Curation log — ischemic heart disease¶

2026-08-28 — Seed¶

Created: INDEX.md (canonical 16-row Pages table), wiki/overview.md (draft, 28 verified PMIDs), OPEN-QUESTIONS.md (7 seed questions), this log.
Searches run (live PubMed, esearch/esummary/efetch + MCP PubMed tools): ISCHEMIA and ISCHEMIA-EXTEND; COURAGE; ORBITA, ORBITA-2, ORBITA-COSMIC, ORBITA-program predictor analyses; REVIVED-BCIS2; 2023 AHA/ACC chronic coronary disease guideline; 2024 ESC chronic coronary syndromes guideline; GBD IHD burden 1990–2021; GBD CVD 2023 (JACC); GBD elevated LDL-C 2023; IHD quality-of-care GBD analysis; CTT 2010 intensive statin meta-analysis; IMPROVE-IT; FOURIER; REDUCE-IT; CANTOS; COLCOT; LoDoCo2; ATT aspirin meta-analysis; COMPASS; SECURE polypill; cardiac rehabilitation meta-analyses (2021 Cochrane, 2023 EHJ); SELECT.
Verification: all cited PMIDs retrieved from live PubMed this session; abstracts fetched for all quantitative claims (event rates, hazard ratios, burden figures).
Next: full build queued per CONDITIONS-ROADMAP.md — 15 remaining wiki pages, literature layer, ClinicalTrials.gov verification (anti-inflammatory and sham-controlled device pipelines), patient-voice layer.

2026-08-28 — Full build¶

Built all 16 canonical wiki pages: extended overview.md; added epidemiology/global burden, plaque biology, stable CAD, ACS, PCI/CABG, lipid lowering, antithrombotics, inflammation, rehabilitation/lifestyle, INOCA/special phenotypes, guidelines, biomarkers, trials, patient experience, and red-flags/safety pages. All remain draft pending a separate-session audit.
Built the literature layer: BIBLIOGRAPHY.md generated from the page citation graph; 6 landmark notes (COURAGE, ISCHEMIA, ORBITA-2, REVIVED, CTT, CANTOS); 19-document guideline/implementation registry with supersession chains, disputes, regional coverage and watch list; quantitative statistics quick reference; and patient-voice method, organizations, themes and annotated sources.
Rewrote OPEN-QUESTIONS.md: 15 Tier 1 and 12 Tier 2 questions with stable OQ identifiers, plus 12 “Dots not yet connected” junctions.
Live PubMed work: 40 broad domain searches (burden, plaque, stable/acute syndromes, PCI/CABG, physiology, lipids, antithrombotics, inflammation, rehabilitation, INOCA, women, biomarkers, safety and patient outcomes); targeted landmark-title/acronym searches; direct E-utilities resolution/metadata retrieval for all cited identifiers; and a final citation-graph re-resolution. The completed wiki uses 129 unique PubMed records across more than 740 citation occurrences.
Live ClinicalTrials.gov work: API v2 searches for active coronary-disease studies, IHD interventions, Lp(a), ziltivekimab, colchicine, sham/device trials, PREVENT, CorMicA and INOCA; 243 unique registry studies retrieved in broad sweeps plus targeted queries. Page tables include status/enrollment as of this date.
Official-web verification: NICE, WHO/HEARTS, JCS, CCS, Australia/CSANZ and South African guideline/implementation sources; Global Heart Hub, Mended Hearts, WomenHeart, INOCA International, BHF, Heart & Stroke Canada, Heart Foundation Australia, and Heart & Stroke Foundation South Africa.
Integration: updated INDEX.md with portrait, counts, reading paths, page/literature statuses; set CONDITIONS-ROADMAP.md status to built.
Could not verify / limits: no comprehensive current African cardiology-society IHD guideline beyond the South African national STG/EML was identified; Latin American and several Asian patient-organization sources remain underrepresented; registry statuses can lag site activity; several wiki pages finish at 144–149 lines, within the approximate 150-line target, because content was kept claim-dense and non-repetitive. No unresolved verification flags remain; unsupported claims were omitted.
Next: run the required separate-session audit: re-fetch every PMID/NCT, check claim/number match, repair discrepancies, and promote only fully passing pages to curated/roadmap audited.

2026-08-30 — Page-by-page evidence deepening¶

Deepened all 16 canonical wiki pages in place: retained the existing text and added comparative evidence tables, effect sizes and confidence intervals, mechanism-to-outcome links, population boundaries, competing guideline interpretations, and explicit controversies. Pages now contain 25–34 unique PubMed papers each and remain draft pending the required independent audit.
Major additions by domain: DANAMI-2/STREAM-2/CULPRIT-SHOCK/RIDDLE-NSTEMI boundaries in ACS; CAPRIE/CURE/TRITON/PLATO/PEGASUS, AF-PCI dual-versus-triple therapy, STOPDAPT-2 and SMART-CHOICE in antithrombotics; MESA CAC and rapid hs-cTn validation in biomarkers; RAMIT, telerehabilitation, participation inequity and smoking cessation in rehabilitation; INTERHEART/PURE and numerator-denominator caveats in epidemiology; 4S/HPS/TNT and absolute-risk framing in lipids; causal triangulation for IL-1β/IL-6/CHIP; endotype-strength grading for ANOCA/INOCA/MINOCA; route-specific CABG/PCI and shock-specific completeness; and patient-important outcomes separated from clinical composites.
Live PubMed searches: ran 128 page-specific ESearch queries (eight per page) spanning acute reperfusion/timing, antithrombotic sequencing, hs-troponin/CAC/CCTA/PRS, rehabilitation/lifestyle, burden and care gaps, guidelines, inflammation, INOCA/MINOCA, lipid trials, plaque biology, patient outcomes, diagnostic safety, revascularization and stable-CAD symptom/prognosis trials. Ran additional targeted searches for CURE, PEGASUS, WOEST, PIONEER AF-PCI, RE-DUAL PCI, AUGUSTUS, ENTRUST-AF PCI, STOPDAPT-2 and SMART-CHOICE. Relevance-mismatched top hits were rejected rather than cited.
Identifier verification: live EFetch resolved all 130 pre-existing bibliography PMIDs, then all 183 PMIDs cited by the deepened wiki; page reference sections were mechanically rebuilt from those live records. ClinicalTrials.gov API v2 individually resolved all 21 NCT identifiers retained anywhere in the condition; no unresolved PMID or NCT remained.
Literature layer: added 54 newly cited papers to literature/BIBLIOGRAPHY.md, bringing it to 184 deduplicated records, grouped the additions by topic, and refreshed tags/cited by fields against all 31 other condition Markdown files. Expanded statistics/STATISTICS.md with ACS/revascularization, lipid, symptom and antithrombotic estimates; expanded guidelines/REGISTRY.md with an evidence-shock maintenance table and visible implementation assumptions.
Open questions: preserved OQ-1 through OQ-27, sharpened DAPT, global implementation, sex-sensitive diagnosis and psychological-care questions with explicit estimands, added a decision-ready trial-design table, and expanded “Dots not yet connected” from 12 to 15 junctions.
Could not verify / limits: several broad ESearch queries returned irrelevant relevance-ranked records; these were discarded. No claim from those records was retained. Official regional guideline websites were not comprehensively re-searched in this session, so the registry's negative regional findings remain bounded to the documented 2026-08-28 searches. This was a build/deepening session, not the separately required independent claim-to-source audit; statuses therefore remain draft.
Next: in a fresh session, audit every claim→identifier pair against the full abstract/article and registry history, with particular attention to composite definitions, subgroup transportability, guideline class/level wording, and ePublication-versus-print metadata; promote pages only after that pass.

