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Durand E, Verrez T, Gillibert A, Levesque T, Barbe T, Koning R, Motreff P, Eltchaninoff H, Collet JP, Rangé G. Safety and efficacy of NOAC vs. VKA in patients treated by PCI: a retrospective study of the FRANCE PCI registry. Front Cardiovasc Med 2024; 10:1320001. [PMID: 38292452 PMCID: PMC10824844 DOI: 10.3389/fcvm.2023.1320001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/19/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Dual antithrombotic therapy (DAT) combining oral anticoagulation (OAC), preferentially Non-vitamin K antagonist OAC (NOAC) and single antiplatelet therapy (SAPT) for a period of 6-12 months is recommended after percutaneous coronary intervention (PCI) in patients with an indication for OAC. Objective To compare outcomes between vitamin K antagonist (VKA) and NOAC-treated patients in the nation-wide France PCI registry. Methods All consecutive patients from the France PCI registry treated by PCI and discharged with OAC between 2014 and 2020 were included and followed one-year. Major bleeding was defined as Bleeding Academic Research Consortium (BARC) classification ≥3 and major adverse cardiac events (MACE) as the composite of all-cause mortality, myocardial infarction (MI), and ischemic stroke. A propensity-score analysis was used. Results Of the 7,277 eligible participants, 2,432 (33.4%) were discharged on VKA and 4,845 (66.6%) on NOAC. After propensity-score adjustment, one-year major bleeding was less frequent in NOAC vs. VKA-treated participants [3.1% vs. 5.2%, -2.1% (-3.6% to -0.6%), p = 0.005 as well as the rate of MACE [9.2% vs. 11.9%, -2.7% (-5.0% to -0.4%), p = 0.02]. One-year mortality was also significantly decreased in NOAC vs. VKA-treated participants [7.4% vs. 9.9%, -2.6% (-4.7% to -0.5%), p = 0.02]. The area under ROC curves of the anticoagulant treatment propensity score was estimated at 0.93, suggesting potential indication bias. Conclusions NOAC seems to have a better efficacy and safety profile than VKA. However, potential indication bias were found.
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Affiliation(s)
- Eric Durand
- Department of Cardiology, Normandie Univ, UNIROUEN, U1096, CHU Rouen, Rouen, France
| | - Thibault Verrez
- Department of Cardiology, Normandie Univ, UNIROUEN, U1096, CHU Rouen, Rouen, France
| | - Andre Gillibert
- Department of Biostatistics, Normandie Univ, CHU Rouen, Rouen, France
| | - Thomas Levesque
- Department of Cardiology, Normandie Univ, UNIROUEN, U1096, CHU Rouen, Rouen, France
| | - Thomas Barbe
- Department of Cardiology, Normandie Univ, UNIROUEN, U1096, CHU Rouen, Rouen, France
| | - René Koning
- Department of Cardiology, Clinique Saint Hilaire, Rouen, France
| | - Pascal Motreff
- Department of Cardiology, Clermont Ferrand University Hospital, Clermont-Ferrand, France
| | - Hélène Eltchaninoff
- Department of Cardiology, Normandie Univ, UNIROUEN, U1096, CHU Rouen, Rouen, France
| | - Jean-Philippe Collet
- Sorbonne Université, ACTION Group, INSERM UMRS 1166, Hôpital Pitié-Salpêtrière (AP-HP), Institut de Cardiologie, Paris, France
| | - Gregoire Rangé
- Department of Cardiology, Hôpital de Chartres, Chartres, France
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Rangé G, Laure C, Motreff P. [Insight of France PCI registry in 2023]. Ann Cardiol Angeiol (Paris) 2023; 72:101689. [PMID: 37944223 DOI: 10.1016/j.ancard.2023.101689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 10/09/2023] [Indexed: 11/12/2023]
Abstract
The French PCI Registry collects up to 150 clinical, procedural, and one-year follow-up data on all coronary angiographies and angioplasties performed in the 61 participating centers in September 2023. Thanks to the support of the GACI, the DGOS, the ARS, and numerous hospitals, the registry is continuing to expand its coverage across the entire territory, with 90 centers expected to participate in 2024, accounting for nearly half of the French centers. The high quality of this data has already led to the publication of 18 studies in international journals, and around twenty others are currently being written. The online publication of comprehensive and comparative annual reports, along with the implementation of quality indicators to assess practices, would enhance the performance of all participating centers and ultimately benefit our coronary patients.
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Affiliation(s)
- G Rangé
- Service de cardiologie, Les Hôpitaux de Chartres, 28630 Chartres, France.
| | - C Laure
- Service de cardiologie, Les Hôpitaux de Chartres, 28630 Chartres, France
| | - P Motreff
- Service de cardiologie, CHU Gabriel Montpied, 63000 Clermont-Ferrand, France
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Rangé G, Motreff P, Benamer H, Commeau P, Cayla G, Chassaing S, Laure C, Monsegu J, Van Belle E, Py A, Amabile N, Beygui F, Honton B, Lhermusier T, Boiffard E, Boueri Z, Lhoest N, Deharo P, Adjedj J, Pouillot C, Pereira B, Koning R, Collet JP. The France PCI registry: Design, methodology and key findings. Arch Cardiovasc Dis 2023; 116:489-497. [PMID: 37783602 DOI: 10.1016/j.acvd.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/30/2023] [Accepted: 08/01/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Obstructive coronary artery disease is the main cause of death worldwide. By tracking events and gaining feedback on patient management, the most relevant information is provided to public health services to further improve prognosis. AIMS To create an inclusive and accurate registry of all percutaneous coronary intervention (PCI) procedures performed in France, to assess and improve the quality of care and create research incentives. Also, to describe the methodology of this French national registry of interventional cardiology, and present early key findings. METHODS The France PCI registry is a multicentre observational registry that includes consecutive patients undergoing coronary angiography and/or PCI. The registry was set up to provide online data analysis and structured reports of PCI activity, including process of care measures and assessment of risk-adjusted outcomes in all French PCI centres that are willing to participate. More than 150 baseline data items, describing demographic status, PCI indications and techniques, and in-hospital and 1-year outcomes, are captured into local reporting software by medical doctors and local research technicians, with subsequent encryption and internet transfer to central data servers. Annual activity reports and scoring tools available on the France PCI website enable users to benchmark and improve clinical practices. External validation and consistency assessments are performed, with feedback of data completeness to centres. RESULTS Between 01 January 2014 and 31 December 2022, participating centres increased from six to 47, and collected 364,770 invasive coronary angiograms and 176,030 PCIs, including 54,049 non-ST-segment elevation myocardial infarction cases and 31,631 ST-segment elevation myocardial infarction cases. Fifteen studies stemming from the France PCI registry have already been published. CONCLUSIONS This fully electronic, daily updated, high-quality, low-cost, national registry is sustainable, and is now expanding. Merging with medicoeconomic databases and nested randomized scientific studies are ongoing steps to expand its scientific potential.
