Cardiology Trials

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N Engl J Med 2019;381:1524-1534 Background Dual antiplatelet therapy after percutaneous coronary intervention had become a standard of care. Both prasugrel and ticagrelor had been shown to provide more rapid and consistent platelet inhibition than clopidogrel. Randomized controlled trials had shown both drugs were superior to clopidogrel in patients with acute coronary syndromes. Cardiology Trial’...

N Engl J Med 2013;369:999-1010 Background: Adding P2Y12 inhibitors to aspirin improves outcomes in patients with acute coronary syndrome. Yet, debate persisted regarding the optimal timing for administering these drugs in patients undergoing percutaneous coronary intervention (PCI). The ATLANTIC trial showed that pre-hospital administration of ticagrelor did not improve outcomes compared to in-hos...

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N Engl J Med 2014;371:1016-1027 Background:  Prior trials have demonstrated that combining P2Y12 inhibitors with aspirin in patients with acute coronary syndrome reduces cardiovascular events. Prasugrel, in the TRITON-TIMI 38 trial, and ticagrelor, in the PLATO trial, were administered in the hospital. Cardiology Trial’s Substack is a reader-supported publication. To receive new posts and support...

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JAMA.  2013;309(12):1241-1250 Background Case reports as early as the 1950s suggested chelation of lead might reduce angina. The popularity of chelation accelerated around the turn of the century. Small underpowered trials of chelation were inconclusive. Mainstream medicine considered chelation unproven and potentially hazardous. Cardiology Trial’s Substack is a reader-supported publication. To re...

N Engl J Med 2012;366:9-19 Background Following an acute coronary syndrome, individuals have a substantially elevated risk of recurrent events, compared to a similar individual who did not experience ACS, despite the use of appropriate risk reducing therapies. This is termed “residual risk” and the concept has been mentioned in prior reviews. The quest to lower residual risk continues to be a majo...

N Engl J Med 2010;363:930-942 Background By 2010, dual antiplatelet therapy had been established as beneficial during and after percutaneous coronary intervention for acute coronary syndromes. Optimal dosing however remained unknown. This included the best loading dose of clopidogrel and optimal dose of aspirin. Cardiology Trial’s Substack is a reader-supported publication. To receive new posts an...

N Engl J Med 2012;367:1297-1309 Background: In patients with acute coronary syndrome, clinical guidelines recommend early angiography particularly in those deemed moderate to high risk. However, a proportion of patients do not undergo revascularization, and these patients have poorer outcomes compared to those who do undergo revascularization. Cardiology Trial’s Substack is a reader-supported publ...

N Engl J Med 2009;361:1045-57. Background Similar to Prasugrel, Ticagrelor is a direct-acting oral antagonist of the adenosine diphosphate receptor P2Y12. Unlike clopidogrel that requires transformation of the prodrug to the active metabolite, Ticagrelor provides faster and more consistent P2Y12 inhibition. In the TRITON-TIMI 38 trial , Prasugrel compared to clopidogrel reduced myocardial infarcti...

Note to readers: Since going live with Cardiology Trials Substack in January of 2024 we have been exclusively covering trials that we have categorized as belonging to the major subject heading “Acute Coronary Syndrome” belonging to the subsection “Medicines”. Our indexing scheme was described in one of our original posts and we encourage our audience to read it if you have not already. This is per...

N Engl J Med 2008; 358:2218-2230 Background The use of percutaneous coronary intervention (PCI) is associated with improved outcomes in patients with ST-segment elevation myocardial infarction (STEMI). Nonetheless, there was a need to further improve survival rates. As seen in OASIS-6, the 30-day mortality in the control arm was still high at 8.9%. Glycoprotein IIb/IIIa inhibitors emerged as a pot...

JAMA. 2006;295(13):1519-1530 Background Previous trials demonstrated that aspirin and thrombolytic therapy improve prognosis in patients with ST elevation myocardial infarction (STEMI). The addition of heparin to aspirin and thrombolysis did not improve outcomes in patients with STEMI (see GISSI-2 trial). Fondaparinux, a synthetic pentasaccharide that inhibits factor Xa, was tested in OAISIS-5 , a...

N Engl J Med 2006; 354:1464-1476 Background: Prior studies showed that combined antiplatelets and anticoagulants reduce ischemic events in patients with acute coronary syndrome but increases the risk of bleeding. We saw this in the FRISC trial where low-molecular-weight heparin plus aspirin reduced the primary endpoint of death or nonfatal myocardial infarction compared to placebo at 6 days but al...

Two trials in acute coronary syndrome - CURE (clopidogrel in acute coronary syndrome) and DIGAMI 2 (glucose control in acute coronary syndrome) Get full access to Cardiology Trial’s Substack at cardiologytrials.substack.com/subscribe

European Heart Journal, Volume 26, Issue 7, 2005, 650–661 Background  Patients with diabetes have a higher risk of death after myocardial infarction than those without diabetes. There are many possible reasons for this difference. One may be that diabetic patients have detrimental responses during the acute phase of MI. In the DIGAMI 1 trial, patients with diabetes and AMI were randomized to inten...

N Engl J Med 2001;345:494-502. Background The established medical treatments for acute coronary syndrome reviewed so far include aspirin and thrombolytics along with a smaller role for short-term anticoagulation. Angiotensin converting enzymes inhibitors and, to a lesser extent, beta blockers were also found to reduce recurrent ischemic events and death as well as heart failure and ventricular rem...

Two trials of statin therapy in acute coronary syndrome. See https://cardiologytrials.substack.com/ for more details. Get full access to Cardiology Trial’s Substack at cardiologytrials.substack.com/subscribe

NEJM 2004;350:1495-504. Background The benefit of cholesterol lowering with statins compared to placebo had been demonstrated in multiple trials across a range of cholesterol starting levels in patients with and without a history of coronary artery disease. The average reduction in cholesterol from baseline levels in these trials was in the range of 25% to 35%. Guidelines at the time this trial wa...

JAMA 2001;285:1711-18. Background Statin therapy had been shown to improve blood cholesterol and improve long-term outcomes in patients with stable coronary artery disease with significant effects evident after 2 years of treatment. These early trials excluded patients with recent acute coronary syndromes and thus, the possibility of early benefit from statin therapy in this patient population was...

Two trials of blood glucose lowering and low-molecular-weight heparin in patients with acute coronary syndrome. See https://cardiologytrials.substack.com/ for more details Get full access to Cardiology Trial’s Substack at cardiologytrials.substack.com/subscribe

Lancet 1996;347:561-68. Background In most of the prior AMI trials presented here, patients with non_ST-segment myocardial infarction (NSTEMI) and/or unstable angina were included with patients with ST-segment myocardial infarction (STEMI). Patients with NSTEMI usually represented about 1/3 of trial participants. It had become clear based on subgroup analyses from the previous trials that NSTEMI p...

J Am Coll Cardiol 1995;26:57-65. Background Patients with diabetes have higher short- and long-term rates of mortality following acute myocardial infarction (AMI). Possible explanations for this include increased fatty acid metabolism, compromising glycolysis in ischemic and nonischemic areas as well as impairment of platelet and fibrinolytic function. This led to the theory that both processes co...

Two of important trials of ACE inhibition and aldosterone blockade post myocardial infarction. See https://cardiologytrials.substack.com/ for more details. Get full access to Cardiology Trial’s Substack at cardiologytrials.substack.com/subscribe