Aspirin Monotherapy vs No Antiplatelet Therapy in Stable Patients With Coronary Stents Undergoing Low-to-Intermediate Risk Noncardiac Surgery (ASSURE DES)
Kang DY et al. JACC (December 2024)
Bottom Line: This randomized controlled trial compared the perioperative continuation of aspirin monotherapy versus temporarily holding all antiplatelet therapy in patients who had received drug-eluting stent (DES) > 1 year previously who were now undergoing elective noncardiac surgery. In the intervention group, aspirin was held 5 days prior to surgery and resumed no later than 48 hours after surgery unless contraindicated. A total of 1010 patients were randomized and the primary outcome was a composite of death, myocardial infarction, stent thrombosis, or stroke between 5 days before and 30 days after surgery. The results showed no significant difference between the two groups in terms of ischemic outcomes (0.6% in the aspirin monotherapy group vs. 0.9% in the no antiplatelet group; difference, −0.2 percentage points; 95% CI: −1.3 to 0.9; P > 0.99) or major bleeding (6.5% vs 5.2%; P = 0.39), but minor bleeding was more frequent in the aspirin group. The study concluded that there was no significant difference between perioperative aspirin monotherapy and no antiplatelet therapy in this patient population.
Once-Weekly Semaglutide in Persons with Obesity and Knee Osteoarthritis (STEP 9)
Bliddal H et al. NEJM (October 2024)
Bottom Line: This 68-week, double-blind, randomized, placebo-controlled trial evaluated the effects of semaglutide on weight and pain in participants with obesity (BMI ≥ 30) and clinical and radiologic diagnosis of moderate knee osteoarthritis with at least moderate pain. A total of 407 participants were enrolled and randomized to receive either once-weekly subcutaneous semaglutide (2.4 mg) or placebo, in addition to counselling on physical activity and a reduced-calorie diet. The primary outcomes were percentage change in body weight and change in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score at week 68. Results showed a -13.7% change in body weight and -41.7 points change in WOMAC pain score in the semaglutide group compared to -3.2% and -27.5 points in the placebo group, respectively (P<0.001). Participants in the semaglutide group also had a greater improvement in 36-Item Short Form Health Survey physical-function score. The incidence of serious adverse events was similar in both groups. Treatment with semaglutide resulted in significantly greater reductions in body weight and pain related to knee osteoarthritis compared to placebo.
Finerenone and Kidney Outcomes in Patients With Heart Failure: The FINEARTS-HF Trial
McCausland F et al. JACC (January 2025)
Bottom line: This trial examined the effects of finerenone on kidney outcomes in patients with heart failure with mildly reduced or preserved ejection fraction enrolled in the FINEARTS-HF trial, a randomized trial of finerenone versus placebo among 6001 patients with heart failure with mildly reduced or preserved ejection fraction. The intervention group received finerenone titrated to either 20 mg or 40 mg (depending on baseline eGFR), while the comparator group received placebo. Results showed no significant difference in the primary outcome of sustained ≥50% eGFR decline or kidney failure between finerenone and placebo. However, finerenone did lead to a greater reduction in initial eGFR and reduced the risk of new-onset micro- and macroalbuminuria.
Trial Files Issue #2025-04