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Cherbi M, Bonnefoy E, Puymirat E, Lamblin N, Gerbaud E, Bonello L, Levy B, Lim P, Muller L, Merdji H, Range G, Ferrari E, Elbaz M, Khachab H, Bourenne J, Seronde MF, Florens N, Schurtz G, Labbé V, Harbaoui B, Vanzetto G, Combaret N, Marchandot B, Lattuca B, Leurent G, Faguer S, Roubille F, Delmas C. Cardiogenic shock and chronic kidney disease: Dangerous liaisons. Arch Cardiovasc Dis 2024; 117:255-265. [PMID: 38594150 DOI: 10.1016/j.acvd.2024.01.006] [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: 08/29/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Chronic kidney disease (CKD) is one of the leading causes of death worldwide, closely interrelated with cardiovascular diseases, ultimately leading to the failure of both organs - the so-called "cardiorenal syndrome". Despite this burden, data related to cardiogenic shock outcomes in CKD patients are scarce. METHODS FRENSHOCK (NCT02703038) was a prospective registry involving 772 patients with cardiogenic shock from 49 centres. One-year outcomes (rehospitalization, death, heart transplantation, ventricular assist device) were analysed according to history of CKD at admission and were adjusted on independent predictive factors. RESULTS CKD was present in 164 of 771 patients (21.3%) with cardiogenic shock; these patients were older (72.7 vs. 63.9years) and had more comorbidities than those without CKD. CKD was associated with a higher rate of all-cause mortality at 1month (36.6% vs. 23.2%; hazard ratio 1.39, 95% confidence interval 1.01-1.9; P=0.04) and 1year (62.8% vs. 40.5%, hazard ratio 1.39, 95% confidence interval 1.09-1.77; P<0.01). Patients with CKD were less likely to be treated with norepinephrine/epinephrine or undergo invasive ventilation or receive mechanical circulatory support, but were more likely to receive renal replacement therapy (RRT). RRT was associated with a higher risk of all-cause death at 1month and 1year regardless of baseline CKD status. CONCLUSIONS Cardiogenic shock and CKD are frequent "cross-talking" conditions with limited therapeutic options, resulting in higher rates of death at 1month and 1year. RRT is a strong predictor of death, regardless of preexisting CKD. Multidisciplinary teams involving cardiac and kidney physicians are required to provide integrated care for patients with failure of both organs.
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Affiliation(s)
- Miloud Cherbi
- Intensive Cardiac Care Unit, Rangueil University Hospital, 31059 Toulouse, France; 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
| | - Etienne Puymirat
- Assistance publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Department of Cardiology, 75015 Paris, France; Université de Paris, 75006 Paris, France
| | - Nicolas Lamblin
- Urgences et Soins Intensifs de Cardiologie, CHU de Lille, University of Lille, Inserm U1167, 59000 Lille, France
| | - Edouard Gerbaud
- Intensive Cardiac Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut-Lévêque, 5, avenue de Magellan, 33604 Pessac, France; Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, Hôpital Xavier-Arnozan, avenue du Haut-Lévêque, 33600 Pessac, France
| | - Laurent Bonello
- Aix-Marseille Université, 13385 Marseille, France; Intensive Care Unit, Department of Cardiology, Assistance publique-Hôpitaux de Marseille, Hôpital Nord, 13385 Marseille, France; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
| | - Bruno Levy
- CHRU Nancy, Réanimation Médicale Brabois, 54500 Vandœuvre-Lès-Nancy, France
| | - Pascal Lim
- Université Paris Est Créteil, Inserm, IMRB, 94010 Créteil, France; AP-HP, Hôpital Universitaire Henri-Mondor, Service de Cardiologie, 94010 Créteil, France
| | - Laura Muller
- Réanimation, Centre Hospitalier Broussais, 35400 Saint-Malo, France
| | - Hamid Merdji
- Medical Intensive Care Unit, Nouvel Hôpital Civil, CHU de Strasbourg, 67091 Strasbourg, France
| | - Grégoire Range
- Cardiology Department, Centre Hospitalier Louis-Pasteur, 28630 Chartres, France
| | - Emile Ferrari
- Cardiology Department, CHU de Nice, 06003 Nice, France
| | - Meyer Elbaz
- Intensive Cardiac Care Unit, Rangueil University Hospital, 31059 Toulouse, France; Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (Inserm), 31059 Toulouse, 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
| | - Jeremy Bourenne
- Aix-Marseille Université, Service de Réanimation des Urgences, CHU La Timone 2, 13005 Marseille, France
| | | | - Nans Florens
- Nephrology Department, Strasbourg University Hospital, 67091 Strasbourg, France
| | - Guillaume Schurtz
- Urgences et Soins Intensifs de Cardiologie, CHU de Lille, University of Lille, Inserm U1167, 59000 Lille, France
| | - Vincent Labbé
- Medical Intensive Care Unit, Hôpital Tenon, AP-HP, 75020 Paris, France
| | - Brahim Harbaoui
- Cardiology Department, Hôpital Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France; University of Lyon, CREATIS UMR5220, Inserm U1044, INSA-15, 69229 Lyon, France
| | - Gerald Vanzetto
- Department of Cardiology, Hôpital de Grenoble, 38700 La Tronche, France
| | - Nicolas Combaret
- Department of Cardiology, CHU de Clermont-Ferrand, CNRS, Université Clermont-Auvergne, 63003 Clermont-Ferrand, France
| | - Benjamin Marchandot
- Université de Strasbourg, Pôle d'Activité Médicochirurgicale Cardiovasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 67091 Strasbourg, France
| | - Benoit Lattuca
- Department of Cardiology, Nîmes University Hospital, Montpellier University, 30029 Nîmes, France
| | - Guillaume Leurent
- Department of Cardiology, CHU de Rennes, Inserm, LTSI, UMR 1099, Université Rennes 1, 35000 Rennes, France
| | - Stanislas Faguer
- Department of Nephrology and Transplantation, French Intensive Care Renal Network, Inserm U1297 (Institute of Metabolic and Cardiovascular Diseases), University Hospital of Toulouse, 31059 Toulouse, France
| | - François Roubille
- PhyMedExp, Université de Montpellier, Inserm, CNRS, Cardiology Department, CHU de Montpellier, 34295 Montpellier, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Rangueil University Hospital, 31059 Toulouse, France; Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (Inserm), 31059 Toulouse, France.
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Manzo-Silberman S, Martin AC, Boissier F, Hauw-Berlemont C, Aissaoui N, Lamblin N, Roubille F, Bonnefoy E, Bonello L, Elbaz M, Schurtz G, Morel O, Leurent G, Levy B, Jouve B, Harbaoui B, Vanzetto G, Combaret N, Lattucca B, Champion S, Lim P, Bruel C, Schneider F, Seronde MF, Bataille V, Gerbaud E, Puymirat E, Delmas C. Sex disparities in cardiogenic shock: Insights from the FRENSHOCK registry. J Crit Care 2024; 82:154785. [PMID: 38493531 DOI: 10.1016/j.jcrc.2024.154785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/10/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Cardiogenic shock (CS) is the most severe form of acute heart failure. Discrepancies have been reported between sexes regarding delays, pathways and invasive strategies in CS complicating acute myocardial infarction. However, effect of sex on the prognosis of unselected CS remains controversial. OBJECTIVES The aim was to analyze the impact of sex on aetiology, management and prognosis of CS. METHODS The FRENSHOCK registry included all CS admitted in 49 French Intensive Care Units (ICU) and Intensive Cardiac Care Units (ICCU) between April and October 2016. RESULTS Among the 772 CS patients included, 220 were women (28.5%). Women were older, less smokers, with less history of ischemic cardiac disease (20.5% vs 33.6%) than men. At admission, women presented less cardiac arrest (5.5 vs 12.2%), less mottling (32.5 vs 41.4%) and higher LVEF (30 ± 14 vs 25 ± 13%). Women were more often managed via emergency department while men were directly admitted at ICU/ICCU. Ischemia was the most frequent trigger irrespective of sex (36.4% in women vs 38.2%) but women had less coronary angiogram and PCI (45.9% vs 54% and 24.1 vs 31.3%, respectively). We found no major difference in medication and organ support. Thirty-day mortality (26.4 vs 26.5%), transplant or permanent assist device were similar in both sexes. CONCLUSION Despite some more favorable parameters in initial presentation and no significant difference in medication and support, women shared similar poor prognosis than men. Further analysis is required to cover the lasting gap in knowledge regarding sex specificities to distinguish between differences and inequalities. NCT02703038.
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Affiliation(s)
- Stéphane Manzo-Silberman
- Sorbonne University, Institute of Cardiology- Hôpital Pitié-Salpêtrière (AP-HP), ACTION Study Group, Paris, France; Université de Paris, INSERM, Innovative Therapies in Haemostasis, 75006 Paris, France; Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, F-13385 Marseille, France; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France; University of Lyon, CREATIS UMR5220, INSERM U1044, INSA-15 Lyon, France; AP-HP, Hôpital Universitaire Henri-Mondor, Service de Cardiologie, F-94010 Créteil, France; Bordeaux Cardio-Thoracic Research Centre, Bordeaux University, Bordeaux U1045, France; Université de Paris, 75006 Paris, France.
| | - Anne-Céline Martin
- Cardiology Department, AP HP, European Hospital Georges Pompidou, 75015, France
| | - Florence Boissier
- Service de Médecine Intensive Réanimation, Centre Hospitalo-Universitaire de Poitiers, INSERM CIC 1402 (IS-ALIVE group), Université de Poitiers, Member of FEMMIR (Femmes Médecins en Médecine Intensive Réanimation) Group for the French Intensive Care Society, Poitiers, France
| | - Caroline Hauw-Berlemont
- Medical Intensive Care Unit, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, FEMMIR (Femmes Médecins en Médecine Intensive Réanimation) Group for the French Intensive Care Society, Université Paris Cité, Paris, France
| | - Nadia Aissaoui
- Medical Intensive Care Unit, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, Centre - Université de Paris, Medical School, Paris, France
| | - Nicolas Lamblin
- USIC Urgences et Centre Hémodynamique, Institut Coeur Poumon, Centre Hospitalier Universitaire Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, F-59000 Lille, France
| | - François Roubille
- PhyMedExp, Cardiology Department, University of Montpellier, INSERM U1046, CNRS UMR, 9214; INI-CRT, Montpellier, France
| | - Eric Bonnefoy
- Intensive Cardiac Care Unit, Lyon Brom University Hospital, Lyon, France
| | | | - Meyer Elbaz
- Intensive Cardiac Care Unit, Cardiology department, Rangueil University Hospital, 1 Avenue Jean Poulhes, Toulouse, France
| | - Guillaume Schurtz
- USIC Urgences et Centre Hémodynamique, Institut Coeur Poumon, Centre Hospitalier Universitaire Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, F-59000 Lille, France
| | - Olivier Morel
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 67091 Strasbourg, France
| | - Guillaume Leurent
- Univ Rennes1, Department of Cardiology, CHU Rennes, Inserm, LTSI-UMR 1009, F-35000 Rennes, France
| | - Bruno Levy
- CHRU Nancy, Réanimation Médicale Brabois, Vandoeuvre-les Nancy, France
| | - Bernard Jouve
- Intensive Cardiac Care Unit, Department of Cardiology, CH d'Aix en Provence, Aix en Provence, Avenue des Tamaris, 13616, cedex 1, France
| | - Brahim Harbaoui
- Cardiology Department, Hôpital Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Gérald Vanzetto
- Department of Cardiology, Hôpital de Grenoble, 38700 La Tronche, France
| | - Nicolas Combaret
- Department of Cardiology, Clermont-Ferrand University Hospital Center, CNRS, Clermont Auvergne University, Clermont-Ferrand, France
| | - Benoit Lattucca
- Department of Cardiology, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Sébastien Champion
- Clinique de Parly 2, Ramsay Générale de Santé, 21 rue Moxouris, 78150 Le Chesnay, France
| | - Pascal Lim
- Univ Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France
| | - Cédric Bruel
- Groupe Hospitalier Saint Joseph, 185 rue Raymond Losserand, 75674 Paris, France
| | - Francis Schneider
- Médecine intensive réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg et Unistra, Faculté de Médecine, Strasbourg, France
| | | | - Vincent Bataille
- Intensive Cardiac Care Unit, Cardiology department, Rangueil University Hospital, 1 Avenue Jean Poulhes, Toulouse, France; Adimep : Association pour la Diffusion de la Médecine de Prévention, Toulouse, France
| | - Edouard Gerbaud
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, Pessac, France
| | - Etienne Puymirat
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology, 75015 Paris, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Cardiology department, Rangueil University Hospital, 1 Avenue Jean Poulhes, Toulouse, France; Recherche Enseignement en Insuffisance cardiaque Avancée Assistance et Transplantation (REICATRA), Institut Saint Jacques, CHU de Toulouse, France.
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Lemesle G, Schurtz G, Verdier B, Bonello L. Very early invasive strategy in patients with non-ST-elevation myocardial infarction: should we go for it? Heart 2024; 110:461-462. [PMID: 38103914 DOI: 10.1136/heartjnl-2023-323688] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Affiliation(s)
- Gilles Lemesle
- USIC et Centre Hemodynamique, Centre Hospitalier Universitaire de Lille, Institut Coeur Poumon, Lille, France
| | - Guillaume Schurtz
- Centre Hospitalier Universitaire de Lille, Institut Coeur Poumon, Lille, France
| | - Basile Verdier
- Centre Hospitalier Universitaire de Lille, Institut Coeur Poumon, Lille, France
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Matsushita K, Delmas C, Marchandot B, Roubille F, Lamblin N, Leurent G, Levy B, Elbaz M, Champion S, Lim P, Schneider F, Khachab H, Carmona A, Trimaille A, Bourenne J, Seronde M, Schurtz G, Harbaoui B, Vanzetto G, Biendel C, Labbe V, Combaret N, Mansourati J, Filippi E, Maizel J, Merdji H, Lattuca B, Gerbaud E, Bonnefoy E, Puymirat E, Bonello L, Morel O. Optimal Heart Failure Medical Therapy and Mortality in Survivors of Cardiogenic Shock: Insights From the FRENSHOCK Registry. J Am Heart Assoc 2024; 13:e030975. [PMID: 38390813 PMCID: PMC10944045 DOI: 10.1161/jaha.123.030975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 01/17/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND The effects of pharmacological therapy on cardiogenic shock (CS) survivors have not been extensively studied. Thus, this study investigated the association between guideline-directed heart failure (HF) medical therapy (GDMT) and one-year survival rate in patients who are post-CS. METHODS AND RESULTS FRENSHOCK (French Observatory on the Management of Cardiogenic Shock in 2016) registry was a prospective multicenter observational survey, conducted in metropolitan French intensive care units and intensive cardiac care units. Of 772 patients, 535 patients were enrolled in the present analysis following the exclusion of 217 in-hospital deaths and 20 patients with missing medical records. Patients with triple GDMT (beta-blockers, renin-angiotensin system inhibitors, and mineralocorticoid receptor antagonists) at discharge (n=112) were likely to have lower left ventricular ejection fraction on admission and at discharge compared with those without triple GDMT (n=423) (22% versus 28%, P<0.001 and 29% versus 37%, P<0.001, respectively). In the overall cohort, the one-year mortality rate was 23%. Triple GDMT prescription was significantly associated with a lower one-year all-cause mortality compared with non-triple GDMT (adjusted hazard ratio 0.44 [95% CI, 0.19-0.80]; P=0.007). Similarly, 2:1 propensity score matching and inverse probability treatment weighting based on the propensity score demonstrated a lower incidence of one-year mortality in the triple GDMT group. As the number of HF drugs increased, a stepwise decrease in mortality was observed (log rank; P<0.001). CONCLUSIONS In survivors of CS, the one-year mortality rate was significantly lower in those with triple GDMT. Therefore, this study suggests that intensive HF therapy should be considered in patients following CS.
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Affiliation(s)
- Kensuke Matsushita
- Université de Strasbourg, Pôle d’Activité Médico‐Chirurgicale Cardio‐Vasculaire, Nouvel Hôpital CivilCentre Hospitalier UniversitaireStrasbourgFrance
- UMR1260 INSERM, Nanomédecine RégénérativeUniversité de StrasbourgStrasbourgFrance
| | - Clément Delmas
- Intensive Cardiac Care UnitRangueil University Hospital/Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR‐1048, INSERMToulouseFrance
| | - Benjamin Marchandot
- Université de Strasbourg, Pôle d’Activité Médico‐Chirurgicale Cardio‐Vasculaire, Nouvel Hôpital CivilCentre Hospitalier UniversitaireStrasbourgFrance
| | - François Roubille
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Cardiology DepartmentCHU de MontpellierMontpellierFrance
| | - Nicolas Lamblin
- Urgences et Soins Intensifs de CardiologieCHU Lille, University of Lille, Inserm U1167LilleFrance
| | - Guillaume Leurent
- Department of CardiologyCHU Rennes, Inserm, LTSI‐UMR 1099RennesFrance
| | - Bruno Levy
- Réanimation Médicale BraboisCHRU NancyNancyFrance
| | - Meyer Elbaz
- Intensive Cardiac Care UnitRangueil University Hospital/Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR‐1048, INSERMToulouseFrance
| | | | - Pascal Lim
- Univ Paris Est Créteil, INSERM, IMRBAP‐HP, Hôpital Universitaire Henri‐Mondor, Service de CardiologieCréteilFrance
| | - Francis Schneider
- Médecine Intensive‐RéanimationHôpital de Hautepierre, Hôpitaux Universitaires de StrasbourgStrasbourgFrance
| | - Hadi Khachab
- Intensive Cardiac Care Unit, Department of CardiologyCH d’Aix en ProvenceAix‐en‐ProvenceFrance
| | - Adrien Carmona
- Université de Strasbourg, Pôle d’Activité Médico‐Chirurgicale Cardio‐Vasculaire, Nouvel Hôpital CivilCentre Hospitalier UniversitaireStrasbourgFrance
| | - Antonin Trimaille
- Université de Strasbourg, Pôle d’Activité Médico‐Chirurgicale Cardio‐Vasculaire, Nouvel Hôpital CivilCentre Hospitalier UniversitaireStrasbourgFrance
- UMR1260 INSERM, Nanomédecine RégénérativeUniversité de StrasbourgStrasbourgFrance
| | - Jeremy Bourenne
- Aix Marseille UniversitéService de Réanimation des Urgences, CHU La Timone 2MarseilleFrance
| | | | - Guillaume Schurtz
- Urgences et Soins Intensifs de CardiologieCHU Lille, University of Lille, Inserm U1167LilleFrance
| | - Brahim Harbaoui
- Cardiology DepartmentHôpital Croix‐Rousse and Hôpital Lyon Sud, Hospices Civils de LyonLyonFrance
- University of Lyon, CREATIS UMR5220, INSERM U1044, INSA‐15LyonFrance
| | | | - Caroline Biendel
- Intensive Cardiac Care UnitRangueil University Hospital/Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR‐1048, INSERMToulouseFrance
| | - Vincent Labbe
- Service de Médecine Intensive Réanimation, Hôpital Tenon, Département Médico‐Universitaire APPROCHESAssistance Publique‐Hôpitaux de Paris (APHP), Sorbonne UniversitéParisFrance
| | - Nicolas Combaret
- Department of CardiologyHU Clermont‐Ferrand, CNRS, Université Clermont AuvergneClermont‐FerrandFrance
| | - Jacques Mansourati
- Department of CardiologyUniversity Hospital of Brest and University of Western BrittanyOrphyFrance
| | - Emmanuelle Filippi
- Department of CardiologyGeneral Hospital of Atlantic BrittanyVannesFrance
| | - Julien Maizel
- Intensive Care DepartmentCHU Amiens‐PicardieAmiensFrance
| | - Hamid Merdji
- UMR1260 INSERM, Nanomédecine RégénérativeUniversité de StrasbourgStrasbourgFrance
- Medical Intensive Care UnitNouvel Hôpital Civil, Centre Hospitalier UniversitaireStrasbourgFrance
| | - Benoit Lattuca
- Department of CardiologyNîmes University Hospital, Montpellier UniversityNîmesFrance
| | - Edouard Gerbaud
- Cardiology Intensive Care Unit and Interventional CardiologyHôpital Cardiologique du Haut Lévêque, Bordeaux Cardio‐Thoracic Research Centre, U1045, Bordeaux University, Hôpital Xavier ArnozanPessacFrance
| | - Eric Bonnefoy
- Intensive Cardiac Care UnitLyon Brom University HospitalLyonFrance
| | - Etienne Puymirat
- Cardiology DepartmentEuropean Georges Pompidou HospitalParisFrance
| | - Laurent Bonello
- Department of Cardiology, Aix‐Marseille Université, Intensive Care Unit, Assistance Publique‐Hôpitaux de MarseilleHôpital Nord, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio)MarseilleFrance
| | - Olivier Morel
- Université de Strasbourg, Pôle d’Activité Médico‐Chirurgicale Cardio‐Vasculaire, Nouvel Hôpital CivilCentre Hospitalier UniversitaireStrasbourgFrance
- UMR1260 INSERM, Nanomédecine RégénérativeUniversité de StrasbourgStrasbourgFrance
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5
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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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Bouillot E, Cherpin A, Remacle Bonnet A, Bonello L, Peyron F. [Temporary circulatory assistance by Impella™ in interventional cardiology: Observational study and medico-economic assessment after four years of use]. Ann Pharm Fr 2024; 82:110-120. [PMID: 37923010 DOI: 10.1016/j.pharma.2023.10.012] [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] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/20/2023] [Accepted: 10/27/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES During life-threatening emergencies or risky cardiologic interventions, pharmacology can be limited and the use of appropriate medical devices is then necessary. The Impella™ catheter, CP and 2.5, has been referenced for the exclusive use of the interventional cardiology technical platform at Hôpital Nord (AP-HM) in the absence of rapid access to the Extracorporeal Circulation unit. It is a temporary mechanical circulatory support device mainly indicated in refractory cardiogenic shock and coronary angioplasty at high risk of hemodynamic instability. The objective of this study, observational and retrospective, is to carry out a clinical and economic assessment linked to the use of this device over a period of four years (2017-2020). METHODS The criteria relating to the 71 patients (51 Impella™ CP and 20 Impella™ 2.5) and their clinical evolution as well as the costs and valuation of the stays were determined. RESULTS In particular, the Impella™ CP enabled myocardial recovery in 18 out of 51 patients and it was an intermediary in the context of heavier care for 11 patients. The balance between expenditure and valuation shows a deficit of -819,937 euros over the study period, with however a probable margin for improvement. CONCLUSIONS The Impella™ is of clinical interest under very specific conditions. Its high cost and the absence of inclusion on the list of reimbursements in addition to Homogeneous Groups of Stays represent a significant financial burden for health care establishments. Thus, optimizing the rating of future stays is a necessity.
