Cardiology Trails Flashcards

Question

What did the CIBIS-II trial show?

Answer 1

Bisoprolol improved mortality in NYHA 3-4 --------------------------- 1999

Answer 2

Carvedilol superior to metoprolol reducing mortality in NYHA II+ & EF <35% (e.g. there is some difference in outcome with b-blocker choice) -------------------------- 2003

Answer 3

CRT (added to ICD) reduced CCF exasc in well low EF patients -------------------------------- 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 ----------------------------- 2009

Answer 4

``` 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 -------------------------------- 2005

Answer 5

Digoxin reduced CCF hospitalisation but not mortality ----------------------------------- 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 ------------------------------- 1997

Answer 6

Overall: Ivabradine beneficial in angina 7 HR > 70; see SHIFT ----------------------------- Very detailed trial with a lot of outcomes: ------------------------------- 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 --------------------------------- 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 ------------------------------ 2008 - 2009 ```

Answer 7

Ultrafiltration inferior to diuretics in cardiorenal syndrome ------------------------------- 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 ------------------------------- 2012