Written: Katie Coffee
Photo: Anatomical model of the human heart. Ali Hajiluyi / Unsplash
PCI did not reduce death or heart attack over 25 years in stable coronary disease
Extended follow-up of the landmark COURAGE trial finds stenting plus medication no better than medication alone.
Researchers tracked 959 of the trial’s 2,287 participants, all veterans, for a median of 15 years and up to 25 [1]. Death or myocardial infarction occurred in 93.3% of those assigned to percutaneous coronary intervention plus optimal medical therapy and 91.0% of those on medical therapy alone (hazard ratio 1.01; 95% CI, 0.88–1.15) [1]. The authors, reporting in JAMA and at the American Heart Association Scientific Sessions, say the findings do not support routine upfront elective PCI to prevent those outcomes; the presenter noted a nearly all-male cohort and outdated technology such as bare-metal stents [1][2].
Community CPR push failed to improve cardiac arrest survival in North Carolina
A five-year, NIH-funded randomized trial across 60 counties came up neutral.
RACE-CARS assigned 31 counties to community CPR training, dispatcher coaching and earlier first-responder defibrillation and 29 to usual practice, covering 22,459 adults with out-of-hospital cardiac arrest [3]. Survival to discharge with favorable brain function was about 9% with the intervention and 9.4% without [3]. The results appeared in the New England Journal of Medicine on Nov. 8; investigators cited the pandemic, Hurricane Helene and 911 staffing shortages among the limitations [3][4].
Vir’s monthly hepatitis delta combination meets Phase 3 primary endpoint
Company-reported ECLIPSE 1 results precede a planned mid-2027 FDA filing.
Among 124 adults with chronic hepatitis delta, 44% of those given monthly injections of elebsiran and tobevibart had undetectable virus plus normalized ALT at week 48, versus none in a delayed-treatment arm assessed at week 12 [5]. Vir reported one grade 3 treatment-related adverse event and no discontinuations [5]. The data were presented at the AASLD Liver Meeting in Denver; two further Phase 3 trials are expected to read out in early 2027 [5][6].
Left bundle branch pacing outperforms conventional pacing in international trial
OptimPacing was stopped early after a planned interim analysis showed superiority.
In 685 adults at 17 centers in Asia, Europe and the United States, the composite of death, heart failure hospitalization or pacing-induced cardiomyopathy occurred in 8.5% with left bundle branch pacing versus 19.2% with right ventricular pacing (hazard ratio 0.41; 95% CI, 0.23–0.75) [7][8]. Pacing-induced cardiomyopathy occurred in none versus 11.7%, while death rates were similar (7.4% vs. 7.7%) [7][8]. Investigators caution that early stopping can overstate benefit [7].
Digest references
1. Butala NM, et al. “Percutaneous Coronary Intervention and Long-Term Outcomes in Stable Coronary Artery Disease: Extended Follow-Up of the COURAGE Randomized Trial.” JAMA, Nov. 7, 2026. jamanetwork.com
2. Swain E. “No clinical benefit for PCI in stable coronary artery disease, long-term data show.” Healio, Nov. 8, 2026. healio.com
3. American Heart Association. “Community CPR and EMS intervention program did not increase survival after cardiac arrest.” AHA Newsroom, Nov. 8, 2026. newsroom.heart.org
4. Cooney E. “Survival after sudden cardiac arrest didn’t improve despite training bystanders, emergency responders.” STAT, Nov. 8, 2026. statnews.com
5. Vir Biotechnology. “Vir Biotechnology Announces Primary Endpoint Met in Pivotal Phase 3 ECLIPSE 1 Trial for Elebsiran and Tobevibart in Chronic Hepatitis Delta.” Business Wire (via StockTitan), Nov. 8, 2026. stocktitan.net
6. Jennings S. “Elebsiran Plus Tobevibart Suppresses HDV RNA in Phase 3 ECLIPSE 1 Trial.” HCPLive, Nov. 8, 2026. hcplive.com
7. American Heart Association. “Novel pacemaker technique reduced cardiac events in people with a heart rhythm disorder.” AHA Newsroom, Nov. 8, 2026. newsroom.heart.org
8. Buzby S. “Left bundle branch pacing superior to right ventricular pacing for atrioventricular block.” Healio, Nov. 8, 2026. healio.com
