Cardio Trial Files Throwback Thursday: Aspirin for ASCVD 1° Prevention, Stenting vs. CEA in Carotid Stenosis, and ICD for ICM Post MI
Effect of Aspirin on Disability-free Survival in the Healthy Elderly
McNeil JJ et al. NEJM (September 2018)
Bottom Line: This randomized, double-blind, placebo-controlled trial recruited 19,114 community-dwelling persons in Australia and the United States aged 70 or older (or ‚â•65 among blacks and Hispanics in the US) without cardiovascular disease, dementia, or physical disability. Participants were randomly assigned to receive 100 mg per day of enteric-coated aspirin or placebo orally for a median of 4.7 years. The primary end point was a composite of death, dementia, or persistent physical disability. Results showed that the rate of the composite of death, dementia, or persistent physical disability was not significantly different between the aspirin group and the placebo group (21.5 events per 1000 person-years vs. 21.2 per 1000 person-years, respectively). However, the rate of major hemorrhage was higher in the aspirin group than in the placebo group (3.8% vs. 2.8%). In conclusion, aspirin use in healthy elderly persons did not prolong disability-free survival over a period of 5 years but led to a higher rate of major hemorrhage than placebo.
Stenting versus Endarterectomy for Treatment of Carotid-Artery Stenosis
Brott TG et al. NEJM (July 2010)
Bottom Line: This randomized clinical trial compared carotid-artery stenting and carotid endarterectomy in 2502 patients with symptomatic or asymptomatic carotid stenosis over a median follow-up period of 2.5 years. The primary composite end point was stroke, myocardial infarction, or death from any cause during the periprocedural period or any ipsilateral stroke within 4 years after randomization. The 4-year rate of the primary end point was 7.2% with stenting and 6.8% with endarterectomy (hazard ratio with stenting, 1.11; 95% confidence interval, 0.81 to 1.51; P=0.51). The 4-year rate of stroke or death was 6.4% with stenting and 4.7% with endarterectomy (hazard ratio, 1.50; P=0.03). There was no differential treatment effect with regard to the primary end point according to symptomatic status or sex. The results suggest that carotid-artery stenting and carotid endarterectomy are similarly safe for treating carotid-artery stenosis.
Prophylactic Use of an Implantable Cardioverter–Defibrillator after Acute Myocardial Infarction
Hohnloser SH et al. NEJM (December 2004)
Bottom Line: The Defibrillator in Acute Myocardial Infarction Trial was a randomized, open-label study of 674 patients with reduced left ventricular function and impaired cardiac autonomic function, who received either ICD therapy or no ICD therapy 6 to 40 days after a myocardial infarction. Over a mean follow-up period of 30 months, there was no difference in overall mortality between the two groups. ICD therapy was associated with a reduction in the rate of death due to arrhythmia, but this was offset by an increase in the rate of death from nonarrhythmic causes.
Cardio Trial Files Issue #CRD-2024-25
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