1
|
Fayol A, Schiele F, Ferrières J, Puymirat E, Bataille V, Tea V, Chamandi C, Albert F, Lemesle G, Cayla G, Weizman O, Simon T, Danchin N. Association of Use and Dose of Lipid-Lowering Therapy Post Acute Myocardial Infarction With 5-Year Survival in Older Adults. Circ Cardiovasc Qual Outcomes 2024:e010685. [PMID: 38682335 DOI: 10.1161/circoutcomes.123.010685] [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: 11/01/2023] [Accepted: 03/18/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Older people are underrepresented in randomized trials. The association between lipid-lowering therapy (LLT) and its intensity after acute myocardial infarction and long-term mortality in this population deserves to be assessed. METHODS The FAST-MI (French Registry of Acute ST-Elevation or Non-ST-Elevation Myocardial Infarction) program consists of nationwide French surveys including all patients admitted for acute myocardial infarction ≤48 hours from onset over a 1- to 2-month period in 2005, 2010, and 2015, with long-term follow-up. Numerous data were collected and a centralized 10-year follow-up was organized. The present analysis focused on the association between prescription of LLT (atorvastatin ≥40 mg or equivalent, or any combination of statin and ezetimibe) and 5-year mortality in patients aged ≥80 years discharged alive. Cox multivariable analysis and propensity score matching were used to adjust for baseline differences. RESULTS Among the 2258 patients aged ≥80 years (mean age, 85±4 years; 51% women; 39% ST-segment elevation myocardial infarction; 58% with percutaneous coronary intervention), 415 were discharged without LLT (18%), 866 with conventional doses (38%), and 977 with high-dose LLT (43%). Five-year survival was 36%, 47.5%, and 58%, respectively. Compared with patients without LLT, high-dose LLT was significantly associated with lower 5-year mortality (adjusted hazard ratio, 0.78 [95% CI, 0.66-0.92]), whereas conventional-intensity LLT was not (adjusted hazard ratio, 0.93 [95% CI, 0.80-1.09]). In propensity score-matched cohorts (n=278 receiving high-intensity LLT and n=278 receiving no statins), 5-year survival was 52% with high-intensity LLT at discharge and 42% without statins (hazard ratio, 0.78 [95% CI, 0.62-0.98]). CONCLUSIONS In these observational cohorts, high-intensity LLT at discharge after acute myocardial infarction was associated with reduced all-cause mortality at 5 years in an older adult population. These results suggest that high-intensity LLT should not be denied to patients on the basis of old age. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifiers: NCT00673036, NCT01237418, and NCT02566200.
Collapse
Affiliation(s)
- Antoine Fayol
- Assistance Publique-Hôpitaux de Paris, Departement of Cardiology, Hôpital Européen Georges-Pompidou, France (A.F., E.P., V.T., C.C., O.W., N.D.)
- University Paris Cité, France (A.F., E.P., V.T., C.C., O.W., N.D.)
| | - François Schiele
- Department of Cardiology, University Hospital Jean-Minjoz, Besançon, France (F.S.)
| | - Jean Ferrières
- Department of Cardiology, Toulouse Rangueil University Hospital, Institut National pour la Santé Et la Recherche Médicale Unité Mixte de Recherche, Toulouse cedex, France Emergency Department, Rangueil Hospital, Toulouse (J.F., V.B.)
| | - Etienne Puymirat
- Assistance Publique-Hôpitaux de Paris, Departement of Cardiology, Hôpital Européen Georges-Pompidou, France (A.F., E.P., V.T., C.C., O.W., N.D.)
- University Paris Cité, France (A.F., E.P., V.T., C.C., O.W., N.D.)
| | - Vincent Bataille
- Department of Cardiology, Toulouse Rangueil University Hospital, Institut National pour la Santé Et la Recherche Médicale Unité Mixte de Recherche, Toulouse cedex, France Emergency Department, Rangueil Hospital, Toulouse (J.F., V.B.)
| | - Victoria Tea
- Assistance Publique-Hôpitaux de Paris, Departement of Cardiology, Hôpital Européen Georges-Pompidou, France (A.F., E.P., V.T., C.C., O.W., N.D.)
- University Paris Cité, France (A.F., E.P., V.T., C.C., O.W., N.D.)
| | - Chekrallah Chamandi
- Assistance Publique-Hôpitaux de Paris, Departement of Cardiology, Hôpital Européen Georges-Pompidou, France (A.F., E.P., V.T., C.C., O.W., N.D.)
- University Paris Cité, France (A.F., E.P., V.T., C.C., O.W., N.D.)
| | - Franck Albert
- Department of Cardiology, Hospital of Chartres, France (F.A.)
| | - Gilles Lemesle
- Department of Cardiology, Heart and Lung Institute, University Hospital of Lille, France (G.L.)
- University of Lille, France (G.L.)
- Institut Pasteur de Lille, France (G.L.)
- FACT (French Alliance for Cardiovascular Trials), Paris (G.L.)
| | - Guillaume Cayla
- Department of Cardiology, University Hospital of Nimes, University of Montpellier, France (G.C.)
| | - Orianne Weizman
- Assistance Publique-Hôpitaux de Paris, Departement of Cardiology, Hôpital Européen Georges-Pompidou, France (A.F., E.P., V.T., C.C., O.W., N.D.)
- University Paris Cité, France (A.F., E.P., V.T., C.C., O.W., N.D.)
| | - Tabassome Simon
- Department of Pharmacology and Clinical Research Platform of East of Paris (Unité de Recherche Clinique des hopitaux EST parisiens, Comité de Recherche Clinique des hopitaux EST parisiens, Centre de Ressources Biologiques), Hôpital St Antoine, Sorbonne University, and FACT (T.S.)
| | - Nicolas Danchin
- Assistance Publique-Hôpitaux de Paris, Departement of Cardiology, Hôpital Européen Georges-Pompidou, France (A.F., E.P., V.T., C.C., O.W., N.D.)
- University Paris Cité, France (A.F., E.P., V.T., C.C., O.W., N.D.)
- Hôpital Paris St Joseph, and FACT (N.D.)
| |
Collapse
|
2
|
Weizman O, Gandjbakhch E, Magnin-Poull I, Proukhnitzky J, Bordet C, Palmyre A, Bloch A, Fressart V, Charron P. Molecular genetic screening after non-ischaemic sudden cardiac arrest and no overt cardiomyopathy in real life: A major tool for the aetiological diagnostic work-up. Arch Cardiovasc Dis 2024:S1875-2136(24)00051-2. [PMID: 38670870 DOI: 10.1016/j.acvd.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 02/22/2024] [Accepted: 02/26/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND With the development of advanced sequencing techniques, genetic testing has emerged as a valuable tool for the work-up of non-ischaemic sudden cardiac arrest (SCA). AIMS To evaluate the effectiveness of genetic testing in patients with unexplained SCA, according to clinical phenotype. METHODS All patients who underwent molecular genetic testing for non-ischaemic SCA with no left ventricular cardiomyopathy between 2012 and 2021 in two French university hospitals were included. RESULTS Of 66 patients (mean age 36.7±11.9years, 54.5% men), 21 (31.8%; 95% confidence interval 22.4-45.3%) carried a genetic variant: eight (12.1%) had a pathogenic or likely pathogenic (P/LP) variant and 13 (19.7%) had a variant of uncertain significance (VUS). Among 37 patients (56.1%) with no phenotypic clues, genetic testing identified a P/LP variant in five (13.5%), mainly in RYR2 (n=3) and SCN5A (n=2), and a VUS in nine (24.3%). None of the nine patients with phenotypic evidence of channelopathies had P/LP variants, but two had VUS in RYR2 and NKX2.5. Among the 20 patients with suspected arrhythmogenic cardiomyopathy, three P/LP variants (15.0%) and two VUS (10.0%) were found in DSC2, PKP2, SCN5A and DSG2, TRPM4, respectively. Genetic testing was performed sooner after cardiac arrest (P<0.001) and results were obtained more rapidly (P=0.02) after versus before 2016. CONCLUSION This study highlights the utility of molecular genetic testing with a genetic variant of interest identified in one-third of patients with unexplained SCA. Genetic testing was beneficial even in patients without phenotypic clues, with one-fourth of patients carrying a P/LP variant that could have direct implications.
Collapse
Affiliation(s)
- Orianne Weizman
- Cardiology department, Nancy university hospital, Nancy, France; AP-HP, unité de génétique médicale, CHU Ambroise-Paré, 92100 Boulogne-Billancourt, France.
| | - Estelle Gandjbakhch
- AP-HP, cardiology department, Institute of cardiology, Institute for cardiometabolism and nutrition (ICAN), Pitié-Salpêtrière hospital, Paris, France; Sorbonne université, Inserm 1166, Paris, France; AP-HP, département de génétique, Centre de référence des maladies cardiaques héréditaires ou rares, Pitié-Salpêtrière hospital, Paris, France
| | | | - Julie Proukhnitzky
- AP-HP, cardiology department, Institute of cardiology, Institute for cardiometabolism and nutrition (ICAN), Pitié-Salpêtrière hospital, Paris, France; Sorbonne université, Inserm 1166, Paris, France; AP-HP, département de génétique, Centre de référence des maladies cardiaques héréditaires ou rares, Pitié-Salpêtrière hospital, Paris, France
| | - Céline Bordet
- AP-HP, département de génétique, Centre de référence des maladies cardiaques héréditaires ou rares, Pitié-Salpêtrière hospital, Paris, France
| | - Aurélien Palmyre
- AP-HP, unité de génétique médicale, CHU Ambroise-Paré, 92100 Boulogne-Billancourt, France
| | - Adrien Bloch
- AP-HP, Biochemistry department, molecular cardiogenetics unit, Pitié-Salpêtrière hospital, Paris, France
| | - Véronique Fressart
- AP-HP, Biochemistry department, molecular cardiogenetics unit, Pitié-Salpêtrière hospital, Paris, France
| | - Philippe Charron
- AP-HP, unité de génétique médicale, CHU Ambroise-Paré, 92100 Boulogne-Billancourt, France; AP-HP, cardiology department, Institute of cardiology, Institute for cardiometabolism and nutrition (ICAN), Pitié-Salpêtrière hospital, Paris, France; Sorbonne université, Inserm 1166, Paris, France; AP-HP, département de génétique, Centre de référence des maladies cardiaques héréditaires ou rares, Pitié-Salpêtrière hospital, Paris, France.
| |
Collapse
|
3
|
Bohm P, Barra S, Weizman O, Narayanan K, Meyer T, Schmied C, Bougouin W, Jouven X, Marijon E. Sudden Cardiac Arrest During Sports in Children and Adolescents. Circulation 2024; 149:794-796. [PMID: 38437484 DOI: 10.1161/circulationaha.123.064739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Affiliation(s)
- Philipp Bohm
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany (P.B., T.M.)
- Department of Cardiology, University Heart Center Zurich, Switzerland (P.B., C.S.)
- Rehabilitation Centre, Hochgebirgsklinik, Davos, Switzerland (P.B.)
| | - Sergio Barra
- Université Paris-Cité, Institut National de la Santé et de la Recherche Médicale U970, Paris Cardiovascular Research Center, France (S.B., O.W., K.N., W.B., X.J., E.M.)
- Cardiology Department, Hospital da Luz Arrábida, V. N. Gaia, Portugal (S.B.)
| | - Orianne Weizman
- Université Paris-Cité, Institut National de la Santé et de la Recherche Médicale U970, Paris Cardiovascular Research Center, France (S.B., O.W., K.N., W.B., X.J., E.M.)
| | - Kumar Narayanan
- Université Paris-Cité, Institut National de la Santé et de la Recherche Médicale U970, Paris Cardiovascular Research Center, France (S.B., O.W., K.N., W.B., X.J., E.M.)
- Medicover Hospitals, Hyderabad, India (K.N.)
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany (P.B., T.M.)
| | - Christian Schmied
- Department of Cardiology, University Heart Center Zurich, Switzerland (P.B., C.S.)
| | - Wulfran Bougouin
- Université Paris-Cité, Institut National de la Santé et de la Recherche Médicale U970, Paris Cardiovascular Research Center, France (S.B., O.W., K.N., W.B., X.J., E.M.)
- Intensive Care Unit, Jacques Cartier Hospital, Massy, France (W.B.)
| | - Xavier Jouven
- Université Paris-Cité, Institut National de la Santé et de la Recherche Médicale U970, Paris Cardiovascular Research Center, France (S.B., O.W., K.N., W.B., X.J., E.M.)
- Division of Cardiology, European Georges Pompidou Hospital, Paris, France (X.J., E.M.)
| | - Eloi Marijon
- Université Paris-Cité, Institut National de la Santé et de la Recherche Médicale U970, Paris Cardiovascular Research Center, France (S.B., O.W., K.N., W.B., X.J., E.M.)
- Division of Cardiology, European Georges Pompidou Hospital, Paris, France (X.J., E.M.)
| |
Collapse
|
4
|
Weizman O, Tea V, Marijon E, Eltchaninoff H, Manzo-Silberman S, Leclercq F, Albert F, Bataille V, Drouet E, Naccache N, Puymirat E, Ferrières J, Schiele F, Simon T, Danchin N. Very long-term outcomes after acute myocardial infarction in young men and women: Insights from the FAST-MI program. Arch Cardiovasc Dis 2023; 116:324-334. [PMID: 37391340 DOI: 10.1016/j.acvd.2023.05.006] [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: 03/01/2023] [Revised: 04/27/2023] [Accepted: 05/02/2023] [Indexed: 07/02/2023]
Abstract
AIMS Conflicting data exists about long-term outcomes in young women and men experiencing acute myocardial infarction (AMI). METHODS The FAST-MI program consists of three nationwide French surveys carried out 5years apart from 2005 to 2015, including consecutive patients with AMI over a 1-month period with up to 10-year follow-up. The present analysis focused on adults≤50 yo according to their gender. RESULTS Women accounted for 17.5% (335) of the 1912 patients under 50 yo and had a similar age as men (43.9±5.1 vs. 43.9±5.5years, P=0.92). They received less percutaneous coronary interventions (PCI) than men (85.9% vs. 91.3%, P=0.005), even in ST-elevation myocardial infarction (83.6% vs. 93.5%, P<0.001). Recommended secondary prevention medications were less frequently prescribed at discharge in women (40.6% vs. 52.8%, P<0.001), a trend that persisted in 2015 (59.1% vs. 72.8% in 2015, P<0.001). Still, ten-year survival was similar in men (90.5%) and women (92.3%) (crude HR: 0.86 [95% CI: 0.55-1.35], P=0.52, adjusted HR: 0.63 [95% CI: 0.38-1.07], P=0.09); similar results were found for ten-year survival among hospital survivors (91.2% in men vs. 93.7% in women, adjusted HR: 0.87 [95% CI: 0.45-1.66], P=0.66). Of the 1684 patients alive at hospital discharge with morbidity follow-up≥6months available, death, AMI or stroke at 8years occurred in 12.9% men and 11.2% in women (adjusted HR: 0.90 [95% CI: 0.60-1.33], P=0.59). CONCLUSIONS Young women with AMI undergo less cardiac interventions and are less often prescribed secondary prevention treatment than men, even when significant coronary artery disease is present, but keep a similar long-term prognosis after AMI. Optimal management of these young patients, regardless of gender, is necessary to ensure best outcomes after this major cardiovascular event.