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Affiliation(s)
- Grégoire Rangé
- Cardiology Department, Les Hôpitaux de Chartres, 28630 Chartres, France.
| | - Pascal Motreff
- Cardiology Department, University Hospital Gabriel-Montpied, 63000 Clermont-Ferrand, France
| | - Hakim Benamer
- Cardiology Department, Clinique de la Roseraie, 02200 Soissons, France
| | - Philippe Commeau
- Cardiology Department, Polyclinique Les Fleurs, Groupe ELSAN, 83190 Ollioules, France
| | - Guillaume Cayla
- Cardiology Department, Centre Hospitalier Universitaire de Nîmes, 30029 Nîmes, France
| | - Stephan Chassaing
- Cardiology Department, Nouvelle Clinique Tourangelle, 37540 Saint-Cyr-sur-Loire, France
| | - Christophe Laure
- Cardiology Department, Les Hôpitaux de Chartres, 28630 Chartres, France
| | - Jacques Monsegu
- Department of Interventional Cardiology, Institut Cardio-Vasculaire, Groupe Hospitalier Mutualiste, 38028 Grenoble, France
| | - Eric Van Belle
- Department of Cardiology, Institut Coeur-Poumon-CHU Lille and INSERM U1011, 59000 Lille, France
| | - Antoine Py
- Department of Cardiology, Clinique Victor Pauchet, 80094 Amiens, France
| | - Nicolas Amabile
- Cardiology Department, Institut Mutualiste Montsouris, 75014 Paris, France
| | - Farzin Beygui
- Cardiology Department, CHU de Caen, 14000 Caen, France
| | - Benjamin Honton
- Department of Interventional Cardiology, Clinique Pasteur, 31076 Toulouse, France
| | - Thomas Lhermusier
- Department of Cardiology, Toulouse University Hospital, 31000 Toulouse, France
| | - Emmanuel Boiffard
- Department of Cardiology, Centre Hospitalier Départemental de Vendée, 85000 La Roche-sur-Yon, France
| | - Ziad Boueri
- Department of Cardiology, Centre Hospitalier de Bastia, 20600 Bastia, France
| | - Nicolas Lhoest
- Department of Cardiology, Clinique Rhéna, 67000 Strasbourg, France
| | - Pierre Deharo
- Department of Cardiology, CHU Timone, Aix Marseille Université, INSERM, INRA, C2VN, 13005 Marseille, France
| | - Julien Adjedj
- Department of Cardiology, Arnault Tzanck Institute, 06700 Saint-Laurent-du-Var, France
| | - Christophe Pouillot
- Department of Cardiology, Clinique Sainte Clotilde, 97400 Saint-Denis, Reunion
| | - Bruno Pereira
- Cardiology Department, University Hospital Gabriel-Montpied, 63000 Clermont-Ferrand, France
| | - René Koning
- Cardiology Department, Clinique Saint-Hilaire, 76000 Rouen, France
| | - Jean-Philippe Collet
- Sorbonne Université, Action Study Group (action-groupe.org), Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France
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Duband B, Souteyrand G, Clerc JM, Chassaing S, Fichaux O, Marcollet P, Deballon R, Roussel L, Pereira B, Collet JP, Commeau P, Cayla G, Koning R, Motreff P, Benamer H, Rangé G. Prevalence, Management and Outcomes of Percutaneous Coronary Intervention for Coronary In-Stent Restenosis: Insights From the France PCI Registry. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 52:39-46. [PMID: 36813696 DOI: 10.1016/j.carrev.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 02/10/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Despite the evolution of stent technology, there is a non-negligible risk of in-stent restenosis (ISR) after Percutaneous coronary intervention (PCI). Large-scale registry data on the prevalence and clinical management of ISR is lacking. METHODS The aim was to describe the epidemiology and management of patients with ≥1 ISR lesions treated with PCI (ISR PCI). Data on characteristics, management and clinical outcomes were analyzed for patients undergoing ISR PCI in the France-PCI all-comers registry. RESULTS Between January 2014 and December 2018, 31,892 lesions were treated in 22,592 patients, 7.3 % of whom underwent ISR PCI. Patients undergoing ISR PCI were older (68.5 vs 67.8; p < 0.001), and more likely to have diabetes (32.7 % vs 25.4 %, p < 0.001), chronic coronary syndrome or multivessel disease. ISR PCI concerned drug eluting stents (DES) ISR in 48.8 % of cases. Patients with ISR lesions were more frequently treated with DES than drug eluting balloon or balloon angioplasty (74.2 %, 11.6 % and 12.9 %, respectively). Intravascular imaging was rarely used. At 1 year, patients with ISR had higher target lesion revascularization rates (4.3 % vs. 1.6 %; HR 2.24 [1.64-3.06]; p < 0.001). CONCLUSIONS In a large all-comers registry, ISR PCI was not infrequent and associated with worse prognosis than non-ISR PCI. Further studies and technical improvements are warranted to improve the outcomes of ISR PCI.
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Affiliation(s)
- Benjamin Duband
- Cardiology Department, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France.
| | - Géraud Souteyrand
- Cardiology Department, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Jean Michel Clerc
- Cardiology Department, Centre Hospitalier Universitaire de Tours, Tours, France
| | | | - Olivier Fichaux
- Cardiology Department, Centre Hospitalo-Régional d'Orléans, Orléans, France
| | - Pierre Marcollet
- Cardiology Department, Centre Hospitalier Jacques Cœur, Bourges, France
| | | | - Laurent Roussel
- Cardiology Department, Les Hôpitaux de Chartres, Chartres, France
| | - Bruno Pereira
- Biostatistics Unit, Direction de la Recherche Clinique, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Philippe Commeau
- Cardiology Department, Polyclinique Les Fleurs, Groupe ELSAN, Ollioules, France
| | - Guillaume Cayla
- Cardiology Department, Centre Hospitalier Universitaire de Nîmes, Nîmes, France
| | - Rene Koning
- Cardiology Department, Clinique Saint-Hilaire, Rouen, France
| | - Pascal Motreff
- Cardiology Department, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Hakim Benamer
- Cardiology Department, Clinique de la Roseraie, Soissons, France
| | - Gregoire Rangé
- Cardiology Department, Les Hôpitaux de Chartres, Chartres, France
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Mezier A, Motreff P, Clerc JM, Bar O, Deballon R, Demicheli T, Dechery T, Souteyrand G, Py A, Lhoest N, Lhermusier T, Honton B, Gommeaux A, Jeanneteau J, Deharo P, Benamer H, Cayla G, Koning R, Pereira B, Collet JP, Rangé G. Is the duration of dual antiplatelet therapy (DAPT) excessive in post-angioplasty in chronic coronary syndrome? Data from the France-PCI registry (2014-2019). Front Cardiovasc Med 2023; 10:1106503. [PMID: 37034332 PMCID: PMC10080068 DOI: 10.3389/fcvm.2023.1106503] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
Background while the duration of dual antiplatelet therapy (DAPT) following coronary angioplasty for chronic coronary syndrome (CCS) recommended by the European Society of Cardiology has decreased over the last decade, little is known about the adherence to those guidelines in clinical practice in France. Aim To analyze the real duration of DAPT post coronary angioplasty in CCS, as well as the factors affecting this duration. Methods Between 2014 and 2019, 8.836 percutaneous coronary interventions for CCS from the France-PCI registry were evaluated, with 1 year follow up, after exclusion of patients receiving oral anticoagulants, procedures performed within one year of an acute coronary syndrome, and repeat angioplasty. Results Post-percutaneous coronary intervention (PCI) DAPT duration was > 12 months for 53.1% of patients treated for CCS; 30.5% had a DAPT between 7 and 12 months, and 16.4% a DAPT ≤ 6 months. Patients with L-DAPT (>12 months) were at higher ischemic risk [25.0% of DAPT score ≥2 vs. 18.8% DAPT score ≥2 in S&I-DAPT group (≤12 months)]. The most commonly used P2Y12 inhibitor was clopidogrel (82.2%). The prescription of ticagrelor increased over the period. Conclusions post-PCI DAPT duration in CCS was higher than international recommendations in the France PCI registry between 2014 and 2019. More than half of the angioplasty performed for CCS are followed by a DAPT > 12 months. Ischemic risk assessment influences the duration of DAPT. This risk is probably overestimated nowadays, leading to a prolongation of DAPT beyond the recommended durations, thus increasing the bleeding risk.
