Discover and read the best of Twitter Threads about #PCI

Most recents (7)

1. rispondo a chi mi ha criticato sul cablo del 1978 in cui #Montanelli dice alla diplomazia USA: meglio un #Pinochet che un governo del #PCI. Il cablo originale è qui (inglese): wikileaks.org/plusd/cables/1… è stato desecretato dalle stesse autorità USA e ripubblicato da #WikiLeaks
2. la critica che mi è stata fatta privatamente è la seguente: lei difende la #privacy e poi diffonde il cablo di un giornalista che parla confidenzialmente con una sua fonte?
3. il giornalista #Montanelli NON parlava con una sua fonte,parlava con diplomazia della più grande potenza mondiale,che ha OBBLIGHI di trasparenza. La conversazione #Montanelli -diplomatici USA è del 1978:Dipartimento Stato l'ha desecretata dopo ben 36 ANNI
Read 9 tweets
Features of #COVID19 @ACCinTouch #CCAACC
🔹fever predominant feature
🔹cough (less often productive)
🔹cough presents on discharge (Lancet paper)
🔹 more than pneumonia
🔹 abnormal coagulation: ⬆️ d-dimer so anticoag needed
@TheLancet @Drroxmehran @CMichaelGibson @hmkyale
Rapid deterioration seen quite often. Cases below demonstrate this: #COVID19
Discussion of this dilemma of ACEI and ARBs: question still remains. We don’t have evidence to stop these and shouldn’t yet.
🔹48% have HTN, less with HTN who survive (~20%)
🔹limited data to say stop anti-RAS
🔹 need studies
@ACCinTouch @hmkyale @DrJenniferCo_Vu
Read 17 tweets
DOI: doi.org/10.1016/j.ijca…

Drs @SukhNijjer, @jerd10 and @RicardoPetraco. What are your views on @DavidLBrownMD fallacies of FFR?

As a budding interventional cardiologist, I like to hear all opinions and sides to the story :)
“In conclusion, FFR in isolation is of no proven clinical value in the evaluation of patients with suspected ischemia. The ESC guidelines continue to promote an outdated paradigm for the evaluation of suspected ischemia that focuses on the focal epicardial stenosis.”
The 4 fallacies

1/4 - The first fallacy is the foundational premise of FFR that ischemia caused by a focal obstructive epicardial coronary stenosis is on the direct pathway to death or MI and therefore should be a target of revascularization
Read 7 tweets
Readdressing the validity of repeat revascularization as an outcome measure in #PCI Vs #CABG. For readers in a hurry:
1) visit @cardiomicsclub cardiomics.club/2019/12/20/rea…
2) go to @JACCJournals and listen podcast onlinejacc.org/content/74/25/…
3) read this thread! (Laziest!)
Repeat revasc has been used in multiple #PCI Vs #CABG RCTs, consistently favoring CABG, making composite outcomes mostly influenced by repeat revasc in many scenarios. Also, repeat revasc has been cited as (at least part of) the justification for recommending CABG over PCI
However, repeat revasc (alone, no associated MI) has many clinical and methdological limitations warranting deep understanding for an appropriate appraisal, summarized in this slide. First one is confounding by indication: repeat revasc is indicated, does not happen spontaneously
Read 11 tweets
1. “STEMI equivalent” #ECG patterns is crucial for every👨🏻‍⚕️👩🏻‍⚕️ dealing with #ACS.
-in 10-25% pts for urgent #PCI
📍Wellens’ syndrome
📍de Winter sign
📍hyperacute T waves,
📍left bundle branch block (LBBB)
📍right bundle branch block (RBBB)

📎ajconline.org/article/S0002-…
2.📍Wellen’s syndrome📍
(other names Wellens' sign, Wellens' warning, Wellens' waves):
is a pattern of deeply inverted or biphasic T waves in V2-3, which is highly specific for a critical stenosis of the left anterior descending artery (LAD)
3.📍de Winter sign📍
-ECG abnormality described by de Winter et al. in 1998
-Characterized by 1-3 mm of ST-depression with upright, symmetrical T-waves
-Suspicious for proximal occlusion of the LAD
-Recognized as a STEMI equivalent by Rokos et al. in 2010
Read 6 tweets
#WeeklyCardioReview Left main: #PCI or #CABG? A methodological review of #EXCELtrial and #NOBLEtrial, research in context and final answer to what should I do with my patient with #LMdisease. Stay tuned, enjoy and comment
#EXCELtrial Intended population: 2010-2014
1. LM >70% visually, or >50% hemodynamically significant
2. Heart team suitable for both Tx
3. SYNTAX score <32
Actual population:
Core lab detected high SYNTAX score (≥33) in 24.2%
Distal LM 80.5%
2 or 3 VD 51.3%
Most common exclusion criteria: Disease too complex for PCI (31.9%)
1905 pts randomized, small cross overs, balanced LTFU
Read 32 tweets
1/10 #STEMI from ruptured plaque, less plaque erosion. @BraunwaldEugene pic demonstrates LDL oxidized, glycated➡️cytokines release express adhesion molecules➡️monocytes roll, diapedesis➡️ingest LDL, become foam cell➡️SMC migrate, proliferate➡️some apoptosis➡️plaque
2/10 Why #STEMI on #ECG
1. Diastolic current of injury: current away from relatively depolarized injury➡️TQ depression➡️normalized on ECG➡️ST elevation
2. Systolic current of injury: current towards injury due to early repol➡️ST elevation
Read 19 tweets

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