@SyedYNaqvi1 We just finished our RCT with pre-procedural 3D-CT versus angio guided PCI to determine the optimal C-arm angle for ostial RCA lesions (n=30). Primary end-point coverage of the ostium by IVUS. Results will be out soon!
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Koen_Ameloot
19 posts
Koen_Ameloot
@kameloot3
Dad x3, interventional & ICU cardiologist, Marathon x4
Zonhoven, België Katılım Nisan 2019
189 Takip Edilen130 Takipçiler
What is the best view to land a stent in order to cover the ostium of the RCA? See case example below.
#MedTwitter #CardioTwitter #PCI
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@bmorecardiology @AnnGageMD @MKIttlesonMD @tonkhueMdPhd @SusanJosephMD @GRamaniMD @PatrickBering @gcfmd @WesElyMD @toddrice_ICU @DrJohnMcP In AMI-CS we showed that ⬆️MAP to 80mmHg with vasopressors ⬇️AMI size jacc.org/doi/abs/10.101…. ↔️in non-AMI-CS, we go for maximal unloading and evaluate end-organ perfusion
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#clinicalquestion
What is your goal MAP in cardiogenic shock (and why.. ie: any lit to support)?
@AnnGageMD @MKIttlesonMD @tonkhueMdPhd @SusanJosephMD @GRamaniMD @PatrickBering @gcfmd @WesElyMD @toddrice_ICU @DrJohnMcP
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@FH_Verbrugge @EHJACVCEiC Great work! Provocative question: should coronary anatomy be a variable in the decision to use vasodilators? Being a big fan of nitroprusside, I am a little more hesitant in patients with severe 3VD or unknown anatomy since DBP ⬇️ could ⬇️ coronary perfusion and ⬇️ CO…
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What is your take on #vasodilators in acute #HeartFailure? The upcoming November issue of #EHJACVC will bring you a PRO/CON "Vasodilator therapy in acute heart failure revisited"
As our PRO paper was published in advanced access, a sneak preview Tweetorial below...
@EHJACVCEiC
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@JohannesGrand @thiele_holger @escardio @AGIKinterv @AnneFreund3 @krychtiukmd @PabloJ I think it may be due to the combination of (1) inadequate ventilation in the cathlab with hypo/hyperoxemia & hypo/hypercapnia (2) MAP fluctuations during the cath procedure and (3) missed diagnoses such as PE or ICB in these patients without ST elevation
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@thiele_holger @escardio @AGIKinterv @AnneFreund3 Dear Holger,
Do you think potential harm is due to unnecessary stents and rushed procedures or from delay of ICU treatment?
Of course it may be a chance finding.
@krychtiukmd @PabloJ
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More importantly. At 6 months even harm for immediate angiography after OHCA. Looking forward to guideline update @escardio @AGIKinterv @AnneFreund3
Anne Freund@AnneFreund3
TOMAHAWK - 6 months follow-up data presented by Steffen Desch today at #DGKJahrestagung 🔥🔥🔥 > no superiority of immediate angiography in #OHCA without ST-elevation! 🚑 @thiele_holger @AGIKinterv @YoungDgk
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@nolanjimradial @evandrofilhobr We are currently randomizing patients in the RADVES trial between Terumo and Silverway after the standard J-tip wire had failed to cross (NCT05231889). Results expected end Q2…
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@evandrofilhobr I am not sure
I know the BJ is highly regarded by users
I think it may have a polymer jacket and is a variant of the standard Terumo wire?
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Small but interesting study that accurately reflects our experience with silverway wire that has almost eliminated need for BAT or CAT in our radial practice
auctoresonline.org/uploads/articl…
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@JohannesGrand Impressive trial! Both Neuroprotect and COMACARE were pilot trials with (poor) surrogate end-points. Looking ffwd to the results!
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The BOX-trial have finished inclusion.
- 800 comatose patients, resuscitated from OHCA at two centers in DK.
- interventions: comparing blood pressure- and oxygenation-targets during ICU-stay
- follow-up pending...
Hopefully improving care of future patients.
Johannes Grand@JohannesGrand
Blood Pressure and OXygenation Targets After Out-of-Hospital cardiac arrest #OHCA (The BOX-trial) has almost finished inclusion. Thread below with a description of the study
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@ElevenSportsBEn @Jupiler Wat vinden jullie bij @ElevenSportsBEn van een commentator die vindt dat Onuachu ‘op zijn poten moet blijven staan’? Beetje niveau aub…
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Wie is jullie '@Jupiler Man of the Match'? 🏅
👉 Stem hier: j.mp/3lGt0gZ!
