From anticoagulation after acute coronary syndromes to primary prevention in older adults, we highlight five Hot Line studies set to generate discussion at ESC Congress 2026.
Late-breaking clinical research will once again be a major focus at ESC Congress 2026, taking place in Munich, Germany, from August 28–31. This year, a record 59 trials have been selected for presentation across 12 Hot Line sessions, spanning new pharmacological approaches, diagnostic strategies, devices, imaging and digital technologies.1
Ahead of the meeting, we highlight five studies addressing questions with potentially important implications for cardiovascular practice.
Don’t miss out on hearing about our latest peer-reviewed articles, expert opinions, conference news, podcasts and more.
1. LIBREXIA ACS: Can factor XIa inhibition improve secondary prevention after ACS?
For patients who have experienced an acute coronary syndrome (ACS), reducing the risk of recurrent ischemic events must be balanced against the increased bleeding risk associated with more intensive antithrombotic treatment.
The LIBREXIA ACS trial is investigating whether the oral factor XIa inhibitor milvexian can help shift that balance. More than 14,000 patients with recent ACS were enrolled, making it one of the largest studies being presented in the ESC 2026 Hot Line program.1
Factor XIa has attracted interest as a therapeutic target because inhibiting this pathway may reduce pathological thrombosis while having less effect on normal hemostasis than conventional anticoagulants. Whether that theoretical advantage translates into improved clinical outcomes is an important question for the field.
Why it matters: LIBREXIA ACS could provide important evidence on whether factor XIa inhibition has a role alongside existing antiplatelet strategies in patients who remain at risk of recurrent events following ACS.
Details: LIBREXIA ACS – Milvexian after recent acute coronary syndrome | Presenter: Philippe Gabriel Steg | Hot Line 3, August 29, 2026
2. PRESC1SE-MI: Can suspected myocardial infarction be assessed more efficiently?
Rapidly ruling myocardial infarction in or out is a routine but critical challenge in emergency cardiovascular care.
PRESC1SE-MI examines the implementation of the ESC 0/1-hour algorithm for patients presenting with suspected myocardial infarction. The international, multicenter study included almost 68,000 emergency department presentations across Europe, the United States, Australia and Asia.1,2
The study compares the more rapid ESC 0/1-hour approach with standard care pathways, assessing whether faster triage can be achieved while maintaining patient safety.2
With chest pain accounting for a substantial number of emergency presentations, the implications extend beyond diagnostic performance alone. An effective accelerated pathway could influence waiting times, use of hospital resources and decisions around discharge or further investigation.
Why it matters: PRESC1SE-MI could provide large-scale randomized evidence to support how rapid troponin-based algorithms are implemented in everyday emergency care.
Details: PRESC1SE-MI – Safety and efficacy of the ESC 0/1-hour algorithm versus standard care pathways in myocardial infarction | Presenter: Christian Eugen Mueller | Hot Line 4, August 29, 2026
3. CARDIO-TTRansform: What can the full results tell us about eplontersen in ATTR-CM?
Transthyretin amyloid cardiomyopathy (ATTR-CM) has moved rapidly from an under-recognized cause of heart failure to a condition with an expanding range of disease-modifying treatment options.
The Phase III CARDIO-TTRansform trial evaluated eplontersen, an antisense oligonucleotide designed to reduce production of transthyretin, in patients with ATTR-CM.
Unlike several of the other studies on this list, the topline outcome is already known. In July 2026, Ionis Pharmaceuticals and AstraZeneca announced that the study did not meet its primary efficacy endpoint, a composite of cardiovascular mortality and recurrent cardiovascular clinical events up to Week 140 compared with placebo.3
The companies reported that most participants were receiving contemporary standard-of-care treatment, including a transthyretin stabilizer, and that adding eplontersen did not result in a statistically significant benefit for the primary endpoint. A prespecified subgroup analysis of patients receiving eplontersen as monotherapy produced a nominally significant result.3
The ESC presentation will therefore be important for understanding the complete dataset, including secondary and subgroup findings, safety and the potential influence of background therapy.
Why it matters: Rather than a simple positive-or-negative readout, CARDIO-TTRansform may help clarify how transthyretin-lowering therapies could fit into an increasingly complex ATTR-CM treatment landscape.
Details: CARDIO-TTRansform – Eplontersen in transthyretin amyloid cardiomyopathy | Presenter: Mathew Maurer | Hot Line 1, August 28, 2026
4. ACACIA-HCM: Could myosin inhibition extend to non-obstructive HCM?
Cardiac myosin inhibition has changed the therapeutic landscape for obstructive hypertrophic cardiomyopathy (HCM), but effective disease-specific treatment for patients with non-obstructive HCM remains an important unmet need.
