59 Hot Line late-breaking trials presented across 12 sessions at ESC Congress 2026 in Munich, 28-31 August. Each trial includes PICO analysis, expert commentary, key results, and clinical implications.
ESC Congress 2026 Hot Line Results — every trial's key result on one page
ESC 2026
Trial authors joining the discussion on Synapse
Trial authors first
At 1 year, the primary endpoint occurred in 11.8% with ticagrelor and 11.1% with prasugrel, showing no significant difference between the two policies.
Cardiology · Sahlgrenska University Hospital
What should clinicians watch for when these results land?
SWITCH SWEDEHEART co-author
Great study pioneering to use of cluster randomization in registries to test different treatment strategies in real life. Very useful cost-effective model when implementing novel treatment strategies in the real life setting. The comparison of the strategies "prasugrel first choice" vs "ticagrelor first choice" turned out neutral on efficacy - safety difficult to evaluate in this setting. Good to have two similar alternatives to tailor to different patients and settings.
SWITCH SWEDEHEART
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.
Electrophysiology · Copenhagen University Hospital
What do you think the place is for CSP in heart failure patients who are candidates for CRT?
HIS Alternative II co-author
this is an interesting first take. A well done study but limited by duration of follow up and sample size. It does seem to indicate when the procedure is well done, actually both procedures well done there may not be that much difference between both techniques.
HIS Alternative II
Catheter ablation for AF did not improve AF-related quality of life versus a double-blind sham procedure, despite substantially higher freedom from AF at 6 months.
Hi everybody, I am the PI of PVI-SHAM-AF. Looking forward to discussing PVI-SHAM-AF with this community.
PVI-SHAM-AF co-authorNOAC monotherapy reduced TAVI valve leaflet thrombosis at 12 months compared to ASA monotherapy and was noninferior for safety.
Interventional · Oslo University Hospital
Looking forward to discussing ACASA-TAVI with this community.
ACASA-TAVI co-author
Interventional · Maastricht University Medical Centre
Wouldn’t it be better to diagnose subclinical valve thrombosis first with CT followed bij randomisation of only positive patients to continuing ASA vs DOAC (POPULAR ATLANTIS)
The 0/1-hour pathway was noninferior to 0/3-hour for 30-day death or type 1 MI but did not reduce median ED length of stay.
Interventional · University of Basel
What should clinicians watch for when these results land?
PRESC1SE-MI co-author
Functional coronary angiography–guided complete revascularisation cut death, MI, stroke, or ischaemia-driven revascularisation versus conventional angiography in STEMI with multivessel disease at a median 17.9 months.
Cross-Cutting Cardiology · University of Bologna
Congrats to the investigators! AIR-STEMI shows angio-FFR with virtual PCI cuts MACE (HR 0.62) and AKI/bleeding (HR 0.63) vs visual angiography in STEMI. Only 20–23% of non-culprit lesions were intermediate (50–69%), yet physiology safely halved PCIs (52% vs 95%) even in angiographically severe disease. Caveats include offline core-lab reliance, top-center volume leverage, bundled deferral/planning, excluded complex anatomies (LM, CTOs), low female representation (24%).
AIR-STEMI
Eplontersen did not meet the primary composite of cardiovascular death and recurrent cardiovascular events versus placebo through week 140.
The CARDIO-TTRansform trial was designed to examine the role of Wainua, a gene silencer treatment, on top of today's standard of care in reducing recurring cardiovascular events and mortality. Although the trial did not meet its primary objective, we believe the results support greater scientific understanding of treatment approaches for the hundreds of thousands of patients worldwide suffering from this progressive and often fatal condition.
CARDIO-TTRansform
Interventional · Unity Hospital
Where will these results lead us with other medications in this realm. The important part will be finding out the right patient who may benefit from this medication
The response-tailored antibiotic strategy increased median days alive without antibiotic treatment to 183 versus 169 days with standard therapy and was noninferior for safety but had higher relapse rates.
