Five Cardiology Practice Changing Trials in 2019 of Importance to CMAAO Countries

Five Cardiology Practice Changing Trials in 2019 of Importance to CMAAO Countries

Dr KK Aggarwal

President CMAAO and HCFI

ISCHEMIA Trial: Chronic coronary artery disease is not a time bomb in the chest but a condition that should be treated with reassurance, lifestyle changes, and medical therapy.

DAPA-HF trial: Dapagliflozin, a SGLT2 inhibitor reduces CV death, worsening heart failure, and overall death when used on top of optimal medical therapy in patients with heart failure due to a reduced ejection fraction.

The ISCHEMIA-CKD: The best thing a cardiologist can do for a patient with advanced kidney disease is to resist the urge to do procedures. The trial despite great efforts to reduce contrast-induced kidney injury, the invasive approach was not associated with a reduction in CV death or MI. The safety endpoint of death or dialysis was 48% higher in the invasive arm, and stroke rates were nearly fourfold higher.

 RACE 7 ACWAS: no need for early cardioversion for recent-onset AF. Wait for 48 hours. 69% of patients in the delayed-cardioversion group converted spontaneously within 48 hours. Most patients we cardiovert in the emergency department for acute-onset AF could be spared an anesthetic and high-voltage shock if clinicians would simply give peace a chance and wait 48 hours.

ISAR-REACT 5 study showed that prasugrel trounced ticagrelor for the reduction of death, myocardial infarction, or stroke at 1 year. And prasugrel achieved this superiority without an increase in major bleeding.

Other trials

• AUGUSTUS: Antithrombotic Therapy After Acute Coronary Syndrome or PCI in Atrial Fibrillation
• DECLARE-TIMI 58: Dapagliflozin Effect on Cardiovascular Events–Thrombolysis in Myocardial Infarction 58
• EMPA-REG OUTCOME: Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients
• EVAPORATE: Effect of Icosapent Ethyl on Progression of Coronary Atherosclerosis in Patients With Elevated Triglycerides on Statin Therapy
• REDUCE-IT: Reduction of Cardiovascular Events With Icosapent Ethyl–Intervention Trial
• STOP-DAPT 2: Short and Optimal Duration of Dual Antiplatelet Therapy After Everolimus-Eluting Cobalt-Chromium Stent-2

• VITAL: Vitamin D and Omega-3 Trial