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ACC.26 IMPEDENCE-HFpEF - CardioSet Lung Impedence guided management reduces HFpEF hospitalisation

IMPEDANCE-HFpEF: a randomized trial testing whether non-invasive lung impedance monitoring can guide diuretic therapy in HFpEF — and the results are remarkable. In 150 patients followed for a mean of 38 months, lung impedance–guided management reduced HF hospitalizations by 81% (HR 0.19; P

ACC.26: PRO-TAVI - PCI can safely be deferred until after TAVI

PRO-TAVI: the first RCT to show that PCI can safely be deferred in TAVI patients with concomitant coronary artery disease. In 466 elderly patients across 12 Dutch centres, a TAVI-first strategy was noninferior to routine pre-TAVI revascularization for the composite of death, MI, stroke, or major bleeding at 1 year (24.1% vs 25.8%; rate difference −1.7 pp; P

ACC.26: TRI-FR - TEER gives long terms improves in outcomes

TRI-FR extended follow-up: the first RCT to show transcatheter tricuspid repair delivers long-term outcome benefit. At a median follow-up of ~35 months, T-TEER added to medical therapy reduced the composite of first HF hospitalization, tricuspid surgery, or CV death by 44% (HR 0.56; 95% CI 0.36–0.88; P=0.0109) and halved recurrent HF hospitalizations (rate ratio 0.52; P=0.0073). Benefit emerged beyond year 1 — reframing severe TR from a passive marker to a treatable driver of right-sided heart failure.



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ACC.26: ALL RISE - Cathworks FFRangio is non-inferior to invasive FFR

ALL-RISE delivers landmark evidence for wire-free coronary physiology: in 1,930 patients across 59 international sites, a treatment strategy guided by angiography-derived FFR was noninferior to pressure wire–guided physiology for 1-year MACE (6.9% vs 7.1%; HR 0.98; 95% CI 0.70–1.39; P=0.0008 for noninferiority). Assessment was faster (6 vs 8 min), with shorter procedure times, less fluoroscopy, and lower contrast volume. Published simultaneously in NEJM.

ACC.26 ORBITA CTO - placebo controlled trial shows CTO PCI improves symptoms

ORBITA-CTO delivers landmark evidence: in the first randomized, double-blind, placebo-controlled trial of CTO PCI, recanalization significantly improved the angina symptom score (OR 4.38; 95% CrI 1.57–12.69; Pr[Benefit] = 99.6%). Patients undergoing CTO PCI experienced 30.6 additional angina-free days over 6 months, with consistent improvements across SAQ domains and CCS class. Blinding was rigorously maintained. Published simultaneously in JACC.



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CHIP-BCIS3 delivers a sobering result: in 300 patients with severe LV dysfunction undergoing complex PCI, routine elective mechanical circulatory support did not reduce the primary hierarchical composite outcome (win ratio 0.85; P=0.30). Cardiovascular death was significantly higher in the pump group — 26.7% vs 14.5% (HR 1.91; P=0.018). The first randomized trial of elective pump-supported high-risk PCI challenges current practice. Published simultaneously in the NEJM.



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ACC26: HI-PEITHO - EKOS catheter directed thrombolysis improved outcomes in PE

HI-PEITHO delivers landmark results: ultrasound-facilitated catheter-directed fibrinolysis reduced the composite of PE-related death, cardiorespiratory decompensation and recurrence by 61% compared with anticoagulation alone in intermediate-risk PE patients. The safety profile was reassuring — with no intracranial haemorrhage in either group. This is the first randomized trial to show clinical benefit for any catheter-based PE intervention. Published simultaneously in the NEJM.



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STEMI-DTU Trial - Up front Impella in Anterior STEMI without shock did not reduce infarct size

STEMI-DTU delivers a nuanced negative: mechanical ventricular unloading before PCI did not reduce infarct size in 527 anterior STEMI patients without shock. But the real story lies in the timing data - despite 47 minutes of additional ischaemia from the protocolized delay, infarct sizes were remarkably similar between groups. Published simultaneously in JACC, this pivotal trial challenges assumptions about ischaemic time while raising important questions about patient selection and device evolution.



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