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Post PCI management

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Post-PCI Management

2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization (Please do not edit).

Dual Antiplatelet Therapy in Patients After PCI

Class IIa
” 1. In selected patients undergoing PCI, shorter-duration DAPT (1–3 months) is reasonable, with subsequent transition to P2Y12 inhibitor monotherapy to reduce the risk of bleeding events (Level of Evidence A)”.

[1]

Beta Blockers in Patients After Revascularization

Class III (No Benefit)
“1. In patients with SIHD and normal left ventricular function, the routine use of chronic oral beta-blockers is not beneficial to reduce cardiovascular events after complete revascularization.(Level of Evidence:C-LD ”

[1]

Antiplatelet Therapy in Patients With Atrial Fibrillation on Anticoagulation After PCI

Class I
“1. In patients with atrial fibrillation who are undergoing PCI and are taking oral anticoagulant therapy, it is recommended to discontinue aspirin treatment after 1 to 4 weeks while maintaining P2Y12 inhibitors in addition to a non–vitamin K oral anticoagulant (rivaroxaban, dabigatran, apixaban, or edoxaban) or warfarin to reduce the risk of bleeding (Level of Evidence: B-R)”

[1]

Class IIa
” 2. In patients with atrial fibrillation who are undergoing PCI, are taking oral anticoagu-lant therapy, and are treated with DAPT or a P2Y12 inhibitor monotherapy, it is reasonable to choose a non–vitamin K oral anticoagulant over warfarin to reduce the risk of bleeding (Level of Evidence B-R)”.

[1]

2011 ACCF/AHA/SCAI Guidelines for Percutaneous Coronary Intervention (DO NOT EDIT)[2]

Post-procedural Antiplatelet Therapy (DO NOT EDIT)[2]

Class I
“1. After PCI, use of aspirin should be continued indefinitely.[3][4][5][6] (Level of Evidence: A)”
“2. The duration of P2Y12 inhibitor therapy after stent implantation should generally be as follows:
a. In patients receiving a stent (bare metal stent (BMS) or drug eluting stent (DES)) during PCI for ACS, P2Y12 inhibitor therapy should be given for at least 12 months. Options include clopidogrel 75 mg daily [7], prasugrel 10 mg daily [8], and ticagrelor 90 mg twice daily.[9] (Level of Evidence: B)
b. In patients receiving drug eluting stent (DES) for a non-ACS indication, clopidogrel 75 mg daily should be given for at least 12 months if the patient is not at high risk of bleeding.[10][11][12] (Level of Evidence: B)
c. In patients receiving bare metal stent (BMS) for a non-ACS indication, clopidogrel should be given for a minimum of 1 month and ideally up to 12 months (unless the patient is at increased risk of bleeding; then it should be given for a minimum of 2 weeks).[13] (Level of Evidence: B)“
“3. Patients should be counseled on the importance of compliance with dual antiplatelet therapy (DAPT) and that therapy should not be discontinued before discussion with their cardiologist.[12] (Level of Evidence: C)”
Class IIa
“1. After PCI, it is reasonable to use aspirin 81 mg per day in preference to higher maintenance doses.[14][15][16][17][18] (Level of Evidence: B)”
“2. If the risk of morbidity from bleeding outweighs the anticipated benefit afforded by a recommended duration of P2Y12 inhibitor therapy after stent implantation, earlier discontinuation (e.g., less than 12 months) of P2Y12 inhibitor therapy is reasonable. (Level of Evidence: C)”
Class IIb
“1. Continuation of clopidogrel, prasugrel or ticagrelor beyond 12 months may be considered in patients undergoing placement of drug eluting stent (DES).[8][9] (Level of Evidence: C)”

Post-Procedural Proton Pump Inhibitors and Anti-platelet Therapy (DO NOT EDIT)[2]

Class I
“1. Proton pump inhibitors should be used in patients with a history of prior gastrointestinal bleeding who require dual antiplatelet therapy (DAPT).[19] (Level of Evidence: C)”
Class III (No Benefit)
“1. Routine use of a proton pump inhibitor is not recommended for patients at low risk of gastrointestinal bleeding, who have much less potential to benefit from prophylactic therapy.[19] (Level of Evidence: C)”
Class IIa
“1. Use of proton pump inhibitors is reasonable in patients with an increased risk of gastrointestinal bleeding (e.g., advanced age, concomitant use of warfarin, steroids, nonsteroidal antiinflammatory drugs, Helicobacter pylori infection) who require dual antiplatelet therapy (DAPT).[19] (Level of Evidence: C)”

