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Guedeney P, Farjat-Pasos JI, Asslo G, Roule V, Beygui F, Hermida A, Gabrion P, Leborgne L, Houde C, Huang F, Lattuca B, Leclercq F, Mesnier J, Abtan J, Rouanet S, Hammoudi N, Collet JP, Zeitouni M, Silvain J, Montalescot G, Rodés-Cabau J. Impact of the antiplatelet strategy following patent foramen ovale percutaneous closure. Eur Heart J Cardiovasc Pharmacother 2023; 9:601-607. [PMID: 36963773 DOI: 10.1093/ehjcvp/pvad023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/01/2023] [Accepted: 03/23/2023] [Indexed: 03/26/2023]
Abstract
AIMS Temporary dual antiplatelet therapy (DAPT) is recommended following patent foramen ovale (PFO) percutaneous closure although its benefit, compared to single antiplatelet therapy (SAPT), has not been demonstrated in this setting. We aimed at assessing outcomes following PFO closure according to the antiplatelet strategy at discharge. METHODS AND RESULTS The ambispective AIR-FORCE cohort included consecutive patients from seven centres in France and Canada undergoing PFO closure and discharged without anticoagulation. Patients treated in French and Canadian centres were mostly discharged with DAPT and SAPT, respectively. The primary endpoint was the composite of death, stroke, transient ischaemic attack, peripheral embolism, myocardial infarction, or BARC type ≥2 bleeding with up to 5 years of follow-up. The impact of the antiplatelet strategy on outcomes was evaluated with a marginal Cox model (cluster analyses per country) with inverse probability weighting according to propensity score. A total of 1532 patients (42.2% female, median age: 49 [40-57] years) were included from 2001 to 2022, of whom 599 (39.1%) were discharged with SAPT and 933 (60.9%) with DAPT, for ≤3 months in 894/923 (96.9%) cases. After a median follow-up of 2.4 [1.1-4.4] years, a total of 58 events were observed. In the weighted analysis, the rate of the primary endpoint up to 5 years was 7.8% in the SAPT strategy and 7.3% in the DAPT strategy (weighted hazard ratio 1.04, 95% confidence interval 0.59-1.83). CONCLUSION The antiplatelet strategy following PFO closure did not seem to impact clinical outcomes, thus challenging the current recommendations of temporary DAPT.
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Affiliation(s)
- Paul Guedeney
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de cardiologie (AP-HP), Paris, France
| | | | - Gabriel Asslo
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de cardiologie (AP-HP), Paris, France
| | - Vincent Roule
- Service de Cardiologie, ACTION Study Group, Centre Hospitalier Universitaire (CHU) de Caen Normandie, Normandie Univ, INSERM UMRS 1237, GIP Cyceron, Caen, France
| | - Farzin Beygui
- Service de Cardiologie, ACTION Study Group, Centre Hospitalier Universitaire (CHU) de Caen Normandie, Normandie Univ, INSERM UMRS 1237, GIP Cyceron, Caen, France
| | - Alexis Hermida
- Cardiac Arrhythmia Service, Amiens-Picardie University Hospital, Amiens, France
| | - Paul Gabrion
- Cardiac Arrhythmia Service, Amiens-Picardie University Hospital, Amiens, France
| | - Laurent Leborgne
- Cardiac Arrhythmia Service, Amiens-Picardie University Hospital, Amiens, France
| | - Christine Houde
- Centre Hospitalier Universitaire de Québec, Quebec City, Quebec, Canada
| | - Florent Huang
- Service de Cardiologie, Hôpital Foch, Suresnes, France
| | - Benoit Lattuca
- ACTION Study Group, Cardiology Department, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Florence Leclercq
- Department of Cardiology, Arnaud de Villeneuve University Hospital, Montpellier, France
| | - Jules Mesnier
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
- FACT (French Alliance for Cardiovascular Clinical Trials), Université de Paris, INSERM U-1148, Hôpital Bichat (Assistance Publique-Hôpitaux de Paris), Paris, France
| | - Jérémie Abtan
- FACT (French Alliance for Cardiovascular Clinical Trials), Université de Paris, INSERM U-1148, Hôpital Bichat (Assistance Publique-Hôpitaux de Paris), Paris, France
| | - Stéphanie Rouanet
- Statistician Unit, StatEthic, ACTION Study Group, Levallois-Perret, France
| | - Nadjib Hammoudi
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de cardiologie (AP-HP), Paris, France
| | - Jean-Philippe Collet
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de cardiologie (AP-HP), Paris, France
| | - Michel Zeitouni
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de cardiologie (AP-HP), Paris, France
| | - Johanne Silvain
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de cardiologie (AP-HP), Paris, France
| | - Gilles Montalescot
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de cardiologie (AP-HP), Paris, France
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
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Mesnier J, Suc G, Sayah N, Abtan J, Steg PG. Relevance of medical information obtained from ChatGPT: Are large language models friends or foes? Arch Cardiovasc Dis 2023; 116:485-486. [PMID: 37718185 DOI: 10.1016/j.acvd.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/30/2023] [Accepted: 07/31/2023] [Indexed: 09/19/2023]
Affiliation(s)
- Jules Mesnier
- Hôpital Bichat, Assistance publique-Hôpitaux de Paris, Inserm U-1148, université de Paris, 46, rue Henri-Huchard, 75018 Paris, France
| | - Gaspard Suc
- Hôpital Bichat, Assistance publique-Hôpitaux de Paris, Inserm U-1148, université de Paris, 46, rue Henri-Huchard, 75018 Paris, France
| | - Neila Sayah
- Hôpital Bichat, Assistance publique-Hôpitaux de Paris, Inserm U-1148, université de Paris, 46, rue Henri-Huchard, 75018 Paris, France
| | - Jérémie Abtan
- Hôpital Bichat, Assistance publique-Hôpitaux de Paris, Inserm U-1148, université de Paris, 46, rue Henri-Huchard, 75018 Paris, France
| | - Philippe Gabriel Steg
- Hôpital Bichat, Assistance publique-Hôpitaux de Paris, Inserm U-1148, université de Paris, 46, rue Henri-Huchard, 75018 Paris, France.
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Fuchs A, Urena M, Chong-Nguyen C, Kikoïne J, Brochet E, Abtan J, Fischer Q, Ducrocq G, Vahanian A, Iung B, Himbert D. Valve-in-Valve and Valve-in-Ring Transcatheter Mitral Valve Implantation in Young Women Contemplating Pregnancy. Circ Cardiovasc Interv 2020; 13:e009579. [DOI: 10.1161/circinterventions.120.009579] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Transcatheter mitral valve implantation (TMVI) is emerging as an alternative to surgical mitral valve replacement in selected high-risk patients. Delaying definitive mechanical mitral valve replacement and the constraints of anticoagulation thanks to TMVI may be an attractive option in young women contemplating pregnancy and suffering from failure of mitral bioprosthesis or annuloplasty. The aim of the study was to evaluate the possibility, safety, and outcomes of pregnancy after TMVI in this population.
Methods:
From 2013 to 2019, 12 young women contemplating pregnancy underwent transseptal valve-in-valve or valve-in-ring TMVI using the Edwards SAPIEN XT/3 valves and were prospectively followed up at 1 month, 6 months, 1 year, and yearly thereafter.
