Zaid Almarzooq
@ZaidAlMarzooq
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Cardiovascular Medicine @BrighamWomens @harvardmed | Research Fellow @SmithBIDMC | Alum: @HarvardHSPH , @cornellcmr , @WeillCornell , @RCSI_Irl
Boston, MA
Joined October 2013
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Excited to share our new study in
@JAMACardio
evaluating both inpatient and outpatient PCI trends in an all-payer cohort 👥👥
Big thanks to
@rwyeh
@rkwadhera
@SmithBIDMC
for their support and mentorship.
Summary points below.
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Had a blast at this years
#SCAIFellows
! Lots of learning, thought provoking discussions, and many wonderful memories!
One key highlight was superstar cofellow
@JKhambhati
presenting a fantastic case from our
@BrighamFellows
Cath Lab!
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Check out our latest study. In a collaborative
@SmithBIDMC
@US_FDA
effort, we ask,
Can we assess the effectiveness of the Impella in AMICS using observational data?
Special thanks to amazing mentor
@rwyeh
, expert team
@SmithBIDMC
, &
@US_FDA
.
1/10
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Check out our recent
@smithbidmc
study using
#NCDR
CathPCI on outcomes of CTO PCI vs high-risk non-CTO PCI
Enjoyed working with mentors & coauthors:
@rwyeh
@ajaykirtane
@hectortamezmd
@lindavals
@EricSecemskyMD
J. Curtis & Y. Wang
#CTO
#PCI
#CHIP
1/5
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How does Elazer Edelman earn the fellows’ respect? Beat them in a game of squash!
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There has been a rapid 📈 in novel device use for PE.
In this editorial,
@BrianBergmark
& I discuss recent evidence in use of catheter-based interventions, issues with existing comparative effectiveness studies, and upcoming trials to look forward to:
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What an amazing conference last weekend at
#PCIMasters
!
Fantastic faculty, great cases, and plenty of hands-on skills sessions!
Shout out to
@kevinjamescroce
@BrianBergmark
@JDawnAbbott1
@jason_wollmuth
@Ajar_Kochar
@ekgpdx
@AbbottCardio
@bhavmannn
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Excited to share our latest
#REGARDScohort
pub in
@Heart_BMJ
on outcomes of small MI events!
#MicrosizeMI
A big thank you to
@MonikaSafford
,
@lcolantonio
, and many others.
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Congratulations to Greg Piazza and the entire
#CORONAVTE
Registry team at
@BrighamResearch
@MassGenBrigham
for the recent pub in
@JACCJournals
!
A great team effort by
@BrighamFellows
-
@nauffal_victor
,
@LeivaOrly
, and many more!
#VTE
#COVID19
#cardiotwitter
Happy to share this important work I had the privilege to contribute to!
#COVID19
#thrombosis
#vascular
@JACCJournals
@nauffal_victor
@ZaidAlMarzooq
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Another step in understanding small MI events. Our new study in EHJ QCCO delving into the risk profiles of smaller NSTEMIs
#MicrosizeMI
Great working with the
#REGARDScohort
@MonikaSafford
@lcolantonio
and many others
@ESC_Journals
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Thank you very much for the invitation. A great summit. Special thanks to the organizers and to Gregory Piazza for being a great host.
Last night we had the pleasure of listening to these guest speakers talk about risk factors and lifestyle contributors to cardiovascular disease along with much more at our 2019 Summit. Thank you all!
#NATF
@TuftsMedicalCtr
@BrighamWomens
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Thank you
@BrighamBEI
for hosting us! Enjoyed talking about innovations in virtual learning
@BrighamFellows
and our recent publication in
@JACCJournals
!
@BrighamWomens
#MedEd
#COVID19
Our 9th
#BrighamBEI
Podcast discuses Virtual Learning During the COVID-19 Pandemic with
@ZaidAlMarzooq
in his co-authored article in
@JACCJournals
!
Listen here
#MedEd
#BrighamBEI
#COVID19
@BrighamFellows
@MathewLopesMD
@Ajar_Kochar
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Congrats
@FilipeAMoura
, well deserved! And congratulations to the graduating class
@BrighamMedRes
Congratulations to 2nd year cardiology fellow Dr. Filipe Moura on being selected for the Soma Weiss Award for Excellence in Teaching from the
@BrighamMedRes
Housestaff!
@FilipeAMoura
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Thank you
@emily_gutowski
,
@WalkerReddMD
,
@bsenman3
, and the
@runthelistpod
team for hosting and letting me share what I’ve learned from mentors and colleagues
@BrighamFellows
!
Check out our newest episode, 💗Atrial Fibrillation💗 here! Handout coming soon.
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Congratulations
@IUCPQ
on this work and thank you
@TCTMD_Yael
&
@ACCinTouch
for highlighting it.
Enjoyed working on this editorial with
@AragamJayashri
TEE-associated injury is apparent in most pts undergoing structural interventions, w/ procedure length &image quality affecting the level of risk, according to new data. Notably, no pts in the study had clinically significant injury
@djc795
@ZaidAlMarzooq
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Absolutely speechless and beyond humbled! Thank you to my amazing mentors, friends, colleagues and
@ForbesUnder30
for this incredible honor!!! What a privilege to be considered a part of this inspiring group.
