{"id":39027,"date":"2013-09-23T10:24:20","date_gmt":"2013-09-23T14:24:20","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=voices&p=39027"},"modified":"2013-09-23T10:24:20","modified_gmt":"2013-09-23T14:24:20","slug":"selections-from-richard-lehmans-literature-review-september-23rd","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2013\/09\/23\/selections-from-richard-lehmans-literature-review-september-23rd\/","title":{"rendered":"Selections from Richard Lehman\u2019s Literature Review: September 23rd"},"content":{"rendered":"

CardioExchange is pleased to reprint this selection from Dr. Richard Lehman\u2019s\u00a0weekly journal review blog<\/a>\u00a0at\u00a0BMJ.com<\/a>. Selected summaries are relevant to our audience, but we encourage members to engage with the\u00a0entire blog<\/a>.<\/em><\/p>\n

NEJM 19 Sep 2013 Vol 369<\/strong><\/p>\n

Randomized Trial of Preventive Angioplasty in MI (pg. 1115):<\/strong> Interventional cardiologists are gun dogs. A cardiologist who spots a stenosis wants to rush off and do something, like a springer spaniel hearing the rustle of a pheasant in the covert. Following the COURAGE study, we are trying to retrain our cardiology springers to ignore stable angina on optimal medical treatment: \u201cNo, Doc! Sit! Stay!\u201d we tell them, as they quiver and make whimpering noises. But the PRAMI study<\/a> will let them off the leash to stent at their hearts\u2019 content when faced with acute myocardial infarction. Patients with ST elevation MI in five large British hospitals were randomised to receive immediate percutaneous intervention for the \u201cculprit lesion\u201d alone, or for as many significant stenoses as the cardiologist felt worth stenting. The trial was stopped early when it was clear that there was a big benefit from the latter approach: \u201cHazard ratios \u2026were 0.34 (95% CI, 0.11 to 1.08) for death from cardiac causes, 0.32 (95% CI, 0.13 to 0.75) for nonfatal myocardial infarction, and 0.35 (95% CI, 0.18 to 0.69) for refractory angina\u201d during a mean follow-up of 23 months. Woof!<\/p>\n

JAMA 18 Sep 2013 Vol 310<\/strong><\/p>\n

Effect of Aliskiren on Progression of Coronary Disease in Patients With Prehypertension (pg. 1135):<\/strong> The AQUARIUS trial<\/a> is just the latest in which Novartis fails to find a market for aliskiren, a renin blocker which was first licensed six years ago. They hoped to use it in people with \u201cpre-hypertension\u201d and coronary disease, and used a surrogate outcome: coronary atheroma measured by intravascular ultrasound. I can\u2019t do better than to quote a tweet from Ken Covinsky: Rx of pre-htn (not a disease) wth aliskiren doesnt reduce atheroma volume (not an outcome) That was helpful. Not.<\/p>\n

Anticoagulation With Otamixaban and Ischemic Events in NSTE-ACS (pg. 1145):<\/strong> At the moment my bedtime reading is Peter G\u00f8tzsche\u2019s damning indictment of the drug industry, Deadly Medicines and Organised Crime<\/em>, which has just been published by Radcliffe. It\u2019s a must-read. He describes all the ways that companies running trials manipulate the results or hide them altogether. But this week I am going to praise three industry run trials for their integrity, because they all show the opposite of what the manufacturer was hoping for. The first is the AQUARIUS trial described above, \u00a0run by Steve Nissen, with company sponsorship, but without company control of the data; and the third is the HERA trial<\/a> in The Lancet<\/em>. In the middle lies this trial of otamixaban<\/a>. It sounds like a treatment for otitis externa, but otamixaban is actually the latest direct factor X inhibitor to reach a crowded market. The TAO trial was designed by its manufacturer to \u201ccompare the clinical efficacy and safety of otamixaban, a novel intravenous direct factor Xa inhibitor, with that of unfractionated heparin plus downstream eptifibatide in patients with NSTE-ACS undergoing a planned early invasive strategy.\u201d But sadly for Sanofi, \u201cOtamixaban did not reduce the rate of ischemic events relative to unfractionated heparin plus eptifibatide but did increase bleeding.\u201d So onwards to another trial for some other indication\u2014though it\u2019s a fair bet it won\u2019t involve a direct comparison with another drug in the same class.<\/p>\n","protected":false},"excerpt":{"rendered":"

This week’s topics include a randomized trial of preventive angioplasty in MI, aliskiren in patients with prehypertension, and otamixaban and ischemic events in NSTE-ACS.<\/p>\n","protected":false},"author":475,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[660,1172,1989,1747,1758,1314,1991,1990,1992],"class_list":["post-39027","post","type-post","status-publish","format-standard","hentry","category-general","tag-aliskiren","tag-angioplasty","tag-aquarius","tag-coronary-disease","tag-ischemic-events","tag-myocardial-infarction","tag-nste-acs","tag-otamixaban","tag-prehypertension"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/39027","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/475"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=39027"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/39027\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=39027"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=39027"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=39027"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}