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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
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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
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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
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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
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Pareek M, Bhatt DL, Zheng L, Lee JJ, Leiter LA, Simon T, Mehta SR, Harrington RA, Fox K, Himmelmann A, Vidal-Petiot E, Steg PG. Blood pressure and clinical outcomes in patients with diabetes and stable coronary artery disease in THEMIS. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Various BP characteristics, e.g., systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP), as well as heart rate (HR) may affect the risk of both cardiovascular events and bleeding events. However, the exact way in which these characteristics and outcomes are associated among patients with diabetes and stable coronary artery disease (CAD) remains debated. Moreover, it is unknown whether the risks and benefits of intensified antiplatelet therapy in this patient population are affected by their baseline BP and HR.
Purpose
To assess the relationship between BP components (including HR) and cardiovascular and bleeding events, and to determine if the effects of ticagrelor vs. placebo varied across the BP and HR spectrum, in patients with diabetes and stable CAD.
Methods
THEMIS was a randomized, controlled trial in which 19,220 individuals ≥50 years of age with stable CAD and type 2 diabetes were randomized to receive either ticagrelor plus aspirin or placebo plus aspirin. Patients with a prior myocardial infarction or stroke, or already on dual antiplatelet therapy, were excluded. The primary efficacy outcome was a composite of cardiovascular death, myocardial infarction, or stroke. The primary safety outcome was TIMI major bleeding. We examined prognostic implications of BP components using 1) restricted cubic splines for the overall trends with outcomes; 2) Cox proportional-hazards regression models with predefined BP component intervals adjusted for demographic, clinical, and laboratory variables; and 3) Cox regression models for the effects of ticagrelor vs. placebo on outcomes across the spectrum of BP component values (test for interaction). THEMIS is registered at ClinicalTrials.gov (NCT01991795).
Results
Mean values of baseline BP components were similar between the two study groups. Median follow-up duration was 39.9 months (range 0–57), with 1554 primary efficacy events and 306 primary safety events occurring over the course of the study. All BP components (including HR) displayed various, independent relationships with the tested outcomes. For example, in adjusted spline models, SBP displayed non-linear relationships with the primary outcome, all-cause death, any bleeding, serious adverse events, and intracranial bleeding, and linear relationships with the remaining outcomes. Figure 1 shows the associations of each BP component with the primary efficacy outcome. BP components did not substantially modify the risks and benefits of ticagrelor vs. placebo for the tested outcomes.
Conclusions
BP components were independently associated with efficacy and safety outcomes in patients with stable CAD and type 2 diabetes. However, no important modification of BP components on the effect of ticagrelor vs. placebo was detected.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): AstraZeneca
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Affiliation(s)
- M Pareek
- Brigham and Women's Hospital, Heart and Vascular Center , Boston , United States of America
| | - D L Bhatt
- Brigham and Women's Hospital, Heart and Vascular Center , Boston , United States of America
| | - L Zheng
- Brigham and Women's Hospital, Heart and Vascular Center , Boston , United States of America
| | - J J Lee
- Brigham and Women's Hospital, Heart and Vascular Center , Boston , United States of America
| | - L A Leiter
- St. Michael's Hospital , Toronto , Canada
| | - T Simon
- Sorbonne University , Paris , France
| | - S R Mehta
- McMaster University , Hamilton , Canada
| | - R A Harrington
- Stanford University Medical Center , Stanford , United States of America
| | - K Fox
- Royal Brompton Hospital Imperial College London , London , United Kingdom
| | - A Himmelmann
- AstraZeneca BioPharmaceuticals , Molndal , Sweden
| | - E Vidal-Petiot
- Bichat Hospital, University Paris-Diderot, INSERM-UMR1148, FACT French Alliance for Cardiovascular T , Paris , France
| | - P G Steg
- Bichat Hospital, University Paris-Diderot, INSERM-UMR1148, FACT French Alliance for Cardiovascular T , Paris , France
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Khonsari RH, Bernaux M, Vie JJ, Diallo A, Paris N, Luong LB, Assouad J, Paugam C, Simon T, Vicaut E, Nizard R, Vibert E. Risks of early mortality and pulmonary complications following surgery in patients with COVID-19. Br J Surg 2021; 108:e158-e159. [PMID: 33793755 PMCID: PMC7929121 DOI: 10.1093/bjs/znab007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/01/2020] [Accepted: 12/27/2020] [Indexed: 11/29/2022]
Affiliation(s)
- R H Khonsari
- Service de Chirurgie Maxillo-faciale et Chirurgie Plastique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Université de Paris, Paris, France
| | - M Bernaux
- Direction de la Stratégie et de la Transformation, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - J-J Vie
- Université de Lille, Inria, CNRS, UMR 9189 - CRIStAL, Lille, France
| | - A Diallo
- Unité de Recherche Clinique (URC) Saint-Louis Lariboisière Fernand-Widal, Assistance Publique - Hôpitaux de Paris, Université de Paris, Paris, France
| | - N Paris
- Direction des Systèmes d'Information, Web INnovations Données (WIND), Assistance Publique - Hôpitaux de Paris, Paris, France
| | - L B Luong
- CIC Cochin Pasteur, Assistance Publique - Hôpitaux de Paris, Université de Paris, Paris, France
| | - J Assouad
- Service de Chirurgie Thoracique et Vasculaire, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris; Sorbonne Université, Paris, France
| | - C Paugam
- Direction Générale, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - T Simon
- Service de Pharmacologie Clinique, Plateforme de Recherche Clinique de l'Est Parisien (URCEST-CRB-CRCEST), AP-HP.SU, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - E Vicaut
- Unité de Recherche Clinique (URC) Saint-Louis Lariboisière Fernand-Widal, Assistance Publique - Hôpitaux de Paris, Université de Paris, Paris, France
| | - R Nizard
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Lariboisière, Assistance Publique - Hôpitaux de Paris, Université de Paris, Paris, France
| | - E Vibert
- Centre Hépato-biliaire, Hôpital Paul-Brousse, Assistance Publique - Hôpitaux de Paris, Université Paris-Saclay, Villejuif, France
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5
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Ferrières J, Bataille V, Puymirat E, Schiele F, Simon T, Danchin N. Applicability of the REDUCE-IT trial to the FAST-MI registry. Are the results of randomized trials relevant in routine clinical practice? Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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6
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Steg P, Bhatt D, James S, Darlington O, Hoskin L, Simon T, Fox K, Leiter L, Mehta S, Harrington R, Himmelmann A, Ridderstrale W, Andersson M, Mellstrom C, Mcewan P. Cost-effectiveness of ticagrelor in patients with type 2 diabetes and coronary artery disease with a history of PCI: an economic evaluation of THEMIS-PCI using a Swedish healthcare perpective. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The Effect of Ticagrelor on Health Outcomes in diabEtes Mellitus patients Intervention Study (THEMIS) evaluated ticagrelor compared to placebo for the prevention of myocardial infarction (MI), stroke and cardiovascular (CV) death in 19 220 patients with type 2 diabetes (T2DM) and stable coronary artery disease (CAD) with no prior myocardial infarction (MI) or stroke. THEMIS-PCI was a pre-specified subgroup of 11 154 patients who had a history of percutaneous coronary intervention (PCI) when entering the study. In THEMIS, ticagrelor reduced CV death, MI or stroke, although with an increase in major bleeding compared to aspirin alone, and there was a significant interaction between a prior history of PCI and the net benefit of ticagrelor. In the THEMIS-PCI population, ticagrelor plus aspirin provided a favourable net clinical benefit with a significant 15% reduction in all-cause death, MI, stroke, fatal bleed, or intracranial haemorrhage.
Objective
The objective of this analysis was to estimate the cost-effectiveness of ticagrelor for the prevention of CV events based on the results of the THEMIS-PCI population using a lifetime horizon from a Swedish healthcare perspective.
Methods
A lifetime Markov state transition model was developed with health states aligned to the THEMIS trial endpoints. Health state transitions were informed by parametric survival equations fitted to patient level data from THEMIS-PCI population. Treatment discontinuation rates were informed by the THEMIS-PCI population, with all patients assumed to discontinue treatment with ticagrelor after four years. The incidence of bleeding and dyspnoea were modelled as adverse events. Costs (2019 Euros) and utility data were derived from the published literature and the THEMIS-PCI population, respectively, and discounted at 3.0% annually. Probabilistic (PSA) and deterministic sensitivity analysis (DSA) were conducted to quantify uncertainty of key input parameters.
Results
Treatment with ticagrelor plus aspirin over four years resulted in estimated Quality Adjusted Life Year (QALY) gains of 0.09 at an incremental cost of €1,891 compared to aspirin alone. The estimated incremental cost-effectiveness ratio (ICER) was €19,959/QALY. PSA indicated that ticagrelor was cost-effective in 93% of simulations using a willingness-to-pay threshold of €47,000/QALY and DSA showed that cost-effectiveness was robust to changes in key input parameters (ICER range: €16,504 to €25,012/QALY).
Conclusion
Based on the results of the THEMIS trial, dual antiplatelet therapy with ticagrelor plus aspirin is likely to be a cost-effective treatment compared with aspirin alone for the prevention of CV events in patients with T2DM and CAD with a history of PCI.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): AstraZeneca
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Affiliation(s)
- P Steg
- Hospital Bichat-Claude Bernard, Paris, France
| | - D.L Bhatt
- Brigham and Women's Hospital, Boston, United States of America
| | - S.K James
- Uppsala Clinical Research Center, Uppsala, Sweden
| | - O Darlington
- Health Economics and Outcomes Research Ltd, Cardiff, United Kingdom
| | - L Hoskin
- Health Economics and Outcomes Research Ltd, Cardiff, United Kingdom
| | - T Simon
- Hôpital Saint Antoine, Sorbonne-Université, Paris, France
| | - K Fox
- Royal Brompton Hospital Imperial College London, London, United Kingdom
| | | | - S Mehta
- McMaster University, Hamilton, Canada
| | | | | | | | | | | | - P Mcewan
- Health Economics and Outcomes Research Ltd, Cardiff, United Kingdom
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7
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Puymirat E, Schiele F, Roubille F, Tea V, Ferrieres J, Simon T, Danchin N. Participation in a research study related to acute myocardial infarction is not a guarantee to live more longer: results from the FAST-MI registries. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The main potential benefits of participating in a clinical trial is to have access to a treatment that is not available yet and to have a regular and careful attention from physicians. Several data have suggested that inclusion in a research study was associated with better clinical outcome.
Aims
The aim of this study is to describe the prevalence of inclusions in a research study (i.e., device or medication), clinical characteristics, management and clinical outcome in patients admitted for acute myocardial infarction (AMI) according to participation in a research study (versus not) using data from the French registries of Acute ST-or non-ST-elevation Myocardial infarction (FAST-MI) 2010 and 2015.
Methods
We used data from 2 one-month French registries, conducted 5 years apart, including 9,414 AMI admitted to coronary or intensive care units. We analyzed baseline characteristics, management and one-year survival according to participation in a research study.
Results
From 2010 to 2015, the prevalence of patients included in a research study decreased from 6.8% to 3.6% (P<0.001). Inclusions were performed mainly in university hospitals (8%). Clinical characteristics according to participation in a research study were strongly different. Overall, patients included in a research study were younger (61.2±12.7 vs 65.7±14.1; P<0.001) with less previous medical history and co-morbidities. Clinical presentation was preferentially a ST-elevation myocardial infarction (STEMI: 70% vs 52%; P<0.001) in these patients who had a lower GRACE score (133±32 vs. 141±35; P<0.001). The use of invasive strategies was more used in patients included in a research study (coronary angiogram: 99% vs 95%, P<0.001) as prescriptions of recommended medications (i.e., antiplatelet agents, beta-blockers, angiotensin-converting-enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB) and statins) at discharge (72% vs 63%; P<0.001).
In a cox multivariate analysis, participation in a research study was not associated with lower mortality at one-year (HR= 0.68, 95% CI, 0.39–1.18, P=0.17). Similar results were observed in patients discharge alive (HR= 0.81, 95% CI, 0.44–1.48, P=0.49). Recommended medications were however more used in patients included in a clinical trial (OR=1.34; 95% CI, 1.09–1.65; P=0.007).
