Ops check and Garmin database updates. #Outreach in Gillette, WY, Philip, SD, and hopefully another site in ND or NE within the next 2-3 months.

How to manage this? Elderly male, adm for PNA, on Abx, underlying ILD. Trop 6k, EF normal on Echo. EDP = 9. #stringsign @agtruesdell @drAliyor @cardiojaydoc02 @IntervnCardio @TomVargheseJr @DrIHHashmi1 @sandeep_jalli @realarainmd @jl35wilsonMD @Hragy @evandrofilhobr

Heading to work—beautiful sunrise. As an outpatient heart & vascular specialist, I travel to maintain acute MI/shock skills. #weekendwarrior

Healthcare administration costs should never exceed patient care costs.

Study conclusion: Angiography guided PCI was associated with significantly higher risk for MACE, However, IVI-guided PCI had comparable risk with CABG in DM patients. But there's a methodological concern hiding in the study design that the authors didn't discuss: Immortal time bias. 1/

I have been outspoken on the massive misuse of CAC testing for a long time (excerpt from my book in 2011) and have never ordered one.

It’s always challenging seeing a patient for the last time. But encouraging to see a supportive and loving family helping a mother live graciously outside of a nursing home.

#cardiotwitter @cingolani_oscar @cardiojaydoc02 @CMichaelGibson @JayMathewsMD @AntoniousAttall @SrihariNaiduMD 60s Male see on “urgent” basis. PA did CAC—6k. Told the patient “3000 in the widowmaker.” Said Cath was needed. No clear Sx, was told to cancel Vacation w friends. Now I tell him at mos one could argue a stress test could be ordered. Had FHx as well. Now I’m accused of “not doing enough” after spending 30m explaining everything about a CAC.

"The term [provider] should not be used to describe physicians, nor should physicians use it to describe themselves, their team members, or their trainees." acpjournals.org/doi/10.7326/… @AnnalsofIM @ACPIMPhysicians

1st RDN case in South Dakota, MT, WY. Resistant HTN is a killer. Lowering SBP by 10 mmHg makes a difference! Why hasn’t this become more mainstream? Reimbursement in all likelihood. Thank you @MedtronicCRDN. Simple, easy, quick. Both myself & @jl35wilsonMD at Black Hills Heart & Vascular are making 🌊. Thank you to the team at BHSH here in Rapid City, SD.

Tyler Childress, Gavin Adcock, Tucker Westmore headlining the TG playlist tonight. What else to add? @jl35wilsonMD @txsportsdoc @Allison_Dupont @drjohnm @DrJayMohan @AntoniousAttall @AndrewJSauer

🚀 Calcium Score & CCTA: Key Highlights from the 2025 AHA Scientific Statement (DOI: 10.1161/CIR.0000000000001394) Non-obstructive CAD in Chest Pain Patients 🧊 1. CAC = Atherosclerotic Burden, Not Just a Number CAC is one of the strongest predictors of future ASCVD risk—better than biomarkers or stenosis alone. 📉 CAC = 0 → high NPV for obstructive CAD (but not zero risk: ~10% still have non-calcified plaque, especially if young or high-risk). 🔥 CAC ≥1000 = extreme risk → annual CV mortality similar to 2ndry prevention populations. 📊 CAC → intensity of preventive therapy: from lifestyle (CAC 0) → to statins (CAC ≥100) → to high-intensity LLT aspirin (CAC ≥300). 🧮 2. CAC for Risk Upgrading & Therapy Decisions CAC ≥100 or ≥75th percentile supports starting statins even in borderline/intermediate-risk patients. - hidden high-risk phenotypes (eg, DM or preDM patients with CAC ≥100). 🌈 CAC from non-gated PET/SPECT CT is increasingly used and correlates well with dedicated CAC scans. 🫀 3. CCTA: The New Backbone of Chest Pain Evaluation The 2021 Chest Pain Guidelines expanded CCTA → leading to a surge in detecting nonobstructive CAD (NOCA). CCTA is essential because: - plaque beyond the lumen (including noncalcified plaque). - vessels down to ~2 mm (even smaller with photon-counting CT). - high-risk plaque features (LAP, positive remodeling, spotty calcification). 👁️ CCTA reveals that up to 50% of symptomatic patients have NOCA. 🧨 4. High-Risk Plaque on CCTA = High Future Event Risk High-risk markers include: 📦 High total plaque volume 🟣 Low-attenuation plaque (>4%) ➕ ≥2 high-risk features (per CAD-RADS 2.0) 🔥 Pericoronary adipose tissue (PCAT) inflammation These features predict MI better than stenosis, shifting the paradigm from stenosis-centric to plaque-centric care. 📈 5. CCTA-Based Risk Staging (CAD-RADS 2.0 Plaque Volume) Stage 0 → no plaque Stage 1–2 → increasing plaque burden Stage 3 → high-risk NOCA 🎯 Treatment intensity escalates with plaque volume, not stenosis alone. 🔄 6. CAC CCTA = The Most Powerful Combination CAC quantifies calcified burden → great for long-term risk and therapy escalation. CCTA quantifies total plaque (calcified noncalcified) → great for short-term event risk. 💡 7. Why This Matters Most ACS events originate from nonobstructive lesions. 📢 The statement pushes clinicians to: Detect early plaque (especially noncalcified). Classify risk by plaque burden inflammation. Intensify therapy before stenosis develops. #PCCT #Atherosclerosis #PhotonCountingCT #CCT #yesCCT

Ten-year outcome in the NOBLE trial 🫀Today, we presented that there is no difference in all-cause mortality ten years after randomization to PCI or CABG in patients with unprotected LMCA disease. For more info contact @h_evald or me - always eager to interact!

📖#Transradial access is viable & potentially superior alternative to femoral or brachial access for #PVI, offering reduced complication rates and enhanced patient outcomes #RadialFirst In 137 patients (213 lesions): ✅ 98.5% procedural success ✅ 2.1% complication rate ✅ 96.5% same-day discharge ➡️jscai.org/article/S2772-9303… @fuadfehmi @MohamedOsmanMD #PeripheralVascularIntervention

#CTO #HDR #MAT #MHA #singleaccess #EuroCTO #EUROACTOS2025 Live CTO CASE. RCA CTO How to do #HDR . Pilot 200→HDR→sionblack→HDR→sionblack→HDR→sionblack→CB Stent DCB @realarainmd　@cto_chip_japan　@DaitaroK @calcbreaker @UmihikoKaneko @SKuramitsu0511 @tadano98 @rotamonster @OpolskiMP @jcspratt @KambisMashayek1 @LAzzaliniMD @AgostoniPF @skat_ct @mornei2011 @uziyahya46 @DrBIqbal @Bernard_TW_Wong #MedTwitter @akbarul @K_DeSilva @evandrofilhobr @MichaelMegalyMD @asaadnakhle @SCVC2023 @girishviswa1　@baijazvascular @ErwMulia @jbspadoni @GTawade84　@drAliyor @SandyCTO #cardiotwitter @PCRonline @SCAI　@ikki1127 @CtoEuro @SPyxaras　@JuradoRomanAl　@JiunnWen_Lin @MLCTOAcademy @shci_sec　@drdharmarajk @sapporohunt @ogoktekin

Where can I find a high quality white coat? Most (nearly all) are polyester, of poor quality, and uncomfortable. I don’t use them every day but still need one. #cardiotwitter

Practice-changing meta-analysis presented by ⁦@vlgmrc⁩ at #ESCCongress2025 and published in ⁦@TheLancet⁩.

Morning commute. 0500 departure. Always a privilege to watch the sunrise at FL210. Maybe catch the sunset on the way back home?