Landmark Cardiology Trials: A List for Medical Students

Maybe your attending pimped the snot out of you on rounds this morning. Maybe your clerkship director told you to “be familiar with the big trials”. Or maybe (if you’re like me) an older student told you that cardiologists really dig evidence-based medicine…and then couldn’t give you a list of papers to read or abstracts to skim. Being the AOA-grade medical student that you are, you’ve probably already hit up Google and PubMed and failed to find a list of landmark trials that’s both short and free.

Fear not, young grasshopper – NC/AT’s got your back. This is a short list of trials I compiled by talking to a few cardiology attendings and fellows. It’s not complete, but it’s a good place to start; just being familiar with a few of these abstracts will score you some easy points. If you’re only going to read a few abstracts, read AFFIRM, RALES, and Juurlink’s paper on the incidence of hyperkalemia after RALES was published. If you’re really serious about going into cardiology and want to look up trials on the fly, this probably isn’t the list for you; you may want to check out Skyscape’s PDA database instead. Finally, if you just want to know what to do for your patients, check out the AHA/ACC joint guidelines.

Hypertension/CHF/Stable CAD:

• Predictors of successful BP control: ALLHAT (PMID 12461301).
• Use of beta-blockers: Merit-HF (PMID 10714728).
• Use of ACE inhibitors: HOPE (PMID 10639539).
• Use of ARBs: VALIANT (PMID 16487836), meta-analysis (PMID 11823085).
• Use of K-sparing diuretics: RALES (PMID 10471456), effects on rate of hyperkalemia (PMID 15295047).
• Racial differences in response to therapy: V-HeFT I and II (PMID 10496190), A-HeFT (PMID 15533851), review (PMID 16330707).
• Cardiac resynchronization therapy: CARE-HF (PMID 15753115), SCD-HeFT (PMID 15659722).
• PCI v. optimal medical management for stable coronary artery disease: review covering COURAGE and AVERT (PMID 10987582).

Atrial Fibrillation:

• Rate control versus rhythm control: AFFIRM (PMID 12466506).

Acute Coronary Syndrome:

• Statins after ACS: REVERSAL (PMID 14996776), Prove-IT (PMID 15007110).
• Early invasive therapy in NSTEMI/UA: TACTICS (PMID 11712935).

[Edit, 03 May 2009]: Watch for the ENHANCE (the study that showed no additional plaque thinning when adding ezetimibe to high-dose statins) data to be published; it was presented at the ACC meeting in March 2009.

Tagged as: cardiology, ebm, evidence-based medicine