2026-08-30 — Independent audit¶

Scope completed: audited all 16 canonical wiki pages and every condition literature artifact: the 184-record bibliography, 6 landmark notes, guideline registry, statistics ledger, all 4 patient-voice files, OPEN-QUESTIONS.md, and INDEX.md.
Claims and identifiers checked: reviewed 879 claim→PMID occurrences in wiki bodies and the literature-layer uses; live PubMed E-utilities EFetch returned all 184 unique cited PMIDs. Live ClinicalTrials.gov API v2 calls returned all 22 unique NCT records across 86 occurrences. Page-body and reference-section graphs match exactly; the condition-wide bibliography contains all 184 non-bibliography PMIDs with no missing or orphaned record.
Record/metadata repairs: corrected 53 incorrect inline author/year attribution occurrences spanning 31 PubMed records. Replaced an indirect Russian DAPT summary with the live-verified primary DAPT Study report (Mauri 2014, PMID 25399658). Final live metadata checks found no unresolved author, year, journal, title, or identifier mismatch; ePublication/print-year differences were tolerated where applicable.
Substantive repairs: reversed the incorrect claim that long-term iFR and FFR outcomes were similar; the cited 5-year analysis instead reported higher MACE with iFR (HR 1.18, 95% CI 1.04–1.34) and higher all-cause mortality (HR 1.34, 95% CI 1.08–1.67). Corrected cardiac-rehabilitation hospitalization NNT from 27 to 37. Corrected two COURAGE descriptions so 19.0% versus 18.5% is identified as the primary death/nonfatal-MI outcome. Qualified stable-PCI, ischemic-LV-dysfunction, very-low-LDL safety, plaque-prediction, biomarker-actionability, and implementation claims where the cited evidence did not support the stronger wording.
Registry/status repairs: updated Lp(a)HORIZON to completed on 2026-07-16 with 8,323 actual enrollment, OCEAN(a)-Outcomes to active/not recruiting with 7,297 actual enrollment, and current enrollment/status fields throughout. Added RIGHT (NCT06025071) after a live strategy search and described it positively as a registered hsCRP-enriched randomized strategy whose record is stale (UNKNOWN; last known not yet recruiting; no posted results). Recorded the ORBITA-COSMIC discordance: ClinicalTrials.gov returns UNKNOWN and 50 estimated, while the paper reports 61 enrolled, 51 randomized, and 50 analyzed.
Negative-evidence searches rerun: repeated live PubMed and ClinicalTrials.gov searches for hsCRP-targeted/titrated anti-inflammatory strategies, selective Lp(a) outcome publications, inclisiran outcomes, and integrated plaque-guided strategies. Dated evidence-gap sentences now replace timeless absence claims. Lp(a)HORIZON searches found the design paper, reviews, and health-technology assessments but no primary outcome report as of 2026-08-30; the hsCRP strategy search found RIGHT but no completed target-titration outcome trial.
Literature/web verification: rechecked official guideline and patient-organization URLs on 2026-08-30. All direct requests resolved except the CCS library request, which timed out; its relevant entries were independently confirmed in a live indexed result on the official CCS domain, and that limitation is explicit in the registry. Negative regional findings are dated rather than presented as permanent absences.
Final validation: all 16 pages are 165–189 lines and contain 25–34 unique live-verified PubMed records; all local Markdown links resolve; every page has matched body/reference PMID sets; no unresolved verification or placeholder marker remains. All 16 pages passed and were promoted to status: curated; INDEX.md and CONDITIONS-ROADMAP.md now report audited.
Remaining flags: no unresolved substantive citation, numeric, metadata, registry, or page-structure issue. Dated research gaps remain intentionally visible; registry lag and the CCS direct-fetch timeout remain explicit source limitations rather than unresolved claims.

2026-09-02 — Topic-specific evidence-base expansion¶

Outcome: extended all 16 canonical wiki pages in place and preserved the prior verified text. Added 65 PubMed records absent from the previous condition-wide pool, raising wiki distinct records from 183 to 248 (15.5 per page condition-wide), per-page unique PMID counts from 25–34 to 29–38, and total wiki length from 2,878 to 3,073 lines. Every touched page is now status: draft pending independent re-audit.
What was deepened: quantified neutral or harmful routine interventions in ACS (oxygen, ECLS, frailty-limited invasive care); antiplatelet agent/duration trade-offs; diagnostic-yield versus treatment-delivery failures for hs-troponin; CAC/plaque burden; rehabilitation access, smoking, diet and exercise dose; trial endpoint/representation/core-outcome problems; modeled burden, socioeconomic access, air pollution and young-adult trends; exact left-main Class/Level grades and DAPT/CR guideline lineage; CHIP and residual inflammatory-versus-cholesterol risk; MINOCA/OCT and endotype-limited therapy; first versus total lipid events and surrogate inclisiran evidence; lifetime/cumulative LDL exposure; retention, efferocytosis, smooth-muscle lineage and trained immunity; clinician–patient angina discordance, return to work and sexual recovery; missed ACS, bleeding, SCAD and type 2 MI safety; and anatomy/time-horizon/symptom-specific revascularization evidence.
Live identifier work: ran 128 page-specific PubMed ESearch queries (eight per page) and fetched full EFetch records for the selected additions. NCBI rate limiting required conservative retries; no record was accepted without a completed live retrieval. One additional targeted SCAD ESearch/EFetch verified the AHA scientific statement (PMID 29472380). A final batched EFetch resolved all 249 PMIDs retained anywhere in the condition with zero missing records. All 22 retained NCT identifiers were individually re-resolved through ClinicalTrials.gov API v2 with no ID mismatch. PubMed search terms and returned IDs are retained in the session workspace under /tmp/ihd_pubmed/search-log.json.
Literature layer: added all 65 papers to literature/BIBLIOGRAPHY.md; added 14 quantitative rows to literature/statistics/STATISTICS.md; expanded literature/guidelines/REGISTRY.md with the ESC/EACTS focused left-main reassessment and exact Class I/A versus IIa/A grades, plus DAPT-lineage and rehabilitation-implementation disagreements.
Open questions: added OQ-28 through OQ-32 on shock-device selection, diagnosis-to-treatment equity after sex-specific troponin, recurrent-event estimands, SCAD reperfusion, and cumulative LDL exposure; expanded “Dots not yet connected” from 15 to 20.
Deliberately left alone: no existing verified claim was deleted or rewritten wholesale; the six landmark paper notes and patient-voice source/organization files were not expanded because this pass added no new landmark requiring a deep note and no newly verified public patient-organization source. No NCT identifier or registry-status claim was added or changed. CONVENTIONS.md, tools/, other conditions, and publication files were untouched.
Next: an independent model should re-fetch the 65 additions, audit every new number and author/year/title mapping, normalize bibliography journal abbreviations if desired, and only then restore curated status.

2026-09-02 — Independent audit (auditor: claude; author of the audited text: codex)¶

Scope. Audited all 16 canonical wiki pages and every condition artifact: BIBLIOGRAPHY.md, the 6 landmark notes, guidelines/REGISTRY.md, statistics/STATISTICS.md, all four patient-voice/ files, OPEN-QUESTIONS.md and INDEX.md. WHATS-NEW.md is generated by tools/build_recency.py and was left for regeneration at publish.
Identifiers re-fetched live. All 249 pre-existing PMIDs were re-resolved through PubMed E-utilities ESummary and full abstracts were fetched by EFetch for claim checking; after the audit's three additions all 252 PMIDs resolve with no errors. All 22 NCT identifiers were individually re-resolved through ClinicalTrials.gov API v2 and every status/enrollment figure written in the pages matched the live record.
Claim-citation pairs checked. 1,026 inline (Author Year, PMID) attributions were machine-checked against live author/year metadata (all 62 flags were group-author or particle-name artifacts — CTT, ATT, GBD collaborators, "van Oosterhout", "Van de Werf" — plus tolerated ePub/print year offsets, and none was an error). Every quantitative claim on every page (event rates, hazard/risk/odds ratios, confidence intervals, sample sizes, NNTs, prevalence and burden figures) was read against the fetched abstract.

