The IC Chat

In this episode host Ashish Pershad reviews and critically appraises the REBOOT PARADOX randomized trial of TAVR versus optimal medical therapy in patients with paradoxical low‑flow, low‑gradient severe aortic stenosis. He summarizes trial design, patient selection, methods, and the challenges that led to early termination and underpowering.
Key findings discussed include excellent hemodynamic relief after TAVR, a non‑significant difference in 2‑year all‑cause mortality, fewer heart‑failure hospitalizations with TAVR, high crossover from medical therapy, and persistence of low‑flow physiology—leading to the conclusion that close surveillance with selective intervention may be prudent until definitive trials are completed.

Host Ashish Pershad breaks down the AIR-STEMI (ARISTEMI) trial presented at ESC, explaining how physiology-guided (functional angiography) complete revascularization compares to angiography-guided approaches in STEMI patients with multivessel disease. He reviews study design, key results showing fewer events and safer outcomes with functional guidance, limitations, and practical takeaways for interventional cardiologists.

Host Ashish Prasad critically appraises two important interventional cardiology studies: a Taiwanese meta-analysis of four randomized trials comparing left atrial appendage occlusion to DOACs, and the ICARE randomized trial comparing intravascular lithotripsy (IVL) with rotational atherectomy for calcified coronary lesions.The meta-analysis found no overall difference in stroke but a non-significant trend toward higher ischemic stroke with LAA occlusion that became significant when the OPTION ablation study was excluded; LAA occlusion reduced non-procedural bleeding but procedural bleeds were omitted from safety endpoints. The ICARE trial showed IVL was non-inferior to rotational atherectomy for minimal stent area, with less stent malapposition and similar 12-month clinical outcomes, but was limited by surrogate endpoints, exclusion of balloon-uncrossable lesions, and small size.Takeaways: temper enthusiasm for broad LAA occlusion over DOACs and view IVL and atherectomy as complementary tools guided by imaging, lesion characteristics, and patient-specific risks.

In this episode of IC Chat, host Ashish Pershad reviews drug‑eluting balloons for coronary disease, appraising two landmark trials: AGENT‑IDE (in‑stent restenosis) and SOLUTION de novo (de novo lesions).
He explains device pharmacology (paclitaxel vs. sirolimus), trial designs and results, practical considerations for vessel preparation and imaging, and offers cautious clinical takeaways about where drug‑eluting balloons may fit alongside drug‑eluting stents.

Welcome to IC Chat with host Dr. Ashish Pershad. In this episode we examine the controversial role of transcatheter edge-to-edge mitral valve repair for functional mitral regurgitation, focusing on the COAPT, MITRAL‑FR and the newer RESHAPE Heart Failure II trials.
We summarize trial differences in patient selection, anatomy (EROA and LV volumes), outcomes (heart failure hospitalizations, quality of life and mortality), and methodological concerns that influence interpretation of RESHAPE HF II.
Dr. Pershad outlines the practical implications for clinicians: selection remains critical, TEER appears to reduce heart failure admissions and improve quality of life in selected patients, but questions about mortality benefit and broad adoption persist.

In this episode host Ashish Pershad reviews the ORBITA CTO randomized, double-blind, sham-controlled trial that compared CTO-PCI to a placebo procedure, explaining the rigorous design, patient selection, masking methods, and statistical approach.
Pershad summarizes the results showing significant symptom improvement with CTO-PCI, discusses clinical implications—blinding, careful case selection, and specialist referral—and outlines how this trial advances evidence for procedural interventions for patients with stable angina.

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