When bivalirudin is used during STEMI, the infusion should be continued for 2-4 hrs post-PCI. This will not only reduce any increased risk of stent thrombosis but in BRIGHT-4 reduced stent thrombosis compared with UFH. The post-PCI infusion is not necessary in NSTE-ACS.

Evaluating the Appropriate Use Criteria for Coronary Revascularization in Stable Ischemic Heart Disease Using Randomized Data From the ISCHEMIA Trial #AHAJournals Gregg W. Stone MD Sripal Bangalore ahajrnls.org/43iDaej

ECLIPSE publ today in Lancet. In 2005 pts with severe lsn calcification by angiography that did not absolutely require atherectomy, there were no sig differences in acute MSA or 1-year TVF with orbital atherectomy vs. balloon pre-dilatation. Free link: authors.elsevier.com/a/1krhgV-4XSfdR

RECHARGE is actively randomizing women, Black and Hispanic pts with multivessel or left main CAD in the US and Canada to PCI vs CABG with a novel primary endpoint of improved survival and quality of life. 50/1200 pts enrolled to date. if you would like to participate DM me.

Our new publ from COAPT in Circ CV Interv: Elevated natriuretic peptides were a stronger risk factor for death and HF hosp than prior HF hosp within 1 yr, although prognosis was worst if both were present. MitraClip improved outcomes regardless of risk.

Our publ in EHJ: state of the art review of intrer-atrial shunting - potentially a major breakthrough in HFrEF and selected pts with HFpEF. Add to this the ongoing placebo-procedure controlled ALLAY-HFrEF trial which has just started randomizing 350 HFrEF pts.

Celebrating my son-in-law’s PhD graduation from Yale - everything on the cake is meaningful. Future of the next generation is bright!

Our publ of outcomes of PCI vs. CABG in ISCHEMIA now online in AHJ. Even though this was NOT a randomized comparison, everyone wanted to see it. For the 1203 pts (385 CABG, 818 PCI), the adj 4y primary event rate was 14.5% for CABG & 13.2% for PCI (diff 1.3%, 95%CI -4.9% - 7.7%).

sciencedirect.com/science/articl…

Our JACC publ from PROSPECT II. ↑ TC, LDL-C, & non-HDL-C were strongly associated with pancoronary athero and lipid deposition. ↑ Lp(a) was strongly associated with focal vulnerable plaques→unique role for Lp(a) role in plaque progression & vulnerability -synergistic with LDL.

2nd new PROSPECT II publ, this in JACC Int: hs-CRP (inflammation) was independently associated with both diffuse cor plaque and lipid deposition as well as focal vulnerable plaques. Coupled with the JACC article: LDL & CRP → diffuse plaque and lipid whereas Lp[a] & CRP → VP.

Our publication in EHJ: In ILUMIEN IV, >50% of lesions were mod/sev calcified. OCT-guided PCI in calcified lesions reduced 2-yr rate of TVF and serious MACE - one of the best uses for OCT guidance! Free access link: academic.oup.com/eurheartj/adva…

Saddened beyond words. Dimitri was a very special person.

Which term do you prefer?

I'm thrilled to announce that we've completed randomizing 1252 pts with LVEF <40% and complex CAD to high-risk PCI with Impella CP support vs. control. Now we are in the 1-year follow-up phase and then the results of the PROTECT IV trial will be reported.

Our new PROSPECT II study in Circulation comparing untreated non-obstructive lsns in STEMI & NSTEMI. ~4 such lsns per pt. 2-feature high-risk plaques were equally present (in 38.8% vs. 32.7%; P=0.11). 4-yr rates of untreated lesion-related MACE were also similar (8.6% vs 7.8%).

How often do you insert a right heart catheter to manage cardiogenic shock?

So surprised the answers are all over the place. Holdover effect of the JAMA article >10 yrs ago showing assn of ICU RHC use & death, since debunked, w/many studies showing assn w/RHC use & lower death in shock. But no definitive RCTs. I would use RHC in ~100% of shock cases.