- CARDIO-TTRansform: Efficacy and safety of eplontersen in patients with transthyretin amyloid cardiomyopathy
Eplontersen did not meet the primary composite of cardiovascular death and recurrent cardiovascular events versus placebo through week 140.
— Cardiomyopathy - SINGLE-AF: Anticoagulation for atrial fibrillation with intermediate stroke risk
DOAC therapy (apixaban or rivaroxaban) cut the 24-month composite of stroke, systemic embolism, major bleeding, or cardiovascular death by 69% versus no anticoagulation in AF with intermediate stroke risk (0.5% vs 1.5%; HR 0.31, 95% CI 0.10-0.94; p=0.028), driven by fewer ischemic strokes with no increase in major bleeding.
— Atrial Fibrillation - POET-II: Tailored duration antibiotic treatment for infectious endocarditis
The response-tailored antibiotic strategy increased median days alive without antibiotic treatment to 183 versus 169 days with standard therapy (difference 13 days; 95% CI 12 to 13; P<0.001) and was noninferior for safety (8.2% vs. 10.7%; difference -2.4 percentage points; 95% CI -7.7 to 2.7; P<0.001) but had higher relapse rates (5.1% vs. 1.6%).
— Endocarditis - ACACIA-HCM: Aficamten for the treatment of symptomatic nonobstructive hypertrophic cardiomyopathy
Aficamten met both primary endpoints versus placebo, improving KCCQ-CSS and peak VO2 at week 36 in symptomatic nonobstructive HCM.
— Cardiomyopathy - CMR GUIDE: Cardiac magnetic resonance GUIDEd management of mild-moderate left ventricular systolic dysfunction with an implantable cardioverter defibrillator
An ICD did not significantly reduce the primary composite of sudden cardiac death or hemodynamically significant ventricular arrhythmias versus an implantable loop recorder in patients with LVEF 36-50% and CMR-detected scar (7.8% vs 9.2%; HR 0.76, 95% CI 0.37-1.58), though sudden cardiac death alone fell (HR 0.26) and patients under 70 saw a 72% reduction in the primary endpoint.
— Devices & Arrhythmias - STAREE: Statins for Reducing Events in the Elderly
In the STAREE trial, atorvastatin reduced major cardiovascular events compared to placebo (HR 0.70, 95% CI 0.61-0.82; P<0.001) but did not significantly affect disability-free survival.
— Prevention - AMUNDSEN: Evolocumab before percutaneous coronary intervention for acute myocardial infarction
The primary outcome of LDL-C <55 mg/dL and ≥50% reduction at 12 months was achieved in 82% with evolocumab vs 40% with standard care (adjusted OR 5.54, 95% CI 4.50-6.82; P < .001).
— Lipids - TRANQUILITY: Monthly and quarterly pacibekitug in patients with chronic kidney disease at high cardiovascular risk
Pacibekitug produced sustained, dose-dependent hs-CRP reductions through day 180 versus placebo (+7% vs −76% / −85% / −89% across 25 mg q90d, 50 mg q90d, and 15 mg q30d; all p<0.0001), with no clear dose-related safety signals.
— Prevention - REACT: Prevalence of silent atherosclerosis across adult life
Silent atherosclerosis was present in 57.1% of 16,808 asymptomatic adults aged 18–70, including 1 in 13 aged 18–29 and 9 in 10 aged 60–70; SCORE2 classified only a small minority of those with plaque as high risk.
— Prevention - ENRICH-AF: Edoxaban in intracranial haemorrhage survivors with atrial fibrillation
Edoxaban did not reduce stroke or systemic embolism versus no anticoagulation (11.8% vs 12.8%; HR 0.88, 95% CI 0.61–1.26; p=0.48) and doubled major bleeding (11.6% vs 5.2%; HR 2.23).
