EuroPCR 2026 launched its four-day late-breaking program on Day 1 with three high-profile trials in coronary device innovation and lipid-lowering therapy.
Data presented on the first day of EuroPCR 2026 highlighted continued advances in lipid lowering, coronary scaffold technology, and vessel restoration strategies. From substantial reductions in cardiovascular events with aggressive LDL-cholesterol lowering to encouraging long-term outcomes with next-generation bioresorbable and adaptive coronary devices, these studies offered important insights into the future direction of PCI and secondary prevention.
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Evolocumab drives major LDL reduction and fewer events in post-PCI patients
What do the data show?
The VESALIUS-CV trial randomized 12,257 high-cardiovascular-risk individuals without prior myocardial infarction (MI) or stroke to evolocumab plus usual care or usual care alone. A prespecified analysis presented at EuroPCR 2026 focused on the 3,627 participants who had previously undergone percutaneous coronary intervention (PCI), with a median time from PCI to enrollment of 4 years.
Median baseline LDL-cholesterol of 109.5 mg/dL was reduced to 41.5 mg/dL at Week 48 and 40.0 mg/dL at Week 96 in the evolocumab arm, versus 97.0 mg/dL with usual care. Over 5 years, evolocumab reduced the three-point composite of coronary heart disease death, MI, or ischemic stroke from 9.5% to 7.0% (HR 0.70; 95% CI 0.56–0.89) and the four-point composite, including ischemia-driven revascularization, from 21.7% to 17.9% (HR 0.82; 95% CI 0.71–0.96). The relative risk of MI fell by approximately 50%, with significant reductions in both STEMI and NSTEMI. Treatment effect on stroke was neutral, and mortality reductions were exploratory. Patients with prior PCI experienced higher baseline event rates than those without.
Key clinical takeaway
Aggressive LDL-cholesterol lowering with evolocumab delivers substantial event reductions in stable patients following PCI who have not yet experienced an MI or stroke. Clinicians should not assume lipid optimization has been achieved after revascularization; coronary stenting itself identifies a clearly high-risk group in whom PCSK9 inhibition can be intensified to reach the lowest achievable LDL-cholesterol targets.
Reference: Bergmark BA, Bohula EA, Marston NA, et al. Evolocumab in patients with prior percutaneous coronary intervention and no prior MI: results from the VESALIUS-CV trial. Circulation 2026; Epub ahead of print. Presented at EuroPCR 2026, Paris, France, 19 May 2026.
Thinner-strut Firesorb scaffold shows comparable 5-year outcomes to contemporary DES
What does the data show?
FUTURE-II randomized 433 patients across 28 Chinese centers to a thinner-strut sirolimus-eluting bioresorbable scaffold (Firesorb; MicroPort Medical, Shanghai, China; n=215) or a contemporary everolimus-eluting stent (EES; n=218). Enrolled patients had myocardial ischemia suitable for elective PCI, with up to two de novo lesions ≤25 mm long in vessels 2.5–4.0 mm in diameter (mean age 56.5 years; 25.5% women).
At 5 years, with follow-up available in 96% of the cohort, target lesion failure (TLF) occurred in 5.2% of bioresorbable scaffold (BRS) and 5.7% of EES patients (p=0.84). Component rates were similar for cardiac death (0.9% versus 0.5%), target-vessel MI (1.0% versus 0.5%), and ischemia-driven target lesion revascularization (3.4% versus 5.2%). No device-related thrombosis occurred in either arm. A landmark analysis from 1–5 years showed no late divergence, with TLF of 1.5% in both groups (HR 1.01; 95% CI 0.20–4.99). According to the investigators, the scaffold begins to resorb at Year 3 and is fully absorbed by Year 5.
Key clinical takeaway
In carefully selected non-complex lesions, the thinner-strut Firesorb bioresorbable scaffold achieves event rates comparable to a contemporary everolimus-eluting stent through 5 years, with no scaffold thrombosis observed. Rigorous patient and lesion selection, particularly avoidance of heavily calcified or otherwise complex disease, remains essential when considering a bioresorbable scaffold strategy in routine practice.
Reference: Song L. Five-year outcomes of thinner-strut Firesorb bioresorbable scaffold in the FUTURE-II trial. Presented at EuroPCR 2026, Paris, France, 19 May 2026.
Bioadaptor system reduces long-term target lesion failure versus drug-eluting stent
The BIOADAPTOR randomized controlled trial enrolled 445 patients with de novo coronary lesions across 34 sites in Japan, Europe, and New Zealand, comparing the sirolimus-eluting DynamX Coronary Bioadaptor System (Elixir Medical, Milpitas, CA, USA) with the zotarolimus-eluting Resolute Onyx drug-eluting stent (DES). The bioadaptor functions as a conventional scaffold during early healing, then mechanically disengages at approximately 6 months to allow restoration of vasomotion and pulsatile flow.
Four-year results presented at EuroPCR 2026 demonstrated significantly lower target lesion failure with the bioadaptor than with the DES (2.8% versus 7.8%, p=0.020). No new bioadaptor TLF events were observed between 3 and 4 years, in contrast to event accrual seen in the DES arm. Cardiovascular death was reduced by 88% with the bioadaptor (0.5% versus 3.7%, p=0.020). The 4-year data extend earlier findings showing stabilization of event rates with the bioadaptor and are consistent with the larger INFINITY-SWEDEHEART registry-based randomized trial.
Key clinical takeaway
Long-term divergence in target lesion failure and cardiovascular mortality between the DynamX Bioadaptor and a contemporary drug-eluting stent suggests that restoring vessel motion after scaffold function may translate into clinically meaningful protection from late events. The device is positioned for broader evaluation in routine de novo coronary intervention, with consistent supportive signals from INFINITY-SWEDEHEART.
