Dr. Stefan Anker, MD Charité - From University of Medicine Berlin
Speaks about Empagliflozin in Heart Failure with a Preserved Ejection Fraction.
Link to Abstract:
https://www.nejm.org/doi/full/10.1056/NEJMoa2110956?query=cardiology
BACKGROUND: Finerenone, a nonsteroidal mineralocorticoid receptor antagonist, has been shown to improve cardiorenal outcomes in patients with stage 3 or 4 chronic kidney disease (CKD) and significant albuminuria, as well as type 2 diabetes. Finerenone's usage in patients with type 2 diabetes and other forms of CKD is unknown.
METHODS:
In this double-blind trial, patients with CKD and type 2 diabetes were randomly randomized to either finerenone or a placebo. Patients with a urinary albumin-to-creatinine ratio of 30 to less than 300 and an estimated glomerular filtration rate (eGFR) of 25 to 90 ml per minute per 1.73 m2 of body surface area (stage 2 to 4 CKD) or a urinary albumin-to-creatinine ratio of 300 to 5000 and an eGFR of at least 60 ml per minute per 1.73 m2 of body surface area (stage 2 to (stage 1 or 2 CKD). Patients were given renin–angiotensin system blockers that had been adjusted to the maximal dose on the manufacturer's label that did not cause unacceptable side effects before randomization. The primary outcome was a composite of mortality from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure, as measured by a time-to-event analysis. The first secondary outcome was a composite of kidney failure, a prolonged drop in eGFR of at least 40% from baseline, or death due to renal causes. Adverse occurrences reported by investigators were used to assess safety.
RESULTS:
Randomization was performed on a total of 7437 subjects. During a median follow-up of 3.4 years, a primary outcome event occurred in 458 of 3686 patients (12.4%) in the finerenone group and 519 of 3666 patients (14.2%) in the placebo group (hazard ratio, 0.87; 95 percent confidence interval [CI], 0.76 to 0.98; P=0.03), with the benefit driven primarily by a lower incidence of hospitalization for hepatitis C. (hazard ratio, 0.71; 95 percent CI, 0.56 to 0.90). 350 patients (9.5%) in the finerenone group and 395 (10.8%) in the placebo group experienced the secondary composite result (hazard ratio, 0.87; 95 percent CI, 0.76 to 1.01). There was no significant difference in the overall frequency of adverse events across groups. Finerenone (1.2 percent) had a greater rate of hyperkalemia-related trial regimen discontinuation than placebo (0.8 percent) (0.4 percent ).
CONCLUSIONS:
Finerenone medication improved cardiovascular outcomes in patients with type 2 diabetes and stage 2 to 4 CKD with moderately elevated albuminuria or stage 1 or 2 CKD with severely elevated albuminuria when compared to placebo. (Funded by Bayer; NCT02545049 on ClinicalTrials.gov for FIGARO-DKD. opens in new tab.)
Dr. Stefan Anker, MD Charité - From University of Medicine Berlin
Speaks about Empagliflozin in Heart Failure with a Preserved Ejection Fraction.
Link to Abstract:
https://www.nejm.org/doi/full/10.1056/NEJMoa2110956?query=cardiology
BACKGROUND: Finerenone, a nonsteroidal mineralocorticoid receptor antagonist, has been shown to improve cardiorenal outcomes in patients with stage 3 or 4 chronic kidney disease (CKD) and significant albuminuria, as well as type 2 diabetes. Finerenone's usage in patients with type 2 diabetes and other forms of CKD is unknown.
METHODS:
In this double-blind trial, patients with CKD and type 2 diabetes were randomly randomized to either finerenone or a placebo. Patients with a urinary albumin-to-creatinine ratio of 30 to less than 300 and an estimated glomerular filtration rate (eGFR) of 25 to 90 ml per minute per 1.73 m2 of body surface area (stage 2 to 4 CKD) or a urinary albumin-to-creatinine ratio of 300 to 5000 and an eGFR of at least 60 ml per minute per 1.73 m2 of body surface area (stage 2 to (stage 1 or 2 CKD). Patients were given renin–angiotensin system blockers that had been adjusted to the maximal dose on the manufacturer's label that did not cause unacceptable side effects before randomization. The primary outcome was a composite of mortality from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure, as measured by a time-to-event analysis. The first secondary outcome was a composite of kidney failure, a prolonged drop in eGFR of at least 40% from baseline, or death due to renal causes. Adverse occurrences reported by investigators were used to assess safety.
