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de Framond Y, Schaaf M, Pichot-Lamoureux S, Range G, Dubreuil O, Angoulvant D, Claeys MJ, Dorado DG, Bochaton T, Rioufol G, Jossan C, Boussaha I, Ovize M, Mewton N. Regression of Q waves and clinical outcomes following primary PCI in anterior STEMI. J Electrocardiol 2019; 73:131-136. [PMID: 31668455 DOI: 10.1016/j.jelectrocard.2019.09.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 10/18/2018] [Revised: 08/19/2019] [Accepted: 09/20/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pathological Q waves are correlated with infarct size, and Q-wave regression is associated with left ventricular ejection fraction improvement. There are limited data regarding the association of Q-wave regression and clinical outcomes. Our main objective was to assess the association of pathological Q wave evolution after reperfusion with clinical outcomes after anterior STEMI. METHODS Standard 12-lead electrocardiograms (ECGs) were recorded in 780 anterior STEMI patients treated with primary percutaneous coronary intervention (PCI) from the CIRCUS trial. ECGs were recorded before and 90 min following PCI, as well as at hospitalization discharge and 12 months of follow-up. The number of classic ECG criteria Q waves was scored for each ECG. Patients were classified in the Q wave regression group if they had regression of at least one Q wave between the post-PCI, the discharge and/or one year ECGs. Patients were classified in the Q wave persistent group if they had the same number or greater between the post-PCI, the discharge and/or 1 and one year ECGs. All-cause death and heart failure events were assessed for all patients at one year. RESULTS There were 323(43%) patients with persistent Q waves (PQ group), 378(49%) patients with Q wave regression (RQ group) and 60(8%) patients with non-Q wave MI (NQ group). Infarct size as measured by the peak creatine kinase was significantly greater in the PQ group compared to the RQ and NQ groups (4633 ± 2784 IU/l vs. 3814 ± 2595 IU/l vs. 1733 ± 1583 IU/l respectively, p < 0.0001). At one year, there were 22 deaths (7%) in the PQ-group, 15 (4%) in the RQ-group and none in the NQ-group (p = 0.04). There was a 4-fold increase in the risk of death or heart failure in the PQ compared to the NQ group (HR 4.7 [1.1; 19.3]; p = 0.03), but there was no significant difference between NQ and RQ groups (HR 3.3 [0.8; 13.8]; p = 0.09). CONCLUSION In a population of anterior STEMI patients, persistent Q waves defined according to the classic ECG criteria after reperfusion was associated with a 4-fold increase in the risk of heart failure or death compared to non-Q-wave MI, while Q-wave regression was associated with significantly lower risk of events.
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Affiliation(s)
- Yuni de Framond
- Hopital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon, Lyon, France, Centre d'Investigation Clinique de Lyon, Université Claude Bernard Lyon 1, France
| | | | - Sophie Pichot-Lamoureux
- Hopital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon, Lyon, France, Centre d'Investigation Clinique de Lyon, Université Claude Bernard Lyon 1, France
| | | | | | | | | | - David Garcia Dorado
- Vall d'Hebron University Hospital and Research Institut and CIBERC, Universtitat Autonoma de Barcelona, Spain
| | - Thomas Bochaton
- Hopital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon, Lyon, France, Centre d'Investigation Clinique de Lyon, Université Claude Bernard Lyon 1, France
| | - Gilles Rioufol
- Hopital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon, Lyon, France, Centre d'Investigation Clinique de Lyon, Université Claude Bernard Lyon 1, France
| | - Claire Jossan
- Hopital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon, Lyon, France, Centre d'Investigation Clinique de Lyon, Université Claude Bernard Lyon 1, France
| | - Inesse Boussaha
- Hopital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon, Lyon, France, Centre d'Investigation Clinique de Lyon, Université Claude Bernard Lyon 1, France
| | - Michel Ovize
- Hopital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon, Lyon, France, Centre d'Investigation Clinique de Lyon, Université Claude Bernard Lyon 1, France
| | - Nathan Mewton
- Hopital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon, Lyon, France, Centre d'Investigation Clinique de Lyon, Université Claude Bernard Lyon 1, France.
