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Darmon A, Elbez Y, Bhatt DL, Abtan J, Mas JL, Cacoub P, Montalescot G, Billaut-Laden I, Ducrocq G, Steg PG. Clinical characteristics and outcomes of COMPASS eligible patients in France. An analysis from the REACH Registry. Ann Cardiol Angeiol (Paris) 2020; 69:158-166. [PMID: 32778388 DOI: 10.1016/j.ancard.2020.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/21/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Following the publication of the COMPASS trial, the European Medicines Agency has approved a regimen of combination of rivaroxaban 2.5mg twice daily and a daily dose of 75-100mg acetylsalicylic acid (ASA) for patients with coronary artery disease (CAD) or symptomatic peripheral artery disease (PAD) at high risk of ischemic events. However, the applicability of such a therapeutic strategy in France is currently unknown. AIMS To describe the proportion of patients eligible to COMPASS in France, their baseline clinical characteristics and the rate of major adverse cardiovascular events, using the REACH registry. METHODS From the the REduction of Atherothrombosis for Continued Health (REACH) registry database, a large international registry of patients with, or at risk, of atherothrombosis, we analyzed patients included in France with either established CAD and/or PAD and fulfilling the inclusion and exclusion criteria of the COMPASS trial. The ischemic outcome was a composite of cardiovascular (CV) death, myocardial infarction (MI), or stroke, and serious bleeding were defined as haemorrhagic stroke or bleeding leading to hospitalization or transfusion. RESULTS Among more than 65000 patients enrolled in REACH, 2.012 patients were evaluable and enrolled in France. Among them, 1194 patients (59.3%) were eligible to COMPASS. The main reasons for exclusion of the COMPASS trial, were high bleeding risk (59.1%), anticoagulant use (43.4%), requirement for dual antiplatelet therapy within 1 year of an ACS or PCI (24.7%). In the "COMPASS eligible population", the rate of MACE (CV, MI and stroke) at 4 years follow-up was 13.4% [11.3-15.8], and serious bleeding was 2.5% at 4 years [1.6-3.4]. Patients with polyvascular disease (n=219) had the highest rate of MACE, compared with patients with CAD only and PAD only (19.1% [13.9-26.1] vs. 11.6% [9.1-14.8] vs 13.2% [9.2-18.8], P<0.0001, respectively). CONCLUSION The COMPASS therapeutic strategy in France appears to be applicable to more than half of CAD or PAD patients. This population appears at high residual risk of atherothrombotic events, and patients with polyvascular disease experienced the highest rate of events.
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Affiliation(s)
- A Darmon
- FACT, French Alliance for Cardiovascular Trials, Département Hospitalo-Universitaire FIRE, Hôpital Bichat, Paris, France; Université de Paris, assistance publique-Hopitaux de Paris, Paris, France
| | - Y Elbez
- FACT, French Alliance for Cardiovascular Trials, Département Hospitalo-Universitaire FIRE, Hôpital Bichat, Paris, France
| | - D L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, USA
| | - J Abtan
- FACT, French Alliance for Cardiovascular Trials, Département Hospitalo-Universitaire FIRE, Hôpital Bichat, Paris, France; Université de Paris, assistance publique-Hopitaux de Paris, Paris, France
| | - J L Mas
- Department of Neurology, Sainte-Anne Hospital, Paris Descartes University, Inserm U1266, Paris, France
| | - P Cacoub
- Sorbonne Universités, UPMC Université Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), 75005 Paris, France; INSERM, UMR_S 959, 75013 Paris, France; CNRS, FRE3632, 75005 Paris, France; Department of Internal Medicine and Clinical Immunology, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - G Montalescot
- ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, Paris, France
| | | | - G Ducrocq
- FACT, French Alliance for Cardiovascular Trials, Département Hospitalo-Universitaire FIRE, Hôpital Bichat, Paris, France; INSERM U1148, LVTS, Paris, France; Université de Paris, assistance publique-Hopitaux de Paris, Paris, France.
