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Cherbi M, Bouisset F, Bonnefoy E, Lamblin N, Gerbaud E, Bonello L, Levy B, Lim P, Joffre J, Beuzelin M, Roland Y, Niquet L, Favory R, Khachab H, Harbaoui B, Vanzetto G, Combaret N, Marchandot B, Lattuca B, Leurent G, Lairez O, Puymirat E, Roubille F, Delmas C. Characteristics, management, and mid-term prognosis of older adults with cardiogenic shock admitted to intensive care units: Insights from the FRENSHOCK registry. Int J Cardiol 2024; 395:131578. [PMID: 37956759 DOI: 10.1016/j.ijcard.2023.131578] [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: 08/12/2023] [Revised: 10/25/2023] [Accepted: 11/09/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND The incidence of heart failure and cardiogenic shock (CS) in older adults is continually increasing due to population aging. To date, prospective data detailing the specific characteristics, management and outcomes of CS in this population are scarce. METHODS FRENSHOCK is a prospective registry including 772 CS patients from 49 centers. We studied 1-month and 1-year mortality among patients over 75-year-old, adjusted for independent predictors of 1-month and 1-year mortalities. RESULTS Out of 772 patients included, 236 (30.6%) were 75 years old or more (mean age 81.9 ± 4.7 years, 63.6% male). Compared to patients <75 years old, older adults had a higher prevalence of comorbidities including hypertension, dyslipidemia, chronic kidney disease, and history of heart disease. Older adults were characterized by a lower blood pressure, as well as higher creatinine and lower haemoglobin levels at presentation. Yet, they were less likely to be treated with norepinephrine, epinephrine, invasive ventilation, and renal replacement therapy. They showed a higher 1-month (aHR: 2.5 [1.86-3.35], p < 0.01) and 1-year mortality (aHR: 2.01 [1.58-2.56], p < 0.01). Analysis of both 1-month and 1-year mortality stratified by age quartiles showed a gradual relationship between aging and mortality in CS patients. CONCLUSION A third of patient with CS in critical care unit are older than 75 years and their risk of death at one month and one year is more than double compared to the younger ones. Further research is essential to identify best therapeutic strategy in this population. NCT02703038.
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Affiliation(s)
- Miloud Cherbi
- Intensive Cardiac Care Unit, Cardiology department, Toulouse University Hospital, Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), 31059 Toulouse, France
| | - Frédéric Bouisset
- Intensive Cardiac Care Unit, Cardiology department, Toulouse University Hospital, Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), 31059 Toulouse, France
| | - Eric Bonnefoy
- Intensive Cardiac Care Unit, Lyon Brom University Hospital, Lyon, France
| | - Nicolas Lamblin
- Urgences et Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, F-59000 Lille, France
| | - Edouard Gerbaud
- Intensive Cardiac Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, Hôpital Xavier Arnozan, Avenue du Haut Lévêque, 5 Avenue de Magellan, 33600 Pessac, France
| | - Laurent Bonello
- Aix-Marseille Université, Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), F-13385 Marseille, France
| | - Bruno Levy
- CHRU Nancy, Réanimation Médicale Brabois, Vandoeuvre-les Nancy, France
| | - Pascal Lim
- Univ Paris Est Créteil, INSERM, IMRB, AP-HP, Hôpital Universitaire Henri-Mondor, Service de Cardiologie, F-94010 Créteil, France
| | | | | | - Yves Roland
- IHU HealthAge, Gerontopole of Toulouse, Institute of Ageing, Toulouse University Hospital (CHU Toulouse), Toulouse, France
| | - Louis Niquet
- Intensive Care Unit, CH Intercommunal des Vallées de l'Ariège, France
| | - Raphael Favory
- Intensive Care Unit, Hôpital Roger Salengro, CHU de Lille, France
| | - Hadi Khachab
- Intensive Cardiac Care Unit, Department of Cardiology, CH d'Aix en Provence, Avenue des Tamaris, 13616, Aix-en-Provence cedex 1, France
| | - Brahim Harbaoui
- Cardiology Department, Hôpital Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, University of Lyon, CREATIS UMR5220, INSERM U1044, INSA-15, Lyon, France
| | - Gerald Vanzetto
- Department of Cardiology, Hôpital de Grenoble, 38700 La Tronche, France
| | - Nicolas Combaret
- Department of Cardiology, CHU Clermont-Ferrand, CNRS, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Benjamin Marchandot
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 67091 Strasbourg, France
| | - Benoit Lattuca
- Department of Cardiology, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Guillaume Leurent
- Department of Cardiology, CHU Rennes, Inserm, LTSI-UMR 1099, Univ Rennes 1, F-35000 Rennes, France
| | - Olivier Lairez
- Cardiology department, Toulouse University Hospital, Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse 31059, France
| | - Etienne Puymirat
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology, 75015 Paris, Université de Paris, 75006 Paris, France
| | - François Roubille
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Cardiology Department, CHU de Montpellier, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Cardiology department, Toulouse University Hospital, Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), 31059 Toulouse, France; REICATRA, Institut Saint Jacques, CHU de Toulouse, Toulouse, France.
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Delmas C, Barbosa H, David CH, Bouisset F, Piriou PG, Roubille F, Leick J, Pavlov M, Leurent G, Potapov EV, Linke A, Mierke J, Lanmüller P, Mangner N. Impella for the Management of Ventricular Septal Defect Complicating Acute Myocardial Infarction: A European Multicenter Registry. ASAIO J 2023; 69:e491-e499. [PMID: 37935014 DOI: 10.1097/mat.0000000000002060] [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] [Indexed: 11/09/2023] Open
Abstract
Ventricular septal defect (VSD) is a rare but severe complication of myocardial infarction (MI). Temporary mechanical circulatory support (MCS) can be used as a bridge to VSD closure, heart transplantation, or ventricular assist device. We describe the use of Impella device in this context based on a multicenter European retrospective registry (17 centers responded). Twenty-eight post-MI VSD patients were included (Impella device were 2.5 for 1 patient, CP for 20, 5.0 for 5, and unknown for 2). All patients were in cardiogenic shock with multiple organ failure (SAPS II 41 [interquantile range {IQR} = 27-53], lactate 4.0 ± 3.5 mmol/L) and catecholamine support (dobutamine 55% and norepinephrine 96%). Additional temporary MCS was used in 14 patients (50%), mainly extracorporeal life support (ECLS) (n = 9, 32%). Severe bleedings were frequent (50%). In-hospital and 1 year mortalities were 75%. Ventricular septal defect management was surgical for 36% of patients, percutaneous for 21%, and conservative for 43%. Only surgically managed patients survived (70% in-hospital survival). Type and combination of temporary MCS used were not associated with mortality (Impella alone or in combination with intra-aortic balloon pump [IABP] or ECLS, p = 0.84). Impella use in patients with post-MI VSD is feasible but larger prospective registries are necessary to further elucidate potential benefits of left ventricular unloading in this setting.
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Affiliation(s)
- Clement Delmas
- From the Intensive Cardiac Care Unit, Cardiology Department, Rangueil University Hospital, Toulouse, France
| | - Hélène Barbosa
- From the Intensive Cardiac Care Unit, Cardiology Department, Rangueil University Hospital, Toulouse, France
| | - Charles-Henri David
- Cardiovascular Surgery Department, Nantes University Hospital, Nantes, France
| | - Frédéric Bouisset
- From the Intensive Cardiac Care Unit, Cardiology Department, Rangueil University Hospital, Toulouse, France
| | | | - François Roubille
- Cardiology Department INI-CRT PhyMedExp INSERM CNRS CHU de Montpellier, Université de Montpellier, Montpellier, France
| | - Juergen Leick
- Herzzentrum Krankenhaus der Barmherzigen Brüder, Trier, Germany
| | | | | | - Evgenij V Potapov
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Germany/Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Axel Linke
- Department of Internal Medicine and Cardiology, Heart Center Dresden, Technische Universität Dresden, Dresden, Germany
| | - Johannes Mierke
- Department of Internal Medicine and Cardiology, Heart Center Dresden, Technische Universität Dresden, Dresden, Germany
| | - Pia Lanmüller
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Germany/Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Norman Mangner
- Department of Internal Medicine and Cardiology, Heart Center Dresden, Technische Universität Dresden, Dresden, Germany
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Servoz C, Matta A, Bataille V, Philippe J, Laszlo L, Blanco S, Elbaz M, Bouisset F, Campelo-Parada F, Carrié D, Lhermusier T. Outcomes of Provisional Stenting With Versus Without Side Branch Intervention in Patients With Bifurcation Lesion-Related ST-Segment Elevation Myocardial Infarction. Am J Cardiol 2023; 208:190-194. [PMID: 37871531 DOI: 10.1016/j.amjcard.2023.09.049] [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: 06/29/2023] [Revised: 09/05/2023] [Accepted: 09/09/2023] [Indexed: 10/25/2023]
Abstract
To date, the best approach to coronary bifurcation lesion remains unsettled, and the parameters to guide side branch ballooning or stenting are not yet defined. This study aimed to compare the survival outcomes after provisional stenting with versus without side branch intervention. A cohort was conducted on 132 patients who underwent coronary angiography at Toulouse University Hospital for ST-segment elevation myocardial infarction with large culprit nonleft main coronary bifurcation lesion. Study participants were divided into 2 groups depending on the performance or not of a side branch intervention. We observed the living status at 1-year after hospital discharge. Side branch intervention by balloon inflation or final balloon kissing technique was performed in 34.1% of study participants. At 1-year follow-up, the incidence of all-cause mortality was 7.8 per 100 person-years (95% confidence interval [CI] 4.1 to 15), and although it seemed higher in the side branch intervention group (10 per 100 person-years [95% CI 3.8 to 26.7] vs 6.6 per 100 persons-years [95% CI 2.8 to 15.9]), the survival analyses showed no differences in survival outcomes (hazard ratio side branch intervention 1.55 [0.42 to 5.78], p = 0.513). In conclusion, in the setting of a coronary bifurcation causing ST-segment elevation myocardial infarction, simple provisional stenting without side branch intervention showed a low mortality rate and no differences in the 1-year survival outcomes.
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Affiliation(s)
- Clément Servoz
- Department of Cardiology, Toulouse University Hospital, Toulouse, France.
| | - Anthony Matta
- Department of cardiology, Civilians Hospital of Colmar, Colmar, France
| | - Vincent Bataille
- Department of Cardiology, Toulouse University Hospital, Toulouse, France
| | - John Philippe
- Department of cardiology, Civilians Hospital of Colmar, Colmar, France
| | - Levai Laszlo
- Department of cardiology, Civilians Hospital of Colmar, Colmar, France
| | - Stéphanie Blanco
- Department of Cardiology, Toulouse University Hospital, Toulouse, France
| | - Meyer Elbaz
- Department of Cardiology, Toulouse University Hospital, Toulouse, France
| | - Frédéric Bouisset
- Department of Cardiology, Toulouse University Hospital, Toulouse, France
| | | | - Didier Carrié
- Department of Cardiology, Toulouse University Hospital, Toulouse, France
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Ohashi H, Bouisset F, Buytaert D, Seki R, Sonck J, Sakai K, Belmonte M, Kitslaar P, Updegrove A, Amano T, Andreini D, De Bruyne B, Collet C. Coronary CT Angiography in the Cath Lab: Leveraging Artificial Intelligence to Plan and Guide Percutaneous Coronary Intervention. Interv Cardiol 2023; 18:e26. [PMID: 38125928 PMCID: PMC10731535 DOI: 10.15420/icr.2023.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/15/2023] [Indexed: 12/23/2023] Open
Abstract
The role of coronary CT angiography for the diagnosis and risk stratification of coronary artery disease is well established. However, its potential beyond the diagnostic phase remains to be determined. The current review focuses on the insights that coronary CT angiography can provide when planning and performing percutaneous coronary interventions. We describe a novel approach incorporating anatomical and functional pre-procedural planning enhanced by artificial intelligence, computational physiology and online 3D CT guidance for percutaneous coronary interventions. This strategy allows the individualisation of patient selection, optimisation of the revascularisation strategy and effective use of resources.
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Affiliation(s)
- Hirofumi Ohashi
- Cardiovascular Center OLVAalst, Belgium
- Department of Cardiology, Aichi Medical UniversityAichi, Japan
| | - Frédéric Bouisset
- Cardiovascular Center OLVAalst, Belgium
- Department of Cardiology, Toulouse University HospitalToulouse, France
| | | | | | | | - Koshiro Sakai
- Cardiovascular Center OLVAalst, Belgium
- Department of Cardiology, Showa University HospitalTokyo, Japan
| | - Marta Belmonte
- Cardiovascular Center OLVAalst, Belgium
- Department of Advanced Biomedical Sciences, University Federico IINaples, Italy
| | | | | | - Tetsuya Amano
- Department of Cardiology, Aichi Medical UniversityAichi, Japan
| | - Daniele Andreini
- Division of Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi – Sant’AmbrogioMilan, Italy
- Department of Biomedical and Clinical Sciences, University of MilanMilan, Italy
| | - Bernard De Bruyne
- Cardiovascular Center OLVAalst, Belgium
- Department of Cardiology, University Hospital of LausanneLausanne, Switzerland
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Matta A, Regueiro A, Urena M, Nombela-Franco L, Riche M, Rodriguez-Gabella T, Amat-Santos I, Chamandi C, Akiki T, Gabani R, Vera-Urquiza R, Lhermusier T, Bouisset F, Carrié D, Campelo-Parada F. Comparison of Paravalvular Leak in SAPIEN 3 and EVOLUT PRO Valves in Transcatheter Aortic Valve Replacement: A Multicenter Registry. Am J Cardiol 2023; 207:114-120. [PMID: 37734300 DOI: 10.1016/j.amjcard.2023.08.098] [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: 06/13/2023] [Revised: 08/09/2023] [Accepted: 08/17/2023] [Indexed: 09/23/2023]
Abstract
Paravalvular leak (PVL), conduction disturbances, and vascular complications remain the most common complications after TAVR. To address these adverse outcomes, the third generation of transcatheter heart valves has been developed. The last generation prosthesis provides an outer pericardial wrap for enhanced sealing and PVL prevention. This study aimed to compare the incidence and severity of PVL and 1-year survival after TAVR using SAPIEN 3 with those using EVOLUT PRO. An observational retrospective analysis was conducted in 1,481 patients who underwent TAVR for symptomatic severe aortic stenosis in 6 different European centers. The primary end point was to assess the frequency and severity of PVL at 30 days after TAVR. The secondary end point was to compare 1-year survival using EVOLUT PRO with that using SAPIEN 3. SAPIEN 3 transcatheter heart valve was implanted in 78.3% of study participants (n = 1,160) whereas EVOLUT PRO was implanted in 21.7% (n = 321). PVL is more commonly observed in patients treated with EVOLUT PRO at prehospital discharge (55.1% vs 37.3%) and at 1-month (51% vs 41.4%) and 1-year (51.3% vs 39.3%) follow-up. This difference mainly concerns low-grade (mild/trace) PVL. The frequency of high-degree (moderate/severe) PVL was almost similar in both groups throughout the study period (5.3% vs 5.8% before hospital discharge, 4% vs 3.1% at 1 month, and 3.2% vs 4.9% at 1 year). No significant difference in survival over 1 year has been observed (hazard ratio 0.73 [0.33 to 1.63], p = 0.442) (Graphical abstract). In conclusion, the detection rate of PVL after TAVR with third-generation heart valves remains high, and there are no major differences between the devices regarding the frequency of significant (moderate/severe) PVL and survival.
