Treatment decisions in stable coronary artery disease: Insights from the Euro Heart Survey on Coronary Revascularization

Breeman, Arno; Hordijktrion, M; Lenzen, Mattie J.; Hoeks, Sanne E.; Ottervanger, Jan Paul; Bertrand, Michel E.; Sechtem, Udo; Žaliūnas, Remigijus; Legrand, Victor; Boer, Menko‐Jan de; Ståhle, Elisabeth; Mercado, Nestor; Wijns, William; Boersma, Eric

doi:10.1016/j.jtcvs.2006.05.051

Cited by 25 publications

(9 citation statements)

References 17 publications

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“…had undergone invasive evaluation for angina pectoris or acute coronary syndromes and who had verified CAD in other European hospitals. 26,27 Hence, our findings should be generalizable to other CAD populations, primarily to patients with stable CAD. The power of the trial was less than planned because of lower event rates than anticipated and shorter follow-up than planned, the latter due to premature study termination of 692 participants (22%).…”

Section: Commentmentioning

confidence: 80%

Mortality and Cardiovascular Events in Patients Treated With Homocysteine-Lowering B Vitamins After Coronary Angiography

Ebbing¹,

Bleie²,

Ueland³

et al. 2008

JAMA

377

312

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Context Observational studies have reported associations between circulating total homocysteine concentration and risk of cardiovascular disease. Oral administration of folic acid and vitamin B 12 can lower plasma total homocysteine levels.Objective To assess the effect of treatment with folic acid and vitamin B 12 and the effect of treatment with vitamin B 6 as secondary prevention in patients with coronary artery disease or aortic valve stenosis.Design, Setting, and Participants Randomized, double-blind controlled trial conducted in the 2 university hospitals in western Norway in 1999-2006. A total of 3096 adult participants undergoing coronary angiography (20.5% female; mean age, 61.7 years) were randomized. At baseline, 59.3% had double-or triple-vessel disease, 83.7% had stable angina pectoris, and 14.9% had acute coronary syndromes.Interventions Using a 2ϫ2 factorial design, participants were randomly assigned to 1 of 4 groups receiving daily oral treatment with folic acid, 0.8 mg, plus vitamin B 12 , 0.4 mg, plus vitamin B 6 , 40 mg (n=772); folic acid plus vitamin B 12 (n=772); vitamin B 6 alone (n=772); or placebo (n=780). Main Outcome MeasuresThe primary end point was a composite of all-cause death, nonfatal acute myocardial infarction, acute hospitalization for unstable angina pectoris, and nonfatal thromboembolic stroke. ResultsMean plasma total homocysteine concentration was reduced by 30% after 1 year of treatment in the groups receiving folic acid and vitamin B 12 . The trial was terminated early because of concern among participants due to preliminary results from a contemporaneous Norwegian trial suggesting adverse effects from the intervention. During a median 38 months of follow-up, the primary end point was experienced by a total of 422 participants (13.7%): 219 participants (14.2%) receiving folic acid/vitamin B 12 vs 203 (13.1%) not receiving such treatment (hazard ratio, 1.09; 95% confidence interval, 0.90-1.32; P=.36) and 200 participants (13.0%) receiving vitamin B 6 vs 222 (14.3%) not receiving vitamin B 6 (hazard ratio, 0.90; 95% confidence interval, 0.74-1.09; P=.28).Conclusions This trial did not find an effect of treatment with folic acid/vitamin B 12 or vitamin B 6 on total mortality or cardiovascular events. Our findings do not support the use of B vitamins as secondary prevention in patients with coronary artery disease.

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Section: Commentmentioning

confidence: 80%

Mortality and Cardiovascular Events in Patients Treated With Homocysteine-Lowering B Vitamins After Coronary Angiography

Ebbing¹,

Bleie²,

Ueland³

et al. 2008

JAMA

377

312

View full text Add to dashboard Cite

show abstract

“…Currently and at variance with European reports [41], patients with CAD receive more recommendations for PCI and fewer recommendations for CABG treatment than indicated in the U.S. guidelines [42] depending on non-angiographic as well as angiographic factors [43].…”

Section: Guidelines and Appropriateness Revascularization Criteriamentioning

confidence: 96%

Revascularization strategies for stable multivessel and unprotected left main coronary artery disease: From BARI to SYNTAX

Hahalis¹,

Dangas²,

Davlouros³

et al. 2011

International Journal of Cardiology

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“…6 Some argue that revascularization should be reserved only for symptom relief. 5,7,8 Criteria for the appropriate use of revascularization have been developed to aid in clinical decision-making; however, a substantial proportion of revascularization procedures for stable ischemic heart disease are performed under clinical circumstances deemed as "uncertain." 9,10 Reflecting this uncertainty, there is wide regional variation in the rate of coronary revascularization, [11][12][13] which suggests different thresholds for invasive therapy for stable ischemic heart disease.…”

mentioning

confidence: 99%

Determinants of variations in initial treatment strategies for stable ischemic heart disease

Bennell

Qiu

Kingsbury

et al. 2015

CMAJ

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Treatment decisions in stable coronary artery disease: Insights from the Euro Heart Survey on Coronary Revascularization

Cited by 25 publications

References 17 publications

Mortality and Cardiovascular Events in Patients Treated With Homocysteine-Lowering B Vitamins After Coronary Angiography

Mortality and Cardiovascular Events in Patients Treated With Homocysteine-Lowering B Vitamins After Coronary Angiography

Revascularization strategies for stable multivessel and unprotected left main coronary artery disease: From BARI to SYNTAX

Determinants of variations in initial treatment strategies for stable ischemic heart disease

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