The genuinely unsettled questions in clinical cardiology, ranked by debate-worthiness. Scanned continuously from the major journals, FDA actions, new guidelines, and the conversation among cardiologists on X.
4 live debatesLast scanned Aug 24, 2026, 3:58 AM UTC
Sources — the evidence behind it
How many distinct sources we linked for this debate (12 sources here) — journals, guidelines, FDA actions, preprints, news, and posts on X. More bars mean deeper coverage.
Open “The evidence” below to see each one. Counts and quotes are scan-reported and link to their primary source — not yet independently verified.
01★ Top debate
Stop aspirin at one month after ACS stenting?
After PCI for ACS, drop aspirin at one month or continue dual antiplatelet therapy twelve months?
Dropping aspirin early cuts bleeding. Who still needs it for clot protection?
After PCI for ACS, drop aspirin at one month or continue dual antiplatelet therapy twelve months?
Stop aspirin at one month, P2Y12 inhibitor alone
Continue ticagrelor alone. Bleeding falls with no clear rise in clots.
Keep both antiplatelets for 12 months
Keep aspirin a full year when the anatomy is high risk, especially on clopidogrel.
Undecided
“It is my belief that it’s time to change the guidelines and standard clinical practice such that we no longer treat most acute coronary artery syndrome (ACS) patients with dual antiplatelet therapy beyond one month after a successful PCI procedure.”
Gregg W. Stone · Professor of Medicine (Cardiology) · X ↗
Sources — the evidence behind it
How many distinct sources we linked for this debate (21 sources here) — journals, guidelines, FDA actions, preprints, news, and posts on X. More bars mean deeper coverage.
Open “The evidence” below to see each one. Counts and quotes are scan-reported and link to their primary source — not yet independently verified.
02
Should incretin drugs treat HFpEF itself, or only the obesity?
Start an incretin agonist in obesity-related HFpEF, or optimize diuretic and SGLT2 inhibitor only?
Incretins improve symptoms in obese HFpEF. Are they heart failure drugs?
Sources — the evidence behind it
How many distinct sources we linked for this debate (9 sources here) — journals, guidelines, FDA actions, preprints, news, and posts on X. More bars mean deeper coverage.
Open “The evidence” below to see each one. Counts and quotes are scan-reported and link to their primary source — not yet independently verified.
03
Asymptomatic severe aortic stenosis: operate now or wait?
Asymptomatic severe aortic stenosis with normal EF: intervene now or watchful waiting?
Patients either get a new valve years early or wait for symptoms.
Sources — the evidence behind it
How many distinct sources we linked for this debate (20 sources here) — journals, guidelines, FDA actions, preprints, news, and posts on X. More bars mean deeper coverage.
Open “The evidence” below to see each one. Counts and quotes are scan-reported and link to their primary source — not yet independently verified.
04
Device-detected AF lasting hours: anticoagulate or not?
Device-detected atrial fibrillation lasting hours: start a DOAC or continue aspirin/nothing?
Anticoagulation cuts strokes but adds bleeds. The net call is unsettled.
Debates are surfaced by a continuous scan of the cardiology literature and the conversation among clinicians. The heat score (0-10) reflects how live and consequential the disagreement is right now and drives the ranking; it becomes the measured expert split as cardiologists weigh in. Quotes and engagement counts are scan-reported and link to their primary source.
“For patients receiving a predictably high level of platelet P2Y12 inhibition, this has become clearer: most patients benefit from withdrawal of aspirin between 2 weeks and 3 months after PCI, followed by P2Y12 inhibitor monotherapy.”
“In low-risk acute MI patients with early complete revascularisation and no complications after one month of DAPT, switching to P2Y12 inhibitor monotherapy-maintained protection from ischaemic events and reduced bleeding.”
“This study provides evidence that stopping aspirin within 1 month after implantation of drug-eluting stents for ticagrelor monotherapy is a reasonable alternative to 12-month DAPT for adverse cardiovascular and bleeding events.”
Myeong-Ki Hong · Yonsei University College of Medicine; T-PASS investigator · X ↗
“These results are inconclusive for the benefit of clopidogrel monotherapy after 1-month DAPT compared with standard 12-month DAPT in ACS patients.”
“And we need to convince the people that the short DAPT regimen is the way forward. This is something I would like to emphasize. Whatever the type of monotherapy you're going to choose, you have to go for a short DAPT regimen.”
Marco Valgimigli · Cardiocentro Ticino Institute · news_interview ↗
Named experts we found publicly on record — a sample, not a representative poll of the field.
7unplaced
Named experts on the record — a snapshot from the scan, not a poll. The measured clinician split builds below.
Where do you land?
No votes yet — the measured split appears at 10.
Clinician takes
Sim smoke: after ULTIMATE-DAPT we stop aspirin at one month for most ACS patients on ticagrelor.
iOS Sim Dev· Stop aspirin at one month, P2Y12 inhibitor alone
Takes from signed-in Synapse members — a measured read of this board, not a representative poll of the field.
On the board:since Aug 24, 2026 (2 weeks)— time live on Synapse
›The evidence
What we know
✓Dropping aspirin early on a potent P2Y12 inhibitor cuts clinically relevant bleeding without an obvious ischemic price in trials so far; clopidogrel monotherapy did not clear the same bar.
