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Grave C, Gabet A, Iliou MC, Cinaud A, Tuppin P, Blacher J, Olié V. Temporal trends in admission for cardiac rehabilitation after an acute coronary syndrome in France from 2009 to 2021: Persistent sex, age and social disparities. Arch Cardiovasc Dis 2024; 117:234-243. [PMID: 38458957 DOI: 10.1016/j.acvd.2023.12.008] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/17/2023] [Accepted: 12/19/2023] [Indexed: 03/10/2024]
Abstract
BACKGROUND Cardiac rehabilitation after an acute coronary syndrome is recommended to decrease patient morbidity and mortality and to improve quality of life. AIMS To describe time trends in the rates of patients undergoing cardiac rehabilitation after an acute coronary syndrome in France from 2009 to 2021, and to identify possible disparities. METHODS All patients hospitalized for acute coronary syndrome in France between January 2009 and June 2021 were identified from the national health insurance database. Cardiac rehabilitation attendance was identified within 6 months of acute coronary syndrome hospital discharge. Age-standardized cardiac rehabilitation rates were computed and stratified for sex and acute coronary syndrome subtypes (ST-segment elevation and non-ST-segment elevation). Patient characteristics and outcomes were described and compared. Factors independently associated with cardiac rehabilitation attendance were identified. RESULTS In 2019, among 134,846 patients with an acute coronary syndrome, 22.3% underwent cardiac rehabilitation within 6 months of acute coronary syndrome hospital discharge. The mean age of patients receiving cardiac rehabilitation was 62 years. The median delay between acute coronary syndrome hospitalization and cardiac rehabilitation was 32 days, with about 60% receiving outpatient cardiac rehabilitation. Factors significantly associated with higher cardiac rehabilitation rates were male sex, younger age (35-64 years), least socially disadvantaged group, ST-segment elevation, percutaneous coronary intervention and coronary artery bypass graft. Between 2009 and 2019, cardiac rehabilitation rates increased by 40% from 15.9% to 22.3%. Despite greater upward trends in women, their cardiac rehabilitation rate was significantly lower than that for men (14.8% vs. 25.8%). In 2020, cardiac rehabilitation attendance dropped because of the coronavirus disease 2019 pandemic. CONCLUSIONS Despite the health benefits of cardiac rehabilitation, current cardiac rehabilitation attendance after acute coronary syndrome remains insufficient in France, particularly among the elderly, women and socially disadvantaged people.
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Affiliation(s)
- Clémence Grave
- Surveillance des maladies cardio-neuro-vasculaires, direction des maladies non transmissibles, Santé Publique France, 94415 Saint-Maurice, France.
| | - Amélie Gabet
- Surveillance des maladies cardio-neuro-vasculaires, direction des maladies non transmissibles, Santé Publique France, 94415 Saint-Maurice, France
| | | | - Alexandre Cinaud
- Centre de diagnostic et de thérapeutique, université Paris-Cité, Hôpital Hôtel-Dieu, AP-HP, 75004 Paris, France
| | - Philippe Tuppin
- Direction de la stratégie, des études et des statistiques, Caisse Nationale de l'Assurance Maladie, 75020 Paris, France
| | - Jacques Blacher
- Centre de diagnostic et de thérapeutique, université Paris-Cité, Hôpital Hôtel-Dieu, AP-HP, 75004 Paris, France
| | - Valérie Olié
- Surveillance des maladies cardio-neuro-vasculaires, direction des maladies non transmissibles, Santé Publique France, 94415 Saint-Maurice, France
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Grave C, Gabet A, Cinaud A, Tuppin P, Blacher J, Olié V. Nationwide time trends in patients hospitalized for acute coronary syndrome: a worrying generational and social effect among women. Eur J Prev Cardiol 2024; 31:116-127. [PMID: 37794752 DOI: 10.1093/eurjpc/zwad288] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/25/2023] [Accepted: 08/29/2023] [Indexed: 10/06/2023]
Abstract
AIMS To estimate the time trends in the annual incidence of patients hospitalized for acute coronary syndrome (ACS) in France from 2009 to 2021 and to analyse the current sex and social differences in ACS, management, and prognosis. METHODS AND RESULTS All patients hospitalized for ACS in France were selected from the comprehensive National Health Insurance database. Age-standardized rates were computed overall and according to age group (over or under 65 years), sex, proxy of socioeconomic status, and ACS subtype [ST-segment elevation (STSE) and non-ST-segment elevation]. Patient characteristics and outcomes were described for patients hospitalized in 2019. Differences in management (coronarography, revascularization), and prognosis were analysed by sex, adjusting for cofonders. In 2019, 143,670 patients were hospitalized for ACS, including 53,227 STSE-ACS (mean age = 68.8 years; 32% women). Higher standardized incidence rates among the most socially deprived people were observed. Women were less likely to receive coronarography and revascularization but had a higher excess in-hospital mortality. In 2019, the age-standardized rate for hospitalized ACS patients reached 210 per 100 000 person-year. Between 2009 and 2019, these rates decreased by 11.4% (men: -11.2%; women: -14.0%). Differences in trends of age-standardized incidence rate have been observed according to sex, age, and social status. Middle aged women (45-64 years) showing more unfavourable trends than in other age classes or in men. In addition, among women the temporal trends were more unfavourable as social deprivation increased. CONCLUSION Despite encouraging overall trends in patients hospitalized for ACS rates, the increasing trends observed among middle-aged women, especially socially deprived women, is worrying. Targeted cardiovascular prevention and close surveillance of this population should be encouraged.