Results:
Mean age of the patients was 30±6 years. Bioprosthesis degeneration was observed in 7 cases and annuloplasty failure in 5. Three valve-in-ring patients required the implantation of a second valve, which led to an overall procedural success rate of 75%. One delayed left ventricular outflow tract obstruction required elective surgical mitral valve replacement. At 6 months/1 year, 83% of the patients were in New York Heart Association classes I/II. Mitral regurgitation was ≤2+ in all the cases and mean gradient was 7±2 mm Hg. Four patients could complete 6 full-term pregnancies. One symptomatic thrombosis occurred and resolved under aspirin and anticoagulation therapy. All others pregnancies were uneventful. Predelivery mean gradient was 11 mm Hg, and systolic pulmonary artery pressure was 32 mm Hg. There were 4 vaginal deliveries and 2 cesarians. Newborns were alive and healthy. At last follow-up, there was no death, and 3 patients required elective surgical mitral valve replacement at 6- to 54-month follow-up.
Conclusions:
Our study suggests that, in young women, transseptal TMVI to treat failing bioprostheses may result in good short-term outcomes that allow uneventful pregnancies. The results are less favorable in women with failed annuloplasty rings.
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Affiliation(s)
- Adeline Fuchs
- Department of Cardiology, Bichat Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, France (A.F., M.U., C.C.-N., J.K., E.B., J.A., Q.F., G.D., B.I., D.H.)
| | - Marina Urena
- Department of Cardiology, Bichat Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, France (A.F., M.U., C.C.-N., J.K., E.B., J.A., Q.F., G.D., B.I., D.H.)
- University of Paris, France (M.U., C.C.-N., Q.F., G.D., B.I.)
- INSERM U 1148, France (M.U., C.C.-N., G.D., A.V., B.I., D.H.)
| | - Caroline Chong-Nguyen
- Department of Cardiology, Bichat Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, France (A.F., M.U., C.C.-N., J.K., E.B., J.A., Q.F., G.D., B.I., D.H.)
- University of Paris, France (M.U., C.C.-N., Q.F., G.D., B.I.)
- INSERM U 1148, France (M.U., C.C.-N., G.D., A.V., B.I., D.H.)
| | - John Kikoïne
- Department of Cardiology, Bichat Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, France (A.F., M.U., C.C.-N., J.K., E.B., J.A., Q.F., G.D., B.I., D.H.)
| | - Eric Brochet
- Department of Cardiology, Bichat Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, France (A.F., M.U., C.C.-N., J.K., E.B., J.A., Q.F., G.D., B.I., D.H.)
| | - Jérémie Abtan
- Department of Cardiology, Bichat Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, France (A.F., M.U., C.C.-N., J.K., E.B., J.A., Q.F., G.D., B.I., D.H.)
| | - Quentin Fischer
- Department of Cardiology, Bichat Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, France (A.F., M.U., C.C.-N., J.K., E.B., J.A., Q.F., G.D., B.I., D.H.)
- University of Paris, France (M.U., C.C.-N., Q.F., G.D., B.I.)
| | - Grégory Ducrocq
- Department of Cardiology, Bichat Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, France (A.F., M.U., C.C.-N., J.K., E.B., J.A., Q.F., G.D., B.I., D.H.)
- University of Paris, France (M.U., C.C.-N., Q.F., G.D., B.I.)
- INSERM U 1148, France (M.U., C.C.-N., G.D., A.V., B.I., D.H.)
| | - Alec Vahanian
- INSERM U 1148, France (M.U., C.C.-N., G.D., A.V., B.I., D.H.)
| | - Bernard Iung
- Department of Cardiology, Bichat Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, France (A.F., M.U., C.C.-N., J.K., E.B., J.A., Q.F., G.D., B.I., D.H.)
- University of Paris, France (M.U., C.C.-N., Q.F., G.D., B.I.)
- INSERM U 1148, France (M.U., C.C.-N., G.D., A.V., B.I., D.H.)
| | - Dominique Himbert
- Department of Cardiology, Bichat Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, France (A.F., M.U., C.C.-N., J.K., E.B., J.A., Q.F., G.D., B.I., D.H.)
- INSERM U 1148, France (M.U., C.C.-N., G.D., A.V., B.I., D.H.)
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Desroche LM, Milleron O, Safar B, Ou P, Garbarz E, Lavie-Badie Y, Abtan J, Millischer D, Pathak A, Durand-Zaleski I, Cattan S, Ronchard T, Jondeau G. Cardiovascular Magnetic Resonance May Avoid Unnecessary Coronary Angiography in Patients With Unexplained Left Ventricular Systolic Dysfunction: A Retrospective Diagnostic Pilot Study. J Card Fail 2020; 26:1067-1074. [PMID: 32942010 DOI: 10.1016/j.cardfail.2020.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 09/07/2020] [Accepted: 09/10/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Coronary angiography (CA) is usually performed in patients with reduced left ventricular ejection fraction (LVEF) to search ischemic cardiomyopathy. Our aim was to examine the agreement between CA and cardiovascular magnetic resonance (CMR) imaging among a cohort of patients with unexplained reduced LVEF, and estimate what would have been the consequences of using CMR imaging as the first-line examination. METHODS Three hundred five patients with unexplained reduced LVEF of ≤45% who underwent both CA and CMR imaging were retrospectively registered. Patients were classified as CMR+ or CMR- according to presence or absence of myocardial ischemic scar, and classified CA+ or CA- according to presence or absence of significant coronary artery disease. RESULTS CMR+ (n = 89) included all 54 CA+ patients, except 2 with distal coronary artery disease in whom no revascularization was proposed. Among the 247 CA- patients, 15% were CMR+. CMR imaging had 96% sensitivity, 85% specificity, 99% negative predictive value, and 58% positive predictive value for detecting CA+ patients. Revascularization was performed in 6.5% of the patients (all CMR+). Performing CA only for CMR+ patients would have decreased the number of CAs by 71%. CONCLUSIONS In reduced LVEF, performing CA only in CMR+ patients may significantly decrease the number of unnecessary CAs performed, without missing any patients requiring revascularization.
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Affiliation(s)
- Louis-Marie Desroche
- Department of Cardiology, Hôpital Bichat, Paris, France; Department of Cardiology, Hôpital Montfermeil, Montfermeil, France.
| | | | - Benjamin Safar
- Department of Cardiology, Hôpital Montfermeil, Montfermeil, France
| | - Phalla Ou
- Department of Cardiology, Hôpital Bichat, Paris, France; Faculté Denis Diderot, INSERM U1148 LVTS, France
| | - Eric Garbarz
- Department of Cardiology, Hôpital Bichat, Paris, France
| | - Yoan Lavie-Badie
- Department of Cardiology, Hôpital Montfermeil, Montfermeil, France
| | - Jérémie Abtan
- Department of Cardiology, Hôpital Bichat, Paris, France
| | | | - Atul Pathak
- Department of Cardiology, Clinique Pasteur, Toulouse, France
| | | | - Simon Cattan
- Department of Cardiology, Hôpital Montfermeil, Montfermeil, France
| | - Thibault Ronchard
- Department of Cardiology, Felix-Guyon University Hospital, Saint-Denis-de-La-Réunion, France
| | - Guillaume Jondeau
- Department of Cardiology, Hôpital Bichat, Paris, France; Faculté Denis Diderot, INSERM U1148 LVTS, France
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5
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Gautier A, Urena M, Chong-Nguyen C, Fischer Q, Abtan J, Carrasco JL, Brochet E, Iung B, Himbert D. Outcomes of Transcatheter Aortic Valve Implantation in Patients Receiving Chronic Systemic Corticosteroid Treatment. Am J Cardiol 2020; 130:108-114. [PMID: 32653084 DOI: 10.1016/j.amjcard.2020.06.021] [Citation(s) in RCA: 2] [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: 04/08/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 01/08/2023]
Abstract
The aim of this study was to describe the effects of chronic systemic corticosteroid treatment (SCT) on early and late outcomes after transcatheter aortic valve implantation (TAVI). From October 2006 to November 2018, 1,299 patients underwent TAVI in our institution. Among them, 48 (3.7%) received chronic SCT at the time of procedure (SCT group). They were more frequently women (p = 0.08) and needed more often dialysis (p = 0.002). All other baseline characteristics were similar between both groups. At 30 days, there was no difference on mortality. However, after adjustment, the SCT group had more major vascular complications: 16.7% versus 7.4%, hazard ratio (HR) 2.52 (95% confidence interval [CI] 1.14 to 5.9, p = 0.023), major or life-threatening bleedings: 22.9% versus 12.4%, HR 2.02 (95% CI 1.00 to 4.08, p = 0.05), and tamponades: 8.3% versus 2.4%, HR 4.05 (95% CI 1.35 to 12.15, p <0.001) than the non-SCT group. One-year all-cause mortality was significantly higher in the SCT than in the non-SCT group (37.5% vs 12.5%, p <0.0001). Multivariate analysis confirmed that SCT use was an independent predictor of 1-year mortality (HR 2.29, 95% CI 1.16 to 4.50, p = 0.017). In conclusion, chronic use of SCT significantly increases the rates of early vascular complications, major or life-threatening bleedings and tamponade and is an independent predictor of 1-year all-cause mortality after TAVI.
