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Cherbi M, Roubille F, Lamblin N, Bonello L, Leurent G, Levy B, Elbaz M, Champion S, Lim P, Schneider F, Cariou A, Khachab H, Bourenne J, Seronde MF, Schurtz G, Harbaoui B, Vanzetto G, Quentin C, Delabranche X, Aissaoui N, Combaret N, Tomasevic D, Marchandot B, Lattuca B, Henry P, Gerbaud E, Bonnefoy E, Puymirat E, Maury P, Delmas C. One-year outcomes in cardiogenic shock triggered by ventricular arrhythmia: An analysis of the FRENSHOCK multicenter prospective registry. Front Cardiovasc Med 2023; 10:1092904. [PMID: 36776263 PMCID: PMC9909601 DOI: 10.3389/fcvm.2023.1092904] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/09/2023] [Indexed: 01/28/2023] Open
Abstract
Background Cardiogenic shock (CS) is a life-threatening condition carrying poor prognosis, potentially triggered by ventricular arrhythmia (VA). Whether the occurrence of VA as trigger of CS worsens the prognosis compared to non-VA triggers remains unclear. The aim of this study was to evaluate 1-year outcomes [mortality, heart transplantation, ventricular assist devices (VAD)] between VA-triggered and non-VA-triggered CS. Methods FRENSHOCK is a prospective multicenter registry including 772 CS patients from 49 centers. One to three triggers can be identified in the registry (ischemic, mechanical complications, ventricular/supraventricular arrhythmia, bradycardia, iatrogenesis, infection, non-compliance). Baseline characteristics, management and 1-year outcomes were analyzed according to the VA-trigger in the CS population. Results Within 769 CS patients included, 94 were VA-triggered (12.2%) and were compared to others. At 1 year, although there was no mortality difference [42.6 vs. 45.3%, HR 0.94 (0.67-1.30), p = 0.7], VA-triggered CS resulted in more heart transplantations and VAD (17 vs. 9%, p = 0.02). Into VA-triggered CS group, though there was no 1-year mortality difference between ischemic and non-ischemic cardiomyopathies [42.5 vs. 42.6%, HR 0.97 (0.52-1.81), p = 0.92], non-ischemic cardiomyopathy led to more heart transplantations and VAD (25.9 vs. 5%, p = 0.02). Conclusion VA-triggered CS did not show higher mortality compared to other triggers but resulted in more heart transplantation and VAD at 1 year, especially in non-ischemic cardiomyopathy, suggesting the need for earlier evaluation by advanced heart failure specialized team for a possible indication of mechanical circulatory support or heart transplantation. Clinical trial registration https://clinicaltrials.gov, identifier NCT02703038.
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Affiliation(s)
- Miloud Cherbi
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France,Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse, France
| | - François Roubille
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Cardiology Department, INI-CRT, CHU de Montpellier, Montpellier, France
| | - Nicolas Lamblin
- Department of Cardiology, Urgences et Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, Lille, France
| | - Laurent Bonello
- Aix-Marseille Université, Marseille, France,Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France,Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
| | - Guillaume Leurent
- Department of Cardiology, CHU Rennes, Inserm, LTSI-UMR 1099, Univ Rennes 1, Rennes, France
| | - Bruno Levy
- CHRU Nancy, Réanimation Médicale Brabois, Nancy, France
| | - Meyer Elbaz
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France,Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse, France
| | | | - Pascal Lim
- Université Paris Est-Créteil, INSERM, IMRB, Créteil, France,AP-HP, Hôpital Universitaire Henri-Mondor, Service de Cardiologie, Créteil, France
| | - Francis Schneider
- Médecine Intensive-Réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Centre–Université de Paris, Medical School, Paris, France
| | - Hadi Khachab
- Intensive Cardiac Care Unit, Department of Cardiology, CH d’Aix-en-Provence, Aix-en-Provence, France
| | - Jeremy Bourenne
- Aix-Marseille Université, Service de Réanimation des Urgences, CHU La Timone 2, Marseille, France
| | | | - Guillaume Schurtz
- Department of Cardiology, Urgences et Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, Lille, France
| | - Brahim Harbaoui
- Cardiology Department, Hôpital Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France,Department of Cardiology, University of Lyon, CREATIS UMR5220, INSERM U1044, INSA-15, Lyon, France
| | - Gerald Vanzetto
- Department of Cardiology, Hôpital de Grenoble, Grenoble, France
| | - Charlotte Quentin
- Service de Réanimation Polyvalente, Centre Hospitalier Broussais, 1 Rue de la Marne, Saint-Malo, France
| | - Xavier Delabranche
- Réanimation Chirurgicale Polyvalente, Pôle Anesthésie–Réanimation Chirurgicale–Médecine Péri-opératoire, Les Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil 1, Porte de l’Hôpital, Strasbourg, France
| | - Nadia Aissaoui
- Intensive Cardiac Care Unit, Department of Cardiology, CH d’Aix-en-Provence, Aix-en-Provence, France
| | - Nicolas Combaret
- Department of Cardiology, CHU Clermont-Ferrand, CNRS, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Danka Tomasevic
- Intensive Cardiac Care Unit, Lyon Brom University Hospital, Lyon, France
| | - Benjamin Marchandot
- Université de Strasbourg, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Benoit Lattuca
- Department of Cardiology, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Patrick Henry
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Lariboisière, Department of Cardiology, Paris, France
| | - Edouard Gerbaud
- Intensive Cardiac Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, Pessac, France,Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, Hôpital Xavier Arnozan, Pessac, France
| | - Eric Bonnefoy
- Intensive Cardiac Care Unit, Lyon Brom University Hospital, Lyon, France
| | - Etienne Puymirat
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology, Paris, France,Université de Paris, Paris, France
| | - Philippe Maury
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France,Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France,Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse, France,REICATRA, Institut Saint Jacques, CHU de Toulouse, Toulouse, France,*Correspondence: Clément Delmas, ,
