Apr 18 2025 This Week in Cardiology

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Apr 18, 2025

This week, the discussion centers on the significant findings from the FAME 3 trial, showing stents can be as effective as surgery for triple-vessel disease. TAVR outcomes in low-risk patients are explored, revealing similar results to traditional surgery. The implications of pacemaker use after TAVR also come into play. Additionally, mavacamten's limitations for treating hypertrophic cardiomyopathy are analyzed, prompting a deeper look into the evolving landscape of cardiac treatments.

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INSIGHT

FAME III 5-Year Results Reality

The 5-year FAME III results show PCI is still worse than CABG when considering death, MI, stroke, and repeat revascularization.
Omitting repeat revascularization from endpoints skews the narrative to falsely equate PCI with CABG.

ADVICE

Inform Patients on PCI vs CABG Risks

Patients must be fully informed about the risks and benefits of PCI versus CABG for multivessel disease.
Do not let endpoint changes obscure the reality of higher risks with PCI in shared decision-making.

INSIGHT

TAVR vs SAVR Long-Term Nuances

TAVR and SAVR have similar 5-year outcomes in low-risk patients, but younger patients and certain anatomies were excluded from trials.
TAVR reoperation risk is significant and should be carefully discussed with patients considering the procedure.

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The FAME 3 trial 5-year results, TAVR at 5 years, pacers after TAVR, and mavacamten not a wonder drug 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 FAME 3 at Five Years

Stents as Good as Surgery for Triple-Vessel Disease https://www.medscape.com/viewarticle/noninvasive-stents-good-surgery-triple-vessel-disease-2025a10007l4

Main trial NEJM https://www.nejm.org/doi/full/10.1056/NEJMoa2112299
Circulation 3-years https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.065770
5-year results Lancet 10.1016/S0140-6736(25)00505-7 https://linkinghub.elsevier.com/retrieve/pii/S0140673625005057

II TAVR in Low-Risk Patients at 5 years

5-Year TAVR, Surgery Outcomes Similar in Low-Risk Patients

https://www.medscape.com/viewarticle/5-year-tavr-surgery-outcomes-similar-low-risk-patients-2025a10007zl

EVOLUT Low-Risk 5 years https://www.jacc.org/doi/10.1016/j.jacc.2025.03.004
EVOLUT Editorial – We're Halfway There https://www.jacc.org/doi/10.1016/j.jacc.2025.03.428
PARTNER 3 Low-Risk https://www.nejm.org/doi/full/10.1056/NEJMoa2307447
NOTION at 5 years https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.118.036606

III The Matter of Pacemakers After TAVI

JACC IV Study Badertscher https://www.jacc.org/doi/10.1016/j.jcin.2025.03.028
Assessing the quality of reporting of harms in randomized controlled trials published in high impact cardiovascular journals

IV Mavacamten Looks to Have Specific Indications

EXPLORER HCM 10.1016/S0140-6736(20)31792-X External Link
VALOR HCM https://jamanetwork.com/journals/jamacardiology/fullarticle/2809050
BMS Press Release https://news.bms.com/news/details/2025/Bristol-Myers-Squibb-Provides-Update-on-Phase-3-ODYSSEY-HCM-Trial/

FINAL THOUGHTS

PRAGUE 25 https://bmjopen.bmj.com/content/12/6/e056522

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