Episode 376: 387. Methods Monday and an Example of Subgroup Analysis
Questioning Medicine17 Maalis 2025

Episode 376: 387. Methods Monday and an Example of Subgroup Analysis

https://www.nejm.org/doi/full/10.1056/NEJMoa2405923?query=clinical-medicine

Mineralocorticoid receptor antagonists have been shown to reduce mortality in patients after myocardial infarction with congestive heart failure. Whether routine use of spironolactone is beneficial after myocardial infarction is uncertain.

Recent attempts to improve outcomes with intensified renin–angiotensin–aldosterone inhibition have not shown improvements in outcomes.7,8 A trial of routine aldosterone antagonism with spironolactone in addition to standard therapy among 1603 patients after myocardial infarction without heart failure showed no improvement in outcomes.9

https://pubmed.ncbi.nlm.nih.gov/27102506/ “ In a non-pre-specified exploratory analysis, the odds of death were reduced in the treatment group (3 [0.5%] vs. 15 [2.4%]; HR: 0.20; 95% CI: 0.06 to 0.70) in the subgroup of ST-segment elevation MI (n = 1,229), but not in non-ST-segment elevation MI (p for interaction = 0.01).”’

However, there was a significant reduction in mortality in the subgroup of 1229 patients with ST-segment elevation myocardial infarction (STEMI), a finding that highlights the need for a large trial.

We conducted the CLEAR trial to evaluate whether routine use of spironolactone is beneficial in patients after myocardial infarction.

Jaksot(387)

Episode 353: 252. 2.4 Million to Prevent 4 Hospitalizations!

Episode 353: 252. 2.4 Million to Prevent 4 Hospitalizations!

Packer M et al. Tirzepatide for heart failure with preserved ejection fraction and obesity. N Engl J Med 2024 Nov 16; [e-pub].https://doi.org/10.1056/NEJMoa2410027  In the industry-funded SUMMIT trial...

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Episode 352: 251. Safety of Triptans in Patients Who Have or Are at High Risk for Cardiovascular Disease

Episode 352: 251. Safety of Triptans in Patients Who Have or Are at High Risk for Cardiovascular Disease

Wang Z et al. Safety of triptans in patients who have or are at high risk for cardiovascular disease: A target trial emulation. Mayo Clin Proc 2024 Nov; 99:1722. (https://doi.org/10.1016/j.mayocp.2024...

12 Joulu 20246min

Episode 351: 250. STROKE part 3 CME

Episode 351: 250. STROKE part 3 CME

STROKE part 3 CME

29 Marras 20249min

Episode 350: 249. STROKE - LA closure, alteplase vs tenecteplase, and thrombectomy

Episode 350: 249. STROKE - LA closure, alteplase vs tenecteplase, and thrombectomy

CME FOR FREEE

27 Marras 202417min

Episode 349: 248. Stroke- UIA, CHAD-VASC, HAS-BLED, SPARC, PFO

Episode 349: 248. Stroke- UIA, CHAD-VASC, HAS-BLED, SPARC, PFO

CME --- Stroke- UIA, CHAD-VASC, HAS-BLED, SPARC, PFO

26 Marras 202436min

Episode 348: 247. Early diagnostic paracentesis improves outcomes of hospitalized patients with cirrhosis and ascites

Episode 348: 247. Early diagnostic paracentesis improves outcomes of hospitalized patients with cirrhosis and ascites

Beran A et al. Early diagnostic paracentesis improves outcomes of hospitalized patients with cirrhosis and ascites: A systematic review and meta-analysis. Am J Gastroenterol 2024 Nov; 119:2259. (https...

22 Marras 20246min

Episode 347: 246.  Acupuncture vs Sham Acupuncture for Chronic Sciatica From Herniated Disk

Episode 347: 246. Acupuncture vs Sham Acupuncture for Chronic Sciatica From Herniated Disk

Acupuncture vs Sham Acupuncture for Chronic Sciatica From Herniated Disk: A Randomized Clinical Trial | Complementary and Alternative Medicine | JAMA Internal Medicine | JAMA Network  In a randomized ...

21 Marras 20248min

Episode 346: 245. Duration of benefit and risk of dual antiplatelet therapy after mild ischemic stroke

Episode 346: 245. Duration of benefit and risk of dual antiplatelet therapy after mild ischemic stroke

And now a secondary analysis of the trial focused on the timing of major ischemic events and the potential tradeoffs of benefits and risks,------ maybe there is magic sauce where the benefit is drasti...

20 Marras 20247min

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