scholarly journals The future of clinical trials in secondary prevention after acute coronary syndromes

2010 ◽  
Vol 32 (13) ◽  
pp. 1583-1589 ◽  
Author(s):  
H. Bueno ◽  
P. W. Armstrong ◽  
M. J. Buxton ◽  
N. Danchin ◽  
J. Lubsen ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Secondary Prevention ◽  
Acute Coronary Syndromes ◽  
The Future ◽  
Coronary Syndromes

Gender considerations in acute coronary syndromes

2015 ◽  
Author(s):  
Eva Swahn ◽  
Joakim Alfredsson ◽  
Sofia Sederholm Lawesson
Keyword(s):  
Gender Differences ◽  
Clinical Trials ◽  
Acute Coronary Syndromes ◽  
Statistical Power ◽  
Proper Treatment ◽  
The Future ◽  
Coronary Syndromes ◽  
Mixed Populations ◽  
Gender Differences And Similarities ◽  
Inadequate Statistical Power

It is a very important issue to enlighten on gender differences and similarities regarding the management of patients with acute coronary syndromes. It is a fact that women have not been included in clinical trials in numbers equal to men, for whatever reason. In the future, it will be necessary to individualize, as much as possible, the management of patients, regardless of gender. To get there, it is necessary to have sufficient numbers of patients from both genders included in trials, or otherwise it is not possible to draw proper conclusions. Until now, most results regarding women and acute coronary syndromes have been based on substudy analyses with inadequate statistical power. If gender differences have become evident in studies with gender-mixed populations, it seems obvious that the calculated power to show significant differences is also inadequate for men. There is an urgent need of more research in this area, in order not to harm our patients with our treatment because of a paucity of knowledge. It is also as important not to withdraw proper treatment from certain individuals when they can benefit from it.

Gender considerations in acute coronary syndromes

2018 ◽  
Author(s):  
Eva Swahn ◽  
Joakim Alfredsson ◽  
Sofia Sederholm Lawesson
Keyword(s):  
Gender Differences ◽  
Clinical Trials ◽  
Acute Coronary Syndromes ◽  
Statistical Power ◽  
Proper Treatment ◽  
The Future ◽  
Coronary Syndromes ◽  
Mixed Populations ◽  
Gender Differences And Similarities ◽  
Inadequate Statistical Power

It is a very important issue to enlighten on gender differences and similarities regarding the management of patients with acute coronary syndromes. It is a fact that women have not been included in clinical trials in numbers equal to men, for whatever reason. In the future, it will be necessary to individualize, as much as possible, the management of patients, regardless of gender. To get there, it is necessary to have sufficient numbers of patients from both genders included in trials, or otherwise it is not possible to draw proper conclusions. Until now, most results regarding women and acute coronary syndromes have been based on substudy analyses with inadequate statistical power. If gender differences have become evident in studies with gender-mixed populations, it seems obvious that the calculated power to show significant differences is also inadequate for men. There is an urgent need of more research in this area, in order not to harm our patients with our treatment because of a paucity of knowledge. It is also as important not to withdraw proper treatment from certain individuals when they can benefit from it.

Statins in Acute Coronary Syndromes

2018 ◽  
Vol 23 (46) ◽  
pp. 7086-7098 ◽  
Author(s):  
Manolis Vavuranakis ◽  
Maria Kariori ◽  
Gerasimos Siasos ◽  
Konstantinos Kalogeras ◽  
Dimitris Tousoulis
Keyword(s):  
Clinical Trials ◽  
Coronary Artery ◽  
Adverse Events ◽  
Secondary Prevention ◽  
Acute Coronary Syndromes ◽  
Lipid Lowering ◽  
Line Treatment ◽  
First Line ◽  
Coronary Syndromes ◽  
First Line Treatment

