Cardio Trial Files Throwback Thursday: Intensive Lipid Lowering in CHD, Antithrombotics After PCI with Stent and AF, and Aspirin/Clopidogrel Duration after PCI
Intensive Lipid Lowering with Atorvastatin in Patients with Stable Coronary Disease
LaRosa JC et al. NEJM (April 2005)
Bottom Line: This randomized, double-blind study of 10,001 patients with coronary heart disease (CHD) and LDL cholesterol levels of less than 130 mg per deciliter (3.4 mmol per liter) evaluated the efficacy and safety of 80 mg of atorvastatin per day versus 10 mg of atorvastatin per day over a median of 4.9 years. The primary endpoint was occurrence of a first major cardiovascular event (defined as death from CHD, nonfatal non-procedure-related myocardial infarction, resuscitation after cardiac arrest, or fatal or nonfatal stroke). Results showed that there was an absolute reduction in the rate of major cardiovascular events of 2.2 percent and a 22 percent relative reduction in risk with the 80 mg of atorvastatin group, with an increased incidence of elevated aminotransferase levels. The conclusion was that intensive lipid-lowering therapy with 80 mg of atorvastatin per day in patients with stable CHD provides significant clinical benefit beyond that afforded by treatment with 10 mg of atorvastatin per day.
Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation
Lopes RD et al. NEJM (March 2019)
Bottom Line: This randomized controlled trial enrolled 4614 patients with atrial fibrillation who had an acute coronary syndrome or had undergone PCI and were planning to take a P2Y12 inhibitor. The patients were assigned to receive apixaban or a vitamin K antagonist and to receive aspirin or matching placebo for 6 months. The primary outcome was major or clinically relevant nonmajor bleeding. Results showed that apixaban was associated with less bleeding and fewer hospitalizations than the vitamin K antagonist, aspirin, or both, without significant differences in the incidence of ischemic events.
Twelve or 30 Months of Dual Antiplatelet Therapy after Drug-Eluting Stents
Mauri L et al. NEJM (December 2014)
Bottom Line: This randomized, double-blind, placebo-controlled trial included 9961 patients who had undergone a coronary stent procedure and were treated with thienopyridine and aspirin for 12 months. Patients were then randomized to either continue thienopyridine treatment or receive placebo for another 18 months. The coprimary outcomes were stent thrombosis and major adverse cardiovascular and cerebrovascular events (a composite of death, myocardial infarction, or stroke), and the primary safety outcome was moderate or severe bleeding. Results showed that continued thienopyridine treatment significantly reduced the risks of stent thrombosis (hazard ratio, 0.29 [95%CI], 0.17 to 0.48]; P<0.001) and major adverse cardiovascular and cerebrovascular events (hazard ratio, 0.71 [95% CI, 0.59 to 0.85]; P<0.001), but was associated with an increased risk of bleeding (2.5% vs. 1.6%, P=0.001).
Cardio Trial Files Issue #CRD-2024-23
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