New Orleans, Louisiana | March 28–30, 2026 | 75th Anniversary Meeting 7 LBCT Sessions · 27 Late-Breaking Trials · 4,730 Abstracts from 82 Countries
1. Electrophysiology & Arrhythmia
CHAMPION-AF (LBCT I, Mar 28) WATCHMAN FLX vs. NOACs in 3,000 NVAF patients eligible for anticoagulation. Non-inferior for stroke/CV death/systemic embolism (5.7% vs. 4.8%); superior for non-procedural bleeding (10.9% vs. 17.2%). Published in NEJM. Practice: WATCHMAN FLX is now a valid first-line option via shared decision-making, even in NOAC-eligible patients. Superior bleeding profile is clinically meaningful — but this is not a blanket NOAC replacement. Individualize.
HI-PEITHO (LBCT I, Mar 28) EKOS ultrasound-facilitated catheter-directed thrombolysis vs. anticoagulation alone in 544 intermediate-to-high-risk PE patients. Met primary composite (PE death, hemodynamic collapse, recurrent PE ≤7 days). No increase in major bleeding. Published in NEJM. Practice: USCDT now has RCT-level evidence as first-line for intermediate-high-risk PE with imminent hemodynamic decompensation.
PREVUE-VALVE (Investigative Horizons, Mar 30) AI-based 12-lead ECG algorithm detected significant AS and MR at the population level with high sensitivity. Practice: Could be integrated into routine ECG platforms to reduce the burden of missed, asymptomatic severe valve disease in primary care.
PKP2 Gene Therapy — LX2020 (Investigative Horizons III, Mar 30) First-in-human safety and preliminary efficacy data for AAVrh.10hPKP2 gene replacement in PKP2-arrhythmogenic cardiomyopathy. Early feasibility signal in a disease with no current disease-modifying therapy. Practice: Relevant for young patients with PKP2-ACM at high SCD risk. Enroll patients in genetic testing/counseling programs now.
2. Interventional Cardiology — Coronary
STEMI Door-to-Unload (STEMI-DTU) (LBCT I, Mar 28) Impella CP with deliberate 40-minute delay to reperfusion vs. immediate PCI in anterior STEMI without cardiogenic shock. Neutral — no reduction in infarct size. Higher bleeding and vascular complications in treatment arm. Published in JACC. Practice: Routine Impella use before PCI in non-shock STEMI is not supported. Reserve for hemodynamic compromise.
CHIP-BCIS3 (LBCT III, Mar 29) Elective Impella CP during high-risk PCI (LVEF ≤35%, complex CAD) vs. standard care (n=300, UK). No benefit on composite outcome; numerically higher CV death in the Impella arm. Published in NEJM. Practice: Routine "protected PCI" in stabilized high-risk patients without active hemodynamic instability is not recommended.
ORBITA-CTO (LBCT III, Mar 29) Sham-controlled RCT of CTO-PCI vs. placebo in symptomatic single-vessel CTO without bystander CAD. CTO-PCI significantly improved angina symptom score vs. placebo. Published in JACC. Practice: First sham-controlled evidence that CTO-PCI delivers genuine angina relief. Strengthens its role in carefully selected, symptomatic single-vessel CTO — not for all-comers.
ALL-RISE & FAST III (LBCT III, Mar 29) Both trials confirmed angiography-derived physiology (vFFR/QFR) non-inferior to invasive pressure-wire FFR for guiding PCI revascularization decisions. Practice: Supports guideline-level adoption of angiography-derived physiological indices — reduces cost and procedural complexity.
IVUS-CHIP (LBCT VII, Mar 30) IVUS-guided vs. angiography-guided PCI in complex/high-risk procedures. Routine IVUS not superior — TVF 14% vs. 11%, non-significant. Published in NEJM. Practice: Challenges mandatory IVUS in all complex PCI. A selective, operator-driven approach appears appropriate.
OPTIMAL (LBCT VII, Mar 30) IVUS vs. angiography-guided PCI for unprotected left main CAD (n=806). IVUS not superior — primary composite 34% vs. 31%, HR 1.11. Published in NEJM. Practice: May challenge the current mandate for intravascular imaging in all left main PCI. Note a possible higher stroke signal with IVUS that warrants further investigation.
