Important Cardiology trials summarized!

[NMed]

Hey guys,

I looked around online but couldn't find a good reference on summaries of important cardiology trials for any resident/aspiring cardiologist like myself. So I created one myself and would like it share it for fellow studentdoctor networkees..

Any suggestions/error corrections are appreciated. If I missed a particular trial, please let me know and I'll try to add them to next updates of the document. Mods please sticky if appropriate.

Enjoy and hope it helps!

NMed

Wikipedia link: Cardiology Trials Quick Review

---

Members don't see this ad.

 

[Terex]

Thanks a lot Man!!!

Hey guys,

I looked around online but couldn't find a good reference on summaries of important cardiology trials for any resident/aspiring cardiologist like myself. So I created one myself and would like it share it for fellow studentdoctor networkees..

Any suggestions/error corrections are appreciated. If I missed a particular trial, please let me know and I'll try to add them to next updates of the document. Mods please sticky if appropriate.

Enjoy and hope it helps!

NMed

 

[cool c]

thanks a bunch

 

[NMed]

glad to help!

 

[Dreemer005]

You should make a wiki page for it. Would be neat to fill in additional information about the study, such as inclusion/exclusion, etc.

 

[KaLiMaN]

Thank you very helpful information.

 

[NMed]

You should make a wiki page for it. Would be neat to fill in additional information about the study, such as inclusion/exclusion, etc.

yep..wiki page is coming along as well.. once it's up, user contribution will make adding such info much faster ..

Thank you very helpful information.

you're welcome!

 

[LatinGeorge]

hey,

perhaps this could help outhttp://www.incirculation.net/whatswhat/11078_0.aspx

those r the clasic trials who r relevant in each day for a cardiologist..

hope it helps

 

[tkim]

http://www.thennt.com/

 

[DrStevo]

Anybody have any good websites or references for principles or basics of left heart cath. Thanks

 

[NMed]

hey,

perhaps this could help outhttp://www.incirculation.net/whatswhat/11078_0.aspx

those r the clasic trials who r relevant in each day for a cardiologist..

hope it helps

thanks, it's a great resource; it helped me alot when i was intinially starting the project

http://www.thennt.com/

thanks! i'll check it out

 

[whatevr]

@NMED

this is a great summary!
iam a pgy 1 & hard core cards fan(though much ignorant) but no mentor or any research in my program. love research though still wrapping my head around how to s of a research.. i have to start an research from scratch here & have no idea where to begin, and dont now enough cards to come up with a good idea..
any guidance or collaboration with any one doing any kind or form of research will be much appreciated!

 

[KaLiMaN]

@NMED

this is a great summary!
iam a pgy 1 & hard core cards fan(though much ignorant) but no mentor or any research in my program. love research though still wrapping my head around how to s of a research.. i have to start an research from scratch here & have no idea where to begin, and dont now enough cards to come up with a good idea..
any guidance or collaboration with any one doing any kind or form of research will be much appreciated!

Hi,

I would encourage you to talk to somebody working on cardiac imaging, either echo, nuclear, CT and/or MRI. There are tons of thins you could do doing retrospective analysis on any of these imaging modalities.

 

[hcn22]

Amazing! Thanks so much for sharing!

 

[PercAVR]

Thank you for the great review.

However, be careful with your conclusions. For example, you wrote:

COGENT - use of plavix in pts with ACS, DES placed, on PPI who have high risk of GI bleeding - When used with plavix, PPI reduces rate of GI outocmes without change in cardiovascular events. Weak recommendation in pts without risk of GI bleed; 2010

