coronary disease, stable
DISEASE INTERVENTION COMPARISON RESULTS
N Engl J Med. 2017 10 05;377(14):1319-1330 Randomized Controlled Trial, Multicenter Study
IN coronary disease, stable The Use of
anticoagulants, oral factor Xa inhibitors, rivaroxaban (2.5 mg twice daily) plus aspirin (100 mg once daily)
As Treatment, Chronic
Is better Than
rivaroxaban (5 mg twice daily) alone, or aspirin (100 mg once daily) alone
To reduce cardiovascular events (death, stroke or MI): 4.1% riva+aspirine VS 5.4% aspirine. But increased major bleeding: 3.1% VS 1.9%. Riva 5 mg/d alone did not better than aspirin and had more bleeding.
N Engl J Med. 2011 Dec 1;365(22):2078-87. Epub 2011 Nov 15 Clinical Trial (non-controlled, non-randomized)
IN coronary disease, stable The Use of
high dose statins, atorvastatin 80 mg daily, or rosuvastatin 40 mg daily
As Treatment, Chronic
Is useful Than
no comparison done
To induced regression of atherome plaques (decrease percent atheroma volume (by about 1%) and total atheroma volume) measured by serial intravascular ultrasonography at 4.5 years
N Engl J Med. 1999 Jul 8;341(2):70-6 Randomized Controlled Trial
IN coronary disease, stable The Use of
high dose statins, atorvastatin 80 mg/d
As Treatment, Chronic
Is better Than
routine angioplasty, without statins
To reduce cardiovascular events (composite of coronary fatal and nonfatal events and stroke) at 18 months: 13.4% statin VS 20.9% angioplasty (mostly worsening angor)
N Engl J Med. 2007 Apr 12;356(15):1503-16. Epub 2007 Mar 26 Randomized Controlled Trial, Multicenter Study
IN coronary disease, stable The Use of
routine invasive strategy (angiography and revascularization)
As Treatment, Chronic
Is equal Than
optimal medical therapy alone
To reduce all-cause mortality or myocardial infarction, at 4.6 years: 19% routine PCI vs. 18.5% medical Tt alone. No difference in stroke or hospitalizations neither.
Lancet. 1992 Dec 12;340(8833):1421-5 Randomized Controlled Trial, Multicenter Study
IN coronary disease, stable angina The Use of
aspirin, low dose (75 mg/d)
As Treatment, Chronic
Is better Than
placebo
To reduce major cardiovascular events (34% relative reduction)
JAMA. 1999 May 26;281(20):1927-36 Meta-Analysis
IN coronary disease, stable angina The Use of
beta blockers
As Treatment, Chronic
Is better Than
calcium channel blockers
To reduce number of angina episodes (OR 0.31). But no significant differences in rates of death or myocardial infarction.
JAMA. 2003 Mar 5;289(9):1117-23 Randomized Controlled Trial, Multicenter Study
IN coronary disease, stable angina, elderly patients The Use of
routine invasive strategy (angiography and revascularization)
As Treatment, Chronic
Is equal Than
optimal medical therapy alone
To modify 1-year mortality (11% invasive VS 8% medical, p NS) or modify death + nonfatal infarction (17% invasive VS 20% medical). Invasive approach had increased events early months, and medical management had more cardiac events after 6 months.
Circulation. 2007 Mar 6;115(9):1082-9 Randomized Controlled Trial, Multicenter Study
IN coronary disease, stable angina, multvessel disease The Use of
coronary artery bypass graft (CABG)
As Treatment, Chronic
Is better Than
naked percutaneous coronary intervention (PCI), or medical therapy alone
To reduce, at 5 years, myocardial infarction, or refractory angina requiring revascularization (21% CABG VS 33% PCI VS 36% medical). No differences in overall mortality between the 3 goups
N Engl J Med. 2005 Apr 7;352(14):1425-35 Randomized Controlled Trial
IN coronary disease, stable, normal cholesterol The Use of
high dose statins, atorvastatin 80 mg/d
As Treatment, Chronic
Is better Than
standard dose statins, atorvastatin 10 mg/d
To reduce cardiovascular events (cardiac death or arrest, AMI or stroke) at 5 years: 8,7% with 80mg/d VS 10,9% with 10mg/d, an ARR of 0,44% year
Circulation. 2014 Apr 15;129(15):1577-85 Cohorts
IN coronary disease, stable, atrial fibrillation The Use of
anticoagulation alone, vitamin K antagonists
As Treatment, Chronic
Is equal Than
bi-therapy combining anticoagulant (vitamin K antagonist) + an antiplatelet
To modify at 3 years the risk of myocardial infarction, cardiac death or thromboembolism, while the risk of bleeding was higher with bi-therapy (HR 1.5)
N Engl J Med. 2009 Jun 11;360(24):2503-15. Epub 2009 Jun 7 Randomized Controlled Trial, Multicenter Study
IN coronary disease, stable, diabetes mellitus, type 2 The Use of
systematic prompt revascularization, either by percutaneous coronary intervention (PCI) or coronary-artery bypass grafting (CABG)
As Treatment, Chronic
Is equal Than
intensified medical therapy alone
To reduce at 5 years major cardiovascular events (77.2% revascularization VS 75.9% medical Tt). A reduction in cardiovascular events was observed with CABG in tri-troncular patients (22% revascularization VS 30% medical Tt)
Lancet. 2003 Sep 6;362(9386):782-8 Randomized Controlled Trial, Multicenter Study
IN coronary disease, stable, normal left ventricular function, most patients previous myocardial infarction and revascularization The Use of
angiotensin converting enzyme (ACE) inhibitors, perindopril 8 mg/d, added to standard treatment
As Treatment, Chronic
Is better Than
placebo
To reduce cardiac events (cardiovascular death, myocardial infarction, or cardiac arrest): 8% perindopril VS 10% placebo
N Engl J Med. 2004 Nov 11;351(20):2058-68 Randomized Controlled Trial, Multicenter Study
IN coronary disease, stable, normal left ventricular function, most patients previous revascularization The Use of
angiotensin converting enzyme (ACE) inhibitors, trandolapril (4 mg/d), added to standard treatment
As Treatment, Chronic
Is equal Than
placebo
To reduce cardiac events (death from cardiovascular causes, myocardial infarction, or coronary revascularization): 21.9% in trandolapil VS 22.5% in placebo - at 5 years (so, aprox. 4.4% per year event rate)
Lancet. 2008 Sep 6;372(9641):807-16 Randomized Controlled Trial, Multicenter Study
IN coronary disease, stable, reduced left ventricular function The Use of
ivabradine, added to beta-blockers
As Treatment, Chronic
Is equal Than
placebo
To reduce a composite outcome (cardiovascular deah, myocardial infarction or worsening heart failure) at 20 months. It improved a secondary endpoint (myocardial infarction) but not main endpoint, in one subgroup analysis (patients with heart rate > 70 bpm)