Recent clinical trials demonstrate that intensive blood pressure lowering—targeting systolic levels below 120 mm Hg—can significantly reduce cardiovascular events and mortality, even among older adults, individuals with diabetes, and those with chronic kidney disease. This challenges the long-standing belief that looser blood pressure targets are safer for older patients, showing instead that with proper monitoring, tighter control offers substantial net benefits for most high-risk groups. 

 In this interview, Dr. Alison L. Bailey and Dr. Keith C. Ferdinand explore the evolving landscape of hypertension management, highlighting new evidence supporting the benefits of tight blood pressure control across diverse populations. 

Suggested Materials: 

 1. Liu J, Li Y, Ge J, et al. Lowering systolic blood pressure to less than 120 mm Hg versus less than 140 mm Hg in patients with high cardiovascular risk with and without diabetes or previous stroke: an open-label, blinded-outcome, randomised trial. Lancet. 2024;404(10449):245-255. doi:10.1016/S0140-6736(24)01028-6 

2. Bi Y, Li M, Liu Y, et al. Intensive Blood-Pressure Control in Patients with Type 2 Diabetes. N Engl J Med. 2025;392(12):1155-1167. doi:10.1056/NEJMoa2412006 

3. Reddy TK, Nasser SA, Pulapaka AV, Gistand CM, Ferdinand KC. Tackling the Disproportionate Burden of Resistant Hypertension in US Black Adults. Curr Cardiol Rep. 2024;26(11):1163-1171. doi:10.1007/s11886-024-02115-5 

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Rapid emergency medical services transport to a percutaneous coronary intervention (PCI)-capable hospital is critical for timely intervention and management of life-threatening arrhythmias in ST-elevation myocardial infarction patients. Upon emergency room arrival, immediate transfer to the cath lab is essential to restore perfusion and improve both short- and long-term cardiovascular outcomes, as recommended by clinical guidelines. Interventional cardiologists must also be adept at managing culprit lesions in multivessel disease (MVD) and addressing complications like the no-reflow phenomenon during PCI. 

 In this interview, Drs. Dipti Itchhaporia and Nabil Farag discuss “What's the Best Time to Revascularize the Non-culprit Lesions in MVD.” 

 Suggested Materials: 

1. Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC Guidelines for the management of acute coronary syndromes [published correction appears in Eur Heart J. 2024 Apr 1;45(13):1145. doi: 10.1093/eurheartj/ehad870.]. Eur Heart J. 2023;44(38):3720-3826. doi:10.1093/eurheartj/ehad191 

1. Mehta SR, Wood DA, Meeks B, et al. Design and rationale of the COMPLETE trial: A randomized, comparative effectiveness study of complete versus culprit-only percutaneous coronary intervention to treat multivessel coronary artery disease in patients presenting with ST-segment elevation myocardial infarction. Am Heart J. 2019;215:157-166. doi:10.1016/j.ahj.2019.06.006 

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Cardiogenic shock remains a critical, time-sensitive emergency with a high mortality rate. However, recent advances—particularly multidisciplinary, team-based strategies—have shown promise in improving patient outcomes.  With the release of the 2025 ACC Concise Clinical Guidance on Cardiogenic Shock, clinicians now have access to a streamlined, evidence-informed roadmap for early recognition, rapid stabilization, and escalation of care.  

 In this episode, Drs. Glenn A. Hirsch and Shashank S. Sinha explore the latest strategies in cardiogenic shock management in 2025, emphasizing the how the new guidance integrates clinical decision-making tools and highlighting the role of shock teams and regional partnerships in optimizing care delivery. 

 SUGGESTED MATERIALS:   

1. Sinha SS, Geller BJ, Katz JN, et al; American Heart Association Acute Cardiac Care and General Cardiology Committee of the Council on Clinical Cardiology; Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation; Council on Cardiovascular and Stroke Nursing; and Council on Kidney in Cardiovascular Disease. Evolution of Critical Care Cardiology: An Update on Structure, Care Delivery, Training, and Research Paradigms: A Scientific Statement From the American Heart Association. Circulation. 2025 Feb 13. doi: 10.1161/CIR.0000000000001300. Epub ahead of print. PMID: 39945062.  