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Affiliation(s)
- Anthony Matta
- Department of Cardiology, Hôpital Rangueil, CHU-Toulouse, Toulouse, France; Department of Cardiology, Civilian Hospitals of Colmar, Colmar, France
| | - Ander Regueiro
- Department of Cardiology, Hospital Clinic de Barcelona, Spain
| | - Marina Urena
- Department of Cardiology, Hôpital Bichat, AP-HP, Paris, France
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Maya Riche
- Department of Cardiology, Hôpital Rangueil, CHU-Toulouse, Toulouse, France
| | | | - Ignacio Amat-Santos
- Department of Cardiology, Hospital Clínico Universitario de Valladolid, Spain
| | - Chekrallah Chamandi
- Department of Cardiology, Hôpital Européen Georges-Pompidou, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Tanios Akiki
- Department of Cardiology, Hôpital Européen Georges-Pompidou, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Rami Gabani
- Department of Cardiology, Hospital Clinic de Barcelona, Spain
| | - Rafael Vera-Urquiza
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Thibault Lhermusier
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Frédéric Bouisset
- Department of Cardiology, Hôpital Rangueil, CHU-Toulouse, Toulouse, France
| | - Didier Carrié
- Department of Cardiology, Hôpital Rangueil, CHU-Toulouse, Toulouse, France
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Hascoët S, Smolka G, Brochet E, Bouisset F, Leurent G, Thambo JB, Combes N, Bauer F, Nejjari M, Pilliere R, Dauphin C, Bonnet G, Ketelers R, Dumonteil N, Ciobotaru V, Gallet R, Hammoudi N, Spaulding C, Champagnac D, Gérardin B. Predictors of clinical success after transcatheter paravalvular leak closure: An international prospective multicenter registry. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Bouisset F, Ribichini F, Bataille V, Reczuch K, Lhermusier T, Dobrzycki S, Meyer-Gessner M, Bressollette E, Zajdel W, Faurie B, Mezilis N, Palazuelos J, Vaquerizo B, Ferenc M, Cayla G, Barbato E, Carrié D. Clinical Outcomes of Left Main Coronary Artery PCI With Rotational Atherectomy. Am J Cardiol 2023; 186:36-42. [PMID: 36343444 DOI: 10.1016/j.amjcard.2022.09.031] [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] [Received: 06/18/2022] [Revised: 09/10/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022]
Abstract
Data regarding rotational atherectomy percutaneous coronary intervention (RA PCI) angioplasty in the left main (LM) coronary artery are scarce, and mostly outdated. We aimed to describe clinical outcomes of RA PCI in LM. Patients requiring RA in 8 European countries and 19 centers were prospectively and consecutively included in the European registry of Cardiac Care of Calcified and Complex patients registry. In-hospital data collection and 1-year follow-up were performed for each patient. Between October 2016 and July 2018, 966 patients with complete data were included. Among them, 241 presented with an LM lesion, and 171 required an LM lesion preparation by RA. The latter, allocated to the LM-RA group, were compared with the 725 patients in the non-LM-RA group. Clinical success of the RA procedure was comparable in both groups, but in-hospital major adverse cardiac events were higher in the RA-LM group (7.6% vs 3.2%, adjusted p = 0.04), mainly driven by a higher in-hospital mortality rate (5.3 vs 0.3%, adjusted p = 0.005). At 1-year follow-up, mortality and major adverse cardiac event rates were comparable in both groups (12.9% vs 8.0%, adjusted p value: 0.821, and 15.8% vs 10.9%, adjusted p value: 0.329, respectively), but the rate of target vessel revascularization remained higher in the RA-LM group (5.3% vs 3.2%, adjusted p = 0.021). In conclusion, RA PCI is an efficient option for calcified LM lesions, providing acceptable outcomes regarding this population with high risk at 1 year, and yields comparable outcomes with RA PCI performed on non-LM lesions.
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Affiliation(s)
- Frédéric Bouisset
- Department of Cardiology, Rangueil Toulouse University Hospital, University Paul Sabatier, Toulouse, France.
| | | | - Vincent Bataille
- Department of Cardiology, Rangueil Toulouse University Hospital, University Paul Sabatier, Toulouse, France; Association pour la Diffusion de la Médecine de Prévention (ADIMEP), Toulouse, France
| | - Krzysztof Reczuch
- Institute of Heart Diseases, Wroclaw Medical University, Wrocław, Poland
| | - Thibault Lhermusier
- Department of Cardiology, Rangueil Toulouse University Hospital, University Paul Sabatier, Toulouse, France
| | | | | | | | - Wojciech Zajdel
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
| | - Benjamin Faurie
- Cardiovascular Institute, Groupe Hospitalier Mutualiste, Grenoble, France
| | - Nikolaos Mezilis
- Department of Cardiology, St Luke's Hospital, Thessaloniki, Greece
| | - Jorge Palazuelos
- Department of Cardiology, Interventional Cardiology Unit, Hospital La Luz, Madrid, Spain
| | - Beatriz Vaquerizo
- Department of Cardiology, Hospital del Mar, Barcelona, Spain; Heart Diseases Biomedical Research Group (GREC), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Department of Medicine, School of Medicine, Universitat Pompeu Fabra, Barcelona, Spain
| | - Miroslaw Ferenc
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Guillaume Cayla
- Department of Cardiology, Centre Hospitalier Universitaire de Nîmes, Université de Montpellier, Nîmes, France
| | - Emanuele Barbato
- Division of Cardiology, Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Didier Carrié
- Department of Cardiology, Rangueil Toulouse University Hospital, University Paul Sabatier, Toulouse, France
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Matta A, Campelo-Parada F, Nader V, Lhermusier T, Bouisset F, Blanco S, Roncalli J, Carrié D. Long-term outcomes of conservative versus invasive approach of coronary aneurysm. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.012] [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: 01/01/2023]
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Delmas C, Scaglione M, Bouisset F, Roubille F. Post-mRNA COVID-19 vaccines myocarditis: Not so rare in cardiology practice. Archives of Cardiovascular Diseases Supplements 2023. [PMCID: PMC9800765 DOI: 10.1016/j.acvdsp.2022.10.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Treille de Grandsaigne H, Bouisset F, Porterie J, Biendel C, Marcheix B, Lairez O, Labaste F, Elbaz M, Galinier M, Delmas C. Incidence, management, and prognosis of post-ischaemic ventricular septal defect: Insights from a 12-year tertiary centre experience. Front Cardiovasc Med 2022; 9:1066308. [PMID: 36561773 PMCID: PMC9763320 DOI: 10.3389/fcvm.2022.1066308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
Background Among mechanical complications of acute myocardial infarction, ventricular septal defect (VSD) is uncommon but still serious. The evolution of emergency coronary revascularisation paradoxically decreased our knowledge of this disease, making it even rarer. Aim To describe ischaemic VSD incidence, management, and associated in-hospital and 1-year outcomes over a 12-years period. Methods A retrospective single-centre register of patients managed for ischaemic VSD between January 2009 and December 2020. Results Ninety-seven patients were included representing 8 patients/ years and an incidence of 0.44% of ACS managed. The majority of the patients were 73-years-old males (n = 54, 56%) with STEMI presentation (n = 75, 79%) and already presented with Q necrosis on ECG (n = 70, 74%). Forty-nine (51%) patients underwent PCI, 60 (62%) inotrope/vasopressors infusion, and 70 (72%) acute mechanical circulatory support (IABP 62%, ECMO 13%, and Impella® 3%). VSD surgical repair was performed for 44 patients (45%) and 1 patient was transplanted. In-hospital mortality was 71%, and 86% at 1 year, without significant improvement over the decade. Surgery appears to be a protective factor [0.51 (0.28-0.94) p = 0.003], whereas age [1.06 (1.03-1.09), p < 0.001] and lactate [1.16 (1.09-1.23), p < 0.001] were linked to higher 1-year mortality. None of the patients that were managed medically survived 1 year. Conclusion Post-ischaemic VSD is a rare but serious complication still associated with high mortality. Corrective surgery is associated with better survival, however, timing, patient selection, and a place for mechanical circulatory support need to be defined.
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Affiliation(s)
- Henri Treille de Grandsaigne
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France,Cardiology Department, Rangueil University Hospital, Toulouse, France
| | - Frédéric Bouisset
- Cardiology Department, Rangueil University Hospital, Toulouse, France
| | - Jean Porterie
- Cardiovascular Surgery Department, Rangueil University Hospital, Toulouse, France
| | - Caroline Biendel
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France,Cardiology Department, Rangueil University Hospital, Toulouse, France
| | - Bertrand Marcheix
- Cardiovascular Surgery Department, Rangueil University Hospital, Toulouse, France
| | - Olivier Lairez
- Cardiology Department, Rangueil University Hospital, Toulouse, France
| | - François Labaste
- Department of Anesthesiology, Intensive Care Medicine and Perioperative Medicine, Rangueil University Hospital, Toulouse, France
| | - Meyer Elbaz
- Cardiology Department, Rangueil University Hospital, Toulouse, France
| | - Michel Galinier
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France,Cardiology Department, Rangueil University Hospital, Toulouse, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France,Cardiology Department, Rangueil University Hospital, Toulouse, France,*Correspondence: Clément Delmas
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11
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Hascoet S, Smolka G, Brochet E, Bouisset F, Leurent G, Thambo JB, Combes N, Bauer F, Nejjari M, Pilliere R, Dauphin C, Bonnet G, Ketelers R, Champagnac D, Gerardin B. Predictors of clinical success after transcatheter para-valvular leak closure: an international prospective multicentre registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2138] [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
Prosthetic paravalvular leaks (PVLs) are associated with congestive heart failure and haemolysis, for which the standard treatment is open-heart surgery with the attendant risks to the patient. Transcatheter closure has emerged as an alternative. Patient selection criteria for the best option are needed. We aimed to identify predictors of clinical success after transcatheter PVL closure.
Purpose
We aimed to identify predictors of clinical success after transcatheter PVL closure.
Methods
Consecutive patients referred to 24 European centres for transcatheter PVL closure in 2017–2019 were included in a prospective registry (Fermeture de Fuite ParaProthétique, FFPP). Clinical success was absence of any of the following within 1 month: re-admission for heart failure, blood transfusion, open-heart valvular surgery, and death.
Results
We included 216 symptomatic patients, who underwent 238 percutaneous PVL closure procedures on the mitral (64.3%), aortic (34.0%), or tricuspid (1.7%) valve. The prosthesis was mechanical in 53.3% and biological in 45.3% of procedures. All patients were symptomatic with heart failure, haemolytic anaemia, and the association of both conditions in 48.9%, 7.8% and 43.3%. One, two and three PVL were addressed during the same procedure in 69.6%, 26.6% and 3.8% respectively. Mitral and aortic PVL were severe in 35.3% and 13.8% (p<0.001). PVL was punctiform or extended to 1/8 or 1/4 of valve circumference in 18.6%, 52.4% and 28.1% of cases. A total of 331 devices were implanted. More than one device (up to 5) was implanted in 34.2% of procedures. Vascular plug 3, muscular ventricular septal defect occluder, vascular plug 2 and paravalvular leak device were the most frequently used devices, implanted in 45.0%, 16.0%, 14.2% and 13.6%, respectively. Successful device(s) implantation(s) within the leak and leak reduction ≤ grade 2 occurred in 85.0% and 91.4% of patients with mitral and aortic procedures, respectively (p=0.164), with major intra-procedural adverse event rates of 3.3% and 1.2%, respectively (p=0.371). The clinical success rates were 77.8% and 88.9% following mitral and aortic procedures, respectively (p=0.01). By multivariate logistic regression analysis, technical failure, mechanical valve and haemolytic anaemia were independently associated with absence of clinical success (odds ratios [95% CIs]: 7.7 [2.0–25.0], p=0.002; 3.6 [1.1–11.1], p=0.036 and 3.7 [1.2–11.9], p=0.025; respectively).
Conclusion
Transcatheter PVL closure is efficient and safe in symptomatic patients but is more challenging and associated with an increased risk of clinical failure when performed in patients with hemolysis and/or on a mechanical valve.
Funding Acknowledgement
Type of funding sources: Private hospital(s). Main funding source(s): The study is promoted and financially supported by Groupe Hospitalier Paris Saint Joseph
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Affiliation(s)
- S Hascoet
- Marie Lannelongue Hospital , Le Plessis Robinson , France
| | - G Smolka
- School of Medicine in Katowice, Medical University of Silesia , Katowice , Poland
| | - E Brochet
- Bichat APHP Site of Paris Nord University Hospital , Paris , France
| | - F Bouisset
- Rangueil Hospital of Toulouse , Toulouse , France
| | - G Leurent
- Hospital Pontchaillou of Rennes , Rennes , France
| | - J B Thambo
- Hospital Haut Leveque , Bordeaux , France
| | - N Combes
- Clinic Pasteur , Toulouse , France
| | - F Bauer
- Rouen University Medical School , Rouen , France
| | - M Nejjari
- centre cardiologique du nord , Saint-Denis , France
| | - R Pilliere
- Clinique Ambroise Pare , Neuilly sur Seine , France
| | - C Dauphin
- University Hospital Gabriel Montpied , Clermont-Ferrand , France
| | - G Bonnet
- APHM La Timone Hospital , Marseille , France
| | | | - D Champagnac
- Medipole Lyon-Villeurbanne , Villeurbanne , France
| | - B Gerardin
- Marie Lannelongue Hospital , Le Plessis Robinson , France
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12
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Matta A, Nader V, Canitrot R, Delmas C, Bouisset F, Lhermusier T, Blanco S, Parada FC, Elbaz M, Carrie D, Galinier M, Roncalli J. Myocardial bridging is significantly associated with myocardial infarction with non-obstructive coronary arteries. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1458] [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
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a common disorder characterized by the presence of clinical criteria for acute myocardial infarction in the absence of obstructive coronary artery disease on angiography. We aim to investigate the relationship between myocardial bridging (MB) and MINOCA.