— Atrial Fibrillation - DAN-RSV: RSVpreF vaccine for preventing cardiorespiratory hospitalisations
Expanded DAN-RSV follow-up at ESC 2026: RSVpreF cut RSV-related respiratory hospitalizations versus no vaccine (0.16 vs 0.55 per 1000 person-years; ~70% vaccine effectiveness), published in NEJM Evidence (10.1056/EVIDoa2600272).
— Prevention - LIBREXIA ACS: Milvexian after recent acute coronary syndrome
Milvexian 25 mg twice daily did not reduce CV death, MI, or ischaemic stroke versus placebo after ACS (5.4% vs 5.1%; HR 1.05, 95% CI 0.91–1.21; p=0.50); intracranial or fatal bleeding was 0.3% in both groups.
— Acute Coronary Syndromes - PREMIUM: Aspirin omission at the time of primary percutaneous coronary intervention in ST-elevation myocardial infarction
Prasugrel monotherapy was not noninferior to 12-month DAPT for death, MI, or stroke at 12 months (11.0% vs 8.5%; HR 1.34, 95% CI 1.02–1.75; p=0.40 for noninferiority).
— Acute Coronary Syndromes - SWITCH SWEDEHEART: Switching from ticagrelor to prasugrel in acute coronary syndrome
At 1 year, the primary endpoint occurred in 11.8% with ticagrelor and 11.1% with prasugrel (adjusted OR 0.90, 95% CI 0.77-1.06), showing no significant difference between the two policies.
— Acute Coronary Syndromes - A-CLOSE: Clopidogrel monotherapy versus extended dual antiplatelet therapy after high-risk percutaneous coronary intervention
Clopidogrel monotherapy was noninferior to extended DAPT for net adverse clinical events at 24 months (risk difference −0.1 percentage points; 90% CI −1.3 to 1.2; P=0.001 for noninferiority).
— Interventional Cardiology - EPIDAURUS: Escalated single platelet inhibition for one month plus a non-vitamin K antagonist oral anticoagulant in patients with atrial fibrillation and acute coronary syndrome undergoing percutaneous coronary intervention
One month of escalated single antiplatelet therapy with a potent P2Y12 inhibitor plus a direct oral anticoagulant did not reduce ischemic events versus standard therapy (win-loss ratio 1.19) and increased bleeding in patients with atrial fibrillation and acute coronary syndrome undergoing PCI; the trial was stopped early.
— Interventional Cardiology - PRESC1SE-MI: Safety and efficacy of the ESC 0/1-hour algorithm for the rapid rule-out and rule-in of myocardial infarction
The 0/1-hour pathway was noninferior to 0/3-hour for 30-day death or type 1 MI (1.1% vs 1.2%; adjusted OR 0.93, 95% CI 0.77–1.13; p for noninferiority <0.001) but did not reduce median ED length of stay (309 minutes in both groups; p=0.65).
— Acute Coronary Syndromes - 0/1-hour versus standard care pathways in MI: 0/1-hour versus standard care diagnostic pathways in suspected myocardial infarction: a systematic review and individual patient data meta-analysis
Across five randomised trials and 110,933 ED presentations, the 0/1-hour pathway had similar safety to standard care but did not reduce ED length of stay or increase direct discharge.
— Acute Coronary Syndromes - AIR-STEMI: Functional coronary angiography in ST-elevation myocardial infarction
Functional coronary angiography–guided complete revascularisation cut death, MI, stroke, or ischaemia-driven revascularisation versus conventional angiography in STEMI with multivessel disease (8.9% vs 13.7%; HR 0.62, 95% CI 0.47–0.83; p<0.001) at a median 17.9 months.
— Interventional Cardiology - TARGET-CTCA: Troponin in acute chest pain to risk stratify and guide computed tomography coronary angiography
Routine CTCA after myocardial infarction was ruled out did not reduce subsequent MI or cardiovascular death versus standard care over three years (7.1% vs 7.3%) among 3,170 patients with acute chest pain.
— Imaging - EMAIL-HF: Implementation of sodium-glucose co-transporter 2 inhibitors in heart failure through a digital strategy
A digital strategy increased SGLT2 inhibitor initiation at 6 months versus usual care (18.6% vs 8.2%; p<0.001). Heart-failure hospitalisation or death was similar (13.0% vs 14.0%; p=0.276).
