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Durand E, Beziau-Gasnier D, Michel M, Iung B, Tchetche D, Bonnet G, Lhermusier T, Gilard M, Souteyrand G, Bouleti C, Ohlmann P, Lefevre T, Beygui F, Chassaing S, Chevreul K, Eltchaninoff H. Reducing length of stay after transfemoral transcatheter aortic valve implantation: the FAST-TAVI II trial. Eur Heart J 2024; 45:952-962. [PMID: 38437633 DOI: 10.1093/eurheartj/ehae081] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 11/22/2023] [Accepted: 01/29/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND AND AIMS The length of stay (LOS) after transcatheter aortic valve implantation (TAVI) remains extremely variable whereas early discharge has been shown to be feasible and safe. The study objective was to evaluate the efficacy and safety of an intervention aimed at reducing LOS after transfemoral TAVI. METHODS FAST-TAVI II is a prospective, multicentre, cluster, randomized, controlled study including patients with severe symptomatic aortic stenosis, who had transfemoral TAVI. The intervention consisted in a dedicated training programme to implement 10 quality of care measures to reduce LOS with an implementation phase of eight weeks. The primary endpoint was the proportion of patients discharged early within 3 days. Secondary endpoints included: LOS, 30-day mortality and 30-day incidence of readmission for cardiovascular events. RESULTS During the study period, 969 patients were enrolled in the intervention group and 860 patients in the control group. Mean age was 81.9 ± 6.6 years and mean EuroSCORE II was 4.4 ± 4.5%. Early discharge was achieved in 563 (58.1%) patients in the intervention group vs. 364 (42.3%) patients in the control group (P < .0001). Median LOS was significantly reduced in the intervention group compared to the control group [3 (IQR: 3) vs. 4 days (IQR: 3), P < .0001]. Thirty-day mortality was low and similar in the two groups (0.5% vs. 0.9%, P = .30), as were 30-day readmissions (4.6% vs. 2.8%, P = .28). CONCLUSIONS The intervention was simple and fast to implement, and was effective and safe to reduce LOS and increase the proportion of patients discharged early after TAVI (NCT04503655).
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Affiliation(s)
- Eric Durand
- Univ Rouen Normandie, Inserm U1096, CHU Rouen, Department of Cardiology, F-76000 Rouen, France
| | - Delphine Beziau-Gasnier
- Univ Rouen Normandie, Inserm U1096, CHU Rouen, Department of Cardiology, F-76000 Rouen, France
| | - Morgane Michel
- Université Paris Cité, Paris, France
- Inserm, ECEVE, Paris, France
- Clinical Epidemiology Unit, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Bernard Iung
- Cardiology Department, Bichat-Claude-Bernard Hospital Cardiology Service, Paris, France
| | | | - Guillaume Bonnet
- Unité médico-chirurgicale des valvulopathies, CHU de Bordeaux, 33600 Pessac, France
| | | | - Martine Gilard
- Department of Cardiology, CHRU Brest, 29200 Brest, France
| | | | - Claire Bouleti
- Clinical Investigation Center (INSERM 1204), Cardiology Department, ACTION and FACT study groups, University of Poitiers, Poitiers Hospital, France
| | - Patrick Ohlmann
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Thierry Lefevre
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Générale de santé, Massy, France
| | - Farzin Beygui
- Service de Cardiologie, ACTION Study Group, Centre Hospitalier Universitaire (CHU) de Caen Normandie, Normandie Univ, INSERM UMRS 1237, GIP Cyceron, Caen, France
| | - Stephan Chassaing
- Cardiology Department, Clinique NCT+-Saint Gatien-Alliance, Tours, France
| | - Karine Chevreul
- Université Paris Cité, Paris, France
- Inserm, ECEVE, Paris, France
- Clinical Epidemiology Unit, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Hélène Eltchaninoff
- Univ Rouen Normandie, Inserm U1096, CHU Rouen, Department of Cardiology, F-76000 Rouen, France
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Beygui F, Guillemot V, Saloux E. Complex mitral para-prosthetic leak closure as a bridge to heart transplant. Eur Heart J 2024; 45:968. [PMID: 37769354 DOI: 10.1093/eurheartj/ehad602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Affiliation(s)
- Farzin Beygui
- Department of Cardiology, Caen University Hospital, Avenue de la Cote de Nacre, Caen 14000, France
- INSERM U1237, GIP CYCERON, Campus Jules Horowitz, Bd Henri Becquerel, Caen 14074, France
| | - Valentin Guillemot
- Department of Cardiology, Caen University Hospital, Avenue de la Cote de Nacre, Caen 14000, France
| | - Eric Saloux
- Department of Cardiology, Caen University Hospital, Avenue de la Cote de Nacre, Caen 14000, France
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Lattuca B, Mazeau C, Cayla G, Ducrocq G, Guedeney P, Laredo M, Dumaine R, El Kasty M, Kala P, Nejjari M, Hlinomaz O, Morel O, Varenne O, Leclercq F, Payot L, Spaulding C, Beygui F, Rangé G, Motovska Z, Portal JJ, Vicaut E, Collet JP, Montalescot G, Silvain J. Ticagrelor vs Clopidogrel for Complex Percutaneous Coronary Intervention in Chronic Coronary Syndrome. JACC Cardiovasc Interv 2024; 17:359-370. [PMID: 38355265 DOI: 10.1016/j.jcin.2023.12.011] [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: 08/23/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 02/16/2024]
Abstract
BACKGROUND Whether ticagrelor in chronic coronary syndrome patients undergoing complex percutaneous coronary intervention (PCI) can prevent cardiovascular events is unknown. OBJECTIVES The authors sought to evaluate outcomes of complex PCI and the efficacy of ticagrelor vs clopidogrel in stable patients randomized in the ALPHEUS (Assessment of Loading with the P2Y12 inhibitor ticagrelor or clopidogrel to Halt ischemic Events in patients Undergoing elective coronary Stenting) trial. METHODS All PCI procedures were blindly reviewed and classified as complex if they had at least 1 of the following criteria: stent length >60 mm, 2-stent bifurcation, left main, bypass graft, chronic total occlusion, use of atherectomy or guiding catheter extensions, multiwire technique, multiple stents. The primary endpoint was a composite of type 4a or b myocardial infarction (MI) and major myocardial injury during the 48 hours after PCI. We compared the event rates according to the presence or not of complex PCI criteria and evaluated the interaction with ticagrelor or clopidogrel. RESULTS Among the 1,866 patients randomized, 910 PCI (48.3%) were classified as complex PCI. The primary endpoint was more frequent in complex PCI (45.6% vs 26.6%; P < 0.001) driven by higher rates of type 4 MI and angiographic complications (12.2% vs 4.8 %; P < 0.001 and 19.3% vs 8.6%; P < 0.05, respectively). The composite of death, MI, and stroke at 48 hours (12.7% vs 5.1 %; P < 0.05) and at 30 days (13.4% vs 5.3%; P < 0.05) was more frequent in complex PCI. No interaction was found between PCI complexity and the randomized treatment for the primary endpoint (Pinteraction = 0.47) nor the secondary endpoints. CONCLUSIONS In chronic coronary syndrome, patients undergoing a complex PCI have higher rates of periprocedural and cardiovascular events that are not reduced by ticagrelor as compared with clopidogrel.
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Affiliation(s)
- Benoit Lattuca
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France; Cardiology Department, Nîmes University Hospital, Montpellier University, ACTION Study Group, Nîmes, France
| | - Cedric Mazeau
- Cardiology Department, Nîmes University Hospital, Montpellier University, ACTION Study Group, Nîmes, France
| | - Guillaume Cayla
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France; Cardiology Department, Nîmes University Hospital, Montpellier University, ACTION Study Group, Nîmes, France
| | - Grégory Ducrocq
- Cardiology Department, Université de Paris, Hôpital Bichat, AP-HP, French Alliance for Cardiovascular Trials (FACT), INSERM U1148, Paris, France
| | - Paul Guedeney
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Mikael Laredo
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Raphaëlle Dumaine
- Les Grands Prés Cardiac Rehabilitation Centre, Villeneuve St Denis, France
| | - Mohamad El Kasty
- Département de Cardiologie, Grand Hôpital de l'Est Francilien site Marne-La-Vallée, Marne-la-Vallée, France
| | - Petr Kala
- University Hospital Brno, Medical Faculty of Masaryk University Brno, Brno, Czech Republic
| | - Mohammed Nejjari
- Cardiology Department, Centre Cardiologique du Nord, Paris, France
| | - Ota Hlinomaz
- University Hospital Brno, Medical Faculty of Masaryk University Brno, Brno, Czech Republic
| | - Olivier Morel
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Olivier Varenne
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Florence Leclercq
- Department of Cardiology, Arnaud de Villeneuve Hospital, Montpellier University, Montpellier, France
| | - Laurent Payot
- Cardiology Department, General Hospital Yves Le Foll, Saint-Brieuc, France
| | - Christian Spaulding
- Department of Cardiology, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris Cité University, Sudden Cardiac Death Expert Center, INSERM U 971, PARCC, Paris, France
| | - Farzin Beygui
- Cardiology Department, Caen University Hospital, ACTION Study Group, Caen, France
| | - Grégoire Rangé
- Cardiology Department, Chartres Hospital, Chartres, France
| | - Zuzana Motovska
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Jean-Jacques Portal
- ACTION Study Group, Unité de Recherche Clinique, Hôpital Fernand Widal (AP-HP), EA 4543, Université Paris 1 Panthéon-Sorbonne Paris, Paris, France
| | - Eric Vicaut
- ACTION Study Group, Unité de Recherche Clinique, Hôpital Fernand Widal (AP-HP), EA 4543, Université Paris 1 Panthéon-Sorbonne Paris, Paris, France
| | - Jean-Philippe Collet
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Gilles Montalescot
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France.
| | - Johanne Silvain
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
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Hauguel-Moreau M, Guedeney P, Dauphin C, Auffret V, Marijon E, Aldebert P, Clerc JM, Beygui F, Elbaz M, Khalil WA, Da Costa A, Macia JC, Elhadad S, Cayla G, Brugier D, Silvain J, Hammoudi N, Duthoit G, Vicaut E, Montalescot G. Flecainide to prevent atrial arrhythmia after patent foramen ovale closure Rationale and design of the randomized AFLOAT study. Eur Heart J Cardiovasc Pharmacother 2024:pvad100. [PMID: 38216511 DOI: 10.1093/ehjcvp/pvad100] [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] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
INTRODUCTION Atrial arrhythmia is the most common complication of patent foramen ovale (PFO) closure. The real incidence of post-PFO closure atrial arrhytmia and whether this complication can be prevented is unknown. METHODS/DESIGN The Assessment of Flecainide to Lower the patent foramen Ovale closure risk of Atrial fibrillation or Tachycardia (AFLOAT) trial is a prospective, national, multicentre, randomized, open-label, superiority trial with a blind evaluation of all the endpoints (PROBE design). A total of 186 patients are randomized in a 1:1:1 ratio immediately after PFO closure to receive Flecainide (150 mg per day in a single sustained-release dose) for 6 months (Group 1), Flecainide (150 mg per day in a single sustained-release dose) for 3 months (Group 2), or no additional treatment (standard of care) for 6 months (Group 3). The primary endpoint is the percentage of patients with at least one episode of symptomatic or asymptomatic atrial arrhythmia episode (≥30s) recorded within 3 months after PFO closure on long-term monitoring with an insertable cardiac monitor. Whether 3 months of treatment is sufficient compared to 6 months will be analyzed as a secondary objective of the study. CONCLUSION AFLOAT is the first trial to test the hypothesis that a short treatment with oral Flecainide can prevent the new-onset of atrial arrhythmia after PFO closure. Clinical trial registration: NCT05213104 (clinicaltrials.gov).
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Affiliation(s)
- Marie Hauguel-Moreau
- Université de Versailles-Saint Quentin, INSERM U1018, CESP, ACTION Study Group, Department of Cardiology, Ambroise Paré Hospital (AP-HP), Boulogne, France
| | - Paul Guedeney
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, ICAN - Institute of CardioMetabolism and Nutrition, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Claire Dauphin
- Department of Cardiology and Cardiovascular Diseases, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Vincent Auffret
- University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, France
| | - Eloi Marijon
- Cardiology Department, European Georges Pompidou Hospital, Paris, France
| | | | - Jean-Michel Clerc
- Cardiology Department, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Farzin Beygui
- CHU de la Côte de Nacre, Département de Cardiologie, Caen, France
| | - Meyer Elbaz
- Department of Cardiology, Institute CARDIOMET, CHU-Toulouse, Toulouse, France
| | - Wissam Abi Khalil
- Institut Mitovasc, University of Angers, UMR CNRS 6015-INSERMU1083, Angers, France
| | - Antoine Da Costa
- Service de cardiologie, hôpital Nord, université Jean-Monnet, CHU de Saint-Étienne, Saint-Étienne, France
| | - Jean-Christophe Macia
- Montpellier University Hospital, UFR de Médecine, Université Montpellier 1, Department of Cardiology, 371, avenue du Doyen-Gaston-Giraud, Montpellier 5, France
| | - Simon Elhadad
- Service de Cardiologie, Centre hospitalier de Marne-la-Vallée, Jossigny, France
| | - Guillaume Cayla
- Cardiology department, Nimes university Hospital, Montpellier University, ACTION group, Nimes, France
| | - Delphine Brugier
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, ICAN - Institute of CardioMetabolism and Nutrition, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Johanne Silvain
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, ICAN - Institute of CardioMetabolism and Nutrition, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Nadjib Hammoudi
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, ICAN - Institute of CardioMetabolism and Nutrition, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Guillaume Duthoit
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, ICAN - Institute of CardioMetabolism and Nutrition, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Eric Vicaut
- ACTION Study Group, Unité de Recherche Clinique, Hopital Lariboisière, (APHP), Université Paris-Diderot Paris 7, Paris, France
| | - Gilles Montalescot
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, ICAN - Institute of CardioMetabolism and Nutrition, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
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Roule V, Beygui F, Cayla G, Rangé G, Motovska Z, Delarche N, Jourda F, Goube P, Guedeney P, Zeitouni M, El Kasty M, Laredo M, Dumaine R, Ducrocq G, Derimay F, Van Belle E, Manigold T, Cador R, Combaret N, Vicaut E, Montalescot G, Silvain J. P2Y 12 Inhibitor Loading Time Before Elective PCI and the Prevention of Myocardial Necrosis. Can J Cardiol 2024; 40:31-39. [PMID: 37660934 DOI: 10.1016/j.cjca.2023.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/21/2023] [Accepted: 08/27/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND There are dated and conflicting data about the optimal timing of initiation of P2Y12 inhibitors in elective percutaneous coronary intervention (PCI). Peri-PCI myocardial necrosis is associated with poor outcomes. We aimed to assess the impact of the P2Y12 inhibitor loading time on periprocedural myocardial necrosis in the population of the randomized Assessment of Loading With the P2Y12 Inhibitor Ticagrelor or Clopidogrel to Halt Ischemic Events in Patients Undergoing Elective Coronary Stenting (ALPHEUS) trial, which compared ticagrelor with clopidogrel in high-risk patients who received elective PCI. METHODS The ALPHEUS trial divided 1809 patients into quartiles of loading time. The ALPHEUS primary outcome was used (type 4 [a or b] myocardial infarction or major myocardial injury) as well as the main secondary outcome (type 4 [a or b] myocardial infarction or any type of myocardial injury). RESULTS Patients in the first quartile group (Q1) presented higher rates of the primary outcome (P = 0.01). When compared with Q1, incidences of the primary outcome decreased in patients with longer loading times (adjusted odds ratio [adjOR], 0.70 [0.52.-0.95]; P = 0.02 for Q2; adjOR 0.65 [0.48-0.88]; P < 0.01 for Q3; adjOR 0.66 [0.49-0.89]; P < 0.01 for Q4). Concordant results were found for the main secondary outcome. There was no interaction with the study drug allocated by randomization (clopidogrel or ticagrelor). Bleeding complications (any bleeding ranging between 4.9% and 7.3% and only 1 major bleeding at 48 hours) and clinical ischemic events were rare and did not differ among groups. CONCLUSIONS In elective PCI, administration of the oral P2Y12 inhibitor at the time of PCI could be associated with more frequent periprocedural myocardial necrosis than an earlier administration. The long-term clinical consequences remain unknown.
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Affiliation(s)
- Vincent Roule
- ACTION Study Group, Sorbonne Université, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France; Département de Cardiologie, CHU de Caen, Caen, France
| | - Farzin Beygui
- Département de Cardiologie, CHU de Caen, Caen, France
| | - Guillaume Cayla
- Cardiology Department, Nîmes University Hospital, Montpellier University, ACTION Study Group, Nîmes, France
| | - Grégoire Rangé
- Département de Cardiologie, CH de Chartres, Chartres, France
| | - Zuzana Motovska
- Cardiocentre, 3rd Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | | | | | - Pascal Goube
- Service de Cardiologie, Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France
| | - Paul Guedeney
- ACTION Study Group, Sorbonne Université, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Michel Zeitouni
- ACTION Study Group, Sorbonne Université, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Mohamad El Kasty
- Department of Cardiology, Grand Hôpital de l'Est Francilien, Jossigny, France
| | - Mikael Laredo
- ACTION Study Group, Sorbonne Université, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Raphaëlle Dumaine
- Les Grands Prés Cardiac Rehabilitation Centre, Villeneuve St Denis, France
| | - Gregory Ducrocq
- Université de Paris, AP-HP, French Alliance for Cardiovascular Trials (FACT), INSERM U1148, Paris, France
| | - François Derimay
- Service de Cardiologie Interventionnelle, Hospices Civils de Lyon and CARMEN INSERM 1060, Lyon, France
| | - Eric Van Belle
- CHU Lille, Institut Cœur Poumon, Cardiology, and Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, INSERM U1011, Institut Pasteur de Lille, EGID, Université de Lille, Lille, France
| | | | - Romain Cador
- Department of Cardiology Saint Joseph Hospital, Paris, France
| | - Nicolas Combaret
- Department of Cardiology, Clermont-Ferrand University Hospital, CNRS, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Eric Vicaut
- Unité de Recherche Clinique, ACTION Study Group, Hôpital Fernand Widal (AP-HP), Paris, France and SAMM (Statistique, Analyse et Modélisation Multidisciplinaire) EA 4543, Université Paris 1 Panthéon, Sorbonne, France
| | - Gilles Montalescot
- ACTION Study Group, Sorbonne Université, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France. http://www.action-cœur.org
| | - Johanne Silvain
- ACTION Study Group, Sorbonne Université, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
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Landolff Q, Quillot M, Picard F, Henry P, Sideris G, Bizeau O, Piot C, Jouve B, Rischner J, Mejri M, Charmasson C, Lasserre R, Pouliquen H, Joseph T, Monsegu J, Karsenty B, Martin Yuste V, Richet N, Lapeyre G, Beverelli F, Beygui F, Koning R. In-Hospital and 1-Year Clinical Results from the French Registry Using Polymer-Free Sirolimus-Eluting Stents in Acute Coronary Syndrome and Stable Coronary Artery Disease. J Interv Cardiol 2023; 2023:8907315. [PMID: 38125031 PMCID: PMC10733033 DOI: 10.1155/2023/8907315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/07/2023] [Accepted: 11/24/2023] [Indexed: 12/23/2023] Open
Abstract
Objectives The aim of this postmarket clinical study was to assess the safety and efficacy of the latest generation polymer-free sirolimus-eluting stents (PF-SES) in an all-comers population comparing outcomes in stable coronary artery disease (CAD) versus acute coronary syndrome (ACS) in France. Background The efficacy and safety of the first-generation PF-SES have already been demonstrated by randomized controlled trials and "all-comers" observational studies. Methods For this all-comers observational, prospective, multicenter study, 1456 patients were recruited in 22 French centers. The primary endpoint was target lesion revascularization (TLR) rate at 12 months and secondary endpoints included major adverse cardiac events (MACE) and bleeding. Results 895 patients had stable CAD and 561 had ACS. At 12 months, 2% of patients had a TLR, with similar rates between stable CAD and ACS (1.9% vs 2.2%, p = 0.7). The overall MACE rate was 5.2% with an expected higher rate in patients with ACS as compared to those with stable CAD (7.3% vs 3.9%, p = 0.007). The overall bleeding event rate was 4.5%, with similar rates in stable CAD as compared to ACS patients (3.8% vs 5.6%, p = 0.3). Dual antiplatelet therapy (DAPT) interruptions prior to the recommended duration occurred in 41.7% of patients with no increase in MACE rates as compared to patients who did not prematurely interrupt DAPT (3.9% vs 6.1%, p = 0.073). Conclusions The latest generation PF-SES is associated with low clinical event rates in these all-comers patients. There was a high rate of prematurely terminated DAPT, without any effect on MACE at 12 months. This trial is registered with NCT03809715.