The primary outcome of LDL-C </dL and ≥50% reduction at 12 months was achieved in 82% with evolocumab vs 40% with standard care.
Why didn’t achieving an LDL-C of 16mg/dl 6 weeks after MI and an LDL-C difference between groups of 40mg/dl at week 6 with the aforementioned rationale translate into significant clinical benefits at 1 year?
AMUNDSENThe first possibility is the absence of any purported pleiotropic effects of PCSK9 on atherothrombosis as the trial was powered to show superiority of evolocumab over usual standard of care on the main clinical endpoint with 80% power to detect an odds ratio of 0.683. For an effect size of this magnitude, there would have to be meaningful independent clinical benefits from PCSK9 lowering beyond LDL-C change.
One can therefore conclude that there were no meaningful pleiotropic benefits from PCSK9 lowering beyond LDL-C mediated effects. This is supported by studies showing that when standardized per 38mg/dl LDL-C lowering PCSK9i (lower Lp(a)) and statins (lower hsCRP) have near identical hazard ratios in each year of treatment.10
A Marathon, Not a Sprint—AMUNDSEN and LDL-C Lowering After Myocardial Infarction
jamanetwork.com
Catheter-directed thrombolysis reduced 7-day all-cause death, PE recurrence, or cardiorespiratory decompensation versus anticoagulation alone in intermediate-high-risk pulmonary embolism. 7-day bleeding was compared between the groups.
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, driven by fewer ischemic strokes with no increase in major bleeding.
Quarterly plozasiran cut median triglycerides at month 12 by 79% in SHASTA-3 and 81% in SHASTA-4 versus roughly 27% with placebo, and reduced cumulative acute pancreatitis events by 78% across the pooled severe hypertriglyceridaemia population.
Aficamten met both primary endpoints versus placebo, improving quality of life and exercise capacity at week 36 in symptomatic nonobstructive HCM.
An ICD did not 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, though sudden cardiac death alone fell and patients under 70 saw a 72% reduction in the primary endpoint.
In the STAREE trial, atorvastatin reduced major cardiovascular events compared to placebo but did not affect disability-free survival.
Pacibekitug produced sustained, dose-dependent hs-CRP reductions through day 180 versus placebo, with no clear dose-related safety signals.
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.
Edoxaban did not reduce stroke or systemic embolism versus no anticoagulation and doubled major bleeding.
Expanded DAN-RSV follow-up at ESC 2026: RSVpreF cut RSV-related respiratory hospitalizations versus no vaccine, published in NEJM Evidence.
Milvexian twice daily did not reduce CV death, MI, or ischaemic stroke versus placebo after ACS; intracranial or fatal bleeding was 0.3% in both groups.
Prasugrel monotherapy was not noninferior to 12-month DAPT for death, MI, or stroke at 12 months.
Clopidogrel monotherapy was noninferior to extended DAPT for net adverse clinical events at 24 months.
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 and increased bleeding in patients with atrial fibrillation and acute coronary syndrome undergoing PCI; the trial was stopped early.
Routine CTCA after myocardial infarction was ruled out did not reduce subsequent MI or cardiovascular death versus standard care over three years among 3,170 patients with acute chest pain.
A digital strategy increased SGLT2 inhibitor initiation at 6 months versus usual care. Heart-failure hospitalisation or death was similar.
In adults with recent statin nonadherence, adaptive digital outreach increased 14-day statin refill rates versus usual communication.
Hydralazine-isosorbide dinitrate did not reduce death or heart-failure events versus placebo, and treatment discontinuation was high. All-cause death was compared between the groups.
Pooling three hydralazine-isosorbide dinitrate trials (2,101 patients, including A-HeFT and H-HeFT), H-ISDN was associated with lower all-cause death and cardiovascular death, but heart-failure hospitalisation results were inconsistent and the investigators concluded that heterogeneity in trial design and tolerability make firm conclusions difficult.
