Thread by @khurramn1

Debate CAC vs CTA in primary prevention?
I will start with a provocative statement
Screening, foundational strategy for decades in prev cardio is a seductive paradigm
Its so 1990’s
We are barking on the wrong tree
In 2020, I will explain why this strategy is a fallacy
#ASPC2020

#1 Both primary and secondary prevention lower disease burden and outcomes
#2 Marginal benefit of extensive screening
#3 Whats left to screen? Majority already treatment candidates
#4 Our stakeholders asking for "derisking" vs "screening"

#APSC2020

-Despite being being an avid advocate of CAC screening in past, it was time to move on
-Showed 1 in 2 statin candidates have #PowerOfZero
-Proposed CAC as SDM tool
-Concept confirmed in 3 other cohorts, better than any neg marker, cost-effective, and no statin treatment benefit

-Consequently, despite opposition, including my esteemed colleague, Jim Min, whom I debate today

-AHA/ACC agreed with our pragmatic suggestion of accepting the #PowerOfZero

-180 degree switch from CAC role of screening in 2010 to #SDM tool in 2018

-Widely accepted by experts

At the same time I believe CCTA Next Frontier in Understanding Coronary Atherosclerotic Plaque
Personal bias as the PI for #MiamiHeartStudy at @BaptistHealthSF
Key questions
Prevalence of non-calcified Plaque?
CCTA Prognostic value above CAC?

So what do we know so far?
-4% noncalcified plaque with #PowerOfZero
-CCTA does add prognostic value above CAC in short FU
-In longterm FU (13 yrs) can't beat #PowerOfZero
-Even in symptomatic pts, no diagnostic/prognostic value if CAC zero
Am I missing something here?

well lets talk about the "4 Horsemen of Apocalypse"-> High risk plaque features
-#PowerOfZero same prognosis as absence of all features
-When u take all fancy #CCTA measure, simple CAC is still the last one standing out
-Even my opponent agree with #PowerOfZero
-Jim...
🤔

My take home message, you will better served if you
-Understand screening is a seducing paradigm in prevention and its time to move on
-In 2020 we need derisking
-Accept the #PowerOfZero
-#CCTA screening is a hype
-Trust CAC Rock Hard Data, Not Just #CCTA Pretty Images
#ASPC2020