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Affiliation(s)
- Elodie Bouillot
- Pharmacie à usage intérieur, AP-HM Nord, chemin des Bourrely, 13915 Marseille cedex 20, France.
| | - Amélie Cherpin
- Pharmacie à usage intérieur, AP-HM Nord, chemin des Bourrely, 13915 Marseille cedex 20, France
| | - Anne Remacle Bonnet
- Service d'information médicale, AP-HM Nord, chemin des Bourrely, 13915 Marseille cedex 20, France
| | - Laurent Bonello
- Service de cardiologie, AP-HM Nord, chemin des Bourrely, 13915 Marseille cedex 20, France
| | - Florence Peyron
- Pharmacie à usage intérieur, AP-HM Nord, chemin des Bourrely, 13915 Marseille cedex 20, France
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7
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Cardelli LS, Cherbi M, Huet F, Schurtz G, Bonnefoy-Cudraz E, Gerbaud E, Bonello L, Leurent G, Puymirat E, Casella G, Delmas C, Roubille F. Beta Blockers Improve Prognosis When Used Early in Patients with Cardiogenic Shock: An Analysis of the FRENSHOCK Multicenter Prospective Registry. Pharmaceuticals (Basel) 2023; 16:1740. [PMID: 38139866 PMCID: PMC10747751 DOI: 10.3390/ph16121740] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/04/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Beta blockers (BBs) are a cornerstone for patients with heart failure (HF) and ventricular dysfunction. However, their use in patients recovering from a cardiogenic shock (CS) remains a bone of contention, especially regarding whether and when to reintroduce this class of drugs. METHODS FRENSHOCK is a prospective multicenter registry including 772 CS patients from 49 centers. Our aim was to compare outcomes (1-month and 1-year all-cause mortality) between CS patients taking and those not taking BBs in three scenarios: (1) at 24 h after CS; (2) patients who did or did not discontinue BBs within 24 h; and (3) patients who did or did not undergo the early introduction of BBs. RESULTS Among the 693 CS included, at 24 h after the CS event, 95 patients (13.7%) were taking BB, while 598 (86.3%) were not. Between the groups, there were no differences in terms of major comorbidities or initial CS triggers. Patients receiving BBs at 24 h presented a trend toward reduced all-cause mortality both at 1 month (aHR = 0.61, 95% CI 0.34 to 1.1, p = 0.10) and 1 year, which was, in both cases, not significant. Compared with patients who discontinued BBs at 24 h, patients who did not discontinue BBs showed lower 1-month mortality (aHR = 0.43, 95% CI 0.2 to 0.92, p = 0.03) and a trend to lower 1-year mortality. No reduction in outcomes was observed in patients who underwent an early introduction of BB therapy. CONCLUSIONS BBs are drugs of first choice in patients with HF and should also be considered early in patients with CS. In contrast, the discontinuation of BB therapy resulted in increased 1-month all-cause mortality and a trend toward increased 1-year all-cause mortality.
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Affiliation(s)
| | - Miloud Cherbi
- Intensive Cardiac Care Unit, Rangueil University Hospital, 31059 Toulouse, France (C.D.)
| | - Fabien Huet
- Department of Cardiology, Centre Hospitalier Bretagne Atlantique, 56000 Vannes, France
| | - Guillaume Schurtz
- Department of Cardiology, Urgences et Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, 59000 Lille, France
| | | | - Edouard Gerbaud
- Intensive Cardiac Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, 5 Avenue de Magellan, 33604 Pessac, France;
| | - Laurent Bonello
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, 13015 Marseille, France
| | - Guillaume Leurent
- Department of Cardiology, CHU Rennes, Inserm, LTSI—UMR 1099, Univ Rennes 1, 35000 Rennes, France
| | - Etienne Puymirat
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, 75015 Paris, France
| | - Gianni Casella
- Cardiology Department, Ospedale Maggiore, 40131 Bologna, Italy
| | - Clément Delmas
- Intensive Cardiac Care Unit, Rangueil University Hospital, 31059 Toulouse, France (C.D.)
- REICATRA, Institut Saint Jacques, 31059 Toulouse, France
| | - François Roubille
- PhyMedExp, INSERM, CNRS, Cardiology Department, INI-CRT, Université de Montpellier, 34295 Montpellier, France
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8
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Schurtz G, Mewton N, Lemesle G, Delmas C, Levy B, Puymirat E, Aissaoui N, Bauer F, Gerbaud E, Henry P, Bonello L, Bochaton T, Bonnefoy E, Roubille F, Lamblin N. Beta-blocker management in patients admitted for acute heart failure and reduced ejection fraction: a review and expert consensus opinion. Front Cardiovasc Med 2023; 10:1263482. [PMID: 38050613 PMCID: PMC10693984 DOI: 10.3389/fcvm.2023.1263482] [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: 07/19/2023] [Accepted: 10/31/2023] [Indexed: 12/06/2023] Open
Abstract
The role of the beta-adrenergic signaling pathway in heart failure (HF) is pivotal. Early blockade of this pathway with beta-blocker (BB) therapy is recommended as the first-line medication for patients with HF and reduced ejection fraction (HFrEF). Conversely, in patients with severe acute HF (AHF), including those with resolved cardiogenic shock (CS), BB initiation can be hazardous. There are very few data on the management of BB in these situations. The present expert consensus aims to review all published data on the use of BB in patients with severe decompensated AHF, with or without hemodynamic compromise, and proposes an expert-recommended practical algorithm for the prescription and monitoring of BB therapy in critical settings.
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Affiliation(s)
- Guillaume Schurtz
- USICet Centre Hémodynamique, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Nathan Mewton
- Hôpital Cardio-Vasculaire Louis Pradel. Filière Insuffisance Cardiaque, Centre D'Investigation Clinique, INSERM 1407. Unité CarMeN, INSERM 1060, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Gilles Lemesle
- USICet Centre Hémodynamique, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, Lille, France
- Institut Pasteur de Lille, Unité INSERM UMR1011, Lille, France
- Faculté de Médecine de l’Université de Lille, Lille, France
- FACT (French Alliance for Cardiovascular Trials), Paris, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France
| | - Bruno Levy
- Service de Réanimation Médicale Brabois, CHRU Nancy, Pôle Cardio-Médico-Chirurgical, Vandoeuvre-les-Nancy, INSERM U1116, Faculté de Médecine, Vandoeuvre-les-Nancy, Université de Lorraine, Nancy, France
| | - Etienne Puymirat
- Department of Cardiology, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Nadia Aissaoui
- Médecine Intensive Réanimation, Cochin, AfterROSC, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Cité, Paris, France
| | - Fabrice Bauer
- Heart Failure Network, Advanced Heart Failure Clinic and Pulmonary Hypertension Department, Cardiac Surgery Department, INSERM U1096, Rouen University Teaching Hospital, Rouen, France
| | - Edouard Gerbaud
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut-Lévêque, Pessac, France
- Bordeaux Cardio-Thoracic Research Centre, INSERM U1045, Bordeaux University, Bordeaux, France
| | - Patrick Henry
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, INSERM U942, University of Paris, Paris, France
| | - Laurent Bonello
- Cardiology Department, APHM, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Centre for CardioVascular and Nutrition Research (C2VN), INSERM 1263, INRA 1260, Aix-Marseille Univ, Marseille, France
| | - Thomas Bochaton
- Intensive Cardiological Care Division, Hospices Civils de Lyon-Hôpital Cardiovasculaire et Pulmonaire, Lyon, France
| | - Eric Bonnefoy
- Intensive Cardiological Care Division, Hospices Civils de Lyon-Hôpital Cardiovasculaire et Pulmonaire, Lyon, France
| | - François Roubille
- Cardiology Department, INI-CRT, CHU de Montpellier, PhyMedExp, INSERM, CNRS, Université de Montpellier, Montpellier, France
| | - Nicolas Lamblin
- Cardiology Department, Heart and Lung Institute, University Hospital of Lille, Lille, France
- INSERM U1167, Institut Pasteur of Lille, Lille, France
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9
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Delmas C, Laine M, Schurtz G, Roubille F, Coste P, Leurent G, Hraiech S, Pankert M, Gonzalo Q, Dabry T, Letocart V, Loubière S, Resseguier N, Bonello L. Rationale and design of the ULYSS trial: A randomized multicenter evaluation of the efficacy of early Impella CP implantation in acute coronary syndrome complicated by cardiogenic shock. Am Heart J 2023; 265:203-212. [PMID: 37657594 DOI: 10.1016/j.ahj.2023.08.066] [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: 05/23/2023] [Revised: 08/26/2023] [Accepted: 08/28/2023] [Indexed: 09/03/2023]
Abstract
CONTEXT Despite 20 years of improvement in acute coronary syndromes care, patients with acute myocardial infarction complicated by cardiogenic shock (AMICS) remains a major clinical challenge with a stable incidence and mortality. While intra-aortic balloon pump (IABP) did not meet its expectations, percutaneous mechanical circulatory supports (pMCS) with higher hemodynamic support, large availability and quick implementation may improve AMICS prognosis by enabling early hemodynamic stabilization and unloading. Both interventional and observational studies suggested a clinical benefit in selected patients of the IMPELLAⓇ CP device within in a well-defined therapeutic strategy. While promising, these preliminary results are challenged by others suggesting a higher rate of complications and possible poorer outcome. Given these conflicting data and its high cost, a randomized clinical trial is warranted to delineate the benefits and risks of this new therapeutic strategy. DESIGN The ULYSS trial is a prospective randomized open label, 2 parallel multicenter clinical trial that plans to enroll patients with AMICS for whom an emergent percutaneous coronary intervention (PCI) is intended. Patients will be randomized to an experimental therapeutic strategy with pre-PCI implantation of an IMPELLAⓇ CP device on top of standard medical therapy or to a control group undergoing PCI and standard medical therapy. The primary objective of this study is to compare the efficacy of this experimental strategy by a composite end point of death, need to escalate to ECMO, long-term left ventricular assist device or heart transplantation at 1 month. Among secondary objectives 1-year efficacy, safety and cost effectiveness will be assessed. CLINICAL TRIAL REGISTRATION NCT05366452.
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Affiliation(s)
- Clement Delmas
- Department of Cardiology, Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France; INSERM U1048, I2MC, Toulouse, France; REICATRA, Institut Saint Jacques, Toulouse, France.
| | - Marc Laine
- Aix-Marseille Université, F-13385 Marseille, France; Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, F-13385 Marseille, France; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
| | - Guillaume Schurtz
- Department of Cardiology, Intensive Cardiac Care Unit, Lille University Hospital, Lille, France
| | - Francois Roubille
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Cardiology Department, CHU de Montpellier, France
| | - Pierre Coste
- Cardiology Department, Bordeaux University Hospital, Pessac, France
| | - Guillaume Leurent
- Intensive Cardiac Care Unit, Cardiology Department, Rennes University Hospital, Rennes, France
| | - Sami Hraiech
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France
| | | | | | | | - Vincent Letocart
- Department of Cardiology, Nantes Université, CHU Nantes, l'institut du thorax, Nantes, France
| | - Sandrine Loubière
- Department of Epidemiology and Health Economics, APHM, Marseille, France; CEReSS-Health Service Research and Quality of Life Center, School of Medicine Aix-Marseille University Marseille France
| | - Noémie Resseguier
- Department of Epidemiology and Health Economics, APHM, Marseille, France; CEReSS-Health Service Research and Quality of Life Center, School of Medicine Aix-Marseille University Marseille France
| | - Laurent Bonello
- Aix-Marseille Université, F-13385 Marseille, France; Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, F-13385 Marseille, France; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
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Cherbi M, Gerbaud E, Lamblin N, Bonnefoy E, Bonello L, Levy B, Ternacle J, Schneider F, Elbaz M, Khachab H, Paternot A, Seronde MF, Schurtz G, Leborgne L, Filippi E, Mansourati J, Genet T, Harbaoui B, Vanzetto G, Combaret N, Marchandot B, Lattuca B, Leurent G, Puymirat E, Roubille F, Delmas C. Cardiogenic Shock in Idiopathic Dilated Cardiomyopathy Patients: Red Flag for Myocardial Decline. Am J Cardiol 2023; 206:89-97. [PMID: 37690150 DOI: 10.1016/j.amjcard.2023.07.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/20/2023] [Accepted: 07/30/2023] [Indexed: 09/12/2023]
Abstract
Idiopathic dilated cardiomyopathy (IDCM) is one of the most common forms of nonischemic cardiomyopathy worldwide, possibly leading to cardiogenic shock (CS). Despite this heavy burden, the outcomes of CS in IDCM are poorly reported. Based on a large registry of unselected CS, our aim was to shed light on the 1-year outcomes after CS in patients with and without IDCM. FRENSHOCK was a prospective registry including 772 patients with CS from 49 centers. The 1-year outcomes (rehospitalizations, mortality, heart transplantation [HTx], ventricular assist devices [VAD]) were analyzed and adjusted on independent predictive factors. Within 772 CS included, 78 occurred in IDCM (10.1%). Patients with IDCM had more frequent history of chronic kidney failure and implantable cardioverter-defibrillator implantation. No difference was found in 1-month all-cause mortality between groups (28.2 vs 25.8%for IDCM and others, respectively; adjusted hazard ratio 1.14 [0.73 to 1.77], p = 0.57). Patients without IDCM were more frequently treated with noninvasive ventilation and intra-aortic balloon pump. At 1 year, IDCM led to higher rates of death or cardiovascular rehospitalizations (adjusted odds ratio 4.77 [95% confidence interval 1.13 to 20.1], p = 0.03) and higher rates of HTx or VAD for patients aged <65 years (adjusted odds ratio 2.68 [1.21 to 5.91], p = 0.02). In conclusion, CS in IDCM is a very common scenario and is associated with a higher rate of 1-year death or cardiovascular rehospitalizations and a more frequent recourse to HTx or VAD for patients aged <65 years, encouraging the consideration of it as a red flag for myocardial decline and urging for a closer follow-up and earlier evaluation for advanced heart failure therapies.
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Affiliation(s)
- Miloud Cherbi
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France/ Institute of Metabolic and Cardiovascular Diseases, National Institute of Health and Medical Research (Inserm), Toulouse, France.
| | - Edouard Gerbaud
- Intensive Cardiac Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, Pessac, France/Bordeaux Cardio-Thoracic Research Centre, Bordeaux University, Pessac, France
| | - Nicolas Lamblin
- Intensive Cardiac Care Unit, CHU Lille, University of Lille, Inserm U1167, Lille, France
| | - Eric Bonnefoy
- Intensive Cardiac Care Unit, Lyon Brom University Hospital, Lyon, France
| | - Laurent Bonello
- Intensive Care Unit, Department of Cardiology, Marseille University Hospital, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
| | - Bruno Levy
- Intensitve Care Unit, Nancy University Hospital, Vandoeuvre-les Nancy, France
| | - Julien Ternacle
- Intensive Cardiac Care Unit, Cardiology Department, AP-HP, Henri Mondor University Hospital, Créteil, France
| | - Francis Schneider
- Intensive Care Unit, Strasbourg University Hospital, Strasbourg, France
| | - Meyer Elbaz
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France/ Institute of Metabolic and Cardiovascular Diseases, National Institute of Health and Medical Research (Inserm), Toulouse, France
| | - Hadi Khachab
- Intensive Cardiac Care Unit, Department of Cardiology, CH d'Aix en Provence, Aix en Provence, France, Avenue des Tamaris Aix-en-Provence Cedex 1, France
| | - Alexis Paternot
- Intensive Care Unit, Hôpital Ambroise-Paré, AP-HP, Paris, France
| | | | - Guillaume Schurtz
- Intensive Cardiac Care Unit, CHU Lille, University of Lille, Inserm U1167, Lille, France
| | - Laurent Leborgne
- Cardiology Department, Amiens University Hospital, Amiens, France
| | | | | | - Thibaud Genet
- Cardiology Department, Tours University Hospital, Tours, France
| | - Brahim Harbaoui
- Cardiology Department, Lyon University Hospital, University of Lyon, CREATIS UMR5220; Inserm U1044; INSA-15 Lyon, France
| | - Gérald Vanzetto
- Cardiology Department, Grenoble University Hospital, Grenoble, France
| | - Nicolas Combaret
- Department of Cardiology, Clermont-Ferrand University Hospital, CNRS, Clermont Auvergne University, Clermont-Ferrand, France
| | - Benjamin Marchandot
- Cardiovascular Medical-Surgical Activity Center, Strasbourg Uniersity Hospital, Centre Hospitalier Universitaire, Strasbourg, France
| | - Benoit Lattuca
- Department of Cardiology, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Guillaume Leurent
- Department of Cardiology, Rennes University Hospital, Inserm, LTSI-UMR 1099, Univ Rennes 1, Rennes, France
| | - Etienne Puymirat
- Georges Pompidou European Hospital, Department of Cardiology, Paris, Université de Paris, 75006 Paris, France
| | - François Roubille
- Cardiology Department, Montpellier University Hospital, PhyMedExp, Inserm, CNRS, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France/ Institute of Metabolic and Cardiovascular Diseases, National Institute of Health and Medical Research (Inserm), Toulouse, France; REICATRA, Saint Jacques Institute, Toulouse, France
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11
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Merdji H, Gantzer J, Bonello L, Lamblin N, Roubille F, Levy B, Champion S, Lim P, Schneider F, Cariou A, Khachab H, Bourenne J, Seronde MF, Schurtz G, Harbaoui B, Vanzetto G, Quentin C, Curtiaud A, Kurtz JE, Combaret N, Marchandot B, Lattuca B, Biendel C, Leurent G, Bataille V, Gerbaud E, Puymirat E, Bonnefoy E, Aissaoui N, Delmas C. Characteristics, management, and outcomes of active cancer patients with cardiogenic shock. Eur Heart J Acute Cardiovasc Care 2023; 12:682-692. [PMID: 37410588 DOI: 10.1093/ehjacc/zuad072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/21/2023] [Accepted: 07/03/2023] [Indexed: 07/08/2023]
Abstract
AIMS Characteristics, management, and outcomes of patients with active cancer admitted for cardiogenic shock remain largely unknown. This study aimed to address this issue and identify the determinants of 30-day and 1-year mortality in a large cardiogenic shock cohort of all aetiologies. METHODS AND RESULTS FRENSHOCK is a prospective multicenter observational registry conducted in French critical care units between April and October 2016. 'Active cancer' was defined as a malignancy diagnosed within the previous weeks with planned or ongoing anticancer therapy. Among the 772 enrolled patients (mean age 65.7 ± 14.9 years; 71.5% male), 51 (6.6%) had active cancer. Among them, the main cancer types were solid cancers (60.8%), and hematological malignancies (27.5%). Solid cancers were mainly urogenital (21.6%), gastrointestinal (15.7%), and lung cancer (9.8%). Medical history, clinical presentation, and baseline echocardiography were almost the same between groups. In-hospital management significantly differed: patients with cancers received more catecholamines or inotropes (norepinephrine 72% vs. 52%, P = 0.005 and norepinephrine-dobutamine combination 64.7% vs. 44.5%, P = 0.005), but had less mechanical circulatory support (5.9% vs. 19.5%, P = 0.016). They presented a similar 30-day mortality rate (29% vs. 26%) but a significantly higher mortality at 1-year (70.6% vs. 45.2%, P < 0.001). In multivariable analysis, active cancer was not associated with 30-day mortality but was significantly associated with 1-year mortality in 30-day survivors [HR 3.61 (1.29-10.11), P = 0.015]. CONCLUSION Active cancer patients accounted for almost 7% of all cases of cardiogenic shock. Early mortality was the same regardless of active cancer or not, whereas long-term mortality was significantly increased in patients with active cancer.
