Sex considerations in 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

10.1093/med/9780199687039.003.0050_update_002 ◽

2018 ◽

Author(s):

Eva Swahn ◽

Joakim Alfredsson ◽

Sofia Sederholm Lawesson

Keyword(s):

Gender Differences ◽

Clinical Trials ◽

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

10.1093/med/9780199687039.003.0050_update_001 ◽

2016 ◽

Author(s):

Eva Swahn ◽

Joakim Alfredsson ◽

Sofia Sederholm Lawesson

Keyword(s):

Gender Differences ◽

Clinical Trials ◽

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.

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

European Heart Journal ◽

10.1093/eurheartj/ehq388 ◽

2010 ◽

Vol 32 (13) ◽

pp. 1583-1589 ◽

Cited By ~ 23

Author(s):

H. Bueno ◽

P. W. Armstrong ◽

M. J. Buxton ◽

N. Danchin ◽

J. Lubsen ◽

...

Keyword(s):

Clinical Trials ◽

Secondary Prevention ◽

The Future ◽

Clinical Trials with Glycoprotein IIb/IIIa Receptor Antagonists in Acute Coronary Syndromes

Thrombosis and Haemostasis ◽

10.1055/s-0038-1657528 ◽

1997 ◽

Vol 78 (01) ◽

pp. 210-213 ◽

Cited By ~ 16

Author(s):

Frans Van de Werf

Keyword(s):

Clinical Trials ◽

Receptor Antagonists ◽

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

Trials ◽

10.1186/1745-6215-9-45 ◽

2008 ◽

Vol 9 (1) ◽

Cited By ~ 7

Author(s):

Piotr Iwanowski ◽

Andrzej Budaj ◽

Anna Członkowska ◽

Wojciech Wąsek ◽

Beata Kozłowska-Boszko ◽

...

Keyword(s):

Clinical Trials ◽

Informed Consent ◽

Prasugrel versus ticagrelor in acute coronary syndromes

Journal of Transcatheter Interventions ◽

10.31160/jotci202129a202016 ◽

2021 ◽

pp. 1-7

Author(s):

Luiz Tanajura ◽

José Costa Júnior ◽

Áurea Chaves ◽

Marinella Centemero ◽

Fausto Feres

Keyword(s):

Clinical Trials ◽

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.

Treatment of ST-segment elevation acute coronary syndromes

ESC CardioMed ◽

10.1093/med/9780198784906.003.0312 ◽

2018 ◽

pp. 1255-1276

Author(s):

Borja Ibanez ◽

Sigrun Halvorsen

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Clinical Trials ◽

Real Life ◽

Compelling Evidence ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Over the last 50 years, the treatment of acute ST-segment elevation myocardial infarction (STEMI) has been considerably improved. The widespread implementation of reperfusion (initially pharmacological and later mechanical) resulted in a magnificent reduction in the rates of in-hospital mortality from about 25% in the 1970s to 5% in the late 2010s. Mortality in real life, however, is higher than these figures shown in clinical trials. There is compelling evidence showing the association between duration of ischaemia and mortality. This is the basis for the timely reperfusion in STEMI. All actions should be made to reduce all components of the ischaemic time. Despite these advances, STEMI survivors are still at high risk for developing repetitive events, including reinfarctions, heart failure, and sudden death. Evolving therapies beyond timely reperfusion are contributing to further reduce the morbidity associated with STEMI.