Sripal Bangalore

Percutaneous multivalvular endocarditis debulking with whole body embolic protection. Step by step in 2 different scenarios @ATYounesMD @EmbolineInc @angiodynamics @aelsab @zlotnick_david @krosenfieldMD @ChetRihal @sanjum @kvoudris jacc.org/doi/10.1016/j.jacca…

I am a member of the Norwegian Nobel Committee. There are five of us. Five people, appointed by a parliament most of the planet could not find on a map, who decide, once a year, which human being the world has agreed to call good. I know. I know. I think about it on the tram. We meet in a building on Henrik Ibsens gate, a street named after a man who wrote almost exclusively about people discovering they are frauds, which nobody on the committee finds funny except me. There is a room with a long table and the portraits of the dead laureates looking down, Mandela, the Dalai Lama, a great many earnest men in spectacles, and one portrait we do not discuss, which is Kissinger, 1973, awarded while the bombs were still falling, after which two of our predecessors resigned and the satirist Tom Lehrer said political satire was now obsolete. We keep him on the wall. A reminder. Every family has the uncle. It is October in Oslo, which means the sun gives up around four in the afternoon like a civil servant, and it rains the particular Norwegian rain that isn’t quite falling, just hanging there, judging you. I arrive with wet shoes. I always arrive with wet shoes. There is coffee, because this is Norway and there is always coffee, we drink more of it per person than almost anyone alive, and someone’s wife has sent kanelboller, the cinnamon buns, and we sit, five Norwegians, damp, caffeinated, sugared, and we decide the moral standing of the entire species. Let me tell you how it actually works, because the world imagines a cathedral and it is, I promise you, a book club with a mandate. 287 nominations this year. 208 people, 79 organizations. Anyone can nominate, that’s the secret nobody understands: a professor, a parliamentarian, a former laureate, so the “nominee” list is meaningless, it’s a suggestion box, and every autumn some congressman nominates his own golden retriever and the press writes “SHORTLISTED.” Nobody is shortlisted. There is no short list the public ever sees. There is us, and the coffee, and the rain, and the portraits, and a Norwegian stubbornness that is older than the prize itself. We read reports. The institute’s advisers write them, thick dull documents, and we argue. Our chairman told the BBC once that in the final meeting “there is a high temperature.” High temperature, for a Norwegian, means someone slightly raised an eyebrow and then apologized for it. We don’t do high temperature. We do a long silence, and then Kristin says “well,” and everyone knows exactly what “well” meant, and it’s settled. That’s our shouting. “Well.” You’d have to be raised here to hear the violence in it. Now. This year. I will not say the name, because we never say the name, but you know the name. A certain head of state wanted this prize the way a child wants a thing in a shop window, which is to say loudly, and in public, and with the full belief that wanting it was itself the argument. He said he deserved it. He said he’d ended eight wars, a number that grew most times he said it, like a fish. He had other heads of state phone us. Israel’s prime minister posted it on the internet, “Give him the Nobel.” The leaders of Cambodia and Pakistan announced they’d nominated him, as though announcing it were part of it, as though we tally mentions. A man flew around the globe collecting endorsements for a Norwegian committee the way you’d collect signatures for a petition to the council about a noisy dog. And here, uff da, is the detail I treasure, the one that makes me smile into my coffee. The nomination deadline is the 31st of January. He took office on the 20th. So for all the phone calls, all the posts, all the gilded lobbying, the only nominations that could possibly count for this year’s prize were filed in the first eleven days of his term, before he had, by his own arithmetic, ended a single one of the eight wars. He campaigned all year for a prize whose window had shut while he was still hanging up his coat. We didn’t have to reject him. The calendar did. We just watched. Norwegians are very good at watching. We have long winters. People think we sit there weighing his deeds. We don’t. That’s the thing I can’t make the world understand. We’re not grading his homework. We don’t owe anyone the prize for a ceasefire, however real, however loud the announcement. “He made peace” is not a sentence that ends in a medal, the way he believes it does, the way he believes every good thing ends in his name on it. The will of a dead Swede says the prize goes to whoever did the most for fraternity between nations. A dead Swede, I should add, who made his entire fortune inventing dynamite and selling arms, and spent his last years horrified at his own obituary, which called him a merchant of death, and so bought his way to immortality as a man of peace. The whole prize is one guilty arms dealer’s attempt to launder his name. We are, all of us, administering a dead man’s public relations. I find this clarifying. It keeps me humble. It should keep everyone humble, and it keeps, by my count, no one humble at all. So who did we give it to? An eighty-five-year-old woman. A judge. Born in Durban, under apartheid, granddaughter of a Tamil man who came to South Africa as indentured labor, a bus driver’s daughter from the poor Indian quarter, who became the first non-white woman to run a law practice in her province, who defended Mandela’s people when defending them was dangerous, who sat on the Rwanda tribunal and the court at the Hague, and who, at eighty-five, is right now a judge weighing whether a genocide is a genocide. When we told the world, our chairman said the rule of law “underpins the system we have set up to ensure peace,” and that “peace requires justice.” She wasn’t even in Oslo. She was in Nuremberg. In courtroom 600. The actual room where they tried the Nazis. You cannot stage that. God staged that, and God, it turns out, is a better satirist than any of us. She did not phone us. She did not post. No prime minister demanded it for her on the internet. She had, as far as our deliberations are concerned, the one qualification the loud man could never manufacture, which is that she wanted the work and not the medal. The medal finds those people. It flees the ones who chase it. This is not a rule we wrote. It’s just the only pattern the hundred-odd years of our mistakes has ever shown. The reaction from across the ocean was immediate. His spokesman posted that we “place politics over peace.” Ja. Perhaps. We’re five damp pensioners in a rainy city; of course it’s political, it was always political, it was political when we gave it to a sitting American president nine months into his first term for the promise of things he had not yet done, and we have been quietly embarrassed about that one for fifteen years, so believe me, we had a particular reason this year to prefer a woman with fifty years of verdicts behind her over a man with eight wars in front of him and a deadline already behind him. Here is what he will never understand, the thing I’d tell him on the tram if he ever took one. We are the one prize he cannot buy, cannot post his way to, cannot have a friendly dictator phone in for him. Not because we’re incorruptible, nei, we’re as vain and wrong and human as the portraits on our wall. But because the entire point of the thing, the only power a small cold country’s book club has ever held, is that it goes to the person not performing the wanting. The moment you demand it, you’ve proven you don’t understand what it’s for, and proving that is itself the disqualification. He ran the most expensive campaign in the history of the prize and the campaign was the reason. He was never losing to Navi Pillay. He was losing to the concept. It’s dark now. Four o’clock dark. The buns are gone. Kristin said “well” an hour ago and we all went home. I’m on the tram with my wet shoes, and somewhere across the water a very powerful man is explaining to a camera that the prize is rigged, that we’re corrupt, that he’ll win it next year, and he genuinely might, we’re only five idiots and we’ve been wrong before, Kissinger is still on the wall. But not this year. This year an old woman in Nuremberg, in the room where the law once stared down the exact kind of man who thinks wanting a thing loudly enough should make it his, got a phone call she didn’t ask for. That’s the job. We don’t reward the man who ends the war and announces it. We reward the woman who spent fifty years deciding what a war was. He’ll never see the difference. That’s rather the whole point of him. Takk for i dag. I have to change trams.