Conclusions
The number of inclusions in a research study related to AMI in France is low. Our data suggest that patients included in a research study are selected and received more recommended medications and invasive strategies. However, this management is not associated with a lower mortality at one-year.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- E Puymirat
- European Hospital Georges Pompidou, Cardiology, Paris, France
| | - F Schiele
- Regional University Hospital Jean Minjoz, Cardiology, Besancon, France
| | - F Roubille
- University Hospital Arnaud de Villeneuve, Cardiology, Montpellier, France
| | - V Tea
- European Hospital Georges Pompidou, Cardiology, Paris, France
| | - J Ferrieres
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - T Simon
- Hospital Saint-Antoine, Paris, France
| | - N Danchin
- European Hospital Georges Pompidou, Cardiology, Paris, France
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Danchin N, Ferrieres J, Puymirat E, Cayla G, Cottin Y, Coste P, Roubille F, Furber A, Albert F, Schiele F, Simon T. Association between lipid lowering regimen intensity at discharge and long-term mortality in optimally-treated patients with acute myocardial infraction. The FAST-MI programme. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Randomised trials evaluate the efficacy of individual medications, irrespective of overall patient management. We assessed the association between lipid-lowering therapy (LLT) intensity and long-term mortality in otherwise optimally-treated patients with acute myocardial infarction (AMI).
Methods
FAST-MI consists in one-month nationwide French surveys of patients admitted for a recent AMI, repeated every 5 years. We used the 2010 and 2015 data with 3-year follow-up. Background optimal therapy was defined as use of PCI, together with ESC guideline-recommended treatment with beta-blockers, ACEi/ARB, when indicated, and optimal antithrombotic medications including type of P2Y12-i; of 9,460 patients included, 4,042 were optimally-treated, with 478 (12%), 1120 (28%), and 2,444 (60%) respectively receiving conventional-dose statins (Gr 1), moderate-intensity statins (atorvastatin 40 mg or rosuvastatin 10 mg) (Gr2) or high-dose LLT (atorvastatin 80 mg, rosuvastatin ≥20 mg or statin-ezetimibe combination) (Gr3).
Results
Baseline characteristics markedly differed in the 3 groups (Table 1).
Three-year Kaplan-Meier survival was 88.5%, 93.5% and 96.3% respectively for gr 1, 2 and 3, with Cox-adjusted HR of 0.75 (0.51–1.10), P=0.137, and 0.59 (0.41–0.86), P=0.006 for gr 2 and 3 compared with Gr1 (Figure).
Conclusion
In otherwise optimally-treated AMI patients, lipid-lowering regimen intensity at discharge was inversely associated with 3-year mortality. These results confirm that high-intensity lipid lowering therapy at discharge is likely beneficial even in patients receiving otherwise optimal therapy.
Figure 1. 3-year survival
Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): MSD, AstraZeneca
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Affiliation(s)
- N Danchin
- AP-HP - European Hospital Georges Pompidou, Paris, France
| | - J Ferrieres
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - E Puymirat
- AP-HP - European Hospital Georges Pompidou, Paris, France
| | - G Cayla
- University Hospital of Nimes, Nimes, France
| | - Y Cottin
- University Hospital of Dijon, Dijon, France
| | - P Coste
- Haut-Leveque Hospital - University Hospital Centre, Pessac, France
| | - F Roubille
- University Hospital Arnaud de Villeneuve, Montpellier, France
| | - A Furber
- University Hospital of Angers, Angers, France
| | - F Albert
- Hospital Louis Pasteur of Chartres, Chartres, France
| | - F Schiele
- Regional University Hospital Jean Minjoz, Besancon, France
| | - T Simon
- AP-HP - Hospital Saint Antoine, Paris, France
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9
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Dillinger J, Achkouty G, Albert F, Labeque J, Morelle J, Cottin Y, Lim P, Schiele F, Ferrieres J, Henry P, Puymirat E, Simon T, Danchin N. Correlates and prognostic impact of acute heart failure at the acute stage of ST-elevation and non-ST-elevation myocardial infarction according to diabetic status: the FAST-MI registries. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Diabetes mellitus (DM) predisposes to cardiovascular diseases including acute myocardial infarction (AMI) and acute heart failure (AHF).
Purpose
Analysing the French Registries of Acute ST-elevation and non-ST-elevation Myocardial Infarction (FAST-MI) 2005 and 2010, we assessed correlates of AHF occurring at the acute stage of ST-elevation AMI (STEMI) and non-ST-elevation AMI (NSTEMI), as well as the prognostic impact of AHF on 5-year mortality according to diabetic status.
Methods
The FAST-MI 2005 and 2010 registries included 7,839 consecutive patients admitted for AMI (4,250 STEMI and 3,589 NSTEMI). Vital status at 5 years was available in >96% of the patients. Binary logistic regression analysis was used to determine independent correlates of AHF and Cox multivariate analysis was used to determine independent correlates of 5-year mortality. Long-term survival curves were estimated using the Kaplan Meier method and comparisons were made using log-rank tests.
Results
2,151 patients presented with DM (27,4%) and 629 patients (8,0%) were treated by insulin (DMi). DM patients were older (70.0 vs. 64.6 years; p<0.001), with more comorbidities and more severe coronary artery disease. AHF (pulmonary edema or cardiogenic shock) was the most frequent in-hospital complication (12.5%) and was twice as frequent in DM patients (20.2% vs. 9.6%; adjusted OR=1.66; 95% confidence interval: 1.43–1.94; P<0.001). AHF was more frequently observed in DM patients on insulin therapy compared with DM patients not receiving insulin (29.1% vs 16.6%; adjusted OR=1.53; 95% CI: 1.20–1.96; P=0.001). The significant difference in AHF between DM patients and patients without DM was found in both STEMI (18.8% vs 8.0%; P=0.001) and in NSTEMI (21.3% vs 11.9%; P=0.001) patients.
After multivariate analysis on confounders (risk factors, previous medical history, type of AMI, year of survey and medications used before the index AMI), compared with patients without DM nor AHF, those with AHF without DM and those with DM without AHF had a 50% increase in 5-year mortality (adjusted HR=1.50; 95% CI: 1.32–1.69; P<0.001 and adjusted HR=1.46; 95% CI: 1.23–1.74; P<0.001) while the risk of 5-year death was doubled in those with both DM and AHF (adjusted HR=1.97; 95% CI: 1.66–2.34; P<0.0001).
Conclusion
AHF is the most frequent complication of AMI and is twice as common in DM patients. It is associated with reduced 5-year survival in non-diabetic and DM patients, with the worst outcomes in patients with both conditions (AHF and DM). In AMI, new management strategies are needed to prevent AHF and improve survival in DM patients with AHF.
Figure 1
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): The FAST-MI 2005 and 2010 registries are the propriety of the French Society of Cardiology and were funded by grants from the following companies: Amgen, AstraZeneca, Bayer, BMS, Daiichi-Sankyo, Eli-Lilly, GSK, MSD, Novartis, Pfizer, Sanofi, and Servier, and by a grant from the French National Health Insurance body (CNAM-TS).
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Affiliation(s)
- J.G Dillinger
- Lariboisiere University Hospital, Department of Cardiology, paris, France
| | - G Achkouty
- Lariboisiere University Hospital, Department of Cardiology, paris, France
| | - F Albert
- Les Hôpitaux de Chartres, Department of Cardiology, Le Coudray, France
| | - J.N Labeque
- Centre Hospitalier Cote Basque, Department of Cardiology, Bayonne, France
| | - J.F Morelle
- Private Hospital Saint Martin, Department of Cardiology, Caen, France
| | - Y Cottin
- University Hospital of Dijon, Department of Cardiology, Dijon, France
| | - P Lim
- University Hospital Henri Mondor, Department of Cardiology, Creteil, France
| | - F Schiele
- Regional University Hospital Jean Minjoz, Department of Cardiology, Besancon, France
| | - J Ferrieres
- Toulouse Rangueil University Hospital (CHU), Department of Cardiology, Toulouse, France
| | - P Henry
- Lariboisiere University Hospital, Department of Cardiology, paris, France
| | - E Puymirat
- European Hospital of Georges Pompidou,, Department of Cardiology, paris, France
| | - T Simon
- Saint-Antoine University Hospital, Department of Clinical Pharmacology and Clinical Research Platform of East of Paris, paris, France
| | - N Danchin
- European Hospital of Georges Pompidou,, Department of Cardiology, paris, France
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Danchin N, Fauchier L, Marijon E, Lavergne T, Boveda S, Martinet M, Defaye P, Piot O, Puymirat E, Bataille V, Drouet E, Ferrieres J, Schiele F, Simon T. Compared prognostic impact of incident atrial fibrillation versus history of atrial fibrillation in patients with AMI: the FAST-MI programme. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1596] [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
History of atrial fibrillation (HxAF) and new onset atrial fibrillation (NOAF) at acute stage of MI are associated with poorer survival. Whether both entities carry an increased risk of stroke is uncertain.
Using data from the FAST-MI 2010 and 2015 registries, we analysed the associations between HxAF and NOAF and risk of 3-year death, nonfatal stroke or combined death or stroke.
Methods
The FAST-MI registries are nationwide French cohorts consecutively including AMI patients admitted over a 1-month period every 5 years. Baseline characteristics, acute management and medications at discharge are collected. Among 9460 patients with STEMI or NSTEMI, 610 (6.4%) had HxAF, and 626 (6.6%) developed NOAF.
Main characteristics
Table 1 Overall, NOAF was associated with larger and more severe AMIs.
Results
In hospital survivors, 3-year death was 8.6% in patients without AF, 23.2% in those with NOAF and 29.2% in those with HxAF. 3-year Kaplan-Meier rates of non-fatal stroke were 1.1%, 0.3% and 3.6%, respectively (Figure).
Compared with no AF, NOAF was not associated with non-fatal stroke (Cox HR, 95% CI: 0.17, 0.02–1.21), while HxAF was (HR, 95% CI 2.04, 1.13–3.66, P=0.017). Risk of death or stroke was increased for both NOAF (HR, 95% CI 1.35, 1.10–1.65, P=0.004) and HxAF (HR 95% CI, 1.37, 1.14–1.65, P=0.001). Risk of all-cause death at 3 years was increased for NOAF (HR, 95% CI 1.32, 1.09–1.60) and HxAF (HR, 95% CI 1.30, 1.09–1.55). The results were concordant in patients not receiving oral anticoagulants at discharge.
Conclusion
Both NOAF and HxAF are associated with increased risk of death at 3 years after AMI. NOAF, however, is not associated with an increased risk of non-fatal stroke.
Figure 1. Non-fatal stroke
Funding Acknowledgement
Type of funding source: Other. Main funding source(s): Pharma companies
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Affiliation(s)
- N Danchin
- AP-HP - European Hospital Georges Pompidou, Paris, France
| | - L Fauchier
- University Hospital of Tours, Tours, France
| | - E Marijon
- AP-HP - European Hospital Georges Pompidou, Paris, France
| | - T Lavergne
- AP-HP - European Hospital Georges Pompidou, Paris, France
| | - S Boveda
- Clinic Pasteur, Toulouse, France
| | - M Martinet
- AP-HP - European Hospital Georges Pompidou, Paris, France
| | - P Defaye
- University Hospital of Grenoble, Grenoble, France
| | - O Piot
- Centre Cardiologique du Nord (CCN), Saint Denis, France
| | - E Puymirat
- AP-HP - European Hospital Georges Pompidou, Paris, France
| | - V Bataille
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - E Drouet
- AP-HP - Hospital Saint Antoine, Paris, France
| | - J Ferrieres
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - F Schiele
- Regional University Hospital Jean Minjoz, Besancon, France
| | - T Simon
- AP-HP - Hospital Saint Antoine, Paris, France
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Danchin N, Puymirat E, Eltchaninoff H, Manzo-Silberman S, Marchand S, Bataille V, Drouet E, Naccache N, Ferrieres J, Schiele F, Simon T. Compared presentation, management and long-term outcomes after acute myocardial infraction in men and women <50 years of age. The FAST-MI programme. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1663] [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
The number of young women suffering acute myocardial infarction (AMI) is increasing. There are conflicting results on the prognostic impact of gender in young patients with AMI. The aim of the present study was to assess in-hospital and 5-year outcomes in men and women ≤50 years old admitted for AMI and participating in the FAST-MI programme.
Methods
FAST-MI consists in one-month nationwide French surveys of patients admitted for a recent AMI, repeated every 5 years since 2005. We used the 2005, 2010 and 2015 data with up to 5-year follow-up, to describe baseline characteristics and outcomes according to gender in young patients. Of 13,130 patients included, 1,912 were ≤50 years old (335 women, 17.5%).
Results
Men and women had a similar age (44±5 years), BMI, current smoking (72% vs 75%), diabetes, family history, prior history of CVD, GRACE score (104±22 vs 106±23), and LVEF (54±10%). LDL at admission was lower in women (127±46 vs 138±46 mg/dl). Women had a higher admission heart rate (81±19 vs 78±17 BPM) and lower systolic blood pressure (133±26 vs 136±25 mm Hg). Presenting AMI was STEMI in 63% in women vs 68% in men (P=0.08).