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Affiliation(s)
- Hamid Merdji
- Faculté de Médecine, Université de Strasbourg (UNISTRA), Strasbourg university hospital, Nouvel Hôpital Civil, Medical intensive care unit, Strasbourg, France
| | - Justine Gantzer
- Department of Medical Oncology, Strasbourg-Europe Cancer Institute (ICANS), Strasbourg, France
| | - Laurent Bonello
- Aix-Marseille Université, F-13385 Marseille, France
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, F-13385 Marseille, France
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
| | - Nicolas Lamblin
- Urgences et Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, F-59000, Lille, France
| | - François Roubille
- Cardiology Department, PhyMedExp, Université de Montpellier, INSERM, CNRS, INI-CRT, CHU de Montpellier, Montpellier, France
| | - Bruno Levy
- CHRU Nancy, Réanimation Médicale Brabois, Vandoeuvre-les Nancy, France
| | - Sebastien Champion
- Clinique de Parly 2, Ramsay Générale de Santé, 21 rue Moxouris, 78150 Le Chesnay, France
| | - Pascal Lim
- Service de Cardiologie, Univ Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France
- AP-HP, Hôpital Universitaire Henri-Mondor, F-94010 Créteil, France
| | - Francis Schneider
- Médecine Intensive-Réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, Centre-Université de Paris, Medical School, Paris, France
| | - Hadi Khachab
- Intensive Cardiac Care Unit, Department of Cardiology, CH d'Aix en Provence, Aix en Provence, France, Avenue des Tamaris 13616 Aix-en-Provence cedex 1, France
| | - Jeremy Bourenne
- Service de Réanimation des Urgences, Aix Marseille Université, CHU La Timone 2, Marseille, France
| | | | - Guillaume Schurtz
- Urgences et Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, F-59000, Lille, France
| | - Brahim Harbaoui
- Cardiology Department, Hôpital Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
- University of Lyon, CREATIS UMR5220; INSERM U1044; INSA-15 Lyon, France
| | - Gerald Vanzetto
- Department of Cardiology, Hôpital de Grenoble, 38700 La Tronche, France
| | - Charlotte Quentin
- Service de Reanimation Polyvalente, Centre Hospitalier Broussais St Malo, 1 rue de la Marne, 35400 St Malo, France
| | - Anais Curtiaud
- Faculté de Médecine, Université de Strasbourg (UNISTRA), Strasbourg university hospital, Nouvel Hôpital Civil, Medical intensive care unit, Strasbourg, France
| | - Jean-Emmanuel Kurtz
- Department of Medical Oncology, Strasbourg-Europe Cancer Institute (ICANS), Strasbourg, France
| | - Nicolas Combaret
- Department of Cardiology, CHU Clermont-Ferrand, CNRS, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Benjamin Marchandot
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Université de Strasbourg, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 67091 Strasbourg, France
| | - Benoit Lattuca
- Department of Cardiology, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Caroline Biendel
- Intensive Cardiac Care Unit, Rangueil University Hospital, 31059 Toulouse, France
- Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse, France
| | - Guillaume Leurent
- Department of Cardiology, CHU Rennes, Inserm, LTSI-UMR 1099, Univ Rennes 1, F-35000, Rennes, France
| | - Vincent Bataille
- Association pour la diffusion de la médecine de prévention (ADIMEP), Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - Edouard Gerbaud
- Intensive Cardiac Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, 5 Avenue de Magellan, 33604 Pessac, France
- Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, Hôpital Xavier Arnozan, Avenue du Haut Lévêque, 33600 Pessac, France
| | - Etienne Puymirat
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, 75015 Paris, France
- Université de Paris, 75006 Paris, France
| | - Eric Bonnefoy
- Intensive Cardiac Care Unit, Lyon Brom University Hospital, Lyon, France
| | - Nadia Aissaoui
- Médecine Intensive-Réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Clément Delmas
- Department of Cardiology, CHU Clermont-Ferrand, CNRS, Université Clermont Auvergne, Clermont-Ferrand, France
- Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse, France
- Recherche et Enseignement en Insuffisance Cardiaque Avancée Assistance et Transplantation (REICATRA), Institut Saint Jacques, CHU Toulouse, Toulouse, France
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12
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Merdji H, Bataille V, Curtiaud A, Bonello L, Roubille F, Levy B, Lim P, Schneider F, Khachab H, Dib JC, Seronde MF, Schurtz G, Harbaoui B, Vanzetto G, Marchand S, Gebhard CE, Henry P, Combaret N, Marchandot B, Lattuca B, Biendel C, Leurent G, Gerbaud E, Puymirat E, Bonnefoy E, Meziani F, Delmas C. Mottling as a prognosis marker in cardiogenic shock. Ann Intensive Care 2023; 13:80. [PMID: 37672139 PMCID: PMC10482815 DOI: 10.1186/s13613-023-01175-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/22/2023] [Indexed: 09/07/2023] Open
Abstract
AIMS Impact of skin mottling has been poorly studied in patients admitted for cardiogenic shock. This study aimed to address this issue and identify determinants of 30-day and 1-year mortality in a large cardiogenic shock cohort of all etiologies. METHODS AND RESULTS FRENSHOCK is a prospective multicenter observational registry conducted in French critical care units between April and October, 2016. Among the 772 enrolled patients (mean age 65.7 ± 14.9 years; 71.5% male), 660 had skin mottling assessed at admission (85.5%) with almost 39% of patients in cardiogenic shock presenting mottling. The need for invasive respiratory support was significantly higher in patients with mottling (50.2% vs. 30.1%, p < 0.001) and likewise for the need for renal replacement therapy (19.9% vs. 12.4%, p = 0.09). However, the need for mechanical circulatory support was similar in both groups. Patients with mottling at admission presented a higher length of stay (19 vs. 16 days, p = 0.033), a higher 30-day mortality rate (31% vs. 23.3%, p = 0.031), and also showed significantly higher mortality at 1-year (54% vs. 42%, p = 0.003). The subgroup of patients in whom mottling appeared during the first 24 h after admission had the worst prognosis at 30 days. CONCLUSION Skin mottling at admission in patients with cardiogenic shock was statistically associated with prolonged length of stay and poor outcomes. As a perfusion-targeted resuscitation parameter, mottling is a simple, clinical-based approach and may thus help to improve and guide immediate goal-directed therapy to improve cardiogenic shock patients' outcomes.
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Affiliation(s)
- Hamid Merdji
- Faculté de Médecine, Strasbourg University Hospital, Nouvel Hôpital Civil, Medical Intensive Care Unit, Université de Strasbourg (UNISTRA), Strasbourg, France
| | - Vincent Bataille
- Department of Cardiology, Toulouse Rangueil University Hospital, UMR 1295 INSERM, Toulouse, France
| | - Anais Curtiaud
- Faculté de Médecine, Strasbourg University Hospital, Nouvel Hôpital Civil, Medical Intensive Care Unit, Université de Strasbourg (UNISTRA), Strasbourg, France
| | - Laurent Bonello
- Aix-Marseille Université, 13385, Marseille, France
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, 13385, Marseille, France
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
| | - François Roubille
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Cardiology Department, INI-CRT, CHU de Montpellier, Montpellier, France
| | - Bruno Levy
- CHRU Nancy, Réanimation Médicale Brabois, Vandoeuvre-les Nancy, France
| | - Pascal Lim
- Univ Paris Est Créteil, INSERM, IMRB, 94010, Créteil, France
- AP-HP, Hôpital Universitaire Henri-Mondor, Service de Cardiologie, 94010, Créteil, France
| | - Francis Schneider
- Médecine Intensive-Réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Hadi Khachab
- Intensive Cardiac Care Unit, Department of Cardiology, CH d'Aix en Provence, Aix-en-Provence, France
- Avenue des Tamaris, 13616, Aix-en-Provence cedex 1, France
| | | | | | - Guillaume Schurtz
- Urgences et Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, 59000, Lille, France
| | - Brahim Harbaoui
- Cardiology Department, Hôpital Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
- University of Lyon, CREATIS UMR5220, INSERM U1044, INSA-15, Lyon, France
| | - Gerald Vanzetto
- Department of Cardiology, Hôpital de Grenoble, 38700, La Tronche, France
| | | | - Caroline Eva Gebhard
- Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Patrick Henry
- Department of Cardiology, AP-HP, Lariboisière University Hospital, Paris, 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
| | - Caroline Biendel
- Intensive Cardiac Care Unit, Rangueil University Hospital, 1 Avenue Jean Poulhes, 31059, Toulouse Cedex, France
- Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse, France
| | - Guillaume Leurent
- Department of Cardiology, CHU Rennes, Inserm, LTSI-UMR 1099, Univ Rennes 1, 35000, Rennes, France
| | - Edouard Gerbaud
- Intensive Cardiac Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, 5 Avenue de Magellan, 33604, Pessac, France
- Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, Hôpital Xavier Arnozan, Avenue du Haut Lévêque, 33600, Pessac, France
| | - Etienne Puymirat
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, 75015, Paris, France
- Université de Paris, 75006, Paris, France
| | - Eric Bonnefoy
- Intensive Cardiac Care Unit, Lyon Bron University Hospital, Lyon, France
| | - Ferhat Meziani
- Faculté de Médecine, Strasbourg University Hospital, Nouvel Hôpital Civil, Medical Intensive Care Unit, Université de Strasbourg (UNISTRA), Strasbourg, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Rangueil University Hospital, 1 Avenue Jean Poulhes, 31059, Toulouse Cedex, France.
- Recherche et Enseignement en Insuffisance Cardiaque Avancée Assistance et Transplantation (REICATRA), Institut Saint Jacques, CHU Toulouse, Toulouse, France.
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13
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Cherbi M, Bonnefoy E, Lamblin N, Gerbaud E, Bonello L, Roubille F, Levy B, Champion S, Lim P, Schneider F, Elbaz M, Khachab H, Bourenne J, Seronde MF, Schurtz G, Harbaoui B, Vanzetto G, Combaret N, Labbe V, Marchandot B, Lattuca B, Biendel-Picquet C, Leurent G, Puymirat E, Maury P, Delmas C. One-year outcomes in cardiogenic shock triggered by supraventricular tachycardia: an analysis of the FRENSHOCK multicenter prospective registry. Front Cardiovasc Med 2023; 10:1167738. [PMID: 37731529 PMCID: PMC10507701 DOI: 10.3389/fcvm.2023.1167738] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 08/11/2023] [Indexed: 09/22/2023] Open
Abstract
Background Cardiogenic shock (CS) is the most severe form of heart failure (HF), resulting in high early and long-term mortality. Characteristics of CS secondary to supraventricular tachycardia (SVT) are poorly reported. Based on a large registry of unselected CS, we aimed to compare 1-year outcomes between SVT-triggered and non-SVT-triggered CS. Methods FRENSHOCK is a French prospective registry including 772 CS patients from 49 centers. For each patient, the investigator could report 1-3 CS triggers from a pre-established list (ischemic, mechanical complications, ventricular/supraventricular arrhythmia, bradycardia, iatrogenesis, infection, non-compliance, and others). In this study, 1-year outcomes [rehospitalizations, mortality, heart transplantation (HTx), ventricular assist devices (VAD)] were analyzed and adjusted for independent predictive factors. Results Among 769 CS patients included, 100 were SVT-triggered (13%), of which 65 had SVT as an exclusive trigger (8.5%). SVT-triggered CS patients exhibited a higher proportion of male individuals with a more frequent history of cardiomyopathy or chronic kidney disease and more profound CS (biventricular failure and multiorgan failure). At 1 year, there was no difference in all-cause mortality (43% vs. 45.3%, adjusted HR 0.9 (95% CI 0.59-1.39), p = 0.64), need for HTx or VAD [10% vs. 10%, aOR 0.88 (0.41-1.88), p = 0.74], or rehospitalizations [49.4% vs. 44.4%, aOR 1.24 (0.78-1.98), p = 0.36]. Patients with SVT as an exclusive trigger presented more 1-year rehospitalizations [52.8% vs. 43.3%, aOR 3.74 (1.05-10.5), p = 0.01]. Conclusion SVT is a frequent trigger of CS alone or in association in more than 10% of miscellaneous CS cases. Although SVT-triggered CS patients were more comorbid with more pre-existing cardiomyopathies and HF incidences, they presented similar rates of mortality, HTx, and VAD at 1 year, arguing for a better overall prognosis. Clinical Trial Registration https://clinicaltrials.gov, identifier: NCT02703038.
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Affiliation(s)
- Miloud Cherbi
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France
- Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse, France
| | - 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, Lille, France
| | - Edouard Gerbaud
- Intensive Cardiac Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, Pessac, France
- Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, Hôpital Xavier Arnozan, Pessac, France
| | - Laurent Bonello
- Cardiology Department, Hopital Nord, AP-HM, Aix-Marseille Université, Marseille, France
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
| | - François Roubille
- Cardiology Department, PhyMedExp, Université de Montpellier, INSERM, CNRS, INI-CRT, CHU de Montpellier, Montpellier, France
| | - Bruno Levy
- Réanimation Médicale Brabois, CHRU Nancy, Vandoeuvre-les Nancy, France
| | - Sebastien Champion
- Anesthesiology and Intensive Care Department, Clinique de Parly 2, Ramsay Générale de Santé, Le Chesnay, France
| | - Pascal Lim
- Univ Paris Est Créteil, INSERM, IMRB, Créteil, France
- Cardiology Department, AP-HP, Hôpital Universitaire Henri-Mondor, Service de Cardiologie, Créteil, France
| | - Francis Schneider
- Médecine Intensive-Réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Meyer Elbaz
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France
- Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse, France
| | - Hadi Khachab
- Intensive Cardiac Care Unit, Cardiology Department, CH d'Aix-en-Provence, Aix-en-Provence, France
| | - Jeremy Bourenne
- Service de Réanimation des Urgences, AP-HM, Hôpital de La Timone, Marseille, France
| | | | - Guillaume Schurtz
- Urgences et Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, Lille, France
| | - Brahim Harbaoui
- Cardiology Department, Hôpital Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
- University of Lyon, CREATIS, UMR5220, INSERM U1044, INSA-15, Lyon, France
| | - Gerald Vanzetto
- Department of Cardiology, Hôpital de Grenoble, La Tronche, France
| | - Nicolas Combaret
- Department of Cardiology, CHU Clermont-Ferrand, CNRS, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Vincent Labbe
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Tenon,Paris, France
| | - Benjamin Marchandot
- Université de Strasbourg, Pôle D'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Benoit Lattuca
- Department of Cardiology, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Caroline Biendel-Picquet
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France
- Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse, France
| | - Guillaume Leurent
- Department of Cardiology, CHU Rennes, Inserm, LTSI—UMR 1099, Univ Rennes 1, Rennes, France
| | - Etienne Puymirat
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Paris, France
- Université de Paris, Paris, France
| | - Philippe Maury
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France
- Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France
- Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse, France
- REICATRA, Institut Saint Jacques, CHU de Toulouse, ToulouseFrance
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14
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Karsenty C, Touafchia A, Ladouceur M, Roubille F, Bonnefoy E, Bonello L, Leurent G, Levy B, Champion S, Lim P, Schneider F, Cariou A, Khachab H, Bourenne J, Seronde MF, Harbaoui B, Vanzetto G, Quentin C, Delabranche X, Combaret N, Morel O, Lattuca B, Leborgne L, Fillippi E, Gerbaud E, Brusq C, Bongard V, Lamblin N, Puymirat E, Delmas C. Cardiogenic shock in adults with congenital heart disease: Insights from the FRENSHOCK registry. Arch Cardiovasc Dis 2023; 116:390-396. [PMID: 37598062 DOI: 10.1016/j.acvd.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/13/2023] [Accepted: 06/19/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Data on cardiogenic shock in adults with congenital heart disease (ACHD) are scarce. AIM We sought to describe cardiogenic shock in ACHD patients in a nationwide cardiogenic shock registry. METHODS From the multicentric FRENSHOCK registry (772 patients with cardiogenic shock from 49 French centres between April and October 2016), ACHD patients were compared with adults without congenital heart disease (non-ACHD). The primary outcome was defined by all-cause mortality, chronic ventricular assist device or heart transplantation at 1year. RESULTS Out of the 772 patients, seven (0.9%) were ACHD, who were younger (median age: 56 vs. 67years), had fewer cardiovascular risk factors, such as hypertension (14.3% vs. 47.5%) and diabetes (14.3% vs. 28.3%), and no previous ischaemic cardiopathy (0 vs. 61.5%). Right heart catheterization (57.1% vs. 15.4%), pacemakers (28.6% vs. 4.6%) and implantable cardioverter-defibrillators (28.6% vs. 4.8%) were indicated more frequently in the management of ACHD patients compared with non-ACHD patients, whereas temporary mechanical circulatory support (0 vs. 18.7%) and invasive mechanical ventilation (14.3% vs. 38.1%) were less likely to be used in ACHD patients. At 1year, the primary outcome occurred in 85.7% (95% confidence interval: 42.1-99.6) ACHD patients and 52.3% (95% confidence interval: 48.7-55.9) non-ACHD patients. Although 1-year mortality was not significantly different between ACHD patients (42.9%) and non-ACHD patients (45.4%), ventricular assist devices and heart transplantation tended to be more frequent in the ACHD group. CONCLUSIONS Cardiogenic shock in ACHD patients is rare, accounting for only 0.9% of an unselected cardiogenic shock population. Despite being younger and having fewer co-morbidities, the prognosis of ACHD patients with cardiogenic shock remains severe, and is similar to that of other patients.
