Proposal for a Randomized Study of Surgical Vs Medical Treatment in Patients with Asymptomatic Coronary Artery Disease

1984 ◽  
pp. 194-200
Author(s):  
Michel E. Bertrand ◽  
François A. Thieuleux ◽  
Jean M. Lablanche
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Medical Treatment ◽  
Randomized Study ◽  
Artery Disease ◽  
Asymptomatic Coronary Artery Disease

scholarly journals The randomized study of preventive revascularization of vulnerable coronary artery plaques in patients with stable coronary artery disease

2020 ◽  
Vol 8 (4S) ◽  
pp. 104-110 ◽  
Author(s):  
N. A. Kochergin ◽  
V. I. Ganyukov
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Intravascular Ultrasound ◽  
Medical Therapy ◽  
Stable Coronary Artery Disease ◽  
Randomized Study ◽  
Optimal Medical Therapy ◽  
Plaque Burden ◽  
Fractional Flow ◽  
Artery Disease

Background. Today, a number of unresolved issues remain regarding vulnerable coronary plaques, one of which is the need for preventive revascularization.Aim. Evaluation of the appropriateness of preventive revascularization of functionally insignificant lesions of the coronary arteries with signs of vulnerability according to the virtual histology of intravascular ultrasound in patients with stable coronary artery disease.Methods. The prospective randomized study includes patients with stable coronary artery disease and isolated intermediate-grade coronary stenosis. The first step in patients is measured fractional flow reserve to confirm the hemodynamic insignificance of stenosis. Then an intravascular ultrasound is performed to verify signs of plaque vulnerability: a thin-cap fibroatheroma and / or minimum lumen area <4 mm2 and/or plaque burden >70%. After that, patients are randomized into two groups: preventive revascularization or optimal medical therapy. After 12 months, patients undergo repeated intravascular ultrasound and end-point analysis.Results. So far, 10 patients have been included in the study (6 in the preventive revascularization group and 4 in the optimal medical therapy group). No endpoints and complications were recorded in both groups in 30-days follow-up.Conclusion. Intravascular imaging methods can identify vulnerable coronary plaques, which allows you to use a personalized approach in determining treatment tactics, one of which can be preventive revascularization.

Abstract 18682: Inflammatory Biomarkers for Prognostication of Outcomes in Stable Coronary Artery Disease - Experiences From the STABILITY Trial

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Claes Held ◽  
Harvey D White ◽  
Ralph A Stewart ◽  
Andrzej Budaj ◽  
Christopher P Cannon ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Medical Treatment ◽  
Cox Regression ◽  
Stable Coronary Artery Disease ◽  
Cardiac Biomarkers ◽  
Prognostic Information ◽  
Hs Crp ◽  
Artery Disease ◽  
The Impact

Introduction: Prognostication of outcome in patients with stable coronary artery disease (CAD) is currently based on clinical characteristics and biomarkers indicating dysglycemia, dyslipidemia, renal dysfunction and possibly cardiac biomarkers. Hypothesis: We assessed the incremental prognostic value of biomarkers of inflammation in the Stabilization of Atherosclerotic Plaque By Initiation of Darapladib Therapy (STABILITY) trial. Methods: In STABILITY, 15,828 patients with chronic CAD on optimal medical treatment were randomized to treatment with darapladib or placebo. Serum levels of hs-C-reactive protein (CRP) and Interleukin (IL)-6 were measured at randomization in 14,373 and 4733 patients, respectively. Centrally adjudicated outcome events were accumulated during a median of 3.7 years follow-up. The associations between levels of the biomarkers and outcomes were evaluated by multivariable Cox regression. Results: The impact of biomarker levels at baseline in relation to the composite endpoint, MACE (major adverse cardiovascular event), of cardiovascular (CV) death, myocardial infarction (MI) and stroke, and its individual components are presented in the Table. Both hs-CRP and IL-6 provided strong prognostic information in addition to clinical predictors for outcomes of MACE, CV death and MI, but not for stroke. Conclusions: In conclusion, the cardiac biomarkers hs-CRP and IL-6, provided important complementary prognostic information on the risk of CV mortality and MI, but not for stroke in patients with stable CAD on optimal medical treatment.

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