Collapse
Affiliation(s)
- Orianne Weizman
- Assistance publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou (HEGP), Department of Cardiology, Paris, France; Université Paris-Descartes, Paris, France
| | - Victoria Tea
- Assistance publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou (HEGP), Department of Cardiology, Paris, France; Université Paris-Descartes, Paris, France
| | - Eloi Marijon
- Assistance publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou (HEGP), Department of Cardiology, Paris, France; Université Paris-Descartes, Paris, France
| | - Hélène Eltchaninoff
- Normandie Université, UNIROUEN, U1096, CHU Rouen, Department of Cardiology, 76000 Rouen, France
| | - Stéphane Manzo-Silberman
- Institut de Cardiologie, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France; Sorbonne Université, ACTION Study Group, Paris, France
| | - Florence Leclercq
- Centre Hospitalier Universitaire Arnaud-de-Villeneuve, Montpellier, France
| | | | - Vincent Bataille
- Toulouse University Hospital, Department of Cardiology B and Epidemiology, Toulouse, France; UMR INSERM 1027, Toulouse, France
| | - Elodie Drouet
- AP-HP, Hôpital Saint-Antoine, Department of Clinical Pharmacology and Unité de Recherche Clinique (URCEST), Paris, France; Université Pierre-et-Marie-Curie (UPMC-Paris 06), INSERM U-698, Paris, France
| | | | - Etienne Puymirat
- Assistance publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou (HEGP), Department of Cardiology, Paris, France; Université Paris-Descartes, Paris, France
| | - Jean Ferrières
- Toulouse University Hospital, Department of Cardiology B and Epidemiology, Toulouse, France; UMR INSERM 1027, Toulouse, France
| | - François Schiele
- University Hospital Jean-Minjoz, Department of Cardiology, Besançon, France
| | - Tabassome Simon
- AP-HP, Hôpital Saint-Antoine, Department of Clinical Pharmacology and Unité de Recherche Clinique (URCEST), Paris, France; Université Pierre-et-Marie-Curie (UPMC-Paris 06), INSERM U-698, Paris, France
| | - Nicolas Danchin
- Assistance publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou (HEGP), Department of Cardiology, Paris, France; Université Paris-Descartes, Paris, France.
| |
Collapse
|
5
|
Martin AC, Weizman O, Sellal JM, Algalarrondo V, Amara W, Bouzeman A, Gandjbakhch E, Lellouche N, Louembe J, Menet A, Roumegou P, Treguer F, Godier A, Boveda S, Garcia R, Marijon E. Impact of peri-procedural management of direct oral anticoagulants on pocket haematoma after cardiac electronic device implantation: the StimAOD multicentre prospective study. Europace 2023; 25:euad057. [PMID: 36932714 PMCID: PMC10227661 DOI: 10.1093/europace/euad057] [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] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/17/2023] [Indexed: 03/19/2023] Open
Abstract
AIMS The study aims to investigate the impact of direct oral anticoagulant (DOAC) management on the incidence of pocket haematoma in patients undergoing pacemaker or implantable cardioverter-defibrillator implantation. METHODS AND RESULTS All consecutive patients receiving DOAC and undergoing cardiac electronic device implantation were included in a large multicentre prospective observational study (NCT03879473). The primary endpoint was clinically relevant haematoma within 30 days after implantation. Overall, 789 patients were enrolled [median age 80 (IQR 72-85) years old, 36.4% women, median CHA2DS2-VASc score 4 (IQR 0-8)], of which 632 (80.1%) received a pacemaker implantation. Antiplatelet therapy was combined with DOAC in 146 patients (18.5%). Direct oral anticoagulants (DOACs) were interrupted 52 (IQR 37-62) h before the procedure and resumed 31 (IQR 21-47) h later. Ninety-six percent of the patients had at least 12 h DOAC interruption before the procedure, and 78% had at least 12 h DOAC interruption after the procedure. Overall, anticoagulation was interrupted for 72 (IQR 48-96) h. Pre- or post-procedural heparin bridging was used in 8.2% and 3.9%, respectively. Timing of DOAC interruption of resumption was not associated with clinically relevant haematoma. Clinically relevant haematoma occurred in 26 patients (3.3%), and thromboembolic events occurred in 5 patients (0.6%). CONCLUSION In this large real-life registry where most patients had DOAC interruption, clinically relevant haematoma was rare. Despite DOAC interruption and high CHA2DS2-VASc score, thromboembolic events occurred seldomly, highlighting that bleeding exceeds thromboembolic risk in this peri-procedural period. Future research is needed to identify risk factors for clinically relevant haematoma and meaningfully guide clinicians in optimizing DOAC management.
Collapse
Affiliation(s)
- Anne-Céline Martin
- Department of Cardiology, AP HP, European Hospital Georges Pompidou, 20 rue Leblanc, 75015 Paris, France
- Université Paris Cité, INSERM, Innovative Therapies in Haemostasis, 4 Rue de l'Observatoire 75006 Paris, France
| | - Orianne Weizman
- Department of Cardiology, AP HP, European Hospital Georges Pompidou, 20 rue Leblanc, 75015 Paris, France
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75015 Paris, France
| | - Jean-Marc Sellal
- Department of Cardiology, Nancy University Hospital, Rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
- IADI, INSERM U1254, Université de Lorraine, Rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - Vincent Algalarrondo
- Department of Cardiology, Rhythm Disorders Unit, Bichat Hospital, AP-HP, 46 Rue Henri Huchard, 75018 Paris, France
- Paris Cité University, Paris, France
| | - Walid Amara
- Department of Cardiology, GHI Le Raincy Montfermeil, 10 Rue du Général Leclerc, 93370 Montfermeil, France
| | - Abdeslam Bouzeman
- Department of Cardiology, Parly 2 Private Hospital, 21 Rue Moxouris, 78150 Le Chesnay-Rocquencourt, France
| | - Estelle Gandjbakhch
- Department of Cardiology, Pitié-Salpêtrière University Hospital, Institute of Cardiology, 47-83 Bd de l'Hôpital, 75013 Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, 1166 Paris, France
| | - Nicolas Lellouche
- Department of Cardiology, Hôpital Henri MONDOR, AP-HP, 1 Rue Gustave Eiffel, 94000 Créteil, France
| | - Jules Louembe
- Department of Cardiology, Hôpital d’Instruction des Armées Percy, 2 Rue Lieutenant Raoul Batany, 92140 Clamart, France
| | - Aymeric Menet
- Laboratoire ETHICS, Groupement des Hôpitaux de l'Institut Catholique de Lille, Service de Cardiologie USIC, Université Catholique de Lille, Rue du Grand But, 59400 Lille, France
| | - Pierre Roumegou
- Department of Cardiology, University Hospital Poitiers, 2 Rue de la Milétrie, 86000 Poitiers, France
| | - Frederic Treguer
- Department of Cardiology, Clinique Saint Joseph, 51 Rue de la Foucaudière, 49800 Trélazé, France
| | - Anne Godier
- Université Paris Cité, INSERM, Innovative Therapies in Haemostasis, 4 Rue de l'Observatoire 75006 Paris, France
- Department of Anaesthesiology and Critical Care, APHP, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France
| | - Serge Boveda
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75015 Paris, France
- Cardiology—Heart Rhythm Management Department, Clinique Pasteur, 45 Avenue de Lombez, 31076 Toulouse, France
- Universiteit Ziekenhuis, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Jette Brussels, Belgium
| | - Rodrigue Garcia
- Department of Cardiology, University Hospital Poitiers, 2 Rue de la Milétrie, 86000 Poitiers, France
- CIC1402, University Hospital of Poitiers, 86021 Poitiers, France
| | - Eloi Marijon
- Department of Cardiology, AP HP, European Hospital Georges Pompidou, 20 rue Leblanc, 75015 Paris, France
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75015 Paris, France
| |
Collapse
|
6
|
Weizman O, Empana JP, Blom M, Tan HL, Jonsson M, Narayanan K, Ringh M, Marijon E, Jouven X. Incidence of Cardiac Arrest During Sports Among Women in the European Union. J Am Coll Cardiol 2023; 81:1021-1031. [PMID: 36922087 DOI: 10.1016/j.jacc.2023.01.015] [Citation(s) in RCA: 7] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Women represent a growing proportion of sports participants. Still, few original data regarding sudden cardiac arrest during sports (Sr-SCA) in women are available. OBJECTIVES The authors sought to assess the incidence, characteristics, and outcomes of women presenting with Sr-SCA. METHODS Data were analyzed from 3 population-based European registries (ESCAPE-NET 2020 Horizon Program) that prospectively and exhaustively collect every case of SCA: SDEC (Paris-Sudden Death Expertise Center), ARREST (AmsteRdam REsuscitation Studies), and SRCR (Swedish Register for Cardiopulmonary Resuscitation). Sr-SCA was defined as SCA during or ≤1 hour after cessation of sports activity. RESULTS Of 34,826 SCA between 2006 and 2017, 760 Sr-SCA (2.2%) were identified, including 54 in women. The average annual incidence of Sr-SCA in women in the 3 registries ranged from 0.10 per million (95% CI: 0.01-0.71 per million) to 0.38 per million (95% CI: 0.14-1.04 per million). Overall, the average annual incidence rate of Sr-SCA in women was 0.19 per million (95% CI: 0.14-0.24 per million), >10-fold lower compared with men (2.63 per million [95% CI: 2.45-2.83 per million]; P < 0.0001). When extrapolating to the total European population and accounting for age and sex, this yields 98 cases per year (95% CI: 72-123 cases per year) in women and 1,350 cases per year (95% CI: 1,256-1,451 cases per year) in men. Subject characteristics and circumstances of occurrence were similar in women vs men. Bystander response, time to defibrillation, and survival rate at hospital admission (58.8% vs 58.5%; P = 0.99) and 30 days did not differ significantly between women and men. CONCLUSIONS These findings emphasize the dramatically lower risk of Sr-SCA in women compared with men, despite similar subject characteristics. This should be considered in designing preparticipation screening strategies in the future.
Collapse
Affiliation(s)
- Orianne Weizman
- Université Paris Cité, Inserm, PARCC, Paris, France; Paris Sudden Death Expertise Center (Paris-SDEC), Paris, France
| | - Jean-Philippe Empana
- Université Paris Cité, Inserm, PARCC, Paris, France; Paris Sudden Death Expertise Center (Paris-SDEC), Paris, France
| | - Marieke Blom
- Cardiology Department, Academic Medical Center, Amsterdam, the Netherlands
| | - Hanno L Tan
- Cardiology Department, Academic Medical Center, Amsterdam, the Netherlands
| | - Martin Jonsson
- Center for Resuscitation Science, Karolinska Institute, Stockholm, Sweden
| | - Kumar Narayanan
- Université Paris Cité, Inserm, PARCC, Paris, France; Paris Sudden Death Expertise Center (Paris-SDEC), Paris, France
| | - Mattias Ringh
- Center for Resuscitation Science, Karolinska Institute, Stockholm, Sweden
| | - Eloi Marijon
- Université Paris Cité, Inserm, PARCC, Paris, France; Paris Sudden Death Expertise Center (Paris-SDEC), Paris, France; Hôpital Européen Georges Pompidou, Paris, France.
| | - Xavier Jouven
- Université Paris Cité, Inserm, PARCC, Paris, France; Paris Sudden Death Expertise Center (Paris-SDEC), Paris, France; Hôpital Européen Georges Pompidou, Paris, France
| | | |
Collapse
|
7
|
Boursier C, Weizman O, Chevalier E, Imbert L, Mandry D, Varlot J, Hueber A, Marie PY. Acute Left Atrial Myocarditis due to Close Contact With Inflammatory Nodes and Identified by Combined Cardiac Magnetic Resonance and 68Ga-Dotatoc Positron Emission Tomography Image Analysis. Circ Cardiovasc Imaging 2023; 16:e014770. [PMID: 36715021 DOI: 10.1161/circimaging.122.014770] [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: 01/31/2023]
Affiliation(s)
- Caroline Boursier
- Department of Nuclear Medicine, Université de Lorraine, and Nancyclotep Imaging Platform, CHRU-Nancy, F-54000, Nancy, France. (C.B., E.C., L.I., P.-Y.M.)
| | - Orianne Weizman
- Department of Cardiology, Claude Bernard Clinic Hospital, Metz, France (O.W., A.H.)
| | - Elodie Chevalier
- Department of Nuclear Medicine, Université de Lorraine, and Nancyclotep Imaging Platform, CHRU-Nancy, F-54000, Nancy, France. (C.B., E.C., L.I., P.-Y.M.)
| | - Laetitia Imbert
- Department of Nuclear Medicine, Université de Lorraine, and Nancyclotep Imaging Platform, CHRU-Nancy, F-54000, Nancy, France. (C.B., E.C., L.I., P.-Y.M.).,IADI, INSERM, UMR 1254, Université de Lorraine, Nancy, France (L.I., D.M.)
| | - Damien Mandry
- Department of Radiology, CHRU-Nancy, F-54000, Nancy, France. (D.M.).,IADI, INSERM, UMR 1254, Université de Lorraine, Nancy, France (L.I., D.M.)
| | - Jeanne Varlot
- Department of Cardiology, CHRU-Nancy, F-54000, Nancy, France (J.V.).,Université de Lorraine, INSERM, UMR 1116, 54000, Nancy, France (J.V., P.-Y.M.)
| | - Arnaud Hueber
- Department of Cardiology, Claude Bernard Clinic Hospital, Metz, France (O.W., A.H.)
| | - Pierre-Yves Marie
- Department of Nuclear Medicine, Université de Lorraine, and Nancyclotep Imaging Platform, CHRU-Nancy, F-54000, Nancy, France. (C.B., E.C., L.I., P.-Y.M.).,Université de Lorraine, INSERM, UMR 1116, 54000, Nancy, France (J.V., P.-Y.M.)
| |
Collapse
|
8
|
Weizman O, Duceau B, Trimaille A, Pommier T, Cellier J, Geneste L, Panagides V, Marsou W, Deney A, Attou S, Delmotte T, Ribeyrolles S, Chemaly P, Karsenty C, Giordano G, Gautier A, Chaumont C, Guilleminot P, Sagnard A, Pastier J, Ezzouhairi N, Perin B, Zakine C, Levasseur T, Ma I, Chavignier D, Noirclerc N, Darmon A, Mevelec M, Sutter W, Mika D, Fauvel C, Pezel T, Waldmann V, Cohen A, Bonnet G. Machine learning-based scoring system to predict in-hospital outcomes in patients hospitalized with COVID-19. Arch Cardiovasc Dis 2022; 115:617-626. [PMID: 36376208 PMCID: PMC9595484 DOI: 10.1016/j.acvd.2022.08.003] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/19/2022] [Accepted: 08/01/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The evolution of patients hospitalized with coronavirus disease 2019 (COVID-19) is still hard to predict, even after several months of dealing with the pandemic. AIMS To develop and validate a score to predict outcomes in patients hospitalized with COVID-19. METHODS All consecutive adults hospitalized for COVID-19 from February to April 2020 were included in a nationwide observational study. Primary composite outcome was transfer to an intensive care unit from an emergency department or conventional ward, or in-hospital death. A score that estimates the risk of experiencing the primary outcome was constructed from a derivation cohort using stacked LASSO (Least Absolute Shrinkage and Selection Operator), and was tested in a validation cohort. RESULTS Among 2873 patients analysed (57.9% men; 66.6±17.0 years), the primary outcome occurred in 838 (29.2%) patients: 551 (19.2%) were transferred to an intensive care unit; and 287 (10.0%) died in-hospital without transfer to an intensive care unit. Using stacked LASSO, we identified 11 variables independently associated with the primary outcome in multivariable analysis in the derivation cohort (n=2313), including demographics (sex), triage vitals (body temperature, dyspnoea, respiratory rate, fraction of inspired oxygen, blood oxygen saturation) and biological variables (pH, platelets, C-reactive protein, aspartate aminotransferase, estimated glomerular filtration rate). The Critical COVID-19 France (CCF) risk score was then developed, and displayed accurate calibration and discrimination in the derivation cohort, with C-statistics of 0.78 (95% confidence interval 0.75-0.80). The CCF risk score performed significantly better (i.e. higher C-statistics) than the usual critical care risk scores. CONCLUSIONS The CCF risk score was built using data collected routinely at hospital admission to predict outcomes in patients with COVID-19. This score holds promise to improve early triage of patients and allocation of healthcare resources.
Collapse
Affiliation(s)
- Orianne Weizman
- Centre Hospitalier Régional Universitaire de Nancy, 54511 Vandoeuvre-lès-Nancy, France,Université de Paris, PARCC, INSERM, 75015 Paris, France
| | | | - Antonin Trimaille
- Nouvel Hopital Civil, Centre Hospitalier Régional Universitaire de Strasbourg, 67000 Strasbourg, France
| | - Thibaut Pommier
- Centre Hospitalier Universitaire de Dijon, 21000 Dijon, France
| | - Joffrey Cellier
- Hôpital Européen Georges-Pompidou, Université de Paris, 75015 Paris, France
| | - Laura Geneste
- Centre Hospitalier Universitaire d’Amiens-Picardie, 80000 Amiens, France
| | - Vassili Panagides
- Centre Hospitalier Universitaire de Marseille, 13005 Marseille, France
| | - Wassima Marsou
- GCS-Groupement des Hôpitaux de l’Institut Catholique de Lille, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, 59800 Lille, France
| | - Antoine Deney
- Centre Hospitalier Universitaire de Toulouse, 31400 Toulouse, France
| | - Sabir Attou
- Centre Hospitalier Universitaire de Caen-Normandie, 14000 Caen, France
| | - Thomas Delmotte
- Centre Hospitalier Universitaire de Reims, 51100 Reims, France
| | | | | | - Clément Karsenty
- Centre Hospitalier Universitaire de Toulouse, 31400 Toulouse, France
| | - Gauthier Giordano
- Centre Hospitalier Régional Universitaire de Nancy, 54511 Vandoeuvre-lès-Nancy, France
| | | | - Corentin Chaumont
- Centre Hospitalier Universitaire de Rouen, FHU REMOD-VHF, 76000 Rouen, France
| | | | - Audrey Sagnard
- Centre Hospitalier Universitaire de Dijon, 21000 Dijon, France
| | - Julie Pastier
- Centre Hospitalier Universitaire de Dijon, 21000 Dijon, France
| | - Nacim Ezzouhairi
- Centre Hospitalier Universitaire de Bordeaux, 33076 Bordeaux, France
| | - Benjamin Perin
- Centre Hospitalier Régional Universitaire de Nancy, 54511 Vandoeuvre-lès-Nancy, France
| | - Cyril Zakine
- Clinique Saint-Gatien, 37540 Saint-Cyr-sur-Loire, France
| | - Thomas Levasseur
- Centre Hospitalier Intercommunal Fréjus-Saint-Raphaël, 83600 Fréjus, France
| | - Iris Ma
- Hôpital Européen Georges-Pompidou, Université de Paris, 75015 Paris, France
| | | | | | - Arthur Darmon
- Hôpital Bichat-Claude-Bernard, AP–HP, Université de Paris, 75018 Paris, France
| | - Marine Mevelec
- Centre Hospitalier Régional de Orléans, 45100 Orléans, France
| | - Willy Sutter
- Université de Paris, PARCC, INSERM, 75015 Paris, France
| | - Delphine Mika
- Université Paris-Saclay, Inserm, UMR-S 1180, 92296 Chatenay-Malabry, France
| | - Charles Fauvel
- Centre Hospitalier Universitaire de Rouen, FHU REMOD-VHF, 76000 Rouen, France
| | - Théo Pezel
- Hôpital Lariboisière, AP–HP, Université de Paris, 75010 Paris, France
| | - Victor Waldmann
- Université de Paris, PARCC, INSERM, 75015 Paris, France,Hôpital Européen Georges-Pompidou, Université de Paris, 75015 Paris, France
| | - Ariel Cohen
- Hôpital Saint-Antoine, 75012 Paris, France,Corresponding author. Hôpital Saint-Antoine, 184, Rue du Faubourg Saint-Antoine, 75012 Paris, France
| | - Guillaume Bonnet
- Université de Paris, PARCC, INSERM, 75015 Paris, France,Hôpital Européen Georges-Pompidou, Université de Paris, 75015 Paris, France
| | | |
Collapse
|
9
|
Bohm P, Meyer T, Narayanan K, Schindler M, Weizman O, Beganton F, Schmied C, Bougouin W, Barra S, Dumas F, Varenne O, Cariou A, Karam N, Jouven X, Marijon E. Sports-related sudden cardiac arrest in young adults. Europace 2022; 25:627-633. [PMID: 36256586 PMCID: PMC9935050 DOI: 10.1093/europace/euac172] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 04/11/2022] [Accepted: 08/08/2022] [Indexed: 01/14/2023] Open
Abstract
AIMS Data on sports-related sudden cardiac arrest (SrSCA) among young adults in the general population are scarce. We aimed to determine the overall SrSCA incidence, characteristics, and outcomes in young adults. METHODS AND RESULTS Prospective cohort study of all cases of SrSCA between 2012 and 2019 in Germany and Paris area, France, involving subjects aged 18-35 years. Detection of SrSCA was achieved via multiple sources, including emergency medical services (EMS) reporting and web-based screening of media releases. Cases and aetiologies were centrally adjudicated. Overall, a total of 147 SrSCA (mean age 28.1 ± 4.8 years, 95.2% males) occurred, with an overall burden of 4.77 [95% confidence interval (CI) 2.85-6.68] cases per million-year, including 12 (8.2%) cases in young competitive athletes. While bystander cardiopulmonary resuscitation (CPR) was initiated in 114 (82.6%), automated external defibrillator (AED) use by bystanders occurred only in a minority (7.5%). Public AED use prior to EMS arrival (odds ratio 6.25, 95% CI 1.48-43.20, P = 0.02) was the strongest independent predictor of survival at hospital discharge (38.1%). Among cases that benefited from both immediate bystander CPR and AED use, survival rate was 90.9%. Coronary artery disease was the most frequent aetiology (25.8%), mainly through acute coronary syndrome (86.9%). CONCLUSION Sports-related sudden cardiac arrest in the young occurs mainly in recreational male sports participants. Public AED use remains disappointingly low, although survival may reach 90% among those who benefit from both bystander CPR and early defibrillation. Coronary artery disease is the most prevalent cause of SrSCA in young adults.
