Clinical evidence, distilled.

In acute cardiogenic pulmonary edema, noninvasive ventilation eased distress and gas exchange faster than oxygen but did not cut 7-day mortality.

Simvastatin cut all-cause mortality in patients with coronary disease, the first trial to prove statins save lives.

In high-risk T2DM, targeting near-normal A1c increased mortality and did not reduce major CV events enough to justify the strategy.

Bolus tenecteplase 0.25 mg/kg was noninferior to alteplase for excellent function at 90-120 days after disabling ischemic stroke in Canada.

Zidovudine dramatically reduced mother-to-infant HIV transmission.

Early cisatracurium improved adjusted survival in severe early ARDS in ACURASYS.

In ventilated septic shock, hydrocortisone 200 mg daily for 7 days did not lower 90-day mortality versus placebo.

In older high-risk AF patients, rhythm control did not improve survival compared with rate control.

FFRangio-guided PCI decisions were noninferior to pressure-wire physiology for 1-year MACE in intermediate coronary stenoses.

Chlorthalidone was at least as good as amlodipine or lisinopril for major CHD outcomes and better for several HF/stroke-related outcomes.

In shock-refractory VF or pulseless VT, neither amiodarone nor lidocaine improved survival to discharge or neurologic outcome versus placebo.

Apixaban was noninferior to enoxaparin/warfarin for acute VTE treatment and caused less major bleeding.

Andexanet improved hemostatic efficacy versus usual care in factor Xa inhibitor-related ICH, but increased thrombotic events including ischemic stroke.

In CT-proven uncomplicated appendicitis, antibiotics did not meet noninferiority versus appendectomy; most antibiotic-assigned patients avoided surgery at 1 year.

Hydrocortisone plus fludrocortisone reduced 90-day mortality in severe septic shock.

Low tidal-volume ventilation reduced mortality in acute lung injury/ARDS.

In ED patients with early septic shock, EGDT did not reduce 90-day mortality compared with usual care.

Apixaban beat warfarin for stroke prevention with less major bleeding and lower mortality in atrial fibrillation.

In a single-center trial of refractory VF arrest, early ECMO-facilitated resuscitation improved survival to discharge versus standard ACLS.

Elective induction at 39 weeks in low-risk nulliparous patients did not worsen perinatal outcomes and reduced cesarean delivery.

Aspirin started early reduced preterm preeclampsia in screened high-risk pregnancies.

In healthy older adults, 100 mg aspirin did not prolong disability-free survival and increased major hemorrhage versus placebo.

Targeting SBP 110 to 139 mm Hg in acute ICH did not reduce death or disability versus 140 to 179 mm Hg and increased renal adverse events.

Apixaban beat aspirin for stroke prevention in AF patients unsuitable for warfarin.

In seropositive active SLE, IV belimumab 1 or 10 mg/kg plus standard care raised the week-52 SRI response versus placebo.

In AF patients interrupting warfarin for procedures, forgoing LMWH bridging was noninferior for arterial thromboembolism and reduced major bleeding.

AF ablation did not significantly reduce the primary composite versus drug therapy by intention-to-treat.

In very-low-birth-weight infants, caffeine reduced oxygen use at 36 weeks postmenstrual age versus placebo, with temporarily lower weight gain.

Oral apixaban was noninferior to dalteparin for recurrent cancer-associated VTE and did not increase major bleeding.

In gout with cardiovascular disease, febuxostat was noninferior to allopurinol for the MACE composite, but all-cause and cardiovascular death were higher.

Suppressing post-MI ventricular ectopy with class IC drugs increased mortality.

Most antipsychotics had high discontinuation rates; olanzapine lasted longer but caused more metabolic effects.

In minor stroke/TIA treated within 24 hours, 21 days of aspirin plus 90 days of clopidogrel reduced recurrent stroke without increasing hemorrhage in the Chinese trial population.

Treating mild chronic hypertension in pregnancy to <140/90 improved pregnancy outcomes without increasing small-for-gestational-age births.

In cancer-associated VTE, 6 months of dalteparin reduced recurrent thrombosis versus a coumarin (HR 0.48) without a significant increase in bleeding.

After initial fluids for sepsis-induced hypotension, a restrictive strategy did not change death before discharge home by day 90 versus liberal fluids.

After OHCA without STEMI, immediate coronary angiography did not improve 90-day survival compared with delayed angiography after neurologic recovery.

In selected HFrEF with severe secondary MR despite optimized GDMT, MitraClip reduced HF hospitalizations and mortality.