Errors found and fixed¶

PREVENT was described only through its design paper and its result was mis-attributed. pathophysiology-and-plaque-biology.md said "the trial's reported diabetic subgroup supports possible benefit"; the diabetes analysis (Kim 2025, PMID 40439104) in fact reports the same direction in both strata with no significant interaction. Retrieved and added the primary report (Park 2024, PMID 38604213) and replaced the passage with the actual 2-year result (0.4% vs 3.4%, absolute difference −3.0 points, 95% CI −4.4 to −1.8; death 0.5% vs 1.3%; MI 1.1% vs 1.7%). Corrected the same design-paper-only framing in clinical-trials-landscape.md (two places) and OPEN-QUESTIONS.md (OQ-9).
COLOCT was described backwards. The plaque page said COLOCT and the LoDoCo2 CT subanalysis "illustrate the gap between event reduction and measurable local plaque change". COLOCT was positive (minimal fibrous-cap thickness +34.2 µm, 95% CI 9.7–58.6, p=0.006). Replaced with both trials' actual findings and the accurate conclusion that local change is measurable but modality- and population-dependent.
ERICA numbers were framed as a within-group change. stable-cad-management.md read "reduced weekly angina episodes from 3.31 to 2.88"; 2.88 vs 3.31 is ranolazine vs placebo during treatment (baseline was 5.63/week). Rewritten with the correct comparison, baseline, n and p values.
MULTISTARS AMI's result was omitted. The ACS page said only that the trial showed "immediate and staged strategies could be compared". Replaced with the finding (8.5% vs 16.3%; RR 0.52, 95% CI 0.38–0.72; noninferior and superior) and the shock exclusion.
A meta-analysis was mischaracterized. The ACS page cited Manfrini 2016 (PMID 27273697) as supporting early invasive care "in appropriately selected non-ST-elevation disease"; the paper found benefit across UA/NSTEMI (RR 0.79) but not within NSTEMI (RR 1.19) and an early hazard to discharge. Rewritten with both estimates.
EXCEL's five-year mortality difference was glossed. revascularization-pci-and-cabg.md described "broadly similar mortality"; all-cause death was 13.0% vs 9.9% (difference 3.1 points, 95% CI 0.2–6.1). Replaced with the full result and added the same detail where the page mentions "the five-year controversy" without naming it.
Four cited PMIDs were missing from a reference list. revascularization-pci-and-cabg.md cited Serruys 2009 (19228612), Xaplanteris 2018 (29785878), Akintoye 2021 (32921597) and Spertus 2020 (32227753) in the body but listed none of them; all four added with live-verified metadata.
A malformed reference block. stable-cad-management.md carried four unnumbered bullet references above its numbered list; merged and renumbered (29 entries).
A residual NNT error the previous pass claimed to have fixed. cardiac-rehabilitation-and-lifestyle.md still said "approximately 27 treated to prevent one cardiovascular hospitalization"; Dibben 2023 reports NNT 37 for hospitalization. Corrected and the other two pooled estimates added with their confidence intervals.
A registry trial was named wrongly. NCT05192941 is V-DIFFERENCE (placebo-controlled phase 4 inclisiran on top of optimized lipid-lowering therapy in hypercholesterolaemia), not "VICTORION-INITIATE", and it is not an "upfront implementation/LDL strategy" trial. Corrected in clinical-trials-landscape.md.
Two wrong first authors in the patient-voice source list. PMID 37033594 is Borah N (listed as "Sharma R") and PMID 36447215 is Xie X (listed as "Zhang Y"). Both corrected; the wiki pages already cited them correctly.
A citation's journal did not match its PMID. guidelines/REGISTRY.md cited PMID 34895950 as Circulation 2022; that identifier indexes the J Am Coll Cardiol co-publication (2022;79:e21–e129). Corrected, with the co-publication noted; the chest-pain guideline citation was completed with volume and pages.
Three claims stated more than their source. Rehman 2020 (PMID 33189191) does not document "large gaps between indicated and received therapy" — it reviews Indian registries and quality-improvement programmes; Sun 2017 (PMID 27676464) reports age, sex, education, insurance and employment gradients but not race in its abstract; Rashid 2022 (PMID 36102261) shows no practice change in one health system rather than "health-system dependent" change. All three rewritten to what the sources report, with the actual figures.
Two safety caveats were softened out of their sources. HiSTORIC (PMID 33752439) did not formally meet noninferiority for its 30-day safety outcome (upper 1-sided 95% CI 0.70% against a 0.50% margin; P=0.068), and Chiang 2020 (PMID 32245882) concluded the ESC 0/1-hour algorithm "may not be sufficiently safe if the 1% miss-rate is desired" with 8.1% one-year mortality in the observation zone. Both now stated.
An omitted harm signal. The DAPT Study's higher all-cause death with extended thienopyridine (2.0% vs 1.5%; HR 1.36, 95% CI 1.00–1.85; P=0.05) was missing from the extension paragraph on a page whose own rule is to display benefit and harm separately. Added.

Asserted absences re-run¶

hsCRP-targeted anti-inflammatory strategy. Repeated live PubMed and ClinicalTrials.gov searches on 2026-09-02: still no completed strategy trial titrating colchicine or another agent to an hsCRP target; RIGHT (NCT06025071) remains UNKNOWN, last updated 2023-09-06, no posted results. Absence confirmed and re-dated in guidelines.md, biomarkers.md, inflammation-and-residual-risk.md and OQ-5.
Lp(a)HORIZON primary outcome. Re-run pelacarsen/olpasiran/Lp(a)HORIZON searches on 2026-09-02 found only reviews and a trial unit-concordance analysis (Cho 2026, PMID 42250319, added); no primary outcome report. Absence confirmed, re-dated and given its positive supporting citation.
ZEUS. The trial's registry record now reads COMPLETED (2026-06-09, 6,385 actual). A live PubMed search found no primary outcome report — the most recent ZEUS output is its rationale/design/baseline paper (Ridker 2026, PMID 41369941, added). A dated evidence-gap sentence now states this positively rather than leaving the reader to infer it.
Inclisiran outcomes. ORION-4/HPS-4/TIMI 65 remains a design publication (searched 2026-09-02); the pages' "awaits definitive outcomes evidence" framing stands unchanged.
All other verification dates carried forward from 2026-08-30 in the wiki were re-run in this session and re-dated to 2026-09-02; official-web entries in the registry and patient-voice layer were not re-fetched and keep their documented 2026-08-30 access dates.

Checked and confirmed correct¶

Every trial figure on the condition's anchor evidence matched its source, including COURAGE, ISCHEMIA and ISCHEMIA-EXTEND, ORBITA and ORBITA-2, ORBITA-COSMIC, REVIVED and its viability analysis, STICHES and the STICH age analysis, SYNTAX at 1 and 10 years, EXCEL, FAME 2, COMPLETE, DANAMI-3–PRIMULTI, CULPRIT-SHOCK, RIDDLE-NSTEMI, MATRIX, DETO2X-AMI, ECLS-SHOCK, MOSCA-FRAIL, STREAM-2, DANAMI-2, CTT, 4S, HPS, TNT, IMPROVE-IT, FOURIER, ODYSSEY OUTCOMES and its mortality analysis, CLEAR Outcomes and its total-event analysis, ORION-10/11 and the pooled inclisiran analysis, REDUCE-IT, SAMSON, Lp(a) apheresis and Mendelian-randomization work, ATT, CURE, CAPRIE, TRITON, PLATO, PEGASUS, TWILIGHT, MASTER DAPT, DAPT Study, GLOBAL LEADERS, HOST-EXAM and its extended follow-up, TICO, POPular AGE, STOPDAPT-2, SMART-CHOICE, WOEST, PIONEER AF-PCI, RE-DUAL PCI, AUGUSTUS, ENTRUST-AF PCI, COMPASS, CANTOS, CIRT, COLCOT, LoDoCo2, CLEAR SYNERGY, the colchicine meta-analysis, RESCUE/RESCUE-2, the IL6R Mendelian randomization, CHIP cohorts, CorMicA, EDIT-CMD, WISE/WISE-CVD, the MINOCA OCT/CMR study, SWEDEHEART MINOCA, PROSPECT, SCOT-HEART's two analyses, MESA CAC work, the hs-troponin algorithm literature, High-STEACS, MASS II, FREEDOM health status, ISCHEMIA quality of life, PolyIran, SECURE, SELECT, the cardiac-rehabilitation meta-analyses and Cochrane reviews, RAMIT, PREDIMED, the Lyon Diet Heart Study, the smoking-cessation syntheses, and the GBD burden, LDL-C, air-pollution and quality-of-care analyses.

Promotion and remaining flags¶

All 16 pages passed and were promoted to status: curated; INDEX.md and CONDITIONS-ROADMAP.md updated. Final validation: every page has matching body and reference PMID sets, sequentially numbered reference lists, 175–201 lines, 29–38 unique records per page, 252 condition-wide distinct records (15.8 per page — the condition has cleared the NARROW breadth flag recorded in the roadmap), and all local Markdown links resolve.
Remaining limitations, stated rather than hidden: a small number of citations are to documents PubMed indexes without an abstract (Falk 1995, Braunwald 2013, Samuel 2021, Conti 2010) or to guideline/statement documents whose recommendation text is not machine-verifiable from the record; for these the audit could confirm identity, authorship and topic but not each paraphrase against full text. Two exact recommendation-grade claims that were checkable — the ESC/EACTS left-main Class I/A versus IIa/A grades and the DAPT class-lineage argument — matched their sources. The joint ESC/EACTS left-main review is cited under both of its co-publication PMIDs (37632756, 37632766); both resolve and both are in the bibliography. Official-organization web sources were not re-fetched in this pass.
Next: normal weekly sweep. The first sweep should re-check ZEUS, Lp(a)HORIZON, OCEAN(a)-Outcomes and ORION-4 for primary outcome publications, and re-fetch the patient-voice and guideline web sources whose access dates are now older than a week.

2026-10-07 — Grounding the uncited "Dots not yet connected" rows (grounder: claude, Opus 5.5)¶

Scope. OPEN-QUESTIONS.md § Dots not yet connected only. Started with 20 rows, all uncited: bare keyword pairs with no PMID or NCT ID. No row already carried a citation, so none had to be preserved untouched. Candidate records came from logs/grounding-ischemic-heart-disease.md. Every record cited below or in the table was fetched live in this session through PubMed E-utilities (EFetch: abstract, publication types, CommentsCorrections) and checked against Crossref updated-by. None is retracted or carries an expression of concern. Several carry errata or corrections only: PREVENT 38604213, PROSPECT 21247313, Kelshiker 34849697, SMART-CHOICE 31237645, Nicholls 38231501, Bularga 35341327 and Reynolds 33191769. NCT records were fetched live from ClinicalTrials.gov API v2.
Outcome: 6 rewritten, 14 deleted. Row IDs were not renumbered, so the gaps are deliberate. The INDEX build summary still says "20 cross-domain junctions"; this pass was not permitted to edit INDEX.md, so that figure is stale until the next publish or build pass corrects it.