Methods
An observational retrospective study was conducted on 15,036 patients who had been referred for coronary angiography and who fulfilled the Fourth Universal Definition of Myocardial Infarction. The study population was divided into STEMI and non-STEMI patients, from which we defined two main groups: the MINOCA group and the coronary artery disease (CAD) group. Statistical analyses were carried out by using SPSS, version 20.
Results
The prevalence of angiographic MB among the groups was significantly greater in the MINOCA group (2.9% vs. 0.8%). MINOCA accounted for 14.5% of spontaneous myocardial infarction, and the clinical presentation was frequently NSTEMI rather than STEMI (84.3% vs. 15.7%). After adjusting for confounders, multivariate analyses showed a positive association between MB and MINOCA [OR=3.28, 95% CI (2.34; 4.61) p<0.001]. Cardiovascular risk factors were less common in the MINOCA population, which was younger and more often female.
Conclusion
MB is a risk factor for MINOCA. Because MB prevalence differed significantly between the controls (CAD group) and cases (MINOCA group), which were positively associated to MB, it seems likely that MB would be a potential cause of MINOCA. Investigations for MB in MINOCA cases and especially in NSTEMI patients seem necessary.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Rangueil Hospital
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Affiliation(s)
- A Matta
- Rangueil Hospital of Toulouse , Toulouse , France
| | - V Nader
- Rangueil Hospital of Toulouse , Toulouse , France
| | - R Canitrot
- Rangueil Hospital of Toulouse , Toulouse , France
| | - C Delmas
- Rangueil Hospital of Toulouse , Toulouse , France
| | - F Bouisset
- Rangueil Hospital of Toulouse , Toulouse , France
| | - T Lhermusier
- Rangueil Hospital of Toulouse , Toulouse , France
| | - S Blanco
- Rangueil Hospital of Toulouse , Toulouse , France
| | - F C Parada
- Rangueil Hospital of Toulouse , Toulouse , France
| | - M Elbaz
- Rangueil Hospital of Toulouse , Toulouse , France
| | - D Carrie
- Rangueil Hospital of Toulouse , Toulouse , France
| | - M Galinier
- Rangueil Hospital of Toulouse , Toulouse , France
| | - J Roncalli
- Rangueil Hospital of Toulouse , Toulouse , France
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13
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Kai SHY, Ferrières J, Rossignol M, Bouisset F, Herry J, Esquirol Y. Prevalence and determinants of return to work after various coronary events: meta-analysis of prospective studies. Sci Rep 2022; 12:15348. [PMID: 36097026 PMCID: PMC9468005 DOI: 10.1038/s41598-022-19467-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 12/01/2021] [Accepted: 08/30/2022] [Indexed: 11/29/2022] Open
Abstract
Return to work (RTW) after a coronary event remains a major concern. This systematic review and meta-analysis of prospective studies published between January 1988 and August 2020, aim to evaluate the prevalence of RTW after a coronary event (myocardial infarction, acute coronary syndrome, angina pectoris) and to assess the determinants of RTW (such as follow-up duration, date of recruitment, country, gender, occupational factors, etc.). PRISMA and MOOSE guidelines were followed. Study quality was assessed using the Newcastle–Ottawa Scale. Random-effects models were carried out to determine pooled prevalence estimates and 95% confident interval. A total of 43 prospective studies (34,964 patients) were investigated. RTW overall random effects pooled prevalence was estimated at 81.1% [95% CI 75.8–85.8]. Country, year of implementation or gender did not significantly modify the prevalence estimates. Lower level of education and degraded left ventricular ejection fraction decreased RTW prevalence estimates (respectively, 76.1% vs 85.6% and 65.3% vs 77.8%). RTW prevalence estimates were higher for white-collars (81.2% vs 65.0% for blue-collars) and people with low physical workload (78.3% vs 64.1% for elevated physical workload).Occupational physical constraints seem to have a negative role in RTW while psycho-logical factors at work are insufficiently investigated. A better understanding of the real-life working conditions influencing RTW would be useful to maintain coronary patients in the labor market.
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Affiliation(s)
- Samantha Huo Yung Kai
- CERPOP, Université de Toulouse, Inserm, UPS, 31000, Toulouse, France.,Department of Epidemiology, Toulouse University Hospital, 31000, Toulouse, France
| | - Jean Ferrières
- CERPOP, Université de Toulouse, Inserm, UPS, 31000, Toulouse, France.,Department of Cardiology, Toulouse University Hospital, 31400, Toulouse, France
| | - Mélisande Rossignol
- Occupational Health Department, Toulouse University Hospital, 31300, Toulouse, France
| | - Frédéric Bouisset
- CERPOP, Université de Toulouse, Inserm, UPS, 31000, Toulouse, France.,Department of Cardiology, Toulouse University Hospital, 31400, Toulouse, France
| | - Julie Herry
- Occupational Health Department, Toulouse University Hospital, 31300, Toulouse, France
| | - Yolande Esquirol
- CERPOP, Université de Toulouse, Inserm, UPS, 31000, Toulouse, France. .,Occupational Health Department, Toulouse University Hospital, 31300, Toulouse, France.
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14
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Delmas C, Vallee L, Bouisset F, Porterie J, Biendel C, Lairez O, Crognier L, Marcheix B, Conil JM, Maury P, Minville V. Use of Percutaneous Atrioseptotosmy for Left Heart Decompression During Veno-Arterial Extracorporeal Membrane Oxygenation Support: An Observational Study. J Am Heart Assoc 2022; 11:e024642. [PMID: 36000436 PMCID: PMC9496417 DOI: 10.1161/jaha.121.024642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Left ventricular overload is frequent under veno‐arterial extracorporeal membrane oxygenation, which is associated with a worsening of the prognosis of these patients. Several left heart decompression (LHD) techniques exist. However, there is no consensus on their timing and type. We aimed to describe characteristics and outcomes of patients undergoing LHD and to compare percutaneous atrioseptostomy (PA) to other LHD techniques. Methods and Results Retrospective analysis was conducted of consecutive and prospectively collected patients supported by veno‐arterial extracorporeal membrane oxygenation for refractory cardiac arrest or cardiogenic shock between January 2015 and April 2018, with a 90‐day follow‐up in our tertiary center. Patients were divided according to the presence of LHD, and then according to its type (PA versus others). Thirty‐nine percent (n=63) of our patients (n=163) required an LHD. Patients with LHD had lower left ventricular ejection fraction, more ischemic cardiomyopathy, and no drug intoxication‐associated cardiogenic shock. PA was frequently used for LHD (41% of first‐line and 57% of second‐line LHD). PA appears safe and fast to realize (6.3 [interquartile range, 5.8–10] minutes) under fluoroscopic and echocardiographic guidance, with no acute complications. PA was associated with fewer neurological complications (12% versus 38%, P=0.02), no need to insert a second LHD (0% versus 19%, P=0.04), and higher 90‐day survival compared with other techniques (42% versus 19%, log‐rank test P=0.02), despite more sepsis (96% versus 73%, P=0.02) and blood transfusions (13.5% versus 7%, P=0.01). Multivariate analysis confirms the association between PA and 90‐day survival (hazard ratio, 2.53 [1.18–5.45], P=0.019). Conclusions LHD was frequently used for patients supported with veno‐arterial extracorporeal membrane oxygenation, especially in cases of ischemic cardiomyopathy and low left ventricular ejection fraction. PA seems to be a safe and efficient LHD technique associated with greater mid‐term survival justifying the pursuit of research on this topic.
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Affiliation(s)
- Clément Delmas
- Intensive Cardiac Care Unit Cardiology Department Rangueil University Toulouse France.,Cardiology Department Rangueil University Hospital Toulouse France
| | - Luigi Vallee
- Department of Anesthesiology, Intensive Care Medicine, and Perioperative Medicine Rangueil University Hospital Toulouse France
| | | | - Jean Porterie
- Cardiovascular Surgery Department Rangueil University Hospital Toulouse France
| | - Caroline Biendel
- Intensive Cardiac Care Unit Cardiology Department Rangueil University Toulouse France.,Cardiology Department Rangueil University Hospital Toulouse France
| | - Olivier Lairez
- Cardiology Department Rangueil University Hospital Toulouse France
| | - Laure Crognier
- Department of Anesthesiology, Intensive Care Medicine, and Perioperative Medicine Rangueil University Hospital Toulouse France
| | - Bertrand Marcheix
- Cardiovascular Surgery Department Rangueil University Hospital Toulouse France
| | - Jean-Marie Conil
- Department of Anesthesiology, Intensive Care Medicine, and Perioperative Medicine Rangueil University Hospital Toulouse France
| | - Philippe Maury
- Cardiology Department Rangueil University Hospital Toulouse France
| | - Vincent Minville
- Department of Anesthesiology, Intensive Care Medicine, and Perioperative Medicine Rangueil University Hospital Toulouse France
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15
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Matta A, Campelo-Parada F, Nader V, Lhermusier T, Bouisset F, Blanco S, Elbaz M, Roncalli J, Carrié D. Long-Term Outcomes of Conservative Versus Invasive Approach of Coronary Aneurysm. Rev Cardiovasc Med 2022. [DOI: 10.31083/j.rcm2308281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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16
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Schoenfeld J, Cohen E, Nutting C, Licitra L, Burtness B, Omar M, Bouisset F, Nauwelaerts H, Urfer Y, Zanna C, Sr JB. Trilynx: A Phase 3 Trial of Xevinapant and Concurrent Chemoradiotherapy (CRT) for Locally Advanced Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2021.12.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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17
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Pagezy A, Carrie D, Marcheix B, Inamo J, Fabre J, Labaste F, Bouisset F. Predictive factors for coronary angioplasty in early postoperative follow-up of heart surgery. Archives of Cardiovascular Diseases Supplements 2022. [DOI: 10.1016/j.acvdsp.2021.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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18
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Matta A, Nader V, Canitrot R, Delmas C, Bouisset F, Lhermusier T, Blanco S, Parada F, Elbaz M, Carrié D, Galinier M, Roncalli J. Myocardial Bridging is Significantly Related to Myocardial Infarction with Non-Obstructive Coronary Artery Disease. Archives of Cardiovascular Diseases Supplements 2022. [DOI: 10.1016/j.acvdsp.2021.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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19
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Matta A, Lhermusier T, Parada F, Bouisset F, Ronan C, Nader V, Blanco S, Elbaz M, Roncalli J, Carrié D. Impact of Coronary Artery Disease and Percutaneous Coronary Intervention on Transcatheter Aortic Valve Implantation. Archives of Cardiovascular Diseases Supplements 2022. [DOI: 10.1016/j.acvdsp.2021.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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20
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Matta A, Lhermusier T, Bouisset F, Parada F, Elbaz M, Nader V, Blanco S, Roncalli J, Carrié D. Outcomes of transcatheter aortic valve implantation in nonagenarians compared to < 90 years patients. Archives of Cardiovascular Diseases Supplements 2022. [DOI: 10.1016/j.acvdsp.2021.09.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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Gerbaud E, Bouisset F, Ferrières J. Late is not always too late for revascularization in late-presenting patients with ST-segment elevation myocardial infarction. Arch Cardiovasc Dis 2021; 114:691-693. [PMID: 34772645 DOI: 10.1016/j.acvd.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)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Edouard Gerbaud
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, 33604 Pessac, France
| | - Frédéric Bouisset
- Department of Cardiology, Toulouse Rangueil University Hospital, UMR 1295, INSERM, TSA 50032, 31059 Toulouse cedex 9, France
| | - Jean Ferrières
- Department of Cardiology, Toulouse Rangueil University Hospital, UMR 1295, INSERM, TSA 50032, 31059 Toulouse cedex 9, France.
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22
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Matta A, Bayard N, Revel-Mouroz P, Marcheix B, Bouisset F. Percutaneous Approach for Late Left Main Coronary Detachment Resulting in Aortic Pseudoaneurysm After Bentall Procedure. JACC Case Rep 2021; 3:1586-1588. [PMID: 34729506 PMCID: PMC8543132 DOI: 10.1016/j.jaccas.2021.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/03/2021] [Accepted: 05/24/2021] [Indexed: 11/15/2022]
Abstract
We describe the case of 35-year-old patient with known Marfan syndrome, and previously treated by a Bentall procedure, who presented with an aortic pseudoaneurysm secondary to a partial proximal left main coronary artery detachment fixed by covered stent implantation. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Anthony Matta
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | - Nathanael Bayard
- Department of Cardiac Surgery, Rangueil University Hospital, Toulouse, France
| | - Paul Revel-Mouroz
- Department of Radiology, Rangueil University Hospital, Toulouse, France
| | - Bertrand Marcheix
- Department of Cardiac Surgery, Rangueil University Hospital, Toulouse, France
| | - Frédéric Bouisset
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
- Address for correspondence: Dr Frédéric Bouisset, Department of Cardiology, Toulouse University Hospital, 1, avenue Jean Poulhès, TSA 50032, 31059 Toulouse Cedex 9, France.
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23
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Bouisset F, Gerbaud E, Bataille V, Coste P, Puymirat E, Belle L, Delmas C, Cayla G, Motreff P, Lemesle G, Aissaoui N, Blanchard D, Schiele F, Simon T, Danchin N, Ferrières J. Percutaneous Myocardial Revascularization in Late-Presenting Patients With STEMI. J Am Coll Cardiol 2021; 78:1291-1305. [PMID: 34556314 DOI: 10.1016/j.jacc.2021.07.039] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 05/10/2021] [Revised: 06/28/2021] [Accepted: 07/19/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The optimal management of patients with ST-segment elevation myocardial infarction (STEMI) presenting late->12 hours following symptom onset-is still under debate. OBJECTIVES The purpose of this study was to describe characteristics, temporal trends, and impact of revascularization in a large population of latecomer STEMI patients. METHODS The authors analyzed the data of 3 nationwide observational studies from the FAST-MI (French Registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction) program, conducted over a 1-month period in 2005, 2010, and 2015. Patients presenting between 12 and 48 hours after symptom onset were classified as latecomers. RESULTS A total of 6,273 STEMI patients were included in the 3 cohorts, 1,169 (18.6%) of whom were latecomers. After exclusion of patients treated with fibrinolysis and patients deceased within 2 days after admission, 1,077 patients were analyzed, of whom 729 (67.7%) were revascularized within 48 hours after hospital admission. At 30-day follow-up, all-cause death rate was significantly lower among revascularized latecomers (2.1% vs 7.2%; P < 0.001). After a median follow-up of 58 months, the rate of all-cause death was 30.4 (95% CI: 25.7-35.9) per 1,000 patient-years in the revascularized latecomers group vs 78.7 (95% CI: 67.2-92.3) per 1,000 patient-years in the nonrevascularized latecomers group (P < 0.001). In multivariate analysis, revascularization of latecomer STEMI patients was independently associated with a significant reduction of mortality occurrence during follow-up (HR: 0.65 [95% CI: 0.50-0.84]; P = 0.001). CONCLUSIONS Coronary revascularization of latecomer STEMI patients is associated with better short and long-term clinical outcomes.