All in-hospital complications except reinfarction (1.8 vs 0.6%, p<0.03) were similar in women and men; in-hospital death was 1.5% vs 0.8%, P=0.20. Coronary angiography was performed slightly less often (97.6% vs 99.0%, P=0.047) and more women had non-significant coronary artery disease (CAD) (13% vs 6%, P<0.001); PCI was less often used (74% vs 85.5%, P<0.001). At discharge, ESC guidelines-recommended medical treatment was less often prescribed in women (41% vs 53%, P<0.001), even in patients with significant CAD (46% vs 55%, P=0.004).
Kaplan-Meier 5-year survival did not differ in women (94.7%) and men (95.2%), P=0.56 (Figure). The respective figures for hospital survivors were 96.1% and 96.0% (HR 1.00, 95% CI 0.52–1.91; HR adjusted on age, type of MI, previous history of CAD, presence of significant CAD, LVEF, Killip class and appropriate medications at discharge: 0.99, 95% CI 0.51–0.92). Similar results were found for the combined end-point of death, AMI or stroke.
Conclusion
There were more similarities than differences between women and men who sustained an AMI at age ≤50 years. Women had lower LDL-c, lower haemoglobin, higher heart rate and lower blood pressure on admission. Non-significant CAD was more frequently found in women, who were less often treated with PCI and recommended medications at discharge. Five-year outcomes, however, did not differ according to gender.
Five-year mortality
Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Pfizer, MSD, AstraZeneca
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Affiliation(s)
- N Danchin
- AP-HP - European Hospital Georges Pompidou, Paris, France
| | - E Puymirat
- AP-HP - European Hospital Georges Pompidou, Paris, France
| | | | | | - S Marchand
- Mutualist Hospital Group of Grenoble, Grenoble, France
| | - V Bataille
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - E Drouet
- AP-HP - Hospital Saint Antoine, Paris, France
| | - N Naccache
- French Society of Cardiology, Paris, France
| | - J Ferrieres
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - F Schiele
- Regional University Hospital Jean Minjoz, Besancon, France
| | - T Simon
- AP-HP - Hospital Saint Antoine, Paris, France
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Ferrieres J, Bataille V, Puymirat E, Schiele F, Simon T, Danchin N. Are the results of clinical trials relevant in the real world? The applicability of REDUCE-IT to the FAST-MI Registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Large clinical trials are often criticized for testing therapeutic strategies in selected populations. The REDUCE-IT data revealed robust atherosclerotic cardiovascular risk reduction with a strategy comprising of high dose omega-3 icosapent ethyl versus placebo in statin treated patients with triglyceride values (TG) between 150 and 499 mg/dl and controlled LDL-C (41–100 mg/ dl).
Purpose
In order to evaluate the applicability of REDUCE-IT in a French population, we applied the inclusion and exclusion criteria in the French Registry on Acute ST- elevation and non-ST-elevation Myocardial Infarction (FAST-MI) [2010 and 2015].
Methods
From the FAST-MI registry, we included patients over 45 years, who had detailed lipid values post-acute hospitalization [11.1 months (median) after hospitalization for myocardial infarction]. We thus compared the applicability of REDUCE-IT [in patients with TG between 150 (or 200) and 500 mg/dl and an LDL-C between 40 and 100 mg/dl while treated with statin therapy] in the FAST-MI registry focusing on the general characteristics, the risk factors, and the cardiovascular prognosis i.e. the rate of total mortality, myocardial infarction and stroke.
Results
12.5% of the patients (5.5% if TG between 200 and 500 mg/dl) met the eligibility criteria for REDUCE-IT. The differences between the REDUCE-IT like (n=472) and REDUCE-IT excluded (n=3317) samples were related to age (61 vs 65, NS), male gender (79.5% vs 73.8%, p<0.01), body mass index in kg/m2 (28 vs 26.2, p<0.001), current smoking (45% vs 31.4%, p<0.001), hypertension (56.5% vs 50.2%, p<0.01), and the percentage of diabetic patients (29.5% vs 15.6%, p<0.001). In the REDUCE-IT like sample, the mean values of total cholesterol, TG (median) and the HDL-C were respectively 159, 192, 43 and the LDL-C value was 72 mg/dl. The distribution of the statin regimens in the REDUCE-IT like sample was as follows: 65.3%, 32.4% and 2.3% had high, moderate and low intensity statin therapy. The distribution of TG categories in the REDUCE-IT like sample was as follows: 55.3% (150–199), 36.0% (200–299) and 8.7% (300–500 mg/dl). The subgroup with TGs greater than 200 mg/dl and HDL-C less than 35 mg/dl was 16.1% in the REDUCE-IT like group and 2.1% in the REDUCE-IT excluded group (p<0.001). The cardiovascular event rate (death, nonfatal MI, nonfatal stroke) was respectively 36.7 for the FAST-MI REDUCE-IT like group and 36.9 persons-years (CVD death, nonfatal MI, nonfatal stroke) for the REDUCE-IT trial.
Conclusion
The cardiovascular residual risk related to elevated TG in the applicable patient population in the FAST-MI registry was similar to the risk in REDUCE-IT. If the results of REDUCE-IT are applied to patients hospitalized for a myocardial infarction in France, on top of statins, 12.5% of these patients could benefit from a strategy of high dose omega-3 icosapent ethyl on top of contemporary medical therapy to improve their future cardiovascular health.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- J Ferrieres
- Toulouse Rangueil University Hospital of Toulouse, Department of Cardiology, Toulouse, France
| | - V Bataille
- Toulouse Rangueil University Hospital of Toulouse, Department of Cardiology, Toulouse, France
| | - E Puymirat
- Hopital Europeen Georges Pompidou- University Paris Descartes, Cardiology, Paris, France
| | - F Schiele
- Regional University Hospital Jean Minjoz, Cardiology, Besancon, France
| | - T Simon
- University Pierre & Marie Curie Paris VI, Pharmacology, Paris, France
| | - N Danchin
- Hopital Europeen Georges Pompidou- University Paris Descartes, Cardiology, Paris, France
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Suissa S, Brassard P, Dominique AL, Simon T, Hudson M. FRI0106 RISK FACTORS FOR SERIOUS INFECTIONS IN PATIENTS WITH RA INITIATING TREATMENT WITH BIOLOGIC DMARDS: A REAL-WORLD POPULATION-BASED OBSERVATIONAL STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.326] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Patients with RA are at increased risk of infection compared with the general population, but it is unclear whether this is due to the underlying disease or to immunosuppressive medications used to manage the disease.1Some biologic DMARDs (bDMARDs) have been associated with an increased risk of serious infection.2A large cohort study found no increased risk of serious infection in patients initiating abatacept compared with patients initiating other bDMARDs.3It is clinically important to identify which patients are at a higher risk of infections at the time of initiating treatment with a bDMARD. However, studies that assess risk factors for infection and derive corresponding risk scores of infection, especially at the time of bDMARD treatment initiation, are lacking or based on too few patients.4Objectives:To identify the risk factors for serious infections among patients with RA initiating treatment with a bDMARD in a real-world observational setting.Methods:The Truven MarketScan®Commercial and Supplemental Medicare databases were used to identify patients diagnosed with RA who initiated treatment with a bDMARD between January 2007 and December 2015. Patients were followed from treatment initiation until the occurrence of a serious infection requiring hospitalisation, the end of enrolment or 31 December 2015, whichever came first. The Cox proportional hazards model was used to estimate the hazard ratios (HRs) of serious infection associated with baseline risk factors including demographics, the presence of co-morbidities, prior hospitalised infections and medications. An infection risk score was developed using the independent risk factors found to be significant in the model.Results:The study cohort included 84,308 patients initiating treatment with a bDMARD, mainly etanercept (36.7%), adalimumab (29.3%), infliximab (12.4%), rituximab (7.3%) and abatacept (6.8%). During a mean follow-up of 6.6 months, 1724 patients were hospitalised for a serious infection (incidence rate 3.7/100 persons per year). The baseline risk factors significantly and independently associated with serious infections were age, prior hospitalisation for infection, hypertension, diabetes, lymphoma, asthma, chronic obstructive pulmonary disease, cardiovascular disease, other autoimmune disease, corticosteroid use and antibiotic use. The infection risk score, with a possible range of 0 to 15, had a mean (SD) value of 2.6 (1.9) with range 0–12.5. The HR (95% CI) of serious infection was 1.43 (1.40–1.45) for every unit increase in the risk score. Relative to patients with a score of 0, the HR (95% CI) of serious infection for a risk score of 5 was 5.9 (5.3–6.5), and for a risk score of 10 was 34.5 (28.5–41.6).Conclusion:In this large, real-world cohort of patients with RA who were initiating treatment with a bDMARD, several patient characteristics were found to independently predict the subsequent risk of serious infection. The risk score, based on easily available patient characteristics, can be a simple and useful tool for the clinician to identify patients at higher risk of infection at the time of bDMARD initiation for the treatment of RA.References:[1]Doran MF, et al.Arthritis Rheum2002;46:2287–93.[2]Singh JA.Curr Rheumatol Rep2016;18:61.[3]Montastruc F, et al.Semin Arthritis Rheum2019;48:1053–8.[4]Jani M, et al.Curr Opin Rheumatol2019;31:285–92.Acknowledgments:Joanna Wright (editorial assistance, Caudex; funding: Bristol-Myers Squibb).Disclosure of Interests:Samy Suissa Grant/research support from: AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Novartis, Consultant of: AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Novartis (advisory board meetings), Speakers bureau: AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Novartis, Paul Brassard: None declared, Alyssa L. Dominique Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Teresa Simon Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Marie Hudson: None declared
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Simon T, Panzolini C, Lavergne J, Hypolite N, Glaichenhaus N, Vervoordeldonk M, Blancou P. SAT0018 THE THERAPEUTIC EFFECT OF STIMULATION OF THE SPLENIC NEUROVASCULAR BUNDLE IN MICE WITH COLLAGEN-INDUCED ARTHRITIS IS ENHANCED BY CONCOMITANT ANTI-TNF TREATMENT. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5462] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Vagus nerve (VN) stimulation has shown the potential to improve the disease development in animal models of arthritis and in patients with RA. However, the VN can affect respiratory, cardiovascular, endocrine and gastro-intestinal physiology. The splenic nerve (SpN) has been confirmed to be the principal effector nerve for the VN-mediated immune control. Previous studies have shown that stimulating the splenic nerve resulted in an increase of norephiniphrine in the spleen, as well as a significant reduction in LPS-induced TNF (1).Objectives:To test the therapeutic efficiency of splenic nerve stimulation (SNS) in collagen-induced arthritis (CIA) in mice alone or in combination with anti-TNF treatment.Methods:CIA was induced in DBA1/J mice by immunization with bovine type II collagen at days 0 and 21. At day 11, mice were implanted with micro-cuff electrode (CorTec) onto the SpN or VN. From day 16 to day 45, SNS were applied as rectangular charged-balanced biphasic pulses with 650 μA pulse amplitude, 200 µs pulse width at 10 Hz frequency for 2 min 1 or 6 times a day using a Plexon stimulator. In order to investigatedthe mechanism of action in more detail, propranolol, a beta-adrenergic receptor (β-AR) antagonist, was added to the drinking water of mice receiving SNS. In addition, a control group was treated with anti-TNF (etanercept, 3 times/week; 10mg/kg i.p.). In curative settings, SNS and/or anti-TNF treatment was applied starting when mice scored positive for 3 consecutive days. Clinical arthritis was determined by visual examination of swelling and redness of the paws and measurement of paw thickness. Sham mice were undergoing the same procedure but did not receive stimulation.Results:In CIA in mice all sham animals developed arthritis, compared to only 14% following six times per day SNS (p <0.001) in a prophylactic setting. In contrast, 85% of the animals developed arthritis (p = 0.35) when SNS was applied only once a day. In both stimulated groups a significant decrease in clinical scores and paw thickness was observed compared to unstimulated group (p < 0.01 and p < 0.05, respectively). While etanercept treatment reduced clinical scores (p <0.001) an immediate rebound in clinical score was seen following treatment arrest, while mice with SNS were still partially protected 35 days after treatment discontinuation (p = 0.013, compared to sham). Propranolol inverted the effect of SNS in CIA mice. Finally, when SNS was applied as a curative treatment, clinical scores were significantly reduced (p < 0.001). Importantly, these clinical scores even further decreased when anti-TNF treatment was given to mice receiving SNS.Conclusion:These studies demonstrate that SNS suppresses pro-inflammatory cytokine production, and reduces clinical symptoms in mice with CIA which is at least partially mediated by the β-AR. The additive effect of anti-TNF in reducing the clinical scores demonstrates that that mechanism of action of SNS is not primarilys mediated by reducing TNF levels. Moreover, anti-TNF potentiating the inhibitory effect of SNS is supporting a combined use of these treatments, or even a combination of SNS with other biologicals, to treat RA, potentially getting more patients closer to remission. In conclusion, the data is providing compelling scientific rationale and pre-clinical evidence that splenic neuromodulation might be a new treatment modality for RA.References:[1] Guyot M et al, Brain Behav Immun. 2019;80:238.Disclosure of Interests:Thomas Simon Grant/research support from: research grant from Galvani Bioelectronics, Clara Panzolini Grant/research support from: Working on research grant Galvani bioelectronics, Julien Lavergne Grant/research support from: working on research grant Galvani Bioelectrocnics, Nicolas Hypolite Grant/research support from: Working on research grant Galvani Bioelectronics, Nicolas Glaichenhaus: None declared, Margriet Vervoordeldonk Employee of: I am an employee of Galvani Bioelectronics, Philippe Blancou Grant/research support from: Received research grant from Galvani Bioelectronics
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Bourcigaux N, Rubino C, Berthaud I, Toubert ME, Donadille B, Leenhardt L, Petrot-Keller I, Brailly-Tabard S, Fromigué J, de Vathaire F, Simon T, Siffroi JP, Schlumberger M, Bouchard P, Christin-Maitre S. Impact on testicular function of a single ablative activity of 3.7 GBq radioactive iodine for differentiated thyroid carcinoma. Hum Reprod 2020; 33:1408-1416. [PMID: 29912343 DOI: 10.1093/humrep/dey222] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/06/2018] [Accepted: 05/29/2018] [Indexed: 02/07/2023] Open
Abstract
STUDY QUESTION What are the consequences of radioactive iodine (RAI) therapy for testicular function? SUMMARY ANSWER A single activity of 3.7 GBq RAI for differentiated thyroid carcinoma (DTC) treatment in young men transiently altered Sertoli cell function and induced sperm chromosomal abnormalities. WHAT IS KNOWN ALREADY Few studies, mainly retrospective, have reported the potential impacts of RAI on endocrine and exocrine testicular function. STUDY DESIGN, SIZE, DURATION A longitudinal prospective multi-center study on testicular function performed in DTC patients before a single 131I ablative activity of 3.7 GBq (V0) and at 3 months (V3) and 13 months (V13) after treatment. PARTICIPANTS/MATERIALS, SETTING, METHODS Forty male patients, aged 18-55 years, with DTC participated. Hormonal analysis included FSH, LH, testosterone and inhibin B serum levels at V0, V3 and V13. Furthermore, sperm parameters, DNA fragmentation and sperm chromosomal abnormalities were evaluated at each time points. The differences in all parameters, between V0-V3, V0-V13 and V3-V13, were analyzed, using a Wilcoxon test. MAIN RESULTS AND THE ROLE OF CHANCE Prior to RAI administration, all patients had normal gonadal function. At V3, a statistically significant increase in FSH levels and a decrease in inhibin B levels were observed and sperm concentration, as well as the percentage of morphologically normal spermatozoa, were significantly decreased (P < 0.0001). These modifications were transient as both sperm concentration and normal morphology rate returned to baseline values at V13. However, at this later time point, FSH and inhibin B levels were still impacted by RAI administration but remained in the normal range. Although no DNA fragmentation was observed at V3 nor V13, our study revealed a statistically significant increase in the number of sperm chromosomal abnormalities both at V3 (P < 0.001) and V13 (P = 0.01). LIMITATIONS, REASONS FOR CAUTION Among the 40 patients included in the study, only 24 had all the parameters available at all visits. WIDER IMPLICATIONS OF THE FINDINGS Prospective studies with longer term follow up would be helpful to determine whether the chromosome abnormalities persist. These studies would be required before sperm banking should be suggested for all patients. However, sperm preservation for DTC patients who require cumulative radioiodine activities higher than 3.7 GBq should be proposed. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by the Programme Hospitalier de Recherche Clinique, AP-HP (No. P040419). The authors report no conflict of interest in this work. TRIAL REGISTRATION NUMBER NCT01150318.
