Cardiovascular prevention, acute care and interventional cardiology converged in a wide-ranging Hot Line Session at ESC Congress 2026 that delivered new evidence on how clinicians assess risk, treat older heart attack patients and guide complex coronary procedures. Among the highlights were fresh data from the CorCal Outcomes trial supporting the use of coronary artery calcium (CAC) in cardiovascular risk stratification, findings from the EVAOLD trial aimed at optimizing care for older adults after myocardial infarction, and research from ISOLEDS showing two imaging-guided approaches perform equally well in complex stenting procedures.

CorCal Outcomes
In CorCal Outcomes, researchers found no difference in major adverse cardiovascular events when statin initiation was based on coronary artery calcium compared with traditional risk factor assessment using pooled cohort equations (PCE).

The trial randomized 5,772 patients (mean age 64 years; 51% women) to receive guidance on statin initiation based on either their CAC or PCE scores. After approximately four years of follow-up major adverse cardiovascular events occurred in nearly 3% of patients in both groups and noninferiority criterion was not met.

In other findings, researchers noted that those patients randomized to the PCE group received a recommendation to initiate statins more than three times as frequently as those in the CAC group. However, patients in the CAC group who received a statin recommendation were much more adherent to medications than those in the PCE group (62% vs. 23%).

While the study did not demonstrate noninferiority between the groups, Joseph B. Muhlestein, MD, said it does provide important hypothesis-generating insights. "Taken together, our data could be used to plan an additional well-powered randomized trial comparing CAC with current risk factor-based algorithms," he said.

EVAOLD
The EVAOLD trial found stress imaging-guided selective invasive management failed to demonstrate noninferiority to routine invasive management (angiography only) in patients 80 years or older who were hospitalized with NSTEMI.

The trial was stopped for futility after randomization of the first 587 patients, but researchers noted the primary endpoint of death from any cause, nonfatal myocardial infarction or nonfatal stroke at one year occurred in 24% of patients in the imaging-guided selective strategy group compared with 20.7% of patients in the routine invasive group.

"Although the stress imaging-guided selective strategy reduced the need for coronary angiography and angiography-related complications, it did not demonstrate noninferiority to routine invasive management for major cardiovascular events," said Gilles Barone-Rochette, MD, PhD, from University Hospital of Grenoble, La Tronche, France. "The trial [did show] that implementing the stress imaging-guided strategy was challenging in this population, which is an important finding in itself," he added.

ISOLEDS
When it comes to cardiovascular imaging, two techniques to guide stenting in patients with true distal left main bifurcation lesions demonstrated noninferiority in the ISOLEDS trial out of China.

ISOLEDS shows that optical coherence tomography guidance may be considered an alternative to intravascular ultrasound guidance for appropriately selected patients undergoing PCI for true distal left main bifurcation lesions, noted Yong Zeng from Beijing Anzhen Hospital, Capital Medical University. "The findings do not establish equivalence or superiority," he said. "In practice, selection of the imaging modality should account for coronary anatomy, image-acquisition feasibility and local expertise."

Visit ACC's ESC Congress 2026 coverage page to explore the latest science and key takeaways shaping cardiovascular care.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Interventions and Coronary Artery Disease, Interventions and Imaging, Interventions and Vascular Medicine

Keywords: ESC Congress, ESC26, Percutaneous Coronary Intervention, Tomography, Optical Coherence, Myocardial Ischemia, Vascular Diseases, Infarction, Ischemia, Coronary Disease, Coronary Artery Disease, Arteriosclerosis, Myocardial Infarction