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Affiliation(s)
- Clémence Grave
- Surveillance des maladies cardio-neuro-vasculaires, Direction des maladies non transmissibles, Santé publique France, 12 rue du Val d'Osne, 94415 Saint-Maurice Cedex, France
| | - Amélie Gabet
- Surveillance des maladies cardio-neuro-vasculaires, Direction des maladies non transmissibles, Santé publique France, 12 rue du Val d'Osne, 94415 Saint-Maurice Cedex, France
| | - Alexandre Cinaud
- Centre de diagnostic et de thérapeutique, Hôpital Hôtel-Dieu AP-HP, Université Paris Cité, Paris, France
| | - Philippe Tuppin
- Direction de la stratégie, des études et des statistiques, Caisse Nationale de l'Assurance Maladie, Paris, France
| | - Jacques Blacher
- Centre de diagnostic et de thérapeutique, Hôpital Hôtel-Dieu AP-HP, Université Paris Cité, Paris, France
| | - Valérie Olié
- Surveillance des maladies cardio-neuro-vasculaires, Direction des maladies non transmissibles, Santé publique France, 12 rue du Val d'Osne, 94415 Saint-Maurice Cedex, France
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Vay-Demouy J, Cinaud A, Malka N, Mion B, Kretz S, Lelong H, Blacher J. Advanced practice nurse intervention versus usual care for hypertension control: study protocol for an open-label randomized controlled trial. Trials 2023; 24:438. [PMID: 37400867 DOI: 10.1186/s13063-023-07437-3] [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] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 06/07/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Hypertension is the most frequent chronic pathology in France and in the world. It is one of the main modifiable cardiovascular risk factors. In France, 50% of treated hypertensives are uncontrolled and only 30% of treated patients are fully adherent to their antihypertensive treatment. Poor adherence to drug treatments is considered as one of the main causes of non-control of hypertension. Since 2018, a new profession has entered the French healthcare system: advanced practice nurses (APN). They have many broad-based skills, at the interface of nursing and medical exercises. The purpose of this study is to assess the impact of an APN intervention versus usual care on hypertension control. METHODS The study will take place at the Hôtel-Dieu University Hospital, Paris, France, as prospective, open-label, controlled, randomized 1-to-1, monocentric, and superiority trial. The participants will be recruited during day hospitalization for cardiovascular assessment in the context of their hypertension management. Patients will be divided into two groups: a "usual care" group which will continue traditional follow-up (day hospitalization followed by consultation with a medical doctor (MD) within approximately 2-12 months) and an "intervention" group which will meet an APN between the day hospitalization and the MD consultation. Participants will be monitored until 12 months after the day hospitalization, depending on their last follow-up study appointment (MD consultation). The primary outcome is the rate of controlled BP (BP < 140/90 mmHg in office BP measurement) in each group. The hypothesis formulated is that an individual APN intervention, included in usual hypertension management, improves hypertension control. DISCUSSION This innovative study will be the first in France where APNs are beginning to be established in the healthcare system. It will provide an objective look at this new profession and the impact it can have in the framework of global management of hypertension. TRIAL REGISTRATION ClinicalTrials.gov NCT0448249. Registered on June 24, 2020.
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Affiliation(s)
- Juliette Vay-Demouy
- Diagnosis and Therapeutic Center, Hôtel-Dieu University Hospital, Assistance Publique-Hôpitaux de Paris, Paris Cité University, Paris, 75004, France
| | - Alexandre Cinaud
- Diagnosis and Therapeutic Center, Hôtel-Dieu University Hospital, Assistance Publique-Hôpitaux de Paris, Paris Cité University, Paris, 75004, France
| | - Nathan Malka
- Diagnosis and Therapeutic Center, Hôtel-Dieu University Hospital, Assistance Publique-Hôpitaux de Paris, Paris Cité University, Paris, 75004, France
| | - Baptiste Mion
- Diagnosis and Therapeutic Center, Hôtel-Dieu University Hospital, Assistance Publique-Hôpitaux de Paris, Paris Cité University, Paris, 75004, France
| | - Sandrine Kretz
- Diagnosis and Therapeutic Center, Hôtel-Dieu University Hospital, Assistance Publique-Hôpitaux de Paris, Paris Cité University, Paris, 75004, France
| | - Hélène Lelong
- Diagnosis and Therapeutic Center, Hôtel-Dieu University Hospital, Assistance Publique-Hôpitaux de Paris, Paris Cité University, Paris, 75004, France
| | - Jacques Blacher
- Diagnosis and Therapeutic Center, Hôtel-Dieu University Hospital, Assistance Publique-Hôpitaux de Paris, Paris Cité University, Paris, 75004, France.