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Affiliation(s)
- N Bourcigaux
- Department of Endocrinology, St Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - C Rubino
- Radiation Epidemiology Group and Center for Research in Epidemiology and Population Health (CESP), Inserm, U1018, Institute Gustave Roussy, Villejuif, France
- University of Paris-Sud, Villejuif, France
| | - I Berthaud
- Department of Reproduction Biology CECOS, Tenon Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - M E Toubert
- Department of Nuclear Medicine, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - B Donadille
- Department of Endocrinology, St Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - L Leenhardt
- Department of Nuclear Medicine, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - I Petrot-Keller
- Department of Nuclear Medicine, St Antoine Hospital, Assistance Publique Hôpitaux de Paris, France
| | - S Brailly-Tabard
- Department of Molecular Genetics, Pharmacogenetics and Hormonology, Kremlin-Bicêtre Hospital, Assistance Publique Hôpitaux de Paris, Inserm, U1185, Le Kremlin-Bicêtre, France
| | - J Fromigué
- Department of Endocrinology, St Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - F de Vathaire
- Radiation Epidemiology Group and Center for Research in Epidemiology and Population Health (CESP), Inserm, U1018, Institute Gustave Roussy, Villejuif, France
- University of Paris-Sud, Villejuif, France
| | - T Simon
- Clinical Research Unit (GH HUEP), St Antoine Hospital, Assistance Publique-Hôpitaux de Paris, France
| | - J P Siffroi
- Department of Medical Genetics, Pediatrics Hospital Armand Trousseau, Assistance Publique-Hôpitaux de Paris, France
- Inserm, UMR-S933, Paris, France
- Sorbonne Université, Paris, France
| | - M Schlumberger
- Department of Nuclear Medicine and Endocrine Oncology, Institute Gustave Roussy, University of Paris-Saclay, Villejuif, France
| | - P Bouchard
- Department of Gynecology, Hospital Foch, Suresnes, France
| | - S Christin-Maitre
- Department of Endocrinology, St Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Inserm, UMR-S933, Paris, France
- Sorbonne Université, Paris, France
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Berthold F, Faldum A, Ernst A, Boos J, Dilloo D, Eggert A, Fischer M, Frühwald M, Henze G, Klingebiel T, Kratz C, Kremens B, Krug B, Leuschner I, Schmidt M, Schmidt R, Schumacher-Kuckelkorn R, von Schweinitz D, Schilling FH, Theissen J, Volland R, Hero B, Simon T. Extended induction chemotherapy does not improve the outcome for high-risk neuroblastoma patients: results of the randomized open-label GPOH trial NB2004-HR. Ann Oncol 2020; 31:422-429. [PMID: 32067684 DOI: 10.1016/j.annonc.2019.11.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/12/2019] [Accepted: 11/13/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Long-term survival of high-risk neuroblastoma patients is still below 50% despite intensive multimodal treatment. This trial aimed to address whether the addition of two topotecan-containing chemotherapy courses compared to standard induction therapy improves event-free survival (EFS) of these patients. PATIENTS AND METHODS An open-label, multicenter, prospective randomized controlled trial was carried out at 58 hospitals in Germany and Switzerland. Patients aged 1-21 years with stage 4 neuroblastoma and patients aged 6 months to 21 years with MYCN-amplified tumors were eligible. The primary endpoint was EFS. Patients were randomly assigned to standard induction therapy with six chemotherapy courses or to experimental induction chemotherapy starting with two additional courses of topotecan, cyclophosphamide, and etoposide followed by standard induction chemotherapy (eight courses in total). After induction chemotherapy, all patients received high-dose chemotherapy with autologous hematopoietic stem cell rescue and isotretinoin for consolidation. Radiotherapy was applied to patients with active tumors at the end of induction chemotherapy. RESULTS Of 536 patients enrolled in the trial, 422 were randomly assigned to the control arm (n = 211) and the experimental arm (n = 211); the median follow-up time was 3.32 years (interquartile range 1.65-5.92). At data lock, the 3-year EFS of experimental and control patients was 34% and 32% [95% confidence Interval (CI) 28% to 40% and 26% to 38%; P = 0.258], respectively. Similarly, the 3-year overall survival of the patients did not differ [54% and 48% (95% CI 46% to 62% and 40% to 56%), respectively; P = 0.558]. The response to induction chemotherapy was not different between the arms. The median number of non-fatal toxicities per patient was higher in the experimental group while the median number of toxicities per chemotherapy course was not different. CONCLUSION While the burden for the patients was increased by prolonging the induction chemotherapy and the toxicity, the addition of two topotecan-containing chemotherapy courses did not improve the EFS of high-risk neuroblastoma patients and thus cannot be recommended. CLINICAL TRIALS. GOV NUMBER NCT number 03042429.
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Affiliation(s)
- F Berthold
- Department of Pediatric Oncology and Hematology, University of Cologne, Cologne, Germany.
| | - A Faldum
- Institute of Medical Statistics and Clinical Research, University of Muenster, Muenster, Germany
| | - A Ernst
- Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Cologne, Germany
| | - J Boos
- Department of Pediatric Oncology and Hematology, University of Muenster, Muenster, Germany
| | - D Dilloo
- Department of Pediatric Oncology and Hematology, University of Bonn, Bonn, Germany
| | - A Eggert
- Department of Pediatric Oncology and Hematology, Charité Universitätsmedizin Berlin and Berlin Institute of Health, Berlin, Germany
| | - M Fischer
- Department of Experimental Pediatric Oncology and Center for Molecular Medicine, Medical Faculty, University of Cologne, Cologne, Germany
| | - M Frühwald
- Swabian Children's Cancer Center, Children's Hospital, University Hospital Augsburg, Augsburg, Germany
| | - G Henze
- Department of Pediatric Oncology and Hematology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - T Klingebiel
- Department of Children and Adolescents, University Hospital, Goethe University Frankfurt (Main), Frankfurt am Main, Germany
| | - C Kratz
- Department of Pediatric Oncology and Hematology, Medicinal University, Hannover, Germany
| | - B Kremens
- Department of Pediatric Oncology and Hematology, University of Essen, Essen, Germany
| | - B Krug
- Institute of Diagnostic and Interventional Radiology, University of Cologne, Cologne, Germany
| | - I Leuschner
- Children's Tumor Registry, Institute of Pathology, University of Kiel, Kiel, Germany
| | - M Schmidt
- Department of Nuclear Medicine, University of Cologne, Cologne, Germany
| | - R Schmidt
- Institute of Medical Statistics and Clinical Research, University of Muenster, Muenster, Germany
| | | | - D von Schweinitz
- Department of Pediatric Surgery, University of Munich, Munich, Germany
| | - F H Schilling
- Department of Pediatric Oncology and Hematology, Olgahospital Stuttgart, Stuttgart, Germany
| | - J Theissen
- Department of Pediatric Oncology and Hematology, University of Cologne, Cologne, Germany
| | - R Volland
- Department of Pediatric Oncology and Hematology, University of Cologne, Cologne, Germany
| | - B Hero
- Department of Pediatric Oncology and Hematology, University of Cologne, Cologne, Germany
| | - T Simon
- Department of Pediatric Oncology and Hematology, University of Cologne, Cologne, Germany
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17
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Russo JJ, Yan AT, Pocock SJ, Brieger D, Owen R, Andersson Sundell K, Granger CB, Cohen MG, Yasuda S, Nicolau JC, Brandrup-Wognsen G, Westermann D, Simon T, Goodman SG. P1932Predictors of DAPT use in patients beyond 1 year post myocardial infarction: Insights from the TIGRIS observational study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0679] [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
International guidelines vary in their recommendations for dual antiplatelet therapy (DAPT) use beyond 1 year post-myocardial infarction (MI).
Purpose
To identify predictors of DAPT use in patients ≥1 year post-MI prior to the publication of the DAPT score and the 2017 European Society of Cardiology (ESC) guidelines for DAPT in coronary artery disease.
Methods
TIGRIS (NCT01866904) was a prospective, multi-center (369 centers in 25 countries), observational study of patients 1 to 3 years post-MI between June 2013 and November 2014. We performed a multivariable logistic regression analysis to identify independent predictors of DAPT use at 396 days post-MI (365 + 31 days overrun period to allow intended DAPT discontinuation at 1 year). Patients on oral anticoagulation were excluded.
Results
Of 8464 patients enrolled (mean age 66 years, women 24%, ST-elevation MI 53%), 40% were on DAPT at 396 days post-MI (Figure). In the subset of patients on DAPT at 396 days post-MI, aspirin was combined with clopidogrel in 84%, prasugrel in 12%, and other antiplatelet agents in 4%. DAPT use at 396 days post-MI was independently associated with geographic region, age, PCI for the index MI, and a history of multivessel disease or angina (Table). Several variables included in the DAPT score and ESC guideline recommendations (diabetes, second prior MI, hypertension, peripheral artery disease, heart failure, smoking, and renal insufficiency) were not independent predictors of DAPT use at 396 days.
