Cardio Trial Files Throwback Thursday: Bilateral vs. Single IMA Graft in Multivessel CAD, Rosuvastatin for Primary CV Prevention, and ARNI vs. Enalapril in HFrEF
Bilateral versus Single Internal-Thoracic-Artery Grafts at 10 Years
Taggart DP et al. NEJM (January 2019)
Bottom Line: This randomized controlled, non-blinded, trial included 3098 patients scheduled for coronary-artery bypass grafting (CABG) surgery who were assigned to either bilateral or single internal-thoracic-artery grafting. The primary outcome was death from any cause at 10 years, with the composite of death from any cause, myocardial infarction, or stroke as a secondary outcome. There was no significant difference between the two groups in the rate of death from any cause at 10 years (HR, 0.96; 95% CI, 0.82 to 1.12; P=0.62) or in the composite outcome of death, myocardial infarction, or stroke (HR, 0.90; 95% CI, 0.79 to 1.03).
Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein
Ridker PM et al. NEJM (November 2008)
Bottom Line: This randomized, double-blinded, clinical trial of 17,802 apparently healthy men and women with elevated high-sensitivity C-reactive protein levels but without hyperlipidemia compared the effects of rosuvastatin (20 mg daily) to placebo for a median follow-up of 1.9 years. The primary outcome of myocardial infarction, stroke, arterial revascularization, hospitalization for unstable angina, or death from cardiovascular causes was significantly reduced in the rosuvastatin group (HR 0.56; 95% CI, 0.46 to 0.69; P<0.00001). Rosuvastatin also reduced LDL cholesterol levels by 50% and high-sensitivity C-reactive protein levels by 37%. The safety outcome of physician-reported diabetes was higher in the rosuvastatin group, but there was no significant increase in myopathy or cancer.
Angiotensin–Neprilysin Inhibition versus Enalapril in Heart Failure
McMurray JJV et al. NEJM (September 2014)
Bottom Line: This double-blind, randomized controlled trial compared angiotensin receptor–neprilysin inhibitor LCZ696 with enalapril in 8442 patients with class II, III, or IV heart failure and an ejection fraction of 40% or less. The primary outcome was a composite of death from cardiovascular causes or hospitalization for heart failure. After a median follow-up of 27 months, LCZ696 was found to reduce the risk of the primary outcome by 20% (HR 0.80; 95% CI, 0.73 to 0.87; P<0.001) and the risk of death from any cause by 16% (HR 0.84; 95% CI, 0.76 to 0.93; P<0.001). LCZ696 also reduced the risk of hospitalization for heart failure by 21% (P<0.001) and decreased the symptoms and physical limitations of heart failure (P=0.001).
Cardio Trial Files Issue #CRD-2024-15
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