Antibiotics were noninferior to appendectomy for 30-day health status in appendicitis.

During short urban ground transport, prehospital plasma did not improve 28-day survival compared with saline.

In stable CAD/PAD, vascular-dose rivaroxaban plus aspirin reduced CV death, stroke, or MI but increased major bleeding.

After culprit PCI for stable STEMI with multivessel CAD, staged complete revascularization reduced CV death or MI.

Hydrocortisone did not improve 28-day survival or overall shock reversal in septic shock, though it hastened reversal in patients whose shock resolved.

In stable CAD, adding PCI to optimal medical therapy did not reduce death or MI compared with medical therapy alone.

Early tranexamic acid reduced death due to bleeding in trauma patients with significant hemorrhage, especially when given within 3 hours.

In TBI without major extracranial bleeding, early TXA did not significantly reduce overall head-injury death; benefit appeared in milder injury and with earlier treatment.

Canagliflozin reduced kidney failure and cardiovascular events in T2DM with albuminuric CKD.

In MI with cardiogenic shock, culprit-only PCI beat immediate multivessel PCI for death or renal failure.

In NSTE-ACS, adding clopidogrel to aspirin reduced CV death, MI, or stroke but increased bleeding.

Dapagliflozin reduced CKD progression and death in albuminuric CKD with or without diabetes.

Dapagliflozin reduced worsening heart failure and cardiovascular death in HFrEF, with or without diabetes.

In selected LVO stroke patients 6-24 hours from last known well, thrombectomy improved functional independence when clinical-core mismatch was present.

In type 1 diabetes, intensive insulin reduced new-retinopathy risk 76% (primary-prevention) and slowed existing retinopathy 54% (secondary-intervention); severe hypoglycemia rose.

In adults with acute bacterial meningitis, adjunctive dexamethasone reduced unfavorable 8-week outcomes (primary); death was also lower versus placebo.

Low-dose digoxin did not significantly reduce total worsening HF events or CV death in contemporary HFrEF/HFmrEF care.

In imaging-selected anterior-circulation LVO stroke 6-16 hours from last known well, thrombectomy improved functional outcomes.

Dapagliflozin reduced worsening HF or CV death in HF with mildly reduced or preserved EF.

Routine oxygen did not reduce 1-year mortality in suspected MI when baseline saturation was already 90% or higher.

In ED and ICU intubation, video laryngoscopy raised first-pass success compared with direct laryngoscopy.

In high-risk adults with impaired glucose regulation, intensive lifestyle intervention prevented diabetes more effectively than metformin.

Digoxin reduced HF hospitalizations but did not improve survival in heart failure.

For refractory VF in OHCA, double sequential and vector-change defibrillation improved survival to discharge compared with standard shocks.

In high-risk cirrhosis with acute variceal bleeding, early covered TIPS reduced treatment failure and death versus drugs plus band ligation.

In recent AF with cardiovascular conditions, early rhythm control reduced major cardiovascular outcomes versus usual care.

Alteplase given 3 to 4.5 hours after ischemic stroke improved 90-day disability versus placebo, at the cost of more symptomatic intracranial hemorrhage.

In nonpsychotic treatment-resistant depression, ketamine was noninferior to ECT for response after 3 weeks; that is not a superiority result.

Empagliflozin reduced kidney disease progression or CV death across a broad CKD population.

Empagliflozin reduced CV death, all-cause mortality, and HF hospitalization in T2DM with established cardiovascular disease.

Empagliflozin reduced CV death or HF hospitalization in HFpEF, mainly through fewer HF hospitalizations.

Empagliflozin reduced cardiovascular death or heart-failure hospitalization in symptomatic HFrEF, with or without diabetes.

Eplerenone improved outcomes in mildly symptomatic HFrEF, extending MRA benefit beyond severe HF.

European PSA screening reduced prostate-cancer mortality but caused substantial overdiagnosis.

Tolvaptan improved short-term dyspnea and weight but not long-term mortality or HF morbidity.

In perfusion-selected late or wake-up stroke, alteplase at 4.5 to 9 hours improved excellent 90-day outcomes versus placebo, with more symptomatic hemorrhage.

Before thrombectomy for large-vessel occlusion, tenecteplase 0.25 mg/kg achieved more reperfusion and better 90-day function than alteplase.

In multivessel CAD undergoing PCI, FFR-guided PCI used fewer stents and reduced 1-year MACE versus angiography-guided PCI.

In stable CAD with FFR-positive lesions, PCI plus medical therapy reduced urgent revascularization more than death or MI.

