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Pablo Lamelas 🇦🇷🇨🇦 Profile picture
Pablo Lamelas 🇦🇷🇨🇦
@lamelaspablo
Interventional cardiologist @ICBAonline 🇦🇷 Assistant Professor at Health Research Methods @HEI_McMaster 🇨🇦 Birthplace of Evidence-Based Medicine
Dec 21, 2019 • 11 tweets • 9 min read
Readdressing the validity of repeat revascularization as an outcome measure in #PCI Vs #CABG. For readers in a hurry:
1) visit @cardiomicsclub cardiomics.club/2019/12/20/rea…
2) go to @JACCJournals and listen podcast onlinejacc.org/content/74/25/…
3) read this thread! (Laziest!) Repeat revasc has been used in multiple #PCI Vs #CABG RCTs, consistently favoring CABG, making composite outcomes mostly influenced by repeat revasc in many scenarios. Also, repeat revasc has been cited as (at least part of) the justification for recommending CABG over PCI
May 25, 2019 • 32 tweets • 26 min read
#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
Apr 9, 2019 • 21 tweets • 14 min read
#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
Mar 28, 2019 • 13 tweets • 11 min read
#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
Feb 25, 2019 • 5 tweets • 6 min read
#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)
Nov 12, 2017 • 4 tweets • 1 min read
Noooooooo!!!! Nooooooooo!!!!! OOOMMMMGGGGGGHHHHHHH THE EFFECTS OF FATS IN DIET ARE MULTIFACTORIAL, they may increase some LDL but they increase HDL or other mechanisms that may be protective. LDL is a clear risk factor for CVD, before and after CVD is developed, NO DOUBT