Cardio Trial Files: Colchicine vs. Placebo in MI, Catheter Ablation vs. Antiarrhythmics in VTach, and Spironolactone vs. Placebo in MI
Colchicine in Acute Myocardial Infarction
Jolly SS et al. NEJM (November 2024)
Bottom Line: This multicenter, randomized controlled trial with a 2-by-2 factorial design evaluated the efficacy and safety of colchicine in patients who had myocardial infarction. A total of 7062 patients were randomized to receive either colchicine or placebo for a median of 3 years. The primary outcome, a composite of death from cardiovascular causes, recurrent myocardial infarction, stroke, or unplanned ischemia-driven coronary revascularization, was not significantly different between the two groups. However, there was a higher incidence of diarrhea in the colchicine group. Overall, treatment with colchicine did not reduce the risk of adverse cardiovascular events in this patient population.
Catheter Ablation or Antiarrhythmic Drugs for Ventricular Tachycardia
Sapp JL et al. NEJM (November 2024)
Bottom Line: This international trial compared the effectiveness of catheter ablation versus antiarrhythmic drug therapy as a first-line treatment for patients with ischemic cardiomyopathy and ventricular tachycardia. A total of 416 patients were randomly assigned to receive either catheter ablation or drug therapy. The primary outcome, a composite of death from any cause during follow-up or adverse events related to ventricular tachycardia, was found to be lower in the catheter ablation group compared to the drug therapy group. Adverse events within 30 days after catheter ablation included death in 2 patients and nonfatal adverse events in 23 patients, while adverse events attributed to drug therapy included death from pulmonary toxic effects in 1 patient and nonfatal adverse events in 46 patients. This study suggests that catheter ablation may be a more effective initial treatment for patients with ischemic cardiomyopathy and ventricular tachycardia.
Routine Spironolactone in Acute Myocardial Infarction
Jolly SS et al. NEJM (November 2024)
Bottom Line: This multicenter trial with a 2-by-2 factorial design aimed to determine the effectiveness of spironolactone in reducing mortality in patients with myocardial infarction. 7062 patients were enrolled and randomly assigned to receive either spironolactone or placebo. The primary outcomes were a composite of death from cardiovascular causes or new or worsening heart failure and a composite of the first occurrence of myocardial infarction, stroke, new or worsening heart failure, or death from cardiovascular causes. The results showed no statistically significant difference between the intervention and control groups. Safety was also assessed, with serious adverse events reported in 7.2% of patients in the spironolactone group and 6.8% in the placebo group. In conclusion, spironolactone did not reduce the incidence of death from cardiovascular causes or new or worsening heart failure in patients with myocardial infarction.
Cardio Trial Files Issue #CRD-2025-08
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