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

1. Silvia Valbuena LópezGALACTIC Trial
GALACTIC
Goal-directed AfterLoad Reduction in Acute
Congestive Cardiac Decompensation:
a randomized controlled trial

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. 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. 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. Silvia Valbuena LópezGALACTIC Trial
METHODS

6. Silvia Valbuena LópezGALACTIC Trial
STUDY FLOW

7. Silvia Valbuena LópezGALACTIC Trial
RESULTS. Primary endpoint
PRIMARY ENDPOINT: DEATH OR AHF

8. Silvia Valbuena LópezGALACTIC Trial
RESULTS. Subgroup analysis

9. Silvia Valbuena LópezGALACTIC Trial
RESULTS

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. 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