Collapse
Affiliation(s)
- Philipp Bohm
- Institute of Sports and Preventive Medicine, Saarland University, 66123 Saarbrücken, Germany,Department of Cardiology, University Heart Center Zurich, HerzZentrum Hirslanden Zurich Witellikerstrasse 36, CH-8008 Zurich, Switzerland
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, 66123 Saarbrücken, Germany
| | - Kumar Narayanan
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France,Cardiology Department, Medicover Hospitals, Madhapur, Hyderabad, Telangana 500081, India
| | - Matthias Schindler
- Department of Cardiology, University Heart Center Zurich, HerzZentrum Hirslanden Zurich Witellikerstrasse 36, CH-8008 Zurich, Switzerland
| | - Orianne Weizman
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France
| | - Frankie Beganton
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France
| | - Christian Schmied
- Department of Cardiology, University Heart Center Zurich, HerzZentrum Hirslanden Zurich Witellikerstrasse 36, CH-8008 Zurich, Switzerland
| | - Wulfran Bougouin
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France,Intensive Care Unit, Jacques cartier Hospital, 6 Av. du Noyer Lambert, 91300 Massy, France
| | - Sergio Barra
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France,Cardiology Department, Hospital da Luz Arrábida, V. N. PCT de Henrique Moreira 150, 4400-346 Vila Nova de Gaia, Portugal
| | - Florence Dumas
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France,Intensive Care Unit, Jacques cartier Hospital, 6 Av. du Noyer Lambert, 91300 Massy, France,Emergency Department, Cochin Hospital, 25 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Olivier Varenne
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France,Intensive Care Unit, Jacques cartier Hospital, 6 Av. du Noyer Lambert, 91300 Massy, France,Cardiology Department, Cochin Hospital, 25 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Alain Cariou
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France,Intensive Care Unit, Jacques cartier Hospital, 6 Av. du Noyer Lambert, 91300 Massy, France,Intensive Care Unit, Cochin Hospital, 25 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Nicole Karam
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France,University of Paris, 103, Boulevard Saint-Michel, Paris, France,Cardiology Department, European Georges Pompidou Hospital, 20 rue Leblanc, 75015 Paris, France
| | - Xavier Jouven
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France,University of Paris, 103, Boulevard Saint-Michel, Paris, France,Cardiology Department, European Georges Pompidou Hospital, 20 rue Leblanc, 75015 Paris, France
| | - Eloi Marijon
- Corresponding author. Tel: +33 6 6283 3848; fax: +33 1 5609 3047. E-mail address:
| |
Collapse
|
10
|
Weizman O, Tea V, Puymirat E, Eltchaninoff H, Cayla G, Ferrieres J, Schiele F, Simon T, Danchin N. Very long-term outcomes after acute myocardial infarction in young men and women. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
There is a paucity of data on very long-term outcomes in young women and men experiencing acute myocardial infarction (AMI).
Methods and results
The FAST-MI program consists of three nationwide French surveys carried out 5 years apart from 2005 to 2015, including consecutive AMI patients over a 1-month period with up to 10-year follow-up. The present analysis focused on adults ≤50 yo according to their gender. Women accounted for 17.5% (N=335) of the 1912 patients under 50 yo and were as old as men (43.9±5.5 vs. 43.9±5.1yo, p=0.92). Non-significant coronary artery disease was more frequent in women (12.8% vs. 5.8%, P<0.001). Women with significant coronary artery disease underwent less percutaneous coronary internvention (PCI) than men (85.9% vs. 91.3%, p=0.005), though primary PCI in ST-elevated myocardial infarction was as frequent in women (67.3% vs. 66.8%). Recommended secondary prevention medications were less prescribed at discharge in women (40.6% vs. 52.8%, p<0.001), a trend that persisted in 2015 (59.1% vs. 72.8% in 2015, p<0.001). Still, ten-year survival was similar in men (90.5%) and women (92.6%) (crude HR 0.87 [95% CI 0.55–1.57], adjusted HR 0.77 [95% CI 0.48–1.23], p=0.27) even among hospital survivors (adjusted HR 0.64 [95% CI 0.32–1.30], p=0.22). Ten-year survival was similar in patients with myocardial infarction with non-obstructive coronary arteries compared with those with significant coronary artery disease (91.8% vs. 91.0%, P=0.46)), both among men (91.6% vs. 90.7%) and women (92.9% vs. 93.0%). However, when taking into account early revascularization and discharge medications, in patients with significant coronary artery disease, adjusted 10-year mortality was significantly lower in women (HR 0.53, 95% CI 0.29–0.96, P=0.04).
Conclusions
Ten-year survival in young women with AMI is similar to that of men. However, in those with significant coronary artery disease, improving secondary prevention in women should result in better long-term outcome.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): French Society of Cardiology
Collapse
Affiliation(s)
- O Weizman
- University Hospital of Nancy , Nancy , France
| | - V Tea
- Hopital Europeen Georges Pompidou-University Paris Descartes, Cardiology , Paris , France
| | - E Puymirat
- Hopital Europeen Georges Pompidou-University Paris Descartes, Cardiology , Paris , France
| | | | - G Cayla
- University Hospital of Nimes , Nimes , France
| | - J Ferrieres
- Toulouse Rangueil University Hospital (CHU) , Toulouse , France
| | - F Schiele
- Regional University Hospital Jean Minjoz , Besancon , France
| | - T Simon
- Hospital Saint-Antoine , Paris , France
| | - N Danchin
- Hopital Europeen Georges Pompidou-University Paris Descartes, Cardiology , Paris , France
| |
Collapse
|
11
|
Weizman O, Marijon E, Narayanan K, Garcia R, Puymirat E, Simon T, Danchin N. Ventricular fibrillation complicating acute myocardial infarction in women. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Very little data is available in women presenting with ventricular fibrillation in the setting of acute myocardial infarction.
Purpose
To investigate sex-discrepancies in the incidence, characteristics and outcomes of acute myocardial infarction complicated by ventricular fibrillation.
Methods
Data were analyzed from the FAST-MI registry, which prospectively included 14,406 patients with acute myocardial infarction (mean age 66±14 years, 72% male, mean left ventricular ejection fraction 52±12%, 59% with ST elevation myocardial infarction). All consecutive patients admitted to French cardiac intensive care units ≤48 hours from acute myocardial infarction onset during a 1-month period every five years during 1995 and 2015 were included. This analysis focused on ventricular fibrillation occurring during the initial in-hospital stay for acute myocardial infarction in women compared to men.
Results
A total of 359 patients developed ventricular fibrillation during acute myocardial infarction, including 81 women (2.0% of 4,091 women overall) and 278 men (2.7% of 10,315) (p=0.02). ST-elevation myocardial infarction (OR 2.29, 95% CI 1.75–2.99, p<0.001) was independently associated with occurrence of ventricular fibrillation, while female gender (OR 0.73, 95% CI 0.56–0.95, p=0.02), hypertension (OR 0.75, 95% CI 0.60–0.94, p=0.01) and prior MI (OR 0.69, 95% CI 0.50–0.96, p=0.03) were protective factors. Women were less likely to have percutaneous coronary intervention during hospitalization than men (48.1% vs. 69.1%, OR 0.48, 95% CI 0.29–0.80, p<0.001). One-year mortality was higher in women compared to men (23.1% vs. 7.0%, HR 5.5, 95% CI 1.7–17.2, p=0.001). However, after adjustment for age, type of myocardial infarction and percutaneous coronary intervention, female gender was no longer associated with a worse one-year mortality (adjusted HR 1.04, 95% CI 0.71–1.51, p=0.85).
Conclusion and relevance
Women have lower risk of developing ventricular fibrillation during acute myocardial infarction compared to men. However, they are less likely to receive early coronary interventions than men, possibly contributing to worse outcomes.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): French Society of Cardiology
Collapse
Affiliation(s)
- O Weizman
- University Hospital of Nancy , Nancy , France
| | - E Marijon
- Hopital Europeen Georges Pompidou-University Paris Descartes, Cardiology , Paris , France
| | - K Narayanan
- Paris Cardiovascular Research Center (PARCC) , Paris , France
| | - R Garcia
- University Hospital of Poitiers, cardiology , Poitiers , France
| | - E Puymirat
- Hopital Europeen Georges Pompidou-University Paris Descartes, Cardiology , Paris , France
| | - T Simon
- Hospital Saint-Antoine , Paris , France
| | - N Danchin
- Hopital Europeen Georges Pompidou-University Paris Descartes, Cardiology , Paris , France
| |
Collapse
|
12
|
Smadja DM, Fellous BA, Bonnet G, Hauw-Berlemont C, Sutter W, Beauvais A, Fauvel C, Philippe A, Weizman O, Mika D, Juvin P, Waldmann V, Diehl JL, Cohen A, Chocron R. D-dimer, BNP/NT-pro-BNP, and creatinine are reliable decision-making biomarkers in life-sustaining therapies withholding and withdrawing during COVID-19 outbreak. Front Cardiovasc Med 2022; 9:935333. [PMID: 36148049 PMCID: PMC9485619 DOI: 10.3389/fcvm.2022.935333] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background The decision for withholding and withdrawing of life-sustaining treatments (LSTs) in COVID-19 patients is currently based on a collegial and mainly clinical assessment. In the context of a global pandemic and overwhelmed health system, the question of LST decision support for COVID-19 patients using prognostic biomarkers arises. Methods In a multicenter study in 24 French hospitals, 2878 COVID-19 patients hospitalized in medical departments from 26 February to 20 April 2020 were included. In a propensity-matched population, we compared the clinical, biological, and management characteristics and survival of patients with and without LST decision using Student's t-test, the chi-square test, and the Cox model, respectively. Results An LST was decided for 591 COVID-19 patients (20.5%). These 591 patients with LST decision were secondarily matched (1:1) based on age, sex, body mass index, and cancer history with 591 COVID-19 patients with no LST decision. The patients with LST decision had significantly more cardiovascular diseases, such as high blood pressure (72.9 vs. 66.7%, p = 0.02), stroke (19.3 vs. 11.1%, p < 0.001), renal failure (30.4 vs. 17.4%, p < 0.001), and heart disease (22.5 vs. 14.9%, p < 0.001). Upon admission, LST patients were more severely attested by a qSOFA score ≥2 (66.5 vs. 58.8%, p = 0.03). Biologically, LST patients had significantly higher values of D-dimer, markers of heart failure (BNP and NT-pro-BNP), and renal damage (creatinine) (p < 0.001). Their evolutions were more often unfavorable (in-hospital mortality) than patients with no LST decision (41.5 vs. 10.3%, p < 0.001). By combining the three biomarkers (D-dimer, BNP and/or NT-proBNP, and creatinine), the proportion of LST increased significantly with the number of abnormally high biomarkers (24, 41.3, 48.3, and 60%, respectively, for none, one, two, and three high values of biomarkers, trend p < 0.01). Conclusion The concomitant increase in D-dimer, BNP/NT-proBNP, and creatinine during the admission of a COVID-19 patient could represent a reliable and helpful tool for LST decision. Circulating biomarker might potentially provide additional information for LST decision in COVID-19.
Collapse
Affiliation(s)
- David M. Smadja
- Université de Paris-Cité, Innovative Therapies in Haemostasis, INSERM, Paris, France
- Hematology Department, AP-HP, Georges Pompidou European Hospital, Paris, France
- *Correspondence: David M. Smadja
| | - Benjamin A. Fellous
- Université de Paris-Cité, Innovative Therapies in Haemostasis, INSERM, Paris, France
| | - Guillaume Bonnet
- Université de Paris, Paris Cardiovascular Research Centre (PARCC), INSERM, UMR-S970, Paris, France
- Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Unité Médico-Chirurgical de Valvulopathies et Cardiomyopathies, Pessac, France
| | | | - Willy Sutter
- Université de Paris, Paris Cardiovascular Research Centre (PARCC), INSERM, UMR-S970, Paris, France
- Vascular Surgery Department, AP-HP, Georges Pompidou European Hospital, Paris, France
| | - Agathe Beauvais
- Université de Paris-Cité, Innovative Therapies in Haemostasis, INSERM, Paris, France
- Emergency Department, AP-HP, Georges Pompidou European Hospital, Paris, France
| | | | - Aurélien Philippe
- Université de Paris-Cité, Innovative Therapies in Haemostasis, INSERM, Paris, France
- Hematology Department, AP-HP, Georges Pompidou European Hospital, Paris, France
| | - Orianne Weizman
- Institut Lorrain du Cœur et des Vaisseaux, CHU de Nancy, Vandoeuvre les Nancy, France
| | - Delphine Mika
- Université Paris-Saclay, Inserm, UMR-S 1180, Chatenay-Malabry, France
| | - Philippe Juvin
- Emergency Department, AP-HP, Georges Pompidou European Hospital, Paris, France
| | - Victor Waldmann
- Université de Paris, Paris Cardiovascular Research Centre (PARCC), INSERM, UMR-S970, Paris, France
- Cardiology Department, AP-HP, Georges Pompidou European Hospital, Paris, France
| | - Jean-Luc Diehl
- Université de Paris-Cité, Innovative Therapies in Haemostasis, INSERM, Paris, France
- Medical Intensive Care Department AP-HP, Georges Pompidou European Hospital, Paris, France
| | - Ariel Cohen
- Cardiology Department, AP-HP, Saint Antoine Hospital, Paris, France
| | - Richard Chocron
- Université de Paris, Paris Cardiovascular Research Centre (PARCC), INSERM, UMR-S970, Paris, France
- Emergency Department, AP-HP, Georges Pompidou European Hospital, Paris, France
| |
Collapse
|
13
|
Weizman O, Marijon E, Narayanan K, Boveda S, Defaye P, Martins R, Deharo JC, Laurent G, Klug D, Sadoul N, Hocini M, Mansencal N, Anselme F, Da Costa A, Maury P, Ferrières J, Schiele F, Simon T, Danchin N. Incidence, Characteristics, and Outcomes of Ventricular Fibrillation Complicating Acute Myocardial Infarction in Women Admitted Alive in the Hospital. J Am Heart Assoc 2022; 11:e025959. [PMID: 36017613 PMCID: PMC9496428 DOI: 10.1161/jaha.122.025959] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Little data are available in women presenting with ventricular fibrillation (VF) in the setting of acute myocardial infarction (AMI). We assessed frequency, predictors of VF, and outcomes, with a special focus on women compared with men. Methods and Results Data were analyzed from the FAST‐MI (French Registry of Acute ST‐Elevation or Non‐ST‐Elevation Myocardial Infarction) program, which prospectively included 14 406 patients admitted to French cardiac intensive care units ≤48 hours from AMI onset between 1995 and 2015 (mean age, 66±14 years; 72% men; mean left ventricular ejection fraction, 52±12%; 59% with ST‐segment–elevation myocardial infarction). A total of 359 patients developed VF during AMI, including 81 women (2.0% of 4091 women) and 278 men (2.7% of 10 315 men, P=0.02). ST‐segment–elevation myocardial infarction (odds ratio [OR], 2.29 [95% CI, 1.75–2.99]; P<0.001) was independently associated with the onset of VF during AMI. In contrast, female sex (OR, 0.73 [95% CI, 0.56–0.95]; P=0.02), hypertension (OR, 0.75 [95% CI, 0.60–0.94]; P=0.01), and prior myocardial infarction (OR, 0.69 [95% CI, 0.50–0.96]; P=0.03) were protective factors. Women were less likely to have cardiac intervention than men (percutaneous coronary intervention during hospitalization 48.1% versus 66.9%, respectively; P=0.04) with a higher 1‐year mortality in women compared with men (50.6% versus 37.4%, respectively; P=0.03), including increased in‐hospital mortality (42.0% versus 32.7%, respectively; P=0.12). After adjustment, female sex was no longer associated with a worse 1‐year mortality (adjusted hazard ratio, 1.10 [95% CI, 0.75–1.61]; P=0.63). Conclusions Women have lower risk of developing VF during AMI compared with men. However, they are less likely to receive cardiac interventions than men, possibly contributing to missed opportunities of improved outcomes.
