10 research outputs found
The continuation of the Prevention of Events with Angiotensin Converting Enzyme inhibition (PEACE) trial
Documented growth of autogenous pulmonary valve translocated to the aortic valve position
Early percutaneous coronary intervention, platelet inhibition with eptifibatide, and clinical outcomes in patients with acute coronary syndromes. PURSUIT Investigators
BACKGROUND: Platelet glycoprotein (GP) IIb/IIIa antagonists prevent the
composite end point of death or myocardial infarction (MI) in patients
with acute coronary syndromes. There is uncertainty about whether this
effect is confined to patients who have percutaneous coronary
interventions (PCIs) and whether PCIs further prevent death or MI in
patients already treated with GP IIb/IIIa antagonists. METHODS AND
RESULTS: PURSUIT patients were treated with the GP IIb/IIIa antagonist
eptifibatide or placebo; PCIs were performed according to physician
practices. In 2253 of 9641 patients (23.4%), PCI was performed by 30 days.
Early (<72 hours) PCI was performed in 1228 (12.7%). In 34 placebo
patients (5.5%) and 10 treated with eptifibatide (1.7%) (P=0.001), MI
preceded early PCI. In patients censored for PCI across the 30-day period,
there was a significant reduction in the primary composite end point in
eptifibatide patients (P=0.035). Eptifibatide reduced 30-day events in
patients who had early PCI (11.6% versus 16.7%, P=0.01) and in patients
who did not (14.6% versus 15.6%, P=0.23). After adjustment for PCI
propensity, there was no evidence that eptifibatide treatment effect
differed between patients with or without early PCI (P for
interaction=0.634). PCI was not associated with a reduction of the primary
composite end point but was associated with a reduced (nonspecified)
composite of death or Q-wave MI. This association disappeared after
adjustment for propensity for early PCI. CONCLUSIONS: Eptifibatide reduced
the composite rates of death or MI in PCI patients and those managed
conservatively
The long-term multicenter observational study of dabigatran treatment in patients with atrial fibrillation (RELY-ABLE) study
BACKGROUND - : During follow-up of between 1 and 3 years in the Randomized Evaluation of Long-term Anticoagulation Therapy (RE-LY) trial, 2 doses of dabigatran etexilate were shown to be effective and safe for the prevention of stroke or systemic embolism in patients with atrial fibrillation. There is a need for longer-term follow-up of patients on dabigatran and for further data comparing the 2 dabigatran doses. METHODS AND RESULTS - : Patients randomly assigned to dabigatran in RE-LY were eligible for the Long-term Multicenter Extension of Dabigatran Treatment in Patients with Atrial Fibrillation (RELY-ABLE) trial if they had not permanently discontinued study medication at the time of their final RE-LY study visit. Enrolled patients continued to receive the double-blind dabigatran dose received in RE-LY, for up to 28 months of follow up after RE-LY (median follow-up, 2.3 years). There were 5851 patients enrolled, representing 48% of patients originally randomly assigned to receive dabigatran in RE-LY and 86% of RELY-ABLE-eligible patients. Rates of stroke or systemic embolism were 1.46% and 1.60%/y on dabigatran 150 and 110 mg twice daily, respectively (hazard ratio, 0.91; 95% confidence interval, 0.69-1.20). Rates of major hemorrhage were 3.74% and 2.99%/y on dabigatran 150 and 110 mg (hazard ratio, 1.26; 95% confidence interval, 1.04-1.53). Rates of death were 3.02% and 3.10%/y (hazard ratio, 0.97; 95% confidence interval, 0.80-1.19). Rates of hemorrhagic stroke were 0.13% and 0.14%/y. CONCLUSIONS - : During 2.3 years of continued treatment with dabigatran after RE-LY, there was a higher rate of major bleeding with dabigatran 150 mg twice daily in comparison with 110 mg, and similar rates of stroke and death. CLINICAL TRIAL REGISTRATION - : URL: http://www.clinicaltrials.gov. Unique identifier: NCT00808067. © 2013 American Heart Association, Inc