The Rhythm | Issue 8
Issue 8 | Week of 25 May 2026
EuroPCR took place in Paris from 19 to 22 May, dominating this week's evidence with three simultaneous publications across Circulation and EuroIntervention.
Cardiology Intelligence Briefing: refining what we already do
The five papers this week ask a narrower but increasingly important question in cardiology: not whether existing pathways work, but whether they can be made more precise. The strongest hard-outcome evidence comes from stable patients several years beyond their initial revascularisation, already receiving contemporary therapy but continuing to carry substantial residual cardiovascular risk.1 In this population, the trajectory of secondary prevention continues to move in one direction: lower low-density lipoprotein cholesterol (LDL-C), lower event rates, and less willingness to accept residual risk as inevitable.
Antithrombotic prevention forms the second theme this week. The 2024 European Society of Cardiology (ESC) chronic coronary syndromes (CCS) guideline elevated clopidogrel monotherapy to a class I, level A alternative to aspirin for long-term secondary prevention following percutaneous coronary intervention (PCI) or myocardial infarction (MI), supported largely by trials conducted in East Asian populations. New evidence does not challenge that recommendation, but raises an important question about how confidently it can be generalised: the observed benefit appears statistically robust in East Asian populations, whereas evidence in the European and North American populations to whom the recommendation is increasingly being applied remains underpowered.2
The remaining three studies come from the EuroPCR programme and examine procedural strategy rather than new therapies. A head-to-head randomised trial of calcium modification techniques, both guided by optical frequency-domain imaging (OFDI), positions intravascular lithotripsy (IVL) as a non-inferior alternative to rotational atherectomy on an imaging endpoint.3 A second study suggests that carbon dioxide (CO₂) flushing of the transcatheter aortic valve implantation (TAVI) prosthesis before deployment may reduce subsequent cerebral lesion burden on magnetic resonance imaging (MRI).4 An individual participant data (IPD) meta-analysis in patients undergoing TAVI with concomitant coronary artery disease (CAD) further suggests that physiology-guided revascularisation may be associated with better one-year outcomes than angiography-guided approaches.5
The gains in cardiology increasingly appear to come not from entirely new therapeutic categories, but from defining more precisely who benefits, when they benefit, and where the limits of existing strategies lie.