Collapse
Affiliation(s)
- Orianne Weizman
- Université Paris Cité Inserm, PARCC, F-75015 Paris France.,Faculté de Médecine Université de Lorraine Vandœuvre-lès-Nancy France
| | - Eloi Marijon
- Université Paris Cité Inserm, PARCC, F-75015 Paris France.,Cardiology Department AP-HP, European Georges Pompidou Hospital Paris France
| | | | - Serge Boveda
- Cardiology Department Clinique Pasteur Toulouse France
| | - Pascal Defaye
- Cardiology Department CHU Grenoble La Tronche France
| | | | | | | | - Didier Klug
- Cardiology Department CHU Lille Lille France
| | | | - Meleze Hocini
- Cardiology Department Institut de Rythmologie-Hopital Cardiologique, CHU Bordeaux Pessac France
| | - Nicolas Mansencal
- Cardiology Department AP-HP Hopital Ambroise Paré Boulogne Bilancourt France
| | | | - Antoine Da Costa
- Cardiology Department CHU Saint Etienne Saint Priez en Jarez France
| | - Philippe Maury
- Cardiology Department Rangueil University Hospital Toulouse France
| | - Jean Ferrières
- Cardiology Department Rangueil University Hospital Toulouse France
| | - François Schiele
- Cardiology Department University Hospital Jean Minjoz Besançon France
| | - Tabassome Simon
- Clinical Research Unit Saint-Antoine Hospital AP-HP Paris France
| | - Nicolas Danchin
- Université Paris Cité Inserm, PARCC, F-75015 Paris France.,Cardiology Department AP-HP, European Georges Pompidou Hospital Paris France
| | | |
Collapse
|
14
|
Fauvel C, Trimaille A, Weizman O, Pezel T, Mika D, Waldmann V, Cohen A, Bonnet G. Cardiovascular manifestations secondary to COVID-19: A narrative review. Respir Med Res 2022; 81:100904. [PMID: 35525097 PMCID: PMC9065692 DOI: 10.1016/j.resmer.2022.100904] [Citation(s) in RCA: 1] [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: 12/20/2021] [Revised: 03/01/2022] [Accepted: 03/08/2022] [Indexed: 02/07/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has spread rapidly, becoming a major threat to global health. In addition to having required the adaptation of healthcare workers for almost 2 years, it has been much talked about, both in the media and among the scientific community. Beyond lung damage and respiratory symptoms, the involvement of the cardiovascular system largely explains COVID-19 morbimortality. In this review, we emphasize that cardiovascular involvement is common and is associated with a worse prognosis, and that earlier detection by physicians should lead to better management. First, direct cardiac involvement will be discussed, in the form of COVID-19 myocarditis, then secondary cardiac involvement, such as myocardial injury, myocardial infarction and arrhythmias, will be considered. Finally, worsening of previous cardiovascular disease as a result of COVID-19 will be examined, as well as long-term COVID-19 effects and cardiovascular complications of COVID-19 vaccines.
Collapse
Affiliation(s)
- C. Fauvel
- Cardiology Department, Rouen University Hospital, Rouen 76000, France,Division of Cardiovascular Medicine, Wexner Medical Center, The Ohio State University, 410 West 10th Avenue, Columbus, OH 43210, USA,Corresponding author at: Division of Cardiovascular Medicine, Wexner Medical Center, The Ohio State University, 410 West 10th Avenue, Columbus, OH 43210, USA
| | - A. Trimaille
- Department of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg 67000, France
| | - O. Weizman
- Cardiology Department, Institut Lorrain du Cœur et des Vaisseaux, CHU de Nancy, 54500, France
| | - T. Pezel
- Cardiology Department, Lariboisière Hospital, AP-HP, Université de Paris, Paris 75010, France
| | - D. Mika
- Paris-Saclay University, Inserm, UMR-S 1180, Châtenay-Malabry 92296, France
| | - V. Waldmann
- Cardiology Department, Hôpital Européen Georges Pompidou, Université de Paris, Paris 75015, France
| | - A. Cohen
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, INSERM UMRS-ICAN 1166 and Sorbonne University, Paris, France
| | - G. Bonnet
- Université de Bordeaux, 33000, France,Service Médico-Chirurgicale de Valvulopathies et Cardiomyopathies, Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac 33600, France
| |
Collapse
|
15
|
Trimaille A, Ribeyrolles S, Fauvel C, Chaumont C, Weizman O, Pommier T, Cellier J, Geneste L, Panagides V, Marsou W, Deney A, Attou S, Delmotte T, Chemaly P, Karsenty C, Giordano G, Gautier A, Guilleminot P, Sagnard A, Pastier J, Duceau B, Sutter W, Waldmann V, Pezel T, Mika D, Cohen A, Bonnet G. Cardiovascular Characteristics and Outcomes of Young Patients with COVID-19. J Cardiovasc Dev Dis 2021; 8:jcdd8120165. [PMID: 34940520 PMCID: PMC8704739 DOI: 10.3390/jcdd8120165] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/14/2021] [Accepted: 11/21/2021] [Indexed: 01/10/2023] Open
Abstract
Although 18–45-year-old (y-o) patients represent a significant proportion of patients hospitalized for COVID-19, data concerning the young population remain scarce. The Critical COVID France (CCF) study was an observational study including consecutive patients hospitalized for COVID-19 in 24 centers between 26 February and 20 April 2020. The primary composite outcome included transfer to the intensive care unit (ICU) or in-hospital death. Secondary outcomes were cardiovascular (CV) complications. Among 2868 patients, 321 (11.2%) patients were in the 18–45-y-o range. In comparison with older patients, young patients were more likely to have class 2 obesity and less likely to have hypertension, diabetes and dyslipidemia. The primary outcome occurred less frequently in 18–45-y-o patients in comparison with patients > 45 years old (y/o) (16.8% vs. 30.7%, p < 0.001). The 18–45-y-o patients presented with pericarditis (2.2% vs. 0.5%, p = 0.003) and myocarditis (2.5% vs. 0.6%, p = 0.002) more frequently than patients >45 y/o. Acute heart failure occurred less frequently in 18–45-y-o patients (0.9% vs. 7.2%, p < 0.001), while thrombotic complications were similar in young and older patients. Whereas both transfer to the ICU and in-hospital death occurred less frequently in young patients, COVID-19 seemed to have a particular CV impact in this population.
Collapse
Affiliation(s)
- Antonin Trimaille
- Centre Hospitalier Régional Universitaire de Strasbourg, 67000 Strasbourg, France;
| | | | - Charles Fauvel
- Centre Hospitalier Universitaire de Rouen, 76000 Rouen, France; (C.F.); (C.C.)
| | - Corentin Chaumont
- Centre Hospitalier Universitaire de Rouen, 76000 Rouen, France; (C.F.); (C.C.)
| | - Orianne Weizman
- Centre Hospitalier Régional Universitaire de Nancy, 54511 Vandœuvre-Lès-Nancy, France; (O.W.); (G.G.)
| | - Thibaut Pommier
- Centre Hospitalier Universitaire de Dijon, 21000 Dijon, France; (T.P.); (P.G.); (A.S.); (J.P.)
| | - Joffrey Cellier
- Hôpital Européen Georges Pompidou, Université de Paris, 75015 Paris, France; (J.C.); (W.S.); (V.W.)
| | - Laura Geneste
- Centre Hospitalier Universitaire d’Amiens-Picardie, 80000 Amiens, France;
| | - Vassili Panagides
- Centre Hospitalier Universitaire de Marseille, 13005 Marseille, France;
| | - Wassima Marsou
- Faculté de Médecine et de Maïeutique, GCS-Groupement des Hôpitaux de l’Institut Catholique de Lille, Université Catholique de Lille, 59800 Lille, France;
| | - Antoine Deney
- Centre Hospitalier Universitaire de Toulouse, 31400 Toulouse, France; (A.D.); (C.K.)
| | - Sabir Attou
- Centre Hospitalier Universitaire de Caen-Normandie, 14000 Caen, France;
| | - Thomas Delmotte
- Centre Hospitalier Universitaire de Reims, 51100 Reims, France;
| | - Pascale Chemaly
- Institut Cardiovasculaire Paris Sud, Massy, 91300 Paris, France; (P.C.); (A.G.)
| | - Clément Karsenty
- Centre Hospitalier Universitaire de Toulouse, 31400 Toulouse, France; (A.D.); (C.K.)
| | - Gauthier Giordano
- Centre Hospitalier Régional Universitaire de Nancy, 54511 Vandœuvre-Lès-Nancy, France; (O.W.); (G.G.)
| | - Alexandre Gautier
- Institut Cardiovasculaire Paris Sud, Massy, 91300 Paris, France; (P.C.); (A.G.)
| | - Pierre Guilleminot
- Centre Hospitalier Universitaire de Dijon, 21000 Dijon, France; (T.P.); (P.G.); (A.S.); (J.P.)
| | - Audrey Sagnard
- Centre Hospitalier Universitaire de Dijon, 21000 Dijon, France; (T.P.); (P.G.); (A.S.); (J.P.)
| | - Julie Pastier
- Centre Hospitalier Universitaire de Dijon, 21000 Dijon, France; (T.P.); (P.G.); (A.S.); (J.P.)
| | - Baptiste Duceau
- Paris Cardiovascular Research Center (PARCC), Paris Translational Research Center for Organ Transplantation, INSERM, UMR-S970, Université de Paris, 75015 Paris, France; (B.D.); (G.B.)
| | - Willy Sutter
- Hôpital Européen Georges Pompidou, Université de Paris, 75015 Paris, France; (J.C.); (W.S.); (V.W.)
- Paris Cardiovascular Research Center (PARCC), Paris Translational Research Center for Organ Transplantation, INSERM, UMR-S970, Université de Paris, 75015 Paris, France; (B.D.); (G.B.)
| | - Victor Waldmann
- Hôpital Européen Georges Pompidou, Université de Paris, 75015 Paris, France; (J.C.); (W.S.); (V.W.)
- Paris Cardiovascular Research Center (PARCC), Paris Translational Research Center for Organ Transplantation, INSERM, UMR-S970, Université de Paris, 75015 Paris, France; (B.D.); (G.B.)
| | - Théo Pezel
- Hôpital Lariboisière, APHP, Université de Paris, 75010 Paris, France;
| | - Delphine Mika
- Signaling and Cardiovascular Pathophysiology, Inserm, UMR-S 1180, Université Paris-Saclay, Chatenay-Malabry, 92296 Paris, France;
| | - Ariel Cohen
- Hôpital Saint Antoine, 75012 Paris, France
- Correspondence:
| | - Guillaume Bonnet
- Paris Cardiovascular Research Center (PARCC), Paris Translational Research Center for Organ Transplantation, INSERM, UMR-S970, Université de Paris, 75015 Paris, France; (B.D.); (G.B.)
- Unité Médico-Chirurgicale de Valvulopathies et Cardiomyopathies, Université de Bordeaux, Hopital Cardiologique Haut-Lévêque, 33600 Pessac, France
| | | |
Collapse
|
16
|
Smadja DM, Bonnet G, Gendron N, Weizman O, Khider L, Trimaille A, Mirault T, Fauvel C, Diehl JL, Mika D, Philippe A, Pezel T, Goudot G, Sutter W, Planquette B, Waldmann V, Sanchez O, Cohen A, Chocron R. Intermediate- vs. Standard-Dose Prophylactic Anticoagulation in Patients With COVID-19 Admitted in Medical Ward: A Propensity Score-Matched Cohort Study. Front Med (Lausanne) 2021; 8:747527. [PMID: 34722585 PMCID: PMC8553987 DOI: 10.3389/fmed.2021.747527] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/08/2021] [Indexed: 01/17/2023] Open
Abstract
Background: Microthrombosis and large-vessel thrombosis are the main triggers of COVID-19 worsening. The optimal anticoagulant regimen in COVID-19 patients hospitalized in medical wards remains unknown. Objectives: To evaluate the effects of intermediate-dose vs. standard-dose prophylactic anticoagulation (AC) among patients with COVID-19 hospitalized in medical wards. Methods and results: We used a large French multicentric retrospective study enrolling 2,878 COVID-19 patients hospitalized in medical wards. After exclusion of patients who had an AC treatment before hospitalization, we generated a propensity-score-matched cohort of patients who were treated with intermediate-dose or standard-dose prophylactic AC between February 26 and April 20, 2020 (intermediate-dose, n = 261; standard-dose prophylactic anticoagulation, n = 763). The primary outcome of the study was in-hospital mortality; this occurred in 23 of 261 (8.8%) patients in the intermediate-dose group and 74 of 783 (9.4%) patients in the standard-dose prophylactic AC group (p = 0.85); while time to death was also the same in both the treatment groups (11.5 and 11.6 days, respectively, p = 0.17). We did not observe any difference regarding venous and arterial thrombotic events between the intermediate dose and standard dose, respectively (venous thrombotic events: 2.3 vs. 2.4%, p=0.99; arterial thrombotic events: 2.7 vs. 1.2%, p = 0.25). The 30-day Kaplan-Meier curves for in-hospital mortality demonstrate no statistically significant difference in in-hospital mortality (HR: 0.99 (0.63-1.60); p = 0.99). Moreover, we found that no particular subgroup was associated with a significant reduction in in-hospital mortality. Conclusion: Among COVID-19 patients hospitalized in medical wards, intermediate-dose prophylactic AC compared with standard-dose prophylactic AC did not result in a significant difference in in-hospital mortality.
Collapse
Affiliation(s)
- David M. Smadja
- Innovative Therapies in Haemostasis, INSERM, Université de Paris, Paris, France
- Department of Hematology and Biosurgical Research Lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, Paris, France
- F-CRIN INNOVTE, Saint-Étienne, France
| | - Guillaume Bonnet
- Paris Cardiovascular Research Center (PARCC), INSERM, Université de Paris, Paris, France
- Center Hospitalier Universitaire de Bordeaux, Hôpital Cardiologique Haut-Lévêque, Unité Médico-Chirurgical de Valvulopathies et Cardiomyopathies, Pessac, France
| | - Nicolas Gendron
- Innovative Therapies in Haemostasis, INSERM, Université de Paris, Paris, France
- Department of Hematology and Biosurgical Research Lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, Paris, France
| | - Orianne Weizman
- Paris Cardiovascular Research Center (PARCC), INSERM, Université de Paris, Paris, France
- Institut Lorrain du Coeur et des Vaisseaux, CHU de Nancy, Vandoeuvre les Nancy, France
| | - Lina Khider
- Department of Vascular Medicine, AP-HP, Georges Pompidou European Hospital, Paris, France
| | - Antonin Trimaille
- Nouvel Hôpital Civil, Center Hospitalier Régional Universitaire de Strasbourg, Strasbourg, France
| | - Tristan Mirault
- Paris Cardiovascular Research Center (PARCC), INSERM, Université de Paris, Paris, France
- Department of Vascular Medicine, AP-HP, Georges Pompidou European Hospital, Paris, France
| | | | - Jean-Luc Diehl
- Innovative Therapies in Haemostasis, INSERM, Université de Paris, Paris, France
- Medical Intensive Care Department and Biosurgical Research Lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, Paris, France
| | - Delphine Mika
- INSERM, Université Paris-Saclay, Chatenay-Malabry, France
| | - Aurelien Philippe
- Innovative Therapies in Haemostasis, INSERM, Université de Paris, Paris, France
- Department of Hematology and Biosurgical Research Lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, Paris, France
| | - Théo Pezel
- Department of Cardiology, Lariboisière Hospital, AP-HP, University of Paris, Paris, France
| | - Guillaume Goudot
- Paris Cardiovascular Research Center (PARCC), INSERM, Université de Paris, Paris, France
- Department of Vascular Medicine, AP-HP, Georges Pompidou European Hospital, Paris, France
| | - Willy Sutter
- Paris Cardiovascular Research Center (PARCC), INSERM, Université de Paris, Paris, France
- Department of Vascular Surgery, AP-HP, Georges Pompidou European Hospital, Paris, France
| | - Benjamin Planquette
- Innovative Therapies in Haemostasis, INSERM, Université de Paris, Paris, France
- F-CRIN INNOVTE, Saint-Étienne, France
- Department of Pneumology and Intensive Care and Biosurgical Research Lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, Paris, France
| | - Victor Waldmann
- Paris Cardiovascular Research Center (PARCC), INSERM, Université de Paris, Paris, France
- Department of Cardiology, AP-HP, Georges Pompidou European Hospital, Paris, France
| | - Olivier Sanchez
- Innovative Therapies in Haemostasis, INSERM, Université de Paris, Paris, France
- F-CRIN INNOVTE, Saint-Étienne, France
- Department of Pneumology and Intensive Care and Biosurgical Research Lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, Paris, France
| | - Ariel Cohen
- Department of Cardiology, AP-HP, Saint Antoine Hospital, Paris, France
| | - Richard Chocron
- Paris Cardiovascular Research Center (PARCC), INSERM, Université de Paris, Paris, France
- Department of Emergency, AP-HP, Georges Pompidou European Hospital, Paris, France
| |
Collapse
|
17
|
Panagides V, Vincent F, Weizman O, Jonveaux M, Trimaille A, Pommier T, Cellier J, Geneste L, Marsou W, Deney A, Attou S, Delmotte T, Fauvel C, Ezzouhairi N, Perin B, Zakine C, Levasseur T, Ma I, Chavignier D, Noirclerc N, Darmon A, Mevelec M, Karsenty C, Duceau B, Sutter W, Mika D, Pezel T, Waldmann V, Ternacle J, Cohen A, Bonnet G. History of heart failure in patients with coronavirus disease 2019: Insights from a French registry. Arch Cardiovasc Dis 2021; 114:415-425. [PMID: 34099379 PMCID: PMC8141712 DOI: 10.1016/j.acvd.2021.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/20/2021] [Accepted: 04/27/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although cardiovascular comorbidities seem to be strongly associated with worse outcomes in patients with coronavirus disease 2019 (COVID-19), data regarding patients with preexisting heart failure are limited. AIMS To investigate the incidence, characteristics and clinical outcomes of patients with COVID-19 with a history of heart failure with preserved or reduced ejection fraction. METHODS We performed an observational multicentre study including all patients hospitalized for COVID-19 across 24 centres in France from 26 February to 20 April 2020. The primary endpoint was a composite of in-hospital death or need for orotracheal intubation. RESULTS Overall, 2809 patients (mean age 66.4±16.9years) were included. Three hundred and seventeen patients (11.2%) had a history of heart failure; among them, 49.2% had heart failure with reduced ejection fraction and 50.8% had heart failure with preserved ejection fraction. COVID-19 severity at admission, defined by a quick sequential organ failure assessment score>1, was similar in patients with versus without a history of heart failure. Before and after adjustment for age, male sex, cardiovascular comorbidities and quick sequential organ failure assessment score, history of heart failure was associated with the primary endpoint (hazard ratio [HR]: 1.41, 95% confidence interval [CI]: 1.06-1.90; P=0.02). This result seemed to be mainly driven by a history of heart failure with preserved ejection fraction (HR: 1.61, 95% CI: 1.13-2.27; P=0.01) rather than heart failure with reduced ejection fraction (HR: 1.19, 95% CI: 0.79-1.81; P=0.41). CONCLUSIONS History of heart failure in patients with COVID-19 was associated with a higher risk of in-hospital death or orotracheal intubation. These findings suggest that patients with a history of heart failure, particularly heart failure with preserved ejection fraction, should be considered at high risk of clinical deterioration.
