Cardio Trial Files Throwback Thursday: Acetylcysteine with IV Contrast, Early Invasive Strategy in UA/NSTEMI, and DOAC, VKA, Antiplatelets after PCI with Stent
Acetylcysteine for Prevention of Renal Outcomes in Patients Undergoing Coronary and Peripheral Vascular Angiography
ACT Investigators. Circulation (August 2011)
Bottom Line: This large randomized trial evaluated the efficacy of acetylcysteine 1200 mg versus placebo in preventing contrast-induced acute kidney injury among 2308 patients with risk factors undergoing angiographic procedures. The study was double-blinded and lasted until the evaluation of outcomes. The primary outcome, incidence of contrast-induced acute kidney injury, was 12.7% in both groups. Additionally, the combined endpoint of mortality or need for dialysis at 30 days was similar, at 2.2% for acetylcysteine and 2.3% for placebo. The findings indicate that acetylcysteine does not provide a benefit in this patient population.
Invasive compared with non-invasive treatment in unstable coronary-artery disease (FRISC II)
FRISC II Investigators. The Lancet (August 1999)
Bottom Line: This prospective randomized multicenter study involving 2457 patients with unstable coronary-artery disease compared an early invasive treatment strategy with a non-invasive strategy, utilizing placebo-controlled low-molecular-mass heparin (dalteparin) for 3 months. Follow-up occurred over 6 months. The primary outcome, a composite of death or myocardial infarction, showed a decrease of 9.4% in the invasive group versus 12.1% in the non-invasive group (risk ratio 0.78 [95% CI 0.62-0.98], p=0.031). The study concluded that the early invasive approach should be preferred in patients with signs of ischaemia or raised markers of myocardial damage.
Prevention of Bleeding in Patients with Atrial Fibrillation Undergoing PCI
Gibson CM et al. NEJM (December 2016)
Bottom Line: This randomized clinical trial (PIONEER AF-PCI) assessed the safety and efficacy of low-dose rivaroxaban plus a P2Y12 inhibitor and very-low-dose rivaroxaban plus DAPT compared to standard therapy in patients with nonvalvular atrial fibrillation undergoing PCI with stenting. A total of 2124 participants were enrolled and followed for 12 months. The primary outcome was clinically significant bleeding, with rates of 16.8% and 18.0% for the rivaroxaban groups versus 26.7% for the standard therapy group. Rivaroxaban groups had significantly lower bleeding rates, while efficacy outcomes showed similar rates across all groups. The study concluded that rivaroxaban regimens resulted in lower bleeding rates without compromising efficacy.
Cardio Trial Files Issue #CRD-2025-13
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