DKCRUSH-VIII (LBCT VII, Mar 30) IVUS-guided DK-crush PCI significantly superior to angiography-guidance for complex bifurcation lesions — significantly lower TVF in IVUS arm. Practice: IVUS benefit is lesion-complexity-dependent. Use it for bifurcation stenting; contrast with IVUS-CHIP/OPTIMAL results.
SMART-DECISION (LBCT VI, Mar 30) Beta-blocker discontinuation vs. continuation ≥1 year post-MI in stable patients (LVEF ≥40%, no HF). Discontinuation non-inferior — primary composite 7.2% vs. 9.0%, HR 0.80. Published in NEJM. Practice: Deprescribing beta-blockers is safe in appropriately selected, stable post-MI patients. Challenges the "lifelong beta-blocker" reflex.
SirPAD (LBCT VII, Mar 30) Phase III RCT of sirolimus-coated balloons vs. uncoated balloons for infra-inguinal PAD. Assessed primary patency and limb outcomes in symptomatic claudication and CLI. Practice: Sirolimus-coated balloons may offer improved vessel patency in infra-inguinal PAD — relevant for all interventionalists managing peripheral disease.
3. Heart Failure & Cardiomyopathy
SPIRIT-HF (LBCT IV, Mar 29) Spironolactone vs. placebo in HFpEF/HFmrEF (LVEF ≥40%). Inconclusive — primary endpoint non-significant (10.9 vs. 8.2/100 patient-years). Trial severely underpowered due to COVID-19 impact (only ~50% of planned enrollment). Practice: Does not exclude benefit. Finerenone (FINEARTS-HF) remains the preferred MRA for HFpEF. The SPIRRIT trial is ongoing for a definitive answer.
CADENCE (LBCT IV, Mar 29) Phase 2 RCT of sotatercept (Winrevair) in combined pre/postcapillary pulmonary hypertension (CpcPH) associated with HFpEF. Significant reduction in PVR and improvement in functional endpoints vs. placebo. Practice: Sotatercept now extends into CpcPH-HFpEF — a phenotype previously without targeted therapy. Refer to PH centers for phenotyping and eligibility.
Impedance-HFpEF (LBCT IV, Mar 29) Noninvasive lung impedance-guided fluid management significantly reduced death and HF hospitalization in HFpEF patients. Practice: Remote monitoring-guided diuretic titration is effective in HFpEF — adds to the management toolkit beyond CardioMEMS, which is primarily HFrEF-focused.
SCOUT-HCM (LBCT IV, Mar 29) Phase 3 RCT of mavacamten (Camzyos) in symptomatic adolescents (12–18 years) with obstructive HCM. Significant reduction in LVOT gradient and symptom class vs. placebo. Practice: Mavacamten is now effective in adolescents with obHCM. Extends prescribing consideration to younger patients — maintain close LVEF monitoring per REMS program.
Acoramidis (Attruby) — ATTRIBUTE-CM Long-Term Data (Investigative Horizons III, Mar 30) Sustained reduction in CV mortality and HF hospitalization with acoramidis in ATTR-CM over extended follow-up. Practice: Confirms durable benefit. Reinforce early ATTR-CM diagnosis — baseline 6MWT, NT-proBNP, Tc-99m PYP scintigraphy — and initiate TTR stabilizer therapy early.
4. Structural Heart Disease
SURVIV (LBCT V, Mar 29) Redo mitral surgery vs. transcatheter mitral valve-in-valve (TMViV) for failing bioprosthetic mitral valves. TMViV non-inferior with significantly lower procedural risk. Published simultaneously. Practice: TMViV is the preferred strategy for failing mitral bioprostheses, particularly in high-surgical-risk patients. Confirm via Heart Team discussion.
PRO-TAVI (LBCT V, Mar 29) Routine pre-TAVI PCI vs. deferred approach for concomitant CAD. Deferred (selective) PCI equivalent to routine revascularization on clinical outcomes. Practice: Avoid routine PCI of non-hemodynamically significant lesions before TAVI — individualize based on lesion significance.
