Kasper Kyhl

A reminder that optimal PCI is often about strategy and flexibility #provisional #pragmatic #DEB @twj1974

No difference in IVUS-guided vs. angio for LM PCI? It is ESCAPE trial all over again. Like pulmonary artery catheters, IVUS is a diagnostic tool. The catheter, per se, doesn’t have a magic power to change the outcome of a procedure. We should move away from doing trials that only compare IVUS vs angio. Trials that successfully advanced the field, such as ULTIMATE and DKcrush VIII(presented at ACC as well) had strict criteria for “real IVUS-guided PCI”. Here, only 65% of the IVUS guided group had a pre IVUS to “guide the PCI”. Prior trials showed that IVUS-guided PCI leads to statistically significantly larger balloons and stents, and more post-dilation. Here we see less POT in the IVUS group. Also, despite most patients receiving less than 2 stents (provisional), the cardiac mortality at 2 years was exceptionally high at 9.5% (Syntax II was 2.8%, DKCRUSH 1.3%, PRECOMBAT 2.7%, all at 5 years). I hope this does not make us lose the recent improvement in imaging uptake. It took us years to convince people that a PA catheter is important in cardiogenic shock because of ESCAPE. I hope the field moves to design better trials with different strategies for imaging-guided PCI, rather than reverting to angio, where you have to guess the calcium arch, a nodule, or even whether the stent is indeed expanded.

The match is at SELUTION’s home stadium (so effectively the ITT analysis).😄Gregg and Davide exchange a few passes. Greg, in red, takes the shot… Goal! …or maybe not? Wait a second. The captain of the SELUTION team, wearing blue, walks onto the field and says: “This is not a goal. The goalposts must have shifted. We usually keep them a bit further back.” @GreggWStone , @DFCapodanno and I were thinking about the position of the goal using the traditional NI margin. But the SELUTION investigators apparently decided to use a dynamic margin.

I am not particularly surprised that the SELUTION DeNovo paper has not yet been published if this is the interpretation being promoted by the authors. The noninferiority margin was 2.44%. In the intention-to-treat analysis, the upper bound of the risk difference for TLF was 2.38%, therefore technically meeting the criterion for noninferiority. However, in a noninferiority trial the per-protocol analysis carries greater weight, and in that analysis the upper bound of the risk difference is 2.63%, meaning that noninferiority is not achieved. To be precise, in noninferiority trials both intention-to-treat and per-protocol analyses are required, and concordant results are generally expected; when they diverge, the evidence for noninferiority is considered weak. The authors now state that “the results of the per-protocol analysis did not confirm noninferiority, but they are similar to the intention-to-treat analysis in both direction and magnitude.” Well, where I come from we would say: “If my grandfather had wheels, he would have been a cart.”

In low-risk patients with severe aortic stenosis, transcatheter and surgical aortic-valve replacement led to similar 7-year survival and valve durability outcomes, with no evidence of differences in composite end points. Full PARTNER 3 trial results and Research Summary: nej.md/4nieHfx

@ONOCORvascular @TrackYourHeart @Obisht Can you share full case description or published case of Ōnō removing af SEV, please?

@TrackYourHeart @Obisht ŌNŌ helps…

What's happening here?

@Blogless1380 @DavidLBrownMD 75mg

@DavidLBrownMD Experts in Denmark- you are doing what?

Gold standard science = let’s copy Demark

Great technique!

Take a deep dive into #ShockwaveJavelin! Learn about the device, how it’s used, and how it compares to other devices in the #ShockwaveIVL lineup. Read full @EVToday article here: evtoday.com/articles/2025-… US Rx only. ISI bit.ly/3iEq7fC

Published a letter in @TheEconomist @mmamas1973 @SVRaoMD @cpgale3 @DavidLBrownMD @drjohnm @Lpa_Doc @NielsRHolm

🙌Game-changing real-world data from SWEDEHEART! 📰Leosdottir et al., JACC 2024 jacc.org/doi/10.1016/j.… Title: Early Ezetimibe Initiation After Myocardial Infarction Protects Against Later Cardiovascular Outcomes 👩‍🦰🧑‍🦰Population: >71,000 post-MI patients on high-intensity statins Groups: 1️⃣ Ezetimibe within 6 months of MI 2️⃣ Ezetimibe 6–12 months post-MI 3️⃣ No ezetimibe 🤩Findings: Early ezetimibe → ↓ 22% in MACE (HR 0.78 [0.70–0.86]) vs. late initiation ☝️Compared to no ezetimibe → HR 0.85 [0.79–0.91] ☝️NNT = 53 to prevent 1 MACE with early initiation ☝️Mortality also significantly reduced with early use 👉Delaying ezetimibe after MI = missed opportunity to prevent events. The message is clear: Start combination lipid-lowering therapy early—not when LDLc remains high, but when risk is high. @society_eas @ProfKausikRay

New study highlights the need for earlier Advance Care Planning in heart failure management and tailored support for caregivers to enhance patient well-being. Read more: academic.oup.com/eurjcn/advance… #HeartHealth #AdvanceCarePlanning

@DFCapodanno All the benefit was in the 90% stenosis group. Wouldn’t waste time/money with physiology, which is unreliable in this group.

In this Editorial, @ziadalinyc, Keyvan Karimi Galaugahi, and @GreggWStone explore key unresolved questions in intracoronary imaging: Should it be universally adopted in PCI or reserved for specific patients and lesions? What factors define its utility? How do we characterize lesion complexity—is it driven by the lesion itself or the patient’s overall profile? eurointervention.pcronline.com/article/intrac…

A common phenomenon is to label a trial single-blind, double-blind etc. But is this helpful? 1/8 #MethodologyMonday #103

@JohannesGrand @DocFakhri @joyland2704 @JakobHartvig @Torsten_B_R

@JohannesGrand @DocFakhri @joyland2704 @JakobHartvig

Ugeskrift for læger har fokus på kardiologi 🫀🔊 Vi har skrevet et indlæg om akutte kardiologiske tilstande, hvor hurtig udredning og behandling er vigtigt 🚑 Det er vigtigt, at vi tænker de akutte sygdomme med når sundhedsvæsenet skal udvikle sig 🏨 tinyurl.com/233ukhxs

Velskrevet artikel om kronisk koronart syndrom