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Affiliation(s)
- Clément Karsenty
- Paediatric and Adult Congenital Cardiology Unit, CHU de Toulouse, 31300 Toulouse, France; Institut Des Maladies Métaboliques et Cardiovasculaires (I2MC), Inserm U1048, 31432 Toulouse, France.
| | - Anthony Touafchia
- Intensive Cardiac Care Unit, Cardiology Department, Rangueil University Hospital, 31400 Toulouse, France
| | - Magalie Ladouceur
- Department of Cardiology, Hôpital Européen Georges-Pompidou, AP-HP, 75015 Paris, France; Université de Paris, 75006 Paris, France
| | - François Roubille
- PhyMedExp, Université de Montpellier, Inserm, CNRS, 34295 Montpellier, France; Cardiology Department, CHU de Montpellier, 34295 Montpellier, France
| | - Eric Bonnefoy
- Intensive Cardiac Care Unit, Lyon University Hospital, 69622 Bron, France
| | - Laurent Bonello
- Aix-Marseille University, 13385 Marseille, France; Intensive Care Unit, Department of Cardiology, Hôpital Nord, AP-HM, 13385 Marseille, France; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13385 Marseille, France
| | - Guillaume Leurent
- Department of Cardiology, CHU de Rennes, 35000 Rennes, France; LTSI-UMR 1099, Inserm, University of Rennes 1, 35000 Rennes, France
| | - Bruno Levy
- Réanimation Médicale Brabois, CHRU Nancy, 54511 Vandœuvre-les Nancy, France
| | | | - Pascal Lim
- Université Paris-Est Créteil, Inserm, IMRB, 94010 Créteil, France; Service de Cardiologie, Hôpital Universitaire Henri-Mondor, AP-HP, 94010 Créteil, France
| | - Francis Schneider
- Médecine Intensive-Réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 67200 Strasbourg, France
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin Hospital, AP-HP, 75014 Paris, France; Medical School, Centre-Université de Paris, 75014 Paris, France
| | - Hadi Khachab
- Intensive Cardiac Care Unit, Department of Cardiology, CH d'Aix-en-Provence, 13616 Aix-en-Provence, France
| | - Jeremy Bourenne
- Service de Réanimation des Urgences, CHU de la Timone 2, Aix-Marseille Université, 13385 Marseille, France
| | | | - Brahim Harbaoui
- Cardiology Department, Hôpital Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, 69004 Lyon, France; University of Lyon, CREATIS UMR 5220, Inserm U1044, INSA-15, 69100 Lyon, France
| | - Gérald Vanzetto
- Department of Cardiology, Hôpital de Grenoble, 38700 La Tronche, France
| | | | - Xavier Delabranche
- Réanimation Chirurgicale Polyvalente, Pôle Anesthésie-Réanimation Chirurgicale-Médecine Péri-opératoire, Les Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil 1, 67091 Strasbourg, France
| | - Nicolas Combaret
- Department of Cardiology, CHU de Clermont-Ferrand, CNRS, Université Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - Olivier Morel
- Pôle d'Activité Médico-Chirurgicale Cardiovasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, 67091 Strasbourg, France
| | - Benoit Lattuca
- Department of Cardiology, Nîmes University Hospital, Montpellier University, 30900 Nîmes, France
| | | | | | - Edouard Gerbaud
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut-Lévêque, 33604 Pessac, France; Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, Hôpital Xavier-Arnozan, 33600 Pessac, France
| | - Clara Brusq
- Unité de Soutien Méthodologique à la Recherche (USMR), Service d'Épidémiologie Clinique et Santé Publique, CHU de Toulouse, 31300 Toulouse, France
| | - Vanina Bongard
- Unité de Soutien Méthodologique à la Recherche (USMR), Service d'Épidémiologie Clinique et Santé Publique, CHU de Toulouse, 31300 Toulouse, France
| | - Nicolas Lamblin
- Urgences et Soins Intensifs de Cardiologie, CHU de Lille, Inserm U1167, University of Lille, 59000 Lille, France
| | - Etienne Puymirat
- Department of Cardiology, Hôpital Européen Georges-Pompidou, AP-HP, 75015 Paris, France; Université de Paris, 75006 Paris, France
| | - Clément Delmas
- Paediatric and Adult Congenital Cardiology Unit, CHU de Toulouse, 31300 Toulouse, France; Institut Des Maladies Métaboliques et Cardiovasculaires (I2MC), Inserm U1048, 31432 Toulouse, France; REICATRA, Institut Saint-Jacques, CHU de Toulouse, 31059 Toulouse, France
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15
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Delmas C, Bonello L, Roubille F. For the best management, please ask for assistance! Eur J Heart Fail 2023; 25:573-575. [PMID: 36924144 DOI: 10.1002/ejhf.2826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/06/2023] [Indexed: 03/18/2023] Open
Affiliation(s)
- Clément Delmas
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France.,REICATRA, Institut Saint Jacques, CHU de Toulouse, Toulouse, France
| | - Laurent Bonello
- Aix-Marseille Université, Marseille, France.,Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France.,Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
| | - François Roubille
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Cardiology Department, INI-CRT, CHU de Montpellier, Montpellier, France
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Cherbi M, Roubille F, Lamblin N, Bonello L, Leurent G, Levy B, Elbaz M, Champion S, Lim P, Schneider F, Cariou A, Khachab H, Bourenne J, Seronde MF, Schurtz G, Harbaoui B, Vanzetto G, Quentin C, Delabranche X, Aissaoui N, Combaret N, Tomasevic D, Marchandot B, Lattuca B, Henry P, Gerbaud E, Bonnefoy E, Puymirat E, Maury P, Delmas C. One-year outcomes in cardiogenic shock triggered by ventricular arrhythmia: An analysis of the FRENSHOCK multicenter prospective registry. Front Cardiovasc Med 2023; 10:1092904. [PMID: 36776263 PMCID: PMC9909601 DOI: 10.3389/fcvm.2023.1092904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/09/2023] [Indexed: 01/28/2023] Open
Abstract
Background Cardiogenic shock (CS) is a life-threatening condition carrying poor prognosis, potentially triggered by ventricular arrhythmia (VA). Whether the occurrence of VA as trigger of CS worsens the prognosis compared to non-VA triggers remains unclear. The aim of this study was to evaluate 1-year outcomes [mortality, heart transplantation, ventricular assist devices (VAD)] between VA-triggered and non-VA-triggered CS. Methods FRENSHOCK is a prospective multicenter registry including 772 CS patients from 49 centers. One to three triggers can be identified in the registry (ischemic, mechanical complications, ventricular/supraventricular arrhythmia, bradycardia, iatrogenesis, infection, non-compliance). Baseline characteristics, management and 1-year outcomes were analyzed according to the VA-trigger in the CS population. Results Within 769 CS patients included, 94 were VA-triggered (12.2%) and were compared to others. At 1 year, although there was no mortality difference [42.6 vs. 45.3%, HR 0.94 (0.67-1.30), p = 0.7], VA-triggered CS resulted in more heart transplantations and VAD (17 vs. 9%, p = 0.02). Into VA-triggered CS group, though there was no 1-year mortality difference between ischemic and non-ischemic cardiomyopathies [42.5 vs. 42.6%, HR 0.97 (0.52-1.81), p = 0.92], non-ischemic cardiomyopathy led to more heart transplantations and VAD (25.9 vs. 5%, p = 0.02). Conclusion VA-triggered CS did not show higher mortality compared to other triggers but resulted in more heart transplantation and VAD at 1 year, especially in non-ischemic cardiomyopathy, suggesting the need for earlier evaluation by advanced heart failure specialized team for a possible indication of mechanical circulatory support or heart transplantation. Clinical trial registration https://clinicaltrials.gov, identifier NCT02703038.
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Affiliation(s)
- Miloud Cherbi
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France,Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse, France
| | - François Roubille
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Cardiology Department, INI-CRT, CHU de Montpellier, Montpellier, France
| | - Nicolas Lamblin
- Department of Cardiology, Urgences et Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, Lille, France
| | - Laurent Bonello
- Aix-Marseille Université, Marseille, France,Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France,Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
| | - Guillaume Leurent
- Department of Cardiology, CHU Rennes, Inserm, LTSI-UMR 1099, Univ Rennes 1, Rennes, France
| | - Bruno Levy
- CHRU Nancy, Réanimation Médicale Brabois, Nancy, France
| | - Meyer Elbaz
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France,Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse, France
| | | | - Pascal Lim
- Université Paris Est-Créteil, INSERM, IMRB, Créteil, France,AP-HP, Hôpital Universitaire Henri-Mondor, Service de Cardiologie, Créteil, France
| | - Francis Schneider
- Médecine Intensive-Réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Centre–Université de Paris, Medical School, Paris, France
| | - Hadi Khachab
- Intensive Cardiac Care Unit, Department of Cardiology, CH d’Aix-en-Provence, Aix-en-Provence, France
| | - Jeremy Bourenne
- Aix-Marseille Université, Service de Réanimation des Urgences, CHU La Timone 2, Marseille, France
| | | | - Guillaume Schurtz
- Department of Cardiology, Urgences et Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, Lille, France
| | - Brahim Harbaoui
- Cardiology Department, Hôpital Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France,Department of Cardiology, University of Lyon, CREATIS UMR5220, INSERM U1044, INSA-15, Lyon, France
| | - Gerald Vanzetto
- Department of Cardiology, Hôpital de Grenoble, Grenoble, France
| | - Charlotte Quentin
- Service de Réanimation Polyvalente, Centre Hospitalier Broussais, 1 Rue de la Marne, Saint-Malo, France
| | - Xavier Delabranche
- Réanimation Chirurgicale Polyvalente, Pôle Anesthésie–Réanimation Chirurgicale–Médecine Péri-opératoire, Les Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil 1, Porte de l’Hôpital, Strasbourg, France
| | - Nadia Aissaoui
- Intensive Cardiac Care Unit, Department of Cardiology, CH d’Aix-en-Provence, Aix-en-Provence, France
| | - Nicolas Combaret
- Department of Cardiology, CHU Clermont-Ferrand, CNRS, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Danka Tomasevic
- Intensive Cardiac Care Unit, Lyon Brom University Hospital, Lyon, France
| | - Benjamin Marchandot
- Université de Strasbourg, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Benoit Lattuca
- Department of Cardiology, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Patrick Henry
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Lariboisière, Department of Cardiology, Paris, France
| | - Edouard Gerbaud
- Intensive Cardiac Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, Pessac, France,Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, Hôpital Xavier Arnozan, Pessac, France
| | - Eric Bonnefoy
- Intensive Cardiac Care Unit, Lyon Brom University Hospital, Lyon, France
| | - Etienne Puymirat
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology, Paris, France,Université de Paris, Paris, France
| | - Philippe Maury
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France,Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France,Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse, France,REICATRA, Institut Saint Jacques, CHU de Toulouse, Toulouse, France,*Correspondence: Clément Delmas, ,
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Cherbi M, Maury P, Schneider F, Bonnefoy-Cudraz E, Roubille F, Puymirat E, Bonello L, Leurent G, Levy B, Lamblin N, Bourenne J, Quentin C, Delabranche X, Combaret N, Marchandot B, Lattuca B, Leborgne L, Fillippi E, Gerbaud E, Delmas C. 1-year outcomes in cardiogenic shock triggered by ventricular tachycardia: An analysis of the FRENSHOCK nationwide multicenter prospective registry. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.303] [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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Al-Rashid F, Van Mieghem NM, Bonello L, Oreglia J, Romagnoli E. Standardized pre-procedural clinical workup for protected percutaneous coronary intervention. Eur Heart J Suppl 2022; 24:J11-J16. [PMCID: PMC9730791 DOI: 10.1093/eurheartjsupp/suac061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Abstract
In addition to appropriate patient screening, pre-procedural preparation is essential to optimize both technical success and patient outcome for protected percutaneous coronary intervention (PCI). A critical component of optimization is the identification and preparation of a suitable femoral access site. Here, we describe several options for both imaging and image-guided access to optimize the approach.
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Affiliation(s)
- Fadi Al-Rashid
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, Medical Faculty, University Hospital Essen , Essen , Germany
| | - Nicolas M Van Mieghem
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter , Rotterdam , The Netherlands
| | - Laurent Bonello
- Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University , Marseille , France
| | - Jacopo Oreglia
- Department of Cardiology, ASST Grande Ospedale Metropolitano Niguarda , Milan , Italy
| | - Enrico Romagnoli
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore , Rome , Italy
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Schurtz G, Delmas C, Fenouillet M, Roubille F, Puymirat E, Bonello L, Leurent G, Verdier B, Levy B, Ternacle J, Harbaoui B, Vanzetto G, Combaret N, Lattuca B, Bruel C, Bourenne J, Labbé V, Henry P, Bonnefoy-Cudraz É, Lamblin N, Lemesle G. Impact of Pre-Existing History of Heart Failure on Patient Profile, Therapeutic Management, and Prognosis in Cardiogenic Shock: Insights from the FRENSHOCK Registry. Life (Basel) 2022; 12:life12111844. [PMID: 36430979 PMCID: PMC9698880 DOI: 10.3390/life12111844] [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: 09/30/2022] [Revised: 10/25/2022] [Accepted: 11/09/2022] [Indexed: 11/13/2022] Open
Abstract
There is a large heterogeneity among patients presenting with cardiogenic shock (CS). It is crucial to better apprehend this heterogeneity in order to adapt treatments and improve prognoses in these severe patients. Notably, the presence (or absence) of a pre-existing history of chronic heart failure (CHF) at time of CS onset may be a significant part of this heterogeneity, and data focusing on this aspect are lacking. We aimed to compare CS patients with new-onset HF to those with worsening CHF in the multicenter FRENSHOCK registry. Altogether, 772 CS patients were prospectively included: 433 with a previous history of CHF and 339 without. Worsening CHF patients were older (68 +/− 13.4 vs. 62.7 +/− 16.2, p < 0.001) and had a greater burden of extra-cardiac comorbidities. At admission, acute myocardial infarction was predominantly observed in the new-onset HF group (49.9% vs. 25.6%, p < 0.001). When focusing on hemodynamic parameters, worsening CHF patients showed more congestion and higher ventricular filling pressures. Worsening CHF patients experienced higher in-hospital all-cause mortality (31.3% vs. 24.2%, p = 0.029). Our results emphasize the great heterogeneity of the patients presenting with CS. Worsening CHF patients had higher risk profiles, and this translated to a 30% increase in in-hospital all-cause mortality. The heterogeneity of this population prompts us to better determine the phenotype of CS patients to adapt their management.
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Affiliation(s)
- Guillaume Schurtz
- USIC et Centre Hémodynamique, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, 59000 Lille, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Rangueil University Hospital/Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), 1 Avenue Jean Poulhes, 31059 Toulouse, France
| | - Margaux Fenouillet
- USIC et Centre Hémodynamique, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, 59000 Lille, France
| | - François Roubille
- Cardiology Department, INI-CRT, CHU de Montpellier, PhyMedExp, Université de Montpellier, INSERM, CNRS, 34000 Montpellier, France
| | - Etienne Puymirat
- Department of Cardiology, Assistance Publique des Hôpitaux de Paris, 75000 Paris, France
| | - Laurent Bonello
- Cardiology Department, APHM, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Centre for CardioVascular and Nutrition Research (C2VN), Aix-Marseille University, INSERM 1263, INRA 1260, 13000 Marseille, France
| | - Guillaume Leurent
- Department of Cardiology, CHU Rennes, Inserm, LTSI-UMR 1099, University Rennes 1, 35000 Rennes, France
| | - Basile Verdier
- USIC et Centre Hémodynamique, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, 59000 Lille, France
| | - Bruno Levy
- Service de Réanimation Médicale Brabois, CHRU Nancy, Pôle Cardio-Médico-Chirurgical, INSERM U1116, Faculté de Médecine, Vandoeuvre-les-Nancy, Université de Lorraine, 54000 Nancy, France
| | - Julien Ternacle
- Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, 33318 Pessac, France
| | - Brahim Harbaoui
- Cardiology Department, Hôpital Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, 69000 Lyon, France
- CREATIS UMR5220, INSERM U1044, INSA-15, University of Lyon, 69000 Lyon, France
| | - Gerald Vanzetto
- Department of Cardiology, Hôpital de Grenoble, 38000 Grenoble, France
| | - Nicolas Combaret
- Department of Cardiology, CHU Clermont-Ferrand, CNRS, Université Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - Benoît Lattuca
- Department of Cardiology, Nîmes University Hospital, Montpellier University, 30000 Nîmes, France
| | - Cedric Bruel
- Medical and Surgical Intensive Care Unit, Groupe Hospitalier Paris Saint Joseph, 75000 Paris, France
| | - Jeremy Bourenne
- Service de Réanimation des Urgences, CHU La Timone 2, Aix Marseille Université, 13000 Marseille, France
| | - Vincent Labbé
- Medical Intensive Care Unit, AP-HP, Tenon University Hospital, 75000 Paris, France
| | - Patrick Henry
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, INSERM U942, University of Paris, 75000 Paris, France
| | - Éric Bonnefoy-Cudraz
- Intensive Cardiological Care Division, Hospices Civils de Lyon-Hôpital Cardiovasculaire et Pulmonaire, 69000 Lyon, France
| | - Nicolas Lamblin
- Cardiology Department, Heart and Lung Institute, University Hospital of Lille, 59000 Lille, France
- INSERM U1167, Institut Pasteur of Lille, 59000 Lille, France
| | - Gilles Lemesle
- USIC et Centre Hémodynamique, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, 59000 Lille, France
- Heart and Lung Institute, University Hospital of Lille, 59000 Lille, France
- Inserm U1011, Institut Pasteur of Lille, 59000 Lille, France
- FACT (French Alliance for Cardiovascular Trials), 75000 Paris, France
- Correspondence: ; Tel.: +33-320445330; Fax: +33-320444898
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Le Bras A, Puymirat E, Rabetrano H, Cayla G, Simon T, Steg G, Montalescot G, Varenne O, Bonello L, Coste P, Delarche N, Georges JL, Chassaing S, Letocart V, Chatellier G, Danchin N, Durand-Zaleski I. Economic evaluation of fractional flow reserve-guided versus angiography-guided multivessel revascularisation in ST-segment elevation myocardial infarction patients in the FLOWER-MI randomised trial. EUROINTERVENTION 2022; 18:235-241. [PMID: 35191838 PMCID: PMC9980404 DOI: 10.4244/eij-d-21-00867] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND In patients with ST-segment elevation myocardial infarction (STEMI) who have multivessel disease, the FLOWER-MI trial found no significant clinical benefit to fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) compared to angiography-guided PCI. AIMS Our aim was to estimate the cost-effectiveness and cost-utility of FFR-guided PCI, the secondary endpoint of the FLOWER-MI trial. METHODS Costs, major adverse cardiovascular events (composite of all-cause death, non-fatal myocardial infarction [MI], and unplanned hospitalisation leading to urgent revascularisation), and quality-adjusted life years were calculated in both groups. The incremental cost-effectiveness and cost-utility ratios were estimated. Uncertainty was explored by probabilistic bootstrapping. The analysis was conducted from the perspective of the health care provider with a time horizon of one year. RESULTS At one year, the average cost per patient was 7,560€ (±2,218) in the FFR-guided group and 7,089€ (±1,991) in the angiography-guided group (p-value<0.01). The point estimates for the incremental cost-effectiveness and cost-utility ratios found that the angiography-guided strategy was cost saving and improved outcomes, with a probabilistic sensitivity analysis confirming dominance. CONCLUSIONS The FFR-guided strategy at one year is unlikely to be cost effective compared to the angiography-guided strategy on both clinical and quality of life outcomes.
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Affiliation(s)
- Alicia Le Bras
- Unité de Recherche Clinique en Économie de la Santé, Hôpital Hôtel Dieu AP-HP, 1 Parvis Notre-Dame, 75004 Paris, France
| | - Etienne Puymirat
- Department of Cardiology, Hôpital Européen Georges Pompidou AP-HP, Paris, France,Université de Paris, Paris, France,French Alliance for Cardiovascular Trials (FACT), Paris, France
| | - Hasina Rabetrano
- Clinical Research Unit Eco Ile de France, Hôpital Hôtel Dieu AP-HP, Paris, France
| | | | - Tabassome Simon
- French Alliance for Cardiovascular Trials (FACT), Paris, France,Department of Clinical Pharmacology, Hôpital Saint Antoine AP-HP, Paris, France,Université Pierre et Marie Curie (UPMC), Paris, France
| | - Gabriel Steg
- French Alliance for Cardiovascular Trials (FACT), Paris, France,Université Paris-Diderot, Sorbonne Paris Cité, Paris, France,Hôpital Bichat – Claude Bernard AP-HP, Paris,France
| | - Gilles Montalescot
- ACTION Groupe, Institut de Cardiologie (AP-HP) and INSERM UMRS 1166, Hôpital Pitié-Salpêtrière, Paris, France
| | - Olivier Varenne
- Université de Paris, Paris, France,Department of Cardiology, Hôpital Cochin AP-HP, Paris, France
| | - Laurent Bonello
- Mediterranean Association for research and studies in cardiology (MARS CARDIO) and Centre for cardiovascular and nutrition research, INSERM 1263, INRA 1260, Marseille, France,Cardiology Department, Hôpital Nord, Marseille, France
| | - Pierre Coste
- Intensive Cardiology Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut-Lévêque, Pessac, France
| | - Nicolas Delarche
- Department of Cardiology, Centre Hospitalier de Pau, Pau, France
| | - Jean-Louis Georges
- Cardiology Department, Centre Hospitalier de Versailles, Le Chesnay-Rocquencourt, France
| | | | - Vincent Letocart
- Department of Cardiology, Thorax Institute, Nantes University Hospital, Nantes, France
| | - Gilles Chatellier
- Clinical Research Unit and CIC 1418 INSERM, Hôpital Européen Georges Pompidou AP-HP, Paris, France
| | - Nicolas Danchin
- Department of Cardiology, Hôpital Européen Georges Pompidou AP-HP, Paris, France,Université de Paris, Paris, France,French Alliance for Cardiovascular Trials (FACT), Paris, France
| | - Isabelle Durand-Zaleski
- Clinical Research Unit Eco Ile de France, Hôpital Hôtel Dieu AP-HP, Paris, France,Université de Paris Est Creteil (UPEC), Créteil, France
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Paul P, Picard C, Lyonnet L, Resseguier N, Hubert L, Arnaud L, Di Cristofaro J, Laine M, Paganelli F, Dignat-George F, Frère C, Sabatier F, Guieu R, Bonello L. FCGR2A-HH Gene Variants Encoding the Fc Gamma Receptor for the C-Reactive Protein Are Associated with Enhanced Monocyte CD32 Expression and Cardiovascular Events’ Recurrence after Primary Acute Coronary Syndrome. Biomedicines 2022; 10:biomedicines10020495. [PMID: 35203703 PMCID: PMC8962261 DOI: 10.3390/biomedicines10020495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/12/2022] [Accepted: 02/16/2022] [Indexed: 01/08/2023] Open
Abstract
Fcγ receptors (FcγRs) interact with the C-reactive protein (CRP) and mediate activation of inflammation-related pathogenic mechanisms affecting cardiovascular health. Our study evaluated whether FcγRIIA and FcγRIIIA profiles are associated with the recurrence of adverse cardiovascular events during the first year after a primary acute coronary syndrome (ACS). The primary endpoint was the recurrence of cardiovascular events (RCE), identified as a composite outcome comprising acute heart failure (AHF) and major adverse cardiovascular events (MACE). We obtained blood samples of 145 ACS patients to measure hsCRP circulating levels, to identify FcγRIIA-131RH rs1801274 and FcγRIIIA-158FV rs396991 polymorphisms, to analyze circulating monocytes and NK cell subsets expressing CD16 and CD32, and to detect serum-mediated FCGR2A-HH activation by luciferase reporter assays. The hsCRP, CD32-expression, and Fc-R mediated activation levels were similar in all patients regardless of their MACE risk. In contrast, the hsCRP levels and the proportion of CD14+ circulating monocytes expressing the CD32 receptor for CRP were significantly higher in the patients who developed AHF. The FCGR2A rs1801274 HH genotype was significantly more common in patients who developed RCE and MACE than in RCE-free patients and associated with an enhanced percentage of circulating CD32+CD14+ monocytes. The FCGR2A-HH genotype was identified as an independent predictor of subsequent RCE (OR, 2.7; p = 0.048; CI, 1.01–7.44) by multivariate analysis. These findings bring preliminary evidence that host FCGR2A genetic variants can influence monocyte CD32 receptor expression and may contribute to the fine-tuning of CD32-driven chronic activating signals that affect the risk of developing RCEs following primary ACS events.
