coronary disease, myocardial infarction
DISEASE INTERVENTION COMPARISON RESULTS
Heart. 2009 Mar;95(3):198-202 Systematic Review
IN coronary disease, myocardial infarction The Use of
rutine oxygen
As Treatment, Acute
Is worse Than
room air
To improve mortality or clinical outcomes: the only one study found that high-flow O2 had non-sifnificant increased risk of death and higher enzyme levels
Eur Heart J. 2007 Dec;28(24):3012-9 Meta-Analysis
IN coronary disease, myocardial infarction The Use of
further reduction of resting heart rate using beta blockers (or calcium channel blockers)
As Treatment, Chronic
Is better Than
less important reduction of resting herat rate
To reduce cardiac mortality: each 10 b.p.m. reduction estimated to reduce the relative risk of cardiac death by 30%
J Am Coll Cardiol. 2014 Nov 18-25;64(20):2071-82 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction The Use of
polypill, fixed-dose combinations of drugs
As Treatment, Chronic
Is better Than
same drugs given separately
To improve medication adherence : 51% polypill VS 41% drugs separately
Ann Intern Med. 1998 Nov 1;129(9):681-9 Randomized Controlled Trial
IN coronary disease, myocardial infarction The Use of
statins
As Treatment, Chronic
Is Than
To
N Engl J Med. 2002 Sep 26;347(13):969-74 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction The Use of
vitamin K antagonists, warfarin, added to aspirin or alone
As Treatment, Chronic
Is better Than
aspirin alone
To reduce cardiovascular events (death, MI or ischemic stroke), rates per year: 3.5% warfarin plus aspirin VS 4.2% warfarin VS 5% aspirin.
N Engl J Med. 1999 Aug 26;341(9):625-34 Randomized Controlled Trial
IN coronary disease, myocardial infarction, cardiogenic shock The Use of
early invasive strategy, early revascularization, angioplasty or surgical
As Treatment, Acute
Is better Than
conservative strategy: initial medical stabilization and selective late revascularization
To reduce mortality at 6 months: 50% with urgent revascularization vs. 63% conttrols
JAMA. 2006 Jun 7;295(21):2511-5 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, cardiogenic shock The Use of
early invasive strategy, early revascularization, angioplasty or surgical
As Treatment, Acute
Is better Than
conservative strategy: initial medical stabilization and selective late revascularization
To to improve patient long term survival: at 6 years, overall survival rates were 32.8% in early revasc and 19.6% in initial medical Tt
N Engl J Med. 2003 Nov 13;349(20):1893-906 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, heart failure, chronic, systolic The Use of
angiotensin II receptor blockers, valsartan, alone or combined with ACE inhibitors
As Treatment, Chronic
Is equal Than
angiotensin converting enzyme (ACE) inhibitors, captopril
To modify overall mortality (about 9.97% per year in valsartan, 9.75% per year in captopril and 9.63% per year with combined treatment) Combining valsartan + captopril did not increased survival but it did adverse events
PLoS Med. 2009 Apr 21;6(4):e1000057 Cohorts
IN coronary disease, myocardial infarction, non-Q, unrecognized The Use of
delayed-enhancement cardiac magnetic resonance
As Diagnostic Tool
Is better Than
ECG and cardiac enzymes
To diagnose recent non-Q myocardial infarction: 27% of patients suspected of ischemic heart disease. Unrecognized non-Q infarction carries a hight mortality: 26% at 2.2 years.
N Engl J Med. 2005 Mar 24;352(12):1179-89 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, ST-segment elevation The Use of
antiplatelet drugs, adenosine diphosphate (ADP) receptor inhibitors, clopidogrel (300-mg loading dose, 75 mg/d after) added to fibrinolysis plus aspirin plus heparin
As Treatment, Acute
Is better Than
standard antithrombotic Tt with fibrinolysis + aspirin + heparin alone (+ placebo)
To reduce at 30 days vascular events (cardiovascular death, recurrent infarction, revascularization because recurrent ischemia): 11,6% with clopidogrel VS 14,6% standard Tt, Major bleeding and intracranial hemorrhage similar in the two groups.
