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Ninni S, Lemesle G, Meurice T, Tricot O, Lamblin N, Bauters C. Relative Importance of Heart Failure Events Compared to Stroke and Bleeding in AF Patients. J Clin Med 2021; 10:jcm10050923. [PMID: 33670912 PMCID: PMC7957734 DOI: 10.3390/jcm10050923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/17/2021] [Accepted: 02/20/2021] [Indexed: 01/27/2023] Open
Abstract
Introduction: Incident heart failure (HF), ischemic stroke and systemic embolism (IS/SE), and major bleeding related to anticoagulation therapy are still the most frequent events occurring in patients with atrial fibrillation (AF). The aim of this study was to assess the 3-year incidence, predictors, and related mortality of IS/SE, major bleeding, and HF in a large cohort of AF outpatients. Methods and results: We studied 4973 outpatients with prevalent AF included in the CARDIONOR registry. The mean age was 72.9 ± 11.2 years, 24.1% had diabetes mellitus and 78.9% had anticoagulant therapy at baseline. The mean CHA2DS2Vasc score was 3.4 ± 1.7. After a median follow-up of 3.2 years (IQR: 2.8 to 3.5), incident HF, IS/SE and major bleeding occurred in 10.5%, 3.3% and 2.1% of patients, respectively. When analyzed as time-dependent variables, IS/SE, major bleeding and hospitalization for decompensated HF were all strongly associated with mortality. The independent predictors of incident HF were age, women, hypertension, diabetes mellitus, coronary artery disease and a previous history of HF. A sensitivity analysis in patients without history of HF at inclusion revealed that incident HF remained the most frequent adverse event, occurring in 5.3% of patients, compared to IS/SE (1.7%) and major bleeding (2.5%). Conclusion: HF is a common residual cardiovascular adverse event occurring in AF outpatients and is associated with a very high mortality. Since modifiable risk factors are associated with incident HF, upstream intensive management of these risk factors would be of interest.
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Affiliation(s)
- Sandro Ninni
- Institut Cœur Poumon, University of Lille, CHU Lille, 59000 Lille, France;
- Correspondence: ; Tel.: +33-320-429-373
| | - Gilles Lemesle
- Institut Cœur Poumon, University of Lille, CHU Lille, 59000 Lille, France;
| | | | - Olivier Tricot
- Centre Hospitalier de Dunkerque, 59240 Dunkerque, France;
| | - Nicolas Lamblin
- Institut Pasteur, U1167, Inserm, University of Lille, CHU Lille, 59000 Lille, France; (N.L.); (C.B.)
| | - Christophe Bauters
- Institut Pasteur, U1167, Inserm, University of Lille, CHU Lille, 59000 Lille, France; (N.L.); (C.B.)
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Ninni S, Lemesle G, Meurice T, Tricot O, Lamblin N, Bauters C. Real-Life Incident Atrial Fibrillation in Outpatients with Coronary Artery Disease. J Clin Med 2020; 9:jcm9082367. [PMID: 32722139 PMCID: PMC7465814 DOI: 10.3390/jcm9082367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 11/29/2022] Open
Abstract
Background: The risk, correlates, and consequences of incident atrial fibrillation (AF) in patients with chronic coronary artery disease (CAD) are largely unknown. Methods and results: We analyzed incident AF during a 3-year follow-up in 5031 CAD outpatients included in the prospective multicenter CARDIONOR registry and with no history of AF at baseline. Incident AF occurred in 266 patients (3-year cumulative incidence: 4.7% (95% confidence interval (CI): 4.1 to 5.3)). Incident AF was diagnosed during cardiology outpatient visits in 177 (66.5%) patients, 87 of whom were asymptomatic. Of note, 46 (17.3%) patients were diagnosed at time of hospitalization for heart failure, and a few patients (n = 5) at the time of ischemic stroke. Five variables were independently associated with incident AF: older age (p < 0.0001), heart failure (p = 0.003), lower left ventricle ejection fraction (p = 0.008), history of hypertension (p = 0.010), and diabetes mellitus (p = 0.033). Anticoagulant therapy was used in 245 (92%) patients and was associated with an antiplatelet drug in half (n = 122). Incident AF was a powerful predictor of all-cause (adjusted hazard ratio: 2.04; 95% CI: 1.47 to 2.83; p < 0.0001) and cardiovascular mortality (adjusted hazard ratio: 2.88; 95% CI: 1.88 to 4.43; p < 0.0001). Conclusions: In CAD outpatients, real-life incident AF occurs at a stable rate of 1.6% annually and is frequently diagnosed in asymptomatic patients during cardiology outpatient visits. Anticoagulation is used in most cases, often combined with antiplatelet therapy. Incident AF is associated with increased mortality.
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Affiliation(s)
- Sandro Ninni
- CHU Lille, Department of Cardiology, University of Lille, F-59000 Lille, France; (G.L.); (N.L.); (C.B.)
- Institut Pasteur de Lille, U1011, F-59000 Lille, France
- Correspondence: ; Tel.: +33-320-429373
| | - Gilles Lemesle
- CHU Lille, Department of Cardiology, University of Lille, F-59000 Lille, France; (G.L.); (N.L.); (C.B.)
- Institut Pasteur de Lille, U1011, F-59000 Lille, France
| | | | - Olivier Tricot
- Centre Hospitalier de Dunkerque, 59240 Dunkerque, France;
| | - Nicolas Lamblin
- CHU Lille, Department of Cardiology, University of Lille, F-59000 Lille, France; (G.L.); (N.L.); (C.B.)
- Institut Pasteur de Lille, U1167, F-59000 Lille, France
| | - Christophe Bauters
- CHU Lille, Department of Cardiology, University of Lille, F-59000 Lille, France; (G.L.); (N.L.); (C.B.)