— Digital Health - Remote Exercise SWEDEHEART: Cardiac telerehabilitation: a cluster randomised cross-over trial
Adding remotely delivered exercise-based cardiac rehabilitation to centre-based programmes did not increase completion of the full exercise programme (13.8% vs 13.6%) or the mean number of completed sessions.
— Digital Health - ADHERE-ASCVD: Adaptive digital outreach to improve statin adherence in atherosclerotic cardiovascular disease
In adults with recent statin nonadherence, adaptive digital outreach increased 14-day statin refill rates versus usual communication (14.4% vs 12.0%; adjusted risk difference 2.3 percentage points, 95% CI 1.3-3.4; adjusted risk ratio 1.20, 95% CI 1.10-1.30).
— Digital Health - VIRTUES ICD/PM: Digital platforms for patients with implantable cardioverter defibrillators and pacemakers
VIRTUES remote monitoring was noninferior to standard in-clinic care for death, stroke, or cardiovascular- or device-related hospitalisation at 18 months in ICD (11.0% vs 11.2%; p=0.007 for noninferiority) and pacemaker (6.1% vs 7.4%; p=0.0213 for noninferiority) patients.
— Digital Health - H-HeFT: Hydralazine-isosorbide dinitrate in patients with heart failure and reduced ejection fraction
Hydralazine-isosorbide dinitrate did not significantly reduce death or heart-failure events versus placebo (8.6 vs 9.3 events per 100 patient-years; HR 0.90, 95% CI 0.67-1.21), and treatment discontinuation was high. All-cause death was 19.4% versus 24.2% (HR 0.72, 95% CI 0.51-1.02).
— Heart Failure - H-ISDN meta-analysis: Hydralazine-isosorbide dinitrate in heart failure with reduced ejection fraction: a meta-analysis
Pooling three hydralazine-isosorbide dinitrate trials (2,101 patients, including A-HeFT and H-HeFT), H-ISDN was associated with lower all-cause death (HR 0.71, 95% CI 0.58-0.87) and cardiovascular death (HR 0.65, 95% CI 0.47-0.90), but heart-failure hospitalisation results were inconsistent and the investigators concluded that heterogeneity in trial design and tolerability make firm conclusions difficult.
— Heart Failure - Met-HeFT: Metformin in patients with chronic heart failure
Metformin did not reduce death, worsening heart failure, myocardial infarction, or stroke versus placebo over a mean 3.7 years in HFrEF with diabetes or prediabetes (25.1% vs 23.4%; HR 1.10, 95% CI 0.84-1.42; p=0.48).
— Heart Failure - Met-HeFT meta-analysis: Metformin in heart failure and ischaemic heart disease: a meta-analysis
The pooled analysis reached the same conclusion as the Met-HeFT trial: no significant difference in cardiovascular outcomes with metformin in heart failure with reduced ejection fraction, and no significant effect in established ischaemic heart disease.
— Heart Failure - LUMINARA: A once-daily oral relaxin agonist (AZD5462) in patients with heart failure
In cohort A, AZD5462 20 mg reduced end-systolic volume index by -5.4 mL/m2 versus placebo at week 25 (95% CI, -10.9 to 0.1; P=0.054). In cohort B, AZD5462 significantly reduced systemic vascular resistance index across all doses (all P<0.05).
— Heart Failure - PADN-PH-LHD: Pulmonary artery denervation for pulmonary hypertension due to left heart failure
Pulmonary-artery denervation plus medical therapy significantly reduced clinical worsening compared to medical therapy alone in pulmonary hypertension associated with left heart disease (HR 0.49, 95% CI 0.30-0.82; P=0.006).