Lancet. 2005 Nov 5;366(9497):1607-21 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, ST-segment elevation The Use of
antiplatelet drugs, adenosine diphosphate (ADP) receptor inhibitors, clopidogrel (75 mg/d) added to standard Tt (aspirin 100%, fibrinolysis 50%, anticoagulant 75%)
As Treatment, Acute
Is better Than
aspirin alone and standard antithrombotic Tt
To To reduce at 30 days vascular events (death, recurrent infarction, stroke): 9,2% with clopidogrel VS 10,1% aspirin alone.
Lancet. 2005 Nov 5;366(9497):1622-32 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, ST-segment elevation The Use of
early intravenous beta-blockers (metoprolol, up to 15 mg IV then 200 mg oral daily
As Treatment, Acute
Is equal Than
placebo
To reduce at 30 days death (7.7% VS 7.8%) or death, reinfarction, or cardiac arrest combined (9.4% with metoprolol VS 9.9% with placebo).
Circulation. 2010 Apr 6;121(13):1484-91 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, ST-segment elevation The Use of
early treatment with primary percutaneous coronary intervention, angioplasty
As Treatment, Acute
Is better Than
early primary fibrinolysis
To reduce at 8 years reinfarction (13% angioplasty VS 18.5% fibrinolysis ) and mortality (27% angioplasty VS 33% fibrinolysis )
JAMA. 2007 Nov 28;298(20):2399-405 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, ST-segment elevation The Use of
glucose-insulin-potassium infusion
As Treatment, Acute
Is equal Than
no this treatment
To improve death or heart failure: 6.2% in the GIK group VS 5.5% in the control group, p non significant.
Am J Cardiol. 2005 Oct 15;96(8):1053-8. Epub 2005 Aug 24 Randomized Controlled Trial
IN coronary disease, myocardial infarction, ST-segment elevation The Use of
glucose-insulin-potassium infusion
As Treatment, Acute
Is better Than
usual care (thrombolysis with streptokinase) alone
To reduce at 1 month major adverse cardiac events (death, reinfarction, serious arrhythmias and severe heart failure): 10% with gluc-insulin-K vs 32.5% without.
JAMA. 2005 Jan 26;293(4):437-46 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, ST-segment elevation The Use of
glucose-insulin-potassium infusion
As Treatment, Acute
Is equal Than
usual care alone
To reduce mortality, cardiogenic shock or reinfarction at 30 days
Eur Heart J. 2004 Dec;25(24):2187-94 Randomized Controlled Trial
IN coronary disease, myocardial infarction, ST-segment elevation The Use of
late (2 - 15 days after MI) routine percutaneous revascularization
As Treatment, Acute
Is equal Than
medical treatment alone, if patient stable
To reduce cardivascular events (composite of cardiac death, non-fatal MI, or ventricular tachyarrhythmia) at 3 years: 7.3% revascularization VS 8.7% controls
N Engl J Med. 2006 Apr 6;354(14):1477-88. Epub 2006 Mar 14 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, ST-segment elevation The Use of
low molecular weight heparins (LMWH), enoxaparin, for at least 2 days
As Treatment, Acute
Is better Than
unfractionated heparin (UFH), for the same time
To reduce, at 30 days, death or recurrent infarction: 9.9% enoxaparin VS 12% unfractionated heparin. Major bleeding were a little more frequent with enoxaparin (2.1%) than with UFH (1.4%)
Circulation. 2005 Dec 20;112(25):3855-67. Epub 2005 Dec 12 Meta-Analysis
IN coronary disease, myocardial infarction, ST-segment elevation The Use of
low molecular weight heparins (LMWH), for 4 to 8 days
As Treatment, Acute
Is better Than
placebo or unfractionated heparin (UFH)
To reduce, at 7 days, the risk of reinfarction (1.6% LMWH VS 2.2% placebo, NNT 167) and reduce death (7.8% LMWH VS 8.7% placebo, NNT 111)
Circulation. 2005 Dec 20;112(25):3846-54. Epub 2005 Nov 15 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, ST-segment elevation The Use of
low molecular weight heparins (LMWH), for 4 to 8 days
As Treatment, Acute
Is better Than
unfractionated heparin (UFH)
To reduce, at 30 days, cardiovascular death or recurrent myocardial infarction (6.9% with LMWH versus 11.5% with UFH)
JAMA. 2005 Jan 26;293(4):427-35 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, ST-segment elevation The Use of
low molecular weight heparins (LMWH), reviparin, for 7 days
As Treatment, Acute
Is better Than
placebo, added to usual medical care
To reduce cardivascular events (composite of death, reinfarction or stroke) at 30 days: 11,8% LMWH VS 13,6% controls; with reductions of 1,5% in mortality and 0,3% in reinfartion, non significant for stroke, 0,1% increase of severe bleeding.
