Shahrad Shadman, MD

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Shahrad Shadman, MD

Shahrad Shadman, MD

@SShadman1

Interventional and structural cardiology @gwsmhs | Cardiovascular Imaging @NIH_NHLBI @MedStarHealth| Gen Cards via @StLukesCards @Templemedschool

Washington, DC Katılım Ağustos 2019
1.1K Takip Edilen609 Takipçiler
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Shahrad Shadman, MD
Shahrad Shadman, MD@SShadman1·
🧵So OPTIMAL just dropped at ACC.26, and I’ll be honest — it’s going to make a lot of interventionalists very UNCOMFORTABLE. 806 patients 😮. Unprotected left main PCI. Randomized to IVUS vs angiography guidance. Result? No difference.🤯
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Shahrad Shadman, MD
Shahrad Shadman, MD@SShadman1·
🧵So OPTIMAL just dropped at ACC.26, and I’ll be honest — it’s going to make a lot of interventionalists very UNCOMFORTABLE. 806 patients 😮. Unprotected left main PCI. Randomized to IVUS vs angiography guidance. Result? No difference.🤯
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Pedro E.P. Carvalho, MD
Pedro E.P. Carvalho, MD@PedroEPCarvalho·
🧵Intriguing results!! Our meta-analysis published at @JACCJournals reinforced the benefits of intravascular imaging in complex lesions, particularly in left main. Link: pubmed.ncbi.nlm.nih.gov/41534986/ 1/2
Shahrad Shadman, MD@SShadman1

🧵So OPTIMAL just dropped at ACC.26, and I’ll be honest — it’s going to make a lot of interventionalists very UNCOMFORTABLE. 806 patients 😮. Unprotected left main PCI. Randomized to IVUS vs angiography guidance. Result? No difference.🤯