1. Hall EJ, Agarwal S, Cullum CM, Sinha SS, Ely EW, Farr MA. Survivorship After Cardiogenic Shock. Circulation. 2025 Jan 21;151(3):257-271. doi: 10.1161/CIRCULATIONAHA.124.068203. Epub 2025 Jan 21. PMID: 39836757.  

1. Ton VK, Li S, John K, et al. Serial Shock Severity Assessment Within 72 Hours After Diagnosis: A Cardiogenic Shock Working Group Report. J Am Coll Cardiol. 2024 Aug 1:S0735-1097(24)07740-4. doi: 10.1016/j.jacc.2024.04.069. Epub ahead of print. PMID: 39217545.  

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Heart failure arises when the heart is unable to pump or fill with blood effectively. In the cardiac catheterization lab, we have the unique ability to directly measure the physiological abnormalities underlying this condition, making it the gold standard for diagnosing heart failure. While not every patient requires heart catheterization, it is often essential for those with heart failure with preserved ejection fraction (HFpEF). This is because noninvasive tests, which are commonly used, frequently fall short—providing false reassurance and leading to missed diagnoses. As a result, HFpEF remains underrecognized. And ultimately, a condition that goes unrecognized cannot be properly treated. 

In this interview, Drs. Matthew Martinez and Barry Borlaug discuss “Hemodynamic Assessment for Diagnosis and Treatment Selection in HFpEF.” 

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The SOUL trial demonstrated that in patients with type 2 diabetes (T2DM) and established atherosclerotic cardiovascular disease (ASCVD), chronic kidney disease (CKD), or both, treatment with oral semaglutide significantly reduced the risk of major adverse cardiovascular events (MACE) compared to placebo—without an increase in serious adverse events. These findings position oral semaglutide as a compelling option with cardiovascular benefits consistent with those seen in injectable GLP-1 receptor agonists. 

 In this episode, Drs. Deepak L. Bhatt and Darren K. McGuire explore how the SOUL trial further strengthens the favorable risk-benefit profile of oral semaglutide for patients with T2DM and coexisting ASCVD and/or CKD, highlighting its potential to reshape cardiovascular risk management in this high-risk population. 

 SUGGESTED MATERIALS 

1. McGuire DK, Marx N, Mulvagh SL, et al.; SOUL Study Group. Oral Semaglutide and Cardiovascular Outcomes in High-Risk Type 2 Diabetes. N Engl J Med. 2025 Mar 29. doi: 10.1056/NEJMoa2501006. Epub ahead of print. 

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The SMART-CHOICE 3 trial demonstrated that clopidogrel monotherapy is more effective than aspirin monotherapy in reducing the risk of major adverse cardiac and cerebrovascular events in high-risk patients who completed standard dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI). Despite concerns that more potent antiplatelet agents may increase bleeding risk, the study found that clopidogrel significantly reduced ischemic events—including myocardial infarction and all-cause death—without increasing bleeding risk, making it a highly favorable option for long-term maintenance therapy. 

 In this episode, Drs. Allen J. Taylor and Joo-Yong Hahn discuss the clinical implications of these findings and offer insights into selecting the optimal single antiplatelet regimen after PCI. 

  SUGGESTED MATERIALS 

1. Choi H, Park H, Lee JY, et al. Efficacy and safety of clopidogrel versus aspirin monotherapy in patients at high risk of subsequent cardiovascular event after percutaneous coronary intervention (SMART-CHOICE 3): a randomised, open-label, multicentre trial. Lancet. 2025;405(10486):1252-63. doi: 10.1016/S0140-6736(25)00449-0. 

1. Koo BK, Kang J, Park KW, et al.; HOST-EXAM investigators. Aspirin versus clopidogrel for chronic maintenance monotherapy after percutaneous coronary intervention (HOST-EXAM): an investigator-initiated, prospective, randomised, open-label, multicentre trial. Lancet. 2021;397(10293):2487-2496. doi: 10.1016/S0140-6736(21)01063-1. 

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The DapaTAVI trial, conducted across 39 centers in Spain, is the first study to evaluate the use of sodium-glucose co-transporter-2 (SGLT-2) inhibitors, specifically dapagliflozin, in patients with heart failure undergoing transcatheter aortic valve implantation (TAVI). The trial found that patients who received dapagliflozin (10 mg daily) within 14 days of hospital discharge after TAVI experienced a 28% relative risk reduction in the composite outcome of all-cause mortality or worsening heart failure at one year, compared to those receiving standard care  

 In this episode, Drs. Allen J. Taylor and Sergio Raposeiras Roubin discuss the safety and clinical benefits of initiating dapagliflozin—or other SGLT-2 inhibitors—in patients undergoing TAVI who are at risk for heart failure, emphasizing its potential to improve outcomes in this high-risk population. 

