@TCT_ME_ we had an interesting debate re CHIP-BCIS..entertainment aside I had to stop & review some of the evidence because I was the first mAFP user in KSA over a decade ago. Judicious use has always been my belief. As
@NavinKapur4 elegantly noted the trials is more about strategy rather than mAFP use & here's why:
1. Patient selection: Median SYNTAX score: 38 (IQR 30–48), & BCIS-JS = 12 (3VD)..guidelines for PCI in high SS IIIB
2. Same day transfer to referral site w limited continuity of care (it's not the device, it's comprehensive care plan)
3. rSS>8 after PCI did not meet the threshold for clinically significant complete revasc. (aggressive revs vs selective)
4. 17 of 21 centers were new users (with 13 sites having no experience the year prior to enrollment)..reminiscent of the early carotid stenting trials
5. Restrictive escalation algorithm with an unexplained high procedural mortality rate (the mAFP treated arm Baseline CI was 2.07 & fell to 1.65 L/min/m² meeting criteria for CS w no escalation?)
@NEJM
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nejm.org/doi/10.1056/NEJMc26…