Independent predictors of DAPT @396 days Variable at enrolment Patients Odds ratio (95% CI) P-value Region: Europe 3813 Reference group 0.01 North America 923 1.65 (0.56, 4.86) Latin America 1084 2.55 (1.19, 5.47) Asia and Australia 2644 3.01 (1.42, 6.36) Age <65 years 3274 1.15 (1.04, 1.28) 0.005 PCI for index MI 6925 2.08 (1.82, 2.38) <0.0001 Multi-vessel disease 5598 1.37 (1.24, 1.52) <0.0001 History of angina 829 1.46 (1.24, 1.71) <0.0001
DAPT use at 396 days post-MI by region
Conclusion
During the study period, DAPT use ≥1 year post-MI was prevalent and appeared to be influenced by regional practices. Further research is needed to determine whether the DAPT score and the 2017 ESC guidelines for dual antiplatelet therapy have changed long-term DAPT use practices.
Acknowledgement/Funding
AstraZeneca AB, Södertälje, Sweden
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Affiliation(s)
- J J Russo
- University of Ottawa Heart Institute, Ottawa, Canada
| | - A T Yan
- St Michael's Hospital, University of Toronto, Toronto, Canada
| | - S J Pocock
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - D Brieger
- Concord Repatriation General Hospital, Sydney, Australia
| | - R Owen
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - K Andersson Sundell
- AstraZeneca, Medical Evidence and Observational Research, Gothenburg, Sweden
| | - C B Granger
- Duke Clinical Research Institute, Durham, United States of America
| | - M G Cohen
- University of Miami Hospital, Miami, United States of America
| | - S Yasuda
- National Cerebral and Cardiovascular Center, Osaka, Japan
| | - J C Nicolau
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - G Brandrup-Wognsen
- AstraZeneca, Medical Evidence and Observational Research, Gothenburg, Sweden
| | - D Westermann
- University Heart Center Hamburg, Hamburg, Germany
| | - T Simon
- Assistance Publique-Hopitaux de Paris (APHP), UPMC-Paris 06 University, Paris, France
| | - S G Goodman
- Canadian Heart Research Centre and St. Michael's Hospital, University of Toronto, Toronto, Canada
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18
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Schiele F, Puymirat E, Ferrieres J, Onceanu S, Beard T, Marchand X, Landel J, Meneveau N, Simon T, Danchin N. 468Patients eligible for proprotein convertase subtilisin/kexin type9 inhibitors (pcsk9i) after acute myocardial infarction. The ESC position applied to patients included in the FAST-MI 2015 registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
PCSK9i on top of high intensity statins have shown clinical benefit in patients after Acute Myocardial Infarction (AMI) who are not at LDL-c target. The ESC Task Force has defined guidance for the prescription of PCSK9i. Among patients discharged after AMI, the rate of those eligible for PCSCK9i is poorly documented.
Methods
We used data from the nationwide French FAST-MI 2015 registry. PSCK9-eligible patients were defined as those discharged with high intensity statins with expected-LDL>140 mg/dL, or >100mg/dL if they had additional high risk features such as diabetes with renal dysfunction or hypertension, multivessel coronary disease, associated peripheral artery disease or recurrent MI. The expected LDL-c was estimated from admission LDL-c and changes in lipid-lowering treatment. The rate of eligible patients was estimated from actual treatment and optimized treatment (i.e. addition of ezetimibe).
Results
Among 5291 pts included, 4715 (89%) were discharged with statins, at high intensity in 3655 (71%). Expected LDL was 71mg/dL (IQ 56, 95). Among patients discharged with high intensity statins, 3146 (59%) had an expected LDL-c<100/mg (figure, in green). PCSK9-eligible patients were those with LDL-c>140mg/dL (n=178, 3.3%, in red) and, among those with LDL-c 100–140mg/dL (n=331, 6.2%, in yellow), patients who had additional risk features (n=227 (4%)). As a result, the population eligible for PSCK9i according to the ESC guidance would represent 7.6% (405 pts) of the population admitted with AMI. Expanding the indication to patients with statins, but not at high intensity would add 159 (3%). Conversely, optimizing discharge treatment with ezetimibe would reduce the rate of eligible patients to 3% (181 pts, in brown).
Conclusions
In real life, according to the ESC Task Force, 7.6% of the whole population admitted for AMI would be eligible for PCK9i. This rate could be reduced to 3% with the addition of ezetimibe.
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Affiliation(s)
- F Schiele
- University Hospital of Besancon, Besancon, France
| | - E Puymirat
- European Hospital Georges Pompidou, Paris, France
| | - J Ferrieres
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | | | - T Beard
- Polyclinique de l'Ormeau, Tarbes, France
| | - X Marchand
- Hospital Poissy-St Germain en Laye, Poissy, France
| | - J Landel
- Hospital Saint Philibert, Lomme, France
| | - N Meneveau
- University Hospital of Besancon, Besancon, France
| | - T Simon
- Hospital Saint-Antoine, Paris, France
| | - N Danchin
- European Hospital Georges Pompidou, Paris, France
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19
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Danchin N, Puymirat E, Ducrocq G, Henry P, Collet JP, Genee O, Joseph T, Belle L, Naccache N, Ferrieres J, Schiele F, Simon T. P4569Differential prognostic impact of blood glucose levels at the acute stage of myocardial infarction according to HbA1c. The FAST-MI programme. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0959] [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
Hyperglycemia is a well-known prognostic marker in patients with acute myocardial infarction (AMI), associated with higher mortality compared with normoglycemia. Whether the prognostic impact of glycemic status at the acute stage of AMI is similar in patients with chronic dysglycemia has not been extensively explored.
Aims and methods
Using data from the nationwide French FAST-MI cohorts (2005, 2010 and 2015), we analysed the association between glycemia at entry and 30-day death, according to HbA1c level. From the 13,130 patients included, 5,452 had both glycemia and HbA1c assessed at entry. Of those, 1173 (21.5%) had an HbA1c ≥7%.
Results
In patients with HbA1c <7%, LVEF was inversely correlated with glycemic levels (55±11% for glycemia <100, 52±11% for glycemia 100–140, 50±12% for glycemia 140–160 and 49±12% for glycemia >180 mg/dl); a graded association between admission glycemia and 30-day mortality was observed, ranging from 0.7% in normoglycemic patients to 6.3% in patients with admission glycemia >180 mg/dl. In contrast, in patients with HbA1c ≥7%, LVEF was not correlated with glycemia (<100 mg/dl: 49±14%, >180 mg/dl 49±12%), and mortality was the highest in patients with normoglycemia (9.2%) and the lowest in patients with glycemia between 140 and 180 mg/dl (3.1%) (Figure). In multivariate analyses adjusting for baseline characteristics and early management, normoglycemia was associated with a decreased risk of 30-day mortality in patients with HbA1c <7% (HR 0.27, 95% confidence interval 0.10–0.73, P=0.01), while it was associated with a two-fold increase in mortality in patients with HbA1c ≥7% (HR 2.49, 95% confidence interval 1.02–6.09, P=0.046).
Figure 1. 30-day death
Conclusion
In AMI patients with high HbA1c levels on admission, normoglycemia is associated with higher early mortality than hyperglycemia. In contrast, a graded correlation is observed between admission glycemia and early mortality in patients with HbA1c <7%. Management of glycemia at the acute stage of MI might require different measures according to the initial HbA1c level.
Acknowledgement/Funding
Amgen, AstraZeneca, Bayer, Daiichi-Sankyo, Eli-Lilly, GSK, MSD, Novartis, Pfizer, Sanofi, Servier
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Affiliation(s)
- N Danchin
- AP-HP - European Hospital Georges Pompidou, Paris, France
| | - E Puymirat
- AP-HP - European Hospital Georges Pompidou, Paris, France
| | - G Ducrocq
- Hospital Bichat-Claude Bernard, Paris, France
| | - P Henry
- Hospital Lariboisiere, Paris, France
| | - J P Collet
- Hospital Pitie-Salpetriere, Paris, France
| | - O Genee
- Clinique de la Reine Blanche, Orleans, France
| | - T Joseph
- Centre Hospitalier, Quimper, France
| | - L Belle
- Hospital of Annecy, Annecy, France
| | - N Naccache
- French Society of Cardiology, Paris, France
| | - J Ferrieres
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - F Schiele
- Regional University Hospital Jean Minjoz, Besancon, France
| | - T Simon
- AP-HP - Hospital Saint Antoine, Paris, France
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20
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Nicolau JC, Brieger D, Goodman S, Cohen MG, Simon T, Westermann D, Granger CB, Grieve R, Chen JY, Hedman K, Mellstrom C, Brandrup-Wognsen G, Owen R, Pocock S. P5471Baseline characteristics, healthcare resource use and clinical outcomes of stable post-myocardial infarction patients with diabetes: insights from the global prospective TIGRIS study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
There is a growing prevalence of diabetes worldwide in patients in the general population, including those with prior myocardial infarction (MI).
Purpose
To describe the characteristics, health status, resource utilization and clinical adverse events of stable post-MI patients with diabetes.
Methods
The long-Term rIsk, clinical manaGement and healthcare Resource utilization of stable coronary artery dISease (TIGRIS) prospective observational study (NCT01866904) obtained data from 8985 stable patients 1–3 years post-MI from 369 centres in 25 countries, who provided diabetes status (no, yes, insulin-treated) and follow-up. Diabetes status, other patient characteristics, medications, medical history and healthcare resource utilization were recorded at enrolment. Health status was assessed at enrolment, 1 and 2 years by EQ-5D-3L and converted to an EQ-5D score. Deaths, cardiovascular (CV) events, bleeding events and related hospitalizations were recorded during 2 years of follow-up.
Results
Diabetes mellitus (DM) was prevalent at enrolment in 2966 (33%) patients of whom 872 (29%) were insulin-treated. Compared to patients without DM, those with DM had a higher mean body mass index (28.2 vs 26.6kg/m2) and heart rate (71 vs 67bpm), were more likely to have had ≥2 prior MIs (12% vs 10%), chronic kidney disease (10% vs 6%), peripheral artery disease (10% vs 5%), heart failure (15% vs 10%), anaemia (4% vs 2%), angina (12% vs 9%), stroke (6% vs 4%) and chronic obstructive pulmonary disease (9% vs 7%). Patients with DM reported more problems for each domain of the EQ-5D (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression), which resulted in a lower mean EQ-5D utility score at enrolment (0.83±0.22 for no-diabetes vs 0.86±0.19 for diabetes). Moreover, they also had higher CV hospitalization rates in the 6 months prior to enrolment (6.4% vs 5%). All these measures were more marked in insulin-dependent diabetics. The incidences of all-cause death, CV death and the composite of CV death, MI and stroke were all significantly higher in patients with DM, especially those on insulin (see Figure). For CV death, MI and stroke the 2-year risk ratios, compared to patients without DM, were 2.64 (P<0.001) and 1.48 (P<0.001) respectively for those with insulin-treated DM and non-insulin treated.
Figure 1
Conclusions
Within a global population of stable post-MI patients, those with DM (especially those on insulin) have poorer health status and EQ-5D utility score, higher hospitalization rates and worse clinical outcomes compared with those without DM. Thus, in cardiac clinics worldwide, patients with DM require particularly close attention.
Acknowledgement/Funding
The study was funded by AstraZeneca
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Affiliation(s)
| | - D Brieger
- Concord Hospital and University of Sydney, Sydney, Australia
| | - S Goodman
- Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, Toronto, Canada
| | - M G Cohen
- University of Miami Miller School of Medicine, Miami, United States of America
| | - T Simon
- Assistance Publique-Hopitaux de Paris (APHP), Department of Clinical Pharmacology and Clinical Research Platform of East of Paris, Paris, France
| | - D Westermann
- University Heart Center Eppendorf, Department of General and Interventional Cardiology, Hamburg, Germany
| | - C B Granger
- Duke University Medical Center, Duke Clinical Research Institute, Durham, United States of America
| | - R Grieve
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - J Y Chen
- Guangdong General Hospital, Provincial Key Laboratory of Coronary Disease, Guangzhou, China
| | - K Hedman
- AstraZeneca Gothenburg, Mölndal, Sweden
| | | | | | - R Owen
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - S Pocock
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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21
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Schiele F, Puymirat E, Ferrieres J, Simon T, Danchin N. P2480Sub-optimal anti-diabetic treatment in patients with pre-existing and newly diagnosed diabetes admitted for acute myocardial infarction. A study from the FAST-MI 2015 registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0810] [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
In patients (pts) with Acute Myocardial Infarction (AMI), we evaluate how diabetes is detected and treated at discharge.
Methods
Using the French FAST-MI 2015 registry, pts were classed as non-diabetic (NonDiab), pre-existing (PreEx) or newly diagnosed (NewDiab) diabetes. PreEx was defined by history or pretreatment; NewDiab as no history, no anti-diabetic treatment plus HbA1C>6.5% or admission glucose ≥200mg/dL. Characteristics and adjusted 1-year mortality were compared.