Collapse
Affiliation(s)
- Vassili Panagides
- Aix-Marseille Université, Intensive Care Unit, Hôpital Nord, AP-HM, 13015 Marseille, France
| | - Flavien Vincent
- Centre Hospitalier Universitaire de Lille, Institut Cœur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, INSERM U1011, Institut Pasteur de Lille, EGID, Université de Lille, 59800 Lille, France
| | - Orianne Weizman
- Institut Lorrain du Cœur et des Vaisseaux, CHU de Nancy, 54500 Vandœuvre-les-Nancy, France; Université de Paris, Paris Cardiovascular Research Centre (PARCC), INSERM, UMR-S970, 75015 Paris, France
| | - Melchior Jonveaux
- Département de Cardiologie, Expert Valve Center, Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, 94010 Créteil, France
| | - Antonin Trimaille
- Nouvel Hôpital Civil, Centre Hospitalier Régional Universitaire de Strasbourg, 67000 Strasbourg, France
| | - Thibaut Pommier
- Centre Hospitalier Universitaire de Dijon, 21000 Dijon, France
| | - Joffrey Cellier
- Hôpital Européen Georges-Pompidou, Université de Paris, 75015 Paris, France
| | - Laura Geneste
- Centre Hospitalier Universitaire d'Amiens-Picardie, 80000 Amiens, France
| | - Wassima Marsou
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, 59800 Lille, France
| | - Antoine Deney
- Centre Hospitalier Universitaire de Toulouse, 31400 Toulouse, France
| | - Sabir Attou
- Centre Hospitalier Universitaire de Caen-Normandie, 14000 Caen, France
| | - Thomas Delmotte
- Centre Hospitalier Universitaire de Reims, 51100 Reims, France
| | - Charles Fauvel
- Rouen University Hospital, FHU REMOD-VHF, 76000 Rouen, France
| | - Nacim Ezzouhairi
- University of Bordeaux, Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Benjamin Perin
- Institut Lorrain du Cœur et des Vaisseaux, CHU de Nancy, 54500 Vandœuvre-les-Nancy, France
| | - Cyril Zakine
- Clinique Saint-Gatien, 37540 Saint-Cyr-sur-Loire, France
| | - Thomas Levasseur
- Centre Hospitalier Intercommunal Fréjus-Saint-Raphaël, 83600 Fréjus, France
| | - Iris Ma
- Hôpital Européen Georges-Pompidou, Université de Paris, 75015 Paris, France
| | | | | | - Arthur Darmon
- Hôpital Bichat-Claude-Bernard, AP-HP, Université de Paris, 75018 Paris, France
| | - Marine Mevelec
- Centre Hospitalier Annecy Genevois, 74370 Épagny-Metz-Tessy, France
| | - Clément Karsenty
- Centre Hospitalier Universitaire de Toulouse, 31400 Toulouse, France
| | - Baptiste Duceau
- Département de Cardiologie, Expert Valve Center, Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, 94010 Créteil, France
| | - Willy Sutter
- Département de Cardiologie, Expert Valve Center, Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, 94010 Créteil, France
| | - Delphine Mika
- Université Paris-Saclay, INSERM, UMR-S 1180, 92296 Châtenay-Malabry, France
| | - Théo Pezel
- Hôpital Lariboisière, AP-HP, University of Paris, 75010 Paris, France
| | - Victor Waldmann
- Département de Cardiologie, Expert Valve Center, Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, 94010 Créteil, France
| | - Julien Ternacle
- University of Bordeaux, Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval/Québec Heart and Lung Institute, Laval University, Québec G1V 4G5, Canada
| | | | - Guillaume Bonnet
- Université de Paris, Paris Cardiovascular Research Centre (PARCC), INSERM, UMR-S970, 75015 Paris, France; University of Bordeaux, Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | | |
Collapse
|
18
|
Weizman O, Mika D, Cellier J, Geneste L, Trimaille A, Pommier T, Panagides V, Marsou W, Deney A, Attou S, Delmotte T, Ribeyrolles S, Chemaly P, Karsenty C, Giordano G, Gautier A, Chaumont C, Guilleminot P, Sagnard A, Pastier J, Duceau B, Sutter W, Fauvel C, Pezel T, Bonnet G, Cohen A, Waldmann V. Characteristics and impact of cardiovascular comorbidities on coronavirus disease 2019 in women: A multicentre cohort study. Arch Cardiovasc Dis 2021; 114:394-406. [PMID: 34154954 PMCID: PMC8139232 DOI: 10.1016/j.acvd.2021.04.002] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/23/2021] [Accepted: 04/13/2021] [Indexed: 01/10/2023]
Abstract
Background Although women account for up to half of patients hospitalized for coronavirus disease 2019 (COVID-19), no specific data have been reported in this population. Aims To assess the burden and impact of cardiovascular comorbidities in women with COVID-19. Methods All consecutive patients hospitalized for COVID-19 across 24 hospitals from 26 February to 20 April 2020 were included. The primary composite outcome was transfer to an intensive care unit or in-hospital death. Results Among 2878 patients, 1212 (42.1%) were women. Women were older (68.3 ± 18.0 vs. 65.4 ± 16.0 years; P < 0.001), but had less prevalent cardiovascular comorbidities than men. Among women, 276 (22.8%) experienced the primary outcome, including 161 (13.3%) transfers to an intensive care unit and 115 (9.5%) deaths without transfer to intensive care unit. The rate of in-hospital death or transfer to an intensive care unit was lower in women versus men (crude hazard ratio [HR]: 0.62, 95% confidence interval [CI]: 0.53–0.72). Age (adjusted HR: 1.05 per 5-year increase, 95% CI: 1.01–1.10), body mass index (adjusted HR: 1.06 per 2-unit increase, 95% CI: 1.02–1.10), chronic kidney disease (adjusted HR: 1.57, 95% CI: 1.11–2.22) and heart failure (adjusted HR: 1.52, 95% CI: 1.04–2.22) were independently associated with the primary outcome in women. Elevated B-type natriuretic peptide/N-terminal prohormone of B-type natriuretic peptide (adjusted HR: 2.41, 95% CI: 1.70–3.44) and troponin (adjusted HR: 2.00, 95% CI: 1.39–2.88) concentrations at admission were also associated with the primary outcome, even in women free of previous coronary artery disease or heart failure. Conclusions Although female sex was associated with a lower risk of transfer to an intensive care unit or in-hospital death, COVID-19 remained associated with considerable morbimortality in women, especially in those with cardiovascular diseases.
Collapse
Affiliation(s)
- Orianne Weizman
- Centre Hospitalier Régional Universitaire de Nancy, 54511 Vandœuvre-Les-Nancy, France; Université de Paris, PARCC, INSERM, 75015 Paris, France
| | - Delphine Mika
- Université Paris-Saclay, INSERM, UMR-S 1180, 92296 Châtenay-Malabry, France
| | - Joffrey Cellier
- Hôpital Européen Georges-Pompidou, AP-HP, Université de Paris, 75015 Paris, France
| | - Laura Geneste
- Centre Hospitalier Universitaire d'Amiens-Picardie, 80000 Amiens, France
| | - Antonin Trimaille
- Nouvel Hôpital Civil, Centre Hospitalier Régional Universitaire de Strasbourg, 67000 Strasbourg, France
| | - Thibaut Pommier
- Centre Hospitalier Universitaire de Dijon, 21000 Dijon, France
| | - Vassili Panagides
- Centre Hospitalier Universitaire de Marseille, 13005 Marseille, France
| | - Wassima Marsou
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - Antoine Deney
- Centre Hospitalier Universitaire de Toulouse, 31400 Toulouse, France
| | - Sabir Attou
- Centre Hospitalier Universitaire de Caen-Normandie, 14000 Caen, France
| | - Thomas Delmotte
- Centre Hospitalier Universitaire de Reims, 51100 Reims, France
| | | | | | - Clément Karsenty
- Centre Hospitalier Universitaire de Toulouse, 31400 Toulouse, France
| | - Gauthier Giordano
- Centre Hospitalier Régional Universitaire de Nancy, 54511 Vandœuvre-Les-Nancy, France
| | | | | | | | - Audrey Sagnard
- Centre Hospitalier Universitaire de Dijon, 21000 Dijon, France
| | - Julie Pastier
- Centre Hospitalier Universitaire de Dijon, 21000 Dijon, France
| | | | - Willy Sutter
- Université de Paris, PARCC, INSERM, 75015 Paris, France
| | - Charles Fauvel
- Rouen University Hospital, FHU REMOD-VHF, 76000 Rouen, France
| | - Théo Pezel
- Hôpital Lariboisiere, AP-HP, University of Paris, 75010 Paris, France
| | - Guillaume Bonnet
- Université de Paris, PARCC, INSERM, 75015 Paris, France; University of Bordeaux, Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Ariel Cohen
- Hôpital Saint-Antoine, AP-HP, 75012 Paris, France.
| | - Victor Waldmann
- Université de Paris, PARCC, INSERM, 75015 Paris, France; Hôpital Européen Georges-Pompidou, AP-HP, Université de Paris, 75015 Paris, France
| | | |
Collapse
|
19
|
Soulat-Dufour L, Fauvel C, Weizman O, Barbe T, Pezel T, Mika D, Cellier J, Geneste L, Panagides V, Marsou W, Deney A, Attou S, Delmotte T, Ribeyrolles S, Chemaly P, Karsenty C, Giordano G, Gautier A, Duceau B, Sutter W, Chaumont C, Guilleminot P, Sagnard A, Pastier J, Trimaille A, Bonnet G, Canu M, Coisne A, Cohen A. Prognostic value of right ventricular dilatation in patients with COVID-19: a multicentre study. Eur Heart J Cardiovasc Imaging 2021; 23:569-577. [PMID: 34008835 PMCID: PMC8600376 DOI: 10.1093/ehjci/jeab067] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 12/23/2020] [Accepted: 03/30/2021] [Indexed: 02/07/2023] Open
Abstract
Aims Although cardiac involvement has prognostic significance in coronavirus disease 2019 (COVID-19) and is associated with severe forms, few studies have explored the prognostic role of transthoracic echocardiography (TTE). We investigated the link between TTE parameters and prognosis in COVID-19. Methods and results Consecutive patients with COVID-19 admitted to 24 French hospitals were retrospectively included. Comprehensive data, including clinical and biological parameters, were recorded at admission. Focused TTE was performed during hospitalization, according to clinical indication. Patients were followed for a primary composite outcome of death or transfer to intensive care unit (ICU) during hospitalization. Among 2878 patients, 445 (15%) underwent TTE. Most of these had cardiovascular risk factors, a history of cardiovascular disease, and were on cardiovascular treatments. Dilatation and dysfunction were observed in, respectively, 12% (48/412) and 23% (102/442) of patients for the left ventricle, and in 12% (47/407) and 16% (65/402) for the right ventricle (RV). Primary composite outcome occurred in 44% (n = 196) of patients [9% (n = 42) for death without ICU transfer and 35% (n = 154) for admission to ICU]. RV dilatation was the only TTE parameter associated with the primary outcome. After adjustment, male sex [hazard ratio (HR) 1.56, 95% confidence interval (CI) 1.09 − 2.25; P = 0.02], higher body mass index (HR 1.10, 95% CI 1.02 − 1.18; P = 0.01), anticoagulation (HR 0.53, 95% CI 0.33 − 0.86; P = 0.01), and RV dilatation (HR 1.66, 95% CI 1.05 − 2.64; P = 0.03) remained independently associated with the primary outcome. Conclusion Echocardiographic evaluation of RV dilatation could be useful for assessing risk of severe COVID-19 developing in hospitalized patients.
Collapse
Affiliation(s)
- Laurie Soulat-Dufour
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, INSERM UMRS-ICAN 1166 and Sorbonne Université, Paris, France
| | - Charles Fauvel
- Department of Cardiology, Rouen University Hospital, FHU REMOD-VHF, F76000 Rouen, France
| | - Orianne Weizman
- Department of Cardiology, Centre Hospitalier Régional Universitaire de Nancy, 54511 Vandoeuvre-Les-Nancy, France.,Université de Paris, PARCC, INSERM, 75015 Paris, France
| | - Thomas Barbe
- Department of Cardiology, Rouen University Hospital, FHU REMOD-VHF, F76000 Rouen, France
| | - Théo Pezel
- Department of Cardiology, Lariboisiere Hospital, APHP, University of Paris, 75010 Paris, France
| | - Delphine Mika
- Université Paris-Saclay, Inserm, UMR-S 1180, 92296 Chatenay-Malabry, France
| | - Joffrey Cellier
- Department of Cardiology, Hôpital Européen Georges Pompidou, Université de Paris, 75015 Paris, France
| | - Laura Geneste
- Department of Cardiology, Centre Hospitalier Universitaire d'Amiens-Picardie, 80000 Amiens, France
| | - Vassili Panagides
- Department of Cardiology, Aix-Marseille Université, Intensive care unit, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France
| | - Wassima Marsou
- Department of Cardiology, GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - Antoine Deney
- Departement of Cardiology, Rangueil University Hospital, Toulouse, France" et "Institute of Cardiovascular and Metabolic Diseases, National Institute of Health and Medical Research (INSERM), UMR-1048 Toulouse, France
| | - Sabir Attou
- Department of Cardiology, Centre Hospitalier Universitaire de Caen-Normandie, 14000 Caen, France
| | - Thomas Delmotte
- Department of Cardiology, Centre Hospitalier Universitaire de Reims, 51100 Reims, France
| | - Sophie Ribeyrolles
- Department of Cardiology, Institut Mutualiste Montsouris, 75014 Paris, France
| | - Pascale Chemaly
- Department of Cardiology, Institut Cardiovasculaire Paris Sud, 91300 Massy, France
| | - Clement Karsenty
- Paediatric and Congenital Cardiology, Children's Hospital, CHU Toulouse, Institut des Maladies Métaboliques et Cardiovasculaires, Toulouse University, France
| | - Gauthier Giordano
- Department of Cardiology, Centre Hospitalier Régional Universitaire de Nancy, 54511 Vandoeuvre-Les-Nancy, France
| | - Alexandre Gautier
- Department of Cardiology, Institut Cardiovasculaire Paris Sud, 91300 Massy, France
| | | | - Willy Sutter
- Université de Paris, PARCC, INSERM, 75015 Paris, France
| | - Corentin Chaumont
- Department of Cardiology, Rouen University Hospital, FHU REMOD-VHF, F76000 Rouen, France
| | - Pierre Guilleminot
- Department of Cardiology, Centre Hospitalier Universitaire de Dijon, 21079 Dijon, France
| | - Audrey Sagnard
- Department of Cardiology, Centre Hospitalier Universitaire de Dijon, 21079 Dijon, France
| | - Julie Pastier
- Paediatric and Congenital Cardiology, Children's Hospital, CHU Toulouse, Institut des Maladies Métaboliques et Cardiovasculaires, Toulouse University, France
| | - Antonin Trimaille
- Department of Cardiology, Nouvel Hôpital Civil, Centre Hospitalier Régional Universitaire de Strasbourg, 67000 Strasbourg, France
| | - Guillaume Bonnet
- Université de Paris, PARCC, INSERM, 75015 Paris, France.,Department of Cardiology, Hôpital Européen Georges Pompidou, Université de Paris, 75015 Paris, France
| | - Marjorie Canu
- Department of Cardiology, University Hospital, CHU Grenoble, BP 217, 38043 Grenoble Cedex 09, France
| | - Augustin Coisne
- CHU Lille, Department of Clinical Physiology and Echocardiography-Heart Valve Center. University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011- EGID, F-59000 Lille, France
| | - Ariel Cohen
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, INSERM UMRS-ICAN 1166 and Sorbonne Université, Paris, France
| |
Collapse
|
20
|
Anys S, Billon C, Mazzella JM, Karam N, Pechmajou L, Youssfi Y, Bellenfant F, Jost D, Jabre P, Soulat G, Bruneval P, Weizman O, Varlet E, Baudinaud P, Dumas F, Bougouin W, Cariou A, Lavergne T, Wahbi K, Jouven X, Marijon E. [Fighting against unexplained sudden death]. Ann Cardiol Angeiol (Paris) 2021; 70:129-135. [PMID: 33972104 DOI: 10.1016/j.ancard.2021.03.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 03/25/2021] [Indexed: 11/18/2022]
Abstract
Sudden cardiac death, mostly related to ventricular arrhythmia, is a major public health issue, with still very poor survival at hospital discharge. Although coronary artery disease remains the leading cause, other etiologies should be systematically investigated. Exhaustive and standardized exploration is required to eventually offer specific therapeutics and management to the patient as well as his/her family members in case of inherited cardiac disease. Identification and establishing direct causality of the detected cardiac anomaly may remain challenging, underlying the need for a multidisciplinary and experimented team.
