David Erlinge @derlinge

SWITCH-SWEDEHEART is a comparison between policies, not between drugs. The policy-recommended agent was dispensed to 75.8% of patients in the ticagrelor-policy group and 60.6% of those in the prasugrel-policy group. Why did patients in the prasugrel-policy group experience less bleeding? Among the 40% of patients who did not receive prasugrel, 10% received ticagrelor and 30% received clopidogrel (so, a de-escalation). But there was also a whole range of treatment switches and dose adjustments among patients who did follow the assigned policy during the trial. In my opinion, the comparison between the two drugs is very interesting (in some respects, it helps demystify some concerns about ticagrelor’s efficacy), but because of issues arising from secular trends in a stepped-wedge, cluster randomized trial and the imperfect concordance between the assigned policy and the treatment actually received, this is anything but a pure head-to-head comparison. #ESCCongress nejm.org/doi/full/10.10…

They wanted a 50% NI margin. Ignore the fact that this is wide. They observed DEB 5.3% vs. DES 4.4%. So upper bound of margin = 2.2% increase. Their risk diff=0.91, 95% CI (-0.55, 2.38). 2.38 is >2.2 - the trial missed non-inferiority. This was a NEGATIVE trial.

John Mandrola, MD @drjohnm

7 months ago

@kaulcsmc @ihtanboga @DFCapodanno @djc795 @venkmurthy @CMichaelGibson @sbrugaletta @GreggWStone Why wouldn’t it be a superiority test? Nothing less costly or less invasive about DCB? Any “advantage” is theoretical. Stuff like this is why it’s so bad that docs like @VPrasadMDMPH can’t work at FDA. Regulatory failure that pts were experimented on in a badly designed trial

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Guidelines recommend dual antiplatelet therapy after CABG for acute coronary syndrome, but whether it reduces adverse events as compared with aspirin alone is unclear. Research findings from the TACSI trial are summarized in a new Quick Take video. nej.md/499wznZ

Our PRECISE-DAPT Cancer score now validated in a Swedish Cohort (SWEDE-Heart registry) suggesting that the majority of patients with cancer would benefit with short DAPT following ACS / PCI although a few would still benefit from prolonged therapy. We now can better better personalise care in this vulnerable population Thank you to our swedish collaborators for leading on this @SachariasVK @moman_am @DavidErlinge @MoDafaalla

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Mamas A. Mamas @mmamas1973

2 years ago

1. Bleeding risk prediction after acute myocardial infarction-integrating cancer data: the updated PRECISE-DAPT cancer score academic.oup.com/eurheartj/arti… our work led by @MoDafaalla

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Our editorial on Early heparin has been published. A cheap efficient way to open coronary arteries in STEMI patients. academic.oup.com/eurheartj/adva…

We have a new Lp(a) paper, led by @derlinge from PROSPECT 2 using IVUS/NIRS. It shows high Lp(a) associates most with vulnerable plaque characteristics, whereas LDL-C with plaque burden. Lp(a) was measured by our @UCSDCardiology assay, the only Lp(a) assay I am aware of that is truly isoform-independent (uses monoclonal antibody LPA-KIV9). This study creates a rationale to perform an imaging study with Lp(a) lowering drugs and assess effect of features of high-risk plaques. doi.org/10.1016/j.jacc…

In PROSPECT II, elevated TC, LDL-C, and non-HDL-C were strongly associated with pancoronary #atherosclerosis & lipid deposition, whereas elevated Lp(a) was strongly associated with the presence of focal vulnerable plaques jacc.org/doi/10.1016/j.… #JACC #ASCVD #cvAMI @GreggWStone