What’s Going to Be Hot at ESC Congress 2025?

The European Society of Cardiology (ESC) is returning to Spain for its annual congress, this time to the capital city of Madrid where thousands of cardiologists and other health professionals will gather to hear, debate, and discuss the latest research in cardiovascular medicine.

The spotlight of this year’s meeting is “Global Health,” with 50 dedicated tracks focused on the burden of cardiovascular disease around the world.

“Our tagline is ‘cardiology beyond borders’ because we want to look at the global problems from the perspective of their local relevance,” Tomasz Guzik, MD, PhD (University of Edinburgh, Scotland), ESC program committee chair, told TCTMD. “Many sessions in the global health track are designed in a way that we ask our speakers—cardiologists from all over the world--to tell us how they are dealing with specific challenges and clinical issues.”

Clinicians representing more than 100 countries are part of this year’s program, said Guzik.

“Global health as we understand it extends beyond the prevalence of diseases across different countries,” Guzik continued. “It extends to problems such as climate change, pandemics, lifestyle diseases, inequalities, and global conflicts that are unraveling and affecting cardiovascular disease treatment.”

The ESC Congress 2025, which is held in conjunction with the World Congress of Cardiology, runs from Friday, August 29, 2025, until Monday, September 1, 2025, at the IFEMA Feria de Madrid.   

Ten Hotline Sessions, Oh My!

The meeting, as always, includes numerous Hotline sessions dedicated to new cardiovascular research. There are 10 Hotline sessions, the first of which starts on Friday at 11:00 CET in the main auditorium. This is followed by four Hotlines on Saturday, three on Sunday, and two on the meeting’s last day.

In all, 40 studies make up the Hotlines, including many that Guzik expects to reshape clinical practice. For example, there are the REBOOT-CNIC and BETAMI-DANBLOCK trials, two studies looking into the safety and efficacy of stopping beta blockers after MI in patients with normal or mildly reduced left ventricular ejection fraction.  

“It’s a very important question that I hope this Congress will bring an answer to,” said Guzik.

There also are several trials that can help provide more personalized and cost-effective care, he said. Along this line are NEO-MINDSET and TARGET-FIRST, two studies looking at the early discontinuation of aspirin after PCI in patients with ACS. In the same Hotline session, the TAILORED-CHIP investigators are looking at tailored antiplatelet strategies in patients undergoing complex, high-risk PCI. The ALONE-AF trial, on the other hand, is investigating the safety of stopping long-term oral anticoagulation after successful ablation of atrial fibrillation.

Additionally, a couple of trials are testing novel antihypertensive therapies, such as the phase III BaxHTN and phase II KARDIA-3 studies. In the former, researchers are evaluating the safety and efficacy of the aldosterone synthase inhibitor baxdrostat (AstraZeneca) in patients with uncontrolled or resistant hypertension. In KARDIA-3, zilebesiran (Alnylam Pharmaceuticals), a twice-yearly injection that works by interfering with messenger RNA to stop the production of angiotensinogen, is being put to the test as an add-on therapy in patients with hypertension and high cardiovascular risk.

For patients with elevated triglycerides, the ESSENCE-TIMI 73 evaluated the investigational antisense oligonucleotide olezarsen (Ionis Pharmaceuticals) in patients with either moderate hypertriglyceridemia and increased cardiovascular risk or severe hypertriglyceridemia; earlier this year, it was announced the study met its primary endpoint.

There are also a number of Hotline studies dedicated to heart failure (HF), among them PARACHUTE-HF. There, investigators are comparing sacubitril/valsartan (Entresto; Novartis) to enalapril in patients with chronic Chagas cardiomyopathy, a condition that Guzik believes is neglected by Western countries even though it’s a large problem in Central and South American countries. VICTOR is investigating the role of the soluble guanylate cyclase stimulator vericiguat (Verquvo; Merck Sharp & Dohme) in patients with chronic HF while DAPA ACT HF-TIMI 68 is testing the SGLT2 inhibitor dapagliflozin (Farxiga; AstraZeneca) in patients hospitalized with acute HF.

The DIGIT-HF study, which is part of the meeting’s first Hotline session, is investigating the role of digitoxin in HF patients with reduced ejection fraction who are treated with optimal guideline-directed medical therapy. In the area of hypertrophic cardiomyopathy (HCM), MAPLE-HCM researchers compared the still investigational aficamten (Cytokinetics) to metoprolol in patients with obstructive disease while the ODYSSEY-HCM investigators will present the full data on mavacamten (Camzyos; Bristol-Myers Squibb) in nonobstructive HCM. The latter trial has already been announced as negative.

The last hotline on Monday is devoted to CABG surgery, and includes NEWTON-CABG, a study investigating the PCSK9 inhibitor evolocumab (Repatha; Amgen) in improving saphenous vein graft patency (SVG). The TOP-CABG study is also investigating SVG patency after surgery—in this study, researchers are looking to see if de-escalating DAPT to a single antiplatelet agent is as effective as DAPT while also reducing bleeding. Similarly, the TACSI study is investigating DAPT versus single antiplatelet therapy after CABG, although the primary outcome here is a composite of clinical events.

“We are giving voice to everyone,” said Guzik. “It’s an amazing lineup. The program of trials looks extremely exciting.”

Guidelines and Fireside Chats

In addition to the Hotline sessions, there will be 42 sessions dedicated to late-breaking clinical science. These sessions focus on a wide range of topics, including artificial intelligence in cardiology, vaccinations for cardiovascular prevention, lipid therapy, management of aortic stenosis, optimal management of cardiogenic shock, and CAD interventions, among others.

There will be sessions devoted to multiple clinical guidelines, including the new 2025 ESC recommendations for the management of myocarditis and pericarditis, valvular heart disease, and CVD and pregnancy. A new focused update on the treatment of dyslipidemias will also be presented, as will a new consensus statement on the impact of mental health on CVD. A half dozen sessions are dedicated to explaining how physicians can put these various guideline recommendations into practice.

Scattered throughout the 4-day meeting are a multitude of “Ask the Trialists” sessions where attendees can participate in discussions with study leaders. With the guidelines, there are also “Ask the Task Force” sessions where program planners hope the audience will pose clinical scenarios to the experts, all with the intent of bringing back solutions to their daily practice.

Lastly, there are 11 “Fireside Chats” scheduled throughout the meeting, which are more intimate discussion sessions. Each fireside chat is loosely connected to cardiology, but is focused on broader topics, such as the ethical challenges in medical publishing, strategies for funding basic science and clinical research, and the pros and cons of AI in cardiology education. One fireside chat even promises to address the “unspoken truths of cardiology.”    

“We want to create an intimate and unique interaction opportunity to discuss certain aspects, not necessarily directly related to cardiology, but related to some ethical aspects, some innovations, funding, and problems that cardiologists face in the organization of healthcare structures,” said Guzik.

A number of symposiums also include a patient perspective, something Guzik said was a deliberate effort to “widen the conversation” as it helps shape how science is translated into everyday care. He also stressed that in creating this year’s program, they received a lot of input from young cardiologists and other health professionals early in their careers.  

For those lucky enough with a day or two on hand in Madrid, there is no shortage of destinations to keep cardiologists culturally well rounded. A visit to the Museo Nacional del Prado, home to the largest collections from artists Diego Velásquez and Francisco Goya, among others, is always a worthy stop. Not to be outdone, the Reina Sofía Museum, Spain’s national museum of 20th century works, has paintings by Pablo Picasso--including Guernica--as well as Salvador Dali and many others.