Post-Procedural Clopidogrel Genetic Testing (DO NOT EDIT)[2]

Class III (No Benefit)
“1. The routine clinical use of genetic testing to screen patients treated with clopidogrel who are undergoing PCI is not recommended.[20] (Level of Evidence: C)”
Class IIb
“1. Genetic testing might be considered to identify whether a patient at high risk for poor clinical outcomes is predisposed to inadequate platelet inhibition with clopidogrel.[20] (Level of Evidence: C)”
“2. When a patient predisposed to inadequate platelet inhibition with clopidogrel is identified by genetic testing, treatment with an alternate P2Y12 inhibitor (e.g., prasugrel or ticagrelor) might be considered.[20] (Level of Evidence: C)”

Post-Procedural Platelet Function Testing (DO NOT EDIT)[2]

Class III (No Benefit)
“1. The routine clinical use of platelet function testing to screen patients treated with clopidogrel who are undergoing PCI is not recommended.[20] (Level of Evidence: C)”
Class IIb
“1. Platelet function testing may be considered in patients at high risk for poor clinical outcomes.[20] (Level of Evidence: C)”
“2. In patients treated with clopidogrel with high platelet reactivity, alternative agents, such as prasugrel or ticagrelor, might be considered.[20] (Level of Evidence: C)”

Exercise Testing (DO NOT EDIT)[2]

Class III (No Benefit)
“1. Routine periodic stress testing of asymptomatic patients after PCI without specific clinical indications should not be performed.[21](Level of Evidence: C)”
Class IIa
“1. In patients entering a formal cardiac rehabilitation program after PCI, treadmill exercise testing is reasonable. (Level of Evidence: C)”

Cardiac Rehabilitation (DO NOT EDIT)[2]

Class I
“1. Medically supervised exercise programs (cardiac rehabilitation) should be recommended to patients after PCI, particularly for moderate- to high-risk patients for whom supervised exercise training is warranted.[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] (Level of Evidence: A)”

