The following science will be presented during ACC.26 in New Orleans and was simultaneously published in JACC, JACC: Cardiovascular Interventions, JACC: CardioOncology, JACC: Clinical Electrophysiology and JACC: Heart Failure. Access all JACC Journals' simultaneous publications on the JACC Journals at ACC.26 event page.

Lp(a) and CAC Predict CV Risk

In a pooled multicohort study published in JACC, Harpreet S. Bhatia, MD, FACC, et al., found an independent association between an elevated Lp(a) (>50 mg/dL) and coronary artery calcium (CAC) score >0 and risk for atherosclerotic cardiovascular disease (ASCVD) (hazard ratio [HR], 1.24 and 2.44, respectively; p_int=0.80). Across the strata of CAC, elevated Lp(a) was associated with a higher relative risk of ASCVD, while absolute event rates were low among those with a CAC of 0. In an accompanying editorial comment, the authors write the research strengthens "the case for CAC as a pragmatic gatekeeper in deciding when to initiate or escalate preventive therapy in middle-to-older age individuals with elevated Lp(a), particularly in primary prevention settings where overtreatment is a concern."

Differential Impact of Adverse Events on Mortality Post PCI

Of nonfatal adverse events experienced after PCI, heart failure hospitalization (HFH) was more strongly associated with subsequent mortality than acute coronary syndrome (ACS) or bleeding, with adjusted HRs of 6.11, 3.22 and 2.62, respectively, according to findings from a large, multicenter PCI registry study conducted in Japan and published in JACC: Cardiovascular Interventions.

Additionally, HFH accounted for a disproportionately larger share of the overall mortality burden, followed by ACS and bleeding (20.1%, 4.3% and 2.9%). At two years, the cumulative rate of events was 4.7% for HFH, 3.4% for ACS and 2.5% for major bleeding.

Patients who experience HFH after PCI "should be considered at exceptionally high risk and may benefit from enhanced follow-up and intervention strategies," write Takahiro Suzuki, MD, MPH, and colleagues. "Proactive measures, including closer monitoring and optimizing [HF] management, could potentially improve survival outcomes in this vulnerable group."

Patients With CAD at Higher Risk of Mortality With TCE Immunotherapy

A dual-center retrospective study published in JACC: CardioOncology, found that while t-cell engager (TCE) immunotherapies had an overall favorable safety profile, patients with coronary artery disease (CAD) at baseline or who developed grade ≥2 cytokine-release syndrome and/or immune effector cell-associated neurotoxicity syndrome were at significantly higher risk of mortality.

Over a mean follow-up of 248 days, 65 cardiovascular events occurred, defined as HF, arrhythmias, myocardial infarction, stroke; new left ventricular dysfunction and new-onset atrial fibrillation (AFib) were most common. The cumulative incidence rate was 10.4%.

Osnat Itzhaki Ben Zadok, MD, MSc, et al., reported that cardiovascular complications during therapy were associated with a significant time-dependent increased mortality risk (HR, 6.76) independent of age, sex, TCE agent and prior anthracycline exposure. Cardiovascular mortality was rare (0.4%).

Dysfunctional Fat as Driver of HFpEF

Milton Packer, MD, FACC, et al., discuss the central role of excess and biologically dysfunctional adipose tissue in driving heart failure with preserved ejection fraction (HFpEF) in an article published in JACC: Heart Failure. They write that dysfunctional fat is a "primary cause of or a critically important upstream accelerant of other potential mechanisms of HFpEF in the large majority of patients" with [cardiovascular‑kidney‑metabolic (CKM) syndrome]."

The article highlights evidence contributing to the connection between central obesity, visceral adiposity, CKM, HFpEF and its comorbidities, including the role of adipokines; explores the best imaging methods for quantifying and targeting dysfunctional fat; and discuss what is needed in the next generation of clinical trials to develop more specific treatments, and more.

Readmissions Higher With Bariatric Surgery Than GLP-1s Post AFib Ablation

In a retrospective multicenter cohort study, Harsh Patel, MD, FACC, et al., found that bariatric surgery was associated with a significantly higher risk of readmission for AFib post ablation compared with GLP-1 therapy at two years. Among 2,466 patients with a BMI ≥30 mg/m² who had bariatric surgery or started GLP-1s after ablation, the readmission rate was 45.3% vs. 36.4% (HR, 1.37; p<0.001).

Additionally, the risk was higher in the bariatric group than the GLP-1 group for HF readmission (HR, 1.51), all-cause readmission (HR, 1.55) and all-cause mortality (HR, 2.53), even though the GLP-1 cohort had a higher baseline prevalence of diabetes, hypertension, HF and chronic kidney disease.

"GLP-1RAs may confer benefits beyond weight reduction by improving atrial remodeling, reducing calcium-mediated arrhythmogenic triggers, and attenuating angiotensin II-driven fibrosis," write the authors in a research letter published in JACC: Clinical Electrophysiology. "These findings highlight the potential role of GLP-1RAs as an adjunct in rhythm management strategies and support the need for prospective randomized trials."

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure

Keywords: ACC Annual Scientific Session, ACC26, Adipose Tissue, T-Lymphocytes, Percutaneous Coronary Intervention, Cardio-oncology, Atrial Fibrillation, Adiposity, Heart Failure