— Pulmonary Hypertension - TIME-HF: A team-based collaborative care model in heart failure
The intervention increased the probability of surviving 730 days without hospitalization to 84.0% versus 79.4% in usual care (OR 1.78, 95% CI 1.42–2.23) and reduced all-cause mortality by 22% (HR 0.78, 95% CI 0.63–0.95; p=0.028).
— Heart Failure - POPular ACE TAVI: Routine versus selective protamine administration after transcatheter aortic valve implantation
Routine protamine administration after transfemoral TAVI reduced the primary composite of all-cause death or clinically relevant bleeding versus selective protamine (18.5% vs 29.4%; risk difference 10.9 percentage points; p<0.001). Anaphylactic reactions occurred in 1.3% of the routine arm; thromboembolic event rates were ~4% in both arms.
— Structural Heart - TAVI PCI: Percutaneous coronary intervention in patients undergoing transcatheter aortic valve implantation
A TAVI-first strategy was noninferior to a PCI-first strategy in severe aortic stenosis with concomitant coronary artery disease: the primary composite endpoint occurred in 22.2% vs 24.2% at 1 year (risk difference -2.0 percentage points; 95% CI -7.4 to 3.4; p for noninferiority <0.001) among 986 patients.
— Structural Heart - TRIC-I-HF: Tricuspid valve intervention in patients with heart failure
Transcatheter tricuspid-valve repair plus medical therapy significantly improved the hierarchical composite of death, heart failure hospitalization, and quality-of-life at 1 year (win ratio 2.42, 95% CI 1.76-3.33; p<0.001) and reduced death or hospitalization through 3 years (HR 0.40, 95% CI 0.29-0.55; p<0.001).
— Structural Heart - ACASA-TAVI: Antithrombotic therapy after transcatheter aortic valve implantation
NOAC monotherapy reduced TAVI valve leaflet thrombosis at 12 months compared to ASA monotherapy (17.2% vs 32.6%; risk ratio 0.55, 95% CI 0.37-0.82; P=0.004) and was noninferior for safety (7.5% vs 10.6%; risk difference −3.3%, 95% CI −9.5% to 2.8%; P for noninferiority <0.001).
— Structural Heart - NOTION-4: Subclinical leaflet thrombosis after transcatheter aortic valve implantation
Three months of DOAC therapy after successful TAVI reduced subclinical leaflet thickening (HALT) at 3 months (12% vs 32% with SAPT alone), but the effect was not sustained at 12 months (28% vs 32%), and all-cause mortality, stroke, or major/life-threatening bleeding occurred more often with DOAC (8.2% vs 2.3%).
— Structural Heart - AFFIRMO: An integrated approach to atrial fibrillation in frail, multimorbid and polymedicated older people
An mHealth intervention implementing the Atrial Fibrillation Better Care (ABC) pathway combined with comprehensive geriatric assessment did not reduce unplanned hospitalisations versus usual care in older, multimorbid patients with AF. Investigators noted high baseline guideline adherence, low event rates and low use of the mobile app.
— Atrial Fibrillation - PVI-SHAM-AF: Pulmonary vein isolation versus sham procedure in patients with atrial fibrillation
Catheter ablation for AF did not significantly improve AF-related quality of life versus a double-blind sham procedure (AFEQT summary score 61.3 to 81.1 with ablation vs 59.2 to 74.9 with sham; p=0.36), despite substantially higher freedom from AF at 6 months (73% vs 52%).
— Atrial Fibrillation - NEXAF: Long-term exercise training in patients with non-permanent atrial fibrillation
A one-year tailored exercise programme cut AF burden versus usual care (3.9% vs 7.1% of monitored time in AF; p=0.016, a 45% relative reduction) but did not significantly improve AF-specific quality of life (AFEQT overall score change +5.6 vs +4.4; p=0.43).
— Atrial Fibrillation - IDEAL-AF: Individualised low-voltage area ablation in persistent atrial fibrillation
In patients with persistent AF and significant low-voltage zones, adjunctive low-voltage zone ablation plus pulmonary vein isolation achieved freedom from atrial arrhythmia in 67.6% vs 37.4% with pulmonary vein isolation alone (OR 3.5, 95% CI 2.0-6.2; p<0.001).