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Darmon A, Elbez Y, Bhatt DL, Abtan J, Mas JL, Cacoub P, Montalescot G, Billaut-Laden I, Ducrocq G, Steg PG. Clinical characteristics and outcomes of COMPASS eligible patients in France. An analysis from the REACH Registry. Ann Cardiol Angeiol (Paris) 2020; 69:158-166. [PMID: 32778388 DOI: 10.1016/j.ancard.2020.07.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/21/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Following the publication of the COMPASS trial, the European Medicines Agency has approved a regimen of combination of rivaroxaban 2.5mg twice daily and a daily dose of 75-100mg acetylsalicylic acid (ASA) for patients with coronary artery disease (CAD) or symptomatic peripheral artery disease (PAD) at high risk of ischemic events. However, the applicability of such a therapeutic strategy in France is currently unknown. AIMS To describe the proportion of patients eligible to COMPASS in France, their baseline clinical characteristics and the rate of major adverse cardiovascular events, using the REACH registry. METHODS From the the REduction of Atherothrombosis for Continued Health (REACH) registry database, a large international registry of patients with, or at risk, of atherothrombosis, we analyzed patients included in France with either established CAD and/or PAD and fulfilling the inclusion and exclusion criteria of the COMPASS trial. The ischemic outcome was a composite of cardiovascular (CV) death, myocardial infarction (MI), or stroke, and serious bleeding were defined as haemorrhagic stroke or bleeding leading to hospitalization or transfusion. RESULTS Among more than 65000 patients enrolled in REACH, 2.012 patients were evaluable and enrolled in France. Among them, 1194 patients (59.3%) were eligible to COMPASS. The main reasons for exclusion of the COMPASS trial, were high bleeding risk (59.1%), anticoagulant use (43.4%), requirement for dual antiplatelet therapy within 1 year of an ACS or PCI (24.7%). In the "COMPASS eligible population", the rate of MACE (CV, MI and stroke) at 4 years follow-up was 13.4% [11.3-15.8], and serious bleeding was 2.5% at 4 years [1.6-3.4]. Patients with polyvascular disease (n=219) had the highest rate of MACE, compared with patients with CAD only and PAD only (19.1% [13.9-26.1] vs. 11.6% [9.1-14.8] vs 13.2% [9.2-18.8], P<0.0001, respectively). CONCLUSION The COMPASS therapeutic strategy in France appears to be applicable to more than half of CAD or PAD patients. This population appears at high residual risk of atherothrombotic events, and patients with polyvascular disease experienced the highest rate of events.
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Affiliation(s)
- A Darmon
- FACT, French Alliance for Cardiovascular Trials, Département Hospitalo-Universitaire FIRE, Hôpital Bichat, Paris, France; Université de Paris, assistance publique-Hopitaux de Paris, Paris, France
| | - Y Elbez
- FACT, French Alliance for Cardiovascular Trials, Département Hospitalo-Universitaire FIRE, Hôpital Bichat, Paris, France
| | - D L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, USA
| | - J Abtan
- FACT, French Alliance for Cardiovascular Trials, Département Hospitalo-Universitaire FIRE, Hôpital Bichat, Paris, France; Université de Paris, assistance publique-Hopitaux de Paris, Paris, France
| | - J L Mas
- Department of Neurology, Sainte-Anne Hospital, Paris Descartes University, Inserm U1266, Paris, France
| | - P Cacoub
- Sorbonne Universités, UPMC Université Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), 75005 Paris, France; INSERM, UMR_S 959, 75013 Paris, France; CNRS, FRE3632, 75005 Paris, France; Department of Internal Medicine and Clinical Immunology, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - G Montalescot
- ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, Paris, France
| | | | - G Ducrocq
- FACT, French Alliance for Cardiovascular Trials, Département Hospitalo-Universitaire FIRE, Hôpital Bichat, Paris, France; INSERM U1148, LVTS, Paris, France; Université de Paris, assistance publique-Hopitaux de Paris, Paris, France.
| | - P G Steg
- FACT, French Alliance for Cardiovascular Trials, Département Hospitalo-Universitaire FIRE, Hôpital Bichat, Paris, France; INSERM U1148, LVTS, Paris, France; Imperial College, Royal Brompton Hospital, London, United Kingdom; Université de Paris, assistance publique-Hopitaux de Paris, Paris, France
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7
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Hyafil F, Chequer R, Sorbets E, Estellat C, Ducrocq G, Rouzet F, Alfaiate T, Regaieg H, Abtan J, Leygnac S, Milliner M, Imbert L, Burg S, Ben Azzouna R, Potier L, Laouénan C, Quintin C, Roussel R, Hartemann A, Montalescot G, Marie PY, Steg G, Le Guludec D. Head-to-head comparison of the diagnostic performances of Rubidium-PET and SPECT with CZT camera for the detection of myocardial ischemia in a population of women and overweight individuals. J Nucl Cardiol 2020; 27:755-768. [PMID: 30574676 DOI: 10.1007/s12350-018-01557-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 11/11/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND The aim of this study was to compare the diagnostic performances for the detection of myocardial ischemia of 82-Rb-PET-MPS and 99m-Tc-SPECT-MPS in overweight individuals and women. METHODS AND RESULTS Men with BMI ≥ 25 and women referred for MPS were considered for inclusion. All individuals underwent 99m-Tc-SPECT-MPS with CZT cameras and 82-Rb-PET-MPS in 3D-mode. Individuals with at least one positive MPS were referred for coronary angiography (CA) with FFR measurements. A criterion for positivity was a composite endpoint including significant stenosis on CA or, in the absence of CA, the occurrence of acute coronary event during the following year. 313 patients (46% women) with mean BMI of 31.8 ± 6.5 were included. Sensitivity for the detection of myocardial ischemia was higher with 82-Rb-PET-MPS compared with 99m-Tc-SPECT-MPS (85% vs. 57%, P < .05); specificity was equally high with both imaging techniques (93% vs. 94%, P > .05). 82-Rb-PET allowed for a more accurate detection of patients with a high-risk coronary artery disease (HR-CAD) than 99m-Tc-SPECT-MPS (AUC = 0.86 vs. 0.75, respectively; P = .04). CONCLUSIONS In women and overweight individuals, 82-Rb-PET-MPS provides higher sensitivity for the detection of myocardial ischemia than 99m-Tc-SPECT-MPS thanks to a better image quality and an improved detection of HR-CAD.
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Affiliation(s)
- Fabien Hyafil
- Department of Nuclear Medicine, Bichat University Hospital, AP-HP, University Diderot, 75018, Paris, France.