- Institut Pasteur de Lille, U1167, F-59000 Lille, France
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Lamblin N, Ninni S, Tricot O, Meurice T, Lemesle G, Bauters C. Secondary prevention and outcomes in outpatients with coronary artery disease, atrial fibrillation or heart failure: a focus on disease overlap. Open Heart 2020; 7:e001165. [PMID: 32399249 PMCID: PMC7204557 DOI: 10.1136/openhrt-2019-001165] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 02/14/2020] [Accepted: 03/26/2020] [Indexed: 12/11/2022] Open
Abstract
Objective To assess secondary prevention and outcomes in patients with chronic coronary artery disease (CAD), atrial fibrillation (AF) and heart failure (HF), focusing on disease overlap. Methods We analysed the data of 10 517 outpatients with a diagnosis of CAD, AF and/or HF included in a prospective cohort study. Follow-up (median 3.2 years) was achieved in 10 478 (99.6%) patients. Seven mutually exclusive patient groups were formed: CAD alone (n=4303), AF alone (n=2604), CAD+AF (n=700), HF alone (n=513), HF+CAD (n=728), HF+AF (n=1087) and HF+CAD+AF (n=582). Results Patients with disease overlaps represented 29.4% of the total population. The level of secondary prevention was high in all subgroups and in accordance with European class I – level A guidelines. Among patients with CAD, 99% received an antithrombotic and 91% received a statin. Among patients with AF, 81.7% were treated with an anticoagulant if indicated. Among HF patients with left ventricular ejection fraction <40%, 90.9% received a renin-angiotensin system antagonist and 91% a beta-blocker. Three-year all cause/cardiovascular mortality rates were: 6.4%/2%, 9.7%/3.3%, 15.6%/6.7%, 19.2%/9.4%, 24.3%/13.6%, 28%/15.7% and 35.4%/24.8%, for patients with CAD alone, AF alone, CAD+AF, HF alone, HF+CAD, HF+AF and HF+CAD+AF, respectively. In all groups with HF, observed all-cause mortality was higher (p<0.0001) than expected mortality for age-matched, gender-matched and geography-matched persons. In contrast, observed mortality was lower than expected for patients with CAD alone and AF alone (p<0.0001). Conclusions In a context of adequate secondary prevention, overlap between diseases is a frequent and high-risk situation with incremental increases in mortality. These patients deserve specific attention.
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Affiliation(s)
- Nicolas Lamblin
- Department of Cardiology, Université de Lille, Lille, France
| | - Sandro Ninni
- Department of Cardiology, Université de Lille, Lille, France
| | - Olivier Tricot
- Department of Cardiology, Centre Hospitalier de Dunkerque, Dunkerque, France
| | - Thibaud Meurice
- Department of Cardiology, Hôpital Privé Le Bois, Lille, France
| | - Gilles Lemesle
- Department of Cardiology, Université de Lille, Lille, France
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Mouquet F, Tricot O, Zores F. [Acute pericarditis]. Rev Prat 2020; 70:e83-e87. [PMID: 32877077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Frédéric Mouquet
- Soins intensifs cardiologiques, hôpital privé Le Bois, Lille, France
| | - Olivier Tricot
- Soins intensifs cardiologiques, hôpital privé Le Bois, Lille, France
| | - Florian Zores
- Groupe médical spécialisé Le Premium, Strasbourg, France
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Madika AL, Lemesle G, Lamblin N, Meurice T, Tricot O, Mounier-Vehier C, Bauters C. Gender differences in clinical characteristics, medical management, risk factor control, and long-term outcome of patients with stable coronary artery disease: from the CORONOR registry. Panminerva Med 2020; 61:432-438. [DOI: 10.23736/s0031-0808.18.03525-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ennezat PV, Malergue MC, Czitrom D, Maréchaux S, Tricot O, Le Jemtel TH, Vincentelli A. [Benefit of elective percutaneous coronary intervention for stable coronary artery disease]. Presse Med 2019; 48:1037-1042. [PMID: 31676217 DOI: 10.1016/j.lpm.2019.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 08/25/2019] [Accepted: 09/16/2019] [Indexed: 01/09/2023] Open
Affiliation(s)
| | | | | | - Sylvestre Maréchaux
- Groupement des hôpitaux de l'institut catholique de Lille, service de cardiologie, 59160 Lomme, France
| | - Olivier Tricot
- Hôpital privé Le Bois, service de cardiologie, 59000 Lille, France
| | - Thierry H Le Jemtel
- Tulane University Heart and Vascular Institute, New Orleans, Louisiane, États-Unis
| | - André Vincentelli
- CHRU de Lille, département de chirurgie cardiovasculaire, 59000 Lille, France
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Hamon M, Lemesle G, Meurice T, Tricot O, Lamblin N, Bauters C. Elective Coronary Revascularization Procedures in Patients With Stable Coronary Artery Disease: Incidence, Determinants, and Outcome (From the CORONOR Study). JACC Cardiovasc Interv 2018; 11:868-875. [PMID: 29747917 DOI: 10.1016/j.jcin.2018.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 02/08/2018] [Accepted: 02/13/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The authors sought to describe the incidence, determinants, and outcome of elective coronary revascularization (ECR) in patients with stable coronary artery disease (CAD). BACKGROUND Observational data are lacking regarding the practice of ECR in patients with stable CAD receiving modern secondary prevention. METHODS The authors analyzed coronary revascularization procedures performed during a 5-year follow-up in 4,094 stable CAD outpatients included in the prospective multicenter CORONOR (Suivi d'une cohorte de patients COROnariens stables en région NORd-Pas-de-Calais) registry. RESULTS Secondary prevention medications were widely prescribed at inclusion (antiplatelet agents 96.4%, statins 92.2%, renin-angiotensin system antagonists 81.8%). A total of 481 patients underwent ≥1 coronary revascularization procedure (5-year cumulative incidences of 3.6% [0.7% per year] for acute revascularizations and 8.9% [1.8% per year] for ECR); there were 677 deaths during the same period. Seven baseline variables were independently associated with ECR: prior coronary stent implantation (p < 0.0001), absence of prior myocardial infarction (p < 0.0001), higher low-density lipoprotein cholesterol (p < 0.0001), lower age (p < 0.0001), multivessel CAD (p = 0.003), diabetes mellitus (p = 0.005), and absence of treatment with renin-angiotensin system antagonists (p = 0.020). Main indications for ECR were angina associated with a positive stress test (31%), silent ischemia (31%), and angina alone (25%). The use of ECR had no impact on the subsequent risk of death, myocardial infarction, or ischemic stroke (hazard ratio: 1.04; 95% confidence interval: 0.76 to 1.41). CONCLUSIONS These real-life data show that ECR is performed at a rate of 1.8% per year in stable CAD patients widely treated by secondary medical prevention. ECR procedures performed in patients without noninvasive stress tests are not rare. Having an ECR was not associated with the risk of ischemic adverse events.
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Affiliation(s)
- Martial Hamon
- University Hospital of Caen, Caen University, Caen, France
| | - Gilles Lemesle
- University of Lille, Inserm, CHU Lille, Institut Pasteur, U1011, Lille, France
| | | | | | - Nicolas Lamblin
- University of Lille, Inserm, CHU Lille, Institut Pasteur, U1167, Lille, France
| | - Christophe Bauters
- University of Lille, Inserm, CHU Lille, Institut Pasteur, U1167, Lille, France.
