Cardiology Trails

Question 1

What did the EPHESUS trail show?

Answer 1

Eplerenone vs. placebo
-15% RRR in deaths
-16% RRR in CV death or hospitalization for CV events
-8% RRR in death from any cause or any hospitalization
-21% RRR in sudden death from cardiac causes
-Increased risk of serious hyperkalaemia
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6500 patients
Double blind multi center RCT

Question 2

What did the COMMIT trial show?

Answer 2

2005
45,000 patients
Double-blinded multi-center RCT
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Refuted earlier controversial trial (ISIS-1) which claimed to show benefit of atenolol within 24hrs MI (unblinded trial). Better to wait now before starting B-blockers.

Question 3

What did the CURRENT-OASIS trial show?

Answer 3

2010
25086 patients
Double-blinded multi-center RCT

Question 4

What did the TRITON-TIMI-38 trial show?

Answer 4

Prasugrel superior to clopidogrel in ACS scheduled for PCI
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2007
13600 patients
Randomised, blinded

Question 5

What did the TRILOGY-ACS trial show?

Answer 5

2012
9000 patients
Randomized, double-blind, double-dummy, active-control, event-driven trial

Question 6

What did the CURE trail show?

Answer 6

Proved benefit of clopidogrel added to aspirin in NSTEMI/UA
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2001
12500 patients
Double-blinded multi-center RCT

Question 7

What did the CADILLAC trial show?

Answer 7

Abciximab reduces mortality and thrombosis/TVR in addition to ticlodipine/aspirin in PCI
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2003
2082 patients	
Double-blinded multi-center RCT

Question 8

What did the IMPROVE-IT trial show?

Answer 8

2015

Question 9

What did the OASIS-6 trial show?

Answer 9

2006

Question 10

What did the NORDISTEMI trial show?

Answer 10

2010

Question 11

What did the PROVE-IT trial show?

Answer 11

2004

Question 12

What did the ISIS-3 trial show?

Answer 12

UFH no benefit added to aspirin without PCI. 3 thrombolysis agents similar (streptokinase, tPA, alteplace)

Question 13

What did the AFFIRM trial show?

Answer 13

Rate control non-inferior to rhythm control and possibly superior in elderly and co-morbid patients.
Anticoagulation is beneficial even in rate control
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2002

Question 14

What did the RACE-II trial show?

Answer 14

2010

Question 15

What did the ARISTOTLE trial show?

Answer 15

2011

Question 16

What did the ROCKET-AF trial show?

Answer 16

2011

Question 17

What did the ATHENA and PALLAS trials show?

Answer 17

Dronedarone may be beneficial in low-risk paroxysmal or persistant AF patients (ATHENA) but appears harmful in higher risk patients (PALLAS) - e.g. stopped early as it killed patients

Question 18

What did the HOPE trial show?

Answer 18

2000

Question 19

What did the ONTARGET trial show?

Answer 19

2008

Question 20

What did the SATURN trial show?

Answer 20

2011

Question 21

What did the ASCERT trial show?

Answer 21

2012

Question 22

What did the CONSENSUS trial show?

Answer 22

1987

Question 23

What did the SOLVD trial show?

Answer 23

1992

Question 24

What did the CHARM trial show?

Answer 24

2003

Question 25

What did the CIBIS-II trial show?

Answer 25

1999

Question 26

What did the COMET trial show?

Answer 26

2003

Question 27

What did the MADIT-CRT trial show?

Answer 27

ICD-CRT (vs. ICD alone):
-41% (significant) reduction in heart-failure exascerbations (ARR 8.9%)
–Similar benefits for ischaemic & non-ischaemic cardiomyopathy
-Significant reduction in LV volume & EF improvement
-Similar risks of death (3%/yr)
-Greatest benefit when QRS > 150ms
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2009

Question 28

What did the SCD-HeFT trial show?

Answer 28

ICD in NYHA II/III reduced mortality; amiodarone did not
-------------------------------
ICD
-Significantly increase survival
-RRR 23%, ARR 7.2% at 5yr

Amiodarine
-No benefit to survival
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2005

Question 29

What did the DIG trial show?

Answer 29

Digoxin (+-ACE/diuretic) vs. placebo (+-ACE/diuretic)
-No difference in mortality (RR 0.99; p=0.8)
-Reduced hospitalisation for HF (RR 0.72; p<0.001)
-6% fewer all-cause hospitalisation (p=0.01)

Ancillary trial (EF > 45% - "diastolic HF")
-No difference in mortality
-Similar trend towards reduce hospitalisation
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1997

Question 30

What did the BEAUTIFUL trial show?

Answer 30

Very detailed trial with a lot of outcomes:
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Patients with HR > 70 showed increased:
-Risk for cardiovascular death
-Admission to hospital for heart failure
-Admission to hospital for myocardial infarction
-Coronary revascularisation
Risks increased for all every 5 bpm
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Subgroup analysis on patients with angina as limiting symptom at baseline (13.8%)
-Ivabradine associated with 24% reduction in primary endpoint
–(CV mortality, MI or CCF hospitalisation)

In those with angina & HR > 70
-73% reduction in hospitalization for MI
-59% reduction in coronary revascularization
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2008 - 2009

Question 31

What did the CARRESS-HF trial show?

Answer 31

Ultrafiltration vs. stepped pharmacologic therapy in cardiorenal syndrome
-Increased serum creatinine at 96hrs (P=0.003)
-No significant difference in weight loss
-Increased serious adverse events
Pharmacologic therapy included continuous infusion of diuretics +-metolazone +-vasoactive therapy
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2012