Mike Mostwill

@RonKarlsbergMD @MichaelAlbertMD In an ideal world, CTA over CAC for sure... The problem for the average patient though is💲.

Let’s move beyond the calcium score—a ~40-year-old technology that is useful for population risk stratification but offers limited individualized prediction. Randomized evidence supports the clinical value of coronary CT angiography (CTA) in patients with suspected coronary artery disease. In the SCOT-HEART trial (4,146 patients), adding CTA to standard care improved diagnostic certainty and led to more targeted preventive therapy, resulting in a 41% reduction in coronary death or non-fatal myocardial infarction at 5 years compared with standard evaluation alone. The PROMISE trial (10,003 patients) similarly showed that an initial CTA strategy provides outcomes comparable to functional testing while improving identification of obstructive coronary disease and guiding preventive treatment. As the field advances, trials continue to test CTA within rigorous randomized frameworks. The TRANSFORM trial is ongoing, reflecting a methodical effort to determine where CTA belongs within the highest levels of the evidence base through well-designed randomized controlled trials. Taken together, these studies show that CTA is not simply an imaging modality—it can meaningfully influence diagnosis, preventive therapy, and cardiovascular outcomes. As the remaining trials report, CTA will likely become firmly established in the evidence base—used appropriately as a high-value diagnostic tool, rather than an overused test.

I would add that I use CAC screening for intermediate-to-high risk individuals who are LDL skeptical (thanks, keto people). While I don't know the true impact on my decision-making, I take solace in the fact that many agree on the value of LDL-lowering therapy after a positive CAC scan (non-zero).

Let's see how this is looking in a day or two. These waves can be tricky to forecast, particularly in the medium range as they ride along a relatively zonal flow. Once in mesoscale guidance range, the picture should become clearer, if not a bit before that.

For early next week, we have a wave(s) ejecting out of the SW, traversing the CONUS, running into strong CAD courtesy of a strong HP to the N. ? is, can it/they hold together enough? (& possibly interact w/a northern stream disturbance?) I'm a bit skeptical, but it's intriguing

Coating on all surfaces ❄️ ☃️. #njwx

Each event is a learning opportunity & this historic one will be no exception. Thank you to all who follow me, I appreciate the support! After a light snow event tomorrow & a low-confidence, possible light event Thurs/Fri, eyes turn to next week to see what it may have in store.

All in all, I'd give it a C+; Maybe a B-. My main disappointment was failing to miss the extent of the obvious deform N/S band that was inevitable to develop, which should have guided that longitudinal maxima more accurately. That was a fundamental human error, not a model one.

In the end, the extreme totals worked out well across ENJ/LI/SECT. Issue was, the zone wasn't expansive enough south into DE/MD or N into C&NENJ/NYC/SNY/SWCT. The steep gradient idea was correct, but was still a bit too far W w/the cutoff. The contour bend idea in SEPA was decent

Tomorrow morning will feature a light snowfall across the region. Considering that this will be occurring during the morning rush & temps will be quite cold at the onset, it's worth mentioning to use caution & plan accordingly in case you need extra time. #njwx #nycwx #nywx #pawx

Storm Total: 14.2" in Bedminster/Pluckemin, NJ (Somerset County) SMNJ-115

This 100% happened btw. ☃️❄️

@WxRiskGrains It's really just the first part I'm touching on. I'm not looking at any of the fine details like snowfall output, or even weighting QPF too much for that matter in the medium range. Just noting it had the general phased system idea and held onto it moving up in time.

@MikeMostwill Well I disagree with most of this. yes the GFS gets credit for latching on to the huge storm idea early and finally getting something right . but the widespread 30 -36 ch snow amounts it depicted for the big cities in the Mid-Atlantic did not come close to verifying.

Rare medium-range performance win from the GFS, outperforming the ECMWF, its classic comparator. Wise forecasters of course don't play this age-old game; Using NWP for its strengths & weaknesses requires nuance. Nevertheless, for the wx nerds, this was quite the aberration!

EXTREME BLIZZARD CONDITIONS are blasting Plymouth, MA as of 6:00 AM Monday. Wind gusts up to 65 MPH currently…

@cooperj1123 We agree on this front. 🤝

@MikeMostwill Subsidence and I have some serious beef

This storm is still ripping over the eastern half of the area, but early interpolated reports would lead me to believe this map will have fallen short of my expectations, a C+ perhaps😑-Too low in DE, too high in NW NJ & not extending the max & 12-18 zone further N & to the SW.

@cooperj1123 Yeah, these are early, often unverified. NWS will review and adjust in a few days.

@MikeMostwill Whoever reported 10 inches in southern Chester county pa is lying 🤣 we have barely 6 inches

By far the worst conditions of this blizzard so far in New York City. Heavy snow, gusty winds and visibility less than 1/4 of a mile. #nywx

@RKarHol Yeahhhh, for NNJ it was like Deja Vu! Though all of central and SNJ cashed in big this time vs in BDB where they were also shortchanged to the west. Where are you situated?

@MikeMostwill mmmhmmm BDB repeat :(

Watching the deform bands crush E-NJ, NYC & LI from home. 😭 😂

Per the teal region, the deformation band did indeed position on a NNE to SSW axis, splitting NJ, leading to very high amounts within the band. But the subsidence is what snuffed out totals in NW-NJ. LI max zone will verify well, just perhaps too low!