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Lemesle G, Meurice T, Tricot O, Lamblin N, Bauters C. Association of Diabetic Status and Glycemic Control With Ischemic and Bleeding Outcomes in Patients With Stable Coronary Artery Disease: The 5-Year CORONOR Registry. J Am Heart Assoc 2018; 7:JAHA.117.008354. [PMID: 29728374 PMCID: PMC6015307 DOI: 10.1161/jaha.117.008354] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background The relation between diabetes mellitus, glycemic control, and ischemic and bleeding events is poorly described in outpatients with stable coronary artery disease receiving modern secondary prevention. Methods and Results The multicenter CORONOR (Suivi d'une cohorte de patients Coronariens stables en région Nord‐pas‐de‐Calais) registry enrolled 4184 outpatients with stable coronary artery disease, including 1297 patients (31%) with diabetes mellitus. A recent glycosylated hemoglobin (HbA1c) was available for 1146 diabetic patients, and 48% had HbA1c ≥7%. We analyzed 5‐year ischemic (cardiovascular death, myocardial infarction, and stroke) and bleeding (Bleeding Academic Research Consortium ≥3) outcomes, according to diabetic status and glycemic control. When compared with nondiabetic patients, the ischemic risk was higher in diabetic patients with HbA1c ≥7% (hazard ratio [HR], 1.57; 95% confidence interval [CI], 1.25–1.93) but not in diabetic patients with HbA1c <7% (HR, 1.06; 95% CI, 0.83–1.36). Diabetic patients with HbA1c ≥7% were at higher risk than diabetic patients with HbA1c <7% (HR, 1.47; 95% CI, 1.09–1.98). When compared with nondiabetic patients, the bleeding risk was higher in diabetic patients, with HbA1c <7% (HR, 1.66; 95% CI, 1.04–2.67) and in those with HbA1c ≥7% (HR, 1.75; 95% CI, 1.07–2.86). No difference in bleeding risk was observed between diabetic patients with HbA1c ≥7% versus those with HbA1c <7%. Similar results were obtained when adjusted for baseline characteristics. Conclusions The 5‐year increased risk of ischemic events in patients with stable coronary artery disease with diabetes mellitus was restricted to those with HbA1c ≥7%. By contrast, the increase in bleeding risk associated with diabetes mellitus was observed in patients with HbA1c ≥7% and in patients with HbA1c <7%. The level of HbA1c should be taken into account for future research and may help physicians to manage prolonged antithrombotic therapies in this high‐risk subgroup.
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Affiliation(s)
- Gilles Lemesle
- Inserm units 1011 and 1167, CHU Lille, Institut Pasteur, University of Lille, Lille, France
| | | | | | - Nicolas Lamblin
- Inserm units 1011 and 1167, CHU Lille, Institut Pasteur, University of Lille, Lille, France
| | - Christophe Bauters
- Inserm units 1011 and 1167, CHU Lille, Institut Pasteur, University of Lille, Lille, France
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Bauters C, Tricot O, Lemesle G, Meurice T, Hennebert O, Farnier M, Lamblin N. Reaching low-density lipoprotein cholesterol treatment targets in stable coronary artery disease: Determinants and prognostic impact. Arch Cardiovasc Dis 2017; 111:634-643. [PMID: 29198936 DOI: 10.1016/j.acvd.2017.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 06/24/2017] [Accepted: 07/29/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Low-density lipoprotein cholesterol (LDL-C) reduction is an integral part of the management of patients with coronary artery disease (CAD). AIMS To assess attainment of LDL-C goals during long-term treatment of patients with stable CAD, and to determine predictors of goal attainment and the prognostic impact of reaching LDL-C<70mg/dL (1.8mmol/L) in a real-life setting. METHODS Data were obtained for 4080 outpatients with stable CAD included in the multicentre CORONOR study. Five-year follow-up was achieved for 3991 (97.8%) patients. RESULTS At inclusion, a recent (<1 year) measurement of LDL-C was available in 3757 (92.1%) patients. LDL-C<70mg/dL was reached by 885 (23.6%) patients. Independent predictors of LDL-C<70mg/dL were diabetes mellitus, statin treatment, treatment with renin-angiotensin system inhibitors, previous myocardial infarction and short time since last coronary event. The adjusted hazard ratio (HR) for the composite endpoint (cardiovascular death, myocardial infarction, ischemic stroke or coronary revascularization) during the 5-year follow-up was 1.31 (95% confidence interval [CI]: 1.09-1.58; P=0.004) for LDL-C≥70mg/dL versus<70mg/dL. When compared with patients with LDL-C<70mg/dL, the adjusted HRs for LDL-C 70-99mg/dL and ≥100mg/dL (2.6mmol/L) were 1.27 (95% CI: 1.05-1.55; P=0.016) and 1.38 (95% CI: 1.12-1.70; P=0.003), respectively. When LDL-C was used as a continuous variable, the adjusted HRs for increases of 10mg/dL (0.3mmol/L) and 1mmol/L were 1.05 (95% CI: 1.03-1.08) and 1.21 (95% CI: 1.10-1.33), respectively. CONCLUSIONS In this observational study, only a minority of stable CAD patients had LDL-C<70mg/dL. The patients who reached their LDL-C goal had the lowest risk of cardiovascular events.
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Affiliation(s)
- Christophe Bauters
- U1167, Inserm, Institut Pasteur, université de Lille, CHU de Lille, 59000 Lille, France.
| | - Olivier Tricot
- Centre hospitalier de Dunkerque, 59240 Dunkerque, France
| | - Gilles Lemesle
- U1011, Inserm, Institut Pasteur, université de Lille, CHU de Lille, 59000 Lille, France
| | | | | | | | - Nicolas Lamblin
- U1167, Inserm, Institut Pasteur, université de Lille, CHU de Lille, 59000 Lille, France
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Lemesle G, Tricot O, Meurice T, Lallemant R, Delomez M, Equine O, Lamblin N, Bauters C. Incident Myocardial Infarction and Very Late Stent Thrombosis in Outpatients With Stable Coronary Artery Disease. J Am Coll Cardiol 2017; 69:2149-2156. [DOI: 10.1016/j.jacc.2017.02.050] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 02/13/2017] [Accepted: 02/14/2017] [Indexed: 10/19/2022]
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Lamblin N, Meurice T, Tricot O, De Groote P, Lemesle G, Bauters C. Hospitalization for heart failure in stable coronary artery disease outpatients: determinants, role of interim myocardial infarction, and prognosis. Archives of Cardiovascular Diseases Supplements 2017. [DOI: 10.1016/s1878-6480(17)30512-8] [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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Lemesle G, Lamblin N, Meurice T, Tricot O, Bauters C. Angiotensin II receptor blockers versus angiotensin-converting enzyme inhibitors in patients with stable coronary artery disease: Prevalence, correlates, and prognostic impact (from the CORONOR study). J Cardiol 2017; 69:542-547. [DOI: 10.1016/j.jjcc.2016.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 04/18/2016] [Accepted: 05/12/2016] [Indexed: 11/28/2022]
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Lamblin N, Meurice T, Tricot O, Lemesle G, Deneve M, de Groote P, Bauters C. Effect of left ventricular systolic dysfunction on secondary medical prevention and clinical outcome in stable coronary artery disease patients. Arch Cardiovasc Dis 2016; 110:35-41. [PMID: 27591820 DOI: 10.1016/j.acvd.2016.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 03/09/2016] [Accepted: 04/20/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Limited recent data are available in the literature on whether the presence of left ventricular systolic dysfunction (LVSD) affects the therapeutic management of patients with stable coronary artery disease (CAD). AIMS The objectives of this study were to analyse prevalence, effect on therapeutics and prognosis of LVSD in stable CAD. METHODS We prospectively included 4184 CAD outpatients free from any myocardial infarction or coronary revascularization for>1year. Left ventricular ejection fraction (EF) was available for 4124 (98.6%) patients. Follow-up was performed at 2years. All events were adjudicated blindly. RESULTS The mean EF was 57.5±10.8%, and 201 (4.9%) patients had an EF≤35%. The prescription of renin-angiotensin system inhibitors and beta-blockers was inversely related to EF, and reached>90% in patients with EF≤35%. Seventy-five (37.3%) of the patients with EF≤35% received a mineralocorticoid receptor antagonist. Eighty-five (42.3%) of the patients with EF≤35% had an implantable cardioverter defibrillator. Clinical follow-up data were obtained for 4090 patients (99.2%). Event rates were higher in patients with low EF (adjusted hazard ratio [95% confidence interval] for EF≤35%, with EF≥60% as reference: 3.93 [2.60-5.93] and 7.12 [3.85-13.18], for all-cause death and cardiovascular death, respectively). CONCLUSIONS In patients with stable CAD, LVSD is well taken into account by cardiologists, with extensive use of evidence-based medications and interventions. Despite this, LVSD remains a major prognostic indicator in this population.
