1
|
Fauvel C, Dillinger JG, Bouleti C, Trimaille A, Tron C, Chaussade AS, Thuaire C, Delmas C, Boccara A, Roule V, Millischer D, Thevenet E, Meune C, Stevenard M, Charbonnel C, Ballesteros LM, Pommier T, El Ouahidi A, Swedsky F, Martinez D, Hauguel-Moreau M, Schurtz G, Coisne A, Dupasquier V, Bochaton T, Gerbaud E, Puymirat E, Henry P, Pezel T. TAPSE/sPAP prognostic value for In-Hospital Adverse Events in Patients Hospitalized for Acute Coronary Syndrome. Eur Heart J Cardiovasc Imaging 2024:jeae110. [PMID: 38650518 DOI: 10.1093/ehjci/jeae110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 02/20/2024] [Accepted: 04/06/2024] [Indexed: 04/25/2024] Open
Abstract
AIMS Although several studies have shown that the right ventricular to pulmonary artery (RV-PA) coupling, assessed by the ratio between tricuspid annular plane systolic excursion and systolic pulmonary artery pressure (TAPSE/sPAP) using echocardiography, is strongly associated with cardiovascular events, its prognostic value is not established in acute coronary syndrome (ACS). We aimed to assess the in-hospital prognostic value of TAPSE/sPAP among patients hospitalized for ACS in a retrospective analysis from the prospective ADDICT-ICCU study. METHODS AND RESULTS 481 consecutive patients hospitalized in intensive cardiac care unit (mean age 65±13 years, 73% of male, 46% STEMI) for ACS (either ST-elevation [STEMI] or non-ST-elevation [NSTEMI] myocardial infarction) with TAPSE/sPAP available were included in this prospective French multicentric study (39 centers). The primary outcome was in-hospital major adverse cardiovascular events (MACEs) defined as all-cause death, resuscitated cardiac arrest or cardiogenic shock and occurred in 33 (7%) patients. ROC-curve analysis identified 0.55 mm/mmHg as the best TAPSE/sPAP cut-off to predict in-hospital MACEs. TAPSE/sPAP <0.55 was associated with in-hospital MACEs, even after adjustment with comorbidities (OR:19.1, 95%CI[7.78-54.8]), clinical severity including left ventricular ejection fraction (OR:14.4, 95%CI[5.70-41.7]) and propensity-matched population analysis (OR:22.8, 95%CI[7.83-97.2], all p<0.001). After adjustment, TAPSE/sPAP <0.55 showed the best improvement in model discrimination and reclassification above traditional prognosticators (C-statistic improvement: 0.16; global chi-square improvement: 52.8; LR-test p<0.001) with similar results for both STEMI and NSTEMI subgroups. CONCLUSION A low RV-PA coupling defined as TAPSE/sPAP ratio <0.55 was independently associated with in-hospital MACEs and provided incremental prognostic value over traditional prognosticators in patients hospitalized for ACS. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05063097.
Collapse
Affiliation(s)
- Charles Fauvel
- Cardiology department, FHU CARNAVAL, Rouen University Hospital, Rouen, France
- INSERM EnVI U1096, Rouen University Hospital, Rouen, France
| | - Jean-Guillaume Dillinger
- Université de Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, Paris, France
| | - Claire Bouleti
- University Hospital of Poitiers, Clinical Investigation Center (INSERM 1204), Cardiology Department, 86000 Poitiers, France
| | - Antonin Trimaille
- Department of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 67000 Strasbourg, France
| | - Christophe Tron
- Cardiology department, FHU CARNAVAL, Rouen University Hospital, Rouen, France
| | | | - Christophe Thuaire
- Service de Cardiologie, Centre Hospitalier de Chartres, 28630 Le Coudray, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France
| | - Albert Boccara
- Department of Cardiology Andre Gregoire Hospital 93100 Montreuil, France
| | - Vincent Roule
- Department of Cardiology, Caen University Hospital, Caen, France
| | | | - Eugénie Thevenet
- Department of Cardiology, University Hospital of Martinique, France
| | - Christophe Meune
- Department of Cardiology, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Mathilde Stevenard