Results
In 5291 FAST MI pts, 3857 (73%) were NonDiab, 1145 (21.5%) PreEx and 289 (5.5%) NewDiab (176 had glucose ≥200mg/dL; 143 had HbA1C >6.5%). PreEx pts were older, had more comorbidities, and higher GRACE score vs NonDiab. NewDiab pts had higher HbA1C (8.9%±9.2 vs 5.65%±0.38 in NonDiab; 7.5%±2.2 in PreEx). At 1 yr, diabetic pts (PreEx and/or NewDiab) had a 2.5-times higher adjusted risk of death. At discharge, DAPT, statins, ACEi and betablockers were less often prescribed in PreEx vs NonDiab or NewDiab pts. In diabetic pts, vs admission, the number of anti-diabetic treatments decreased at discharge in 11%, no change in 69% and increased in 20%. Despite higher HbA1C in NewDiab vs PreEx pts, anti-diabetics were less often prescribed in NewDiab (23%) vs PreEx pts (75%) (table). In pts with HbA1C>8%, treatment intensification was observed in 30%.
Admission treatment Discharge treatment NonDiab PreEx NewDiab NonDiab PreEx NewDiab 3759 (71%) 1283 (24%) 249 (5%) 3759 (71%) 1283 (24%) 249 (5%) Any Anti Diabetic Tx 0 975 (76%) 0 51 (1%) 931 (75%) 53 (23%) Insulin 0 339 (26%) 0 2 404 (33%) 13 (6%) Biguanide 0 456 (36%) 0 2 412 (34%) 30 (13%) Sulfonylureas 0 258 (20%) 0 2 244 (20%) 4 DPP4i 0 175 (14%) 0 2 176 (14%) 6 (3%) GLP1 RAs 0 108 (8%) 0 1 117 (10%) 10 (1%) DAPT 3212 (88%) 1009 (90%) 201 (87%) Aspirin 778 (21%) 550 (45%) 66 (27%) 3533 (96%) 1170 (95%) 218 (94%) Statins 964 (25%) 721 (56%) 69 (28%) 2394 (92%) 1109 (82%) 216 (93%) ACEi/ARB 1028 (27%) 672 (53%) 69 (28%) 2744 (74%) 925 (75%) 174 (87%) Coronary Angiography 3684 (98%) 1202 (94%) 240 (96%) PCI 3010 (80%) 907 (71%) 201 (81%)
Conclusions
In AMI pts, 5.5% have previously unknown diabetes and have a higher risk of death, similar to that of pts with PreEx diabetes. Treatment initiation and intensification are sub-optimal.
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Affiliation(s)
- F Schiele
- University Hospital of Besancon, Besancon, France
| | - E Puymirat
- European Hospital Georges Pompidou, Paris, France
| | - J Ferrieres
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - T Simon
- Hospital Saint-Antoine, Paris, France
| | - N Danchin
- European Hospital Georges Pompidou, Paris, France
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22
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Danchin N, Puymirat E, Bataille V, Cottin Y, Tabone X, Lucke V, Muligo A, Dillinger JG, Ferrieres J, Schiele F, Simon T. P5473Perceived well-being after acute myocardial infarction according to diabetic status and its impact long-term mortality. The FAST-MI programme. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Little information is available regarding subjective well-being according to diabetic status in patients surviving an acute myocardial infarction (AMI).
Aims and methods
A health status questionnaire was sent to all patients participating in the nationwide French FAST-MI cohorts (2005, 2010 and 2015) one year after the acute episode of AMI, with a specific question on overall health condition (how do you feel: very well, well, fair, poor) (n=6082), and additional questions on the presence of any chest pain (n=4590), presence nuisance bleedings (n=3968), and reporting of perceived medication side-effects (n=2220). Answers were analysed according to diabetic status. We also analysed in the 2005 and 2010 cohorts whether subjective health status at one year was a correlate of 5-year mortality.
Results
Compared with non-diabetic patients (n=4692), those with diabetes (n=1390) had a poorer perceived health status (poor/fair health status: 40% vs 30%, P<0.001), more presence of chest pain (31% vs 23%, P<0.001), but less nuisance bleedings (47% vs 56%, P<0.001) and similar reported medication side-effects (37% vs 41%, P=0.12). Using logistic regression analysis, diabetes was an independent correlate of poorer health status (any diabetes OR vs non-diabetic 1.29, 1.13–1.49, P<0.001; non-insulin-treated: 1.17, 1.00–1.36, P=0.05, insulin-treated: 1.58, 1.29–1.94, P<0.001). In diabetic patients, perceived health condition at one year was an independent correlate of 5-year death (Cox multivariate analysis): compared with patients reporting very good health, HR (95% CI) 2.16 (1.08–4.32) for good health, 3.06 (1.53–6.11) for fair health, and 3.63 (1.55–8.55) for poor health; in non-diabetic patients, 5-year survival was similar in those reporting good or very good health status, but lower in those reporting fair or poor health status (Figure).
Figure 1. 5-year survival by health status
Conclusion
Compared with non-diabetic patients, patients with diabetes described a poorer general health and more residual chest pain after AMI, but had less nuisance bleedings. Health condition reported one year after AMI was an independent correlate of subsequent long-term mortality, particularly for diabetic patients.
Acknowledgement/Funding
Amgen, AstraZeneca, Bayer, Daiichi-Sankyo, Eli-Lilly, GSK, MSD, Novartis, Pfizer, Sanofi, Servier
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Affiliation(s)
- N Danchin
- AP-HP - European Hospital Georges Pompidou, Paris, France
| | - E Puymirat
- AP-HP - European Hospital Georges Pompidou, Paris, France
| | - V Bataille
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - Y Cottin
- University Hospital of Dijon, Dijon, France
| | - X Tabone
- Centre Hospitalier, Bourges, France
| | - V Lucke
- Centre Hospitalier, Angouleme, France
| | - A Muligo
- Clinique Saint Gatien, Tours, France
| | | | - J Ferrieres
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - F Schiele
- Regional University Hospital Jean Minjoz, Besancon, France
| | - T Simon
- AP-HP - Hospital Saint Antoine, Paris, France
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Puymirat E, Tea V, Schiele F, Baixas C, Lamit X, Karsenty B, Demicheli T, Ferriere J, Simon T, Danchin N. P823Clinical benefits of high dose statins according to the atherothrombotic risk stratification after acute myocardial infarction. The FAST-MI registries. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
High dose statins prescription are strongly recommended in patients after acute myocardial infarction (AMI) in current guidelines.
Aim
We aimed to assess the clinical impact on major cardiovascular events (MACE) of high dose statins prescription at discharge according to the atherothrombotic risk stratification in a routine-practice population of AMI patients, and to determine the relative efficacy of currently recommended high dose statins according to risk level.
Methods
We used data from the 2005, and 2010 FAST-MI nationwide registries, including 7,839 patients with AMI (54% STEMI) admitted to cardiac intensive care units in France. Atherothrombotic risk stratification was performed using the TIMI Risk Score for Secondary Prevention (TRS-2P). Patients were defined in 3 categories: Group 1 (Low-risk; TRS-2P=0/1); Group 2 (Intermediate-risk; TRS-2P=2); and, Group 3 (High-risk; TRS-2P≥3). Baseline characteristics and the rate of MACE (defined as death, stroke or re-MI) at 5-years were analyzed according to TRS-2P categories, and the impact of high dose statins (i.e. atorvastatin 80mg/day or rosuvastatin 20mg/day) at discharge was compared using Cox multivariate analysis among the different risk groups.
Results
A total of 7,348 patients discharge alive and in whom TRS-2P was available. Prevalence of Groups 1, 2, and Group 3 was 41.5%, 25% and 33.5% respectively. Over the 5-year period, the overall risk of patients admitted for AMI decreased in Group 3 from 41% to 27% (P<0.001). Optimal medical therapy at discharge (defined by the use of dual antiplatelets therapy, statins for all; and, beta-blocker, ACE-I or ARB when appropriate) was 53% in Group 3, 67% in Group 2, and 80% in Group 1 (P<0.001). High dose statins prescription at discharge was 18.5% (Group 3), 31.3% (Group 2), and 41.3%% (Group 1). High dose statins prescription was associated with lower MACE at five-year in the overall population compared to patients with intermediate/low dose statins or without statin prescription (14.3% vs. 29.6%; Δ absolute risk= 15.3%; HR adjusted on baseline characteristics and management: 0.86, 0.76–0.97, P=0.018). The decrease in MACE at five-year was observed in all TRS-2P categories (Group 1: 8.1% vs. 10.7%, Δ= 2.6%; Group 2: 14.8% vs. 21.6%, Δ= 6.8%; Group 3: 30.8% vs. 51.6%, Δ= 20.8%). Finally, the benefits of high dose statins in low- and intermediate-risk was lower (HR=0.97; 95% CI, 0.74–1.26; P=0.81 and HR=1.06; 95% CI, 0.81–1.38; P=0.81) compared to high-risk patients (HR=0.78; 95% CI, 0.65–0.94; P=0.008).
Five-year events-free survival
Conclusions
High dose statins prescription at discharge after AMI was associated with lower MACE at five-year regardless of the atherothrombotic risk stratification, although the highest absolute reduction was found in the high risk TRS2P class.
Acknowledgement/Funding
The FAST-MI 2010 registry is a registry of the French Society of Cardiology, supported by unrestricted grants from: Merck, the Eli-Lilly-Daiichi-Sanky
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Affiliation(s)
- E Puymirat
- European Hospital Georges Pompidou, Cardiology, Paris, France
| | - V Tea
- European Hospital Georges Pompidou, Cardiology, Paris, France
| | - F Schiele
- Regional University Hospital Jean Minjoz, Besancon, France
| | - C Baixas
- Polyclinique des Cédres, Toulouse, France
| | | | | | | | - J Ferriere
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - T Simon
- Hospital Saint-Antoine, Paris, France
| | - N Danchin
- European Hospital Georges Pompidou, Cardiology, Paris, France
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24
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Danchin N, Puymirat E, Isaaz K, Druelles P, Dibon O, Lefevre T, Bernasconi F, Drouet E, Ferrieres J, Schiele F, Simon T. 5197Correlates and prognostic significance of nuisance bleeding after acute myocardial infarction. The FAST-MI programme. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0056] [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
Following acute myocardial infarction (AMI), most patients receive potent antithrombotic medications, which may promote nuisance bleedings (ecchymoses, minor nose or dental bleeds etc.). Little information is available on the factors related to nuisance bleedings, nor on their prognostic significance in post-AMI patients.
Aims and methods
A health status questionnaire was sent to all patients participating in the nationwide French FAST-MI cohorts (2010 and 2015) one year after the acute episode, with a specific question on the presence of nuisance bleedings. Overall, 3968 patients answered the question on the presence nuisance bleedings. In the 2010 cohorts, we also analysed whether the presence of nuisance bleedings at one year was an independent correlate of 5-year mortality.
Results
54% of the patients reported the presence of nuisance bleedings (59% in 2010 and 51% in 2015). In univariate analyses, nuisance bleedings were more frequently found in younger patients, women, patients with STEMI, current smokers, patients treated with PCI, those receiving newer P2Y12 inhibitors or ACE-inhibitors but less frequent in patients with diabetes, hypertension, or those receiving ARBs or direct oral anticoagulants. Using logistic regression analysis, however, the only independent correlates of nuisance bleedings were: female gender (OR 1.45, 1.25–1.68), age ≤60 years (OR 1.22, 1.06–1.41), VKAs (OR 1.72, 1.28–2.31), clopidogrel (OR 1.62, 1.29–2.03), prasugrel (OR 3.16, 2.43–4.09), ticagrelor (OR 2.61, 2.04–3.35) at discharge, diabetes (OR 0.74, 0.63–0.88) and year 2015 vs 2010 (OR 0.62, 0.53–0.73).
In the 2010 cohort, the presence of nuisance bleeding at one year was not a predictor of mortality at 5 years (90% survival in both patients with or without nuisance bleedings; adjusted HR 0.96, 95% CI 0.69–1.33) (Figure).
Figure 1. 5-yr survival by nuisance bleed
Conclusion
Nuisance bleedings one year after AMI are extremely frequent. They are more common in women, younger patients, in patients receiving P2Y12 inhibitors, especially newer P2Y12-i, and in those receiving VKAs; in contrast, diabetic patients report less nuisance bleedings. The presence of nuisance bleeding at one year does not appear to impact 5-year mortality.
