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Patrick Myers

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10 Oct, 11 tweets, 7 min read

@kaulcsmc

@kaulcsmc discussing TAVI in low-risk patients
Disclosure: from an impartial observer
#EACTS2020

Current recommendations for TAVR
#EACTS2020

Trial design in TAVI
Total number of total primary outcome events 4x lower in low-risk trial for Sapien. CoreValve more robust by design, yet events 2.5x lower and 2yr follow-up computed.
#EACTS2020

Interpretation of this evidence in the litterature
#EACTS2020

Laws of diminishing objectivity in the interpretation of evidence
#EACTS2020

Evolution - there is insufficient quantum of evidence to recommend TAVI in low risk
#EACTS2020

What should the strenghth of evidence be to support expansion: higher!
#EACTS2020

External validity of LR TAVI trials at issue
#EACTS2020

What factors can mitigate universal adoption of TAVR?
#EACTS2020

Durability: catch-up effect in the limited 2yr follow-up
#EACTS2020

How should LR trials inform guidelines?
#EACTS2020

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More from @pomyers

Patrick Myers

@pomyers

10 Oct

@BavariaMd

@BavariaMd giving insights of TVT registry on TAVI
#EACTS2020

Importance of registries
#EACTS2020

Numbers in TVT: ViV represents 6-7%; TAVR
#EACTS2020

Read 13 tweets

Patrick Myers

@pomyers

10 Oct

Dr Barili updating meta-analysis from last year - TAVI and SAVR

#EACTS2020

Major updates in data from randomized trials. 5 yr follow-up now doubled!
#EACTS2020

7 trials included with 1 yr data
#EACTS2020

Read 7 tweets

Patrick Myers

@pomyers

10 Oct

@gbiondizoccai

@gbiondizoccai at #EACTS2020

SYNTAX score is an angiographic score of angiographic complexity
Designed to predict feasibility of PCI - nothing to do with feasibility of CABG or outcomes
#EACTS2020

It may prove actually wrong for CABG: a CTO can easily be grafted, yet prediction by SYNTAX would suspect bad outcome.
#EACTS2020

Read 10 tweets

Patrick Myers

@pomyers

17 Jul

@NEJM

After almost 1 year, the wait is over - the #EXCEL investigators finally release the UDMI data in @NEJM
nejm.org/doi/full/10.10…
🧵 in a nutshell:
- the EXCEL investigators had the UDMI data, although they said they didn’t
- It shows higher MI risk for PCI

@BBCnewsnight

- This is research fraud and the papers should be retracted

@BBCnewsnight have had this data since december, why did it take 7 months more? Gosh @NEJM, what is up?
/2

https://twitter.com/VictorDayan1/status/1283711323419836416?s=20

Main finding: PCI has 2x the incidence of PMI (95%CI: 0.5-3.3), and 4.9x the incidence of all MI when using UDMI (95%CI: 2.6-7.2)

https://twitter.com/VictorDayan1/status/1283711323419836416?s=20

Read 25 tweets

Patrick Myers

@pomyers

3 Feb

PVL is decreasing with improving sizing and devices in TAVR. I definitively have this impression from my practice. Or is it really? 1/11

@VictorDayan1

2/ @VictorDayan1 showed in October that the criteria for PVL weren’t the same between PARTNER2 and PARTNER3

https://twitter.com/victordayan1/status/1181611613427769348?s=21

3/ VARC-II criteria define mild PVL as circumferential extent <10% and regurgitant volume of <30%.

academic.oup.com/ejcts/article/…

Read 12 tweets

Patrick Myers

@pomyers

2 Oct 19

@NEJM

After a few days to go over the #EXCEL 5 year results published in @NEJM and thinking hard about @DrMoritzWvB tweet on IC and cardiac surgery seeing things quite differently, here are a few thoughts. Glad to hear your thoughts
@tssmn @ctsnetorg @EACTS
1/30

2/ Congratulations to the investigators for an outstanding RCT! Important question and results, which will have an impact on guidelines. The protocol was powered for non-inferiority of the composite outcome at 3 years, and congratulations for following these patients to 5 years

3/ why were p-values for secondary outcomes reported selectively? e.g. for revascularization, but not others?

Read 34 tweets

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