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Affiliation(s)
| | - Marine Quillot
- Department of Cardiology, Centre Hospitalier Henri Duffaut, Avignon, France
| | - Fabien Picard
- Department of Cardiology, Hôpital Cochin-Port Royal, AP-HP, Paris, France
| | - Patrick Henry
- Department of Cardiology, Hôpital Lariboisière- Fernand Widal, AP-HP, Paris, France
| | - Georgios Sideris
- Department of Cardiology, Hôpital Lariboisière- Fernand Widal, AP-HP, Paris, France
- Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Olivier Bizeau
- Department of Cardiology, Centre Hospitalier Régional d'Orléans Hôpital de la source, Orléans, France
| | - Christophe Piot
- Department of Cardiology, Clinique du Millénaire, Montpellier, France
| | - Bernard Jouve
- Department of Cardiology, Centre Hospitalier d'Aix en Provence, Aix en Provence, France
| | - Jérôme Rischner
- Department of Cardiology, Hôpital Albert Schweitzer, Colmar, France
| | - Mourad Mejri
- Department of Cardiology, Centre Hospitalier de Saint-Malo, Saint-Malo, France
| | | | - Raphael Lasserre
- Department of Cardiology, Centre Hospitalier de Pau, Pau, France
| | - Hervé Pouliquen
- Department of Cardiology, CHD les Oudairies, La Roche sur Yon, France
| | - Thierry Joseph
- Department of Cardiology, Centre Hospitalier de Cornouaille, Quimper, France
| | | | - Bernard Karsenty
- Department of Cardiology, Hopital Privé Saint-Martin, Pessac, France
| | | | - Nicolas Richet
- Department of Cardiology, Centre Hospitalier de Valence, Valence, France
| | - Guy Lapeyre
- Department of Cardiology, Clinique Claude Bernard, Albi, France
| | - Fabrizio Beverelli
- Department of Cardiology, Clinique Ambroise Paré, Neuilly sur Seine, France
| | | | - René Koning
- Department of Cardiology, Clinique Saint Hilaire, Rouen, France
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Roule V, Guedeney P, Silvain J, Beygui F, Zeitouni M, Sorrentino S, Kerneis M, Barthelemy O, Beaupré F, Portal JJ, Vicaut E, Montalescot G, Collet JP. Bioprosthetic leaflet thrombosis and reduced leaflet motion after transcatheter aortic valve replacement: A systematic review and meta-analysis. Arch Cardiovasc Dis 2023; 116:563-571. [PMID: 37968182 DOI: 10.1016/j.acvd.2023.10.003] [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: 05/17/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Leaflet thrombosis and reduced leaflet motion have become a concern with the expanding use of transcatheter aortic valve replacement in lower-risk patients. AIMS To assess the proportions, predictors and clinical impact of leaflet thrombosis and reduced leaflet motion after transcatheter aortic valve replacement. METHODS We performed a meta-analysis of studies assessing the proportions of and/or clinical outcomes according to the presence of leaflet thrombosis after transcatheter aortic valve replacement identified with computed tomography and/or echocardiography. RESULTS Fifty-three studies, representing 25,258 patients undergoing transcatheter aortic valve replacement, were considered. The proportion of leaflet thrombosis was 5.2% overall, and was higher in computed tomography versus echocardiography (16.4% vs. 1.1%, respectively); reduced leaflet motion was identified in 11% of patients with four-dimensional computed tomography. Intra-annular bioprostheses were associated with a higher proportion of leaflet thrombosis, whereas chronic oral anticoagulation was protective for leaflet thrombosis in both computed tomography and echocardiographic studies (9.7% vs. 17.5%; relative risk [RR]: 0.51, 95% confidence interval [95% CI]: 0.37-0.71 and 0.9% vs. 2.7%; RR: 0.22, 95% CI: 0.06-0.79, respectively) and for reduced leaflet motion (2.5% vs. 12.4%; RR: 0.32, 95% CI: 0.13-0.76). Leaflet thrombosis was not associated with an increased risk of death, but with a higher risk of stroke in computed tomography studies (2.8% vs. 2.4%; RR: 1.63, 95% CI: 1.05-2.55), a difference more pronounced when considering reduced leaflet motion (3.5% vs. 1.7%; RR: 2.39, 95% CI: 0.63-8.34). CONCLUSIONS The proportion of leaflet thrombosis is highly variable according to the screening approach, the type of valve and the use of oral anticoagulation. The occurrence of cerebral events is increased when leaflet thrombosis and/or reduced leaflet motion are diagnosed, but leaflet thrombosis has no impact on survival.
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Affiliation(s)
- Vincent Roule
- ACTION Study Group, Sorbonne Université, UMRS 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), 75013 Paris, France; Service de Cardiologie, CHU de Caen Normandie, Normandie Université, 14000 Caen, France
| | - Paul Guedeney
- ACTION Study Group, Sorbonne Université, UMRS 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), 75013 Paris, France
| | - Johanne Silvain
- ACTION Study Group, Sorbonne Université, UMRS 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), 75013 Paris, France
| | - Farzin Beygui
- Service de Cardiologie, CHU de Caen Normandie, Normandie Université, 14000 Caen, France
| | - Michel Zeitouni
- ACTION Study Group, Sorbonne Université, UMRS 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), 75013 Paris, France
| | - Sabato Sorrentino
- Division of Cardiology, Department of Medical and Surgical Science, Magna Graecia University, 88100 Catanzaro, Italy
| | - Mathieu Kerneis
- ACTION Study Group, Sorbonne Université, UMRS 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), 75013 Paris, France
| | - Olivier Barthelemy
- ACTION Study Group, Sorbonne Université, UMRS 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), 75013 Paris, France
| | - Frédéric Beaupré
- ACTION Study Group, Sorbonne Université, UMRS 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), 75013 Paris, France
| | - Jean-Jacques Portal
- ACTION Study Group, Unité de Recherche Clinique, Lariboisière Hospital, AP-HP, 75010 Paris, France
| | - Eric Vicaut
- ACTION Study Group, Unité de Recherche Clinique, Lariboisière Hospital, AP-HP, 75010 Paris, France
| | - Gilles Montalescot
- ACTION Study Group, Sorbonne Université, UMRS 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), 75013 Paris, France.
| | - Jean-Philippe Collet
- ACTION Study Group, Sorbonne Université, UMRS 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), 75013 Paris, France
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8
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Guedeney P, Farjat-Pasos JI, Asslo G, Roule V, Beygui F, Hermida A, Gabrion P, Leborgne L, Houde C, Huang F, Lattuca B, Leclercq F, Mesnier J, Abtan J, Rouanet S, Hammoudi N, Collet JP, Zeitouni M, Silvain J, Montalescot G, Rodés-Cabau J. Impact of the antiplatelet strategy following patent foramen ovale percutaneous closure. Eur Heart J Cardiovasc Pharmacother 2023; 9:601-607. [PMID: 36963773 DOI: 10.1093/ehjcvp/pvad023] [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] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/01/2023] [Accepted: 03/23/2023] [Indexed: 03/26/2023]
Abstract
AIMS Temporary dual antiplatelet therapy (DAPT) is recommended following patent foramen ovale (PFO) percutaneous closure although its benefit, compared to single antiplatelet therapy (SAPT), has not been demonstrated in this setting. We aimed at assessing outcomes following PFO closure according to the antiplatelet strategy at discharge. METHODS AND RESULTS The ambispective AIR-FORCE cohort included consecutive patients from seven centres in France and Canada undergoing PFO closure and discharged without anticoagulation. Patients treated in French and Canadian centres were mostly discharged with DAPT and SAPT, respectively. The primary endpoint was the composite of death, stroke, transient ischaemic attack, peripheral embolism, myocardial infarction, or BARC type ≥2 bleeding with up to 5 years of follow-up. The impact of the antiplatelet strategy on outcomes was evaluated with a marginal Cox model (cluster analyses per country) with inverse probability weighting according to propensity score. A total of 1532 patients (42.2% female, median age: 49 [40-57] years) were included from 2001 to 2022, of whom 599 (39.1%) were discharged with SAPT and 933 (60.9%) with DAPT, for ≤3 months in 894/923 (96.9%) cases. After a median follow-up of 2.4 [1.1-4.4] years, a total of 58 events were observed. In the weighted analysis, the rate of the primary endpoint up to 5 years was 7.8% in the SAPT strategy and 7.3% in the DAPT strategy (weighted hazard ratio 1.04, 95% confidence interval 0.59-1.83). CONCLUSION The antiplatelet strategy following PFO closure did not seem to impact clinical outcomes, thus challenging the current recommendations of temporary DAPT.
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Affiliation(s)
- Paul Guedeney
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de cardiologie (AP-HP), Paris, France
| | | | - Gabriel Asslo
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de cardiologie (AP-HP), Paris, France
| | - Vincent Roule
- Service de Cardiologie, ACTION Study Group, Centre Hospitalier Universitaire (CHU) de Caen Normandie, Normandie Univ, INSERM UMRS 1237, GIP Cyceron, Caen, France
| | - Farzin Beygui
- Service de Cardiologie, ACTION Study Group, Centre Hospitalier Universitaire (CHU) de Caen Normandie, Normandie Univ, INSERM UMRS 1237, GIP Cyceron, Caen, France
| | - Alexis Hermida
- Cardiac Arrhythmia Service, Amiens-Picardie University Hospital, Amiens, France
| | - Paul Gabrion
- Cardiac Arrhythmia Service, Amiens-Picardie University Hospital, Amiens, France
| | - Laurent Leborgne
- Cardiac Arrhythmia Service, Amiens-Picardie University Hospital, Amiens, France
| | - Christine Houde
- Centre Hospitalier Universitaire de Québec, Quebec City, Quebec, Canada
| | - Florent Huang
- Service de Cardiologie, Hôpital Foch, Suresnes, France
| | - Benoit Lattuca
- ACTION Study Group, Cardiology Department, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Florence Leclercq
- Department of Cardiology, Arnaud de Villeneuve University Hospital, Montpellier, France
| | - Jules Mesnier
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
- FACT (French Alliance for Cardiovascular Clinical Trials), Université de Paris, INSERM U-1148, Hôpital Bichat (Assistance Publique-Hôpitaux de Paris), Paris, France
| | - Jérémie Abtan
- FACT (French Alliance for Cardiovascular Clinical Trials), Université de Paris, INSERM U-1148, Hôpital Bichat (Assistance Publique-Hôpitaux de Paris), Paris, France
| | - Stéphanie Rouanet
- Statistician Unit, StatEthic, ACTION Study Group, Levallois-Perret, France
| | - Nadjib Hammoudi
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de cardiologie (AP-HP), Paris, France
| | - Jean-Philippe Collet
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de cardiologie (AP-HP), Paris, France
| | - Michel Zeitouni
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de cardiologie (AP-HP), Paris, France
| | - Johanne Silvain
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de cardiologie (AP-HP), Paris, France
| | - Gilles Montalescot
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de cardiologie (AP-HP), Paris, France
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
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9
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Rangé G, Motreff P, Benamer H, Commeau P, Cayla G, Chassaing S, Laure C, Monsegu J, Van Belle E, Py A, Amabile N, Beygui F, Honton B, Lhermusier T, Boiffard E, Boueri Z, Lhoest N, Deharo P, Adjedj J, Pouillot C, Pereira B, Koning R, Collet JP. The France PCI registry: Design, methodology and key findings. Arch Cardiovasc Dis 2023:S1875-2136(23)00169-9. [PMID: 37783602 DOI: 10.1016/j.acvd.2023.08.005] [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: 05/22/2023] [Revised: 07/30/2023] [Accepted: 08/01/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Obstructive coronary artery disease is the main cause of death worldwide. By tracking events and gaining feedback on patient management, the most relevant information is provided to public health services to further improve prognosis. AIMS To create an inclusive and accurate registry of all percutaneous coronary intervention (PCI) procedures performed in France, to assess and improve the quality of care and create research incentives. Also, to describe the methodology of this French national registry of interventional cardiology, and present early key findings. METHODS The France PCI registry is a multicentre observational registry that includes consecutive patients undergoing coronary angiography and/or PCI. The registry was set up to provide online data analysis and structured reports of PCI activity, including process of care measures and assessment of risk-adjusted outcomes in all French PCI centres that are willing to participate. More than 150 baseline data items, describing demographic status, PCI indications and techniques, and in-hospital and 1-year outcomes, are captured into local reporting software by medical doctors and local research technicians, with subsequent encryption and internet transfer to central data servers. Annual activity reports and scoring tools available on the France PCI website enable users to benchmark and improve clinical practices. External validation and consistency assessments are performed, with feedback of data completeness to centres. RESULTS Between 01 January 2014 and 31 December 2022, participating centres increased from six to 47, and collected 364,770 invasive coronary angiograms and 176,030 PCIs, including 54,049 non-ST-segment elevation myocardial infarction cases and 31,631 ST-segment elevation myocardial infarction cases. Fifteen studies stemming from the France PCI registry have already been published. CONCLUSIONS This fully electronic, daily updated, high-quality, low-cost, national registry is sustainable, and is now expanding. Merging with medicoeconomic databases and nested randomized scientific studies are ongoing steps to expand its scientific potential.
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Affiliation(s)
- Grégoire Rangé
- Cardiology Department, Les Hôpitaux de Chartres, 28630 Chartres, France.
| | - Pascal Motreff
- Cardiology Department, University Hospital Gabriel-Montpied, 63000 Clermont-Ferrand, France
| | - Hakim Benamer
- Cardiology Department, Clinique de la Roseraie, 02200 Soissons, France
| | - Philippe Commeau
- Cardiology Department, Polyclinique Les Fleurs, Groupe ELSAN, 83190 Ollioules, France
| | - Guillaume Cayla
- Cardiology Department, Centre Hospitalier Universitaire de Nîmes, 30029 Nîmes, France
| | - Stephan Chassaing
- Cardiology Department, Nouvelle Clinique Tourangelle, 37540 Saint-Cyr-sur-Loire, France
| | - Christophe Laure
- Cardiology Department, Les Hôpitaux de Chartres, 28630 Chartres, France
| | - Jacques Monsegu
- Department of Interventional Cardiology, Institut Cardio-Vasculaire, Groupe Hospitalier Mutualiste, 38028 Grenoble, France
| | - Eric Van Belle
- Department of Cardiology, Institut Coeur-Poumon-CHU Lille and INSERM U1011, 59000 Lille, France
| | - Antoine Py
- Department of Cardiology, Clinique Victor Pauchet, 80094 Amiens, France
| | - Nicolas Amabile
- Cardiology Department, Institut Mutualiste Montsouris, 75014 Paris, France
| | - Farzin Beygui
- Cardiology Department, CHU de Caen, 14000 Caen, France
| | - Benjamin Honton
- Department of Interventional Cardiology, Clinique Pasteur, 31076 Toulouse, France
| | - Thomas Lhermusier
- Department of Cardiology, Toulouse University Hospital, 31000 Toulouse, France
| | - Emmanuel Boiffard
- Department of Cardiology, Centre Hospitalier Départemental de Vendée, 85000 La Roche-sur-Yon, France
| | - Ziad Boueri
- Department of Cardiology, Centre Hospitalier de Bastia, 20600 Bastia, France
| | - Nicolas Lhoest
- Department of Cardiology, Clinique Rhéna, 67000 Strasbourg, France
| | - Pierre Deharo
- Department of Cardiology, CHU Timone, Aix Marseille Université, INSERM, INRA, C2VN, 13005 Marseille, France
| | - Julien Adjedj
- Department of Cardiology, Arnault Tzanck Institute, 06700 Saint-Laurent-du-Var, France
| | - Christophe Pouillot
- Department of Cardiology, Clinique Sainte Clotilde, 97400 Saint-Denis, Reunion
| | - Bruno Pereira
- Cardiology Department, University Hospital Gabriel-Montpied, 63000 Clermont-Ferrand, France
| | - René Koning
- Cardiology Department, Clinique Saint-Hilaire, 76000 Rouen, France
| | - Jean-Philippe Collet
- Sorbonne Université, Action Study Group (action-groupe.org), Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France
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10
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Roule V, Alexandre J, Lemaitre A, Chrétien B, Sassier M, Fedrizzi S, Beygui F, Dolladille C. Rhabdomyolysis with Co-Administration of Statins and Antiplatelet Therapies-Analysis of the WHO Pharmacovigilance Database. Cardiovasc Drugs Ther 2023:10.1007/s10557-023-07459-8. [PMID: 37115431 DOI: 10.1007/s10557-023-07459-8] [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] [Accepted: 04/21/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE While statins and antiplatelet therapies are largely prescribed together worldwide, limited information is available on the safety of their association regarding rhabdomyolysis occurrence. We aimed to assess the reporting of rhabdomyolysis in patients treated with a combination of statin and antiplatelet therapy, compared to statin alone. METHODS We used the World Health Organization pharmacovigilance database (VigiBase®) to compare the rhabdomyolysis reporting between statin (atorvastatin, fluvastatin, pravastatin, rosuvastatin, and simvastatin) plus antiplatelet therapy (acetylsalicylic acid, clopidogrel, prasugrel and ticagrelor) groups versus statin alone groups, for each statin and antiplatelet therapy. Study setting was restricted to patients aged 45 or older, including reports up until 1st September, 2021. We computed reporting Odds-Ratio (ROR) and their 95% confidence interval (CI) to quantify the disproportionality between groups, adjusted on age and sex. RESULTS Among the 11,431,708 reports of adverse reactions, we extracted 9,489 cases of rhabdomyolysis in patients treated with statins, of whom 2,464 (26%) were also treated with antiplatelet therapy. The reporting of rhabdomyolysis was increased when ticagrelor was associated with atorvastatin (ROR 1.30 [1.02-1.65]) or rosuvastatin (ROR 1.90 [1.42-2.54]) compared to the respective statin alone but did not change when aspirin, clopidogrel or prasugrel were considered. CONCLUSION Rhabdomyolysis reporting was increased when ticagrelor -but not other antiplatelet agents- was notified with the most prescribed statins in practice. This finding needs to be considered by physicians especially in high-risk patients.
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Affiliation(s)
- Vincent Roule
- Service de Cardiologie, CHU de Caen Normandie, 14000, Caen, France.
- UMRS 1237, INSERM, GIP Cyceron, 14000, Caen, France.
- Cardiology department, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France.
| | - Joachim Alexandre
- Service de Pharmacologie, CHU de Caen Normandie, PICARO Cardio-Oncology Program, 14000, Caen, France
| | - Adrien Lemaitre
- Service de Cardiologie, CHU de Caen Normandie, 14000, Caen, France
| | - Basile Chrétien
- Service de Pharmacologie, CHU de Caen Normandie, PICARO Cardio-Oncology Program, 14000, Caen, France
| | - Marion Sassier
- Service de Pharmacologie, CHU de Caen Normandie, PICARO Cardio-Oncology Program, 14000, Caen, France
| | - Sophie Fedrizzi
- Service de Pharmacologie, CHU de Caen Normandie, PICARO Cardio-Oncology Program, 14000, Caen, France
| | - Farzin Beygui
- Service de Cardiologie, CHU de Caen Normandie, 14000, Caen, France
- UMRS 1237, INSERM, GIP Cyceron, 14000, Caen, France
- ACTION Study Group, Pitié-Salpêtrière University Hospital, Cardiology Department, Paris, France
| | - Charles Dolladille
- Service de Pharmacologie, CHU de Caen Normandie, PICARO Cardio-Oncology Program, 14000, Caen, France
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11
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Mesrar H, Hakim R, Chassaing S, Fichaux O, Marcollet P, Decomis MP, Beygui F, Angoulvant D, Motreff P, Rangé G. Impact of the COVID-19 pandemic on overall percutaneous coronary interventions from the France-PCI registry: Comparative analysis of the years 2019 and 2020. Archives of Cardiovascular Diseases. Supplements 2023. [PMCID: PMC9800760 DOI: 10.1016/j.acvdsp.2022.10.013] [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] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Introduction In 2020, the coronavirus disease 2019 (COVID-19) pandemic disrupted the health system and a drop in percutaneous coronary interventions (PCI) was observed. Objective The objective of this study was to evaluate the impact of the COVID-19 pandemic on a full year of elective and urgent PCIs, from the national France-PCI registry. Method The primary endpoint was to compare the number of PCIs performed in 2019 (before the pandemic), and 2020 (during the pandemic). Results Between January 1, 2019 and December 31, 2020, in the 20 participating centers, 22,807 consecutive PCIs were included. The total number of PCIs was reduced by −11.5% between 2019 and 2020 (12,102 versus 10,705; P < 0.001), mainly due to a reduction in elective interventions (−21.9%; P < 0.001). There was a significant decrease in PCIs for stable angina (P < 0.001) and silent ischemia (P < 0.001). For urgent PCIs, the decrease was less, mainly driven by a non-ST+ acute coronary syndromes (ACS) reduction (−5.7%; P = 0.01), as well as a decrease of early ST-Elevation myocardial infarctions (STEMIs) < 24 Hours (−7.1%; P = 0.02). There was also a significant increase in the number of late STEMIs > 24H (+23.4%; P = 0.002). Following the decrease in ACS during the first lockdown from March to May 2020, there was an unexpected significant increase in urgent interventions (“rebound effect”) out of step with the rest of the year (P = 0.002) (Fig. 1A). Nevertheless, there was no increase in elective PCIs after the first lockdown in comparison with the rest of the year 2020 (P = 0.67) (Fig. 1B). In 2020, patients were significantly younger (P = 0.001), with less prior history of coronary artery disease (P = 0.001), and prasugrel was more often prescribed after PCIs (P = 0.001). In 2020, the radial approach was more often performed (P = 0.001), as well as an “Ad-hoc” PCI (P = 0.01), and the median fluoroscopy time was lengthened (P < 0.001). For STEMIs < 24H, there was more frequently anterior localizations (P = 0.03), and ground medical transport was the majority (P = 0.03). The time from onset of symptoms to first medical contact was significantly lengthened (P = 0.01), and a non-significant increase in total ischemic time (P = 0.08) was found. Finally, there was no significant increase in intra-hospital cardiovascular events during the pandemic in 2020. Conclusion We show an extraordinary reduction in elective and urgent PCIs, as well as a never described paradoxical increase in urgent PCIs after the first lockdown, during the COVID-19 pandemic.