ProtectH2H (LBCT V, Mar 29) Head-to-head RCT of Emboliner vs. Sentinel cerebral protection devices in TAVR — compared embolic debris capture and DW-MRI stroke lesion burden. Practice: Both systems remain valid; results guide institutional device selection based on anatomy and operator experience.
Tri.fr — 2-Year Outcomes (LBCT V, Mar 29) Sustained 2-year benefit of tricuspid TEER over medical therapy in severe TR — durable improvement in QoL and functional class. Practice: Do not dismiss severe TR as benign. Refer symptomatic patients early for structural heart evaluation.
TRISCEND II — 2-Year Data (Featured Research V, Mar 30) Extended follow-up confirms durable TR reduction and sustained functional improvement with transcatheter tricuspid valve replacement. Practice: TTVR is an effective, durable option for severe TR in high-surgical-risk patients — expands the toolkit beyond TEER.
ALERT Trial (Featured Research, Mar 29) EHR-integrated automated alerts for severe AS and MR significantly improved guideline-appropriate referral and intervention rates. Practice: Implement clinical decision support for valvular disease in your EHR system — particularly for primary care and non-cardiology inpatient settings.
5. Preventive Cardiology — Lipids & Hypertension
VESALIUS-CV Substudy (LBCT II) Evolocumab (Repatha) reduced MACE by ~25% in high-risk primary prevention patients without prior MI or stroke — including those with diabetes, FH, or elevated Lp(a). Practice: Expands PCSK9 inhibition beyond secondary prevention. Justified in high-risk primary prevention patients who remain above LDL target on maximum statin/ezetimibe.
Ez-PAVE (LBCT II) Intensive LDL lowering to <55 mg/dL in ASCVD patients was safe, with no cognitive harm signal, and demonstrated residual risk reduction. Practice: Supports ESC/ACC-aligned LDL targets in very high-risk patients. Justifies combination therapy to achieve <55 mg/dL in secondary prevention.
KARDINAL (LBCT II) Tonlamarsen (Kardigan), an antisense oligonucleotide targeting angiotensinogen — substantial and sustained SBP reduction over 24 weeks in uncontrolled hypertension. Phase 2. Practice: A once-monthly subcutaneous RNA-targeted antihypertensive. Highly promising for resistant hypertension. Watch for Phase 3 development.
GoFreshRx (LBCT II) & THRIVE (LBCT VI) DASH-patterned grocery delivery and culturally targeted food-is-medicine interventions significantly reduced systolic BP in hypertensive, food-insecure adults. Practice: Food access is a modifiable antihypertensive target. Integrate SDOH screening and food pharmacy programs into hypertension management protocols.
CORALreef AddOn — Enlicitide Decanoate (Investigative Horizons II) Phase 3 data for an oral macrocyclic peptide PCSK9 inhibitor — non-injection-based LDL lowering in statin-intolerant and inadequately treated patients. Practice: An oral PCSK9 inhibitor could dramatically expand access. Monitor for FDA filing and payer coverage.
ACC/AHA 2026 Dyslipidemia Guidelines Key updates: lower LDL targets initiated earlier in life, broader PCSK9 inhibitor indications, and a strengthened primary prevention framework. Featured across 20 dedicated guideline sessions.
6. Cardiometabolic Disease & GLP-1 Agents
SURPASS-CVOT — Tirzepatide Extended Analysis All-cause mortality significantly lower with tirzepatide vs. dulaglutide. Expanded 6-point MACE — including kidney and HF hospitalization endpoints — also significantly reduced. Practice: Tirzepatide is the preferred agent when GLP-1/GIP dual agonism is indicated in high-CV-risk T2DM and obesity. Superior cardiometabolic signal vs. older GLP-1 monotherapy.
SURPASS-CVOT Substudy — Obese HFpEF Sustained QoL, 6MWT, and NT-proBNP improvement in obese HFpEF patients at extended follow-up — builds on STEP-HFpEF data. Practice: GLP-1 agonists (semaglutide, tirzepatide) are increasingly central to HFpEF management in obese patients. Screen all obese HFpEF patients for eligibility.
