This Week in Cardiology Mar 20 2026 This Week in Cardiology
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Mar 20, 2026 Listener feedback sparks a deep dive into trial dosing and bleeding risks. A large LAAC trial challenges device benefit, with procedural harms and composite endpoints under scrutiny. Preview and critique of an upcoming LAAC vs DOACs trial and what to watch for. A contentious new ACC/AHA lipid guideline is unpacked, with concerns about evidence strength, complexity, and conflicts of interest.
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A Doctor's Slide Showing Soft LAAC Indications
- John Mandrola recounts an EP's broad indications for LAAC including bruising, athletic risk, falls, and inability to pay for DOACs.
- He uses this to illustrate how soft indications in the U.S. push many patients toward LAAC.
Per-Protocol Analysis Strengthened Medical Therapy Advantage
- The trial's per-protocol analysis (more conservative for non-inferiority) favored medical therapy even more strongly than intention-to-treat.
- Device event rates were ~26% higher, bringing point estimate close to the non-inferiority margin of 1.3.
Contemporary Stroke Rates Are Lower Than Expected
- Observed stroke rates in modern trials are ~3% despite high CHA2DS2-VASc, indicating a secular decline in stroke risk and reduced predictive power of CHA2DS2-VASc today.
- This temporal decline makes stroke endpoints harder to power and interpret in contemporary device trials.