- INSERM, U-1148, DHU FIRE, University Diderot, 75018, Paris, France.
| | - Renata Chequer
- Department of Nuclear Medicine, Bichat University Hospital, AP-HP, University Diderot, 75018, Paris, France
| | - Emmanuel Sorbets
- Department of Cardiology, Avicenne University Hospital, AP-HP, University Paris 13, 9300, Bobigny, France
| | - Candice Estellat
- Département de Biostatistiques, Hôpital Pitié-Salpêtrière, AP-HP, Santé Publique et Informatique Médicale, 75013, Paris, France
- INSERM, CIC-EC 1425, ECEVE UMR 1123, 75018, Paris, France
| | - Gregory Ducrocq
- INSERM, U-1148, DHU FIRE, University Diderot, 75018, Paris, France
- Department of Cardiology, Bichat University Hospital, AP-HP, 75018, Paris, France
- French Alliance for Cardiovascular Trials, and F-CRIN Network, Paris, France
| | - François Rouzet
- Department of Nuclear Medicine, Bichat University Hospital, AP-HP, University Diderot, 75018, Paris, France
- INSERM, U-1148, DHU FIRE, University Diderot, 75018, Paris, France
| | - Toni Alfaiate
- Département d'Epidémiologie, Hôpital Bichat, AP-HP, Biostatistique et Recherche Clinique, 75018, Paris, France
| | - Hamza Regaieg
- Department of Nuclear Medicine, Bichat University Hospital, AP-HP, University Diderot, 75018, Paris, France
| | - Jérémie Abtan
- Department of Cardiology, Bichat University Hospital, AP-HP, 75018, Paris, France
- French Alliance for Cardiovascular Trials, and F-CRIN Network, Paris, France
| | - Sébastien Leygnac
- Department of Nuclear Medicine, Bichat University Hospital, AP-HP, University Diderot, 75018, Paris, France
- INSERM, U-1148, DHU FIRE, University Diderot, 75018, Paris, France
| | - Milan Milliner
- Department of Nuclear Medicine, Bichat University Hospital, AP-HP, University Diderot, 75018, Paris, France
- INSERM, U-1148, DHU FIRE, University Diderot, 75018, Paris, France
| | - Laetitia Imbert
- Department of Nuclear Medicine, Brambois University Hospital, Lorraine University, 54500, Vandœuvre-Lès-Nancy, France
| | - Samuel Burg
- Department of Nuclear Medicine, Bichat University Hospital, AP-HP, University Diderot, 75018, Paris, France
- INSERM, U-1148, DHU FIRE, University Diderot, 75018, Paris, France
| | - Rana Ben Azzouna
- Department of Nuclear Medicine, Bichat University Hospital, AP-HP, University Diderot, 75018, Paris, France
- INSERM, U-1148, DHU FIRE, University Diderot, 75018, Paris, France
| | - Louis Potier
- Department of Diabetology, DHU FIRE, Bichat University Hospital, AP-HP, University Diderot, 75018, Paris, France
| | - Cédric Laouénan
- Département d'Epidémiologie, Hôpital Bichat, AP-HP, Biostatistique et Recherche Clinique, 75018, Paris, France
| | - Caroline Quintin
- Département d'Epidémiologie, Hôpital Bichat, AP-HP, Biostatistique et Recherche Clinique, 75018, Paris, France
| | - Ronan Roussel
- Department of Diabetology, DHU FIRE, Bichat University Hospital, AP-HP, University Diderot, 75018, Paris, France
| | - Agnès Hartemann
- Department of Diabetology, Pitié-Salpétriêre University Hospital, AP-HP, Sorbonne University Paris 6, 75006, Paris, France
| | - Gilles Montalescot
- ACTION Study Group, Department of Cardiology, Pitié-Salpétriêre, Sorbonne Université-Paris 6, 75006, Paris, France
| | - Pierre-Yves Marie
- Department of Nuclear Medicine, Brambois University Hospital, Lorraine University, 54500, Vandœuvre-Lès-Nancy, France
| | - Gabriel Steg
- INSERM, U-1148, DHU FIRE, University Diderot, 75018, Paris, France
- Department of Cardiology, Bichat University Hospital, AP-HP, 75018, Paris, France
- French Alliance for Cardiovascular Trials, and F-CRIN Network, Paris, France
| | - Dominique Le Guludec
- Department of Nuclear Medicine, Bichat University Hospital, AP-HP, University Diderot, 75018, Paris, France
- INSERM, U-1148, DHU FIRE, University Diderot, 75018, Paris, France
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Amarenco P, Kim JS, Labreuche J, Charles H, Abtan J, Béjot Y, Cabrejo L, Cha JK, Ducrocq G, Giroud M, Guidoux C, Hobeanu C, Kim YJ, Lapergue B, Lavallée PC, Lee BC, Lee KB, Leys D, Mahagne MH, Meseguer E, Nighoghossian N, Pico F, Samson Y, Sibon I, Steg PG, Sung SM, Touboul PJ, Touzé E, Varenne O, Vicaut É, Yelles N, Bruckert E. A Comparison of Two LDL Cholesterol Targets after Ischemic Stroke. N Engl J Med 2020; 382:9. [PMID: 31738483 DOI: 10.1056/nejmoa1910355] [Citation(s) in RCA: 264] [Impact Index Per Article: 66.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The use of intensive lipid-lowering therapy by means of statin medications is recommended after transient ischemic attack (TIA) and ischemic stroke of atherosclerotic origin. The target level for low-density lipoprotein (LDL) cholesterol to reduce cardiovascular events after stroke has not been well studied. METHODS In this parallel-group trial conducted in France and South Korea, we randomly assigned patients with ischemic stroke in the previous 3 months or a TIA within the previous 15 days to a target LDL cholesterol level of less than 70 mg per deciliter (1.8 mmol per liter) (lower-target group) or to a target range of 90 mg to 110 mg per deciliter (2.3 to 2.8 mmol per liter) (higher-target group). All the patients had evidence of cerebrovascular or coronary-artery atherosclerosis and received a statin, ezetimibe, or both. The composite primary end point of major cardiovascular events included ischemic stroke, myocardial infarction, new symptoms leading to urgent coronary or carotid revascularization, or death from cardiovascular causes. RESULTS A total of 2860 patients were enrolled and followed for a median of 3.5 years; 1430 were assigned to each LDL cholesterol target group. The mean LDL cholesterol level at baseline was 135 mg per deciliter (3.5 mmol per liter), and the mean achieved LDL cholesterol level was 65 mg per deciliter (1.7 mmol per liter) in the lower-target group and 96 mg per deciliter (2.5 mmol per liter) in the higher-target group. The trial was stopped for administrative reasons after 277 of an anticipated 385 end-point events had occurred. The composite primary end point occurred in 121 patients (8.5%) in the lower-target group and in 156 (10.9%) in the higher-target group (adjusted hazard ratio, 0.78; 95% confidence interval, 0.61 to 0.98; P = 0.04). The incidence of intracranial hemorrhage and newly diagnosed diabetes did not differ significantly between the two groups. CONCLUSIONS After an ischemic stroke or TIA with evidence of atherosclerosis, patients who had a target LDL cholesterol level of less than 70 mg per deciliter had a lower risk of subsequent cardiovascular events than those who had a target range of 90 mg to 110 mg per deciliter. (Funded by the French Ministry of Health and others; Treat Stroke to Target ClinicalTrials.gov number, NCT01252875.).
