Journal articles

Question 1

Ascend trial

Answer 1

Benefits of aspirin for primary prevention in type 2 diabetics were counterbalanced by bleeding risks.

Question 2

Arrive trial

Answer 2

Use of aspirin in low to moderate risk patients did not improve outcomes and worsened bleeding events.

Question 3

Declare Timi 58

Answer 3

Dapagliflozen reduces MACE in patients with T2DM and precious infarction

Question 4

Fame 2 trial

Answer 4

FFR guided PCI reduced urgent revascularisation 8% ARR

Stopped early and did not detect difference in MI or Death

Question 5

Coapt trial

Answer 5

Mitral clip reduced
- Hospitalisation (ARR 32%)
- all cause death (ARR 17%)
Over 2 years with improvement in symptoms

Patients were functional MR both ischaemic and non ischaemic EF <50% in origin deemed surgically inappropriate and interventional appropriate for mitraclip by heart team meeting

Question 6

Plato trial

Answer 6

2% ARR with ticagrelor over clopidogrel for ACS (mortality reduction by 1.5%) with no increased major bleeding BUT increased fatal bleeding (0.2% increase) and fatal ICH (<0.1% increase)

Question 7

Triton timi trial

Answer 7

In ACS Prasugrel compared to clopidogrel reduced recurrent MI by 2% (without mortality reduction) while also increasing non-CABG major bleeding by about 0.6%

Question 8

Accoast trial

Answer 8

Pretreatment with prasugrel in ACS prior to defining coronary artery anatomy did not reduce MACE at 30 days with an increase in timi major bleeds by 1.2%.

Question 9

CURE trial

Answer 9

Dapt with clopidogrel for 12 months after ACS reduces MACE by 2% (driven by MI) with 1% increase in major bleeding

Question 10

DAPT trial

Answer 10

30 months of Dapt (clopidogrel) compared to 12 months resulted in 2% reduction in MI, 1% reduction in stent thrombosis, 0.5% reduction in all cause mortality (though just not significant, P 0.05) with 1% increase in moderate to major bleeding.

N.B all cause mortality is better in meta analyses on this issue combining ACS and stable CAD

Question 11

ISAR React

Answer 11

Prasugrel when compared to ticagrelor in ACS had lower rates of MI (1.8%) with similar rates of major bleeding.

Numerically lower rates of stent thrombosis and death.

Question 12

Cure trial

Answer 12

For medically managed NSTEACs DAPT over aspirin alone resulted in 2% ARR in mortality and MI

Question 13

Woest Trial

Answer 13

Compared to 12 months of triple therapy, dual therapy with clopidogrel was associated with significantly less bleeding and reduced all cause death and no difference in MACE.

Question 14

Zeus trial

Answer 14

Zotarolimus stent was better than BMS for MI and stent thrombosis.

Question 15

Partner trial

Answer 15

In those not eligible for SAVR, TAVR provided 20% ARR for mortality over 1 year

Question 16

Carp trial

Answer 16

Revascularisation of ischaemic heart disease did NOT result in improved perioperative or long term mortality/MI in patients undergoing AAA repair or lower limb arterial vascular surgery.

Question 17

Digami trial

Answer 17

Insulin infusion and 3 months of insulin S/C in diabetics with AMI resulted in 7% mortality reduction at 1 year and 10% mortality reduction at 3 years

Question 18

Madit CRT

Answer 18

CRT in HFREF <31% with QRS >130 showed reduction in heart failure exacerbation by ARR 8% over 2.5 years

Question 19

Hope trial

Answer 19

Ace inhibition in ACS with ramipril, regardless of BP resulted 3.8% ARR for composite endpoint of cardiovascular death/MI/stroke

Question 20

Race 2 trial

Answer 20

No difference in strict rate control (80) vs lenient rate control (110) in composite endpoint

Numerical increase in death stroke and heart failure hospitalisation