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Ribera A, Ferreira-Gonzalez I, Marsal JR, Oristrell G, Faixedas MT, Rosas A, Tizón-Marcos H, Rojas S, Labata C, Cardenas M, Homs S, Tomas-Querol C, Garcia-Picart J, Gomez-Hospital JA, Pijoan JI, Masotti M, Mauri J, Garcia Dorado D. Persistence with dual antiplatelet therapy after percutaneous coronary intervention for ST-segment elevation acute coronary syndrome: a population-based cohort study in Catalonia (Spain). BMJ Open 2019; 9:e028114. [PMID: 31340964 PMCID: PMC6661631 DOI: 10.1136/bmjopen-2018-028114] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES Guidelines recommending 12-month dual antiplatelet therapy (DAPT) in patients with ST-elevation acute coronary syndrome (STEACS) undergoing percutaneous coronary intervention (PCI) were published in year 2012. We aimed to describe the influence of guideline implementation on the trend in 12-month persistence with DAPT between 2010 and 2015 and to evaluate its relationship with DAPT duration regimens recommended at discharge from PCI hospitals. DESIGN Observational study based on region-wide registry data linked to pharmacy billing data for DAPT follow-up. SETTING All PCI hospitals (10) belonging to the acute myocardial infarction (AMI) code network in Catalonia (Spain). PARTICIPANTS 10 711 STEACS patients undergoing PCI between 2010 and 2015 were followed up. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome was 12-month persistence with DAPT. Calendar year quarter, publication of guidelines, DAPT duration regimen recommended in the hospital discharge report, baseline patient characteristics and significant interactions were included in mixed-effects logistic regression based interrupted time-series models. RESULTS The proportion of patients on-DAPT at 12 months increased from 58% (56-60) in 2010 to 73% (71-75) in 2015. The rate of 12-month persistence with DAPT significantly increased after the publication of clinical guidelines with a time lag of 1 year (OR=1.20; 95% CI 1.11 to 1.30). A higher risk profile, more extensive and complex coronary disease, use of drug-eluting stents (OR=1.90; 95% CI 1.50 to 2.40) and a 12-month DAPT regimen recommendation at discharge from the PCI hospital (OR=5.76; 95% CI 3.26 to 10.2) were associated with 12-month persistence. CONCLUSION Persistence with 12-month DAPT has increased since publication of clinical guidelines. Even though most patients were discharged on DAPT, only 73% with potential indication were on-DAPT 12 months after PCI. A guideline-based recommendation at PCI hospital discharge was highly associated with full persistence with DAPT. Establishing evidence-based, common prescribing criteria across hospitals in the AMI-network would favour adherence and reduce variability.
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Affiliation(s)
- Aida Ribera
- Cardiology Department, Vall d’Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública CIBERESP, The Spanish Health Institute (ISCIII), Spain
| | - Ignacio Ferreira-Gonzalez
- Cardiology Department, Vall d’Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública CIBERESP, The Spanish Health Institute (ISCIII), Spain
| | - Josep Ramon Marsal
- Cardiology Department, Vall d’Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública CIBERESP, The Spanish Health Institute (ISCIII), Spain
| | - Gerard Oristrell
- Cardiology Department, Vall d’Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red para Enfermedades Cardiovasculares CIBERCV, Spanish Health Institute (ISCIII), Spain
| | | | - Alba Rosas
- Departament de Salut, Generalitat de Catalunya, Barcelona, Spain
| | - Helena Tizón-Marcos
- Cardiology Department, Hospital del Mar, and Heart Diseases Biomedical Research Group and IMIM (Hospital del Mar Medical Research Institute), Faculty of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Sergio Rojas
- Cardiology Department, Hospital Universitari de Tarragona Joan XXIII, IISPV, Universidad Rovira Virgili, Tarragona, Spain
| | - Carlos Labata
- Cardiology Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | | | - Silvia Homs
- Cardiology Department, Hospital Mútua de Terrassa, Barcelona, Spain
| | | | - Joan Garcia-Picart
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Jose Ignacio Pijoan
- Clinical Epidemiology Unit, Hospital Universitario de Cruces. Biocruces Bizkaia Health Research Institute, Bilbao, Spain
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública CIBERESP, The Spanish Health Institute (ISCIII), Spain
| | - Monica Masotti
- Institut Clínic Cardio vascular (ICCV), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Josepa Mauri
- Departament de Salut, Generalitat de Catalunya, Barcelona, Spain
- Cardiology Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | - David Garcia Dorado
- Cardiology Department, Vall d’Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red para Enfermedades Cardiovasculares CIBERCV, Spanish Health Institute (ISCIII), Spain
