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Lemesle G, Lamblin N, Schurtz G, Labreuche J, Duhamel A, Verdier B, Steg PG, Bauters C. Comparison of Incidence and Prognostic Impact of Ischemic, Major Bleeding and Heart Failure Events in Patients With Chronic Coronary Syndrome: Insights From the CORONOR Registry. Circulation 2024; 149:1708-1716. [PMID: 38660793 DOI: 10.1161/circulationaha.123.067938] [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: 11/13/2023] [Accepted: 03/28/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Evaluation of the residual risk in patient with chronic coronary syndrome is challenging in daily practice. Several types of events (myocardial infarction, ischemic stroke, bleeding, and heart failure [HF]) may occur, and their impact on subsequent mortality is unclear in the era of modern evidence-based pharmacotherapy. METHODS CORONOR (Suivi d'une cohorte de patients Coronariens stables en région Nord-pas-de-Calais) is a prospective multicenter cohort that enrolled 4184 consecutive unselected outpatients with chronic coronary syndrome. We analyzed the incidence, correlates, and impact of ischemic events (a composite of myocardial infarction and ischemic stroke), major bleeding (Bleeding Academic Research Consortium 3 or higher), and hospitalization for HF on subsequent patient mortality. RESULTS During follow-up (median, 4.9 years), 677 patients (16.5%) died. The 5-year cumulative incidences (death as competing event) of ischemic events, major bleeding, and HF hospitalization were 6.3% (5.6%-7.1%), 3.1% (2.5%-3.6%), and 8.1% (7.3%-9%), respectively. Ischemic events, major bleeding, and HF hospitalization were each associated with all-cause mortality. Major bleeding and hospitalization for HF were associated with the highest mortality rates in the postevent period (42.4%/y and 34.7%/y, respectively) compared with incident ischemic events (13.1%/y). The age- and sex-adjusted hazard ratios for all-cause mortality were 3.57 (95% CI, 2.77-4.61), 9.88 (95% CI, 7.55-12.93), and 8.60 (95% CI, 7.15-10.35) for ischemic events, major bleeding, and hospitalization for HF, respectively (all P<0.001). CONCLUSIONS Hospitalization for HF has become both the most frequent and one of the most ominous events among patients with chronic coronary syndrome. Although less frequent, major bleeding is strongly associated with worse patient survival. Secondary prevention should not be limited to preventing ischemic events. Minimizing bleeding and preventing HF may be at least as important.
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Affiliation(s)
- Gilles Lemesle
- Heart and Lung Institute, University Hospital of Lille, France (G.L.)
- Université de Lille, France (G.L.)
- Institut Pasteur of Lille, Inserm U1011, Lille, France (G.L.)
- FACT (French Alliance for Cardiovascular Trials), Paris, France (G.L.)
| | - Nicolas Lamblin
- Université de Lille, Inserm, CHU Lille, Institut Pasteur de Lille, France (N.L., C.B.)
| | | | - Julien Labreuche
- Department of Biostatistics, CHU Lille, Lille, France (J.L., A.D.)
| | - Alain Duhamel
- Department of Biostatistics, CHU Lille, Lille, France (J.L., A.D.)
| | | | - Philippe Gabriel Steg
- Université Paris-Diderot, France (P.G.S.)
- AP-HP, Hopital Bichat, and INSERM U1148, FACT (French Alliance for Cardiovascular Trials), an F-CRIN network, Paris, France (P.G.S.)
| | - Christophe Bauters
- Université de Lille, Inserm, CHU Lille, Institut Pasteur de Lille, France (N.L., C.B.)
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Very long-term outcomes of older adults with stable coronary artery disease (from the CORONOR study). Coron Artery Dis 2021; 33:169-175. [PMID: 34380959 DOI: 10.1097/mca.0000000000001086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There are limited data on stable coronary artery disease (CAD) in the very elderly. The present study aimed to investigate incident cardiovascular events and mortality in older adults (≥85 years) included in a multicenter registry on stable CAD. METHODS A long-term follow-up was performed in 198 patients ≥85 years with stable CAD, free from myocardial infarction (MI) or coronary revascularization within the year. The median age was 87 years. Clinical events during the follow-up period [death, MI, ischemic stroke, coronary revascularization and hospitalization for heart failure (HF)] were centrally adjudicated. RESULTS There were 164 deaths during follow-up. The cumulative risk of all-cause death was 9.1% at 1 year, 53.9% at 5 years and 85.5% at 10 years. The cause of death was adjudicated as cardiovascular in 64 patients with death from HF in 36 patients. Male gender, previous hospitalization for HF and an estimated glomerular filtration rate <60 ml/min/1.73 m2 were independently associated with all-cause death. Ten-year cumulative incidences of MI, ischemic stroke and coronary revascularization were low (6.6, 7.7 and 6.6%, respectively). By contrast, the 10-year cumulative incidence of hospitalization for HF was high (27.8%). CONCLUSION The 10-year mortality of elderly patients with stable CAD is very high. While ischemic events are relatively unfrequent, HF events are frequent and represent the most common cause of cardiovascular death in this population. Prevention and management of HF are important goals for physicians in charge of older adults with stable CAD.