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What an amazing group! Congratulations to you all and welcome to
@BrighamWomens
!
#cardiotwitter
@bwhcvls
We are very excited and proud to welcome an incredibly talented group of incoming fellows to the Brigham and Women's Cardiology Fellowship!!!
#TheFutureIsBright
#BWHCVFellowship
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@BrighamFellows
@bwhcvls
@BrighamChiefs
Thank you all for the support! Humbled by the recognition. A true privilege getting to work with so many amazing people!
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Congratulations
@EllaZomer
@Febyfsavira
on their pub in
@ESC_Journals
on the cost of CHD and promise of prevention.
1⃣11% increase in working Australians with CHD in the next decade (~40k new CHD cases)
2⃣$14.8 billion of preventable cost
3⃣Early retirement is
#1
contributor
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@SanjayDivakaran
@BrighamWomens
@BrighamChiefs
Thank you Sanjay! It means the world to me to get this from our house staff! A true privilege to get to work with them!
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@rwyeh
@SmithBIDMC
@BrighamWomens
Thank you very much, Bobby and
@SmithBIDMC
, for all your support; very grateful!
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Link to paper:
Enjoyed writing the editorial:
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4⃣
These findings do not reflect the impact of more recent trials, like ORBITA and ISCHEMIA, that future studies will need to evaluate.
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3⃣
We observed a strong shift in PCIs to the outpatient setting.
This likely reflects the 📈 evidence on the safety of same-day discharges after PCI and changes in incentives💰
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@PrakritiGaba
@SmithBIDMC
@BrighamFellows
Thanks
@PrakritiGaba
! So glad you were able to attend. Looking forward to your talk tomorrow
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Our latest
#MicrosizeMI
study shows that:
1⃣ Similar risk of composite of CV events.
2⃣ Risk of recurrent MI ⬆️(driven by ⬆️
#MicrosizeMI
).
3⃣ Similar risk of all-cause mortality (~40% do not survive to 5 years).
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@JACCJournals
@BrighamWomens
Thank you for sharing our experience! This was not possible without the collective efforts of
@MathewLopesMD
@Ajar_Kochar
@BrighamFellows
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3⃣CTO PCI vs non-CTO PCI: similar long-term risk of MACE but slightly higher risk of repeat revasc
4⃣ CTO PCI vs high-risk non-CTO PCI: lower risk of MACE incl death post-discharge, all-cause readmission, and repeat revascularization.
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These findings highlight the comparative outcomes of different complex PCIs and highlight an important subgroup of non-CTO PCIs that, similar to CTO PCI, may require special consideration to ensure optimal outcomes.
@MyJSCAI
@ACCinTouch
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An earlier study evaluating PCI trends after the COURAGE trial had shown steep ⬇️ in PCI rates but have those ⬇️ continued❓
Recent studies have suggested yes, but they did not include outpatient PCIs.
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Dr. Dominick Angiolillo “How long do you continue DAPT after PCI? In those PRECISE DAPT score > 25 should be considered for shorter duration of DAPT. Data was published after publication of ACC guidelines so not incorporated in the guidelines”
@AHAMeetings
#AHA18
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Want to learn more about how to interpret these findings in light of current challenges with using observational studies and how we can move forward?
Check out the editorial by
@djc795
&
@manesh_patelMDfor
their take and some key lessons.
10/10
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@SamiaMoraMD
@BrighamFellows
@Clin_Chem_AACC
@JACCJournals
@DrPJoshi
Excited to see this in print
@SamiaMoraMD
and really enjoyed working on this with you! We at
@BrighamFellows
are lucky to have you!
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@SunnyVMD
@rwyeh
@Ajar_Kochar
@SmithBIDMC
@STS_CTsurgery
Thanks for highlighting our work
@SunnyVMD
!
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Observational studies are often used to assess efficacy/safety of medical devices.
Recent studies using administrative data brought forth concerns about the safety of the Impella. However, questions about their methodological validity were raised.
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In the IPTW & Grace period analyses (methods 1 & 2), Impella appeared to be a/w ⬆️ in 30-day mortality.
🚫 Assumption Violation - unmeasured confounding, as patients receiving Impella had ⬆️ frequency of factors a/w severe illness (e.g. intubation, RHC, vasopressor use).
6/10
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@kardiologykazi
@MerilynVarghese
@YaleMed
@SmithBIDMC
@rwyeh
@BIDMChealth
@BIDMCVFellows
@BidmcCvi
Congrats
@MerilynVarghese
and good luck at Yale!!!
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@enricoferroMD
@BIDMChealth
@harvardmed
@SmithBIDMC
@rwyeh
@EricSecemskyMD
@rkwadhera
@kardiologykazi
@DocStrom
Congrats Enrico!
