Focusing on the theme of global health, this year’s European Society of Cardiology (ESC) Congress championed the very latest innovations and discoveries in cardiovascular medicine and science, as well as emerging best practice. Showcasing the very latest research and new ESC guidelines presented at the congress, cardiologists Dr Stefania Angela Di Fusco and Professor Furio Colivicchi from San Filippo Neri Hospital in Rome, Italy, share their highlights.

The 2025 European Society of Cardiology (ESC) Congress was a record-breaking meeting for two key reasons. More than 33,000 participants met in Madrid from 29 August to 1 September, breaking the record of worldwide attendees, while over 190 studies were published simultaneously in leading scientific journals, marking another milestone.

With the 2025 ESC Congress attendees coming from 169 nations across five continents, they were united in the aim of pushing ‘Cardiology beyond borders’, as the leitmotif of the congress stated.

Research highlights from ESC Congress 2025

Several practice-changing clinical trials where presented at the ESC Congress 2025, including several clinical studies evaluating the impact of beta-blockers after myocardial infarction in patients with preserved or only mildly reduced left ventricular ejection fraction (LVEF).

The REBOOT trial results were presented during the conference and commented on by Professor Furio Colivicchi, a co-author of the paper that was simultaneously published in the New England Journal of Medicine. Although the study showed no evidence of benefit with beta-blocker treatment in the global population of patients with myocardial infarction and without reduced LVEF, a meta-analysis that also included data from the BETAMI, DANBLOCK and CAPITAL-RCT trials showed a significant reduction in major adverse cardiovascular events in patients with mildly reduced EF.

In addition, a pre-specified analysis of the REBOOT trial, which results were also presented during the meeting in Madrid, showed that women treated with beta-blockers had worse outcomes, underscoring the need for further studies to evaluate sex-specific impact of pharmacological treatments.

Professor Xin Yuan from Beijing, China, presented the result of the Top-CABG study. This randomised, double-blinded clinical trial showed that a three-month strategy with ticagrelor plus aspirin, followed by aspirin alone, as compared with a 12-month dual antiplatelet therapy (DAPT) strategy, reduced clinically relevant bleeding and was non-inferior in reducing the risk of venous graft occlusion. These results may change future guideline recommendations on antiplatelet treatment after coronary artery bypass grafting (CABG), Professor Yuan said.

The TACSI trial results, presented in Madrid by Professor Anders Jeppsson from Gothenburg, Sweden, and simultaneously published in the New England Journal of Medicine, point in the same direction. Indeed, while current guidelines recommend 12-month DAPT after CABG in patients with acute coronary syndrome, the TACSI trial showed that this treatment duration does not reduce major cardiovascular events when compared with aspirin alone. In the light of these studies presented in Madrid, it seems that DAPT should not be considered as the standard treatment after CABG.

The OPTION-STEMI trial is a further study presented in an ESC Congress Hot Line session and published in The Lancet. Professor Youngkeun Ahn from Gwangju in the Republic of Korea reported the results of this randomised controlled trial that included patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease. Immediate complete revascularisation was found to cause possible harm if compared with staged complete revascularisations.

During the international meeting, a pooled analysis of the VICTOR and VICTORIA trials, which globally included more than 11,000 patients with heart failure and reduced LVEF, was also discussed. This study showed a clinical benefit of the treatment with vericiguat in terms of reduction in all-cause mortality, cardiovascular mortality and hospitalisation for heart failure, as well as maintaining a good safety profile. As pointed out by Professor Javed Butler from Dallas, US, these findings support the use of vericiguat for the management of patients across the spectrum of heart failure and reduced LVEF.

ESC guideline updates

Once again, the ESC Congress also offered the opportunity to discover the main novelties of the latest clinical practice guidelines published in the European Heart Journal at the same time as the Congress.

The first new guideline presented in Madrid focused on the management of valvular heart disease. A joint publication between ESC and the European Association for Cardio-Thoracic Surgery, this document emphasises the importance of a multidisciplinary expert heart team to provide timely and correct diagnosis and guarantee appropriate treatment. The document also recommends referring complex patients to experienced high-volume centres for optimal treatment.

The guideline also highlights the relevance of advanced imaging modalities for an appropriate evaluation of causes and mechanisms underlying valvular heart diseases. Furthermore, the criteria for the choice of optimal aortic valve stenosis and primary mitral regurgitation management are redefined based on the most recent evidence.

A Focused Update of the 2019 ESC and European Atherosclerosis Society Guidelines for the management of dyslipidaemias was also presented. It recommends new algorithms to predict the risk of cardiovascular events and death and highlights the role of combination therapy with statins and ezetimibe during the hospitalisation for acute coronary syndrome.

It also outlines new data on lipoprotein(a) as a risk modifier. Moreover, based on available evidence on the clinical benefit of bempedoic acid in patients who are unable to take statins, the document provides guidance on the use of this drug introduced for clinical use in the EU in 2020 and the UK in 2021.

The first-ever ESC Guidelines addressing the management of both myocarditis and pericarditis was also presented during the congress. For the first time, the term inflammatory myopericardial syndrome (IMPS) was introduced to refer to the spectrum of the disease with possible overlap between myocarditis and pericarditis.

This new guideline discusses the role of multimodality imaging, with particular attention to cardiac magnetic resonance and the role of endomyocardial biopsy. The document also provides practical indications on how to help patients return to exercise and work in a shorter time.

The growing awareness of the close relationship between mental health and cardiovascular disease has led to the publication of the first ESC Consensus Statement on this topic. During its presentation in Madrid, the authors summarised practical recommendations on how to prevent or reduce the impact of mental health conditions on cardiovascular health and vice versa.

In addition, the authors discussed knowledge gaps that needed to be urgently addressed, including the multidirectional relationship between mental health, cardiovascular health, and cardiovascular disease, as well as its underlying mechanisms.

The fifth guideline presented at the ESC Congress 2025 was an update to the 2018 ESC Guidelines on cardiovascular disease during pregnancy. The new guidelines for the management of cardiovascular disease and pregnancy discusses the composition and the role of the pregnancy heart team.

Key points addressed in the document included pre-conception counselling, lifestyle modifications, the management of appropriate risk factors and recommendations on anticoagulation and delivery strategies.

Read Dr Di Fusco and Professor Colivicchi’s highlights from last year's ESC Congress here.