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Affiliation(s)
- H. Mesrar
- Cardiologie, CH de Chartres, Le Coudray,Corresponding author
| | - R. Hakim
- Cardiologie, CH de Chartres, Le Coudray
| | - S. Chassaing
- Cardiologie interventionnelle et imagerie cardiaque, Nouvelle Clinique Tourangelle, Saint-Cyr-sur-Loire
| | - O. Fichaux
- Cardiologie, CH régional d’Orléans, hôpital de La Source, Orléans
| | | | | | | | | | - P. Motreff
- Cardiologie, CHU Clermont-Fd: Site Gabriel-Montpied, Clermont-Ferrand
| | - G. Rangé
- Cardiologie, CH de Chartres, Le Coudray
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12
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Legallois D, Hodzic A, Milliez P, Manrique A, Dolladille C, Saloux E, Beygui F. Left atrial strain quantified after myocardial infarction is associated with early left ventricular remodeling. Echocardiography 2022; 39:1581-1588. [PMID: 36376262 DOI: 10.1111/echo.15492] [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: 03/22/2022] [Revised: 08/23/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Left ventricular remodeling (LVR) is common and associated with adverse outcome after ST-elevation myocardial infarction (STEMI). We aimed to investigate the association between left atrial (LA) mechanical function using speckle tracking imaging and early LVR at follow-up in STEMI patients. METHODS Baseline 3D thoracic echocardiograms were performed within 48 h following admission and at a median follow-up of 7 months after STEMI. A > 20% increase in the left ventricular (LV) end-diastolic volume compared to baseline at follow-up was defined as LVR. LA global longitudinal strain was evaluated for the reservoir, conduit, and contraction (LASct) phases. RESULTS A total of 121 patients without clinical heart failure (HF) were prospectively included, between June 2015 and October 2018 (age 58.3 ± 12.5 years, male 98 (81%)). Baseline and follow-up LV ejection fraction (LVEF) were 46.8% [41.0, 52.9] and 52.1% [45.8, 57.0] respectively (p < .001). Compared to other patients, those with LVR had significantly lower values of LASct at baseline (-7.4% [-10.1, -6.5] vs. -9.9% [-12.8, -8.1], p < .01), both on univariate and baseline LV volumes-adjusted analyses. Baseline LA strain for reservoir and conduit phases were not associated with significant LVR at follow-up. Intra- and interobserver analysis showed good reproducibility of LA strain. CONCLUSIONS Baseline LASct may help identifying patients without HF after STEMI who are at higher risk of further early LVR and subsequent HF and who may benefit from more intensive management.
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Affiliation(s)
- Damien Legallois
- Department of Cardiology, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, France.,Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, FHU REMOD-VHF, Caen, France
| | - Amir Hodzic
- Department of Clinical Physiology, Normandie Univ, UNICAEN, CHU de Caen Normandie, INSERM Comete, Caen, France
| | - Paul Milliez
- Department of Cardiology, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, France.,Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, FHU REMOD-VHF, Caen, France
| | - Alain Manrique
- Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, FHU REMOD-VHF, Caen, France.,Department of Nuclear Medicine, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, France
| | - Charles Dolladille
- Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, FHU REMOD-VHF, Caen, France.,Department of Pharmacology, Normandie Univ, UNICAEN, CHU de Caen Normandie, PICARO Cardio-Oncology program, Caen, France
| | - Eric Saloux
- Department of Cardiology, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, France.,Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, FHU REMOD-VHF, Caen, France
| | - Farzin Beygui
- Department of Cardiology, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, France.,Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, FHU REMOD-VHF, Caen, France.,ACTION academic research group, Pitié-Salpêtrière University Hospital, Paris, France
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13
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Hauw-Berlemont C, Lamhaut L, Diehl JL, Andreotti C, Varenne O, Leroux P, Lascarrou JB, Guerin P, Loeb T, Roupie E, Daubin C, Beygui F, Boissier F, Marjanovic N, Christiaens L, Vilfaillot A, Glippa S, Prat JD, Chatellier G, Cariou A, Spaulding C. Emergency vs Delayed Coronary Angiogram in Survivors of Out-of-Hospital Cardiac Arrest: Results of the Randomized, Multicentric EMERGE Trial. JAMA Cardiol 2022; 7:700-707. [PMID: 35675081 DOI: 10.1001/jamacardio.2022.1416] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [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]
Abstract
Importance Although an emergency coronary angiogram (CAG) is recommended for patients who experience an out-of-hospital cardiac arrest (OHCA) with ST-segment elevation on the postresuscitation electrocardiogram (ECG), this strategy is still debated in patients without ST-segment elevation. Objective To assess the 180-day survival rate with Cerebral Performance Category (CPC) 1 or 2 of patients who experience an OHCA without ST-segment elevation on ECG and undergo emergency CAG vs delayed CAG. Design, Setting, and Participants The Emergency vs Delayed Coronary Angiogram in Survivors of Out-of-Hospital Cardiac Arrest (EMERGE) trial randomly assigned survivors of an OHCA without ST-segment elevation on ECG to either emergency or delayed (48 to 96 hours) CAG in 22 French centers. The trial took place from January 19, 2017, to November 23, 2020. Data were analyzed from November 24, 2020, to July 30, 2021. Main Outcomes and Measures The primary outcome was the 180-day survival rate with CPC of 2 or less. The secondary end points were occurrence of shock, ventricular tachycardia, and/or fibrillation within 48 hours, change in left ventricular ejection fraction between baseline and 180 days, CPC scale at intensive care unit discharge and day 90, survival rate, and hospital length of stay. Results A total of 279 patients (mean [SD] age, 64.7 [14.6] years; 195 men [69.9%]) were enrolled, with 141 (50.5%) in the emergency CAG group and 138 (49.5%) in the delayed CAG group. The study was underpowered. The mean (SD) time delay between randomization and CAG was 0.6 (3.7) hours in the emergency CAG group and 55.1 (37.2) hours in the delayed CAG group. The 180-day survival rates among patients with a CPC of 2 or less were 34.1% (47 of 141) in the emergency CAG group and 30.7% (42 of 138) in the delayed CAG group (hazard ratio [HR], 0.87; 95% CI, 0.65-1.15; P = .32). There was no difference in the overall survival rate at 180 days (emergency CAG, 36.2% [51 of 141] vs delayed CAG, 33.3% [46 of 138]; HR, 0.86; 95% CI, 0.64-1.15; P = .31) and in secondary outcomes between the 2 groups. Conclusions and Relevance In this randomized clinical trial, for patients who experience an OHCA without ST-segment elevation on ECG, a strategy of emergency CAG was not better than a strategy of delayed CAG with respect to 180-day survival rate and minimal neurologic sequelae. Trial Registration ClinicalTrials.gov Identifier: NCT02876458.
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Affiliation(s)
- Caroline Hauw-Berlemont
- Medical Intensive Care Unit, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Lionel Lamhaut
- Paris Cité University, Paris, France.,Service d'Aide Médicale D'Urgence 75, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,INSERM U970; Paris Cardiovascular Research Centre, Paris, France
| | - Jean-Luc Diehl
- Medical Intensive Care Unit, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France.,INSERM Unité Mixte de Recherche-S1140, Paris Cité University, Paris, France
| | - Christophe Andreotti
- Service Mobile d'Urgence et de Réanimation, Emergency Department Cochin Hôtel Dieu, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Olivier Varenne
- Interventional Cardiology, Department of Cardiology, Groupe Hospitalier Cochin-Saint Vincent de Paul-Hôtel Dieu, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pierre Leroux
- Service d'Aide Médicale d' Urgence 44, University Hospital of Nantes, Nantes, France
| | | | - Patrice Guerin
- Unité d'Hémodynamique, L'Institut du Thorax, University Hospital of Nantes, Nantes, France
| | - Thomas Loeb
- Service d'Aide Médicale d'Urgence 92, Hôpitaux Universitaires Paris-Saclay, Site Raymond Poincaré, Garches, France
| | - Eric Roupie
- Service d'Aide Médicale d'Urgence 14, University Hospital of Caen, Caen, France
| | - Cédric Daubin
- Medical Intensive Care Unit, University Hospital of Caen, Caen, France
| | - Farzin Beygui
- Department of Cardiology, University Hospital of Caen, Caen, France
| | - Florence Boissier
- Medical Intensive Care Unit, University Hospital of Poitiers, INSERM CIC 1402, Poitiers University, Poitiers, France
| | - Nicolas Marjanovic
- Service d'Aide Médicale d'Urgence 86, University of Poitiers, Poitiers, France
| | - Luc Christiaens
- Cardiology Department Poitiers University Hospital, University of Poitiers, Poitiers, France
| | - Aurélie Vilfaillot
- INSERM CIC1418 and Département d'Informatique, Biostatistique et Santé Publique, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sophie Glippa
- INSERM CIC1418 and Département d'Informatique, Biostatistique et Santé Publique, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Juliette Djadi Prat
- INSERM CIC1418 and Département d'Informatique, Biostatistique et Santé Publique, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Gilles Chatellier
- INSERM CIC1418 and Département d'Informatique, Biostatistique et Santé Publique, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Cité University, Paris, France
| | - Christian Spaulding
- Department of Cardiology, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris Cité University, Sudden Cardiac Death Expert Center, INSERM U 971, PARCC, Paris, France
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14
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Valgimigli M, Smits PC, Frigoli E, Bongiovanni D, Tijssen J, Hovasse T, Mafragi A, Ruifrok WT, Karageorgiev D, Aminian A, Garducci S, Merkely B, Routledge H, Ando K, Fernandez JFD, Cuisset T, Malik FTN, Halabi M, Belle L, Din J, Beygui F, Abhyankar A, Reczuch K, Pedrazzini G, Heg D, Vranckx P. Duration of Antiplatelet Therapy After Complex Percutaneous Coronary Intervention In Patients at High Bleeding Risk: a MASTER DAPT trial sub-analysis. Eur Heart J 2022; 43:3100-3114. [PMID: 35580836 DOI: 10.1093/eurheartj/ehac284] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/05/2022] [Accepted: 05/16/2022] [Indexed: 11/14/2022] Open
Abstract
AIMS To assess the effects of 1- or ≥3-month dual antiplatelet therapy (DAPT) in high bleeding risk (HBR) patients who received biodegradable-polymer sirolimus-eluting stents for complex percutaneous coronary intervention (PCI) and/or acute coronary syndrome (ACS). METHODS AND RESULTS In the MASTER DAPT trial, 3383 patients underwent noncomplex (abbreviated DAPT, n = 1707; standard DAPT, n = 1676) and 1196 complex (abbreviated DAPT, n = 588; standard DAPT, n = 608) PCI. Co-primary outcomes at 335 days were net adverse clinical events (NACE; composite of all-cause death, myocardial infarction, stroke, and Bleeding Academic Research Consortium [BARC] 3 or 5 bleeding events); major adverse cardiac or cerebral events (MACCE; all-cause death, myocardial infarction, and stroke); and type 2, 3, or 5 BARC bleeding.NACE and MACCE did not differ with abbreviated versus standard DAPT among patients with complex (hazard ratio [HR]: 1.03, 95% confidence interval [CI]: 0.69-1.52, and HR: 1.24, 95% CI: 0.79-1.92, respectively) and noncomplex PCI (HR: 0.90, 95% CI: 0.71-1.15, and HR: 0.91, 95% CI: 0.69-1.21; Pinteraction = 0.60 and 0.26, respectively). BARC 2, 3 or 5 was reduced with abbreviated DAPT in patients with and without complex PCI (HR: 0.64; 95% CI: 0.42-0.98, and HR: 0.70; 95% CI: 0.55-0.89; Pinteraction = 0.72). Among the 2,816 patients with complex PCI and/or ACS, NACE and MACCE did not differ and BARC 2, 3 or 5 was lower with abbreviated DAPT. CONCLUSION In HBR patients free from recurrent ischemic events at 1 month, DAPT discontinuation was associated with similar NACE and MACCE and lower bleeding rates compared with standard DAPT, regardless of PCI or patient complexity.
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Affiliation(s)
- Marco Valgimigli
- From the Cardiocentro Institute, Ente Ospedaliero Cantonale, Università della Svizzera Italiana (USI), CH- 6900 Lugano, Switzerland
| | - Pieter C Smits
- Department of Cardiology, Maasstad Hospital, Rotterdam, the Netherlands
| | | | - Dario Bongiovanni
- From the Cardiocentro Institute, Ente Ospedaliero Cantonale, Università della Svizzera Italiana (USI), CH- 6900 Lugano, Switzerland
| | - Jan Tijssen
- Amsterdam University Medical Center, the Netherlands
| | - Thomas Hovasse
- Ramsay Générale de Santé, ICPS, Hôpital Jacques Cartier, Massy, France
| | - Al Mafragi
- Department of Cardiology, Zorgsaam Hospital, Terneuzen, the Netherlands
| | | | | | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Stefano Garducci
- Unita' Operativa Complessa di Cardiologia, ASST Di Vimercate (MB), Vimercate, Italy
| | - Bela Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Kenji Ando
- Department of Cardiolog y, Kokura Memorial Hospital, Kitakyushu, Japan
| | | | - Thomas Cuisset
- Assistance Publique - Hôpitaux de Marseille, Centre Hospitalier Universitaire La Timone, Service de Cardiologie, Marseille, France
| | | | - Majdi Halabi
- Department of Cardiology, Ziv Medical Center, Safed, Israel
| | - Loic Belle
- Cardiology Department, Hospital of Annecy, Annecy, France
| | - Jehangir Din
- Royal Bournemouth Hospital, East Bournemouth, UK
| | - Farzin Beygui
- Service de Cardiologie, Centre Hospitalier Universitaire (CHU) de Caen Normandie, Caen, France; Électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, Normandie Univ, UNICAEN, Caen, France
| | - Atul Abhyankar
- Department of Cardiology, Shree B. D. Mehta Mahavir Heart Institute, Surat, India
| | - Krzysztof Reczuch
- Institute of Heart Diseases, Wroclaw Medical University, Wrocław, Poland
| | - Giovanni Pedrazzini
- From the Cardiocentro Institute, Ente Ospedaliero Cantonale, Università della Svizzera Italiana (USI), CH- 6900 Lugano, Switzerland
| | - Dik Heg
- CTU Bern, University of Bern, Bern, Switzerland
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis Hasselt, faculty of medicine and life sciences University of Hasselt, Hasselt, Belgium
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15
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Roule V, Rebouh I, Lemaitre A, Sabatier R, Blanchart K, Briet C, Bignon M, Beygui F. Impact of wait times on late postprocedural mortality after successful transcatheter aortic valve replacement. Sci Rep 2022; 12:5967. [PMID: 35395869 PMCID: PMC8993919 DOI: 10.1038/s41598-022-09995-z] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 03/21/2022] [Indexed: 11/30/2022] Open
Abstract
Wait times are associated with mortality on waiting list for transcatheter aortic valve replacement (TAVR). Whether longer wait times are associated with long term mortality after successful TAVR remains unassessed. Consecutive patients successfully treated with elective TAVR in our center between January 2013 and August 2019 were included. The primary end point was one-year all-cause mortality. TAVR wait times were defined as the interval from referral date for valve replacement to the date of TAVR procedure. A total of 383 patients were included with a mean wait time of 144.2 ± 83.87 days. Death occurred in 55 patients (14.4%) at one year. Increased wait times were independently associated with a relative increase of 1-year mortality by 2% per week after referral (Adjusted Hazard Ratio 1.02 [1.002–1.04]; p = 0.02) for TAVR. Chronic kidney disease, left ventricular ejection fraction ≤ 30%, access site and STS score were other independent correlates of 1-year mortality. Our study shows that wait times are relatively long in routine practice and associated with increased 1-year mortality after successful TAVR. Such findings underscore the need of strategies to minimize delays in access to TAVR.
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Affiliation(s)
- Vincent Roule
- CHU de Caen Normandie, Service de Cardiologie, 14000, Caen, France. .,INSERM UMRS 1237, GIP Cyceron, 14000, Caen, France. .,Cardiology Department, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France.
| | - Idir Rebouh
- CHU de Caen Normandie, Service de Cardiologie, 14000, Caen, France
| | - Adrien Lemaitre
- CHU de Caen Normandie, Service de Cardiologie, 14000, Caen, France
| | - Rémi Sabatier
- CHU de Caen Normandie, Service de Cardiologie, 14000, Caen, France
| | | | - Clément Briet
- CHU de Caen Normandie, Service de Cardiologie, 14000, Caen, France
| | - Mathieu Bignon
- CHU de Caen Normandie, Service de Cardiologie, 14000, Caen, France
| | - Farzin Beygui
- CHU de Caen Normandie, Service de Cardiologie, 14000, Caen, France.,INSERM UMRS 1237, GIP Cyceron, 14000, Caen, France.,ACTION Study Group, Cardiology Department, Pitié-Salpêtrière University Hospital, Paris, France
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16
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Beygui F, Roule V, Ivanes F, Dechery T, Bizeau O, Roussel L, Dequenne P, Arnould MA, Combaret N, Collet JP, Commeau P, Cayla G, Montalescot G, Benamer H, Motreff P, Angoulvant D, Marcollet P, Chassaing S, Blanchart K, Koning R, Rangé G. Indirect Transfer to Catheterization Laboratory for ST Elevation Myocardial Infarction Is Associated With Mortality Independent of System Delays: Insights From the France-PCI Registry. Front Cardiovasc Med 2022; 9:793067. [PMID: 35360033 PMCID: PMC8962625 DOI: 10.3389/fcvm.2022.793067] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 02/09/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundFirst medical contact (FMC)-to-balloon time is associated with outcome of ST-elevation myocardial infarction (STEMI). We assessed the impact on mortality and the determinants of indirect vs. direct transfer to the cardiac catheterization laboratory (CCL).MethodsWe analyzed data from 2,206 STEMI patients consecutively included in a prospective multiregional percutaneous coronary intervention (PCI) registry. The primary endpoint was 1-year mortality. The impact of indirect admission to CCL on mortality was assessed using Cox models adjusted on FMC-to-balloon time and covariables unequally distributed between groups. A multivariable logistic regression model assessed determinants of indirect transfer.ResultsA total of 359 (16.3%) and 1847 (83.7%) were indirectly and directly admitted for PCI. Indirect admission was associated with higher risk features, different FMCs and suboptimal pre-PCI antithrombotic therapy.At 1-year follow-up, 51 (14.6%) and 137 (7.7%) were dead in the indirect and direct admission groups, respectively (adjusted-HR 1.73; 95% CI 1.22–2.45). The association of indirect admission with mortality was independent of pre-FMC and FMC characteristics. Older age, paramedics- and private physician-FMCs were independent determinants of indirect admission (adjusted-HRs 1.02 per year, 95% CI 1.003–1.03; 5.94, 95% CI 5.94 3.89–9.01; 3.41; 95% CI 1.86–6.2, respectively).ConclusionsOur study showed that, indirect admission to PCI for STEMI is associated with 1-year mortality independent of FMC to balloon time and should be considered as an indicator of quality of care. Indirect admission is associated with higher-risk features and suboptimal antithrombotic therapy. Older age, paramedics-FMC and self-presentation to a private physician were independently associated with indirect admission. Our study, supports population education especially targeting elderly, more adequately dispatched FMC and improved pre-CCL management.
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Affiliation(s)
- Farzin Beygui
- Cardiology Department, CHU de Caen, Caen, France
- *Correspondence: Farzin Beygui
| | | | | | - Thierry Dechery
- Cardiology Department, Center Hospitalier de Bourges, Bourges, France
| | | | - Laurent Roussel
- Cardiology Department, Les Hôpitaux de Chartres, Chartres, France
| | | | - Marc-Antoine Arnould
- Cardiology Department, Nouvelle clinique Tourangelle, Saint-Cyr-sur-Loire, France
| | - Nicolas Combaret
- Cardiology Department, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Philippe Commeau
- Cardiology Department, Polyclinique les fleurs, Ollioules, France
| | | | - Gilles Montalescot
- Cardiology Department, Groupe hospitalier Pitié-Salpêtrière, Paris, France
| | - Hakim Benamer
- Cardiology Department, Clinique de la Roseraie, Aubervilliers, France
| | - Pascal Motreff
- Cardiology Department, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Pierre Marcollet
- Cardiology Department, Center Hospitalier de Bourges, Bourges, France
| | - Stephan Chassaing
- Cardiology Department, Nouvelle clinique Tourangelle, Saint-Cyr-sur-Loire, France
| | | | - René Koning
- Cardiology Department, Clinique Saint Hilaire, Saint Hilaire, France
| | - Grégoire Rangé
- Cardiology Department, Les Hôpitaux de Chartres, Chartres, France
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17
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Beygui F, Ivanes F, Roule V, Dechery T, Roussel L, Dequenne P, Arnould MA, Combaret N, Collet JP, Commeau P, Cayla G, Montalescot G, Benamer H, Motreff P, Angoulvant D, Marcollet P, Chassaing S, Blanchart K, Koning R, Range G. INDIRECT TRANSFER TO CATHETERIZATION LABORATORY FOR ST ELEVATION MYOCARDIAL INFARCTION IS ASSOCIATED WITH MORTALITY INDEPENDENT OF SYSTEM DELAYS: INSIGHTS FROM THE FRANCE-PCI REGISTRY. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02088-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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18
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Roule V, Rebouh I, Roupie E, Malcor G, Bignon M, Trotel J, Potier B, Lecoq G, Arrot X, Beygui F. Effectiveness and Safety of P2Y12 Inhibitors Pretreatment in Primary Percutaneous Coronary Intervention with Long Transfer Times. J Emerg Med 2021; 62:240-249. [PMID: 34955318 DOI: 10.1016/j.jemermed.2021.10.001] [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: 02/18/2021] [Revised: 08/30/2021] [Accepted: 10/12/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Early initiation of a new P2Y12 inhibitor in ST-elevation myocardial infarction (STEMI) patients prior to primary percutaneous coronary intervention (PCI) is recommended over clopidogrel. However, comparative data remain limited, especially in semi-rural regions with subsequent longer transfer times. OBJECTIVES We aimed to assess the determinants, effectiveness, and safety of pretreatment with new P2Y12 inhibitors compared with clopidogrel in a primary PCI regional network. METHODS Outcomes of 1235 primary PCI patients pretreated with new P2Y12 inhibitors (n = 1050) or clopidogrel (n = 185) were evaluated using a prospective registry. Primary effectiveness endpoint was the composite of death, recurrent myocardial infarction, stroke, or new revascularization. Serious bleedings were defined as Bleeding Academic Research Consortium ≥ 2. RESULTS Clopidogrel was more likely to be used in older and female patients with more comorbidities. Mean transfer time was longer in the clopidogrel group (123.3 ± 67.3 vs. 102.3 ± 57.2 min; p < 0.01). The primary endpoint was less frequent with new P2Y12 inhibitors compared with clopidogrel (14.9 vs. 30.3%; odds ratio 0.58, 95% confidence interval [CI] 0.39-0.87; p < 0.01), mostly driven by a reduced rate of death (4.5 vs. 26% respectively; hazard ratio 0.25, 95% CI 0.16-0.38; p < 0.01). Bleeding rates did not differ between groups (1 vs. 0.5%, respectively; p = 0.96). CONCLUSION Compared with clopidogrel, pretreatment with new P2Y12 inhibitors seems to be associated with lower risks of mortality and ischemic outcomes, and similar risks of bleeding in a real-world registry. Our results are in line with the guidelines recommending the preferential pre-PCI administration of new P2Y12 inhibitors in STEMI patients referred for primary PCI.