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Shahrad Shadman, MD
Shahrad Shadman, MD@SShadman1·
@djc795 To clarify, I’m not suggesting the operators in OPTIMAL were bad. Quite the opposite.These were elite imagers who have spent careers with IVUS in their hands. They’ve likely recalibrated their angiography with IVUS knowledge, so the delta btwn 2 strategies shrinks!
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David J. Cohen, MD, MSc
David J. Cohen, MD, MSc@djc795·
@SShadman1 And while we're at it, I would like a show of hands in responses of everyone who thinks they are a "bad operator". :)
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Shahrad Shadman, MD retweetledi
Dr. Martha Gulati ♥️🫀❤️‍🩹🇨🇦
Dr. Martha Gulati ♥️🫀❤️‍🩹🇨🇦@DrMarthaGulati·
SMART DECISION TRIAL Beta-Blocker Discontinuation Post-MI Can β-blockers be safely discontinued in stabilized post-MI patients? 🤔 A key clinical question in the era of revascularization and modern GDMT ♥️ Among stable patients who received beta-blocker beyond the 1st year after MI, discontinuation of beta-blocker therapy was noninferior to continuation 👎🏽13%💃🏻 Interesting to have HF as an endpoint since this wasn’t necessarily a population that have a lot of HF (excluded LVEF<40%) #ACC26 #Cardiotwitter #LBCT #SecondaryPrevention @NEJM 📎 nejm.org/doi/full/10.10…
Dr. Martha Gulati ♥️🫀❤️‍🩹🇨🇦 tweet mediaDr. Martha Gulati ♥️🫀❤️‍🩹🇨🇦 tweet mediaDr. Martha Gulati ♥️🫀❤️‍🩹🇨🇦 tweet mediaDr. Martha Gulati ♥️🫀❤️‍🩹🇨🇦 tweet media
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Shahrad Shadman, MD
Shahrad Shadman, MD@SShadman1·
@spitzertweets @mmamas1973 To clarify-I’m not suggesting the operators in OPTIMAL were bad. Quite the opposite. These were elite imagers at high-volume centers who have spent careers with IVUS in their hands. They’ve likely recalibrated their angiography with IVUS knowledge. So the delta is small!
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Ernest Spitzer
Ernest Spitzer@spitzertweets·
These data are difficult to digest and are nuanced. Assuming that some of the largest centers in Europe and top-performing imagers (looking at the co-authors) did not use IVUS information appears as looking things upside down. A better look is that expert operators recalibrated their angio-only practices with IVUS knowledge making the impact (i.e., effect size) smaller or non-existent. Stent thromboses were much lower in IVUS CHIP, though. Education and training are key and the adequate learning-curve volumes are unknown.
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Shahrad Shadman, MD
Shahrad Shadman, MD@SShadman1·
@spitzertweets @mmamas1973 The trial tells us expert hands can approximate it. It doesn’t tell us angiography alone is sufficient everywhere. Sorry about the long response 😁
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Shahrad Shadman, MD
Shahrad Shadman, MD@SShadman1·
@spitzertweets @mmamas1973 But that’s an argument FOR IVUS training, not against IVUS itself. In real-world practice, I can’t accept that vessel sizing, plaque characterization, and disease length in an unprotected left main won’t change my stent strategy.
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Shahrad Shadman, MD
Shahrad Shadman, MD@SShadman1·
@djc795 Fair point, and you may well be right. Elite operators who’ve internalized IVUS principles may deliver IVUS-level results without the wire. That’s not a failure of IVUS, that’s the ceiling of what training can do. We just can’t export that ceiling to labs doing 3 LMs a year.
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David J. Cohen, MD, MSc
David J. Cohen, MD, MSc@djc795·
@SShadman1 So, your conclusion is that the operators in these trials were bad? Maybe they were so good that they already did the steps that IVUS would have dictated based on angiography. How would you distinguish?
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Shahrad Shadman, MD
Shahrad Shadman, MD@SShadman1·
@SVRaoMD @Hragy I hate to ask this question, but do you think IVUS analysis/use is operator dependent and unfortunately many don’t use it correctly?
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Sunil V. Rao
Sunil V. Rao@SVRaoMD·
Just when I thought the case was closed on IVUS to guide PCI.... #ACC26
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Shahrad Shadman, MD retweetledi
American College of Cardiology
American College of Cardiology@ACCinTouch·
Results of IVUS-CHIP and OPTIMAL: When compared with angiography-guided #PCI, IVUS-guided PCI was found to be not superior in patients with 👇 ❇️ Complex coronary arteries ➡️ IVUS-CHIP ❇️ Unprotected LM-CAD ➡️ OPTIMAL More on these #ACC26 LBCT trials: bit.ly/3Q7OZiK
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Yiannis Chatzizisis
Yiannis Chatzizisis@YChatzizisis·
My thoughts on angio-based FFR are summarized in this NEJM editorial. Both FAST III and ALL-RISE - nearly identical in design and results - send a clear message that angio-based FFR is easy, safe, fast, and efficacious. Practice changing! nejm.org/doi/pdf/10.105…
Yiannis Chatzizisis tweet mediaYiannis Chatzizisis tweet media
NEJM@NEJM

Presented at #ACC26: Among patients with intermediate coronary lesions, angiography-guided revascularization was noninferior to pressure-wire–based guidance with respect to death, myocardial infarction, or revascularization. FAST III trial results: nejm.org/doi/full/10.10… Editorial: Redefining Physiology in the Cardiac Catheterization Laboratory nejm.org/doi/full/10.10… @ACCinTouch

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Amitabh Yaduvanshi MD, DM, FACC, FSCAI
Amitabh Yaduvanshi MD, DM, FACC, FSCAI@IntervnCardio·
🚨 𝗕𝗥𝗘𝗔𝗞𝗜𝗡𝗚 from #ACC2026: Two major RCTs just challenged everything we thought about Impella pumps in cardiac care. The results? Surprising. The implications? Massive. A thread on what every cardiologist needs to know 🧵👇
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Shahrad Shadman, MD
Shahrad Shadman, MD@SShadman1·
My cynical read: IVUS works when you actually USE the information it gives you. A probe in the artery operated by someone who ignores it is just an expensive catheter. The question was never “IVUS vs angiography.” It was always “good operator vs bad operator.” Uncomfortable? 😳
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Shahrad Shadman, MD
Shahrad Shadman, MD@SShadman1·
🚨 There it is. The escape hatch. Meanwhile, the January JACC meta-analysis of 13,751 patients says both IVUS and OCT are superior to angiography for MACE reduction in complex lesions including left main. So which is it?
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@JMannisi @sandeep_jalli @Cardiology @NEJM @MaadAlhudairy @PedroEPCarvalho @JACCJournals @djc795