Several Factors Linked to Subsequent Events After TIA, Minor Stroke

A new systematic review and meta-analysis published in Circulation identifies multiple factors—spanning demographics, medical history, and characteristics of the index event—that help predict long-term stroke risk following a transient ischemic attack (TIA) or minor stroke.

The investigation synthesized data from 28 cohort studies encompassing over 86,000 patients to estimate population attributable fractions (PAFs) and determine which variables most strongly influence future stroke events.

Among nonmodifiable traits, having a minor stroke rather than a TIA as the index event carried the largest population impact (PAF 28%). Modifiable contributors—hypertension, smoking, and specific stroke subtypes linked to cardio-embolism, large-artery atherosclerosis, and small-vessel disease—also emerged as key drivers (PAFs 11.1%–19.3%).

These findings highlight how targeted follow-up and aggressive secondary prevention strategies could be directed toward high-risk individuals. Given limited capacity to monitor all TIA or minor stroke patients, this approach helps identify those who would benefit most from intensified prevention.

Risk also increased with advancing age, male sex, atrial fibrillation, diabetes, and prior stroke/TIA, with adjusted hazard ratios ranging from 1.29 to 1.70. Additionally, markers at presentation—including an elevated ABCD2 score, DWI-positive lesions, and ischemic subtypes—proved prognostic for recurrence.

The study underscores the importance of precise diagnosis since misclassification of a minor stroke could affect management intensity. Quantifying risk through PAFs, rather than relying solely on qualitative assessments, provides actionable insights for clinical decision-making and resource allocation.

These findings reinforce that identifying high-risk subsets after TIA or minor stroke can refine clinical resources and improve long-term outcomes through better-tailored care.

Full study: Prognostic factors for long-term risk of stroke after transient ischemic attack or minor stroke.

Related coverage: Risk of Another Event Remains High Years After TIA, Minor Stroke.

LAA Closure vs. Medical Therapy: New Insights from CLOSURE-AF

For high-risk patients with Atrial Fibrillation (AFib), choosing the right stroke prevention strategy is a delicate balance. The recently published CLOSURE-AF trial in the New England Journal of Medicine provides critical clarity on whether Left Atrial Appendage (LAA) closure is a viable alternative to standard medical care for this specific group.

The Study at a Glance

The trial, detailed by the American College of Cardiology, followed 912 older patients (average age 78) who faced a high risk for both stroke and major bleeding. Participants were randomized to receive either a catheter-based LAA closure device or physician-directed medical therapy, which typically included direct oral anticoagulants.

Key Findings

• Noninferiority Not Met: The study found that LAA closure was not noninferior to medical therapy regarding the composite endpoint of stroke, systemic embolism, or death.

• Complication Risks: While the device was successfully implanted in 98% of cases, 6% of patients suffered periprocedural complications, including pericardial tamponade and major bleeding.

• Standard of Care: The results suggest that for older, high-risk patients, individualized medical therapy remains the preferred standard over catheter-based interventions.

As noted by study authors, this vulnerable patient group is particularly prone to early complications, making the "theoretical promise" of the device difficult to realize in clinical practice.

Premature Menopause: A Hidden Risk Factor for Heart Disease

A recent study published in JAMA has highlighted a significant link between premature natural menopause and an increased lifetime risk of Coronary Heart Disease (CHD). The research, which followed over 10,000 women, reveals that those experiencing early menopause face a 40% higher risk of developing heart disease.

Key Findings

• Disparities in Occurrence: Premature menopause was found to be more common in Black women (16%) compared to White women (5%).

• Health Correlations: Black women with premature menopause often had a history of diabetes, while White women were more likely to be smokers.

• Clinical Impact: These findings suggest that the perimenopausal period is a "unique window of opportunity" for healthcare providers to monitor and manage cardiovascular risks.

The study underscores the necessity of including reproductive history in standard cardiovascular risk assessments to better protect women's long-term heart health.

Epicardial Fat Emerging as a New CAD Risk Marker

New research suggests that higher volumes of epicardial adipose tissue (EAT)—the fat surrounding the heart—are closely linked to both the presence and progression of coronary artery disease (CAD).