Eur Heart J. 2011 Jan;32(1):51-60 Randomized Controlled Trial
IN coronary disease, myocardial infarction, ST-segment elevation, elder patients The Use of
primary percutaneous coronary intervention
As Treatment, Acute
Is equal Than
fibrinolysis
To significantly reduce cardiovascular events (all-cause mortality, re-infarction, or disabling stroke) at 30 days: 19% pPCI VS. 25% fibrinolysis. A pooled analysis with other 2 trials showed, however, a significant reduction of cardiovascular events
J Am Coll Cardiol. 2007 Jan 30;49(4):422-30 Meta-Analysis
IN coronary disease, myocardial infarction, ST-segment elevation, failed thrombolysis The Use of
rescue emergency angioplasty after failed thrombolytic therapy
As Treatment, Acute
Is better Than
repeated thrombolysis or conservative treatment
To reduce heart failure (RR 0.73) and reinfarction (RR 0.58), but associated with increased risk of stroke (RR 4.98)
N Engl J Med. 2005 Dec 29;353(26):2758-68 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, ST-segment elevation, failed thrombolysis The Use of
rescue emergency angioplasty after failed thrombolytic therapy
As Treatment, Acute
Is better Than
repeated thrombolysis or conservative treatment
To reduce, at 6 months, cardiovascular events (composite of death, reinfarction, stroke, or severe heart failure): 15.4% with rescue angioplasty VS 31.3% with repeated thrombolysis and 29.1% with conservative treatment
N Engl J Med. 2006 Dec 7;355(23):2395-407 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, total occlusion of the infarct-related artery The Use of
routine (3 to 28 days) invasive strategy, percutaneous coronary stenting
As Treatment, Acute
Is equal Than
optimal medical therapy and percutaneous intervention only if needed
To reduce, at 4 year, death or myocardial reinfarction: 17.2% invasive group VS 15.6% medical therapy
Lancet. 2005 Sep 10;366(9489):914-20 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, without ST-segment elevation The Use of
routine invasive strategy (angiography and revascularization)
As Treatment, Acute
Is better Than
conservative strategy (ischaemia- or symptom-driven angiography)
To reduce at 5 years: death or non-fatal myocardial infarction (16.6% in invasive VS 20% in conservative strategy). A trend to reduce death but not significant.
Am J Med. 2005 May;118(5):465-74 Meta-Analysis
IN coronary disease, myocardial infarction, without ST-segment elevation, unstable angina The Use of
routine invasive strategy
As Treatment, Acute
Is better Than
conservative strategy
To reduce rates of fatal or nonfatal re-infarction and hospital readmission, but not all-cause mortality.
J Am Coll Cardiol. 2005 Aug 2;46(3):425-31 Randomized Controlled Trial, Multicenter Study
IN heart failure, acute, coronary disease, myocardial infarction The Use of
aldosterone blockers, eplerone, 25 mg/day initiated 3 to 14 days after AMI
As Treatment, Chronic
Is better Than
placebo
To reduce at 30 days all-cause mortality (3.2% with eplerone VS 4.6% with placebo), reduce cardiovascular mortality and reduce hospitalizations.