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C52 Cardiology and Cardiac Surgery Landmark Cardiac Trials Toronto Notes 2019
Trial Reference
MYOCARDIAL INFARCTION
Results
In patients with suspected or definite acute MI, early treatment with captopril reduced all-cause mortality at 35 d and during long-term follow-up
Compared to enoxaparin, fondaparinux reduced mortality rates, major bleeds at 9 and MI at 30 and 180 d
Ticagrelor on top of ASA reduces CV events and in patients with a history of MI
ACS patients with either STEMI or NSTEMI, regardless of reperfusion strategy, ticagrelor reduced mortality, MI, and stroke without increased bleeding compared to clopidogrel
In patients hospitalized for ACS, high-dose atorvastatin reduced all-cause mortality, MI, unstable angina, revascularization, and stroke compared with pravastatin
In ACS patients scheduled for PCI, prasugrel reduced ischemic events but increased major bleeding compared to clopidogrel; no change in mortality
Ramipril commenced 3-10 d after MI and continued for a mean 15 mo period significantly reduced all-cause mortality in patients with non-severe CHF
Candesartan reduced overall mortality, cardiovascular death, and CHF hospitalizations
Bisoprolol reduced all-cause mortality, cardiovascular death, all-cause hospitalization, and CHF hospitalization
Carvedilol was associated with a reduction in all cause mortality compared with metoprolol
Enalapril reduced all-cause mortality, death due to progression of heart failure
Carvedilol in addition to standard treatment significantly reduced the risk of death or hospitalization in patients with severe CHF
In patients with CHF and normal LVEF treatment with ARB (irbesartan) did not improve mortality or cardiovascular morbidity compared to placebo
Metoprolol CR/XL daily in addition to optimum standard therapy improved survival in clinically stable patients equating to prevention of 1 death per 27 patients treated per year
Novel drug (LCZ696 containing valsartan and a neprilysin inhibitor (prevents degradation of natriuretic peptides) reduces hospitalization and mortality
In severe CHF (class III/IV) and LVEF <35%, spironolactone reduced all-cause mortality, sudden death, and death due to progression of heart failure
Patients with LV dysfunction post-MI long-term captopril over 3.5 yr reduced the risk of death due to cardiovascular causes, recurrent MI, development of severe CHF, and CHF hospitalization
In mild-to-moderate CHF shock-only ICD significantly reduces risk of death; amiodarone had no benefit compared with placebo in treating patients with mild-to-moderate CHF
In stable chronic CHF with decreased LVEF (<0.35), long-term enalapril reduced death due to all causes and death or hospitalization due to CHF
In patients with LV dysfunction post-MI, long-term trandolapril reduced the risk of death or progression to severe CHF and reduced risk of sudden death
In chronic CHF, enalapril reduced mortality more than hydralazine-isosorbide for at least 2 yr; treatment with either enalapril or hydralazine-isosorbide increased LVEF
Atorvastatin reduces the risk of cardiovascular events in patients with type 2 DM
In patients with vascular disease or DM without CHF, telmisartan is equally as effective as ramipril, with telmisartan causing a reduced risk of cough and angioedema, and an increased risk of hypotensive symptoms; combination therapy offers no advantage
ISIS-4
OASIS-5 PEGASUS-TIMI 54 PLATO
PROVE IT – TIMI 22 TRITON-TIMI 38
HEART FAILURE
AIRE
CHARM
CIBIS II
COMET
CONSENSUS COPERNICUS
I-PRESERVE MERIT-HF
PARADIGM-HF RALES
SAVE
SCD-HeFT
SOLVD TRACE V-HeFT II
DIABETES
CARDS ONTARGET
Lancet 1995;345:669-85 NEJM 2006;354:1464-76 NEJM 2015;EPUB
NEJM 2009:361:1045-57
NEJM 2004;350:1495-1504 NEJM 2007;357:2001-15
Lancet 1993;342:821-8
Lancet 2003;362:759-66
Lancet 1999;353:9-13
Lancet 2003;362:7-13
NEJM 1987;316:1429-35 NEJM 2001;344:1651-8
NEJM 2008;359:2456-2467 Lancet 1999;353:2001-7
NEJM 2014;371:993-1004 NEJM 1999;341:709-17 NEJM 1992;327:669-77
NEJM 2005;352:225-237 NEJM 1991;325:293-302
NEJM 1995;333:1670-6 NEJM 1991;325:303-10
Lancet 2004;264:685-96 NEJM 2008;358:1547-59