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Goninet M, Bourdin J, Kochly F, Tores C, Prieur C, Scheppler B, Tomasevic D, Roccia H, Mewton N, Bonnefoy-Cudraz E, Bochaton T. Prognostic factors in a contemporary cohort of cardiogenic shocks managed in ICU. Archives of Cardiovascular Diseases Supplements 2022. [DOI: 10.1016/j.acvdsp.2022.04.089] [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: 11/17/2022]
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3
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Hayek A, Azar L, Pozzi M, Grinberg D, Abou-Saleh I, Simion H, Tomasevic D, Prieur C, Kochly F, Scheppler B, Rioufol G, Derimay F, Farhat F, Obadia JF, Mewton N, Bonnefoy-Cudraz E, Bochaton T. Ventricular septal rupture: insights into an old disease. Heart Vessels 2022; 37:1305-1315. [PMID: 35133497 DOI: 10.1007/s00380-022-02031-0] [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: 10/06/2021] [Accepted: 01/21/2022] [Indexed: 11/04/2022]
Abstract
Ventricular septal rupture (VSR) is a serious complication of ST-elevation myocardial infarction (STEMI) and surgery is the reference treatment. We aimed at describing trends in management and mortality during the last four decades and reporting mortality predictors in these patients. We conducted a single-center retrospective study of patients sustaining a VSR from 1981 to 2020. We screened 274 patients and included 265 for analysis. The number of patients decreased over the years: 80, 88, 56, and 50 in each 10-year time span. In-hospital mortality decreased significantly since 1990 (logrank 0.007). The median age was 72.0 years IQR [66-78] and 188 patients (70.9%) were operated on. IABP was used more routinely (p < 0.0001). In-hospital mortality was assessed at 66.8% (177 patients) and main predictors of death were a time from MI to surgery < 8 days HR 2.7 IC95% [1.9-3.8] p < 0.0001, a Killip class > 2 HR 2.5 IC [1.9-3.4] p < 0.0001 and Euroscore 2 > 20 HR 2.4 IC [1.8-3.2] p < 0.0001. A "time from MI to surgery" of 8 days offers the best ability to discriminate between patients with or without mortality. The ability of "Euroscore 2 and Killip" to detect the patients most likely to wait 8 days for surgery was at 0.81 [0.73-0.89] p < 0.0001. Mortality remains high over the years. Euroscore 2, Killip class, and time from MI to surgery are the main mortality predictors. Patients with a Killip < 3 and a Euroscore < 20 should be monitored at least 8 days since MI before being referred to surgery.
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Affiliation(s)
- Ahmad Hayek
- Cardiac Intensive Care Unit, Hôpital Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France. .,Claude Bernard University Lyon 1, Villeurbanne, France. .,INSERM U1060, CarMeN laboratory, Université de Lyon, Groupement Hospitalier Est, Bâtiment B13, 59 boulevard Pinel, 69500, Bron, France.
| | - Léa Azar
- Cardiac Intensive Care Unit, Hôpital Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France.,Claude Bernard University Lyon 1, Villeurbanne, France
| | - Matteo Pozzi
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, 28 Avenue du Doyen Lépine, 69500, Lyon, France
| | - Daniel Grinberg
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, 28 Avenue du Doyen Lépine, 69500, Lyon, France
| | - Iyad Abou-Saleh
- Cardiac Intensive Care Unit, Hôpital Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France.,Claude Bernard University Lyon 1, Villeurbanne, France
| | - Héléna Simion
- Cardiac Intensive Care Unit, Hôpital Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France.,Claude Bernard University Lyon 1, Villeurbanne, France
| | - Danka Tomasevic
- Cardiac Intensive Care Unit, Hôpital Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France.,Claude Bernard University Lyon 1, Villeurbanne, France
| | - Cyril Prieur
- Cardiac Intensive Care Unit, Hôpital Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France.,Claude Bernard University Lyon 1, Villeurbanne, France
| | - Flora Kochly
- Cardiac Intensive Care Unit, Hôpital Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France.,Claude Bernard University Lyon 1, Villeurbanne, France
| | - Bertrand Scheppler
- Cardiac Intensive Care Unit, Hôpital Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France.,Claude Bernard University Lyon 1, Villeurbanne, France
| | - Gilles Rioufol
- Claude Bernard University Lyon 1, Villeurbanne, France.,Department of Cardiology and Interventional Cardiology, Hôpital Cardiologique Louis Pradel, Université Claude-Bernard, Inserm UMR 1060, Lyon, France
| | - François Derimay
- Claude Bernard University Lyon 1, Villeurbanne, France.,Department of Cardiology and Interventional Cardiology, Hôpital Cardiologique Louis Pradel, Université Claude-Bernard, Inserm UMR 1060, Lyon, France
| | - Fadi Farhat
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, 28 Avenue du Doyen Lépine, 69500, Lyon, France
| | - Jean-François Obadia
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, 28 Avenue du Doyen Lépine, 69500, Lyon, France
| | - Nathan Mewton
- Claude Bernard University Lyon 1, Villeurbanne, France.,Centre d'investigation Clinique, Hôpital Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France
| | - Eric Bonnefoy-Cudraz
- Cardiac Intensive Care Unit, Hôpital Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France.,Claude Bernard University Lyon 1, Villeurbanne, France
| | - Thomas Bochaton
- Cardiac Intensive Care Unit, Hôpital Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France.,Claude Bernard University Lyon 1, Villeurbanne, France.,INSERM U1060, CarMeN laboratory, Université de Lyon, Groupement Hospitalier Est, Bâtiment B13, 59 boulevard Pinel, 69500, Bron, France
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Delmas C, Roubille F, Lamblin N, Bonello L, Leurent G, Levy B, Elbaz M, Danchin N, Champion S, Lim P, Schneider F, Cariou A, Khachab H, Bourenne J, Seronde MF, Schurtz G, Harbaoui B, Vanzetto G, Quentin C, Delabranche X, Aissaoui N, Combaret N, Manzo-Silberman S, Tomasevic D, Marchandot B, Lattuca B, Henry P, Gerbaud E, Bonnefoy E, Puymirat E. Baseline characteristics, management, and predictors of early mortality in cardiogenic shock: insights from the FRENSHOCK registry. ESC Heart Fail 2021; 9:408-419. [PMID: 34973047 PMCID: PMC8788015 DOI: 10.1002/ehf2.13734] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 10/15/2021] [Accepted: 11/11/2021] [Indexed: 11/26/2022] Open