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Affiliation(s)
- A. Mezier
- Cardiology Department, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
- Correspondence: A. Mezier
| | - P. Motreff
- Cardiology Department, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - J. M. Clerc
- Cardiology Department, Centre Hospitalier Universitaire de Tours, Tours, France
| | - O. Bar
- Cardiology Department, Nouvelle Clinique Tourangelle, Saint-Cyr-sur-Loire, France
| | - R. Deballon
- Cardiology Department, Clinique Oréliance, Orléans, France
| | - T. Demicheli
- Cardiology Department, Les Hôpitaux de Chartres, Chartres, France
| | - T. Dechery
- Cardiology Department, Centre Hospitalier Jacques Coeur, Bourges, France
| | - G. Souteyrand
- Cardiology Department, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - A. Py
- Cardiology Department, Clinique de l’Europe, Amiens, France
| | - N. Lhoest
- Cardiology Departemnt, Clinique Rhéna, Strasbourg, France
| | - T. Lhermusier
- Cardiology Department, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - B. Honton
- Cardiology Department, Clinique Pasteur, Toulouse, France
| | - A. Gommeaux
- Cardiology Department, Hôpital Privé de Bois-Bernard, Bois-Bernard, France
| | - J. Jeanneteau
- Cardiology Department, Clinique Saint Joseph, Trelaze, France
| | - P. Deharo
- Cardiology Department, Centre Hospitalier Universitaire de la Timone, Marseille, France
| | - H. Benamer
- Cardiology Department, Institut Cardiovasculaire Paris Sud, Massy, France
| | - G. Cayla
- Cardiology Department, Centre Hospitalier Universitaire de Nîmes, Nîmes, France
| | - R. Koning
- Cardiology Department, Clinique Saint Hilaire, Rouen, France
| | - B. Pereira
- Clinical Research and Innovation Direction, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - J. P. Collet
- Cardiology Institute, Hôpital Pitié-Salpêtrière (Assistance Publique-Hôpitaux de Paris), Paris, France
| | - G. Rangé
- Cardiology Department, Les Hôpitaux de Chartres, Chartres, France
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Rangé G, Hakim R. [Penetration of endocoronary imaging in France (data from France PCI): The French exception]. Ann Cardiol Angeiol (Paris) 2022; 71:350-355. [PMID: 36272832 DOI: 10.1016/j.ancard.2022.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/17/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE Evaluate intravascular coronary imaging (ICI) utilization in France and compare it with other countries. METHODOLOGY We included in our study all PCI performed between 2014 and 2021 in all participating centers of France PCI registry. RESULTS The percentage of ICI use during PCI varied from 1.2% to 1% between 2014 and 2020 in the France PCI Registry. In 2021, among 45,227 PCI procedures performed at the 41 participating centers, 768 (1.7%) had an ICI, including 329 (0.7%) with OCT, 341 (0.8%) with IVUS, and 98 (0.2%) undetermined. In "all-comers" PCI, the rate of ICI use was 1.7% in France, 2.5% in the United States, 10% in Sweden, 16.2% in the United Kingdom, and 84.4% in Japan. In left main PCI, the rate was 5.8% in France, 62.3% in Sweden, 66.6% in the UK, and 96.6% in Japan. In the France PCI registry, the rate of ICI use ranged from 0% to 9.5% in all PCI and from 0% to 30% in left main PCI. CONCLUSION ICI techniques are exceptionally used in France in routine practice, in contrast to our European neighbors such as Swede or the United Kingdom. Obtaining reimbursement in certain recommended indications and participation in a national interventional cardiology registry with incentive practice indicators should improve this situation.
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Affiliation(s)
| | - Radwan Hakim
- Hôpitaux de Chartres, Service de Cardiologie, France
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Duband B, Motreff P, Marcollet P, Gamet A, Decomis MP, Bar O, Saint Etienne C, Hakim R, Canville A, Viallard L, BeyguI F, Lesault PF, Bonnet P, Durand E, Boiffard E, Collet JP, Benamer H, Commeau P, Cayla G, Pereira B, Koning R, Rangé G. Early survival after acute myocardial infarction with ST-segment elevation: What could be improved? Insights from France PCI French registry. Medicine (Baltimore) 2022; 101:e30190. [PMID: 36107504 PMCID: PMC9439734 DOI: 10.1097/md.0000000000030190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Early mortality post-ST-segment elevation myocardial infarction (STEMI) in France remains high. The multicentre France Percutaneous Coronary Intervention Registry includes every patient undergoing coronary angiography in France. We analyzed the prevalence and impact of unmodifiable and modifiable risk factors on 30-day survival in patients experiencing STEMI. Patients admitted for STEMI between 01/2014 and 12/2016 were included in the analysis. Patients with nonobstructive coronary artery disease, with cardiogenic shock or cardiac arrest without STEMI, were excluded. Prehospital, clinical and procedural data were collected prospectively by the cardiologist in the cath lab using medical reporting software. Information on outcomes, including mortality, was obtained by a dedicated research technician by phone calls or from medical records. Marginal Cox proportional hazards regression was used to test the predictive value for survival at 30 days in a multivariable analysis. Included were 2590 patients (74% men) aged 63 ± 14 years. During the first month, 174 patients (6.7%) died. After adjustment, unmodifiable variables significantly associated with reduced 30-day survival were: age > 80 years (prevalence 15%; hazard ratio [HR] 2.7; 95% confidence interval [CI] 1.5-4.7), chronic kidney disease (2%; HR 5.3; 95% CI 2.6-11.1), diabetes mellitus (14%; HR 1.6; 95% CI 1.0-2.5), anterior or circumferential electrical localization (39%; HR 2.0; 95% CI 1.4-2.9), and Killip class 2, 3, or 4 (7%; HR 3.4; 95% CI 1.9-5.9; 2%; HR 10.1; 95% CI 5.3-19.4; 4%; HR 18; 95% CI 10.8-29.8, respectively). Among modifiable variables, total ischemic time > 3 hours (68%; HR 1.8; 95% CI 1.1-3.0), lack of appropriate premedication (18%; HR 2.2; 95% CI 1.5-3.3), and post-PCI TIMI < 3 (6%; HR 4.9; 95% CI 3.2-7.6) were significantly associated with reduced 30-day survival. Most predictors of 30-day survival post-STEMI are unmodifiable, but outcomes might be improved by optimizing modifiable factors, most importantly ischemic time and appropriate premedication.
