Synapse2026

ESC Congress 2026 Hot Line Trials — European Society of Cardiology, Munich

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

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

ESC 2026

Hot Line trial discussion

Trial authors joining the discussion on Synapse

B. JoungSINGLE-AF

R. WachterPVI-SHAM-AF

E. OmerovicSWITCH SWEDEHEART

M. VintherHIS Alternative II

Ø. LieACASA-TAVI

U. WisløffNEXAF

C. BallantyneSHASTA-3/4

S. BiscagliaAIR-STEMI

J. BoeddinghausPRESC1SE-MI

Hot Line Trials

Trial authors first

2Atrial Fibrillation

SINGLE-AF

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.

B. Joung et al.

NEJM

20 comments

38Atrial Fibrillation

PVI-SHAM-AF

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%).

R. Wachter et al.

The Lancet

17 comments

14Acute Coronary Syndromes

SWITCH SWEDEHEART

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.

E. Omerovic et al.

NEJM

9 comments

49Devices & Arrhythmias

HIS Alternative II

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.

M. Vinther et al.

JACC Clinical Electrophysiology

4 comments

35Structural Heart

ACASA-TAVI

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).

Ø. Lie et al.

JAMA

3 comments

SWITCH SWEDEHEART

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.

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Author asks

Elmir Ömerovic65d ago

Cardiology · Sahlgrenska University Hospital

What should clinicians watch for when these results land?

SWITCH SWEDEHEART co-author

Member takes

Lars Wallentin52d ago

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

9 comments

HIS Alternative II

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.

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Author asks

Michael Vinther61d ago

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

Member takes

Kenneth Ellenbogen54d ago

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

4 comments

PVI-SHAM-AF

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From the author

Rolf Wachter58d ago

Hi everybody, I am the PI of PVI-SHAM-AF. Looking forward to discussing PVI-SHAM-AF with this community.

PVI-SHAM-AF co-author

17 comments

ACASA-TAVI

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From the author

Øyvind Lie65d ago

Interventional · Oslo University Hospital

Looking forward to discussing ACASA-TAVI with this community.

ACASA-TAVI co-author

3 comments

PRESC1SE-MI

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).

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Author asks

Jasper Boeddinghaus65d ago

Interventional · University of Basel

What should clinicians watch for when these results land?

PRESC1SE-MI co-author

28 comments

AIR-STEMI

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.

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Member takes

Edina Cenko58d ago

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

8 comments

CARDIO-TTRansform

Eplontersen did not meet the primary composite of cardiovascular death and recurrent cardiovascular events versus placebo through week 140.

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Member takes

Jesse Linson31d ago

CARDIO-TTRansform

Jesse Linson31d ago

CARDIO-TTRansform

Sharon Barr63d ago

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

Devesh Rai62d ago

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

28 comments

POET-II

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%).

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Member takes

Steven Russell5d ago

What result or caveat matters most to you?

POET-II

5 comments

AMUNDSEN

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).

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Member takes

Kausik Ray56d ago

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?

AMUNDSEN

Kausik Ray56d ago

The 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.

Kausik Ray56d ago

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

Kausik Ray56d ago

A Marathon, Not a Sprint—AMUNDSEN and LDL-C Lowering After Myocardial Infarction jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2026.16837?guestAccessKey=ab11ca15-af2a-4bf5-81e7-3739c71fd08c&utm_source=jps&utm_medium=email&utm_campaign=author_alert-jamanetwork&utm_content=author-author_engagement&utm_term=1m

24 comments

Prague 26

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).

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Member takes

Ginebra ferreira31d ago

Cardiology

Interesting

Prague 26

4 comments

SINGLE-AF

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20 comments

SHASTA-3/4

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.

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3 comments

ACACIA-HCM

Aficamten met both primary endpoints versus placebo, improving KCCQ-CSS and peak VO2 at week 36 in symptomatic nonobstructive HCM.

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22 comments

CMR GUIDE

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.

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17 comments

STAREE

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.

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46 comments

TRANQUILITY

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.

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12 comments

REACT

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.

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25 comments

ENRICH-AF

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).

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10 comments

DAN-RSV

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).

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11 comments

LIBREXIA ACS

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.

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16 comments

PREMIUM

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).

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17 comments

A-CLOSE

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).

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15 comments

EPIDAURUS

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.

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6 comments

TARGET-CTCA

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.

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12 comments

EMAIL-HF

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).

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2 comments

ADHERE-ASCVD

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).

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4 comments

H-HeFT

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).

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5 comments

H-ISDN 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.

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4 comments

Met-HeFT

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).

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6 comments

LUMINARA

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).

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10 comments

PADN-PH-LHD

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).

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8 comments

TIME-HF

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).