In a recent analysis from the PARADIGM registry, published in JACC: Cardiovascular Imaging, serial coronary CT angiography (CCTA) scans from over 700 patients showed that greater EAT volume was associated with more frequent and faster plaque progression, including both calcified and noncalcified plaque. Over an average of eight years, participants with the highest EAT volumes were significantly more likely to experience plaque progression and rapid plaque progression, which correlated with higher long-term cardiovascular risk.

While EAT volume itself was not independently predictive of major adverse cardiovascular events (MACE) after adjustment for traditional risk factors, it remained a strong indicator of plaque burden and progression. Importantly, EAT can be measured automatically from both contrast and noncontrast CT images using AI-based tools, making it an accessible imaging biomarker.

EAT may also represent a modifiable risk factor, as therapies like statins and GLP-1 receptor agonists have been shown to reduce epicardial fat volume in prior studies. This supports its potential role as a clinically actionable biomarker in coronary prevention and disease monitoring.

Still, questions remain about how much additional predictive value EAT offers compared with current noninvasive imaging markers such as coronary calcium scoring, IVUS, or OCT. Further research will be essential to determine whether reducing epicardial fat can slow or reverse plaque progression and translate into improved clinical outcomes.

ACC 2026: What to Watch

ACC 2026 is returning to New Orleans with one of the most expansive and diverse scientific programs in recent memory. With thousands of abstracts distilled into a high‑impact lineup featuring 27 Late-Breaking Clinical Trials (LBCTs), Featured Clinical Research, Investigative Horizons, and AI-driven innovation, this year’s meeting promises to shape cardiovascular practice well beyond 2026.

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Opening Highlights & Leadership Voices

ACC 2026 launches on Saturday, March 28 with insights from:

• Christopher Kramer, MD – ACC Presidential Address

• Kathryn Berlacher, MD – Meeting Chair

• Julie Damp, MD – Vice Chair

Their opening session will introduce the structure of this year’s meeting: 11 clinical pathways, over 20 guideline-focused sessions, and a strong emphasis on practice-changing science, including the updated guidance for dyslipidemia management.

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Preconference Immersive Programs – Friday, March 27
For attendees arriving early, ACC 2026 offers several deep‑dive sessions:
• Cardio‑Oncology Immersive
Updates in cardiovascular management for patients undergoing cancer therapies.
• Sports Cardiology Intensive
Training, screening, and return‑to‑play strategies across athletic populations.
• Critical Care Cardiology Workshop
Advanced hemodynamics, shock management, and multidisciplinary critical care models.
These programs historically sell out — and this year’s offerings reflect the rapid evolution of these subspecialties.

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Practice Models & Clinical Innovation
Concierge Cardiology Takes Center Stage
This year’s crowdsourced town hall focuses on concierge medicine, responding to the growing number of cardiology groups exploring membership‑based models. The discussion will cover:

• Clinical workflow redesign

• Economics and reimbursement

• Equity considerations

• Patient expectations

• Experience from early cardiology adopters

Expect strong debate, as the model continues expanding beyond primary care.

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AI at ACC 2026: Moving From Promise to Practicality
Artificial intelligence continues to dominate cardiovascular discussions, and ACC 2026 features a robust lineup of AI-focused sessions.
Key AI Presentations
Mintu Turakhia, MD (Stanford Medicine; Chief Medical & Scientific Officer, iRhythm)

• Keynote on scaling AI across cardiology practice

Rohan Khera, MD (Yale School of Medicine)

• Challenges in translating AI research into frontline care

AI-themed sessions will also examine:

• AI‑ECG screening tools

• AI‑driven retinal imaging for ASCVD risk

• AI models evaluating surgical technique

• Financial and governance structures for deploying AI

• Real-world examples of AI‑enabled imaging workflows

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🚨 Late-Breaking Clinical Trials (LBCTs)

All 27 trials from Sessions I–VII are included below.

