Mustafa Alam

Interested in all things Medicine and Cardiovascular. Always looking to learn!

[Mustafa Alam @Mustafa_Medical]

@drjohnm @VPrasadMDMPH AC ineligible patients appear to be amongst the most sick, I wonder how LAAC devices would fare in this population

[John Mandrola, MD @drjohnm]

#acc26 Six reasons why CHAMPION AF should not change oral anticoagulation for AF

I will have a formal post up on @theheartorg but here is a short summary

1) Stroke and Ischemic Stroke went the wrong way.
All S -> 33 vs 50 [HR 1.46 95% CI, 0.94-2.27)]
IS -> 27 vs 45; [HR = 1.61; 95% CI, 1.00-2.59)]
Look at those upper-bounds.

2) NI would not have been met for efficacy had they used a margin with both rate ratio and risk difference, which is standard practice.

The margin of 4.8% is based on event rates at 12%, which is 1.4 in relative terms (40% higher). But when event rates come in lower, as they did: 4.8% vs 5.7%, the 4.8% margin is too lenient.

The 0.9% higher rate of the primary endpoint has a 95% CI of (-0.8-2.6%), so 2.6% is less than the margin of 4.8%. Now do it with relative risk.

It's in table 2. The relative risk is 1.20. The 95% confidence intervals were 0.87-1.66. Note that 1.66> 1.40 so LAAC is not noninferior based on rate ratio margins

3) The primary safety endpoint is flawed because it excludes periprocedural bleeding and uses nonmajor bleeds, such as gum bleeds and bruising. It's open label trial so who which group will complain of more nonmajor bleeding?

4) When counting all events, Watchman barely reduced major bleeds. Also in the main results table is that major bleeds were 83 vs 87 (5.5% vs 5.8%; HR 0.92 95% CI 0.68-1.24)

5) Net Clinical Benefit was also flawed because they used nonprocedural bleeding and nonmajor bleeds.
A normal patient would simply say, there were 17 more strokes and only 4 less bleeds. Hardly a good trade.

6) Bayes: trials don't give answers, they update priors. For Watchman, you have PREVAIL failing against warfarin, CLOSURE AF clearly failing against best med Rx (mostly DOACs) so priors are pessimistic. To go from pessimistic priors to enthusiastic posteriors you'd need hugely positive data. CHAMPION is not that.

Don't believe the stories that CLOSURE failed due to them using other LAAC devices. In the AMULET IDE trial, Watchman and Amulet were similar. Also, if you believe that German operators are worse than US authors, you need to travel more.

Conclusion: Oral anticoagulation for AF is one of the most evidence-based practices in all of medicine. To upend that would take much stronger data.

Don't be bamboozled by this trial, which was designed to be positive before the first patient was enrolled.

#ACC2026

[Venk Murthy MD PhD @venkmurthy]

Many guidelines have been based on little evidence

Now we have a lipid guideline, one of the best studied areas in medicine, having half of its class I (strongest recommendations) being based essentially on opinion

[Mustafa Alam @Mustafa_Medical]

Excellent Post PE syndrome #CTEPD presentation by @stanhenkin . High incidence after PE dx, and Pulmonary rehab helps! @SVM_tweets

[Mustafa Alam @Mustafa_Medical]

Great interventional approaches to CTEPH patients presented by Dr. @mnyoung1 , HI PEITHO results eagerly anticipated @SVM_tweets

[Mustafa Alam @Mustafa_Medical]

@djc795 @YuoTheodore P value of 0.02 is not as robust and a few events would have changed the outcome in setting of low event rates, I wonder if TCAR can help mitigate the up front stroke risk for a better outcome

[Prof. Hector M. Garcia-Garcia @hect2701]

#TCT2023
Immediate CR is safe in patients with #NSTE-ACS and MVD and was associated with a reduction in #MI & unplanned ischemia driven revasc at 1 year.