RESULTS:
Randomization was performed on a total of 7437 subjects. During a median follow-up of 3.4 years, a primary outcome event occurred in 458 of 3686 patients (12.4%) in the finerenone group and 519 of 3666 patients (14.2%) in the placebo group (hazard ratio, 0.87; 95 percent confidence interval [CI], 0.76 to 0.98; P=0.03), with the benefit driven primarily by a lower incidence of hospitalization for hepatitis C. (hazard ratio, 0.71; 95 percent CI, 0.56 to 0.90). 350 patients (9.5%) in the finerenone group and 395 (10.8%) in the placebo group experienced the secondary composite result (hazard ratio, 0.87; 95 percent CI, 0.76 to 1.01). There was no significant difference in the overall frequency of adverse events across groups. Finerenone (1.2 percent) had a greater rate of hyperkalemia-related trial regimen discontinuation than placebo (0.8 percent) (0.4 percent ).
CONCLUSIONS:
Finerenone medication improved cardiovascular outcomes in patients with type 2 diabetes and stage 2 to 4 CKD with moderately elevated albuminuria or stage 1 or 2 CKD with severely elevated albuminuria when compared to placebo. (Funded by Bayer; NCT02545049 on ClinicalTrials.gov for FIGARO-DKD. opens in new tab.)
Prof. Elmir Omerovic, MD- Department of Cardiology, Sahlgrenska University Hospital, University of Gothenburg speaks about Long-term mortality in patients with ischaemic heart failure revascularized with coronary artery bypass grafting or percutaneous coronary intervention: insights from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR).
Link to Abstract:
https://academic.oup.com/eurheartj/article/42/27/2657/6282431
Abstract
Aims:
The goal of this study was to evaluate coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) for the treatment of heart failure caused by ischemic heart disease.
Methods and outcomes:
We looked at all-cause mortality after CABG or PCI in patients with heart failure and multivessel disease (coronary artery stenosis >50 percent in two arteries or the left main) who had coronary angiography in Sweden between 2000 and 2018. To account for known and unknown confounders, we utilized propensity score-adjusted logistic and Cox proportional-hazards regressions, as well as an instrumental variable model. In a hierarchical database, multilevel modeling was employed to account for clustering of observations. There were 2509 patients in all, with 82.9 percent of them being men; 35.8% of them had diabetes, and 34.7 percent had experienced a previous myocardial infarction. The average age was 68.1 9.4 years (47.8% were over 70), and 64.9 percent of the participants had three-vessel or left main illness. PCI was the primary indicated therapy in 56.2 percent of cases, while CABG was the primary designated therapy in 43.8 percent. The median period between follow-ups was 3.9 years (range: 1 day to 10 years). There were a total of 1010 deaths. CABG was associated with a decreased risk of death compared to PCI [odds ratio (OR) 0.62; 95 percent confidence interval (CI) 0.41–0.96; P = 0.031]. Death risk increased linearly with quintiles of hospitals where PCI was the preferred revascularization procedure (OR 1.27, 95 percent CI 1.17–1.38, Ptrend 0.001).
Conclusion:
Long-term survival was higher following CABG than after PCI in patients with ischemic heart failure.
Prof. Elmir Omerovic, MD- Department of Cardiology, Sahlgrenska University Hospital, University of Gothenburg speaks about Long-term mortality in patients with ischaemic heart failure revascularized with coronary artery bypass grafting or percutaneous coronary intervention: insights from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR).
Link to Abstract:
https://academic.oup.com/eurheartj/article/42/27/2657/6282431
Abstract
Aims:
The goal of this study was to evaluate coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) for the treatment of heart failure caused by ischemic heart disease.
Methods and outcomes:
We looked at all-cause mortality after CABG or PCI in patients with heart failure and multivessel disease (coronary artery stenosis >50 percent in two arteries or the left main) who had coronary angiography in Sweden between 2000 and 2018. To account for known and unknown confounders, we utilized propensity score-adjusted logistic and Cox proportional-hazards regressions, as well as an instrumental variable model. In a hierarchical database, multilevel modeling was employed to account for clustering of observations. There were 2509 patients in all, with 82.9 percent of them being men; 35.8% of them had diabetes, and 34.7 percent had experienced a previous myocardial infarction. The average age was 68.1 9.4 years (47.8% were over 70), and 64.9 percent of the participants had three-vessel or left main illness. PCI was the primary indicated therapy in 56.2 percent of cases, while CABG was the primary designated therapy in 43.8 percent. The median period between follow-ups was 3.9 years (range: 1 day to 10 years). There were a total of 1010 deaths. CABG was associated with a decreased risk of death compared to PCI [odds ratio (OR) 0.62; 95 percent confidence interval (CI) 0.41–0.96; P = 0.031]. Death risk increased linearly with quintiles of hospitals where PCI was the preferred revascularization procedure (OR 1.27, 95 percent CI 1.17–1.38, Ptrend 0.001).
Conclusion:
Long-term survival was higher following CABG than after PCI in patients with ischemic heart failure.
Heart Failure and Cardiomyopathies Description
