review of the latest clinical trials about CHD

1. Clinical trials in
CHD (2017)
By
M.Wafaie aboleineen,MD,FACC

14. Compare-Acute
• All-cause death, MI, cerebrovascular
event, or any revascularization at 12
months: 7.8% of the complete group
versus 20.5% of the infarct artery only
group (p < 0.001)
• MI: 2.4% for complete vs. 4.7% for
infarct artery only (p = 0.10)
• Revascularization: 6.1% for complete vs.
17.5% for infarct artery only (p < 0.001)
Trial design: STEMI patients undergoing primary PCI were randomized to fractional flow
reserve (FFR)-guided complete revascularization (n = 295) versus infarct artery only
revascularization (n = 590).
Results
Conclusions
•Among STEMI patients undergoing
primary PCI, FFR-guided complete
revasc. was superior to infarct artery
only revasc.
Smits PC, et al. N Engl J Med 2017;376:1234-44
FFR-guided
complete revasc.
Infarct artery
only revasc.
%
(p < 0.001)
7.8
20.5

15. Pharmacogenomic Approach to Selecting Antiplatelet
Therapy in ACS, PHARMCLO trial, JACC, : 22 February
2018 Francesca Maria Notarangelo, MD
Genotyping . CVdeath (15.9%) in the
pharmacogenomic arm and (25.9%) in the
standard of care arm (P<0.001).
Conclusion: A personalised approach to
selecting antiplatelet therapy for ACS
reduce ischemic and bleeding events .

22. The DARE trial
(Drug-eluting bAlloon for in-stent Restenosis)
José PS Henriques, MD
Jan Baan, MD
Academic Medical Center
Amsterdam, The Netherlands
A randomized comparison of paclitaxel-eluting
balloon* versus everolimus-eluting stent for the
treatment of any in-stent restenosis
DARE TRIAL
Jose PS Henriques
*DEB Not approved in US

23. Clinical Endpoints
Drug-eluting
balloon
Drug- eluting
stent p-value
n=137 n=141
Death 0.7% (1) 1.4% (2) 0.58
Cardiac death 0 0.7% (1) 0.32
Myocardial infarction 2.2% (3) 2.8% (4) 0.74
Stent thrombosis 0 0 n/a
Stroke 0.7% (1) 1.4% (2) 0.58
Target vessel revascularization 8.8% (12) 7.1% (10) 0.65
Composite major adverse events* 10.9% (15) 9.2% (13) 0.66
DARE TRIAL

24. *DEB Not approved in US
Conclusion Dare Trial
• Greater acute gain with DES , offset
by greater late loss .
• DEB alternative therapy for ISR .
• Confirming European guidelines class
1A DEB for ISR
DARE TRIAL

25. Dr. Michelle M. Graham
University of Alberta and Mazankowski Alberta Heart
Institute, Edmonton, Canada
on behalf of POISE-2 Investigators
PeriOperative ISchemic Evaluation-2 Trial
POISE-2
Aspirin in patients with previous
percutaneous coronary intervention (PCI)
undergoing noncardiac surgery: The
POISE-2 PCI Substudy

26. Death/MI in prior PCI patients

27. Conclusions
For every 1000 patients with prior
PCI, perioperative aspirin will prevent
59 MIs but cause 8 major bleeds
Preoperative aspirin more likely
benefit than harm patients

29. Results Six trials (14 580 with
STEMI and 15 036 with NSTE-
ACS).

33. Chiarito M, et al. , . JAMA Cardiol
2018;Feb 7
Conclusions
With NSTEMI, the risk-benefit profile of
DOAC appears unfavorable.
DOAC in addition to APT might
represent an attractive option for patients
with STEMI