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Hi, everyone.

This is John Mandrola from the heart.org medscape Cardiology, and this is this week in cardiology

for May 8th, 2026.

This week, some listener feedback from the danger shock investigators themselves, complete

versus staged revascularization, polygenic risk scores, and quality improvement fails in an RCT.

Last week, I received feedback from the Danger Shock investigators, and before I tell you

the story, may I say what an honor it is that such prominent and accomplished academics

engaged with the This Week in Cardiology podcast. Thank you. About a month ago, I discussed

the CHIPBCIS 3 trial of impella support versus no impella in high-risk PCI. CHIP BCIS, published in a New England

journal in March, randomized 300 patients with severe left and trigger dysfunction, extensive

coronary artery disease,

to Impella versus no Impella, and the trial reported 37% of pairwise comparisons favored

the flow pump versus 43% favored standard care. That win ratio was 0.85.

So basically that was no difference in major adverse cardiac outcomes. However, death was 54% higher in the impella arm hazard ratio 1.54.

So a 54% increase in death in those conference intervals were tantalizingly close to significant 0.99 to 2.41.

There was also an absolute increase in cardiovascular deaths by 12%.

That's a number needed to kill of only eight patients in the impella arm.

Now, at the time, I emphasized the specific and larger messages of Chip B-CIS.

And, of course, specifically is don't use Impella for high-risk PCI, like those patients in Chip B-CIS.

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