ACC.26 Late-Breakers to Watch, With Deepak Bhatt, MD, MPH, MBA

As the cardiovascular community prepares to convene in New Orleans for the American College of Cardiology’s Annual Scientific Session & Expo (ACC.26), attention is once again turning to the late-breaking clinical trials expected to define the meeting’s scientific and clinical impact.

Each year, these presentations serve as a bellwether for where cardiovascular care is headed, often introducing data directly informs guideline updates, reshapes treatment algorithms, and accelerates adoption of emerging therapies across practice settings.

The momentum heading into ACC.26 follows a high-impact showing at ACC.25, where more than 50 late-breaking trials highlighted rapid advances across cardiometabolic care, lipid management, and interventional cardiology.

Notable data included the REVERSE-IT trial demonstrating rapid reversal of ticagrelor’s antiplatelet effects, the ALPACA study showing profound and sustained reductions in lipoprotein(a), and the ADVANCE-HTN trial evaluating novel approaches for treatment-resistant hypertension. These findings underscored a broader shift toward precision therapeutics, long-acting agents, and targeted mechanisms addressing previously unmet clinical needs.1

Against this backdrop of accelerating innovation, ACC.26 is expected to build on these themes, with new data poised to further refine risk stratification, expand minimally invasive treatment strategies, and uncover novel drivers of cardiovascular disease. Increasingly, the field is moving toward earlier intervention and more individualized care, supported by advances in both pharmacologic and device-based therapies.

ACC.26 Late-Breakers to Watch, With Deepak Bhatt, MD, MPH, MBA

1. MOMENTUM Trial (Corcept Therapeutics)

Presentation Title: Prevalence of Endogenous Hypercortisolism in Resistant Hypertension: Results of the MOMENTUM Trial
Presenter: Deepak L. Bhatt, MD, MPH, MBA
NCT06829537

MOMENTUM (NCT06829537), a prospective, multicenter observational study enrolling 1000 patients across 45 US sites, examines whether endogenous hypercortisolism (Cushing's syndrome) underlies treatment resistance in this population. Patients screening positive by dexamethasone suppression test (DST ≥1.8 µg/dL) undergo additional workup and adrenal imaging.2

The design mirrors the CATALYST study, which found hypercortisolism in approximately 1 in 4 patients with difficult-to-control type 2 diabetes. Bhatt, a lead investigator and steering committee member, anticipates results will open new therapeutic pathways, potentially including cortisol-modulating agents, for patients whose hypertension remains poorly controlled on standard care.

2. HI-PEITHO (Boston Scientific / PERT Consortium)

Presentation Title: Higher-Risk Pulmonary Embolism Thrombolysis (HI-PEITHO): Primary Results
Presenter: Stavros Konstantinidis, MD, PhD
NCT04790370

HI-PEITHO is the first large-scale randomized controlled trial powered to determine whether ultrasound-facilitated, catheter-directed thrombolysis (USCDT) via the EKOS™ endovascular system plus anticoagulation improves outcomes versus anticoagulation alone in acute intermediate-high-risk pulmonary embolism (PE).3

The 7-day primary composite endpoint includes PE-related death, cardiorespiratory decompensation or collapse, and non-fatal symptomatic PE recurrence. Enrolling 544 patients across 72 US and European hospitals, the adaptive-design trial addresses the longstanding gap left by the original PEITHO study, which demonstrated hemodynamic benefit of systemic thrombolysis at the cost of unacceptable hemorrhagic stroke rates. HI-PEITHO employs the validated National Early Warning Score (NEWS ≥9) to standardize decompensation criteria.3

3. SURVIV Trial (Instituto Dante Pazzanese de Cardiologia, São Paulo)

Transcatheter Valve-in-Valve Versus Redo-Surgical Valve Replacement for Mitral Bioprosthetic Valve Dysfunction: Primary Results of the SURVIV Randomised Trial
Presenter: Dimytri A. Siqueira, MD, PhD

Bioprosthetic mitral valves inevitably undergo structural deterioration, yet the optimal reintervention strategy, transcatheter mitral valve-in-valve (mViV) via transseptal, balloon-expandable approach versus redo surgical mitral valve replacement (rMVR), has never been tested in a randomized trial.4

SURVIV is a prospective, multicenter, open-label RCT enrolling 150 patients with mitral bioprosthetic valve dysfunction across multiple Brazilian centers, randomized 1:1 to mViV or rMVR. Bhatt, a co-investigator, noted the study could shift decision-making away from high-risk redo surgery toward a less invasive standard of care for this growing patient population, particularly as the prevalence of failed bioprostheses rises with longer patient lifespans and expanding valve repair programs.4

4. IVUS-CHIP Trial (ECRI / Boston Scientific)

Presentation Title: Intravascular Ultrasound Guidance for Complex High-Risk Indicated Procedures: Primary Results of the IVUS-CHIP Trial
Presenter: Roberto Diletti, PhD
NCT04854070

Despite accumulating evidence favoring intravascular ultrasound (IVUS) guidance over angiography alone in PCI, rigorous randomized data in patients specifically defined as complex and high-risk, the CHIP population, have remained limited.5

IVUS-CHIP is a randomized, controlled, multicenter, post-marketing study enrolling 2,020 patients with complex coronary lesions across approximately 40 hospitals in 7 European countries, randomized 1:1 to IVUS-guided versus angiography-guided PCI with a minimum 2-year follow-up. The primary endpoint is target-lesion failure, which is defined as a composite of cardiac death, target-vessel MI, and clinically indicated target-lesion revascularization.5

Editor’s Note: Bhatt reports disclosures with GSK, Merck, Cereno Scientific, Angiowave, Boehringer Ingelheim, Novo Nordisk, and others.

References:

1. Bhatt DL. Key clinical trial insights from ACC 2025, with Deepak Bhatt, MD, MPH, MBA. HCPLive. Published April 9, 2025. Accessed March 20, 2026. https://www.hcplive.com/view/key-clinical-trial-insights-from-acc-2025-with-deepak-bhatt-md-mph-mba-

2. Corcept Therapeutics. Corcept Therapeutics initiates MOMENTUM trial to determine prevalence of hypercortisolism in patients with resistant hypertension. Business Wire. Published March 10, 2025. Accessed March 19, 2026. https://ir.corcept.com/news-releases/news-release-details/corcept-therapeutics-initiates-momentum-trial-determine/

3. Skhirtladze-Dworschak K, Konstantinidis SV, Rosenfeld K, et al. Ultrasound-facilitated, catheter-directed thrombolysis vs anticoagulation alone for acute intermediate-high-risk pulmonary embolism: rationale and design of the HI-PEITHO study. Am Heart J. 2026;S0002870326000013. doi:10.1016/j.ahj.2026.01.001. Accessed March 19, 2026.

4. Boston Scientific Corporation. The HI-PEITHO study. Boston Scientific website. Accessed March 19, 2026. https://www.bostonscientific.com/en-EU/medical-specialties/vascular-surgery/venous-thromboembolism-portal/pulmonary-embolism/clinical-data/hi-peitho.html

5. Siqueira DA, Abizaid AAC, Ramos AA, et al. Transcatheter valve-in-valve versus redo-surgical valve replacement for mitral bioprosthetic valve dysfunction: rationale and design of the SURVIV randomized trial. EuroIntervention. Published online 2026. doi:10.4244/EIJ-D-25-01090. Accessed March 19, 2026.