Reviewer 2 strikes again. Never give up. Ever. "No today means yes is coming tomorrow" #cmgsays

This is the best critical care cardiology symposium in the world!

please stay clear of AI to write letters to medical journals, write papers, essays, etc. would much rather have flawed humans with incompletely/maybe not well expressed ideas, thinking/challenging/debating what we know, than algorithmic fakery. we will make ourselves stupid

Pick any medical specialty other than your own. Who’s the most famous physician in it? You probably can’t name one. Almost none of us will be known outside our field, and even those who achieve real professional fame are mostly forgotten within a few decades. Fame is a poor reason to devote your life to medicine. The work itself matters more: caring for patients, discovering new knowledge, and teaching the next generation.

More IVUS vs. Angio data—with a twist! A lot of work went into this meta-analysis. I’ll confess: the statistics are beyond my pay grade. 😅 But the question is fascinating and provocative: Does IVUS-guided PCI perform differently in Asian vs. non-Asian populations? I know @GreggWStone and @SripalBangalore are working on an updated Lancet meta-analysis. I wonder if they’re accounting for geography? 🤔 (And I secretly hope @ihtanboga and @djc795 can help me/us parse the statistical methods here. 😅) Provocative follow-up question: In a “mixed” lab like ours, does IVUS benefit Asian patients more than non-Asian patients? (My assumption is no, the benefit is equal because IVUS makes me a better operator! 😀)