References

  1. ↑ 1.0 1.1 1.2 1.3 “Correction to: 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines”. Circulation. 145 (11): e771. 2022. doi:10.1161/CIR.0000000000001061. PMID 35286170 Check |pmid= value (help).
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH (2011). “2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions” (PDF). Journal of the American College of Cardiology. 58 (24): 2550–83. doi:10.1016/j.jacc.2011.08.006. PMID 22070837. Retrieved 2011-12-08. Text “PDF” ignored (help); Unknown parameter |month= ignored (help)
  3. ↑ Schömig A, Neumann FJ, Kastrati A, Schühlen H, Blasini R, Hadamitzky M, Walter H, Zitzmann-Roth EM, Richardt G, Alt E, Schmitt C, Ulm K (1996). “A randomized comparison of antiplatelet and anticoagulant therapy after the placement of coronary-artery stents”. The New England Journal of Medicine. 334 (17): 1084–9. doi:10.1056/NEJM199604253341702. PMID 8598866. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  4. ↑ “Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients”. BMJ (Clinical Research Ed.). 324 (7329): 71–86. 2002. PMC 64503. PMID 11786451. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  5. ↑ Smith SC, Allen J, Blair SN, Bonow RO, Brass LM, Fonarow GC, Grundy SM, Hiratzka L, Jones D, Krumholz HM, Mosca L, Pasternak RC, Pearson T, Pfeffer MA, Taubert KA (2006). “AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update: endorsed by the National Heart, Lung, and Blood Institute”. Circulation. 113 (19): 2363–72. doi:10.1161/CIRCULATIONAHA.106.174516. PMID 16702489. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  6. ↑ Baigent C, Blackwell L, Collins R, Emberson J, Godwin J, Peto R, Buring J, Hennekens C, Kearney P, Meade T, Patrono C, Roncaglioni MC, Zanchetti A (2009). “Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials”. Lancet. 373 (9678): 1849–60. doi:10.1016/S0140-6736(09)60503-1. PMC 2715005. PMID 19482214. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  7. ↑ Mehta SR, Yusuf S, Peters RJ, Bertrand ME, Lewis BS, Natarajan MK, Malmberg K, Rupprecht H, Zhao F, Chrolavicius S, Copland I, Fox KA (2001). “Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study”. Lancet. 358 (9281): 527–33. PMID 11520521. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  8. ↑ 8.0 8.1 Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S, Neumann FJ, Ardissino D, De Servi S, Murphy SA, Riesmeyer J, Weerakkody G, Gibson CM, Antman EM (2007). “Prasugrel versus clopidogrel in patients with acute coronary syndromes”. The New England Journal of Medicine. 357 (20): 2001–15. doi:10.1056/NEJMoa0706482. PMID 17982182. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  9. ↑ 9.0 9.1 Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, Horrow J, Husted S, James S, Katus H, Mahaffey KW, Scirica BM, Skene A, Steg PG, Storey RF, Harrington RA, Freij A, Thorsén M (2009). “Ticagrelor versus clopidogrel in patients with acute coronary syndromes”. The New England Journal of Medicine. 361 (11): 1045–57. doi:10.1056/NEJMoa0904327. PMID 19717846. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  10. ↑ Brar SS, Kim J, Brar SK, Zadegan R, Ree M, Liu IL, Mansukhani P, Aharonian V, Hyett R, Shen AY (2008). “Long-term outcomes by clopidogrel duration and stent type in a diabetic population with de novo coronary artery lesions”. Journal of the American College of Cardiology. 51 (23): 2220–7. doi:10.1016/j.jacc.2008.01.063. PMID 18534267. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  11. ↑ Eisenstein EL, Anstrom KJ, Kong DF, Shaw LK, Tuttle RH, Mark DB, Kramer JM, Harrington RA, Matchar DB, Kandzari DE, Peterson ED, Schulman KA, Califf RM (2007). “Clopidogrel use and long-term clinical outcomes after drug-eluting stent implantation”. JAMA : the Journal of the American Medical Association. 297 (2): 159–68. doi:10.1001/jama.297.2.joc60179. PMID 17148711. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  12. ↑ 12.0 12.1 Grines CL, Bonow RO, Casey DE, Gardner TJ, Lockhart PB, Moliterno DJ, O’Gara P, Whitlow P (2007). “Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians”. Journal of the American College of Cardiology. 49 (6): 734–9. doi:10.1016/j.jacc.2007.01.003. PMID 17291948. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  13. ↑ Steinhubl SR, Berger PB, Mann JT, Fry ET, DeLago A, Wilmer C, Topol EJ (2002). “Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial”. JAMA : the Journal of the American Medical Association. 288 (19): 2411–20. PMID 12435254. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  14. ↑ Jolly SS, Pogue J, Haladyn K, Peters RJ, Fox KA, Avezum A, Gersh BJ, Rupprecht HJ, Yusuf S, Mehta SR (2009). “Effects of aspirin dose on ischaemic events and bleeding after percutaneous coronary intervention: insights from the PCI-CURE study”. European Heart Journal. 30 (8): 900–7. doi:10.1093/eurheartj/ehn417. PMID 18819961. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  15. ↑ Patrono C, Baigent C, Hirsh J, Roth G (2008). “Antiplatelet drugs: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)”. Chest. 133 (6 Suppl): 199S–233S. doi:10.1378/chest.08-0672. PMID 18574266. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  16. ↑ Steinhubl SR, Bhatt DL, Brennan DM, Montalescot G, Hankey GJ, Eikelboom JW, Berger PB, Topol EJ (2009). “Aspirin to prevent cardiovascular disease: the association of aspirin dose and clopidogrel with thrombosis and bleeding”. Annals of Internal Medicine. 150 (6): 379–86. PMID 19293071. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  17. ↑ Serebruany VL, Steinhubl SR, Berger PB, Malinin AI, Baggish JS, Bhatt DL, Topol EJ (2005). “Analysis of risk of bleeding complications after different doses of aspirin in 192,036 patients enrolled in 31 randomized controlled trials”. The American Journal of Cardiology. 95 (10): 1218–22. doi:10.1016/j.amjcard.2005.01.049. PMID 15877994. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  18. ↑ Peters RJ, Mehta SR, Fox KA, Zhao F, Lewis BS, Kopecky SL, Diaz R, Commerford PJ, Valentin V, Yusuf S (2003). “Effects of aspirin dose when used alone or in combination with clopidogrel in patients with acute coronary syndromes: observations from the Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) study”. Circulation. 108 (14): 1682–7. doi:10.1161/01.CIR.0000091201.39590.CB. PMID 14504182. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  19. ↑ 19.0 19.1 19.2 Abraham NS, Hlatky MA, Antman EM, Bhatt DL, Bjorkman DJ, Clark CB, Furberg CD, Johnson DA, Kahi CJ, Laine L, Mahaffey KW, Quigley EM, Scheiman J, Sperling LS, Tomaselli GF (2010). “ACCF/ACG/AHA 2010 expert consensus document on the concomitant use of proton pump inhibitors and thienopyridines: a focused update of the ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use. A Report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents”. Journal of the American College of Cardiology. 56 (24): 2051–66. doi:10.1016/j.jacc.2010.09.010. PMID 21126648. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  20. ↑ 20.0 20.1 20.2 20.3 20.4 20.5 Holmes DR, Dehmer GJ, Kaul S, Leifer D, O’Gara PT, Stein CM (2010). “ACCF/AHA clopidogrel clinical alert: approaches to the FDA “boxed warning”: a report of the American College of Cardiology Foundation Task Force on clinical expert consensus documents and the American Heart Association endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons”. Journal of the American College of Cardiology. 56 (4): 321–41. doi:10.1016/j.jacc.2010.05.013. PMID 20633831. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  21. ↑ Eisenberg MJ, Blankenship JC, Huynh T, Azrin M, Pathan A, Sedlis S, Panja M, Starling MR, Beyar R, Azoulay A, Caron J, Pilote L (2004). “Evaluation of routine functional testing after percutaneous coronary intervention”. The American Journal of Cardiology. 93 (6): 744–7. doi:10.1016/j.amjcard.2003.11.071. PMID 15019882. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  22. ↑ Goel K, Lennon RJ, Tilbury RT, Squires RW, Thomas RJ (2011). “Impact of cardiac rehabilitation on mortality and cardiovascular events after percutaneous coronary intervention in the community”. Circulation. 123 (21): 2344–52. doi:10.1161/CIRCULATIONAHA.110.983536. PMID 21576654. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  23. ↑ Taylor RS, Brown A, Ebrahim S, Jolliffe J, Noorani H, Rees K, Skidmore B, Stone JA, Thompson DR, Oldridge N (2004). “Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials”. The American Journal of Medicine. 116 (10): 682–92. doi:10.1016/j.amjmed.2004.01.009. PMID 15121495. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  24. ↑ Giannuzzi P, Temporelli PL, Marchioli R, Maggioni AP, Balestroni G, Ceci V, Chieffo C, Gattone M, Griffo R, Schweiger C, Tavazzi L, Urbinati S, Valagussa F, Vanuzzo D (2008). “Global secondary prevention strategies to limit event recurrence after myocardial infarction: results of the GOSPEL study, a multicenter, randomized controlled trial from the Italian Cardiac Rehabilitation Network”. Archives of Internal Medicine. 168 (20): 2194–204. doi:10.1001/archinte.168.20.2194. PMID 19001195. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  25. ↑ Witt BJ, Jacobsen SJ, Weston SA, Killian JM, Meverden RA, Allison TG, Reeder GS, Roger VL (2004). “Cardiac rehabilitation after myocardial infarction in the community”. Journal of the American College of Cardiology. 44 (5): 988–96. doi:10.1016/j.jacc.2004.05.062. PMID 15337208. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  26. ↑ Fletcher GF, Balady GJ, Amsterdam EA, Chaitman B, Eckel R, Fleg J, Froelicher VF, Leon AS, Piña IL, Rodney R, Simons-Morton DA, Williams MA, Bazzarre T (2001). “Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association”. Circulation. 104 (14): 1694–740. PMID 11581152. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  27. ↑ Thompson PD (2003). “Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease”. Arteriosclerosis, Thrombosis, and Vascular Biology. 