- Service de cardiologie et médecine aéronautique, Hôpital d'Instruction des Armées Percy, 101 avenue Henri Barbusse, 92140 Clamart
| | | | | | - Thibaut Pommier
- Department of Cardiology, University Hospital, Dijon, France
| | - Amine El Ouahidi
- Department of Cardiology, University Hospital of Brest, 29609, Brest cedex, France
| | - Fédérico Swedsky
- Service de cardiologie, Hôpital Henri Duffaut, 84902 AVIGNON, France
| | - David Martinez
- Department of Cardiology, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Marie Hauguel-Moreau
- Service de Cardiologie, Hôpital Ambroise Pare, AP-HP, Boulogne Billancourt, France
| | | | - Augustin Coisne
- Department of Cardiology, University Hospital of Lille, France
| | | | - Thomas Bochaton
- Intensive Cardiological Care Division, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France
| | - Edouard Gerbaud
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut-Lévêque, 33604 Pessac, France
- Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, 33076 Bordeaux, France
| | - Etienne Puymirat
- Department of Cardiology, Hôpital Européen Georges Pompidou (HEGP), France
| | - Patrick Henry
- Université de Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, Paris, France
| | - Théo Pezel
- Université de Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, Paris, France
| |
Collapse
|
2
|
Dillinger JG, Pezel T, Delmas C, Schurtz G, Trimaille A, Piliero N, Bouleti C, Lattuca B, Andrieu S, Fabre J, Rossanaly Vasram R, Dib JC, Aboyans V, Fauvel C, Roubille F, Gerbaud E, Boccara A, Puymirat E, Toupin S, Vicaut E, Henry P. Carbon monoxide and prognosis in smokers hospitalised with acute cardiac events: a multicentre, prospective cohort study. EClinicalMedicine 2024; 67:102401. [PMID: 38261914 PMCID: PMC10796965 DOI: 10.1016/j.eclinm.2023.102401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/04/2023] [Accepted: 12/13/2023] [Indexed: 01/25/2024] Open
Abstract
Background Smoking cigarettes produces carbon monoxide (CO), which can reduce the oxygen-carrying capacity of the blood. We aimed to determine whether elevated expiratory CO levels would be associated with a worse prognosis in smokers presenting with acute cardiac events. Methods From 7 to 22 April 2021, expiratory CO levels were measured in a prospective registry including all consecutive patients admitted for acute cardiac event in 39 centres throughout France. The primary outcome was 1-year all-cause death. Initial in-hospital major adverse cardiac events (MAE; death, resuscitated cardiac arrest and cardiogenic shock) were also analysed. The study was registered at ClinicalTrials.gov (NCT05063097). Findings Among 1379 patients (63 ± 15 years, 70% men), 368 (27%) were active smokers. Expiratory CO levels were significantly raised in active smokers compared to non-smokers. A CO level >11 parts per million (ppm) found in 94 (25.5%) smokers was associated with a significant increase in death (14.9% for CO > 11 ppm vs. 2.9% for CO ≤ 11 ppm; p < 0.001). Similar results were found after adjustment for comorbidities (hazard ratio [HR] [95% confidence interval (CI)]): 5.92 [2.43-14.38]) or parameters of in-hospital severity (HR 6.09, 95% CI [2.51-14.80]) and propensity score matching (HR 7.46, 95% CI [1.70-32.8]). CO > 11 ppm was associated with a significant increase in MAE in smokers during initial hospitalisation after adjustment for comorbidities (odds ratio [OR] 15.75, 95% CI [5.56-44.60]) or parameters of in-hospital severity (OR 10.67, 95% CI [4.06-28.04]). In the overall population, CO > 11 ppm but not smoking was associated with an increased rate of all-cause death (HR 4.03, 95% CI [2.33-6.98] and 1.66 [0.96-2.85] respectively). Interpretation Elevated CO level is independently associated with a 6-fold increase in 1-year death and 10-fold in-hospital MAE in smokers hospitalized for acute cardiac events. Funding Grant from Fondation Coeur & Recherche.
