2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, I

The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates.

Author/s:

Janet E. Bray, Kee-Chong Ng, Helen G. Liley, Robert Greif, Jestin N. Carlson, Peter T. Morley, an R. Drennan, Michael Smyth, Barnaby R. Scholefield, Gary M. Weiner, Adam Cheng, Therese Djärv, Cristian Abelairas-Gómez, Jason Acworth, Lars W. Andersen, Dianne L. Atkins, David C. Berry, Farhan Bhanji, Joost Bierens, Thomaz Bittencourt Couto, Vere Borra, Bernd W. Böttiger, Richard N. Bradley, Jan Breckwoldt, Pascal Cassan, Wei-Tien Chang, Nathan P. Charlton, Sung Phil Chung, Julie Considine, Daniela T. Costa-Nobre, Keith Couper, Katie N. Dainty, Vihara Dassanayake, Peter G. Davis, Jennifer A. Dawson, Maria Fernanda de Almeida, Allan R. De Caen, Charles D. Deakin, Bridget Dicker, Matthew J. Douma, Kathryn Eastwood, Walid El-Naggar, Jorge G. Fabres, Joe Fawke, ino Fijacko, Judith C. Finn, Gustavo E. Flores, Elizabeth E. Foglia, Fredrik Folke, Elaine Gilfoyle, Craig A. Goolsby, Asger Granfeldt, Anne-Marie Guerguerian, Ruth Guinsburg, Tetsuo Hatanaka, Karen G. Hirsch, Mathias J. Holmberg, et al.

Initial Invasive or Conservative Strategy for Stable Coronary Disease

John Bayhi — Thu, 02 Apr 2020 18:30:58 +0000

Date Added:

April 2, 2020

Journal/Publication:

The New England Journal of Medicine

Publisher:

Massachusetts Medical Society

Publication Date:

March 30, 2020

Issue:

Online ahead of print

URL:

Initial Invasive or Conservative Strategy for Stable Coronary Disease

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1056/nejmoa1915922

Keywords

coronary artery disease

cardiac ischemia

cardiac interventions

PMID (1):

32227755

MeSH

myocardial infarction

coronary artery disease

Once again, opening up coronary arteries by whatever invasive method does not prevent heart attacks any better than medical management. CABG and PTCA should be reserved for patients with clinically significant angina unresponsive to medical management and possibly those with critical LAD stenosis or CHF with 3-vessel disease. James W. Mold, MD, MPH

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Background: Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain.

Methods: We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction.

Results: Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, -1.8 percentage points; 95% CI, -4.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32).

Conclusions: Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used. (Funded by the National Heart, Lung, and Blood Institute and others; ISCHEMIA ClinicalTrials.gov number, NCT01471522.).

Author/s:

Maron, DJ, Hochman, JS, Reynolds, HR, Bangalore, S, O'Brien, SM, Boden, WE, Chaitman, BR, Senior, R, Lopez-Sendon, J, Alexander, KP, Lopes, RD, Shaw, LJ, Berger, JS, Newman, JD, Sidhu, MS, Goodman, SG, Ruzyllo, W, Gosselin, G, Maggioni, AP, White, HD, Bhargava, B, Min, JK, Mancini, GBJ, Berman, DS, Picard, MH, Kwong, RY, Ali, ZA, Mark, DB, Spertus, JA, Krishnan, MN, Elghamaz, A, Moorthy, N, Hueb, WA, Demkow, M, Mavromatis, K, Bockeria, O, Peteiro, J, Miller, TD, Szwed, H, Doerr, R, Keltai, M, Selvanayagam, JB, Steg, PG, Held, C, Kohsaka, S, Mavromichalis, S, Kirby, R, Jeffries, NO, Harrell, FE Jr, Rockhold, FW, Broderick, S, Ferguson, TB Jr, Williams, DO, Harrington, RA, Stone, GW, Rosenberg, Y, ISCHEMIA Research Group