Collapse
MESH Headings
- Adult
- Age Factors
- Algorithms
- Arrhythmias, Cardiac/complications
- Arrhythmias, Cardiac/diagnosis
- Autopsy
- Cardiomyopathies/complications
- Coronary Artery Disease/complications
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Female
- France/epidemiology
- Genetic Diseases, Inborn/complications
- Genetic Diseases, Inborn/diagnosis
- Heart Defects, Congenital/complications
- Heart Defects, Congenital/diagnosis
- Humans
- Male
- Middle Aged
- Myocardial Infarction/complications
- Registries
- Risk Factors
- Sex Factors
Collapse
Affiliation(s)
- S Anys
- Centre d'Expertise Mort Subite de Paris (Paris-CEMS), Inserm U970, 56, rue Leblanc, 75015 Paris, France; Université de Paris, 85, boulevard Saint Germain, 75006 Paris, France; Service de cardiologie, Unité de rythmologie, Hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - C Billon
- Université de Paris, 85, boulevard Saint Germain, 75006 Paris, France; Service de génétique, Hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - J-M Mazzella
- Service de génétique, Hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - N Karam
- Centre d'Expertise Mort Subite de Paris (Paris-CEMS), Inserm U970, 56, rue Leblanc, 75015 Paris, France; Université de Paris, 85, boulevard Saint Germain, 75006 Paris, France; Service de cardiologie, Unité de cardiologie interventionnelle, Hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - L Pechmajou
- Centre d'Expertise Mort Subite de Paris (Paris-CEMS), Inserm U970, 56, rue Leblanc, 75015 Paris, France; Université de Paris, 85, boulevard Saint Germain, 75006 Paris, France; Service de cardiologie, Unité de cardiologie interventionnelle, Hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - Y Youssfi
- Centre d'Expertise Mort Subite de Paris (Paris-CEMS), Inserm U970, 56, rue Leblanc, 75015 Paris, France; École Polytechnique, route de Saclay, 91120 Palaiseau, France
| | - F Bellenfant
- Centre d'Expertise Mort Subite de Paris (Paris-CEMS), Inserm U970, 56, rue Leblanc, 75015 Paris, France; Unité de soins intensifs, Hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - D Jost
- Centre d'Expertise Mort Subite de Paris (Paris-CEMS), Inserm U970, 56, rue Leblanc, 75015 Paris, France; Brigade de Sapeurs-Pompiers de Paris (BSPP), 1, place Jules-Renard, 75017 Paris, France
| | - P Jabre
- Centre d'Expertise Mort Subite de Paris (Paris-CEMS), Inserm U970, 56, rue Leblanc, 75015 Paris, France; Service d'aide médicale d'urgence (Samu) de Paris, Paris, France
| | - G Soulat
- Université de Paris, 85, boulevard Saint Germain, 75006 Paris, France; Service de radiologie, Hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - P Bruneval
- Université de Paris, 85, boulevard Saint Germain, 75006 Paris, France; Service anatomie pathologie, Hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - O Weizman
- Centre hospitalier régional universitaire de Nancy, 54511 Vandœuvre-Lès-Nancy, France
| | - E Varlet
- Centre d'Expertise Mort Subite de Paris (Paris-CEMS), Inserm U970, 56, rue Leblanc, 75015 Paris, France; Service de cardiologie, Unité de rythmologie, Hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - P Baudinaud
- Centre d'Expertise Mort Subite de Paris (Paris-CEMS), Inserm U970, 56, rue Leblanc, 75015 Paris, France; Université de Paris, 85, boulevard Saint Germain, 75006 Paris, France; Service de cardiologie, Unité de rythmologie, Hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - F Dumas
- Centre d'Expertise Mort Subite de Paris (Paris-CEMS), Inserm U970, 56, rue Leblanc, 75015 Paris, France; Université de Paris, 85, boulevard Saint Germain, 75006 Paris, France; Département de médecine d'urgence, Hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - W Bougouin
- Centre d'Expertise Mort Subite de Paris (Paris-CEMS), Inserm U970, 56, rue Leblanc, 75015 Paris, France; Université de Paris, 85, boulevard Saint Germain, 75006 Paris, France; Unité de soins intensifs, Hôpital privé Jacques-Cartier, Ramsay Santé, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - A Cariou
- Centre d'Expertise Mort Subite de Paris (Paris-CEMS), Inserm U970, 56, rue Leblanc, 75015 Paris, France; Université de Paris, 85, boulevard Saint Germain, 75006 Paris, France; Unité de soins intensifs, Hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - T Lavergne
- Centre d'Expertise Mort Subite de Paris (Paris-CEMS), Inserm U970, 56, rue Leblanc, 75015 Paris, France; Université de Paris, 85, boulevard Saint Germain, 75006 Paris, France; Service de cardiologie, Unité de rythmologie, Hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - K Wahbi
- Centre d'Expertise Mort Subite de Paris (Paris-CEMS), Inserm U970, 56, rue Leblanc, 75015 Paris, France; Université de Paris, 85, boulevard Saint Germain, 75006 Paris, France; Service de cardiologie, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - X Jouven
- Centre d'Expertise Mort Subite de Paris (Paris-CEMS), Inserm U970, 56, rue Leblanc, 75015 Paris, France; Université de Paris, 85, boulevard Saint Germain, 75006 Paris, France; Service de cardiologie, Unité de rythmologie, Hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - E Marijon
- Centre d'Expertise Mort Subite de Paris (Paris-CEMS), Inserm U970, 56, rue Leblanc, 75015 Paris, France; Université de Paris, 85, boulevard Saint Germain, 75006 Paris, France; Service de cardiologie, Unité de rythmologie, Hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
| |
Collapse
|
21
|
Chocron R, Duceau B, Gendron N, Ezzouhairi N, Khider L, Trimaille A, Goudot G, Weizman O, Alsac JM, Pommier T, Bory O, Cellier J, Philippe A, Geneste L, Ben Abdallah I, Panagides V, El Batti S, Marsou W, Juvin P, Deney A, Messas E, Attou S, Planquette B, Mika D, Gaussem P, Fauvel C, Diehl JL, Pezel T, Mirault T, Sutter W, Sanchez O, Bonnet G, Cohen A, Smadja DM. D-dimer at hospital admission for COVID-19 are associated with in-hospital mortality, independent of venous thromboembolism: Insights from a French multicenter cohort study. Arch Cardiovasc Dis 2021; 114:381-393. [PMID: 33846096 PMCID: PMC7942155 DOI: 10.1016/j.acvd.2021.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/16/2021] [Accepted: 02/03/2021] [Indexed: 12/19/2022]
Abstract
Background Coronavirus disease 2019 (COVID-19) has been associated with coagulation disorders, in particular high concentrations of D-dimer, and increased frequency of venous thromboembolism. Aim To explore the association between D-dimer at admission and in-hospital mortality in patients hospitalised for COVID-19, with or without symptomatic venous thromboembolism. Methods From 26 February to 20 April 2020, D-dimer concentration at admission and outcomes (in-hospital mortality and venous thromboembolism) of patients hospitalised for COVID-19 in medical wards were retrospectively analysed in a multicenter study in 24 French hospitals. Results Among 2878 patients enrolled in the study, 1154 (40.1%) patients had D-dimer measurement at admission. Receiver operating characteristic curve analysis identified a D-dimer concentration > 1128 ng/mL as the best cut-off value for in-hospital mortality (area under the curve 64.9%, 95% confidence interval [CI] 60–69), with a sensitivity of 71.1% (95% CI 62–78) and a specificity of 55.6% (95% CI 52–58), which did not differ in the subgroup of patients with venous thromboembolism during hospitalisation. Among 545 (47.2%) patients with D-dimer concentration > 1128 ng/mL at admission, 86 (15.8%) deaths occurred during hospitalisation. After adjustment, in Cox proportional hazards and logistic regression models, D-dimer concentration > 1128 ng/mL at admission was also associated with a worse prognosis, with an odds ratio of 3.07 (95% CI 2.05–4.69; P < 0.001) and an adjusted hazard ratio of 2.11 (95% CI 1.31–3.4; P < 0.01). Conclusions D-dimer concentration > 1128 ng/mL is a relevant predictive factor for in-hospital mortality in patients hospitalised for COVID-19 in a medical ward, regardless of the occurrence of venous thromboembolism during hospitalisation.
Collapse
Affiliation(s)
- Richard Chocron
- Université de Paris, PARCC, INSERM; Emergency department, Georges-Pompidou European hospital, AP-HP, 75015 Paris, France.
| | | | - Nicolas Gendron
- Université de Paris, Innovative therapies in haemostasis, INSERM; Haematology department and biosurgical research laboratory (Carpentier Foundation), Georges-Pompidou European Hospital, AH-HP, 75015 Paris, France
| | - Nacim Ezzouhairi
- Université de médecine de Bordeaux, Centre hospitalier universitaire de Bordeaux, 33076 Bordeaux, France
| | - Lina Khider
- Université de Paris, Vascular medicine department and biosurgical research laboratory (Carpentier Foundation), Georges-Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Antonin Trimaille
- Nouvel hôpital civil, Centre hospitalier régional universitaire de Strasbourg, 67000 Strasbourg, France
| | - Guillaume Goudot
- Université de Paris, Vascular medicine department and biosurgical research laboratory (Carpentier Foundation), Georges-Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Orianne Weizman
- Centre hospitalier régional universitaire de Nancy, 54511 Vandœuvre-Les-Nancy, France
| | - Jean Marc Alsac
- Université de Paris, Innovative therapies in haemostasis, INSERM; Vascular surgery department and biosurgical research laboratory (Carpentier Foundation), Georges-Pompidou European Hospital, AH-HP, 75015 Paris, France
| | | | - Olivier Bory
- Université de Paris, Emergency department, Georges-Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Joffrey Cellier
- Georges-Pompidou European Hospital, AP-HP, Université de Paris, 75015 Paris, France
| | - Aurélien Philippe
- Université de Paris, Innovative therapies in haemostasis, INSERM; Haematology department and biosurgical research laboratory (Carpentier Foundation), Georges-Pompidou European Hospital, AH-HP, 75015 Paris, France
| | - Laura Geneste
- Centre hospitalier universitaire d'Amiens-Picardie, 80000 Amiens, France
| | - Iannis Ben Abdallah
- Université de Paris, Innovative therapies in haemostasis, INSERM; Vascular surgery department and biosurgical research laboratory (Carpentier Foundation), Georges-Pompidou European Hospital, AH-HP, 75015 Paris, France
| | - Vassili Panagides
- Centre hospitalier universitaire de Marseille, 13005 Marseille, France
| | - Salma El Batti
- Université de Paris, Innovative therapies in haemostasis, INSERM; Vascular surgery department and biosurgical research laboratory (Carpentier Foundation), Georges-Pompidou European Hospital, AH-HP, 75015 Paris, France
| | - Wassima Marsou
- Centre hospitalier universitaire de Lille, Université catholique de Lille, 59000 Lille, France
| | - Philippe Juvin
- Université de Paris, Emergency department, Georges-Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Antoine Deney
- Centre hospitalier universitaire de Toulouse, 31400 Toulouse, France
| | - Emmanuel Messas
- Université de Paris, PARCC, INSERM; Vascular medicine department, Georges-Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Sabir Attou
- Centre hospitalier universitaire de Caen-Normandie, 14000 Caen, France
| | - Benjamin Planquette
- Université de Paris, Innovative therapies in haemostasis, INSERM; Respiratory medicine department and biosurgical research laboratory (Carpentier Foundation), Georges-Pompidou European hospital, AH-HP, 75015 Paris, France
| | - Delphine Mika
- Université Paris-Saclay, INSERM, UMR-S 1180, 92296 Chatenay-Malabry, France
| | - Pascale Gaussem
- Université de Paris, Innovative therapies in haemostasis, INSERM; Haematology department, Georges-Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Charles Fauvel
- Rouen university hospital, FHU REMOD-VHF, 76000 Rouen, France
| | - Jean-Luc Diehl
- Université de Paris, Innovative therapies in haemostasis, INSERM; Intensive care medicine department and biosurgical research laboratory (Carpentier Foundation), Georges-Pompidou European Hospital, AH-HP, 75015 Paris, France
| | - Theo Pezel
- Lariboisière hospital, AP-HP, Université de Paris, 75010 Paris, France
| | - Tristan Mirault
- Université de Paris, PARCC, INSERM; Vascular medicine department, Georges-Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Willy Sutter
- Université de Paris, PARCC, INSERM, 75015 Paris, France
| | - Olivier Sanchez
- Université de Paris, Innovative therapies in haemostasis, INSERM; Respiratory medicine department and biosurgical research laboratory (Carpentier Foundation), Georges-Pompidou European hospital, AH-HP, 75015 Paris, France
| | | | - Ariel Cohen
- Department of cardiology, Saint-Antoine hospital, AP-HP, 75012 Paris, France
| | - David M Smadja
- Université de Paris, Innovative therapies in haemostasis, INSERM; Haematology department and biosurgical research laboratory (Carpentier Foundation), Georges-Pompidou European Hospital, AH-HP, 75015 Paris, France
| | | |
Collapse
|
22
|
Bonnet G, Weizman O, Trimaille A, Pommier T, Cellier J, Geneste L, Panagides V, Marsou W, Deney A, Attou S, Delmotte T, Ribeyrolles S, Chemaly P, Karsenty C, Giordano G, Gautier A, Chaumont C, Guilleminot P, Sagnard A, Pastiero J, Ezzouhairi N, Perin B, Zakine C, Levasseur T, Ma I, Chavignier D, Noirclerc N, Darmon A, Mevelec M, Duceau B, Sutter W, Mika D, Fauvel C, Pezel T, Waldmann V, Cohen A. Characteristics and outcomes of patients hospitalized for COVID-19 in France: The Critical COVID-19 France (CCF) study. Arch Cardiovasc Dis 2021; 114:352-363. [PMID: 34154953 PMCID: PMC7923854 DOI: 10.1016/j.acvd.2021.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/11/2021] [Accepted: 01/18/2021] [Indexed: 01/08/2023]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has led to a public health crisis. Only limited data are available on the characteristics and outcomes of patients hospitalized for COVID-19 in France. Aims To investigate the characteristics, cardiovascular complications and outcomes of patients hospitalized for COVID-19 in France. Methods The Critical COVID-19 France (CCF) study is a French nationwide study including all consecutive adults with a diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) infection hospitalized in 24 centres between 26 February and 20 April 2020. Patients admitted directly to intensive care were excluded. Clinical, biological and imaging parameters were systematically collected at hospital admission. The primary outcome was in-hospital death. Results Of 2878 patients included (mean ± SD age 66.6 ± 17.0 years, 57.8% men), 360 (12.5%) died in the hospital setting, of which 7 (20.7%) were transferred to intensive care before death. The majority of patients had at least one (72.6%) or two (41.6%) cardiovascular risk factors, mostly hypertension (50.8%), obesity (30.3%), dyslipidaemia (28.0%) and diabetes (23.7%). In multivariable analysis, older age (hazard ratio [HR] 1.05, 95% confidence interval [CI] 1.03 − 1.06; P < 0.001), male sex (HR 1.69, 95% CI 1.11 − 2.57; P = 0.01), diabetes (HR 1.72, 95% CI 1.12 − 2.63; P = 0.01), chronic kidney failure (HR 1.57, 95% CI 1.02 − 2.41; P = 0.04), elevated troponin (HR 1.66, 95% CI 1.11 − 2.49; P = 0.01), elevated B-type natriuretic peptide or N-terminal pro-B-type natriuretic peptide (HR 1.69, 95% CI 1.0004 − 2.86; P = 0.049) and quick Sequential Organ Failure Assessment score ≥ 2 (HR 1.71, 95% CI 1.12 − 2.60; P = 0.01) were independently associated with in-hospital death. Conclusions In this large nationwide cohort of patients hospitalized for COVID-19 in France, cardiovascular comorbidities and risk factors were associated with a substantial morbi-mortality burden.