In resource-limited African hospitals, fluid boluses increased mortality in children with severe infection and impaired perfusion.

In type 2 diabetes with CKD on RAS blockade, finerenone lowered the primary kidney composite and the key secondary CV composite versus placebo.

After hip-fracture surgery in adults 50 or older at cardiovascular risk, a liberal Hb 10 g/dL threshold did not reduce 60-day death or inability to walk.

In established ASCVD on statins, evolocumab lowered LDL to very low levels and reduced cardiovascular events.

In GCA, weekly or every-other-week tocilizumab plus a 26-week prednisone taper increased sustained glucocorticoid-free remission at week 52 versus placebo tapers.

High-dose 24-hour tranexamic acid did not reduce death from GI bleeding and increased venous thromboembolic events.

Adjuvant trastuzumab improved disease-free survival in HER2-positive early breast cancer.

In hip fracture, a goal of surgery within 6 hours of diagnosis did not significantly lower 90-day death or major complications versus standard care.

In children 6 to 23 months with stringently diagnosed AOM, 10 days of amoxicillin-clavulanate reduced clinical failure; initial symptom resolution did not differ.

In cancer-associated VTE, edoxaban was noninferior to dalteparin for recurrent VTE or major bleeding; major bleeding was higher with edoxaban.

Ramipril reduced major cardiovascular events in high-risk patients without heart failure.

In matched older medical inpatients, a multicomponent risk-factor program was associated with less delirium than usual care; this was not a randomized trial.

Early ART in HIV-positive partners dramatically reduced linked HIV transmission to uninfected partners.

After ACS, adding ezetimibe to simvastatin modestly reduced cardiovascular events compared with simvastatin alone.

In refractory OHCA, early extracorporeal CPR did not improve 30-day survival with favorable neurologic outcome compared with conventional CPR.

Intensive SBP lowering below 140 mm Hg in acute ICH did not significantly reduce death or major disability versus a target below 180 mm Hg.

In schizophrenia or schizoaffective disorder at high suicide risk, clozapine reduced suicidal behavior versus olanzapine; completed suicide was uncommon in both arms.

In newly diagnosed chronic-phase CML, imatinib produced higher cytogenetic response rates and less progression than interferon plus low-dose cytarabine.

In stable CAD with moderate/severe ischemia, an initial invasive strategy did not reduce major ischemic events or death versus conservative therapy over the primary follow-up.

In acute MI, aspirin and streptokinase each reduced early vascular mortality, with additive benefit together.

Rosuvastatin reduced first cardiovascular events in adults with normal LDL but elevated hsCRP.

In untreated advanced NSCLC with PD-L1 of at least 50% and no EGFR or ALK alteration, pembrolizumab prolonged PFS versus platinum chemotherapy.

In high-risk acute UGIB (GBS 12 or higher), endoscopy within 6 hours did not lower 30-day death versus endoscopy at 6 to 24 hours.

Liraglutide reduced major adverse cardiovascular events and mortality in high-risk T2DM.

In high-risk infants, peanut consumption lowered peanut allergy at 60 months in both skin-prick-negative and skin-prick-positive cohorts.

In ICU sepsis on vasopressors, IV vitamin C increased death or persistent organ dysfunction at 28 days versus placebo.

In prior MI with LVEF <=30%, prophylactic ICD implantation reduced all-cause mortality versus conventional therapy.

Magnesium sulfate roughly halved eclampsia risk in women with preeclampsia.

In hospitalized medical patients older than 40, enoxaparin 40 mg daily reduced VTE versus placebo; the 20 mg dose did not.

Piperacillin-tazobactam was not noninferior to meropenem for 30-day death in ceftriaxone-resistant E. coli or Klebsiella bacteremia.

Metoprolol succinate reduced mortality in stable symptomatic HFrEF.

Adding oxaliplatin to fluorouracil plus leucovorin improved 3-year disease-free survival after resection of stage II or III colon cancer.

Endovascular therapy improved functional outcome in anterior-circulation large-vessel stroke treated within 6 hours.

Multifactor risk counseling improved risk factors but did not significantly reduce CHD mortality overall.

In childhood ADHD, medication management beat behavioral treatment and community care for core symptoms; adding behavior therapy did not further improve those symptoms.

Whole-body cooling to 33.5 degrees C for 72 hours reduced the composite of death or moderate or severe disability in infants of at least 36 weeks with HIE.

IV alteplase within 3 hours improved functional outcomes after acute ischemic stroke despite increased symptomatic intracranial hemorrhage.

Low-dose CT screening reduced lung-cancer mortality in high-risk smokers.