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Affiliation(s)
- Nicolas Lamblin
- CHRU de Lille, 59037 Lille, France; Inserm U1167, Institut Pasteur de Lille, université Lille Nord de France, 59000 Lille, France; Faculté de médecine de Lille, 59045 Lille, France
| | | | - Olivier Tricot
- Centre hospitalier de Dunkerque, 59240 Dunkerque, France
| | - Gilles Lemesle
- CHRU de Lille, 59037 Lille, France; Faculté de médecine de Lille, 59045 Lille, France
| | | | - Pascal de Groote
- CHRU de Lille, 59037 Lille, France; Inserm U1167, Institut Pasteur de Lille, université Lille Nord de France, 59000 Lille, France
| | - Christophe Bauters
- CHRU de Lille, 59037 Lille, France; Inserm U1167, Institut Pasteur de Lille, université Lille Nord de France, 59000 Lille, France; Faculté de médecine de Lille, 59045 Lille, France.
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Lemesle G, Schurtz G, Meurice T, Tricot O, Lemaire N, Caudmont S, Philias A, Ketelers R, Lamblin N, Bauters C. Clopidogrel Use as Single Antiplatelet Therapy in Outpatients with Stable Coronary Artery Disease: Prevalence, Correlates and Association with Prognosis (from the CORONOR Study). Cardiology 2016; 134:11-8. [DOI: 10.1159/000442706] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 11/23/2015] [Indexed: 11/19/2022]
Abstract
Background: Clopidogrel use as single antiplatelet therapy (SAPT) has never been evaluated in stable coronary artery disease (CAD) outpatients either as compared to placebo or aspirin. Methods: We therefore studied 2,823 outpatients included in a prospective registry. The patients were divided into 2 groups according to their antiplatelet therapy regimen: patients treated with clopidogrel were compared with those treated with aspirin alone. Results: The mean time since CAD diagnosis was 7.9 years. Altogether, 776 (27.5%) patients received clopidogrel as SAPT. Factors independently associated with clopidogrel use were prior aortic or peripheral intervention, drug-eluting stent implantation, stroke, carotid endarterectomy and time since CAD diagnosis. Clopidogrel tended to be used in higher-risk patients: composite of cardiovascular death, myocardial infarction or stroke at 5.8 versus 4.2% (p = 0.056). However, after propensity score matching, similar event rates were observed between the groups: 5.9% when treated with clopidogrel versus 4.4% with aspirin (p = 0.207). The rate of bleeding was also similar between the groups. Conclusions: Our study shows that a significant proportion of stable CAD patients are treated with clopidogrel as SAPT in modern practice. Several correlates of such an attitude were identified. Our results suggest that this strategy is not beneficial as compared to aspirin alone in terms of ischaemic or bleeding events.
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Meurice T, Tricot O, Lemesle G, Deneve M, Lejeune P, Biausque F, Cordier C, Savoye C, Hennebert O, Taghipour K, Sivery B, Pruvost P, Alaoui M, Carpentier L, Segrestin B, Lamblin N, Bauters C. Prevalence and correlates of non-optimal secondary medical prevention in patients with stable coronary artery disease. Arch Cardiovasc Dis 2015; 108:340-6. [PMID: 25858539 DOI: 10.1016/j.acvd.2015.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 12/22/2014] [Accepted: 01/12/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND In patients with coronary artery disease (CAD), non-optimal use of evidence-based medications is associated with an increased risk of adverse outcome. AIMS To assess the prevalence and correlates of non-optimal secondary medical prevention in patients with stable CAD. METHODS We included 4184 consecutive outpatients with stable CAD. Treatment at inclusion was classified as optimal/non-optimal regarding the four major classes of secondary prevention drugs: antithrombotics; statins; angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs); and beta-blockers. For each treatment, the prescription was considered non-optimal if the drug was missing despite a class IA indication according to international guidelines. To assess the information globally, non-optimal secondary prevention was defined as at least one major treatment missing. RESULTS The proportions of patients with non-optimal treatment were 0.7%, 7.8%, 12.9% and 10.3% for antithrombotics, statins, ACE inhibitors/ARBs and beta-blockers, respectively. Non-optimal secondary medical prevention was observed in 16.8% of cases. By multivariable analysis, the correlates of non-optimal secondary medical prevention were long time interval since last coronary event (P<0.0001), older age (P<0.0001), diabetes mellitus (P<0.0001), hypertension (P<0.0001), no history of myocardial infarction (P=0.001), no history of coronary revascularization (P=0.013) and low glomerular filtration rate (P=0.042). CONCLUSIONS Although most patients with stable CAD are receiving evidence-based medications according to guidelines, there remain subgroups at higher risk of non-optimal treatment. In particular, it might be feasible to improve prevention by focusing on patients in whom a long time has elapsed since the last coronary event.
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Affiliation(s)
| | | | - Gilles Lemesle
- Centre Hospitalier Régional et Universitaire de Lille, Lille, France; Inserm U744, Institut Pasteur de Lille, Université Lille Nord de France, Lille, France; Faculté de Médecine de Lille, Lille, France
| | - Michel Deneve
- Centre Hospitalier Régional et Universitaire de Lille, Lille, France
| | | | | | | | | | | | | | - Bruno Sivery
- Centre Hospitalier de Wattrelos, Wattrelos, France
| | | | - Moulay Alaoui
- Centre Hospitalier de Boulogne-sur-mer, Boulogne-sur-mer, France
| | | | | | - Nicolas Lamblin
- Centre Hospitalier Régional et Universitaire de Lille, Lille, France; Inserm U744, Institut Pasteur de Lille, Université Lille Nord de France, Lille, France; Faculté de Médecine de Lille, Lille, France
| | - Christophe Bauters
- Centre Hospitalier Régional et Universitaire de Lille, Lille, France; Inserm U744, Institut Pasteur de Lille, Université Lille Nord de France, Lille, France; Faculté de Médecine de Lille, Lille, France.