Collapse
Affiliation(s)
- Jean-Guillaume Dillinger
- Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010, Paris, France
| | - Théo Pezel
- Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010, Paris, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Rangueil University Hospital, 31000, Toulouse, France
| | | | | | | | | | | | | | - Julien Fabre
- University Hospital of Fort de France, Fort De France, Martinique
| | | | - Jean-Claude Dib
- Clinique Medico-Chirurgicale Ambroise Pare, Neuilly Sur Seine, France
| | | | - Charles Fauvel
- Rouen University Hospital, INSERM EnVI 1096, 76000, Rouen, France
| | - Francois Roubille
- Cardiology Department, INI-CRT, CHU de Montpellier, PhyMedExp, Université de Montpellier, INSERM, CNRS, 34295, Montpellier, France
| | - Edouard Gerbaud
- Cardiology Intensive Care Unit and, Interventional Cardiology, Hôpital Cardiologique du Haut-Lévêque, Pessac, France
- Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, Bordeaux, France
| | | | - Etienne Puymirat
- Université Paris Cité, Department of Cardiology, Hôpital Européen Georges Pompidou (HEGP), France
| | - Solenn Toupin
- Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010, Paris, France
| | - Eric Vicaut
- Unité de recherche clinique – Hopital Lariboisiere, Paris, France
| | - Patrick Henry
- Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010, Paris, France
| |
Collapse
|
3
|
Dillinger JG, Pezel T, Fauvel C, Delmas C, Schurtz G, Trimaille A, Gerbaud E, Roule V, Dib JC, Boccara A, Millischer D, Thuaire C, Fabre J, Levasseur T, Boukertouta T, Darmon A, Azencot R, Merat B, Haugel-Moreau M, Grentzinger A, Charbonnel C, Zakine C, Bedossa M, Lattuca B, Roubille F, Aboyans V, Puymirat E, Cohen A, Vicaut E, Henry P. Prevalence of psychoactive drug use in patients hospitalized for acute cardiac events: Rationale and design of the ADDICT-ICCU trial, from the Emergency and Acute Cardiovascular Care Working Group and the National College of Cardiologists in Training of the French Society of Cardiology. Arch Cardiovasc Dis 2022; 115:514-520. [PMID: 36154799 DOI: 10.1016/j.acvd.2022.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/21/2022] [Accepted: 05/24/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Psychoactive drugs, including illicit drugs, are associated with an increased rate of cardiovascular events. The prevalence and outcome of patients using these drugs at the time of admission to an intensive cardiac care unit is unknown. AIM To assess the prevalence of psychoactive drugs detected in consecutive patients hospitalized in an intensive cardiac care unit for an acute cardiovascular event. METHODS This is a nationwide prospective multicentre study, involving 39 centres throughout France, including all consecutive patients hospitalized in an intensive cardiac care unit within 2weeks. Psychoactive drug use will be assessed systematically by urine drug assay within 2hours of intensive cardiac care unit admission, to detect illicit (cannabinoids, cocaine, amphetamines, ecstasy, heroin and other opioids) and non-illicit (barbiturates, benzodiazepines, tricyclic antidepressants, methadone and buprenorphine) psychoactive drugs. Smoking will be investigated systematically by exhaled carbon monoxide measurement, and alcohol consumption using a standardized questionnaire. In-hospital major adverse events, including death, resuscitated cardiac arrest and cardiogenic shock, will be recorded. After discharge, all-cause death and major adverse cardiovascular events will be recorded systematically and adjudicated at 12months of follow-up. RESULTS The primary outcome will be the prevalence of psychoactive drugs detected by systematic screening among all patients hospitalized in an intensive cardiac care unit. The in-hospital major adverse events will be analysed according to the presence or absence of detected psychoactive drugs. Subgroup analysis stratified by initial clinical presentation and type of psychoactive drug will be performed. CONCLUSIONS This is the first prospective multicentre study to assess the prevalence of psychoactive drugs detected by systematic screening in consecutive patients hospitalized for acute cardiovascular events.
