Acs

Front 1

ISIS 2

Back 1

reduce mortality rates in patients w/ suspected MI led to recommendation That ASA be initiated immediately in ED once Dx of ACS is made or suspected

Front 2

CURE

Back 2

pt with NSTEMI ASA vs ASA plus Clopidogrel reduction in endpoint of CV death and nonfatal MI/Stroke was greater in group with dual tx

Front 3

CLASSIC

Back 3

better tollerance for clopidogrel than ticlopidine

Front 4

TRITON-TIMI 38

Back 4

clopidogrel vs. prasugrel; CV death , nonfatal MI, and nonfatal stroke occurred signif. Less with prasugrel; likelihood of primary endpoint recurring was signif. Reduced w/prasugrel than clopidogrel; signif. More bleeding with prasugrel

Front 5

PLATO

Back 5

ticagular superior to clopidogrel (death from vascular causes by 16%)
---however effacacy decreases if pts mis dosees (needs to be BID)

Front 6

ACCUITY

Back 6

Bivalrudin alone, Bivalirudin plus IIb/IIIa, vs uFH plus IIb/IIIa for composite of (death, MI, or unplanned revasc.)

RESULT--> use Bilvalrudin alone is noninferior to UFH/IIb/IIIa combo as long as bilvalirudin is given with Plavix; when bivalirudin is give alone there is less bleeding than combo

Front 7

ESSENCE

Back 7

ASA+Enoxaparin vs ASA+UFH (noninvasive)

Result--> enoxaparin had larger decrease in death, MI, angina, revasc., and recurrent ischemia was

Front 8

TIMI 11B

Back 8

Enoxaparin vs UFH (noninvasive)
Result-->enoxaparin had larger decrease of death, MI, and urgent revasc. at day 8 (continued through day 43) in pts with elevated Troponin I, but enoxaparin was also associated with increase bleeds

Front 9

SYNERGY

Back 9

Enoxaparin vs UFH with planned invasive strategy (PCI)
Results--> in patients with a NSTEMI who receive a GP IIb/IIIa inhibitor and undergo PCI, enoxaparin is as effective as UFH, but is associated with a small but statistically significant increase in major bleeding.

Front 10

OASIS-5

Back 10

Fondaparinux can be perfered over enoxaparin when a conservative strategy is used--> trial showed patients receiving GP IIb/IIIa inhibitors or thienopyridines, fondaparinux reduces major bleeding and improves net clinical outcome compared with enoxaparin

However, fondaparinus should NOT be used in invasive strategy due to higher catherter related thrombi (use in cath lab doesn't make sense bc it needs to be used with UFH wich cancels out decreased risk of bleed)

Front 11

Naples II

Back 11

continue low dose statin or Lipitor 80 – periprocedural MIs SS reduction

Front 12

Armada

Back 12

statins caused SS lower composite CV death, MI or need for revascularization

Front 13

Miracle

Back 13

atorva 80 vs. placebo – 1st 24-96 hours on presentation 16% decrease of composite for all Nonfatal MI, cardiac arrest with resuscitation and cardiac ischemia requiring hosptialization

Front 14

Prove IT TIMI 22

Back 14

– Lipitor 80 16% lower risk all cause mortality, MI, revascularization as compared to pravastatin 40mg

Front 15

COMMIT

Back 15

BBlocker (Metoprolol) Modest reduction ventricular arrhythmias and reinfarction

should only be used in pts that dont' have signs fo HF and are hemodynamically stable

Front 16

DAVIT I and II

Back 16

Verapamil no benefit bu a trend for reduced death or nonfatal MI

Front 17

MDPIT

Back 17

reduced mortality and major events in pt without HF but no effect in patients with HF

Front 18

EPHESUS

Back 18

Eplerenone vs placebo in patients with MI within 3-14 days and LVEF<40

Resulted in decreased all cause mortality RR 15%

Front 19

OPTIMAL

Back 19

captopril vs losartan
noninferior for reduced mortality (STEMI or any MI associated with HF)

Front 20

VALIANT

Back 20

captopril vs valsartan
noninferior for reduced mortality (STEMI or any MI associated with HF)