study Post-hoc Analysis https://dom-pubs.pericles-prod.literatumonline.com/doi/10.1111/dom.14862 Substudy of EXSCEL Trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.119.041659 III LA Posterior Wall Isolation Saga Failure of PW Wall Isolation by PFA with Epicardial Mapping https://doi.org/10.1016/

Two great stories of translation science leading to beneficial drugs in terrible diseases of the heart and the Sisyphean task of predicting the need for pacing after TAVI 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 Sotatercept HYPERION Trial https://www.nejm.org/doi/10.1056/NEJMoa2508170 ZENITH Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2415160 Evidence report on treatment for PAH https://icer.org/news-insights/press-releases/icer-publishes-final-evidence-report-on-treatment-for-pulmonary-arterial-hypertension/ PAH Sotatercept Editorial https://www.nejm.org/doi/full/10.1056/NEJMe2503944 II Acoramidis and ATTR Cardiomyopathy ATTRIBUTE-CM Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2305434?logout=true ATTRIBUTE-CM Analysis - Substudy https://www.jacc.org/doi/10.1016/j.jacc.2025.09.013 Tafamadis Trial https://www.nejm.org/doi/full/1

A bold trial in valvular heart disease, a CV prevention trial whose message is humility, VTE dogma challenged, more news on oral GLP-1 agonists, and a few public service announcements 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 DOUBLE-CHOICE: Minimalist Approach to TAVI May Be as Good as Standard of Care https://www.medscape.com/viewarticle/double-choice-minimalist-approach-tavi-may-be-good-standard-2025a1000pp7 Patient & Physician Perspectives on CV Risk https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.124.011837 II KP Vaccinate Trial KP Vaccinate Trial https://evidence.nejm.org/doi/full/10.1056/EVIDoa2500208 IAMI trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057042 Increasing Flu Vaccinations in Patients With Chronic Disease https://jamanetwork.com/journals/jama/fullarticle/2824956 MI FREEE Trial https://www.nejm.

More trials at ESC, including PARACHUTE HF, DAPA ACT HF-TIMI 68, AMALFI, and a super-interesting modeling study of when to start oral anticoagulants in AF, 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 PARACHUTE HF First Evidence of Treatment Benefit in Chagas Heart Failure https://www.medscape.com/viewarticle/first-evidence-treatment-benefit-chagas-heart-failure-2025a1000oem PARACHUTE-HF https://www.jacc.org/doi/10.1016/j.jchf.2024.05.021 II SGLT2i Early Initiation — DAPA ACT HF-TIMI 68 Trial Trial Data Support In-Hospital Initiation of SGLT2 Inhibitors for Heart Failure https://www.medscape.com/viewarticle/trial-data-support-hospital-initiation-sglt2-inhibitors-2025a1000o5q DAPA ACT HF-TIMI 68 https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.125.076575 III AMALFI Trial of AF Screening Remote ECG Screening Ups Atrial Fibrillation

More from ESC including: Valvular HD guidelines, a new drug class for HTN, myosin inhibition in HCM, vericiguat, and digoxin are the topic discussed by John Mandrola, MD. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I New European Valvular Heart Disease Guidelines 2025 ESC/EACTS Guidelines for the management of valvular heart disease  https://doi.org/10.1093/eurheartj/ehaf194 Debate: Does Asymptomatic Aortic Stenosis Warrant Early Intervention? https://exp.medscape.com/debates/does-asymptomatic-aortic-stenosis-warrant-early-intervention/ Surgical Ablation of Atrial Fibrillation during Mitral-Valve Surgery https://www.nejm.org/doi/full/10.1056/NEJMoa1500528 Surgical ablation of atrial fibrillation: a systematic review and meta-analysis https://doi.org/10.1093/europace/eux336 II  New Drug for Resistant HTN Baxdrostat: A 'Game Changer' for Hypertension? https://www.medscape.com/viewarticle/baxdrostat-game-changer-h

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-

CAC 0 takes a gut punch, ICD therapies cannot be surrogates for benefit, and two important trials from ESC 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 CAC 0 LDL-C and CVD Risk With CAC Score 0 https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehaf497/8228645 II ICD Therapies Contemporary ICD Benefit https://www.jacc.org/doi/10.1016/j.jacep.2025.06.028 PROFID Trial https://profid-project.eu/profid-ehra-trial/ MADIT-RIT Trial https://www.nejm.org/doi/full/10.1056/NEJMoa1211107 Declining Risk of Sudden Death in HF https://www.nejm.org/doi/full/10.1056/NEJMoa1609758 III Digit-HF DIGIT-HF Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2415471 Digoxin–Mortality: Comparison in the DIG trial https://academic.oup.com/eurheartj/article/40/40/3336/5520008 IV POTCAST POTCAST trial https://www.nejm.org/doi/full/10.1056/NEJMoa