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Affiliation(s)
- Vincent Roule
- Service de Cardiologie, Centre Hospitalier Universitaire (CHU) de Caen Normandie, Caen, France; Électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, Normandie Univ, UNICAEN, Caen, France
| | - Idir Rebouh
- Service de Cardiologie, Centre Hospitalier Universitaire (CHU) de Caen Normandie, Caen, France
| | - Eric Roupie
- Pôle Urgences-Service d'Aide Médicale Urgente (SAMU), CHU de Caen Normandie, Caen, France
| | - Guillaume Malcor
- Service de Cardiologie, Centre Hospitalier Public Du Cotentin, Cherbourg, France
| | - Mathieu Bignon
- Service de Cardiologie, Centre Hospitalier Universitaire (CHU) de Caen Normandie, Caen, France
| | - Julien Trotel
- SAMU, Centre Hospitalier d'Alençon-Mamers, Alençon, France
| | | | - Guillaume Lecoq
- Service de Cardiologie, Centre Hospitalier Privé St Martin, Caen, France
| | - Xavier Arrot
- Pôle Urgences-Service d'Aide Médicale Urgente (SAMU), CHU de Caen Normandie, Caen, France
| | - Farzin Beygui
- Service de Cardiologie, Centre Hospitalier Universitaire (CHU) de Caen Normandie, Caen, France; Électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, Normandie Univ, UNICAEN, Caen, France
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Chevalier B, Mamas M, Hovasse T, Rashid M, Gómez-Hospital J, Pan M, Witkowski A, Crowley J, Aminian A, McDonald J, Beygui F, Fernandez Portales J, Roguin A, Stankovic G. Clinical outcomes of the proximal optimisation technique (POT) in bifurcation stenting. EUROINTERVENTION 2021; 17:e910-e918. [PMID: 33970107 PMCID: PMC9724857 DOI: 10.4244/eij-d-20-01393] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 11/23/2022]
Abstract
BACKGROUND Optimal deployment of coronary stents in a bifurcation lesion remains a matter of debate. AIMS We sought to capture the daily practice of bifurcation stenting by means of a worldwide registry and to investigate how post-implantation deployment techniques influence clinical outcomes. METHODS Data from the e-ULTIMASTER registry were used to perform an analysis of 4,395 patients undergoing percutaneous coronary intervention for bifurcation lesions. Inverse probability of treatment weights (IPTW) propensity score methodology was used to adjust for any baseline differences. The primary outcome of interest was target lesion failure (TLF) at one year (follow-up rate 96.2%). RESULTS The global one-year TLF rate was low (5.1%). The proximal optimisation technique (POT) was used in 33.9% of cases and was associated with a reduction in the adjusted TLF rate (4.0% [95% confidence interval: 3.0-5.1%] vs 6.0% [5.1-6.9%], p<0.01) due to a reduction of all components of this composite endpoint, except for cardiac death. Stent thrombosis was also positively impacted (0.4% [0.04-0.7%] vs 1.3% [0.8-1.7%], p<0.01). POT benefit was uniform across subgroups. Conversely, the use of the kissing balloon technique (36.5%) did not influence the adjusted TLF rate. CONCLUSIONS Despite a low one-year failure rate in this large bifurcation stenting cohort, POT was associated with a further reduction in the event rate and a uniform benefit across subgroups, suggesting systematic use of this deployment technique regardless of the bifurcation anatomy and stenting technique.
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Affiliation(s)
- Bernard Chevalier
- ICPS, Hôpital Privé Jacques Cartier, 6 Avenue du Noyer Lambert, 91300 Massy, France
| | - Mamas Mamas
- Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom,Keele Cardiovascular Research Group, Centre of Prognosis Research, Institute of Primary Care Sciences, Keele University, Stoke-on-Trent, United Kingdom
| | - Thomas Hovasse
- Ramsay Générale de Santé, ICPS, Hôpital Jacques Cartier, Massy, France
| | - Muhammad Rashid
- Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom,Keele Cardiovascular Research Group, Centre of Prognosis Research, Institute of Primary Care Sciences, Keele University, Stoke-on-Trent, United Kingdom
| | - Joan Gómez-Hospital
- Heart Disease Institute, Bellvitge University Hospital (IDIBELL), University of Barcelona, Barcelona, Spain
| | - Manuel Pan
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba (IMIBIC), Cordoba, Spain
| | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - James Crowley
- Department of Cardiology, University Hospital Galway, Galway, Ireland
| | - Adel Aminian
- Centre Hospitalier Universitaire de Charleroi, Department of Cardiology, Charleroi, Belgium
| | - John McDonald
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, United Kingdom
| | - Farzin Beygui
- Department of Interventional Cardiology and Cardiology Research Units, CHU Caen, Caen, France,Keele Cardiovascular Research Group, Centre of Prognosis Research, Institute of Primary Care Sciences, Keele University, Stoke-on-Trent, United Kingdom
| | | | - Ariel Roguin
- Department of Cardiology, Hillel Yafe Medical Center, Hadera, Israel
| | - Goran Stankovic
- Department of Cardiology, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
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20
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Rangé G, Hakim R, Etienne CS, Deballon R, Dechery T, Souteyrand G, Bar O, Albert F, Canville A, Gamet A, Beygui F, Viallard L, Bonnet P, Durand E, Lesault PF, Boiffard E, Koning R, Benamer H, Commeau P, Cayla G, Motreff P. [stent thrombosis : A won battle ? (data from the France PCI registry)]. Ann Cardiol Angeiol (Paris) 2021; 70:388-394. [PMID: 34686307 DOI: 10.1016/j.ancard.2021.10.001] [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: 09/16/2021] [Accepted: 10/02/2021] [Indexed: 10/20/2022]
Abstract
GOAL The aim of the study is to assess the incidence, risk factors and prognosis of definite stent thrombosis (ST) at 1 year in the France PCI multicenter prospective registry. PATIENTS AND METHODS Only patients who underwent coronary angioplasty with at least one stent implantation between 1st January 2014 and 31 December 2019 were included. The population was separated into 2 groups: the "ST" group with stent thrombosis and the "control" group without stent thrombosis. RESULTS 35,435 patients were included. 256 patients (0.72%) presented a ST at 1 year. The rate of ST decreased significantly in acute coronary syndrome (1.5% in 2014 vs. 0.73% in 2019; p = 0.05) but not in chronic coronary syndrome (0.46% in 2014 vs 0.40%; p = 0.98). The risk factors are young age (65.8 years vs 68.2; p = 0.002), clinical context (35.27% vs 16.68%; p = 0.0001), diabetes (35.2 % vs 26.4%; p = 0.002), renal failure (11.7% vs 8%; p = 0.009) and history of coronary angioplasty (28.63% vs 21.86%; p = 0.009) and peripheral arterial disease (14.5% vs 10.1%; p = 0.021), LV dysfunction (37% vs 27.5%; p = 0.003), mean length (39.6 mm vs 31, 7mm; p <0.0001) and the mean number of stents per procedure (1.9 vs 1.6; p <0.0001), a TIMI flow ≤1 pre procedure (21.5% vs 12.4%; p <0.0001) and an intrastent restenosis (11% vs 6%; p <0.0001). The 1-year mortality of the ST group was significantly higher than that of the control group (19.14% vs 5.82%; p <0.0001). CONCLUSION Since 2014, the incidence of ST at 1 year has been decreasing but remains stuck at a floor level of 0.54% in 2019. The battle for ST seems to have been partly won and its risk factors well identified, but its mortality is still high.
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Affiliation(s)
- G Rangé
- Hôpitaux de Chartres, Service de Cardiologie, 4 rue Claude Bernard 28630 Le Coudray.
| | - R Hakim
- Hôpitaux de Chartres, Service de Cardiologie, 4 rue Claude Bernard 28630 Le Coudray
| | - C Saint Etienne
- Service de cardiologie, Centre Hospitalo-Universitaire de Tours, 37170 Chambray les Tours, France
| | - R Deballon
- Service de cardiologie, Pôle santé Oréliance, 45770 Saran, France
| | - T Dechery
- Service de cardiologie, Centre Hospitalier Jacques-Cœur, 18020 Bourges, France
| | - G Souteyrand
- Service de cardiologie, Centre Hospitalo-Universitaire Gabriel-Montpied, 63000 Clermont Ferrand, France
| | - O Bar
- Service de cardiologie, Nouvelle Clinique Tours Plus, 37541 Saint Cyr sur Loire, France
| | - F Albert
- Hôpitaux de Chartres, Service de Cardiologie, 4 rue Claude Bernard 28630 Le Coudray
| | - A Canville
- Service de cardiologie, Clinique Saint-Hilaire, 76000 Rouen, France
| | - A Gamet
- Service de cardiologie, Centre Hospitalier Régional d'Orléans, 45100 Orléans, France
| | - F Beygui
- Service de cardiologie, Centre Hospitalo-Universitaire de Caen, 14033 Caen, France
| | - L Viallard
- Service de cardiologie, Centre Hospitalier Henri-Mondor, 15000 Aurillac, France
| | - P Bonnet
- Service de cardiologie, Groupe Hospitalier du Havre, 76290 Montivilliers, France
| | - E Durand
- Service de cardiologie, Centre Hospitalo-Universitaire de Rouen, 76038 Rouen, France
| | - P-F Lesault
- Service de cardiologie, Hôpital Privé de l'Estuaire, 76600 Le Havre, France
| | - E Boiffard
- Service de cardiologie, Centre Hospitalier Départemental de Vendée, 85000 La Roche-Sur-Yon, France
| | - R Koning
- Service de cardiologie, Clinique Saint-Hilaire, 76000 Rouen, France
| | - H Benamer
- Service de cardiologie, ICVGVM La Roseraie, 93300 Aubervilliers, France
| | - P Commeau
- Service de cardiologie, Polyclinique des Fleurs, 83190 Ollioules, France
| | - G Cayla
- Service de cardiologie, CHU Nîmes, Université Montpellier, Nîmes, France
| | - P Motreff
- Service de cardiologie, Centre Hospitalo-Universitaire Gabriel-Montpied, 63000 Clermont Ferrand, France
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21
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Peron C, Lacote C, Guillemot V, Attou S, Kuefouet S, Rebouh I, Blanchart K, Briet C, Roule V, Beygui F. Bedside assessment of dependence as an independent correlate of mortality in elderly patients admitted for Acute Coronary Syndromes. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1140] [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
Background
Elderly patients are at high risk of dependence and mortality after acute coronary syndrome (ACS)
Purpose
To assess the impact of dependence detected by a simple bedside test in elderly patients admitted for ACS on 1-year mortality.
Methods
We compared mortality between patients with or without dependence based on an Activities of Daily Living (ADL) index <6 in a prospective, cohort of patients ≥75 years old admitted for an ACS to the cardiology department of our center using a Cox proportional survival model adjusted on pre-defined confounding variables (age, gender, revascularization, heart failure, left ventricular ejection fraction and admission GRACE and CRUSADE scores).
Results
In a cohort of 1011 consecutive patients, 946 underwent ADL assessment and completed one-year follow-up. Dependence was identified in 190 (20%). At 1 year follow-up 112 patients died, 52 (27.4%) in the dependent and 60 (7.9%) in the independent groups. Dependence was associated with higher rates of 1 year mortality both on undajusted (HR 3.79; 95% CI 2.62; 5.50], p<0.0001) and adjusted models (adj-HR 2.85; 95% CI 1.89; 4.33], p<0.0001). Other independent correlates of mortality were female gender (p<0.0001), CRUSADE score (p<0.0001) and coronary revascularization (p<0.001).
Conclusions
Dependence detected by a simple bedside test in patients ≥75 admitted for ACS is associated with a 2 to 3-fold increase of the risk of mortality independent of other predictors of poor outcome. Assessment of dependence should be performed in all elderly patients as a risk stratification tool and considered for the management of such patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C Peron
- University Hospital of Caen, Department of Cardiology, Caen, France
| | - C Lacote
- University Hospital of Caen, Department of Cardiology, Caen, France
| | - V Guillemot
- University Hospital of Caen, Department of Cardiology, Caen, France
| | - S Attou
- University Hospital of Caen, Department of Cardiology, Caen, France
| | - S Kuefouet
- University Hospital of Caen, Department of Cardiology, Caen, France
| | - I Rebouh
- University Hospital of Caen, Department of Cardiology, Caen, France
| | - K Blanchart
- University Hospital of Caen, Department of Cardiology, Caen, France
| | - C Briet
- University Hospital of Caen, Department of Cardiology, Caen, France
| | - V Roule
- University Hospital of Caen, Department of Cardiology, Caen, France
| | - F Beygui
- University Hospital of Caen, Department of Cardiology, Caen, France
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22
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Roule V, Schwob L, Briet C, Lemaitre A, Bignon M, Ardouin P, Sabatier R, Blanchart K, Beygui F. Residual platelet reactivity, thrombus burden and myocardial reperfusion in patients treated by PCI after successful pre-hospital fibrinolysis compared to primary PCI. J Thromb Thrombolysis 2021; 50:858-866. [PMID: 32306289 DOI: 10.1007/s11239-020-02113-8] [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] [Indexed: 11/28/2022]
Abstract
We compared residual platelet reactivity and post PCI atherothrombotic burden using OFDI in patients successfully treated by primary PCI versus pharmacoinvasive approach (PI) defined as PCI after successful pre-hospital fibrinolysis. Despite pre-hospital P2Y12-inhibitor loading dose, high rates of high on-treatment platelet reactivity were found at the time of PCI in both groups. Primary PCI patients had higher post stenting thrombus burden and lower rates of final normal myocardial blush grade compared to PI. These findings support the use of a pharmacoinvasive reperfusion strategy especially when primary PCI cannot be timely performed.
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Affiliation(s)
- Vincent Roule
- CHU de Caen Normandie, Service de Cardiologie, Caen, 14000, France. .,UNICAEN, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, Normandie Univ, Caen, 14000, France.
| | - Lin Schwob
- CHU de Caen Normandie, Service de Cardiologie, Caen, 14000, France
| | - Clément Briet
- CHU de Caen Normandie, Service de Cardiologie, Caen, 14000, France
| | - Adrien Lemaitre
- CHU de Caen Normandie, Service de Cardiologie, Caen, 14000, France
| | - Mathieu Bignon
- CHU de Caen Normandie, Service de Cardiologie, Caen, 14000, France
| | - Pierre Ardouin
- CHU de Caen Normandie, Service de Cardiologie, Caen, 14000, France
| | - Rémi Sabatier
- CHU de Caen Normandie, Service de Cardiologie, Caen, 14000, France
| | | | - Farzin Beygui
- CHU de Caen Normandie, Service de Cardiologie, Caen, 14000, France.,UNICAEN, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, Normandie Univ, Caen, 14000, France
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23
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Blanchart K, Heudel T, Ardouin P, Lemaitre A, Briet C, Bignon M, Sabatier R, Legallois D, Roule V, Beygui F. Glycoprotein IIb/IIIa inhibitors use in the setting of primary percutaneous coronary intervention for ST elevation myocardial infarction in patients pre-treated with newer P2Y12 inhibitors. Clin Cardiol 2021; 44:1080-1088. [PMID: 34114653 PMCID: PMC8364724 DOI: 10.1002/clc.23654] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 05/07/2021] [Accepted: 05/18/2021] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES We sought to investigate the safety and potential benefit of administrating glycoprotein IIb-IIIa inhibitors (GPIs) on top of more potent P2Y12 inhibitors. BACKGROUND A number of clinical trials, performed at a time when pretreatment and potent platelet inhibition was not part of routine clinical practice, have documented clinical benefits of GPI in ST-segment elevation myocardial infarction (STEMI) patients at the cost of a higher risk of bleeding. METHODS We used the data of a prospective, ongoing registry of patients admitted for STEMI in our center. For the purpose of this study only patients presenting for primary percutaneous coronary intervention and pretreated with new P2Y12 inhibitors (prasugrel or ticagrelor) were included. We compared patients who received GPI with those who did not. RESULTS Eight hundred twenty-four STEMI patients were included in our registry; GPIs were used in 338 patients (41%). GPI patients presented more often with cardiogenic shock and Thrombolysis in myocardial infarction (TIMI) flow grade <3. GPI use was not associated with an increase in in-hospital or 3-month mortality. Bleeding endpoints were similar in both groups. CONCLUSIONS Our study suggests that GPI may be used safely in combination with recent P2Y12 inhibitors in STEMI patients in association with modern primary percutaneous coronary intervention strategies (radial access and anticoagulation with enoxaparin) with similar bleeding and mortality rates at hospital discharge and 3-month follow-up.
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Affiliation(s)
| | | | | | | | - Clément Briet
- CHU de Caen Normandie, Service de CardiologieCaenFrance
| | | | - Rémi Sabatier
- CHU de Caen Normandie, Service de CardiologieCaenFrance
| | - Damien Legallois
- CHU de Caen Normandie, Service de CardiologieCaenFrance
- Normandie Univ, UNICAEN, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie‐reperfusion myocardiqueCaenFrance
| | - Vincent Roule
- CHU de Caen Normandie, Service de CardiologieCaenFrance
- Normandie Univ, UNICAEN, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie‐reperfusion myocardiqueCaenFrance
| | - Farzin Beygui
- CHU de Caen Normandie, Service de CardiologieCaenFrance
- Normandie Univ, UNICAEN, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie‐reperfusion myocardiqueCaenFrance
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24
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Didier R, Lhermusier T, Auffret V, Eltchaninoff H, Le Breton H, Cayla G, Commeau P, Collet JP, Cuisset T, Dumonteil N, Verhoye JP, Beurtheret S, Lefèvre T, Teiger E, Carrié D, Himbert D, Albat B, Cribier A, Sudre A, Blanchard D, Bar O, Rioufol G, Collet F, Houel R, Labrousse L, Meneveau N, Ghostine S, Manigold T, Guyon P, Delepine S, Favereau X, Souteyrand G, Ohlmann P, Doisy V, Beygui F, Gommeaux A, Claudel JP, Bourlon F, Bertrand B, Iung B, Gilard M. TAVR Patients Requiring Anticoagulation: Direct Oral Anticoagulant or Vitamin K Antagonist? JACC Cardiovasc Interv 2021; 14:1704-1713. [PMID: 34274294 DOI: 10.1016/j.jcin.2021.05.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Using French transcatheter aortic valve replacement (TAVR) registries linked with the nationwide administrative databases, the study compared the rates of long-term mortality, bleeding, and ischemic events after TAVR in patients requiring oral anticoagulation with direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs). BACKGROUND The choice of optimal drug for anticoagulation after TAVR remains debated. METHODS Data from the France-TAVI and FRANCE-2 registries were linked to the French national health single-payer claims database, from 2010 to 2017. Propensity score matching was used to reduce treatment-selection bias. Two primary endpoints were death from any cause (efficacy) and major bleeding (safety). RESULTS A total of 24,581 patients who underwent TAVR were included and 8,962 (36.4%) were treated with OAC. Among anticoagulated patients, 2,180 (24.3%) were on DOACs. After propensity matching, at 3 years, mortality (hazard ratio [HR]: 1.37; 95% confidence interval [CI]: 1.12-1.67; P < 0.005) and major bleeding including hemorrhagic stroke (HR: 1.64; 95% CI: 1.17-2.29; P < 0.005) were lower in patients on DOACs compared with those on VKAs. The rates of ischemic stroke (HR: 1.32; 95% CI: 0.81-2.15; P = 0.27) and acute coronary syndrome (HR: 1.17; 95% CI: 0.68-1.99; P = 0.57) did not differ among groups. CONCLUSIONS In these large multicenter French TAVR registries with an exhaustive clinical follow-up, the long-term mortality and major bleeding were lower with DOACs than VKAs at discharge. The present study supports preferential use of DOACs rather than VKAs in patients requiring oral anticoagulation therapy after TAVR.
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Affiliation(s)
- Romain Didier
- Department of Cardiology, Brest University Hospital, Brest, France
| | | | | | | | | | | | | | - Jean Philippe Collet
- Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | | | | | | | | | - Emmanuel Teiger
- University Hospital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Dominique Himbert
- Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Bernard Albat
- University Hospital of Montpellier, Montpellier, France
| | | | | | - Didier Blanchard
- University Hospital Paris Ouest, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | | | | | - Remi Houel
- Saint Joseph Hospital, Marseille, France
| | | | | | - Said Ghostine
- Hospital Marie Lannelongue, Le Plessis-Robinson, France
| | - Thibaut Manigold
- University of Nantes, Department of Cardiologie, Saint-Herblain, France
| | | | | | - Xavier Favereau
- Private Hospital of Parly II, Le Chesnay-Rocquencourt, France
| | | | | | | | | | | | | | | | - Bernard Bertrand
- Department of Cardiology, Grenoble Alpes University Hospital, Grenoble, France
| | - Bernard Iung
- Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Martine Gilard
- Department of Cardiology, Brest University Hospital, Brest, France.
