I'm so excited!

PCI proven to save lives!

And we in ORBITA have played our part!
A picture tells a thousand words. And if you use a thousand colours, it tells a million words.
Here we are! The bestest trial in all the world!

Today I am happy to say I am something to do with it!!! No longer am I saying I had nothing to do with it and it was just something @rallamee was doing without my knowledge.
@rallamee Obviously I can't take all the credit for this meta-analysis being positive.

I did have some help from my mates.
So I will share my Nobel with the SWISSI-2 boys, who had this cunning plan:

Wait for people to have an MI.
Don't PCI them.
Afterwards, look for ischaemia.
If ischaemia present, declare them to be "stable IHD" and randomize!

And of course the ECSS brigade, who had the wonderful idea to do a trial without statins.

(They were helped a little, by statins not being invented yet, but still it was clever of them, so I will give them a bit of my Nobel.)

Oh dear. I am seeing David Brown's tweets now.

Hmph. Maybe I am thwarted yet again from getting my Nobel Prize.
Here is Liza Chacko and Yousif Ahmad's analysis which is a bit more careful as to what is considered "stable IHD".

In this paper we had to fight with the reviewers who said:

"No sane person says unrevascularised post MI is stable angina, so you can't say that people say that. Prove it"

We had to show them examples, and eventually settled on this wording:
Still, a 0.90 RR from ORBITA is a fine showing.

Albeit from our 0 events.
Here is the original paper, that triggered this all-too-brief moment of pride.

And thank you to @RicardoPetraco for whatsapping me with the news, and Burt at @angioplastyorg for the original tweet.

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More from @ProfDFrancis

17 Apr
I do admit I pour vitriol on fellows who say NYHA is 2 to 3.


"Whats the point of going to medical school and then training in cardiology? Could have just gone to the pub."
NYHA has 4 possible values.

The cleaner could tell the people in NYHA 1: they are basically feeling normal.

The cleaner could also tell people in NYHA 4. They are slumped in a chair or bed, breathless at rest.

Everyone else is in 2 or 3.
Therefore the entire purpose of the 10 years of medical school, cardiology training, PhD and whatnot, is to be more skilled than the cleaner, i.e. to be able to distinguish NYHA 2 from 3.
Read 23 tweets
15 Apr
Yes but this is not because they are evil.

It is because they feel that they are responsible for being advocates for their craft. That is why we congratulate people who broaden the indications for an intervention, and shun those who narrow it.
The Echo CRT trialists did an excellent job discovering that CRT given to people with only mechanical dyssynchrony, killed you progressively over time. In the same way that CRT for LBBB saved your life progressively over time.
In other words they showed that it was not a procedural complication problem (that happens soon after the implant) but a progressive result of the pacing itself.

They rarely get credit for this exquisite insight.
Read 7 tweets
11 Apr
I like this analysis.

However take no notice of this. I am an interventionist and it shows a reduction in some sort of events, when interventionists do our thing, so I am bound to like it.
What I do when I read research is ask myself who organised it and why.

It's not their fault, we are all creatures of habit and are biased.
The meta analysis was by Avi, who is understandably desperate for a resounding victory for PCI.

I am too, but just less energetic in my searching, with every passing disappointment.
Read 9 tweets
4 Apr
When this happens ...
What be your response?
Happily the plumber fixes it. He explains that this is a problem with blockage in the pipes that he had to clear.

You tell your neighbour about your lucky escape with your life.
Read 36 tweets
23 Dec 20
Tony Blair is (for once) right that the most efficient use of the limited vaccine supplies would be to give everyone (who wants it) one dose, and once that is all done, and more vaccine is available, go back for 2nd doses.
HOWEVER, much as I love to kick the government, I can see fully why they are NOT doing this.

If I was the head of my village in Outer Francisia, and I had only n vaccine doses for my n people, I would give them all 1 each. (If I had less, I would give to the most at-risk)
... based on this startling graph
Read 49 tweets

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