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Affiliation(s)
- Pierre Amarenco
- From the Department of Neurology and Stroke Center (P.A., J.L., H.C., L.C., C.G., C.H., P.C.L., E.M., P.-J.T.) and the Department of Cardiology (J.A., G.D., P.G.S.), Assistance Publique-Hôpitaux de Paris (APHP), Bichat Hospital, Laboratory for Vascular Translational Science, INSERM Unité 1148, Département Hospitalo Universitaire-Fibrose Inflammation Remodelage, and the Department of Cardiology, Cochin Hospital (O.V.), University of Paris, the Department of Neurology, Foch Hospital (B.L.), Urgences Cerebrovasculaires (Y.S.), Centre de Pharmacoépidémiologie de l'APHP (N.Y.), and the Department of Endocrinology (E.B.), Hôpital de la Pitié-Salpêtrière, the Department of Biostatistics, APHP, Université Paris Diderot, Sorbonne Paris Cité, Fernand Widal Hospital (É.V.), and the Department of Endocrinology, Sorbonne University (E.B.), Paris, Équipe d'Accueil EA2694, Santé Publique: Epidémiologie et Qualité des Soins (J.L.), and the Department of Neurology, Stroke Unit, University of Lille, Centre Hospitalier Universitaire (CHU) de Lille (D.L.), Lille, the Department of Neurology, University Hospital of Dijon, University of Burgundy, Dijon (Y.B., M.G.), the Stroke Unit, Pasteur Hospital, Nice (M.-H.M.), Hospices Civils de Lyon, Department of Neurology and Stroke Center, Lyon University, Lyon (N.N.), the Department of Neurology, Versailles University Hospital, Versailles (F.P.), the Department of Vascular Neurology, Pellegrin Tripode Hospital, University of Bordeaux, Bordeaux (I.S.), and the Department of Neurology, Université Caen Normandie, CHU Caen Normandie, INSERM Unité 1237, Cyceron, Caen (E.T.) - all in France; Asan Medical Center (J.S.K.), the Department of Neurology, Eunpyeong St. Mary's Hospital, Catholic University of Korea (Y.-J.K.), and the Department of Neurology, Soonchunhyang University College of Medicine (K.-B.L.), Seoul, Dong-a University Hospital (J.-K.C.) and the Department of Neurology and Stroke Center, Pusan National University Hospital (S.M.S.), Busan, and the Department of Neurology, Hallym University Sacred Heart Hospital, Anyang (B.-C.L.) - all in South Korea; and the National Heart and Lung Institute-Imperial College and the Institute of Cardiovascular Medicine and Science-Royal Brompton Hospital, London (P.G.S.)
| | - Jong S Kim
- From the Department of Neurology and Stroke Center (P.A., J.L., H.C., L.C., C.G., C.H., P.C.L., E.M., P.-J.T.) and the Department of Cardiology (J.A., G.D., P.G.S.), Assistance Publique-Hôpitaux de Paris (APHP), Bichat Hospital, Laboratory for Vascular Translational Science, INSERM Unité 1148, Département Hospitalo Universitaire-Fibrose Inflammation Remodelage, and the Department of Cardiology, Cochin Hospital (O.V.), University of Paris, the Department of Neurology, Foch Hospital (B.L.), Urgences Cerebrovasculaires (Y.S.), Centre de Pharmacoépidémiologie de l'APHP (N.Y.), and the Department of Endocrinology (E.B.), Hôpital de la Pitié-Salpêtrière, the Department of Biostatistics, APHP, Université Paris Diderot, Sorbonne Paris Cité, Fernand Widal Hospital (É.V.), and the Department of Endocrinology, Sorbonne University (E.B.), Paris, Équipe d'Accueil EA2694, Santé Publique: Epidémiologie et Qualité des Soins (J.L.), and the Department of Neurology, Stroke Unit, University of Lille, Centre Hospitalier Universitaire (CHU) de Lille (D.L.), Lille, the Department of Neurology, University Hospital of Dijon, University of Burgundy, Dijon (Y.B., M.G.), the Stroke Unit, Pasteur Hospital, Nice (M.-H.M.), Hospices Civils de Lyon, Department of Neurology and Stroke Center, Lyon University, Lyon (N.N.), the Department of Neurology, Versailles University Hospital, Versailles (F.P.), the Department of Vascular Neurology, Pellegrin Tripode Hospital, University of Bordeaux, Bordeaux (I.S.), and the Department of Neurology, Université Caen Normandie, CHU Caen Normandie, INSERM Unité 1237, Cyceron, Caen (E.T.) - all in France; Asan Medical Center (J.S.K.), the Department of Neurology, Eunpyeong St. Mary's Hospital, Catholic University of Korea (Y.-J.K.), and the Department of Neurology, Soonchunhyang University College of Medicine (K.-B.L.), Seoul, Dong-a University Hospital (J.-K.C.) and the Department of Neurology and Stroke Center, Pusan National University Hospital (S.M.S.), Busan, and the Department of Neurology, Hallym University Sacred Heart Hospital, Anyang (B.-C.L.) - all in South Korea; and the National Heart and Lung Institute-Imperial College and the Institute of Cardiovascular Medicine and Science-Royal Brompton Hospital, London (P.G.S.)
| | - Julien Labreuche
- From the Department of Neurology and Stroke Center (P.A., J.L., H.C., L.C., C.G., C.H., P.C.L., E.M., P.-J.T.) and the Department of Cardiology (J.A., G.D., P.G.S.), Assistance Publique-Hôpitaux de Paris (APHP), Bichat Hospital, Laboratory for Vascular Translational Science, INSERM Unité 1148, Département Hospitalo Universitaire-Fibrose Inflammation Remodelage, and the Department of Cardiology, Cochin Hospital (O.V.), University of Paris, the Department of Neurology, Foch Hospital (B.L.), Urgences Cerebrovasculaires (Y.S.), Centre de Pharmacoépidémiologie de l'APHP (N.Y.), and the Department of Endocrinology (E.B.), Hôpital de la Pitié-Salpêtrière, the Department of Biostatistics, APHP, Université Paris Diderot, Sorbonne Paris Cité, Fernand Widal Hospital (É.V.), and the Department of Endocrinology, Sorbonne University (E.B.), Paris, Équipe d'Accueil EA2694, Santé Publique: Epidémiologie et Qualité des Soins (J.L.), and the Department of Neurology, Stroke Unit, University of Lille, Centre Hospitalier Universitaire (CHU) de Lille (D.L.), Lille, the Department of Neurology, University Hospital of Dijon, University of Burgundy, Dijon (Y.B., M.G.), the Stroke Unit, Pasteur Hospital, Nice (M.-H.M.), Hospices Civils de Lyon, Department of Neurology and Stroke Center, Lyon University, Lyon (N.N.), the Department of Neurology, Versailles University Hospital, Versailles (F.P.), the Department of Vascular Neurology, Pellegrin Tripode Hospital, University of Bordeaux, Bordeaux (I.S.), and the Department of Neurology, Université Caen Normandie, CHU Caen Normandie, INSERM Unité 1237, Cyceron, Caen (E.T.) - all in France; Asan Medical Center (J.S.K.), the Department of Neurology, Eunpyeong St. Mary's Hospital, Catholic University of Korea (Y.-J.K.), and the Department of Neurology, Soonchunhyang University College of Medicine (K.-B.L.), Seoul, Dong-a University Hospital (J.-K.C.) and the Department of Neurology and Stroke Center, Pusan National University Hospital (S.M.S.), Busan, and the Department of Neurology, Hallym University Sacred Heart Hospital, Anyang (B.-C.L.) - all in South Korea; and the National Heart and Lung Institute-Imperial College and the Institute of Cardiovascular Medicine and Science-Royal Brompton Hospital, London (P.G.S.)