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Franken R, Teixido-Tura G, Brion M, Forteza A, Rodriguez-Palomares J, Gutierrez L, Garcia Dorado D, Pals G, Mulder BJM, Evangelista A. Relationship between fibrillin-1 genotype and severity of cardiovascular involvement in Marfan syndrome. Heart 2017; 103:1795-1799. [DOI: 10.1136/heartjnl-2016-310631] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 03/13/2017] [Accepted: 03/16/2017] [Indexed: 11/03/2022] Open
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Schaaf M, Des Horts TB, Croisille P, Roubille F, Prunier F, Garcia Dorado D, Jossan C, Bergerot C, Thibault H, Ovize M, Mewton N. 0488 : Predictive value of early cardiac magnetic resonance left ventricular indices at the acute phase of myocardial infarction on chronic left ventricular remodeling. Archives of Cardiovascular Diseases Supplements 2016. [DOI: 10.1016/s1878-6480(16)30408-6] [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: 10/21/2022]
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Figueras J, Bañeras J, Peña-Gil C, Barrabés JA, Rodriguez Palomares J, Garcia Dorado D. Hospital and 4-Year Mortality Predictors in Patients With Acute Pulmonary Edema With and Without Coronary Artery Disease. J Am Heart Assoc 2016; 5:JAHA.115.002581. [PMID: 26883921 PMCID: PMC4802455 DOI: 10.1161/jaha.115.002581] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Long-term prognosis of acute pulmonary edema (APE) remains ill defined. METHODS AND RESULTS We evaluated demographic, echocardiographic, and angiographic data of 806 consecutive patients with APE with (CAD) and without coronary artery disease (non-CAD) admitted from 2000 to 2010. Differences between hospital and long-term mortality and its predictors were also assessed. CAD patients (n=638) were older and had higher incidence of diabetes and peripheral vascular disease than non-CAD (n=168), and lower ejection fraction. Hospital mortality was similar in both groups (26.5% vs 31.5%; P=0.169) but APE recurrence was higher in CAD patients (17.3% vs 6.5%; P<0.001). Age, admission systolic blood pressure, recurrence of APE, and need for inotropics or endotracheal intubation were the main independent predictors of hospital mortality. In contrast, overall mortality (70.0% vs 57.1%; P=0.002) and readmission for nonfatal heart failure after a 45-month follow-up (10-140; 17.3% vs 7.6%; P=0.009) were higher in CAD than in non-CAD patients. Age, peripheral vascular disease, and peak creatine kinase MB during index hospitalization, but not ejection fraction, were the main independent predictors of overall mortality, whereas coronary revascularization or valvular surgery were protective. These interventions were mostly performed during hospitalization index (294 of 307; 96%) and not intervened patients showed a higher risk profile. CONCLUSIONS Long-term mortality in APE is high and higher in CAD than in non-CAD patients. Considering the different in-hospital and long-term mortality predictors herein described, which do not necessarily involve systolic function, it is conceivable that a more aggressive interventional program might improve survival in high-risk patients.
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Affiliation(s)
- Jaume Figueras
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Jordi Bañeras
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Carlos Peña-Gil
- Servicio de Cardiología, Complexo Hospitalario Universitario de Vigo, SERGAS, Vigo, Spain
| | - José A Barrabés
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Jose Rodriguez Palomares
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - David Garcia Dorado
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
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Figueras J, Barrabés JA, Lidón RM, Sambola A, Bañeras J, Palomares JR, Martí G, Dorado DG. Predictors of moderate-to-severe pericardial effusion, cardiac tamponade, and electromechanical dissociation in patients with ST-elevation myocardial infarction. Am J Cardiol 2014; 113:1291-6. [PMID: 24560064 DOI: 10.1016/j.amjcard.2013.11.071] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 11/27/2013] [Accepted: 11/27/2013] [Indexed: 11/15/2022]
Abstract
