A second ESC roundup examines pelacarsen’s failure to reduce cardiovascular events and the FDA clearance of an AI-ECG tool for acute MI detection. The discussion also covers CT angiography and coronary calcium-guided statin decisions, early evolocumab after heart attack, and tricuspid repair results that raise questions about trial design.
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Lp(a) Lowering Fails To Reduce Cardiovascular Events
Pelacarsen lowered genetically determined Lp(a) but failed to reduce major cardiovascular events in 8,000 high-risk patients.
HORIZON challenges whether Lp(a) is causal or merely a risk marker, though intensive background therapy may have masked incremental benefit.
question_answer ANECDOTE
AI ECG Helps Detect Subtle Occlusion MIs
The Queen of Hearts app analyzes a photographed ECG and identifies occlusion MI, outperforming physicians in studies of difficult STEMI presentations.
John Mandrola, MD, says subtle reciprocal changes and STEMI mimics are where the tool could prevent dangerous missed diagnoses.
insights INSIGHT
TARGET CTCA Finds No Outcome Benefit
In TARGET CTCA, adding coronary CT angiography after MI exclusion did not reduce MI or cardiovascular death over three years.
The result questions routine imaging when high-sensitivity troponin and guideline-directed prevention already identify manageable risk.
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A second ESC recap plus two breaking stories on the failure of an investigational Lp(a) reducing drug and a new FDA approval of an AI-ECG app are covered by John Mandrola, MD
This podcast is intended for healthcare professionals only.
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Rationale paper https://doi.org/10.1016/j.ahj.2025.03.019
II FDA Clears AI-ECG for Acute MI Detection
Accuracy of cath lab activation decisions for STEMI-equivalent and mimic ECGs: Physicians vs. AI (Queen of Hearts by PMcardio) 10.1016/j.ajem.2025.07.061
AI-Enabled ECG Analysis Improves Diagnostic Accuracy and Reduces False STEMI Activations: A Multicenter U.S. Registry https://www.jacc.org/doi/10.1016/j.jcin.2025.10.018
Queen of Hearts™ AI ECG App https://www.powerfulmedical.com/pmcardio-stemi/
III TARGET CTCA Trial
Targeted Use of Computed Tomographic Coronary Angiography in Acute Chest Pain https://www.nejm.org/doi/10.1056/NEJMoa2608903
CorCal Outcomes: A randomized trial using the pooled cohort equation or coronary artery calcium to select statin therapy in primary prevention patients. Study design and baseline characteristics https://doi.org/10.1016/j.ahj.2026.107473
V AMUNDSEN Trial
LDL Cholesterol Lowering With Evolocumab Before Percutaneous Coronary Intervention for Acute Myocardial InfarctionThe AMUNDSEN Randomized Clinical Trial https://jamanetwork.com/journals/jama/fullarticle/2853274
VI TRIC-I-HF trial
Tricuspid Repair Cuts Death, HF Hospitalization in Severe TR https://www.medscape.com/viewarticle/tricuspid-repair-cuts-death-hf-hospitalization-severe-tr-2026a1000wvk
Tricuspid-Valve Intervention in Heart Failure https://www.nejm.org/doi/full/10.1056/NEJMoa2606934
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