Background: Patients with acute coronary syndrome (ACS) frequently experience recurrent adverse events from the cardiovascular system comparing to either healthy individuals or individuals with stable coronary artery disease. This is attributed to the inflammatory cascade that is activated during ACS resulting in increased risk for rupture of vulnerable plaques. </P><P> Objective: Therefore, it is of great importance to avoid recurrent events with treatment aiming at secondary prevention which includes the management of lipid profile besides alteration in the lifestyle and habits. </P><P> Methods: This review will present current data concerning present status of treatment with statins, and refer to non-statin strategies as well as novel and promising agents for the secondary prevention therapy after ACS. A thorough search of PubMed and the Cochrane Database was conducted in order to identify the majority of trials, studies, current guidelines and novel articles related to the subject. </P><P> Results: Statins have been proved to play very significant role in the part of secondary prevention since they decrease the burden of atherosclerotic plaques, the risk of adverse events and the need for revascularization in symptomatic patients with CAD. Therefore, they were established and suggested by both European and American guidelines as first-line treatment option for lipid-lowering management. Several clinical trials, meta- analyses and randomized trials strongly recommended the application of early and intensive treatment with statins in patients with ACS. Nevertheless, a vast majority of individuals neither tolerated statins nor achieved the optimal value for LDL-C with the highest tolerated dose of statins resulting in poor clinical outcome. Furthermore, recent clinical trials indicated further benefit of combined treatment of statins with non-statins drugs on the decrease of cardiovascular events as well as progress of coronary artery plaque. Finally, novel agents that are still evaluated with ongoing clinical trials have been turned into a very promising treatment option. </P><P> Conclusion: In conclusion, statins are established as the first-line treatment for the secondary prevention after acute coronary syndromes in order to avoid the recurrence of thrombotic events. However, the research field on the field of lipid-lowering therapies is still ongoing and very promising for the future.

Gender considerations in acute coronary syndromes

2016 ◽  
Author(s):  
Eva Swahn ◽  
Joakim Alfredsson ◽  
Sofia Sederholm Lawesson
Keyword(s):  
Gender Differences ◽  
Clinical Trials ◽  
Acute Coronary Syndromes ◽  
Statistical Power ◽  
Proper Treatment ◽  
The Future ◽  
Coronary Syndromes ◽  
Mixed Populations ◽  
Gender Differences And Similarities ◽  
Inadequate Statistical Power

It is a very important issue to enlighten on gender differences and similarities regarding the management of patients with acute coronary syndromes. It is a fact that women have not been included in clinical trials in numbers equal to men, for whatever reason. In the future, it will be necessary to individualize, as much as possible, the management of patients, regardless of gender. To get there, it is necessary to have sufficient numbers of patients from both genders included in trials, or otherwise it is not possible to draw proper conclusions. Until now, most results regarding women and acute coronary syndromes have been based on substudy analyses with inadequate statistical power. If gender differences have become evident in studies with gender-mixed populations, it seems obvious that the calculated power to show significant differences is also inadequate for men. There is an urgent need of more research in this area, in order not to harm our patients with our treatment because of a paucity of knowledge. It is also as important not to withdraw proper treatment from certain individuals when they can benefit from it.

Sex considerations in acute coronary syndromes

2021 ◽  
pp. 585-600
Author(s):  
Eva Swahn ◽  
Joakim Alfredsson ◽  
Sofia Sederholm Lawesson
Keyword(s):  
Gender Differences ◽  
Clinical Trials ◽  
Acute Coronary Syndromes ◽  
Statistical Power ◽  
Proper Treatment ◽  
The Future ◽  
Coronary Syndromes ◽  
Mixed Populations ◽  
Gender Differences And Similarities ◽  
Inadequate Statistical Power

It is a very important issue to enlighten on gender differences and similarities regarding the management of patients with acute coronary syndromes. It is a fact that women have not been included in clinical trials in numbers equal to men, for whatever reason. In the future, it will be necessary to individualize, as much as possible, the management of patients, regardless of gender. To get there, it is necessary to have sufficient numbers of patients from both genders included in trials, or otherwise it is not possible to draw proper conclusions. Until now, most results regarding women and acute coronary syndromes have been based on substudy analyses with inadequate statistical power. If gender differences have become evident in studies with gender-mixed populations, it seems obvious that the calculated power to show significant differences is also inadequate for men. There is an urgent need of more research in this area, in order not to harm our patients with our treatment because of a paucity of knowledge. It is also as important not to withdraw proper treatment from certain individuals when they can benefit from it.

scholarly journals Informed consent for clinical trials in acute coronary syndromes and stroke following the European Clinical Trials Directive: investigators' experiences and attitudes