Invitation to one screening colonoscopy lowered 10-year colorectal cancer incidence on intention-to-screen analysis but not colorectal cancer death.

At 20 years, lumpectomy plus irradiation matched mastectomy on survival and reduced ipsilateral breast recurrence versus lumpectomy alone.

Alirocumab reduced recurrent ischemic events after recent ACS on statin therapy.

In older adults with RA and cardiovascular risk, tofacitinib did not meet noninferiority versus TNF inhibitors for MACE or cancer.

For complex bone and joint infections, early oral antibiotic therapy was noninferior to prolonged IV therapy during the first 6 weeks.

Prehospital thawed plasma during air medical transport reduced 30-day mortality in injured patients at risk for hemorrhagic shock.

Sacubitril/valsartan beat enalapril for cardiovascular death and heart-failure hospitalization in HFrEF.

In OHCA, epinephrine improved 30-day survival versus placebo but did not improve favorable neurologic outcome, with more severe impairment among survivors.

In inoperable severe symptomatic AS, TAVR reduced 1-year mortality versus standard therapy but increased vascular complications and stroke.

In antiplatelet-associated ICH, platelet transfusion increased death or dependence compared with standard care and should not be used routinely.

Prehospital TXA did not improve 6-month favorable functional outcome after major trauma in advanced trauma systems.

A standardized DOAC interruption/resumption strategy without heparin bridging produced low rates of major bleeding and arterial thromboembolism.

In intermediate-risk PE, tenecteplase reduced hemodynamic collapse but increased major extracranial bleeding and stroke.

In severe ANCA vasculitis, plasma exchange did not reduce death or ESKD; reduced-dose glucocorticoids were noninferior to a standard-dose regimen.

Ticagrelor beat clopidogrel for cardiovascular events in ACS, including lower cardiovascular and all-cause mortality.

Organized PSA/DRE screening did not reduce prostate-cancer mortality in PLCO.

In stable left-sided endocarditis, switching to oral antibiotics after at least 10 days of IV therapy was noninferior to staying on IV treatment.

In minor stroke/high-risk TIA, clopidogrel plus aspirin reduced major ischemic events but increased major hemorrhage.

Perioperative metoprolol reduced MI but increased stroke and death when started right before surgery.

Perioperative aspirin and clonidine did not prevent death or MI; aspirin increased bleeding.

In noncardiac surgery, TXA reduced 30-day composite bleeding versus placebo; cardiovascular noninferiority was not established.

In ICD patients with potassium ≤4.3 mmol/L, targeting 4.5-5.0 reduced arrhythmia, hospitalization, or death versus standard care.

Before emergency intubation, NIV preoxygenation reduced hypoxemia compared with an oxygen mask.

In high-risk angiography, IV bicarbonate was not better than saline, and oral acetylcysteine was not better than placebo, for 90-day death, dialysis, or persistent creatinine rise.

Intra-arterial prourokinase improved outcomes in MCA stroke but increased symptomatic ICH.

In modern early septic shock care, protocol-based EGDT did not improve mortality versus usual care.

In early septic shock, a 6-hour EGDT protocol did not improve 90-day mortality versus usual care.

In severely injured patients predicted to need massive transfusion, a 1:1:1 blood product ratio did not reduce 24-hour or 30-day mortality versus 1:1:2.

Early prolonged prone positioning markedly reduced mortality in severe ARDS.

In severe HFrEF, spironolactone reduced mortality and HF hospitalizations when added to standard therapy.

Rituximab was noninferior to cyclophosphamide for remission induction in severe ANCA vasculitis.

Dabigatran provided effective stroke prevention in AF: 150 mg BID reduced stroke/systemic embolism versus warfarin, while 110 mg BID had less major bleeding with similar efficacy.

Dexamethasone reduced mortality in hospitalized COVID-19 patients requiring oxygen or mechanical ventilation, but not in those without oxygen requirement.

In statin-treated high-risk patients with elevated triglycerides, icosapent ethyl reduced major ischemic events.

In major abdominal surgery, a restrictive fluid regimen did not improve 1-year disability-free survival versus a liberal regimen and was associated with more AKI.

Losartan slowed kidney disease progression in type 2 diabetes with nephropathy.

Pitavastatin reduced major cardiovascular events in adults with HIV at low-to-moderate traditional risk.

In remission from recurrent HE, rifaximin 550 mg twice daily reduced breakthrough HE over 6 months versus placebo.

Single-center early goal-directed therapy reduced mortality in severe sepsis/septic shock versus then-usual care.