Abstract
Aims Published data on cardiogenic shock (CS) are scarce and are mostly focused on small registries of selected populations. The aim of this study was to examine the current CS picture and define the independent correlates of 30 day mortality in a large non‐selected cohort. Methods and results FRENSHOCK is a prospective multicentre observational survey conducted in metropolitan French intensive care units and intensive cardiac care units between April and October 2016. There were 772 patients enrolled (mean age 65.7 ± 14.9 years; 71.5% male). Of these patients, 280 (36.3%) had ischaemic CS. Organ replacement therapies (respiratory support, circulatory support or renal replacement therapy) were used in 58.3% of patients. Mortality at 30 days was 26.0% in the overall population (16.7% to 48.0% depending on the main cause and first place of admission). Multivariate analysis showed that six independent factors were associated with a higher 30 day mortality: age [per year, odds ratio (OR) 1.06, 95% confidence interval (CI): 1.04–1.08], diuretics (OR 1.74, 95% CI: 1.05–2.88), circulatory support (OR 1.92, 95% CI: 1.12–3.29), left ventricular ejection fraction <30% (OR 2.15, 95% CI: 1.40–3.29), norepinephrine (OR 2.55, 95% CI: 1.69–3.84), and renal replacement therapy (OR 2.72, 95% CI: 1.65–4‐49). Conclusions Non‐ischaemic CS accounted for more than 60% of all cases of CS. CS is still associated with significant but variable short‐term mortality according to the cause and first place of admission, despite frequent use of haemodynamic support, and organ replacement therapies.
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Affiliation(s)
- Clement Delmas
- Intensive Cardiac Care Unit, Rangueil University Hospital/Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), 1 Avenue Jean Poulhes, Toulouse, 31059, France
| | - François Roubille
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Cardiology Department, CHU de Montpellier, Montpellier, France
| | - Nicolas Lamblin
- Urgences et Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, Lille, France
| | - Laurent Bonello
- Aix-Marseille Université; Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
| | - Guillaume Leurent
- Department of Cardiology, CHU Rennes, Inserm, LTSI-UMR 1099, Univ Rennes 1, Rennes, France
| | - Bruno Levy
- Réanimation Médicale Brabois, CHRU Nancy, Nancy, France
| | - Meyer Elbaz
- Intensive Cardiac Care Unit, Rangueil University Hospital/Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), 1 Avenue Jean Poulhes, Toulouse, 31059, France
| | - Nicolas Danchin
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology, Université de Paris, Paris, France
| | | | - Pascal Lim
- Univ Paris Est Créteil, INSERM, IMRB; AP-HP, Hôpital Universitaire Henri-Mondor, Service de Cardiologie, Créteil, France
| | - Francis Schneider
- Médecine Intensive-Réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Centre-Université de Paris, Medical School, Paris, France
| | - Hadi Khachab
- Intensive Cardiac Care Unit, Department of Cardiology, CH d'Aix en Provence, Aix-en-Provence, France
| | - Jeremy Bourenne
- Aix Marseille Université, Service de Réanimation des Urgences, CHU La Timone 2, Marseille, France
| | | | - Guillaume Schurtz
- Urgences et Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, Lille, France
| | - Brahim Harbaoui
- Cardiology Department, Hôpital Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France, University of Lyon, CREATIS UMR5220; INSERM U1044; INSA-15, Lyon, France
| | - Gerald Vanzetto
- Department of Cardiology, Hôpital de Grenoble, Grenoble, France
| | - Charlotte Quentin
- Service de Reanimation Polyvalente, Centre Hospitalier Broussais St Malo, Saint-Malo, France
| | - Xavier Delabranche
- Réanimation Chirurgicale Polyvalente, Pôle Anesthésie-Réanimation chirurgicale-Médecine Péri-opératoire, Les Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil 1, Porte de l'Hôpital, Strasbourg, France
| | - Nadia Aissaoui
- Médecine Intensive Réanimation, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France
| | - Nicolas Combaret
- Department of Cardiology, CHU Clermont-Ferrand, CNRS, Université Clermont Auvergne, Clermont-Ferrand, France
| | | | - Danka Tomasevic
- Intensive Cardiac Care Unit, Lyon Brom University Hospital, Lyon, France
| | - Benjamin Marchandot
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Benoit Lattuca
- Department of Cardiology, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Patrick Henry
- Department of Cardiology, Université de Paris, Hôpital Lariboisière, AP-HP, Paris, France
| | - Edouard Gerbaud
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, Hôpital Xavier Arnozan, Pessac, France
| | - Eric Bonnefoy
- Intensive Cardiac Care Unit, Lyon Brom University Hospital, Lyon, France
| | - Etienne Puymirat
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology, Université de Paris, Paris, France
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Paccalet A, Crola Da Silva C, Mechtouff L, Amaz C, Varillon Y, de Bourguignon C, Cartier R, Prieur C, Tomasevic D, Genot N, Leboube S, Derimay F, Rioufol G, Bonnefoy-Cudraz E, Mewton N, Ovize M, Bidaux G, Bochaton T. Serum Soluble Tumor Necrosis Factor Receptors 1 and 2 Are Early Prognosis Markers After ST-Segment Elevation Myocardial Infarction. Front Pharmacol 2021; 12:656928. [PMID: 34539391 PMCID: PMC8440863 DOI: 10.3389/fphar.2021.656928] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 07/31/2021] [Indexed: 11/30/2022] Open
Abstract
