Complete vs. Culprit-Only Revascularization in Older Patients with Myocardial Infarction with or without ST-segment elevation

In the November 19, 2024, issue of JACC, Dr. Valentin Fuster discusses four groundbreaking studies that could shape the future of cardiovascular care. Topics include the impact of atrial fibrillation screening on stroke prevention, risk factors in Brugada syndrome, new methods to reduce heart block after congenital heart disease surgery, and genetic insights into arrhythmogenic triggers of atrial fibrillation, alongside a review of a decade of leadless cardiac pacing technology.

In this episode, Dr. Valentin Fuster discusses the Garter AF trial, which evaluates the impact of screening for undiagnosed atrial fibrillation (AF) in older adults using a 14-day ECG monitor to reduce stroke risk. While the study found a marginal increase in AF diagnoses, it suggests that AI could play a crucial role in identifying high-risk patients who would benefit most from such screenings, highlighting the need for a more targeted approach in future trials.

In this episode, Dr. Valentin Fuster discusses a groundbreaking study on Brugada Syndrome, exploring how non-modifiable risk factors—such as male sex, SCN 5A mutations, and polygenic risk scores—can predict life-threatening arrhythmic events in patients. The research, published in JACC (November 2024), offers new insights into personalized risk assessment for this inherited arrhythmia syndrome, though its clinical implications remain limited for now.

In this podcast, Dr. Valentin Fuster reviews a groundbreaking study on intraoperative conduction mapping to prevent postoperative atrioventricular block (AVB) in children with complex congenital heart disease. The study highlights how mapping the His bundle during surgery significantly reduces the need for pacemakers, particularly in high-risk populations like those with Heterotaxy syndrome and non-Transposed Great Arteries, offering a promising tool to improve long-term outcomes for these patients.

In this episode, Dr. Valentin Fuster discusses a groundbreaking study on the embryological origins of atrial fibrillation triggers, which could help refine treatment strategies for the condition. The research highlights how genetic factors linked to specific atrial regions, like the sinus venosus and primitive atrium, influence arrhythmia recurrence after ablation, potentially paving the way for more personalized, effective treatments.

In this episode, Dr. Valentin Fuster explores the evolution of leadless cardiac pacing over the past decade, highlighting its safety, efficacy, and growing role in treating heart patients. He reviews key advancements, including single and dual-chamber leadless pacemakers, ongoing innovations, and future developments, emphasizing their potential to replace traditional pacemakers and improve patient outcomes.

In this episode, Dr. Valentin Fuster highlights the groundbreaking studies featured in the November 12, 2024 issue of the JACC, focusing on the emerging role of proteomics in understanding heart failure and hypertrophic cardiomyopathy. He discusses key findings on SGLT2 inhibitors, the efficacy of complete revascularization in myocardial infarction patients, and novel treatments for hypercholesterolemia, emphasizing the transformative potential of these insights for cardiovascular care.

In this episode, Dr. Valentin Fuster discusses groundbreaking research on SGLT2 inhibitors and their impact on heart failure, highlighting the validation of mechanistic proteomic signatures from a major clinical trial. The study reveals how empagliflozin influences over 2,000 proteins, promoting autophagy, enhancing mitochondrial health, and normalizing kidney function, offering new insights into therapeutic strategies for heart failure management.

In this episode, Dr. Valentin Fuster discusses groundbreaking research on hypertrophic cardiomyopathy (HCM), revealing dysregulated signaling pathways through comprehensive proteomic profiling of human myocardial tissue. The study identifies novel therapeutic targets, including the Ras MAPK pathway and the ubiquitin-proteasome system, while emphasizing the need for further exploration beyond obstructive cases to better understand the disease's molecular mechanisms.

In this episode, Dr. Valentin Fuster discusses a pivotal study on revascularization strategies in older patients with myocardial infarction, comparing complete versus culprit-only approaches. The findings suggest that physiology-guided complete revascularization significantly reduces adverse outcomes in both STEMI and non-STEMI patients, emphasizing its potential benefits across a diverse patient population.