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Hamon M, Lemesle G, Tricot O, Meurice T, Deneve M, Dujardin X, Brufau JM, Bera J, Lamblin N, Bauters C. Incidence, Source, Determinants, and Prognostic Impact of Major Bleeding in Outpatients With Stable Coronary Artery Disease. J Am Coll Cardiol 2014; 64:1430-6. [DOI: 10.1016/j.jacc.2014.07.957] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 06/21/2014] [Accepted: 07/01/2014] [Indexed: 11/25/2022]
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Lemesle G, Lamblin N, Meurice T, Tricot O, Lallemant R, Nugue O, Delomez M, Equine O, Tondeux S, Bauters C. Dual antiplatelet therapy in patients with stable coronary artery disease in modern practice: prevalence, correlates, and impact on prognosis (from the Suivi d'une cohorte de patients COROnariens stables en region NORd-Pas-de-Calais study). Am Heart J 2014; 168:479-86. [PMID: 25262257 DOI: 10.1016/j.ahj.2014.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 06/15/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND The prevalence and correlates of dual-antiplatelet therapy (DAPT) use in stable coronary artery disease (CAD) are unknown. In addition, whether prolonged DAPT may impact prognosis in stable CAD has not been studied in real-life conditions. METHODS We studied 3,691 patients included in a prospective registry on stable CAD. The patients were divided in 2 groups according to their antiplatelet therapy regimen at inclusion: patients treated with DAPT were compared with those treated with single-antiplatelet therapy (SAPT). The primary outcome was a composite of cardiovascular death, myocardial infarction, or stroke. RESULTS Altogether, 868 (24%) patients received DAPT. Factors positively associated with DAPT use were persistent angina at inclusion, body mass index, myocardial infarction since 1 to 3 years, myocardial revascularization since 1 to 3 years, multivessel CAD, prior drug-eluting stent implantation, and prior aortic or peripheral intervention. Factors negatively associated with DAPT use were age, prior coronary bypass, and left ventricular ejection fraction. The rate of the primary outcome at 2 years was similar whether patients were treated with SAPT (4.6%) or DAPT (5.5%) (P = .301). Similar rates were also observed after propensity score matching: 5.7% when treated with SAPT versus 5.5% when treated with DAPT (P = .886). The rate of bleeding was similar between groups. CONCLUSIONS Our study shows that a significant proportion of stable CAD patients are treated with DAPT in modern practice. Several correlates of DAPT were identified. Although no increase in bleeding was observed, our results do not support the prescription of prolonged DAPT.
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Abstract
OBJECTIVE To assess the association of ß-blocker use with cardiovascular mortality in patients with stable coronary artery disease (CAD). METHODS We analysed the data of 4184 outpatients included in a prospective cohort study on stable CAD. Two groups were formed based on ß-blocker use at enrolment. Two propensity score analyses were performed to control for differences in covariates: one with adjustment among the entire cohort, and the other with propensity score matching. The outcome variable was cardiovascular mortality after a 2-year follow-up. RESULTS There were 3320 patients with ß-blocker use. Younger age, hypertension, diabetes, prior myocardial infarction, multivessel CAD, prior coronary revascularisation, prior stroke, prior hospitalisation for heart failure and a low LVEF were associated with ß-blocker use. Clinical follow-up data were obtained for 4149 patients (99.2%). When adjusted on propensity score, ß-blocker use was associated with a HR for cardiovascular mortality of 0.64 (0.42-0.98) in the whole cohort (p=0.04). After one-to-one propensity score matching, both groups (n=839 in each group) were well matched on covariates. The cardiovascular mortality rate in the propensity-matched cohort was significantly lower in patients with ß-blocker use with a HR of 0.43 (0.22-0.82) (p=0.011). Non-cardiovascular mortality was similar in both groups. These results were consistent across different subgroups. CONCLUSIONS In this observational study of patients with stable CAD, the use of ß-blockers was associated with a lower risk of cardiovascular mortality.
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Affiliation(s)
- Christophe Bauters
- Centre Hospitalier Régional et Universitaire de Lille, Lille, France Inserm U744, Institut Pasteur de Lille, Université Lille Nord de France, Lille, France Faculté de Médecine de Lille, Lille, France
| | - Gilles Lemesle
- Centre Hospitalier Régional et Universitaire de Lille, Lille, France Inserm U744, Institut Pasteur de Lille, Université Lille Nord de France, Lille, France Faculté de Médecine de Lille, Lille, France
| | | | | | - Pascal de Groote
- Centre Hospitalier Régional et Universitaire de Lille, Lille, France Inserm U744, Institut Pasteur de Lille, Université Lille Nord de France, Lille, France
| | - Nicolas Lamblin
- Centre Hospitalier Régional et Universitaire de Lille, Lille, France Inserm U744, Institut Pasteur de Lille, Université Lille Nord de France, Lille, France Faculté de Médecine de Lille, Lille, France
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Delsart P, Lemesle G, Lamblin N, Tricot O, Meurice T, Mycinski C, Elkohen M, Chmait A, Haulon S, Bauters C. Secondary medical prevention and clinical outcome in coronary artery disease patients with a history of non-coronary vascular intervention: A report from the CORONOR investigators. Eur J Prev Cardiol 2014; 22:864-71. [DOI: 10.1177/2047487314538857] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 05/18/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Pascal Delsart
- Centre Hospitalier Régional et Universitaire de Lille, Lille, France
| | - Gilles Lemesle
- Centre Hospitalier Régional et Universitaire de Lille, Lille, France
- Inserm U744, Institut Pasteur de Lille, Université Lille Nord de France, Lille, France
- Faculté de Médecine de Lille, Lille, France
| | - Nicolas Lamblin
- Centre Hospitalier Régional et Universitaire de Lille, Lille, France
- Inserm U744, Institut Pasteur de Lille, Université Lille Nord de France, Lille, France
- Faculté de Médecine de Lille, Lille, France
| | | | | | | | - Mariam Elkohen
- Hôpital Privé de Villeneuve d’Ascq, Villeneuve d’Ascq, France
| | - Akram Chmait
- Clinique de la Côte d’Opale, Boulogne-Sur-Mer, France
| | - Stéphan Haulon
- Centre Hospitalier Régional et Universitaire de Lille, Lille, France
- Faculté de Médecine de Lille, Lille, France
- Inserm U1008, Université Lille Nord de France, Lille, France
| | - Christophe Bauters
- Centre Hospitalier Régional et Universitaire de Lille, Lille, France
- Inserm U744, Institut Pasteur de Lille, Université Lille Nord de France, Lille, France
- Faculté de Médecine de Lille, Lille, France
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Bauters C, Deneve M, Tricot O, Meurice T, Lamblin N. Prognosis of patients with stable coronary artery disease (from the CORONOR study). Am J Cardiol 2014; 113:1142-5. [PMID: 24507170 DOI: 10.1016/j.amjcard.2013.12.019] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [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: 11/07/2013] [Revised: 12/16/2013] [Accepted: 12/16/2013] [Indexed: 11/18/2022]
Abstract