Acknowledgement/Funding
Amgen, AstraZeneca, Bayer, Daiichi-Sankyo, Eli-Lilly, GSK, MSD, Novartis, Pfizer, Sanofi, Servier
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Affiliation(s)
- N Danchin
- AP-HP - European Hospital Georges Pompidou, Paris, France
| | - E Puymirat
- AP-HP - European Hospital Georges Pompidou, Paris, France
| | - K Isaaz
- CHU Saint Etienne Hopital Nord, Saint-Etienne, France
| | - P Druelles
- Polyclinic Saint Laurent of Rennes, Rennes, France
| | - O Dibon
- Centre Hospitalier, Orleans, France
| | - T Lefevre
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - F Bernasconi
- Hospital of Antibes Juan Les Pins, Antibes, France
| | - E Drouet
- AP-HP - Hospital Saint Antoine, Paris, France
| | - J Ferrieres
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - F Schiele
- Regional University Hospital Jean Minjoz, Besancon, France
| | - T Simon
- AP-HP - Hospital Saint Antoine, Paris, France
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25
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Sheen AJ, Montgomery A, Simon T, Ilves I, Paajanen H. Randomized clinical trial of open suture repair versus totally extraperitoneal repair for treatment of sportsman's hernia. Br J Surg 2019; 106:837-844. [DOI: 10.1002/bjs.11226] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 02/22/2019] [Accepted: 04/04/2019] [Indexed: 12/31/2022]
Abstract
Abstract
Background
Sportsman's hernia/athletic pubalgia is a recognized cause of chronic groin pain in athletes. Both open and laparoscopic surgical repairs have been described for treatment, but there are no comparative studies. The hypothesis here was that relief of pain would be achieved earlier in patients treated with open minimal suture repair than totally extraperitoneal repair.
Methods
A randomized multicentre trial in four European countries was conducted to compare open minimal suture repair with totally extraperitoneal repair. The primary endpoint was complete relief of pain (visual analogue scale (VAS) score 20 or less on a scale from 0 to 100 mm) at 1 month. Secondary endpoints included complications, time to return to sporting activity, and number of patients returning to sport within 1 year.
Results
A total of 65 athletes (92 per cent men) with a median age of 29 years were enrolled (31 open repair, 34 totally extraperitoneal repair). By 4 weeks after surgery, median preoperative VAS scores had dropped from 70–80 to 10–20 in both groups (P < 0·001). Relief of pain (VAS score 20 or less) during sports activity 4 weeks after surgery was achieved in 14 of 31 patients after open repair and 24 of 34 after totally extraperitoneal repair (P = 0·047). Return to full sporting activity was achieved by 16 and 18 patients respectively after 1 month (P = 0·992), and by 25 versus 31 after 3 months (P = 0·408).
Conclusion
Totally extraperitoneal repair was less painful than open repair in the first month, but otherwise both procedures were similarly effective in treating chronic pain due to sportsman's hernia. Registration number: NCT02297711 ( http://www.clinical.trials.gov).
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Affiliation(s)
- A J Sheen
- Department of Surgery, Manchester University Foundation Trust, Manchester, UK
- Centre of Biomedicine Manchester Metropolitan University, Manchester, UK
- Fortius Clinic, London, UK
| | - A Montgomery
- Department of Surgery, Institution for Clinical Science, Lund University, Skåne University Hospital, Malmö, Sweden
| | - T Simon
- Department of General Surgery, GRN-Klinik Sinsheim, Heidelberg University Hospital, Heidelberg, Germany
| | - I Ilves
- Department of Surgery, Mikkeli Central Hospital, Mikkeli, Finland
| | - H Paajanen
- Department of Gastrointestinal Surgery, Kuopio University Hospital, Kuopio, Finland
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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Guillodo Y, Madouas G, Simon T, Le Dauphin H, Saraux A. Platelet-rich plasma (PRP) treatment of sports-related severe acute hamstring injuries. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.04.2015.06] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | - G. Madouas
- Cabinet de Médecine du sport, ZA Questel, Brest, France
| | - T. Simon
- Cabinet de Médecine du sport, ZA Questel, Brest, France
| | | | - A. Saraux
- Service de Rhumatologie, CHU Brest, France
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27
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Schiele F, Simon T, Puymirat E, Cayla G, Gerbaud E, Ohlmann P, Popovic B, Bresson D, Farah B, Ferrieres J, Meneveau N, Danchin N. P832Temporal changes in quality of care for acute myocardial infarction and relation with 1 year survival: acute cardiac care association quality indicators applied to the FAST-MI registries. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- F Schiele
- University Hospital of Besancon, Besancon, France
| | - T Simon
- Hospital Saint-Antoine, Paris, France
| | - E Puymirat
- European Hospital Georges Pompidou, Paris, France
| | - G Cayla
- University Hospital of Nimes, Nimes, France
| | - E Gerbaud
- Hospital Haut Leveque, Bordeaux-Pessac, France
| | - P Ohlmann
- University Hospital of Strasbourg, Strasbourg, France
| | - B Popovic
- Hospital Brabois of Nancy, Vandoeuvre les Nancy, France
| | - D Bresson
- Hospital Emile Muller, Mulhouse, France
| | - B Farah
- Clinic Pasteur of Toulouse, Toulouse, France
| | - J Ferrieres
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - N Meneveau
- University Hospital of Besancon, Besancon, France
| | - N Danchin
- European Hospital Georges Pompidou, Paris, France
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28
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Puymirat E, Iliou MC, Ducrocq G, Douard H, Labrunee M, Plastaras P, Chevalereau P, Taldir G, Bataille V, Ferrieres J, Schiele F, Simon T, Danchin N. P1231Clinical impact of cardiac rehabilitation according to the atherothrombotic risk stratification after acute myocardial infarction. The FAST-MI registries. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E Puymirat
- European Hospital Georges Pompidou, Cardiology, Paris, France
| | - M C Iliou
- Corentin Celton Hospital APHP, Issy Les Moulineaux, France
| | - G Ducrocq
- Hospital Bichat-Claude Bernard, Paris, France
| | - H Douard
- Hospital Haut Leveque, Bordeaux-Pessac, France
| | - M Labrunee
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | | | | | - G Taldir
- Centre Hospitalier, Saint-Brieuc, France
| | - V Bataille
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - J Ferrieres
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - F Schiele
- University of Besançon, Besançon, France
| | - T Simon
- Hospital Saint-Antoine, Paris, France
| | - N Danchin
- Hôpital Européen Georges Pompidou, Université Paris Descartes, Cardiology, Paris, France
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29
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Danchin N, Puymirat E, Elbaz M, Perret T, Tartiere JM, Cottin Y, Fayard M, Mabo P, Champin S, Isaaz K, Ferrieres J, Schiele F, Simon T. P3428Changing profile and outcome of AMI patients with previously known coronary artery disease. The FAST-MI programme. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- N Danchin
- AP-HP - European Hospital Georges Pompidou, Paris, France
| | - E Puymirat
- AP-HP - European Hospital Georges Pompidou, Paris, France
| | - M Elbaz
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - T Perret
- St Joseph St Luc Hospital, Lyon, France
| | - J M Tartiere
- Hospital Center of Toulon-La Seyne Sur Mer, Toulon, France
| | - Y Cottin
- University Hospital Center, Dijon, France
| | - M Fayard
- Centre Hospitalier, Chalon sur Saone, France
| | - P Mabo
- Hospital Pontchaillou of Rennes, Rennes, France
| | | | - K Isaaz
- CHU Saint Etienne Hopital Nord, Saint Etienne, 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
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30
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Danchin N, Puymirat E, Roubille F, Silvain J, Ducrocq G, Soto F, De Poli F, Bataille V, Drouet E, Naccache N, Ferrieres J, Schiele F, Simon T. 6127Type of P2Y12 inhibitor at the acute stage and one-year mortality in acute myocardial infarction. The FAST-MI programme. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.6127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- N Danchin
- AP-HP - European Hospital Georges Pompidou, Paris, France
| | - E Puymirat
- AP-HP - European Hospital Georges Pompidou, Paris, France
| | - F Roubille
- University Hospital Arnaud de Villeneuve, Montpellier, France
| | - J Silvain
- Hospital Pitie-Salpetriere, Paris, France
| | - G Ducrocq
- Hospital Bichat-Claude Bernard, Paris, France
| | - F Soto
- Centre Hospitalier, Auxerre, France
| | - F De Poli
- Centre Hospitalier, Haguenau, France
| | - V Bataille
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - E Drouet
- AP-HP - Hospital Saint Antoine, Paris, France
| | - N Naccache
- French Society of Cardiology, Paris, France
| | - J Ferrieres
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - F Schiele
- Regional University Hospital Jean Minjoz, Besancon, France
| | - T Simon
- AP-HP - Hospital Saint Antoine, Paris, France
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31
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Brieger D, Pocock SJ, Goodman SG, Westermann D, Blankenberg S, Nicolau JC, Chen JY, Granger CB, Grieve R, Yasuda S, Simon T, Cohen MG, Hedman K, Gregson J, Rennie K. 5261Linear ongoing risk of major cardiovascular events in a global prospective registry of high-risk patients with stable coronary disease: insights from the TIGRIS study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.5261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D Brieger
- Concord Hospital, Anzac Research Institute, Sydney, Australia
| | - S J Pocock
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - S G Goodman
- Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, Toronto, Canada
| | - D Westermann
- University Heart Center Hamburg, Hamburg, Germany
| | | | - J C Nicolau
- Instituto do Coracao FMUSP, Sao Paulo, Brazil
| | - J Y Chen
- Guangdong General Hospital Guangdong Cardiovascular Institute, Provincial Key Laboratory of Coronary Disease, Guangzhou, China People's Republic of
| | - C B Granger
- Duke Clinical Research Institute, Durham, United States of America
| | - R Grieve
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - S Yasuda
- National Cerebral and Cardiovascular Center, Osaka, Japan
| | - T Simon
- University Pierre & Marie Curie Paris VI, Assistance Publique-Hopitaux de Paris (APHP), Paris, France
| | - M G Cohen
- University of Miami Leonard M. Miller School of Medicine, Miami, United States of America
| | | | - J Gregson
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - K Rennie
- Oxon Epidemiology UK, London, United Kingdom
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32
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Schiele F, Simon T, Puymirat E, Cayla G, Gerbaud E, Ohlmann P, Popovic B, Bresson D, Farah B, Ferrieres J, Meneveau N, Danchin N, Lemesle G, Martinet M. P973Impact of existing or new-onset atrial fibrillation in a setting of acute myocardial infarction. Insights from the FAST-MI 2005, 2010 and 2015 registries. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- F Schiele
- University Hospital of Besancon, Besancon, France
| | - T Simon
- Hospital Saint-Antoine, Paris, France
| | - E Puymirat
- European Hospital Georges Pompidou, Paris, France
| | - G Cayla
- University Hospital of Nimes, Nimes, France
| | - E Gerbaud
- Hospital Haut Leveque, Bordeaux-Pessac, France
| | - P Ohlmann
- University Hospital of Strasbourg, Strasbourg, France
| | - B Popovic
- Hospital Brabois of Nancy, Vandoeuvre les Nancy, France
| | - D Bresson
- Hospital Emile Muller, Mulhouse, France
| | - B Farah
- Clinic Pasteur of Toulouse, Toulouse, France
| | - J Ferrieres
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - N Meneveau
- University Hospital of Besancon, Besancon, France
| | - N Danchin
- European Hospital Georges Pompidou, Paris, France
| | | | - M Martinet
- European Hospital Georges Pompidou, Paris, France
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Even G, Kiss M, Laschet J, Ozvar Kozma M, Simon T, Wigren M, Gaston A, Procopio E, Le Borgne-Moynnier M, Nilsson J, Kuiper J, Nicoletti A, Binder C, Caligiuri G. Vaccination with Prevenar® boosts the production of anti-phosphorylcholine antibodies and protects APOE knockout mice from atherosclerosis. Atherosclerosis 2018. [DOI: 10.1016/j.atherosclerosis.2018.06.903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Puymirat E, Bonaca M, Cayla G, Lemesles G, Dillinger JG, Ducrocq G, Ferrieres J, Schiele F, Simon T, Danchin N. P5348Atherothrombotic risk stratification after acute myocardial infarction: the TIMI Risk Score for Secondary Prevention (TRS-2P) in the light of the FAST-MI registries. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- E Puymirat
- European Hospital Georges Pompidou, Cardiology, Paris, France
| | - M Bonaca
- Harvard Medical School, Boston, United States of America
| | - G Cayla
- University Hospital of Nimes, Nimes, France
| | - G Lemesles
- Lille University Hospital, Lille, France
| | | | - G Ducrocq
- Hospital Bichat-Claude Bernard, Paris, 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
- European Hospital Georges Pompidou, Cardiology, Paris, France