Occurrence of moderate-to-severe pericardial effusion (PE; ≥10 mm), cardiac tamponade (CT), and sudden electromechanical dissociation (EMD) was investigated in 4,361 patients with ST-elevation myocardial infarction from 1993 to 2011 in 3 different periods: 1993 to 2000 (n: 1,488); 2001 to 2008 (n: 1,844); and 2009 to 2011 (n: 1,014). Their predictors, including the use of no reperfusion therapy (n: 1,186), thrombolysis (n: 1,607), or primary percutaneous coronary intervention (PPCI, n: 1,562), were also evaluated. Incidence of PE (8.7%, 6.8%, and 5.0%), CT (5.0%, 2.9%, and 1.9%), and EMD (3.7%, 1.7%, and 1.0%), declined over the 3 periods as did mortality (12.0% 8.2%, and 5.9%) with different rates of thrombolytic therapy (52%, 37%, and 14%) and PPCI (7%, 38%, and 76%; all p<0.001). In patients treated without reperfusion therapy, thrombolysis, and PPCI, incidence of PE (12.0%, 5.7%, and 4.3%), CT (6.0%, 3.0%, and 2.2%), and EMD (4.1%, 2.2%, and 0.8%) was different as was mortality (14.4%, 8.3%, and 5.9%; all p<0.001). Independent predictors of PE were lateral infarction (odds ratio [OR] 4.09, 95% confidence interval [CI] 2.57 to 6.49), increasing age (OR 1.05, 95% CI 1.04 to 1.07), number of electrocardiographic leads involved (OR 1.34, 95% CI 1.23 to 1.45), and admission delay (OR 1.01, 95% CI 1.01 to 1.02). Increasing ejection fraction (OR 0.97, 95% CI 0.96 to 0.98), thrombolysis (OR 0.53, 95% CI 0.37 to 0.75), and PPCI (OR 0.35, 95% CI 0.25 to 0.50), however, were protectors (all p<0.001). Lateral infarction, age, number of leads involved, ejection fraction, thrombolytic therapy, and PPCI were also predictors/protectors of CT and EMD. In conclusion, PE, CT, and EMD rates in patients with ST-elevation myocardial infarction have objectively fallen in the last 2 decades, and their predictors are lateral site, increasing age, number of leads involved, and lack of reperfusion therapy. Late hospital admission is also a relevant predictor of PE.
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Affiliation(s)
- Jaume Figueras
- Unitat Coronària, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
| | - Jose A Barrabés
- Unitat Coronària, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Rosa-Maria Lidón
- Unitat Coronària, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Antonia Sambola
- Unitat Coronària, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jordi Bañeras
- Unitat Coronària, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Gerard Martí
- Unitat Coronària, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - David Garcia Dorado
- Unitat Coronària, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Martínez-Acedo P, Núñez E, Gómez FJS, Moreno M, Ramos E, Izquierdo-Álvarez A, Miró-Casas E, Mesa R, Rodriguez P, Martínez-Ruiz A, Dorado DG, Lamas S, Vázquez J. A novel strategy for global analysis of the dynamic thiol redox proteome. Mol Cell Proteomics 2012; 11:800-13. [PMID: 22647871 DOI: 10.1074/mcp.m111.016469] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Nitroxidative stress in cells occurs mainly through the action of reactive nitrogen and oxygen species (RNOS) on protein thiol groups. Reactive nitrogen and oxygen species-mediated protein modifications are associated with pathophysiological states, but can also convey physiological signals. Identification of Cys residues that are modified by oxidative stimuli still poses technical challenges and these changes have never been statistically analyzed from a proteome-wide perspective. Here we show that GELSILOX, a method that combines a robust proteomics protocol with a new computational approach that analyzes variance at the peptide level, allows a simultaneous analysis of dynamic alterations in the redox state of Cys sites and of protein abundance. GELSILOX permits the characterization of the major endothelial redox targets of hydrogen peroxide in endothelial cells and reveals that hypoxia induces a significant increase in the status of oxidized thiols. GELSILOX also detected thiols that are redox-modified by ischemia-reperfusion in heart mitochondria and demonstrated that these alterations are abolished in ischemia-preconditioned animals.
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Affiliation(s)
- Pablo Martínez-Acedo
- Centro de Biología Molecular Severo Ochoa, Nicolás Cabrera 1, 28049 Madrid, Spain
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Figueras J, Domingo E, Cortadellas J, Padilla F, Dorado DG, Segura R, Galard R, Soler JS. Comparison of plasma serotonin levels in patients with variant angina pectoris versus healed myocardial infarction. Am J Cardiol 2005; 96:204-7. [PMID: 16018842 DOI: 10.1016/j.amjcard.2005.03.044] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2004] [Revised: 03/12/2005] [Accepted: 03/10/2005] [Indexed: 11/21/2022]
Abstract
Patients with variant angina pectoris showed greater serotonin plasma levels than did control subjects and patients with healed myocardial infarction. The levels also tended to be greater in those with >1 episode/month than in those with fewer episodes. Moreover, patients with variant angina pectoris also had greater levels of nitrite and nitrate plasma levels than did control subjects or patients with healed myocardial infarction, partly, perhaps, as a compensatory mechanism.
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Affiliation(s)
- Jaume Figueras
- Unitat Coronària, Servei de Cardiologia, Hospital General Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
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