7. Cardiovascular Imaging & Diagnostics
GPS-CAD (Featured Research) CAC=0 reliability to exclude coronary plaque varies across ethnic groups — reduced negative predictive value demonstrated in South Asian populations. Practice: CAC=0 is not a universal rule-out across all ethnicities. Supplement with Lp(a), family history, and clinical context in South Asian patients.
CLAiR — AI Retinal Imaging (Investigative Horizons I) AI-based fundus photography analysis reliably stratified 10-year ASCVD risk — scalable, non-invasive, and deployable in non-cardiology settings. Practice: Potential future integration into optometry and primary care for opportunistic CV risk screening.
DISCOVER INOCA (Featured Research) Comprehensive INOCA phenotyping using coronary physiology and intravascular imaging — defined the burden of myocardial bridging and microvascular dysfunction across phenotypes. Practice: Physiological testing (CFR, IMR) and intravascular imaging are essential in INOCA workup. Phenotyping guides targeted therapy.
MINOCA Studies (Featured Research) Registry and cohort data highlighting sex differences in pathophysiology and significant underuse of guideline-directed diagnostics in MINOCA patients. Practice: MINOCA patients — particularly women — require comprehensive evaluation: CMR, OCT/IVUS, vasoreactivity testing. Antiplatelet benefit is less established than ACE inhibitor/statin therapy.
8. Pulmonary Hypertension
CADENCE — Sotatercept in CpcPH-HFpEF (LBCT IV, Mar 29) Phase 2 RCT of sotatercept in combined pre/postcapillary PH associated with HFpEF. Significant improvement in PVR, 6MWT, and NT-proBNP vs. placebo. Practice: First targeted therapy with signal in this notoriously difficult phenotype. Refer to PH centers for formal hemodynamic characterization and trial eligibility.
9. Rheumatic Heart Disease
Dig-RHD (LBCT VI, Mar 30) RCT of digoxin in rheumatic heart disease with AF/HF in low-middle income country settings — assessed whether this inexpensive, globally available agent reduces death and hospitalization. Practice: Relevant for managing patients from RHD-endemic regions and for global cardiology practice where modern GDMT access is limited.
10. Cardiac Devices & Resynchronization
Atrial Pacing Support in CRT — Non-Inferiority RCT (Featured Research V) Assessed optimal pacing configuration in CRT-eligible patients — whether atrial pacing support is non-inferior to standard programming for biventricular pacing outcomes. Practice: Clarifies CRT programming strategy for EP and HF implanters managing device optimization.
11. Guideline Updates
- ACC/AHA 2026 Dyslipidemia Guidelines — Lower LDL targets earlier in life; expanded PCSK9 inhibitor indications; stronger primary prevention framework.
- ACC/AHA Pulmonary Embolism Guidelines (New) — Risk-stratified PE management incorporating catheter-directed therapy and PERT team frameworks.
- ACC Expert Consensus on AI in Cardiovascular Medicine — Framework for implementing, validating, and governing AI-based tools in clinical cardiology practice.
12. Artificial Intelligence & Innovation
PREVUE-VALVE — AI-ECG detects significant AS and MR at population scale. Integration into routine ECG analysis platforms could close the asymptomatic valve disease detection gap.
CLAiR — Retinal AI — Fundus photography + AI predicts 10-year ASCVD risk. Scalable for non-cardiology screening settings.
AI Cardiac Surgeon Evaluation — Intraoperative video-based AI objectively assesses surgical technique quality and predicts outcomes. Future applications in credentialing and quality improvement.
Eugene Braunwald Keynote: The Future of AI in Cardiovascular Medicine — Delivered by Paul Friedman, MD (Mayo Clinic). Explored how deep learning will transform diagnostics, risk prediction, arrhythmia management, and imaging across cardiovascular medicine.
Full session recordings and abstracts available at accscientificsession.acc.org. Content compiled from ACC News, TCTMD, NEJM, JACC, and official press releases. For educational use only.
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