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
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
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