Bryan Cogar retweeted
Replying to @Papa_Heme
For interventional cardiology guidelines, I would highly recommend for authors to do some occasional cases in a cath lab
Bryan Cogar retweeted
BREAKING: A source close to Iranian officials says Tehran has documented a pattern of oil market manipulation tied to Axios reports and Trump administration insiders, including evidence of a $9 billion insider trading operation linked to Jared Kushner and Steve Witkoff.
Some of the documented timeline from the $9 billion insider profit:
Between April and May 2026, a series of suspiciously timed trades in oil futures markets preceded major Iran war announcements—each tied to reporting by Axios.
On March 23, approximately $500–580 million in shorts were placed 15 minutes before Trump announced he was postponing strikes on Iran. Oil dropped.
On April 7, roughly $950–960 million in shorts were placed hours before Trump announced a two-week ceasefire with Iran. Oil fell around 15 percent.
On April 17, around $760 million in shorts were placed 20 minutes before Iran's foreign minister announced the reopening of the Strait of Hormuz. Oil dropped.
On April 21, approximately $430 million in shorts were placed 15 minutes before Trump extended the ceasefire. Oil dropped again.
On May 6, nearly $920 million to $1.7 billion in crude oil shorts were placed approximately 70 minutes before an Axios scoop claimed the U.S. and Iran were near a "14-point agreement." Oil dropped 12 percent. Traders made an estimated $125 million. Iran called the report "the Americans' wish list."
Previously, a senior Iranian official told investigative outlet Drop Site News that Tehran privately warned JD Vance during Switzerland talks that Jared Kushner and Steve Witkoff were "abusing" negotiations—"more interested in exploiting insider knowledge to profit in financial markets than reaching a deal."
Bryan Cogar retweeted
The U.S. National Debt is $40T
Donald Trump accumulated $16T of that $40T
In just 6 years, Donald Trump has been responsible for 40% of the debt our country has ever accumulated in 250 years.
Bryan Cogar retweeted
#CTO #PCI in cardiogenic shock, shall we even do it?
Our study led by @MohamedDomaa and @AdhamGR97 in the @CJCJournals investigated the long-term outcomes of patients who already had a diagnosis of cardiogenic shock and underwent CTO PCI in the same hospitalization.
While the in-hospital mortality is around 27% (which is way lower than the 40-50% cited mortality of cardiogenic shock), the long-term survival was even more impressive, with a 5-year survival of 60%.
We stipulate that the reason CTO PCI was performed was either that further revascularization was needed (e.g., inability to wean from mechanical circulatory support) or that the culprit of shock was NSTEMI with multiple CTOs (18% of our cohort)
Any other reason you would do CTO PCI in shock?
onlinecjc.ca/article/S0828-2…
Bryan Cogar retweeted
I hope to see you at ARCH this week! #arch2026
#ARCH2026 IS THIS WEEK!
Connect with your favorite industry partners in the exhibit hall, during their Thursday evening events, or in the NEW Industry Suites on floor 2.
Don't miss out on their new technology! archsymposium.com/registrati…
#Cardiology #InterventionalCardiology
Bryan Cogar retweeted
#ARCH2026 BEGINS TOMORROW!
It's not too late to register - secure your seat today!
archsymposium.com/registrati…
#Cardiology #InterventionalCardiology
Bryan Cogar retweeted
#ARCH2026 IS THIS WEEK!
Connect with your favorite industry partners in the exhibit hall, during their Thursday evening events, or in the NEW Industry Suites on floor 2.
Don't miss out on their new technology! archsymposium.com/registrati…
#Cardiology #InterventionalCardiology
Bryan Cogar retweeted
LIMITED-TIME OFFER ⏰
Take 35% OFF your registration for ARCH Symposium today through Sunday!
Use Code "ARCHSOCIAL25" here: archsymposium.com/arch/
#Cardiology #InterventionalCardiology #Peripheral #StructuralInterventions #Fellows #CathLab
Bryan Cogar retweeted
#acc26 Six reasons why CHAMPION AF should not change oral anticoagulation for AF
I will have a formal post up on @theheartorg but here is a short summary
1) Stroke and Ischemic Stroke went the wrong way.
All S -> 33 vs 50 [HR 1.46 95% CI, 0.94-2.27)]
IS -> 27 vs 45; [HR = 1.61; 95% CI, 1.00-2.59)]
Look at those upper-bounds.
2) NI would not have been met for efficacy had they used a margin with both rate ratio and risk difference, which is standard practice.
The margin of 4.8% is based on event rates at 12%, which is 1.4 in relative terms (40% higher). But when event rates come in lower, as they did: 4.8% vs 5.7%, the 4.8% margin is too lenient.
The 0.9% higher rate of the primary endpoint has a 95% CI of (-0.8-2.6%), so 2.6% is less than the margin of 4.8%. Now do it with relative risk.
It's in table 2. The relative risk is 1.20. The 95% confidence intervals were 0.87-1.66. Note that 1.66> 1.40 so LAAC is not noninferior based on rate ratio margins
3) The primary safety endpoint is flawed because it excludes periprocedural bleeding and uses nonmajor bleeds, such as gum bleeds and bruising. It's open label trial so who which group will complain of more nonmajor bleeding?
4) When counting all events, Watchman barely reduced major bleeds. Also in the main results table is that major bleeds were 83 vs 87 (5.5% vs 5.8%; HR 0.92 95% CI 0.68-1.24)
5) Net Clinical Benefit was also flawed because they used nonprocedural bleeding and nonmajor bleeds.
A normal patient would simply say, there were 17 more strokes and only 4 less bleeds. Hardly a good trade.