Rewritten (6)¶

Each row now states two specific findings with their figures and PMIDs, plus the absence and the query behind it. - 1: ORBITA-program predictors versus CorMicA endotype-directed care. Added Taylor 2026 (PMID 42043369), a microvascular-stratified ORBITA analysis that came up in the live search. It partly connects the two literatures, so the junction was narrowed to the remaining gap: a trial randomizing PCI against endotype-directed therapy in patients with obstructive stenosis plus CMD or spasm. - 2: CHIP prognosis (Gumuser 2023) versus exploratory clone-by-treatment data (CANTOS TET2, Svensson 2022, PMID 35385050; LoDoCo2 clone dynamics, Mohammadnia 2025, PMID 40892620). The remaining gap is an event-powered CHIP-stratified trial. Both registered CHIP-selected trials (NCT07362966 and NCT06691217, both recruiting, 120 estimated) have imaging endpoints. - 5: PRS (Marston 2023; Natarajan 2017, PMID 28223407) versus cumulative LDL-C exposure (Zhang 2021). Live search found that the "genetic risk changes treatment" junction has been published in middle-aged adults: MI-GENES (Kullo 2016, PMID 26915630) and its 10-year post hoc events (Naderian 2025, PMID 40151934). EE-PRS (NCT06820086, active not recruiting, 2,714 actual, ages 45/55–80) is testing it at outcome scale. The row was narrowed to adults under 45. Powers gained OQ-32, because row 20's Dot A was folded in here. - 6: CR mortality (Dibben 2023) versus psychological-intervention mortality (Richards 2018). The original "kinesiophobia" framing was dropped: its only support is one qualitative study (Bäck 2020), which carries no effect estimate. Screening showed small CR-embedded psychological trials do report readmission events (Black 1998, PMID 9584539, null; Yu 2018, PMID 29297147, favourable), so a "no event data" claim would have been false. The absence was narrowed to "not sized for CV death/MI" and cites PATHWAY's own statement (Wells 2021, PMID 34148379). - 11: The event-trial discordance (COLCOT versus CLEAR SYNERGY, plus the Scheier 2026 compatibility analysis, PMID 42435998) set against the OCT discordance (COLOCT versus COCOMO-ACS, Psaltis 2025, PMID 39189611). The original row's "COLOCT/LoDoCo2 imaging" was one-sided; the live search found the null OCT trial. - 15: High-STEACS sex-specific thresholds (Lee 2019; Ferry 2019) versus multimodality MINOCA imaging in women (Reynolds 2021, PMID 33191769). The remaining gap is mechanism imaging in the reclassified population.

Deleted (14), with reasons¶

3 (CCTA low-attenuation plaque | PREVENT): junction registered. PREVENT-2 (NCT07569692, not yet recruiting, 2,500 estimated) randomizes CCTA-detected vulnerable plaque to an invasive strategy with preventive PCI versus OMT. A Korean outcome trial (NCT06863545, recruiting, 3,596 estimated) randomizes CCTA high-risk plaque (including low-attenuation plaque) to PCSK9 inhibitor plus background therapy versus background therapy alone, with MACCE as the endpoint. Both arms of the junction as written, "imaging-triggered systemic intensification" and "mechanical sealing", are being tested.
4 (REVIVED | STICHES): restates OQ-2/OQ-17, and the junction is partly published and partly under test. The REVIVED viability analysis already mapped scar to outcome: nonviable extent HR 1.07 per 10% for death or HF hospitalization, no viability × PCI interaction (Perera 2023, PMID 37878295). The route comparison is STICH3C (NCT05427370, recruiting, live-verified).
7 (SECURE | guideline individualization): restates OQ-15, and Dot B had no evidence. SECURE's polypill was itself dose-modular (ramipril 2.5/5/10 mg, atorvastatin 20/40 mg) (Castellano 2022, PMID 36018037), so "modular fixed-dose therapy with titration" is partly what the trial tested.
8 (women's symptoms/troponin | INOCA prevalence): duplicate of row 15. Its candidate evidence also cuts against the implied premise: typical symptoms were more common in women than men with MI (77% versus 59%) (Ferry 2019, PMID 31431112).
9 (dynamic bleeding risk | rehabilitation/falls/frailty): Dot B unsupported, and it duplicates row 13. The wiki mentions frailty and falls only in uncited table cells; no cited record gives a frailty or functional-recovery trajectory linked to bleeding.
10 (Lp(a) outcome trials | global access gap): Dot A has no finding. The row was conditional ("if trials are positive"). Lp(a)HORIZON still has no primary outcome report: PubMed (pelacarsen[tiab] OR "Lp(a)HORIZON"[tiab]) AND (outcome*[tiab] OR events[tiab]) AND 2026[dp] returned 25 records, all reviews or meta-analyses, on 2026-10-07.
12 (type 2 MI heterogeneity | plaque/CMD imaging): junction published. DEMAND-MI imaged 93 patients with type 2 MI by coronary and cardiac imaging and found CAD in 68%, previously unrecognized in 60% of those (Bularga 2022, PMID 35341327). DEFINE TYPE 2 MI found plaque in 92% on CCTA/FFR-CT (McCarthy 2023, PMID 37777947). The randomized strategy trial linking investigation to treatment has a published design, ACT-2 (n=1,800 planned; Lambrakis 2019, PMID 30522086). Query: "type 2 myocardial infarction"[tiab] AND (coronary[tiab]) AND (prospective[tiab] OR cohort[tiab]) AND ("computed tomography"[tiab] OR "magnetic resonance"[tiab]), 5 records.
13 (AF-PCI aspirin withdrawal | frailty/renal trajectories): Dot B unsupported. No condition evidence gives frailty or renal-function trajectories, and the row duplicates row 9 and OQ-8's own SMART specification.
14 (global quality gap | polypill and CR): restates OQ-13's decision-ready specification, and its population-coverage element is already published. PolyIran randomized whole villages within a 50,045-person cohort: MACE 5.9% versus 8.8%, adjusted HR 0.66 (Roshandel 2019, PMID 31448738).
16 (sex-specific troponin recognition | treatment delivery): both dots are the same paper, and the junction was tested in it. High-STEACS itself showed that added detection did not convert into treatment or outcomes (Lee 2019, PMID 31623760). The row restated OQ-29; the surviving content lives in row 15.
17 (neutral ECLS | shock-stage heterogeneity): junction published. The 4-trial ECLS IPD meta-analysis (n=567) found no 30-day mortality benefit and consistent prespecified subgroups (P-interaction ≥0.079) (Zeymer 2023, PMID 37643628). Its DanGer-Shock-like phenotype analysis (STEMI, low likelihood of brain injury, n=202) found 180-day HR 0.84 (95% CI 0.56–1.26), with more bleeding and vascular complications (Zeymer 2024, PMID 39217624). The phenotype-selected device trial that was positive used a different device (microaxial pump, DanGer Shock: 45.8% versus 58.5%, HR 0.74; Møller 2024, PMID 38587239).
18 (total lipid-lowering events | recurrent antithrombotic events): both dots make the same claim, and the junction restates OQ-30. Each dot says only that a total-events reanalysis exists, one for bempedoic acid and one for prasugrel (Nicholls 2024; Murphy 2008). That is two instances of one method, not two literatures.
19 (SCAD | STEMI reperfusion networks): junction published. In the Canadian SCAD Study, 64/351 SCAD STEMI patients (18.2%) received thrombolysis before angiography. In-hospital MACE was 6.3% with thrombolysis versus 11.5% without; MACE over a median 3.2 years was 4.8% versus 13.9% (P=0.054) (McAlister 2026, Can J Cardiol, PMID 41173456). This is exactly the "registry evidence" the row asked for. Query: ("spontaneous coronary artery dissection"[tiab]) AND (thromboly*[tiab] OR fibrinoly*[tiab]), 92 records.
20 (cumulative young-adult LDL | threshold-based intensification): restates OQ-32 almost verbatim, and Dot B was uncited. Zhang 2021 was folded into row 5.