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Grave C, Gabet A, Cinaud A, Iliou MC, Tuppin P, Blacher J, Olié V. Cardiac rehabilitation after an acute coronary syndrome in France: Latest estimates and temporal trends 2009–2021. An overall improvement but persistent regional and sex disparities. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.239] [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] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Tan BK, Chalouni M, Ceron DS, Cinaud A, Esterle L, Loko MA, Katlama C, Poizot-Martin I, Neau D, Chas J, Morlat P, Rosenthal E, Lacombe K, Naqvi A, Barange K, Bouchaud O, Gervais A, Lascoux-Combe C, Garipuy D, Alric L, Goujard C, Miailhes P, Aumaitre H, Duvivier C, Simon A, Lopez-Zaragoza JL, Zucman D, Raffi F, Lazaro E, Rey D, Piroth L, Boué F, Gilbert C, Bani-Sadr F, Dabis F, Sogni' P, Wittkop L, Boccara F. Atherosclerotic Cardiovascular Events in Patients Infected With Human Immunodeficiency Virus and Hepatitis C Virus. Clin Infect Dis 2021; 72:e215-e223. [PMID: 32686834 DOI: 10.1093/cid/ciaa1014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND An increased risk of cardiovascular disease (CVD) was reported in patients coinfected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV), without identifying factors associated with atherosclerotic CVD (ASCVD) events. METHODS HIV-HCV coinfected patients were enrolled in the Agence Nationale de Recherches sur le Sida et les hépatites virales (ANRS) CO13 HEPAVIH nationwide cohort. Primary outcome was total ASCVD events. Secondary outcomes were coronary and/or cerebral ASCVD events, and peripheral artery disease (PAD) ASCVD events. Incidences were estimated using the Aalen-Johansen method. Factors associated with ASCVD were identified using cause-specific Cox proportional hazards models. RESULTS At baseline, median age of the study population (N = 1213) was 45.4 (interquartile range [IQR] 42.1-49.0) years and 70.3% were men. After a median follow-up of 5.1 (IQR 3.9-7.0) years, the incidence was 6.98 (95% confidence interval [CI], 5.19-9.38) per 1000 person-years for total ASCVD events, 4.01 (2.78-6.00) for coronary and/or cerebral events, and 3.17 (2.05-4.92) for PAD ASCVD events. Aging (hazard ratio [HR] 1.06; 95% CI, 1.01-1.12), prior CVD (HR 8.48; 95% CI, 3.14-22.91), high total cholesterol (HR 1.43; 95% CI, 1.11-1.83), high-density lipoprotein cholesterol (HR 0.22; 95% CI, 0.08-0.63), statin use (HR 3.31; 95% CI, 1.31-8.38), and high alcohol intake (HR 3.18; 95% CI, 1.35-7.52) were independently associated with total ASCVD events, whereas undetectable baseline viral load (HR 0.41, 95% CI, 0.18-0.96) was associated with coronary and/or cerebral events. CONCLUSIONS HIV-HCV coinfected patients experienced a high incidence of ASCVD events. Some traditional cardiovascular risk factors were the main determinants of ASCVD. Controlling cholesterol abnormalities and maintaining undetectable HIV RNA are essential to control cardiovascular risk.
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Affiliation(s)
- Boun Kim Tan
- Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Department of Internal Medicine, Hôpital Cochin, Paris, France.,Unité des Maladies Infectieuses et Tropicales, Hôpitaux Universitaires Paris Centre, Assistance Publique des Hôpitaux de Paris, Paris, France.,Université Paris Descartes, Paris, France
| | - Mathieu Chalouni
- Université de Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR, Bordeaux, France
| | - Dominique Salmon Ceron
- Unité des Maladies Infectieuses et Tropicales, Hôpitaux Universitaires Paris Centre, Assistance Publique des Hôpitaux de Paris, Paris, France.,Université Paris Descartes, Paris, France
| | - Alexandre Cinaud
- Université Paris Descartes, Paris, France.,Assistance Publique des Hôpitaux de Paris, Hypertension and Cardiovascular Prevention Unit, Diagnosis and Therapeutic Center, Hôtel-Dieu Hospital, Paris, France
| | - Laure Esterle
- Université de Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR, Bordeaux, France
| | - Marc Arthur Loko
- Université de Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR, Bordeaux, France
| | - Christine Katlama
- Assistance Publique des Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Service des Maladies Infectieuses et Tropicales, Paris, France.,Inserm Institut Pierre Louis Epidémiologie et Santé Publique, UPMC, Sorbonne Université, Paris, France
| | - Isabelle Poizot-Martin
