Current Opinion in Cardiology

Current Issue Highlights

Antithrombotic therapy to minimize total events after ACS or PCI in atrial fibrillation: insights from AUGUSTUS
November 2026: 41(6):593-599
Purpose of review
Antithrombotic therapy for patients with atrial fibrillation (AF) after acute coronary syndrome (ACS) or percutaneous coronary intervention (PCI) requires balancing prevention of stroke and coronary events against bleeding. Recent recurrent-event and patient-centered analyses of AUGUSTUS make this review timely by reframing treatment benefit beyond first events.
Recent findings
Four dedicated trials support dual antithrombotic therapy with direct oral anticoagulants (DOAC) plus P2Y₁₂ inhibitor and early aspirin withdrawal to reduce bleeding without significant increase in ischemic events. However, aspirin-free strategies differ by anticoagulation indication: in patients without anticoagulation, very early aspirin withdrawal after ACS or PCI may increase the risk of coronary events, whereas in patients with AF receiving anticoagulation, oral anticoagulation may assume the early antithrombotic role of aspirin. AUGUSTUS showed that apixaban and placebo each reduced bleeding compared with vitamin K antagonist and aspirin. The recent total-event analyses further showed lower cumulative bleeding with apixaban than with vitamin K antagonist, and substantially greater cumulative bleeding with randomized aspirin than with placebo, along with similar total ischemic events and hospitalizations.
Summary
For patients with AF after ACS or PCI, DOAC-based dual antithrombotic therapy provides the most favorable cumulative safety-efficacy balance. Future research should focus on the timing of aspirin discontinuation and validate recurrent-event endpoints.
Colchicine for cardiovascular secondary prevention: evidence from recent trials and meta-analyses
November 2026: 41(6):584-592
Purpose of review
Residual inflammatory risk remains an important driver of recurrent vascular events despite contemporary lipid-lowering and antithrombotic therapies. Low-dose colchicine is the first widely available anti-inflammatory therapy to be incorporated into contemporary guidelines for secondary prevention in coronary artery disease. This review summarizes contemporary evidence on the efficacy and safety of low-dose colchicine for secondary prevention.
Recent findings
Large randomized trials have demonstrated that colchicine reduces recurrent ischemic events in patients with chronic coronary disease and after myocardial infarction. Recent trials in acute myocardial infarction and stroke populations, however, have produced heterogeneous results. Nevertheless, contemporary meta-analyses consistently demonstrate reductions in major adverse cardiovascular events (MACE), driven mainly by fewer myocardial infarctions, strokes, and coronary revascularizations. Safety data are reassuring, with no consistent excess in serious infection, cancer, pneumonia, or noncardiovascular death, although gastrointestinal intolerance remains the most common adverse effect.
Summary
Low-dose colchicine has established residual inflammation as an actionable target in secondary prevention of vascular events in patients with chronic coronary disease or recent myocardial infarction. Ongoing trials will clarify colchicine's role across broader vascular indications. Future work should also focus on implementing the use of colchicine for prevention of clinical events in patients with coronary artery disease in clinical practice.
Diagnostic performance and clinical impact of photon-counting detector computed tomography in coronary artery disease
November 2026: 41(6):575-583
Purpose of review
Photon-counting detector computed tomography (PCD-CT) is an emerging technology that addresses key limitations of conventional coronary CT angiography, including calcium blooming, stent-related artifacts, and limited spatial resolution. This review summarizes recent evidence regarding the diagnostic performance and clinical impact of PCD-CT in the evaluation of coronary artery disease (CAD) and discusses its potential role in contemporary cardiovascular imaging.
Recent findings
Recent studies demonstrate that PCD-CT provides superior spatial resolution, improved contrast-to-noise ratio, and reduced blooming artifacts compared with conventional energy-integrating detector CT. Clinical investigations have shown improved diagnostic accuracy for detecting obstructive CAD, particularly in patients with heavy coronary calcification, older patients and coronary stents. Large observational studies report higher specificity, improved positive predictive value, fewer indeterminate examinations, reduced invasive coronary angiography referrals, and greater revascularization yield. Emerging applications include advanced plaque characterization, extracellular volume quantification, and ultra-low-dose radiation and contrast imaging.
Summary
Current evidence suggests that PCD-CT represents a transformative advancement in noninvasive coronary imaging. Beyond improving diagnostic accuracy, PCD-CT may enhance clinical decision-making, reduce unnecessary downstream testing, and expand the role of CT in comprehensive cardiovascular assessment. Future multicenter outcome studies and standardized imaging protocols will be essential to establish its long-term clinical and economic value.
Beyond stenosis: imaging phenotyping and risk stratification in nonobstructive coronary artery disease
November 2026: 41(6):564-574
Purpose of review
Nonobstructive coronary artery disease (NOCA) is now frequently detected by coronary CT angiography (CCTA), but the term compresses biologically distinct patterns into a single anatomic label. This review examines how CT-derived markers can reorganize NOCA around plaque burden, inflammatory activity, clinical expression, and temporal change.
Recent findings
Recent work distinguishes three related but distinct tasks in NOCA: identify disease, stratify risk, and define phenotypes that may inform future prevention strategies. CCTA addresses the atherosclerotic and prognostic dimensions by quantifying plaque burden, plaque composition, and high-risk features; CT-derived inflammatory and cardiometabolic markers may further identify active vascular and metabolic phenotypes. In symptomatic patients, CCTA and fractional flow reserve CT can evaluate epicardial anatomy and lesion-specific hemodynamic significance, but normal or nonobstructive findings do not exclude coronary microvascular dysfunction or vasospasm. In asymptomatic patients, coronary artery calcium and CCTA can reveal subclinical atherosclerosis and refine preventive risk assessment. Serial imaging and intervention studies suggest that adverse plaque phenotypes can stabilize or change with intensive prevention, but outcome-proven CCTA-guided treatment algorithms are still lacking.
Summary
CCTA is evolving into a multidimensional phenotyping tool for NOCA. Its immediate value is refined risk stratification; whether these markers will improve outcomes remains unproven and should be tested prospectively.
Statins in abdominal aortic aneurysm: a risk–benefit analysis
November 2026: 41(6):556-563
Purpose of review
To evaluate emerging evidence supporting statins as a potential disease-modifying treatment for abdominal aortic aneurysm (AAA), a condition without approved pharmacological therapy.
Recent findings
Recent nationwide registry analyses and prospective screening cohorts demonstrate consistent dose-dependent associations between statin exposure and reduced AAA growth, rupture, and surgical repair. In Danish screening trial cohorts, maximal statin exposure was associated with an approximately 0.88 mm/year reduction in aneurysm expansion, nearly halving observed growth rates. Mendelian randomization studies support a causal role of lipid pathways in AAA development and implicate HMG-CoA reductase activity in aneurysm development risk. The contribution of statins’ pleiotropic effects may increase as AAA progresses, although direct clinical evidence remains limited. Contemporary randomized trial meta-analyses confirm a favourable safety profile, with only small excess risks of muscle symptoms and dysglycaemia.
Summary
Convergent evidence from meta-analyses, drug-wide association study, prospective dose-response cohorts, and Mendelian randomization identifies high-intensity statin therapy as a leading pharmacological candidate for slowing AAA progression. Important uncertainties remain, including the absence of randomized trials and limited evidence in women. Nevertheless, given the favourable safety profile and the near-universal cardiovascular indication in this population, current evidence supports consideration of high-intensity statin therapy in patients with AAA.