5 practice-changing trials from ESC Congress 2026
Multiple studies presented at ESC Congress 2026 could reshape how clinicians approach the management of heart patients.
Cardiovascular Business spoke with Damodhar Suresh, MD, executive medical director of the St. Elizabeth Healthcare Heart and Vascular Institute in Edgewood, Kentucky, and science chair of the American Heart Association (AHA) International Committee, about some of those trials for a new video interview. He highlighted five practice-changing trials presented during the conference.
1. Incidental CT findings can identify cardiac disease years before symptoms
One of the most notable presentations involved data from the REACT study, which clearly showed evidence that atherosclerosis begins much earlier than the age at which cardiovascular disease typically becomes clinically apparent. Suresh explained that researchers found evidence of silent plaque buildup in about one in 13 adults between the ages of 18 and 29. Much of the plaque was identified incidentally when young adults underwent CT imaging for other reasons.
“Cardiovascular disease is not something that you have to look at in the 50s and 60s and 70s,” Suresh said. “It starts at a very young age.”
These findings reinforce the potential importance of addressing modifiable risk factors early, including smoking, vaping, diet, cholesterol, blood pressure and diabetes, he said.
The study also adds supporting data for cardiologists and imagers calling for a wider use of opportunistic screenings to look for arterial calcifications in vessels across many exam types. By flagging these patients for followup, cardiovascular prevention efforts could begin decades earlier than they do now.
2. FFR-angio improves multivessel PCI decision making
The AIR-STEMI trial examined the role of functional coronary angiography using angiography-derived fractional flow reserve (FFR) in patients with ST-elevation myocardial infarction (STEMI) involving multivessel disease. It found that the use of functional coronary FFR-angio resulted in better outcomes for percutaneous coronary intervention (PCI). This technology allows an FFR value to be performed using an angiographic image alone, no pressure wires required.
FFR-angio was better at selecting which non-culprit blockages needed to be treated compared to angiography alone. Major cardiovascular events also were reduced by 38%, and complications were reduced by 37% when functional coronary angiography was used.
The study suggested that using functional coronary imaging to help determine which blockages require treatment could reduce unnecessary procedures and complications while improving outcomes, Suresh explained.
3. PCI before or after TAVR?
The TAVI PCI study addressed another longstanding clinical question: Should transcatheter aortic valve replacement (TAVR) be performed before or after PCI when patients require both procedures?
The study found that PCI performed after TAVR was as safe as PCI performed before TAVR. This provides physicians with greater flexibility in determining the sequence of treatments based on individual patient circumstances. For patients with critical aortic valve disease, for example, clinicians may prioritize the TAVR and address coronary disease afterward.
4. Controlling blood pressure reduces dementia
Data from the China Rural Hypertension Control Program (CRHCP), examined whether more intensive blood pressure management could have benefits extending beyond cardiovascular health to the brain. The answer, it turns out, was yes.
The community-based study in China compared patients receiving focused hypertension management with those receiving standard care. According to Suresh, more aggressive blood pressure control was associated in this study with lower rates of dementia and neurodegenerative disease. He said the findings add to growing interest in cardiovascular prevention as a means of protecting multiple organ systems, and that many diseases have an integrated relationship with cardiovascular diseases.
5. Should statins be used in patients older than 70 for primary prevention?
The STAREE trial provided evidence supporting lipid-lowering therapy in older adults. It looked at the impact of prescribing atorvastatin in patients older than age 70 who had not previously experienced a heart attack to see if statin therapy could prevent cardiovascular events.
After about three years, atorvastatin was associated with reductions in heart attacks and strokes, although Suresh noted that the study did not demonstrate a mortality benefit during that period. However, for clinicians, it gives additional information for patient discussions.
While it will not make you live longer, the data show it did lower the number of heart attacks and stroke. Suresh said that is a big win for prevention in older patients who generally have a much harder time recovering from these event than younger patients.
STAREE demonstrated a 30% relative reduction in major cardiovascular events with atorvastatin vs. placebo in people aged 70 years or older without known cardiovascular disease, diabetes or dementia over six years.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]