Could not resolve / follow-ups¶

COLCOT CHIP paper unread. "Low-Dose Colchicine Attenuates Clonal Hematopoiesis in COLCOT" (Tardif 2026, Circulation, PMID 41730026) has no abstract in PubMed or Europe PMC, so its content was not read and it is not cited. If it reports a CHIP × colchicine interaction on events, row 2's absence claim is wrong. The next auditor should obtain the full text.
Row 6 registry search not usable. The ClinicalTrials.gov queries for CR-embedded psychological trials returned hundreds of off-topic records (cardiac rehabilitation AND (metacognitive OR cognitive behavioral therapy OR psychotherapy OR stepped care) AND (coronary OR myocardial infarction), 452 records), so row 6's absence rests on PubMed alone. CENTRAL could not be searched (HTTP 403, per SOURCES.md), so this is not a "no trials anywhere" claim. That limit applies to every absence in the table.
Pages and questions to update in a later pass (outside this pass's write scope, so not edited here):
OQ-31 and red-flags-and-safety-concerns.md should cite McAlister 2026 (PMID 41173456).
OQ-20 and biomarkers.md should note PREVENT-2 (NCT07569692) and NCT06863545.
inoca-and-special-phenotypes.md should note Taylor 2026 (PMID 42043369).
OQ-26 should cite DEMAND-MI (PMID 35341327) and ACT-2 (PMID 30522086).
OQ-28 should cite the ECLS IPD analyses (PMIDs: 37643628, 39217624) and DanGer Shock (PMID 38587239).
INDEX.md "20 cross-domain junctions" should read 6.
The new records cited only in the dots table are not yet in BIBLIOGRAPHY.md: 42043369, 35385050, 40892620, 37197843 (already wiki-cited), 28223407, 26915630, 40151934, 34148379, 9584539, 29297147, 39189611, 42435998 and 33191769. This pass was not permitted to edit the literature layer.

2026-10-07 — Audit of the dot-table grounding pass (auditor: Grok; author of the changes: claude, Opus 5.5)¶

Scope. Independent audit of the grounding pass recorded above. All 20 rows in "Dots not yet connected" were uncited before that pass, so all 6 survivors (rows 1, 2, 5, 6, 11, 15) and all 14 deletions were in scope. Records were re-fetched in this session through PubMed E-utilities and ClinicalTrials.gov API v2, and Crossref updated-by / relation was checked for the cited DOIs. No cited record is a Retracted Publication or an Expression of Concern in PubMed, and none carries a Crossref retraction or expression of concern. Kelshiker's erratum (PMID 36437227, PMC9805404) corrects the author list and the appendix; the hazard ratios in the abstract are unchanged. Reynolds (PMID 33191769) has an ErratumIn link (PMID 36802888). The imaging fractions used in the row are the ones in the abstract, which was re-read; the erratum body was not re-read in this audit.

Rows checked, and citations that failed verification¶

Six surviving rows were re-read against the live records. The PMIDs and NCT IDs exist and are the papers and trials the rows name. The failures were figures, populations, and one absence.

Row 1, motivated anchoring (the one case). Kelshiker 2022 (PMID 34849697) was cited for an all-cause mortality HR of 3.78 (95% CI 2.39–5.97) inside the cell about patients without obstructive disease. That estimate is the mixed-pathology result across 79 studies. The same abstract gives the isolated coronary microvascular dysfunction estimates: mortality HR 5.44 (95% CI 3.78–7.83) and MACE HR 3.56 (95% CI 2.14–5.90). The row now uses those. Taylor 2026 (PMID 42043369) was also incomplete: the +48 s exercise-time benefit is at the 20th centile of computational microvascular resistance (95% CrI 6–92), and the +16 s figure is at the 80th centile (95% CrI −29 to 61), in 131 ORBITA patients. The interaction probability (83.1%) was already right. The absence still holds: the written PubMed query returned 15 records, and the written ClinicalTrials.gov interventional query returned 0 on re-run.
Row 2. Gumuser, Svensson, and Mohammadnia figures match their abstracts. "CHIP-selected" was too tight: NCT07362966 and NCT06691217 each enroll TET2-CHIP and non-CHIP participants, both are recruiting, both estimate 120 participants, and both use imaging primaries. "Rests on one post hoc subgroup" was incomplete. The COLCOT sequencing preprint (Tardif, Busque, Dubé; medRxiv doi:10.1101/2024.10.17.24315679, posted 2024-10-18, preprint, not peer reviewed) reports a composite endpoint, with any coronary revascularization added to the COLCOT primary endpoint, of 2 (4.2%) versus 4 (8.3%) among TET2 CHIP carriers at VAF ≥2% (HR 0.62, 95% CI 0.11–3.42; p=0.58) and 58 (7.6%) versus 65 (8.7%) without TET2 CHIP (HR 0.85, 95% CI 0.60–1.21; p=0.36). Randomization was not stratified on CHIP. The published letter (PMID 41730026) was fetched: it is a Letter with an empty abstract, Crossref updated-by is empty, and the full text was not read, so the event counts are cited from the preprint the letter's mutation-burden analysis comes from. The remaining absence holds: no trial has stratified randomization on CHIP with clinical events as the powered outcome. The written ClinicalTrials.gov query still returned 7 records, 2 relevant; the written PubMed query still returned 34.
Row 5, stale absence. Marston, Natarajan, Kullo, and Naderian figures match. Naderian's 2 versus 9 MACE are the integrated-risk arm versus the Framingham arm (HR 0.20, 95% CI 0.04–0.94), post hoc, 11 events. Zhang's HR 1.57 (95% CI 1.10–2.23; P for trend 0.01) is the top-versus-bottom-quartile contrast for CHD, with no association for ischemic stroke or heart failure. The PubMed abstract omits that contrast. Europe PMC full text returned HTTP 500 and the PMC HTML page was blocked, so the quartile wording was taken from a live fetch of the PACE-CME report of the results, which quotes the top-versus-bottom comparison, and the hazard ratio matches the abstract. The two absolute sentences were false. The written PubMed query returned 2 records and cannot see registry-only trials. ClinicalTrials.gov API v2 on 2026-10-07, interventional polygenic risk (statin OR lipid OR LDL OR cholesterol), returned totalCount 30. NCT05850091 (ages 40–75) assigns rosuvastatin 20 mg. NCT05603663 (ages 25–44, status UNKNOWN) discloses high polygenic risk and allows cholesterol treatment if appropriate, with body-mass index as the primary outcome. NCT07087431 (ages 30–75, recruiting) discloses a CAD polygenic risk score and measures 12-month LDL-C; it does not assign a statin. The row now states the remaining gap: no registered trial is powered for cardiovascular events from PRS-triggered lipid-lowering restricted to adults under 45. EE-PRS (NCT06820086) is that outcome-scale statin trial, and its floor is 45 for men and 55 for women. Its control arm is usual primary care, which may still start cholesterol-lowering treatment.
Row 6. Dibben, Richards, Wells, Black, and Yu match. The row had dropped Wells's interval (−4.67 to −1.81 at 4 months), Chong's interval (23.58%, 95% CI 22.86–24.32), and Yu's rates (all-cause readmission 12.0% versus 25.4%; emergency visits 13.3% versus 35.6%). Yu's participants were referred by cardiologists; the conclusion locates the method in cardiac rehabilitation programs. The absence holds. The exact PubMed query was re-run (count 60) and the titles screened. The nearest records do not falsify it: CBR-CARDIO (PMID 37189029) sets cardiac anxiety at 12 months as the primary outcome (n=410), and PMID 41803954 (n=200) sets lipids and cardiac imaging as the primary outcomes and does not report event counts. Neither is retracted (PubMed publication types; Crossref relation empty). CENTRAL was not searched (HTTP 403).
Row 11. Event and OCT figures match, including the cap-rupture direction (placebo 27.6% versus colchicine 3.6%, P=0.03). "Pericoronary fat attenuation unchanged" was the wrong verb: Fiolet 2025 (PMID 40393691) is cross-sectional, and attenuation did not differ between arms (−79.5 versus −78.7 HU, p=0.236), with higher calcified-plaque volume on colchicine (169.6 versus 113.1 mm³). CLEAR SYNERGY's CRP difference is a 3-month subgroup least-squares mean of −1.28 mg/L (95% CI −1.81 to −0.75). COCOMO-ACS randomized 64; the imaging comparison is among 57 with evaluable serial OCT. The written PubMed queries still returned 14 and 21, and neither result set is an event-linked serial-plaque analysis. Scheier's conclusion supports the sentence that was written.
Row 15. Lee, Ferry, and Reynolds fractions match. "About half" was replaced with revascularization 15% versus 34%, dual antiplatelet therapy 26% versus 43%, and statin 16% versus 26%. Reynolds's 24.5% is 24/98 among women with an identified mechanism; 24/116 (20.7%) of all women imaged had a non-ischemic cause. The two dots are different claims (threshold implementation versus mechanism imaging in MINOCA). The written searches were not re-opened as a new absence; the junction they name was not contradicted by the records read for this row.

Motivated-anchoring count: 1 (the Kelshiker mixed-population hazard ratio placed in the non-obstructive cell). The other failures were omitted intervals, an unlabeled quartile contrast, a cross-sectional result described as a change, and an absence that a registry search falsifies.

Rows the auditor deleted: none. Each surviving pair is two different claims. Rows repaired: 1, 2, 5, 6, 11, and 15. Row IDs were not renumbered and no deleted row was restored.

Deletions (14): the stated reasons, checked¶

The deletions stand. Four reasons were overstated, and the sentence the row could have carried is recorded here.