— Atrial Fibrillation - SHASTA-3/4: Plozasiran in patients with severe hypertriglyceridaemia: 12-month results
Quarterly plozasiran 25 mg cut median triglycerides at month 12 by 79% in SHASTA-3 and 81% in SHASTA-4 versus roughly 27% with placebo (p<0.0001 in each trial), and reduced cumulative acute pancreatitis events by 78% across the pooled severe hypertriglyceridaemia population.
— Lipids - CRHCP: Long-term blood pressure control and the risk of dementia
In the CRHCP cluster-randomised trial, an intensive blood pressure intervention led by non-physician community healthcare providers reduced all-cause dementia versus usual care: 8.85% vs 10.55%; adjusted risk ratio 0.85 (95% CI 0.78–0.91); p<0.001.
— Hypertension - BP-lowering treatment across the spectrum of CV risk: Blood pressure-lowering treatment across the spectrum of cardiovascular risk: an individual patient data meta-analysis
Across 51 randomised trials and 357,440 participants, blood pressure-lowering treatment reduced major cardiovascular disease similarly across the spectrum of baseline risk (HR 0.90 per 5 mmHg SBP reduction; p for interaction >0.99). Absolute risk reductions rose from 0.4 percentage points in the lowest predicted-risk decile to 2.6 percentage points in the highest.
— Hypertension - ECLIPSE-CKD: Salt substitution in patients with chronic kidney disease
In 640 patients with hypertension and chronic kidney disease, a salt substitute (75% sodium chloride / 25% potassium chloride) lowered systolic blood pressure at 3 months by 6.6 mmHg versus 2.0 mmHg with regular salt (p<0.001). Serum potassium rose by 0.2 vs 0 mmol/L, with no episodes of hyperkalaemia.
— Hypertension - ASPIRED: Immediate enhanced ambulatory electrocardiographic monitoring versus standard monitoring in acute unexplained syncope
Immediate 14-day ambulatory ECG monitoring did not reduce mean self-reported syncope episodes at one year versus standard care (1.37 vs 1.58; IRR 0.89, 95% CI 0.68-1.18; p=0.43). Arrhythmia detection more than doubled (22% vs 9%) and all-cause mortality was 1.5% vs 2.9%.
— Devices & Arrhythmias - DANISH-CRT: Targeted left ventricular lead placement for cardiac resynchronisation therapy in heart failure
Targeted left-ventricular lead placement at the latest electrical activation site did not reduce death or first unplanned heart-failure hospitalisation versus standard posterolateral non-apical placement (27.9% vs 25.5%; HR 1.10, 95% CI 0.86-1.39; p=0.45) after a median 45.8 months.
— Devices & Arrhythmias - SyncAV PMT: Clinical benefit of dynamic atrioventricular optimisation during cardiac resynchronisation therapy
CRT efficacy was robust and similar overall with SyncAV dynamic AV optimisation versus a conventional fixed AV interval. In the subgroup with PR interval ≥185 ms, SyncAV reduced all-cause mortality, heart failure hospitalisations, persistent AF and negative echocardiographic CRT response.
— Devices & Arrhythmias - Syncope-Stopper: Upfront pacing versus standard care in high-risk unexplained syncope
Upfront pacing reduced the primary composite of recurrent syncope, bradycardia requiring pacemaker, cardiovascular death and device-related complications at 1 year versus standard care in high-risk unexplained syncope (age ≥55 years with DROP score ≥2): 17.2% vs 31.7%; p=0.014.
— Devices & Arrhythmias - HIS Alternative II: His bundle pacing versus biventricular pacing in patients with heart failure
His/LBB pacing was noninferior to biventricular pacing for left ventricular reverse remodeling: LVESV decreased 35% with His/LBB pacing versus 34% with biventricular pacing.