Collapse
Affiliation(s)
- Guillaume Bonnet
- Université de Paris, PARCC, inserm, 75015 Paris, France; Hôpital Européen Georges-Pompidou, Université de Paris, 75015 Paris, France
| | - Orianne Weizman
- Université de Paris, PARCC, inserm, 75015 Paris, France; Centre Hospitalier Régional Universitaire de Nancy, 54511 Vandoeuvre-Les-Nancy, France
| | - Antonin Trimaille
- Nouvel hopital Civil, Centre Hospitalier régional universitaire de Strasbourg, 67000 Strasbourg, France
| | - Thibaut Pommier
- Lariboisiere hospital, AP-HP, university of Paris, 75010 Paris, France; Centre Hospitalier Universitaire de Dijon, 21000 Dijon, France
| | - Joffrey Cellier
- Hôpital Européen Georges-Pompidou, Université de Paris, 75015 Paris, France
| | - Laura Geneste
- Centre Hospitalier universitaire d'Amiens-Picardie, 80000 Amiens, France
| | - Vassili Panagides
- Centre Hospitalier Universitaire de Marseille, 13005 Marseille, France
| | - Wassima Marsou
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - Antoine Deney
- Centre Hospitalier universitaire de Toulouse, 31400 Toulouse, France
| | - Sabir Attou
- Centre Hospitalier universitaire de Caen-Normandie, 14000 Caen, France
| | - Thomas Delmotte
- Centre Hospitalier universitaire de Reims, 51100 Reims, France
| | | | | | - Clément Karsenty
- Centre Hospitalier universitaire de Toulouse, 31400 Toulouse, France
| | - Gauthier Giordano
- Centre Hospitalier Régional Universitaire de Nancy, 54511 Vandoeuvre-Les-Nancy, France
| | | | | | | | - Audrey Sagnard
- Centre Hospitalier Universitaire de Dijon, 21000 Dijon, France
| | - Julie Pastiero
- Centre Hospitalier Universitaire de Dijon, 21000 Dijon, France
| | - Nacim Ezzouhairi
- Centre Hospitalier universitaire de Bordeaux, 33076 Bordeaux, France
| | - Benjamin Perin
- Centre Hospitalier Régional Universitaire de Nancy, 54511 Vandoeuvre-Les-Nancy, France
| | - Cyril Zakine
- Clinique Saint-Gatien, 37540 Saint-Cyr-sur-Loire, France
| | - Thomas Levasseur
- Centre Hospitalier intercommunal Fréjus-Saint-Raphaël, 83600 Fréjus, France
| | - Iris Ma
- Hôpital Européen Georges-Pompidou, Université de Paris, 75015 Paris, France
| | | | | | - Arthur Darmon
- Hôpital Bichat-Claude-Bernard, AP-HP, université de Paris, 75018 Paris, France
| | - Marine Mevelec
- Centre Hospitalier régional de Orléans, 45100 Orléans, France
| | - Baptiste Duceau
- Université de Paris, PARCC, inserm, 75015 Paris, France; Centre Hospitalier Régional Universitaire de Nancy, 54511 Vandoeuvre-Les-Nancy, France
| | - Willy Sutter
- Université de Paris, PARCC, inserm, 75015 Paris, France; Centre Hospitalier Régional Universitaire de Nancy, 54511 Vandoeuvre-Les-Nancy, France
| | - Delphine Mika
- Université Paris-Saclay, Inserm, UMR-S 1180, 92296 Chatenay-Malabry, France
| | - Charles Fauvel
- Rouen University Hospital, FHU REMOD-VHF, 76000 Rouen, France
| | - Théo Pezel
- Lariboisiere hospital, AP-HP, university of Paris, 75010 Paris, France
| | - Victor Waldmann
- Université de Paris, PARCC, inserm, 75015 Paris, France; Hôpital Européen Georges-Pompidou, Université de Paris, 75015 Paris, France
| | - Ariel Cohen
- Hôpital Saint-Antoine, Saint-Antoine and Tenon hospitals, AP-HP, Inserm UMRS-ICAN 1166 Sorbonne-Université, French Society of Cardiology 2020-2022, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France.
| |
Collapse
|
23
|
Chavarot N, Gueguen J, Bonnet G, Jdidou M, Trimaille A, Burger C, Amrouche L, Weizman O, Pommier T, Aubert O, Celier J, Sberro-Soussan R, Geneste L, Panagides V, Delahousse M, Marsou W, Aguilar C, Deney A, Zuber J, Fauvel C, Legendre C, Mika D, Pezel T, Anglicheau D, Sutter W, Zaidan M, Snanoudj R, Cohen A, Scemla A. COVID-19 severity in kidney transplant recipients is similar to nontransplant patients with similar comorbidities. Am J Transplant 2021; 21:1285-1294. [PMID: 33252201 PMCID: PMC7753406 DOI: 10.1111/ajt.16416] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [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: 08/05/2020] [Revised: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 01/25/2023]
Abstract
Higher rates of severe COVID-19 have been reported in kidney transplant recipients (KTRs) compared to nontransplant patients. We aimed to determine if poorer outcomes were specifically related to chronic immunosuppression or underlying comorbidities. We used a 1:1 propensity score-matching method to compare survival and severe disease-free survival (defined as death and/or need for intensive care unit [ICU]) incidence in hospitalized KTRs and nontransplant control patients between February 26 and May 22, 2020. Patients were matched for risk factors of severe COVID-19: age, sex, body mass index, diabetes mellitus, preexisting cardiopathy, chronic lung disease, and basal renal function. We included 100 KTRs (median age [interquartile range (IQR)]) 64.7 years (55.3-73.1) in three French transplant centers. After a median follow-up of 13 days (7-30), transfer to ICU was required for 34 patients (34%) and death occurred in 26 patients (26%). Overall, 43 patients (43%) developed a severe disease during a median follow-up of 8.5 days (2-14). Propensity score matching to a large French cohort of 2017 patients hospitalized in 24 centers, revealed that survival was similar between KTRs and matched nontransplant patients with respective 30-day survival of 62.9% and 71% (p = .38) and severe disease-free 30-day survival of 50.6% and 47.5% (p = .91). These findings suggest that severity of COVID-19 in KTRs is related to their associated comorbidities and not to chronic immunosuppression.
Collapse
Affiliation(s)
- Nathalie Chavarot
- Départment de Néphrologie et transplantation rénale, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France,Université de Paris, Paris, France,Correspondence Nathalie Chavarot
| | - Juliette Gueguen
- Université de Paris, Paris, France,Paris Translational Research Centre for Organ Transplantation, PARCC, INSERM, Paris, France
| | - Guillaume Bonnet
- Université de Paris, Paris, France,Paris Translational Research Centre for Organ Transplantation, PARCC, INSERM, Paris, France
| | - Mariam Jdidou
- Département de Néphrologie et transplantation, Hôpital Foch, Suresnes
| | - Antonin Trimaille
- Nouvel Hôpital Civil, Centre Hospitalier Régional Universitaire de Strasbourg, Strasbourg, France
| | - Carole Burger
- Départment de Néphrologie et transplantation rénale, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France,Université de Paris, Paris, France
| | - Lucile Amrouche
- Départment de Néphrologie et transplantation rénale, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Orianne Weizman
- Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre-Les-Nancy, France
| | | | - Olivier Aubert
- Université de Paris, Paris, France,Paris Translational Research Centre for Organ Transplantation, PARCC, INSERM, Paris, France
| | - Joffrey Celier
- Hôpital Européen Georges Pompidou, Université de Paris, Paris, France
| | - Rebecca Sberro-Soussan
- Départment de Néphrologie et transplantation rénale, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Laura Geneste
- Centre Hospitalier Universitaire d’Amiens-Picardie, Amiens, France
| | | | - Michel Delahousse
- Département de Néphrologie et transplantation, Hôpital Foch, Suresnes
| | - Wassima Marsou
- GCS-Groupement des Hôpitaux de l’Institut Catholique de Lille, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - Claire Aguilar
- Université de Paris, Paris, France,Départment de maladies infectieuses et tropicales, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Antoine Deney
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Julien Zuber
- Départment de Néphrologie et transplantation rénale, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France,Université de Paris, Paris, France
| | - Charles Fauvel
- Centre Hospitalier Universitaire de Rouen, FHU REMOD-VHF, Rouen, France
| | - Christophe Legendre
- Départment de Néphrologie et transplantation rénale, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France,Université de Paris, Paris, France
| | - Delphine Mika
- Université Paris-Saclay, Inserm, UMR-S 1180, Chatenay-Malabry, France
| | - Theo Pezel
- Hôpital Lariboisière, APHP, University of Paris, Paris, France
| | - Dany Anglicheau
- Départment de Néphrologie et transplantation rénale, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France,Université de Paris, Paris, France
| | - Willy Sutter
- Université de Paris, Paris, France,Paris Translational Research Centre for Organ Transplantation, PARCC, INSERM, Paris, France
| | - Mohamad Zaidan
- Département de Néphrologie et transplantation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Renaud Snanoudj
- Département de Néphrologie et transplantation, Hôpital Foch, Suresnes
| | - Ariel Cohen
- Université de Paris, Paris, France,Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anne Scemla
- Départment de Néphrologie et transplantation rénale, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | |
Collapse
|
24
|
Weizman O, Sharifzadehgan A, Bougouin W, Narayanan K, Tence N, Dumas F, Waldmann V, Lamhaut L, Jost D, Wahbi K, Varenne O, Garcia R, Karam N, Cariou A, Jouven X, Marijon E. Sudden Cardiac Arrest in Young Women. Circulation 2021; 143:758-760. [PMID: 33587656 DOI: 10.1161/circulationaha.120.052219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Orianne Weizman
- University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.)
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- Nancy University Hospital, Cardiology Department, France (O.W.)
| | - Ardalan Sharifzadehgan
- University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.)
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- European Georges Pompidou Hospital, Cardiology Department, Paris, France (A.S., N.T., N.K., V.W., X.J., E.M.)
| | - Wulfran Bougouin
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- Jacques Cartier Hospital, Intensive Care Unit, Massy, France (W.B.)
| | - Kumar Narayanan
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- Medicover Hospitals, Cardiology Department, Hyderabad, India (K.N.)
| | - Noémie Tence
- University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.)
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- European Georges Pompidou Hospital, Cardiology Department, Paris, France (A.S., N.T., N.K., V.W., X.J., E.M.)
| | - Florence Dumas
- University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.)
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- Cochin Hospital, Emergency Department, Paris, France (F.D.)
| | - Victor Waldmann
- University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.)
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- European Georges Pompidou Hospital, Cardiology Department, Paris, France (A.S., N.T., N.K., V.W., X.J., E.M.)
| | - Lionel Lamhaut
- University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.)
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- Emergency Medical Services 75, Necker University Hospital, APHP, Paris, France (L.L.)
| | - Daniel Jost
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- Paris Firefighters Brigade, France (D.J.)
| | - Karim Wahbi
- University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.)
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- Cochin Hospital, Cardiology Intensive Care Unit (K.W., O.V.), Paris, France
| | - Olivier Varenne
- University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.)
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- Cochin Hospital, Cardiology Intensive Care Unit (K.W., O.V.), Paris, France
| | - Rodrigue Garcia
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- Cardiovascular Center, University Hospital La Milétrie, Poitiers, France (R.G.)
- University of Poitiers, France (R.G.)
| | - Nicole Karam
- University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.)
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- European Georges Pompidou Hospital, Cardiology Department, Paris, France (A.S., N.T., N.K., V.W., X.J., E.M.)
| | - Alain Cariou
- University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.)
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- Intensive Care Unit (A.C.), Paris, France
| | - Xavier Jouven
- University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.)
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- European Georges Pompidou Hospital, Cardiology Department, Paris, France (A.S., N.T., N.K., V.W., X.J., E.M.)
| | - Eloi Marijon
- University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.)
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- European Georges Pompidou Hospital, Cardiology Department, Paris, France (A.S., N.T., N.K., V.W., X.J., E.M.)
| |
Collapse
|
25
|
Chocron R, Galand V, Cellier J, Gendron N, Pommier T, Bory O, Khider L, Trimaille A, Goudot G, Weizman O, Alsac JM, Geneste L, Schmeltz A, Panagides V, Philippe A, Marsou W, Ben Abdallah I, Deney A, El Batti S, Attou S, Juvin P, Delmotte T, Messas E, Pezel T, Planquette B, Duceau B, Gaussem P, Sutter W, Sanchez O, Waldman V, Diehl JL, Mirault T, Bonnet G, Cohen A, Smadja DM. Anticoagulation Before Hospitalization Is a Potential Protective Factor for COVID-19: Insight From a French Multicenter Cohort Study. J Am Heart Assoc 2021; 10:e018624. [PMID: 33550816 PMCID: PMC8174166 DOI: 10.1161/jaha.120.018624] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Coronavirus disease 2019 (COVID‐19) is a respiratory disease associated with thrombotic outcomes with coagulation and endothelial disorders. Based on that, several anticoagulation guidelines have been proposed. We aimed to determine whether anticoagulation therapy modifies the risk of developing severe COVID‐19. Methods and Results Patients with COVID‐19 initially admitted in medical wards of 24 French hospitals were included prospectively from February 26 to April 20, 2020. We used a Poisson regression model, Cox proportional hazard model, and matched propensity score to assess the effect of anticoagulation on outcomes (intensive care unit admission or in‐hospital mortality). The study enrolled 2878 patients with COVID‐19, among whom 382 (13.2%) were treated with oral anticoagulation therapy before hospitalization. After adjustment, anticoagulation therapy before hospitalization was associated with a better prognosis with an adjusted hazard ratio of 0.70 (95% CI, 0.55–0.88). Analyses performed using propensity score matching confirmed that anticoagulation therapy before hospitalization was associated with a better prognosis, with an adjusted hazard ratio of 0.43 (95% CI, 0.29–0.63) for intensive care unit admission and adjusted hazard ratio of 0.76 (95% CI, 0.61–0.98) for composite criteria intensive care unit admission or death. In contrast, therapeutic or prophylactic low‐ or high‐dose anticoagulation started during hospitalization were not associated with any of the outcomes. Conclusions Anticoagulation therapy used before hospitalization in medical wards was associated with a better prognosis in contrast with anticoagulation initiated during hospitalization. Anticoagulation therapy introduced in early disease could better prevent COVID‐19–associated coagulopathy and endotheliopathy, and lead to a better prognosis.
