PCP_CE

8/8: Click on this video for a full summary of the trial results! #SponsoredbyCleerly

7/8: In #PARAMOUNT, plaque-based care produced a win ratio of 2.0 versus usual care for the prespecified hierarchical composite. The difference was driven primarily by greater diagnostic certainty and lower LDL-C, important context when interpreting the overall trial result.

6/8: Two tiers drove this result: ⬆️diagnostic certainty and plaque image-guided ⬇️LDL-C. In addition, plaque-based care did NOT ⬆️% of pts referred for #angio nor were invasive procedures ⬆️. BUT . . . can ⬇️unnecessary procedures (cath without finding #CAD):

5/8: A #WinRatio of 1.0 ➡️no advantage for either arm. WR 1.2 ➡️test treatment has 20% more wins than losses; 1.5 ➡️test treatment has 50% more wins than losses; 2.0 ➡️test treatment has twice as many wins as losses. In #PARAMOUNT, WR = 2.0

4/8: #WinRatio allows a clinical trial to assess several different measures of treatment benefit simultaneously, without treating all outcomes as equally important. The win ratio is the number of comparisons won by the experimental treatment divided by the number lost.

3/8: A hierarchical #WinRatio was calculated for each plaque-based care patient vs each usual care patient for 4 outcomes, ranked by clinical priority:

2/8: #CCTA + #AI-QCT plaque & ischemia analysis was compared 1:1 to usual care (functional stress test) in stable symptomatic pts w/suspected #CAD. Image guidance informed stage-based medical therapy & revasc decisions; usual care was guideline-based per treating physician.

1/8: The #PARAMOUNT trial of #coronary plaque-based care was presented this morning at #AHA26. Here are the key findings and some context for interpreting the results. The trial and this post were sponsored by @CleerlyHealth, for whom I serve as a consultant.