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25
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Roule V, Lemaitre A, Pommier W, Bignon M, Sabatier R, Blanchart K, Beygui F. Safety and efficacy of very short dual antiplatelet therapy followed by P2Y12 inhibitor monotherapy in older patients undergoing percutaneous coronary intervention: meta-analysis of randomised controlled trials. Age Ageing 2021; 50:1102-1107. [PMID: 33755049 DOI: 10.1093/ageing/afab047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 09/02/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND older patients undergoing percutaneous coronary intervention (PCI) represent a growing population sharing both a high ischemic and bleeding risk. Dual antiplatelet therapy (DAPT) reduces the incidence of thrombotic events but exposes patients to an increased risk of bleeding and subsequent mortality. Its optimal duration after PCI remains unclear. OBJECTIVE to assess the impact of short-duration DAPT on both bleeding and ischemic events in the specific population of older patients undergoing PCI. METHODS we performed a meta-analysis of randomised controlled trials comparing the safety and efficacy of standard versus very short duration (≤ 3 months, followed by P2Y12 inhibitor monotherapy) DAPT after PCI with a drug-eluting stent in older patients. RESULTS four studies, representing 8,961 older patients, were finally included. Compared with standard duration, short-duration DAPT was associated with similar rates of major bleeding (relative risks, RR 0.70 [0.47; 1.05]) and the composite efficacy endpoint (RR 0.85 [0.63; 1.14]). There was a high level of heterogeneity between the studies (I2 = 68%) regarding major bleeding. CONCLUSION our meta-analysis suggests that short DAPT may be a valid option in older patients after PCI but it also highlights the need for specific studies in such patients on optimal duration of antiplatelet therapy.
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Affiliation(s)
- Vincent Roule
- CHU de Caen Normandie, Service de Cardiologie, 14000 Caen, France
- Normandie Univ, UNICAEN, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, 14000 Caen, France
| | - Adrien Lemaitre
- CHU de Caen Normandie, Service de Cardiologie, 14000 Caen, France
| | - Wilhelm Pommier
- CHU de Caen Normandie, Service de Gériatrie, 14000 Caen, France
| | - Mathieu Bignon
- CHU de Caen Normandie, Service de Cardiologie, 14000 Caen, France
| | - Rémi Sabatier
- CHU de Caen Normandie, Service de Cardiologie, 14000 Caen, France
| | | | - Farzin Beygui
- CHU de Caen Normandie, Service de Cardiologie, 14000 Caen, France
- Normandie Univ, UNICAEN, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, 14000 Caen, France
- ACTION Academic Group, Pitié Salpêtrière University Hospital, 75013, Paris, France
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26
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Sinning C, Ahrens I, Cariou A, Beygui F, Lamhaut L, Halvorsen S, Nikolaou N, Nolan JP, Price S, Monsieurs K, Behringer W, Cecconi M, Van Belle E, Jouven X, Hassager C. The cardiac arrest centre for the treatment of sudden cardiac arrest due to presumed cardiac cause - aims, function and structure: Position paper of the Association for Acute CardioVascular Care of the European Society of Cardiology (AVCV), European Association of Percutaneous Coronary Interventions (EAPCI), European Heart Rhythm Association (EHRA), European Resuscitation Council (ERC), European Society for Emergency Medicine (EUSEM) and European Society of Intensive Care Medicine (ESICM). Eur Heart J Acute Cardiovasc Care 2021; 9:S193-S202. [PMID: 33327761 DOI: 10.1177/2048872620963492] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Approximately 10% of patients resuscitated from out-of-hospital cardiac arrest survive to hospital discharge. Improved management to improve outcomes is required, and it is proposed that such patients should be preferentially treated in cardiac arrest centres. The minimum requirements of therapy modalities for the cardiac arrest centre are 24/7 availability of an on-site coronary angiography laboratory, an emergency department, an intensive care unit, imaging facilities such as echocardiography, computed tomography and magnetic resonance imaging, and a protocol outlining transfer of selected patients to cardiac arrest centres with additional resources (out-of-hospital cardiac arrest hub hospitals). These hub hospitals are regularly treating a high volume of patients and offer further treatment modalities. This consensus document describes the aims, the minimal requirements for therapeutic modalities and expertise, and the structure, of a cardiac arrest centre. It represents a consensus among the major European medical associations and societies involved in the treatment of out-of-hospital cardiac arrest patients.
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Affiliation(s)
- Christoph Sinning
- Department of Cardiology, University Heart and Vascular Center Hamburg, Germany.,Association for Acute CardioVascular Care (ACVC)
| | - Ingo Ahrens
- Association for Acute CardioVascular Care (ACVC).,Clinic of Cardiology and Medical Intensive Care, Augustinerinnen Hospital, Germany
| | - Alain Cariou
- Cochin University Hospital (APHP)-Université de Paris-INSERM U970 (Team 4 "Sudden Death Expertise Centre"), Paris, France
| | - Farzin Beygui
- Association for Acute CardioVascular Care (ACVC).,Department of Cardiology, Caen University Hospital, France
| | - Lionel Lamhaut
- Association for Acute CardioVascular Care (ACVC).,SAMU de Paris-DAR Necker Université Hospital-Assistance Public Hopitaux de Paris, France.,Department of Cardiology, CHU Lille, France
| | - Sigrun Halvorsen
- Association for Acute CardioVascular Care (ACVC).,Department of Cardiology, Oslo University Hospital Ullevål, Norway
| | - Nikolaos Nikolaou
- Konstantopouleio General Hospital, Greece.,European Resuscitation Council (ERC)
| | - Jerry P Nolan
- European Resuscitation Council (ERC).,Department of Anaesthesia, Royal United Hospital Bath NHS Trust, UK
| | - Susanna Price
- Association for Acute CardioVascular Care (ACVC).,Imperial College London, UK
| | - Koenraad Monsieurs
- Department of Emergency Medicine, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium.,European Society for Emergency Medicine (EUSEM)
| | - Wilhelm Behringer
- European Society for Emergency Medicine (EUSEM).,Centre of Emergency Medicine, Friedrich-Schiller University Jena, Germany
| | - Maurizio Cecconi
- Department of Anesthesia and Intensive Care, Humanitas Clinical and Research Center - IRCCS, Italy.,European Society of Intensive Care Medicine (ESICM)
| | - Eric Van Belle
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, CHU Lille, Institut Coeur Poumon, Cardiology, INSERM U1011, Institut Pasteur de Lille, Lille, France
| | - Xavier Jouven
- Paris Sudden Death Expertise Center, Hôpital Européen Georges Pompidou APHP, Université de Paris INSERM UMRS-970 Paris, France
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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27
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Fontaine F, Legallois D, Créveuil C, Chtourou M, Coulbault L, Milliez P, Hodzic A, Saloux E, Beygui F, Allouche S. Is plasma concentration of coenzyme Q10 a predictive marker for left ventricular remodelling after revascularization for ST-segment elevation myocardial infarction? Ann Clin Biochem 2021; 58:327-334. [PMID: 33622041 DOI: 10.1177/00045632211001100] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Left ventricular remodelling that frequently occurs after acute myocardial infarction is associated with an increased risk of heart failure and cardiovascular death. Although several risk factors have been identified, there is still no marker in clinical use to predict left ventricular remodelling. Plasma concentration of coenzyme Q10, which plays a key role in mitochondrial energy production and as an antioxidant, seems to be negatively correlated with left ventricular function after acute myocardial infarction. OBJECTIVE The goal of our study was to determine whether the plasma coenzyme Q10 baseline concentrations at time of the ST-elevation myocardial infarction (STEMI) could predict left ventricular remodelling at six months' follow-up. METHODS Sixty-eight patients who were admitted to hospital for STEMI and successfully revascularized with primary percutaneous coronary intervention were recruited. All patients underwent a 3D-echocardiography examination within the first four days after percutaneous coronary intervention and six months later then divided into two groups based on the presence or not of left ventricular remodelling. Plasma coenzyme Q10 concentration at the time of percutaneous coronary intervention was determined using high-performance liquid chromatography-tandem mass spectrometry. RESULTS While we found similar plasma coenzyme Q10 concentrations compared with other studies, no association was evidenced between coenzyme Q10 concentrations and left ventricular remodelling (P = 0.89). CONCLUSION We found no evidence for using plasma coenzyme Q10 concentration as an early prediction marker of left ventricular remodelling after STEMI.
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Affiliation(s)
- Fanny Fontaine
- Department of Biochemistry, University Hospital of Caen, Caen, France
| | - Damien Legallois
- Department of Cardiology, University Hospital of Caen, Caen, France.,Department of Signalisation, Électrophysiologie et Imagerie des Lésions d'Ischémie-Reperfusion Myocardique EA4650, Normandie Univ, UNICAEN, Caen, France
| | - Christian Créveuil
- Department of Biostatistics and Clinical Research, University Hospital of Caen, Caen, France
| | - Mohamed Chtourou
- Department of Biochemistry, University Hospital of Caen, Caen, France
| | - Laurent Coulbault
- Department of Biochemistry, University Hospital of Caen, Caen, France.,Department of Signalisation, Électrophysiologie et Imagerie des Lésions d'Ischémie-Reperfusion Myocardique EA4650, Normandie Univ, UNICAEN, Caen, France
| | - Paul Milliez
- Department of Cardiology, University Hospital of Caen, Caen, France.,Department of Signalisation, Électrophysiologie et Imagerie des Lésions d'Ischémie-Reperfusion Myocardique EA4650, Normandie Univ, UNICAEN, Caen, France
| | - Amir Hodzic
- Department of Clinical Physiology, INSERM Comete, Normandie Univ, UNICAEN, Caen, France
| | - Eric Saloux
- Department of Cardiology, University Hospital of Caen, Caen, France.,Department of Signalisation, Électrophysiologie et Imagerie des Lésions d'Ischémie-Reperfusion Myocardique EA4650, Normandie Univ, UNICAEN, Caen, France
| | - Farzin Beygui
- Department of Cardiology, University Hospital of Caen, Caen, France.,Department of Signalisation, Électrophysiologie et Imagerie des Lésions d'Ischémie-Reperfusion Myocardique EA4650, Normandie Univ, UNICAEN, Caen, France
| | - Stéphane Allouche
- Department of Biochemistry, University Hospital of Caen, Caen, France.,Department of Signalisation, Électrophysiologie et Imagerie des Lésions d'Ischémie-Reperfusion Myocardique EA4650, Normandie Univ, UNICAEN, Caen, France
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28
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Collard F, Buklas D, Maragnes P, Milliez P, Beygui F, Labombarda F. High-risk congenital coronary abnormalities in patients with bicuspid aortic valve. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.299] [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: 12/01/2022]
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29
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Labombarda F, Bonopéra M, Maragnes P, Milliez P, Manrique A, Beygui F. Impaired left atrial function in adults and adolescents with corrected aortic coarctation. Pediatr Cardiol 2021; 42:199-209. [PMID: 32975604 DOI: 10.1007/s00246-020-02471-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/18/2020] [Indexed: 11/30/2022]
Abstract
This study examined the left atrial (LA) function using two-dimensional (2D) strain analysis after aortic coarctation (CoA) repair, as well as relationships between LA function and patient characteristics, especially aortic arch anatomy. 56 patients (34 males, age: 31 ± 16 years) with CoA repair (46 post 'end-to-end anastomosis/subclavian flap') and 56 controls were studied. 2D strain imaging was performed to assess left ventricular (LV) and LA functions including peak-positive LA strain, early and late diastolic LA strains, and global longitudinal (LV-GLS) and circumferential (LV-GCS) strains. LA dysfunction (LAD) was defined as a peak-positive LA strain value lower than the mean value of the control group minus 2 SDs. Peak-positive LA strain, early and late diastolic LA strains, and LV-GLS were significantly lower in the CoA group while LV-GCS did not differ. No significant correlation was found between LA strain and either current age, age at initial repair, or blood pressure; Ea and LV-GLS were moderately correlated to peak-positive LA strain (r = 0.49, p < 0.001 and r = - 0.55, p < 0.001, respectively). 23 CoA patients (41%) presented LAD (abnormal peak-positive LA strain < 25%). Among patients who underwent end-to-end anastomosis/subclavian flap, those with a non-romanesque aortic arch anatomy exhibited a significantly lower peak-positive LA strain. Ischemic stroke and atrial arrhythmia were more frequent in CoA patients with LAD. Our findings suggest that LAD may be prevalent late after CoA repair. Postoperative aortic arch anatomy may impact peak-positive LA strain.
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Affiliation(s)
- Fabien Labombarda
- Department of Cardiology, CHU de Caen, Avenue cote de nacre, 14000, Caen, France. .,Medical School, UNICAEN, CHU Caen, Université Caen Normandie, 4650, Caen, EA, France. .,Signalisation, Electrophysiologie et Imagerie des Lésions d'ischémie-Reperfusion Myocardique, 14000, Caen, France.
| | - Maud Bonopéra
- Department of Cardiology, CHU de Caen, Avenue cote de nacre, 14000, Caen, France
| | - Pascale Maragnes
- Department of Cardiology, CHU de Caen, Avenue cote de nacre, 14000, Caen, France
| | - Paul Milliez
- Department of Cardiology, CHU de Caen, Avenue cote de nacre, 14000, Caen, France.,Medical School, UNICAEN, CHU Caen, Université Caen Normandie, 4650, Caen, EA, France.,Signalisation, Electrophysiologie et Imagerie des Lésions d'ischémie-Reperfusion Myocardique, 14000, Caen, France
| | - Alain Manrique
- Medical School, UNICAEN, CHU Caen, Université Caen Normandie, 4650, Caen, EA, France.,Signalisation, Electrophysiologie et Imagerie des Lésions d'ischémie-Reperfusion Myocardique, 14000, Caen, France
| | - Farzin Beygui
- Department of Cardiology, CHU de Caen, Avenue cote de nacre, 14000, Caen, France.,Medical School, UNICAEN, CHU Caen, Université Caen Normandie, 4650, Caen, EA, France.,Signalisation, Electrophysiologie et Imagerie des Lésions d'ischémie-Reperfusion Myocardique, 14000, Caen, France
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30
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Silvain J, Lattuca B, Beygui F, Rangé G, Motovska Z, Dillinger JG, Boueri Z, Brunel P, Lhermusier T, Pouillot C, Larrieu-Ardilouze E, Boccara F, Labeque JN, Guedeney P, El Kasty M, Laredo M, Dumaine R, Ducrocq G, Collet JP, Cayla G, Blanchart K, Kala P, Vicaut E, Montalescot G. Ticagrelor versus clopidogrel in elective percutaneous coronary intervention (ALPHEUS): a randomised, open-label, phase 3b trial. Lancet 2020; 396:1737-1744. [PMID: 33202219 DOI: 10.1016/s0140-6736(20)32236-4] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 10/16/2020] [Accepted: 10/22/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI)-related myonecrosis is frequent and can affect the long-term prognosis of patients. To our knowledge, ticagrelor has not been evaluated in elective PCI and could reduce periprocedural ischaemic complications compared with clopidogrel, the currently recommended treatment. The aim of the ALPHEUS study was to examine if ticagrelor was superior to clopidogrel in reducing periprocedural myocardial necrosis in stable coronary patients undergoing high-risk elective PCI. METHODS The ALPHEUS study, a phase 3b, randomised, open-label trial, was done at 49 hospitals in France and Czech Republic. Patients with stable coronary artery disease were eligible for the study if they had an indication for PCI and at least one high-risk characteristic. Eligible patients were randomly assigned (1:1) to either ticagrelor (180 mg loading dose, 90 mg twice daily thereafter for 30 days) or clopidogrel (300-600 mg loading dose, 75 mg daily thereafter for 30 days) by use of an interactive web response system, and stratified by centre. The primary outcome was a composite of PCI-related type 4 (a or b) myocardial infarction or major myocardial injury and the primary safety outcome was major bleeding, both of which were evaluated within 48 h of PCI (or at hospital discharge if earlier). The primary analysis was based on all events that occurred in the intention-to-treat population. The trial was registered with ClinicalTrials.gov, NCT02617290. FINDINGS Between Jan 9, 2017, and May 28, 2020, 1910 patients were randomly assigned at 49 sites, 956 to the ticagrelor group and 954 to the clopidogrel group. 15 patients were excluded from the ticagrelor group and 12 from the clopidogrel group. At 48 h, the primary outcome was observed in 334 (35%) of 941 patients in the ticagrelor group and 341 (36%) of 942 patients in the clopidogrel group (odds ratio [OR] 0·97, 95% CI 0·80-1·17; p=0·75). The primary safety outcome did not differ between the two groups, but minor bleeding events were more frequently observed with ticagrelor than clopidogrel at 30 days (105 [11%] of 941 patients in the ticagrelor group vs 71 [8%] of 942 patients in the clopidogrel group; OR 1·54, 95% CI 1·12-2·11; p=0·0070). INTERPRETATION Ticagrelor was not superior to clopidogrel in reducing periprocedural myocardial necrosis after elective PCI and did not cause an increase in major bleeding, but did increase the rate of minor bleeding at 30 days. These results support the use of clopidogrel as the standard of care for elective PCI. FUNDING ACTION Study Group and AstraZeneca.
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Affiliation(s)
- Johanne Silvain
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Benoit Lattuca
- ACTION Study Group, Cardiology Department, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Farzin Beygui
- ACTION Study Group, Département de Cardiologie, CHU de Caen, Caen, France
| | - Grégoire Rangé
- Département de Cardiologie, CH de Chartres, Chartres, France
| | - Zuzana Motovska
- Third Faculty of Medicine, Charles University and Cardiocentre Kralovske Vinohrady, Prague, Czech Republic
| | - Jean-Guillaume Dillinger
- Université de Paris, Department of Cardiology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, INSERM U942, Paris, France
| | - Ziad Boueri
- ACTION Study Group, Département de Cardiologie, CH de Bastia, Bastia, France
| | - Philippe Brunel
- Hôpital Privé Dijon Bourgogne-Cardiologie Interventionelle GCIDB VALMY, Dijon, France
| | | | | | | | - Franck Boccara
- AP-HP, Hôpitaux de l'Est Parisien, Hôpital Saint-Antoine, Department of Cardiology, Sorbonne Université-INSERM UMR S_938, Centre de Recherche Saint-Antoine, Paris, France
| | | | - Paul Guedeney
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Mohamad El Kasty
- Département de Cardiologie, Grand Hôpital de l'Est Francilien site Marne-La-Vallée, Marne-la-Vallée, France
| | - Mikael Laredo
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Raphaëlle Dumaine
- Les Grands Prés Cardiac Rehabilitation Centre, Villeneuve St Denis, France
| | - Grégory Ducrocq
- Université de Paris, Hôpital Bichat, AP-HP, French Alliance for Cardiovascular Trials (FACT), INSERM U1148, Paris, France
| | - Jean-Philippe Collet
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Guillaume Cayla
- ACTION Study Group, Cardiology Department, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Katrien Blanchart
- ACTION Study Group, Département de Cardiologie, CHU de Caen, Caen, France
| | - Petr Kala
- University Hospital Brno, Medical Faculty of Masaryk University Brno, Brno, Czech Republic
| | - Eric Vicaut
- ACTION Study Group, Unité de Recherche Clinique, Hôpital Fernand Widal (AP-HP), Paris, France; Statistique, Analyse et Modélisation Multidisciplinaire EA 4543, Université Paris 1 Panthéon Sorbonne, Paris, France
| | - Gilles Montalescot
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France.
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31
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Arbault-Biton C, Chenevier-Gobeaux C, Legallois D, Msadek S, Boubaya M, Roule V, Boukertouta T, Goudot FX, Beygui F, Meune C. Multiple biomarkers measurement to estimate the duration of atrial fibrillation. Ann Clin Biochem 2020; 58:102-107. [PMID: 33143434 DOI: 10.1177/0004563220975171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND An accurate estimation of the duration of atrial fibrillation is critical for its safe management. Recent studies suggested that copeptin, carbohydrate antigen-125, galectin-3 and growth differentiation factor-15 are increased in atrial fibrillation. We examined the ability of these markers to identify patients presenting with atrial fibrillation of ≤48 versus >48 h duration. METHODS Retrospective analysis of a prospective study that included patients with atrial fibrillation of known duration. RESULTS A total of 98 patients were analysed, 47 with atrial fibrillation ≤48 h and 51 with >48 h. In patients presenting with atrial fibrillation of ≤48 versus >48 h duration, the mean carbohydrate antigen-125 concentration was 16.9 ± 12.5 versus 30.9 ± 36.3 U/mL (P = 0.01), and growth differentiation factor-15 concentration was 1320 ± 889 versus 2608 ±2163 pg/mL (P < 0.001). Copeptin concentration was not independently associated with atrial fibrillation duration. The galectin-3 concentration did not differ between groups. Area under the ROC curve to identify patients with atrial fibrillation ≤48 h was 0.869 for carbohydrate antigen-125, 0.853 for growth differentiation factor-15. CONCLUSION The plasma concentrations of carbohydrate antigen-125, growth differentiation factor-15 and copeptin, but not galectin-3, are higher in patients presenting with atrial fibrillation of >48 h duration than in those with atrial fibrillation ≤48 h. The ability to discriminate recent atrial fibrillation offered by carbohydrate antigen-125 and growth differentiation factor-15 seems high.
