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ACC 2026 Late-Breaking Trials
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Left Atrial Appendage Closure or Anticoagulation for Atrial Fibrillation
Does device-based left atrial appendage closure prevent a composite of cardiovascular death, stroke, or systemic embolism compared to NOAC therapy in patients with atrial fibrillation who are suitable candidates for anticoagulation?
Result: At 3 years, the primary efficacy end point occurred in 5.7% of the device group and 4.8% of the anticoagulation group (difference, 0.9 percentage points; 95% CI, -0.8 to 2.6; P<0.001 for noninferiority).
“Left Atrial Appendage Closure or Medical Therapy in Atrial Fibrillation | New England Journal of Medicine https://t.co/fELezUF2Jl”
In patients with nonvalvular atrial fibrillation suitable for anticoagulation, left atrial appendage closure using the Watchman FLX device, at 3 years was noninferior to NOACs for the composite primary endpoint [of] cardiovascular death, stroke, and systemic embolization, and significantly reduced clinically relevant nonprocedural bleeding.
Left Atrial Appendage Closure or Medical Therapy in Atrial Fibrillation
Does left atrial appendage closure reduce a composite end point of stroke, systemic embolism, major bleeding, or cardiovascular or unexplained death in patients with atrial fibrillation at high risk for stroke and bleeding?
Result: Left atrial appendage closure was not noninferior to physician-directed best medical care with regard to a composite end point of stroke, systemic embolism, major bleeding, or cardiovascular or unexplained death.
“Left Atrial Appendage Closure or Medical Therapy in Atrial Fibrillation | New England Journal of Medicine https://t.co/fELezUF2Jl”
In general, the benefit from any percutaneous intervention in cardiology is often the greatest with regard to the most acute or life-threatening problem the patient is facing. In contrast, in clinical situations in which the patient’s life is not directly at risk and the symptoms are controllable by medical treatment, conservative management should always be considered to be an equally effective alternative.
Discontinuation of Beta-Blocker Therapy after Myocardial Infarction
Does discontinuation of beta-blocker therapy prevent adverse cardiovascular events compared to continuation in stable patients with LVEF ≥40% at least 1 year post-myocardial infarction?
Result: Discontinuation of beta-blocker therapy was noninferior to continuation for the primary composite endpoint (HR 0.80; 95% CI 0.57 to 1.13; P=0.001 for noninferiority).
At subsequent visits, it’s always an opportunity to revisit [and ask] can we reduce this pill burden? This study demonstrated in a more definitive fashion than the ABYSS study that yes, at 1 year, it is safe in patients with normal ejection fraction and no atrial fibrillation to stop that beta-bl...
Left Ventricular Unloading in High-Risk Percutaneous Coronary Intervention
Does elective left ventricular unloading with a microaxial flow pump improve clinical outcomes in patients with severe left ventricular dysfunction and extensive coronary artery disease undergoing complex PCI?
Result: Win ratio 0.85 (95% CI 0.63 to 1.15, P=0.30) for the primary hierarchical composite outcome, indicating no significant difference between groups.
“Left Ventricular Unloading in Anterior STEMI without Shock: The STEMI Door to Unload (DTU) Randomized Controlled Trial | JACC https://t.co/3vBWjrFz75 - time is heart but they waited”
The results were 'surprising because the whole premise of LV unloading was that it protects the heart.' But we found that patients assigned to LV unloading had more damage to the [LV] than those assigned to standard care. Our findings strongly suggest that we shouldn't be using this device routinely without more evidence of benefit.
Ultrasound-Facilitated, Catheter-Directed Fibrinolysis for Acute Pulmonary Embolism
Does ultrasound-facilitated, catheter-directed fibrinolysis with alteplase plus anticoagulation reduce the composite of pulmonary embolism-related death, cardiorespiratory decompensation or collapse, or symptomatic recurrence of pulmonary embolism within 7 days in patients with acute, intermediate-risk pulmonary embolism compared to anticoagulation alone?
Result: The primary composite outcome occurred in 4.0% of the intervention group versus 10.3% of the control group (RR 0.39, 95% CI 0.20-0.77, P=0.005).
