Cardiovascular trials

 

CARP 2004

Question

PCI/CABG pre-vascular surgery

Type

·      Multi-centre RCT

Upshot

·      ↔AMI

·      ↔Mortality

Comments

·      High risk patients excluded (e.g. LMCA disease, LVEF <20%, severe AS)

·      98% male

 

POISE 2008

Question

Metoprolol in patients undergoing non-cardiac surgery

Background

·      Discredited DECREASE studies supported peri-op b-blocker

Type

·      Multi-national RCT

Upshot

·      ↓Non-fatal AMI

·      ↑Significant bradycardia

·      ↑Significant hypotension

·      ↑Stroke

·      ↑Death

 

Partner Cohort A

Question

TAVI vs AVR

Type

·      Multi-centre, randomized parallel trial

Subjects

·      Severe AS, high risk patients

Upshot

·      ↔Composite all-cause mortality or major stroke

·      ↓Major bleeding

·      ↑Vascular complication

Not sure which trials this stuff comes from

·      From multiple trials, TAVI… (I think)

·      ↓AKI

·      ↓New AF

·      ↓Major bleeding

·      ↓Mean valve gradient

·       

·      ↑Major vascular complications

·      ↑Pacemaker requirement

·      ↑Paravalvular regurgitation

·      ↑Re-intervention rate

·       

·      ↔Stroke

·      ↔Mortality

 

Partner Cohort B

Question

TAVI vs nothing

Type

·      Multi-centre, randomized parallel trial

Subjects

·      Severe AS, inoperable

Upshot

·      ↓All-cause mortality or major stroke at 1 year

·      ↓Readmission for valve at 1 year

·      ↑Vascular complications

 

POISE 2 Aspirin 2014

Question

Peri-op aspirin

Type

·      Multi-national, 2x2 factorial placebo-controlled RCT

Subjects

·      Non-cardiac surgery

Upshot

·      ↔Mortality

·      ↔AMI

·      ↑Major bleeding in those not already taking aspirin

 

POISE 2 Clonidine 2014

Question

Peri-op low dose clonidine

Upshot

·      ↔AMI

·      ↑Hypotension

·      ↑Non-fatal cardiac arrest

 

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