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.
In cohort A, AZD5462 reduced end-systolic volume index by -5.4 mL/m2 versus placebo at week 25. In cohort B, AZD5462 reduced systemic vascular resistance index across all doses.
Pulmonary-artery denervation plus medical therapy reduced clinical worsening compared to medical therapy alone in pulmonary hypertension associated with left heart disease.
The intervention increased the probability of surviving 730 days without hospitalization to in usual care and reduced all-cause mortality by 22%.
Routine protamine administration after transfemoral TAVI reduced the primary composite of all-cause death or clinically relevant bleeding versus selective protamine. Anaphylactic reactions occurred in 1.3% of the routine arm; thromboembolic event rates were ~4% in both arms.
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 at 1 year among 986 patients.
Transcatheter tricuspid-valve repair plus medical therapy improved the hierarchical composite of death, heart failure hospitalization, and quality-of-life at 1 year and reduced death or hospitalization through 3 years.
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.
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:; adjusted risk ratio 0.85;.
Immediate 14-day ambulatory ECG monitoring did not reduce mean self-reported syncope episodes at one year versus standard care. Arrhythmia detection more than doubled and all-cause mortality was compared between the groups.
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.
Statin initiation guided by coronary artery calcium was not shown noninferior to pooled-cohort-equation risk assessment for major cardiovascular events over 4.2 years. Event rates were lower than expected.
Activation of community first responders did not improve 30-day survival after out-of-hospital cardiac arrest: when estimated responder arrival was under three minutes, and at three to nine minutes. Bystander CPR and defibrillation increased significantly, with no safety concerns.
More discussion
Electrophysiology · University of Copenhagen
Our results do not support routine LAA closure in all patients undergoing planned cardiac surgery. However, closure appeared to confer protection in patients at high risk of stroke. As we saw in the LAACS trial, the primary endpoint curves diverged over time in LAACS-2 and follow-up will be continued.
LAACS-2 co-author
Interventional · Centre Hospitalier Universitaire de Grenoble
Although the stress imaging-guided selective strategy reduced the need for coronary angiography and angiography-related complications, it did not demonstrate noninferiority to routine invasive management for major cardiovascular events.
EVAOLD co-author
Cardiac Imaging · Cedars-Sinai Medical Center
@MasriAhmadMD Thank you @MasriAhmadMD for this excellent summary and for enrolling the largest number of participants in the REVEAL study!
REVEAL co-authorCardiac Imaging · Cedars-Sinai Medical Center
@JAMA_current Diagnosis of cardiac amyloidosis with a single test-I124 evuzamitide PET/CT: a (-) scan excludes and a (+) scan confirms it. Can image multiple amyloid types and in multiple organs. Grateful to the commitment of patients, investigators, & study committees of the REVEAL trial.
REVEAL co-authorCardiac Imaging · Cedars-Sinai Medical Center
These I 124 evuzamitide data demonstrate the potential of a single test to help health care providers identify or exclude cardiac amyloidosis. Clinically, a sensitive, specific and quantitative PET tracer could help distinguish cardiac amyloidosis from other causes of heart failure, differentiate amyloid subtypes when used alongside appropriate laboratory testing, and track changes in cardiac amyloid burden over time.
REVEAL co-author
General · Sahlgrenska University Hospital
According to the Swedish quality registry SWEDEHEART, only about 20% of patients with myocardial infarction complete a physiotherapist-led exercise program within cardiac rehabilitation. The question is whether it would even have been accepted if a correspondingly low figure had been measured for, for example, elevated blood pressure?
Remote Exercise SWEDEHEART co-authorDoes this change your practice? Why or why not?
HonorHealth
In persistent AF with significant low voltage zones, the IDEAL-AF trial found that adding targeted low voltage zone ablation to PVI significantly improved arrhythmia-free survival. An important step toward more individualized, substrate-guided ablation.
IDEAL-AF
