John Mandrola offers an ACC recap of 5 big trials—Hi-PEITHO, PROTAVI, ORBITA-CTO, CHIPS-BCIS3 and CHAMPION AF

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I Catheter Based Fibrinolysis of Pulmonary Embolism –Hi PEITHO

  • Fibrinolysis Treatment Validated in Large Trial for Acute Intermediate-Risk PE https://www.medscape.com/viewarticle/fibrinolysis-treatment-validated-large-trial-acute-2026a10009im
  • Ultrasound-Facilitated, Catheter-Directed Fibrinolysis for Acute Pulmonary Embolism (HI PEITHO) https://www.nejm.org/doi/full/10.1056/NEJMoa2516567
  • National Early Warning Score (NEWS) https://www.england.nhs.uk/ourwork/clinical-policy/sepsis/nationalearlywarningscore/

II PRO-TAVI trial

  • Deferral of percutaneous coronary intervention in patients undergoing transcatheter aortic valve implantation (PRO-TAVI) 10.1016/S0140-6736(26)00308-9 External Link
  • PCI in Patients Undergoing Transcatheter Aortic-Valve Implantation (Notion 3) https://www.nejm.org/doi/full/10.1056/NEJMoa2401513

III ORBITA CTO Sham vs PCI for Angina Relief

  • Tightly Blinded Trial Confirms PCI Reduces Angina in Obstructive Occlusion https://www.medscape.com/viewarticle/tightly-blinded-trial-confirms-pci-reduces-angina-2026a10009ob

  • A Randomized, Placebo-Controlled Trial of Chronic Total Occlusion Percutaneous Coronary Intervention in Stable Angina - ORBITA-CTO https://www.jacc.org/doi/10.1016/j.jacc.2026.03.027

  • ORBITA 1 10.1016/S0140-6736(17)32714-9 External Link
  • ORBITA 2 https://www.nejm.org/doi/full/10.1056/NEJMoa2310610
  • DECISION CTO https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.118.031313
  • EuroCTO https://doi.org/10.1093/eurheartj/ehy220

IV CHIPS BCIS3 Impella Supported High-Risk PCI

  • Adoption Before Evidence: CHIP-BCIS3 Humbles Impella https://www.medscape.com/viewarticle/adoption-before-evidence-chip-bcis3-humbles-impella-2026a10009jh

  • Left Ventricular Unloading in High-Risk PCI (CHIP BCIS3) https://www.nejm.org/doi/full/10.1056/NEJMoa2515704

  • Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock (DanGer Shock) https://www.nejm.org/doi/full/10.1056/NEJMoa2312572

V CHAMPION AF – Watchman vs DOAC in Patients With AF

  • CHAMPION-AF Trial Finds LAAC an Alternative for NOAC in Lower-Risk Patients https://www.medscape.com/viewarticle/champion-af-trial-finds-laac-alternative-noac-lower-risk-2026a10009ij

  • Six Reasons Why CHAMPION-AF Should Not Change Practice https://www.medscape.com/viewarticle/six-reasons-why-champion-af-should-not-change-practice-2026a10009i7

  • Left Atrial Appendage Closure or Anticoagulation for Atrial Fibrillation (CHAMPION AF) https://www.nejm.org/doi/full/10.1056/NEJMoa2517213

  • Left Atrial Appendage Closure or Medical Therapy in Atrial Fibrillation (CLOSURE AF) https://www.nejm.org/doi/full/10.1056/NEJMoa2513310

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