| | - Hugo Charles
- From the Department of Neurology and Stroke Center (P.A., J.L., H.C., L.C., C.G., C.H., P.C.L., E.M., P.-J.T.) and the Department of Cardiology (J.A., G.D., P.G.S.), Assistance Publique-Hôpitaux de Paris (APHP), Bichat Hospital, Laboratory for Vascular Translational Science, INSERM Unité 1148, Département Hospitalo Universitaire-Fibrose Inflammation Remodelage, and the Department of Cardiology, Cochin Hospital (O.V.), University of Paris, the Department of Neurology, Foch Hospital (B.L.), Urgences Cerebrovasculaires (Y.S.), Centre de Pharmacoépidémiologie de l'APHP (N.Y.), and the Department of Endocrinology (E.B.), Hôpital de la Pitié-Salpêtrière, the Department of Biostatistics, APHP, Université Paris Diderot, Sorbonne Paris Cité, Fernand Widal Hospital (É.V.), and the Department of Endocrinology, Sorbonne University (E.B.), Paris, Équipe d'Accueil EA2694, Santé Publique: Epidémiologie et Qualité des Soins (J.L.), and the Department of Neurology, Stroke Unit, University of Lille, Centre Hospitalier Universitaire (CHU) de Lille (D.L.), Lille, the Department of Neurology, University Hospital of Dijon, University of Burgundy, Dijon (Y.B., M.G.), the Stroke Unit, Pasteur Hospital, Nice (M.-H.M.), Hospices Civils de Lyon, Department of Neurology and Stroke Center, Lyon University, Lyon (N.N.), the Department of Neurology, Versailles University Hospital, Versailles (F.P.), the Department of Vascular Neurology, Pellegrin Tripode Hospital, University of Bordeaux, Bordeaux (I.S.), and the Department of Neurology, Université Caen Normandie, CHU Caen Normandie, INSERM Unité 1237, Cyceron, Caen (E.T.) - all in France; Asan Medical Center (J.S.K.), the Department of Neurology, Eunpyeong St. Mary's Hospital, Catholic University of Korea (Y.-J.K.), and the Department of Neurology, Soonchunhyang University College of Medicine (K.-B.L.), Seoul, Dong-a University Hospital (J.-K.C.) and the Department of Neurology and Stroke Center, Pusan National University Hospital (S.M.S.), Busan, and the Department of Neurology, Hallym University Sacred Heart Hospital, Anyang (B.-C.L.) - all in South Korea; and the National Heart and Lung Institute-Imperial College and the Institute of Cardiovascular Medicine and Science-Royal Brompton Hospital, London (P.G.S.)
| | - Jérémie Abtan
- From the Department of Neurology and Stroke Center (P.A., J.L., H.C., L.C., C.G., C.H., P.C.L., E.M., P.-J.T.) and the Department of Cardiology (J.A., G.D., P.G.S.), Assistance Publique-Hôpitaux de Paris (APHP), Bichat Hospital, Laboratory for Vascular Translational Science, INSERM Unité 1148, Département Hospitalo Universitaire-Fibrose Inflammation Remodelage, and the Department of Cardiology, Cochin Hospital (O.V.), University of Paris, the Department of Neurology, Foch Hospital (B.L.), Urgences Cerebrovasculaires (Y.S.), Centre de Pharmacoépidémiologie de l'APHP (N.Y.), and the Department of Endocrinology (E.B.), Hôpital de la Pitié-Salpêtrière, the Department of Biostatistics, APHP, Université Paris Diderot, Sorbonne Paris Cité, Fernand Widal Hospital (É.V.), and the Department of Endocrinology, Sorbonne University (E.B.), Paris, Équipe d'Accueil EA2694, Santé Publique: Epidémiologie et Qualité des Soins (J.L.), and the Department of Neurology, Stroke Unit, University of Lille, Centre Hospitalier Universitaire (CHU) de Lille (D.L.), Lille, the Department of Neurology, University Hospital of Dijon, University of Burgundy, Dijon (Y.B., M.G.), the Stroke Unit, Pasteur Hospital, Nice (M.-H.M.), Hospices Civils de Lyon, Department of Neurology and Stroke Center, Lyon University, Lyon (N.N.), the Department of Neurology, Versailles University Hospital, Versailles (F.P.), the Department of Vascular Neurology, Pellegrin Tripode Hospital, University of Bordeaux, Bordeaux (I.S.), and the Department of Neurology, Université Caen Normandie, CHU Caen Normandie, INSERM Unité 1237, Cyceron, Caen (E.T.) - all in France; Asan Medical Center (J.S.K.), the Department of Neurology, Eunpyeong St. Mary's Hospital, Catholic University of Korea (Y.-J.K.), and the Department of Neurology, Soonchunhyang University College of Medicine (K.-B.L.), Seoul, Dong-a University Hospital (J.-K.C.) and the Department of Neurology and Stroke Center, Pusan National University Hospital (S.M.S.), Busan, and the Department of Neurology, Hallym University Sacred Heart Hospital, Anyang (B.-C.L.) - all in South Korea; and the National Heart and Lung Institute-Imperial College and the Institute of Cardiovascular Medicine and Science-Royal Brompton Hospital, London (P.G.S.)
| | - Yannick Béjot
- From the Department of Neurology and Stroke Center (P.A., J.L., H.C., L.C., C.G., C.H., P.C.L., E.M., P.-J.T.) and the Department of Cardiology (J.A., G.D., P.G.S.), Assistance Publique-Hôpitaux de Paris (APHP), Bichat Hospital, Laboratory for Vascular Translational Science, INSERM Unité 1148, Département Hospitalo Universitaire-Fibrose Inflammation Remodelage, and the Department of Cardiology, Cochin Hospital (O.V.), University of Paris, the Department of Neurology, Foch Hospital (B.L.), Urgences Cerebrovasculaires (Y.S.), Centre de Pharmacoépidémiologie de l'APHP (N.Y.), and the Department of Endocrinology (E.B.), Hôpital de la Pitié-Salpêtrière, the Department of Biostatistics, APHP, Université Paris Diderot, Sorbonne Paris Cité, Fernand Widal Hospital (É.V.), and the Department of Endocrinology, Sorbonne University (E.B.), Paris, Équipe d'Accueil EA2694, Santé Publique: Epidémiologie et Qualité des Soins (J.L.), and the Department of Neurology, Stroke Unit, University of Lille, Centre Hospitalier Universitaire (CHU) de Lille (D.L.), Lille, the Department of Neurology, University Hospital of Dijon, University of Burgundy, Dijon (Y.B., M.G.), the Stroke Unit, Pasteur Hospital, Nice (M.-H.M.), Hospices Civils de Lyon, Department of Neurology and Stroke Center, Lyon University, Lyon (N.N.), the Department of Neurology, Versailles University Hospital, Versailles (F.P.), the Department of Vascular Neurology, Pellegrin Tripode Hospital, University of Bordeaux, Bordeaux (I.S.), and the Department of Neurology, Université Caen Normandie, CHU Caen Normandie, INSERM Unité 1237, Cyceron, Caen (E.T.) - all in France; Asan Medical Center (J.S.K.), the Department of Neurology, Eunpyeong St. Mary's Hospital, Catholic University of Korea (Y.-J.K.), and the Department of Neurology, Soonchunhyang University College of Medicine (K.-B.L.), Seoul, Dong-a University Hospital (J.-K.C.) and the Department of Neurology and Stroke Center, Pusan National University Hospital (S.M.S.), Busan, and the Department of Neurology, Hallym University Sacred Heart Hospital, Anyang (B.-C.L.) - all in South Korea; and the National Heart and Lung Institute-Imperial College and the Institute of Cardiovascular Medicine and Science-Royal Brompton Hospital, London (P.G.S.)