- Assistance Publique des Hôpitaux de Marseille, Hôpital Sainte-Marguerite, Service d'Immuno-Hématologie Clinique, Marseille, France.,Aix-Marseille Université, APHM, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | - Didier Neau
- Centre Hospitalier Universitaire de Bordeaux, Service des Maladies Infectieuses et Tropicales, Hôpital Pellegrin, Bordeaux, France.,Université de Bordeaux, Bordeaux, France
| | - Julie Chas
- France Assistance Publique des Hôpitaux de Paris, Hôpital Tenon, Service des Maladies Infectieuses et Tropicales, Paris, France
| | - Philippe Morlat
- Université de Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR, Bordeaux, France.,Université de Bordeaux, Bordeaux, France.,Centre Hospitalier Universitaire de Bordeaux, Service de Médecine Interne, Hôpital Saint-André, Bordeaux, France
| | - Eric Rosenthal
- Centre Hospitalier Universitaire de Nice, Service de Médecine Interne et Cancérologie, Hôpital l'Archet, Nice, France.,Université de Nice-Sophia Antipolis, Nice, France
| | - Karine Lacombe
- Inserm Institut Pierre Louis Epidémiologie et Santé Publique, UPMC, Sorbonne Université, Paris, France.,Assistance Publique des Hôpitaux de Paris, Hôpital Saint-Antoine, Service des Maladies Infectieuses et Tropicales, Paris, France
| | - Alissa Naqvi
- Centre Hospitalier Universitaire de Nice, Service d'Infectiologie, Hôpital l'Archet, Nice, France
| | - Karl Barange
- Centre Hospitalier Universitaire de Toulouse, Service d'Hépatologie, Hôpital Purpan, Toulouse, France
| | - Olivier Bouchaud
- Assistance Publique des Hôpitaux de Paris, Hôpital Avicenne, Service des Maladies Infectieuses et Tropicales, Bobigny, France.,Université Sorbonne Paris Nord, Bobigny, France
| | - Anne Gervais
- Assistance Publique des Hôpitaux de Paris, Hôpital Bichat Claude Bernard, Service des Maladies Infectieuses et Tropicales, Paris, France
| | - Caroline Lascoux-Combe
- Assistance Publique des Hôpitaux de Paris, Hôpital Saint-Louis, Service des Maladies Infectieuses et Tropicales, Paris, France
| | - Daniel Garipuy
- Centre Hospitalier Universitaire de Toulouse, Hôpital Purpan, Services des Maladies Infectieuses et Tropicales, Toulouse, France
| | - Laurent Alric
- Centre Hospitalier Universitaire de Toulouse, Hôpital Purpan, Service de Médecine Interne-Pôle Digestif, Toulouse, France.,Université Toulouse III, UMR 152, IRD, Toulouse, France
| | - Cécile Goujard
- Assistance Publique des Hôpitaux de Paris, Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, Service de Médecine Interne et Immunologie Clinique, Le Kremlin-Bicêtre, Parris, France.,Université Paris-Saclay, Le Kremlin-Bicêtre, Parris, France
| | - Patrick Miailhes
- Centre Hospitalier Universitaire de Lyon, Service des Maladies Infectieuses et Tropicales, Hôpital de la Croix Rousse, Lyon, France
| | - Hugues Aumaitre
- Centre Hospitalier de Perpignan, Service des Maladies Infectieuses et Tropicales, Perpignan, France
| | - Claudine Duvivier
- Assistance Publique des Hôpitaux de Paris, Service des Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants malades, Centre d'Infectiologie Necker-Pasteur, IHU Imagine, Paris, France
| | - Anne Simon
- Assistance Publique des Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Département de Médecine Interne et Immunologie Clinique, Paris, France
| | - Jose-Luis Lopez-Zaragoza
- Assistance Publique des Hôpitaux de Paris, Hôpital Henri Mondor, Service d'Immunologie Clinique et de Maladies Infectieuses, Créteil, France
| | | | - François Raffi
- Centre Hospitalier Universitaire de Nantes, Department of Infectious Diseases, Nantes, France.,Université de Nantes, CIC 1413, INSERM, Nantes, France
| | - Estibaliz Lazaro
- Université de Bordeaux, Bordeaux, France.,Centre Hospitalier Universitaire de Bordeaux, hôpital Haut-Lévèque, Service de Médecine Interne et Maladies Infectieuses, Pessac, France
| | - David Rey
- Centre Hospitalier Universitaire de Strasbourg, Le Trait d'Union, HIV Infection Care Center, Strasbourg, France
| | - Lionel Piroth
- Centre Hospitalier Universitaire de Dijon, Département d'Infectiologie, Dijon, France.,Université de Bourgogne, Dijon, France
| | - François Boué
- Université Paris-Saclay, Le Kremlin-Bicêtre, Parris, France.,Assistance Publique des Hôpitaux de Paris, Hôpital Antoine Béclère, Service de Médecine Interne et d'Immunologie clinique, Clamart, France
| | - Camille Gilbert
- Université de Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR, Bordeaux, France
| | - Firouzé Bani-Sadr