Background: As inflammation following ST-segment elevation myocardial infarction (STEMI) is both beneficial and deleterious, there is a need to find new biomarkers of STEMI severity. Objective: We hypothesized that the circulating concentration of the soluble tumor necrosis factor α receptors 1 and 2 (sTNFR1 and sTNFR2) might predict clinical outcomes in STEMI patients. Methods: We enrolled into a prospective cohort 251 consecutive STEMI patients referred to our hospital for percutaneous coronary intervention revascularization. Blood samples were collected at five time points: admission and 4, 24, 48 h, and 1 month after admission to assess sTNFR1 and sTNFR2 serum concentrations. Patients underwent cardiac magnetic resonance imaging at 1 month. Results: sTNFR1 concentration increased at 24 h with a median of 580.5 pg/ml [95% confidence interval (CI): 534.4–645.6]. sTNFR2 increased at 48 h with a median of 2,244.0 pg/ml [95% CI: 2090.0–2,399.0]. Both sTNFR1 and sTNFR2 peak levels were correlated with infarct size and left ventricular end-diastolic volume and inversely correlated with left ventricular ejection fraction. Patients with sTNFR1 or sTNFR2 concentration above the median value were more likely to experience an adverse clinical event within 24 months after STEMI [hazards ratio (HR): 8.8, 95% CI: 4.2–18.6, p < 0.0001 for sTNFR1; HR: 6.1, 95% CI: 2.5 –10.5, p = 0.0003 for sTNFR2]. Soluble TNFR1 was an independent predictor of major adverse cardiovascular events and was more powerful than troponin I (p = 0.04 as compared to the troponin AUC). Conclusion: The circulating sTNFR1 and sTNFR2 are inflammatory markers of morphological and functional injury after STEMI. sTNFR1 appears as an early independent predictor of clinical outcomes in STEMI patients.
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Affiliation(s)
- Alexandre Paccalet
- INSERM U1060, CarMeN Laboratory, Groupement Hospitalier Est, Université de Lyon, Bron, France
| | - Claire Crola Da Silva
- INSERM U1060, CarMeN Laboratory, Groupement Hospitalier Est, Université de Lyon, Bron, France
| | - Laura Mechtouff
- Stroke Department, Hôpital Wertheimer, Hospices Civils de Lyon, Bron, France
| | - Camille Amaz
- Centre D'investigation Clinique de Lyon, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France
| | - Yvonne Varillon
- Centre D'investigation Clinique de Lyon, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France
| | - Charles de Bourguignon
- Centre D'investigation Clinique de Lyon, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France
| | - Regine Cartier
- Centre de Biologie Est, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - Cyril Prieur
- Unité de Soins Intensifs Cardiologiques, Hôpital Louis Pradel et Université Claude Bernard, Hospices Civils de Lyon, Bron, France
| | - Danka Tomasevic
- Unité de Soins Intensifs Cardiologiques, Hôpital Louis Pradel et Université Claude Bernard, Hospices Civils de Lyon, Bron, France
| | - Nathalie Genot
- Unité de Soins Intensifs Cardiologiques, Hôpital Louis Pradel et Université Claude Bernard, Hospices Civils de Lyon, Bron, France
| | - Simon Leboube
- INSERM U1060, CarMeN Laboratory, Groupement Hospitalier Est, Université de Lyon, Bron, France
| | - François Derimay
- Department of Interventional Cardiology, Cardiovascular Hospital and Claude-Bernard University, Bron, France
| | - Gilles Rioufol
- Department of Interventional Cardiology, Cardiovascular Hospital and Claude-Bernard University, Bron, France
| | - Eric Bonnefoy-Cudraz
- Unité de Soins Intensifs Cardiologiques, Hôpital Louis Pradel et Université Claude Bernard, Hospices Civils de Lyon, Bron, France
| | - Nathan Mewton
- INSERM U1060, CarMeN Laboratory, Groupement Hospitalier Est, Université de Lyon, Bron, France.,Centre D'investigation Clinique de Lyon, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France
| | - Michel Ovize
- INSERM U1060, CarMeN Laboratory, Groupement Hospitalier Est, Université de Lyon, Bron, France.,Centre D'investigation Clinique de Lyon, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France.,Service D'explorations Fonctionnelles Cardiovasculaires, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France
| | - Gabriel Bidaux
- INSERM U1060, CarMeN Laboratory, Groupement Hospitalier Est, Université de Lyon, Bron, France
| | - Thomas Bochaton
- INSERM U1060, CarMeN Laboratory, Groupement Hospitalier Est, Université de Lyon, Bron, France.,Unité de Soins Intensifs Cardiologiques, Hôpital Louis Pradel et Université Claude Bernard, Hospices Civils de Lyon, Bron, France
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Si-Mohamed SA, Restier LM, Branchu A, Boccalini S, Congi A, Ziegler A, Tomasevic D, Bochaton T, Boussel L, Douek PC. Diagnostic Performance of Extracellular Volume Quantified by Dual-Layer Dual-Energy CT for Detection of Acute Myocarditis. J Clin Med 2021; 10:jcm10153286. [PMID: 34362070 PMCID: PMC8348100 DOI: 10.3390/jcm10153286] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/17/2021] [Accepted: 07/19/2021] [Indexed: 02/07/2023] Open
Abstract
Background: Myocardial extracellular volume (ECV) is a marker of the myocarditis inflammation burden and can be used for acute myocarditis diagnosis. Dual-energy computed tomography (DECT) enables its quantification with high concordance with cardiac magnetic resonance (CMR). Purpose: To investigate the diagnostic performance of myocardial ECV quantified on a cardiac dual-layer DECT in a population of patients with suspected myocarditis, in comparison to CMR. Methods: 78 patients were included in this retrospective monocenter study, 60 were diagnosed with acute myocarditis and 18 patients were considered as a control population, based on the 2009 Lake and Louise criteria. All subjects underwent a cardiac DECT in acute phase consisted in an arterial phase followed by a late iodine enhancement phase at 10 min after injection (1.2 mL/kg, iodinated contrast agent). ECV was calculated using the hematocrit level measured the day of DECT examinations. Non-parametric analyses have been used to test the differences between groups and the correlations between the variables. A ROC curve has been used to identify the optimal ECV cut-off discriminating value allowing the detection of acute myocarditis cases. A p value < 0.05 has been considered as significant. Results: The mean ECV was significantly higher (p < 0.001) for the myocarditis group compared to the control (34.18 ± 0.43 vs. 30.04 ± 0.53%). A cut-off value of ECV = 31.60% (ROC AUC = 0.835, p < 0.001) allows to discriminate the myocarditis with a sensitivity of 80% and a specificity of 78% (positive predictive value = 92.3%, negative predictive value = 53.8% and accuracy = 79.5%). Conclusion: Myocardial ECV enabled by DECT allows to diagnose the acute myocarditis with a cut-off at 31.60% for a sensitivity of 80% and specificity of 78%.