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Affiliation(s)
- Frédéric Bouisset
- Department of Cardiology, Toulouse Rangueil University Hospital, UMR 1295 INSERM, Toulouse, France
| | - Edouard Gerbaud
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, Pessac, France
| | - Vincent Bataille
- Department of Cardiology, Toulouse Rangueil University Hospital, UMR 1295 INSERM, Toulouse, France; Association pour la Diffusion de la Médecine de Prévention, Toulouse, France
| | - Pierre Coste
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, Pessac, France
| | - Etienne Puymirat
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Cardiology, Université Paris-Descartes, INSERM U-970, Paris, France
| | - Loic Belle
- Department of Cardiology, Centre hospitalier Annecy Genevois, Epagny Metz-Tessy, France
| | - Clément Delmas
- Department of Cardiology, Toulouse Rangueil University Hospital, UMR 1295 INSERM, Toulouse, France
| | - Guillaume Cayla
- Centre Hospitalier Universitaire Nîmes, Université de Montpellier, Nîmes, France
| | - Pascal Motreff
- Department of Cardiology, University Hospital of Clermont-Ferrand, UMR 6284 Auvergne University, Clermont-Ferrand, France
| | - Gilles Lemesle
- Department of Cardiology, Lille Regional University Hospital, Lille, France
| | - Nadia Aissaoui
- Department of Critical Care, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | | | - François Schiele
- University Hospital Jean Minjoz, Department of Cardiology, Besançon, France
| | - Tabassome Simon
- AP-HP, Hôpital Saint Antoine, Department of Clinical Pharmacology and Unité de Recherche Clinique, Université Pierre et Marie Curie (UPMC-Paris 06), INSERM U-698, Paris, France
| | - Nicolas Danchin
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Cardiology, Université Paris-Descartes, INSERM U-970, Paris, France
| | - Jean Ferrières
- Department of Cardiology, Toulouse Rangueil University Hospital, UMR 1295 INSERM, Toulouse, France.
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24
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Volle K, Delmas C, Ferrières J, Toulza O, Blanco S, Lairez O, Lhermusier T, Biendel C, Galinier M, Carrié D, Elbaz M, Bouisset F. Prevalence and Prognosis Impact of Frailty Among Older Adults in Cardiac Intensive Care Units. CJC Open 2021; 3:1010-1018. [PMID: 34505040 PMCID: PMC8413242 DOI: 10.1016/j.cjco.2021.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 03/18/2021] [Indexed: 11/25/2022] Open
Abstract
Background Whether frailty, defined as a biological syndrome that reflects a state of decreased physiological reserve and vulnerability to stressors, may impact the outcomes of elderly patients admitted to a cardiac intensive care unit (CICU) remains unclear. We aimed to determine the prevalence of frailty and its impact on mortality in patients aged ≥ 80 years admitted to a CICU. Methods This prospective single-centre observational study was conducted among patients aged ≥ 80 years admitted to a CICU in a tertiary centre. Frailty was assessed using the Edmonton Frail Scale (EFS), which provides a score ranging from 0 (not frail) to 17 (very frail). The population was divided into 3 classes: EFS-score of 0-3, EFS-score of 4-6, and EFS-score > 7. Results A total of 199 patients were included, and median follow-up duration was 365 days. The mean age was 84.8 years, and 50 patients (25.1%) died during the follow-up period. In all, 45 (22.6%), 60 (30.2%), and 94 patients (47.2%) had an EFS-score of 0-3, 4-6, and ≥ 7, respectively. The all-cause mortality rate was 4.4%, 27.1%, and 37.2% in the 0-3, 4-6, and ≥ 7 EFS-score groups, respectively (P < 0.001). After multivariate analysis, frailty status remained associated with all-cause mortality: hazard ratio was 2.60 (95% confidence interval 0.54-12.45) within the 4-6 EFS-score group, and 5.46 (95% confidence interval 1.23-24.08) within the ≥ 7 EFS-score group. Conclusions Frailty is highly prevalent in older adults admitted to the population hospitalized in a CICU and represents a strong prognostic factor for 1-year all-cause mortality.
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Affiliation(s)
- Kim Volle
- Department of Cardiology, University Hospital of Toulouse, Toulouse, France
| | - Clément Delmas
- Department of Cardiology, University Hospital of Toulouse, Toulouse, France
| | - Jean Ferrières
- Department of Cardiology, University Hospital of Toulouse, Toulouse, France.,UMR1027, INSERM-Toulouse University III, Toulouse, France.,Department of Epidemiology, University Hospital of Toulouse, Toulouse, France
| | - Olivier Toulza
- Department of Gerontology, University Hospital of Toulouse, Toulouse, France
| | - Stephanie Blanco
- Department of Cardiology, University Hospital of Toulouse, Toulouse, France
| | - Olivier Lairez
- Department of Cardiology, University Hospital of Toulouse, Toulouse, France
| | | | - Caroline Biendel
- Department of Cardiology, University Hospital of Toulouse, Toulouse, France
| | - Michel Galinier
- Department of Cardiology, University Hospital of Toulouse, Toulouse, France
| | - Didier Carrié
- Department of Cardiology, University Hospital of Toulouse, Toulouse, France
| | - Meyer Elbaz
- Department of Cardiology, University Hospital of Toulouse, Toulouse, France
| | - Frédéric Bouisset
- Department of Cardiology, University Hospital of Toulouse, Toulouse, France.,UMR1027, INSERM-Toulouse University III, Toulouse, France
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Ferré F, Viarnes M, Martin C, Bosch L, Bouisset F, Lhermusier T, Reina N, Lairez O, Minville V. Is preoperative balloon aortic valvuloplasty of interest for severe aortic stenosis in hip fracture surgery? Injury 2021; 52:1438-1444. [PMID: 32998825 DOI: 10.1016/j.injury.2020.09.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 05/28/2020] [Revised: 07/16/2020] [Accepted: 09/22/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE In elderly patients, the discovery and management of a severe aortic stenosis (AS) prior to emergency non-cardiac surgery is a frequent and controversial issue. The objective of this study was to evaluate preoperative balloon aortic valvuloplasty (BAV) for severe AS in hip fracture surgery. METHODS We conducted an observational, monocentric, retrospective study from 2011 to 2018. Survival (30-day, 90-day and 180-day mortality) and the occurrence of perioperative complications were analyzed and compared between control (i.e. no BAV prior to surgery) and preoperative BAV groups in patients with hip fracture surgery and a formal transthoracic echocardiographic diagnosis of severe AS (aortic valve area < 1 cm²). Patients' allocation to the intervention and control groups was after a discussion between cardiologist, anesthesiologist and the surgeon. RESULTS Among the 8506 patients who underwent hip fracture surgery, 29 patients in the control group and 30 patients in the BAV group were finally included. Kaplan-Meier survival analysis demonstrated a significant decrease in mortality in the BAV group (p=0.014) despite an increase in median time to operation of about 48 hours (p<0.0001). Multivariate analysis (stepwise logistic regression) showed that postoperative delirium (OR [95%CI]: 17.5 [1.8-168]; p=0.013) and postoperative acute congestive heart failure (OR [95%CI]: 59.4 [5.0-711.1]; p=0.0013) were predictive factors of 30-day mortality with an area under ROC curve of 0.90 (95%CI: 0.80-0.97; p<0.0001). CONCLUSIONS preoperative BAV for severe AS could reduce the mortality of hip fracture patients despite an increase in time to operation. This improved survival could be linked to the decrease in cardiologic and neurologic adverse events. A larger prospective randomized study is necessary before generalizing our results.
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Affiliation(s)
- Fabrice Ferré
- Centre Hospitalier Universitaire de Toulouse Purpan, Place du Dr Baylac, TSA 40 031, 31059 Toulouse, France
| | - Morgane Viarnes
- Centre Hospitalier Universitaire de Toulouse Purpan, Place du Dr Baylac, TSA 40 031, 31059 Toulouse, France
| | - Charlotte Martin
- Centre Hospitalier Universitaire de Toulouse Purpan, Place du Dr Baylac, TSA 40 031, 31059 Toulouse, France
| | - Laetitia Bosch
- Centre Hospitalier Universitaire de Toulouse Purpan, Place du Dr Baylac, TSA 40 031, 31059 Toulouse, France
| | - Frédéric Bouisset
- Cardiologie, Pôle cardiovasculaire et métabolique, CHU Rangueil, Toulouse, France
| | - Thibault Lhermusier
- Cardiologie, Pôle cardiovasculaire et métabolique, CHU Rangueil, Toulouse, France
| | - Nicolas Reina
- Département de chirurgie Orthopédique et Traumatologique, Hôpital Pierre-Paul Riquet, CHU Purpan, Toulouse, France
| | - Olivier Lairez
- Cardiologie, Pôle cardiovasculaire et métabolique, CHU Rangueil, Toulouse, France
| | - Vincent Minville
- Centre Hospitalier Universitaire de Toulouse Purpan, Place du Dr Baylac, TSA 40 031, 31059 Toulouse, France.
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26
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Robin G, Cognet T, Bouisset F, Cariou E, Méjean S, Pradel S, Colombat M, Galinier M, Carrié D, Lairez O. Value of Longitudinal Strain to Identify Wild-Type Transthyretin Amyloidosis in Patients With Aortic Stenosis. Circ J 2021; 85:1494-1504. [PMID: 33980765 DOI: 10.1253/circj.cj-20-1064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 11/09/2022]
Abstract
BACKGROUND Wild-type transthyretin-related amyloidosis (ATTRwt) and degenerative aortic stenosis (AS) are both age-related. Diagnosis of cardiac amyloidosis (CA) among patients with AS may be difficult due to overlapping morphological and functional criteria. The aim of this study was to describe an echocardiographic longitudinal strain (LS) pattern among patients with AS with and without ATTRwt.Methods and Results:Patients who have AS with ATTRwt (n=30), AS without ATTRwt (n=50) and ATTRwt without AS (n=31) underwent two-dimensional speckle-tracking echocardiography. Transthyretin CA was based on positive bone scintigraphy without monoclonal gammopathy. All patients showed a gradual decrease in LS from the base to the apex resulting in a decrease of the global LS. A cut-off value of 1.0 for relative apical LS (average apical LS/[average basal LS+mid-LS]) was sensitive (88%) but less specific (68%) in differentiating ATTRwt among patients with severe AS. The best cut-off value for relative apical LS for identifying patients with ATTRwt among the whole population was 0.9 (sensitivity 74%, specificity 66%); however, 35%, 25% and 11% of patients who have ATTRwt without AS, with moderate AS and with severe AS, respectively, did not reach this threshold. CONCLUSIONS A decrease of global and relative apical LS is common in patients with AS, even in the absence of ATTRwt. ATTRwt CA can be present even in the absence of relative apical sparing of LS.
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Affiliation(s)
- Guillaume Robin
- Department of Cardiology, Rangueil University Hospital.,Cardiac Imaging Center, Toulouse University Hospital
| | - Thomas Cognet
- Department of Cardiology, Rangueil University Hospital.,Cardiac Imaging Center, Toulouse University Hospital.,Department of Nuclear Medicine, Toulouse University Hospital
| | | | - Eve Cariou
- Department of Cardiology, Rangueil University Hospital.,Cardiac Imaging Center, Toulouse University Hospital
| | - Simon Méjean
- Department of Cardiology, Rangueil University Hospital.,Cardiac Imaging Center, Toulouse University Hospital.,Department of Nuclear Medicine, Toulouse University Hospital
| | - Sarah Pradel
- Department of Cardiology, Rangueil University Hospital.,Cardiac Imaging Center, Toulouse University Hospital
| | | | - Michel Galinier
- Department of Cardiology, Rangueil University Hospital.,Cardiac Imaging Center, Toulouse University Hospital.,Medical School, Toulouse III Paul Sabatier University
| | - Didier Carrié
- Department of Cardiology, Rangueil University Hospital.,Cardiac Imaging Center, Toulouse University Hospital.,Medical School, Toulouse III Paul Sabatier University
| | - Olivier Lairez
- Department of Cardiology, Rangueil University Hospital.,Cardiac Imaging Center, Toulouse University Hospital.,Department of Nuclear Medicine, Toulouse University Hospital.,Medical School, Toulouse III Paul Sabatier University
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27
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Matta A, Bongard V, Bouisset F, Taraszkiewicz D, Rabès JP, Ferrières J. Real-World Efficacy of Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors (PCSK9i) in Heterozygous Familial Hypercholesterolemia Patients Referred for Lipoprotein Apheresis. Med Sci Monit 2021; 27:e928784. [PMID: 33958572 PMCID: PMC8112074 DOI: 10.12659/msm.928784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND A small proportion of familial hypercholesterolemia (FH) patients can adequately control this condition, although achieving the recommended targets for low-density lipoprotein cholesterol (LDL-c) levels remains a challenge. Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) are new and potent lipid-lowering drugs. However, there is scarce literature on real-world data about their use in patients with FH. MATERIAL AND METHODS We examined the reduction in LDL-c levels from the baseline, after PCSK9i initiation in heterozygous familial hypercholesterolemia patients referred for lipoprotein apheresis in our regional lipid clinic. The study was conducted from March 2018 to September 2019, the period immediately after PCSK9i reimbursement was available in France. PCSK9i was added on top of the patients' maximal tolerated lipid-lowering regimens. RESULTS The study had 123 patients with heterozygous FH. The mean age of the patients was 59±11 years. The mean baseline LDL-c for all the participants was 277±78 mg/dl. It was 283±81 mg/dl in the PCSK9i monotherapy group (n=83), 247±68 mg/dl in the PCSK9i plus ezetimibe group (n=12), and 264±78 mg/dl in the PCSK9i plus statin and ezetimibe group (n=28). The mean decrease observed in the LDL-c level from baseline was 136±70 mg/dl (n=123), 125±60 mg/dl (n=83), 103±77 mg/dl (n=12), and 175±70 mg/dl (n=28), respectively. CONCLUSIONS An overall reduction of 49.1% from the baseline LDL-c was observed in the heterozygous FH population after PCSK9i initiation in a real-world experience. The group treated with PCSK9i ezetimibe plus statin showed further reduction of their LDL-c levels with a better responder rate, achieving the target 50% reduction in LDL-c from the baseline.
