Giacomo Maria Cioffi 🇨🇭🇮🇹🇨🇦

Building on our prior single-center work on #SalineOCT (Cardiovasc Revasc Med 2022), thrilled to share our large multicenter validation now published in @JACCJournals! Grateful to all co-authors and the JACC team for the smooth process! In 166 PCI patients (259 paired runs, 2,072 frames analyzed by blinded investigators), heparinized saline showed excellent agreement with contrast OCT (no significant differences in PRD, MLA, MLD & DRD; ICC 0.69–0.79) with ZERO adverse events. A safe, practical alternative for CIN-risk patients! 🔗 New study: jacc.org/doi/10.1016/j.… Previous work: doi.org/10.1016/j.carr… #OCT #PCI #JACCAdvances #CardioTwitter @DrRajeshVijay @Dr_AshokSeth @DrRajeshG1 @APSIC6 @realarainmd @DrArunGopi1 @BoopathyCardio @rajeevafmc @aayshacader @drshantanud @EAPCIPresident @uroojmd1 @GreggWStone @DrJMHill @ihtanboga @JoySanyal74 @latchumanadhas @PunamiyaKirti @LPayoA @drvishalg @drnbajaj76 @ncurzen @NielsRHolm @DrNataliaP @SandeepNathanMD @Obisht @DrQuinnCapers4 @mmamas1973 @mirvatalasnag @DrAshishCardio @sbrugaletta @SanyaChhikara @Preetik60543769 @Sunilbhatti99 @DrSharmaPrafull

> 600,000 left atrial appendage devices have been placed NOT NONINFERIOR 👇🏻 Trial is large, nonindustry funded and done in experienced centers in Germany Endpoint had both efficacy and safety components and still did not make non-inferiority I tried to tell you all

You wish journal editorials were half this good

🫀 Low LDL-C… but High Residual Risk? From our study: Residual coronary atherosclerotic risk and low LDL-cholesterol in chronic coronary syndromes. Eur Heart J Imaging Methods Pract. 2026 Feb 4;4(1):qyag021. doi: 10.1093/ehjimp/qyag021. We aggressively lower LDL-cholesterol in chronic coronary syndromes (CCS). But what if LDL is no longer the whole story? In the HURRICANE cross-sectional study (479 CCS patients undergoing CCTA), a striking paradox emerged: 📉 Patients with LDL-C <70 mg/dL had ⬆️ More severe and extensive CAD ⬆️ Higher plaque burden (including non-calcified plaques) ⬆️ Higher Leiden risk scores Why? Because cardiometabolic risk was clustering in this group. 🔎 Key findings: ✔️Metabolic syndrome in 31% ✔️Diabetes/pre-diabetes in 47% overall ✔️In the lowest LDL group, diabetes/pre-diabetes independently predicted moderate–high CAD risk ✔️OR for diabetes: 6.13 for high-risk CAD Importantly, these associations held: ✔️ After adjusting for medications (including statins) ✔️ In patients without prior ischemic events ✔️ Across multiple plaque metrics (SIS, CAD-RADS 2.0, Leiden score) 🧠 Mechanistic signals: Insulin resistance (HOMA index) → higher plaque burden Atherogenic dyslipidemia (TG/HDL, remnant-C) → more calcified plaque IL-6 (low-grade inflammation) → more non-calcified/mixed plaques 📌 The take-home message: Lowering LDL-C reduces events. But in many CCS patients, residual risk shifts toward glucose dysregulation, insulin resistance, and inflammation. This is not “LDL failure.” It is a reminder that atherosclerosis is metabolic and inflammatory — not just lipid-driven. 🧬 Future prevention in stable CAD may require: Precision metabolic profiling Anti-inflammatory strategies Modern glucose-lowering therapies LDL is necessary. But it may no longer be sufficient.

Lipoprotein(a)-lowering therapies: a promising future. A state-of-the-Art review in #EHJ 👉 ow.ly/V6Rm50YlK3J @RoccoMontone @ehj_ed