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Affiliation(s)
- Salim Aymeric Si-Mohamed
- Department of INSA-Lyon, University of Lyon, University Claude-Bernard Lyon 1, UJM-Saint-Étienne, CNRS, Inserm, CREATIS UMR 5220, U1206, 69621 Lyon, France; (S.B.); (L.B.); (P.C.D.)
- Cardiovascular and Thoracic Radiology Department, Hospices Civils de Lyon, 69500 Lyon, France; (A.B.); (A.Z.)
- Correspondence: ; Tel.: +33-04-7235-7335; Fax: +33-04-7235-7291
| | - Lauria Marie Restier
- Rockfeller Faculty of Medicine, Lyon Est, University Claude-Bernard Lyon 1, 69003 Lyon, France; (L.M.R.); (A.C.)
| | - Arthur Branchu
- Cardiovascular and Thoracic Radiology Department, Hospices Civils de Lyon, 69500 Lyon, France; (A.B.); (A.Z.)
| | - Sara Boccalini
- Department of INSA-Lyon, University of Lyon, University Claude-Bernard Lyon 1, UJM-Saint-Étienne, CNRS, Inserm, CREATIS UMR 5220, U1206, 69621 Lyon, France; (S.B.); (L.B.); (P.C.D.)
- Cardiovascular and Thoracic Radiology Department, Hospices Civils de Lyon, 69500 Lyon, France; (A.B.); (A.Z.)
| | - Anaelle Congi
- Rockfeller Faculty of Medicine, Lyon Est, University Claude-Bernard Lyon 1, 69003 Lyon, France; (L.M.R.); (A.C.)
| | - Arthur Ziegler
- Cardiovascular and Thoracic Radiology Department, Hospices Civils de Lyon, 69500 Lyon, France; (A.B.); (A.Z.)
| | - Danka Tomasevic
- Department of Cardiology, Louis Pradel Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France; (D.T.); (T.B.)
| | - Thomas Bochaton
- Department of Cardiology, Louis Pradel Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France; (D.T.); (T.B.)
| | - Loic Boussel
- Department of INSA-Lyon, University of Lyon, University Claude-Bernard Lyon 1, UJM-Saint-Étienne, CNRS, Inserm, CREATIS UMR 5220, U1206, 69621 Lyon, France; (S.B.); (L.B.); (P.C.D.)
- Cardiovascular and Thoracic Radiology Department, Hospices Civils de Lyon, 69500 Lyon, France; (A.B.); (A.Z.)
| | - Philippe Charles Douek
- Department of INSA-Lyon, University of Lyon, University Claude-Bernard Lyon 1, UJM-Saint-Étienne, CNRS, Inserm, CREATIS UMR 5220, U1206, 69621 Lyon, France; (S.B.); (L.B.); (P.C.D.)
- Cardiovascular and Thoracic Radiology Department, Hospices Civils de Lyon, 69500 Lyon, France; (A.B.); (A.Z.)
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7
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Hayek A, Paccalet A, Mechtouff L, Da Silva CC, Ivanes F, Falque H, Leboube S, Varillon Y, Amaz C, de Bourguignon C, Prieur C, Tomasevic D, Genot N, Derimay F, Bonnefoy‐Cudraz E, Bidaux G, Mewton N, Ovize M, Bochaton T. Kinetics and prognostic value of soluble VCAM-1 in ST-segment elevation myocardial infarction patients. Immun Inflamm Dis 2021; 9:493-501. [PMID: 33559404 PMCID: PMC8127550 DOI: 10.1002/iid3.409] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/18/2021] [Accepted: 01/21/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Soluble vascular cell adhesion molecule-1 (sVCAM-1) is a biomarker of endothelial activation and inflammation. There is still controversy as to whether it can predict clinical outcome after ST-elevation myocardial infarction (STEMI). Our aim was to assess the sVCAM-1 kinetics and to evaluate its prognostic predictive value. METHOD We prospectively enrolled 251 consecutive STEMI patients who underwent coronary revascularization in our university hospital. Blood samples were collected at admission, 4, 24, 48 h and 1 month after admission. sVCAM-1 serum level was assessed using ELISA assay. All patients had cardiac magnetic resonance imaging at 1-month for infarct size (IS) and left ventricular ejection fraction (LVEF) assessment. Clinical outcomes were recorded over 12 months after STEMI. RESULTS sVCAM-1 levels significantly increased from admission up to 1 month and were significantly correlated with IS, LVEF, and LV end-systolic and diastolic volume. (H48 area under curve (AUC) ≥ H48 median) were associated with an increased risk of adverse clinical events during the 12-month follow-up period with a hazard ratio (HR) = 2.6 (95% confidence interval [CI] of ratio = 1.2-5.6, p = .02). The ability of H48 AUC for sVCAM-1 to discriminate between patients with or without the composite endpoint was evaluated using receiver operating characteristics with an AUC at 0.67 (0.57-0.78, p = .004). This ability was significantly superior to H48 AUC creatine kinase (p = .03). CONCLUSIONS In STEMI patients, high sVCAM-1 levels are associated with a poor clinical outcome. sVCAM-1 is an early postmyocardial infarction biomarker and might be an interesting target for the development of future therapeutic strategies.