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Affiliation(s)
- Anthony Matta
- Department of Cardiology, UMR INSERM 1295, Toulouse-Rangueil University Hospital, Toulouse University School of Medicine, Toulouse, France.,Department of Epidemiology, Health Economics and Public Health, UMR INSERM 1295, Toulouse-Rangueil University Hospital, Toulouse University School of Medicine, Toulouse, France.,Faculty of Medicine, Holy Spirit University of Kaslik, Mount Lebanon, Lebanon
| | - Vanina Bongard
- Department of Cardiology, UMR INSERM 1295, Toulouse-Rangueil University Hospital, Toulouse University School of Medicine, Toulouse, France.,Department of Epidemiology, Health Economics and Public Health, UMR INSERM 1295, Toulouse-Rangueil University Hospital, Toulouse University School of Medicine, Toulouse, France
| | - Frédéric Bouisset
- Department of Cardiology, UMR INSERM 1295, Toulouse-Rangueil University Hospital, Toulouse University School of Medicine, Toulouse, France.,Department of Epidemiology, Health Economics and Public Health, UMR INSERM 1295, Toulouse-Rangueil University Hospital, Toulouse University School of Medicine, Toulouse, France
| | - Dorota Taraszkiewicz
- Department of Cardiology, UMR INSERM 1295, Toulouse-Rangueil University Hospital, Toulouse University School of Medicine, Toulouse, France.,Department of Epidemiology, Health Economics and Public Health, UMR INSERM 1295, Toulouse-Rangueil University Hospital, Toulouse University School of Medicine, Toulouse, France
| | - Jean-Pierre Rabès
- Department of Biochemistry and Molecular Biology, Ambroise Paré Hospital, (APHP. Paris-Saclay University/UVSQ-UFR Simone Veil-Santé), Boulogne-Billancourt, France
| | - Jean Ferrières
- Department of Cardiology, UMR INSERM 1295, Toulouse-Rangueil University Hospital, Toulouse University School of Medicine, Toulouse, France.,Department of Epidemiology, Health Economics and Public Health, UMR INSERM 1295, Toulouse-Rangueil University Hospital, Toulouse University School of Medicine, Toulouse, France
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28
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Bonnet G, Panagides V, Becker M, Rivière N, Yvorel C, Deney A, Lattuca B, Duband B, Moussa K, Juenin L, Pamart T, Semaan C, Uhry S, Noirclerc N, Vincent F, Vignac M, Palermo V, Martin AS, Zeitouni M, Van Belle E, Tirouvanziam A, Manchuelle A, Chamandi C, Kerneis M, Boukantar M, Belle L, De Poli F, Angoulvant D, Meneveau N, Robin M, Pansieri M, Bonello L, Motreff P, Bouisset F, Isaaz K, Cetran L, Khalife K, Lesizza P, Adjedj J, Benamer H, Cayla G. ST-segment elevation myocardial infarction: Management and association with prognosis during the COVID-19 pandemic in France. Arch Cardiovasc Dis 2021; 114:340-351. [PMID: 33926830 PMCID: PMC9056233 DOI: 10.1016/j.acvd.2021.01.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/11/2021] [Accepted: 01/18/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Systems of care have been challenged to control progression of the COVID-19 pandemic. Whether this has been associated with delayed reperfusion and worse outcomes in French patients with ST-segment elevation myocardial infarction (STEMI) is unknown. AIM To compare the rate of STEMI admissions, treatment delays, and outcomes between the first peak of the COVID-19 pandemic in France and the equivalent period in 2019. METHODS In this nationwide French survey, data from consecutive STEMI patients from 65 centres referred for urgent revascularization between 1 March and 31 May 2020, and between 1 March and 31 May 2019, were analysed. The primary outcome was a composite of in-hospital death or non-fatal mechanical complications of acute myocardial infarction. RESULTS A total of 6306 patients were included. During the pandemic peak, a 13.9±6.6% (P=0.003) decrease in STEMI admissions per week was observed. Delays between symptom onset and percutaneous coronary intervention were longer in 2020 versus 2019 (270 [interquartile range 150-705] vs 245 [140-646]min; P=0.013), driven by the increase in time from symptom onset to first medical contact (121 [60-360] vs 150 [62-420]min; P=0.002). During 2020, a greater number of mechanical complications was observed (0.9% vs 1.7%; P=0.029) leading to a significant difference in the primary outcome (112 patients [5.6%] in 2019 vs 129 [7.6%] in 2020; P=0.018). No significant difference was observed in rates of orotracheal intubation, in-hospital cardiac arrest, ventricular arrhythmias and cardiogenic shock. CONCLUSIONS During the first peak of the COVID-19 pandemic in France, there was a decrease in STEMI admissions, associated with longer ischaemic time, exclusively driven by an increase in patient-related delays and an increase in mechanical complications. These findings suggest the need to encourage the population to seek medical help in case of symptoms.
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Affiliation(s)
- Guillaume Bonnet
- Université de Paris, Paris Cardiovascular Research Center (PARCC), INSERM, UMR-S970, 75015 Paris, France
| | - Vassili Panagides
- Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, 13015 Marseille, France
| | - Mathieu Becker
- CHR Metz -Thionville, Metz Hôpital de Mercy, 57530 Metz, France
| | - Nicolas Rivière
- University of Bordeaux, Cardio-thoracic intensive care unit, CHU de Bordeaux, 33600 Pessac, France
| | - Cédric Yvorel
- Cardiology Department, CHU de Saint Etienne, 42270 Saint Priest-en-Jarez, France
| | - Antoine Deney
- Cardiology Department, Rangueil University Hospital, 31400 Toulouse, France
| | - Benoit Lattuca
- Cardiology Department, Nimes University Hospital, Montpellier University, 30029 Nîmes, France
| | - Benjamin Duband
- Cardiology Department, University Hospital Gabriel Montpied, 63000 Clermont-Ferrand, France
| | - Karim Moussa
- Cardiology Department, Avignon Hôpital Center, 84140 Avignon, France
| | - Léa Juenin
- Cardiology Department, University Hospital of Montpellier, University of Montpellier, 34000 Montpellier, France
| | - Thibault Pamart
- University of Burgundy Franche-Comté, EA3920, University Hospital Besancon, 25000 Besançon, France
| | - Carl Semaan
- Cardiology Department, University Hospital of Tours, 37000 Tours, France
| | - Sabrina Uhry
- Cardiology Department, CH de Haguenau, 67500 Haguenau, France
| | | | | | - Maxime Vignac
- Université de Paris, Paris Cardiovascular Research Center (PARCC), INSERM, UMR-S970, 75015 Paris, France
| | - Vincenzo Palermo
- Cardiology Department, Marie Lannelongue Hospital, 92350 Le Plessis-Robinson, France
| | - Anne Sophie Martin
- CHU Henri Mondor, Service de cardiologie interventionnelle, AP-HP, 94010 Créteil, France
| | - Michel Zeitouni
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), 75013 Paris, France
| | | | | | | | - Chekrallah Chamandi
- Cardiology Department, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Université de Paris, INSERM U970, 75015 Paris, France
| | - Mathieu Kerneis
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), 75013 Paris, France
| | - Madjid Boukantar
- CHU Henri Mondor, Service de cardiologie interventionnelle, AP-HP, 94010 Créteil, France
| | - Loïc Belle
- Centre Hospitalier Annecy Genevois, 74370 Epagny Metz-Tessy, France
| | - Fabien De Poli
- Cardiology Department, CH de Haguenau, 67500 Haguenau, France
| | - Denis Angoulvant
- Cardiology Department, University Hospital of Tours, 37000 Tours, France
| | - Nicolas Meneveau
- University of Burgundy Franche-Comté, EA3920, University Hospital Besancon, 25000 Besançon, France
| | - Marie Robin
- Cardiology Department, University Hospital of Montpellier, University of Montpellier, 34000 Montpellier, France
| | - Michel Pansieri
- Cardiology Department, Avignon Hôpital Center, 84140 Avignon, France
| | - Laurent Bonello
- Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, 13015 Marseille, France
| | - Pascal Motreff
- Cardiology Department, University Hospital Gabriel Montpied, 63000 Clermont-Ferrand, France
| | - Frédéric Bouisset
- Cardiology Department, Rangueil University Hospital, 31400 Toulouse, France; Department of Epidemiology, INSERM UMR 1027, 31000 Toulouse, France
| | - Karl Isaaz
- Cardiology Department, CHU de Saint Etienne, 42270 Saint Priest-en-Jarez, France
| | - Laura Cetran
- University of Bordeaux, Cardio-thoracic intensive care unit, CHU de Bordeaux, 33600 Pessac, France
| | - Khalifé Khalife
- CHR Metz -Thionville, Metz Hôpital de Mercy, 57530 Metz, France
| | | | - Julien Adjedj
- Arnaud Tzanck Institute, 06700 Saint Laurent du Var, France
| | - Hakim Benamer
- Institut Jacques Cartier, Ramsay Générale de Santé, ICPS, 91300 Massy, France
| | - Guillaume Cayla
- Cardiology Department, Nimes University Hospital, Montpellier University, 30029 Nîmes, France.
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Bouisset F, Ribichini F, Bataille V, Reczuch K, Dobrzycki S, Meyer-Gessner M, Bressollette E, Zajdel W, Faurie B, Mezilis N, Palazuelos J, Spedicato L, Valdés M, Vaquerizo B, Ferenc M, Cayla G, Barbato E, Carrié D. Effect of Sex on Outcomes of Coronary Rotational Atherectomy Percutaneous Coronary Intervention (From the European Multicenter Euro4C Registry). Am J Cardiol 2021; 143:29-36. [PMID: 33359202 DOI: 10.1016/j.amjcard.2020.12.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/27/2020] [Accepted: 12/01/2020] [Indexed: 12/28/2022]
Abstract
Data regarding the potential influence of gender on outcomes of rotational atherectomy (RA) percutaneous coronary intervention (PCI) are scarce and conflicting. Using the Euro4C registry, an international prospective multicentric registry of RA PCI, we evaluated the influence of gender on clinical outcomes of RA PCI. Between October 2016 and July 2018, 966 patients were included. In them, 267 (27.6%) were females. Female patients were older than males (77.7 years old ± 9.8 vs 73.3 ± 9.5 years old respectively, p < 0.001) had a poorer renal function (43,1% of females had a GFR < 60 ml/min:1.73m² vs 30.4% of males, p < 0.001) and were more frequently admitted for an acute coronary syndrome (32.2% vs 22.3% p = 0.002). During RA procedure, women were less likely to be treated by radial approach (65.0% vs 74.4%, p = 0.004). In-hospital major adverse cardiac event rate-defined as cardiovascular death, myocardial infarction, stroke/transient ischemic attack, target lesion revascularization, and coronary artery bypass grafting surgery-was higher in the female group (7.1% vs 3.7%, p = 0.043). However, coronary perforation, dissection, slow/low flow and tamponade did not significantly differ in gender, neither did cardiovascular medications at discharge. At 1 year follow-up, rate of major adverse cardiac event was 18.4% in the female group vs 11.2% in the male group (adjusted Hazard Ratio 1.82 [1.24 to 2.67], p = 0.002). No significant bleeding differences were observed in gender, neither in hospital, nor during follow-up. In conclusion women had worse clinical outcomes following RA PCI during hospitalization and at 1 year follow-up than did men.
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30
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Koutsoukis A, Delmas C, Roubille F, Bonello L, Schurtz G, Manzo-Silberman S, Puymirat E, Elbaz M, Bouisset F, Meunier PA, Huet F, Paganelli F, Laine M, Lemesle G, Lamblin N, Henry P, Tea V, Gallet R, Teiger E, Huguet R, Fard D, Lim P. Acute Coronary Syndrome in the Era of SARS-CoV-2 Infection: A Registry of the French Group of Acute Cardiac Care. CJC Open 2021; 3:311-317. [PMID: 33200121 PMCID: PMC7657607 DOI: 10.1016/j.cjco.2020.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 10/07/2020] [Accepted: 11/01/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND In this study, we aimed to report clinical characteristics and outcomes of patients with and without SARS-CoV-2 infection who were referred for acute coronary syndrome (ACS) during the peak of the pandemic in France. METHODS We included all consecutive patients referred for ST-elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI) during the first 3 weeks of April 2020 in 5 university hospitals (Paris, south, and north of France), all performing primary percutaneous coronary intervention. RESULTS The study included 237 patients (67 ± 14 years old; 69% male), 116 (49%) with STEMI and 121 (51%) with NSTEMI. The prevalence of SARS-CoV-2-associated ACS was 11% (n = 26) and 11 patients had severe hypoxemia on presentation (mechanical ventilation or nasal oxygen > 6 L/min). Patients were comparable regarding medical history and risk factors, except a higher prevalence of diabetes mellitus in SARS-CoV-2 patients (53.8% vs 25.6%; P = 0.003). In SARS-CoV-2 patients, cardiac arrest on admission was more frequent (26.9% vs 6.6%; P < 0.001). The presence of significant coronary artery disease and culprit artery occlusion in SARS-CoV-2 patients respectively, was 92% and 69.4% for those with STEMI, and 50% and 15.5% for those with NSTEMI. Percutaneous coronary intervention was performed in the same percentage of STEMI (84.6%) and NSTEMI (84.8%) patients, regardless of SARS-CoV-2 infection, but no-reflow (19.2% vs 3.3%; P < 0.001) was greater in SARS-CoV-2 patients. In-hospital death occurred in 7 SARS-CoV-2 patients (5 from cardiac cause) and was higher compared with noninfected patients (26.9% vs 6.2%; P < 0.001). CONCLUSIONS In this registry, ACS in SARS-CoV-2 patients presented with high a percentage of cardiac arrest on admission, high incidence of no-reflow, and high in-hospital mortality.