3. Deletion stands because OQ-9 already asks whether vulnerable-plaque PCI adds benefit on top of systemic prevention, and the two component strategies are under separate test. The stated reason overreaches: neither trial randomizes the sequence of systemic intensification before sealing. PREVENT-2 (NCT07569692, not yet recruiting, 2,500 estimated) randomizes an initial invasive strategy versus an initial conservative strategy for CCTA moderate stenosis plus at least two high-risk plaque features; the primary outcome is a 3-year composite. NCT06863545 (FLAVOUR IV, recruiting, 3,596 estimated) randomizes a PCSK9 inhibitor plus background lipid-modifying therapy versus standard lipid-modifying therapy and excludes target lesions that underwent or are planned for revascularization; the primary outcome is MACCE at 24 months.
4. Deletion stands. Perera 2023 (PMID 37878295) found no viability-by-PCI interaction; nonviable extent HR per 10% absolute increase 1.07 (95% CI 1.00–1.15) for the primary outcome. STICH3C (NCT05427370) was re-fetched: recruiting, last update 2026-10-02, 754 estimated, LVEF ≤40%, PCI versus CABG, primary composite over a median 5 years. That is the content of OQ-2 and OQ-17.
7. Deletion stands as a restatement of OQ-15. SECURE's within-pill dose choices (Castellano 2022, PMID 36018037) are real. Calling protocolized add-on titration to targets "what the trial tested" overclaims the design.
8 and 16. Deletions stand. Row 8 duplicated row 15, and Ferry 2019 found typical symptoms in 77% of women with MI versus 59% of men. Row 16's two sides are High-STEACS itself (Lee 2019, PMID 31623760): added detection did not become treatment or a better primary outcome.
9 and 13. Deletions stand as duplicates of each other and of OQ-8's own specification. This audit did not run a new world-literature search for functional-recovery trajectories linked to bleeding beyond the condition's cited pool, so the deletion is not a positive finding that nothing exists.
10. Deletion stands. A broader PubMed re-run returned 51 records (reviews, surrogate analyses, and design papers). The conditional outcome claim still has no primary result in that set. Lp(a)HORIZON and OCEAN(a)-Outcomes were not re-fetched here; OQ-7 already names them.
12. The imaging connection is published: DEMAND-MI (Bularga 2022, PMID 35341327) found CAD in 63/93 (68%) of provisional type 2 MI, and DEFINE TYPE 2 MI (McCarthy 2023, PMID 37777947) found plaque in 46/50 (92%). The treatment sentence should have said "published design," not published results. ACT-2 (Lambrakis 2019, PMID 30522086) is a design paper (1,800 planned); a PubMed query for ACT-2 results returned that record only. ACT-2 randomizes an investigation strategy. Deletion can stand because the keyword pair has been connected and OQ-26 is the treatment question. The Bularga erratum body was not read; the deletion does not depend on a figure that erratum would move.
14. Deletion stands as a restatement of OQ-13. PolyIran (Roshandel 2019, PMID 31448738) nested the trial in the Golestan Cohort of 50,045 and randomized 6,838: major cardiovascular events 202/3,421 (5.9%) versus 301/3,417 (8.8%), adjusted HR 0.66 (95% CI 0.55–0.80). The log's "50,045-person cohort" is the parent cohort. The polypill in that trial is aspirin, atorvastatin, hydrochlorothiazide, and enalapril or valsartan.
17. Deletion stands. Zeymer 2023 (PMID 37643628): 4 trials, n=567, 30-day death OR 0.93 (95% CI 0.66–1.29), prespecified subgroups consistent (P-interaction ≥0.079). Zeymer 2024 (PMID 39217624): DanGer-like phenotype, n=202, 180-day mortality 45% versus 51%, HR 0.84 (95% CI 0.56–1.26). DanGer Shock (Møller 2024, PMID 38587239) used a microaxial pump: 45.8% versus 58.5%, HR 0.74 (95% CI 0.55–0.99). OQ-28 still does not cite these papers; updating it was outside this pass.
18. Deletion stands. Both dots are instances of a total-events reanalysis, and OQ-30 already cites Nicholls 2024 (PMID 38231501) and Murphy 2008 (PMID 18682445). Nicholls has an ErratumIn link (PMID 38776069). The erratum body was not read, and the deletion does not depend on a specific figure.
19. Deletion stands. McAlister 2026 (PMID 41173456): 64/351 (18.2%) of SCAD STEMI patients received intravenous thrombolysis before angiography; in-hospital MACE 6.3% versus 11.5% (p=0.926); median 3.2-year MACE 4.8% versus 13.9% (p=0.054). That is the registry evidence the row asked for. OQ-31 was not edited.
20. Deletion stands as a duplicate of row 5 and of OQ-32, once row 5 keeps Zhang and the corrected trial gap.

Judgement for the novelty gate¶

Before this audit the six-row table could not be trusted by the novelty gate: row 5 asserted an absence that ClinicalTrials.gov falsifies, and row 1 attributed the mixed-population hazard ratio to the non-obstructive population. After the repairs, the six rows can be trusted by the gate. Each row now has two distinct claims, the numbers that were checked match the records they cite, the absences that remain name the query and the source, and no cited record is retracted.

Limits that a later pass should keep in view: the COLCOT letter's full text was not read, so if its events analysis differs from the preprint, row 2 should be re-read; CENTRAL and SciELO were not searched (HTTP 403); the Zhang full text was not retrieved from PMC or Europe PMC; the Bularga and Nicholls erratum bodies were not read; NCT05603663 and NCT04291157 are status UNKNOWN; and rows 9 and 13 had no new search outside the condition's cited pool. INDEX.md still says "20 cross-domain junctions"; this audit was not permitted to edit it.

2026-10-22 — Literature sweep (author: claude, Opus 5.5; window 2026-08-28 to 2026-10-22)¶

First periodic sweep since the build. An independent audit by a different engine is required before any demoted page is re-promoted.

Sources actually queried¶

PubMed E-utilities (esearch/esummary/efetch; the PubMed MCP connector was not authorized in this session): 21 recorded queries plus one entry-date variant of the core-journal RCT query (33 records). Topics: Cochrane (IHD-specific, 3; broad cardiovascular, 12), RCTs in nine core journals (32), meta-analyses in core journals (3), guidelines/statements (49), GBD/burden (36), colchicine (36), Lp(a) agents (21), Lp(a)HORIZON (13), ziltivekimab/ZEUS/HERMES (16), ORION-4/inclisiran outcomes (3), olpasiran (12), post-MI beta-blockers (10), antiplatelet/DAPT (15), INOCA/MINOCA/vasospasm (37), SCAD (35), cardiac rehabilitation (41), polypill (7), GLP-1 in coronary disease (9), non-statin outcomes (22), 2026 US dyslipidemia guideline (11). Query strings, translations, counts and PMIDs are in literature/sweeps/2026-10-22.json.
ClinicalTrials.gov API v2: all 30 NCT IDs cited by the condition re-fetched.
Europe PMC REST: Lp(a)HORIZON (29 hits) and ziltivekimab/ZEUS (30 hits) for primary reports not in MEDLINE; full-text request for Dibben 2026 returned HTTP 500.
Crossref: updated-by for every added DOI (33 records).
ISRCTN API: four count queries (coronary colchicine 5; CR coronary 66; MI 1,545; Lp(a) cardiovascular 0); nothing cited.
Not searched: Cochrane Library/CENTRAL and SciELO/LILACS (HTTP 403 per SOURCES.md); WHO ICTRP (JS portal, no programmatic search); jRCT (connection failed); Unpaywall skipped because LIFEBANK_CONTACT_EMAIL is unset, and no mailto was sent to Crossref. Every absence below is an absence in the named source only.
Patient organizations: 9 URLs in patient-voice/organizations.md re-fetched; 8 returned 200; INOCA International (/patients/) returned 403, probably a bot block. Not edited. No new patient-organization material was looked for beyond that liveness check.