Trials ◽  
2008 ◽  
Vol 9 (1) ◽  
Author(s):  
Piotr Iwanowski ◽  
Andrzej Budaj ◽  
Anna Członkowska ◽  
Wojciech Wąsek ◽  
Beata Kozłowska-Boszko ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Informed Consent ◽  
Acute Coronary Syndromes ◽  
Coronary Syndromes

scholarly journals Prasugrel versus ticagrelor in acute coronary syndromes

2021 ◽  
pp. 1-7
Author(s):  
Luiz Tanajura ◽  
José Costa Júnior ◽  
Áurea Chaves ◽  
Marinella Centemero ◽  
Fausto Feres
Keyword(s):  
Clinical Trials ◽  
Acute Coronary Syndromes ◽  
Therapeutic Option ◽  
High Morbidity ◽  
Cardiac Events ◽  
Invasive Treatment ◽  
New Agents ◽  
Advantages And Disadvantages ◽  
Coronary Syndromes ◽  
New Generation

Acute coronary syndromes are common situations in medical practice, with high morbidity and mortality. Consequent to its relevance, its clinical management has always been subject of discussion and controversy. Since the past decade, the dual antiplatelet regimen has been the main therapeutic option used in its passivation, whereas percutaneous interventions have become the most common therapeutic option. Clopidogrel, the drug initially used in combination with aspirin, is effective and safe; however, it has disadvantages that led to the development of a new generation of more efficient antiplatelet drugs, such as prasugrel and ticagrelor. In large comparative clinical trials, these two drugs proved superior to clopidogrel in reducing major combined cardiac events. Hence the main guidelines currently support the two new agents, which are considered first-line drugs. Due to the clear differences between the protocols of clinical trials corroborating their inclusion in clinical practice, it is not possible to make direct comparison without the risk of generating hasty impressions. More recently, a large prospective, randomized clinical trial provided an appropriate head-to-head comparison between prasugrel and ticagrelor in cases of acute coronary disease, in a population submitted to invasive treatment. The study demonstrated a significant advantage of prasugrel. In this review, we discuss the primary details of these more contemporary drugs and the most relevant clinical trials related to them, identifying the advantages and disadvantages of each agent. At the end, we state our view on their current prescription.

scholarly journals Adherence to Guidelines for Cardiac Catheterization Referrals and Secondary Prevention Strategies in Patients with Non-ST Segment Elevation Acute Coronary Syndromes

1970 ◽  
Vol 9 (3) ◽  
Author(s):  
Michelle J. Haroun MD ◽  
Anjali Shroff MD, ◽  
Joshua J. Manolakos ◽  
Madhu K. Natarajan MD MSc ◽  
John You MD MSc, ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Cardiac Catheterization ◽  
Acute Coronary Syndromes ◽  
Wait Times ◽  
Prevention Strategies ◽  
Invasive Procedures ◽  
St Segment Elevation ◽  
Rehabilitation Programs ◽  
St Segment ◽  
Coronary Syndromes

Background: Previous studies have demonstrated higher referral rates for invasive procedures among patients admitted with acute coronary syndromes (ACS) to hospitals with catheterization facilities compared to those without. Studies have also reported underuse of evidence-based medical therapies and cardiac rehabilitation programs post myocardial infarction. We evaluated referral patterns for cardiac catheterization and use of secondary prevention strategies in current practice.Methods: We conducted a retrospective study of 397 patients with non-ST segment elevation ACS, comparing angiography referrals at a hospital with on-site catheterization facilities (Site A, n = 194) versus a hospital without (Site B, n = 203). We also recorded the use of secondary prevention strategies including discharge medications, referrals to smoking cessation programs and cardiac rehabilitation.Results: There was no significant effect of on-site angiography on the decision to manage patients invasively (adjusted OR for on-site angiography 1.49 95% CI 0.92-2.44, p = .11), or wait times for cardiac catheterization (Site A 1.9 days vs. Site B 2.2 days, difference −0.3 days, 95% CI −0.83 to 0.55, p = .70). However, at the time of hospital discharge, less than 70% of patients were prescribed dual antiplatelet therapy and only 13% of patients were referred for cardiac rehabilitation.Conclusion: These observations suggest that in contemporary practice in a Southern Ontario community, the availability of on-site percutaneous coronary intervention does not influence referral rates or wait times for cardiac catheterization. However we did observe significant underuse of cardiac rehabilitation programs and certain medical therapies. This suggests that despite improvements in access to invasive procedures, there remain important gaps in secondary prevention of coronary artery disease, which represent opportunities to improve quality of care in these patients.

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