| | - Lucie Cabrejo
- From the Department of Neurology and Stroke Center (P.A., J.L., H.C., L.C., C.G., C.H., P.C.L., E.M., P.-J.T.) and the Department of Cardiology (J.A., G.D., P.G.S.), Assistance Publique-Hôpitaux de Paris (APHP), Bichat Hospital, Laboratory for Vascular Translational Science, INSERM Unité 1148, Département Hospitalo Universitaire-Fibrose Inflammation Remodelage, and the Department of Cardiology, Cochin Hospital (O.V.), University of Paris, the Department of Neurology, Foch Hospital (B.L.), Urgences Cerebrovasculaires (Y.S.), Centre de Pharmacoépidémiologie de l'APHP (N.Y.), and the Department of Endocrinology (E.B.), Hôpital de la Pitié-Salpêtrière, the Department of Biostatistics, APHP, Université Paris Diderot, Sorbonne Paris Cité, Fernand Widal Hospital (É.V.), and the Department of Endocrinology, Sorbonne University (E.B.), Paris, Équipe d'Accueil EA2694, Santé Publique: Epidémiologie et Qualité des Soins (J.L.), and the Department of Neurology, Stroke Unit, University of Lille, Centre Hospitalier Universitaire (CHU) de Lille (D.L.), Lille, the Department of Neurology, University Hospital of Dijon, University of Burgundy, Dijon (Y.B., M.G.), the Stroke Unit, Pasteur Hospital, Nice (M.-H.M.), Hospices Civils de Lyon, Department of Neurology and Stroke Center, Lyon University, Lyon (N.N.), the Department of Neurology, Versailles University Hospital, Versailles (F.P.), the Department of Vascular Neurology, Pellegrin Tripode Hospital, University of Bordeaux, Bordeaux (I.S.), and the Department of Neurology, Université Caen Normandie, CHU Caen Normandie, INSERM Unité 1237, Cyceron, Caen (E.T.) - all in France; Asan Medical Center (J.S.K.), the Department of Neurology, Eunpyeong St. Mary's Hospital, Catholic University of Korea (Y.-J.K.), and the Department of Neurology, Soonchunhyang University College of Medicine (K.-B.L.), Seoul, Dong-a University Hospital (J.-K.C.) and the Department of Neurology and Stroke Center, Pusan National University Hospital (S.M.S.), Busan, and the Department of Neurology, Hallym University Sacred Heart Hospital, Anyang (B.-C.L.) - all in South Korea; and the National Heart and Lung Institute-Imperial College and the Institute of Cardiovascular Medicine and Science-Royal Brompton Hospital, London (P.G.S.)
| | - Jae-Kwan Cha
- From the Department of Neurology and Stroke Center (P.A., J.L., H.C., L.C., C.G., C.H., P.C.L., E.M., P.-J.T.) and the Department of Cardiology (J.A., G.D., P.G.S.), Assistance Publique-Hôpitaux de Paris (APHP), Bichat Hospital, Laboratory for Vascular Translational Science, INSERM Unité 1148, Département Hospitalo Universitaire-Fibrose Inflammation Remodelage, and the Department of Cardiology, Cochin Hospital (O.V.), University of Paris, the Department of Neurology, Foch Hospital (B.L.), Urgences Cerebrovasculaires (Y.S.), Centre de Pharmacoépidémiologie de l'APHP (N.Y.), and the Department of Endocrinology (E.B.), Hôpital de la Pitié-Salpêtrière, the Department of Biostatistics, APHP, Université Paris Diderot, Sorbonne Paris Cité, Fernand Widal Hospital (É.V.), and the Department of Endocrinology, Sorbonne University (E.B.), Paris, Équipe d'Accueil EA2694, Santé Publique: Epidémiologie et Qualité des Soins (J.L.), and the Department of Neurology, Stroke Unit, University of Lille, Centre Hospitalier Universitaire (CHU) de Lille (D.L.), Lille, the Department of Neurology, University Hospital of Dijon, University of Burgundy, Dijon (Y.B., M.G.), the Stroke Unit, Pasteur Hospital, Nice (M.-H.M.), Hospices Civils de Lyon, Department of Neurology and Stroke Center, Lyon University, Lyon (N.N.), the Department of Neurology, Versailles University Hospital, Versailles (F.P.), the Department of Vascular Neurology, Pellegrin Tripode Hospital, University of Bordeaux, Bordeaux (I.S.), and the Department of Neurology, Université Caen Normandie, CHU Caen Normandie, INSERM Unité 1237, Cyceron, Caen (E.T.) - all in France; Asan Medical Center (J.S.K.), the Department of Neurology, Eunpyeong St. Mary's Hospital, Catholic University of Korea (Y.-J.K.), and the Department of Neurology, Soonchunhyang University College of Medicine (K.-B.L.), Seoul, Dong-a University Hospital (J.-K.C.) and the Department of Neurology and Stroke Center, Pusan National University Hospital (S.M.S.), Busan, and the Department of Neurology, Hallym University Sacred Heart Hospital, Anyang (B.-C.L.) - all in South Korea; and the National Heart and Lung Institute-Imperial College and the Institute of Cardiovascular Medicine and Science-Royal Brompton Hospital, London (P.G.S.)
| | - Grégory Ducrocq
- From the Department of Neurology and Stroke Center (P.A., J.L., H.C., L.C., C.G., C.H., P.C.L., E.M., P.-J.T.) and the Department of Cardiology (J.A., G.D., P.G.S.), Assistance Publique-Hôpitaux de Paris (APHP), Bichat Hospital, Laboratory for Vascular Translational Science, INSERM Unité 1148, Département Hospitalo Universitaire-Fibrose Inflammation Remodelage, and the Department of Cardiology, Cochin Hospital (O.V.), University of Paris, the Department of Neurology, Foch Hospital (B.L.), Urgences Cerebrovasculaires (Y.S.), Centre de Pharmacoépidémiologie de l'APHP (N.Y.), and the Department of Endocrinology (E.B.), Hôpital de la Pitié-Salpêtrière, the Department of Biostatistics, APHP, Université Paris Diderot, Sorbonne Paris Cité, Fernand Widal Hospital (É.V.), and the Department of Endocrinology, Sorbonne University (E.B.), Paris, Équipe d'Accueil EA2694, Santé Publique: Epidémiologie et Qualité des Soins (J.L.), and the Department of Neurology, Stroke Unit, University of Lille, Centre Hospitalier Universitaire (CHU) de Lille (D.L.), Lille, the Department of Neurology, University Hospital of Dijon, University of Burgundy, Dijon (Y.B., M.G.), the Stroke Unit, Pasteur Hospital, Nice (M.-H.M.), Hospices Civils de Lyon, Department of Neurology and Stroke Center, Lyon University, Lyon (N.N.), the Department of Neurology, Versailles University Hospital, Versailles (F.P.), the Department of Vascular Neurology, Pellegrin Tripode Hospital, University of Bordeaux, Bordeaux (I.S.), and the Department of Neurology, Université Caen Normandie, CHU Caen Normandie, INSERM Unité 1237, Cyceron, Caen (E.T.) - all in France; Asan Medical Center (J.S.K.), the Department of Neurology, Eunpyeong St. Mary's Hospital, Catholic University of Korea (Y.-J.K.), and the Department of Neurology, Soonchunhyang University College of Medicine (K.-B.L.), Seoul, Dong-a University Hospital (J.-K.C.) and the Department of Neurology and Stroke Center, Pusan National University Hospital (S.M.S.), Busan, and the Department of Neurology, Hallym University Sacred Heart Hospital, Anyang (B.-C.L.) - all in South Korea; and the National Heart and Lung Institute-Imperial College and the Institute of Cardiovascular Medicine and Science-Royal Brompton Hospital, London (P.G.S.)
