Key Points

• In SURPASS-CVOT, tirzepatide was previously shown to be non-inferior to dulaglutide for 3-point major adverse cardiovascular events (MACE-3) in adults with type 2 diabetes and atherosclerotic cardiovascular disease, with a hazard ratio of 0.92 (95% CI 0.83–1.01) and all-cause mortality of 0.84 (95% CI 0.75–0.94).
• In this prespecified analysis of 13,000+ participants, tirzepatide reduced the composite of all-cause death or heart-failure events to 10.5% versus 12.1% with dulaglutide (HR 0.86, 95% CI 0.77–0.95), with a stronger effect in the 20% of patients who had established heart failure at baseline.
• Among patients with prior heart failure, tirzepatide was associated with lower all-cause death (HR 0.80, 95% CI 0.65–0.97), fewer MACE-4 events (HR 0.81, 95% CI 0.69–0.95), and fewer coronary revascularizations (HR 0.76, 95% CI 0.59–0.98) compared with dulaglutide, while rates of heart-failure hospitalization alone were similar between groups.

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Key Points:

• The optimal duration and choice of dual antiplatelet therapy (DAPT) after one year for patients with multivessel disease who undergo percutaneous coronary intervention (PCI) (MVD) remains uncertain.
• The DAPT-MVD trial, a large-scale multicenter randomized study in China, found that extending DAPT with aspirin and clopidogrel for an additional year after drug-eluting stent (DES) implantation significantly reduced major adverse cardiac and cerebrovascular events (MACCE) compared to aspirin alone, without increasing bleeding.

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Key Points

• The ADAPT AF-DES randomized trial compared NOAC monotherapy (apixaban or rivaroxaban) versus NOAC plus clopidogrel in atrial fibrillation (AF) patients who had undergone drug-eluting stent (DES) implantation ≥1 year earlier.
• NOAC monotherapy reduced net adverse clinical events (9.6% vs 17.2%; HR 0.54; P<0.001) and significantly decreased major or clinically relevant nonmajor bleeding (5.2% vs 13.2%; HR 0.38).
• The trial demonstrated noninferiority and superiority of monotherapy for the composite endpoint without increasing ischemic complications.

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Key Points

• TUXEDO-2 directly compared ticagrelor vs prasugrel based DAPT in 1,800 patients with diabetes and multivessel coronary artery disease (MVD) undergoing PCI with drug-eluting stents.
• Conducted across 66 centers in India, the trial included patients with Type 1 or Type 2 diabetes (median age 60 years; 29% women).
• Prasugrel-based DAPT demonstrated a numerically lower composite rate of death, MI, stroke, or major bleeding than ticagrelor-based DAPT (14.23% vs 16.57%).
• Findings suggest that prasugrel may be the preferred agent in this high-risk population, challenging assumptions of equivalence between potent P2Y12 inhibitors.

Optimal P2Y12 inhibitor selection in patients with diabetes and multivessel CAD undergoing PCI remains uncertain. Both ticagrelor and prasugrel are potent agents proven superior to clopidogrel, yet direct comparative data in this complex, high-risk population have been lacking.

At the American Heart Association 2025 Scientific Sessions, Dr. Sripal Bangalore (NYU Langone, New York) presented the TUXEDO-2 trial, which evaluated clinical outcomes between ticagrelor- and prasugrel-based dual antiplatelet therapy (DAPT) regimens in diabetic patients undergoing PCI.

TUXEDO-2 was a prospective, multicenter, open-label, randomized controlled trial conducted across 66 health centers in India. The trial enrolled 1,800 adults with Type 1 or Type 2 diabetes and angiographically confirmed multivessel disease, all undergoing PCI with a drug-eluting stent (Supraflex Cruz SES or Xience EES). Patients were randomized 1:1 to receive either ticagrelor-based DAPT (ticagrelor + aspirin), or prasugrel-based DAPT (prasugrel + aspirin). Approximately 25% of participants were insulin-dependent, 79% presented with acute coronary syndrome (ACS), and 85% had triple-vessel disease. The primary endpoint was a composite of death, myocardial infarction, stroke, or major bleeding at 12 months, defined using BARC criteria. The composite rate of death, myocardial infarction, stroke, or major bleeding was numerically lower in the prasugrel group compared with the ticagrelor group (14.23% vs 16.57%).