✓Whether one-month aspirin withdrawal is the default for ACS generally, or reserved for ticagrelor and prasugrel patients while higher ischemic-risk anatomy and clopidogrel-treated patients complete twelve months.
What's still unknown
?Trials powered for ischemic events in the highest-risk anatomy, and a clearer answer on whether clopidogrel monotherapy at one month is safe enough.
Start an incretin agonist in obesity-related HFpEF, or optimize diuretic and SGLT2 inhibitor only?
Start an incretin as heart failure therapy
Trials in obese HFpEF improved symptoms and cut heart failure events, so start one as HF therapy.
Use incretins for obesity, not as core HF therapy
Continue standard HFpEF therapy first. Add an incretin when obesity or diabetes is itself a treatment target.
Undecided
“When we think about optimal medical therapy in HFpEF, everybody should be on an SGLT2 inhibitor and an MRA, ideally nonsteroidal. Then you think about individualizing therapy to the patient sitting in front of you.”
“This is the first trial to demonstrate that a medication can change the clinical trajectory of the disease in patients with HFpEF and obesity. We think that these drugs are all compatible with each other and likely to be added in.”
“In the end, SUMMIT is not close to changing treatment norms in patients with HFpEF. As evidence-based clinicians, we should demand more from our partners in industry and academia.”
John M. Mandrola · Cardiac electrophysiologist · X ↗
“Yes. We have seen two large study programs that enrolled patients with heart failure and preserved pump function (ie, HFpEF). Both trials documented a clear symptomatic benefit for patients. The effect of GLP‑1 receptor agonists appears to be additive to that of SGLT2 inhibitors.”
Ulrich Laufs · Professor and Chief of Cardiology · X ↗
“Collectively, these data certainly support semaglutide as an efficacious treatment option in people with heart failure and preserved ejection fraction, not just in terms of improvements in symptoms and physical limitations, as we showed previously in the STEP-HFpEF program”
“Within this framework, incretin-based agents are best positioned as adjunctive, phenotype-targeted therapies in patients with obesity-related HFpEF, implemented primarily to address upstream drivers such as adiposity, insulin resistance, systemic inflammation and multi-organ dysfunction rather than as core HF therapies per se.”
Masliza Mahmod · Heart Failure Reviews co-author · X ↗
Named experts we found publicly on record — a sample, not a representative poll of the field.
7unplaced
Named experts on the record — a snapshot from the scan, not a poll. The measured clinician split builds below.
Asymptomatic severe aortic stenosis with normal EF: intervene now or watchful waiting?
Replace the valve at diagnosis
Refer for valve replacement at diagnosis. Randomized data show fewer deaths, strokes and hospitalizations than surveillance.
Wait for symptoms or a weakening heart
Wait until symptoms, a weakening ventricle or a failed exercise test appear, as guidelines direct.
Undecided
“The most important finding is there's no evidence of any penalty or harm of the strategy of early intervention. It seems that there's no advantages to wait.”
Philippe Généreux · Interventional cardiologist · X ↗
“The lack of convergence of the curves for death from cardiovascular causes and death from any causes over this prolonged period of follow-up underscores the sustained benefits of early surgery.”
“Intervening early isn't necessarily going to make you live longer because there's other things that come into play, but it can make you live better. It’s going to be an individualized discussion, because I think we should be offering early intervention to our patients.”
“As you’re waiting, things are happening, and those things are maladaptive and they’re not reversible. We have to be preemptive, we have to be thinking ahead.”
“There are clear benefits to performing aortic valve replacement when patients with severe aortic stenosis are stable and not yet experiencing symptoms.”
Device-detected atrial fibrillation lasting hours: start a DOAC or continue aspirin/nothing?
Start a DOAC when stroke risk is high
With CHA2DS2-VASc 4 or higher and episodes lasting hours, a DOAC prevents strokes worth the bleeding.
No routine DOAC, monitor and recheck
Neither trial met its primary endpoint. The extra bleeding cancels the small stroke reduction.
Undecided
“The present analysis suggests that a treatment strategy consisting of no anticoagulation and an ECG every six months is acceptable in most patients with DDAF. Individual treatment decisions should include patient preferences.”
Paulus Kirchhof · Professor of cardiovascular medicine · X ↗
“I think the results of ARTESIA are strong enough to change the way we practice and lead to changes in management guidelines so that we recommend that many of these individuals who have subclinical AFib receive an anticoagulant.”
Jeff Healey · Cardiology division director and professor of medicine · X ↗
“The results of the ARTESIA and NOAH-AFNET 6 trials strongly question that idea. Right now, anticoagulation decisions with device-detected short-duration AF require high doses of judgement and patient preference.”
John M. Mandrola · Cardiac electrophysiologist · X ↗
“These patients should generally be treated with an OAC, as it appears to prevent nearly twice as many strokes/SE compared with the major bleeds that it causes.”
Renato D. Lopes · ARTESiA investigator; Duke Clinical Research Institute · X ↗
“For some physicians, these data alone may be sufficient to initiate treatment for patients whose values and preferences align with treatment. However, for many, the treatment paradigm is not yet settled.”
Sachin J. Shah · Massachusetts General Hospital and Harvard Medical School · X ↗
Named experts we found publicly on record — a sample, not a representative poll of the field.
5unplaced
Named experts on the record — a snapshot from the scan, not a poll. The measured clinician split builds below.