Collapse
Affiliation(s)
- Jean-Guillaume Dillinger
- Department of Cardiology, Hôpital Lariboisière, AP-HP, Université de Paris Cité, Inserm U-942, 75010 Paris, France
| | - Théo Pezel
- Department of Cardiology, Hôpital Lariboisière, AP-HP, Université de Paris Cité, Inserm U-942, 75010 Paris, France
| | - Charles Fauvel
- Department of Cardiology, Rouen University Hospital, 76000 Rouen, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Rangueil University Hospital, 31000 Toulouse, France
| | - Guillaume Schurtz
- Department of Cardiology, University Hospital of Lille, 59000 Lille, France
| | - Antonin Trimaille
- Department of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 67000 Strasbourg, France
| | - Edouard Gerbaud
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut-Lévêque, 33604 Pessac Cedex, France; Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, 33000 Bordeaux, France
| | - Vincent Roule
- Department of Cardiology, Caen University Hospital, 14000 Caen, France
| | - Jean-Claude Dib
- Département de Cardiologie, Clinique Ambroise Paré, 92200 Neuilly-sur-Seine, France
| | - Albert Boccara
- Department of Cardiology, Andre Gregoire Hospital, 93100 Montreuil, France
| | - Damien Millischer
- Service de Cardiologie, Hôpital Montfermeil, 93370 Montfermeil, France
| | - Christophe Thuaire
- Service de Cardiologie, Centre Hospitalier de Chartres, 28630 Le Coudray, France
| | - Julien Fabre
- Department of Cardiology, University Hospital of Martinique, 97261 Fort-de-France, France
| | - Thomas Levasseur
- Service de Cardiologie, Centre Hospitalier de Fréjus/Saint-Raphaël, 83600 Fréjus, France
| | | | - Arthur Darmon
- Department of Cardiology, Hôpital Bichat, AP-HP, Université de Paris Cité, 75018 Paris, France
| | - Ruben Azencot
- Service de Cardiologie, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Benoit Merat
- Service de Cardiologie et Médecine Aéronautique, Hôpital d'Instruction des Armées Percy, 92140 Clamart, France
| | - Marie Haugel-Moreau
- Service de Cardiologie, Hôpital Ambroise Paré, AP-HP, 92012 Boulogne-Billancourt, France
| | - Alain Grentzinger
- Service de Cardiologie, Centre Hospitalier de Saintonge, 17100 Saintes, France
| | | | - Cyril Zakine
- Clinique Saint Gatien Alliance (NCT+), 37540 Saint-Cyr-sur-Loire, France
| | - Marc Bedossa
- Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, 35000 Rennes, France
| | - Benoît Lattuca
- Department of Cardiology, Nîmes University Hospital, Montpellier University, 30029 Nîmes, France
| | - François Roubille
- Department of Cardiology, CHU de Montpellier, 34000 Montpellier, France
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital; and Inserm U1094 & IRD U270, Limoges University, 87000 Limoges, France
| | - Etienne Puymirat
- Department of Cardiology, Hôpital Européen Georges Pompidou (HEGP), AP-HP, 75015 Paris, France
| | - Ariel Cohen
- Service de Cardiologie, Hôpital Saint-Antoine, AP-HP, 75012 Paris, France
| | - Eric Vicaut
- Unité de Recherche Clinique, Hôpital Fernand Widal, AP-HP, 75010 Paris, France
| | - Patrick Henry
- Department of Cardiology, Hôpital Lariboisière, AP-HP, Université de Paris Cité, Inserm U-942, 75010 Paris, France.
| | | |
Collapse
|
4
|
Reuter PG, Rouchy C, Cattan S, Benamer H, Jullien T, Beruben A, Montely JM, Assez N, Raphael V, Hennequin B, Boccara A, Javaud N, Soulat L, Adnet F, Lapostolle F. Early invasive strategy in high-risk acute coronary syndrome without ST-segment elevation. The Sisca randomized trial. Int J Cardiol 2015; 182:414-8. [DOI: 10.1016/j.ijcard.2014.12.089] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Revised: 12/13/2014] [Accepted: 12/25/2014] [Indexed: 11/26/2022]
|
5
|
Abtan J, Kerneis M, Boccara A, Chaib A, Payot L, Sayah S, Alperin S, Passefort S, Koubbi A, Gryman R. CathLab procedures change induce great improvements in radiation safety for patients and healthcare professionals. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
6
|
Gross M, Ramaz F, Forget B, Atlan M, Boccara A, Delaye P, Roosen G. Theoretical description of the photorefractive detection of the ultrasound modulated photons in scattering media. Opt Express 2005; 13:7097-7112. [PMID: 19498733 DOI: 10.1364/opex.13.007097] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Acousto-optic imaging of thick biological tissues can be obtained in real-time with an adaptive-wavefront holographic setup, where the holographic media is a self-developping photorefractive crystal. As a consequence, the interference signal resulting from the acousto-optic effect can be easily collected with a high etendue and fast single photodetector. We present a statistical model of the field propagating through the scattering media and show why the various acoustic frequency components contained in the speckle output pattern are uncorrelated. We then give a detailed description of the signal measured through the photorefractive effect, in order to explain the quadratic pressure response observed for the two commonly used configurations setup e.g an amplitude or a phase modulation of the ultrasound.