Collapse
Affiliation(s)
- Richard Chocron
- PARCC INSERM Université de Paris France.,Emergency Department AP-HP. CUP Georges Pompidou European Hospital Paris France
| | | | - Joffrey Cellier
- PARCC INSERM Université de Paris France.,AP-HP. CUP Georges Pompidou European Hospital Paris France
| | - Nicolas Gendron
- Innovative Therapies in Haemostasis INSERM Université de Paris France.,Hematology Department and Biosurgical Research Lab (Carpentier Foundation) AP-HP. CUP Georges Pompidou European Hospital Paris France
| | | | - Olivier Bory
- PARCC INSERM Université de Paris France.,Emergency Department AP-HP. CUP Georges Pompidou European Hospital Paris France
| | - Lina Khider
- Vascular Medicine Department and Biosurgical Research Lab (Carpentier Foundation) AP-HP. CUP Georges Pompidou European HospitalUniversité de Paris France
| | - Antonin Trimaille
- Nouvel Hôpital CivilCentre Hospitalier Régional Universitaire de Strasbourg Strasbourg France
| | - Guillaume Goudot
- Vascular Medicine Department and Biosurgical Research Lab (Carpentier Foundation) AP-HP. CUP Georges Pompidou European HospitalUniversité de Paris France
| | - Orianne Weizman
- PARCC INSERM Université de Paris France.,Cardiology Department AP-HP. CUP Georges Pompidou European Hospital Paris France
| | - Jean Marc Alsac
- Innovative Therapies in Haemostasis INSERM Université de Paris France.,Vascular Surgery Department and Biosurgical Research Lab (Carpentier Foundation) AP-HP. CUP Georges Pompidou European Hospital Paris France
| | - Laura Geneste
- Centre Hospitalier Universitaire d'Amiens-Picardie Amiens France
| | - Armand Schmeltz
- Emergency Department AP-HP. CUP Georges Pompidou European HospitalUniversité de Paris France
| | | | - Aurélien Philippe
- Innovative Therapies in Haemostasis INSERM Université de Paris France.,Hematology Department and Biosurgical Research Lab (Carpentier Foundation) AP-HP. CUP Georges Pompidou European Hospital Paris France
| | - Wassima Marsou
- Centre Hospitalier Universitaire de LilleUniversité Catholique de Lille France
| | - Iannis Ben Abdallah
- Innovative Therapies in Haemostasis INSERM Université de Paris France.,Vascular Surgery Department and Biosurgical Research Lab (Carpentier Foundation) AP-HP. CUP Georges Pompidou European Hospital Paris France
| | - Antoine Deney
- Centre Hospitalier Universitaire de Toulouse Toulouse France
| | - Salma El Batti
- Innovative Therapies in Haemostasis INSERM Université de Paris France.,Vascular Surgery Department and Biosurgical Research Lab (Carpentier Foundation) AP-HP. CUP Georges Pompidou European Hospital Paris France
| | - Sabir Attou
- Centre Hospitalier Universitaire de Caen-Normandie Caen France
| | - Philippe Juvin
- Emergency Department AP-HP. CUP Georges Pompidou European HospitalUniversité de Paris France
| | | | - Emmanuel Messas
- PARCC INSERM Université de Paris France.,Vascular Medicine Department AP-HP. CUP Georges Pompidou European Hospital Paris France
| | - Théo Pezel
- Lariboisiere Hospital AP-HP University of Paris France
| | - Benjamin Planquette
- Innovative Therapies in Haemostasis INSERM Université de Paris France.,Respiratory Medicine Department and Biosurgical Research Lab (Carpentier Foundation) AP-HP. CUP Georges Pompidou European Hospital Paris France
| | - Baptiste Duceau
- PARCC INSERM Université de Paris France.,AP-HP. CUP Georges Pompidou European Hospital Paris France
| | - Pascale Gaussem
- Innovative Therapies in Haemostasis INSERM Université de Paris France.,Hematology Department AP-HP. CUP Georges Pompidou European Hospital Paris France
| | - Willy Sutter
- PARCC INSERM Université de Paris France.,AP-HP. CUP Georges Pompidou European Hospital Paris France
| | - Olivier Sanchez
- Innovative Therapies in Haemostasis INSERM Université de Paris France.,Respiratory Medicine Department and Biosurgical Research Lab (Carpentier Foundation) AP-HP. CUP Georges Pompidou European Hospital Paris France
| | - Victor Waldman
- PARCC INSERM Université de Paris France.,AP-HP. CUP Georges Pompidou European Hospital Paris France
| | - Jean-Luc Diehl
- Innovative Therapies in Haemostasis INSERM Université de Paris France.,Intensive Care Medicine Department and Biosurgical Research Lab (Carpentier Foundation) AP-HP. CUP Georges Pompidou European Hospital Paris France
| | - Tristan Mirault
- PARCC INSERM Université de Paris France.,Vascular Medicine Department AP-HP. CUP Georges Pompidou European Hospital Paris France
| | - Guillaume Bonnet
- PARCC INSERM Université de Paris France.,AP-HP. CUP Georges Pompidou European Hospital Paris France
| | - Ariel Cohen
- Service de Cardiologie Unité de Cardio-Oncologie AP-HP.6 Groupe de Recherche Clinique en Cardio Oncologie Inserm 856 Hôpitaux Universitaires Paris-Est Assistance Publique-Hôpitaux de ParisHôpital Saint AntoineUniversité Pierre et Marie Curie Paris France
| | - David M Smadja
- Innovative Therapies in Haemostasis INSERM Université de Paris France.,Hematology Department and Biosurgical Research Lab (Carpentier Foundation) AP-HP. CUP Georges Pompidou European Hospital Paris France
| | | |
Collapse
|
26
|
Weizman O, Mika D, Geneste L, Cellier J, Trimaille A, Pommier T, Panagides V, Chaumont C, Karsenty C, Duceau B, Sutter W, Fauvel C, Pezel T, Bonnet G, Cohen A, Waldmann V. Cardiovascular Comorbidities and Covid-19 in Women. Archives of Cardiovascular Diseases Supplements 2021. [PMCID: PMC8719934 DOI: 10.1016/j.acvdsp.2020.10.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background While women account for 40-50 % of patients hospitalized for coronavirus disease 2019 (Covid-19), no specific data have been reported in this population. Purpose Assess the burden of cardiovascular comorbidities on outcomes in women hospitalized for Covid-19. Methods We conducted a retrospective observational multicenter study from February 26 to April 20, 2020 in 24 French hospitals including all adults admitted for Covid-19. Primary composite outcome included transfer to intensive care unit (ICU) or in-hospital death. Results Among 2878 patients hospitalized for Covid-19, 1212 (42.1 %) were women. Women were significantly older (68.3 ± 18.0 vs. 65.4 ± 16.0 years, P < 0.001) but had less prevalent cardiovascular comorbidities than men. Among women, 276 (22.8 %) experienced the primary outcome, including 161 (13.3 %) transfer to ICU and 115 (9.5 %) deaths without transfer to ICU. The survival free from death or transfer to ICU was higher in women (HR 0.63, 95 %CI 0.53-0.73, P < 0.001), whereas the observed difference in in-hospital deaths did not reach statistical significance (P = 0.18). The proportion of women that experienced the primary outcome were 37.8 % in women with heart failure (n = 112), 30.9 % in women with coronary artery disease (n = 81), 29.1 % in women with diabetes (n = 254), 26.1 % in women with dyslipidemia (n = 315), and 26.0 % in women with hypertension (n = 632). Age (HR 1.05, 5 years increments, 95 %CI 1.01-1.10), body mass index (HR 1.06, 2 units increments, 95 %CI 1.02-1.10), chronic kidney disease (HR 1.57, 95 %CI 1.11-2.22), and heart failure (HR 1.52, 95 %CI 1.04-2.22) were independently associated with the primary outcome (Fig. 1). Conclusions Women hospitalized for Covid-19 were older and had less prevalent cardiovascular comorbidities than men. While female sex was associated with a lower risk of transfer to ICU or in-hospital death, Covid-19 remains associated with considerable morbi-mortality in women, especially in those with cardiovascular diseases.
Collapse
|
27
|
Bonnet G, Panagides V, Palermo V, Gautier A, Pommier T, Weizman O, Noirclerc N, Adjedj J, Commeau P, Benamer H, Cayla G. Myocardial infarction rates overview during COVID-19 pandemic In France: Results of the MODIF registry. Archives of Cardiovascular Diseases Supplements 2021. [PMCID: PMC8719936 DOI: 10.1016/j.acvdsp.2020.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background The emergence of Coronavirus disease 2019 (COVID-19) has evolved into a global pandemic. Systems of care have been reorganized worldwide in an effort to preserve hospital bed capacity. In France, from March 17 to May 11 2020, government imposed a complete lockdown on the whole population. Only urgent cardiac procedures have been ensured such as ST-elevation myocardial infarction (STEMI) revascularization. Some previously published studies suggest a reduction of admission for STEMI in many countries. Nevertheless, strong evidences and data across different French regions that have been affected variously by the outbreak are still lacking. Purpose We aimed to describe the incidence rates and characteristics of patients presenting with STEMI in order to evaluate the impact of the COVID-19 outbreak on STEMI care in France covering the lockdown period compared to same period one year ago. Methods We performed a retrospective multicenter registry across 60 French interventional cardiology centers including all consecutive STEMI patients referred for urgent revascularization in the heart catheterization laboratory between two periods: March 1st to May 31th 2020 compared with March 1st to May 31th 2019. Comprehensive data, including clinical, biological, COVID status and angiographic variables including time taken for care were recorded at admission. The primary outcome was a composite of invasive mechanical ventilation support or in-hospital death. The secondary outcome was the occurrence of myocardial infarction related complications during hospitalization. Enrollement is not complete at the time of the abstract submission. Conclusion This data collection between two periods with and without COVID19 will gave insights for a complete descriptive cartography of STEMI patients among different French regions which have been variously impacted by the outbreak.
Collapse
|
28
|
Fauvel C, Weizman O, Trimaille A, Mika D, Pace N, Douair A, Barbin E, Fraix A, Bouchot O, Benmansour O, Godeau G, Mecheri Y, Le Bourdon R, Yvorel C, Duceau B, Sutter W, Waldmann V, Bonnet G, Cohen A, Pezel T. Pulmonary Embolism in Covid-19 patients: A French Multicentre Cohort Study. Archives of Cardiovascular Diseases Supplements 2021. [PMCID: PMC8719940 DOI: 10.1016/j.acvdsp.2020.10.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background While pulmonary embolism (PE) appears to be a major issue in Covid-19, data remain sparse. Purpose We aimed to describe the risk factors and baseline characteristics of patients with PE in a large cohort of Covid-19 patients. Methods In a retrospective multicentric observational study, we included consecutive hospitalised patients for Covid-19. Patients without computed tomography pulmonary angiography (CTPA)-proven PE diagnosis, those who were directly admitted to an intensive care unit (ICU), and those still hospitalised without PE experience were excluded. Results Among 1240 patients (58.1% men, mean age 64 ± 17 years), 103 (8.3%) patients had PE confirmed by CTPA. The ICU transfer requirement and mechanical ventilation requirement were significantly higher in the PE group (P < 0.001 and P < 0.001, respectively). In an univariable analysis, traditional venous thromboembolic risk factors were not associated with PE (P > 0.05), while patients under therapeutic-dose anticoagulation before hospitalisation or prophylaxis-dose anticoagulation introduced during hospitalisation had lower PE occurrence (OR 0.40, 95%CI(0.14-0.91); P = 0.04 and OR 0.11, 95%CI(0.06-0.18); P < 0.001, respectively). In a multivariable analysis, the following variables (also statistically significant in univariable analysis) were associated with PE: male gender (OR 1.03, 95%CI(1.003-1.069); P = 0.04), anticoagulation with prophylaxis-dose (OR 0.83, 95%CI(0.79-0.85), P < 0.001) or therapeutic-dose (OR 0.87, 95%CI(0.82-0.92), P < 0.001), C-reactive protein (OR 1.03, 95%CI(1.01-1.04), P = 0.001) and time from symptom onset to hospitalisation (OR 1.02, 95%CI(1.006-1.038), P = 0.002) (Table 1). Conclusion Pulmonary embolism risk factors in Covid-19 context do not include traditional thromboembolic risk factors but rather independent clinical and biological findings at admission, including a major contribution to inflammation.
Collapse
|
29
|
Fauvel C, Weizman O, Trimaille A, Mika D, Pommier T, Pace N, Douair A, Barbin E, Fraix A, Bouchot O, Benmansour O, Godeau G, Mecheri Y, Lebourdon R, Yvorel C, Massin M, Leblon T, Chabbi C, Cugney E, Benabou L, Aubry M, Chan C, Boufoula I, Barnaud C, Bothorel L, Duceau B, Sutter W, Waldmann V, Bonnet G, Cohen A, Pezel T. Pulmonary embolism in COVID-19 patients: a French multicentre cohort study. Eur Heart J 2020; 41:3058-3068. [PMID: 32656565 PMCID: PMC7528952 DOI: 10.1093/eurheartj/ehaa500] [Citation(s) in RCA: 186] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/18/2020] [Accepted: 06/07/2020] [Indexed: 12/13/2022] Open
Abstract
Aims While pulmonary embolism (PE) appears to be a major issue in COVID-19, data remain sparse. We aimed to describe the risk factors and baseline characteristics of patients with PE in a cohort of COVID-19 patients. Methods and results In a retrospective multicentre observational study, we included consecutive patients hospitalized for COVID-19. Patients without computed tomography pulmonary angiography (CTPA)-proven PE diagnosis and those who were directly admitted to an intensive care unit (ICU) were excluded. Among 1240 patients (58.1% men, mean age 64 ± 17 years), 103 (8.3%) patients had PE confirmed by CTPA. The ICU transfer and mechanical ventilation were significantly higher in the PE group (for both P < 0.001). In an univariable analysis, traditional venous thrombo-embolic risk factors were not associated with PE (P > 0.05), while patients under therapeutic dose anticoagulation before hospitalization or prophylactic dose anticoagulation introduced during hospitalization had lower PE occurrence [odds ratio (OR) 0.40, 95% confidence interval (CI) 0.14–0.91, P = 0.04; and OR 0.11, 95% CI 0.06–0.18, P < 0.001, respectively]. In a multivariable analysis, the following variables, also statistically significant in univariable analysis, were associated with PE: male gender (OR 1.03, 95% CI 1.003–1.069, P = 0.04), anticoagulation with a prophylactic dose (OR 0.83, 95% CI 0.79–0.85, P < 0.001) or a therapeutic dose (OR 0.87, 95% CI 0.82–0.92, P < 0.001), C-reactive protein (OR 1.03, 95% CI 1.01–1.04, P = 0.001), and time from symptom onset to hospitalization (OR 1.02, 95% CI 1.006–1.038, P = 0.002). Conclusion PE risk factors in the COVID-19 context do not include traditional thrombo-embolic risk factors but rather independent clinical and biological findings at admission, including a major contribution to inflammation.
Collapse
Affiliation(s)
- Charles Fauvel
- Rouen University Hospital, FHU REMOD-VHF, F-76000 Rouen, France
| | - Orianne Weizman
- Centre Hospitalier Régional Universitaire de Nancy, 54511 Vandoeuvre-Les-Nancy, France.,Université de Paris, PARCC, INSERM, 75015 Paris, France
| | - Antonin Trimaille
- Nouvel Hôpital Civil, Centre Hospitalier Régional Universitaire de Strasbourg, 67000 Strasbourg, France
| | - Delphine Mika
- Université Paris-Saclay, Inserm, UMR-S 1180, 92296 Chatenay-Malabry, France
| | - Thibaut Pommier
- Centre hospitalier Universitaire de Dijon, 21000 Dijon, France
| | - Nathalie Pace
- Centre Hospitalier Régional Universitaire de Nancy, 54511 Vandoeuvre-Les-Nancy, France
| | - Amine Douair
- Centre Hospitalier Annecy Genevois, 74370 Epagny Metz-Tessy, France
| | - Eva Barbin
- Centre Hospitalier Régionnal de Orléans, 45100 Orléans, France
| | - Antoine Fraix
- Centre Hospitalier Régional Universitaire de Nancy, 54511 Vandoeuvre-Les-Nancy, France
| | - Océane Bouchot
- Centre Hospitalier Annecy Genevois, 74370 Epagny Metz-Tessy, France
| | | | | | - Yasmine Mecheri
- Centre Hospitalier Régionnal de Orléans, 45100 Orléans, France
| | - Romane Lebourdon
- Centre Hospitalier Universitaire de Bordeaux, 33076 Bordeaux, France
| | - Cédric Yvorel
- Centre Hospitalier Universitaire de Saint-Etienne, 42270 Saint-Priest-en-Jarez, France
| | - Michael Massin
- Centre Hospitalier Régional Universitaire de Nancy, 54511 Vandoeuvre-Les-Nancy, France
| | - Tiphaine Leblon
- Centre Hospitalier Universitaire de Lille, Université Catholique de Lille, 59000 Lille, France
| | - Chaima Chabbi
- Centre Hospitalier Régionnal de Orléans, 45100 Orléans, France
| | - Erwan Cugney
- Centre Hospitalier Régional Universitaire de Nancy, 54511 Vandoeuvre-Les-Nancy, France
| | - Léa Benabou
- Centre Hospitalier Universitaire de Bordeaux, 33076 Bordeaux, France
| | - Matthieu Aubry
- Hospices Civils de Lyon, Centre Hospitalier Universitaire, 69003 Lyon, France
| | - Camille Chan
- Centre Hospitalier Universitaire de Bordeaux, 33076 Bordeaux, France
| | - Ines Boufoula
- Centre Hospitalier Régionnal de Orléans, 45100 Orléans, France
| | - Clement Barnaud
- Centre Hospitalier Régionnal de Orléans, 45100 Orléans, France
| | - Léa Bothorel
- Centre Hospitalier Régionnal de Orléans, 45100 Orléans, France
| | | | - Willy Sutter
- Université de Paris, PARCC, INSERM, 75015 Paris, France
| | - Victor Waldmann
- Université de Paris, PARCC, INSERM, 75015 Paris, France.,Hôpital Européen Georges Pompidou, Université de Paris, 75015 Paris, France
| | - Guillaume Bonnet
- Université de Paris, PARCC, INSERM, 75015 Paris, France.,Hôpital Européen Georges Pompidou, Université de Paris, 75015 Paris, France
| | | | - Théo Pezel
- Lariboisiere hospital, APHP, University of Paris, 75010 Paris, France
| | | |
Collapse
|
30
|
Affiliation(s)
- L. Sheinbaum
- Department of Polymers & Plastics Engineering; Shenkar College of Engineering Design and Art; Ramat-Gan 52526 Israel
| | - M. Sheinbaum
- Department of Polymers & Plastics Engineering; Shenkar College of Engineering Design and Art; Ramat-Gan 52526 Israel
| | - O. Weizman
- Department of Polymers & Plastics Engineering; Shenkar College of Engineering Design and Art; Ramat-Gan 52526 Israel
| | - H. Dodiuk
- Department of Polymers & Plastics Engineering; Shenkar College of Engineering Design and Art; Ramat-Gan 52526 Israel
| | - S. Kenig
- Department of Polymers & Plastics Engineering; Shenkar College of Engineering Design and Art; Ramat-Gan 52526 Israel
| |
Collapse
|
31
|
Nudman D, Weizman O, Amir E, Ophir A. Development and characterization of expanded graphite filled-PET/PVDF blend: thermodynamic and kinetic effects. POLYM ADVAN TECHNOL 2017. [DOI: 10.1002/pat.3855] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- D. Nudman
- The Pernick Faculty of Engineering, Department of Polymers and Plastics Engineering; Shenkar College of Engineering and Design; Ramat-Gan 52526 Israel
| | - O. Weizman
- The Pernick Faculty of Engineering, Department of Polymers and Plastics Engineering; Shenkar College of Engineering and Design; Ramat-Gan 52526 Israel
| | - E. Amir
- The Pernick Faculty of Engineering, Department of Polymers and Plastics Engineering; Shenkar College of Engineering and Design; Ramat-Gan 52526 Israel
| | - A. Ophir
- The Pernick Faculty of Engineering, Department of Polymers and Plastics Engineering; Shenkar College of Engineering and Design; Ramat-Gan 52526 Israel
| |
Collapse
|