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@SunnyVMD
@Nathan_YG
@AJAdams
@ankeetbhatt
@nauffal_victor
I pledge to oppose racism and hate through active allyship, continuous unlearning, learning, and listening. I nominate 5 others to do the same.
@hsbhatia
@HanaILim_MD
@AlJurdi
@AJBloodMD
@DeepakAtriMD
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We included 23,478 patients with AMICS undergoing PCI between 10/2015 and 12/2019.
🔴 4,063 received Impella
🔴 12,451 received intra-aortic balloon pump (IABP)
🔴 6,694 received medical therapy
4/10
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@djc795
Thanks
@djc795
for highlighting our work and really enjoyed reading the editorial! This work would'nt have been possible without the amazing
@SmithBIDMC
and
@US_FDA
team.
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Earlier studies on
#MicrosizeMI
showed:
1⃣ Accounts for 1/3 of all events!
2⃣ They share a lot of risk factors with larger MI events but have unique risk factors (e.g. functional status).
3⃣ 2o prevention is underutilized
1.
2.
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Overall, while some methods showed an a/w worse outcomes and others were too imprecise to draw conclusions, there were important assumption violations for each of the methods that limit our causal interpretability of these results.
Key findings to follow (see figure).
5/10
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In the instrumented difference-in-differences analysis,
🚫 the 95% CIs were too wide to make any meaningful conclusion about harm/benefit.
8/10
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@bmprii
@bwhcvls
@rwyeh
@GuoPingShi1
Thank you
@bmprii
for the invite! Greatly enjoyed presenting our work from the
@SmithBIDMC
@BrighamFellows
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In our study, we asked if we can assess the effectiveness of the Impella compared w/ alternative treatments for AMICS in an observational claims database?
To do this, we examined a family of questions, each using a different approach that relies on distinct assumptions.
3/10
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@mbelshazly
@MUSC_EP
@MUSChealth
@JRWinterfield
@docAnneSquared
@JPayne_EP
@RyanTedfordMD
@Brian_Houston12
Congratulations!!
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@RonBlankstein
Thank you for the kind words
@RonBlankstein
- I am truly fortunate to be able to work with so many amazing people!
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@AjufoEzim
@BrighamFellows
@dramitkhera
@DrPJoshi
@dhjutsw1
@thomasjwang1
@GailPetersonMD
@UTSWIMchief
Congrats Ezim!🥳🥳🥳 We are lucky to have you!
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We conclude that commonly used observational data sets cannot support a causal interpretation of the estimates produced by different analyses used for the evaluation of Impella in AMICS.
RCTs of MCS will allow valid comparisons and help resolve ongoing controversies.
9/10
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2⃣
⬇️ seen in elective PCIs following the COURAGE trial have stabilized.
New rates likely reflect a more appropriate level given the growing evidence supporting initial OMT, while acknowledging the importance of PCI as an effective treatment.
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In the instrumental variable analysis (method 3), Impella was also a/w ⬆️ in 30-day mortality (albeit w/ a wider 95%CI).
🚫 Assumption Violation -no exchangeability (i.e., patient & institutional differences in baseline characteristics across levels of the instrument).
7/10
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@MusaSharkawiMD
@MusaSharkawi
Nice to have you back on twitter
@MusaSharkawi
!
@BrighamFellows
#cardiotwitter
#ACCFIT
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@DLBHATTMD
@BrighamFellows
@BrighamWomens
@BrighamResearch
Thank you
@DLBHATTMD
for all the guidance and mentorship!
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@NoopurRajeMD
@JagSinghMD
Thank you for sharing and very glad
@JagSinghMD
is doing better. Wishing you a speedy recover 🙏
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Previous studies showed CTO PCI is a/w ⬇️ success & ⬆️ inhospital events, but how does that experience compare to high-risk non-CTO PCI (defined as unprotected left main, SVG graft intervention, rotational atherectomy)? And what about the long-term outcomes of CTO PCI?
2/5
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In this large national cohort, we found:
1️⃣CTO PCI vs non-CTO PCI: ⬇️ success & ⬆️ in-hospital events driven by periprocedural MI, bleeding within 72 hours of the procedure, and cardiogenic shock.
2⃣CTO PCI vs high-risk non-CTO PCI: no differences in short-term outcomes.
3/5
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@RonBlankstein
@MonikaSafford
@lcolantonio
@ESC_Journals
Thanks
@RonBlankstein
! Would be interesting to look at in the Young MI registry!
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@DrNjambi
@malbag1
@ghoshhajra
@MGHHeartHealth
@ddefariayeh
Congrats
@DrNjambi
! So well deserved!🥳🥳🥳🥳🥳
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@Dr_Almubarak
@JKhambhati
@BrighamFellows
@PinakShahMD
@kevinjamescroce
@FarshadForouz
@SCAI
Likewise, great times! Couldn’t have done it without your help 🙏🙏
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What's next?
- Validate these findings in a larger multicenter cohort.
- Evaluate the impact of other factors (e.g. hospital volumes, operator experience, procedure urgency, & other patient factors).
- Assess alternative approaches (ICE, microTEE).
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