This trial shows that a catheter intervention can indeed be effective and improve the prognosis for patients with severe PE and elevated risk of early death or life-threatening complications. If the right patients are selected for this procedure, it can prevent patients from deteriorating and it can do so at an acceptably low risk of bleeding complications.
2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines
Key Takeaway: The 2026 ACC/AHA guideline provides updated recommendations for the evaluation, management, and monitoring of individuals with dyslipidemias, replacing the 2018 blood cholesterol guideline.
Left bundle branch area vs biventricular pacing for cardiac resynchronization therapy: the LEFT-BUNDLE-CRT trial
Is left-bundle branch area pacing non-inferior to biventricular pacing for achieving a positive CRT response at 6 months in patients with guideline-based CRT indications and left-bundle branch block?
Result: The primary endpoint was achieved in 89.7% of LBBAP-CRT patients and 94.6% of BiVP-CRT patients (RR 0.95; 95% CI 0.88-1.02), not meeting the 10% non-inferiority margin.
“Left bundle branch area vs biventricular pacing for cardiac resynchronization therapy: the LEFT-BUNDLE-CRT trial In CRT candidates with typical LBBB, LBBAP-CRT was not shown to be non-inferior to BiVP-CRT. Both strategies yielded high response rates and similar clinical https://t.co/nJkdSOOOYM”
We now have randomized data showing that [LBBAP] is a very credible CRT option, with procedural advantages in some settings and clinical outcomes that are at least broadly comparable to BiV-CRT in selected populations. But I would still be cautious about overinterpreting the current evidence. These trials are important, but they do not yet justify a one-size-fits-all conclusion that LBBAP should replace conventional CRT across the board.
Sotatercept for Combined Post- and Pre-capillary Pulmonary Hypertension Associated With Heart Failure: Results from the Phase 2, Randomized, Placebo-Controlled CADENCE Study
Does sotatercept improve pulmonary vascular resistance in adults with combined post- and pre-capillary pulmonary hypertension associated with heart failure with preserved ejection fraction?
Result: Sotatercept reduced pulmonary vascular resistance at week 24 with Hodges-Lehmann shift estimates of -1.02 Wood units (95% CI, -1.81 to -0.23; P=0.004) for 0.3 mg/kg and -0.75 Wood units (95% CI, -1.52 to 0.03; P=0.024) for 0.7 mg/kg.
Similar to PAH trials, the benefits of sotatercept transcend the relatively modest reductions in resting PVR and highlight the importance of targeting inflammation, cell proliferation and endothelial function in HFpEF. As the biology of ligand traps evolves, sotatercept marks the first step in leveraging the power of signaling networks to reverse fibrosis and cellular hypertrophy. Notably, the CADENCE trial emphasizes the importance of targeting underlying biologic mechanisms responsible for disease, versus focusing solely on improving hemodynamic parameters.
Real-World Outcomes of Transcatheter Tricuspid Valve Replacement
Does Transcatheter Tricuspid Valve Replacement (TTVR) provide safe and effective outcomes at 30 days in a real-world population with severe tricuspid regurgitation?
Result: At 30 days, TTVR demonstrated acceptable safety, near-complete TR elimination, and significant health status improvements, with lower rates of new CIED implantation and bleeding compared to randomized clinical trial experience.
“Real-World Outcomes of Transcatheter Tricuspid Valve Replacement https://t.co/594BIM51cc”
These findings show that transcatheter tricuspid valve replacement is translating well from the clinical trial setting into routine practice across the United States. In a large, older and medically complex patient population, we saw very high procedural success, near-complete elimination of tricuspid regurgitation, and rapid improvement in how patients feel and function.
Intensive LDL Cholesterol Targeting in Atherosclerotic Cardiovascular Disease
Does targeting an LDL cholesterol level of less than 55 mg/dL reduce cardiovascular events compared to targeting less than 70 mg/dL in patients with atherosclerotic cardiovascular disease?
Result: A primary end-point event occurred in 6.6% of the intensive-targeting group and 9.7% of the conventional-targeting group (hazard ratio, 0.67; 95% confidence interval, 0.52 to 0.86; P=0.002).
This is really saying that 55 is our new goal and we need to really embrace that and work hard to get patients to that goal.