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Stable angina symptoms disappeared over time for many medically-treated patients without requiring medication changes or a revascularization procedure, according to CLARIFY registry data.
Among patients who had stable coronary artery disease (CAD) and angina, 39.6% had symptoms resolve at 1 year without coronary revascularization. By 5 years, 45.8% of patients were alive, event-free, and angina-free, reported Philippe Gabriel Steg, MD, of Hôpital Bichat in Paris, and colleagues.
The vast majority (84.4%) of individuals who had baseline angina controlled at 5-year follow-up had no changes in medication or revascularization. Only 11% had received increased antianginal treatment, and 4.5% had coronary revascularization.
"As most patients with angina are likely to experience resolution of symptoms, and as there is no demonstrated outcome benefit to routine revascularization, this study emphasizes the value of conservative management of stable CAD," the authors concluded in their paper published online in
New-yorkUnited-statesParisFrance-general-FranceNicole-louDeepak-bhattPhilippe-gabriel-stegRoxana-mehranIcahn-school-of-medicine-at-mount-sinaiHarvard-medical-schoolIcahn-schoolMay 14, 2021
For patients with type 2 diabetes and stable coronary disease who have not had an MI or stroke, specific factors related to their diabetes should not necessarily come into play when physicians are deciding whether they should add ticagrelor (Brilinta; AstraZeneca) to the treatment regimen, a post hoc analysis of the THEMIS and THEMIS-PCI studies indicates. Nor did they influence the trial findings, investigators say.
The complex balance between efficacy and safety demonstrated in the overall trial cohort as well as in the subset with a history of PCI was not significantly influenced by diabetes duration, baseline HbA1c, or background glucose-lowering medications, researchers led by Lawrence Leiter, MD (St. Michael’s Hospital and University of Toronto, Canada), report.
CanadaParisFrance-generalFranceTorontoOntarioPatrick-henryPhilippe-gabriel-stegJean-guillaume-dillingerLawrence-leiterUniversity-of-torontoAstrazenecaFeb 10, 2021
REALITY results show restrictive transfusions noninferior to liberal transfusions
Restrictive transfusion for patients with acute myocardial infarction (AMI) and anemia is noninferior to a liberal transfusion strategy in the incidence of major adverse cardiovascular events (MACE), according to results from the open-label, randomized Restrictive and Liberal Transfusion Strategies in Patients with Acute Myocardial Infarction (REALITY) trial.
“Anemia is common in patients with AMI and is associated with worse clinical outcomes. In theory, transfusion should increase oxygen delivery, which would argue for a liberal transfusion strategy in patients with acute myocardial ischemia. However, data suggest that oxygen delivery is not necessarily increased in patients receiving transfusions, due to red blood cell depletion in nitric oxide and 2,3-diphosphoglyceric acid during storage, and that, conversely, transfusion may increase platelet activation and aggregation and produce vasoconstriction,” explained senior author Philippe Gabriel Steg, MD, of the Université de Paris, France, and his fellow REALITY researchers in
ParisFrance-generalFranceSpainFrenchPhilippe-gabriel-stegSalud-carlosLiz-meszarosFrench-alliance-for-cardiovascular-trialsProgramme-de-rechercheLiberal-transfusion-strategiesAcute-myocardial-infarction