Cardiology Trials

N Engl J Med 2020;382:1395-407 - ISCHEMIA N Engl J Med 2020;382:1608-16 - ISCHEMIA-CKD Background: The COURAGE trial , published in 2007, represented a major reversal in cardiovascular medicine. In patients with stable CAD an initial strategy of revascularization plus medical therapy did not reduce the chance of dying or having a heart attack compared to an initial strategy of medical therapy alon...

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N Engl J Med 2012;367:991-1001 Background: Percutaneous coronary intervention (PCI) did not improve the outcome of death or nonfatal myocardial infarction in stable coronary artery disease, as seen in the COURAGE trial. Nonetheless, some skepticism remained within the cardiology community regarding the results of the COURAGE trial, with the belief that revascularizing ischemia-causing lesions coul...

N Engl J Med 2007;356:1503-1516 Background: By the turn of the 21st century more than 1 million coronary stent procedures were performed each year in the United States and approximately 85% were undertaken electively in patients with stable coronary artery disease. This pattern evolved without a single clinical trial demonstrating a concrete improvement in hard endpoints with percutaneous coronary...

N Engl J Med 1999;341:70-76 Background: Percutaneous transluminal coronary angioplasty (PTCA) was widely used in the 1990s for its potential benefit in improving symptoms in patients with stable coronary artery disease, as discussed in the ACME and RITA-2 trials. However, the RITA-2 trial showed that PTCA worsened hard outcomes, and ACME was underpowered for such comparison. At the same time, tria...

Lancet 1997;350(9076):461-468 Background: In the ACME trial, percutaneous transluminal coronary angioplasty (PTCA) improved symptoms in patients with single-vessel stable coronary artery disease, but it did not lead to reduction in myocardial infarction or mortality, which were not primary endpoints and the study was under powered for these endpoints. The available data on the efficacy of PTCA for...

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N Engl J Med 1992;326:10-16 Background: Revascularization with coronary artery bypass surgery improves symptoms in patients with chronic stable angina as seen in the European Coronary Surgery Study. Percutaneous transluminal coronary angioplasty (PTCA) is less invasive compared to surgery and is associated with less mortality and morbidity. Consequently, its use increased significantly in the late...

N Engl J Med 2011;364:1607-1616 Background: The three pivotal trials of coronary artery bypass graft surgery (CABG) we previously reviewed, largely included patients with normal left ventricular function. Observational studies suggested that CABG improved survival over medical therapy in patients with coronary artery disease and systolic heart failure. Cardiology Trial’s Substack is a reader-suppo...

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Lancet 1994;344(8922):563-570 Background: Several randomized trials have assessed the benefits of coronary artery bypass graft surgery (CABG) in patients with chronic stable angina. We reviewed three major trials in this area: The Veterans Administration Cooperative Study, the European Coronary Surgery Study , and the CASS study . These trials yielded divergent results, likely due to differences i...

Circulation 68, No. 5, 939-950, 1983 Background   Coronary artery bypass surgery (CABG) had grown in popularity through the 1970s and 1980s. By 1981, approximately 159,000 bypass surgeries had been done. Cardiology Trial’s Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber. The goal of the CASS trial was to rigorously...

Lancet 1982;320:1173-1180 Background: The first coronary artery bypass graft surgery (CABG) was performed in 1964 and by the 1970’s it was commonly used for relief of angina. However, whether it improved survival was unknown. The European Coronary Surgery Study (ECSS) sought to test the hypothesis that CABG compared to medical therapy improved survival at 5 years. Cardiology Trial’s Substack is a...

Circulation 1976; 54:Suppl:III-107-III-117 N Engl J Med 1977;297:621-627 Cardiology Trial’s Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber. Background: By the 1970's, coronary artery bypass surgery was performed to improve the quality of life in patients with chronic stable coronary artery disease. The Veterans Adm...

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N Engl J Med 2024;390:1372-1381 Background: Beta-blockers are prescribed to the majority of patients with acute myocardial infarction. The bulk of evidence supporting this practice comes from trials published in the 1980s - BHAT and ISIS-I . Since the publication of these seminal trials, the care of patients with acute myocardial infarction has significantly changed with improvement in antiplatele...

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N Engl J Med 2024;390:1455-1466 Background Despite advances in the care of patients after myocardial infarction, there remains residual risk of heart failure and death. The amount of risk parallels the degree of left ventricular systolic dysfunction. Previous studies have shown that the drug class of sodium–glucose cotransporter 2 (SGLT2) inhibitors reduce cardiovascular risk (especially recurrent...

NEJM 2021:385:1845-55. Background Over two decades had passed since the publications of the seminal trials comparing ACE inhibitors with placebo in post-MI patients with LV dysfunction and congestive heart failure (SAVE, AIRE and TRACE). The VALIANT trial, published in 2003, found that the ARB drug Valsartan was as effective as Captopril in improving survival and reducing cardiovascular morbidity...

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N Engl J Med 2019;381:2497-2505 Background: Inflammation increases the risk of atherosclerosis, and reducing inflammation with canakinumab, a monoclonal antibody that neutralizes interleukin-1β, reduced plasma markers of inflammation and the risk of future myocardial infarctions but was associated with small yet statistically significant increased risk of fatal infections. Methotrexate, in the CIR...

N Engl J Med 2019;380:752-762 Background: Growing body of evidence suggests the role of inflammation in atherosclerosis. The CANTOS trial , discussed earlier, provided further evidence for that hypothesis. In the CANTOS trial, canakinumab a monoclonal antibody that neutralizes interleukin-1β led to fewer myocardial infarctions compared to placebo. Cardiology Trial’s Substack is a reader-supported...

N Engl J Med 2017;377:1119-1131 Background The hypothesis tested in the CANTOS Trial reflected an emerging view of atherosclerosis development and progression - that it was not simply a matter of plasma cholesterol but also systemic inflammation. In the manuscript’s introduction the authors cite data on the independent association of certain inflammatory markers with an increased risk of cardiovas...

N Engl J Med 2015;372:2387-2397 Background: Statins, inhibitors of 3-hydroxy-3-methylglutaryl-coenzyme A reductase, effectively lower low-density lipoprotein (LDL) and improve cardiovascular outcomes across different populations. High-intensity statins exhibit greater efficacy in lowering LDL and decreasing non-fatal cardiac events compared to moderate-intensity statins. Nonetheless, due to the re...