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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] [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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Lemesle G, Ninni S, de Groote P, Schurtz G, Lamblin N, Bauters C. Relative impact of bleedings over ischaemic events in patients with heart failure: insights from the CARDIONOR registry. ESC Heart Fail 2020; 7:3821-3829. [PMID: 32918405 PMCID: PMC7754769 DOI: 10.1002/ehf2.12971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/16/2020] [Accepted: 08/06/2020] [Indexed: 01/05/2023] Open
Abstract
AIMS Major bleeding events in heart failure (HF) patients are poorly described. We sought to investigate the importance of major bleeding and its impact on outcomes in HF patients. METHODS AND RESULTS We analysed incident bleeding and ischaemic events during a 3 year follow-up in 2910 HF outpatients included in a prospective multicentre registry. Major bleeding was defined as a Type ≥3 bleed using the Bleeding Academic Research Consortium definition. Ischaemic event was a composite of ischaemic stroke and myocardial infarction. Events were adjudicated by a blinded committee. At inclusion, most patients (89%) received at least one antithrombotic: anticoagulation (53.9%) and/or antiplatelet therapy (46.2%). Bleeding occurred in 111 patients {3 year cumulative incidence: 3.6% [95% confidence interval (CI) 3.0-4.3]} and ischaemic events in 102 patients [3 year cumulative incidence: 3.3% (95% CI 2.7-4.0)]. Most bleedings were Bleeding Academic Research Consortium 3a (32.5%) or 3b (31.5%). Most frequent sites of bleeding were gastrointestinal (40.6%) and intracranial (27.9%). Variables associated with bleeding were atrial fibrillation [hazard ratio (HR) = 2.63 (95% CI 1.66-4.19), P < 0.0001], diabetes [HR = 1.62 (95% CI 1.11-2.38), P = 0.012], and older age [HR = 1.19 per 10 year increase (95% CI 1.00-1.41), P = 0.049]. Anticoagulation use was associated with a two-fold increase in the bleeding risk. Bleeding events as well as ischaemic events were strongly associated with subsequent mortality [adjusted HRs: 5.67 (4.41-7.29), P < 0.0001 and 4.29 (3.18-5.78), P < 0.0001, respectively]. CONCLUSIONS In HF outpatients, antithrombotics are widely used. Bleeding occurs at a stable rate of 1.2% annually (as frequent as ischaemic events) and is associated with a dramatic increase in mortality (at least as severe as ischaemic events). Most events occurred in patients receiving anticoagulation. Knowledge of these findings may help physicians to manage antithrombotics in HF patients.
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Affiliation(s)
- Gilles Lemesle
- Institut Cœur PoumonCentre Hospitalier Universitaire de LilleLilleFrance
- Faculté de Médecine de LilleUniversité de LilleLilleFrance
- Institut Pasteur de LilleInserm U1011LilleFrance
- FACT (French Alliance for Cardiovascular Trials)ParisFrance
| | - Sandro Ninni
- Institut Cœur PoumonCentre Hospitalier Universitaire de LilleLilleFrance
- Faculté de Médecine de LilleUniversité de LilleLilleFrance
- Institut Pasteur de LilleInserm U1011LilleFrance
| | - Pascal de Groote
- Institut Cœur PoumonCentre Hospitalier Universitaire de LilleLilleFrance
- Institut Pasteur de LilleInserm U1167LilleFrance
| | - Guillaume Schurtz
- Institut Cœur PoumonCentre Hospitalier Universitaire de LilleLilleFrance
| | - Nicolas Lamblin
- Institut Cœur PoumonCentre Hospitalier Universitaire de LilleLilleFrance
- Faculté de Médecine de LilleUniversité de LilleLilleFrance
- Institut Pasteur de LilleInserm U1167LilleFrance
| | - Christophe Bauters
- Institut Cœur PoumonCentre Hospitalier Universitaire de LilleLilleFrance
- Faculté de Médecine de LilleUniversité de LilleLilleFrance
- Institut Pasteur de LilleInserm U1167LilleFrance
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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] [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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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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Casolla B, Moulin S, Kyheng M, Hénon H, Labreuche J, Leys D, Bauters C, Cordonnier C. Five-Year Risk of Major Ischemic and Hemorrhagic Events After Intracerebral Hemorrhage. Stroke 2019; 50:1100-1107. [DOI: 10.1161/strokeaha.118.024449] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Barbara Casolla
- From the Univ. Lille, Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, Department of Neurology, Lille, France (B.C., S.M., H.H., D.L., C.C.)
| | - Solène Moulin
- From the Univ. Lille, Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, Department of Neurology, Lille, France (B.C., S.M., H.H., D.L., C.C.)
| | - Maéva Kyheng
- Univ. Lille, CHU Lille, EA 2694 Santé Publique: épidémiologie et Qualité des Soins, Lille, France (M.K., J.L.)
| | - Hilde Hénon
- From the Univ. Lille, Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, Department of Neurology, Lille, France (B.C., S.M., H.H., D.L., C.C.)
| | - Julien Labreuche
- Univ. Lille, CHU Lille, EA 2694 Santé Publique: épidémiologie et Qualité des Soins, Lille, France (M.K., J.L.)
| | - Didier Leys
- From the Univ. Lille, Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, Department of Neurology, Lille, France (B.C., S.M., H.H., D.L., C.C.)
| | - Christophe Bauters
- Univ. Lille, Inserm U1167, Institut Pasteur et CHU Lille, Lille, France (C.B.)
| | - Charlotte Cordonnier
- From the Univ. Lille, Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, Department of Neurology, Lille, France (B.C., S.M., H.H., D.L., C.C.)
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