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Lots of headlines @escardio re CT-FFR. 1 of most prominent is ADVANCE multicenter registry from @manesh_patelMD & colleagues using @HeartFlow. I'd like to dissect this a bit to see how excitement in a field combined with lots of industry funding can blind us to basic problems.
Team worked across 38 international sites over >2 years to collect data from N=5083 patients w/ β€œsymptoms concerning for CAD”. They had primary endpoint of change in management plan from coronary CTA. That happened in 67% of patients. Most impressive.
Is this a valid endpoint? I contend that this is a measurement of physician psychology rather than of anything objective.
Read 50 tweets
RELATIVE RISK, ODDS RATIO, HAZARD RATIO
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What are they?
Why do we need 3 of the damn things?
Which should I use?
Are they the same, or different, or a bit samey?

An #ORBITA-HQ #tweetorial.
#Meded #FOAMed
All 3 of these are about comparing the scale of dangerousness of one thing AGAINST ANOTHER.

Suppose you are walking through an unfamiliar forest and the road comes to a fork: you have to choose one path.

As you stand, uncertain, a troll pops out of the ground.
You ask for advice on which path is safer.

As always, the advice he offers is scrupulously correct, but not necessarily instantly interpretable to the layperson.
Read 65 tweets
If you want to kill people, the most effective way to do this in the modern era (since gun laws and annoying people like the Police will make things awkward) is to persuade people to stop (or never start) a statin.

Over the long term, 1 in 10 will be killed by that choice.
You can even write books about it and make money.
And be seen as a crusader against a crooked medicogovernmental conspiracy.
The internet is a good place to operate, because most lay people can't distinguish scientific reasoning from pseudoscience, and because ...
Excellent question from Arnab:
Read 222 tweets
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MYOCARDIAL VIABILITY
================

Lazarus revisited

[Tweetorial from ORBITA-hq: "Making cardiologists think again"(TM)]

Please retweet to cardiology fellows or anyone who might be interested to practice data interpretation.
Let's start our story here, when I was first informed that viability testing saves lives.
A few weeks later, a decisive meta-analysis.

3000 patients
Read 30 tweets
Heh heh, the Amazing Yuripridio, world-conquering hypnotist
But we must be careful on this. I have a PhD student at #ORBITA hq called Frances Wood. I met her first as a manager in a research unit a few years ago. She was the nicest, kindest person there, who would always make me tea when I visited anyone in the unit.
By and by, she wrote a PhD proposal with me. She was a trained nurse, as many of that unit's staff are. But when we submitted the grant, I discovered in her CV that she was also secretly a trained psychologist.
Read 76 tweets
Considering #statin in 35-y-o man worried about extensive family history of MI+stroke: 2 parents, 3 of 4 sibs.

#Cholesterol 5.8 mM, 224 mg/dl. Subtypes typical for such a total.
Non-smoker. Otherwise average.

[Live-quiz from #orbita-HQ for #cardioTwitter fellows & the curious]
Question C2.

First vote was for diet first, and quite right too! That is the guideline, and we must obey.

Natural, organic, eco-friendly and therefore best.

What effect size is a reasonable expectation, for patient and Dr, for the reduction of total cholesterol by diet?
Question C3.

(currently 0.8 mmol/L in the lead for Question C2)
There are several ways to choose a value. Which did you use?
Read 47 tweets
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