Stents or bypass for stable heart disease add no survival at 11 years
Nov 8, 2026
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read by AI voices · all episodesTHE SHORT READ
Routine angiography and revascularization for stable coronary disease with moderate or severe ischemia did not extend survival over 11 years compared with medicines alone, according to ISCHEMIA follow-up data JAMA published Saturday.
The same day at the American Heart Association's Scientific Sessions in Chicago, full results showed that pelacarsen, which cut lipoprotein(a) by 78%, and the interleukin-6 antibody ziltivekimab, which lowered CRP, did not reduce major cardiovascular events. A randomized trial of AI-screened ECGs found a statistically fragile gain in detection of atrial fibrillation or its precursors, and a Stanford study using a language model found lipid therapy was left unchanged at 89% of visits where LDL was above goal.
Weill Cornell Medicine disclosed that patient imaging details were entered into AI tools without authorization for a radiology research study in June.
THE DETAILS
- FYIEvidence Nov 7, 2026Patients with chronic coronary disease and moderate or severe ischemia who were randomized to angiography plus revascularization when feasible had 11-year all-cause mortality of 25.8%, against 26.9% for those started on guideline-directed medical therapy alone (adjusted hazard ratio 0.97; 95% CI, 0.86 to 1.09), the ISCHEMIA investigators led by Dr. Judith Hochman of NYU Grossman School of Medicine reported Saturday in JAMA. The trial randomized 5,179 patients at 320 sites in 37 countries beginning in 2012; all had an ejection fraction of 35% or more and no left main disease, unacceptable angina or recent acute coronary syndrome, and median follow-up reached 9 years. Cardiovascular death was 15.8% with the invasive strategy and 17.1% with the conservative strategy (AHR 0.88; 95% CI, 0.75 to 1.02), while noncardiovascular death was 9.1% and 8.1%. A bayesian analysis put the probability that the invasive strategy improves survival by more than 1 percentage point at 18%, and 11-year restricted mean survival differed by 14 days.Sources: JAMA, PubMed record
- FYIEvidence Nov 7, 2026Pelacarsen, a monthly antisense injection, lowered lipoprotein(a) by a mean 78% in 8,323 patients with established cardiovascular disease and Lp(a) of at least 70 mg/dL, but major adverse cardiovascular events did not differ from placebo, the American Heart Association said of the Lp(a)HORIZON results presented Saturday at its Scientific Sessions in Chicago and published in the New England Journal of Medicine. TCTMD reported a primary event rate of 12.3% with pelacarsen and 12.1% with placebo (hazard ratio 1.02; 95% CI, 0.90 to 1.15) over a median 4.7 years, with discontinuation for adverse events in 20.6% and 7.5%; extended analyses in NEJM Evidence found no benefit in any subgroup or by achieved Lp(a). "The results were completely neutral across multiple analyses," said Dr. Steven Nissen of Cleveland Clinic, the senior author. In ZEUS, the monthly interleukin-6 antibody ziltivekimab lowered high-sensitivity CRP in 6,376 patients with atherosclerotic disease, chronic kidney disease and inflammation, yet three-point MACE occurred in 17.6% and 17.7% on placebo (HR 0.99; 95% CI, 0.88 to 1.11) over a median 33 months, according to the NEJM report led by Dr. Paul Ridker and HCPLive's account of it.
- FYIEvidence Nov 7, 2026Screening past sinus-rhythm ECGs with an AI model and offering Holter monitoring to those it flagged as high risk found new atrial fibrillation, atrial flutter or prespecified pre-AF findings in 0.74% of the AI group and 0.48% of usual care within 90 days (odds ratio 1.54; 95% CI, 1.01 to 2.37; P = .046), researchers at National Defense Medical University in Taipei reported Saturday in Circulation. The single-center, open-label LATENT trial randomized adults 40 to 85 without prior AF; the model labeled 1.1% of each arm high risk, and 48 of 84 flagged patients underwent monitoring. Detection of AF or flutter alone (0.3% vs 0.2%) and antiarrhythmic therapy started by 180 days (2.3% vs 2.4%) did not differ. Reclassifying a single event would have moved the P value to .057, and the authors called the findings "fragile statistically." Correction (Nov. 8): This item and the post's summary have been corrected. An earlier version said the trial found a statistically fragile gain in atrial fibrillation detection; the gain was in detection of atrial fibrillation, atrial flutter or prespecified pre-AF findings, and detection of atrial fibrillation or flutter alone did not differ significantly (0.3% vs 0.2%), according to the Circulation report.Sources: Circulation, PubMed record
- FYIEvidence Nov 7, 2026Among 13,394 patients with atherosclerotic cardiovascular disease and LDL cholesterol of 70 mg/dL or higher, lipid-lowering therapy was not escalated in 88.7% of the most recent visit notes, and 40.4% of those notes gave a reason, Stanford researchers reported Saturday in JAMA Cardiology after having a large language model read the notes. The leading documented reasons were patient-reported adverse effects (12.6%), LDL close to goal (6.9%), patient preference to avoid therapy (6.8%), preference for lifestyle changes (6.1%) and waiting for repeat labs (4.6%); a treat-to-target strategy appeared in 28.1% of notes. The model's agreement with clinical annotators did not differ statistically from annotators' agreement with each other, with F1 scores of 0.80 to 0.98. The retrospective study drew on a large integrated health system in Northern California from 2019 to May 2025.Sources: JAMA Cardiology, PubMed record
- FYIEvidence Nov 7, 2026Patients with atherosclerotic cardiovascular disease who began on combined statin and ezetimibe had a 3-year rate of cardiovascular death, MI, stroke, revascularization or unstable angina admission of 8.5%, against 7.9% for those started on a statin alone (hazard ratio 1.07; 95% CI, 0.83 to 1.37), in a prespecified second randomization of the Ez-PAVE trial published Saturday in Circulation. Both groups were titrated by protocol to LDL targets of under 55 or under 70 mg/dL at 17 centers in South Korea. The combination reached lower median LDL levels (53 vs 62 mg/dL with the intensive target and 63 vs 70 mg/dL with the conventional one), and ezetimibe was later added for 34.3% and 24.8% of patients who started on monotherapy. Safety end points were similar.Sources: Circulation, PubMed record
- FYIIncident Nov 5, 2026Medical record numbers, imaging identifiers and clinical details including diagnoses, procedure histories and medications of patients seen at Weill Cornell Imaging at NewYork-Presbyterian or NewYork-Presbyterian Hospital were entered into AI tools without authorization between June 10 and June 20, Weill Cornell Medicine said in a notice posted Nov. 5. The use violated the organization's policies, it learned of the incident Sept. 6, and it has suspended the research activity and asked for the data to be deleted. Names, addresses, Social Security numbers and financial information were not involved, and the organization said it found no evidence that an unauthorized person viewed the information. The notice did not say which AI tools were used or how many patients were affected, Becker's Hospital Review reported.