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Affiliation(s)
- Benjamin Duband
- Cardiology Department, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
- *Correspondence: Benjamin Duband, Cardiology Department, Centre Hospitalier Universitaire de Clermont-Ferrand, 58, Rue Montalembert, 63000 Clermont-Ferrand, France (e-mail: )
| | - Pascal Motreff
- Cardiology Department, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Pierre Marcollet
- Cardiology Department, Centre Hospitalier Jacques Cœur, Bourges, France
| | - Alexandre Gamet
- Cardiology Department, Centre Hospitalier Régional d’Orléans, Orléans, France
| | | | - Olivier Bar
- Cardiology Department, Centre Hospitalier Universitaire de Tours, Tours, France
| | | | - Radwan Hakim
- Cardiology Department, Les hôpitaux de Chartres, Chartres, France
| | | | - Louis Viallard
- Cardiology Department, Centre Hospitalier Henri Mondor, Aurillac, France
| | - Farzin BeyguI
- Cardiology Department, Centre Hospitalier Universitaire de Caen, Caen, France
| | | | - Philippe Bonnet
- Cardiology Department, Centre Hospitalier Le Havre, Le Havre, France
| | - Eric Durand
- Cardiology Department, Rouen University Hospital, FHU REMOD-VHF, 76000 Rouen, France; Normandie Université, UNIROUEN, INSERM U1096, 76000 Rouen, France
| | - Emmanuel Boiffard
- Cardiology Department, Centre Hospitalier Départemental Vendée, La Roche-sur-Yon, France
| | | | - Hakim Benamer
- Cardiology Department, Clinique de la Roseraie, Soissons, France
| | | | - Guillaume Cayla
- Cardiology Department, Centre Hospitalier Universitaire de Nîmes, Nîmes, France
| | - Bruno Pereira
- Biostatistics Unit, Direction de la Recherche Clinique, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Rene Koning
- Cardiology Department, Clinique Saint-Hilaire, Rouen, France
| | - Gregoire Rangé
- Cardiology Department, Les hôpitaux de Chartres, Chartres, France
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8
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Honton B, Lipiecki J, Monségu J, Leroy F, Benamer H, Commeau P, Motreff P, Cayla G, Banos JL, Bouchou G, Laperche C, Farah B, Rangé G, Lefèvre T, Amabile N. Mid-term outcome of de novo lesions vs. in stent restenosis treated by intravascular lithotripsy procedures: Insights from the French Shock Initiative. Int J Cardiol 2022; 365:106-111. [PMID: 35870637 DOI: 10.1016/j.ijcard.2022.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Intravascular lithotripsy (IVL) is a promising new technology for disrupting de-novo calcified coronary lesions (DNL) before percutaneous coronary intervention (PCI). We assessed 12-month outcomes of IVL in patients undergoing PCI for DNL or intra stent restenosis (ISR) lesions related to device underexpansion. METHODS Prospective analysis of patients in the multicentre all-comers French Shock Initiative IVL registry. The primary safety endpoints in this analysis were in-hospital and 12-month major adverse cardiovascular events (MACE: cardiac death, myocardial infarction or target vessel revascularization). The primary effectiveness endpoint was procedural success, defined as <30% residual stenosis without severe angiographic complications. Event rates were analysed for the cohort and for DNL and ISR procedures separately. RESULTS A total of 220 lesions were treated (76.7% DNL and 23.3% ISR) in 202 patients. Procedural success was achieved in 95.5% of patients (DNL group: 96.5%; ISR group: 92.0%). In-hospital MACE occurred in 6.4% of cases, mainly driven by periprocedural infarctions. The rate of MACE-free survival at 1 year was 86.6% in the overall cohort. Rates of target vessel (TVR) and lesion (TLR) revascularisation were 6.4% and 2.5%, respectively. The 1-year MACE rate was 91.5% in DNL group and 83.8% in ISR group. CONCLUSIONS In this large all-comers IVL cohort, rates of in-hospital and 1-year MACE were moderate. The safety and efficiency of IVL was comparable in DNL and ISR lesions. A comparative study of the impact of IVL on outcomes appears warranted.
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Affiliation(s)
- Benjamin Honton
- Department of Interventional Cardiology, Clinique Pasteur, Toulouse, France.
| | - Janusz Lipiecki
- Department of Interventional Cardiology, Pole Santé République, Clermont-Ferrand, France
| | - Jacques Monségu
- Department of Interventional Cardiology, Institut Cardio Vasculaire, Groupe Hospitalier Mutualiste, Grenoble, France
| | - Fabrice Leroy
- Department of Interventional Cardiology, Clinique La Louviere, Lille, France
| | - Hakim Benamer
- Department of Interventional Cardiology, Hôpital La Roseraie, Aubervilliers, France
| | - Philippe Commeau
- Department of Interventional Cardiology, Polyclinique Les Fleurs, Ollioules, France
| | - Pascal Motreff
- Department of Interventional Cardiology, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Guillaume Cayla
- Department of Interventional Cardiology, Nimes University Hospital, University of Montpellier-Nimes, France
| | - Jean Luc Banos
- Department of Interventional Cardiology, Centre cardiologique du Pays Basque, Bayonne, France
| | - Gael Bouchou
- Department of Interventional Cardiology, Saint Etienne University Hospital, Saint Etienne, France
| | - Clémence Laperche
- Department of Interventional Cardiology, Clinique Pasteur, Toulouse, France
| | - Bruno Farah
- Department of Interventional Cardiology, Clinique Pasteur, Toulouse, France
| | - Grégoire Rangé
- Department of Interventional Cardiology, Centre Hospitalier, Chartres, France
| | - Thierry Lefèvre
- Department of Interventional Cardiology, Institut Cardio-Vasculaire Paris Sud, Ramsay Générale de Santé, Massy, France
| | - Nicolas Amabile
- Department of Interventional Cardiology, Institut Mutualiste Montsouris, Paris, France
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Adjedj J, Morelle JF, Saint Etienne C, Fichaux O, Marcollet P, Decomis MP, Motreff P, Chassaing S, Koning R, Range G. Clinical impact of FFR-guided PCI compared to angio-guided PCI from the France PCI registry. Catheter Cardiovasc Interv 2022; 100:40-48. [PMID: 35544784 DOI: 10.1002/ccd.30225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/16/2022] [Accepted: 04/14/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES We sought to compare, in a national French registry (FrancePCI), the clinical impact of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) compared with angio-guided PCI at 1 year. BACKGROUND FFR has become the invasive gold standard to quantify myocardial ischemia generated by a coronary stenosis in patients with chronic coronary syndrome, but in clinical practice it is still underutilised to guide PCI compared to angiography (angio). METHODS We extracted from the FrancePCI database all chronic coronary syndrome patients treated with PCI for coronary stenosis <90% between 2014 and 2019. Our composite clinical endpoint was the rate of major adverse clinical events (MACE). RESULTS Fourteen thousand three hundred eighty-four patients with 1-year clinical follow-up were included. Among them, 13,125 had angio-guided PCI (91%) and 1259 (9%) had FFR-guided PCI. We observed a significantly higher rate of MACE in the angio-guided group versus the FFR-guided group: 1478 (11.3%) versus 100 (7.9%) (p < 0.0001), respectively, with hazard ratio (HR) of 1.440, 95% confidence interval (CI) [1.211-1.713] (p = 0.0004). This result was driven by the higher occurrence of death in the angio-guided group versus the FFR-guided-group: 506 (3.9%) versus 17 (1.4%) (p < 0.0001), respectively, with HR of 2.845, 95% CI [2.099-3.856] (p < 0.0001). After adjustment for potential confounding factors, HRs were 1.287, 95% CI [1.028-1.613] (p = 0.028) for MACE and 2.527, 95% CI [1.452-4.399] (p = 0.001) for death. No significant differences between angio-guided PCI and FFR-guided PCI were observed for other clinical endpoints. CONCLUSIONS FFR-guided PCI improves outcome at 1 year compared to angio-guided PCI with a reduction of 64% of death.