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Affiliation(s)
- Chloé Arbault-Biton
- Cardiology Department, Avicenne University Hospital, APHP, Université Sorbonne Paris Nord, Bobigny, France
| | - Camille Chenevier-Gobeaux
- Department of Automated Biological Diagnostic, Cochin University Hospital, APHP.Centre-Université Paris, Paris, France
| | | | - Sonia Msadek
- Cardiology Department, Avicenne University Hospital, APHP, Université Sorbonne Paris Nord, Bobigny, France
| | - Marouane Boubaya
- Department of Clinical Research, Avicenne University Hospital, APHP, Bobigny, France
| | - Vincent Roule
- Cardiology Department, Caen University Hospital, Caen, France
| | - Tanissia Boukertouta
- Cardiology Department, Avicenne University Hospital, APHP, Université Sorbonne Paris Nord, Bobigny, France
| | - Francois-Xavier Goudot
- Cardiology Department, Avicenne University Hospital, APHP, Université Sorbonne Paris Nord, Bobigny, France
| | - Farzin Beygui
- Cardiology Department, Caen University Hospital, Caen, France
| | - Christophe Meune
- Cardiology Department, Avicenne University Hospital, APHP, Université Sorbonne Paris Nord, Bobigny, France
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32
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Rangé G, Hakim R, Beygui F, Angoulvant D, Marcollet P, Godin M, Deballon R, Bonnet P, Fichaux O, Barbey C, Viallard L, Lesault PF, Durand E, Boiffard E, Dutheil G, Collet JP, Benamer H, Commeau P, Montalescot G, Koning R, Motreff P. Incidence, delays, and outcomes of STEMI during COVID-19 outbreak: Analysis from the France PCI registry. J Am Coll Emerg Physicians Open 2020; 1:1168-1176. [PMID: 33363285 PMCID: PMC7753646 DOI: 10.1002/emp2.12325] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 08/20/2020] [Revised: 10/29/2020] [Accepted: 10/29/2020] [Indexed: 12/29/2022] Open
Abstract
Objectives The aim of this study was to assess the impact of the coronavirus disease 2019 (COVID‐19) outbreak on incidence, delays, and outcomes of ST‐elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI) in France. Methods We analyzed all patients undergoing PPCI <24 hours STEMI included in the prospective France PCI registry. The 2 groups were compared on mean monthly number of patients, delays in the pathway care, and in‐hospital major adverse cardiac events (MACE: death, stent thrombosis, myocardial infarction, unplanned coronary revascularization, stroke, and major bleeding). Results From January 15, 2019 to April 14, 2020, 2064 STEMI patients undergoing PPCI were included: 1942 in the prelockdown group and 122 in the lockdown group. Only 2 cases in the lockdown group were positive for COVID‐19. A significant drop (12%) in mean number of STEMI/month was observed in the lockdown group compared with prelockdown (139 vs 122, P < 0.04). A significant increase in “symptom onset to first medical contact” delay was found for patients who presented directly to the emergency department (ED) (238 minutes vs 450 minutes; P = 0.04). There were higher rates of in‐hospital MACE (7.7% vs 12.3%; P = 0.06) and mortality (4.9% vs 8.2%; P = 0.11) in the lockdown group but the differences were not significant. Conclusion According to the multicenter France PCI registry, the COVID‐19 outbreak in France was associated with a significant decline in STEMI undergoing PPCI and longer transfer time for patients who presented directly to the ED. Mortality rates doubled, but the difference was not statistically significant.
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Affiliation(s)
- Grégoire Rangé
- Cardiology department Les hôpitaux de Chartres Chartres France
| | - Radwan Hakim
- Cardiology department Les hôpitaux de Chartres Chartres France
| | - Farzin Beygui
- Cardiology Department Centre Hospitalier Universitaire de Caen Caen France
| | - Denis Angoulvant
- Cardiology Department Centre Hospitalier Universitaire de Tours Tours France
| | - Pierre Marcollet
- Cardiology Department Centre Hospitalier Jacques Coeur Bourges France
| | - Matthieu Godin
- Cardiology Department Clinique Saint-Hilaire Rouen France
| | | | - Philippe Bonnet
- Cardiology Department Centre Hospitalier Le Havre Le Havre France
| | - Olivier Fichaux
- Cardiology Department Centre Hospitalier Régional d'Orléans Orléans France
| | - Christophe Barbey
- Cardiology Department Nouvelle Clinique Tourengelle, Saint-Cyr-sur-Loire France
| | - Louis Viallard
- Cardiology Department Centre Hospitalier Henri Mondor Aurillac France
| | | | - Eric Durand
- Cardiology Department UNIROUEN INSERM U1096 Rouen University Hospital Department of Cardiology Normandie Univ FHU REMOD-VHF Rouen F76000 France
| | - Emmanuel Boiffard
- Cardiology Department Centre Hospitalier Départemental Vendée La Roche-sur-Yon France
| | - Gerard Dutheil
- Cardiology Department Clinique Bergouignan Evreux France
| | | | - Hakim Benamer
- Cardiology Department Clinique de la Roseraie Soissons France
| | | | | | - Rene Koning
- Cardiology Department Clinique Saint-Hilaire Rouen France
| | - Pascal Motreff
- Cardiology Department Centre Hospitalier Universitaire de Clermont-Ferrand Clermont-Ferrand France
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33
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Labombarda F, Mulet B, Maragnes P, Beygui F. Impaired left atrial stiffness in patients with corrected congenital left ventricular outflow obstructions. Echocardiography 2020; 38:47-56. [PMID: 33174642 DOI: 10.1111/echo.14925] [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: 10/01/2020] [Accepted: 10/24/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE We examined the left atrial stiffness index (LA Stiff) on echocardiography and its determinants in adults and adolescents with repaired congenital left ventricular outflow obstructions (c-LVOOs), including isolated subaortic stenosis (SAS), stenotic bicuspid aortic valve (BAV), and aortic coarctation (CoA). METHODS Seventy-two patients (43 males, age: 31 ± 15 years) with repaired c-LVOOs (SAS: n = 12; BAV: n = 27; CoA: n = 33) were compared to 72 age- and sex-matched controls. 2D strain imaging was performed to assess left ventricular (LV) and LA function, including peak positive longitudinal LA strain (LAS), late diastolic LA strain (LDS), and LV global longitudinal strain (GLS). The (E/Ea)/LAS ratio was used to calculate LA Stiff. RESULTS LA Stiff was significantly higher in the c-LVOO group than in the control group. Among the c-LVOO patients, the CoA group had the lowest GLS and the highest LA Stiff; no significant differences were found with respect to sex, hypertension history, smoking status, or repeated repair among c-LVOO subtypes. Multivariable regression analysis with the variables "BMI" and "c-LVOO subtype" revealed that BMI and c-LVOO subtypes were independently associated with LA Stiff (b = 0.290, P = .009 and b = 0.353, P = .002, respectively). CONCLUSIONS We documented abnormal LA Stiff values in adults and adolescents after c-LVOO repair. Patients with CoA demonstrated the most impaired LA Stiff values. Overweight may contribute to worse LA Stiff values. Further studies are required to determine the prognostic implications of LA Stiff in patients with repaired c-LVOOs.
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Affiliation(s)
- Fabien Labombarda
- Department of Cardiology, CHU de Caen, Caen, France.,Medical School, Université Caen Normandie, UNICAEN, CHU Caen, Caen, France
| | - Benoit Mulet
- Department of Pediatry, CHU de Caen, Caen, France
| | | | - Farzin Beygui
- Department of Cardiology, CHU de Caen, Caen, France.,Medical School, Université Caen Normandie, UNICAEN, CHU Caen, Caen, France
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34
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Sinning C, Ahrens I, Cariou A, Beygui F, Lamhaut L, Halvorsen S, Nikolaou N, Nolan JP, Price S, Monsieurs K, Behringer W, Cecconi M, Van Belle E, Jouven X, Hassager C, Sionis A, Qvigstad E, Huber K, De Backer D, Kunadian V, Kutyifa V, Bossaert L. The cardiac arrest centre for the treatment of sudden cardiac arrest due to presumed cardiac cause: aims, function, and structure: position paper of the ACVC association of the ESC, EAPCI, EHRA, ERC, EUSEM, and ESICM. European Heart Journal. Acute Cardiovascular Care 2020. [DOI: 10.1093/ehjacc/zuaa024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Abstract
Approximately 10% of patients resuscitated from out-of-hospital cardiac arrest (OHCA) survive to hospital discharge. Improved management to improve outcomes are required, and it is proposed that such patients should be preferentially treated in cardiac arrest centres (CACs). The minimum requirements of therapy modalities for the CAC are 24/7 availability of an on-site coronary angiography laboratory, an emergency department, an intensive care unit, imaging facilities, such as echocardiography, computed tomography, and magnetic resonance imaging, and a protocol outlining transfer of selected patients to CACs with additional resources (OHCA hub hospitals). These hub hospitals are regularly treating a high volume of patients and offer further treatment modalities. This consensus document describes the aims, the minimal requirements for therapeutic modalities and expertise, and the structure, of a CAC. It represents a consensus among the major European medical associations and societies involved in the treatment of OHCA patients.
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Affiliation(s)
| | - Ingo Ahrens
- For the Association for Acute CardioVascular Care (ACVC)
- Clinic of Cardiology and Medical Intensive Care, Augustinerinnen Hospital, Cologne, Germany
| | - Alain Cariou
- For the Association for Acute CardioVascular Care (ACVC)
- Cochin University Hospital (APHP)—Université de Paris—INSERM U970 (Team 4 “Sudden Death Expertise Centre”), Paris, France
| | - Farzin Beygui
- For the Association for Acute CardioVascular Care (ACVC)
- Department of Cardiology, Caen University Hospital, Caen, France
| | - Lionel Lamhaut
- For the Association for Acute CardioVascular Care (ACVC)
- SAMU de Paris-DAR Necker Université Hospital-Assistance Public Hopitaux de Paris, Paris, France
- Université Paris Descartes, INSERM UMRS-970, Paris Cardiovasculare Research Centre, Paris, France
| | - Sigrun Halvorsen
- For the Association for Acute CardioVascular Care (ACVC)
- Department of Cardiology, Oslo University Hospital Ullevål, and University of Oslo, Oslo, Norway
| | - Nikolaos Nikolaou
- Konstantopouleio General Hospital, Athens, Greece
- For the European Resuscitation Council (ERC)
| | - Jerry P Nolan
- For the European Resuscitation Council (ERC)
- Warwick Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK
- Department of Anaesthesia, Royal United Hospital Bath NHS Trust, Bath, UK
| | - Susanna Price
- For the Association for Acute CardioVascular Care (ACVC)
- Imperial College London, London, UK
| | - Koenraad Monsieurs
- Department of Emergency Medicine, Antwerp University Hospital and University Antwerp, Antwerp, Belgium
- For the European Society for Emergency Medicine (EUSEM)
| | - Wilhelm Behringer
- For the European Society for Emergency Medicine (EUSEM)
- Centre of Emergency Medicine, Friedrich-Schiller University Jena, Jena, Germany
| | - Maurizio Cecconi
- Department of Anesthesia and Intensive Care, Humanitas Clinical and Research Center—IRCCS, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- For the European Society of Intensive Care Medicine (ESICM)
| | - Eric Van Belle
- Université Paris Descartes, INSERM UMRS-970, Paris Cardiovasculare Research Centre, Paris, France
- For the European Association of Percutaneous Coronary Interventions (EAPCI)
| | - Xavier Jouven
- Paris Sudden Death Expertise Center, Hôpital Européen Georges Pompidou APHP, Université de Paris INSERM UMRS-970 Paris, France
- For the European Heart Rhythm Association (EHRA)
| | - Christian Hassager
- For the Association for Acute CardioVascular Care (ACVC)
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Alessandro Sionis
- Cardiology Department, Intensive Cardiac Care Unit, Hospital de la Santa Creu i Sant Pau, Universidad Autònoma de Barcelona, Barcelona, Spain
| | - Eirik Qvigstad
- Department of Cardiology, Oslo University Hospital Ullevål, and University of Oslo, Oslo, Norway
| | - Kurt Huber
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria
- Medical School, Sigmund Freud University, Vienna, Austria
| | - Daniel De Backer
- Department of Intensive Care, CHIREC Hospitals, Brussels, Belgium
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Valentina Kutyifa
- University of Rochester Medical Center, Rochester, NY, USA
- Semmelweis University Heart Center, Budapest, Hungary
| | - Leo Bossaert
- Department of Intensive Care Medicine, University Hospital of Antwerp, Antwerp, Belgium
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35
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Legallois D, Hodzic A, Alexandre J, Dolladille C, Saloux E, Manrique A, Roule V, Labombarda F, Milliez P, Beygui F. Definition of left ventricular remodelling following ST-elevation myocardial infarction: a systematic review of cardiac magnetic resonance studies. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1613] [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
Background/Introduction
An increase in left ventricular volumes between baseline and follow-up imaging is the main criteria for the quantification of left ventricular remodeling after ST-elevation myocardial infarction, but without consensual definition.
Purpose
We aimed to review the criterion used for the definition of left ventricular remodeling based on cardiac magnetic resonance imaging in studies including patients with ST-elevation myocardial infarction.
Methods
A systematic literature search was conducted using MEDLINE and the Cochrane Library from January 2010 to August 2019. Thirty-seven studies involving a total of 4209 patients were included.
Results
The median age of the patients was 59 years, 82% were male, and 93% underwent primary percutaneous coronary intervention. The median follow-up duration was 6 months (range, 3–12), and the second cardiac magnetic resonance session was performed at 6 months in 14 (38%) studies. Among these studies, 30 (81%) used a cut-off value for defining left ventricular remodeling, with a pooled left ventricular remodeling prevalence estimate of 22.8%, 95%-CI[19.4%-26.7%], and a major between-study heterogeneity (I2=82%). The seven remaining studies (19%) defined left ventricular remodeling as a continuous variable. A 20% increase in end-diastolic volumes or a 15% increase in end-systolic volumes between a baseline and a follow-up cardiac magnetic resonance imaging were the two most common criterion (13 [35%] and 9 [24%] studies, respectively). Seven studies used both end-diastolic and end-systolic vleft ventricular volumes.
Conclusion(s)
The definition of left ventricular remodeling using cardiac magnetic resonance following ST-elevation myocardial infarction is highly variable, among studies including highly selected patients. The most frequent left ventricular remodeling criterion were a 20% increase in end-diastolic volumes or a 15% increase in end-systolic volumes. A composite cut-off value of a 12% to 15% increase in end-systolic volume and a 12% to 20% increase in end-diastolic volume using a follow-up cardiac magnetic resonance imaging 1 to 3 months after myocardial infarction might be proposed as a consensual cut-off for defining adverse left ventricular remodeling for future large-sized, prospective studies with serial cardiac magnetic resonance imaging and long-term follow-up in unselected patients.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- D Legallois
- University Hospital of Caen, Department of Cardiology, EA4650 (SEILIRM), FHU REMOD-VHF, Caen, France
| | - A Hodzic
- University Hospital of Caen, Department of Clinical Physiology, Inserm Comete, Caen, France
| | - J Alexandre
- University Hospital of Caen, Department of Pharmacology, EA4650 (SEILIRM), FHU REMOD-VHF, Caen, France
| | - C Dolladille
- University Hospital of Caen, Department of Pharmacology, EA4650 (SEILIRM), FHU REMOD-VHF, Caen, France
| | - E Saloux
- University Hospital of Caen, Department of Cardiology, EA4650 (SEILIRM), FHU REMOD-VHF, Caen, France
| | - A Manrique
- University Hospital of Caen, Department of Nuclear Medicine, EA4650 (SEILIRM), FHU REMOD-VHF, GIP Cyceron PET Center, Caen, France
| | - V Roule
- University Hospital of Caen, Department of Cardiology, EA4650 (SEILIRM), FHU REMOD-VHF, Caen, France
| | - F Labombarda
- University Hospital of Caen, Department of Cardiology, EA4650 (SEILIRM), FHU REMOD-VHF, Caen, France
| | - P Milliez
- University Hospital of Caen, Department of Cardiology, EA4650 (SEILIRM), FHU REMOD-VHF, Caen, France
| | - F Beygui
- University Hospital of Caen, Department of Cardiology, EA4650 (SEILIRM), FHU REMOD-VHF, Caen, France
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Legallois D, Hodzic A, Milliez P, Manrique A, Saloux E, Beygui F. Left atrial strain is associated with left ventricular remodeling in patients with ST-elevation myocardial infarction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1582] [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: 11/15/2022] Open
Abstract
Abstract
Background/Introduction
Left ventricular remodeling (LVR) remains common and is associated with outcomes in patients with ST-elevation myocardial infarction (STEMI). Left atrial (LA) volume has been described as a predictor of outcomes in the latter population.
Purpose
To investigate the association between LA mechanical function using speckle tracking imaging and LVR at follow-up in STEMI patients.
Methods
Baseline 3D transthoracic echocardiograms were performed in 121 STEMI patients. LA global longitudinal strain was reported separately for the reservoir (LASr), conduit (LAScd), and contraction (LASct) phases. Follow-up echocardiograms were performed at 6 months.
Results
Mean age was 58.3±12.5 years and 98 (81%) were men. Baseline left ventricular ejection fraction (LVEF) was 46.8% [41.0, 52.9] and significantly improved to 52.1% [45.8, 57.0] at follow-up, (p<0.001). A lower LASct was associated with a significant dilation of left ventricle at follow-up (%end-diastolic volume increase: −1.9% [−11.0, 15.2] in the two higher LASct tertiles group vs. 19.2% [5.0, 34.3] in the lower LASct tertile group, p=0.001). A higher %end-systolic volume increase at follow-up was associated with lower LASct as well: 12.6% [−16.2, 39.8] in the lower LASct group vs. −6.8% [−23.6, 14.4] in the two higher LASct tertiles group (p=0.004). Regarding LVEF, a low LVEF at follow-up was associated with the worst tertile of all LA strains (LASr, p=0.002; LAScd, p=0.01 and LASct, p=0.01).
Conclusion(s)
The three components of baseline LA strain were associated with LVEF at follow-up in patients with STEMI. Some of these components were also significantly associated with lower LVEF at baseline or predictive of a significant increase in left ventricular volumes during follow-up, indicating LVR.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- D Legallois
- University Hospital of Caen, Department of Nuclear Medicine, Caen, France
| | - A Hodzic
- University Hospital of Caen, Department of Clinical Physiology, Inserm Comete, Caen, France
| | - P Milliez
- University Hospital of Caen, Department of Cardiology, EA4650 (SEILIRM), FHU REMOD-VHF, Caen, France
| | - A Manrique
- University Hospital of Caen, Department of Nuclear Medicine, EA4650 (SEILIRM), FHU REMOD-VHF, GIP Cyceron PET Center, Caen, France
| | - E Saloux
- University Hospital of Caen, Department of Cardiology, EA4650 (SEILIRM), FHU REMOD-VHF, Caen, France
| | - F Beygui
- University Hospital of Caen, Department of Cardiology, EA4650 (SEILIRM), FHU REMOD-VHF, Caen, France
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Briet C, Lacote C, Peron C, Blanchart K, Lemaitre A, Bignon M, Sabatier R, Ardouin P, Roule V, Beygui F. Bedside assessment of the risk of non-compliance to medication is associated with mortality in elderly patients admitted for acute coronary syndromes. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1344] [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
Background
Elderly patients are at high risk of mortality in the setting of acute coronary syndromes (ACS).
Purpose
We investigated whether compliance assessed by Compliance Evaluation Test (CET) in elderly patients admitted for acute coronary syndromes was associated with higher risk of one-year mortality.
Methods
We used the data from a prospective, open, ongoing cohort of patients ≥75 years old admitted for ACS to a tertiary center. The CET is a validated 6 item test easily performed at bedside. Non-compliance is defined by ≥ “Yes” answers.
We used a Cox model, un-adjusted and adjusted on predefined correlates of mortality (age, gender, and GRACE score) to assess the relationship between the risk of non-compliance and 1-year mortality.
Results
Two hundred fifty-five consecutive patients (age 83±5, female gender 59.6%, GRACE score 175±24) with CET assessment within 48 hours after admission and 1 year follow-up were included in the analysis. 225 (88%) were identified as compliant and 30 (12%) as non-compliant based on the CET.
Thirthy-six deaths occurred at 1 year follow-up, 24 (10.6%) and 12 (30%) in compliant and non-compliant patients respectively.
There was an almost 4-fold increase in the risk of one-year mortality in association with non-compliance (HR 4.16; 95% CI 2.03 to 8.5, p<0.0001) and adj-HR 3.93; 95% CI 1.87 to 8.3, p=0.003), independent of other covariables.
Conclusions
In elderly patients admitted for ACS, the risk of non-compliance assessed by the simple bedside test is associated with a 4-fold increase in the risk of 1-year mortality independent of other correlates of mortality. Our results support specific measures to improve compliance in such patients.
Survival based on compliance test
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- C Briet
- University Hospital of Caen, Department of Cardiology, Caen, France
| | - C Lacote
- University Hospital of Caen, Department of Cardiology, Caen, France
| | - C Peron
- University Hospital of Caen, Department of Cardiology, Caen, France
| | - K Blanchart
- University Hospital of Caen, Department of Cardiology, Caen, France
| | - A Lemaitre
- University Hospital of Caen, Department of Cardiology, Caen, France
| | - M Bignon
- University Hospital of Caen, Department of Cardiology, Caen, France
| | - R Sabatier
- University Hospital of Caen, Department of Cardiology, Caen, France
| | - P Ardouin
- University Hospital of Caen, Department of Cardiology, Caen, France
| | - V Roule
- University Hospital of Caen, Department of Cardiology, Caen, France
| | - F Beygui
- University Hospital of Caen, Department of Cardiology, Caen, France
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Legallois D, Macquaire C, Hodzic A, Allouche S, El Kouakhi I, Manrique A, Milliez P, Saloux E, Beygui F. Serum neprilysin levels are associated with myocardial stunning after ST-elevation myocardial infarction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1581] [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
Background/Introduction
Left ventricular remodeling following ST-elevation myocardial infarction (STEMI) is associated with poor outcome. Neprilysin inhibition leads to improved outcome in patients with altered left ventricular ejection fraction (LVEF).
