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ACC 2026 Late-Breaking Trials
Live trial results, expert commentary, and discussion with 10+ trial authors
Research Feed
Three Low-Dose Antihypertensive Agents in a Single Pill after Intracerebral Hemorrhage
Implication: Supports single low-dose triple pill after ICH for better BP control; extends INTERACT evidence with practical adherence-enhancing approach.
“Meaningful blood pressure control after intracerebral hemorrhage requires a coordinated, systemwide commitment that integrates team-based care, expanded access to medication, and real-time monitoring to bridge the gap between clinic visits and daily management. Beyond the primary care office, eve...”
Pulsed Field Ablation as Initial Therapy for Persistent Atrial Fibrillation
Implication: Supports first-line PFA over AADs in persistent AF; challenges guidelines mandating drug trial first and extends paroxysmal AF evidence.
“These findings have implications for clinical practice, for guidelines, and for insurance coverage because “there’s a lot of people that are dissuading us from doing persistents because it’s lower yield,” Tung said.”
Left Atrial Appendage Closure or Anticoagulation for Atrial Fibrillation
Implication: Supports LAAC as alternative in anticoagulation-eligible AF; extends head-to-head RCT evidence versus contemporary NOACs.
“In patients with nonvalvular atrial fibrillation suitable for anticoagulation, left atrial appendage closure using the Watchman FLX device, at 3 years was noninferior to NOACs for the composite primary endpoint [of] cardiovascular death, stroke, and systemic embolization, and significantly reduced clinically relevant nonprocedural bleeding.”
Left Atrial Appendage Closure or Medical Therapy in Atrial Fibrillation
Implication: Reinforces medical therapy as standard in high-risk AF; challenges positive prior LAAO trials and guidelines.
“In general, the benefit from any percutaneous intervention in cardiology is often the greatest with regard to the most acute or life-threatening problem the patient is facing. In contrast, in clinical situations in which the patient’s life is not directly at risk and the symptoms are controllable by medical treatment, conservative management should always be considered to be an equally effective alternative.”
Discontinuation of Beta-Blocker Therapy after Myocardial Infarction
Implication: Supports deprescribing in stable post-MI patients with preserved EF; challenges guideline-endorsed indefinite continuation.
“At subsequent visits, it’s always an opportunity to revisit [and ask] can we reduce this pill burden? This study demonstrated in a more definitive fashion than the ABYSS study that yes, at 1 year, it is safe in patients with normal ejection fraction and no atrial fibrillation to stop that beta-bl...”
Sotatercept for Combined Post- and Pre-capillary Pulmonary Hypertension Associated With Heart Failure: Results from the Phase 2, Randomized, Placebo-Controlled CADENCE Study
Implication: Opens new treatment axis for CpcPH-HFpEF with none approved; extends sotatercept efficacy from PAH to this phenotype.
“Similar to PAH trials, the benefits of sotatercept transcend the relatively modest reductions in resting PVR and highlight the importance of targeting inflammation, cell proliferation and endothelial function in HFpEF. As the biology of ligand traps evolves, sotatercept marks the first step in leveraging the power of signaling networks to reverse fibrosis and cellular hypertrophy. Notably, the CADENCE trial emphasizes the importance of targeting underlying biologic mechanisms responsible for disease, versus focusing solely on improving hemodynamic parameters.”
Ultrasound-Facilitated, Catheter-Directed Fibrinolysis for Acute Pulmonary Embolism
Implication: Supports CDT in intermediate-risk PE with distress; extends prior imaging data to clinical outcomes.
“This trial shows that a catheter intervention can indeed be effective and improve the prognosis for patients with severe PE and elevated risk of early death or life-threatening complications. If the right patients are selected for this procedure, it can prevent patients from deteriorating and it can do so at an acceptably low risk of bleeding complications.”
Left Ventricular Unloading in High-Risk Percutaneous Coronary Intervention
Implication: Routine use cannot be recommended in severe LV dysfunction for complex PCI; challenges observational data and protective premise while aligning with neutral RCTs.
“The results were 'surprising because the whole premise of LV unloading was that it protects the heart.' But we found that patients assigned to LV unloading had more damage to the [LV] than those assigned to standard care. Our findings strongly suggest that we shouldn't be using this device routinely without more evidence of benefit.”
Effect of APOC3 Inhibition with Olezarsen on Coronary Atherosclerosis: Essence–TIMI 73b Imaging Study
Implication: Clinicians should not anticipate plaque benefit from olezarsen; challenges the triglyceride hypothesis for atherosclerosis progression.
“This is an important trial looking at a group that we see a lot in clinical practice. We know historically that this group has increased residual risk when they’re optimized on lifestyle, which is [where] we first start with triglyceride lowering.”
Left bundle branch area vs biventricular pacing for cardiac resynchronization therapy: the LEFT-BUNDLE-CRT trial
Implication: LBBAP not noninferior to BiVP in CRT for typical LBBB; leaves open routine replacement pending further RCTs despite similar outcomes.
“We now have randomized data showing that [LBBAP] is a very credible CRT option, with procedural advantages in some settings and clinical outcomes that are at least broadly comparable to BiV-CRT in selected populations. But I would still be cautious about overinterpreting the current evidence. These trials are important, but they do not yet justify a one-size-fits-all conclusion that LBBAP should replace conventional CRT across the board.”