- Centre Hospitalier Universitaire de Reims, Unité des Maladies Infectieuses et Tropicales, Hôpital Robert Debré, Reims, France.,Université Reims Champagne Ardenne, EA-4684/SFR CAP-SANTE, Reims, France
| | - François Dabis
- Université de Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR, Bordeaux, France
| | - Philippe Sogni'
- Université Paris Descartes, Paris, France.,Assistance Publique des Hôpitaux de Paris, Hôpital Cochin, Service d'Hépatologie, Paris, France.,Inserm U-1223, Institut Pasteur, Paris, France
| | - Linda Wittkop
- Université de Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR, Bordeaux, France.,Centre Hospitalier Universitaire de Bordeaux, Pôle de Santé Publique, Bordeaux, France
| | - Franck Boccara
- Assistance Publique des Hôpitaux de Paris, Hôpitaux de l'Est Parisien, Hôpital Saint-Antoine, Department of Cardiology, Faculty of Medicine, Sorbonne Paris University, Paris, France.,National Institute of Health and Medical Research, INSERM, UMR_S 938, UPMC, Paris, France
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Cinaud A, Sorbets E, Blachier V, Vallee A, Kretz S, Lelong H, Blacher J. Hypertension artérielle et COVID-19. La Presse Médicale Formation 2021. [PMCID: PMC7419269 DOI: 10.1016/j.lpmfor.2020.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
L’âge et les comorbidités cardiovasculaires sont des facteurs indépendants de mortalité et d’hospitalisation en unité de soins intensifs chez les patients atteints de coronavirus 19 (COVID-19), contrairement à l’hypertension artérielle (HTA). La forte prévalence de l’HTA chez les personnes âgées, coronariens ou insuffisants cardiaques, explique l’importante prévalence de l’HTA parmi les patients hospitalisés et présentant des formes sévères de COVID-19. L’HTA, en tant que premier facteur de risque de morbi-mortalité cardiovasculaire, constitue le lit des comorbidités cardiovasculaires qui favorisent les formes sévères de COVID-19. L’hypothèse d’une surexpression de l’enzyme de conversion de l’angiotensine de type 2 membranaire par les inhibiteurs de l’enzyme de conversion et antagonistes des récepteurs de l’angiotensine 2, favorisant l’invasion cellulaire par le severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reste hypothétique, est insuffisante pour expliquer la pathogénie de ce virus, et ne doit pas amener à interrompre ces traitements. Les patients hypertendus et cardiovasculaires doivent faire l’objet d’une surveillance particulière en raison de leur susceptibilité aux formes graves de COVID-19, de leur risque accru de complications cardiovasculaires aiguës ou de décompensation de maladies cardiovasculaires chroniques. Le risque d’infection par le SARS-CoV-2 ne doit pas détourner les soignants et les patients de la prise en charge des urgences cardiovasculaires, même en temps d’épidémie.
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7
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Constantin V, Cinaud A, Brigadeau F, Lepillier A, Pierre B, Deharo J, Defaye P, Montalescot G, Fauchier L, Mansourati J. Does left atrial appendage morphology have any impact on the results of percutaneous closure? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Transcatheter left atrial appendage (LAA) occlusion is an alternative treatment in patients with atrial fibrillation (AF), high CHADSVASC Score and a contra-indication to anticoagulants. This retrospective cohort study aims to evaluate the impact of LLA morphology on procedure outcomes.
Methods
Patients from eight French centers who underwent left atrial appendage occlusion from February 2012 to January 2017 were included in this retrospective cohort study. LLA morphology was described by preoperative cardiac computed tomography (CT). Clinical data and Transoesophageal echocardiography (TEE) or CT results were collected during follow-up.
Results
Among 469 included patients, LAA morphologies were described in 215 cases 45.8%), 150 patients (70%) were implanted with Watchman devices, 57 (26%) with Amplatzer devices and 8 procedures (4%) failed. LAA Morphology was Chicken Wing (34%), Windsock (45%), cauliflower (18%) and 3% had another morphology including Cactus.
There was no difference in patient characteristics between the different morphology groups. Mean follow-up was 9.6±11 months, during which 190 patients underwent LAA imaging (TEE in 171 and CT in 19 patients). There was no significant difference in the failure rate (p=0.72), duration of the procedure (p=0.065), peri-device leak (p=0.83) device-related thrombus (p=0.96) and the occurrence of stroke (p=1) during follow-up.