— Devices & Arrhythmias - EVAOLD: Evaluation of reperfusion strategies in elderly patients
Stress imaging-guided selective invasive management did not demonstrate noninferiority to routine invasive management for 1-year death, nonfatal MI, or nonfatal stroke in patients aged 80 or older with NSTEMI (24.1% vs 20.7%; HR 1.22, 95% CI 0.86-1.72; p=0.27). The trial stopped early for futility.
— Interventional Cardiology - ISOLEDS: Intravascular ultrasound versus optical coherence tomography guidance for percutaneous coronary intervention of distal left main bifurcation lesions
OCT-guided PCI was noninferior to IVUS-guided PCI for 12-month target lesion failure in true distal left main bifurcation lesions (14.4% vs 19.6%; adjusted HR 0.90, 95% CI 0.59-1.36; p for noninferiority=0.0003).
— Interventional Cardiology - CorCal: Pooled cohort equations versus coronary artery calcium score in primary prevention of atherosclerotic cardiovascular disease
Statin initiation guided by coronary artery calcium was not shown noninferior to pooled-cohort-equation risk assessment for MACE over 4.2 years (2.7% vs 2.7%; HR 0.99, 95% CI 0.71-1.38; p=0.045 for noninferiority). Event rates were lower than expected.
— Prevention - CoCAP: Graft patency in patients with acute coronary syndrome treated with dual antiplatelet therapy or aspirin alone after coronary artery bypass grafting
In the CoCAP substudy of the TACSI trial, ticagrelor plus aspirin did not improve graft patency compared with aspirin alone when assessed by coronary CT angiography a mean of 20 months after CABG.
— Cardiac Surgery - DISCO: Acute coronary angiography after resuscitated out-of-hospital cardiac arrest without ST-elevation on the electrocardiogram
Immediate coronary angiography did not improve 30-day survival versus a deferred strategy in unconscious out-of-hospital cardiac arrest without ST-elevation (54.6% vs 53.6%; HR 0.95, 95% CI 0.74-1.21; p=0.67).
— Acute Cardiac Care - CAG after OHCA: Coronary angiography after out-of-hospital cardiac arrest without ST-elevation
An individual-patient-data meta-analysis of five randomised trials (2,173 patients), including DISCO, found no difference in 30-day survival between immediate and deferred coronary angiography after out-of-hospital cardiac arrest without ST-elevation.
— Acute Cardiac Care - HeartRunner: Out-of-hospital cardiac arrest survival following community first responder activation
Activation of community first responders did not improve 30-day survival after out-of-hospital cardiac arrest: 15% vs 17% (p=0.42) when estimated responder arrival was under three minutes, and 13% vs 14% (p=0.43) at three to nine minutes. Bystander CPR and defibrillation increased significantly, with no safety concerns.
— Acute Cardiac Care - Prague 26: Catheter-directed thrombolysis in intermediate-high-risk pulmonary embolism
Catheter-directed thrombolysis reduced 7-day all-cause death, PE recurrence, or cardiorespiratory decompensation versus anticoagulation alone in intermediate-high-risk pulmonary embolism (0.7% vs 6.8%; RR 0.10, 95% CI 0.02-0.44; p<0.001). 7-day bleeding was 4.6% vs 5.0% (p=0.846).
— Pulmonary Embolism - LAACS-2: Left atrial appendage closure concomitant with cardiac surgery
Concomitant left atrial appendage closure during planned open-heart surgery did not significantly reduce stroke or TIA versus standard care over a median 4.0 years (4.28% vs 5.04%; HR 0.85, 95% CI 0.53-1.37; p=0.517). Patients with CHA2DS2-VASc above the median had a 56% reduction (p=0.018).
— Cardiac Surgery - REVEAL: 124I-Evuzamitide PET/CT for diagnosing cardiac amyloidosis
In the REVEAL trial, 124I-evuzamitide PET/CT demonstrated a sensitivity of 94% (95% CI, 85%-98%; p<.001) and specificity of 86% (95% CI, 77%-92%; p<.001) for diagnosing cardiac amyloidosis.
— Imaging