| | - P G Steg
- FACT, French Alliance for Cardiovascular Trials, Département Hospitalo-Universitaire FIRE, Hôpital Bichat, Paris, France; INSERM U1148, LVTS, Paris, France; Imperial College, Royal Brompton Hospital, London, United Kingdom; Université de Paris, assistance publique-Hopitaux de Paris, Paris, France
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Epidemiology, treatment patterns and outcomes in patients with coronary or lower extremity artery disease in France. Arch Cardiovasc Dis 2019; 112:670-679. [DOI: 10.1016/j.acvd.2019.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/24/2019] [Accepted: 05/21/2019] [Indexed: 01/22/2023]
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Silva CGDSE, Klein CH, Godoy PH, Salis LHA, Silva NADSE. Up to 15-Year Survival of Men and Women after Percutaneous Coronary Intervention Paid by the Brazilian Public Healthcare System in the State of Rio de Janeiro, 1999-2010. Arq Bras Cardiol 2018; 111:553-561. [PMID: 30365603 PMCID: PMC6199519 DOI: 10.5935/abc.20180184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 05/23/2018] [Indexed: 01/09/2023] Open
Abstract
Background Percutaneous coronary intervention (PCI) is the most frequently used invasive
therapy for ischemic heart disease (IHD). Studies able to provide
information about PCI's effectiveness should be conducted in a population of
real-world patients. Objectives To assess the survival rate of IHD patients treated with PCI in the state of
Rio de Janeiro (RJ). Methods Administrative (1999-2010) and death (1999-2014) databases of dwellers aged
≥ 20 years old in the state of RJ submitted to one single PCI paid by
the Brazilian public healthcare system (SUS) between 1999
and 2010 were linked. Patients were grouped as follows: 20-49 years old,
50-69 years old and ≥ 70 years old, and PCI in primary PCI, with
stent and without stent placement (bare metal stent). Survival probabilities
in 30 days, one year and 15 years were estimated by using the Kaplan-Meier
method. Cox hazards regression models were used to compare risks among sex,
age groups and types of PCI. Test results with a p-value < 0.05 were
deemed statistically significant. Results Data of 19,263 patients (61 ± 11 years old, 63.6% men) were analyzed.
Survival rates of men vs. women in 30 days, one year and 15 years were:
97.3% (97.0-97.6%) vs. 97.1% (96.6-97.4%), 93.6% (93.2-94.1%) vs. 93.4%
(92.8-94.0%), and 55.7% (54.0-57.4%) vs. 58.1% (55.8-60.3%), respectively.
The oldest age group was associated with lower survival rates in all
periods. PCI with stent placement had higher survival rates than those
without stent placement during a two-year follow-up. After that, both
procedures had similar survival rates (HR 0.91, 95% CI 0.82-1.00). Conclusions In a population of real-world patients, women had a higher survival rate than
men within 15 years after PCI. Moreover, using a bare-metal stent failed to
improve survival rates after a two-year follow-up compared to simple balloon
angioplasty.
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Affiliation(s)
- Christina Grüne de Souza E Silva
- Instituto do Coração Edson Saad, Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ - Brasil
| | - Carlos Henrique Klein
- Escola Nacional de Saúde Pública Sergio Arouca - Fundação Oswaldo Cruz, Rio de Janeiro, RJ - Brasil
| | | | - Lucia Helena Alvares Salis
- Instituto do Coração Edson Saad, Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ - Brasil
| | - Nelson Albuquerque de Souza E Silva
- Instituto do Coração Edson Saad, Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ - Brasil
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The Coronary Artery Disease–Reporting and Data System (CAD-RADS). JACC Cardiovasc Imaging 2018; 11:78-89. [DOI: 10.1016/j.jcmg.2017.08.026] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 08/24/2017] [Accepted: 08/24/2017] [Indexed: 12/12/2022]
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Martínez-Sellés M, Gómez Huelgas R, Abu-Assi E, Calderón A, Vidán M. Cardiopatía isquémica crónica en el anciano. Semergen 2017; 43:109-122. [DOI: 10.1016/j.semerg.2016.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 02/07/2016] [Indexed: 01/09/2023]
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Jaradat M, Shetty K, Hasan M, Malik AO, Shawo A, Ahsan C, Yoo JW. Beta-blockers do not provide survival benefit in a population with angiographic coronary artery disease without myocardial infarction or reduced ejection fraction: A meta-analysis. Int J Cardiol 2016; 223:976-980. [DOI: 10.1016/j.ijcard.2016.08.239] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 07/11/2016] [Accepted: 08/12/2016] [Indexed: 11/28/2022]
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Gabet A, Chatignoux E, Ducimetière P, Danchin N, Olié V. Differential trends in myocardial infarction mortality over 1975–2010 in France according to gender: An age-period-cohort analysis. Int J Cardiol 2016; 223:660-664. [PMID: 27567235 DOI: 10.1016/j.ijcard.2016.07.194] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 07/28/2016] [Indexed: 11/15/2022]
Affiliation(s)
- A Gabet
- Department of Chronic Diseases and Injuries, The French Public Health Agency, Saint Maurice, France.
