The Rhythm | Issue 2
Issue 2 | Week of 13 April 2026
ACC.26 produced the most concentrated wave of practice-changing cardiology evidence so far this year. With landmark trials still being digested from the conference, this issue covers five more key papers from ACC.26, each with important implications for clinical decision-making.
Cardiology Intelligence Briefing: knowing when to stop, when to push, and when to prove it
This was a week that forced cardiology to confront its own habits. Three of the five papers in this issue ask whether established treatments are being applied to the right patients, and two others ask whether new technologies can prove their value against the most rigorous standards the field can impose.
The case against routine long-term beta-blocker therapy after myocardial infarction (MI) has been building through recent randomised and meta-analytic evidence questioning initiation in patients without heart failure (HF) or left ventricular (LV) systolic dysfunction. This issue adds the first randomised evidence that stopping beta-blockers in stable patients years after MI is non-inferior to continuing them.1 At the opposite end of the therapeutic spectrum, the first head-to-head comparison of two low-density lipoprotein cholesterol (LDL-C) targets in patients with established atherosclerotic cardiovascular disease (ASCVD) supports the case that aiming for the stricter guideline threshold reduces major cardiovascular events.2 In structural heart disease, routine percutaneous coronary intervention (PCI) before transcatheter aortic valve implantation (TAVI) has been challenged by evidence that deferral is non-inferior, with a notable reduction in major bleeding.3
Elsewhere, a sham-controlled trial isolated the true symptomatic benefit of PCI for chronic total occlusions (CTOs), separating physiological effect from placebo for the first time.4 In peripheral artery disease (PAD), a sirolimus-coated balloon demonstrated superiority over uncoated balloons for hard limb outcomes in a population with no restrictions on disease severity or lesion complexity, including patients with limb-threatening ischaemia whom most device trials exclude.5
The theme across these five papers is that cardiology is entering a phase of greater precision: stopping treatments that do not help, intensifying those that do, deferring procedures that add risk without benefit, and insisting that interventions prove themselves against the highest evidentiary standards.