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Affiliation(s)
- Ahmad Hayek
- Intensive Cardiological Care Division, Louis Pradel HospitalHospices Civils de LyonBronFrance
| | - Alexandre Paccalet
- INSERM U1060, CarMeN LaboratoryUniversity of Lyon, Groupement Hospitalier EstBronFrance
| | - Laura Mechtouff
- Department of Neurology and Stroke Center, Hospices Civils de LyonLyon UniversityLyonFrance
| | - Claire C. Da Silva
- Intensive Cardiological Care Division, Louis Pradel HospitalHospices Civils de LyonBronFrance
| | - Fabrice Ivanes
- Faculty of Medicine, Loire Valley Cardiovascular CollaborationUniversity of ToursToursFrance
- Department of Cardiology and FACTCHRU de ToursToursFrance
| | - Hadrien Falque
- Department of Cardiology, Louis Pradel HospitalHospices Civils de LyonBronFrance
| | - Simon Leboube
- Intensive Cardiological Care Division, Louis Pradel HospitalHospices Civils de LyonBronFrance
| | - Yvonne Varillon
- Clinical Investigation Center and Heart Failure Department, Louis Pradel HospitalHospices Civils de LyonBronFrance
| | - Camille Amaz
- Clinical Investigation Center and Heart Failure Department, Louis Pradel HospitalHospices Civils de LyonBronFrance
| | - Charles de Bourguignon
- Clinical Investigation Center and Heart Failure Department, Louis Pradel HospitalHospices Civils de LyonBronFrance
| | - Cyril Prieur
- Intensive Cardiological Care Division, Louis Pradel HospitalHospices Civils de LyonBronFrance
| | - Danka Tomasevic
- Intensive Cardiological Care Division, Louis Pradel HospitalHospices Civils de LyonBronFrance
| | - Nathalie Genot
- Intensive Cardiological Care Division, Louis Pradel HospitalHospices Civils de LyonBronFrance
| | - François Derimay
- Department of Cardiology, Louis Pradel HospitalHospices Civils de LyonBronFrance
| | - Eric Bonnefoy‐Cudraz
- Intensive Cardiological Care Division, Louis Pradel HospitalHospices Civils de LyonBronFrance
| | - Gabriel Bidaux
- INSERM U1060, CarMeN LaboratoryUniversity of Lyon, Groupement Hospitalier EstBronFrance
| | - Nathan Mewton
- Clinical Investigation Center and Heart Failure Department, Louis Pradel HospitalHospices Civils de LyonBronFrance
| | - Michel Ovize
- INSERM U1060, CarMeN LaboratoryUniversity of Lyon, Groupement Hospitalier EstBronFrance
- Clinical Investigation Center and Heart Failure Department, Louis Pradel HospitalHospices Civils de LyonBronFrance
- Department of Cardiovascular Functional Exploration, Louis Pradel HospitalHospices Civils de LyonBronFrance
| | - Thomas Bochaton
- Intensive Cardiological Care Division, Louis Pradel HospitalHospices Civils de LyonBronFrance
- INSERM U1060, CarMeN LaboratoryUniversity of Lyon, Groupement Hospitalier EstBronFrance
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8
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Si-Mohamed SA, Congi A, Ziegler A, Tomasevic D, Tatard-Leitman V, Broussaud T, Boccalini S, Bensalah M, Rouvière AS, Bonnefoy-Cudraz E, Bochaton T, Boussel L, Douek PC. Early Prediction of Cardiac Complications in Acute Myocarditis by Means of Extracellular Volume Quantification With the Use of Dual-Energy Computed Tomography. JACC Cardiovasc Imaging 2021; 14:2041-2042. [PMID: 34023266 DOI: 10.1016/j.jcmg.2021.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/22/2021] [Accepted: 04/08/2021] [Indexed: 01/12/2023]
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9
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Leboube S, Bochaton T, Paccalet A, Crola Da Silva C, Jeantet P, Amaz C, De Bourguignon C, Varillon Y, Prieur C, Tomasevic D, Genot N, Rioufol G, Bonnefoy-Cudraz E, Mewton N, Ovize M. IL-10 / IL-6 serum ratio as a prognosis marker of STEMI. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1686] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
IL-6 and IL-10 are two major cytokines secreted at the acute phase of myocardial infarction (MI). IL-6 has a pro-inflammatory effect whereas IL-10 has anti-inflammatory effect.
Objective
Our objective was to assess the prognosis value of IL-6, IL-10 and IL-10/IL-6 ratio serum level at the acute phase of ST elevation MI (STEMI).
Methods
We prospectively enrolled 247 patients admitted for acute STEMI from 2016 to 2019. Blood samples were collected at 5 time points: admission, 4, 24, 48 hours and 1 month (H4, H24, H48, M1). IL-6 and IL-10 were assessed using ELISA. Patients underwent cardiac magnetic resonance imaging at one month for infarct size (IS) and left ventricular ejection fraction (LVEF) assessment. Clinical outcomes were prospectively recorded over 18 months.
