Discover and read the best of Twitter Threads about #weeklycardioreview
Most recents (4)
#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
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
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
#WeeklyCardioReview AUGUSTUS trial #NeverTooLate #Apixaban in patients requiring DAPT. Two key aspects to discuss here: 1) Should Apixaban 5mg/BID be the only NOAC used with triple therapy? 2) Time to move to NOAC+Clopidogrel dual therapy? enjoy thread and comment! 😉
Summary: AUGUSTUS RCT 4,614 ppl requiring DAPT (ACS and-or PCI) factorial design: Apixa vs Warfarin (NOAC research question), and ASA vs placebo (triple vs dual tx question) for 6 months. Study powered for bleeding outcomes and had guts to assume no interaction, stay tuned
Major or clinically relevant nonmajor bleeding lower in Apixa vs Warfarin HR 0.69 (0.58-0.81; superiority P<0.001), ASA vs placebo 1.89 (1.59-2.24; placebo superiority P<0.001). Apixa Vs Warfa, and ASA vs placebo similar incidence of ischemic events
#WeeklyCardioReview PARTNER 3 and Evolut Low Risk TAVR #NeverTooLate. Includes a home-made meta-analysis at the end. Time to re-think the standard for treating AS?
PARTER 3: 1000 pts, mean STS 1.9%, death/stroke/rehosp 1 year lower in TAVR HR 0.54; 95% CI, 0.37 to 0.79; P=0.001. At 30 days lower rate of stroke P=0.02 and death or stroke P=0.01 and new AF P<0.001.
@NEJM nejm.org/doi/10.1056/NE… @tavrkapadia @djc795 @J_M_McCabe @EdwardsLifesci
@NEJM nejm.org/doi/10.1056/NE… @tavrkapadia @djc795 @J_M_McCabe @EdwardsLifesci
shorter index hospitalization and lower risk of a poor treatment outcome (death or a low KCCQ score at 30 days (P<0.001). No significant between-group differences in major vascular complications, new permanent pacemaker insertions, or moderate/severe paravalvular regurgitation.
#WeeklyCardioReview New CTO success score CASTLE (from @EuroCtoClub over 20k procedures) shows good discrimination (validation AUC 0.68) and good visual calibration, by @jcspratt in @JACCJournals interventions.onlinejacc.org/content/12/4/3… Great to have contemporary scores to inform patients
Have a methods question: derivation/validation datasets not selected randomly, but derived in an older cohort (A) and validated in a newer cohort (B). Not surprisingly, discrimination properties (AUC) remained similar, but calibration poorer in validation cohort (overestimation)
Likely due to better success rates over time as technology and expertise improve. But calibration is key for talking to patients: they don't want to know if they are more likely to have success vs other patients (discrimination), they want to know their % success (calibration)
