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Toronto Notes 2019 Landmark Cardiac Trials Cardiology and Cardiac Surgery C51 Landmark Cardiac Trials
Trial Reference
Results
In hypertensive patients with risk factors for CHD and average or below- average cholesterol, atorvastatin reduced nonfatal MI, fatal CHD, fatal/nonfatal stroke, coronary events but not all-cause mortality
In atherosclerotic vascular disease, clopidogrel reduced the primary combined endpoint of stroke, MI, or vascular death and improved PAD compared to ASA
Pravastatin reduced MI and stroke in patients with previous MI and average cholesterol
Compared with optimal medical therapy alone, PCI + medical therapy did not reduce all-cause mortality and non fatal MI, and it did not reduce the incidence of major cardiovascular events
Clopidogrel plus ASA reduced death from CV causes, non fatal MI, or stroke but increased bleeding complications
With stable CAD and no CHF, perindopril reduced cardiovascular death, MI, and total mortality
In high-risk patients without low LVEF or CHF, ramipril reduced rates of death, MI, stroke, revascularization, new diagnosis of DM, and complications due to DM; vitamin E had no effect on outcomes
In high-risk patients with various cholesterol values, simvastatin reduced all-cause mortality, coronary deaths, and major vascular events
Nine modifiable risk factors account for 90% of myocardial infarction Ezetimibe added to statin reduces mortality in ACS patients
With low to normal LDL-C and elevated hsCRP treatment with rosuvastatin significantly reduced major cardiovascular events; NNT with rosuvastatin for 2 yr to prevent one primary endpoint = 95
CABG has lower rate of major cardiac or cerebrovascular events; the rate of stroke was increased with CABG, whereas the rate of repeat revascularization was increased with PCI
Lipid-lowering therapy with atorvastatin 80 mg/d in patients with stable CHD provides clinical benefit beyond atorvastatin 10 mg/d
Estrogen plus progestin therapy is associated with increased risks of cardiovascular disease and breast cancer but decreased risks of hip fracture and colorectal cancer in postmenopausal women
In acute MI, propranolol reduced all-cause mortality, cardiovascular death, and sudden death from atherosclerotic heart disease
Compared with optimal medical therapy alone, PCI + medical therapy did not reduce all-cause mortality and non fatal MI, and it did not reduce the incidence of major cardiovascular events
Dual antiplatelet therapy beyond one year confers additional benefit
Early therapy with streptokinase and ASA in patients with MI individually and in combination significantly reduced all-cause mortality and in combination demonstrated additive effect
ISCHEMIC HEART DISEASE
ASCOT-LLA
CAPRIE CARE COURAGE
CURE EUROPA HOPE
HPS
INTERHEART IMPROVE-IT
JUPITER
SYNTAX
TNT WHI
Lancet
Lancet NEJM NEJM
NEJM Lancet NEJM
Lancet Lancet
2003;361:1149-58
1996;348:1329-39 1996;335:1001-9 2007;356:1503-16
2001;345:494-502 2003;362:782-88 2000;342:154-60
2002;360:7-22 2004;364:937-52
N Engl J Med 2015 Jun 3. [Epub ahead of print]
NEJM 2008;359:2195-2207
NEJM 2009;360:961-972
NEJM 2005;352:1425-35 JAMA 2002;288:321-333
MYOCARDIAL INFARCTION
BHAT JAMA 1982;247:1707-14 COURAGE NEJM 2007;356:1503-16
DAPT NEJM 2014;371:2155-66 ISIS-2 Lancet 1988;2:349-60