Results
Patient mean age was 59±12 years. IL-6 reached a peak at H24 at 5.4 pg/mL interquartile range (IQR) [2.1–11.0] and IL-10 peaked as early as admission at 5.6 pg/mL IQR [8.7–29.3] followed by a decrease within the first month. Median IL-10/IL-6 ratio at admission was 4.2 [1.4–8.6] with a strong decrease at H24 (0.5 [0.2–1.3]). IL-6 and IL-10 levels at H24 were correlated with IS (respectively r=0.44, p<0.0001, and r=0.29, p=0.0001) and inversely correlated with LVEF (respectively r=−0.42, p<0.0001 and r=−0.26, p=0.0003). Patients with IL-10/IL-6 ratio ≥1 had smaller IS compared to patients with IL-10/IL-6 ratio <1 (respectively 9.0% IQR [2.4–15.4] of LV versus 17% IQR [8.7–29.3] of LV, p<0.0001) and they had higher LVEF (58.0% IQR [52.0–62.3] versus 49.0% IQR [41.5–56.0], p<0.0001). Patients with IL-10/IL-6 ratio <1 were more likely to have an adverse clinical event (MI, stroke, hospitalization for heart failure and all-cause death) during the first 18 months after STEMI compared to patients with IL-10/IL-6 ratio ≥1 (HR=2.7, 95% CI [1.2–5.5], p=0.04).
Conclusion
Serum IL-10/IL-6 >1 was associated with a poor outcome after STEMI and might be a valuable prognostic marker.
Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Hospices Civils de Lyon, Fédération Française de Cardiologie
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Affiliation(s)
- S Leboube
- Research Laboratory CarMEN of Lyon, Lyon, France
| | - T Bochaton
- Research Laboratory CarMEN of Lyon, Lyon, France
| | - A Paccalet
- Research Laboratory CarMEN of Lyon, Lyon, France
| | | | - P Jeantet
- Hospital Louis Pradel of Bron, Lyon, France
| | - C Amaz
- Hospital Louis Pradel of Bron, Lyon, France
| | | | - Y Varillon
- Hospital Louis Pradel of Bron, Lyon, France
| | - C Prieur
- Hospital Louis Pradel of Bron, Lyon, France
| | | | - N Genot
- Hospital Louis Pradel of Bron, Lyon, France
| | - G Rioufol
- Hospital Louis Pradel of Bron, Lyon, France
| | | | - N Mewton
- Hospital Louis Pradel of Bron, Lyon, France
| | - M Ovize
- Research Laboratory CarMEN of Lyon, Lyon, France
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10
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Leboube S, Bochaton T, Paccalet A, Crola Da Silva C, Jeantet P, Amaz C, De Bourguignon C, Varillon Y, Prieur C, Tomasevic D, Genot N, Rioufol G, Bonnefoy-Cudraz E, Mewton N, Ovize M. IL-10/IL-6 serum ratio as a prognosis marker of STEMI. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2020.03.082] [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: 11/15/2022]
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11
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Charbonnieras F, Bochaton T, Paccalet A, Jeantet P, Crola Da Silva C, Amaz C, De Bourguignon C, Prieur C, Tomasevic D, Genot N, Rioufol G, Bonnefoy-Cudraz E, Mewton N, Ovize M. Basophil count as a prognosis biomarker after STEMI. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2020.03.068] [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: 10/23/2022]
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12
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Bochaton T, Bernelin H, Paccalet A, Crola Da Silva C, Baetz D, Genot N, Prieur C, Tomasevic D, Jossan C, Amaz C, Dufay N, Rioufol G, Bonnefoy-Cudraz E, Mewton N, Ovize M. P1681Daytime variation of infarct size in STEMI patients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1681] [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)
- T Bochaton
- Hospital Louis Pradel of Bron, Lyon, France
| | - H Bernelin
- Hospital Louis Pradel of Bron, Lyon, France
| | - A Paccalet
- Research Laboratory CarMEN of Lyon, Lyon, France
| | | | - D Baetz
- Research Laboratory CarMEN of Lyon, Lyon, France
| | - N Genot
- Hospital Louis Pradel of Bron, Lyon, France
| | - C Prieur
- Hospital Louis Pradel of Bron, Lyon, France
| | | | - C Jossan
- Civils Hospices of Lyon, Centre d'Investigation Clinique, Lyon, France
| | - C Amaz
- Civils Hospices of Lyon, Centre d'Investigation Clinique, Lyon, France
| | - N Dufay
- Civils Hospices of Lyon, Centre de Ressources Biologiques, Lyon, France
| | - G Rioufol
- Hospital Louis Pradel of Bron, Lyon, France
| | | | - N Mewton
- Hospital Louis Pradel of Bron, Lyon, France
| | - M Ovize
- Hospital Louis Pradel of Bron, Lyon, France
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13
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Tomasevic D, El Khoury C, Subtil F, Dubien PY, Bochaton T, Serre P, Gueugniaud PY, Bonnefoy-Cudraz E, Mewton N. Effect of Optimal Medical Therapy at Discharge in Patients With Reperfused ST-Segment Elevation Myocardial Infarction on 1-Year Mortality (from the Regional RESCUe Registry). Am J Cardiol 2018; 121:403-409. [PMID: 29290368 DOI: 10.1016/j.amjcard.2017.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/07/2017] [Accepted: 11/13/2017] [Indexed: 10/18/2022]
Abstract
Several classes of medication improve survival in patients with ST-segment elevation myocardial infarction (STEMI). We sought to assess the frequency and effect of an optimal therapy upon discharge according to current international guidelines on 1-year all-cause mortality in a prospective cohort of reperfused patients with STEMI. Using data from the French Reseau Cardiologie Urgence (RESCUe) Network, we studied all patients with STEMI admitted and discharged alive from hospital between 2009 and 2013. Class I and II level guidelines were used to define the optimal therapy (OT) group. The undertreatment (UT) group comprised patients in whom at least 1 drug with a class I recommendation was missing. Multivariable Cox regression analysis with propensity score for the prescription of OT was used. Of the 5,161 patients discharged alive, 2,991 (58%) had OT. The 1-year overall survival rate was 0.99 in the OT group (95% confidence interval [CI] 0.99 to 1.00) versus 0.90 (95% CI 0.88 to 0.92) in the UT group. Patient characteristics in the UT group were worse than those in the OT group. After multivariable adjustment, the association between the OT group and mortality remained significant, with a hazard ratio of 0.12 (95% CI 0.07 to 0.22; p<0.001). Optimal secondary prevention therapy in patients with STEMI discharged alive from hospital remains independently associated with lower 1-year mortality.