Collapse
|
7
|
Juliard JM, Himbert D, Cristofini P, Desportes JC, Magne M, Golmard JL, Aubry P, Benamer H, Boccara A, Karrillon GJ, Steg PG. A matched comparison of the combination of prehospital thrombolysis and standby rescue angioplasty with primary angioplasty. Am J Cardiol 1999; 83:305-10. [PMID: 10072213 DOI: 10.1016/s0002-9149(98)00858-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study sought to assess the rate of acute Thrombolysis In Myocardial Infarction (TIMI) trial grade 3 patency that can be achieved with the combination of prehospital thrombolysis and standby rescue angioplasty in acute myocardial infarction. No large angiographic study has been performed after prehospital thrombolysis to determine the 90-minute TIMI 3 patency rate in the infarct-related artery. Hospital outcome and artery patency were compared to 170 matched patients treated with primary angioplasty. Prehospital thrombolysis was applied 151+/-61 minutes after the onset of pain in 170 patients (56+/-12 years, 86% men), using recombinant tissue-type plasminogen activator, streptokinase, or eminase. Emergency 90-minute angiography was performed in every case. All patients in whom thrombolysis failed underwent rescue angioplasty. After thrombolysis alone, TIMI grade 3 flow in the infarct-related artery was observed in 108 patients (64%), TIMI grade 2 in 12 (7%), and TIMI grade 0 or 1 in 50 (29%). Rescue angioplasty was successful in 47 of 50 attempts. Overall, TIMI 3 patency was achieved in 91%, and additionally TIMI 2 flow in 7% of patients, an average of 113+/-39 minutes after thrombolysis and 55+19 minutes after admission. Therefore, < 2 hours after thrombolysis, only 2% of patients had persistent occlusion (TIMI 0 or 1) of the infarct-related artery. In-hospital mortality was 4% overall (7 of 170), and 3% in the 155 patients in whom TIMI 3 was obtained during the acute phase. Severe hemorrhagic complications occurred in 14 patients (8%) with 2 fatal cerebral hemorrhages (7% of patients required transfusions). The matched comparison with primary PTCA showed no significant difference in hospital outcome. Combined prehospital thrombolysis, 90-minute angiography, and rescue angioplasty yield a high rate of acute TIMI 3 patency rate early after thrombolysis and hospital admission. A randomized, prospective comparison between these 2 reperfusion strategies may be now warranted.
Collapse
Affiliation(s)
- J M Juliard
- Cardiology Department, Hôpital Bichat, Paris, France
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Benamer H, Steg PG, Benessiano J, Vicaut E, Gaultier CJ, Boccara A, Aubry P, Nicaise P, Brochet E, Juliard JM, Himbert D, Assayag P. Comparison of the prognostic value of C-reactive protein and troponin I in patients with unstable angina pectoris. Am J Cardiol 1998; 82:845-50. [PMID: 9781965 DOI: 10.1016/s0002-9149(98)00490-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study assessed the prognostic value of cardiac troponin I (cTnI) and C-reactive protein (CRP) in unstable angina, and specifically in patients with angiographically proven coronary artery disease. These biochemical parameters, which are related to myocardial injury or to systemic inflammation, may help in short-term risk stratification of unstable angina. We prospectively studied 195 patients with unstable angina, 100 of whom had angiographically proven coronary artery disease (with normal creatine kinase [CK] and CK-MB mass). Serum concentrations of cTnI (N < 0.4 ng/ml) and CRP (N < 3 mg/L) were measured at admission, 12, and 24 hours later. The rate of in-hospital major adverse cardiac events (death, myocardial infarction, or emergency revascularization) was higher in patients with increased cTnI within the first 24 hours, regardless of the results of coronary angiography (23% vs 7%; p < 0.001). Conversely, events occurred at similar rates in patients with or without increased CRP. In patients with angiographic evidence of coronary artery disease, multivariate analysis showed that increased cTnI within 24 hours of admission (35 patients) was an independent predictor of major adverse cardiac events (odds ratio 6.7, range 1.7 to 27.3), but not cTnI levels at admission and CRP at 0, 12, and 24 hours. Thus, both in unselected patients with unstable angina and in patients with angiographically proven coronary artery disease, increased cTnI within 24 hours of admission, but not CRP, is a predictor of in-hospital clinical outcome. We also found a temporal link between cTnI increase and late elevation of CRP, suggesting that systemic inflammation may partially be a consequence of myocardial injury.