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Affiliation(s)
- Pascale Paul
- INSERM 1263, Aix Marseille Université, INRAE, 13005 Marseille, France; (F.D.-G.); (F.S.); (R.G.); (L.B.)
- Department of Hematology, Hopital de la Conception, Assistance Publique-Hôpitaux Marseille, 13005 Marseille, France; (L.L.); (L.A.)
- INSERM UMR_1090, Aix Marseille Université, TAGC Theories and Approaches of Genomic Complexity, Institut MarMaRa, Parc Scientifique de Luminy Case 928, 163 Avenue de Luminy, CEDEX 09, 13288 Marseille, France
- Correspondence:
| | - Christophe Picard
- Biologie des Groupes Sanguins, Établissement Français du Sang, UMR 7268 ADÉS EFS/CNRS, Aix-Marseille Université, 13005 Marseille, France; (C.P.); (L.H.); (J.D.C.)
| | - Luc Lyonnet
- Department of Hematology, Hopital de la Conception, Assistance Publique-Hôpitaux Marseille, 13005 Marseille, France; (L.L.); (L.A.)
| | - Noémie Resseguier
- Support Unit for Clinical Research and Economic Evaluation, EA3279, CEReSS-Health Service Research and Quality of Life Center, Assistance Publique Hôpitaux de Marseille, 13005 Marseille, France;
| | - Lucas Hubert
- Biologie des Groupes Sanguins, Établissement Français du Sang, UMR 7268 ADÉS EFS/CNRS, Aix-Marseille Université, 13005 Marseille, France; (C.P.); (L.H.); (J.D.C.)
| | - Laurent Arnaud
- Department of Hematology, Hopital de la Conception, Assistance Publique-Hôpitaux Marseille, 13005 Marseille, France; (L.L.); (L.A.)
| | - Julie Di Cristofaro
- Biologie des Groupes Sanguins, Établissement Français du Sang, UMR 7268 ADÉS EFS/CNRS, Aix-Marseille Université, 13005 Marseille, France; (C.P.); (L.H.); (J.D.C.)
| | - Marc Laine
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France; (M.L.); (F.P.)
- Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, 13015 Marseille, France
| | - Franck Paganelli
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France; (M.L.); (F.P.)
- Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, 13015 Marseille, France
| | - Françoise Dignat-George
- INSERM 1263, Aix Marseille Université, INRAE, 13005 Marseille, France; (F.D.-G.); (F.S.); (R.G.); (L.B.)
- Department of Hematology, Hopital de la Conception, Assistance Publique-Hôpitaux Marseille, 13005 Marseille, France; (L.L.); (L.A.)
| | - Corinne Frère
- Institute of Cardiometabolism and Nutrition, GRC 27 GRECO, Sorbonne University, INSERM UMRS_1166, 75013 Paris, France;
| | - Florence Sabatier
- INSERM 1263, Aix Marseille Université, INRAE, 13005 Marseille, France; (F.D.-G.); (F.S.); (R.G.); (L.B.)
- Department of Hematology, Hopital de la Conception, Assistance Publique-Hôpitaux Marseille, 13005 Marseille, France; (L.L.); (L.A.)
| | - Regis Guieu
- INSERM 1263, Aix Marseille Université, INRAE, 13005 Marseille, France; (F.D.-G.); (F.S.); (R.G.); (L.B.)
- Department of Biochemistry, Assistance Publique-Hôpitaux, 13005 Marseille, France
| | - Laurent Bonello
- INSERM 1263, Aix Marseille Université, INRAE, 13005 Marseille, France; (F.D.-G.); (F.S.); (R.G.); (L.B.)
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France; (M.L.); (F.P.)
- Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, 13015 Marseille, France
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Panagides V, Laine M, Mancini J, Delmas C, Gaubert M, Dabry T, Boufi M, Paganelli F, Lemesle G, Bonello L. Haemodynamic support during high-risk percutaneous coronary intervention. Arch Cardiovasc Dis 2022; 115:109-113. [PMID: 35115264 DOI: 10.1016/j.acvd.2021.12.002] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 12/13/2021] [Accepted: 12/15/2021] [Indexed: 11/02/2022]
Affiliation(s)
- Vassili Panagides
- Intensive Care Unit, Hôpital Nord, AP-HM, Aix-Marseille University, 13015 Marseille, France, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Centre for CardioVascular and Nutrition Research (C2VN), Inserm 1263, INRA 1260, 13005, Marseille, France
| | - Marc Laine
- Intensive Care Unit, Hôpital Nord, AP-HM, Aix-Marseille University, 13015 Marseille, France, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Centre for CardioVascular and Nutrition Research (C2VN), Inserm 1263, INRA 1260, 13005, Marseille, France
| | - Julien Mancini
- Department of Public Health (BIOSTIC), Hôpital de la Timone, Aix-Marseille University, 13005, Marseille, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Cardiology Department, University Hospital of Rangueil, 31400, Toulouse, France
| | - Melanie Gaubert
- Intensive Care Unit, Hôpital Nord, AP-HM, Aix-Marseille University, 13015 Marseille, France, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Centre for CardioVascular and Nutrition Research (C2VN), Inserm 1263, INRA 1260, 13005, Marseille, France
| | - Thibaut Dabry
- Intensive Care Unit, Hôpital Nord, AP-HM, Aix-Marseille University, 13015 Marseille, France, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Centre for CardioVascular and Nutrition Research (C2VN), Inserm 1263, INRA 1260, 13005, Marseille, France
| | - Mourad Boufi
- Service de chirurgie vasculaire, Hôpital Nord, AP-HM, 13015, Marseille, France
| | - Franck Paganelli
- Intensive Care Unit, Hôpital Nord, AP-HM, Aix-Marseille University, 13015 Marseille, France, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Centre for CardioVascular and Nutrition Research (C2VN), Inserm 1263, INRA 1260, 13005, Marseille, France
| | - Gilles Lemesle
- USIC et centre hémodynamique, Institut Cœur Poumon, Centre Hospitalier Universitaire de Lille, 59000, Lille, France
| | - Laurent Bonello
- Intensive Care Unit, Hôpital Nord, AP-HM, Aix-Marseille University, 13015 Marseille, France, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Centre for CardioVascular and Nutrition Research (C2VN), Inserm 1263, INRA 1260, 13005, Marseille, France.
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Delmas C, Roubille F, Lamblin N, Bonello L, Leurent G, Levy B, Elbaz M, Danchin N, Champion S, Lim P, Schneider F, Cariou A, Khachab H, Bourenne J, Seronde MF, Schurtz G, Harbaoui B, Vanzetto G, Quentin C, Delabranche X, Aissaoui N, Combaret N, Manzo-Silberman S, Tomasevic D, Marchandot B, Lattuca B, Henry P, Gerbaud E, Bonnefoy E, Puymirat E. Baseline characteristics, management, and predictors of early mortality in cardiogenic shock: insights from the FRENSHOCK registry. ESC Heart Fail 2021; 9:408-419. [PMID: 34973047 PMCID: PMC8788015 DOI: 10.1002/ehf2.13734] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 10/15/2021] [Accepted: 11/11/2021] [Indexed: 11/26/2022] Open
Abstract
Aims Published data on cardiogenic shock (CS) are scarce and are mostly focused on small registries of selected populations. The aim of this study was to examine the current CS picture and define the independent correlates of 30 day mortality in a large non‐selected cohort. Methods and results FRENSHOCK is a prospective multicentre observational survey conducted in metropolitan French intensive care units and intensive cardiac care units between April and October 2016. There were 772 patients enrolled (mean age 65.7 ± 14.9 years; 71.5% male). Of these patients, 280 (36.3%) had ischaemic CS. Organ replacement therapies (respiratory support, circulatory support or renal replacement therapy) were used in 58.3% of patients. Mortality at 30 days was 26.0% in the overall population (16.7% to 48.0% depending on the main cause and first place of admission). Multivariate analysis showed that six independent factors were associated with a higher 30 day mortality: age [per year, odds ratio (OR) 1.06, 95% confidence interval (CI): 1.04–1.08], diuretics (OR 1.74, 95% CI: 1.05–2.88), circulatory support (OR 1.92, 95% CI: 1.12–3.29), left ventricular ejection fraction <30% (OR 2.15, 95% CI: 1.40–3.29), norepinephrine (OR 2.55, 95% CI: 1.69–3.84), and renal replacement therapy (OR 2.72, 95% CI: 1.65–4‐49). Conclusions Non‐ischaemic CS accounted for more than 60% of all cases of CS. CS is still associated with significant but variable short‐term mortality according to the cause and first place of admission, despite frequent use of haemodynamic support, and organ replacement therapies.
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Affiliation(s)
- Clement Delmas
- Intensive Cardiac Care Unit, Rangueil University Hospital/Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), 1 Avenue Jean Poulhes, Toulouse, 31059, France
| | - François Roubille
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Cardiology Department, CHU de Montpellier, Montpellier, France
| | - Nicolas Lamblin
- Urgences et Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, Lille, France
| | - Laurent Bonello
- Aix-Marseille Université; Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
| | - Guillaume Leurent
- Department of Cardiology, CHU Rennes, Inserm, LTSI-UMR 1099, Univ Rennes 1, Rennes, France
| | - Bruno Levy
- Réanimation Médicale Brabois, CHRU Nancy, Nancy, France
| | - Meyer Elbaz
- Intensive Cardiac Care Unit, Rangueil University Hospital/Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), 1 Avenue Jean Poulhes, Toulouse, 31059, France
| | - Nicolas Danchin
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology, Université de Paris, Paris, France
| | | | - Pascal Lim
- Univ Paris Est Créteil, INSERM, IMRB; AP-HP, Hôpital Universitaire Henri-Mondor, Service de Cardiologie, Créteil, France
| | - Francis Schneider
- Médecine Intensive-Réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Centre-Université de Paris, Medical School, Paris, France
| | - Hadi Khachab
- Intensive Cardiac Care Unit, Department of Cardiology, CH d'Aix en Provence, Aix-en-Provence, France
| | - Jeremy Bourenne
- Aix Marseille Université, Service de Réanimation des Urgences, CHU La Timone 2, Marseille, France
| | | | - Guillaume Schurtz
- Urgences et Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, Lille, France
| | - Brahim Harbaoui
- Cardiology Department, Hôpital Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France, University of Lyon, CREATIS UMR5220; INSERM U1044; INSA-15, Lyon, France
| | - Gerald Vanzetto
- Department of Cardiology, Hôpital de Grenoble, Grenoble, France
| | - Charlotte Quentin
- Service de Reanimation Polyvalente, Centre Hospitalier Broussais St Malo, Saint-Malo, France
| | - Xavier Delabranche
- Réanimation Chirurgicale Polyvalente, Pôle Anesthésie-Réanimation chirurgicale-Médecine Péri-opératoire, Les Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil 1, Porte de l'Hôpital, Strasbourg, France
| | - Nadia Aissaoui
- Médecine Intensive Réanimation, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France
| | - Nicolas Combaret
- Department of Cardiology, CHU Clermont-Ferrand, CNRS, Université Clermont Auvergne, Clermont-Ferrand, France
| | | | - Danka Tomasevic
- Intensive Cardiac Care Unit, Lyon Brom University Hospital, Lyon, France
| | - Benjamin Marchandot
- Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France
| | - Benoit Lattuca
- Department of Cardiology, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Patrick Henry
- Department of Cardiology, Université de Paris, Hôpital Lariboisière, AP-HP, Paris, France
| | - Edouard Gerbaud
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, Hôpital Xavier Arnozan, Pessac, France
| | - Eric Bonnefoy
- Intensive Cardiac Care Unit, Lyon Brom University Hospital, Lyon, France
| | - Etienne Puymirat
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology, Université de Paris, Paris, France
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Lemesle G, Bauters C, Bonello L, Fauchier L, Cayla G, Marijon E, Guenoun M, Schurtz G, Ninni S, Richardson M, Albert F, Cohen S, Lamblin N, Danchin N. Management of antithrombotics in situations with a gap in evidence: A national French survey focusing on patients with coronary artery disease and atrial fibrillation. Int J Cardiol 2021; 348:15-21. [PMID: 34864080 DOI: 10.1016/j.ijcard.2021.11.077] [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: 09/23/2021] [Revised: 11/21/2021] [Accepted: 11/29/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND If several randomized studies allowed to better apprehend what should be the best antithrombotic strategy in patients with concomitant coronary artery disease (CAD) and atrial fibrillation (AF), there are still several clinical situations with a gap of evidence. METHODS We conducted a national French survey in September-October 2020 among cardiologists in order to assess what are daily practices regarding the antithrombotic management in several specific clinical settings where no or little scientific evidence is available. The questionnaires were built by a committee of 6 cardiologists routinely involved in the field of CAD and/or AF. RESULTS Among the 6388 French cardiologists, 483 (7.6%) cardiologists participated to the survey. The rate of participation was rather homogeneous across the country. The mean age of participants was 48 +/- 12.7. There were 134 women (27.7%) and 349 men. Altogether, 181 (37.5%) cardiologists worked in private, 153 (31.7%) in non-universitary public and 83 (17.2%) in universitary public centers. The remaining had shared activity. Among the participants, 150 were interventional (coronary) cardiologists (31.1%). Others were general cardiologists (n = 229), specialists in the field of rhythmology (n = 43), heart failure (n = 17) or imaging (n = 44). The survey consisted of 10 questions pertaining to 2 virtual clinical scenarios. CONCLUSIONS The present survey is an illustration of how therapeutic decisions may vary in such situations with little or no scientific evidence. Such surveys may help experts to build consensus (answers with little variability) and to target the need for future trials and more research (answers with a lot of variability).
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Affiliation(s)
- Gilles Lemesle
- Heart and Lung Institute, University hospital of Lille, F-59000 Lille, France; Univ. Lille, F-59000, France; Institut Pasteur of Lille, Inserm U1011, F-59000 Lille, France; FACT (French Alliance for Cardiovascular Trials), F-75000 Paris, France.
| | - Christophe Bauters
- Heart and Lung Institute, University hospital of Lille, F-59000 Lille, France; Institut Pasteur of Lille, Inserm U1167, F-59000 Lille, France; Univ. Lille, F-59000, France
| | - Laurent Bonello
- Aix-Marseille Univ, Intensive care unit, Department of Cardiology, 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 1263, INRA 1260, Marseille, France
| | - Laurent Fauchier
- Department of Cardiology, CHU de Trousseau, University François-Rabelais, 37170 Chambray-lès-, Tours, France
| | - Guillaume Cayla
- Department of Cardiology, University Hospital of Nîmes, 30000 Nîmes, France
| | - Eloi Marijon
- Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, University of Paris, Paris, France
| | - Maxime Guenoun
- Department of Cardiology, Hôpital Européen de Marseille, 13003 Marseille, France
| | - Guillaume Schurtz
- Heart and Lung Institute, University hospital of Lille, F-59000 Lille, France
| | - Sandro Ninni
- Heart and Lung Institute, University hospital of Lille, F-59000 Lille, France; Univ. Lille, F-59000, France; Institut Pasteur of Lille, Inserm U1011, F-59000 Lille, France; FACT (French Alliance for Cardiovascular Trials), F-75000 Paris, France
| | - Marjorie Richardson
- Heart and Lung Institute, University hospital of Lille, F-59000 Lille, France
| | - Franck Albert
- Department of Cardiology, Hospital of Chartres, 28000 Chartres, France
| | - Serge Cohen
- Department of Cardiology, Hôpital St Antoine, APHP, Paris, France
| | - Nicolas Lamblin
- Heart and Lung Institute, University hospital of Lille, F-59000 Lille, France; Institut Pasteur of Lille, Inserm U1167, F-59000 Lille, France; Univ. Lille, F-59000, France
| | - Nicolas Danchin
- Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, University of Paris, FACT (French Alliance for Cardiovascular Trials), Paris, France
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Brunet T, Bonello L, Chamandi C, Tea V, Nallet O, Lhermusier T, Gallet R, Labèque JN, Albert F, Schiele F, Ferrières J, Simon T, Danchin N, Puymirat E. Long-term mortality after ST-elevation myocardial infarction in the reperfusion and modern secondary prevention therapy era according to coronary artery disease extent: The FAST-MI registries. Arch Cardiovasc Dis 2021; 114:647-655. [PMID: 34772646 DOI: 10.1016/j.acvd.2021.06.014] [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: 04/08/2021] [Revised: 06/01/2021] [Accepted: 06/14/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Historical cohorts have shown extent of coronary artery disease to be a predictor of poorer outcomes in ST-segment elevation myocardial infarction. However, contemporary data in the era of reperfusion and modern secondary prevention therapy are lacking. AIM To compare 3-year survival in patients with ST-segment elevation myocardial infarction with multivessel disease versus those with single-vessel disease. METHODS Using data from the FAST-MI 2005, 2010 and 2015 registries, three nationwide French surveys, we included all patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention within 24hours of symptom onset. Baseline characteristics, management and 3-year all-cause mortality were analysed according to coronary status (single-, two- and three-vessel disease). RESULTS Among 3907 patients (mean age 62.4±13.7 years; 75.9% male), patients with multivessel disease (two- or three-vessel disease) accounted for 47.9%; overall, they were older, with higher cardiovascular risk profiles. In a multivariable adjusted Cox proportional hazard regression model, only patients with three-vessel disease had a higher rate of mortality at 3 years compared with those with single-vessel disease (hazard ratio 1.52, 95% confidence interval 1.68-2.26; P<0.001). Finally, patients with multivessel disease with complete myocardial revascularization before discharge had a similar prognosis to patients with single-vessel disease (hazard ratio 1.17, 95% confidence interval 0.84-1.64; P=0.35). CONCLUSIONS Multivessel disease still represents an important proportion of patients with ST-segment elevation myocardial infarction. Although three-vessel disease is associated with higher 3-year mortality, patients with multivessel disease and complete myocardial revascularization in the contemporary era have a 3-year risk of death similar to that in patients with single-vessel disease.
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Affiliation(s)
- Thibaud Brunet
- Department of Cardiology, hôpital Européen Georges-Pompidou, AP-HP, 75015 Paris, France; Université de Paris, 75006 Paris, France
| | - Laurent Bonello
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Centre for Cardiovascular and Nutrition Research, AP-HM, Aix-Marseille University, Inserm 1263, INRA 1260 Cardiology Department, hôpital Nord, 13015 Marseille, France
| | - Chekrallah Chamandi
- Department of Cardiology, hôpital Européen Georges-Pompidou, AP-HP, 75015 Paris, France; Université de Paris, 75006 Paris, France
| | - Victoria Tea
- Department of Cardiology, hôpital Européen Georges-Pompidou, AP-HP, 75015 Paris, France; Université de Paris, 75006 Paris, France
| | - Olivier Nallet
- Department of Cardiology, Le Raincy-Montfermeil Intercity Hospital, 93370 Montfermeil, France
| | - Thibault Lhermusier
- Intensive Cardiac Care Unit, Department of Cardiology, Rangueil University Hospital, Medical School, Toulouse III Paul-Sabatier University, 31059 Toulouse, France
| | - Romain Gallet
- Service de Cardiologie, Hôpitaux Universitaires Henri-Mondor, AP-HP, 94000 Créteil, France; U955-IMRB, Equipe 03, Inserm, université Paris Est Creteil (UPEC), ecole nationale vétérinaire D'Alfort (EnVA), 94700 Maisons-Alfort, France
| | - Jean-Noel Labèque
- GCS de Cardiologie de la Côte Basque, CH Bayonne, 64100 Bayonne, France
| | - Franck Albert
- Department of Cardiology, Centre Hospitalier de Chartres, 28630 Le Coudray, France
| | - François Schiele
- Department of Cardiology, University Hospital Jean-Minjoz, 25000 Besançon, France
| | - Jean Ferrières
- Department of Cardiology, Rangueil Hospital, 31059 Toulouse, France
| | - Tabassome Simon
- Department of Clinical Pharmacology and unité de recherche clinique (URCEST), hôpital Saint-Antoine, AP-HP, 75012 Paris, France; Université Pierre et Marie Curie (UPMC-Paris 06), 75005 Paris, France
| | - Nicolas Danchin
- Department of Cardiology, hôpital Européen Georges-Pompidou, AP-HP, 75015 Paris, France; Université de Paris, 75006 Paris, France
| | - Etienne Puymirat
- Department of Cardiology, hôpital Européen Georges-Pompidou, AP-HP, 75015 Paris, France; Université de Paris, 75006 Paris, France.