When outcomes were analyzed individually, nonfatal MI was reported 5.96% in ticagrelor group vs 5.21% in the prasugrel group, major bleeding was 8.41% vs 7.14% in the favor of prasugrel and most importantly mortality was also in the favor of prasugrel (5.03% vs 3.67%). These findings suggest that prasugrel may provide a more favorable overall balance between ischemic protection and bleeding risk in patients with diabetes and MVD undergoing PCI.

According to Dr. Sripal Bangalore, “We were surprised by the results because we hypothesized that ticagrelor should be as good or perhaps even better than prasugrel. It’s important to choose the right medicine, and at least from our data, we cannot say that ticagrelor and prasugrel are interchangeable.” Dr. Bangalore added that the TUXEDO-2 results build upon earlier evidence from TUXEDO-1 and highlight the need for nuanced antiplatelet selection strategies in diabetic patients with multivessel disease, a subset with particularly high ischemic and thrombotic burden. With the prasugrel-based DAPT yielding numerically fewer major adverse events, these findings may influence future DAPT selection guidelines for complex diabetic patients.

Key Points:

• Persistent atrial fibrillation (AF) is common among patients with rheumatic mitral valve disease undergoing surgery, but the optimal surgical ablation strategy remains uncertain.
• In this multicenter randomized trial conducted in China, biatrial ablation during mitral valve surgery resulted in significantly higher rates of arrhythmia-free survival compared to left atrial ablation alone.
• Importantly, the biatrial approach did not increase the risk of permanent pacemaker implantation, meeting non-inferiority criteria for safety.

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Key Points:

1. Over a decade of follow-up, early surgical aortic valve replacement (AVR) continued to confer a substantial survival advantage over conservative management in asymptomatic patients with very severe aortic stenosis (AS).
2. Building on the original 2020 results, early surgery reduced cardiovascular mortality by 90% and all-cause mortality by more than half, without any operative deaths—confirming the long-term durability and safety of an early-intervention strategy.

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Key Points:
• In patients with atrial fibrillation (AF) undergoing PCI, prolonged dual antithrombotic therapy increases bleeding risk.
• OPTIMA-AF tested whether one-month of dual therapy (DOAC + P2Y12i) followed by DOAC alone was as effective as 12 months of dual therapy.
• The shorter strategy was noninferior for thromboembolic events and significantly reduced clinically relevant bleeding.
• These results support a shorter dual antithrombotic strategy in selected AF patients undergoing PCI. Continue reading →

Key Points:

• SGLT2 inhibitors have shown potential antiarrhythmic benefits in cardiometabolic disease, but their role in low-risk AF patients is unknown.
• DARE-AF is the first randomized trial to assess dapagliflozin after catheter ablation in patients without diabetes, heart failure, or chronic kidney disease. The study was conducted in China.
• At 3 months post-ablation, dapagliflozin did not reduce atrial fibrillation (AF) burden, recurrence, or improve left atrial remodeling compared with standard care.
• These findings suggest that SGLT2i may not offer rhythm benefits in patients without structural or metabolic risk factors.

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Key Points:

• PCSK9-inhibitors – including evolocumab – are highly effective LDL-C–lowering medications that reduce major adverse cardiovascular events (MACE) in patients who have had a previous cardiovascular (CV) event, such as a prior myocardial infarction (MI) or stroke.
• Evolocumab was associated with a significant 25% relative risk reduction in a composite of coronary heart disease death, MI, or ischemic stroke compared with placebo in this population.
• This is the first trial to demonstrate that any non-statin LDL-C–lowering therapy reduces major CV events in a primary prevention population.

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Key points:

• PCI is often performed for chronic stable angina, but current evidence is unclear to what extent the benefit is physiologic vs placebo
• This trial compared PCI with placebo-procedure in stable angina patients not on antianginal therapy with primary outcome of angina symptom assessment
• PCI was significantly associated with decreased angina symptoms measured by an angina symptom score compared to placebo

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Key Points

• This pragmatic trial randomizing patients to optical coherence tomography (OCT)-guided or intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) found that OCT was non-inferior to IVUS for a composite outcome of cardiovascular death, target vessel myocardial infarction, or ischemia-driven target vessel revascularization.
• These data indicate that OCT has similar outcomes compared with IVUS in PCI across a broad range of coronary lesions, though patients with chronic kidney disease and ST-elevation myocardial infarction (STEMI) were excluded.