  SUGGESTED MATERIALS 

1. Raposeiras-Roubin S, Amat-Santos IJ, Rossello X, et al.; the DapaTAVI Investigators. Dapagliflozin in patients undergoing transcatheter aortic-valve implantation. N Engl J Med 2025;392:1396-14. Doi: 10.1056/NEJMoa2500366 

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The PRAGUE-25 study evaluated the effectiveness of two treatment strategies in patients with both atrial fibrillation (AF) and obesity: catheter ablation versus lifestyle modification (including weight loss and increased physical activity) combined with antiarrhythmic drug therapy. While motivated patients who adhered to lifestyle changes experienced a reduction in AF episodes, the study found that catheter ablation was significantly more effective in achieving and maintaining sinus rhythm. 

In this episode, Drs. Joseph Marine and Pavel Osmancik discuss the trial’s findings, highlighting that catheter ablation outperformed lifestyle modification and medication in restoring and sustaining normal heart rhythm. 

SUGGESTED MATERIALS 

1. Osmancik P, Havránek Š, Bulková V, et al. Catheter ablation versus antiarrhythmic drugs with risk factor modification for treatment of atrial fibrillation: a protocol of a randomised controlled trial (PRAGUE-25 trial). BMJ Open. 2022 Jun 15;12(6):e056522. doi: 10.1136/bmjopen-2021-056522. 

1. Pathak RK, Middeldorp ME, Meredith M, Mehta AB, Mahajan R, Wong CX, Twomey D, Elliott AD, Kalman JM, Abhayaratna WP, Lau DH, Sanders P. Long-Term Effect of Goal-Directed Weight Management in an Atrial Fibrillation Cohort: A Long-Term Follow-Up Study (LEGACY). J Am Coll Cardiol. 2015 May 26;65(20):2159-69. doi: 10.1016/j.jacc.2015.03.002.  

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A Global Cardiovascular Risk Consortium study of nearly 2 million people worldwide found that avoiding five modifiable risk factors—hypertension, hyperlipidemia, abnormal weight, diabetes, and smoking—by age 50 added over a decade of life expectancy for both sexes. Midlife control of systolic blood pressure and smoking yielded the greatest global gains. 

In this interview, Drs. Roger S. Blumenthal and Christina Magnussen discuss how this landmark study moves beyond a predominantly North American and European focus, translating abstract risk factors into tangible years of healthy life for patients. 

SUGGESTED MATERIALS 

1. The Global Cardiovascular Risk Consortium. Global effect of cardiovascular risk factors on lifetime estimates. NEJM. Published online March 30, 2025. Doi: 10.1056/NEJMoa2415879 

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The ZENITH trial evaluated sotatercept, an activin signaling inhibitor, in patients with advanced pulmonary arterial hypertension (PAH) at high risk of death. Sotatercept met its primary endpoint—time to first morbidity or mortality event—prompting an independent data monitoring committee to recommend early trial termination and offer the drug to all participants. 

In this interview, Drs. Allen J. Taylor and Marc Humbert discuss how ZENITH highlights sotatercept’s clinical benefit even in the sickest PAH patients, offering renewed hope for a disease long seen as unrelenting. 

 SUGGESTED MATERIALS 

1. Humbert M, McLaughlin VV, Badesch DB, et al., for the ZENITH Trial Investigators. Sotatercept in Patients With Pulmonary Arterial Hypertension at High Risk for Death. N Engl J Med 2025;Mar 31:[Epub ahead of print]. 

2. Hoeper MM, Badesch DB, Ghofrani HA, et al.; STELLAR Trial Investigators. Phase 3 trial of sotatercept for treatment of pulmonary arterial hypertension. N Engl J Med 2023;388:1478-90.  

3. Humbert M, McLaughlin V, Gibbs JSR, et al.; PULSAR Trial Investigators. Sotatercept for the treatment of pulmonary arterial hypertension. N Engl J Med 2021;384:1204-15. 

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