Collapse
Affiliation(s)
- H Benamer
- Service de Cardiologie, Hôpital Bichat, Paris, France
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Andreassian B, Sebbag U, Boccara A, Sablayrolles JL, Besse F. [Intramural hematoma in the thoracic aorta: the "porous" aorta]. Ann Cardiol Angeiol (Paris) 1998; 47:42-3. [PMID: 9772931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
|
10
|
Cariou A, Himbert D, Golmard JL, Juliard JM, Benamer H, Boccara A, Aubry P, Steg PG. Sex-related differences in eligibility for reperfusion therapy and in-hospital outcome after acute myocardial infarction. Eur Heart J 1997; 18:1583-9. [PMID: 9347268 DOI: 10.1093/oxfordjournals.eurheartj.a015137] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
AIMS To determine the effect of sex on reperfusion therapy and early mortality after acute myocardial infarction. METHODS We analysed the characteristics, the reperfusion interventions, and in-hospital mortality in 400 consecutive patients (320 men and 80 women) admitted during the first 6 h of acute myocardial infarction and treated by primary angioplasty, or intravenous thrombolysis with rescue angioplasty. RESULTS The differences between men and women were age (57 vs 67 years, P = 0.001), systemic hypertension (33 vs 50%, P = 0.02), cigarette smoking (79 vs 30%, P = 0.0001) and contraindications to thrombolysis (28.5 vs 42.5%, P = 0.02). Successful reperfusion of the infarct-related artery was achieved in 84% of patients of both sexes. In-hospital mortality was 7.2% in men and 18.7% in women (P = 0.001). Multivariate analysis was performed by linear logistic regression in order to compare several embedded models, using repeated maximum likelihood ratio tests. The best model involved the variables of cardiogenic shock and age. Addition of the variable 'sex' did not improve the predictive power of this model (P > 0.5). CONCLUSION During acute myocardial infarction, similar successful early reperfusion rates can be achieved in men and women, despite the lower eligibility of women for thrombolytic therapy. Although in-hospital mortality was higher in women than men, the best predictive model of mortality was the combination of age and cardiogenic shock. Therefore, sex does not appear to be an independent predictor of mortality.
Collapse
Affiliation(s)
- A Cariou
- Service de Cardiologie A, Hôpital Bichat-Claude Bernard, Paris, France
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Steg PG, Himbert D, Benamer H, Karrillon G, Boccara A, Aubry P, Juliard JM. Conservative management of patients with acute myocardial infarction and spontaneous acute patency of the infarct-related artery. Am Heart J 1997; 134:248-52. [PMID: 9313604 DOI: 10.1016/s0002-8703(97)70131-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The role of systematic emergency percutaneous transluminal coronary angioplasty (PTCA) in patients with spontaneous reperfusion during myocardial infarction is debated. We retrospectively examined the inhospital outcome of 47 consecutive patients with myocardial infarction < 6 hours and angiographically proven spontaneous patency of the infarct artery managed without initial PTCA. There was one death (2.1%) and no incidence of reinfarction. Predischarge angiography showed regression of the culprit coronary lesion to < 50% stenosis in 23% of the patients, therefore obviating the need for PTCA. However, 17% of the patients had acute recurrent ischemia, requiring emergency intervention in 10.6%. Comparison with matched patients in whom Thrombolysis in Myocardial infarction grade 3 patency was achieved by thrombolysis or by primary PTCA showed that patients with spontaneous patency tended to have smaller infarctions, as judged from a lower peak creatine kinase level (1132 +/- 1002, 2051 +/- 1536, and 2715 +/- 2146 i.u., respectively; p = 0.001) and a higher left ventricular ejection fraction (56.4%, 47.9%, and 48.7% respectively; p = 0.02). In conclusion, these patients have an excellent inhospital outcome, with evidence of less myocardial damage than in patients in whom reperfusion therapy was required to achieve TIMI 3 patency. Initial conservative treatment appears safe.