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Lemesle G, Puymirat E, Bonello L, Simon T, Steg PG, Ferrières J, Schiele F, Fauchier L, Henry P, Schurtz G, Ninni S, Lamblin N, Bauters C, Danchin N. Compared Impact of Diabetes on the Risk of Heart Failure from Acute Myocardial Infarction to Chronic Coronary Artery Disease. Diabetes Metab 2021; 48:101265. [PMID: 34224895 DOI: 10.1016/j.diabet.2021.101265] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 12/23/2022]
Abstract
AIM . - We attempted to describe the risk of heart failure (HF) occurrence according to diabetes mellitus (DM) status in patients with coronary artery disease (CAD) over time, from acute myocardial infarction (MI) to the chronic stable phase. METHODS . - For the acute and subacute MI phases, we analysed the FAST-MI cohort restricted to patients without history of HF (n=12,473). The analysis on 1-year outcomes after MI was further restricted to patients who were discharged alive and without history of HF and/or HF symptoms during the index hospitalisation for MI (n=9,181). To analyse the chronic phase, we analysed the CORONOR cohort restricted to patients without history of HF (n=3,871). The primary endpoint was HF occurrence according to DM status. We also analysed the composite of all-cause death or HF. RESULTS . - Killip-Kimball class ≥II during the index MI hospitalisation was more frequent in DM patients compared to non-DM patients (29% vs. 15.3%, adjusted OR=1.60). At one year after MI, hospitalisation for HF was more frequent in DM patients (3.3% vs. 1.2%, adjusted HR=1.73). At the chronic phase (5-year outcomes), hospitalisation for HF was more frequent in DM patients (8.5% vs. 4.3%, adjusted HR=1.70). Results focusing on the composite endpoint (all-cause death or HF) were consistent. CONCLUSION . - DM was associated with a very constant near 2-fold increase in the risk of HF whatever the presentation of CAD. Avoiding the risk of HF occurrence in CAD patients with DM is critical in daily practice and should be a constant life-long endeavour.
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Affiliation(s)
- Gilles Lemesle
- Heart and Lung Institute, University hospital of Lille, F-59000 Lille, France. Univ. Lille, F-59000, France. Institut Pasteur of Lille, Inserm U1011, F-59000 Lille, France. FACT (French Alliance for Cardiovascular Trials), F-75000 Paris, France.
| | - Etienne Puymirat
- Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, University of Paris, and FACT (French Alliance for Cardiovascular Trials), Paris, France
| | - Laurent Bonello
- Aix-Marseille Univ, Intensive care unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France; Centre for CardioVascular and Nutrition research (C2VN), INSERM 1263, INRA 1260, Marseille, France
| | - Tabassome Simon
- Department of Pharmacology and URCEST, Hôpital St Antoine, University of Paris Sorbonne, and FACT (French Alliance for Cardiovascular Trials), Paris, France
| | - Philippe-Gabriel Steg
- Department of Cardiology, Hôpital Bichat, AP-HP, University of Paris, and FACT (French Alliance for Cardiovascular Trials), Paris, France
| | - Jean Ferrières
- Department of Cardiology, Rangueil hospital, 31400 Toulouse, France
| | - François Schiele
- Department of Cardiology, university hospital Jean-Minjoz, 25000 Besançon, France
| | - Laurent Fauchier
- Department of Cardiology, CHU de Trousseau, University François-Rabelais, 37170 Chambray-lès-Tours, France
| | - Patrick Henry
- Cardiology Department, APHP, Lariboisière Hospital, Paris, France. University of Paris, Paris, France
| | - Guillaume Schurtz
- Heart and Lung Institute, University hospital of Lille, F-59000 Lille, France
| | - Sandro Ninni
- Heart and Lung Institute, University hospital of Lille, F-59000 Lille, France. Univ. Lille, F-59000, France. Institut Pasteur of Lille, Inserm U1011, F-59000 Lille, France. FACT (French Alliance for Cardiovascular Trials), F-75000 Paris, France
| | - Nicolas Lamblin
- Heart and Lung Institute, University hospital of Lille, F-59000 Lille, France. Univ. Lille, F-59000, France. Institut Pasteur of Lille, Inserm U1167, F-59000 Lille, France
| | - Christophe Bauters
- Heart and Lung Institute, University hospital of Lille, F-59000 Lille, France. Univ. Lille, F-59000, France. Institut Pasteur of Lille, Inserm U1167, F-59000 Lille, France
| | - Nicolas Danchin
- Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, University of Paris, and FACT (French Alliance for Cardiovascular Trials), Paris, France
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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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Gruttemeier J, Cottin Y, Yao H, De Maistre E, Maza M, Bonello L, Laine M, Resseguier N, Zeller M, Camoin-Jau L, Paganelli F. Impact of Platelet Reactivity in ACS Patients on Clinical Outcomes with Triple Antithrombotic Therapy. J Clin Med 2021; 10:1565. [PMID: 33917717 PMCID: PMC8068113 DOI: 10.3390/jcm10081565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/16/2021] [Accepted: 04/05/2021] [Indexed: 11/16/2022] Open
Abstract
Optimal antithrombotic therapy after percutaneous coronary intervention (PCI) in patients on oral anticoagulants (OAC) remains a clinical conundrum. In fact, combining an OAC with dual antiplatelet therapy (triple antithrombotic therapy, TAT) increases the risk of bleeding. Clopidogrel is the only thienopyridine recommended in TAT patients. Whether its response plays a relevant role in this setting remains uncertain. We aimed to evaluate the level of platelet reactivity inhibition (PRI) achieved by oral TAT in Acute Coronary Syndrome (ACS) patients undergoing PCI and its relationship with outcomes. We performed a multicenter prospective observational study and assessed PRI by vasodilator-stimulated phosphoprotein (VASP) index following a loading dose of clopidogrel. The primary endpoint was the incidence of major adverse cerebral or cardiovascular events (MACCE) at six months based on High on Treatment Platelet Reactivity (HTPR, VASP > 50%). The secondary endpoint was the incidence of bleeding at six months based on Low on Treatment Platelet Reactivity (LTPR, VASP < 16%). 491 patients were followed up for six months: 7.7% experienced MACCE and 17.3% experienced bleeding. There was no significant relationship between HTPR and MACCE, neither between LTPR and bleeding. Vitamin-K antagonist (VKA) treatment was associated with more MACCE and bleeding events, and the majority of events occurred within the first months. VASP index failed to predict outcomes in post-ACS patients with TAT. We confirm that direct acting OAC should be prioritized over VKA in TAT regimen.
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Affiliation(s)
- Julia Gruttemeier
- Department of Cardiology, CHU Dijon Bourgogne, 21000 Dijon, France; (J.G.); (Y.C.); (H.Y.); (M.M.)
| | - Yves Cottin
- Department of Cardiology, CHU Dijon Bourgogne, 21000 Dijon, France; (J.G.); (Y.C.); (H.Y.); (M.M.)
| | - Hermann Yao
- Department of Cardiology, CHU Dijon Bourgogne, 21000 Dijon, France; (J.G.); (Y.C.); (H.Y.); (M.M.)
| | - Emmanuel De Maistre
- Department of Biological Haematology, CHU Dijon Bourgogne, 21000 Dijon, France;
| | - Maud Maza
- Department of Cardiology, CHU Dijon Bourgogne, 21000 Dijon, France; (J.G.); (Y.C.); (H.Y.); (M.M.)
| | - Laurent Bonello
- Department of Cardiology, ARCHANTEC, School of Medicine, Aix Marseille University, 13007 Marseille, France; (L.B.); (M.L.)
| | - Marc Laine
- Department of Cardiology, ARCHANTEC, School of Medicine, Aix Marseille University, 13007 Marseille, France; (L.B.); (M.L.)
| | - Noemie Resseguier
- Public Health, Chronic Diseases and Quality of Life—Research Unit, Aix-Marseille University, 13007 Marseille, France;
| | - Marianne Zeller
- Team PEC2, EA 7460, Department of Health Sciences, University of Burgundy Franche Comté, 21000 Dijon, France;
| | - Laurence Camoin-Jau
- Department of Biological Haematology, Assistance Publique Hôpitaux de Marseille, Timone Hospital, 13007 Marseille, France;
| | - Franck Paganelli
- Department of Cardiology, ARCHANTEC, School of Medicine, Aix Marseille University, 13007 Marseille, France; (L.B.); (M.L.)
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Abstract
The rationale for mechanical circulatory support (MCS) in cardiogenic shock is to restore cardiac output in selected patients when critically low or in case of refractory cardiac arrest. Furthermore, an MCS device that moves blood from either the left atrium or the left ventricle to the systemic circulation will potentially unload the ventricle. These devices are used alone or in combination with venoarterial extracorporeal membrane oxygenation (VA-ECMO). If a left-sided Impella device is used, it should be run at the highest possible performance level during treatment while avoiding suction events. When combined with VA-ECMO, the Impella device should be run at a lower performance level, ensuring sufficient left ventricular emptying but avoiding suction. Continuous monitoring is pivotal and patients managed outside the catheterization laboratory should be monitored with an arterial line, a central venous catheter, frequent use of pulmonary artery catheters and regular imaging by transthoracic echocardiogram.
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Affiliation(s)
- Jacob Eifer Møller
- Department of Cardiology, Odense University Hospital and Cardiac Intensive Care Unit, Heart Center, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej, DK - 2100 Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet, Blegdamsvej, DK - 2100 Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej, DK - 2100 Copenhagen, Denmark
| | - Laurent Bonello
- Department of Cardiology, Aix-Marseille Université, Cardiac Intensive Care Unit, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 80 Rue Brochier, 13005 Marseille, France
| | - Clement Delmas
- Intensive Cardiac Care Unit-Acute and Chronic Mechanical Circulatory Support Team Rangueil University Hospital, Avenue du Professeur Jean Poulhès, 31400 Toulouse, France
| | - Federico Pappalardo
- Department of Anesthesia and Intensive Care, IRCCS ISMETT, UPMC Italy, Via Ernesto Tricomi, 5, 90127 Palermo, Italy
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30
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Abstract
Cardiogenic shock is a highly lethal syndrome, leading to rapid death or secondary multiorgan damage, but current shock therapies, including mechanical support devices, also have a significant side effect profile. The overarching goal of shock therapy is ensuring long-term survival with good quality of life. This implies averting death, modifying the disease course by promoting heart recovery and avoiding additional cardiac damage, protecting other organs, and circumventing complications. Monitoring and supportive therapies are subordinate to these goals. Rather than merely following preconceived notions, the rapid evolution in mechanical support technology requires iterative and critical review of the benefits of current procedures, protocols and drugs in view of their overall contribution to the therapeutic goals. This article discusses various monitoring and supportive pharmaceutical modalities typically used in patients with cardiogenic shock requiring mechanical support.
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Affiliation(s)
- David Schibilsky
- Department of Cardiovascular Surgery, University Heartcenter Freiburg-Bad Krozingen, Hugstetter Str. 55, 79106 Freiburg, Germany.,Faculty of Medicine, University Freiburg, Breisacher Str. 153, 79110 Freiburg, Germany
| | - Clement Delmas
- Intensive Cardiac Care Unit, Department of Cardiology, Rangueil University Hospital, 31059 Toulouse, France
| | - Laurent Bonello
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, 13015 Marseille, France
| | - Patrick Hunziker
- Intensive Care Unit, University Hospital Basel, University of Basel, Petersgraben 5, 4031 Basel, Switzerland
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31
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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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32
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Dillinger JG, Laine M, Bouajila S, Paganelli F, Henry P, Bonello L. Antithrombotic strategies in elderly patients with acute coronary syndrome. Arch Cardiovasc Dis 2021; 114:232-245. [PMID: 33632631 DOI: 10.1016/j.acvd.2020.12.002] [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] [Received: 08/01/2020] [Revised: 12/21/2020] [Accepted: 12/21/2020] [Indexed: 12/22/2022]
Abstract
Elderly patients represent a growing proportion of the acute coronary syndrome population in Western countries. However, their frequent atypical symptoms at presentation often lead to delays in management and to misdiagnosis. Furthermore, their prognosis is poorer than that of younger patients because of physiological changes in platelet function, haemostasis and fibrinolysis, but also a higher proportion of comorbidities and frailty, both of which increase the risk of recurrent thrombotic and bleeding events. This complex situation, with ischaemic and haemorrhagic risk factors often being intertwined, may lead to confusion about the required treatment strategy, sometimes resulting in inadequate management or even to therapeutic nihilism. It is therefore critical to provide a comprehensive overview of our understanding of the pathophysiological processes underlying acute coronary syndrome in elderly patients, and to summarise the results from the latest clinical trials to help decision making for these high-risk patients.
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Affiliation(s)
- Jean-Guillaume Dillinger
- Department of cardiology, Hôpital Lariboisière, AP-HP, Inserm U-942, Université de Paris, 2, rue Ambroise-Paré, 75010 Paris, France.
| | - Marc Laine
- Mediterranean Association for research and studies in cardiology (MARS cardio), Centre for cardiovascular and nutrition research, AP-HM, Aix-Marseille University, INSERM 1263, INRA 1260, 13015 Marseille, France; Cardiology department, Hôpital Nord, 13015 Marseille, France; Mediterranean Association for research and studies in cardiology (MARS cardio), 13015 Marseille, France
| | - Sara Bouajila
- Department of cardiology, Hôpital Lariboisière, AP-HP, Inserm U-942, Université de Paris, 2, rue Ambroise-Paré, 75010 Paris, France
| | - Franck Paganelli
- Mediterranean Association for research and studies in cardiology (MARS cardio), Centre for cardiovascular and nutrition research, AP-HM, Aix-Marseille University, INSERM 1263, INRA 1260, 13015 Marseille, France; Cardiology department, Hôpital Nord, 13015 Marseille, France
| | - Patrick Henry
- Department of cardiology, Hôpital Lariboisière, AP-HP, Inserm U-942, Université de Paris, 2, rue Ambroise-Paré, 75010 Paris, France
| | - Laurent Bonello
- Mediterranean Association for research and studies in cardiology (MARS cardio), Centre for cardiovascular and nutrition research, AP-HM, Aix-Marseille University, INSERM 1263, INRA 1260, 13015 Marseille, France; Cardiology department, Hôpital Nord, 13015 Marseille, France; Mediterranean Association for research and studies in cardiology (MARS cardio), 13015 Marseille, France
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33
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Schurtz G, Rousse N, Saura O, Balmette V, Vincent F, Lamblin N, Porouchani S, Verdier B, Puymirat E, Robin E, Van Belle E, Vincentelli A, Aissaoui N, Delhaye C, Delmas C, Cosenza A, Bonello L, Juthier F, Moussa MD, Lemesle G. IMPELLA ® or Extracorporeal Membrane Oxygenation for Left Ventricular Dominant Refractory Cardiogenic Shock. J Clin Med 2021; 10:jcm10040759. [PMID: 33672792 PMCID: PMC7918655 DOI: 10.3390/jcm10040759] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 11/25/2022] Open
Abstract
Mechanical circulatory support (MCS) devices are effective tools in managing refractory cardiogenic shock (CS). Data comparing veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and IMPELLA® are however scarce. We aimed to assess outcomes of patients implanted with these two devices and eligible to both systems. From 2004 to 2020, we retrospectively analyzed 128 patients who underwent VA-ECMO or IMPELLA® in our institution for refractory left ventricle (LV) dominant CS. All patients were eligible to both systems: 97 patients were first implanted with VA-ECMO and 31 with IMPELLA®. The primary endpoint was 30-day all-cause death. VA-ECMO patients were younger (52 vs. 59.4, p = 0.006) and had a higher lactate level at baseline than those in the IMPELLA® group (6.84 vs. 3.03 mmol/L, p < 0.001). Duration of MCS was similar between groups (9.4 days vs. 6 days in the VA-ECMO and IMPELLA® groups respectively, p = 0.077). In unadjusted analysis, no significant difference was observed between groups in 30-day mortality: 43.3% vs. 58.1% in the VA-ECMO and IMPELLA® groups, respectively (p = 0.152). After adjustment, VA-ECMO was associated with a significant reduction in 30-day mortality (HR = 0.25, p = 0.004). A higher rate of MCS escalation was observed in the IMPELLA® group: 32.3% vs. 10.3% (p = 0.003). In patients eligible to either VA-ECMO or IMPELLA® for LV dominant refractory CS, VA-ECMO was associated with improved survival rate and a lower need for escalation.
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Affiliation(s)
- Guillaume Schurtz
- Cardiac Intensive Care Unit, Heart and Lung Institute, CHU Lille, 59000 Lille, France; (G.S.); (O.S.); (V.B.); (N.L.); (B.V.)
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, CHU Lille, Institut Coeur Poumon, Cardiology, 59000 Lille, France; (F.V.); (S.P.); (E.V.B.); (C.D.); (A.C.)
| | - Natacha Rousse
- Department of Cardiac Surgery, Institut Cœur Poumon, CHU Lille, INSERM U1011, Institut Pasteur de Lille, Université de Lille, 59000 Lille, France; (N.R.); (E.R.); (A.V.); (F.J.); (M.D.M.)
| | - Ouriel Saura
- Cardiac Intensive Care Unit, Heart and Lung Institute, CHU Lille, 59000 Lille, France; (G.S.); (O.S.); (V.B.); (N.L.); (B.V.)
| | - Vincent Balmette
- Cardiac Intensive Care Unit, Heart and Lung Institute, CHU Lille, 59000 Lille, France; (G.S.); (O.S.); (V.B.); (N.L.); (B.V.)
| | - Flavien Vincent
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, CHU Lille, Institut Coeur Poumon, Cardiology, 59000 Lille, France; (F.V.); (S.P.); (E.V.B.); (C.D.); (A.C.)
| | - Nicolas Lamblin
- Cardiac Intensive Care Unit, Heart and Lung Institute, CHU Lille, 59000 Lille, France; (G.S.); (O.S.); (V.B.); (N.L.); (B.V.)
- Heart and Lung Institute, University Hospital of Lille, Institut Pasteur of Lille, Inserm U1011 and FACT (French Alliance for Cardiovascular Trials), F-75000 Paris, France
| | - Sina Porouchani
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, CHU Lille, Institut Coeur Poumon, Cardiology, 59000 Lille, France; (F.V.); (S.P.); (E.V.B.); (C.D.); (A.C.)
| | - Basile Verdier
- Cardiac Intensive Care Unit, Heart and Lung Institute, CHU Lille, 59000 Lille, France; (G.S.); (O.S.); (V.B.); (N.L.); (B.V.)
| | - Etienne Puymirat
- Department of Cardiology, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, 75015 Paris, France;
| | - Emmanuel Robin
- Department of Cardiac Surgery, Institut Cœur Poumon, CHU Lille, INSERM U1011, Institut Pasteur de Lille, Université de Lille, 59000 Lille, France; (N.R.); (E.R.); (A.V.); (F.J.); (M.D.M.)
| | - Eric Van Belle
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, CHU Lille, Institut Coeur Poumon, Cardiology, 59000 Lille, France; (F.V.); (S.P.); (E.V.B.); (C.D.); (A.C.)
| | - André Vincentelli
- Department of Cardiac Surgery, Institut Cœur Poumon, CHU Lille, INSERM U1011, Institut Pasteur de Lille, Université de Lille, 59000 Lille, France; (N.R.); (E.R.); (A.V.); (F.J.); (M.D.M.)
| | - Nadia Aissaoui
- Department of Critical Care Unit, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou (HEGP), Université Paris-Descartes, 75015 Paris, France;
| | - Cédric Delhaye
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, CHU Lille, Institut Coeur Poumon, Cardiology, 59000 Lille, France; (F.V.); (S.P.); (E.V.B.); (C.D.); (A.C.)
| | - Clément Delmas
- INSERM UMR-1048, Intensive Cardiac Care Unit, Rangueil University Hospital, 31400 Toulouse, France;
| | - Alessandro Cosenza
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, CHU Lille, Institut Coeur Poumon, Cardiology, 59000 Lille, France; (F.V.); (S.P.); (E.V.B.); (C.D.); (A.C.)
| | - Laurent Bonello
- Cardiology Department, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France;
- Centre for CardioVascular and Nutrition Research (C2VN), Aix-Marseille Univ, INSERM 1263, INRA 1260, Hopital Nord, 13015 Marseille, France
| | - Francis Juthier
- Department of Cardiac Surgery, Institut Cœur Poumon, CHU Lille, INSERM U1011, Institut Pasteur de Lille, Université de Lille, 59000 Lille, France; (N.R.); (E.R.); (A.V.); (F.J.); (M.D.M.)
| | - Mouhamed Djahoum Moussa
- Department of Cardiac Surgery, Institut Cœur Poumon, CHU Lille, INSERM U1011, Institut Pasteur de Lille, Université de Lille, 59000 Lille, France; (N.R.); (E.R.); (A.V.); (F.J.); (M.D.M.)
| | - Gilles Lemesle
- Cardiac Intensive Care Unit, Heart and Lung Institute, CHU Lille, 59000 Lille, France; (G.S.); (O.S.); (V.B.); (N.L.); (B.V.)