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Affiliation(s)
- Julien Adjedj
- Department of Cardiology, Arnault Tzanck Institute, Saint Laurent du Var, France
| | | | | | | | | | | | | | | | - Rene Koning
- Department of Cardiology, Clinique Saint Hilaire, Rouen, France
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10
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Beygui F, Roule V, Ivanes F, Dechery T, Bizeau O, Roussel L, Dequenne P, Arnould MA, Combaret N, Collet JP, Commeau P, Cayla G, Montalescot G, Benamer H, Motreff P, Angoulvant D, Marcollet P, Chassaing S, Blanchart K, Koning R, Rangé G. Indirect Transfer to Catheterization Laboratory for ST Elevation Myocardial Infarction Is Associated With Mortality Independent of System Delays: Insights From the France-PCI Registry. Front Cardiovasc Med 2022; 9:793067. [PMID: 35360033 PMCID: PMC8962625 DOI: 10.3389/fcvm.2022.793067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 02/09/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundFirst medical contact (FMC)-to-balloon time is associated with outcome of ST-elevation myocardial infarction (STEMI). We assessed the impact on mortality and the determinants of indirect vs. direct transfer to the cardiac catheterization laboratory (CCL).MethodsWe analyzed data from 2,206 STEMI patients consecutively included in a prospective multiregional percutaneous coronary intervention (PCI) registry. The primary endpoint was 1-year mortality. The impact of indirect admission to CCL on mortality was assessed using Cox models adjusted on FMC-to-balloon time and covariables unequally distributed between groups. A multivariable logistic regression model assessed determinants of indirect transfer.ResultsA total of 359 (16.3%) and 1847 (83.7%) were indirectly and directly admitted for PCI. Indirect admission was associated with higher risk features, different FMCs and suboptimal pre-PCI antithrombotic therapy.At 1-year follow-up, 51 (14.6%) and 137 (7.7%) were dead in the indirect and direct admission groups, respectively (adjusted-HR 1.73; 95% CI 1.22–2.45). The association of indirect admission with mortality was independent of pre-FMC and FMC characteristics. Older age, paramedics- and private physician-FMCs were independent determinants of indirect admission (adjusted-HRs 1.02 per year, 95% CI 1.003–1.03; 5.94, 95% CI 5.94 3.89–9.01; 3.41; 95% CI 1.86–6.2, respectively).ConclusionsOur study showed that, indirect admission to PCI for STEMI is associated with 1-year mortality independent of FMC to balloon time and should be considered as an indicator of quality of care. Indirect admission is associated with higher-risk features and suboptimal antithrombotic therapy. Older age, paramedics-FMC and self-presentation to a private physician were independently associated with indirect admission. Our study, supports population education especially targeting elderly, more adequately dispatched FMC and improved pre-CCL management.
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Affiliation(s)
- Farzin Beygui
- Cardiology Department, CHU de Caen, Caen, France
- *Correspondence: Farzin Beygui
| | | | | | - Thierry Dechery
- Cardiology Department, Center Hospitalier de Bourges, Bourges, France
| | | | - Laurent Roussel
- Cardiology Department, Les Hôpitaux de Chartres, Chartres, France
| | | | - Marc-Antoine Arnould
- Cardiology Department, Nouvelle clinique Tourangelle, Saint-Cyr-sur-Loire, France
| | - Nicolas Combaret
- Cardiology Department, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Philippe Commeau
- Cardiology Department, Polyclinique les fleurs, Ollioules, France
| | | | - Gilles Montalescot
- Cardiology Department, Groupe hospitalier Pitié-Salpêtrière, Paris, France
| | - Hakim Benamer
- Cardiology Department, Clinique de la Roseraie, Aubervilliers, France
| | - Pascal Motreff
- Cardiology Department, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Pierre Marcollet
- Cardiology Department, Center Hospitalier de Bourges, Bourges, France
| | - Stephan Chassaing
- Cardiology Department, Nouvelle clinique Tourangelle, Saint-Cyr-sur-Loire, France
| | | | - René Koning
- Cardiology Department, Clinique Saint Hilaire, Saint Hilaire, France
| | - Grégoire Rangé
- Cardiology Department, Les Hôpitaux de Chartres, Chartres, France
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11
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Rangé G, Hakim R, Etienne CS, Deballon R, Dechery T, Souteyrand G, Bar O, Albert F, Canville A, Gamet A, Beygui F, Viallard L, Bonnet P, Durand E, Lesault PF, Boiffard E, Koning R, Benamer H, Commeau P, Cayla G, Motreff P. [stent thrombosis : A won battle ? (data from the France PCI registry)]. Ann Cardiol Angeiol (Paris) 2021; 70:388-394. [PMID: 34686307 DOI: 10.1016/j.ancard.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 10/02/2021] [Indexed: 10/20/2022]
Abstract
GOAL The aim of the study is to assess the incidence, risk factors and prognosis of definite stent thrombosis (ST) at 1 year in the France PCI multicenter prospective registry. PATIENTS AND METHODS Only patients who underwent coronary angioplasty with at least one stent implantation between 1st January 2014 and 31 December 2019 were included. The population was separated into 2 groups: the "ST" group with stent thrombosis and the "control" group without stent thrombosis. RESULTS 35,435 patients were included. 256 patients (0.72%) presented a ST at 1 year. The rate of ST decreased significantly in acute coronary syndrome (1.5% in 2014 vs. 0.73% in 2019; p = 0.05) but not in chronic coronary syndrome (0.46% in 2014 vs 0.40%; p = 0.98). The risk factors are young age (65.8 years vs 68.2; p = 0.002), clinical context (35.27% vs 16.68%; p = 0.0001), diabetes (35.2 % vs 26.4%; p = 0.002), renal failure (11.7% vs 8%; p = 0.009) and history of coronary angioplasty (28.63% vs 21.86%; p = 0.009) and peripheral arterial disease (14.5% vs 10.1%; p = 0.021), LV dysfunction (37% vs 27.5%; p = 0.003), mean length (39.6 mm vs 31, 7mm; p <0.0001) and the mean number of stents per procedure (1.9 vs 1.6; p <0.0001), a TIMI flow ≤1 pre procedure (21.5% vs 12.4%; p <0.0001) and an intrastent restenosis (11% vs 6%; p <0.0001). The 1-year mortality of the ST group was significantly higher than that of the control group (19.14% vs 5.82%; p <0.0001). CONCLUSION Since 2014, the incidence of ST at 1 year has been decreasing but remains stuck at a floor level of 0.54% in 2019. The battle for ST seems to have been partly won and its risk factors well identified, but its mortality is still high.
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Affiliation(s)
- G Rangé
- Hôpitaux de Chartres, Service de Cardiologie, 4 rue Claude Bernard 28630 Le Coudray.
