The IC Chat

Host Dr. Ashish Pershad introduces IC Chat’s mission to help clinicians interpret evidence-based medicine and translate trial data into everyday patient care. In this episode he appraises the CHIP-BCIS-3 randomized trial (ACC 2026 / NEJM) comparing prophylactic microaxial flow pump (Impella) versus standard care in very high‑risk elective PCI patients. The trial enrolled patients with low LVEF and high SYNTAX/BCIS scores and used a hierarchical win‑ratio primary endpoint. Results showed no overall benefit for Impella and a concerning signal of increased cardiovascular mortality at two years in the device group, despite similar completeness of revascularization and low bleeding/vascular complication rates. Dr. Pershad discusses implications: avoid routine prophylactic Impella in elective high‑risk PCI, consider staged revascularization, and call for reappraisal of device use and approval processes to prioritize patient safety.

In this episode of ICChat, Dr. Ashish Pershad MD MS  reviews and critiques the CHAMPION‑AF trial comparing Watchman Flex left atrial appendage occlusion to DOACs for atrial fibrillation. He explains the trial design, endpoints, and statistical choices, and contrasts the published results with real‑world implications. The episode highlights concerns about non‑inferiority margins, excluded procedural bleeding, lower than expected event rates, and the importance of shared decision making when considering LAAO versus lifelong anticoagulation.

Critical appraisal of the 6-year Evolut low risk trial data and a one on one with Steve Yakubov one of the senior authors on the paper for his take on TAVR adoption in low-risk patients

Appraisal of the SHORTCUT and VICTORY trials comparing IVL to CB and OPN balloons plus a bonus interview with Ajay Kirtane MD deconstructing the trials

A critical appraisal of the CREST 2 clinical trial 4-year outcomes comparing carotid revascularization with current medical therapy in asymptomatic patients with high grade carotid artery stenosis. 

A critical appraisal of ENCIRCLE and a follow up interview with Encircle Co-PI David Daniels MD make for an interesting episode. 

A Critical appraisal of dedicated TAVR valve trials for AI and a general overview of the status of AI treatment in 2025. 

A deep dive into bicuspid aortic valve stenosis and the choice of BEV vs SEV- A propensity matched observational study critically appraised.

A deep dive into 2 network metanalysis looking at IVI in contemporary PCI. 

A critical appraisal of PLATO (Ticagrelor versus Clopidogrel) and the recent controversies 

A decades long practice of routinely tapping effusions upfront in patients with heart failure is challenged with this simple and elegantly conducted clinical trial from Denmark. The TAP IT clinical trial is critically appraised in this month's edition of IC CHAT

Critical appraisal of the FAME 3 Clinical Trial 5-year data presented at ACC 2025

A critical appraisal of the Protected TAVI trial, comparing Cerebral Embolic Protection with standard of care for routine TAVR cases. Bibliography: 1. Kharbanda RK, Kennedy J, Jamal Z et al; BHF PROTECT-TAVI Investigators. Routine Cerebral Embolic Protection during Transcatheter Aortic-Valve Implantation. N Engl J Med. 2025 Mar 30. 2. Angrist JD, Gao C, Hull P, Yeh RW. Instrumental Variables in Randomized Trials. NEJM Evid. 2025 Apr;4(4). 3. Butala NM, Kapadia SR, Secemsky EA et al. Impact of Cerebral Embolic Protection Devices on Disabling Stroke After TAVR: Updated Results From the STS/ACC TVT Registry. Circ Cardiovasc Interv. 2024 Sep;17(9).

A critical appraisal of a RCT comparing transcatheter tricuspid valve replacement to medical treatment in patients with symptomatic severe tricuspid regurgitation. 

A critical appraisal of the DANGER SHOCK Trial comparing the micro-axial flow pump Impella CP with standard of care in patients with acute myocardial infarction complicated by cardiogenic shock

A critical appraisal of the OPTION trial comparing a strategy of AF ablation plus LAAO versus AF ablation plus DOACS.

An opportunity for practicing Interventional Cardiologists to critically appraise the Early TAVR trial - A strategy trial comparing TAVR to clinical surveillance in asymptomatic patients with severe Aortic valve stenosis. This podcast is intended for health care professionals and practicing cardiologists. **The Start of Something Beautiful by Ketsa is licensed under an Attribution-Non Commercial no Derivatives 4.0 International License