This is my 10 point conversations, I tend to have with any patient who might have had a predetermined mindset based on social media, CHATGPT or influencers. 1. Based on your age/gender and risk, you are already a candidate for statins, if you choose CAC, there is a 40-50% chance that you may have #PowerOfZero and likely risk below threshold of why suggested statins, allowing you flexible decisions. jacc.org/doi/10.1016/j.jacc.… 2. There is no other good tests that will give you the same information about derisking to guide you optimal information to derisk ahajournals.org/doi/full/10.… 3. If decide to make decisions based on CAC vs current risk scores, likely will result in better adherence as seen in the yet to be published CorCal, CAUGHT CAD RCT’s as well accumulation of retrospective literature sciencedirect.com/science/ar… jamanetwork.com/journals/jam… 4. Likely better LDL and risk factors control (EISNER and Caught CAD) jacc.org/doi/10.1016/j.jacc.… jamanetwork.com/journals/jam… 5. In a shorter term, CAC guided decisions will likely reduce the risk of plaque progression based on CAUGHT CAD jamanetwork.com/journals/jam… 6. Thankfully if we can keep the price $150 or less or impact your disutility of taking pills it is even cost effective from a societal perspective jacc.org/doi/10.1016/j.jcmg.… 7. In a clinical trial those randomized to decision based on CAC vs not CAC, we haven’t seen increased risk of extra stress tests, caths or stenting/bypass (EISNER) jacc.org/doi/10.1016/j.jacc.… 8. While to date there is no data showing CAC guided decision will reduce the risk of CVD clinical events in a short term period, the studies have shown a) there is no increased risk (harm) of MACE (CorCal), b) prior non randomized studies have suggested no better outcomes with statin use, suggesting no harm if you decide to have flexible goals jacc.org/doi/10.1016/j.jcmg.… 9. CAC is not one time test, if zero and don't go on treatment repeat in 3-7 yrs based on baseline risk estimate to guide if need to change the decision course jacc.org/doi/10.1016/j.jcmg.… 10. Now based on studies, CAC beyond guiding you whether you need statin or not, can help as a dosing strategy (higher risk, higher intensity) now acknowledged also by cholesterol management guidelines pmc.ncbi.nlm.nih.gov/article… Once we have provided all the information, let patient make the decisions (see our approach below below) bmj.com/content/373/bmj.n776… @rblument1 @MichaelJBlaha @DrMichaelShapir @DrMarthaGulati @AlexRazavi @Sadeer_AlKindi @miguelcainzos23 @HMHCardioFellow @CiccaroneCenter @ASPCardio @JamalRanaMD

A (Coronary) Tree Grows In Houston! F/u from a case I shared earlier this year. 31 F with diffuse CAD + ⬇️ EF. Suboptimal candidate for CABG per🫀team due to poor targets + ⬆️ HbA1c. We treated the LAD with CBA followed by DES + DCB (1 ea.) 8 m f/u angio shown below! 😍

Cricket fans might have some difficulty in recognizing this former Sri Lankan cricket captain who called on me in Colombo. Yes, this is the new, svelte, post-bariatric surgery @ArjunaRanatunga! Asked how it felt after years of being famously roly-poly even at his cricketing peak, he told me he now plays charity matches and cheerfully bats for three hours, whereas pre-surgery he could barely get through three overs!

This article should be mandatory reading for every medical student, PhD candidate, researcher—and honestly, for anyone who mistakes expertise for certainty. “The importance of stupidity in scientific research” sounds provocative, almost offensive. But Martin Schwartz is not glorifying incompetence. He is describing the real operating system of discovery. Science is not built on knowing. Science is built on tolerating not knowing. That distinction matters. Most of education rewards correctness. School teaches us to answer. Exams reward speed, certainty, and precision. You feel intelligent when you get things right. Research is the opposite. Real research begins exactly where competence ends—at the frontier where nobody knows the answer, including the people you thought must know. That moment is psychologically brutal. You ask the expert. The expert shrugs. You assume you’re missing something. Then you realize: no—this is the work. You are not failing. You are standing at the actual boundary of knowledge. That feeling—“I must be stupid”—is often not a sign of inadequacy. It is often the first sign that you are finally asking an important question. Medicine struggles with this. We train doctors to avoid uncertainty, to fear being wrong, to perform confidence. But the best clinicians and the best scientists know how to sit inside ambiguity without collapsing into fake certainty. This is why AI in medicine also deserves caution. Systems trained only to reproduce established answers may become extraordinarily good at passing exams while being terrible at discovering what matters next. Guideline intelligence is not the same as scientific intelligence. Discovery requires productive stupidity: the willingness to stay with the uncomfortable, to look ignorant, to ask naïve questions, to be wrong repeatedly without protecting your ego. Most people want the authority of expertise. Very few want the humiliation required to earn it. But progress lives there. Not in certainty. Not in performance. Not in sounding smart. In the quiet discipline of saying: “I don’t know… yet.” And continuing anyway.

Same-day discharge (SDD) after #CTO #PCI is feasible and safe in a selected (although quite large) proportion of patients. Do you want to know what factors we keep in consideration when choosing the SDD pathway? Read the 📝 below written by rising ⭐️ @Sant_J_Kumar.