Conclusion
LLA morphology did not influence complication occurrence after occlusion in this cohort.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - A Cinaud
- University F. Rabelais of Tours, Cardioloy, Tours, France
| | - F Brigadeau
- CHRU De Lille - Institut Coeur-Poumons, Lille, France
| | - A Lepillier
- Centre Cardiologique du Nord (CCN), Saint Denis, France
| | - B Pierre
- University F. Rabelais of Tours, Cardioloy, Tours, France
| | - J.C Deharo
- Hospital La Timone of Marseille, Marseille, France
| | - P Defaye
- University Hospital of Grenoble, Grenoble, France
| | - G Montalescot
- Pitie Salpetriere APHP University Hospital, Paris, France
| | - L Fauchier
- University F. Rabelais of Tours, Cardioloy, Tours, France
| | - J Mansourati
- University Hospital of Brest and Université de Bretagne Occidentale, Cardioloy and ORPHY (EA4324), Brest, France
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8
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Abstract
PURPOSE OF REVIEW Aortic stiffness (AS) is widely associated with hypertension and considered as a major predictor of coronary heart disease (CHD). AS is measured using carotid-femoral pulse wave velocity (PWV), particularly when this parameter is associated with an index involving age, gender, heart rate, and mean blood pressure. The present review focuses on the interest of measurement of PWV and the calculation of individual PWV index for the prediction of CHD, in addition with the use of new statistical nonlinear models enabling results with very high levels of accuracy. RECENT FINDINGS PWV index may so constitute a substantial marker of large arteries prediction and damage in CHD and may be also used in cerebrovascular and renal circulations models. PWV index determinations are particularly relevant to consider in angiographic CHD decisions and in the presence of vulnerable plaques with high cardiovascular risk. Due to the variability in symptoms and clinical characteristics of patients, together with some imperfections in results, there is no very simple adequate diagnosis approach enabling to improve the so defined CHD prediction in usual clinical practice. In recent works in relation to "artificial intelligence" and involving "decision tree" models and "artificial neural networks," it has been possible to determine consistent pathways introducing predictive medicine and enabling to obtain efficient algorithm classification models of coronary prediction.
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Affiliation(s)
- Alexandre Vallée
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, Paris-Descartes University, AP-HP, Paris, France.
| | - Alexandre Cinaud
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, Paris-Descartes University, AP-HP, Paris, France
| | - Athanase Protogerou
- Cardiovascular Prevention and Research Unit, Department of Pathophysiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Yi Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jirar Topouchian
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, Paris-Descartes University, AP-HP, Paris, France
| | - Michel E Safar
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, Paris-Descartes University, AP-HP, Paris, France
| | - Jacques Blacher
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, Paris-Descartes University, AP-HP, Paris, France
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Blacher J, Cinaud A, Blachier V, Vallée A, Sorbets E. Quantifying the evil for a more effective fight against tobacco. Eur J Prev Cardiol 2019; 28:e5-e6. [PMID: 33611349 DOI: 10.1177/2047487319892400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jacques Blacher
- Diagnosis and Therapeutic Center, Hotel-Dieu Hospital, AP-HP, University Paris Descartes, Paris, France
| | - Alexandre Cinaud
- Diagnosis and Therapeutic Center, Hotel-Dieu Hospital, AP-HP, University Paris Descartes, Paris, France
| | - Vincent Blachier
- Diagnosis and Therapeutic Center, Hotel-Dieu Hospital, AP-HP, University Paris Descartes, Paris, France
| | - Alexandre Vallée
- Diagnosis and Therapeutic Center, Hotel-Dieu Hospital, AP-HP, University Paris Descartes, Paris, France
| | - Emmanuel Sorbets
- Diagnosis and Therapeutic Center, Hotel-Dieu Hospital, AP-HP, University Paris Descartes, Paris, France
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Fauchier L, Bisson A, Cinaud A, Brigadeau F, Lepillier A, Jacon P, Gras D, Klug D, Guedeney P, Pierre B, Mansourati J, Piot O, Montalescot G, Deharo JC, Defaye P. P999Major adverse events with percutaneous left atrial appendage closure in patients with atrial fibrillation in real life setting. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Transcatheter left atrial appendage (LAA) closure is an alternative strategy for stroke prevention in atrial fibrillation (AF) patients with an inacceptable risk of bleeding with oral anticoagulation (OAC). A better characterization of major adverse clinical events after LAA closure in daily practice is still needed.
Methods
We analysed data from all AF patients treated with Watchman or Amplatzer LAA closure according to European guidelines in 8 French cardiology departments. Antithrombotic management was decided for each patient on an individual basis. A Cox regression model was used for multivariable analysis of major adverse events. Yearly rate of ischemic stroke during follow-up was calculated and compared to that expected for a same risk score population. Yearly rate of bleeding was extrapolated from that reported with the HASBLED score.
Results
A total of 469 consecutive AF patients (299 males, 74.9±8.9 years old, mean CHA2DS2-VASc score 4.5±1.4, HASBLED score 3.7±1.0) received LAA closure from March 2012 to January 2017. There were 272 Watchman devices (58%) and 197 ACP devices (42%) implanted. At discharge, 36% received a single anti platelet therapy (APT), 23% received dual APT, 29% received OAC and no APT, 5% received OAC plus APT and 8% received no antithrombotic therapy. Mean follow up was 11.4 months (median 7, interquartile 3–22 months) during which 70 major adverse events (19 ischemic strokes, 18 major haemorrhages and 33 deaths) were recorded in 69 patients. The annual rate of ischemic stroke was 3.96%, which translates into a 13% relative risk reduction (95% CI −59 to 52%) as compared with the calculated stroke rate for similar CHA2DS2-VASc score after adjustment for exposure to APT and OAC. The annual rate of major bleeding in the study was 3.75%, which corresponds to a 48% relative risk reduction (95% CI 9 to 70%) as compared with the rate that would have been expected based on a comparable HAS-BLED score. Yearly rate of mortality was 7.4% (2.5 to 3 fold higher than in previous randomized trials) and the rate of non-cardiovascular death was 82%. None of the baseline characteristics was predictive of major adverse events, neither in univariate nor in multivariable analysis, which highlights the difficulty in identifying a risk of unfavourable outcome with simple tools.