Rivaroxaban was noninferior to warfarin for stroke prevention in higher-risk nonvalvular AF.

Routine early paralysis did not improve mortality versus lighter sedation in moderate-severe ARDS.

For emergency intubation, ketamine did not lower 28-day in-hospital death compared with etomidate.

On a VA detox unit, symptom-triggered chlordiazepoxide shortened treatment and reduced dose versus a fixed schedule, with similar withdrawal severity.

In noncritically ill adults given IV fluids in the ED, balanced crystalloids did not change hospital-free days versus saline.

Four-factor PCC was noninferior to plasma for 24-hour hemostasis and superior for rapid INR correction in VKA-associated major bleeding.

In NYHA II-III HFrEF, ICD therapy reduced mortality while amiodarone did not.

In overweight/obesity with established CVD but no diabetes, semaglutide 2.4 mg reduced major adverse cardiovascular events.

Early revascularization improved longer-term survival in MI complicated by cardiogenic shock.

In ICU patients, balanced crystalloids modestly reduced major adverse kidney events compared with saline.

Enalapril reduced mortality in symptomatic HFrEF.

Combination infliximab plus azathioprine induced more steroid-free remission in Crohn disease.

In cirrhosis with SBP, IV albumin plus cefotaxime reduced in-hospital renal impairment and death compared with cefotaxime alone.

In high-risk non-diabetic adults, targeting SBP <120 mm Hg reduced major CV events and mortality versus <140 mm Hg, at the cost of more adverse events.

After SSRI failure, switching to another antidepressant produced modest remission with no clear winner.

In critically ill severe AKI, accelerated RRT did not lower 90-day death; among survivors, RRT dependence was 10.4% vs 6.0% (accelerated vs standard).

Immediate ART in asymptomatic HIV with CD4 >500 reduced serious AIDS-related and non-AIDS events compared with deferred therapy.

In adults with overweight or obesity without diabetes, weekly semaglutide 2.4 mg plus lifestyle change produced greater 68-week weight loss than placebo.

Adjunctive antidepressants did not improve durable recovery in bipolar depression versus mood stabilizer plus placebo, and switch rates were similar.

In ischemic cardiomyopathy with EF <=35% and CABG-amenable CAD, CABG plus medical therapy reduced 10-year mortality versus medical therapy alone.

After adequate source control for complicated intra-abdominal infection, about 4 days of antibiotics was similar to longer therapy.

High-dose EPA/DHA omega-3 carboxylic acids did not reduce cardiovascular events.

In extremely preterm infants, the lower saturation target did not change the composite of severe retinopathy or death; death was higher and retinopathy among survivors lower.

In adults with obesity without diabetes, weekly tirzepatide 5, 10, or 15 mg produced greater 72-week weight loss than placebo.

For selected term breech pregnancies, planned caesarean section reduced perinatal or neonatal death or serious neonatal morbidity versus planned vaginal birth.

After resuscitated OHCA without ST-segment elevation, immediate angiography did not reduce 30-day death versus delayed or selective angiography.

In diabetes, CKD, and anemia not on dialysis, darbepoetin did not reduce either primary composite and increased stroke.

A restrictive RBC transfusion strategy was at least as effective as a liberal strategy in critically ill patients and may be better in less severely ill/younger patients.

After out-of-hospital cardiac arrest, targeting 33 degrees C did not improve outcomes compared with 36 degrees C when fever was actively prevented.

After OHCA with coma, targeted hypothermia at 33 degrees C did not reduce 6-month death versus targeted normothermia with early fever treatment.

In newly diagnosed T2DM, intensive glycemic control reduced microvascular complications, with less immediate effect on macrovascular outcomes.

Duodenal donor-feces infusion resolved recurrent C. difficile more often than vancomycin alone or vancomycin plus bowel lavage.

In acute upper GI bleeding, restrictive transfusion at Hb <7 g/dL improved survival compared with a liberal Hb <9 g/dL strategy.

Low-dose rivaroxaban plus aspirin reduced limb and cardiovascular events after PAD revascularization.

MRI-selected alteplase improved functional outcome in stroke with unknown onset time.

In acute pancreatitis, aggressive lactated Ringer's did not reduce moderately severe or severe disease and increased fluid overload versus moderate fluids.

In postpartum hemorrhage, TXA did not reduce death or hysterectomy; authors reported less bleeding death, especially if given within 3 hours.

Combined estrogen-progestin therapy increased breast cancer, CHD, stroke, and VTE risk despite fewer fractures and colorectal cancers.