| | - R Hakim
- Hôpitaux de Chartres, Service de Cardiologie, 4 rue Claude Bernard 28630 Le Coudray
| | - C Saint Etienne
- Service de cardiologie, Centre Hospitalo-Universitaire de Tours, 37170 Chambray les Tours, France
| | - R Deballon
- Service de cardiologie, Pôle santé Oréliance, 45770 Saran, France
| | - T Dechery
- Service de cardiologie, Centre Hospitalier Jacques-Cœur, 18020 Bourges, France
| | - G Souteyrand
- Service de cardiologie, Centre Hospitalo-Universitaire Gabriel-Montpied, 63000 Clermont Ferrand, France
| | - O Bar
- Service de cardiologie, Nouvelle Clinique Tours Plus, 37541 Saint Cyr sur Loire, France
| | - F Albert
- Hôpitaux de Chartres, Service de Cardiologie, 4 rue Claude Bernard 28630 Le Coudray
| | - A Canville
- Service de cardiologie, Clinique Saint-Hilaire, 76000 Rouen, France
| | - A Gamet
- Service de cardiologie, Centre Hospitalier Régional d'Orléans, 45100 Orléans, France
| | - F Beygui
- Service de cardiologie, Centre Hospitalo-Universitaire de Caen, 14033 Caen, France
| | - L Viallard
- Service de cardiologie, Centre Hospitalier Henri-Mondor, 15000 Aurillac, France
| | - P Bonnet
- Service de cardiologie, Groupe Hospitalier du Havre, 76290 Montivilliers, France
| | - E Durand
- Service de cardiologie, Centre Hospitalo-Universitaire de Rouen, 76038 Rouen, France
| | - P-F Lesault
- Service de cardiologie, Hôpital Privé de l'Estuaire, 76600 Le Havre, France
| | - E Boiffard
- Service de cardiologie, Centre Hospitalier Départemental de Vendée, 85000 La Roche-Sur-Yon, France
| | - R Koning
- Service de cardiologie, Clinique Saint-Hilaire, 76000 Rouen, France
| | - H Benamer
- Service de cardiologie, ICVGVM La Roseraie, 93300 Aubervilliers, France
| | - P Commeau
- Service de cardiologie, Polyclinique des Fleurs, 83190 Ollioules, France
| | - G Cayla
- Service de cardiologie, CHU Nîmes, Université Montpellier, Nîmes, France
| | - P Motreff
- Service de cardiologie, Centre Hospitalo-Universitaire Gabriel-Montpied, 63000 Clermont Ferrand, France
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12
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The ACIRA Registry: A Regional Tool to Improve the Healthcare Pathway for Patients Undergoing Percutaneous Coronary Interventions and Coronary Angiographies in the French Aquitaine Region: Study Design and First Results. Crit Pathw Cardiol 2021; 19:1-8. [PMID: 31567554 DOI: 10.1097/hpc.0000000000000199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND In France, there is a lack of information about practices and pathways of coronary angiographies and percutaneous coronary interventions (PCI). We present the design and the first results of the ACIRA registry, the goal of which is to answer questions about quality, security, appropriateness, efficiency of, and access to interventional cardiology (IC) healthcare pathway in the French Aquitaine region. METHODS The ACIRA registry is an on-going, multicenter, prospective, exhaustive, scalable, and nominative cohort study of patients who undergo coronary angiographies or percutaneous coronary intervention in any of the catheterization laboratories. The data related to hospitalizations and procedures are directly extracted from hospital information systems. In-hospital mortality, readmissions, and cardiovascular morbidity are collected from the French hospital medical information system database. An identity management system has been implemented to create the patient health care pathway. RESULTS From January 1, 2012, to June 30, 2018, 147,136 procedures performed on 106,005 patients have been included in the ACIRA registry. CONCLUSIONS ACIRA has shown its ability to study the patient IC healthcare pathway, up to 1 year after the procedure. Nominative data enable the linkage between clinical and medico-administrative databases and possible supplementary data collection. The use of existing databases allowed us to limit patients lost to follow-up, prevent the double entry of data, improve data quality, and reduce the operating costs. The prospect of linkage with the French National Health Data System may offer promising opportunities for future medical research projects and for developing collaboration and benchmarking with other IC registries abroad.
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13
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Bensaid R, Georges JL, Angoulvant D, Chassaing S, Deballon R, Marcollet P, Albert F, Fichaux O, Bar O, Rangé G. INCREASED EXPOSURE TO X-RAYS DURING CORONARY ANGIOGRAPHY AND PERCUTANEOUS CORONARY INTERVENTIONS ASSOCIATED WITH FRACTIONAL FLOW RESERVE MEASUREMENT AND ENDOCORONARY IMAGING TECHNIQUES. RADIATION PROTECTION DOSIMETRY 2021; 194:18-26. [PMID: 33954788 DOI: 10.1093/rpd/ncab065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/09/2021] [Accepted: 04/08/2021] [Indexed: 06/12/2023]
Abstract
Growing use of fractional flow reserve (FFR) and intracoronary imaging techniques by optical coherence tomography or intravascular ultrasound has raised concerns about additional exposure during coronary angiography and percutaneous coronary interventions (PCIs). Using data from the prospective CRAC-France PCI Prospective Multicentre registry, we sought to evaluate the effect of these new techniques on the radiation dose to patients undergoing coronary procedures. Data on Kerma Area Product (PKA), total air kerma (KAr) and fluoroscopy time from 42 182 coronary procedures were retrospectively compared, using multivariable linear regression, according to whether they included FFR and intracoronary imaging. In coronary angiography, FFR was associated with longer fluoroscopy time and higher PKA (21.0 vs. 18.9 Gy.cm2) and KAr (372 vs. 299 mGy) (all p < 0.001). Intracoronary imaging was associated with longer fluoroscopy time, higher contrast volume (both p < 0.001), lower PKA (18.3 vs. 19.0 Gy.cm2, p = 0.02) and similar KAr. In PCI, FFR was associated with a moderate increase in KAr (682 vs. 626 mGy, p < 0.01) but not PKA (35.9 vs. 33.7 Gy.cm2, p = 0.34). For intracoronary imaging, there were no differences between groups, except for contrast volume. Increased patient exposure associated with FFR and intracoronary imaging is moderate in diagnostic coronary angiography and minimal or none in PCI, provided optimization techniques are used. It should not be a limitation on the use of these techniques given the important additional information they provide.
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Affiliation(s)
- Réda Bensaid
- Cardiology Department, Les Hôpitaux de Chartres, 28630 Le Coudray, France
| | - Jean-Louis Georges
- Cardiology Department, Centre Hospitalier de Versailles, 78150 Le Chesnay-Rocquencourt, France
| | - Denis Angoulvant
- Cardiology Department, Centre Hospitalo-Universitaire de Tours, and Tours University, 37000 Tours, France
| | - Stephan Chassaing
- Cardiology Department, Centre Hospitalier Régional d'Orléans, 45100 Orléans, France
| | - Ronan Deballon
- Cardiology Department, Clinique Oréliance, 45770 Saran, France
| | - Pierre Marcollet
- Cardiology Department, Centre Hospitalier de Bourges, 18000 Bourges, France
| | - Franck Albert
- Cardiology Department, Les Hôpitaux de Chartres, 28630 Le Coudray, France
| | - Olivier Fichaux
- Cardiology Department, Centre Hospitalier Régional d'Orléans, 45100 Orléans, France
| | - Olivier Bar
- Cardiology Department, Nouvelle clinique Tourengelle, 37000 Tours, France
| | - Grégoire Rangé
- Cardiology Department, Les Hôpitaux de Chartres, 28630 Le Coudray, France
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14
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Puymirat E, Nakache A, Saint Etienne C, Marcollet P, Fichaux O, Decomis MP, Chassaing S, Commeau P, Danchin N, Cayla G, Montalescot G, Benamer H, Koning R, Motreff P, Rangé G. Is coronary multivessel disease in acute myocardial infarction patients still associated with worse clinical outcomes at 1-year? Clin Cardiol 2021; 44:429-437. [PMID: 33586188 PMCID: PMC7943894 DOI: 10.1002/clc.23567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/30/2020] [Accepted: 01/07/2021] [Indexed: 11/23/2022] Open
Abstract
Background ST‐elevation myocardial infarction (STEMI) patients with multivessel disease (MVD) are associated with a worse prognosis. However, few comparisons are available according to coronary status in the era of modern reperfusion and optimized secondary prevention. Hypothesis We hypothesized that the difference in prognosis according to number of vessel disease in STEMI patients has reduced. Methods All consecutive STEMI patients undergoing primary percutaneous coronary intervention (PCI) within 24 h of symptoms onset between January 1, 2014 and June 30, 2016 enrolled in the CRAC (Club Régional des Angioplasticiens de la région Centre) France PCI registry were analyzed. Baseline characteristics, management, and outcomes at 1‐year were analyzed according to coronary status (one‐, two‐, and three‐VD). Results A total of 1886 patients (mean age 62.2 ± 14.0 year; 74% of male) were included. Patients with MVD (two or three‐VD) represented 53.7%. They were older with higher cardiovascular risk factor profile. At 1 year, the rate of major adverse cardiovascular events (MACE, defined as all‐cause death, stroke or re‐MI) was 10%, 12%, and 12% in one‐, two, and three‐VD respectively (p = .28). In multivariable adjusted Cox proportional hazard regression model, two‐ and three‐VD were not associated with higher rate of MACE compared to patients with single VD (HR, 1.09; 95%CI 0.76–1.56 for two‐VD; HR, 0.74; 95%CI 0.48–1.14 for three‐VD). Conclusions MVD still represents an important proportion of STEMI patients but their prognoses were not associated with worse clinical outcomes at 1‐year compared with one‐VD patients in a modern reperfusion area and secondary medication prevention.