🧠🫀 When cardiology forgets to ask “why”: a timely wake-up call This 2025 Open Heart viewpoint by Francesco Tona is not an attack on modern cardiology—but a deeply reasoned warning about what we risk losing amid unprecedented technological power  . ⚙️ The paradox Cardiology has never been more capable. We replace valves percutaneously, map anatomy in exquisite detail, and deploy AI to predict risk. Yet, the author argues, capability is increasingly replacing curiosity. Decisions are often driven by what can be done, not whether it should be done. 🧠 From “why” to “can” Historically, cardiology advanced through physiologic questions and clinical reasoning. Today, the sequence is reversed: - A device appears - Anatomy fits - The procedure proceeds - Reflection, appropriateness, and patient-centred benefit too often come after execution—if at all. 🩺 When feasibility replaces judgement Tona highlights a subtle but dangerous shift: - Anatomical suitability eclipses clinical appropriateness - Procedural success is mistaken for patient benefit - Futility becomes “well-executed” rather than questioned This is not failure of skill—but failure of restraint. 💼 The silent drivers Industry influence, guideline structures, and training environments normalize interventionist reflexes. Research increasingly validates existing technologies using surrogate endpoints, while negative or null results fade into obscurity. 🤖 AI: help or shortcut? AI can augment care—but risks outsourcing thinking. When clinicians validate algorithmic outputs instead of interrogating them, clinical reasoning atrophies. Precision without purpose is not progress. 🔮 The real message This is not anti-innovation. It’s a call to reclaim the “why”: Teach restraint as a clinical skill Design guidelines around meaningful patient benefit Prioritize outcomes that matter to patients, not systems 🧭 Bottom line When cardiology stops asking why, it doesn’t become more efficient—it becomes less human. Technology should serve judgement, not replace it.

Did you know this? #cardiotwitter #MedTwitter Sirolimus , the molecule that changed transplant medicine and became the backbone of modern Des/DCB was discovered by an Indian scientist, Dr. Suren Sehgal. 🇮🇳 Back in the 1970s, his team isolated a compound from a soil sample collected in Easter Island (Rapa Nui). When the company shut down the project, Sehgal didn’t give up. He took the original soil sample home and kept it in his personal freezer so the molecule wouldn’t be lost forever. Sirolimus, and later its next-gen analogue Everolimus, are now widely used in today’s drug-eluting stents and drug-coated balloons, saving millions of lives worldwide. A brilliant Indian mind behind one of the most important drugs in modern cardiology :hardly talked about.

Optimal treatment of OCT defined calcific nodules. Procedural and clinical outcomes of orbital atherectomy versus intravascular lithotripsy @DoosupShin @DakroubAH @OKhaliqueMD @MaeharaAkiko @Eshlof @DrAllenJ @ZiadAliNYC ahajrnls.org/47F0ULv

1/ OCEAN trial of Rivaroxaban vs ASA 1yr post-A fib ablation CHA2DS2-VASc score: 2.2, h/o stroke 2.7% Expected PEP annual rates in DOAC and ASA arm: 2.1% vs 3.5% Sample size: beta 0.2, alpha 0.05, delta RR 0.6 (? too optimistic) Sample size: 1572 nejm.org/doi/full/10.10…

Ok you all, here is my take of the CLOSURE AF trial. On @theheartorg medscape.com/viewarticle/pe… Teaser: this may herald cardiology's biggest medical reversal. Nonindustry funded, non-biased trial. LAAC clearly inferior to best medical therapy (usually DOAC, but 10% no AC.) #AHA25

Some thoughts on PROCTOR As someone who treats both SVGs and native CTOs on a ‘case by case’ basis, this result is not as surprising as it appears to be. The cases depicted in the paper (Fig 2) show focal SVG disease. The use of 1.3 DES per graft reinforces this. These are not the SVG interventions I (we?) shy away from. Those SVGs were all excluded.

In the randomized PROCTOR trial, SVG #PCI was assoc w/ improved 1-yr clinical outcomes compared w/ native vessel PCI, primarily driven by lower rates of PCI-related MI & clinically driven target coronary territory #revasc. jacc.org/doi/10.1016/j.… #TCT2025 #JACC #cvMI #cvCABG

This study makes the Study of the Week on @Sensible__Med Statin benefit may turn on CT imaging, but this study does not support it. My take sensible-med.com/p/statin-benef…

🧵 "What really determines tissue perfusion?" – and why most explanations get it wrong. Let’s sort out MAP, CVP, CCP, autoregulation, vasopressors, and the flow that actually reaches your organs. 👇

An excellent presentation. Americans should be delighted to have @VPrasadMDMPH in this position.

CT based PCI Planning enhanced by Photon Counting CT #CCTA Impressive resolution! better than angio? Want to learn more? Come to the course - very few seats left registration.ctcourse-orsi2025.com/ctorsi25 @ziadalinyc @Bhcintervention @PCRonline @divaka_perera

Optical coherence tomography- vs angiography-guided coronary stent implantation in calcified lesions. Read the results of the ILUMIEN IV trial in #EHJ 👉 ow.ly/OFif50W7yfX @RoccoMontone @ehj_ed @ziadalinyc @GreggWStone

This is the new #PPG Pullback Pressure Gradient - a new physiology-based paradigm in coronary decision-making High PPG = focal CAD / Low PPG = diffuse CAD We hope PPG helps us become better interventional cardiologists🙏 @PCRonline @AbbottCardio @coroventis @TCTMD @CoreAalst

Each day ask if you are really “free” or if Your worth = your h-index Your value = your grant dollars Your career = your titles Sacrifice is glorified Exhaustion is normalized Obedience is excellence Leaving is considered failure & you are told you will not survive