EuroPCR 2026: Hotline data from Day 2

Day 2 hotline data at EuroPCR 2026 highlighted improved outcomes with FFR-guided PCI in TAVI, comparable 10-year survival with PCI and CABG in left main disease and consistent LAAC benefits across age groups

As EuroPCR 2026 reached its halfway point on Wednesday, the Late-Breaking Trials session in Theatre Bleu was anchored by three patient-level analyses with the potential to refine practice in TAVI, left main coronary intervention, and atrial fibrillation stroke prevention. The summaries below highlight some of the key Day 2 hotline data presented during the morning Major Late-Breaking session.

Don’t miss out on hearing about our latest peer-reviewed articles, expert opinions, conference news, podcasts, and more.

Register Register

FFR-guided PCI improves outcomes in patients undergoing TAVI

What do the data show?

The ARTICA individual participant data (IPD) meta-analysis pooled patient-level results from four randomized trials addressing percutaneous coronary intervention (PCI) in patients undergoing transcatheter aortic valve implantation (TAVI): NOTION-3, FAITAVI, ACTIVATION, and TCW. A total of 1,050 patients were analyzed: 439 underwent fractional flow reserve (FFR)-guided PCI, 255 angiography-guided PCI, and 356 optimal medical therapy (OMT) alone.

The primary endpoint was 1-year major adverse cardiac events (MACE: all-cause death, myocardial infarction, any coronary revascularization, or stroke); the co-primary endpoint was net adverse clinical events (NACE: MACE plus major bleeding). PCI reduced MACE by 30% compared with OMT (hazard ratio [HR] 0.70; 95% confidence interval [CI] 0.49–0.99), driven by lower repeat revascularization (HR 0.34; 95% CI 0.14–0.80), with no difference in NACE.

FFR-guided PCI showed reductions in both MACE (HR 0.58; 95% CI 0.37–0.91) and NACE (HR 0.68; 95% CI 0.51–0.90) versus OMT. Angiography-guided PCI showed no advantage. Major bleeding was 8.2% with FFR-guided PCI, 13.7% with angiography-guided PCI, and 12.6% with OMT.

Key clinical takeaway

Routine angiography-guided PCI does not improve outcomes in patients undergoing TAVI, but a selective, physiology-informed strategy using FFR guidance does. For general cardiologists referring patients for TAVI, the message is that decisions about concomitant coronary revascularization should rest on functional ischemia assessment rather than angiographic appearance alone.

Reference: Scarsini R. Coronary revascularization in patients undergoing TAVI: an IPD meta-analysis of four randomized trials. Presented at: EuroPCR 2026, Paris, France, May 20, 2026.

Ten-year mortality remains comparable between PCI and CABG in left main disease

This updated individual participant data (IPD) meta-analysis pooled long-term outcomes from the four landmark randomized trials of left main coronary artery disease revascularization — SYNTAX, PRECOMBAT, NOBLE, and EXCEL — analyzing 4,394 patients to compare all-cause mortality after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) versus coronary artery bypass grafting (CABG).

Follow-up extended to 10 years for SYNTAX, PRECOMBAT, and NOBLE, and to 5 years for EXCEL. All-cause mortality at long-term follow-up was 23.5% in the DES PCI arm and 23.1% in the CABG arm, with no statistically significant difference. When the analysis was restricted to studies with complete 10-year follow-up, mortality was 22.3% with PCI and 23.3% with CABG.

No meaningful differences were observed across key clinical subgroups, including patients stratified by baseline SYNTAX score, which has historically been used to identify those more likely to benefit from surgical revascularization. Investigators concluded that, in patients deemed suitable for either revascularization strategy by a multidisciplinary heart team, PCI is a reasonable long-term alternative to CABG.

Key clinical takeaway

At 10 years, PCI with contemporary drug-eluting stents and CABG yield comparable all-cause mortality in randomized left main coronary artery disease populations, with no clear subgroup signal favoring surgery, including by SYNTAX score. The results reinforce the central role of multidisciplinary heart-team discussion in selecting between PCI and CABG for individual patients with left main disease.

Reference: Bergmark BA, et al. Long-term mortality following PCI with DES versus CABG for left main disease. Presented at: EuroPCR 2026, Paris, France, May 20, 2026.

Left atrial appendage closure shows consistent bleeding benefit across age groups

CHAMPION-AF randomized patients with atrial fibrillation who were candidates for long-term anticoagulation to device-based left atrial appendage closure (LAAC) or direct oral anticoagulant (DOAC) therapy. The parent trial showed non-inferiority for the primary efficacy endpoint of cardiovascular death, stroke, or systemic embolism at 3 years, and superiority of LAAC for non-procedure-related bleeding.

This prespecified subgroup analysis stratified outcomes by age: 1,915 patients aged <75 years and 1,085 aged ≥75 years. The primary efficacy endpoint was similar with LAAC versus DOAC in patients aged <75 years (HR 1.07; 95% CI 0.67–1.71) and ≥75 years (HR 1.34; 95% CI 0.85–2.12; p interaction=0.5014).

Non-procedural major and clinically relevant non-major bleeding was significantly lower with LAAC in both age groups: <75 years (HR 0.64; 95% CI 0.50–0.82) and ≥75 years (HR 0.68; 95% CI 0.51–0.91; p interaction=0.7281). A small numerical excess of ischemic stroke with LAAC in intention-to-treat analysis was not significant in the as-treated cohort, and disabling stroke rates were low and balanced.

Key clinical takeaway

The efficacy and safety advantages of LAAC seen in CHAMPION-AF are consistent across patients younger and older than 75 years. Age alone should therefore not preclude left atrial appendage closure in otherwise suitable candidates; the choice between LAAC and DOAC should remain an individualized, shared-decision conversation weighing patient values, bleeding risk, and procedural factors.

Reference: Nielsen-Kudsk JE. Outcomes of LAA closure versus NOAC in patients with atrial fibrillation across different age groups. Presented at: EuroPCR 2026, Paris, France, May 20, 2026. Parent trial: Doshi SK, et al. N Engl J Med. 2026. doi:10.1056/NEJMoa2517213.

Together, the Day 2 hotline presentations reflected a broader shift toward more individualized cardiovascular intervention strategies, balancing anatomy with physiology, procedural durability with patient selection, and stroke prevention with bleeding risk. As EuroPCR 2026 continues, further late-breaking data are expected to shape evolving approaches across structural heart disease, coronary intervention, and cardiovascular prevention.