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7/7 — WHAT TO KEEP IN MIND ⚠️ • Exploratory extension: confirmatory 20-year mortality testing was not prespecified in the original protocol or analysis plan. • Small sample: n=201; the wide CI cannot exclude meaningful benefit or harm. • Only 4 PCI and 8 CABG patients remained at risk at 20 years. • First-generation DES, universal femoral PCI and no mandated intravascular imaging limit contemporary relevance. • PCI, CABG and secondary prevention changed substantially over 2 decades. • Long-term crossover and repeat-revascularization data were unavailable; this is not a comparison of sustained treatment exposure. • No complete longitudinal nonfatal outcomes, adherence or reliable cause-of-death data. • Subgroup analyses were exploratory and severely underpowered. • Four German centers limit generalizability. 📝BOTTOM LINE Randomized follow-up to 20 years found no statistically significant mortality difference between PCI and CABG for selected left-main disease. It did not establish equivalence and cannot resolve the contemporary choice between modern image-guided PCI and current CABG. The authors reported no relevant relationships to disclose. Evidence appraisal, not patient-specific medical advice. Original article: Desch S, Pugachova S, de Waha S, et al. All-Cause Mortality Up to 20 Years After PCI or CABG for Left Main Disease. J Am Coll Cardiol. 2026. doi.org/10.1016/j.jacc.2026.… #LeftMain #PCI #CABG #CoronaryArteryDisease #InterventionalCardiology #CardiacSurgery #ClinicalTrials #EvidenceBasedMedicine

7/7 – WHAT TO KEEP IN MIND ⚠️ • HALT on CT was the primary endpoint, not a clinical outcome. • Only 84.7% had an evaluable 12-month CT; post hoc sensitivity analyses remained neutral. • Adherence during the first 3 months was 81.3% in the DOAC arm. • No continued-DOAC arm: the post-treatment increase cannot be attributed definitively to withdrawal. • Open-label treatment; CT interpretation and clinical-event adjudication were blinded. • Two Danish centers and a selected population after uncomplicated, single-valve TAVR limit generalizability. • Chronic anticoagulation, recent DAPT and eGFR <30 mL/min/1.73 m² were excluded. • Clinical events were secondary, low-count and underpowered. • Follow-up was 12 months; long-term valve durability remains unknown. 📝BOTTOM LINE Short-course anticoagulation reduced HALT during treatment, not at 12 months, and did not demonstrate clinical benefit. The findings support avoiding routine DOAC after TAVR without another indication. Funded by the Novo Nordisk Foundation. Disclosures include industry relationships and one author employed by Abbott. Evidence appraisal, not patient-specific medical advice. Original article: Jørgensen TH, Larsen AF, Jensen JM, et al. Short-Term Anticoagulant Therapy and Subclinical Leaflet Thickening in Transcatheter Aortic Valves: The NOTION-4 Trial. J Am Coll Cardiol. 2026. doi.org/10.1016/j.jacc.2026.… #NOTION4 #TAVR #TAVI #HALT #DOAC #StructuralHeart #InterventionalCardiology #ClinicalTrials #EvidenceBasedMedicine