23 (8): 1319–21. doi:10.1161/01.ATV.0000087143.33998.F2. PMID 12909570. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  28. ↑ Clark AM, Hartling L, Vandermeer B, McAlister FA (2005). “Meta-analysis: secondary prevention programs for patients with coronary artery disease”. Annals of Internal Medicine. 143 (9): 659–72. PMID 16263889. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  29. ↑ Thomas RJ, King M, Lui K, Oldridge N, Piña IL, Spertus J, Bonow RO, Estes NA, Goff DC, Grady KL, Hiniker AR, Masoudi FA, Radford MJ, Rumsfeld JS, Whitman GR (2007). “AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for referral to and delivery of cardiac rehabilitation/secondary prevention services endorsed by the American College of Chest Physicians, American College of Sports Medicine, American Physical Therapy Association, Canadian Association of Cardiac Rehabilitation, European Association for Cardiovascular Prevention and Rehabilitation, Inter-American Heart Foundation, National Association of Clinical Nurse Specialists, Preventive Cardiovascular Nurses Association, and the Society of Thoracic Surgeons”. Journal of the American College of Cardiology. 50 (14): 1400–33. doi:10.1016/j.jacc.2007.04.033. PMID 17903645. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  30. ↑ Walther C, Möbius-Winkler S, Linke A, Bruegel M, Thiery J, Schuler G, Halbrecht R (2008). “Regular exercise training compared with percutaneous intervention leads to a reduction of inflammatory markers and cardiovascular events in patients with coronary artery disease”. European Journal of Cardiovascular Prevention and Rehabilitation : Official Journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology. 15 (1): 107–12. doi:10.1097/HJR.0b013e3282f29aa6. PMID 18277195. Retrieved 2011-12-16. Unknown parameter |month= ignored (help)
  31. ↑ Smith SC Jr., Benjamin EJ, Bonow RO, et al. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation. Circulation, published online before print November 3, 2011, doi:10.1161/CIR.0b013e318235eb4d. Accessed November 3, 2011.
  32. ↑ Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report Circulation, 106 (2002), pp. 3143–3421
  33. ↑ A.M. Dattilo, P.M. Kris-Etherton Effects of weight reduction on blood lipids and lipoproteins: a meta-analysis Am J Clin Nutr, 56 (1992), pp. 320–328
  34. ↑ C. Baigent, L. Blackwell, J. Emberson et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta analysis of data from 170,000 participants in 26 randomised trials Lancet, 376 (2010), pp. 1670–1681
  35. ↑ T.R. Pedersen, O. Faergeman, J.J. Kastelein et al. High-dose atorvastatin vs usual-dose simvastatin for secondary prevention after myocardial infarction: the IDEAL study: a randomized controlled trial JAMA, 294 (2005), pp. 2437–2445
  36. ↑ J.C. LaRosa, S.M. Grundy, D.D. Waters et al. Intensive lipid lowering with atorvastatin in patients with stable coronary disease N Engl J Med, 352 (2005), pp. 1425–1435
  37. ↑ MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial Lancet, 360 (2002), pp. 7–22
  38. ↑ C. Baigent, L. Blackwell, Cholesterol Treatment Trialists’ (CTT) Collaboration et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials Lancet, 376 (2010), pp. 1670–1681
  39. ↑ C.P. Cannon, E. Braunwald, C.H. McCabe et al. Intensive versus moderate lipid lowering with statins after acute coronary syndromes N Engl J Med, 350 (2004), pp. 1495–1504
  40. ↑ C.P. Cannon, B.A. Steinberg, S.A. Murphy et al. Meta-analysis of cardiovascular outcomes trials comparing intensive versus moderate statin therapy J Am Coll Cardiol, 48 (2006), pp. 438–445
  41. ↑ A.V. Chobanian, G.L. Bakris, H.R. Black et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure Hypertension, 42 (2003), pp. 1206–1252
  42. ↑ S.P. Whelton, A. Chin, X. Xin et al.Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials Ann Intern Med, 136 (2002), pp. 493–503
  43. ↑ L.J. Appel, E.D. Frohlich, J.E. Hall et al. The importance of population-wide sodium reduction as a means to prevent cardiovascular disease and stroke: a call to action from the American Heart Association Circulation, 123 (2011), pp. 1138–1143
  44. ↑ The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) [published corrections appear in JAMA 2003;289:178; JAMA 2004;291:2196] JAMA, 288 (2002), pp. 2981–2997
  45. ↑ C. Duncan, M.J. Stein, S.R. Cummings Staff involvement and special follow-up time increase physicians’ counseling about smoking cessation: a controlled trial Am J Public Health, 81 (1991), pp. 899–901
  46. ↑ W. Rosser, I. McDowell, C. Newell Documenting smoking status: trial of three strategies Can Fam Physician, 38 (1992), pp. 1623–1628
  47. ↑ S.R. Cummings, R.J. Richard, C.L. Duncan et al. Training physicians about smoking cessation: a controlled trial in private practice J Gen Intern Med, 4 (1989), pp. 482–489

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