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14
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Tomasevic D. 0048 : Adherence to guidelines for secondary prevention in patients with ST-segment elevation myocardial infarction: effect on 1-year mortality. Archives of Cardiovascular Diseases Supplements 2016. [DOI: 10.1016/s1878-6480(16)30358-5] [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: 10/21/2022]
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15
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El Khoury C, Bochaton T, Flocard E, Serre P, Tomasevic D, Mewton N, Bonnefoy-Cudraz E. Five-year evolution of reperfusion strategies and early mortality in patients with ST-segment elevation myocardial infarction in France. Eur Heart J Acute Cardiovasc Care 2015; 6:573-582. [PMID: 26680780 DOI: 10.1177/2048872615623065] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To assess 5-year evolutions in reperfusion strategies and early mortality in patients with ST-segment elevation myocardial infarction. METHODS AND RESULTS Using data from the French RESCUe network, we studied patients with ST-segment elevation myocardial infarction treated in mobile intensive care units between 2009 and 2013. Among 2418 patients (median age 62 years; 78.5% male), 2119 (87.6%) underwent primary percutaneous coronary intervention and 299 (12.4%) pre-hospital thrombolysis (94.0% of whom went on to undergo percutaneous coronary intervention). Use of primary percutaneous coronary intervention increased from 78.4% in 2009 to 95.9% in 2013 ( Ptrend<0.001). Median delays included: first medical contact to percutaneous coronary intervention centre 48 minutes; first medical contact to balloon inflation 94 minutes; and percutaneous coronary intervention centre to balloon inflation 43 minutes. Times from symptom onset to first medical contact and first medical contact to thrombolysis remained stable during 2009-2013, but times from symptom onset to first balloon inflation, and first medical contact to percutaneous coronary intervention centre to first balloon inflation decreased ( P<0.001). Among patients with known timings, 2146 (89.2%) had a first medical contact to percutaneous coronary intervention centre delay ⩽90 minutes, while 260 (10.8%) had a longer delay, with no significant variation over time. Primary percutaneous coronary intervention use increased over time in both delay groups, but was consistently higher in the ⩽90 versus >90 minutes delay group (83.0% in 2009 to 97.7% in 2013; Ptrend<0.001 versus 34.1% in 2009 to 79.2% in 2013; Ptrend<0.001). In-hospital (4-6%) and 30-day (6-8%) mortalities remained stable from 2009 to 2013. CONCLUSION In the RESCUe network, the use of primary percutaneous coronary intervention increased from 2009 to 2013, in line with guidelines, but there was no evolution in early mortality.
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Affiliation(s)
- Carlos El Khoury
- 1 Emergency Department and RESCUe Network, Lucien Hussel Hospital, France
| | | | | | - Patrice Serre
- 4 Emergency Department and RESCUe Network, Fleyriat Hospital, France
| | | | - Nathan Mewton
- 5 Centre d'Investigation Clinique (CIC) de Lyon, Louis Pradel Hospital, France
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16
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Mewton N, Subtil F, Mahé J, Tomasevic D, Zouaghi O, De Breyne B, Ovize M, Bonnefoy-Cudraz E. 0447 : Optimal therapeutic management improves long-term survival in ST-elevation myocardial infarction patients with altered glomerular filtration rate. A propensity score comparison. Archives of Cardiovascular Diseases Supplements 2015. [DOI: 10.1016/s1878-6480(15)30072-0] [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: 11/25/2022]
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17
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Dutertre M, Tomasevic D, Guillermin Y, Durupt S, Grange C, Debarbieux S, Martin E, Durieu I. Gonococcemia mimicking a lupus flare in a young woman. Lupus 2013; 23:81-3. [DOI: 10.1177/0961203313507989] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Gonorrhea is a common sexually transmitted infection, which can present as the ‘arthritis-dermatitis syndrome’. Patients with systemic lupus erythematosus often develop disseminated neisserial infections, because of inherited and acquired complement deficiencies. Neisserial infection, and particularly gonococcemia, can mimic a lupus flare. We report one case of gonococcemia presenting as acral papulo-vesiculous lesions of the digits in a young woman with lupus.
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Affiliation(s)
- M Dutertre
- Department of Internal Medicine, Centre Hospitalier Lyon Sud, Pierre Benite, France
| | - D Tomasevic
- Department of Internal Medicine, Centre Hospitalier Lyon Sud, Pierre Benite, France
| | - Y Guillermin
- Department of Internal Medicine, Centre Hospitalier Lyon Sud, Pierre Benite, France
| | - S Durupt
- Department of Internal Medicine, Centre Hospitalier Lyon Sud, Pierre Benite, France
| | - C Grange
- Department of Internal Medicine, Centre Hospitalier Lyon Sud, Pierre Benite, France
| | - S Debarbieux
- Department of Dermatology, Centre Hospitalier Lyon Sud, Pierre Benite, France
| | - E Martin
- Laboratory of Microbiology, Centre Hospitalier Lyon Sud, Pierre Benite, France
| | - I Durieu
- Department of Internal Medicine, Centre Hospitalier Lyon Sud, Pierre Benite, France
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