https://t.co/LRPRYfKFS8

@CRT_meeting @news_hart @Shoaib9702 @jedicath @Mustafa_Medical @Almanfi_Cardio @KimAtianzar
@BakhshiHooman @ABeneduceMD @nyalborgesmd @aayshacader @NishithChandra @baileyannRN @fischman_david @HamidNadira @stefan_harb @AmandaLimaMD @Nidhi_Madan9 @evandrofilhobr @mornei2011 @SrihariNaiduMD @Hragy @DocSavageTJU @drrahulpsharma @vikmd1026 @IndahSP_MD @iamritu @atunuguntla1 @catweneboah @Pooh_Velagapudi @EZancanaroMD

[Prof. Hector M. Garcia-Garcia @hect2701]

#TCT2023
Augmented Reality and Ultrasound-Guided Vascular Access

https://t.co/POJ6GZzrmw

@CRT_meeting @news_hart @Shoaib9702 @jedicath @Mustafa_Medical @Almanfi_Cardio @KimAtianzar
@BakhshiHooman @ABeneduceMD @nyalborgesmd @aayshacader @NishithChandra @baileyannRN @fischman_david @HamidNadira @stefan_harb @AmandaLimaMD @Nidhi_Madan9 @evandrofilhobr @mornei2011 @SrihariNaiduMD @Hragy @DocSavageTJU @drrahulpsharma @vikmd1026 @IndahSP_MD @iamritu @atunuguntla1 @catweneboah @Pooh_Velagapudi @EZancanaroMD

[Indah Sukmawati, MD @IndahSP_MD]

There is no one perfect wire that can pass all types of lesions and coronary. Know which one for which lesion & at what time is the mark of great operator.

My wire escalation of choice:
- Sion Blue / Runthrough NS
- Sion Black
- Gladius / Pilot 200
- Confianza Pro 12

#TCT2023

[Prof. Hector M. Garcia-Garcia @hect2701]

#TCT2023

A virtual planning algorithm accounting for unique TAVR deployment in bicuspid anatomy can adequately assess redo-TAVR risk.
@GiorgioMedranda
https://t.co/N9dXwQ5GRp
@CRT_meeting @news_hart @Shoaib9702 @jedicath @Mustafa_Medical @Almanfi_Cardio @KimAtianzar
@BakhshiHooman @ABeneduceMD @nyalborgesmd @aayshacader @NishithChandra @baileyannRN @fischman_david @HamidNadira @stefan_harb @AmandaLimaMD @Nidhi_Madan9 @evandrofilhobr @mornei2011 @SrihariNaiduMD @Hragy @DocSavageTJU @drrahulpsharma @vikmd1026 @IndahSP_MD @iamritu @atunuguntla1 @catweneboah @Pooh_Velagapudi @EZancanaroMD

[Prof. Hector M. Garcia-Garcia @hect2701]

#TCT2023
Patients with #CTO have higher rates of cardiovascular events than patients w significant CAD wo CTO. This risk is greatest in individuals w nonrevascularized CTO.
https://t.co/L2N5N36awe

@CRT_meeting @news_hart @Shoaib9702 @jedicath @Mustafa_Medical @Almanfi_Cardio @KimAtianzar
@BakhshiHooman @ABeneduceMD @nyalborgesmd @aayshacader @NishithChandra @baileyannRN @fischman_david @HamidNadira @stefan_harb @AmandaLimaMD @Nidhi_Madan9 @evandrofilhobr @mornei2011 @SrihariNaiduMD @Hragy @DocSavageTJU @drrahulpsharma @vikmd1026 @IndahSP_MD @iamritu @atunuguntla1 @catweneboah @Pooh_Velagapudi @EZancanaroMD

[Prof. Hector M. Garcia-Garcia @hect2701]

#TCT2023

Change in Pulmonary Artery Systolic Pressure After #TAVR
https://t.co/1da80iI43R

@CRT_meeting @news_hart @Shoaib9702 @jedicath @Mustafa_Medical @Almanfi_Cardio @KimAtianzar
@BakhshiHooman @ABeneduceMD @nyalborgesmd @aayshacader @NishithChandra @baileyannRN @fischman_david @HamidNadira @stefan_harb @AmandaLimaMD @Nidhi_Madan9 @evandrofilhobr @mornei2011 @SrihariNaiduMD @Hragy @DocSavageTJU @drrahulpsharma @vikmd1026 @IndahSP_MD @iamritu @atunuguntla1 @catweneboah @Pooh_Velagapudi @EZancanaroMD