| | - E Chatignoux
- Department of Chronic Diseases and Injuries, The French Public Health Agency, Saint Maurice, France
| | | | - N Danchin
- Department of Cardiology, European Georges-Pompidou Hospital, Assistance Publique Hôpitaux de Paris, Paris-Descartes University, Paris, France
| | - V Olié
- Department of Chronic Diseases and Injuries, The French Public Health Agency, Saint Maurice, France
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Lamblin N, Meurice T, Tricot O, Lemesle G, Deneve M, de Groote P, Bauters C. Effect of left ventricular systolic dysfunction on secondary medical prevention and clinical outcome in stable coronary artery disease patients. Arch Cardiovasc Dis 2016; 110:35-41. [PMID: 27591820 DOI: 10.1016/j.acvd.2016.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 03/09/2016] [Accepted: 04/20/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Limited recent data are available in the literature on whether the presence of left ventricular systolic dysfunction (LVSD) affects the therapeutic management of patients with stable coronary artery disease (CAD). AIMS The objectives of this study were to analyse prevalence, effect on therapeutics and prognosis of LVSD in stable CAD. METHODS We prospectively included 4184 CAD outpatients free from any myocardial infarction or coronary revascularization for>1year. Left ventricular ejection fraction (EF) was available for 4124 (98.6%) patients. Follow-up was performed at 2years. All events were adjudicated blindly. RESULTS The mean EF was 57.5±10.8%, and 201 (4.9%) patients had an EF≤35%. The prescription of renin-angiotensin system inhibitors and beta-blockers was inversely related to EF, and reached>90% in patients with EF≤35%. Seventy-five (37.3%) of the patients with EF≤35% received a mineralocorticoid receptor antagonist. Eighty-five (42.3%) of the patients with EF≤35% had an implantable cardioverter defibrillator. Clinical follow-up data were obtained for 4090 patients (99.2%). Event rates were higher in patients with low EF (adjusted hazard ratio [95% confidence interval] for EF≤35%, with EF≥60% as reference: 3.93 [2.60-5.93] and 7.12 [3.85-13.18], for all-cause death and cardiovascular death, respectively). CONCLUSIONS In patients with stable CAD, LVSD is well taken into account by cardiologists, with extensive use of evidence-based medications and interventions. Despite this, LVSD remains a major prognostic indicator in this population.
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Affiliation(s)
- Nicolas Lamblin
- CHRU de Lille, 59037 Lille, France; Inserm U1167, Institut Pasteur de Lille, université Lille Nord de France, 59000 Lille, France; Faculté de médecine de Lille, 59045 Lille, France
| | | | - Olivier Tricot
- Centre hospitalier de Dunkerque, 59240 Dunkerque, France
| | - Gilles Lemesle
- CHRU de Lille, 59037 Lille, France; Faculté de médecine de Lille, 59045 Lille, France
| | | | - Pascal de Groote
- CHRU de Lille, 59037 Lille, France; Inserm U1167, Institut Pasteur de Lille, université Lille Nord de France, 59000 Lille, France
| | - Christophe Bauters
- CHRU de Lille, 59037 Lille, France; Inserm U1167, Institut Pasteur de Lille, université Lille Nord de France, 59000 Lille, France; Faculté de médecine de Lille, 59045 Lille, France.
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Martínez-Sellés M, Gómez Huelgas R, Abu-Assi E, Calderón A, Vidán MT. [Chronic ischaemic heart disease in the elderly]. Rev Esp Geriatr Gerontol 2016; 51:170-179. [PMID: 27102136 DOI: 10.1016/j.regg.2016.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 01/21/2016] [Indexed: 06/05/2023]
Abstract
It is the aim of this manuscript to take into account the peculiarities and specific characteristics of elderly patients with chronic ischaemic heart disease from a multidisciplinary perspective, with the participation of the Spanish Society of Cardiology (sections of Geriatric Cardiology and Ischaemic Heart Disease/Acute Cardiovascular Care), the Spanish Society of Internal Medicine, the Spanish Society of Primary Care Physicians and the Spanish Society of Geriatrics and Gerontology. This consensus document shows that in order to adequately address these elderly patients a comprehensive assessment is needed, which includes comorbidity, frailty, functional status, polypharmacy and drug interactions. We conclude that in most patients medical treatment is the best option and that this treatment must take into account the above factors and the biological changes associated with aging.
