Strike early, strike strong

Welcome to the April 2026 issue of the European Heart Journal—Acute Cardiovascular Care! This month, we present a curated collection of groundbreaking research and educational insights tackling some of the most pressing challenges in acute cardiovascular care. Our Editor’s Choice highlights a pivotal sub-study of the TOMAHAWK trial, showing that routine immediate coronary angiography after out-of-hospital cardiac arrest (OHCA) without ST-segment elevation does not improve survival, reinforcing the importance of individualized, context-specific post-resuscitation strategies.1,2 This issue also explores pharmaco-invasive strategies from the STREAM-2 trial,3,4 personalized antithrombotic therapy with Cangrelor in out of hospital cardiac arrest (OHCA), and structured ‘strike early, strike strong’ lipid-lowering protocols in very-high-risk patients. Collectively, these studies reveal rapid, tailored interventions (optimizing reperfusion, bridging platelet inhibition, or achieving LDL-C targets) to be associated with better outcomes, and fewer complications.5–9 These topics help inform clinicians and researchers as they address the core dilemmas of modern acute care: when and how to intervene, how to balance ischaemic and bleeding risk, and how to translate rigorous science into real-world practice.10–16