Impactful Clinical Trials of 2015: What Clinicians Need to Know

Randomized clinical trials (RCTs) remain the foundation for assessing and introducing evidence-based therapies into cardiovascular (CV) medicine. In 2015, a number of RCTs were reported and published that have great potential to improve CV outcomes and thus to change clinical practice. We highlight the results and implications of major RCTs in the areas of acute coronary syndrome (ACS), interventional cardiology, atrial fibrillation, lipids, heart failure, diabetes, and hypertension. Among the trials we discuss, PEGASUS and DAPT provide guidance regarding the potential benefits and hazards of longer-term dual-antiplatelet therapy after percutaneous coronary intervention (PCI) or myocardial infarction (MI). The BRIDGE study evaluated the role of bridging patients with atrial fibrillation who underwent noncardiac surgery with low-molecular-weight heparin while temporarily discontinuing their oral anticoagulant. The REVERSE-AD trial addressed the highly relevant issue of the first reversal agent (idarucizumab) for the direct oral anticoagulant dabigatran. The IMPROVE- IT assessed the benefits of adding ezetimibe to a statin in patients with ACS. Coupled with the latest studies involving proprotein convertase subtilisin/kexin type 9 inhibitors, the lipid field was particularly active in 2015. The year ended with major headlines in hypertension and diabetes. The SPRINT may lead to a new era in hypertension, with lowered blood pressure (BP) targets, and EMPA-REG became the first study ever to demonstrate a convincing reduction in CV events with a glucose-lowering agent, in this case empagliflozin. The results of these and other trials will likely impact practice guidelines and improve outcomes for our patients.