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Affiliation(s)
- Manuel Martínez-Sellés
- Sociedad Española de Cardiología (SEC), Sección de Cardiología Geriátrica, Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Universidad Europea y Universidad Complutense, Madrid, España.
| | - Ricardo Gómez Huelgas
- Sociedad Española de Medicina Interna (SEMI), Departamento de Medicina Interna, Hospital Universitario Regional de Málaga, Fundación Pública Andaluza para la Investigación de Málaga en Biomedicina y Salud (FIMABIS), Málaga, España
| | - Emad Abu-Assi
- Sociedad Española de Cardiología (SEC), Sección de Cardiopatía Isquémica y Cuidados Agudos Cardiovasculares, Servicio de Cardiología y Unidad Coronaria, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - Alberto Calderón
- Sociedad Española de Médicos de Atención Primaria (SEMERGEN), Centro de Salud Rosa Luxemburgo, San Sebastián de los Reyes, Madrid, España
| | - María Teresa Vidán
- Sociedad Española de Geriatría y Gerontología (SEGG), Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, España
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Martínez-Sellés M, Gómez Huelgas R, Abu-Assi E, Calderón A, Vidán MT. Cardiopatía isquémica crónica en el anciano. Med Clin (Barc) 2016; 146:372.e1-372.e10. [DOI: 10.1016/j.medcli.2016.01.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 01/14/2016] [Accepted: 01/21/2016] [Indexed: 12/12/2022]
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Meurice T, Tricot O, Lemesle G, Deneve M, Lejeune P, Biausque F, Cordier C, Savoye C, Hennebert O, Taghipour K, Sivery B, Pruvost P, Alaoui M, Carpentier L, Segrestin B, Lamblin N, Bauters C. Prevalence and correlates of non-optimal secondary medical prevention in patients with stable coronary artery disease. Arch Cardiovasc Dis 2015; 108:340-6. [PMID: 25858539 DOI: 10.1016/j.acvd.2015.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 12/22/2014] [Accepted: 01/12/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND In patients with coronary artery disease (CAD), non-optimal use of evidence-based medications is associated with an increased risk of adverse outcome. AIMS To assess the prevalence and correlates of non-optimal secondary medical prevention in patients with stable CAD. METHODS We included 4184 consecutive outpatients with stable CAD. Treatment at inclusion was classified as optimal/non-optimal regarding the four major classes of secondary prevention drugs: antithrombotics; statins; angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs); and beta-blockers. For each treatment, the prescription was considered non-optimal if the drug was missing despite a class IA indication according to international guidelines. To assess the information globally, non-optimal secondary prevention was defined as at least one major treatment missing. RESULTS The proportions of patients with non-optimal treatment were 0.7%, 7.8%, 12.9% and 10.3% for antithrombotics, statins, ACE inhibitors/ARBs and beta-blockers, respectively. Non-optimal secondary medical prevention was observed in 16.8% of cases. By multivariable analysis, the correlates of non-optimal secondary medical prevention were long time interval since last coronary event (P<0.0001), older age (P<0.0001), diabetes mellitus (P<0.0001), hypertension (P<0.0001), no history of myocardial infarction (P=0.001), no history of coronary revascularization (P=0.013) and low glomerular filtration rate (P=0.042). CONCLUSIONS Although most patients with stable CAD are receiving evidence-based medications according to guidelines, there remain subgroups at higher risk of non-optimal treatment. In particular, it might be feasible to improve prevention by focusing on patients in whom a long time has elapsed since the last coronary event.
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Affiliation(s)
| | | | - Gilles Lemesle
- Centre Hospitalier Régional et Universitaire de Lille, Lille, France; Inserm U744, Institut Pasteur de Lille, Université Lille Nord de France, Lille, France; Faculté de Médecine de Lille, Lille, France
| | - Michel Deneve
- Centre Hospitalier Régional et Universitaire de Lille, Lille, France
| | | | | | | | | | | | | | - Bruno Sivery
- Centre Hospitalier de Wattrelos, Wattrelos, France
| | | | - Moulay Alaoui
- Centre Hospitalier de Boulogne-sur-mer, Boulogne-sur-mer, France
| | | | | | - Nicolas Lamblin
- Centre Hospitalier Régional et Universitaire de Lille, Lille, France; Inserm U744, Institut Pasteur de Lille, Université Lille Nord de France, Lille, France; Faculté de Médecine de Lille, Lille, France
| | - Christophe Bauters
- Centre Hospitalier Régional et Universitaire de Lille, Lille, France; Inserm U744, Institut Pasteur de Lille, Université Lille Nord de France, Lille, France; Faculté de Médecine de Lille, Lille, France.
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