SCAI provides on-site coverage of key late-breaking clinical trials presented at major cardiology conferences, highlighting the studies most relevant to interventional cardiologists and the evolving practice of cardiovascular medicine.
Below are key studies from American College of Cardiology (ACC) Scientific Sessions 2026.
The STEMI Door to Unload (DTU) Trial: Left Ventricular Unloading in Anterior STEMI Without Shock
This randomized trial evaluated whether mechanical left ventricular unloading prior to PCI could reduce infarct size in anterior STEMI. The strategy did not improve infarct size or clinical outcomes and was associated with higher rates of bleeding and vascular complications.
This trial examined the protective effect of ventricular unloading by a microaxial flow pump (mAFP) in patients with severe coronary artery disease and LV dysfunction undergoing elective complex PCI. The study found no reduction in major adverse outcomes with ventricular unloading and observed higher rates of mortality and procedural complications in the device arm.
This trial compared left atrial appendage closure with anticoagulation in patients eligible for long-term therapy. LAAC was noninferior for major cardiovascular outcomes and reduced bleeding, though a numerical increase in stroke and low event rates warrant careful patient selection.
Long-term follow-up from HOST-EXAM showed that clopidogrel monotherapy reduced ischemic events and bleeding compared with aspirin over more than 10 years, supporting its role as the preferred long-term strategy after PCI.
ORBITA-CTO redefines the clinical understanding of CTO PCI by confirming that the procedure offers genuine symptomatic benefit, while simultaneously emphasizing that its effects are incremental and patient-specific.
DKCRUSH VIII: IVUS or Angiography Guidance for PCI in Complex Coronary Bifurcation Lesions
This trial reinforces a paradigm shift toward precision PCI, showing that IVUS-guided PCI significantly reduced target vessel failure compared with angiography guidance in complex bifurcation lesions, driven by reductions in myocardial infarction and repeat revascularization.
This is the first randomized trial demonstrating an advantage of catheter-directed therapy in the care of patients with intermediate-risk PE, and is expected to have an immediate impact on treatment patterns given the current widespread variability in practice.
TRISCEND II showed that transcatheter tricuspid valve replacement significantly reduced tricuspid regurgitation and improved symptoms at two years, with no clear mortality difference in the primary analysis but signals toward benefit in treated patients.
Transcatheter Aortic Valve Implantation Without Routine Percutaneous Coronary Intervention
This randomized study found that deferring PCI in patients undergoing TAVR was noninferior to routine PCI for major outcomes and was associated with a lower risk of major bleeding, though revascularization was more frequent in the deferred group.
The SirPAD Trial: Sirolimus-Coated Balloon Angioplasty for Infrainguinal Artery Disease
SirPAD demonstrated that sirolimus-coated balloon angioplasty reduced major adverse limb events and repeat revascularization compared with uncoated balloons, with no difference in safety outcomes. This positive study is an exciting advance in the treatment of peripheral artery disease.
SCAI Guidewire Coverage Team for ACC 2026
Clinical writers: Chadi Alraies, MD, MPH, FSCAI; Lyndon C. Box, MD, FSCAI; Allison Dupont, MD; Aakash Garg, MD; Gary S. Ledley, MD, FSCAI; S. Tanveer Rab, MD, MSCAI; Luai K. Tabaza, MD, FSCAI
Reviewers: Jordan Safirstein, MD, FSCAI; Chadi Alraies, MD, MPH, FSCAI
Editor: Gavin Stern, MPH, MS
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