- Heart and Lung Institute, University Hospital of Lille, Institut Pasteur of Lille, Inserm U1011 and FACT (French Alliance for Cardiovascular Trials), F-75000 Paris, France
- Correspondence: ; Tel.: +33-320445330; Fax: +33-320444898
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Panagides V, Vase H, Shah SP, Basir MB, Mancini J, Kamran H, Batra S, Laine M, Eiskjær H, Christensen S, Karami M, Paganelli F, Henriques JPS, Bonello L. Impella CP Implantation during Cardiopulmonary Resuscitation for Cardiac Arrest: A Multicenter Experience. J Clin Med 2021; 10:jcm10020339. [PMID: 33477532 PMCID: PMC7831079 DOI: 10.3390/jcm10020339] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/08/2021] [Accepted: 01/15/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Impella CP is a left ventricular pump which may serve as a circulatory support during cardiopulmonary resuscitation (CPR) for cardiac arrest (CA). Nevertheless, the survival rate and factors associated with survival in patients undergoing Impella insertion during CPR for CA are unknown. METHODS We performed a retrospective multicenter international registry of patients undergoing Impella insertion during on-going CPR for in- or out-of-hospital CA. We recorded immediate and 30-day survival with and without neurologic impairment using the cerebral performance category score and evaluated the factors associated with survival. RESULTS Thirty-five patients had an Impella CP implanted during CPR for CA. Refractory ventricular arrhythmias were the most frequent initial rhythm (65.7%). In total, 65.7% of patients immediately survived. At 30 days, 45.7% of patients were still alive. The 30-day survival rate without neurological impairment was 37.1%. In univariate analysis, survival was associated with both an age < 75 years and a time from arrest to CPR ≤ 5 min (p = 0.035 and p = 0.008, respectively). CONCLUSIONS In our multicenter registry, Impella CP insertion during ongoing CPR for CA was associated with a 37.1% rate of 30-day survival without neurological impairment. The factors associated with survival were a young age and a time from arrest to CPR ≤ 5 min.
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Affiliation(s)
- Vassili Panagides
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, 13015 Marseille, France; (V.P.); (M.L.); (F.P.)
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France
- Centre for CardioVascular and Nutrition Research (C2VN), INSERM 1263, INRA 1260, 13015 Marseille, France
| | - Henrik Vase
- Department of Cardiology, Aarhus University Hospital, 8200 Aarhus, Denmark; (H.V.); (H.E.)
| | - Sachin P. Shah
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, MA 01805, USA; (S.P.S.); (H.K.); (S.B.)
| | - Mir B. Basir
- Department of Cardiology, Henry Ford Hospital, Detroit, MI 48202, USA;
| | - Julien Mancini
- Department of Public Health (BIOSTIC), Aix-Marseille University, INSERM, IRD, APHM, UMR1252, SESSTIM, Hôpital de la Timone, 13005 Marseille, France;
| | - Hayaan Kamran
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, MA 01805, USA; (S.P.S.); (H.K.); (S.B.)
| | - Supria Batra
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, MA 01805, USA; (S.P.S.); (H.K.); (S.B.)
| | - Marc Laine
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, 13015 Marseille, France; (V.P.); (M.L.); (F.P.)
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France
- Centre for CardioVascular and Nutrition Research (C2VN), INSERM 1263, INRA 1260, 13015 Marseille, France
| | - Hans Eiskjær
- Department of Cardiology, Aarhus University Hospital, 8200 Aarhus, Denmark; (H.V.); (H.E.)
| | - Steffen Christensen
- Department of Intensive Care Medicine, Aarhus University Hospital, 8200 Aarhus, Denmark;
| | - Mina Karami
- Department of Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, 1081 HV Amsterdam, The Netherlands; (M.K.); (J.P.S.H.)
| | - Franck Paganelli
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, 13015 Marseille, France; (V.P.); (M.L.); (F.P.)
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France
- Centre for CardioVascular and Nutrition Research (C2VN), INSERM 1263, INRA 1260, 13015 Marseille, France
| | - Jose P. S. Henriques
- Department of Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, 1081 HV Amsterdam, The Netherlands; (M.K.); (J.P.S.H.)
| | - Laurent Bonello
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, 13015 Marseille, France; (V.P.); (M.L.); (F.P.)
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France
- Centre for CardioVascular and Nutrition Research (C2VN), INSERM 1263, INRA 1260, 13015 Marseille, France
- Correspondence: ; Tel.: +33-4-9196-7487
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Spanneut T, Paquet P, Bauters C, Modine T, Richardson M, Bonello L, Juthier F, Lemesle G. Utility and safety of systematic coronary angiogram in patients with acute infective endocarditis who required surgery: Single centre experience and comprehensive meta-analysis. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.315] [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: 11/26/2022]
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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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Cautela J, Zeriouh S, Gaubert M, Bonello L, Laine M, Peyrol M, Paganelli F, Lalevee N, Barlesi F, Thuny F. Intensified immunosuppressive therapy in patients with immune checkpoint inhibitor-induced myocarditis. J Immunother Cancer 2020; 8:jitc-2020-001887. [PMID: 33298621 PMCID: PMC7725077 DOI: 10.1136/jitc-2020-001887] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [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] [Accepted: 11/20/2020] [Indexed: 12/14/2022] Open
Abstract
Background Myocarditis is a rare but life-threatening adverse event of cancer treatments with immune checkpoint inhibitors (ICIs). Recent guidelines recommend the use of high doses of corticosteroids as a first-line treatment, followed by intensified immunosuppressive therapy (IIST) in the case of unfavorable evolution. However, this strategy is empirical, and no studies have specifically addressed this issue. Therefore, we aimed to investigate and compare the clinical course, management and outcome of ICI-induced myocarditis patients requiring or not requiring IIST. Methods This case–control study included all patients consecutively admitted to The Mediterranean University Center of Cardio-Oncology (Aix-Marseille University, France) for the diagnosis of ICI-induced myocarditis according to Bonaca’s criteria and treated with or without IIST. In addition, we searched PubMed and included patients from previously published case reports treated with IIST in the analysis. The clinical, biological, imaging, treatment, all-cause death and cardiovascular death data of patients who required IIST were compared with those of patients who did not. Results A total of 60 patients (69±12 years) were included (36 were treated with IIST and 24 were not). Patients requiring IIST were more likely to have received a combination of ICIs (39% vs 8%, p=0.01), and developed the first symptoms/signs of myocarditis earlier after the onset of ICI therapy (median, 18 days vs 60 days, p=0.002). They had a significantly higher prevalence of sustained ventricular arrhythmia, complete atrioventricular block, cardiogenic shock and troponin elevation. Moreover, they were more likely to have other immune-related adverse events simultaneously (p<0.0001), especially myositis (p=0.0002) and myasthenia gravis (p=0.009). Patients who required IIST were more likely to die from any cause (50% vs 21%, p=0.02). Among them, patients who received infliximab were more likely to die from cardiovascular causes (OR, 12.0; 95% CI 2.1 to 67.1; p=0.005). Conclusion The need for IIST was more common in patients who developed myocarditis very early after the start of ICI therapy, as well as when hemodynamic/electrical instability or neuromuscular adverse events occurred. Treatment with infliximab might be associated with an increased risk of cardiovascular death.
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Affiliation(s)
- Jennifer Cautela
- University Mediterranean Centre of Cardio-Oncology (MEDI-CO centre), Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Nord Hospital, Centre for CardioVascular and Nutrition research (C2VN), INSERM 1263, INRAE 1260, Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azur, France.,Mediterranean Group of Cardio-oncology (gMEDICO), Aix-Marseille-University, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Sarah Zeriouh
- University Mediterranean Centre of Cardio-Oncology (MEDI-CO centre), Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Nord Hospital, Centre for CardioVascular and Nutrition research (C2VN), INSERM 1263, INRAE 1260, Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Melanie Gaubert
- University Mediterranean Centre of Cardio-Oncology (MEDI-CO centre), Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Nord Hospital, Centre for CardioVascular and Nutrition research (C2VN), INSERM 1263, INRAE 1260, Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Laurent Bonello
- University Mediterranean Centre of Cardio-Oncology (MEDI-CO centre), Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Nord Hospital, Centre for CardioVascular and Nutrition research (C2VN), INSERM 1263, INRAE 1260, Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Marc Laine
- University Mediterranean Centre of Cardio-Oncology (MEDI-CO centre), Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Nord Hospital, Centre for CardioVascular and Nutrition research (C2VN), INSERM 1263, INRAE 1260, Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Michael Peyrol
- University Mediterranean Centre of Cardio-Oncology (MEDI-CO centre), Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Nord Hospital, Centre for CardioVascular and Nutrition research (C2VN), INSERM 1263, INRAE 1260, Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Franck Paganelli
- University Mediterranean Centre of Cardio-Oncology (MEDI-CO centre), Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Nord Hospital, Centre for CardioVascular and Nutrition research (C2VN), INSERM 1263, INRAE 1260, Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Nathalie Lalevee
- University Mediterranean Centre of Cardio-Oncology (MEDI-CO centre), Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Nord Hospital, Centre for CardioVascular and Nutrition research (C2VN), INSERM 1263, INRAE 1260, Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azur, France.,Technological Advances for Genomics and Clinics (TAGC), UMR/INSERM 1090, Aix-Marseille-University, Marseille, France
| | - Fabrice Barlesi
- Mediterranean Group of Cardio-oncology (gMEDICO), Aix-Marseille-University, Marseille, Provence-Alpes-Côte d'Azur, France.,Gustave Roussy, Drug Development Department (DITEP), Paris-Saclay University, Villejuif, France
| | - Franck Thuny
- University Mediterranean Centre of Cardio-Oncology (MEDI-CO centre), Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Nord Hospital, Centre for CardioVascular and Nutrition research (C2VN), INSERM 1263, INRAE 1260, Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azur, France .,Mediterranean Group of Cardio-oncology (gMEDICO), Aix-Marseille-University, Marseille, Provence-Alpes-Côte d'Azur, France
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Laine M, Panagides V, Frère C, Cuisset T, Gouarne C, Jouve B, Lemesle G, Paganelli F, Alessi MC, Mancini J, Bonello L. On-Ticagrelor Platelet Reactivity and Clinical Outcome in Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndrome. Thromb Haemost 2020; 121:923-930. [PMID: 33260230 DOI: 10.1055/a-1326-5110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND A strong association between on-thienopyridine platelet reactivity (PR) and the risk of both thrombotic and bleeding events in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) has been demonstrated. However, no study has analyzed the relationship between on-ticagrelor PR and clinical outcome in this clinical setting. OBJECTIVES We aimed to investigate the relationship between on-ticagrelor PR, assessed by the vasodilator-stimulated phosphoprotein (VASP) index, and clinical outcome in patients with ACS undergoing PCI. METHODS We performed a prospective, multicenter, observational study of patients undergoing PCI for ACS. PR was measured using the VASP index following ticagrelor loading dose. The primary study endpoint was the rate of Bleeding Academic Research Consortium (BARC) type ≥2 at 1 year. The key secondary endpoint was the rate of major adverse cardiovascular events (MACE) defined as the composite of cardiovascular death, myocardial infarction, stroke, and urgent revascularization. RESULTS We included 570 ACS patients, among whom 33.9% had ST-elevation myocardial infarction. BARC type ≥2 bleeding occurred in 10.9% and MACE in 13.8%. PR was not associated with BARC ≥2 or with MACE (p = 0.12 and p = 0.56, respectively). No relationship between PR and outcomes was observed, neither when PR was analyzed quantitatively nor when it was analyzed qualitatively (low on-treatment PR [LTPR] vs. no LTPR). CONCLUSION On-ticagrelor PR measured by the VASP was not associated with bleeding or thrombotic events in ACS patients undergoing PCI. PR measured by the VASP should not be used as a surrogate endpoint in studies on ticagrelor.
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Affiliation(s)
- Marc Laine
- Intensive care Unit, Department of Cardiology, Assistance publique des hopitaux de Marseille, Hôpital Nord, Aix Marseille University, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
| | - Vassili Panagides
- Intensive care Unit, Department of Cardiology, Assistance publique des hopitaux de Marseille, Hôpital Nord, Aix Marseille University, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
| | - Corinne Frère
- Institute of Cardiometabolism And Nutrition, INSERM UMRS_1166, GRC 27 GRECO, Sorbonne Université, Paris, France.,Department of Haematology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | | | - Caroline Gouarne
- Intensive care Unit, Department of Cardiology, Assistance publique des hopitaux de Marseille, Hôpital Nord, Aix Marseille University, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France.,Department of Haematology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | - Bernard Jouve
- Department of Cardiology, Hospital of Aix-en-Provence, F-13100 Aix-en-Provence, France
| | - Gilles Lemesle
- USIC et Centre Hémodynamique, Institut Cœur Poumon, Centre Hospitalier Universitaire de Lille, Lille, France.,Faculté de Médecine de l'Université de Lille, Lille, France.,INSERM UMR 1011, Institut Pasteur de Lille, Lille, France.,FACT (French Alliance for Cardiovascular Trials), Paris, France
| | - Franck Paganelli
- Intensive care Unit, Department of Cardiology, Assistance publique des hopitaux de Marseille, Hôpital Nord, Aix Marseille University, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
| | - Marie-Christine Alessi
- Centre for CardioVascular and Nutrition Research (C2VN), INSERM 1263, INRA 1260, Marseille, France
| | - Julien Mancini
- Assistance Publique-Hôpitaux de Marseille, INSERM, IRD, SESSTIM, CHU Timone, Department of Public Health (BIOSTIC), Aix Marseille Université, Marseille, France
| | - Laurent Bonello
- Intensive care Unit, Department of Cardiology, Assistance publique des hopitaux de Marseille, Hôpital Nord, Aix Marseille University, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
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Gaubert M, Laine M, Resseguier N, Aissaoui N, Puymirat E, Lemesle G, Michelet P, Hraiech S, Lévy B, Delmas C, Bonello L. Hemodynamic Profiles of Cardiogenic Shock Depending on Their Etiology. J Clin Med 2020; 9:jcm9113384. [PMID: 33105580 PMCID: PMC7690259 DOI: 10.3390/jcm9113384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 09/28/2020] [Accepted: 10/16/2020] [Indexed: 11/16/2022] Open
Abstract
The pathophysiology of cardiogenic shock (CS) varies depending on its etiology, which may lead to different hemodynamic profiles (HP) and may help tailor therapy. We aimed to assess the HP of CS patients according to their etiologies of acute myocardial infarction (AMI) and acute decompensated chronic heart failure (ADCHF). We included patients admitted for CS secondary to ADCHF and AMI. HP were measured before the administration of any inotrope or vasopressor. Systemic Vascular Resistances index (SVRi), Cardiac Index (CI), and Cardiac Power Index (CPI) were measured by trans-thoracic Doppler echocardiography on admission. Among 37 CS patients, 28 had CS secondary to ADCHF or AMI and were prospectively included. The two groups were similar in terms of demographic data and shock severity criteria. AMI CS was associated with lower SVRi compared to CS related to ADCHF: 2010 (interquartile range (IQR): 1895-2277) vs. 2622 (2264-2993) dynes-s·cm-5·m-2 (p = 0.002). A trend toward a higher CI was observed: respectively 2.13 (1.88-2.18) vs. 1.78 (1.65-1.96) L·min-1·m-2 (p = 0.067) in AMICS compared to ADCHF. CS patients had different HP according to their etiologies. AMICS had lower SVR and tended to have a higher CI compared to ADHF CS. These differences should be taken into account for patient selection in future research.
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Affiliation(s)
- Mélanie Gaubert
- Cardiology Department, APHM, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Centre for CardioVascular and Nutrition Research (C2VN), Aix-Marseille Univ, INSERM 1263, INRA 1260, Hopital Nord, 13015 Marseille, France; (M.G.); (M.L.)
| | - Marc Laine
- Cardiology Department, APHM, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Centre for CardioVascular and Nutrition Research (C2VN), Aix-Marseille Univ, INSERM 1263, INRA 1260, Hopital Nord, 13015 Marseille, France; (M.G.); (M.L.)
| | - Noémie Resseguier
- Support Unit for Clinical Research and Economic Evaluation, APHM, 13385 Marseille, France;
| | - Nadia Aissaoui
- Department of Critical Care Unit, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou (HEGP), Université Paris-Descartes, 15015 Paris, France;
| | - Etienne Puymirat
- Département de Cardiologie, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, 75015 Paris, France;
| | - Gilles Lemesle
- USIC et Centre Hémodynamique, Institut Coeur Poumon, Centre Hospitalier Régional et Universitaire de Lille, Faculté de Médecine de l’Université de Lille, Institut Pasteur de Lille, Unité INSERM UMR 1011, and FACT (French Alliance for Cardiovascular Trials), F-59000 Lille, France;
| | - Pierre Michelet
- Service d’accueil des Urgences, Hopital Timone, 13005 Marseille, France;
| | - Sami Hraiech
- Resuscitation Department, Aix-Marseille Univ, APHM, Hôpital Nord, 13005 Marseille, France;
| | - Bruno Lévy
- CHRU Nancy, Service de Réanimation Médicale Brabois, Pôle Cardiovasculaire et Réanimation Médicale, Hôpital Brabois, 54511 Vandoeuvre les Nancy, France;
| | - Clément Delmas
- INSERM UMR-1048, Intensive Cardiac Care Unit, Rangueil University Hospital, 31400 Toulouse, France;
| | - Laurent Bonello
- Cardiology Department, APHM, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Centre for CardioVascular and Nutrition Research (C2VN), Aix-Marseille Univ, INSERM 1263, INRA 1260, Hopital Nord, 13015 Marseille, France; (M.G.); (M.L.)
- Correspondence:
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Spanneut TA, Paquet P, Bauters C, Modine T, Richardson M, Bonello L, Juthier F, Lemesle G. Utility and safety of coronary angiography in patients with acute infective endocarditis who required surgery. J Thorac Cardiovasc Surg 2020; 164:905-913.e19. [PMID: 33131891 DOI: 10.1016/j.jtcvs.2020.08.117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 08/09/2020] [Accepted: 08/15/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To assess the benefit/risk ratio to perform a coronary angiography (CA) before surgery for infective endocarditis (IE). METHODS We conducted a single-center prospective registry including 272 patients with acute IE intended for surgery and compared patients who underwent a preoperative CA (n = 160) with those who did not (n = 112). A meta-analysis of 3 observational studies was also conducted and included 551 patients: 342 who underwent a CA and 209 who did not. RESULTS In our registry, combined bypass surgery (CABG) was performed in 17% of the patients with preoperative CA. At 2 years, the rate of the primary composite end point (all-cause death, new systemic embolism, stroke, new hemodialysis) was similar in the CA (38%) and no-CA (37%) groups. In-hospital and 2-year individual end points were all similar between groups. There were only 2 episodes of systemic embolism after CA and only one possibly related to a vegetation dislodgement. In the meta-analysis, combined CABG was performed in 18% of the patients with preoperative CA. All-cause death was similar in both groups: odds ratio, 0.98 [0.62-1.53], P = .92. Only 5 cases of systemic embolism possibly related to a vegetation dislodgement were reported. New hemodialysis was numerically more frequent in the CA group: odds ratio, 1.68 [0.79-3.58] (18% vs 14%, P = .18). CONCLUSIONS In daily practice, two-thirds of the patients with acute IE who required surgery have a preoperative CA leading to a combined CABG in 18% of the patients. Our results suggest that to perform a preoperative CA in this context is not associated with improved prognosis.
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Affiliation(s)
- Théo-Alexandre Spanneut
- USIC et Centre Hémodynamique, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Pierre Paquet
- USIC et Centre Hémodynamique, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Christophe Bauters
- Service de Cardiologie, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, Lille, France; INSERM UMR 1067, Institut Pasteur de Lille, Lille, France; Faculté de Médecine de l'Université de Lille, Lille, France
| | - Thomas Modine
- Service de chirurgie cardiaque et vasculaire, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Marjorie Richardson
- Service d'exploration fonctionnelle cardiovasculaire, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Laurent Bonello
- Service de Cardiologie, Hopital Nord de Marseille, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Francis Juthier
- Faculté de Médecine de l'Université de Lille, Lille, France; Service de chirurgie cardiaque et vasculaire, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, Lille, France; INSERM UMR 1011, Institut Pasteur de Lille, Lille, France
| | - Gilles Lemesle
- USIC et Centre Hémodynamique, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, Lille, France; Faculté de Médecine de l'Université de Lille, Lille, France; INSERM UMR 1011, Institut Pasteur de Lille, Lille, France; FACT (French Alliance for Cardiovascular Trials), Paris, France.