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Key Points

• This metanalysis integrating data from ILUMIEN IV and OCTOBER Trials with 18 prior randomized trials found that intravascular imaging (IVI) with intravascular ultrasound (IVUS) or optical coherence tomography (OCT) was associated with a 31% reduction in target lesion failure (TLF) compared to angiography alone.
• In addition, there were statistically significant reductions in all-cause death, all myocardial infarction (MI), and target vessel revascularization (TVR), a novel finding.
• OCT and IVUS performed similarly compared against angiography and one another.
• These data indicate that IVI with either OCT or IVUS is associated with better long-term clinical outcomes compared to angiography alone. The authors plan to update the analysis with data from the OCTIVUS trial, also presented the same day at ESC.

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Key Points:

• Femoral access is used for 30% of all coronary procedures, and femoral access site complication can be catastrophic. Since the development of ultrasound-guided vascular access, many institutions have adopted ultrasound-guidance as the standard of care for femoral access. However, there is a paucity of randomized data to understand the role of ultrasound in improving the safety of coronary procedures via femoral access.
• In the UNIVERSAL study, patients randomized to ultrasound-guided femoral access did not experience a reduction in major bleeding or vascular complications at 30 days; however, ultrasound guidance did improve first attempt success and reduce the number of attempts and accidental venipuncture.

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Key Points

• PCI has yet to be shown to be superior to CABG with respect to quality of life and angina in those with multivessel coronary artery disease.
• This substudy of the FAME-3 trial, which randomized participants to FFR-guided PCI versus CABG, sought to understand whether physiology-guided PCI would have an effect on quality of life and angina.
• Quality of Life was assessed by the EQ-5D questionnaire, and angina was assessed on the Canadian Coronary Symptoms scale.
• At 1 year, there were no differences in angina and quality of life between those who underwent FFR-guided PCI and those who underwent CABG.

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Key Points

• The COMPLETE trial, published in 2019, demonstrated that in patients with ST-segment elevation myocardial infarction found to have multivessel disease, complete revascularization was superior to culprit-only revascularization in reducing the risk of cardiovascular death or subsequent myocardial infarction.
• In this secondary analysis of the COMPLETE trial, the authors sought to understand the effect of both treatment modalities (complete or culprit-only) on patients’ perceptions of angina-related quality of life.
• Seattle Angina Questionnaires were administered at baseline, 3 months, 6 months, and 3 years.
• There was no significant difference in angina-related quality of life for patients who underwent complete revascularization or culprit-only percutaneous coronary intervention. Both groups demonstrated significant improvement in Seattle Angina Questionnaire scores

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A study led by Dr. Ronald Waksman showed that in low-risk patients with symptomatic severe aortic stenosis, transcatheter aortic valve replacement (TAVR) appears to be safe at 1 year. This study, which was published in JACC Cardiovascular Interventions, provides evidence to support the use of TAVR in low-risk patients.

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A prespecified analysis of the BIO-RESORT trial demonstrated that patients stent in small coronary vessels were less likely to need repeat revascularization if ultrathin-strut sirolimus-eluting stents were used as compared to the previous generation thin strut zotarolimus-eluting stent. Dr. Rosaly Buiten, the lead authors of this study published in JAMA cardiology, highlights the need to further evaluate the potential benefit of thin stent struts.

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A randomized controlled trial led by Dr. Nicola Vos published in JACC: Cardiovascular Interventions showed that a treatment strategy involving the use of a drug-coated balloon (DCB) was non-inferior to drug-eluting stents (DES) for patients with ST-elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention (PCI). The data here suggest that using DCB could be both safe and feasible.

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In a study published in the European Heart Journal, Dr. Sergio Buccheri showed that patients with bioabsorbable polymer drug-eluting stents (BP-DES) did not have a better outcome when compared to patients who receive permanent polymers (PP-DES) during percutaneous coronary intervention (PCI).

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A study led by Dr. Suzanne Arnold published in the Journal of American College of Cardiology showed that in patients with heart failure secondary to mitral regurgitation, transcatheter mitral valve repair resulted in early and sustained health status improvement compared with medical therapy alone.

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