6) Bayes: trials don't give answers, they update priors. For Watchman, you have PREVAIL failing against warfarin, CLOSURE AF clearly failing against best med Rx (mostly DOACs) so priors are pessimistic. To go from pessimistic priors to enthusiastic posteriors you'd need hugely positive data. CHAMPION is not that.
Don't believe the stories that CLOSURE failed due to them using other LAAC devices. In the AMULET IDE trial, Watchman and Amulet were similar. Also, if you believe that German operators are worse than US authors, you need to travel more.
Conclusion: Oral anticoagulation for AF is one of the most evidence-based practices in all of medicine. To upend that would take much stronger data.
Don't be bamboozled by this trial, which was designed to be positive before the first patient was enrolled.
#ACC2026
Bryan Cogar retweeted
#ARCH2026 Early Bird Rates End Friday! Don't miss out on discounted rates, register TODAY 🫀📅
Register here: archsymposium.com/arch/
#Cardiology #InterventionalCardiology #Peripheral #StructuralInterventions #Cardiologist #Fellows #Coronary #CathLab
Bryan Cogar retweeted
Venture Capital deployed $14.2 Billion and none of went to independent medicine.
Carriers, health systems, pharma, and insurance.
99% of VC are consolidation pushers.
1% of Venture Capital pushes lower prices and higher quality outcomes.
Bryan Cogar retweeted
HCA couldn’t make OU Medical Center profitable and sold it.
Oklahoma used taxpayer-funded bonds to buy it, and now the legislature pumps in $96 million a year to keep it open.
Bryan Cogar retweeted
The 340B drug program was designed to help hospitals serve the poor.
It is now an $81.4 billion spread trade that made hospital executives multi-millionaires and associations executive directors millionaires.
Among patients with atrial fibrillation at high risk for stroke and bleeding, left atrial appendage closure was not noninferior to medical therapy in reducing the risk of stroke, embolism, major bleeding, or death at 3 years. Full CLOSURE-AF trial results: nejm.org/doi/full/10.1056/NE…
Editorial: Left Atrial Appendage Closure — Another Overused Method in Cardiology? nejm.org/doi/full/10.1056/NE…
Bryan Cogar retweeted
I just got back from sledding with the kiddos.
Guess what?
Howard Kern, CEO of Sentara Healthcare: $33.2 million.
Lloyd Dean, CommonSpirit: $35.5 million.
Gene Woods, Advocate Health: $25.8 million.
These are not for-profit hospitals.
Tax-exempt.
Ostensibly charitable.
Is this what people mean when they say doctors are not good at business?
Yeah, sorry mate, that's a horrible way to define business.
Bryan Cogar retweeted
Gaslighting…
It’s fentanyl to:
it’s cocaine
It’s drugs to:
it’s oil
It’s at sea to:
it’s boots on the ground
It’s an arrest to:
it’s an attack
It’s free elections to:
it’s anyone who serves us
It’s just Venezuela to:
it’s any country we choose
nytimes.com/2026/01/08/us/po…
Bryan Cogar retweeted
Note: the @ABIMFoundation $2.3 million condo was a not-so-wise-choice once word got out about their lavish spending on themselves drwes.blogspot.com/2016/07/t…
Bryan Cogar retweeted
“The next obvious observation is that by removing Maduro this is a clear move for control over Venezuelan oil supplies that will ensure stability for the next obvious regime change war in Iran.”
And also takes away a key source of oil from China.
If it was about drugs killing Americans, they would be bombing Mexican cartels.
I’ve served on the Homeland Security Committee for the past three years. I’m 100% for strong safe secure borders and stopping narco terrorists and cartels from trafficking deadly drugs and human trafficking into America.
Fentanyl is responsible for over 70% of U.S. drug overdose deaths and fentanyl comes from Mexican cartels made with chemical precursors from China and trafficked across the U.S. Mexico border.
Mexican cartels are primarily and overwhelmingly responsible for killing Americans with deadly drugs.
If U.S. military action and regime change in Venezuela was really about saving American lives from deadly drugs then why hasn’t the Trump admin taken action against Mexican cartels?
And if prosecuting narco terrorists is a high priority then why did President Trump pardon the former Honduran President Juan Orlando Hernandez who was convicted and sentenced for 45 years for trafficking hundreds of tons of cocaine into America? Ironically cocaine is the same drug that Venezuela primarily traffics into the U.S.
The next obvious observation is that by removing Maduro this is a clear move for control over Venezuelan oil supplies that will ensure stability for the next obvious regime change war in Iran.
And of course why is it ok for America to militarily invade, bomb, and arrest a foreign leader but Russia is evil for invading Ukraine and China is bad for aggression against Taiwan? Is it only ok if we do it? (I’m not endorsing Russia or China)
Regime change, funding foreign wars, and American’s tax dollars being consistently funneled to foreign causes, foreigners both home and abroad, and foreign governments while Americans are consistently facing increasing cost of living, housing, healthcare, and learn about scams and fraud of their tax dollars is what has most Americans enraged. Especially the younger generations. Boomers and half of Gen X will cheer on neocon wars and talking points, but the other half of Gen X and majority on down see through it and hate it.
Americans disgust with our own government’s never ending military aggression and support of foreign wars is justified because we are forced to pay for it and both parties, Republicans and Democrats, always keep the Washington military machine funded and going.
This is what many in MAGA thought they voted to end.
Boy were we wrong.
As the baby boomers slip away both in votes and power, the electoral future will be decided for candidates that focus on American economic populism and promising prosperity for Americans only.
As of right now, neither party is offering the solution.
Bryan Cogar retweeted
So, in 2026, the United States can hold a foreign president responsible for breaking US law but not an American president. Interesting.


