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Biermé C, Laine M, Mouret J, Gaubert M, Petolat E, Noemie P, Bonello L. Survival and recurrence in cardiogenic shock depending on its etiology. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2020.03.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Delmas C, Aissaoui N, Meneveau N, Bouvaist H, Rousseau H, Puymirat E, Sapoval M, Flecher E, Meyer G, Sanchez O, Del Giudice C, Roubille F, Bonello L. Reperfusion therapies in pulmonary embolism-state of the art and expert opinion: A position paper from the "Unité de Soins Intensifs de Cardiologie" group of the French Society of Cardiology. Arch Cardiovasc Dis 2020; 113:749-759. [PMID: 32978090 DOI: 10.1016/j.acvd.2020.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/02/2020] [Accepted: 06/04/2020] [Indexed: 01/21/2023]
Abstract
Acute pulmonary embolism is a frequent cardiovascular emergency with an increasing incidence. The prognosis of patients with high-risk and intermediate-high-risk pulmonary embolism has not improved over the last decade. The current treatment strategies are mainly based on anticoagulation to prevent recurrence and reduce pulmonary vasculature obstruction. However, the slow rate of thrombus lysis under anticoagulation is unable to acutely decrease right ventricle overload and pulmonary vasculature resistance in patients with severe obstruction and right ventricle dysfunction. Therefore, patients with high-risk and intermediate-high-risk pulmonary embolism remain a therapeutic challenge. Reperfusion therapies may be discussed for these patients, and include systemic thrombolysis, catheter-directed therapies and surgical thrombectomy. High-risk patients require systemic thrombolysis, but may have contraindications as a result of the high risk of bleeding. In addition, intermediate-high-risk patients should not receive systemic thrombolysis, despite its high efficacy, because of prohibitive bleeding complications. Recently, percutaneous reperfusion techniques have been developed to acutely decrease pulmonary vascular obstruction with lower-dose or no thrombolytic agents and, thus, potentially higher safety than systemic thrombolysis. Some of these techniques improve key haemodynamic variables. Cardiac surgical techniques and venoarterial extracorporeal membrane oxygenation as temporary circulatory support may be useful in selected cases. The development of pulmonary embolism centres with multidisciplinary pulmonary embolism teams is mandatory to enable adequate use of reperfusion and improve outcomes. We aim to present the state of the art regarding reperfusion therapies in pulmonary embolism, but also to provide guidance on their indications and patient selection.
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Affiliation(s)
- Clément Delmas
- Intensive Cardiac Care Unit, Rangueil University Hospital, Inserm UMR 1048, Institute of Metabolic and Cardiovascular Diseases (I2MC), 31432 Toulouse, France
| | - Nadia Aissaoui
- Critical Care Unit, Penn State Heart and Vascular Institute (HVI), Hershey Medical Center (HMC) and Penn State University, 17033 PA, USA; Inserm U970, Paris Cardiovascular Research Centre, Hôpital Européen George Pompidou, AP-HP, 75015 Paris, France
| | - Nicolas Meneveau
- Department of Cardiology, EA3920, University Hospital Jean Minjoz, 25000 Besancon, France
| | - Helene Bouvaist
- Department of Cardiology, Pôle Thorax et Vaisseaux, CHU Grenoble Alpes, 38700 La Tronche, France
| | - Hervé Rousseau
- Department of Radiology, Hôpital Rangueil 1, CHU de Toulouse, 31059 Toulouse, France
| | - Etienne Puymirat
- Intensive Cardiac Care Unit, Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, 75015 Paris, France
| | - Marc Sapoval
- Vascular and Oncological Interventional Radiology, Inserm U970, Paris Cardiovascular Research Centre, Hôpital Européen Georges Pompidou, AP-HP, 75015 Paris, France
| | - Erwan Flecher
- Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Inserm UMR 1099, 35000 Rennes, France
| | - Guy Meyer
- Department of Pneumology, Hôpital Européen Georges Pompidou, AP-HP, Université de Paris and CIC 1418, 75015 Paris, France
| | - Olivier Sanchez
- Department of Pulmonology and Intensive Care, Hôpital Européen Georges Pompidou, AP-HP, Inserm UMRS 1140, Université de Paris, 75270 Paris, France
| | - Costantino Del Giudice
- Vascular and Oncological Interventional Radiology, Inserm U970, Paris Cardiovascular Research Centre, Hôpital Européen Georges Pompidou, AP-HP, 75015 Paris, France
| | - François Roubille
- Department of Cardiology, CHU de Montpellier, Université de Montpellier, Inserm, CNRS, 34295 Montpellier, France
| | - Laurent Bonello
- Intensive Care Unit, Department of Cardiology, Hôpital Nord, AP-HM, Aix-Marseille Université, 13015 Marseille; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13000 Marseille, France; INSERM 1263, 1260, Centre for Cardiovascular and Nutrition Research (C2VN), INRA, 13385 Marseille, France.
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Lemesle G, Laine M, Bonello L. Reply: The Challenge of Researching Pre-Treatment Omission With Invasive Strategy Timing in NSTEACS. JACC Cardiovasc Interv 2020; 13:1726-1727. [PMID: 32703601 DOI: 10.1016/j.jcin.2020.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 06/01/2020] [Indexed: 11/28/2022]
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Laine M, Lemesle G, Burtey S, Cayla G, Range G, Quaino G, Canault M, Pankert M, Paganelli F, Puymirat E, Bonello L. TicagRelor Or Clopidogrel in severe or terminal chronic kidney patients Undergoing PERcutaneous coronary intervention for acute coronary syndrome: The TROUPER trial. Am Heart J 2020; 225:19-26. [PMID: 32473355 DOI: 10.1016/j.ahj.2020.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 04/20/2020] [Indexed: 12/17/2022]
Abstract
Chronic kidney disease (CKD) is associated with an increased risk of acute coronary syndrome (ACS) and cardiovascular death. CKD patients suffering from ACS are exposed to an increased risk of thrombotic recurrences and a higher bleeding rate than patients with normal renal function. However, CKD patients are excluded or underrepresented in clinical trials. Therefore, determining the optimal antiplatelet strategy in this population is of utmost importance. We designed the TicagRelor Or Clopidogrel in severe or terminal chronic kidney patients Undergoing PERcutaneous coronary intervention for acute coronary syndrome (TROUPER) trial: a prospective, controlled, multicenter, randomized trial to investigate the optimal P2Y12 antagonist in CKD patients with ACS. Patients with stage ≥3b CKD are eligible if the diagnosis of ACS is made and invasive strategy scheduled. Patients are randomized 1:1 between a control group with a 600-mg loading dose of clopidogrel followed by a 75-mg/d maintenance dose for 1 year and an experimental group with a 180-mg loading dose of ticagrelor followed by a 90-mg twice daily maintenance dose for the same duration. The primary end point is defined by the rate of major adverse cardiovascular events, including death, myocardial infarction, urgent revascularization, and stroke at 1 year. Safety will be evaluated by the bleeding rate (Bleeding Academic Research Consortium). To demonstrate the superiority of ticagrelor on major adverse cardiovascular events, we calculated that 508 patients are required. The aim of the TROUPER trial is to compare the efficacy of ticagrelor and clopidogrel in stage >3b CKD patients presenting with ACS and scheduled for an invasive strategy. RCT# NCT03357874.
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Affiliation(s)
- Marc Laine
- Aix-Marseille Univ, Intensive cardiac care unit, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France; Aix Marseille Univ, INSERM, INRA, C2VN, Marseille, France.
| | - Gilles Lemesle
- Institut Cœur et Poumon, CHRU de Lille, Faculté de Médecine de l'Université de Lille, Unité INSERM UMR 1011, Lille, France
| | - Stéphane Burtey
- Aix Marseille Univ, INSERM, INRA, C2VN, Marseille, France; Service de Néphrologie, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | | | - Grégoire Range
- Département de Cardiologie, CHU Chartres, Chartres, France
| | - Gonzalo Quaino
- Service de Cardiologie, Centre Hospitalier Toulon, Toulon, France
| | | | - Mathieu Pankert
- Service de Cardiologie, Centre Hospitalier d'Avignon, Avignon, France
| | - Franck Paganelli
- Aix-Marseille Univ, Intensive cardiac care unit, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
| | - Etienne Puymirat
- Département de Cardiologie, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, Université Paris Descartes, INSERM U-970, Paris, France
| | - Laurent Bonello
- Aix-Marseille Univ, Intensive cardiac care unit, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France; Aix Marseille Univ, INSERM, INRA, C2VN, Marseille, France
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Akodad M, Delmas C, Bonello L, Duflos C, Roubille F. Intra-aortic balloon pump: is the technique really outdated? ESC Heart Fail 2020; 7:1025-1030. [PMID: 32307904 PMCID: PMC7261556 DOI: 10.1002/ehf2.12721] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 02/29/2020] [Accepted: 03/31/2020] [Indexed: 11/21/2022] Open
Abstract
Aims Intra‐aortic balloon pump (IABP) utilization was expected to be quickly abandoned following the IABP‐shock trial and its class III, level B recommendation in the 2016 European Society of Cardiology (ESC) guidelines. The aim of this study was to evaluate the use of IABP compared with other mechanical support devices in a nationwide approach. Methods and results We conducted a retrospective study based on the French national hospital discharge database. All patients undergoing assist device implantation by IABP, extracorporeal membrane oxygenation (ECMO), or IMPELLA® from 2014 to 2018 (2 years before/2 years after the 2016 guidelines) were included. The primary endpoint was the incidence of IABP implantation over the years. Secondary endpoints were incidence of total assist device, ECMO, and IMPELLA® implantations. From 2014 to 2018, a total of 18 940 patients benefited from mechanical support by IABP (n = 6657, 35.2%), ECMO (n = 11 881, 62.7%), or IMPELLA® (n = 402, 2.1%) in France. The incidence of total mechanical support implantations (ECMO and IABP) was constant over the years. IABP implantations decreased progressively from 1725 implantations in 2014 to 996 in 2018 (−42%). By contrast, ECMO implantations increased progressively from 1919 implantations in 2014 to 2763 implantations in 2018 (+44%). IMPELLA® implantations remained stable over the years from 63 (1.7%) implantations in 2014 to 83 (2.1%) in 2018. Conclusions In this nationwide real‐life study, despite a significant decline in IABP implantations over the years since the ESC guidelines, this device remained used in clinical practice with around 1000 implantations in 2018. The size of centres was not strictly correlated with this use, suggesting differential uses depending on the local background.
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Affiliation(s)
- Mariama Akodad
- Department of Cardiology, Montpellier University Hospital, 34295, Montpellier, Cedex 5, France.,PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295, Montpellier, Cedex 5, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Cardiology Department, University Hospital of Rangueil, 31059, Toulouse, France
| | - Laurent Bonello
- Department of Cardiology, Intensive Care Unit, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France
| | - Claire Duflos
- Department of Medical Information, Montpellier University Hospital, 34295, Montpellier, Cedex 5, France
| | - François Roubille
- Department of Cardiology, Montpellier University Hospital, 34295, Montpellier, Cedex 5, France.,PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295, Montpellier, Cedex 5, France
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Bonello L, Delmas C, Gaubert M, Schurtz G, Ouattara A, Roubille F. Trials of mechanical circulatory support with percutaneous axial flow pumps in cardiogenic shock complicating acute myocardial infarction: Mission impossible? Arch Cardiovasc Dis 2020; 113:448-460. [PMID: 32291187 DOI: 10.1016/j.acvd.2020.02.001] [Citation(s) in RCA: 4] [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: 09/11/2019] [Revised: 12/06/2019] [Accepted: 02/11/2020] [Indexed: 01/05/2023]
Abstract
Cardiogenic shock is a complex clinical entity associated with very high mortality and intensive resource utilization. Despite the widespread use of timely reperfusion and appropriate pharmacotherapy, the survival rate remains at around 50%. Recently, percutaneous axial flow pumps have been integrated into the therapeutic spectrum of cardiogenic shock management. However, most of the literature supporting their use stems from observational studies. To date, attempts to perform randomized controlled trials with percutaneous axial flow pumps have failed. This underlines the challenge of performing a well-conducted randomized controlled trial that provides the highest level of evidence. Such a trial is warranted, because percutaneous axial flow pumps are costly, and are associated with serious complications. The major pitfalls of previous studies were lack of standardized cardiogenic shock definitions according to clinical severity, inappropriate patient and device selection, lack of standardized trial endpoints and high rates of crossovers; these issues must be carefully considered and evaluated. In light of recent trial failures, we aim to summarize the challenges associated with performing randomized controlled trials of percutaneous axial flow pumps in patients experiencing acute myocardial infarction complicated by cardiogenic shock, and to suggest potential means of overcoming them.
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Affiliation(s)
- Laurent Bonello
- Aix-Marseille University, Intensive Care Unit, Department of Cardiology, hôpital Nord, AP-HM, chemin des Bourrely, 13015 Marseille, France; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France; Inserm 1263, INRA 1260, Centre for CardioVascular and Nutrition Research (C2VN), 13385 Marseille, France.
| | - Clément Delmas
- Intensive Cardiac Care Unit, Rangueil University Hospital, 31400 Toulouse, France; Cardiovascular Diseases (I2MC), Institute of Metabolic and UMR-1048, Institut national de la santé et de la recherche médicale (Inserm), 31432 Toulouse, France
| | - Mélanie Gaubert
- Aix-Marseille University, Intensive Care Unit, Department of Cardiology, hôpital Nord, AP-HM, chemin des Bourrely, 13015 Marseille, France; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France; Inserm 1263, INRA 1260, Centre for CardioVascular and Nutrition Research (C2VN), 13385 Marseille, France
| | - Guillaume Schurtz
- Intensive Cardiac Care Unit, université de Lille, Institut Coeur-Poumon Inserm, Institut Pasteur, U1011, 59000 Lille, France
| | - Alexandre Ouattara
- Department of Anaesthesia and Critical Care, Magellan Medico-Surgical Centre, CHU de Bordeaux, 33000 Bordeaux, France; Inserm, UMR 1034, Biology of Cardiovascular Diseases, University of Bordeaux, 33600 Pessac, France
| | - François Roubille
- PhyMedExp, CNRS, Cardiology Department, université de Montpellier, Inserm, CHU de Montpellier, 34295 Montpellier, France
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Lemesle G, Laine M, Pankert M, Boueri Z, Motreff P, Paganelli F, Baumstarck K, Roch A, Kerbaul F, Puymirat E, Bonello L. Optimal Timing of Intervention in NSTE-ACS Without Pre-Treatment. JACC Cardiovasc Interv 2020; 13:907-917. [DOI: 10.1016/j.jcin.2020.01.231] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/13/2020] [Accepted: 01/28/2020] [Indexed: 10/24/2022]
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Aissaoui N, Puymirat E, Delmas C, Ortuno S, Durand E, Bataille V, Drouet E, Bonello L, Bonnefoy‐Cudraz E, Lesmeles G, Guerot E, Schiele F, Simon T, Danchin N. Trends in cardiogenic shock complicating acute myocardial infarction. Eur J Heart Fail 2020; 22:664-672. [DOI: 10.1002/ejhf.1750] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/18/2019] [Accepted: 12/28/2019] [Indexed: 12/17/2022] Open
Affiliation(s)
- Nadia Aissaoui
- Department of Critical Care, Assistance Publique‐Hôpitaux de Paris (APHP) Hôpital Européen Georges Pompidou (HEGP) Paris France
- Faculty of Medicine University Paris Descartes Paris France
- INSERM U970, Paris Cardiovascular Research Center PARCC Paris France
| | - Etienne Puymirat
- Faculty of Medicine University Paris Descartes Paris France
- Department of Cardiology Assistance Publique‐Hôpitaux de Paris, Hôpital Européen Georges Pompidou Paris France
| | - Clément Delmas
- Intensive Cardiac Care Unit, CHU Rangueil Toulouse France
| | - Sofia Ortuno
- Department of Critical Care, Assistance Publique‐Hôpitaux de Paris (APHP) Hôpital Européen Georges Pompidou (HEGP) Paris France
- Faculty of Medicine University Paris Descartes Paris France
| | - Eric Durand
- Department of Clinical Pharmacology and Clinical Research Platform of East of Paris (URCEST‐CRB‐CRC) APHP‐Sorbonne Université, Hôpital St Antoine Paris France
- Hôpital Charles Nicolle Rouen France
| | | | - Elodie Drouet
- Department of Clinical Pharmacology and Clinical Research Platform of East of Paris (URCEST‐CRB‐CRC) APHP‐Sorbonne Université, Hôpital St Antoine Paris France
- Hôpital Charles Nicolle Rouen France
| | | | | | | | - Emmanuel Guerot
- Department of Critical Care, Assistance Publique‐Hôpitaux de Paris (APHP) Hôpital Européen Georges Pompidou (HEGP) Paris France
- Faculty of Medicine University Paris Descartes Paris France
| | | | - Tabassome Simon
- Department of Clinical Pharmacology and Clinical Research Platform of East of Paris (URCEST‐CRB‐CRC) APHP‐Sorbonne Université, Hôpital St Antoine Paris France
- Unité INSERM U‐1148 Paris France
- FACT (French Alliance for Cardiovascular Trials), An F‐CRIN Network Paris France
- Sorbonne‐Université, UPMC Paris France
| | - Nicolas Danchin
- Faculty of Medicine University Paris Descartes Paris France
- Department of Cardiology Assistance Publique‐Hôpitaux de Paris, Hôpital Européen Georges Pompidou Paris France
- FACT (French Alliance for Cardiovascular Trials), An F‐CRIN Network Paris France
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Laine M, Panagides V, Frère C, Cuisset T, Gouarne C, Jouve B, Thuny F, Paganelli F, Alessi MC, Mancini J, Bonello L. Platelet reactivity inhibition following ticagrelor loading dose in patients undergoing percutaneous coronary intervention for acute coronary syndrome. J Thromb Haemost 2019; 17:2188-2195. [PMID: 31351022 DOI: 10.1111/jth.14592] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 07/23/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Ticagrelor induces more potent platelet reactivity (PR) inhibition with reduced interindividual variability compared to clopidogrel. Although on-clopidogrel PR was shown to correlate with ischemia and bleeding events, no study has investigated the relationship between on-ticagrelor PR and outcome. OBJECTIVES We aimed to evaluate the relationship between on-ticagrelor PR, assessed by the vasodilator-stimulated phosphoprotein index (VASP), and thrombotic and bleeding events in patients with acute coronary syndrome (ACS) treated by percutaneous coronary intervention (PCI). METHODS We performed a prospective, multicenter observational study on patients treated with PCI for ACS. The VASP index was used to assess PR after ticagrelor loading dose (LD). The primary endpoint was the link between major adverse cardiovascular events (MACE) and PR. RESULTS Among the 530 patients with ACS included, 183 (34.5%) were admitted for ST elevation myocardial infarction. We observed high potency and limited interindividual variability after the ticagrelor LD (VASP 19.1% ± 16.6%). At 1 month, 21 (3.8%) MACE and 29 (5.5%) bleedings ≥ 2 according to the Bleedings Academic Research Consortium (BARC) scale were recorded. Neither MACE nor bleeding was associated with PR (P = .34 and P = .78, respectively). However, there was a strong association between PR and the occurrence of definite acute stent thrombosis (P = .03). Platelet reactivity was the only factor associated with acute definite stent thrombosis. CONCLUSION In patients receiving a ticagrelor LD while undergoing PCI for ACS, PR using the VASP did not predict MACE or bleeding, but it was significantly associated with the occurrence of definite acute stent thrombosis.
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Affiliation(s)
- Marc Laine
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, Marseille, France
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
| | - Vassili Panagides
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, Marseille, France
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
| | - Corinne Frère
- Department of Haematology, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | | | - Caroline Gouarne
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, Marseille, France
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
| | - Bernard Jouve
- Department of Cardiology, Hospital of Aix-en-Provence, Aix-en-Provence, France
| | - Franck Thuny
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, Marseille, France
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
| | - Franck Paganelli
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, Marseille, France
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
| | - Marie-Christine Alessi
- Centre for CardioVascular and Nutrition Research (C2VN), INSERM 1263, INRA 1260, Marseille, France
| | - Julien Mancini
- Department of Public Health (BIOSTIC), Aix-Marseille University, Hôpital de la Timone, Marseille, France
| | - Laurent Bonello
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, Marseille, France
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France
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Leurent G, Auffret V, Pichard C, Laine M, Bonello L. Is there still a role for the intra-aortic balloon pump in the management of cardiogenic shock following acute coronary syndrome? Arch Cardiovasc Dis 2019; 112:792-798. [DOI: 10.1016/j.acvd.2019.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/23/2019] [Accepted: 04/23/2019] [Indexed: 12/21/2022]
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