#MASTERDAPT is out in @NEJM, short vs standard DAPT in high bleeding risk patients. Will be the most important DAPT Study we see this year. Much respect for the authors. Here’s are some quick thoughts (thread):

- high risk patients (1/3 NSTEMI, 11% STEMI, complex long lesions) - OAC patients standard regimen has at least 3 months and sometimes longer of triple therapy. OAC short regimen got 1 month triple and stopped all antiplt therapy by 6 months.

- non OAC stratum majority of short regimen went to P2Y12 monotherapy with clopidogrel at 1 month.

This is pretty cool.

#FauciGrandRounds Dr. Fauci "not naming names", but clearly not pulling punches. Thinks strategy of protecting nursing homes alone exposes large proportion of susceptible Americans at risk for severe infection.

1/Lot's of angst about #ISCHEMIA and what it will mean for cardiology practice. For me, a positive trial is likely to mean more for changing my practice than a negative one. I'll try to explain (Thread). #AHA19 2/I was trained by conservative cardiologists in the post-COURAGE era. I don't offer PCI to stable patients with the idea that I am going to make them live longer or reduce hard endpoints. We offer PCI to stable patients for one predominant reason - symptoms despite meds.

BREAKING NEWS!!!

In the first ever randomized clinical trial, we demonstrated that parachutes did NOT prevent death or major injury compared to control in individuals jumping from aircraft.

Published today in @bmj_latest: bmj.com/content/363/bm…

#PARACHUTETrial #XmasBMJ Deeply appreciative of all the efforts of all the PARACHUTE Trial Investigators.

A multicenter collaboration between @SmithBIDMC and @UM_MiCHAMP.

#XmasBMJ #PARACHUTETrial

Interesting validation of the DAPT Score in a large real world population. I'm most interested in the authors discussion, because the data are largely consistent with everything else that has been published. It's the spin that is different here. 1/

https://twitter.com/ACCinTouch/status/1033648779180892160

Let's start with the validation. The DAPT score is built on 2 separate Cox models. The authors validated each one in their study. Here is how they performed: C-statistic 0.67 for ischemia and 0.67 for bleeding. That's basically how well they performed in the original cohort.

How could you use IV to analyze #CABANA? I haven't seen the publication (is it published?) and am going mostly on what people have tweeted. But if most of the crossover happened early, before patients experienced endpoints, then it could be pretty straightforward...

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Getting randomized to ablation in the trial meant that you were very likely to get it, but not in all cases. Similarly, getting med Rx meant very likely to get med Rx, but not in all cases. So the breakdown is something like below.