Judith S. Hochman

American Heart Journal·Bangalore et al.·RCT

ISCHEMIA-CKD evaluates whether an initial invasive strategy reduces major ischemic events in advanced CKD.

Trial design addresses evidence gap in advanced CKD; extends randomized evaluation of invasive strategy to this high-risk group.

JACC·Arnold et al.·RCT

Invasive strategy yields greater 1-year angina relief in younger patients and those with worse baseline symptoms.

Younger patients and those with worse baseline angina gain more health status benefit from invasive strategy; extends ISCHEMIA by identifying treatment effect modifiers for shared decisions.

American Heart Journal·Sidhu et al.·RCT

Initial invasive strategy shows no benefit over conservative therapy for 4-year CV death.

Similar cardiovascular mortality with invasive versus conservative strategy in chronic coronary disease; confirms neutral effect on cause-specific death and supports medical therapy first.

Cornea·Niederer et al.·Original Research

Impact of COVID-19 Infection and Vaccination on Herpes Zoster Ophthalmicus: A Prospective Analysis From the Zoster Eye Disease Study

Purpose: The aim of this study was to assess the interplay between 2 important viral infections and their management, herpes zoster ophthalmicus (HZO) and COVID-19. Methods: A subanalysis from the Zoster Eye Disease Study, a prospective randomized controlled study examining prophylactic valacyclovir in HZO, and data collected on COVID-19 vaccination and infection from July 2020 were evaluated. Participants were included if enrolled from January 1, 2019, ensuring that their 18-month follow-up overlapped with the COVID-19 pandemic. Recurrence was defined as new or worsening stromal keratitis without ulceration, endothelial keratitis, iritis, dendritiform epithelial keratitis, or stromal keratitis with ulceration requiring a substantial increase or recommencement of topical steroid therapy. Results: A total of 402 participants were included in the analysis. Attenuated zoster vaccination live was given to 35 (8.7%) and recombinant zoster vaccine to 40 (10.0%) before study commencement. No difference was observed in incidence or severity of COVID-19 infection in those with previous zoster vaccination, and no difference was observed in those treated with valacyclovir prophylaxis. COVID-19 infection occurred in 71 participants (17.7%) during the study period, and COVID-19 vaccination was received by 170 participants (42.3%). No association was observed between HZO recurrence and COVID-19 infection ( P = 0.39) or vaccination ( P = 0.75) during the 18-month follow-up. The study was powered to detect a hazard ratio of 1.19 for COVID-19 infection or vaccine-associated recurrence. Conclusions: No significant association was observed between zoster vaccination or valacyclovir use and COVID-19 incidence or severity. In addition, no significant increase in HZO recurrence was observed following COVID-19 infection or vaccination.

JACC·Ikeno et al.·cohort

Mid-to-high SYNTAX score predicts ~36% higher 5-year major cardiovascular events.

In patients with type 2 diabetes and stable ischemic heart disease, a mid/high SYNTAX score (≥23) predicts higher rates of major cardiovascular events and identifies patients who derive significant benefit from CABG revascularization over medical therapy.

Circulation·Jacobs et al.·Guideline

ACCF/AHA Clinical Practice Guideline Methodology Summit Report

Circulation·Hochman·Original Research

Cardiogenic Shock Complicating Acute Myocardial Infarction

Circulation·Anderson et al.·Guideline

Management of Patients With Peripheral Artery Disease (Compilation of 2005 and 2011 ACCF/AHA Guideline Recommendations)

JACC·Ikemura et al.·cohort

Initial invasive strategy linked to ~2-fold higher rate of rapid angina resolution vs conservative care.

Patients with chronic coronary disease and angina experience diverse symptom trajectories, with an initial invasive strategy leading to more favorable angina resolution patterns over two years compared to conservative management.

JACC·Newman et al.·review

Personal-level interventions such as portable air cleaners reduce indoor PM2.5 exposures by 50% to 60% and improve surrogate endpoints, warranting clinical trials in high-risk populations.

This multi-agency expert workshop report establishes the scientific rationale and methodological framework for conducting randomized clinical trials of personal-level PM2.5 filtration interventions (particularly HEPA portable air cleaners) to reduce cardiovascular and pulmonary risk in susceptible populations.

Circulation Cardiovascular Interventions·Shwayder et al.·cross-sectional

Invasive coronary angiography identifies the OCT-defined culprit artery in only ~55% of women with MINOCA.

Invasive coronary angiography alone is insufficient to reliably identify culprit lesions in women with MINOCA, highlighting the need for multivessel intracoronary imaging.

JACC·Sanborn et al.·cohort

In patients with cardiogenic shock, the.59 with medical stabilization and 1.11 with emergency revascularization.

Should not yet change practice; leaves open whether these angiographic correlates of survival persist in contemporary shock care.

Circulation Population Health and Outcomes·O’Keefe et al.·cohort

Each 5-point increase in current SAQ-SS was associated with a lower risk of the primary endpoint in both conservative and invasive cohorts.

Current SAQ-SS was associated with lower event risk in chronic coronary disease; extends prognostic correlations but leaves clinical adoption open.

JACC·Maron et al.·cohort

Attaining all four guideline-directed medical therapy goals at baseline and maintaining them was associated with an absolute 15.9% reduction in cardiovascular death or myocardial infarction compared to attaining no goals.

Early attainment and maintenance of multiple guideline-directed medical therapy goals, particularly systolic blood pressure control, is associated with a substantial reduction in cardiovascular events in patients with chronic coronary disease.