Five practice changing cardiology trials in 2019 of importance to CMAAO Countries

Dr KK Aggarwal , President CMAAO and HCFI

ISCHEMIA Trial: Chronic coronary artery disease is not a time bomb in the chest but a condition that should be treated with reassurance, lifestyle changes, and medical therapy.

DAPA-HF trial: Dapagliflozin, a SGLT2 inhibitor reduces CV death, worsening heart failure, and overall death when used on top of optimal medical therapy in patients with heart failure due to a reduced ejection fraction.

 The ISCHEMIA-CKD: The best thing a cardiologist can do for a patient with advanced kidney disease is to resist the urge to do procedures. The trial despite great efforts to reduce contrast-induced kidney injury, the invasive approach was not associated with a reduction in CV death or MI. The safety endpoint of death or dialysis was 48% higher in the invasive arm, and stroke rates were nearly fourfold higher.

RACE 7 ACWAS: no need for early cardioversion for recent-onset AF. Wait for 48 hours. 69% of patients in the delayed-cardioversion group converted spontaneously within 48 hours. Most patients we cardiovert in the emergency department for acute-onset AF could be spared an anesthetic and high-voltage shock if clinicians would simply give peace a chance and wait 48 hours.

 SAR-REACT 5 study showed that prasugrel trounced ticagrelor for the reduction of death, myocardial infarction, or stroke at 1 year. And prasugrel achieved this superiority without an increase in major bleeding.