This is always a great course with complex cases and excellent talks.

Final poll results - with 440 responses 44% are “sold” after Danger-Shock that Impella use should be routine in appropriate pts with AMI-CS. But 56% of cardiologists are not there yet. Is a 2nd trial possible?

Final poll results: with 677 responses, after PREVENT, 35% are ready to treat non-flow-limiting asymptomatic vulnerable plaques with preventive PCI to improve prognosis. 65% are not yet believers. 4 other trials are ongoing and more are being designed.

Final poll results: with 277 responses, after ULTIMATE -DAPT, 67% are ready for shorter DAPT regimens after PCI in ACS, with most of those ready for 1 month only. 33% still say 1-year DAPT! Not sure why. No one bleeds until they bleed.

General cardiologists and interventional cardiologists only: Following Danger-Shock, would you enroll in a second trial of STEMI with cardiogenic shock in patients without anoxic encephalopathy, randomizing to Impella versus control (pressors +|- balloon pump +|- ECMO)?

Latest poll: With 800 responses from cardiologists, it appears ~2/3 would be willing to randomize into a trial like RECOVER-IV testing an Impella strategy vs control in STEMI with cardiogenic shock.

Please join us for the annual Mount Sinai Complex Coronary Cases Symposium on June 14 at the NY Marriott Marquis! Excellent mix of complex cases by the world's best operators and relevant lectures.

When I was an intern, I had an attending who wore a button on his white coat that said “I used to be disgusted, now I’m just amused.” I did not understand it then, but I do now. What life/medicine situation have you experienced that you would apply this to?

Novel publ in JAHA from our group at Mt Sinai. 3687 pts with MVD and SS >22. Documents for the first time (to my knowledge) worse outcomes (including death) after PCI in pts eligible and recommended for CABG who refused, even after adjustment for SS and other covariates.

1/2 Following the DANGER SHOCK trial demonstrating reduced mortality with Impella in cardiogenic shock, the independent DSMB of the RECOVER IV trial has strongly recommended the trial be discontinued because of lack of equipoise. Therefore, we are ceasing enrollment in the trial.

2/2 We are actively exploring other randomized investigations of Impella in AMI-cardiogenic shock. Possibilities include examining best practices to reduce complications, selected multivessel intervention, early escalation to Impella 5.5, Impella in chronic HF-shock, and more.

Our JACC publ from ILUMIEN IV. In 1973 pts with complex lesions OCT-guided stenting reduced serious MACE (cardiac death, TV-MI, or stent thrombosis) by 37% compared with angiography-guided stenting. Results consistent across all lesion types. Download from authors.elsevier.com/a/1jQ%7Eg2d9GH…

Excellent article “The polarised discourse around face masks is hindering constructive debate." bmj.com/content/386/bm… Applies to PCI v. CABG, OMT vs. revasc, & many other topics. We have lost our capacity to stay open-minded, esp in politics, and this has spread to academics.

Our EHJ publ from ILUMIEN IV: Independent OCT predictors of safety and effectiveness outcomes in 2128 pts were min stent area (esp when <4mm2 [equiv to IVUS 5-5.5 mm2]), flow area and expansion, prox edge dissection (not distal diss like in prior studies), and stent length.

Our publ in Lancet: IPD pooled analysis of all 6 RCTs in which 23,256 pts were treated with 1-yr DAPT vs. 2wks-3mos DAPT (median 78d) followed by ticagrelor monoRx. MACE favored short DAPT, and major bleeding and mortality were reduced. Similar results in CCS & ACS, even post-MI.

Our JACC editorial on the RESHAPE-HF2 trial: M-TEER in FMR-Erasing all doubt. RHF2 pts had lower EROA and ↑ LVEDV c/w COAPT (i.e. mostly mod FMR), w/substantially lower rates of mortality and HFH at 2 years. Nonetheless, HFH was markedly reduced and QOL was improved w/MitraClip.

I don't usually tweet non-cardiology, but this video of a T cell killing a cancer cell is amazing. instagram.com/reel/C--tN-nS5…

Congratulations Bjorn! One of the brightest and best young investigators I’ve ever worked with.