Cardio Trial Files Throwback Thursday: RV Pacing vs. BiV Pacing in HF with AV Block, Rivaroxaban vs. Warfarin in AF, and Scaffold vs. Stent in PCI
Biventricular Pacing for Atrioventricular Block and Systolic Dysfunction
Curtis AB et al. NEJM (April 2013)
Bottom Line: This randomized, controlled study of individuals with atrioventricular block, New York Heart Association class I, II, or III heart failure, and a left ventricular ejection fraction of 50% or less compared biventricular pacing to right ventricular pacing. A total of 691 participants were randomized, and the mean follow-up was 37 months. Results showed that biventricular pacing was superior to conventional right ventricular pacing, with 190 of 342 patients (55.6%) in the right-ventricular-pacing group experiencing the primary outcome, compared with 160 of 349 (45.8%) in the biventricular-pacing group (hazard ratio, 0.74; 95% credible interval, 0.60 to 0.90). Left ventricular lead-related complications occurred in 6.4% of patients.
Rivaroxaban versus Warfarin in Nonvalvular Atrial Fibrillation
Patel MR et al. NEJM (September 2011)
Bottom Line: This double-blind, noninferiority, randomized trial compared the efficacy and safety of rivaroxaban (20 mg/day) to dose-adjusted warfarin in 14,264 patients with nonvalvular atrial fibrillation. The primary outcome of stroke or systemic embolism occurred in 1.7% per year in the rivaroxaban group and 2.2% per year in the warfarin group, showing noninferiority of rivaroxaban (hazard ratio, 0.79; 95% CI, 0.66 to 0.96; P<0.001 for noninferiority). Major and nonmajor clinically relevant bleeding occurred in 14.9% and 14.5% per year in the rivaroxaban and warfarin groups, respectively, with significant reductions in intracranial and fatal bleeding in the rivaroxaban group. In conclusion, rivaroxaban was noninferior to warfarin for the prevention of stroke or systemic embolism.
Bioresorbable Scaffolds versus Metallic Stents in Routine PCI
Wykrzykowska JJ et al. NEJM (June 2017)
Bottom Line: This randomized trial, which was recommended early reporting of the study results because of safety concerns, compared an everolimus-eluting bioresorbable scaffold with an everolimus-eluting metallic stent in 1845 patients undergoing percutaneous coronary intervention. The primary outcome was target-vessel failure; the median follow-up was 707 days. Results showed no significant difference in the rate of target-vessel failure between the two groups, but the bioresorbable scaffold was associated with a higher incidence of device thrombosis than the metallic stent (2-year cumulative event rates, 3.5% vs. 0.9%; hazard ratio, 3.87; 95% CI, 1.78 to 8.42; P<0.001).
Cardio Trial Files Issue #CRD-2024-11
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