There are limited data on the prognosis of patients with stable coronary artery disease (CAD) in modern clinical practice. We conducted a multicenter study enrolling 4,184 outpatients with stable CAD defined as previous myocardial infarction (>1 year ago), previous coronary revascularization (>1 year ago), and/or ≥50% coronary stenosis by angiography. Clinical follow-up was performed after 2 years. All cases of death were adjudicated and the mortality rate was compared with expected mortality of persons of the same age and gender in the same geographical area. Mean age was 66.9±11.6 years; 77.7% were men. There was a wide prescription of secondary prevention drugs: antithrombotic drugs, 99.3%; β blockers, 79.4%; statins, 92.2%; and antagonists of the angiotensin system, 81.9%. Two-year follow-up was obtained for 99.2% of the patients. There were 271 deaths (3.3/100 patient-years). The mortality rate was similar to the expected mortality in the general population (p=0.93). Most deaths were noncardiovascular (1.8/100 patient-years). Among cardiovascular deaths, the leading causes were heart failure death (0.4/100 patient-years) and sudden death (0.4/100 patient-years); in contrast, there were few deaths related to vascular causes (stroke, 0.2/100 patient-years and myocardial infarction, 0.1/100 patient-years). Age, diabetes, multivessel CAD, the absence of previous coronary revascularization, previous hospitalization for decompensated heart failure, a low ejection fraction, a low estimated glomerular filtration rate, and the absence of statin treatment were independent predictors of mortality. In conclusion, the mortality rate of patients with stable CAD in modern clinical practice is similar to that of the general population and is mostly due to noncardiovascular causes.
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Affiliation(s)
- Christophe Bauters
- Centre Hospitalier Régional et Universitaire de Lille, Lille, France; INSERM U744, Institut Pasteur de Lille, Université de Lille 2, Lille, France; Faculté de Médecine de Lille, Lille, France.
| | - Michel Deneve
- Centre Hospitalier Régional et Universitaire de Lille, Lille, France
| | | | | | - Nicolas Lamblin
- Centre Hospitalier Régional et Universitaire de Lille, Lille, France; INSERM U744, Institut Pasteur de Lille, Université de Lille 2, Lille, France; Faculté de Médecine de Lille, Lille, France
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Fertin M, Hennache B, Hamon M, Ennezat PV, Biausque F, Elkohen M, Nugue O, Tricot O, Lamblin N, Pinet F, Bauters C. Usefulness of Serial Assessment of B-Type Natriuretic Peptide, Troponin I, and C-Reactive Protein to Predict Left Ventricular Remodeling After Acute Myocardial Infarction (from the REVE-2 Study). Am J Cardiol 2010; 106:1410-6. [DOI: 10.1016/j.amjcard.2010.06.071] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Revised: 06/28/2010] [Accepted: 06/28/2010] [Indexed: 12/24/2022]
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Ennezat PV, Lamblin N, Mouquet F, Tricot O, Quandalle P, Aumegeat V, Equine O, Nugue O, Segrestin B, de Groote P, Bauters C. The effect of ageing on cardiac remodelling and hospitalization for heart failure after an inaugural anterior myocardial infarction. Eur Heart J 2008; 29:1992-9. [DOI: 10.1093/eurheartj/ehn267] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Ennezat PV, Darchis J, Lamblin N, Tricot O, Elkohen M, Aumégeat V, Equine O, Dujardin X, Saadouni H, Le Tourneau T, de Groote P, Bauters C. Left ventricular remodeling is associated with the severity of mitral regurgitation after inaugural anterior myocardial infarction--optimal timing for echocardiographic imaging. Am Heart J 2008; 155:959-65. [PMID: 18440348 DOI: 10.1016/j.ahj.2007.12.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2007] [Accepted: 12/03/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although mitral regurgitation (MR) has been associated with an increased risk of death and heart failure after myocardial infarction (MI), the relationship between post-MI MR and left ventricular (LV) remodeling has not been entirely clarified. In addition, the optimal timing for assessing MR after MI remains unknown. METHODS Post-MI MR was assessed by Doppler echocardiography at hospital discharge (baseline) and after 3 months in 261 patients with an inaugural anterior MI. We studied LV remodeling during a 1-year period and clinical follow-up after 3 years, according to MR severity at baseline and at 3 months. RESULTS Left ventricular remodeling was demonstrated as an increase in LV end-diastolic volume from 56 +/- 15 mL/m(2) at baseline to 63 +/- 19 mL/m(2) at 1 year (P < .0001). MR severity at baseline was not significantly associated with LV remodeling. By contrast, MR severity at 3 months was a strong indicator of LV remodeling. There was a graded increase in the proportion of patients with a >20% increase in LV end-diastolic volume between baseline and 1 year according to MR severity at 3 months (no MR: 21%, mild MR: 32%, moderate/severe MR: 60%) (P = .008). Both MR at baseline and at 3 months were associated with death or rehospitalization for heart failure by univariate analysis (P = .014 and P < .0001, respectively). By multivariable analysis, MR at baseline was not an independent predictor of adverse outcome (P = .66). By contrast, MR at 3 months was independently associated with adverse outcome with a hazard ratio of 2.23 (1.02-4.91 [P = .04]). CONCLUSIONS After an inaugural anterior MI, MR is associated with LV remodeling and adverse clinical outcome. For prognostic purpose, the optimal timing for assessing MR is the chronic post-MI stage rather than the early post-MI period.
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Affiliation(s)
- Pierre V Ennezat
- Centre Hospitalier Régional et Universitaire de Lille, Lille, France
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Bauters A, Ennezat PV, Tricot O, Lallemant R, Aumégeat V, Segrestin B, Quandalle P, Lamblin N, Bauters C. Relation of admission white blood cell count to left ventricular remodeling after anterior wall acute myocardial infarction. Am J Cardiol 2007; 100:182-4. [PMID: 17631066 DOI: 10.1016/j.amjcard.2007.02.077] [Citation(s) in RCA: 14] [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: 01/24/2007] [Revised: 02/20/2007] [Accepted: 02/20/2007] [Indexed: 10/23/2022]
Abstract
We investigated whether a high white blood cell (WBC) count on admission for acute myocardial infarction (AMI) may be associated with a higher risk of subsequent left ventricular (LV) remodeling. We included 107 patients with anterior AMI. Echocardiographic studies were performed at hospital discharge, at 3 months, and at 1 year after AMI. LV remodeling (>20% increase in end-diastolic volume) was observed in 27% of patients. WBC counts during hospitalization were higher in patients who subsequently underwent LV remodeling (p = 0.003 for WBC count on admission). The increase in end-diastolic volume from baseline to 1 year was greater for patients in the higher tertile of WBC count on admission (p = 0.04). When adjusting for baseline clinical and echocardiographic characteristics by multivariate analysis, WBC count on admission was independently associated with LV remodeling (odds ratio 1.23, 95% confidence interval 1.04 to 1.45, p = 0.018). In conclusion, a high WBC count on admission for AMI is an independent predictor of LV remodeling, even when predischarge echocardiographic variables are taken into account.