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Affiliation(s)
- Etienne Puymirat
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Paris, France.,Université de Paris, Paris, France
| | - Ariel Nakache
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Paris, France.,Université de Paris, Paris, France
| | | | - Pierre Marcollet
- Cardiology Department, Centre Hospitalier de Bourges, Bourges, France
| | - Olivier Fichaux
- Cardiology Department, Centre Hospitalo-régional d'Orléans, Orléans, France
| | | | | | - Philippe Commeau
- Cardiology Department, Polyclinique les Fleurs, Ollioules, France
| | - Nicolas Danchin
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Paris, France.,Université de Paris, Paris, France
| | - Guillaume Cayla
- Cardiology Department, CHU Nîmes, Université Montpellier, Nîmes, France
| | - Gilles Montalescot
- Cardiology Department, Groupe hospitalier Pitié-Salpêtrière, Paris, France
| | - Hakim Benamer
- Cardiology Department, Clinique de la Roseraie; ICPS Massy Ramsay group, Paris 13, France
| | - Rene Koning
- Cardiology Department, Clinique Saint-Hilaire, Rouen, France
| | - Pascal Motreff
- Cardiology Department, Centre Hospitalo-Universitaire de Clermont-Ferrand, Clermont Ferrand, France
| | - Grégoire Rangé
- Cardiology Department, Les Hôpitaux de Chartres, Chartres, France
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15
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Hakim R, Revue E, Saint Etienne C, Marcollet P, Chassaing S, Decomis MP, Yafi W, Laure C, Gautier S, Godillon L, Akkoyun-Farinez J, Angoulvant D, Koning R, Motreff P, Grammatico-Guillon L, Rangé G. Does helicopter transport delay prehospital transfer for STEMI patients in rural areas? Findings from the CRAC France PCI registry. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2020; 9:958-965. [DOI: 10.1177/2048872619848976] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims:
The aim of this study was to analyse delays in emergency medical system transfer of ST-segment elevation myocardial infarction (STEMI) patients to percutaneous coronary intervention (PCI) centres according to transport modality in a rural French region.
Methods and results:
Data from the prospective multicentre CRAC / France PCI registry were analysed for 1911 STEMI patients: 410 transferred by helicopter and 1501 by ground transport. The primary endpoint was the percentage of transfers with first medical contact to primary percutaneous coronary intervention within the 90 minutes recommended in guidelines. The secondary endpoint was time of first medical contact to primary percutaneous coronary intervention. With helicopter transport, time of first medical contact to primary percutaneous coronary intervention in under 90 minutes was less frequently achieved than with ground transport (9.8% vs. 37.2%; odds ratio 5.49; 95% confidence interval 3.90; 7.73; P<0.0001). Differences were greatest for transfers under 50 km (13.7% vs. 44.7%; P<0.0001) and for primary transfers (22.4% vs. 49.6%; P<0.0001). The median time from first medical contact to primary percutaneous coronary intervention and from symptom onset to primary percutaneous coronary intervention (total ischaemic time) were significantly higher in the helicopter transport group than in the ground transport group (respectively, 137 vs. 103 minutes; P<0.0001 and 261 vs. 195 minutes; P<0.0001). There was no significant difference in inhospital mortality between the helicopter and ground transport groups (6.9% vs. 6.6%; P=0.88).
Conclusions:
Helicopter transport of STEMI patients was five times less effective than ground transport in maintaining the 90-minute first medical contact to primary percutaneous coronary intervention time recommended in guidelines, particularly for transfer distances less than 50 km.
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Affiliation(s)
- Radwan Hakim
- Cardiology Department, Les Hôpitaux de Chartres, France
| | - Eric Revue
- Emergency Unit Department, Les Hôpitaux de Chartres, France
| | | | | | | | | | - Wael Yafi
- Cardiology Department, Centre Hospitalo-régional de Orléans, France
| | | | | | | | | | - Denis Angoulvant
- Cardiology Department, Centre Hospitalo-Universitaire de Tours, France
| | - Rene Koning
- Cardiology Department, Clinique Saint-Hilaire, France
| | - Pascal Motreff
- Cardiology Department, Centre Hospitalo-Universitaire de Clermont-Ferrand, France
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16
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Rangé G, Hakim R, Beygui F, Angoulvant D, Marcollet P, Godin M, Deballon R, Bonnet P, Fichaux O, Barbey C, Viallard L, Lesault PF, Durand E, Boiffard E, Dutheil G, Collet JP, Benamer H, Commeau P, Montalescot G, Koning R, Motreff P. Incidence, delays, and outcomes of STEMI during COVID-19 outbreak: Analysis from the France PCI registry. J Am Coll Emerg Physicians Open 2020; 1:1168-1176. [PMID: 33363285 PMCID: PMC7753646 DOI: 10.1002/emp2.12325] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/29/2020] [Accepted: 10/29/2020] [Indexed: 12/29/2022] Open
Abstract
Objectives The aim of this study was to assess the impact of the coronavirus disease 2019 (COVID‐19) outbreak on incidence, delays, and outcomes of ST‐elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI) in France. Methods We analyzed all patients undergoing PPCI <24 hours STEMI included in the prospective France PCI registry. The 2 groups were compared on mean monthly number of patients, delays in the pathway care, and in‐hospital major adverse cardiac events (MACE: death, stent thrombosis, myocardial infarction, unplanned coronary revascularization, stroke, and major bleeding). Results From January 15, 2019 to April 14, 2020, 2064 STEMI patients undergoing PPCI were included: 1942 in the prelockdown group and 122 in the lockdown group. Only 2 cases in the lockdown group were positive for COVID‐19. A significant drop (12%) in mean number of STEMI/month was observed in the lockdown group compared with prelockdown (139 vs 122, P < 0.04). A significant increase in “symptom onset to first medical contact” delay was found for patients who presented directly to the emergency department (ED) (238 minutes vs 450 minutes; P = 0.04). There were higher rates of in‐hospital MACE (7.7% vs 12.3%; P = 0.06) and mortality (4.9% vs 8.2%; P = 0.11) in the lockdown group but the differences were not significant. Conclusion According to the multicenter France PCI registry, the COVID‐19 outbreak in France was associated with a significant decline in STEMI undergoing PPCI and longer transfer time for patients who presented directly to the ED. Mortality rates doubled, but the difference was not statistically significant.