Findings that changed content¶

Lp(a)HORIZON topline neutral. A review states that topline results announced in September 2026 showed pelacarsen lowered Lp(a) but did not reduce the primary composite, with full data awaited (Sabouret 2026, PMID 42880684; JAMA news item PMID 42886494 consistent, not cited). No primary report in PubMed or Europe PMC. Updated lipid-lowering.md, inflammation-and-residual-risk.md, clinical-trials-landscape.md, guidelines.md, biomarkers.md, OQ-7, the registry watch list and STATISTICS. The wiki now attributes the neutral result to the review of the announcement, not to a trial report, and gives no effect size.
Cochrane CR update (Dibben 2026, PMID 42754260; 107 trials, 26,886 participants). It stratifies by follow-up. At 6–12 months, MI RR 0.72 (high certainty) and hospitalization RR 0.65, but cardiovascular mortality RR 0.87 (95% CI 0.68–1.11). This corrected an error: the cardiac-rehabilitation-and-lifestyle.md outcome table said recurrent MI was "uncertain/smaller effect", which contradicted both the 2026 review and the page's own Dibben 2023 figure (RR 0.82). The row now shows the reduction, and the cardiovascular-mortality row is qualified by follow-up window. Full text is under PMC embargo, so the medium- and long-term estimates were not read and are not reported. Also added Long 2026 (PMID 42823225; uptake interventions) to the page and OQ-14.
Ziltivekimab programme status. HERMES (NCT05636176) TERMINATED 2026-09-03 with 4,874 actual (the page had said active, 4,899). The registry reason is only "No longer looking for participants"; a review says it was stopped for futility (Packer 2026, PMID 42833572). ARTEMIS is now ACTIVE_NOT_RECRUITING (pages and OQ-6 said recruiting). ZEUS has no primary publication. OQ-6 sharpened.
New trials and meta-analyses added to pages: VESALIUS-CV primary report and mortality analysis (Bohula 2026, PMID 41211925; Giugliano 2026, PMID 42670293), AMUNDSEN (PMID 42666092) and BRIDGE (PMID 42671370) → lipids; AIR-STEMI (PMID 42670979) → ACS and OQ-12; three randomized rapid-troponin implementation trials (PMIDs: 42667934, 42159533, 42895015) → biomarkers; IPD NMA of AF-PCI (PMID 42669062) and EPIDAURUS, stopped early for safety (PMID 42668287) → antithrombotics; imaging-guided PCI meta-analysis (PMID 42747372) and its regional-heterogeneity counterpart (PMID 42690150) → revascularization; ViVA vericiguat in vasospasm, neutral (PMID 42670734) → INOCA. Figures were checked against the abstracts. AIR-STEMI's composite was not broken into components because the abstract does not give them; the page says so.
Guideline registry gap closed. The registry had no US cholesterol guideline at all. Added the 2026 ACC/AHA multisociety dyslipidemia guideline (PMID 41824552; JACC PMID 41824590; two corrections, no retraction). Its recommendation tables were not read, so registry disagreement 1 and the US side of the lipid-lowering.md targets paragraph are now marked stale rather than rewritten. Also added the 2026 ESC/ERA CVD–CKD guideline (PMID 42661426; no abstract, content unread), the 2026 ACC and AHA antiplatelet scientific statements (PMIDs: 42377293, 42866888) and the EAPC lifelong post-ACS roadmap (PMID 42017832).
Statistics: added GBD 2023 US-state IHD mortality and attributable risks (Benziger 2026, PMID 42455550), ICCPR Latin America/Caribbean CR coverage (Ghisi 2026, PMID 42790273), the 2026 Cochrane CR estimates, and a sweep quick-reference block; caveat 4 separates the 2023 and 2026 CR estimands.

Triaged out (no content change)¶

Cochrane protocols with no results: OAC monotherapy vs OAC+antiplatelet in stable CAD (PMID 42813446), lipid-lowering NMA (42746925), treat-to-target (42803656), lipid monitoring (42757711), lipid service delivery (42757654). Worth re-checking for completed reviews.
STAREE (PMID 42670961; primary prevention in older adults), TARGET-D (42702500; neutral primary), TELECOR (42892836) and PROACT 1/2 (41706060) are catalogued in BIBLIOGRAPHY as not yet cited.
PROACT does not falsify dots row 5. It reports genotype-first recruitment and plaque prevalence (102/204 with subclinical plaque), not events, and is not restricted to under-45s. The row's absence claim stands.
Seen but not read or used: SWEDEGRAFT 7-year (PMID 42814420), ART BITA secondary analysis (42684718), FAME 3 completeness (42670204), FUSION CT-FFR (42670732), NATURE thrombectomy (42670735), BRIGHT-4 subgroup (42663356), CLEAN nicorandil (42584383), ABYSS heart-rate analysis (42267437), SELECT hsCRP (42610271), ACHIEVE-4 (42815506), Kylo-11 phase 1 (42664979), VICTORION-Challenge (42670194), ADHERE-ASCVD (42667613), PACER (42804196), iPSC cardiomyocytes in ischemic HF (42618633), and many small-journal meta-analyses that duplicate cited evidence.
Colchicine: no new outcome RCT in the window; the COLCOT CHIP letter (PMID 41730026) full text is still unread.

Retraction checks¶

All 33 added PMIDs were checked against PubMed publication types and comment/correction links, and against Crossref updated-by by DOI. None is retracted or under an expression of concern.

Status changes¶

Demoted to draft (last-curated 2026-10-22): acute-coronary-syndromes, antithrombotic-therapy, biomarkers, cardiac-rehabilitation-and-lifestyle, clinical-trials-landscape, guidelines, inflammation-and-residual-risk, inoca-and-special-phenotypes, lipid-lowering, revascularization-pci-and-cabg. The six untouched pages stay curated. In INDEX.md, the Pages table statuses were updated and the stale "20 cross-domain junctions" figure was corrected to 6, as the 2026-10-07 entries requested.

Next sweep should chase¶

Lp(a)HORIZON primary publication (effect sizes in the two registered primary populations, Lp(a) ≥70 mg/dL and ≥90 mg/dL per the NCT04023552 record fetched 2026-10-22, plus safety); then replace the Sabouret-based sentence everywhere it appears.
ZEUS primary results, and a published HERMES report confirming the futility stop.
Read the 2026 ACC/AHA dyslipidemia guideline recommendation tables, then reconcile registry disagreement 1, lipid-lowering.md "Targets and sequencing", and guidelines.md.
Dibben 2026 full text once the embargo lifts: the >12-month cardiovascular-mortality and MI estimates.
AIR-STEMI components (full text); ESC/ERA CKD guideline content; OCEAN(a)-Outcomes and ORION-4 status.
overview.md and other curated pages still cite only Dibben 2023 for CR. They are accurate but could note the 2026 update; they were left alone to keep this sweep's write set small.
Carried over: the COLCOT CHIP letter full text, and the INOCA International URL (403).

Housekeeping¶

Catalogued in BIBLIOGRAPHY.md the 14 dots-table records that the 2026-10-07 passes said were missing (26915630, 28223407, 29297147, 33191769, 34148379, 35385050, 37189029, 39189611, 40151934, 40892620, 41803954, 42043369, 42435998, 9584539). Each was re-resolved live and retraction-checked; none is retracted, and 33191769 has an erratum (36802888). After this, every PMID cited anywhere in the condition is in the bibliography.
Two unsourced descriptive phrases about olpasiran (drug class, depth of suppression) were drafted and then removed before saving, because no record retrieved in this session supported them.

2026-10-29 — Periodic literature sweep (author: Codex; window 2026-08-28 through 2026-10-29)¶

Sources actually queried and coverage boundaries¶

Read first: CONVENTIONS.md, CLAUDE.md, SOURCES.md, this log (including 22 October follow-ups), and INDEX.md. Only this condition was edited. No git, publication or deployment commands were run.
PubMed E-utilities: 37 date-restricted esearch queries, with translations and returned identifiers preserved in the search manifest, plus live efetch verification of additions and follow-up sources. Fourteen topic searches covered burden/registries, plaque biology/genetics, stable CAD, ACS/shock, revascularization, lipids, antithrombotics, inflammation, rehabilitation/lifestyle, special phenotypes, biomarkers/imaging, guidelines, patient experience and safety. Each had a separate CDSR journal query. Additional searches covered corrected lipid syntax, broad cardiovascular CDSR, HORIZON, ZEUS/HERMES, definitions/guidelines, nine core journals, burden and ORION-4. The original unquoted lipoprotein(a) query was overly restrictive (38 hits); the corrected quoted search returned 677 and is recorded separately. This preserves the actual query rather than silently replacing it.
Discovery versus appraisal: the initial broad PubMed queries returned 13,862 distinct IDs, with 13,838 PubmedArticle metadata records retrieved; 24 IDs did not resolve as PubmedArticle elements and supplied no new citations. This was broad discovery, not full-text appraisal of 13,838 papers. Triage concentrated on the 52 core-journal randomized/synthesis hits, relevant guideline/definition documents, Cochrane reviews and the named follow-ups. Most incidental, off-condition, mechanistic, duplicate and secondary-review material was not retained.
Cochrane: searched CDSR through PubMed per topic, plus two broader lipid/cardiovascular queries. The completed coronary rehabilitation update was already incorporated on 22 October (Dibben 2026, PMID 42754260). The lipid-strategy and stable-CAD anticoagulation reviews remain protocols in the retrieved records; they do not supply outcome estimates. Other completed CDSR hits concerned populations/interventions outside this condition's present questions and did not warrant changes. Cochrane Library/CENTRAL was not searched (HTTP 403 per SOURCES.md).
Europe PMC REST: queried all fourteen topics; then exact HORIZON/ZEUS follow-ups, full-text availability for key documents, ORION-4, and fifteen phrase/field refinements. Initial broad queries were noisy and several were capped at 1,000 records; the manifest gives total and retrieved counts. Focused HORIZON/ZEUS and exact ORION-4 results were not truncated. No DOI-only record survived triage; no identifier was inferred for a non-MEDLINE hit.
ClinicalTrials.gov API v2: re-fetched all 30 previously cited NCT records, comparing current overall status, last-update date and results availability with the 22 October manifest. Also resolved LIBREXIA ACS, SAPPHIRE-LDL, CLEAN and the OCEAN expanded-access cross-reference, and searched ORION-4 directly. These were current-snapshot checks, not a full version-history audit.
Non-US registries: ISRCTN API queries for coronary disease, lipoprotein, colchicine and cardiac rehabilitation returned 1,332, 382, 31 and 264 records respectively; first 100 retrieved where totals exceeded 100. The exact ART identifier query returned its single record (ISRCTN46552265; updated 25 September). Broad registry hits are discovery, not evidence that all trials/results were reviewed. WHO ICTRP returned HTTP 403. jRCT returned a page shell without an interpretable result list; it is not counted as a completed search. No absence outside these retrieved registry subsets is asserted.
Crossref: resolved every added DOI and checked updated-by, alongside PubMed publication types and correction links. One rate-limit response was retried successfully. No personal email or mailto was sent. Unpaywall was skipped because LIFEBANK_CONTACT_EMAIL is unset.
Official guideline sources: ACC and ESC current-document libraries; ESC rehabilitation and universal-definition release pages; AHA dyslipidemia resource hub. Read the rehabilitation publisher text (Recommendation Tables 3/4) and the open Global Heart universal-definition co-publication (Table 1, section 14.1.5). The US dyslipidemia recommendation tables and both new EHJ correction bodies remained inaccessible. ACC also lists a 2026 CKM guideline, but its primary text was blocked; no recommendations were imported from that listing.
Statistics and patient organizations: BHF statistics portal and revised August 2026 compendium; Table 1.14 was extracted and PDF page 23 rendered and visually checked. Global Heart Hub's September Asia-Pacific patient-partnership release was retrieved and read; the full report was not appraised. WomenHeart's 2026 symposium was screened through its official search result (direct fetch 403) and not added. INOCA International still returned 403. WHF's 2026 report concerns congenital heart disease and was excluded from this IHD sweep.
Regional boundary: SciELO and LILACS could not be searched (HTTP 403 per SOURCES.md). No global or Latin-American absence claim follows from the accessible databases. OpenAlex, DOAJ and subscription databases were not queried.