In fact, COGENT trial (published in NEJM in 10/2010) that evaluated a COMBINATION pill consistent of clopidogrel 75mg/Omeprazole 20 mg could not rule out cardiovascular risks. The study was significantly underpowered to evaluate safety of this drug combo. It was terminated prematurely and the mean follow up period was 106 days, while in previous observational studies the adverse outcomes from concomitant use of Omeprazole and Plavix have been reported up to 12 mos.
The study did NOT evaluate high risk patients fro UGIB, as you mentioned in your summary. They were excluded from study. COGENT evaluated only intermediate risk population (those on NSAIDS and positive for H. pylori).
Again, the study used a combination pill which pharmacokinetics differ from real clopidogrel and omeprazole, used as separate preparations. Also, they used a fixed dose of Omeprazole of 20 mg. In previous ex-vivo studies it has being shown that omeprazole effect on inhibition of clopidogrel is dose dependent (it inhibits cytochrome CYP2C19 , that is responsible for producing an active clopidogrel metabolite), so it is likely, that the higher doses of Omeprazole (40 mg qd or bid) in combination with Plavix would result in higher rates of adverse cardiac events.
Thus, I would probably exclude COGENT from my list at all since this is an inadequate trial that does not provide any convincing evidence beyond the fact that Omerazole has protective effect on GI tract (we already kinda knew that)

 

[NMed]

Wikipedia article created!

Linky

Please edit appropriately.

Amazing! Thanks so much for sharing!

happy to help!

Thank you for the great review.

However, be careful with your conclusions. For example, you wrote:


In fact, COGENT trial (published in NEJM in 10/2010) that evaluated a COMBINATION pill consistent of clopidogrel 75mg/Omeprazole 20 mg could not rule out cardiovascular risks. The study was significantly underpowered to evaluate safety of this drug combo. It was terminated prematurely and the mean follow up period was 106 days, while in previous observational studies the adverse outcomes from concomitant use of Omeprazole and Plavix have been reported up to 12 mos.
The study did NOT evaluate high risk patients fro UGIB, as you mentioned in your summary. They were excluded from study. COGENT evaluated only intermediate risk population (those on NSAIDS and positive for H. pylori).
Again, the study used a combination pill which pharmacokinetics differ from real clopidogrel and omeprazole, used as separate preparations. Also, they used a fixed dose of Omeprazole of 20 mg. In previous ex-vivo studies it has being shown that omeprazole effect on inhibition of clopidogrel is dose dependent (it inhibits cytochrome CYP2C19 , that is responsible for producing an active clopidogrel metabolite), so it is likely, that the higher doses of Omeprazole (40 mg qd or bid) in combination with Plavix would result in higher rates of adverse cardiac events.
Thus, I would probably exclude COGENT from my list at all since this is an inadequate trial that does not provide any convincing evidence beyond the fact that Omerazole has protective effect on GI tract (we already kinda knew that)

noted!

 

[PercAVR]

Very well done job, man!

 

[PHD_2007]

Thank you so much for this page!!! I will be a PGY-1 in a few months and I am very interested in Cardiology!!!! This is a Great Thread. I have been trying to find a mentor but I haven't been very successful. If there are any cardiologists or fellows that would like a good mentee please let me know!!! Thanks!!!

 

[dienekes88]

Wikipedia article created!

Linky

Please edit appropriately.



happy to help!



noted!

Well done!

Regarding ACCORD, it's important to note that the ACCORD cohort had a mean duration of diabetes of almost 10 years and had multiple risk factors for cardiovascular disease. The consensus statement from the ACCF, ADA, and AHA published in Diabetes Care is that newly diagnosed patients should still be treated to a target of <7% with aggressive management of other risk factors: lipids, bp, etc. Older patients with longer duration of illness, greater morbidity associated with hypoglycemic events, etc. are allowed more lax control. According to UKPDS and DCCT, the cardiovascular benefits of improved glycemic control don't show up until about 9 years out, but improvements in microvascular morbidity are seen early on.

Also, it might be good to include ACCOMPLISH.

Thirdly, I think in the BARI-2D trial, PCI and CABG were used for different cohorts with patients in the CABG cohort having more extensive disease and left main (or left main equivalent disease). The CABG cohort actual did better with fewer MIs/deaths, so prompt revascularization given no contraindications is preferred.

 

[jphoward]

Hi there,

I've actually made something quite similar to this and on line at http://cardiologytrials.org

Your document is a great resource, too. There are definitely a few I've missed out that you've got!

 

[CanIMakeIt]

There are apps for iPhone for these as well
- ACS Trials
- CHF Trials

i think each one is $2.99