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Affiliation(s)
- Athanasios Koutsoukis
- Univ Paris Est Créteil, INSERM, IMRB, Créteil, France
- AP-HP, Hôpital Universitaire Henri-Mondor, Service de Cardiologie, Créteil, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France
| | - François Roubille
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Cardiology Department, CHU de Montpellier, France
| | - Laurent Bonello
- Aix-Marseille Univ, Intensive care unit, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille France, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille France, Centre for CardioVascular and Nutrition research (C2VN), INSERM a263, INRA a260, Marseille, France
| | - Guillaume Schurtz
- Intensive Care Unit, Institut Coeur Poumon, Centre Hospitalier de Lille, Lille, France
| | - Stéphane Manzo-Silberman
- Department of Cardiology, Lariboisière hospital, Assistance Publique - Hôpitaux de Paris, Paris University, INSERM UMRS i42, Paris, France
| | - Etienne Puymirat
- AP-HP, Hôpital Européen Georges Pompidou (HEGP), Department of Cardiology, Paris France, Université de Paris, Paris, France
| | - Meyer Elbaz
- Cardiology department, Rangueil University Hospital, Toulouse, France
| | - Frédéric Bouisset
- Cardiology department, Rangueil University Hospital, Toulouse, France
| | - Pierre-Alain Meunier
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Cardiology Department, CHU de Montpellier, France
| | - Fabien Huet
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Cardiology Department, CHU de Montpellier, France
| | - Franck Paganelli
- Aix-Marseille Univ, Intensive care unit, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille France, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille France, Centre for CardioVascular and Nutrition research (C2VN), INSERM a263, INRA a260, Marseille, France
| | - Marc Laine
- Aix-Marseille Univ, Intensive care unit, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille France, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille France, Centre for CardioVascular and Nutrition research (C2VN), INSERM a263, INRA a260, Marseille, France
| | - Gilles Lemesle
- Intensive Care Unit, Institut Coeur Poumon, Centre Hospitalier de Lille, Lille, France
| | - Nicolas Lamblin
- Intensive Care Unit, Institut Coeur Poumon, Centre Hospitalier de Lille, Lille, France
| | - Patrick Henry
- Department of Cardiology, Lariboisière hospital, Assistance Publique - Hôpitaux de Paris, Paris University, INSERM UMRS i42, Paris, France
| | - Victoria Tea
- AP-HP, Hôpital Européen Georges Pompidou (HEGP), Department of Cardiology, Paris France, Université de Paris, Paris, France
| | - Romain Gallet
- Univ Paris Est Créteil, INSERM, IMRB, Créteil, France
- AP-HP, Hôpital Universitaire Henri-Mondor, Service de Cardiologie, Créteil, France
| | - Emmanuel Teiger
- Univ Paris Est Créteil, INSERM, IMRB, Créteil, France
- AP-HP, Hôpital Universitaire Henri-Mondor, Service de Cardiologie, Créteil, France
| | - Raphaëlle Huguet
- Univ Paris Est Créteil, INSERM, IMRB, Créteil, France
- AP-HP, Hôpital Universitaire Henri-Mondor, Service de Cardiologie, Créteil, France
| | - Damien Fard
- Univ Paris Est Créteil, INSERM, IMRB, Créteil, France
- AP-HP, Hôpital Universitaire Henri-Mondor, Service de Cardiologie, Créteil, France
| | - Pascal Lim
- Univ Paris Est Créteil, INSERM, IMRB, Créteil, France
- AP-HP, Hôpital Universitaire Henri-Mondor, Service de Cardiologie, Créteil, France
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Bouisset F, Ruidavets JB, Dallongeville J, Moitry M, Montaye M, Biasch K, Ferrières J. Comparison of Short- and Long-Term Prognosis between ST-Elevation and Non-ST-Elevation Myocardial Infarction. J Clin Med 2021; 10:jcm10020180. [PMID: 33430516 PMCID: PMC7826729 DOI: 10.3390/jcm10020180] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/23/2020] [Accepted: 12/31/2020] [Indexed: 11/23/2022] Open
Abstract
Background: Available data comparing long-term prognosis according to the type of acute coronary syndrome (ACS) are scarce, contradictory, and outdated. Our aim was to compare short- and long-term mortality in ST-elevated (STEMI) and non-ST-elevated myocardial infarction (non-STEMI) ACS patients. Methods: Patients presenting with an inaugural ACS during the year 2006 and living in one of the three areas in France covered by the Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) registry were included. Results: A total of 1822 patients with a first ACS—1121 (61.5%) STEMI and 701 (38.5%) non-STEMI—were included in the study. At the 28-day follow-up, the mortality rates were 6.7% and 4.7% (p = 0.09) for STEMI and non-STEMI patients, respectively, and after adjustment of potential confounding factors, the 28-day probability of death was significantly lower for non-STEMI ACS patients (Odds Ratio = 0.58 (0.36–0.94), p = 0.03). At the 10-year follow-up, the death rates were 19.6% and 22.8% (p = 0.11) for STEMI and non-STEMI patients, respectively, and after adjustment of potential confounding factors, the 10-year probability of death did not significantly differ between non-STEMI and STEMI events (OR = 1.07 (0.83–1.38), p = 0.59). Over the first year, the mortality rate was 7.2%; it then decreased and stabilized at 1.7% per year between the 2nd and 10th year following ACS. Conclusion: STEMI patients have a worse vital prognosis than non-STEMI patients within 28 days following ACS. However, at the 10-year follow-up, STEMI and non-STEMI patients have a similar vital prognosis. From the 2nd year onwards following the occurrence of a first ACS, the patients become stable coronary artery disease patients with an annual mortality rate in the 2% range, regardless of the type of ACS they initially present with.
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Affiliation(s)
- Frédéric Bouisset
- Department of Cardiology, Rangueil University Hospital, 31059 Toulouse, France;
- Department of Epidemiology, INSERM UMR 1027, 31000 Toulouse, France;
- Correspondence: ; Tel./Fax: +33-0561-323-318
| | | | - Jean Dallongeville
- Institut Pasteur de Lille, Department of Epidemiology and Public Health, Inserm-U1167, 59000 Lille, France; (J.D.); (M.M.)
| | - Marie Moitry
- Faculty of Medicine, Department of Epidemiology and Public Health, University of Strasbourg, 67081 Strasbourg, France; (M.M.); (K.B.)
- Department of Public Health, Strasbourg University Hospital, 67085 Strasbourg, France
| | - Michele Montaye
- Institut Pasteur de Lille, Department of Epidemiology and Public Health, Inserm-U1167, 59000 Lille, France; (J.D.); (M.M.)
| | - Katia Biasch
- Faculty of Medicine, Department of Epidemiology and Public Health, University of Strasbourg, 67081 Strasbourg, France; (M.M.); (K.B.)
| | - Jean Ferrières
- Department of Cardiology, Rangueil University Hospital, 31059 Toulouse, France;
- Department of Epidemiology, INSERM UMR 1027, 31000 Toulouse, France;
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Canitrot R, Delmas C, Delon C, Biendel C, Porte L, Bouisset F, Laperche C, Labaste F, Roncalli J, Elbaz M, Carrie D, Galinier M, Lavie Badie Y. Interpreting troponin elevation in the setting of infective endocarditis: Causes and prognostic value. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Fagot J, Bouisset F, Bonello L, Biendel C, Lhermusier T, Porterie J, Roncalli J, Galinier M, Elbaz M, Lairez O, Delmas C. Early Evaluation of Patients on Axial Flow Pump Support for Refractory Cardiogenic Shock is Associated with Left Ventricular Recovery. J Clin Med 2020; 9:jcm9124130. [PMID: 33371473 PMCID: PMC7767477 DOI: 10.3390/jcm9124130] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/08/2020] [Accepted: 12/17/2020] [Indexed: 11/16/2022] Open
Abstract
We investigated prognostic factors associated with refractory left ventricle (LV) failure leading to LV assist device (LVAD), heart transplant or death in patients on an axial flow pump support for cardiogenic shock (CS). Sixty-two CS patients with an Impella® CP or 5.0 implant were retrospectively enrolled, and clinical, biological, echocardiographic, coronarographic and management data were collected. They were compared according to the 30-day outcome. Patients were mainly male (n = 55, 89%), 58 ± 11 years old and most had no history of heart failure or coronary artery disease (70%). The main etiology of CS was acute coronary syndrome (n = 57, 92%). They presented with severe LV failure (LV ejection fraction (LVEF) 22 ± 9%), organ malperfusion (lactate 3.1 ± 2.1 mmol/L), and frequent use of inotropes, vasopressors, and mechanical ventilation (59, 66 and 30%, respectively). At 24 h, non-recovery was associated with higher total bilirubin (odds ratios (OR) 1.07 (1.00–1.14); p = 0.039), lower LVEF (OR 0.89 (0.81–0.96); p = 0.006) and the number of administrated amines (OR 4.31 (1.30–14.30); p = 0.016). Early evaluation in patients with CS with an axial flow pump implant may enable the identification of factors associated with an unlikely recovery and would call for early screening for LVAD or heart transplant.
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Affiliation(s)
- Jérôme Fagot
- Intensive Cardiac Care Unit, Department of Cardiology, Rangueil University Hospital, 31059 Toulouse, France; (J.F.); (F.B.); (C.B.); (T.L.); (J.R.); (M.G.); (M.E.); (O.L.)
- Cardiac Imaging Center, University Hospital of Toulouse, 31059 Toulouse, France
| | - Frédéric Bouisset
- Intensive Cardiac Care Unit, Department of Cardiology, Rangueil University Hospital, 31059 Toulouse, France; (J.F.); (F.B.); (C.B.); (T.L.); (J.R.); (M.G.); (M.E.); (O.L.)
| | - Laurent Bonello
- Medical School, Toulouse III Paul Sabatier University, 31059 Toulouse, France;
- Intensive Care Unit, Department of Cardiology, Centre Hospitalo-Universitaire Nord, Aix-Marseille Univeristy, 13385 Marseille, France
- Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France
| | - Caroline Biendel
- Intensive Cardiac Care Unit, Department of Cardiology, Rangueil University Hospital, 31059 Toulouse, France; (J.F.); (F.B.); (C.B.); (T.L.); (J.R.); (M.G.); (M.E.); (O.L.)
| | - Thibaut Lhermusier
- Intensive Cardiac Care Unit, Department of Cardiology, Rangueil University Hospital, 31059 Toulouse, France; (J.F.); (F.B.); (C.B.); (T.L.); (J.R.); (M.G.); (M.E.); (O.L.)
- Medical School, Toulouse III Paul Sabatier University, 31059 Toulouse, France;
| | - Jean Porterie
- Department of Cardiovascular Surgery, Rangueil University Hospital, 31059 Toulouse, France;
| | - Jerome Roncalli
- Intensive Cardiac Care Unit, Department of Cardiology, Rangueil University Hospital, 31059 Toulouse, France; (J.F.); (F.B.); (C.B.); (T.L.); (J.R.); (M.G.); (M.E.); (O.L.)
- Medical School, Toulouse III Paul Sabatier University, 31059 Toulouse, France;
| | - Michel Galinier
- Intensive Cardiac Care Unit, Department of Cardiology, Rangueil University Hospital, 31059 Toulouse, France; (J.F.); (F.B.); (C.B.); (T.L.); (J.R.); (M.G.); (M.E.); (O.L.)
- Medical School, Toulouse III Paul Sabatier University, 31059 Toulouse, France;
| | - Meyer Elbaz
- Intensive Cardiac Care Unit, Department of Cardiology, Rangueil University Hospital, 31059 Toulouse, France; (J.F.); (F.B.); (C.B.); (T.L.); (J.R.); (M.G.); (M.E.); (O.L.)
- Medical School, Toulouse III Paul Sabatier University, 31059 Toulouse, France;
| | - Olivier Lairez
- Intensive Cardiac Care Unit, Department of Cardiology, Rangueil University Hospital, 31059 Toulouse, France; (J.F.); (F.B.); (C.B.); (T.L.); (J.R.); (M.G.); (M.E.); (O.L.)
- Cardiac Imaging Center, University Hospital of Toulouse, 31059 Toulouse, France
- Medical School, Toulouse III Paul Sabatier University, 31059 Toulouse, France;
| | - Clément Delmas
- Intensive Cardiac Care Unit, Department of Cardiology, Rangueil University Hospital, 31059 Toulouse, France; (J.F.); (F.B.); (C.B.); (T.L.); (J.R.); (M.G.); (M.E.); (O.L.)
- Correspondence: ; Tel.: +33-561322426; Fax: +33-561322307
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Delmas C, Bouisset F, Lairez O. COVID-19 pandemic: no increase of takotsubo syndrome occurrence despite high-stress conditions. ESC Heart Fail 2020; 7:2143-2145. [PMID: 32705813 PMCID: PMC7404584 DOI: 10.1002/ehf2.12871] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/03/2020] [Accepted: 06/12/2020] [Indexed: 01/17/2023] Open
Affiliation(s)
- Clement Delmas
- Intensive Cardiac Care UnitRangueil University HospitalToulouseFrance
| | | | - Olivier Lairez
- Department of CardiologyRangueil University HospitalToulouseFrance
- Cardiac Imaging CenterRangueil University HospitalToulouseFrance
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Bouisset F, Barbato E, Reczuch K, Dobrzycki S, Meyer-Gessner M, Bressollette E, Cayla G, Lhermusier T, Zajdel W, Palazuelos Molinero J, Ferenc M, Ribichini FL, Carrié D. Clinical outcomes of PCI with rotational atherectomy: the European multicentre Euro4C registry. EUROINTERVENTION 2020; 16:e305-e312. [DOI: 10.4244/eij-d-19-01129] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Jolicoeur EM, Dendukuri N, Belisle P, Range G, Souteyrand G, Bouisset F, Zemour G, Delarche N, Harbaoui B, Schampaert E, Kouz S, Cayla G, Roubille F, Boueri Z, Mansour S, Marcaggi X, Tardif JC, McGillion M, Tanguay JF, Brophy J, Yu CW, Berry C, Carrick D, Høfsten DE, Engstrøm T, Kober L, Kelbæk H, Belle L. Immediate vs Delayed Stenting in ST-Elevation Myocardial Infarction: Rationale and Design of the International PRIMACY Bayesian Randomized Controlled Trial. Can J Cardiol 2020; 36:1805-1814. [PMID: 32798463 DOI: 10.1016/j.cjca.2020.01.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/07/2020] [Accepted: 01/21/2020] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Primary percutaneous coronary intervention is used to restore blood flow in the infarct-related coronary artery, followed by immediate stenting to prevent reocclusion. Stents implanted in thrombus-laden arteries cause distal embolization, which paradoxically impairs myocardial reperfusion and ventricular function. Whether a strategy of delayed stenting improves outcomes in patients with acute ST-elevation myocardial infarction (STEMI) is uncertain. METHODS The Primary Reperfusion Secondary Stenting (PRIMACY) is a Bayesian prospective, randomized, open-label, blinded end point trial in which delayed vs immediate stenting in patients with STEMI were compared for prevention of cardiovascular death, nonfatal myocardial infarction, heart failure, or unplanned target vessel revascularization at 9 months. All participants were immediately reperfused, but those assigned to the delayed arm underwent stenting after an interval of 24 to 48 hours. This interval was bridged with antithrombin therapy to reduce thrombus burden. In the principal Bayesian hierarchical random effects analysis, data from exchangeable trials will be combined into a study prior and updated with PRIMACY into a posterior probability of efficacy. RESULTS A total of 305 participants were randomized across 15 centres in France and Canada between April 2014 and September 2017. At baseline, the median age of participants was 59 years, 81% were male, and 3% had a history of percutaneous coronary intervention. Results from PRIMACY will be updated from the patient-level data of 1568 participants enrolled in the Deferred Stent Trial in STEMI (DEFER; United Kingdom), Minimalist Immediate Mechanical Intervention (MIMI; France), Danish Trial in Acute Myocardial Infarction-3 (DANAMI-3; Denmark), and Impact of Immediate Stent Implantation Versus Deferred Stent Implantation on Infarct Size and Microvascular Perfusion in Patients With ST Segment-Elevation Myocardial Infarction (INNOVATION, South Korea) trials. CONCLUSIONS We expect to clarify whether delayed stenting can safely reduce the occurrence of adverse cardiovascular end points compared with immediate stenting in patients with STEMI.