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Affiliation(s)
- Anne Bauters
- Centre Hospitalier Régional et Universitaire de Lille, Lille, France
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Bauters C, Lamblin N, Ennezat PV, Mycinski C, Tricot O, Nugue O, Segrestin B, Hannebicque G, Agraou B, Polge AS, de Groote P, Helbecque N, Amouyel P. A prospective evaluation of left ventricular remodeling after inaugural anterior myocardial infarction as a function of gene polymorphisms in the renin-angiotensin-aldosterone, adrenergic, and metalloproteinase systems. Am Heart J 2007; 153:641-8. [PMID: 17383306 DOI: 10.1016/j.ahj.2007.01.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2006] [Accepted: 01/10/2007] [Indexed: 12/22/2022]
Abstract
BACKGROUND Left ventricular remodeling (LVR) is a strong predictor of cardiovascular events after myocardial infarction (MI). Although several factors have been shown to influence LVR, interindividual variability exists. Some studies have suggested that gene polymorphisms may be associated with LVR, but these studies were limited by either a retrospective design or the inclusion of limited patient numbers. The present study was designed to prospectively assess the impact of gene polymorphisms on LVR. METHODS We included 266 patients with inaugural anterior MI. Systematic echocardiographic follow-ups were performed at 3 months and at 1 year after MI. The polymorphisms were selected using a candidate gene approach based on LVR pathophysiology. We analyzed 14 polymorphisms in 3 different systems: the renin-angiotensin-aldosterone system (ACE I/D, RAT1 1166A/C, angiotensinogen M235T, CYP11B2 -344C/T), the adrenergic system (beta1AR Ser49Gly, beta1AR Gly389Arg, beta2AR Gly16Arg, beta2AR Gln27Glu, beta2AR Thr164Ile, alpha2cAR Del322-325), and the metalloproteinase (MMP) system (-1607 1G/2G MMP-1, -1306 C/T MMP-2, -1171 5A/6A MMP-3, -1562 C/T MMP-9). RESULTS Left ventricular remodeling was documented by a progressive increase in end-diastolic volume from 56.5 +/- 14.9 mL/m2 at baseline to 62.8 +/- 18.8 mL/m2 at 1 year (P < .0001). End-diastolic volume at baseline, 3 months, or 1 year did not differ significantly among genotypes for any polymorphism. The change in end-diastolic volume from baseline to 1 year was also similar among genotypes for all polymorphisms. CONCLUSIONS Left ventricular remodeling after MI is not associated with common polymorphisms in the renin-angiotensin-aldosterone, adrenergic, or MMP systems.
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Aubert JM, Ennezat PV, Tricot O, Darchis J, Bauchart JJ, Auffray JL, Lesenne M, Van Belle E, Goldstein P, Asseman P. Mid-Ventricular Ballooning Heart Syndrome. Echocardiography 2007; 24:329-34. [PMID: 17381639 DOI: 10.1111/j.1540-8175.2007.00399.x] [Citation(s) in RCA: 13] [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] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Stress cardiomyopathies have been increasingly reported these last years, especially in women as a transient left ventricular apical ballooning syndrome. We report six cases in whom, in the context of anxious situations, echocardiograms and ventriculographies revealed mid-ventricular akinesis with preservation of apical and basal contractilities with normal coronary arteriography. This "mid-ventricular ballooning heart syndrome " should probably be classified as a new type of heart stress related syndrome.
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Bauters C, Ennezat PV, Tricot O, Lauwerier B, Lallemant R, Saadouni H, Quandalle P, Jaboureck O, Lamblin N, Le Tourneau T. Stress hyperglycaemia is an independent predictor of left ventricular remodelling after first anterior myocardial infarction in non-diabetic patients. Eur Heart J 2007; 28:546-52. [PMID: 17314113 DOI: 10.1093/eurheartj/ehl546] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [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] [Indexed: 11/14/2022] Open
Abstract
AIMS Stress hyperglycaemia (SH) is associated with adverse outcome in patients with acute myocardial infarction (MI) but the mechanisms underlying this association are unknown. Our hypothesis was that SH on admission for acute MI may be associated with left ventricular (LV) remodelling. METHODS AND RESULTS We analysed LV remodelling in 162 non-diabetic patients with anterior MI. SH was defined as a glycaemia on admission >or=7 mmol/L. Systematic echocardiographic follow-up was performed at 3 months and 1 year after MI. The changes in end-diastolic volume (EDV) and end-systolic volume (ESV) from baseline to 1 year were 11.4 +/- 16.5 and 6.4 +/- 12.4 ml/m(2), respectively, in patients with SH vs. 1.9 +/- 11.1 and 0.2 +/- 8.5 ml/m(2), respectively, in patients without SH (both P < 0.0001). When LV remodelling was defined as a >20% increase in EDV, it was observed in 46% patients in the SH group vs. 19% patients in the no SH group (P = 0.0008). By multivariable analysis, baseline wall motion score index (P = 0.001) and SH (P = 0.009) were independently associated with changes in EDV. SH was an independent predictor of LV remodelling [adjusted OR: 3.22 (1.31-7.94)]. CONCLUSION SH is a major and independent predictor of LV remodelling after anterior MI in non-diabetic patients.
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Affiliation(s)
- Christophe Bauters
- Service de Cardiologie C, Hôpital Cardiologique, Centre Hospitalier Régional et Universitaire de Lille, Boul, Lille Cedex, France.