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Schiele F, Simon T, Puymirat E, Cayla G, Gerbaud E, Ohlmann P, Popovic B, Bresson D, Farah B, Ferrieres J, Meneveau N, Danchin N. P4490Quality matters: classification of centres by quality of care in acute myocardial infarction using the ESC-Acute Cardiac Care Association quality indicators. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- F Schiele
- University Hospital of Besancon, Besancon, France
| | - T Simon
- Hospital Saint-Antoine, Paris, France
| | - E Puymirat
- European Hospital Georges Pompidou, Paris, France
| | - G Cayla
- University Hospital of Nimes, Nimes, France
| | - E Gerbaud
- Hospital Haut Leveque, Bordeaux-Pessac, France
| | - P Ohlmann
- University Hospital of Strasbourg, Strasbourg, France
| | - B Popovic
- Hospital Brabois of Nancy, Vandoeuvre les Nancy, France
| | - D Bresson
- Hospital Emile Muller, Mulhouse, France
| | - B Farah
- Clinic Pasteur of Toulouse, Toulouse, France
| | - J Ferrieres
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - N Meneveau
- University Hospital of Besancon, Besancon, France
| | - N Danchin
- European Hospital Georges Pompidou, Paris, France
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36
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Puymirat E, Bonaca M, Lemesle G, Furber A, Leborgne S, Angoulvant D, Labeque JN, Orion L, Harbaoui D, Bonelo L, Ferrieres J, Schiele F, Simon T, Danchin N. P6257Missed opportunities with underprescription of appropriate secondary prevention treatment at discharge in AMI patients at high risk. The FAST-MI programme. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- E Puymirat
- European Hospital Georges Pompidou, Cardiology, Paris, France
| | - M Bonaca
- Harvard Medical School, Boston, United States of America
| | - G Lemesle
- Lille University Hospital, Lille, France
| | - A Furber
- University Hospital of Angers, Angers, France
| | - S Leborgne
- Hospital Center of Avignon, Avignon, France
| | | | | | - L Orion
- Centre Hospitalier Départemental Les Oudairies, La Roche-sur-Yon, France
| | | | - L Bonelo
- Hospital Nord of Marseille, Marseille, France
| | - J Ferrieres
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - F Schiele
- University of Besançon, Besançon, France
| | - T Simon
- Hospital Saint-Antoine, Paris, France
| | - N Danchin
- European Hospital Georges Pompidou, Cardiology, Paris, France
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Mamlouk S, Simon T, Wedge D, Morkel M, Capper D, Blaeker H, Sers C. PO-322 Multi-region deep sequencing of colorectal carcinoma in-situ defines oncogenic transformation as a gradual and adaptive process. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Simon T, Mamlouk S, Khouja S, Andrea M, Dido L, Detjen K, Pavel M, Rossner F, Haybäck J, Sers C. PO-329 Genomic aberration in pancreatic neuroendocrine tumours (PNET). ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ashari N, Pang HW, Simon T, Xiong Y, Coburn JM, Bromberg JS, Kaplan DL, McLenithan J, Fontaine MJ. Silk fibroin preserves beta cell function under inflammatory stress while stimulating islet cell surface GLUT2 expression. Cell Immunol 2018; 329:10-16. [PMID: 29661473 DOI: 10.1016/j.cellimm.2018.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/08/2018] [Accepted: 04/08/2018] [Indexed: 12/16/2022]
Abstract
Silk fibroin is a novel biomaterial for enhancing transplanted islet cell function and survival. This study investigated whether silk fibroin may have unique properties that improve islet function in the face of inflammatory-mediated stress during transplantation. Murine islet function was tested in vitro with either silk fibroin or alginate and challenged with inflammatory cytokines. The glucose-stimulated insulin secretion index for all conditions decreased with inflammatory cytokines, but was better preserved for islets exposed to silk compared to those exposed to alginate or medium. GLUT2 transporter expression on the cell surface of islets exposed to silk was increased compared to alginate or medium alone. Upon cytokine stress, a greater percentage of islet cells exposed to silk expressed GLUT2 on their surface. We conclude that preconditioning islets with silk fibroin stimulates islet cell surface GLUT2 expression, an increase, which persists under inflammatory stress, and may improve islet engraftment and function after transplantation.
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Affiliation(s)
- N Ashari
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - H W Pang
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - T Simon
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Y Xiong
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - J M Coburn
- Department of Biomedical Engineering, Tufts University, Medford, MA 02155, USA
| | - J S Bromberg
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - D L Kaplan
- Department of Biomedical Engineering, Tufts University, Medford, MA 02155, USA
| | - J McLenithan
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - M J Fontaine
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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Abstract
SummaryAim: Targeted radiotherapies using iodine-131 meta-iodobenzylguanidin have long been in use for treatment of stage IV neuroblastoma but reliable dosimetric data are scarce. Method: This work presents an approach to determine the whole body exposure and tumour doses delivered during therapy. Dosimetric data are reported and discussed for six treatments carried out according to the trial protocol NB2004 as it is in use in our study in the last two years. Results: Whole body exposures are found to be in the range of 1.75 to 2.5 Gy whereas tumour doses vary between 15 and 55 Gy. Conclusion: The course of action prescribed by the trial protocol allows whole body exposure as well as tumour doses to be determined routinely.
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Simon T, Hero B, Eschner W, Dietlein M, Sudbrock F, Bongartz R, Berthold F, Schicha H, Schmidt M. Is there a benefit of 131I-MIBG therapy in the treatment of children with stage 4 neuroblastoma? Nuklearmedizin 2018. [DOI: 10.1055/s-0038-1625111] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryAim: 131I-meta-iodobenzylguanidine (131I-MIBG) therapy has been used in neuroblastoma treatment for many years but its value in high intensive first line treatment protocols is not exactly known. Patients, methods: Stage 4 neuroblastoma patients >1 year with 123I-MIBG positive residual disease (primary tumour and/or metastasis) after complete induction chemotherapy according to the German neuroblastoma trial NB97 were retrospectively analyzed. Results: One-hundred-eleven patients had 123I-MIBG positive residual disease after complete induction chemotherapy. Forty patients received 131I-MIBG therapy using a median activity of 0.44 GBq/kg body weight. By univariate analysis, patients who underwent 131I-MIBG therapy had a better 3-year event free survival (3-y-EFS 46±8%) and 3-year overall survival (3-y-OS 58±9%) than 71 patients without 131I-MIBG therapy (3-y-EFS 19±5%, p=0.003; 3-y-OS 43±6%, p=0.037). However, subgroup analysis of 66 patients who underwent high dose chemotherapy with autologous stem cell transplantation (ASCT) during treatment found a very similar outcome with 131I-MIBG therapy (3-y-EFS 49±9%, 3-y-OS 59±10%) and without 131I-MIBG therapy (3-y-EFS 33±9%, p=0.171; 3-y-OS 59±9%, p=0.285) due to the dominating effect of ASCT. By multivariate analysis, 131I-MIBG therapy had no impact on EFS (p=0.494) and OS (p=0.891). Only ASCT, external beam radiation therapy and MYCN amplification were important for EFS and OS. Conclusions: An independent advantage of I-131-MIBG therapy could not be proven in this retrospective analysis. The ongoing German Neuroblastoma Trial NB2004 will address the influence of 131I-MIBG therapy with emphasis on tumour dosimetry.
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Bailleul C, Aissaoui N, Cayla G, Dillinger J, Jouve B, Schiele F, Simon T, Danchin N, Puymirat E. Prognostic impact of pre-percutaneous coronary intervention TIMI flow in ST and non-ST elevation myocardial infarction patients: Results from the FAST-MI 2010 registry. Archives of Cardiovascular Diseases Supplements 2018. [DOI: 10.1016/j.acvdsp.2017.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Freund Y, Bokobza J, Cachanado M, Aubry A, Aufredou FP, Raynal PA, Simon T, Riou B. 71 PERC Rule to Exclude the Diagnosis of Pulmonary Embolism in Low-Risk Emergency Patients: A Noninferiority Randomized Controlled Trial. Ann Emerg Med 2017. [DOI: 10.1016/j.annemergmed.2017.07.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Boffa J, Mahevas M, Audard V, Krastinova E, Daugas E, Pillebout E, Vrigneaud L, Delahousse M, Verhelst D, Guerrot D, Valeyre D, Simon T. Efficacité et tolérance des bolus de méthylprednisolone dans la sarcoïdose rénale : un essai randomisé. Nephrol Ther 2017. [DOI: 10.1016/j.nephro.2017.08.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Leblanc J, Jegou C, Fossoux N, Lancien C, Bastide T, Verbrugghe R, Jauneau C, Piquet H, Crémieux AC, Simon T. Effectiveness of Nurse-Driven HIV Screening Targeting Key Populations in Emergency Departments in Metropolitan Paris: The Anrs DICI-VIH Cluster-Randomized Two-Period Crossover Trial. Clin Ther 2017. [DOI: 10.1016/j.clinthera.2017.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Puymirat E, Roussel R, Aissaoui N, Ducrocq G, Ferrari E, Legros G, Lemesle G, Marcaggi X, Belle L, Ferrieres J, Schiele F, Simon T, Danchin N. 2187Long-term prognostic significance of diabetes mellitus according to renal function in myocardial infarction patients. The FAST-MI 2005 registry. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.2187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- E. Puymirat
- AP-HP - European Hospital Georges Pompidou, Paris, France
| | - R. Roussel
- Hospital Bichat-Claude Bernard, Paris, France
| | - N. Aissaoui
- AP-HP - European Hospital Georges Pompidou, Paris, France
| | - G. Ducrocq
- Hospital Bichat-Claude Bernard, Paris, France
| | - E. Ferrari
- University Hospital Pasteur of Nice, Nice, France
| | | | | | | | - L. Belle
- Hospital of Annecy, Annecy, France
| | - J. Ferrieres
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - F. Schiele
- Regional University Hospital Jean Minjoz, Besancon, France
| | - T. Simon
- AP-HP - Hospital Saint Antoine, Paris, France
| | - N. Danchin
- AP-HP - European Hospital Georges Pompidou, Paris, France
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Aissaoui N, Puymirat E, Juilieres Y, Jourdain P, Blanchard D, Schiele F, Gueret P, Ferrieres J, Simon T, Danchin N. P3644High-grade atrioventricular block in acute myocardial infarction: evolution of prevalence, patient profile, management and outcomes, 1995-2010. Insights from FAST-MI Registries. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Puymirat E, Aissaoui N, Bailleul C, Cayla G, Dillinger J, Jouve B, Schiele F, Drouet E, Ferrieres J, Simon T, Danchin N. P491Different prognostic impact of pre-percutaneous coronary intervention TIMI flow in ST and non-ST elevation myocardial infarction patients: results from the FAST-MI 2010 registry. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Wendler F, Favicchio R, Simon T, Alifrangis C, Stebbing J, Giamas G. Extracellular vesicles swarm the cancer microenvironment: from tumor-stroma communication to drug intervention. Oncogene 2017; 36:877-884. [PMID: 27546617 DOI: 10.1038/onc.2016.253] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 06/07/2016] [Accepted: 06/07/2016] [Indexed: 02/06/2023]
Abstract
Intercellular communication sets the pace for transformed cells to survive and to thrive. Extracellular vesicles (EVs), such as exosomes, microvesicles and large oncosomes, are involved in this process shuttling reciprocal signals and other molecules between transformed and stromal cells, including fibroblasts, endothelial and immune cells. As a result, these cells are adapted or recruited to a constantly evolving cancer microenvironment. Moreover, EVs take part in the response to anticancer therapeutics not least by promoting drug resistance throughout the targeted tumor. Finally, circulating EVs can also transport important molecules to remote destinations in order to prime metastatic niches in an otherwise healthy tissue. Although the understanding of EV biology remains a major challenge in the field, their characteristics create new opportunities for advances in cancer diagnostics and therapeutics.
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Affiliation(s)
- F Wendler
- School of Life Sciences, Department of Biochemistry and Biomedicine, University of Sussex, Brighton, UK
| | - R Favicchio
- Imperial College London, Department of Surgery and Cancer, Division of Cancer, London, UK
| | - T Simon
- School of Life Sciences, Department of Biochemistry and Biomedicine, University of Sussex, Brighton, UK
| | - C Alifrangis
- Imperial College London, Department of Medical Oncology, NHS Trust, Hammersmith Hospital, London, UK
| | - J Stebbing
- Imperial College London, Department of Surgery and Cancer, Division of Cancer, London, UK
| | - G Giamas
- School of Life Sciences, Department of Biochemistry and Biomedicine, University of Sussex, Brighton, UK
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Dossier C, Boyer O, Ulinski T, Azib S, Madhi F, May A, Nathanson S, Orzechowski C, Simon T, Deschenes G. Évolution du SNI de l’enfant : suivi à 5 ans de la cohorte NEPHROVIR. Arch Pediatr 2016. [DOI: 10.1016/j.arcped.2016.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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