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The Stanford study supports previous findings that long-term mortality is similar after bypass or angioplasty for the average patient with multi-vessel coronary artery disease, but goes one step further to check whether this overall result is also true in most patient subgroups, such as women, smokers and patients with hypertension.
We observed SVR >95% for most patient subgroups including those with co-infection, prior treatment-experience, and cirrhosis.
Event-free survival with surgery progressively improved over the period of the study and, by 1984, was significantly better than medical therapy for most patient subgroups.
INTERPRETATION: Long-term mortality is similar after CABG and PCI in most patient subgroups with multivessel coronary artery disease, so choice of treatment should depend on patient preferences for other outcomes.
This survival benefit holds true across most patient subgroups.
The ivabradine treatment effect was found to be consistent across most patient subgroups but was modified by baseline heart rate.
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Finally, this study emphasises the importance of strong preclinical data and the identification of potential therapeutic response parameters (in this case, ER, cyclin D1, and a gene expression signature) in targeting therapeutic trials to the most appropriate patient subgroups.
Subgroup analysis demonstrated survival benefits across most clinically important patient subgroups, regardless of current use of bisphophonates, prior use of docetaxel, or ECOG performance status.
In the overall population, the difference between levomilnacipran ER and placebo response rates was 10.2% (P <.001); similar advantages for levomilnacipran versus placebo were found in most of the patient subgroups.
Much has been learned about the patient subgroups most likely to benefit from this approach, and we refer the reader to several excellent recent reviews on this topic16,17,18.
"These results suggest that genomic sequencing can optimize the development of new medicines for kidney disease through the selection of patient subgroups most likely to benefit from new therapies," says Adam Platt, PhD, Head of Global Genomics Portfolio at AstraZeneca and a co-senior author of the study.
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