Purpose
We aimed to assess the association between serum levels of neprilysin and left ventricular (LV) volumes, function and remodeling in STEMI patients with successful myocardial reperfusion.
Methods
Sixty-eight patients were admitted for STEMI and had both plasma neprilysin measurement at baseline and 3D transthoracic echocardiogram at baseline and at follow-up (7 months). We compared 3 groups: a group with a low-level of plasma neprilysin (<125 pg/mL, i.e. the lower limit of detection of the assay, 38 patients) and the two other groups were defined as being below or above the median value of the remaining samples (15 patients each).
Results
Median age was 58.5±12.8 years and 56 (82.4%) were men. Median LVEF was 45.0±8.5%. Baseline characteristics were comparable among groups. At baseline there was a non-significant trend towards lower end-diastolic volume (p=0.07) but significantly lower LVEF in the high neprilysin group (46.4±8.3%, 47.1±8.1% and 39.1±6.9%, p<0.01). At follow-up, the magnitude of LVEF increase was significantly more important in the high neprilysin group compared to the other groups (p=0.022 for relative change in LVEF and 6.6±7.3%, 3.6±9.0% and 11.3±8.4%, p=0.031 for absolute change in LVEF) resulting in similar LVEF levels at follow-up between all groups (53.0±8.9%, 50.6±9.7% and 50.4±9.9%, p=0.55).
Conclusion(s)
Initial high neprilysin levels may identify patients with stunned myocardium early after STEMI, with a recovery of contractility leading to improved LVEF at follow-up.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- D Legallois
- University Hospital of Caen, Department of Cardiology, EA4650 (SEILIRM), FHU REMOD-VHF, Caen, France
| | - C Macquaire
- University Hospital of Caen, Department of Cardiology, Caen, France
| | - A Hodzic
- University Hospital of Caen, Department of Clinical Physiology, Inserm Comete, Caen, France
| | - S Allouche
- University Hospital of Caen, Department of Biochemistry, Caen, France
| | - I El Kouakhi
- University Hospital of Caen, Department of Cardiology, Caen, France
| | - A Manrique
- University Hospital of Caen, Department of Nuclear Medicine, EA4650 (SEILIRM), FHU REMOD-VHF, GIP Cyceron PET Center, Caen, France
| | - P Milliez
- University Hospital of Caen, Department of Cardiology, EA4650 (SEILIRM), FHU REMOD-VHF, Caen, France
| | - E Saloux
- University Hospital of Caen, Department of Cardiology, EA4650 (SEILIRM), FHU REMOD-VHF, Caen, France
| | - F Beygui
- University Hospital of Caen, Department of Cardiology, EA4650 (SEILIRM), FHU REMOD-VHF, Caen, France
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Schiele F, Lemesle G, Angoulvant D, Krempf M, Kownator S, Cheggour S, Belle L, Ferrières J, Bauters C, Bergerot C, Beygui F, Boccara F, Bonnefoy E, Bruckert E, Cayla G, Collet JP, Coste P, Descotes-Genon V, Ducrocq G, Elbaz M, Farnier M, Ferrari E, Guedj D, Levai L, Mansourati J, Mansencal N, Meneveau N, Meune C, Morel O, Ohlmann P, Paillard F, Piot C, Puymirat E, Rioufol G, Roubille F, Sabouret P, Teiger E. Proposal for a standardized discharge letter after hospital stay for acute myocardial infarction. European Heart Journal. Acute Cardiovascular Care 2020; 9:788-801. [DOI: 10.1177/2048872619844444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Abstract
In patients admitted for acute myocardial infarction, the communication and transition from specialists to primary care physicians is often delayed, and the information imparted to subsequent healthcare providers (HCPs) may be sub-optimal. A French group of cardiologists, lipidologists and diabetologists decided to establish a consensus to optimize the discharge letter after hospitalization for acute myocardial infarction. The aim is to improve both the timeframe and the quality of the content transmitted to subsequent HCPs, including information regarding baseline assessment, procedures during hospitalization, residual risk, discharge treatments, therapeutic targets and follow-up recommendations in compliance with European Society of Cardiology guidelines. A consensus was obtained regarding a template discharge letter, to be released within two days after patient’s discharge, and containing the description of the patient’s history, risk factors, acute management, risk assessment, discharge treatments and follow-up pathway. Specifically for post acute MI patients, tailored details are necessary regarding the antithrombotic regimen, lipid-lowering and anti-diabetic treatments, including therapeutic targets. Lastly, the follow-up pathway needs to be precisely mentioned in the discharge letter. Additional information such as technical descriptions, imaging, and quality indicators may be provided separately. A template for a standardized discharge letter based on 8 major headings could be useful for implementation in routine practice and help to improve the quality and timing of information transmission between HCPs after acute MI.
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Affiliation(s)
- Francois Schiele
- Department of Cardiology, University Hospital Besancon, and EA3920, University of Franche-Comté, Besancon, France
| | - Gilles Lemesle
- USIC et Centre Hémodynamique, Institut Cœur Poumon, Centre Hospitalier Universitaire de Lille, France
- Faculté de Médecine de l’Université de Lille, France
- INSERM UMR 1011, Institut Pasteur de Lille, France
- FACT (French Alliance for Cardiovascular Trials), Paris, France
| | - Denis Angoulvant
- Service de cardiologie, faculté de médecine, université François-Rabelais, CHU Trousseau, Tours
| | - Michel Krempf
- CHU de Nantes-Hôpital Nord Laennec, Saint Herblain, France
| | | | | | - Loic Belle
- Service de Cardiologie, Centre Hospitalier Annecy-Genevois, Metz-Tessy, France
| | - Jean Ferrières
- Service de Cardiologie B, CHU Rangueil, Toulouse, France
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Legallois D, Macquaire C, Hodzic A, Allouche S, El Khouakhi I, Manrique A, Milliez P, Saloux E, Beygui F. Serum neprilysin levels are associated with myocardial stunning after ST-elevation myocardial infarction. BMC Cardiovasc Disord 2020; 20:316. [PMID: 32615924 PMCID: PMC7333398 DOI: 10.1186/s12872-020-01578-y] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 06/10/2020] [Indexed: 12/11/2022] Open
Abstract
Background Left ventricular remodeling following ST-elevation myocardial infarction (STEMI) is associated with poor outcome, including heart failure (HF). Neprilysin inhibition leads to improved outcome in patients with altered left ventricular ejection fraction (LVEF). Methods We aimed to assess the association between serum levels of neprilysin and left ventricular (LV) volumes, function and remodeling in STEMI patients with successful myocardial reperfusion and no clinical sign of HF. Sixty-eight patients were admitted for STEMI and had both plasma neprilysin measurement at baseline and 3D transthoracic echocardiogram at baseline and after a median follow-up of 7 months. We compared 3 groups: a group with a low-level of plasma neprilysin (< 125 pg/mL, i.e. the lower limit of detection of the assay) and the two other groups were defined as being below or above the median value of the remaining samples. Results Median age was 58.5 ± 12.8 years and 56 (82.4%) were men. Median LVEF was 45.0 ± 8.5%. Baseline characteristics were comparable between groups (low-level of neprilysin group [≤125 pg/mL, n = 38], medium-level of neprilysin group [126–450 pg/mL, n = 15] and a high-level group [> 450 pg/mL, n = 15]). At baseline there was a non-significant trend towards lower end-diastolic volume (p = 0.07) but significantly lower LVEF in the high neprilysin group (46.4 ± 8.3%, 47.1 ± 8.1% and 39.1 ± 6.9%, p < 0.01). At follow-up, the magnitude of LVEF increase was significantly more important in the high neprilysin group compared to the other groups (p = 0.022 for relative change in LVEF and 6.6 ± 7.3%, 3.6 ± 9.0% and 11.3 ± 8.4%, p = 0.031 for absolute change in LVEF) resulting in similar LVEF levels at follow-up between all groups (53.0 ± 8.9%, 50.6 ± 9.7% and 50.4 ± 9.9%, p = 0.55). Conclusions Initial high neprilysin levels may identify patients with stunned myocardium early after STEMI, with a recovery of contractility leading to improved LVEF at follow-up. Future studies will have to assess the role of neprilysin in the setting of STEMI and the potential benefit of its blockade.
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Affiliation(s)
- Damien Legallois
- Department of Cardiology, EA4650 Signalisation, Electrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique (SEILIRM), FHU REMOD-VHF, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000, Caen, France.
| | - Clémence Macquaire
- Department of Cardiology, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000, Caen, France
| | - Amir Hodzic
- Department of Clinical Physiology, INSERM Comete, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000, Caen, France
| | - Stéphane Allouche
- Department of Biochemistry, EA4650 Signalisation, Electrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique (SEILIRM), FHU REMOD-VHF, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000, Caen, France
| | - Ismaïl El Khouakhi
- Department of Cardiology, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000, Caen, France
| | - Alain Manrique
- Department of Nuclear Medicine, EA4650 Signalisation, Electrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique (SEILIRM), GIP Cyceron, FHU REMOD-VHF, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000, Caen, France
| | - Paul Milliez
- Department of Cardiology, EA4650 Signalisation, Electrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique (SEILIRM), FHU REMOD-VHF, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000, Caen, France
| | - Eric Saloux
- Department of Cardiology, EA4650 Signalisation, Electrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique (SEILIRM), FHU REMOD-VHF, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000, Caen, France
| | - Farzin Beygui
- Department of Cardiology, EA4650 Signalisation, Electrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique (SEILIRM), FHU REMOD-VHF, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000, Caen, France.,ACTION academic research group, Pitié Salpêtrière University Hospital, Paris, France
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Silvain J, Cayla G, Beygui F, Range G, Lattuca B, Collet JP, Dillinger JG, Boueri Z, Brunel P, Pouillot C, Boccara F, Christiaens L, Labeque JN, Lhermusier T, Georges JL, Bellemain-Appaix A, Le Breton H, Hauguel-Moreau M, Saint-Etienne C, Caussin C, Jourda F, Motovska Z, Guedeney P, El Kasty M, Laredo M, Dumaine R, Ducrocq G, Vicaut E, Montalescot G. Blunting periprocedural myocardial necrosis: Rationale and design of the randomized ALPHEUS study. Am Heart J 2020; 225:27-37. [PMID: 32473356 DOI: 10.1016/j.ahj.2020.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 04/23/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Clopidogrel associated with aspirin is the recommended treatment for patients undergoing elective percutaneous coronary intervention (PCI). Although severe PCI-related events are rare, evidence suggests that PCI-related myocardial infarction and myocardial injury are frequent complications that can impact the clinical prognosis of the patients. Antiplatelet therapy with a potent P2Y12 receptor inhibitor such as ticagrelor may reduce periprocedural ischemic complications while maintaining a similar safety profile as compared with conventional dual antiplatelet therapy by aspirin and clopidogrel in this setting. METHODS Assessment of Loading with the P2Y12 inhibitor ticagrelor or clopidogrel to Halt ischemic Events in patients Undergoing elective coronary Stenting (ALPHEUS) (NCT02617290) is an international, multicenter, randomized, parallel-group, open-label study in patients with stable coronary artery disease who are planned for an elective PCI. In total, 1,900 patients will be randomized before a planned PCI to a loading dose of ticagrelor 180 mg or a loading dose of clopidogrel (300 or 600 mg) in addition to aspirin. Patients will then receive a dual antiplatelet therapy with aspirin and ticagrelor 90 mg twice daily or clopidogrel 75 mg once daily for 30 days. The primary ischemic end point is PCI-related myocardial infarction (myocardial infarction type 4a or 4b) or major myocardial injury within 48 hours (or at hospital discharge if earlier) after elective PCI/stent. Safety will be evaluated by major bleeding events (Bleeding Academic Research Consortium type 3 or 5) at 48 hours (or discharge if it occurs earlier). CONCLUSION ALPHEUS is the first properly sized trial comparing ticagrelor to clopidogrel in the setting of elective PCI and is especially designed to show a reduction in periprocedural events, a surrogate end point for mortality.
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Affiliation(s)
- Johanne Silvain
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Guillaume Cayla
- Cardiology department, Nîmes university Hospital, Montpellier University, ACTION study group, Nîmes, France
| | - Farzin Beygui
- CHU de Caen-Département de Cardiologie; Caen, France
| | - Grégoire Range
- CH de Chartres-Département de Cardiologie, Chartes, France
| | - Benoit Lattuca
- Cardiology department, Nîmes university Hospital, Montpellier University, ACTION study group, Nîmes, France
| | - Jean-Philippe Collet
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Jean-Guillaume Dillinger
- Department of Cardiology, Inserm U942, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France
| | - Ziad Boueri
- CH de Bastia-Département de Cardiologie, Bastia, France
| | - Philippe Brunel
- Hôpital Privé Dijon Bourgogne-Cardiologie Interventionelle GCIDB VALMY, Dijon, France
| | - Christophe Pouillot
- Clinique Sainte Clotilde, La Réunion-Département de Cardiologie, La Réunion, France
| | - Franck Boccara
- AP-HP, Hôpitaux de l'Est Parisien, Hôpital Saint-Antoine, Department of Cardiology, Sorbonne Université-INSERM UMR S_938, Centre de Recherche Saint-Antoine, Paris, France
| | | | | | | | - Jean-Louis Georges
- CH de Versailles-Service de Cardiologie, Hôpital A. Mignot, Le Chesnay, France
| | - Anne Bellemain-Appaix
- CH d'Antibes Juan-Les-Pins-Département de Cardiologie, Antibes Juan-Les-Pins, France
| | | | - Marie Hauguel-Moreau
- CHU Ambroise Paré (APHP), Université Versailles-Saint Quentin, ACTION study Group, INSERM-U1018 CESP, Boulogne, France-Service de Cardiologie
| | | | - Christophe Caussin
- Institut Mutualiste Montsouris-Département de Cardiologie, Paris, France
| | | | - Zuzana Motovska
- 3rd Faculty of Medicine, Charles University and Cardiocentre Kralovske Vinohrady, Prague, Czech Republic
| | - Paul Guedeney
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Mohamad El Kasty
- Grand Hôpital de l'Est Francilien site Marne-La-Vallée - Département de Cardiologie, Marne La Vallée, France
| | - Mikael Laredo
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Raphaëlle Dumaine
- Les Grands Prés Cardiac Rehabilitation center, Villeneuve St Denis, France
| | - Grégory Ducrocq
- FACT (French Alliance for Cardiovascular Trials), DHU FIRE, Hôpital Bichat, AP-HP, Université de Paris, Inserm U-1148, Paris, France
| | - Eric Vicaut
- Unité de Recherche Clinique, ACTION Study Group, Hôpital Fernand Widal (AP-HP), Paris, France; SAMM - Statistique, Analyse et Modélisation Multidisciplinaire EA 4543, Université Paris 1 Panthéon Sorbonne, Paris, France
| | - Gilles Montalescot
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France.
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Legallois D, Hodzic A, Alexandre J, Dolladille C, Saloux E, Manrique A, Roule V, Labombarda F, Milliez P, Beygui F. Definition of left ventricular remodelling following ST-elevation myocardial infarction: a systematic review of cardiac magnetic resonance studies in the past decade. Heart Fail Rev 2020; 27:37-48. [DOI: 10.1007/s10741-020-09975-3] [Citation(s) in RCA: 4] [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] [Indexed: 12/16/2022]
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43
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Roule V, Verdier L, Blanchart K, Ardouin P, Lemaitre A, Bignon M, Sabatier R, Alexandre J, Beygui F. Systematic review and meta-analysis of the prognostic impact of cancer among patients with acute coronary syndrome and/or percutaneous coronary intervention. BMC Cardiovasc Disord 2020; 20:38. [PMID: 32000685 PMCID: PMC6993442 DOI: 10.1186/s12872-020-01352-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [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: 10/16/2019] [Accepted: 01/20/2020] [Indexed: 12/22/2022] Open
Abstract
Background Patients with cancer admitted for an acute coronary syndrome (ACS) and/or percutaneous coronary intervention (PCI) represent a growing and high-risk population. The influence of co-existing cancer on mortality remains unclear in such patients. We aimed to assess the impact of cancer on early and late, all-cause and cardiac mortality in the setting of ACS and/or PCI. Methods We performed a systematic review and meta-analysis of studies comparing outcomes of patients with and without a history of cancer admitted for ACS and/or PCI. Results Six studies including 294,528 ACS patients and three studies including 39,973 PCI patients were selected for our meta-analysis. Patients with cancer had increased rates of in-hospital all-cause death (RR 1.74 [1.22; 2.47]), cardiac death (RR 2.44 [1.73; 3.44]) and bleeding (RR 1.64 [1.35; 1.98]) as well as one-year all-cause death (RR 2.62 [1.2; 5.73]) and cardiac death (RR 1.89 [1.25; 2.86]) in ACS studies. Rates of long term all-cause (RR 1.96 [1.52; 2.53]) but not cardiac death were higher in cancer patients admitted for PCI. Conclusion Cancer patients represent a high-risk population both in the acute phase and at long-term after an ACS or PCI. The magnitude of the risk of mortality should however be tempered by the heterogeneity among studies. Early and long term optimal management of such patients should be promoted in clinical practice.
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Affiliation(s)
- Vincent Roule
- CHU de Caen Normandie, Service de Cardiologie, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France. .,Normandie Univ, UNICAEN, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, 14000, Caen, France.
| | - Laurine Verdier
- CHU de Caen Normandie, Service de Cardiologie, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Katrien Blanchart
- CHU de Caen Normandie, Service de Cardiologie, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Pierre Ardouin
- CHU de Caen Normandie, Service de Cardiologie, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Adrien Lemaitre
- CHU de Caen Normandie, Service de Cardiologie, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Mathieu Bignon
- CHU de Caen Normandie, Service de Cardiologie, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Rémi Sabatier
- CHU de Caen Normandie, Service de Cardiologie, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Joachim Alexandre
- Normandie Univ, UNICAEN, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, 14000, Caen, France.,CHU de Caen Normandie, Service de Pharmacologie, 14000, Caen, France
| | - Farzin Beygui
- CHU de Caen Normandie, Service de Cardiologie, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France.,Normandie Univ, UNICAEN, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, 14000, Caen, France
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Tomaniak M, Chichareon P, Takahashi K, Kogame N, Modolo R, Chang CC, Spitzer E, Neumann FJ, Plante S, Hernández Antolin R, Jambrik Z, Gelev V, Brunel P, Konteva M, Beygui F, Morelle JF, Filipiak KJ, van Geuns RJ, Soliman O, Tijssen J, Rademaker-Havinga T, Storey RF, Hamm C, Steg PG, Windecker S, Onuma Y, Valgimigli M, Serruys PW. Impact of chronic obstructive pulmonary disease and dyspnoea on clinical outcomes in ticagrelor treated patients undergoing percutaneous coronary intervention in the randomized GLOBAL LEADERS trial. European Heart Journal - Cardiovascular Pharmacotherapy 2019; 6:222-230. [DOI: 10.1093/ehjcvp/pvz052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 08/30/2019] [Accepted: 12/09/2019] [Indexed: 12/21/2022]
Abstract
Abstract
Aims
To evaluate long-term safety and efficacy of ticagrelor monotherapy in patients undergoing percutaneous coronary interventions (PCIs) in relation to chronic obstructive pulmonary disease (COPD) at baseline and the occurrence of dyspnoea reported as adverse event (AE) that may lead to treatment non-adherence.
Methods and results
This is a non-prespecified, post hoc analysis of the randomized GLOBAL LEADERS trial (n = 15 991), comparing the experimental strategy of 23-month ticagrelor monotherapy following 1-month dual antiplatelet therapy (DAPT) after PCI with the reference strategy of 12-month DAPT followed by 12-month aspirin monotherapy. Impact of COPD and dyspnoea AE (as a time-dependent covariate) on clinical outcomes was evaluated up to 2 years. The primary endpoint was a 2-year all-cause mortality or non-fatal, centrally adjudicated, new Q-wave myocardial infarction. The presence of COPD (n = 832) was the strongest clinical predictor of 2-year all-cause mortality after PCI [hazard ratio (HR) 2.84; 95% confidence interval (CI) 2.21–3.66; P adjusted = 0.001] in this cohort (n = 15 991). No differential treatment effects on 2-year clinical outcomes were found in patients with and without COPD (primary endpoint: HR 0.88; 95% CI 0.58–1.35; P = 0.562; P int = 0.952). Overall, at 2 years dyspnoea was reported as an AE in 2101 patients, more frequently among COPD patients, irrespective of treatment allocation (27.2% in experimental arm vs. 14.5% in reference arm, P = 0.001). Its occurrence was not associated with a higher rate of the primary endpoint (P adjusted = 0.640) in the experimental vs. the reference arm.
Conclusion
In this exploratory analysis, COPD negatively impacted long-term prognosis after PCI. Despite higher incidence of dyspnoea in the experimental arm, in particular among COPD patients, the safety of the experimental treatment strategy appeared not to be affected.
Clinical trial registration unique identifier
NCT01813435.