Collapse
Affiliation(s)
- P G Steg
- Cardiology Department, Hôpital Bichat, Paris, France
| | | | | | | | | | | | | |
Collapse
|
12
|
Juliard JM, Himbert D, Golmard JL, Aubry P, Karrillon GJ, Boccara A, Benamer H, Steg PG. Can we provide reperfusion therapy to all unselected patients admitted with acute myocardial infarction? J Am Coll Cardiol 1997; 30:157-64. [PMID: 9207637 DOI: 10.1016/s0735-1097(97)00119-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES This study sought to assess the maximal rate of acute Thrombolysis in Myocardial Infarction (TIMI) grade 3 patency that can be achieved in unselected patients. BACKGROUND Early and complete (TIMI grade 3 flow) reperfusion is an important therapeutic goal during acute myocardial infarction. However, thrombolysis, although widely used, is often contraindicated or ineffective. The selective use of primary and rescue percutaneous transluminal coronary angioplasty (PTCA) may increase the number of patients receiving reperfusion therapy. METHODS A cohort of 500 consecutive unselected patients with acute myocardial infarction were prospectively treated using a patency-oriented scheme: Thrombolysis-eligible patients received thrombolysis (n = 257) and underwent 90-min angiography to detect persistent occlusion for treatment with rescue PTCA. Emergency PTCA (n = 193) was attempted in patients with contraindications to thrombolysis, cardiogenic shock or uncertain diagnosis and in a subset of patients admitted under "ideal conditions." A small group of patients (n = 38) underwent acute angiography without PTCA. Conventional medical therapy was used in 12 patients with contraindications to both thrombolysis and PTCA. RESULTS Ninety-eight percent of patients received reperfusion therapy (thrombolysis, PTCA or acute angiography), and angiographically proven early TIMI grade 3 patency was achieved in 78%. Among patients with TIMI grade 3 patency, thrombolysis alone was the strategy used in 37%, emergency PTCA in 40% and rescue PTCA after failed thrombolysis in 15%; spontaneous patency occurred in 8%. CONCLUSIONS Reperfusion therapy can be provided to nearly every patient (98%) with acute myocardial infarction. Rescue and direct PTCA provided effective early reperfusion to patients in whom thrombolysis failed or was excluded.
Collapse
Affiliation(s)
- J M Juliard
- Cardiology Department, Hôpital Bichat, Paris, France
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Boccara A, Benamer H, Juliard JM, Aubry P, Goy P, Himbert D, Karrillon GJ, Steg PG. A randomized trial of a fixed high dose vs a weight-adjusted low dose of intravenous heparin during coronary angioplasty. Eur Heart J 1997; 18:631-5. [PMID: 9129894 DOI: 10.1093/oxfordjournals.eurheartj.a015308] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
AIMS Prospectively to compare success rate and complications in percutaneous transluminal coronary angioplasty using two doses of heparin. METHODS AND RESULTS Four hundred patients undergoing coronary angioplasty were randomly assigned to receive 15,000 IU (group A) or 100 IU.kg-1 (group B) of heparin. The angioplasty success rate was 95% of both groups. Stents were placed in 28.5% and 26.5% of patients in groups A and B, respectively (P = 0.73). The primary endopoint (freedom from death, myocardial infarction, unplanned revascularization or bailout stenting) occurred in 91% vs 95% of patients in groups A and B, respectively (odds ratio: 1.88, 95% CI: 0.80-4.50, P = 0.12). Haemoglobin loss was 0.36 +/- 1 and 0.27 +/- 0.9 g.dl-1 in groups A and B, respectively (P = 0.37). The time to sheath removal (735 +/- 265 vs 558 +/- 246 min) and the time to transfer to a stepdown unit (12.7 +/- 4.5 vs 9.8 +/- 4.2 h) were longer in groups A (P = 0.0001 for both comparisons). CONCLUSION A weight-adjusted low dose of intravenous heparin is at least as safe as a fixed high dose for coronary angioplasty. It allows earlier sheath removal and discharge to a stepdown unit.
Collapse
Affiliation(s)
- A Boccara
- Service de Cardiologie, Höpital Bichat, Paris, France
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Juliard JM, Himbert D, Aubry P, Benamer H, Karrillon GJ, Boccara A, Feldman LJ, Steg PG. [Orientated management towards reperfusion in the acute phase of myocardial infarction. Results in a cohort of 700 consecutive patients]. Arch Mal Coeur Vaiss 1997; 90:337-43. [PMID: 9232071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The principal objective of treatment of the acute phase of myocardial infarction is the obtention of TIMI 3 complete patency. Usually, only a minority of patients receives thrombolytic therapy and complete reperfusion in unusual. Between June 1988 and April 1996, 700 consecutive patients were admitted to Bichat hospital within 6 hours of the onset of transmural myocardial infarction (81% men; age 59 +/- 13 years). The objective of treatment was to obtain maximal coronary patency in the acute phase, either by thrombolysis (with systematic angiography at 90 minutes and salvage angioplasty in case of failure), or primary angioplasty or conventional treatment (usually in cases of spontaneous reperfusion). The emergency angiography and angioplasty procedures were performed by a medical team on 24 hour duty. During the acute phase, 316 patients received intravenous thrombolysis (angiography at 90' in 302 patients with salvage angioplasty in 79 patients), 304 underwent primary angioplasty (TIMI 3 artery in 85% of cases) and 80 underwent conventional treatment (including 52 cases of angiographically documented spontaneous reperfusion). Therefore, a 81% (566/700) rate of patent TIMI 3 arteries was obtained. The hospital mortality was 8.9%, lower in TIMI 3 arterial patency (6%) than TIMI 2 (20%) or TIMI 0-1 (23%), p < 0.001. The mortality was 4% in patients treated by thrombolysis. Therefore, a reperfusion strategy associating thrombolysis and/or angioplasty provides a high TIMI 3 patency rate in the acute phase of myocardial infarction with a low mortality (6%) in consecutive, unselected patients.