#GNTGNK #Jupiler #ManoftheMatch #JupilerMOTM
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Koen_Ameloot retweetledi
Is a higher MAP in #CardShock pts a road to success? RCTs still needed #EHJACVC" target="_blank" rel="nofollow noopener">academic.oup.com/ehjacc/article… #cardiotwitter #medtwitter @drmilicaa @krychtiukmd @rafavidalperez @pascal_vranckx @mrubini @ACVCPresident @umityasarsinan1
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@Babar_Basir @AlejandroLemor @agtruesdell @behnam_tehrani @SarahGorgis @adityadoc1 @bkolskk @perc_surgeon @NavinKapur4 @BillONeillMD Based on our randomized data on resuscitated AMI patients published in JACC, targeting ⬆️ MAP with ⬆️ vasopressors ⬇️ AMI size with no ⬆️ in arrhythmia’s (PMID: 32792079) . Therefore, I believe vasopressor use in this observational study is a marker of sicker patients..
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There is really no good data that inotropes/vasopressers help in shock. It may be that we are hurting pts by demanding more from the heart when it suffers a large MI & is failing. Building upon Finke et al work, vasopressors associated with harm in #NCSI independent of CPO.
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Koen_Ameloot retweetledi
@CANCARESociety journal club this Thursday with @LiorBibasMD presenting with invited first author Dr. Koen Ameloot. See you all there!
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@LiorBibasMD @JACCJournals Thnx! Agree that cMRI would have been a better estimate of AMI size! However, cMRI Would probably not be feasible at day 5-10 in many shock patients (35% of our cohort would already be death by that time)
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@JACCJournals Congratulations to the authors for a well done study. The primary outcome is troponin rise which IMO is far from a hard clinical outcome. I personally don’t “trend” troponin in post MI patients.
Hoping this leads to a large RCT which will better guide bedside care.
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Koen_Ameloot retweetledi
Targeting a mean arterial pressure between 80/85 and 100 mmHg in post-arrest #cvMI patients in shock is associated with smaller myocardial injury. Learn more in #JACC: bit.ly/2XWurff
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@pedschwartzmann @FH_Verbrugge @JACCJournals In our forest plot, results were mainly driven by differences obtained in STEMI patients with TIMI 0 flow in the LAD.. seems like patients with the largest AMI might benefit most..
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@kameloot3 @FH_Verbrugge @JACCJournals Nice comment. Nevertheless, in my view, those STEMI are very heterogeneous and similarly to HFpEF patients, some might benefit from a higher MAP threshold as you mentioned. Although I don’t know if it applies to the majority of patients.
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Great paper by my friend @kameloot3 @JACCJournals! Should we pursue a higher MAP to reduce infarct size in cardiogenic shock after #AMI?
Mosaad Alhussein@Mosaad
Interesting paper in. In patients with cardiogenic shock after #AMI and cardiac arrest, targeting a higher MAP (80-100) lead to a smaller size infarcts. More work is needed but this could be a practice changing! onlinejacc.org/content/76/7/8…
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@pedschwartzmann @FH_Verbrugge @JACCJournals There are obviously no data at all to support a 65mmHg target.. I think there are some similarities between stroke (penumbra/core) and STEMI and that you should consider giving NE even in patients with MAP 65 and normal lactate/diuresis/brain to salvage the cardiac penumbra..
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@FH_Verbrugge @kameloot3 @JACCJournals Fantastic paper, indeed. However this is a clinical uncertainty. Do you strongly believe that the MAP should be changed based on this relatively small trial? In my view, I still feel uncomfortable with norepinephrine at higher doses to achieve a static goal...
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@drozant1 @FH_Verbrugge @JACCJournals Unfortunately, at least in our series rates of RRT are very low.. analysis will be underpowered for this.. however, data on creatinin and diuresis will be interesting!
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@kameloot3 @FH_Verbrugge @JACCJournals So glad to hear, will be curiously waiting
- need for RRT
- RRT's effect on MAP/VP dose (especially if intermittent HD)
- final GFR/ESRD will be very valuable, too, just a suggestion
Once again, congrats for the great work👏👏👏
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@kameloot3 @Mosaad However, previous data suggest that higher or even sooner initiation of vasoactice drugs confers worst outcomes. Allow me to extent my congratulation to you and the the research team. I look forward to see future publications
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Interesting paper in. In patients with cardiogenic shock after #AMI and cardiac arrest, targeting a higher MAP (80-100) lead to a smaller size infarcts. More work is needed but this could be a practice changing!
onlinejacc.org/content/76/7/8…
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@DrLbatt @Mosaad Unfortunately, it is impossible to say how our 37% reduction in AUC cTnT Would correspond with reduction of infarct size on cMRI.. however, don’t forget that each 5% reduction of infarct size is theoretically associated with a 20% reduction of death and HF hospitalizations..
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@Mosaad It doesn’t look like a big difference in troponins. Would you say it would lead to better clinical outcomes? Interestingly there was no harm associated higher pressors? Finally there is previous experiences of higher vs lower map in other type of shock and no benefit was seen
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@drozant1 @FH_Verbrugge @JACCJournals We are currently working on a pooled analysis of both trials on GFR and diuresis! Will Hopefully be published Q4 2020..
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@FH_Verbrugge @kameloot3 @JACCJournals Excellent paper indeed fully acknowledging strengths and weaknesses, I'd love to see a nephrologic view of this data, does a higher MAP reduce the need for RRT?
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