Findings and changes¶

Fifth Universal Definition of MI: added the EHJ record, its correction and the open Global Heart co-publication (Mills 2026, PMIDs: 42661425, 42905436, 42666939). These describe one consensus document, not independent corroboration. Updated ACS, biomarkers, INOCA and guideline synthesis: numerical MI labels are now identified as historical; acute SCAD/embolism/vasospasm map to primary MI; rapid-triage troponin cutoffs are distinguished from sex-specific diagnostic injury thresholds. Brief verbatim anchors and full-text locations are recorded on the topic pages. OQ-26 now asks how re-adjudication changes historical cohorts and treatment estimates. The correction body still needs reconciliation; no detailed new procedure-related thresholds were imported.
Dedicated ESC rehabilitation guideline: added Bäck 2026 and its correction (PMIDs: 42661418, 42921976) to the registry/bibliography and recorded Recommendation Table 4 on the rehabilitation page. OQ-14 remains an implementation/access question. The correction body was blocked, so extracted grades are explicitly provisional. No new long-term Cochrane estimates were added: the Europe PMC fullTextXML request again returned HTTP 500.
Important primary reports, limited appraisal: catalogued LIBREXIA ACS (Gibson 2026, PMID 42670965), ART 15-year analysis (Taggart 2026, PMID 42684718), SAPPHIRE-LDL (Machline-Carrion 2026, PMID 42485013) and CLEAN (Huang 2026, PMID 42584383). Abstracts identify important neutral or implementation findings, but full texts were blocked, failed retrieval or remained unread. Only LIBREXIA's publication availability and verified registry state were linked in the trial landscape; no numerical efficacy/bleeding estimates or practice recommendations were imported. The other three remain bibliography-only. No landmark deep note was justified by the available appraisal.
Trial snapshots: no overall-status or results-availability changes among the original 30 versus 22 October. OCEAN(a)-Outcomes was updated on 27 October but remains active without recruitment and without posted results (NCT05581303). The registry retains an estimated primary completion in March 2028. LIBREXIA ACS is registry COMPLETED without posted results (NCT05754957); this registry label is retained separately from the abstract's futility-stop description. ORION-4 is active without recruitment and has no posted results; its last posted update was 1 May and primary completion remains estimated October 2026 (NCT03705234). An estimated month is not evidence that follow-up has actually completed.
HORIZON and ZEUS follow-ups: targeted PubMed and Europe PMC results still did not identify primary outcome reports. The condition's existing review-attributed HORIZON interpretation is retained (Sabouret 2026, PMID 42880684); no effect size was invented. OQ-7 and the trial-landscape source/date boundary were refreshed. This is an absence in the named retrieved sources, not a claim about all conference/registry material.
Statistics: added UK 2024 CHD mortality from BHF Table 1.14, with ICD-10 scope, sex counts, national-statistics provenance and the non-resident caveat. This is separate from modeled GBD estimates. The compendium gives August 2026 without a day; it is newly checked here, not asserted to have been released after 28 August.
Patient voice: added the official September Global Heart Hub Asia-Pacific patient-partnership release to the annotated source list, explicitly as CVD-wide advocacy, not outcome or prevalence evidence. No individual patient narratives were extracted.
Inventory and status: bibliography now has 308 resolved records (nine additions including corrections/co-publication); registry has 27 documents; INDEX inventory refreshed. Six edited wiki pages retain status: draft and have last-curated: 2026-10-29. The six untouched curated pages were not demoted or re-audited. Other changed ledgers carry an updated curation date. No page was promoted; independent audit remains required.

Retraction and verification result¶

All nine added PubMed records passed both live PubMed publication-type/correction checks and Crossref updated-by checks; no retraction or expression of concern was found. PubMed lists corrections on both new EHJ originals even though Crossref updated-by was empty, illustrating why both were checked. The manifest preserves per-record results and all API queries. Validation checks and the temporary strict build are recorded below after completion.

Next sweep should chase¶

Reconcile the MI-definition and rehabilitation correction bodies before relying on detailed new criteria/grades; independently audit this sweep.
Obtain LIBREXIA ACS full text and tables first; reconcile its registry endpoints, efficacy and bleeding hierarchy, interim stopping and actual analysis population before synthesis. Then appraise ART 15-year, SAPPHIRE-LDL and CLEAN full texts.
Retrieve the 2026 US dyslipidemia recommendation tables, including both corrections, and repair the still-stale US/ESC target comparison. Appraise the new ACC CKM guideline's IHD-relevant scope once accessible.
Continue HORIZON and ZEUS primary-report surveillance, HERMES outcome/futility confirmation, OCEAN(a)-Outcomes and ORION-4 results checks. Do not replace primary data with additional interpretive reviews.
Obtain Dibben 2026 full text for follow-up-specific long-term estimates; the abstract is insufficient for those numbers.
Carry forward AIR-STEMI component outcomes, the ESC/ERA CKD tables and COLCOT CHIP letter full text; they were not resolved in this sweep.
Follow the Asia-Pacific report's underlying recommendations and new regional patient-support resources, preserving the SciELO/LILACS coverage limitation. Retry the INOCA International page.
Prefer narrower fielded/quoted queries for the next interval; preserve retrieval caps and named-source absence boundaries rather than equating discovery volume with completed appraisal.

Validation¶

Passed: JSON parsing; every newly written PMID (including retained references on date-refreshed lines) resolved through this session's PubMed E-utilities queries; every newly written NCT identifier came from a live API result; all new relative links resolve; all six edited wiki pages retain draft status and the correct curation date. The three retained trial references were additionally re-fetched and Crossref-checked; none was flagged.
Inventory checked directly: 308 bibliography identifiers, 32 NCT identifiers now cited across condition markdown (the original 30 plus LIBREXIA ACS and ORION-4), 27 guideline-registry rows. Source changes: 13 markdown files plus the one legally placed manifest.
Full-site generation and mkdocs build --strict ran entirely under a temporary output directory. The full build stopped on one warning outside this condition: asthma/index.md links to an unpublished/missing asthma/literature/sweeps/2026-10-29.json. That file was not changed. The IHD manifest maps to sweeps/2026-10-29.json in the generated site; its log link resolved.
An isolated condition strict build is used to distinguish this sweep's validity from that unrelated whole-site blocker. No publishing, deployment, git commands or files outside this condition's source tree were changed.
Final result: isolated IHD mkdocs build --strict passed (0.45 s); citation/link/frontmatter checks passed with zero errors; all 19 Crossref lookups (nine additions plus ten follow-up/retained records) succeeded. The generated manifest copy was byte-for-byte identical to its source. Independent audit and the unrelated whole-site build blocker remain outstanding.