John Mandrola discusses conduction system pacing vs standard pacing, withdrawing HF meds when AF is corrected and patient selection in LAAO. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I Conduction System Pacing CSPACE trial https://doi.org/10.1016/j.jacc.2025.06.043 BLOCK HF trial https://www.nejm.org/doi/full/10.1056/NEJMoa1210356 BioPace trial https://doi.org/10.1093/europace/euaf029 II  Withdrawing Meds After AF Corrected WITHDRAW AF https://doi.org/10.1093/eurheartj/ehaf563 TRED HF https://pubmed.ncbi.nlm.nih.gov/30429050/ III Patient Selection in Left Atrial Appendage Occlusion Long-Term Outcomes Following LAAO in Medicare Beneficiaries: Outcomes From the National Cardiovascular Data Registry https://www.ahajournals.org/doi/10.1161/JAHA.124.039780 ESC Preview IV HTN Guidelines New Blood Pressure Guidelines: 4 Things I Like and 2 Concerns https://www.medscape.com/viewarticle/new-blood-pressure-guidelin

Big new hypertension guidelines, ultraprocessed foods, coronary sinus reduction and evidence-based medicine, and more news on pulsed field ablation for atrial fibrillation 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 HTN Guidelines BP Meds Should Begin Promptly, New ACC/AHA Guidelines Say https://www.medscape.com/viewarticle/bp-meds-should-begin-promptly-new-acc-aha-guidelines-say-2025a1000lms Guideline for Management of High Blood Pressure https://www.ahajournals.org/doi/10.1161/CIR.0000000000001356 BPROAD trial https://www.nejm.org/doi/full/10.1056/NEJMoa2412006 Trial Score Framework https://pmc.ncbi.nlm.nih.gov/articles/PMC6459598/ II UltraProcessed Foods AHA statement on Ultraprocessed Foods and Cardiometabolic Health https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000001365 III Refractory Angina and the Coronary Sinus Reducer

Listener feedback on SURPASS CVOT, AF ablation and the limits of meta-analyses, a Watchman alert from FDA, and oral anticoagulation choices in elderly patients are discussed by John Mandola, 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 SURPASS CVOT This Week in Cardiology Podcast, August 1 https://www.medscape.com/viewarticle/1002781 Mounjaro Appears More Heart Protective Than Trulicity in Trial Of Eli Lilly Diabetes Drugs https://www.medscape.com/s/viewarticle/mounjaro-proves-more-heart-protective-than-trulicity-trial-2025a1000kct II Catheter and Surgical AF ablation Catheter and Surgical Ablation for AF: Meta-Analysis https://www.acpjournals.org/doi/10.7326/ANNALS-25-00253 III Watchman Air Embolism Alerts Looming Pay Cut to LAAO Triggers Objection From Card Groups https://www.medscape.com/viewarticle/looming-pay-cut-laao-triggers-objection-card-groups-2025a1000l0j FDA Alert

Exercise and CV outcomes, aldosterone modulation, AI for ECG reading, GLP-1 comparisons, end-of-life decisions, and another well-meaning policy that caused harm in veterans are 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 Exercise and CV outcomes II Aldosterone Modulation in Cardio-Kidney Disease Aldosterone and Aldosterone Modulation https://doi.org/10.1016/j.jacc.2025.06.012 Randomized Aldactone Evaluation Study https://www.nejm.org/doi/full/10.1056/NEJM199909023411001 III AI vs MD ECG-Reading for Cath Lab Activation Accuracy of Cath Lab Activation Decisions https://doi.org/10.1016/j.ajem.2025.07.061 IV Tirzepatide vs Dulaglutide - SURPASS CVOT Study Eli Lilly Press Release https://investor.lilly.com/news-releases/news-release-details/lillys-mounjaro-tirzepatide-gipglp-1-dual-agonist-demonstrated REWIND Study 10.1016/S0140-6736(19)31149-3 External Lin

The VENTOUX study of endurance athletes, the 10,000 step myth was not busted, rate vs rhythm control for AF, and GLP1 drugs and observational studies 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 Endurance Athletes and Arrhythmia (again) VENTOUX trial https://www.ahajournals.org/doi/10.1161/CIRCIMAGING.125.018470 II Daily Step Count and Health — no myths were busted. Lancet Public Health: https://doi.org/10.1016/S2468-2667(25)00164-1 III Rate vs Rhythm Control of AF Medscape: Everyone Deserves a Shot at the American Dream: Sinus Rhythm https://www.medscape.com/viewarticle/everyone-deserves-shot-american-dream-sinus-rhythm-2025a1000jle This Week in Cardiology, July 11, 2025 https://www.medscape.com/viewarticle/1002704 AFFIRM trial https://www.nejm.org/doi/full/10.1056/NEJMoa021328 AFFIRM substudy https://jamanetwork.com/journals/jamainternal

Finerenone, what not to consider when choosing treatment of AS, brain health after atrial fibrillation ablation, early rhythm control for AF, and Watchman reimbursement cuts are 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 Finerenone FDA Widens Indication of Finerenone for Heart Failure Patients https://www.medscape.com/viewarticle/fda-widens-indication-finerenone-heart-failure-patients-2025a1000ive FDA finerenone approval https://bayer2019tf.q4web.com/news/news-details/2025/U-S--FDA-Approves-KERENDIA-finerenone-to-Treat-Patients-With-Heart-Failure-With-Left-Ventricular-Ejection-Fraction-40-Following-Priority-Review/default.aspx FINEARTS-HF trial https://www.nejm.org/doi/full/10.1056/NEJMoa2407107 II Choosing TAVI or Surgical AVR Carbon Emission when treating AS EHJ study https://doi.org/10.1093/eurheartj/ehaf379 III Brain Lesions and Visual Migraine Af