[Prof. Hector M. Garcia-Garcia @hect2701]

#TCT2023
In the setting of #CTO-#PCI, use of #DCBs is safe, and a reduction of stent length might translate into lower TLF rates at 12 months.
https://t.co/UBd6WXWjMN
@CRT_meeting @news_hart @Shoaib9702 @jedicath @Mustafa_Medical @Almanfi_Cardio @KimAtianzar
@BakhshiHooman @ABeneduceMD @nyalborgesmd @aayshacader @NishithChandra @baileyannRN @fischman_david @HamidNadira @stefan_harb @AmandaLimaMD @Nidhi_Madan9 @evandrofilhobr @mornei2011 @SrihariNaiduMD @Hragy @DocSavageTJU @drrahulpsharma @vikmd1026 @IndahSP_MD @iamritu @atunuguntla1 @catweneboah @Pooh_Velagapudi @EZancanaroMD

[Prof. Hector M. Garcia-Garcia @hect2701]

#TCT2023

Paclitaxel-coated balloons (PCB) vs. sirolimus-coated balloons (SCBs) for #ISR

At 1-year, there was no significant difference in outcomes between the 2 groups

https://t.co/EFLXN7IZLn

@CRT_meeting @news_hart @Shoaib9702 @jedicath @Mustafa_Medical @Almanfi_Cardio @KimAtianzar
@BakhshiHooman @ABeneduceMD @nyalborgesmd @aayshacader @NishithChandra @baileyannRN @fischman_david @HamidNadira @stefan_harb @AmandaLimaMD @Nidhi_Madan9 @evandrofilhobr @mornei2011 @SrihariNaiduMD @Hragy @DocSavageTJU @drrahulpsharma @vikmd1026 @IndahSP_MD @iamritu @atunuguntla1 @catweneboah @Pooh_Velagapudi @EZancanaroMD

[Prof. Hector M. Garcia-Garcia @hect2701]

#TCT2023

Parallel wire–based Antegrade dissection re-entry (ADR) is an alternative for complex CTO lesions w a promising success rate
https://t.co/JKpqygCPE4
@CRT_meeting @news_hart @Shoaib9702 @jedicath @Mustafa_Medical @Almanfi_Cardio @KimAtianzar
@BakhshiHooman @ABeneduceMD @nyalborgesmd @aayshacader @NishithChandra @baileyannRN @fischman_david @HamidNadira @stefan_harb @AmandaLimaMD @Nidhi_Madan9 @evandrofilhobr @mornei2011 @SrihariNaiduMD @Hragy @DocSavageTJU @drrahulpsharma @vikmd1026 @IndahSP_MD @iamritu @atunuguntla1 @catweneboah @Pooh_Velagapudi @EZancanaroMD

[Mustafa Alam @Mustafa_Medical]

A privilege to be a part of this panel on balancing dynamics in the cardiology ward! Be sure to check out more of @TCTMD_Yael work: https://t.co/WJVT8MqAaK

[Mustafa Alam @Mustafa_Medical]

Very first cath at #TCT2022 was a great learning experience, thanks to @crfheart @TCTMD

[Mustafa Alam @Mustafa_Medical]

@Babar_Basir @Pooh_Velagapudi @crfheart @TCTConference Tried to catch you after the presentation, but unfortunately missed you! Was great meeting you previously at @SCAI and hopefully future meetings

[Mustafa Alam @Mustafa_Medical]

Wonderful session on cardiogenic shock! @Babar_Basir @duanepinto @Ajar_Kochar @Pooh_Velagapudi @crfheart @TCTConference

[Yael L. Maxwell @TCTMD_Yael]

Thank you #Cardiotwitter for helping me fill not 1 but 2 panels for @TCTMD’s #FellowsForum at #TCT2022. Look out for two videos with @JDawnAbbott1 @anna_bortnick @VicOkunrintemi @csnallapati @smitha_narayana @Mustafa_Medical @TusharMishraMD and @jaya_kanduri in the coming weeks