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GALACTIC Trial

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La Dra. Silvia Valbuena López apunta las principales conclusiones del ensayo publicado en ESC Congress 2019.

Publicada em: Saúde e medicina
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GALACTIC Trial

  1. 1. Silvia Valbuena LópezGALACTIC Trial GALACTIC Goal-directed AfterLoad Reduction in Acute Congestive Cardiac Decompensation: a randomized controlled trial
  2. 2. Silvia Valbuena LópezGALACTIC Trial BACKGROUND • AHF is common and carries a poor prognosis with increased mortality and morbidity • Death or rehospitalization occurs in 40-50% of patients within 180 days • Contemporary trials for new drugs on AHF have mostly failed to show a significant improvement in outcomes • Iv nitrates have shown to improve outcomes in small trials in severe pulmonary oedema • An approach suitable for patients outside Intensive Care Units has not been tested
  3. 3. Silvia Valbuena LópezGALACTIC Trial HYPOTHESIS A strategy of early intensive and sustained vasodilatation versus standard of care would improve outcomes in AHF by decreasing PCP and improving organ perfusion
  4. 4. Silvia Valbuena LópezGALACTIC Trial METHODS • Investigator-led. University of Basel. • Multicenter, randomized, open-label (blind asignment of endpoints) • Inclusion  AHF  NYHA III-IV + BNP >500 or NT-pro-BNP > 2000 mg/l • Endpoint : - Primary endpoint  death or rehospitalization for HF (180 days) - Secondary  subjective dyspnoea, time to discharge, adverse events • Intensive vasodilatation strategy, target SBP 110 mmHg: - S.l. and transdermal high dose nitrates - Hydralazine - Quick uptitration of ACEI/ARB/ARNI
  5. 5. Silvia Valbuena LópezGALACTIC Trial METHODS
  6. 6. Silvia Valbuena LópezGALACTIC Trial STUDY FLOW
  7. 7. Silvia Valbuena LópezGALACTIC Trial RESULTS. Primary endpoint PRIMARY ENDPOINT: DEATH OR AHF
  8. 8. Silvia Valbuena LópezGALACTIC Trial RESULTS. Subgroup analysis
  9. 9. Silvia Valbuena LópezGALACTIC Trial RESULTS
  10. 10. Silvia Valbuena LópezGALACTIC Trial LIMITATIONS • Open-label design  possible bias • Poorly defined population (LVEF, aetiology) • Mid and long-term outcome is probably driven to a larger extent by post-discharge therapies rather than early treatment
  11. 11. Silvia Valbuena LópezGALACTIC Trial CONCLUSIÓN En un amplia población de pacientes con insuficiencia cardíaca aguda, una estrategia de vasodilatación temprana, intensiva y sostenida no mejoró el objetivo combinado de muerte y rehospitalización por ICC a los 180 días

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