This Week in Cardiology

Apr 03 2026 This Week in Cardiology

14 snips
Apr 3, 2026
A rapid ACC trial roundup covering catheter-directed fibrinolysis for pulmonary embolism and concerns about soft endpoints. A debate over deferring PCI during TAVR and the pitfalls of mixed composite outcomes. A sham‑controlled CTO‑PCI study showing placebo‑resistant angina benefits. New data questioning routine Impella use for high‑risk PCI. A contested comparison of left atrial appendage closure versus anticoagulation.
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INSIGHT

Hi-PEITHO Result Driven By Soft Physiologic Scores

  • Hi-PEITHO's positive primary result was driven mainly by NEWS score changes rather than hard outcomes.
  • The trial was open-label, industry-sponsored, and saw more major bleeding and numerically higher PE-related deaths with ultrasound-facilitated thrombolysis.
INSIGHT

PRO-TAVI Non-Inferiority Masks Opposite Trends

  • PRO-TAVI declared non-inferiority for deferring PCI before TAVR mainly because the composite combined ischemic and bleeding outcomes that trended in opposite directions.
  • Deferral raised ischemic events (21% vs 16%) while PCI increased major bleeding (15% vs 6%), so the composite cancelled effects and met the wide non-inferiority margin.
INSIGHT

ORBITA-CTO Demonstrates Placebo-Resistant Angina Relief

  • ORBITA-CTO showed a placebo-resistant moderate angina benefit from CTO-PCI using a tightly blinded sham-controlled design.
  • Benefit was driven by reduced angina frequency and about 30 extra angina-free days over 24 weeks in selected single-vessel CTO patients.
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