Conclusions
AF patients treated with LAA closure may have a lower risk of stroke and bleeding events compared to their theoretical risk. However, our findings indicate that a high rate of major adverse events is observed in these patients during follow-up. This questions the suggested cost-effectiveness of the procedure (with models based on previous trials) for a real-life perspective. A better identification of patients with a relevant benefit of LAA closure is needed among those with long-term anticoagulation contraindication, both for an optimal management of each patient on an individual basis and for a global perspective with limited healthcare resources.
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Affiliation(s)
- L Fauchier
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Bisson
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Cinaud
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | | | - A Lepillier
- Centre Cardiologique du Nord (CCN), Saint Denis, France
| | - P Jacon
- University Hospital of Grenoble, Grenoble, France
| | - D Gras
- Nouvelles Cliniques Nantaises, Nantes, France
| | - D Klug
- Hospital of Lille, Lille, France
| | - P Guedeney
- Hospital Pitie-Salpetriere, Paris, France
| | - B Pierre
- University Hospital of Grenoble, Grenoble, France
| | | | - O Piot
- Centre Cardiologique du Nord (CCN), Saint Denis, France
| | | | - J C Deharo
- Hospital La Timone of Marseille, Marseille, France
| | - P Defaye
- University Hospital of Grenoble, Grenoble, France
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Boccara F, Tan BK, Chalouni M, Salmon Ceron D, Cinaud A, Esterle L, Gilbert C, Bani-Sadr F, Dabis F, Sogni P, Wittkop L. P5341Predictive factors of atherosclerotic cardiovascular diseases events in HIV-HVC co-infected patients: results from hepavih ANRS co13 cohort. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Several studies highlighted an increased risk of cardiovascular disease (CVD) in HIV-HCV co-infected patients without clearly identifying specific virologic factors associated with atherosclerotic CVD (ASCVD) events.
Purpose
Hence, we analyzed data collection from the French nationwide ANRS CO13 HEPAVIH cohort to determine the incidence of ASCVD events in HIV-HCV co-infected patients and the predictive factors associated with its occurrence.
Methods
The French multicenter nationwide ANRS CO13 HEPAVIH clinic-based cohort collected prospective clinical and biological data from HIV-HCV co-infected patients followed-up in 28 different university hospitals between December 2005 to November 2016. Participants with at least one year of follow-up were included. Primary outcome was the occurrence of major ASCVD events (cardiovascular death, acute coronary syndrome, coronary revascularization and stroke). Secondary outcomes were total ASCVD events including major ASCVD events and minor ASCVD events (peripheral arterial disease [PAD]). Incidence rates were estimated using Aalen-Johansen method and factors associated with ASCVD identified with Cox proportional hazards models.
Results
A total of 1213 patients were included: median age 45.4 years [42.1–49.0], 70.3% men, current smoking 70.2%, overweight 19.5%, liver cirrhosis 18.9%, chronic alcohol consumption 7.8%, diabetes mellitus (5.9%), personal history of CVD 2.7%, and statins use 4.1%. After a median follow-up of 5.1 years [3.9–7.0], 44 participants experienced at least one ASCVD event (26 major ASCVD event, and 20 a minor event). Incidences for total, major and minor ASCVD events were of 6.98 [5.19; 9.38], 4.01 [2.78; 6.00], and 3.17 [2.05; 4.92] per 1000 person-years, respectively. Personal history of CVD (Hazard Ratio (HR)=13.94 [4.25–45.66]), high total cholesterol (HR=1.63 [1.24–2.15]), low HDL cholesterol (HR=0.08 [0.02–0.34]) and undetectable HIV viral load (HR=0.41 [0.18–0.96]) were identified as independent factors associated with major ASCVD events while cirrhosis status, liver fibrosis and HCV sustained viral response were not.
Cumulative incidence of CV events
Conclusion
HIV-HCV co-infected patients experience a high incidence of ASCVD events both coronary and peripheral artery diseases. Traditional CV risk factors are the main determinants of ASCVD whereas undetectable HIV viral load seems to be protective. Management of cholesterol abnormalities and controlling viral load are essential to modify this high cardiovascular risk.