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Savoye C, Equine O, Tricot O, Nugue O, Segrestin B, Sautière K, Elkohen M, Pretorian EM, Taghipour K, Philias A, Aumégeat V, Decoulx E, Ennezat PV, Bauters C. Left ventricular remodeling after anterior wall acute myocardial infarction in modern clinical practice (from the REmodelage VEntriculaire [REVE] study group). Am J Cardiol 2006; 98:1144-9. [PMID: 17056315 DOI: 10.1016/j.amjcard.2006.06.011] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.7] [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: 04/05/2006] [Revised: 06/07/2006] [Accepted: 06/07/2006] [Indexed: 11/25/2022]
Abstract
Left ventricular (LV) remodeling after acute myocardial infarction (AMI) has been well described in previous studies. However, there is a paucity of data on the incidence of and risk factors for LV remodeling in modern clinical practice that incorporates widespread use of acute reperfusion strategies and almost systematic use of "antiremodeling" medications, such as angiotensin-converting enzyme inhibitors and beta blockers. We enrolled 266 patients with anterior wall Q-wave AMI who had >or=3 segments of the infarct zone that were akinetic on echocardiography before discharge. Echocardiographic follow-up was performed 3 months and 1 year after AMI. LV volumes, ejection fraction, wall motion score index, and mitral flow velocities were determined in a blinded analysis at a core echocardiographic laboratory. Acute reperfusion was attempted in 220 patients (83%; primary angioplasty in 29% and thrombolysis in 54%). During hospitalization, 99% of patients underwent coronary angiography and 87% underwent coronary stenting of the infarct-related lesion. At 1 year, 95% of patients received an antiplatelet agent, 89% a beta blocker, 93% an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker, and 93% a statin. Echocardiographic follow-up was obtained in 215 patients. There was recovery in LV systolic function as shown by a decrease in wall motion score index and an increase in ejection fraction. There was a significant increase in end-diastolic volume (EDV; 56.4 +/- 14.7 ml/m2 at baseline, 59.3 +/- 15.7 ml/m2 at 3 months, 62.8 +/- 18.7 ml/m2 at 1 year, p <0.0001). LV remodeling (>20% increase in EDV) was observed in 67 patients (31%). Peak creatine kinase level, systolic blood pressure, and wall motion score index were independently associated with changes in EDV. In conclusion, recent improvements in AMI management do not abolish LV remodeling, which remains a relatively frequent event after an initial anterior wall AMI.
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Affiliation(s)
- Christine Savoye
- Centre Hospitalier Régional et Universitaire de Lille, Lille, France
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Sudre A, Chmait A, Rosey G, Tricot O, Meurice T, Bauchart JJ, Bauters C, Van Belle E, Lablanche JM. [The use of the RESCUE thromboaspiration system in acute coronary syndrome]. Ann Cardiol Angeiol (Paris) 2004; 53:245-9. [PMID: 15532449 DOI: 10.1016/j.ancard.2004.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Interventional procedures associated with acute coronary syndromes or performed on saphenous bypass grafts frequently lead to embolic complications, resulting in no-reflow phenomenon, side-branch occlusion, or peri-procedural infarction. The RESCUE thrombo-aspiration system was used in 19 percutaneous coronary interventions. After initial use of the aspiration device, 81% of procedures were followed by stent deployment. TIMI flow 2 or higher was present in 42% at the beginning of the procedure and in 95% at the end. In-hospital MACE rate was 4.76%. This relatively user-friendly technique appears rapid and efficacious in the case of visible intracoronary thrombus.
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Affiliation(s)
- A Sudre
- Service de cardiologie B et hémodynamique, hôpital cardiologique, boulevard du Pr-Jules-Leclercq, 59037 Lille, France.
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Abstract
BACKGROUND Blood flow characteristics influence endothelial cell apoptosis. However, little is known about the occurrence of endothelial cell apoptosis in human atherosclerosis and its relation to blood flow. METHODS AND RESULTS A total of 42 human carotid atherosclerotic plaques were retrieved by endarterectomy; they were examined in the longitudinal axial direction. Plaques were included in this study when upstream and downstream parts were clearly visible, occlusion was absent, and immunostaining for luminal endothelium was present all along the plaque. Using these criteria, 13 plaques were processed for further immunohistochemical studies (using anti-CD31, anti-Ki-67, and anti-splicing factor antibodies) and in situ detection of apoptosis (terminal dUTP nick end-labeling and ligase assay). Eight plaques showed > or =1 apoptotic endothelial cell at the luminal surface. Quantitative analysis of endothelial cell apoptosis in these plaques showed a systematic preferential occurrence of apoptosis in the downstream parts of plaques, where low flow and low shear stress prevail, in comparison with the upstream parts (18.8+/-3.3% versus 2.7+/-1.2%, respectively, P<0.001). Endothelial cell apoptosis was barely detectable in plaque microvessels. CONCLUSIONS Our results suggest that in vivo local shear stress influences luminal endothelial cell apoptosis and may be a major determinant of plaque erosion and thrombosis.
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Affiliation(s)
- O Tricot
- Institut National de la Santé et de la Recherche Médicale, INSERM U541, Institut Fédératif de Recherche "Circulation," Hôpital Lariboisière, Paris, France
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Bordet R, Belabbas A, Lhermitte M, Tricot O, Roussel P, Libersa C. Is there any difference between daytime and nighttime debrisoquine metabolism? Eur J Clin Pharmacol 1997; 52:419-20. [PMID: 9272416 DOI: 10.1007/s002280050313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Agraou B, Tricot O, Strecker A, Bresson R, Leroy F, Langlois P, Lauwerier B, Dujardin JJ. [Hyperthyroidism associated with pulmonary hypertension]. Arch Mal Coeur Vaiss 1996; 89:765-8. [PMID: 8760665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The association of pulmonary hypertension and polyendocrinopathies or connective tissue diseases has been reported by several authors. The causes of this form of pulmonary hypertension are not clear but an autoimmune process has often been proposed. The authors report a case of non-autoimmune hyperthyroidism and reversible pulmonary hypertension after total thyroidectomy and normalisation of thyroid function. This case supports the hypothesis of a non-autoimmune aetiology of some causes of pulmonary hypertension in diseases of the thyroid.
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Affiliation(s)
- B Agraou
- Service de cardiologie et des soins intensifs, C.H. Douar
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Libersa C, Caron J, Guedon-Moreau L, Tricot O, Bordet R. [Methods of antiarrhythmic drug evaluation in man]. Therapie 1994; 49:201-9. [PMID: 7878585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Antiarrhythmic drugs (AA) are useful in some critical situations but their use remains questionable. Evaluation of their efficacy and possible side effects required accurate knowledge of various methods. ECG gives relevant informations on the conduction intervals alterations caused by AA. Holter monitoring allows evaluation of the efficacy and/or proarrhythmic effects throughout 24-48 hour periods provided that spontaneous variability is taken into account. Ambulatory sequential loop ECG allows a longer monitoring of treatment in patients with symptomatic arrhythmias. Provocative electrophysiological testings give good evaluation of AA efficacy in some supraventricular or ventricular arrhythymias but predictivity of efficacy or proarrhythmic effects is sometimes problematical. Use of effort testing is limited to evaluation of antiarrhythmic effects of drugs in major dysrythmias and in some frequency-dependent dysrythmias, but this technique allows also detection of proarrhythmic incidence in those extremely altered autonomic nervous system tone. Other techniques of evaluation (Signal averaged ECG, automatic implantable cardiovecter defibrillator with holter monitoring, drug plasma concentration monitoring) are still under discussion.
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Affiliation(s)
- C Libersa
- Service de Pharmacologie hospitalière, Faculté de Médecine, Lille
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