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Affiliation(s)
- E Marc Jolicoeur
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
| | - Nandini Dendukuri
- Centre for Outcomes Research, McGill University Health Centre-Research Institute, Montreal, Quebec, Canada
| | - Patrick Belisle
- Montreal Health Innovation Coordination Center, Montreal, Quebec, Canada
| | - Grégoire Range
- Department of Cardiology, Les Hôpitaux de Chartres, Euret-Loir, France
| | | | | | - Gilles Zemour
- Centre Hospitalier Pierre Nouveau Cannes, Cannes, France
| | | | - Brahim Harbaoui
- Hôpital Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Erick Schampaert
- Hopital Sacre-Coeur, Interventional Cardiology, Université de Montréal, Montreal, Quebec, Canada
| | - Simon Kouz
- Centre Hospitalier Régional de Lanaudiere, Joliette, Quebec, Canada
| | - Guillaume Cayla
- Centre Hospitalier Universitaire Nimes, Université de Montpellier, Nimes, France
| | - François Roubille
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Cardiology Department, CHU de Montpellier, Montpellier, France
| | - Ziad Boueri
- Centre Hospitalier de Bastia, Bastia, France
| | - Samer Mansour
- Centre Hospitalier Universitaire de l'Université de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Xavier Marcaggi
- Department of Cardiology, Centre Hospitalier de Vichy, Vichy, France
| | - Jean-Claude Tardif
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Michael McGillion
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | | | - James Brophy
- McGill University Health Centre, Division of Cardiology, Montreal, Quebec, Canada
| | - Cheol Woong Yu
- Korea University Anam Hospital, Cardiovascular Center (Interventional Cardiology), Seoul, Republic of Korea
| | - Colin Berry
- BHF Glasgow Cardiovascular Research Center, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow; and West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Dunbartonshire, United Kingdom
| | - David Carrick
- University Hospital Hairmyres, East Kilbride, Glasgow, United Kingdom
| | - Dan Eik Høfsten
- Rigshospitalet-Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - Thomas Engstrøm
- Rigshospitalet-Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - Lars Kober
- Rigshospitalet-Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - Henning Kelbæk
- Dept of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Loic Belle
- Hospital of Annecy, Centre Hospitalier Annecy Genevois, Annecy, France
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Bouisset F, Ruidavets JB, Bongard V, Taraszkiewicz D, Bérard E, Galinier M, Carrié D, Elbaz M, Ferrières J. Long-term Prognostic Impact of Physical Activity in Patients With Stable Coronary Heart Disease. Am J Cardiol 2020; 125:176-181. [PMID: 31740022 DOI: 10.1016/j.amjcard.2019.10.017] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 10/01/2019] [Accepted: 10/03/2019] [Indexed: 11/17/2022]
Abstract
Stable coronary heart disease (CHD) patients are advised to practice regular physical activity (PA). However, data on very long-term prognosis impact of regular exercise remain scarce. We aimed to evaluate the impact of physical activity level on mortality at long term in stable CHD patients. We analyzed 822 patients with stable CHD. They answered questionnaires on medical history, underwent a standardized clinical examination, and provided a fasting blood sample. PA was evaluated by the MOSPA questionnaire. Three tertiles of patients were individualized according to PA level: 0.0-9 Metabolic Equivalent of Task (METs) hour per week (n = 267); 10-39.9 METs hour per week (n = 279); and ≥40 METs hour per week (n = 276). After a median follow-up of 14.6 years, 324 patients had died. In a multivariate analysis adjusted for age, dyslipidemia, smoking status, diabetes, high blood pressure, waist circumference, left ventricular ejection fraction, Gensini score, heart rate, ankle-brachial index and duration of disease, physical activity was significantly and independently associated with all-cause mortality. Compared to the lowest PA tertile, both the median and the highest PA tertiles, were associated to a reduction of all-cause mortality risk with hazard ratios at 0.79 (95%confidence interval [0.61:1.03], P = 0.08) and 0.71 ([0.53:0.96], P = 0.025) respectively; P for trend = 0.02. Adjusted hazard ratios for an increase of 10 METs hour per week was 0.95 [0.92 to 0.98], (P <0.002). In conclusion, our study demonstrates an independent association between PA and long term vital prognosis with a 5% total mortality decrease for an increase of 10 METs hour per week.
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Affiliation(s)
- Frédéric Bouisset
- Department of Cardiology, Rangueil University Hospital, Toulouse, France; Department of epidemiology, INSERM UMR 1027, Toulouse, France.
| | | | - Vanina Bongard
- Department of Cardiology, Rangueil University Hospital, Toulouse, France; Department of epidemiology, INSERM UMR 1027, Toulouse, France
| | | | - Emilie Bérard
- Department of epidemiology, INSERM UMR 1027, Toulouse, France
| | - Michel Galinier
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | - Didier Carrié
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | - Meyer Elbaz
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | - Jean Ferrières
- Department of Cardiology, Rangueil University Hospital, Toulouse, France; Department of epidemiology, INSERM UMR 1027, Toulouse, France
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Laperche C, Lairez O, Ferrieres J, Robin G, Gautier M, Lavie Badie Y, Lhermusier T, Boudou N, Campelo-Parada F, Roncalli J, Marcheix B, Galinier M, Elbaz M, Carrié D, Bouisset F. Coronary angiography in the setting of acute infective endocarditis requiring surgical treatment. Arch Cardiovasc Dis 2020; 113:50-58. [DOI: 10.1016/j.acvd.2019.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/02/2019] [Accepted: 09/30/2019] [Indexed: 02/08/2023]
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Servoz C, Bouisset F, Marcheix B, Grunenwald E, Carrié D, Boudou N, Campelo-Parada F, Chollet T, Lhermusier T. Infective endocarditis after transcatheter aortic-valve implantation: Incidence, impact and treatment in a French university hospital. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Servoz C, Chollet T, Bouisset F, Carrié D, Boudou N, Campelo-Parada F, Marcheix B, Grunenwald E, Lhermusier T. Impact of lung diseases in patients undergoing on transaortic compared with transfemoral TAVI. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Laperche C, Lairez O, Elbaz M, Carrie D, Galinier M, Marcheix B, Gautier M, Robin G, Bouisset F. P859Infective endocarditis requiring surgical intervention: safety and therapeutic impact of preoperative coronary angiography. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Preoperative coronary angiography (CA) cannot be performed systematically in patients with infective endocarditis requiring surgical treatment due to a high risk of embolization, in cases of aortic endocarditis, or when abscesses or vegetations are present.
Purpose
The aim of this study is to assess the safety and the therapeutic impact of preoperative coronary angiography in infective endocarditis requiring surgery.
Methods
This monocentric, observational study included patients with infective endocarditis requiring surgical treatment who were hospitalized between March 2013 and December 2016 in our Hospital. The outcome were i) the occurence of post-CA complications, such as neurological embolization, acute kidney failure requiring post-operative dialysis, or ii) necessity for surgical myocardial revascularization, and the mortality at 28 days and one year.
Results
193 patients were included among which 178 were effectively operated on. 119 patients had an aortic endocarditis with an aortic vegetation for 74 patients. Invasive coronary angiography was performed in 142 patients (91.6% by radial approach), and 14 patients were evaluated by coronary tomodensitometry (one patient had exploration with both techniques).
CA was carried out regardless of the location of the endocarditis, whether it was aortic or not (p=0,39), and regardless of the existence of abscesses and/ or adenoids (p=0,09), even in case of emergency surgery (p=0,79). Among the 178 patients operated on, 35 had significant coronary lesion(s) and 25 underwent an associated artery bypass graft.
Neurological embolization occurred after angiography in only 2 patients with mitral endocarditis, and none was observed in patients with aortic endocarditis. Acute renal failure after CA was observed in 15 (10.6%)
Surgery was performed in 173 patients, and 25 of them had a myocardial revascularization. No increase in post-operative dialysis rate was observed (p=0,43) and there were no differences in the mortality rates, neither at 28 days (p=0,77) nor at 12 months following surgery (p=0,59).
Conclusion
Preoperative CA was not associated with a higher occurence of complications, such as embolizaton or post-operative acute kidney failure, and did not decrease post-operative mortality in infective endocarditis (aortic or not) requiring surgery.
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Affiliation(s)
- C Laperche
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - O Lairez
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - M Elbaz
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - D Carrie
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - M Galinier
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - B Marcheix
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - M Gautier
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - G Robin
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - F Bouisset
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
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42
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Larroche J, Panh L, Lhermusier T, Lairez O, Bataille V, Marachet MA, Chollet T, Petermann A, Bouisset F, Boudou N, Marcheix B, Rousseau H, Galinier MA, Carrie D, Lavie-Badie Y. P906Impact of aortic valve calcification severity on device success after trans catheter aortic valve replacement. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0502] [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
The aim of this study was to determine whether CS, measured on the preoperative contrast enhanced multislice computed tomography (MSCT), is associated with Device Success (DS), Major Adverse Cardiac Events (MACE) and paravalvular leaks (PVL) after TAVR.
Methods
We included 352 consecutive patients who underwent TAVR with a preoperative standardized contrast enhanced MSCT. Valvular calcifications detection was defined by adding +100 Hounsfield Unit (HU) to mean HU determined by a Region Of Interest placed in the contrast enhanced ascending aorta. CS was then indexed to the aortic annulus surface (CSi). Endpoints were DS and 30-days MACE according to Valve Academic Research Consortium-2 consensus document, and PVL greater than or equal to grade 2.
Results
DS was obtained for 305 patients. In multivariate analysis, CS and CSi were negatively and independently associated with DS: OR=0.88, 95% CI 0.81–0.96, p=0.004; and OR=0.94, 95% CI 0.91–0.98, p=0.002 respectively. There was no association between MACE and CS (p=0,953) and CSi (p=0,757). PVL was positively associated with CS (p<0.001) and CSi (p<0.001).
Multivariate analysis for device success Multivariate analysis for device success procedure Initial Model Final Model OR (95% CI) p OR (95% CI) p Age (years) 1.06 (1–1.12) 0.058 Size (cm) 1.02 (0.98–1.07) 0.26 Hypertension 0.35 (0.13–0.92) 0.033 0.34 (0.13–0.87) 0.024 Diabete mellitus 1.72 (0.68–4.34) 0.249 Mean gradient 0.99 (0.97–1.02) 0.517 Mitral regurgitation 0.6 (0.28–1.27) 0.18 Valve size ≤23 1 (REF) 26 1.85 (0.8–4.27) 0.152 29 4.08 (1.32–12.59) 0.015 4.72 (1.62–13.78) 0.004 31 1.42 (0.32–6.38) 0.647 CS (for an increase of 1000 pts) 0.89 (0.81–0.98) 0.017 0.88 (0.81–0.96) 0.004 CSi (for an increase of 100 pts) 0.94 (0.9–0.99) 0.013 0.96 (0.91–0.98) 0.002
Example of CS measurement
Conclusion
In TAVR, the aortic valvular CS, measured on preoperative contrast enhanced MSCT, is significantly associated with DS and PVL, but not with 30-days MACE. Its routine use could be relevant to appreciate success chances of TAVR.
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Affiliation(s)
- J Larroche
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - L Panh
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - T Lhermusier
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - O Lairez
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - V Bataille
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - M.-A Marachet
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - T Chollet
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - A Petermann
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - F Bouisset
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - N Boudou
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - B Marcheix
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - H Rousseau
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - M.-A Galinier
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - D Carrie
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - Y Lavie-Badie
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
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43
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Delmas C, Orloff E, Bouisset F, Moine T, Citoni B, Biendel C, Porterie J, Carrié D, Galinier M, Elbaz M, Lairez O. Predictive factors for long-term mortality in miscellaneous cardiogenic shock: Protective role of beta-blockers at admission. Arch Cardiovasc Dis 2019; 112:738-747. [PMID: 31155464 DOI: 10.1016/j.acvd.2019.04.004] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/08/2019] [Accepted: 04/15/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Despite advances in intensive care medicine, management of cardiogenic shock (CS) remains difficult and imperfect, with high mortality rates, regardless of aetiology. Predictive data regarding long-term mortality rates in patients presenting CS are sparse. AIM To describe prognostic factors for long-term mortality in CS of different aetiologies. METHODS Two hundred and seventy-five patients with CS admitted to our tertiary centre between January 2013 and December 2014 were reviewed retrospectively. Mortality was recorded in December 2016. A Cox proportional-hazards model was used to determine predictors of long-term mortality. RESULTS Most patients were male (72.7%), with an average age of 64±16 years and a history of cardiomyopathy (63.5%), mainly ischaemic (42.3%). Leading causes of CS were myocardial infarction (35.3%), decompensated heart failure (34.2%) and cardiac arrest (20.7%). Long-term mortality was 62.5%. After multivariable analysis, previous use of beta-blockers (hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.41-0.89; P=0.02) and coronary angiography exploration at admission (HR 0.57, 95% CI 0.38-0.86; P=0.02) were associated with a lower risk of long-term mortality. Conversely, age (HR 1.02 per year, 95% CI 1.01-1.04; P<0.001), catecholamine support (HR 1.45 for each additional agent, 95% CI 1.20-1.75; P<0.001) and renal replacement therapy (HR 1.66, 95% CI 1.09-2.55; P=0.02) were associated with an increased risk of long-term mortality. CONCLUSIONS Long-term mortality rates in CS remain high, reaching 60% at 1-year follow-up. Previous use of beta-blockers and coronary angiography exploration at admission were associated with better long-term survival, while age, renal replacement therapy and the use of catecholamines appeared to worsen the prognosis, and should lead to intensification of CS management.
