Bryan Cogar

MIZ ZOU

[Michael Megaly @MichaelMegalyMD]

#CTO #PCI in cardiogenic shock, shall we even do it?
Our study led by @MohamedDomaa and @AdhamGR97 in the @CJCJournals investigated the long-term outcomes of patients who already had a diagnosis of cardiogenic shock and underwent CTO PCI in the same hospitalization.

While the in-hospital mortality is around 27% (which is way lower than the 40-50% cited mortality of cardiogenic shock), the long-term survival was even more impressive, with a 5-year survival of 60%.

We stipulate that the reason CTO PCI was performed was either that further revascularization was needed (e.g., inability to wean from mechanical circulatory support) or that the culprit of shock was NSTEMI with multiple CTOs (18% of our cohort)

Any other reason you would do CTO PCI in shock?

https://t.co/6puFGY5XHF

[Craig Walker, MD, FACC @CraigMWalkerMD]

I hope to see you at ARCH this week! #arch2026

[Advanced Revascularization Chapter (ARCH) @ArchSymposium]

#ARCH2026 BEGINS TOMORROW!

It's not too late to register - secure your seat today!
https://t.co/vUkSf0y6Bi

#Cardiology #InterventionalCardiology

[Advanced Revascularization Chapter (ARCH) @ArchSymposium]

#ARCH2026 IS THIS WEEK!

Connect with your favorite industry partners in the exhibit hall, during their Thursday evening events, or in the NEW Industry Suites on floor 2.

Don't miss out on their new technology! https://t.co/vUkSf0y6Bi

#Cardiology #InterventionalCardiology

[Advanced Revascularization Chapter (ARCH) @ArchSymposium]

LIMITED-TIME OFFER ⏰

Take 35% OFF your registration for ARCH Symposium today through Sunday!

Use Code "ARCHSOCIAL25" here: https://t.co/o5uhqSiuN5

#Cardiology #InterventionalCardiology #Peripheral #StructuralInterventions #Fellows #CathLab

[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

[Advanced Revascularization Chapter (ARCH) @ArchSymposium]

#ARCH2026 Early Bird Rates End Friday! Don't miss out on discounted rates, register TODAY 🫀📅

Register here: https://t.co/o5uhqSj2CD

#Cardiology #InterventionalCardiology #Peripheral #StructuralInterventions #Cardiologist #Fellows #Coronary #CathLab

[Dutch Rojas @DutchRojas]

Venture Capital deployed $14.2 Billion and none of went to independent medicine.

Carriers, health systems, pharma, and insurance.

99% of VC are consolidation pushers.

1% of Venture Capital pushes lower prices and higher quality outcomes.

[Dutch Rojas @DutchRojas]

HCA couldn’t make OU Medical Center profitable and sold it.

Oklahoma used taxpayer-funded bonds to buy it, and now the legislature pumps in $96 million a year to keep it open.

[Dutch Rojas @DutchRojas]

The 340B drug program was designed to help hospitals serve the poor.

It is now an $81.4 billion spread trade that made hospital executives multi-millionaires and associations executive directors millionaires.

[NEJM @NEJM]

Among patients with atrial fibrillation at high risk for stroke and bleeding, left atrial appendage closure was not noninferior to medical therapy in reducing the risk of stroke, embolism, major bleeding, or death at 3 years. Full CLOSURE-AF trial results: https://t.co/qAMC2o36Mi

Editorial: Left Atrial Appendage Closure — Another Overused Method in Cardiology? https://t.co/KyOWdblUR3

[Dutch Rojas @DutchRojas]

I just got back from sledding with the kiddos.

Guess what?

Howard Kern, CEO of Sentara Healthcare: $33.2 million.
Lloyd Dean, CommonSpirit: $35.5 million.
Gene Woods, Advocate Health: $25.8 million.

These are not for-profit hospitals.
Tax-exempt.
Ostensibly charitable.

Is this what people mean when they say doctors are not good at business?
Yeah, sorry mate, that's a horrible way to define business.

[Thomas Massie @RepThomasMassie]

Gaslighting…

It’s fentanyl to:
it’s cocaine

It’s drugs to:
it’s oil

It’s at sea to:
it’s boots on the ground

It’s an arrest to:
it’s an attack

It’s free elections to:
it’s anyone who serves us

It’s just Venezuela to:
it’s any country we choose

https://t.co/OXrhQxMLOJ

[Westby Fisher, MD @doctorwes]

@neil_catherine @SacksDisa @mass_marion Note: the @ABIMFoundation $2.3 million condo was a not-so-wise-choice once word got out about their lavish spending on themselves https://t.co/utLQI5I8Tr

[Marjorie Taylor Greene 🇺🇸 @mtgreenee]

“The next obvious observation is that by removing Maduro this is a clear move for control over Venezuelan oil supplies that will ensure stability for the next obvious regime change war in Iran.”

And also takes away a key source of oil from China.

If it was about drugs killing Americans, they would be bombing Mexican cartels.

[Stuart Stevens @stuartpstevens]

So, in 2026, the United States can hold a foreign president responsible for breaking US law but not an American president. Interesting.

[Michael A. Cohen (NOT TRUMP’S FORMER FIXER) @speechboy71]

So Trump just launched a military operation to capture Venezuelan President Nicolas Maduro, who has been indicted on drug trafficking charges … five weeks after he pardoned former Honduran President Juan Orlando Hernández, who had been convicted of drug trafficking charges

[Wall Street Apes @WallStreetApes]

Senator Elissa Slotkin says the real reason our healthcare in America is so bad and never changes, is because US Congress is being paid off

“If you want to know why all Americans are furious about the price of health care and nothing ever changes, it's because of this very ugly reality. Lobbyists and corporate PACs donate a lot of money, and then members of Congress feel beholden to protect those industries.

And that has real-life consequences for middle-class Americans on health care and on everything else.

The middle class doesn't have a lobbyist. They don't have a Super PAC. They don't have a corporate PAC”

It’s both sides

[Michael O’Brien @DrOBrienMD]

A university student wrote a middle school level essay just to bait her trans professor into correctly failing her so she could retaliate and ruin her teaching career… and it worked.

Absolutely shameful.

[Hemant Mehta @hemantmehta]

Samantha Fulnecky didn’t do the assignment.

She failed.

She cried discrimination and whined to right-wing media personalities.

The University of Oklahoma has now erased the grade and punished the instructor.

This is what academic cowardice looks like.

https://t.co/6jHPfrayi4