Acknowledgement/Funding
Agence Natoinale de Recherche sur le SIDA et les Hépatites virales
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Affiliation(s)
- F Boccara
- AP-HP - Hospital Saint Antoine, Paris, France
| | - B K Tan
- Hospital Cochin, Internal Medicine, Paris, France
| | - M Chalouni
- University of Bordeaux, ISPED, Bordeaux, France
| | - D Salmon Ceron
- Hospital Hotel-Dieu, Infectious Diseases Federation, Paris, France
| | - A Cinaud
- Hospital Hotel-Dieu, Cardiology, Paris, France
| | - L Esterle
- University of Bordeaux, ISPED, Bordeaux, France
| | - C Gilbert
- University of Bordeaux, ISPED, Bordeaux, France
| | - F Bani-Sadr
- University of Bordeaux, ISPED, Bordeaux, France
| | - F Dabis
- University of Bordeaux, ISPED, Bordeaux, France
| | - P Sogni
- Hospital Cochin, Hepatology, Paris, France
| | - L Wittkop
- Hospital Cochin, Hepatology, Paris, France
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Fauchier L, Cinaud A, Brigadeau F, Lepillier A, Pierre B, Gras D, Mansourati J, Deharo JC, Montalescot G, Defaye P. Major Adverse Events With Percutaneous Left Atrial Appendage Closure in Patients With Atrial Fibrillation. J Am Coll Cardiol 2019; 73:2638-2640. [PMID: 31118155 DOI: 10.1016/j.jacc.2019.03.468] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 02/25/2019] [Accepted: 03/08/2019] [Indexed: 10/26/2022]
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Fauchier L, Cinaud A, Brigadeau F, Lepillier A, Pierre B, Gras D, Mansourati J, Deharo JC, Montalescot G, Defaye P. Left Atrial Appendage Closure in Atrial Fibrillation. J Am Coll Cardiol 2018; 72:2806-2807. [DOI: 10.1016/j.jacc.2018.08.2196] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 08/16/2018] [Accepted: 08/21/2018] [Indexed: 11/16/2022]
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Fauchier L, Cinaud A, Brigadeau F, Guedeney P, Jacon P, Mansourati J, Deharo JC, Franceschi F, Pierre B, Klug D, Lepillier A, Piot O, Gras D, Montalescot G, Defaye P. P4809Possible benefits of left atrial appendage closure for stroke prevention in patients with atrial fibrillation in real life setting. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- L Fauchier
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Cinaud
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | | | - P Guedeney
- Hospital Pitie-Salpetriere, Paris, France
| | - P Jacon
- University Hospital of Grenoble, Grenoble, France
| | | | - J C Deharo
- Hospital La Timone of Marseille, Marseille, France
| | - F Franceschi
- Hospital La Timone of Marseille, Marseille, France
| | - B Pierre
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - D Klug
- Cardiology Hospital of Lille, Lille, France
| | - A Lepillier
- Centre Cardiologique du Nord, Saint Denis, France
| | - O Piot
- Centre Cardiologique du Nord, Saint Denis, France
| | - D Gras
- Nouvelles Cliniques Nantaises, Nantes, France
| | | | - P Defaye
- University Hospital of Grenoble, Grenoble, France
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Cinaud A, Mewton N, Ivanes F, Fauchier L, Angoulvant D, Bejan-Angoulvant T. Cyclosporine A to reduce myocardial reperfusion injury: A systematic review and meta-analysis of randomized controlled trials. Archives of Cardiovascular Diseases Supplements 2018. [DOI: 10.1016/j.acvdsp.2018.02.017] [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] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fauchier L, Cinaud A, Lepillier A, Brigadeau F, Jacon P, Pierre B, Paziaud O, Franceschi F, Mansourati J, Klug D, Piot O, Gras D, Montalescot G, Deharo JC, Defaye P. 201Left atrial appendage closure for stroke prevention in patients with atrial fibrillation: the difficult task of estimating the possible benefit in real life setting. Europace 2018. [DOI: 10.1093/europace/euy015.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- L Fauchier
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Cinaud
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Lepillier
- Centre Cardiologique du Nord, Saint Denis, France
| | | | - P Jacon
- University Hospital of Grenoble, Grenoble, France
| | - B Pierre
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - O Paziaud
- Centre Cardiologique du Nord, Saint Denis, France
| | - F Franceschi
- Hospital La Timone of Marseille, Marseille, France
| | | | - D Klug
- Cardiology Hospital of Lille, Lille, France
| | - O Piot
- Centre Cardiologique du Nord, Saint Denis, France
| | - D Gras
- Nouvelles Cliniques Nantaises, Nantes, France
| | | | - J C Deharo
- Hospital La Timone of Marseille, Marseille, France
| | - P Defaye
- University Hospital of Grenoble, Grenoble, France
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Fauchier L, Cinaud A, Brigadeau F, Pierre B, Lepillier A, Paziaud O, Fatemi M, Jacon P, Abbey S, Franceschi F, Klug D, Mansourati J, Deharo J, Gras D, Defaye P. P4562Predictors of cardiovascular events in patients with atrial fibrillation after left atrial appendage closure for stroke prevention in a multicenter analysis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4562] [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: 11/14/2022] Open
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Fauchier L, Cinaud A, Brigadeau F, Pierre B, Lepillier A, Paziaud O, Fatemi M, Jacon P, Abbey S, Franceschi F, Klug D, Mansourati J, Deharo J, Gras D, Defaye P. 5718Incidence, predictors and prognosis of thrombus formation on device in patients with atrial fibrillation after left atrial appendage occlusion for stroke prevention in a multicenter analysis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.5718] [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: 11/14/2022] Open
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