Collapse
Affiliation(s)
- J M Juliard
- Service de cardiologie, hôpital Bichat, Paris
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Benamer H, de Prost D, Bridey F, Boccara A, Brochet E, Himbert D, Sustendal L, Steg PG, Assayag P. Gender difference in factor VII and in activated factor VII levels in unstable angina. Thromb Haemost 1996; 75:981. [PMID: 8822603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
|
16
|
Chatel D, Longrois D, Lenormand C, Calvat S, Timsit JF, Brochet E, Boccara A, Hvass U. [Pulmonary valve replacement for endocarditis. Apropos of 2 cases]. Arch Mal Coeur Vaiss 1996; 89:471-5. [PMID: 8763008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The authors report two cases of pulmonary valve endocarditis which required emergency surgical treatment. A 74 year old patient with trivalvular endocarditis (pulmonary, aortic, mitral), due to Sptreptococcus D bovis, developed cardiogenic shock with acute pulmonary oedema and underwent double aortic and pulmonary valve replacement with Carpentier-Edwards prostheses and simple resection of a mitral valve vegetation. Another 36 year old drug addict developed isolated pulmonary valve endocarditis due to Staphylococcus aureus infection complicated by pulmonary regurgitation with right ventricular failure and by septic pulmonary embolism with persistent sepsis: he underwent pulmonary valve replacement with a Bravo 300 bioprosthesis. The postoperative course was uncomplicated in both cases, with interruption of the infection and normalisation of the haemodynamic status. The insidious and severe nature of pulmonary valve endocarditis is demonstrated by these two cases, confirming previous reports which have underlined the poor prognosis of this condition. Surgery has been shown to be effective and well tolerated and should be integrated early in the therapeutic strategy, the results being all the better when an aggressive attitude is taken.
Collapse
Affiliation(s)
- D Chatel
- Service de chirurgie cardiovasculaire, hôpital Bichat-Claude-Bernard, Paris
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Aubry P, Benamer H, Boccara A, Assayag P, Brochet E, Valère PE. [Unstable angina. Physiopathology, clinical course and therapeutic principles]. Presse Med 1995; 24:1788-94. [PMID: 8545428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The pathogenic mechanism of unstable angina, a clinical expression of coronary heart disease, is similar to that of myocardial infarction. The main event is the instability of the atheromatous plaque adhering to the coronary intima leading to thrombosis and occlusion. Clinical manifestations can be severe since fatal or non-fatal myocardial infarction occurs in 3.9% and 5.4% of the case respectively. Adapted medical treatment can stabilize the situation in most patients, justifying early preventive treatment. Moreover, it has been estimated that a premonitory phase of angina had gone unnoticed or undiagnosed in one-half of all myocardial infarcts. In nearly all patients with unstable angina, coronarography is of major importance for rapidly defining an adapted therapeutic strategy. Myocardial revascularization (especially by angioplasty) is often needed to limit the risk of major cardiac events occurring within a short or moderate delay. Unfortunately, these procedures carry a supplementary risk of thrombosis. Thus the emphasis placed on measures capable of improving the anti-thrombotic risk in unstable angina by using new antiplatelet agents, or for certain patients at high risk of a major cardiac event, antithrombosis agents. Finally, the search for compounds capable of stabilizing the previously formed atheromatous plaque (and thus avoiding rupture) is a prime objective for an overall management strategy for patients with coronary heart disease.
Collapse
Affiliation(s)
- P Aubry
- Service de Cardiologie B, Hôpital Bichat, Paris
| | | | | | | | | | | |
Collapse
|