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Affiliation(s)
- Grégoire Rangé
- Cardiology department Les hôpitaux de Chartres Chartres France
| | - Radwan Hakim
- Cardiology department Les hôpitaux de Chartres Chartres France
| | - Farzin Beygui
- Cardiology Department Centre Hospitalier Universitaire de Caen Caen France
| | - Denis Angoulvant
- Cardiology Department Centre Hospitalier Universitaire de Tours Tours France
| | - Pierre Marcollet
- Cardiology Department Centre Hospitalier Jacques Coeur Bourges France
| | - Matthieu Godin
- Cardiology Department Clinique Saint-Hilaire Rouen France
| | | | - Philippe Bonnet
- Cardiology Department Centre Hospitalier Le Havre Le Havre France
| | - Olivier Fichaux
- Cardiology Department Centre Hospitalier Régional d'Orléans Orléans France
| | - Christophe Barbey
- Cardiology Department Nouvelle Clinique Tourengelle, Saint-Cyr-sur-Loire France
| | - Louis Viallard
- Cardiology Department Centre Hospitalier Henri Mondor Aurillac France
| | | | - Eric Durand
- Cardiology Department UNIROUEN INSERM U1096 Rouen University Hospital Department of Cardiology Normandie Univ FHU REMOD-VHF Rouen F76000 France
| | - Emmanuel Boiffard
- Cardiology Department Centre Hospitalier Départemental Vendée La Roche-sur-Yon France
| | - Gerard Dutheil
- Cardiology Department Clinique Bergouignan Evreux France
| | | | - Hakim Benamer
- Cardiology Department Clinique de la Roseraie Soissons France
| | | | | | - Rene Koning
- Cardiology Department Clinique Saint-Hilaire Rouen France
| | - Pascal Motreff
- Cardiology Department Centre Hospitalier Universitaire de Clermont-Ferrand Clermont-Ferrand France
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17
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Lemaignen A, Grammatico-Guillon L, Astagneau P, Marmor S, Ferry T, Jolivet-Gougeon A, Senneville E, Bernard L. Computerized registry as a potential tool for surveillance and management of complex bone and joint infections in France: French registry of complex bone and joint infections. Bone Joint Res 2020; 9:635-644. [PMID: 33101653 PMCID: PMC7547640 DOI: 10.1302/2046-3758.910.bjr-2019-0362.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aims The French registry for complex bone and joint infections (C-BJIs) was created in 2012 in order to facilitate a homogeneous management of patients presented for multidisciplinary advice in referral centres for C-BJI, to monitor their activity and to produce epidemiological data. We aimed here to present the genesis and characteristics of this national registry and provide the analysis of its data quality. Methods A centralized online secured database gathering the electronic case report forms (eCRFs) was filled for every patient presented in multidisciplinary meetings (MM) among the 24 French referral centres. Metrics of this registry were described between 2012 and 2016. Data quality was assessed by comparing essential items from the registry with a controlled dataset extracted from medical charts of a random sample of patients from each centre. Internal completeness and consistency were calculated. Results Between 2012 and 2016, 30,607 presentations in MM were recorded corresponding to 17,748 individual patients (mean age 62.1 years (SD 18.4); 10,961 (61.8%) males). BJI was considered as complex for 63% of cases (n = 19,355), and 13,376 (44%) had prosthetic joint infections (PJIs). The controlled dataset, available for 19 centres, included 283 patients. Global consistency and completeness were estimated at 88.2% and 88.9%, respectively, considering missing items in the eCRFs as negative results. Conclusion This national registry is one of the largest prospective databases on BJI and its acceptable data quality parameters allow further use for epidemiological purposes.Cite this article: Bone Joint Res 2020;9(9):635-644.
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Affiliation(s)
- Adrien Lemaignen
- Service de Médecine Interne et Maladies Infectieuses, Regional University Hospital Centre Tours, Tours, France.,University of Tours, Tours, France.,iPLESP, Paris, France
| | - Leslie Grammatico-Guillon
- Unité d'Épidémiologie des données cliniques, EpiDcliC, Regional University Hospital Centre Tours, Tours, France.,UMR 1259 - MAVIVH, INSERM, Tours, France
| | - Pascal Astagneau
- iPLESP, Paris, France.,Centre d'appui pour la prévention des infections associées aux soins (CPIAS), Paris, France
| | - Simon Marmor
- Service d'Orthopédie, Groupe Hospitalier Diaconesses Croix Saint Simon, Paris, France
| | - Tristan Ferry
- Service de Maladies Infectieuses et Tropicales, Hospices Civils de Lyon, Lyon, France
| | | | - Eric Senneville
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier de Tourcoing, Tourcoing, Nord-Pas-de-Calais, France
| | - Louis Bernard
- Service de Médecine Interne et Maladies Infectieuses, Regional University Hospital Centre Tours, Tours, France
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18
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Rangé G, Hakim R, Motreff P. Where have the ST-segment elevation myocardial infarctions gone during COVID-19 lockdown? EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2020; 6:223-224. [PMID: 32348457 PMCID: PMC7197594 DOI: 10.1093/ehjqcco/qcaa034] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/22/2020] [Indexed: 11/14/2022]
Affiliation(s)
- Gregoire Rangé
- Cardiology Department, les Hôpitaux de Chartres, 4 rue Claude Bernard, 28630, Le Coudray, France
| | - Radwan Hakim
- Cardiology Department, les Hôpitaux de Chartres, 4 rue Claude Bernard, 28630, Le Coudray, France
| | - Pascal Motreff
- Cardiology Department, Centre Hospitalo-Universitaire de Clermont-Ferrand, 58 Rue Montalembert, 63000, Clermont-Ferrand, France
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19
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Factors associated with delay in transfer of patients with ST-segment elevation myocardial infarction from first medical contact to catheterization laboratory: Lessons from CRAC, a French prospective multicentre registry. Arch Cardiovasc Dis 2019; 112:3-11. [DOI: 10.1016/j.acvd.2018.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 04/06/2018] [Accepted: 04/09/2018] [Indexed: 11/19/2022]
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20
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Hakim R, Thuaire C, Saint-Etienne C, Marcollet P, Chassaing S, Dequenne P, Laure C, Gautier S, Akkoyun-Farinez J, Motreff P, Rangé G. [Non-ST elevation acute coronary syndrome: CRAC register experience]. Ann Cardiol Angeiol (Paris) 2018; 67:422-428. [PMID: 30391012 DOI: 10.1016/j.ancard.2018.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare the clinical, angiographic, therapeutic and prognostic characteristics of nonagenarians presenting with non-ST elevation acute coronary syndrome with those of patients under 90 years of age. METHODS We used the CRAC register database including 6 catheterization laboratories in the Center Val-de-Loire region. Only patients with positive-troponin non-ST elevation ACS included in the registry from 2014 to 2017 were selected for epidemiological and procedural data. Regarding antiplatelet therapy, hospital and one-year follow-up data, only patients in the 2014-2015 period were analyzed. RESULTS From January 1st, 2014 to December 31st, 2017, 5.964 patients with a positive-troponin non-ST ACS, including 133 nonagenarians (2.2%) were included in the CRAC registry. Arterial hypertension and the history of coronary angioplasty were more common among nonagenarians. They present more multivessel and left main disease. The use of the bare metal stent was predominant in 2014-2015 and then became marginal in 2016-2017. Clopidogrel was the most widely used anti platelet and more than one in two nonagenarians remain on dual therapy after 12 months. One-year stroke and hospital and one-year mortality were higher in this age group. CONCLUSIONS Nonagenarians with a positive-troponin non-ST elevation ACS have more severe coronary artery disease and a poorer prognosis than those younger than 90 years of age.
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Affiliation(s)
- R Hakim
- Service de cardiologie, les hôpitaux de Chartres, Chartres, France
| | - C Thuaire
- Service de cardiologie, les hôpitaux de Chartres, Chartres, France
| | - C Saint-Etienne
- Service de cardiologie, centre hospitalo universitaire de Tours, 37170 Tours, France
| | - P Marcollet
- Service de cardiologie, centre hospitalier de Bourges, 18000 Bourges, France
| | - S Chassaing
- Service de cardiologie, clinique Saint-Gatien, 37000 Tours, France
| | - P Dequenne
- Service de cardiologie, clinique Oréliance, 45770 Saran, France
| | - C Laure
- Service de cardiologie, les hôpitaux de Chartres, Chartres, France
| | - S Gautier
- Service de cardiologie, les hôpitaux de Chartres, Chartres, France
| | | | - P Motreff
- Service de cardiologie, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - G Rangé
- Service de cardiologie, les hôpitaux de Chartres, Chartres, France.
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