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Affiliation(s)
- Mariusz Tomaniak
- Department of Cardiology, Erasmus Medical Centre, Erasmus University, Rotterdam, The Netherlands
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Ply Chichareon
- Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | | | - Norihiro Kogame
- Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Rodrigo Modolo
- Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Internal Medicine, Cardiology Division, University of Campinas (UNICAMP), Campinas, Brazil
| | - Chun Chin Chang
- Department of Cardiology, Erasmus Medical Centre, Erasmus University, Rotterdam, The Netherlands
| | - Ernest Spitzer
- Department of Cardiology, Erasmus Medical Centre, Erasmus University, Rotterdam, The Netherlands
- Cardialysis Core Laboratories and Clinical Trial Management, Rotterdam, The Netherlands
| | | | - Sylvain Plante
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | | | - Zoltan Jambrik
- Békés Megyei Pándy Kálmán Kórház County Hospital, Gyula, Hungary
| | | | - Philippe Brunel
- Cardiologie Clinique Valmy Hopital Prive Dijon Bourgogne HPDB Dijon, Dijon, France
| | | | | | | | | | - Robert-Jan van Geuns
- Department of Cardiology, Erasmus Medical Centre, Erasmus University, Rotterdam, The Netherlands
- Department of Cardiology, Radboud UMC, Nijmegen, The Netherlands
| | - Osama Soliman
- Department of Cardiology, National University of Ireland Galway, Galway, Ireland
| | - Jan Tijssen
- Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Cardialysis Core Laboratories and Clinical Trial Management, Rotterdam, The Netherlands
| | | | - Robert F Storey
- Department of Cardiovascular Science, University of Sheffield, Sheffield, UK
| | | | - Philippe Gabriel Steg
- FACT (French Alliance for Cardiovascular Trials), Université Paris Diderot, Hôpital Bichat, Assistance Publique—Hôpitaux de Paris, INSERM U-1148, Paris, France
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland Galway, Galway, Ireland
| | - Marco Valgimigli
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland Galway, Galway, Ireland
- NHLI, Imperial College London, London, UK
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Alexandre J, Dolladille C, Douesnel L, Font J, Dabrowski R, Shavit L, Legallois D, Funck-Brentano C, Champ-Rigot L, Ollitrault P, Beygui F, Bejan-Angoulvant T, Parienti JJ, Milliez P. Effects of Mineralocorticoid Receptor Antagonists on Atrial Fibrillation Occurrence: A Systematic Review, Meta-Analysis, and Meta-Regression to Identify Modifying Factors. J Am Heart Assoc 2019; 8:e013267. [PMID: 31711383 PMCID: PMC6915291 DOI: 10.1161/jaha.119.013267] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background Mineralocorticoid receptor antagonists (MRAs) have emerged as potential atrial fibrillation (AF) preventive therapy, but inconsistent results have been reported. We aimed to examine the effects of MRAs on AF occurrence and explore factors that could influence the magnitude of the effect size. Methods and Results PubMed, Embase, and Cochrane Central databases were used to search for randomized clinical trials and observational studies addressing the effect of MRAs on AF occurrence from database inception through April 03, 2018. We performed a systematic review and random effects meta‐analyses to compute odds ratios with 95% CIs. Meta‐regression was then applied to explore the sources of between‐study heterogeneity. We included 24 studies, 11 randomized clinical trials and 13 observational cohorts, representing a total number of 7914 patients (median age: 64.2 years; median left ventricular ejection fraction: 49.7%; median follow‐up: 12.0 months), 2843 (35.9%) of whom received MRA therapy. Meta‐analyses showed a significant overall reduction in AF occurrence in the MRA‐treated patients versus the control groups (15.0% versus 32.2%; odds ratio, 0.55; 95% CI, 0.44–0.70 [P<0.00001]), with the greatest benefit regarding recurrent AF episodes (odds ratio, 0.42; 95% CI, 0.31–0.59 [P<0.00001]) and with significant heterogeneity among the included studies (I2=54%; P=0.0008). Meta‐regression analyses showed that effect size was significantly associated with older studies and higher AF occurrence rate in the control groups. Conclusions MRAs seem to be effective in AF prevention, especially regarding recurrent AF episodes.
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Affiliation(s)
- Joachim Alexandre
- Department of Pharmacology CHU Caen France.,UNICAEN, CHU Caen Medical School Université Caen Normandie Caen France.,Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique Caen France
| | - Charles Dolladille
- Department of Pharmacology CHU Caen France.,Department of Cardiology CHU Caen France
| | | | - Jonaz Font
- Department of Pharmacology CHU Caen France
| | | | - Linda Shavit
- Adult Nephrology Unit Shaare Zedek Medical Center Jerusalem Israel
| | - Damien Legallois
- UNICAEN, CHU Caen Medical School Université Caen Normandie Caen France.,Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique Caen France.,Department of Cardiology CHU Caen France
| | - Christian Funck-Brentano
- Department of Pharmacology AP-HP Pitié-Salpêtrière Hospital Paris France.,INSERM UMR ICAN 1166 Paris France.,Faculty of Medicine UPMC Univ Paris 06 Sorbonne Universités Paris France.,Institute of Cardiometabolism and Nutrition Paris France
| | - Laure Champ-Rigot
- UNICAEN, CHU Caen Medical School Université Caen Normandie Caen France.,Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique Caen France.,Department of Cardiology CHU Caen France
| | | | - Farzin Beygui
- UNICAEN, CHU Caen Medical School Université Caen Normandie Caen France.,Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique Caen France.,Department of Cardiology CHU Caen France
| | | | - Jean-Jacques Parienti
- Department of Biostatistics and Clinical Research CHU Caen France.,EA2656 Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0) UNICAEN, CHU Caen Medical School Université Caen Normandie Caen France
| | - Paul Milliez
- UNICAEN, CHU Caen Medical School Université Caen Normandie Caen France.,Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique Caen France.,Department of Cardiology CHU Caen France
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46
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Roule V, Heudel T, Lemaitre A, Bignon M, Ardouin P, Sabatier R, Blanchart K, Beygui F. P329Residual platelet reactivity after pre-treatment with ticagrelor prior to primary percutaneous coronary intervention is associated with suboptimal myocardial reperfusion. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0164] [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
Background
The evidence of a clinical benefit of P2Y12 inhibitor pre-treatment in primary percutaneous coronary intervention (PCI) and the relation between the level of platelet inhibition and myocardial reperfusion with newer potent P2Y12 inhibitors remain unclear.
Objectives
We aimed to assess the relationship between platelet reactivity at the time of primary PCI after pre-treatment with aspirin and ticagrelor and the post-PCI myocardial blush grade (MBG).
Methods
We prospectively included 61 patients. Platelet reaction units for ticagrelor (PRU) and aspirin reaction units (ARU) were measured using the point-of-care test VerifyNow before PCI. The high on-ticagrelor (PRU >208) and on-aspirin (ARU ≥550) platelet reactivity (HPR and HaPR) were assessed. Patients were divided into two groups according to MBG 3 or <3.
Results
MBG 3 was identified in 28 (46%) patients. Mean PRU was lower in such patients as compared to those with MBG <3 (155.82±90.91 vs 227.42±65.18; p=0.001) while mean ARU was similar between groups. HPR and HaPR were observed in 30 (49.2%) and 11 patients (18%), respectively. HPR but not HaPR was more frequent in the group with impaired MBG (66.7 vs 28.6%; p=0.003 and 21.2 vs 14.3%; p=0.48 respectively).
Table 1. Platelet reactivity results Verify Now at admission All Final Blush <3 Final Blush 3 p n=61 (100%) n=33 (54%) n=28 (46%) PRU P2Y12 194.56±85.32 227.42±65.18 155.82±90.91 0.001 Base 193.54±49.01 194.79±45.68 192.07±53.48 0.83 Inhibition of platelet aggregation (%) 15.61±29.85 5.7±17.55 27.29±36.79 0.007 ARU 463.97±76.45 472.58±72.5 453.82±81 0.34 PRU >208 30 (49.1%) 22 (66.7%) 8 (28.6%) 0.003 ARU ≥550 11 (18%) 7 (21.2%) 4 (14.3%) 0.48 Verify Now at day 1 n=57 n=30 n=27 p PRU P2Y12 40.86±41.43 47.27±45.87 33.74±35.35 0.21 Base 196.98±36.19 193.67±30.67 200.81±41.97 0.47 Inhibition of platelet aggregation (%) 79.8±17.96 76.37±20.54 83.77±13.78 0.11 ARU = Aspirin reaction units; PRU = P2Y12 reaction units.
Conclusion
In conclusion, our study shows that higher PRU and the subsequent HPR at the time of primary PCI, after pretreatment with ticagrelor, are the only correlates of post PCI MBG. These findings support the earliest possible loading with ticagrelor prior to primary PCI.
Acknowledgement/Funding
The study was supported by grants from Terumo. The funder has no role in any step of the study.
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Affiliation(s)
- V Roule
- University Hospital of Caen, cardiology, Caen, France
| | - T Heudel
- University Hospital of Caen, cardiology, Caen, France
| | - A Lemaitre
- University Hospital of Caen, cardiology, Caen, France
| | - M Bignon
- University Hospital of Caen, cardiology, Caen, France
| | - P Ardouin
- University Hospital of Caen, cardiology, Caen, France
| | - R Sabatier
- University Hospital of Caen, cardiology, Caen, France
| | - K Blanchart
- University Hospital of Caen, cardiology, Caen, France
| | - F Beygui
- University Hospital of Caen, cardiology, Caen, France
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Roule V, Schwob L, Lemaitre A, Bignon M, Ardouin P, Sabatier R, Blanchart K, Beygui F. P3591Residual atherothrombotic burden after primary percutaneous coronary intervention and myocardial reperfusion - An optical frequency domain imaging study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0451] [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: 11/15/2022] Open
Abstract
Abstract
Background
The clinical significance of residual in-stent atherothrombotic burden (ATB) after primary percutaneous coronary intervention (PCI) remains unclear. Several methods of ATB quantification using optical frequency domain imaging (OFDI) exist.
Objectives
We aimed to assess the relationship between residual ATB after primary PCI measured in OFDI using different methods and myocardial blush grade (MBG).
Methods
We prospectively included 60 ST-elevation myocardial infarction patients pre-treated with aspirin and ticagrelor. OFDI volumetric quantification using planimetry (with intervals every frame or every millimeter) and semi-quantitative score were used to determine ATB. Patients were divided into two groups according to final MBG 3 or <3.
Results
MBG 3 was identified in 28 (46%) patients. Altogether, 13318 OFDI cross-sections were analyzed. The mean ATB was 10.08±5.21%. ATB was lower in patients with normal final MBG compared to those with impaired MBG, regardless of the method used (8.15±5.58 vs 11.77±4.28%; p=0.007 for quantification per frame; 7.8±5.19 vs 11.07±4.07%; p=0.009 for quantification per mm and 11.21±11.75 vs 22.91±17.35; p=0.003 for the semi-quantitative thrombus score, respectively).
Table 1. Post stenting OFDI findings OFDI measures All Final Blush <3 Final Blush 3 p n=60 (100%) n=32 (53%) n=28 (47%) Stent volume (mm3) 219.42±135.76 226.08±168.69 211.82±86.57 0.68 Evaluation per frame Atherothrombotic volume (mm3) 21.66±16.81 25.83±18.86 16.89±12.83 0.035 Atherothrombotic burden (%) 10.08±5.21 11.77±4.28 8.15±5.58 0.007 Evaluation per millimeter Atherothrombotic volume (mm3) 20.71±16.16 24.57±18.15 16.29±12.43 0.042 Atherothrombotic burden (%) 9.5±4.88 11.07±4.07 7.8±5.19 0.009 Thrombus score 17.45±16 22.91±17.35 11.21±11.75 0.003
Optical frequency domain imaging example
Conclusion
Residual post-stenting ATB remains substantial after primary PCI in STEMI patients, even when pre-treated with ticagrelor and aspirin. Mostly, it appears as an important surrogate of clinical outcome as patients with normal myocardial reperfusion presented lower residual ATB.
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Affiliation(s)
- V Roule
- University Hospital of Caen, Cardiology, Caen, France
| | - L Schwob
- University Hospital of Caen, Cardiology, Caen, France
| | - A Lemaitre
- University Hospital of Caen, Cardiology, Caen, France
| | - M Bignon
- University Hospital of Caen, Cardiology, Caen, France
| | - P Ardouin
- University Hospital of Caen, Cardiology, Caen, France
| | - R Sabatier
- University Hospital of Caen, Cardiology, Caen, France
| | - K Blanchart
- University Hospital of Caen, Cardiology, Caen, France
| | - F Beygui
- University Hospital of Caen, Cardiology, Caen, France
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48
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Tomaniak M, Chichareon P, Modolo R, Plante S, Brunel P, Beygui F, Van Geuns RJ, Storey R, Hamm C, Steg PG, Vranckx P, Windecker S, Onuma Y, Valgimigli M, Serruys PW. P6411Dyspnea in ticagrelor treated patients in the all-comer randomized GLOBAL LEADERS study and its association with clinical outcomes. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1005] [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
Background
Dyspnea represents a drug adverse effect reported with a higher frequency for ticagrelor, as compared with other P2Y12 antagonists. The impact of dyspnea on clinical outcomes has not been yet evaluated in the context of aspirin-free therapies after percutaneous coronary intervention (PCI).
Purpose
The study aimed to evaluate the incidence of dyspnea and its associations with demographic characteristics and clinical outcomes in patients undergoing PCI treated with ticagrelor either as monotherapy or as a part of a dual antiplatelet therapy (DAPT) in the GLOBAL LEADERS cohort.
Methods
This is a sub-analysis of the randomized all-comer GLOBAL LEADERS study (n=15991), comparing the experimental strategy of ticagrelor monotherapy following one-month DAPT after PCI with the reference strategy of 12-month DAPT followed by 12-month aspirin monotherapy. The incidence of dyspnea reported as adverse event (AE) and its relation to demographic characteristics and 2-year clinical outcomes was evaluated (intention-to-treat analysis). Multivariable Cox proportional hazards models were performed, including randomized treatment and incidence of first dyspnea event as a time-dependent covariate. The primary endpoint was a composite of 2-year all-cause mortality or centrally adjudicated, new Q-wave myocardial infarction (MI). Patient-oriented clinical endpoints (POCE) comprised all-cause death, any stroke, MI or revascularization, whereas net adverse clinical events (NACE) included POCE and Bleeding Academic Research Consortium (BARC)-defined bleeding type 3 or 5.
Results
Overall, dyspnea was reported as an AE in 2101 patients (13.2%) up to two years of follow-up, with a higher frequency in the experimental arm (16.4%) as compared with the reference group (11.1%) (hazard ratio [HR]1.70, 95% confidence interval [CI] 1.56–1.86, p=0.001).
Predictors of dyspnea AE up to 2 years by multivariate analyses were: chronic obstructive pulmonary disease (HR1.71, 95% CI 1.56–1.87, p=0.001), female gender (HR1.31, 95% CI 1.18–1.44, p=0.001), hypertension (HR1.31, 95% CI 1.19–1.44, p=0.001, prior coronary artery bypass grafting (HR1.30, 95% CI 1.10–1.54, p=0.003), left ventricle ejection fraction below 40% (HR1.22, 95% CI 1.04–1.42, p=0.012), presentation with acute coronary syndrome (HR1.19, 95% CI 1.09–1.29, p=0.001) and body mass index (≥27kg/m2) (HR1.17, 95% CI 1.08–1.28, p=0.001).
In patients who reported dyspnea AE, the two-year rates of the efficacy and safety endpoints in the experimental and reference arm were: for the primary endpoint 3.4% vs. 4.3% (p adjusted=0.807), for POCE 15.8% vs. 17.6% (p adjusted=0.218), for NACE 17.2% vs. 19.6% (p adjusted=0.082), for BARC 3 or 5 type bleeding 17.2% vs. 19.6% (p adjusted=0.082), respectively.
Conclusions
The occurrence of dyspnea AE up to two years after PCI appeared not to affect the safety of the experimental treatment strategy of 23-month ticagrelor monotherapy following one-month DAPT after PCI.
Acknowledgement/Funding
Study founded by European Cardiovascular Research Institute, which received unrestricted grants from Biosensors Int., AstraZeneca, Medicines Company.
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Affiliation(s)
- M Tomaniak
- Erasmus Medical Centre, Rotterdam, Medical University of Warsaw, Warsaw, Poland
| | - P Chichareon
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands (The)
| | - R Modolo
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands (The)
| | - S Plante
- Southlake Regional Health Centre, Newmarket, Canada
| | - P Brunel
- Clinique de Fontaine, Paris, France
| | | | - R.-J Van Geuns
- Erasmus Medical Centre, Rotterdam, Radboud UMC, Nijmegen, Netherlands (The)
| | - R Storey
- University of Sheffield, Sheffield, United Kingdom
| | - C Hamm
- University of Giessen, Giessen, Germany
| | - P G Steg
- FACT (French Alliance for Cardiovascular Trials), Université Paris Diderot, Hôpital Bichat, Paris, France
| | - P Vranckx
- Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, Belgium
| | - S Windecker
- Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Y Onuma
- Erasmus Medical Centre, ThoraxCenter, Rotterdam, Netherlands (The)
| | - M Valgimigli
- Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - P W Serruys
- NHLI, Imperial College London, London, United Kingdom
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49
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Roule V, Schwob L, Lemaitre A, Bignon M, Ardouin P, Sabatier R, Blanchart K, Beygui F. Residual atherothrombotic burden after primary percutaneous coronary intervention and myocardial reperfusion-An optical frequency domain imaging study. Catheter Cardiovasc Interv 2019; 96:91-97. [PMID: 31410965 DOI: 10.1002/ccd.28429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 04/16/2019] [Revised: 07/08/2019] [Accepted: 07/27/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVES We aimed to assess the relationship between residual in-stent atherothrombotic burden (ATB) after primary percutaneous coronary intervention (PCI) measured by optical frequency domain imaging (OFDI) using different measurement methods and myocardial blush grade (MBG). BACKGROUND The impact of residual ATB after primary PCI on myocardial reperfusion remains unclear. METHODS We prospectively included 60 ST-elevation myocardial infarction patients pretreated with aspirin and ticagrelor. OFDI volumetric quantification using planimetry (with intervals every frame or every millimeter) and semiquantitative score were used to determine ATB. Patients were divided into two groups according to final MBG 3 or <3. RESULTS The mean ATB was 10.08 ± 5.21%. ATB was lower in patients with final MBG 3 compared to those with impaired MBG, regardless of the measurement method (8.15 ± 5.58 vs. 11.77 ± 4.28%; p = .007 for quantification per frame; 7.8 ± 5.19 vs. 11.07 ± 4.07%; p = .009 for quantification per mm and 11.21 ± 11.75 vs. 22.91 ± 17.35; p = .003 for the semiquantitative thrombus score, respectively). CONCLUSION Residual post-stenting ATB remains substantial after primary PCI in STEMI patients, even when pretreated with ticagrelor and aspirin. ATB appears as a significant correlate of suboptimal myocardial reperfusion, a known surrogate of clinical outcome.
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Affiliation(s)
- Vincent Roule
- CHU de Caen Normandie, Service de Cardiologie, Caen, France.,Normandie Univ, UNICAEN, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, Caen, France
| | - Lin Schwob
- CHU de Caen Normandie, Service de Cardiologie, Caen, France
| | | | - Mathieu Bignon
- CHU de Caen Normandie, Service de Cardiologie, Caen, France
| | - Pierre Ardouin
- CHU de Caen Normandie, Service de Cardiologie, Caen, France
| | - Rémi Sabatier
- CHU de Caen Normandie, Service de Cardiologie, Caen, France
| | | | - Farzin Beygui
- CHU de Caen Normandie, Service de Cardiologie, Caen, France.,Normandie Univ, UNICAEN, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, Caen, France
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Roule V, Heudel T, Lemaitre A, Bignon M, Ardouin P, Sabatier R, Blanchart K, Beygui F. Residual platelet reactivity after pre-treatment with ticagrelor prior to primary percutaneous coronary intervention is associated with suboptimal myocardial reperfusion. Eur Heart J Acute Cardiovasc Care 2019; 10:2048872619860214. [PMID: 31402681 DOI: 10.1177/2048872619860214] [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] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 06/08/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The evidence of a clinical benefit of P2Y12 inhibitor pre-treatment in primary percutaneous coronary intervention (PCI) and the relation between the level of platelet inhibition and myocardial reperfusion with newer potent P2Y12 inhibitors remain unclear. We aimed to assess the relationship between platelet reactivity at the time of primary PCI after pre-treatment with aspirin and ticagrelor and the post-PCI myocardial blush grade (MBG). METHODS We prospectively included 61 patients. Platelet reaction units for ticagrelor (PRU) and aspirin reaction units (ARU) were measured using the point-of-care test VerifyNow before PCI. The high on-ticagrelor (PRU >208) and on-aspirin (ARU ⩾ 550) platelet reactivity (HPR and HaPR) were assessed. Patients were divided into two groups according to MBG 3 or <3. RESULTS MBG 3 was identified in 28 (46%) patients. Mean PRU was lower in such patients as compared with those with MBG <3 (155.82 ± 90.91 vs. 227.42 ± 65.18; p=0.001) while mean ARU was similar between groups. HPR and HaPR were observed in 30 (49.2%) and 11 patients (18%), respectively. HPR but not HaPR was more frequent in the group with impaired MBG (66.7 vs. 28.6%; p=0.003 and 21.2 vs. 14.3%; p=0.48 respectively). CONCLUSION Our study shows that higher PRU and the subsequent HPR at the time of primary PCI, after pretreatment with ticagrelor, are the only correlates of post PCI MBG. These findings support the earliest possible loading with ticagrelor prior to primary PCI.
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Affiliation(s)
- Vincent Roule
- 1 Department of Cardiology, Caen University Hospital, France
- 2 EA 4650, Normandie Université-Caen, France
| | - Thibaut Heudel
- 1 Department of Cardiology, Caen University Hospital, France
| | - Adrien Lemaitre
- 1 Department of Cardiology, Caen University Hospital, France
| | - Mathieu Bignon
- 1 Department of Cardiology, Caen University Hospital, France
| | - Pierre Ardouin
- 1 Department of Cardiology, Caen University Hospital, France
| | - Rémi Sabatier
- 1 Department of Cardiology, Caen University Hospital, France
| | | | - Farzin Beygui
- 1 Department of Cardiology, Caen University Hospital, France
- 2 EA 4650, Normandie Université-Caen, France
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