Flashcards in Journal articles Deck (20)
Benefits of aspirin for primary prevention in type 2 diabetics were counterbalanced by bleeding risks.
Use of aspirin in low to moderate risk patients did not improve outcomes and worsened bleeding events.
Declare Timi 58
Dapagliflozen reduces MACE in patients with T2DM and precious infarction
Fame 2 trial
FFR guided PCI reduced urgent revascularisation 8% ARR
Stopped early and did not detect difference in MI or Death
Mitral clip reduced
- Hospitalisation (ARR 32%)
- all cause death (ARR 17%)
Over 2 years with improvement in symptoms
Patients were functional MR both ischaemic and non ischaemic EF <50% in origin deemed surgically inappropriate and interventional appropriate for mitraclip by heart team meeting
2% ARR with ticagrelor over clopidogrel for ACS (mortality reduction by 1.5%) with no increased major bleeding BUT increased fatal bleeding (0.2% increase) and fatal ICH (<0.1% increase)
Triton timi trial
In ACS Prasugrel compared to clopidogrel reduced recurrent MI by 2% (without mortality reduction) while also increasing non-CABG major bleeding by about 0.6%
Pretreatment with prasugrel in ACS prior to defining coronary artery anatomy did not reduce MACE at 30 days with an increase in timi major bleeds by 1.2%.
Dapt with clopidogrel for 12 months after ACS reduces MACE by 2% (driven by MI) with 1% increase in major bleeding
30 months of Dapt (clopidogrel) compared to 12 months resulted in 2% reduction in MI, 1% reduction in stent thrombosis, 0.5% reduction in all cause mortality (though just not significant, P 0.05) with 1% increase in moderate to major bleeding.
N.B all cause mortality is better in meta analyses on this issue combining ACS and stable CAD
Prasugrel when compared to ticagrelor in ACS had lower rates of MI (1.8%) with similar rates of major bleeding.
Numerically lower rates of stent thrombosis and death.
For medically managed NSTEACs DAPT over aspirin alone resulted in 2% ARR in mortality and MI
Compared to 12 months of triple therapy, dual therapy with clopidogrel was associated with significantly less bleeding and reduced all cause death and no difference in MACE.
Zotarolimus stent was better than BMS for MI and stent thrombosis.
In those not eligible for SAVR, TAVR provided 20% ARR for mortality over 1 year
Revascularisation of ischaemic heart disease did NOT result in improved perioperative or long term mortality/MI in patients undergoing AAA repair or lower limb arterial vascular surgery.
Insulin infusion and 3 months of insulin S/C in diabetics with AMI resulted in 7% mortality reduction at 1 year and 10% mortality reduction at 3 years
CRT in HFREF <31% with QRS >130 showed reduction in heart failure exacerbation by ARR 8% over 2.5 years
Ace inhibition in ACS with ramipril, regardless of BP resulted 3.8% ARR for composite endpoint of cardiovascular death/MI/stroke