Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 6 appraisals
The American journal of cardiology
Systematic Review of Coronary Computed Tomography Angiography Guidance for Chronic Total Occlusion Percutaneous Coronary Intervention
Coronary computed tomography angiography (CCTA) is emerging as a valuable adjunct for chronic total occlusion (CTO) percutaneous coronary intervention (PCI), particularly for lesions in which angiography incompletely defines procedural anatomy. In this systematic review, the authors evaluated the role of CCTA in CTO diagnosis, lesion characterization, prediction of guidewire crossing and procedural success, and procedural guidance. CCTA provides a detailed assessment of key features that directly influence CTO PCI strategy and outcomes. Randomized and observational data suggest that preprocedural CCTA can improve procedural planning, increase technical success in complex lesions, and support safer and more efficient CTO PCI through fluoroscopic co-registration and other real-time guidance applications. These findings highlight the clinical value of CCTA as a tool that can enhance case selection, optimize crossing strategy, and improve procedural success in contemporary CTO PCI.
18 July 2026
Read appraisal →Cardiovascular research
Proteins targeting ischaemic-reperfusion injury and repair after myocardial infarction: a systematic literature review.
Following myocardial infarction (MI), reperfusion strategies ensure that blood flow is promptly restored to salvage the ischaemic myocardium. However, the sudden restoration of blood flow can inflict further damage to the ischaemic tissue, known as myocardial ischaemia/reperfusion injury (MIRI). Therapeutic strategies aimed at reducing MIRI and promoting cardiac repair remain an important clinical need. Protein-based therapies might exert benefits that limit damage and promote cardiac repair post-MI. To explore this further, we performed a systematic review of data from preclinical studies and clinical trial registries evaluating the cardioprotective effects of proteins post-MI. Medline and EMBASE were searched for preclinical studies that examined the potential cardioprotective effects of protein-based therapies to limit damage and/or mediate cardiac repair when administered after MI and/or reperfusion. Studies registered with ClinicalTrials.gov and EudraCT were also reviewed. In total, 84 studies were included in the final analysis, which included 46 different proteins. Overall, our findings support the concept that transiently applying recombinant or modified proteins after acute MI has the potential to promote lasting improvements in heart function via multiple pleiotropic mechanisms. Many of these proteins converge on a limited set of well-established signalling pathways involved in cardiac repair and remodelling after MI, with a few proteins demonstrating consistent and robust effects across multiple outcomes and models (small and large animals; reperfused and non-reperfused models). Despite this, the high potential cardioprotective benefit reported in preclinical studies has not translated into approved therapies for use in patients. Although the previous failure of protein therapies in clinical development does not invalidate the potential relevance of their downstream pathways, our research underlines the challenges in translating preclinical findings of protein-based therapies into the clinical setting. Future preclinical and clinical research should examine the optimal treatment effect and fully characterize the therapeutic potential of proteins involved in post-MI remodelling.
28 June 2026
Read appraisal →Journal of neurointerventional surgery
Comparative safety and efficacy of invasive therapies for carotid artery stenosis: a systematic review and network meta-analysis
BACKGROUND: Carotid artery stenosis is a major cause of stroke and is commonly treated with carotid endarterectomy (CEA) or carotid artery stenting (CAS). Trans-carotid artery revascularization (TCAR) has emerged as a newer alternative designed to reduce the risk of procedural stroke. However, comparative evidence on the safety and efficacy of these interventions is limited. This study evaluates the clinical outcomes of CEA, CAS, and TCAR in patients with carotid artery stenosis. METHODS: A comprehensive search of multiple databases was conducted to identify relevant studies. The outcomes were stroke, mortality, and myocardial infarction, cranial nerve injury, hematoma, infection, transient ischemic attack, and length of hospital stay. Meta-analysis and a frequentist graph-theoretical approach network meta-analysis were performed using the netmeta package in R platform. Risk of bias was assessed using RoB 2 Cochrane and ROBINS-I. RESULTS: Fifty-five studies were included in the review. The short-term stroke risk was significantly lower with CEA than with CAS. TCAR had a potential long-term mortality benefit over CAS, while no significant differences were observed in short-term mortality or myocardial infarction across treatments. CAS was associated with lower risks of cranial nerve injury, hematoma, and infection compared with CEA. CONCLUSION: CEA and TCAR offer better short-term stroke protection than CAS, with TCAR showing promise for long-term mortality benefits. CAS has advantages in reducing cranial nerve injury, hematoma, and infection risks. Overall, the choice of treatment should consider both efficacy and safety profiles. Further high-quality randomized controlled trials, particularly focusing on TCAR, are needed to validate these comparative outcomes. PROSPERO REGISTRY NUMBER: CRD420251055287.
