28/08/2026
🫀 ESC Congress 2026: Practice-Changing Updates in Cardiology
A domain-by-domain summary of the highest-yield, practice-changing messages from the ESC Congress 2026 cycle.
Coronary Artery Disease, ACS & Antithrombotics
🔹 Omit beta-blockers post-MI when LVEF ≥50%. REBOOT and an individual-patient-data meta-analysis showed no benefit for death, MI, or HF, with a possible harm signal in women. Beta-blockers should still be considered when LVEF is 40–49%, where benefit persists.
🔹 Abbreviated DAPT followed by P2Y12 monotherapy is emerging as the preferred strategy in uncomplicated, completely revascularized AMI. One month of DAPT reduced major bleeding by approximately half without an ischemic penalty in TARGET-FIRST. Avoid very early aspirin withdrawal (days 0–4), and clopidogrel monotherapy should not automatically be assumed to be the optimal P2Y12 strategy.
🔹 Consider extending DAPT beyond 12 months in higher-risk patients with multivessel disease who complete the first year event-free. However, remember that the Extended DAPT population was predominantly nonelderly and treated with clopidogrel.
🔹 AF + OAC + previous PCI: beyond 12 months after PCI in stable chronic coronary syndrome, drop the antiplatelet when appropriate. OAC monotherapy reduces bleeding without an apparent MACE penalty.
🔹 Intravascular imaging remains important for complex PCI, particularly left main and bifurcation interventions. Routine IVUS showed less incremental benefit in IVUS-CHIP, but its value remains clearest in anatomically complex PCI.
❤️ Heart Failure
🔹 HFpEF/HFmrEF therapy should increasingly be built around SGLT2 inhibition + finerenone, with an incretin such as semaglutide or tirzepatide added when obesity is present.
🔹 Digitalis has renewed evidence. DIGIT-HF showed that digitoxin reduced death/HF hospitalization in advanced HFrEF, while the DECISION withdrawal data raised concern about stopping established digoxin therapy.
🔹 Vericiguat: VICTOR missed its primary endpoint but demonstrated a nominal mortality signal, supported by pooled VICTORIA + VICTOR analyses.
🔹 TEER is expanding beyond the classic COAPT population. RESHAPE-HF2 supports TEER in appropriately selected patients with moderate-to-severe functional MR, with an NNT of approximately 5 for its primary clinical outcome.
🩸 Lipids & Prevention
🔹 PCSK9 inhibition is moving into high-risk primary prevention. VESALIUS-CV showed that evolocumab reduced MACE in patients without previous MI or stroke, including a substantial benefit in patients with diabetes without known atherosclerosis.
🔹 Measure Lp(a) once in every adult. Lp(a) is increasingly becoming part of routine lifetime cardiovascular risk assessment. The upcoming Lp(a)HORIZON/pelacarsen outcome data will be important for determining whether directly lowering Lp(a) translates into fewer cardiovascular events.
🔹 Target SBP