The Phase III ACACIA-HCM trial evaluated aficamten in 516 patients with symptomatic non-obstructive HCM.4
Positive topline findings were announced in May 2026. Aficamten met both primary endpoints, producing statistically significant improvements versus placebo in Kansas City Cardiomyopathy Questionnaire Clinical Summary Score and peak oxygen uptake at Week 36. Improvements were also reported across several secondary endpoints.4
The presentation at ESC Congress will provide the full primary results and offer an opportunity for closer examination of the magnitude and consistency of benefit, alongside safety findings. Of particular interest will be the effects of treatment on left ventricular ejection fraction: in the topline analysis, LVEF below 50% occurred more frequently with aficamten than placebo.4
Why it matters: ACACIA-HCM could help determine whether cardiac myosin inhibition can address symptoms and impaired exercise capacity across a broader spectrum of HCM, beyond obstructive disease.
Details: ACACIA-HCM: Aficamten for Symptomatic Nonobstructive Hypertrophic Cardiomyopathy | Presenter: Ahmad Masri, MD, MS | Hot Line 1, August 28, 2026
5. STAREE: Do statins benefit healthy adults aged 70 years and older?
Not every potentially important ESC trial involves a new therapy.
STAREE – STAtins for Reducing Events in the Elderly – addresses a familiar clinical question for which the evidence remains less clear: should statins be routinely used for primary prevention in otherwise healthy older adults?
The randomized, placebo-controlled study evaluates atorvastatin 40 mg in community-dwelling adults aged 70 years and older without a history of cardiovascular disease, diabetes or dementia.5
The study was designed to examine both cardiovascular disease prevention and disability-free survival, making it particularly relevant to decisions in older people where treatment benefits need to be considered alongside overall health, function and competing risks.5
Why it matters: With an aging population and widespread statin use, STAREE has the potential to provide evidence directly relevant to preventive treatment discussions between clinicians and millions of older adults.
Details: STAREE – Statins for Reducing Events in the Elderly | Presenter: Sophia Zoungas | Hot Line 2, August 29, 2026
Also on the radar at ESC Congress 2026
These five studies represent only a small part of the Hot Line program. Other trials worth watching include PREMIUM, examining aspirin omission at the time of primary PCI in ST-elevation myocardial infarction; SWITCH SWEDEHEART, evaluating a switch from ticagrelor to prasugrel following ACS; AIR-STEMI, investigating functional coronary angiography in STEMI; and TARGET-CTCA, exploring the use of troponin testing to guide CT coronary angiography in patients presenting with acute chest pain.
Across the 59 Hot Line studies, the broader program will address questions spanning antithrombotic therapy, coronary intervention, heart failure, cardiomyopathy, structural heart disease, arrhythmias and cardiovascular prevention.1
The diversity of these studies reflects an important theme running through ESC Congress 2026: innovation does not always mean introducing a new treatment. Some of the most clinically relevant evidence may instead come from refining how established therapies are used, identifying who benefits most from treatment or finding more efficient ways to diagnose and manage cardiovascular disease.
→ Take a look at the full ESC Congress 2026 programme here
References
- European Society of Cardiology. Hot Lines revealed – the trials that will make the headlines at ESC Congress 2026. Published July 23, 2026. Accessed August 7, 2026.
- Boeddinghaus J, Bima P, Crisanti L, et al; PRESC1SE-MI investigators. PRospective evaluation of the European Society of Cardiology 0/1h-algorithm’s safety and efficacy for triage of patients with suspected myocardial infarction (PRESC1SE-MI): rationale and design of a prospective international multicenter stepped-wedge cluster randomized controlled trial. Am Heart J. 2026;292:107299.
- Ionis Pharmaceuticals. Update on CARDIO-TTRansform Phase 3 trial of eplontersen in adults with transthyretin-mediated amyloid cardiomyopathy. Published July 9, 2026. Accessed August 7, 2026.
- Cytokinetics. Cytokinetics Announces Positive Topline Results from ACACIA-HCM, the Pivotal Phase 3 Clinical Trial of Aficamten in Patients with Non-Obstructive Hypertrophic Cardiomyopathy. Published May 5, 2026. Accessed August 7, 2026.
- Zoungas S, Moran C, Curtis AJ, et al; STAREE investigator group. Baseline characteristics of participants in STAREE: a randomized trial for primary prevention of cardiovascular disease events and prolongation of disability-free survival in older people. J Am Heart Assoc. 2024;13.
Cite: ESC Congress 2026 preview: Five studies to watch. touchCARDIO. August 7, 2026.
Disclosure: This content has been developed independently by Touch Medical Media for touchCARDIO, utilizing AI as an editorial tool (Claude (Sonnet 5) [Large language model] https://claude.ai). No funding was received in the publication of this article.
Editor: Nicola Cartridge, Director of Content
