The ARAMIS trial - Allopurinol in patients with Refractory Angina to iMprove Ischemic Symptoms
Notice bibliographique
Résumé
Abstract Introduction Allopurinol has been considered as a therapeutic option for patients with coronary artery disease (CAD) who remain symptomatic despite optimisation of clinical treatment and with no more revascularization possibilities. The two main mechanisms explaining the potential benefit are the reduction of oxidative stress and improvement in endothelial function. However, the role of allopurinol in the management of patients with refractory angina remains unknown. Objectives To assess the efficacy and safety of allopurinol in improving exercise capacity in patients with refractory angina. Methods A prospective, randomized, placebo-controlled, double-blind study, including patients over 18 years of age with a diagnosis of stable angina, as classified by the Canadian Cardiovascular Society (CCS) grading of angina ≥ 2 for at least 3 months, secondary to obstructive CAD confirmed by invasive coronary angiography, taking at least three classes of antianginal drugs, and with documented ischemia. Patients were randomized to receive allopurinol 300 mg/day for 4 weeks, subsequently increased to 600 mg/day, or placebo, and were followed for 16 weeks. Clinical and laboratory assessments were performed at 0, 4, and 16 weeks, and patients were submitted to a cardiopulmonary exercise test at the start and at the end of the study follow up. Results A total of 41 patients were included, 22 in the allopurinol group and 19 in the placebo group. There was a predominance of male participants in the allopurinol group (86.4% vs. 47.4% in the placebo group, p = 0.007). There were no differences in other demographic data or clinical aspects between the two groups. No significant difference was observed between the two groups in the final total exercise time (591.1 seconds in the allopurinol group vs. 596.8 seconds in the placebo group; p = 0.990), nor in the metabolic parameters of the cardiopulmonary test. The allopurinol group showed a better final ischemic threshold, (531.1 seconds vs. 369.9 seconds; p = 0.027). In the clinical evaluation, there was a trend towards improvement in CCS functional classification (81.8% vs. 55.6%; p = 0.071) and a reduction in nitrate consumption (87.5% vs. 53.8%; p = 0,044) in the allopurinol group. Adverse events were rare, equally distributed between groups, of low severity, and did not require protocol interruption. Conclusion Allopurinol did not demonstrate an impact on improving exercise duration in cardiopulmonary exercise testing in patients with refractory angina. However, it was associated with a higher ischemic threshold, a reduction on use of short-acting nitrates and a trend towards improvement in angina functional CCS classification compared to placebo.Table 1 - Cardiopulmonary exercise test Table 2 - Clinical Data
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».