16 May 2026
Read appraisal →Current heart failure reports
Emerging Artificial Intelligence Tools for the Screening of Structural and Valvular Heart Disease
PURPOSE OF REVIEW: Structural heart disease (SHD) encompasses diseases involving the heart valves, chambers, walls, and muscles. Current diagnostic methods have limited accessibility and predictive value. This review aims to present recent advances in artificial intelligence (AI)-guided tools in the screening of SHD and valvular heart disease (VHD), and to present challenges and opportunities for their use in clinical practice. RECENT FINDINGS: AI-guided models trained on ECGs, chest X-rays, and coronary artery calcium scans have a high accuracy in the diagnosis of SHD, heart failure, low left ventricular ejection fraction, and VHD. Some of these models can highlight the signals that influence their predictions, improving explainability. The use of AI in screening for SHD and VHD could lead to earlier diagnosis, enhanced accuracy, and better accessibility. However, outcome data on earlier diagnosis using these tools is required before broad deployment.
14 May 2026
Read appraisal →PloS one
Risk prediction for cardiovascular related diseases using PRS and EHR in the Framingham Heart Study
Cardiovascular disease is a leading cause of mortality and rising healthcare costs worldwide. Fortunately, the disease is preventable, and addressing risk factors can significantly reduce its effects. Over the past decade, risk prediction models have advanced significantly, with polygenic risk scoring analysis, which is often used in combination with clinical health information for prediction. However, most previous cardiovascular disease prediction studies based on polygenic risk scores have focused on a single specific disease or event, such as cardiac events. Given the complex nature of the cardiovascular disease, which involves a combination of genetic and environmental factors, a comprehensive analysis of the disease prediction results is essential. In this study, we investigate the genetic and environmental factors contributing to cardiovascular disease by utilizing data from the Framingham Heart Study, a leading cardiovascular cohort. We compared the prediction performance of different methods across various scenarios and assessed performance using various evaluation metrics to identify the best-fitting model for six cardiovascular related diseases. We also analyzed the feature importance of genetic and clinical variables, noting that different variables had varying effects on each disease. Our findings demonstrated the performance of prediction algorithms in forecasting cardiovascular disease by utilizing genetic and clinical factors, as well as highlighting the importance of each feature in the disease prediction. While models relying solely on polygenic risk score showed relatively low prediction performance for some diseases, integrating genetic information with clinical data improved prediction performance in most cases. For certain diseases, particularly those known to be heritable, polygenic risk scores demonstrated predictive ability, suggesting that they may serve as standalone predictive tools. We believe our study reveals the value of combining polygenic risk scores with clinical variables and expect that our thorough analysis can inform study designs tailored to specific diseases and research objectives.
20 Apr 2026
Read appraisal →Methodist Debakey Cardiovasc J
Vascular Robotics: Webcast
This 55-minute webcast features a conversation about "Vascular Robotics"-the focus of Issue 21.5. Led by the issue's editors, the discussion engages the authors on emerging themes and lessons learned while researching and writing the articles. View the video at https://vimeo.com/event/5556427.
1 Jan 2025
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