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LBCT I – Saturday, March 28
HI‑PEITHO
Ultrasound-facilitated catheter‑directed thrombolysis vs. anticoagulation for intermediate-to-high–risk pulmonary embolism.
CHAMPION‑AF
Comparison of left atrial appendage occlusion (LAAO) with oral anticoagulation in atrial fibrillation — especially relevant after last year’s CLOSURE-AF controversy.
STEMI Door‑to‑Unload
Impella‑based left ventricular unloading prior to PCI in STEMI without cardiogenic shock.
Device: Impella (Abiomed)

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LBCT II – Saturday
KARDINAL

• Tonlamarsen (Kardigan) — antisense oligonucleotide

• Indication: Uncontrolled hypertension

GoFreshRx

• DASH diet–patterned grocery delivery

• For hypertensive adults with limited access to healthy foods

VESALIUS‑CV (Subgroup Study)

• Evolocumab (Repatha; Amgen)

• Focus: Patients without significant atherosclerosis

Ez‑PAVE

• Targets outcomes with LDL levels <55 mg/dL

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LBCT III – Sunday, March 29
Interventional cardiology takes the spotlight.
ORBITA‑CTO
Placebo-controlled PCI trial for chronic total occlusions (CTO).
CHIP‑BCIS3
High‑risk PCI with percutaneous LV unloading.
ALL‑RISE & FAST III
Competing physiology‑guided PCI strategies.

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LBCT IV – Sunday
Heart failure & cardiomyopathy innovations.
SPIRIT‑HF

• Spironolactone

• For HFpEF and HFmrEF

SCOUT‑HCM

• Mavacamten (Camzyos; Bristol Myers Squibb)

• In adolescent obstructive HCM

Lung Impedance‑Guided Therapy for HFpEF
CADENCE

• Sotatercept (Winrevair; Merck Sharp & Dohme)

• For pre- and post‑capillary pulmonary hypertension due to HFpEF

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LBCT V – Sunday
Structural interventions.
SURVIV
Redo surgery vs. transcatheter mitral valve‑in‑valve.
ProtectH2H
Comparison of two embolic protection devices during TAVI.
PRO‑TAVI
Routine PCI vs. deferred PCI in TAVI candidates.
Tri.fr Update
New outcomes in tricuspid transcatheter edge‑to‑edge repair.

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LBCT VI – Monday, March 30
ESSENCE‑TIMI 73b (CTA Substudy)
Olezarsen (Tryngolza; Ionis Pharmaceuticals) in high-resolution CT angiography modeling.
Dig‑RHD
Digoxin therapy in rheumatic heart disease.
THRIVE Pilot
“Food is medicine” BP intervention in Black and Hispanic adults.
SMART‑DECISION
Evaluates stopping beta‑blockers in stabilized post‑MI patients — one of the most anticipated trials in 2026.

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LBCT VII – Monday
IVUS‑CHIP
IVUS guidance for complex, high‑risk PCI (CHIP) cases.
DKCRUSH‑VIII
Next‑generation bifurcation PCI strategy.
OPTIMAL
Optimization of unprotected left main PCI.
SirPAD (Phase III)
Sirolimus‑coated balloons for infra‑inguinal PAD.

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⭐ Featured Clinical Research (19 Presentations)
Highlights include ongoing advances in:

• MINOCA evaluation and pathophysiology

• Global CAC scoring and its prognostic value

• Long‑term antiplatelet therapy in PCI patients

• New structural insights from TRISCEND II

• Risk stratification and diagnostic strategies spanning imaging, physiology, and prevention

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Investigative Horizons Sessions
ACC 2026 also showcases cutting‑edge frontiers:

• AI‑assisted retinal imaging to assess ASCVD risk

• Gene therapy for Friedreich ataxia cardiomyopathy

• AI‑based evaluation models of surgical technique

• AI‑ECG screening from PREVUE‑VALVE

• Long-term results for acoramidis (Attruby; BridgeBio Pharma) in ATTR‑CM

These sessions highlight technologies that may enter clinical use within the next decade.

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Keynote Lectures
ACC 2026 will host several prominent speakers:

• Cathleen Biga, MSN, RN – James T. Dove Lecture

• Carole Warnes, MD – Dan G. McNamara Address

• Paul Friedman, MD (Mayo Clinic) – Eugene Braunwald Lecture on the future of AI in cardiovascular medicine

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Bottom Line

ACC 2026 is packed with transformative science — from LAAO vs. anticoagulation, to LV unloading, to PCSK9 inhibitor expansion, to HFpEF therapies, TAVI‑PCI strategies, AI‑driven diagnostics, gene therapy, and food‑as‑medicine interventions.

For cardiologists, this year’s meeting offers a clear look at the future of cardiovascular practice, with implications that will reverberate through guidelines, clinical workflows, and patient care models.