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Affiliation(s)
- Clément Delmas
- Department of cardiology, Rangueil university hospital, 31059 Toulouse, France; Intensive cardiac care unit, Rangueil university hospital, 31059 Toulouse, France.
| | - Elisabeth Orloff
- Department of cardiology, Rangueil university hospital, 31059 Toulouse, France
| | - Frédéric Bouisset
- Department of cardiology, Rangueil university hospital, 31059 Toulouse, France
| | - Thomas Moine
- Department of cardiology, Rangueil university hospital, 31059 Toulouse, France
| | | | - Caroline Biendel
- Department of cardiology, Rangueil university hospital, 31059 Toulouse, France; Intensive cardiac care unit, Rangueil university hospital, 31059 Toulouse, France
| | - Jean Porterie
- Department of cardiovascular surgery, Rangueil university hospital, 31059 Toulouse, France
| | - Didier Carrié
- Department of cardiology, Rangueil university hospital, 31059 Toulouse, France; Purpan medical school, university Paul Sabatier, 31300 Toulouse, France
| | - Michel Galinier
- Department of cardiology, Rangueil university hospital, 31059 Toulouse, France; Rangueil medical school, university Paul Sabatier, 31059 Toulouse, France
| | - Meyer Elbaz
- Department of cardiology, Rangueil university hospital, 31059 Toulouse, France; Rangueil medical school, university Paul Sabatier, 31059 Toulouse, France
| | - Olivier Lairez
- Department of cardiology, Rangueil university hospital, 31059 Toulouse, France; Rangueil medical school, university Paul Sabatier, 31059 Toulouse, France; Cardiac imaging centre, Toulouse university hospital, 31059 Toulouse, France; Department of nuclear medicine, Rangueil university hospital, 31059 Toulouse, France
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44
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Hernández-Enríquez M, Chollet T, Bataille V, Campelo-Parada F, Boudou N, Bouisset F, Grunenwald E, Porterie J, Freixa X, Regueiro A, Sabaté M, Carrié D, Marcheix B, Lhermusier T. Comparison of the Frequency of Thrombocytopenia After Transfemoral Transcatheter Aortic Valve Implantation Between Balloon-Expandable and Self-Expanding Valves. Am J Cardiol 2019; 123:1120-1126. [PMID: 30709598 DOI: 10.1016/j.amjcard.2018.12.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 12/21/2018] [Accepted: 12/27/2018] [Indexed: 12/20/2022]
Abstract
Thrombocytopenia after transcatheter aortic valve implantation (TAVI) is common and has been related to worse clinical outcomes. Comparison of platelet kinetics among different types of valves is limited. Our objectives were to analyze the differences in drop platelet count (DPC) between balloon-expandable valves (BEVs) and self-expanding valves and their prognostic implications after TAVI. Patients who underwent transfemoral TAVI from 2008 to 2016 were included. Exclusion criteria were severe baseline thrombocytopenia and periprocedural death. Postprocedural platelet counts were collected. Two groups were created: DPC ≤30 and DPC >30%. Valve Academic Research Consortium-2 criteria were used to define outcomes. Study population included 609 patients (age 84.7 ± 6.0, 46.6% males). The mean DPC was 32.5 ± 13.9%. The DPC was higher in the BEV arm (33.9 ± 14.2 vs 30.7 ± 13.4%, p = 0.006), and the nadir was reached later in comparison to the self-expanding valve arm (3.0 ± 1.3 vs 2.5 ± 1.1 days, p <0.001). After multivariable analysis, the use of BEV, known coronary artery disease, and left ventricle ejection fraction were the factors associated with a higher rate of DPC >30%. At 30 days, the DPC >30% was related with a higher rate of life-threatening and/or major bleeding (6.8 vs 2.1%, p = 0.009) and death (3.5 vs 0.8%, p = 0.036). At 1 year, the difference in mortality disappeared. In conclusion, in this cohort of patients, the use of BEV seems to be associated with a higher risk of DPC after TAVI. A DPC ≥30% was related with increased risk of life-threatening and/or major bleeding and death at 30 days. Larger and prospective studies are needed to understand this phenomenon.
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Hernández-Enríquez M, Lairez O, Campelo-Parada F, Lhermusier T, Bouisset F, Roncalli J, Elbaz M, Carrié D, Boudou N. Outcomes after use of covered stents to treat coronary artery perforations. Comparison of old and new-generation covered stents. J Interv Cardiol 2018; 31:617-623. [DOI: 10.1111/joic.12525] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/05/2018] [Accepted: 05/09/2018] [Indexed: 01/10/2023] Open
Affiliation(s)
- Marco Hernández-Enríquez
- Department of Cardiology, Cardiovascular Institute, Hospital Clinic de Barcelona, Institutd' Investigacions Biomèdiques August Pi iSunyer (IDIBAPS); University of Barcelona; Barcelona Spain
- Department of Cardiology; Rangueil University Hospital; Toulouse France
| | - Olivier Lairez
- Department of Cardiology; Rangueil University Hospital; Toulouse France
| | | | | | - Frédéric Bouisset
- Department of Cardiology; Rangueil University Hospital; Toulouse France
| | - Jérôme Roncalli
- Department of Cardiology; Rangueil University Hospital; Toulouse France
| | - Meyer Elbaz
- Department of Cardiology; Rangueil University Hospital; Toulouse France
| | - Didier Carrié
- Department of Cardiology; Rangueil University Hospital; Toulouse France
| | - Nicolas Boudou
- Department of Cardiology; Rangueil University Hospital; Toulouse France
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46
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Orloff E, Fournier P, Bouisset F, Moine T, Cournot M, Elbaz M, Carrié D, Galinier M, Lairez O, Cognet T. Myocardial multilayer strain does not provide additional value for detection of myocardial viability assessed by SPECT imaging over and beyond standard strain. Echocardiography 2018; 35:1300-1309. [PMID: 29756381 DOI: 10.1111/echo.14022] [Citation(s) in RCA: 3] [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: 11/29/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the value of multilayer strain analysis to the assessment of myocardial viability (MV) through the comparison of both speckle tracking echocardiography and single-photon emission computed tomography (SPECT) imaging. We also intended to determine which segmental longitudinal strain (LS) cutoff value would be optimal to discriminate viable myocardium. METHODS We included 47 patients (average age: 61 ± 11 years) referred to our cardiac imaging center for MV evaluation. All patients underwent transthoracic echocardiography with measures of LS, SPECT, and coronary angiography. RESULTS In all, 799 segments were analyzed. We correlated myocardial tracer uptake by SPECT with sub-endocardial, sub-epicardial, and mid-segmental LS values with r = .514 P < .0001, r = .501 P < .0001, and r = .520 P < .0001, respectively. The measurements of each layer strain (sub-endocardial, sub-epicardial, and mid) had the same performance to predict MV viability as defined by SPECT with areas under curve of 0.819 [0.778-0.861, P < .0001], 0.809 [0.764-0.854, P < .0001], and 0.817 [0.773-0.860, P < .0001], respectively. The receiver-operating characteristic analysis yielded a cutoff value of -6.5% for mid-segmental LS with a sensitivity of 76% and specificity of 76% to predict segmental MV as defined by SPECT. CONCLUSIONS Multilayer strain analysis does not evaluate MV with more accuracy than standard segmental LS analysis.
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Affiliation(s)
- Elisabeth Orloff
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | - Pauline Fournier
- Department of Cardiology, Rangueil University Hospital, Toulouse, France.,Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
| | - Frédéric Bouisset
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | - Thomas Moine
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | - Maxime Cournot
- Department of Cardiology, La Réunion University hospital, Saint-Pierre, France.,Inserm, UMR 1188, Sainte-Clotilde, France
| | - Meyer Elbaz
- Department of Cardiology, Rangueil University Hospital, Toulouse, France.,Medical School of Rangueil, University Paul Sabatier, Toulouse, France
| | - Didier Carrié
- Department of Cardiology, Rangueil University Hospital, Toulouse, France.,Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France.,Medical School of Purpan, University Paul Sabatier, Toulouse, France
| | - Michel Galinier
- Department of Cardiology, Rangueil University Hospital, Toulouse, France.,Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France.,Medical School of Rangueil, University Paul Sabatier, Toulouse, France
| | - Olivier Lairez
- Department of Cardiology, Rangueil University Hospital, Toulouse, France.,Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France.,Medical School of Rangueil, University Paul Sabatier, Toulouse, France.,Department of Nuclear Medicine, Rangueil University Hospital, Toulouse, France
| | - Thomas Cognet
- Department of Cardiology, Rangueil University Hospital, Toulouse, France.,Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France.,Department of Nuclear Medicine, Rangueil University Hospital, Toulouse, France
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Delmas C, Elbaz M, Bonello L, Biendel C, Bouisset F, Lairez O, Silva S, Marcheix B, Galinier M. Place de l’assistance circulatoire dans le choc cardiogénique en France en 2018 : revue de la littérature et perspectives. Méd Intensive Réa 2018. [DOI: 10.3166/rea-2018-0023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Le choc cardiogénique reste de nos jours une entité mal définie, assez fréquente en pratique clinique (60 000–70 000 cas/an en Europe), dont le pronostic est sombre, avec une mortalité souvent supérieure à 40 % à 30 jours. À travers cette revue de la littérature, nous essaierons de définir cette entité et ses étiologies, avant de parler de son incidence et de son pronostic. L’approche physiopathologique du choc cardiogénique nous permettra par la suite d’approcher sa prise en charge thérapeutique classique (gestion de la volémie, amines inotropes et vasoconstrictives, ventilation) et les limites de cette dernière. Ainsi, nous aborderons les assistances circulatoires et cardiocirculatoires disponibles en France, afin de les envisager au sein d’une stratégie globale de prise en charge du patient en choc cardiogénique. Nous discuterons plus spécifiquement leurs indications ainsi que l’importance du moment d’implantation afin d’optimiser leur efficacité. Enfin, nous évoquerons les assistances actuellement en développement, mais également les nouvelles stratégies thérapeutiques qui pourraient arriver dans les prochaines années.
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Mester P, Bouvaist H, Delarche N, Bouisset F, Abdellaoui M, Petiteau PY, Dubreuil O, Boueri Z, Chettibi M, Souteyrand G, Madiot H, Belle L. At least seven days delayed stenting using minimalist immediate mechanical intervention (MIMI) in ST-segment elevation myocardial infarction: the SUPER-MIMI study. EUROINTERVENTION 2018; 13:390-396. [PMID: 28242585 DOI: 10.4244/eij-d-16-00667] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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
AIMS The aim of this study was to ascertain whether a minimalist immediate mechanical intervention (MIMI) aiming to restore an optimal Thrombolysis In Myocardial Infarction (TIMI) flow in the culprit artery, followed ≥7 days later by a second percutaneous coronary intervention with intentional stenting, is safe in patients with ST-segment elevation myocardial infarction and large thrombotic burden. METHODS AND RESULTS SUPER-MIMI was a prospective, observational trial conducted between January 2014 and April 2015 in 14 French centres. A total of 155 patients were enrolled. The pharmacological therapy was left to the operator's discretion. Eighty-one patients (52.3%) had glycoprotein IIb/IIIa inhibitors (GPI) initiated before the end of the first procedure. The median (interquartile range [IQR]) delay between the two procedures was eight (seven to 12) days. Infarct-related artery reocclusion between the two procedures (primary endpoint) occurred in two patients (1.3%), neither of whom received GPI treatment. TIMI flow was maintained or improved between the end of the first procedure and the beginning of the second procedure in all patients. Thrombotic burden and stenosis severity diminished significantly between the two procedures. Stents were ultimately implanted in 97 patients (62.6%). CONCLUSIONS Deferred stenting (≥7 days) in patients with a high thrombus burden was safe on a background of GPI therapy.
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Hernández-Enríquez M, Campelo-Parada F, Lhermusier T, Bouisset F, Roncalli J, Elbaz M, Carrié D, Boudou N. Long-term outcomes of rotational atherectomy of underexpanded stents. A single center experience. J Interv Cardiol 2018; 31:465-470. [PMID: 29372576 PMCID: PMC6099470 DOI: 10.1111/joic.12491] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 12/08/2017] [Accepted: 12/12/2017] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To analyze the procedural and long-term outcomes of the use of rotational atherectomy (RA) in underexpanded stents in our cohort and to provide an overview of currently available data on this technique. BACKGROUND Stent underexpansion (SU) has been related to stent thrombosis and restenosis. RA has been used to treat undilatable SU as a bail-out strategy with encouraging results. METHODS This is an observational, single-center study. We included patients who underwent stentablation between 2013 and 2017. Baseline demographics, procedural results, in-hospital major adverse cardiac events (MACE), and long-term follow-up MACE were retrospectively collected. RESULTS A total of 11 patients (90.9% males, mean age 65.4 ± 18.6) were included in this study. Median left ventricle ejection fraction was 53.5% [46.2-55]. Median calculated Syntax score was 16 [9-31] and 45.5% of patients were admitted for acute coronary syndrome. Radial approach was used in 63.6% of cases. Most patients only required one burr (45% used a 1.5 mm diameter burr) during the intervention. Procedural success was achieved in 90.9% of the cases. Acute lumen gain was 42.7% [30.7-61.49]. There were no in-hospital deaths or MACE. At a median follow-up of 26 months, only one patient (9.1%) suffered MACE in the context of acute coronary syndrome, and two patients (18.2%) required non-target lesion revascularization. No deaths were reported. CONCLUSIONS RA of under expanded stents is a feasible option with a high rate of procedural success. At long-term follow-up, all of them were alive and 90.9% of patients remained free from MACE.
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Affiliation(s)
- Marco Hernández-Enríquez
- Department of Cardiology, Cardiovascular Institute, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.,Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | | | | | - Frédéric Bouisset
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | - Jérôme Roncalli
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | - Meyer Elbaz
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | - Didier Carrié
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | - Nicolas Boudou
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
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50
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Orloff E, Bouisset F, Elbaz M, Moine T, Biendel C, Carrie D, Galinier M, Lairez O, Delmas C. Predictive factors for long-term mortality and role of comorbidities in cardiogenic shock. Archives of Cardiovascular Diseases Supplements 2018. [DOI: 10.1016/j.acvdsp.2017.11.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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