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2 comments

POPular ACE TAVI

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.

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TAVI PCI

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.

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TRIC-I-HF

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).

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13 comments

AFFIRMO

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.

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CRHCP

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.

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ASPIRED

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%.

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SyncAV PMT

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.

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CorCal

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.

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HeartRunner

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.

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5 comments

More discussion

Gilles Barone-Rochette61d ago

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

Konstantinos D. Rizas62d ago

Cross-Cutting Cardiology · University of St.Gallen

In the first trial of its kind, we have answered an important clinical question. These findings do not support the routine use of potent P2Y12 inhibitors in combination with direct oral anticoagulants in patients with AF and MI.

EPIDAURUS co-author

Maria Bäck63d ago

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-author

J. Brent Muhlestein63d ago

Interventional · Intermountain Medical Center

In nearly one in 10 of these kinds of heart scans, we're finding other possible medical issues. They could be nothing, as many abnormalities on these kinds of scans are. But they could be something more significant, as was the case for one study participant who had emergency surgery due to a finding on his CAC CT scan.

CorCal co-author

Sophia Zoungas63d ago

General · The Alfred Hospital

Overall the balance of risks and benefits remains unclear in older people. Almost all of the research into statins and health has been done in younger people. While recommendations are for people up to 75 to take statins, there is no evidence that the these drugs are beneficial, or indeed harmful, in the older age group.

STAREE co-author

Elmir Ömerovic63d ago

Interventional · Sahlgrenska University Hospital

We need to know that treatments work in the real world, not just in strictly controlled study environments. This project shows that we can combine the best possible care for patients with a more efficient use of our shared resources.

SWITCH SWEDEHEART co-author

Joseph B. Muhlestein63d ago

Interventional · University of Utah

We think that PCE gives statins to a lot of patients who don't really need them.

CorCal co-author

Helena Domínguez63d ago

Electrophysiology · University of Copenhagen

The LAACS-2 trial, in which only 5% of patients have been diagnosed with AF before surgery, can help establish whether a LAACS procedure should be added to all patients

LAACS-2 co-author

Esc ReturnTest32d ago

E2E login take: back for the Hot Lines.

Esc ReturnTest32d ago

E2E login take: back for the Hot Lines.

Esc ReturnTest32d ago

E2E login take: back for the Hot Lines.

Esc ReturnTest32d ago

E2E login take: back for the Hot Lines.

Zain Khalpey61d ago

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

Reza Ghanavati61d ago

Polytechnic University of Turin

HEARTRUNNER trial Community first responders ⛔️ did not improve 30-day survival after out-of-hospital cardiac arrest. CardioEd @escardio

HeartRunner

Ihab Suliman61d ago

Cardiac Imaging · King Saud bin Abdulaziz University for Health Sciences

🚨 ESC 2026 — meaningful new Hot Line 10 finding His-Alternative II: conduction-system pacing may now be a credible alternative to conventional biventricular CRT. In 150 patients with HFrEF, LVEF ≤35% and typical LBBB, CRT delivered through His-bundle/left-bundle pacing

HIS Alternative II

Reza Ghanavati61d ago

Polytechnic University of Turin

EVAOLD trial 👥 in >=80 y/o pts w NSTEMI ⚙️ An imaging-guided 🆚 routine invasive strategy 🎬 for preventing 3-P MACE at 1 year ⛔️ was not noninferior (Imaging 24% vs invasive 20.7%) CardioEd @escardio

EVAOLD

Braydon Dymm61d ago

Charleston Area Medical Center

Loving this graphic & thread on SINGLE-AF by @caseyalbin & @neurona_critica on IG.

SINGLE-AF

Edgardo Alania61d ago

Heart Failure

🫀 Do TTR silencers improve ATTR-CM outcomes—and does tafamidis matter? 🧵1/5 This JAMA meta-analysis of HELIOS-B + CARDIO-TTRansform (n=2,086) found benefit overall, but a crucial treatment interaction. Amyloidosis ATTR CardioEd

CARDIO-TTRansform

European Society of Cardiology61d ago

Democritus University of Thrace

Insights into care after cardiac arrest, pulmonary embolism and heart surgery were revealed in Hot Line 12. Discover the latest results from Read the Hot Line Press Releases: lnkd.in/drVaNrmM See the Hot Line Visual Summaries: lnkd.in/dMJnJxaP HealthJournalism HotLine PublicHealth HeartHealth European Society of Cardiology

REVEAL

Edgardo Alania61d ago

Heart Failure

🧵1/5 🫀 Can treating severe TR change prognosis—not just symptoms? TRIC-I-HF randomized 360 high-risk patients: transcatheter repair + medical therapy improved the hierarchical outcome and reduced death/HF hospitalization.

TRIC-I-HF