The physician–scientist track (MD/PhD) in academic medical centers has become one of the great illusions of modern science - a path that promises to unite medicine and science but rarely fulfills either goal. Training stretches on for years as one person is expected to learn two professions at once, and in practice, they seldom master either. Many hold a token clinic for a few hours a week while running labs that produce derivative “translational” research — supposedly aimed at improving patient care. In reality, these efforts seldom advance either basic knowledge or clinical practice in a meaningful way. The personal rewards, however, are significant: MD/PhDs are paid far more than PhDs alone, face far less competition for faculty positions, are treated better by upper administration, and are freed from the full clinical responsibilities of practicing physicians. They also enjoy privileged access to administrative roles in medical centers, journals, and professional societies - positions that often pay handsomely. Yet almost no one has seriously examined whether this track delivers genuine scientific or medical value, or if it merely sustains another bureaucratic layer within an already bloated healthcare system. students-residents.aamc.org/…

The most anticipated trial at next #TCT2025 is SELUTION DeNovo. So let’s take a closer look. This study represents an important crossroads for drug-coated balloons (DCBs) in de novo lesions, since—apart from small vessels—the results so far have been far from impressive. Let’s start with the study population, which includes patients with at least one vessel to be treated, ranging from 2 to 5 mm in diameter. This means that some vessels would typically be treated with a DCB, while others would more commonly receive a drug-eluting stent (DES). Naturally, a proportion of patients initially intended for DCB treatment will end up with a stent—for example, in the case of a dissection or when, after predilatation, the operator feels uncomfortable leaving the vessel without one. This should not be interpreted as a crossover, but rather as part of the treatment strategy being tested. In fact, randomization occurs before predilatation, unlike in other studies. Investigators expect this to happen in no more than 30% of cases—which is not negligible. In other words, the trial aims to avoid stenting and pursue a “leave nothing behind” approach in about 70% of cases. Then there is the DCB itself, which is coated with sirolimus. In theory, sirolimus is not the perfect drug for this use, given its low lipophilicity. However, it has other advantages—lower cytotoxicity and stronger inhibition of neointimal proliferation. In this specific balloon, the microreservoir design is meant to retain the drug, preventing distal embolization and ensuring homogeneous drug delivery for up to 90 days. This means that negative results from previous DCB trials should not automatically be generalized to all DCBs—though this, of course, remains to be seen. Finally, the study hypothesis: noninferiority at 1 and 5 years (with 1-year results expected at TCT). If noninferiority is demonstrated, superiority will also be tested. Investigators expect a 6% event rate in both arms at 1 year and have set a noninferiority margin of 3%. Should the observed event rate be lower than expected—which, as we know, often happens in this type of trial—the margin will be tightened to 2.5%, with statistical power reduced from 95% to 90%. A smart and pragmatic choice. Moreover, the sample size is substantial: 3,326 patients, making this the largest trial ever conducted in this field. Since current guidelines recommend DCBs only for in-stent restenosis, SELUTION DeNovo has the potential to expand indications to de novo coronary lesions—potentially shifting part of the field from drug-eluting stents to drug-coated balloons, if the trial results are positive. It’s an evolving landscape, with emerging contenders such as bioadaptors and, inevitably, a comeback of bioresorbable scaffolds sooner or later.

🥸1️⃣ The U.S. Census Bureau projects the number of Americans aged ≥75 years will double, from 23 million in 2022 to 46 million by 2050. This demographic shift will redefine heart failure (HF) care as aging becomes the dominant driver of cardiovascular disease.

Microdispensing at the picoliter scale is redefining precision in science enabling ultra-accurate droplet placement for biotech, diagnostics and electronics. A raindrop ≈ 50 µL is 50 million× larger than a picoliter.

Read our SCAI position statement on growing role and best practices for intracardiac echo guidance of structural interventions: authors.elsevier.com/sd/arti…

How Americans spend their day

We are enhancing our heart care for older adults with the opening of a Cardiovascular Center on Aging. It will integrate care from geriatric and cardiac specialists to address the unique needs of those over 65. cle.clinic/481Mkym

Great PhD opportunity to study thick and thin filament regulation at sub-sarcomere level in cardiac myofibrils kcl-mrcdtp.com/project/dual-… #MRCDTP26 @KCL_MRCDTP @KingsCollegeLon @The_MRC

If you had him, what would you name him?

I've watched this kid play since he was 10 years old. He's a class act and will never take a shift off. We've got a winner. Wait and see. This kids really good. Great addition.

From the September Issue: Closure Devices Versus Manual Compression to Achieve Hemostasis Post-PFO Closure Read here ➡️ hubs.ly/Q03Jz7RG0 @DLBHATTMD #cardioTwitter #cardioX #cardiology #interventionalcardiology

Since we started this initiative, things have gotten worse. We have stopped tafamidis on many more patients, but the principles are the same. Careful evaluation of ATTR-CM diagnosis is vital to avoid diagnostic and therapeutic errors. tandfonline.com/doi/10.1080/… #cardiotwitter