| | - Maurice Giroud
- From the Department of Neurology and Stroke Center (P.A., J.L., H.C., L.C., C.G., C.H., P.C.L., E.M., P.-J.T.) and the Department of Cardiology (J.A., G.D., P.G.S.), Assistance Publique-Hôpitaux de Paris (APHP), Bichat Hospital, Laboratory for Vascular Translational Science, INSERM Unité 1148, Département Hospitalo Universitaire-Fibrose Inflammation Remodelage, and the Department of Cardiology, Cochin Hospital (O.V.), University of Paris, the Department of Neurology, Foch Hospital (B.L.), Urgences Cerebrovasculaires (Y.S.), Centre de Pharmacoépidémiologie de l'APHP (N.Y.), and the Department of Endocrinology (E.B.), Hôpital de la Pitié-Salpêtrière, the Department of Biostatistics, APHP, Université Paris Diderot, Sorbonne Paris Cité, Fernand Widal Hospital (É.V.), and the Department of Endocrinology, Sorbonne University (E.B.), Paris, Équipe d'Accueil EA2694, Santé Publique: Epidémiologie et Qualité des Soins (J.L.), and the Department of Neurology, Stroke Unit, University of Lille, Centre Hospitalier Universitaire (CHU) de Lille (D.L.), Lille, the Department of Neurology, University Hospital of Dijon, University of Burgundy, Dijon (Y.B., M.G.), the Stroke Unit, Pasteur Hospital, Nice (M.-H.M.), Hospices Civils de Lyon, Department of Neurology and Stroke Center, Lyon University, Lyon (N.N.), the Department of Neurology, Versailles University Hospital, Versailles (F.P.), the Department of Vascular Neurology, Pellegrin Tripode Hospital, University of Bordeaux, Bordeaux (I.S.), and the Department of Neurology, Université Caen Normandie, CHU Caen Normandie, INSERM Unité 1237, Cyceron, Caen (E.T.) - all in France; Asan Medical Center (J.S.K.), the Department of Neurology, Eunpyeong St. Mary's Hospital, Catholic University of Korea (Y.-J.K.), and the Department of Neurology, Soonchunhyang University College of Medicine (K.-B.L.), Seoul, Dong-a University Hospital (J.-K.C.) and the Department of Neurology and Stroke Center, Pusan National University Hospital (S.M.S.), Busan, and the Department of Neurology, Hallym University Sacred Heart Hospital, Anyang (B.-C.L.) - all in South Korea; and the National Heart and Lung Institute-Imperial College and the Institute of Cardiovascular Medicine and Science-Royal Brompton Hospital, London (P.G.S.)
| | - Celine Guidoux
- From the Department of Neurology and Stroke Center (P.A., J.L., H.C., L.C., C.G., C.H., P.C.L., E.M., P.-J.T.) and the Department of Cardiology (J.A., G.D., P.G.S.), Assistance Publique-Hôpitaux de Paris (APHP), Bichat Hospital, Laboratory for Vascular Translational Science, INSERM Unité 1148, Département Hospitalo Universitaire-Fibrose Inflammation Remodelage, and the Department of Cardiology, Cochin Hospital (O.V.), University of Paris, the Department of Neurology, Foch Hospital (B.L.), Urgences Cerebrovasculaires (Y.S.), Centre de Pharmacoépidémiologie de l'APHP (N.Y.), and the Department of Endocrinology (E.B.), Hôpital de la Pitié-Salpêtrière, the Department of Biostatistics, APHP, Université Paris Diderot, Sorbonne Paris Cité, Fernand Widal Hospital (É.V.), and the Department of Endocrinology, Sorbonne University (E.B.), Paris, Équipe d'Accueil EA2694, Santé Publique: Epidémiologie et Qualité des Soins (J.L.), and the Department of Neurology, Stroke Unit, University of Lille, Centre Hospitalier Universitaire (CHU) de Lille (D.L.), Lille, the Department of Neurology, University Hospital of Dijon, University of Burgundy, Dijon (Y.B., M.G.), the Stroke Unit, Pasteur Hospital, Nice (M.-H.M.), Hospices Civils de Lyon, Department of Neurology and Stroke Center, Lyon University, Lyon (N.N.), the Department of Neurology, Versailles University Hospital, Versailles (F.P.), the Department of Vascular Neurology, Pellegrin Tripode Hospital, University of Bordeaux, Bordeaux (I.S.), and the Department of Neurology, Université Caen Normandie, CHU Caen Normandie, INSERM Unité 1237, Cyceron, Caen (E.T.) - all in France; Asan Medical Center (J.S.K.), the Department of Neurology, Eunpyeong St. Mary's Hospital, Catholic University of Korea (Y.-J.K.), and the Department of Neurology, Soonchunhyang University College of Medicine (K.-B.L.), Seoul, Dong-a University Hospital (J.-K.C.) and the Department of Neurology and Stroke Center, Pusan National University Hospital (S.M.S.), Busan, and the Department of Neurology, Hallym University Sacred Heart Hospital, Anyang (B.-C.L.) - all in South Korea; and the National Heart and Lung Institute-Imperial College and the Institute of Cardiovascular Medicine and Science-Royal Brompton Hospital, London (P.G.S.)
| | - Cristina Hobeanu
- From the Department of Neurology and Stroke Center (P.A., J.L., H.C., L.C., C.G., C.H., P.C.L., E.M., P.-J.T.) and the Department of Cardiology (J.A., G.D., P.G.S.), Assistance Publique-Hôpitaux de Paris (APHP), Bichat Hospital, Laboratory for Vascular Translational Science, INSERM Unité 1148, Département Hospitalo Universitaire-Fibrose Inflammation Remodelage, and the Department of Cardiology, Cochin Hospital (O.V.), University of Paris, the Department of Neurology, Foch Hospital (B.L.), Urgences Cerebrovasculaires (Y.S.), Centre de Pharmacoépidémiologie de l'APHP (N.Y.), and the Department of Endocrinology (E.B.), Hôpital de la Pitié-Salpêtrière, the Department of Biostatistics, APHP, Université Paris Diderot, Sorbonne Paris Cité, Fernand Widal Hospital (É.V.), and the Department of Endocrinology, Sorbonne University (E.B.), Paris, Équipe d'Accueil EA2694, Santé Publique: Epidémiologie et Qualité des Soins (J.L.), and the Department of Neurology, Stroke Unit, University of Lille, Centre Hospitalier Universitaire (CHU) de Lille (D.L.), Lille, the Department of Neurology, University Hospital of Dijon, University of Burgundy, Dijon (Y.B., M.G.), the Stroke Unit, Pasteur Hospital, Nice (M.-H.M.), Hospices Civils de Lyon, Department of Neurology and Stroke Center, Lyon University, Lyon (N.N.), the Department of Neurology, Versailles University Hospital, Versailles (F.P.), the Department of Vascular Neurology, Pellegrin Tripode Hospital, University of Bordeaux, Bordeaux (I.S.), and the Department of Neurology, Université Caen Normandie, CHU Caen Normandie, INSERM Unité 1237, Cyceron, Caen (E.T.) - all in France; Asan Medical Center (J.S.K.), the Department of Neurology, Eunpyeong St. Mary's Hospital, Catholic University of Korea (Y.-J.K.), and the Department of Neurology, Soonchunhyang University College of Medicine (K.-B.L.), Seoul, Dong-a University Hospital (J.-K.C.) and the Department of Neurology and Stroke Center, Pusan National University Hospital (S.M.S.), Busan, and the Department of Neurology, Hallym University Sacred Heart Hospital, Anyang (B.-C.L.) - all in South Korea; and the National Heart and Lung Institute-Imperial College and the Institute of Cardiovascular Medicine and Science-Royal Brompton Hospital, London (P.G.S.)
| | - Yong-Jae Kim
- From the Department of Neurology and Stroke Center (P.A., J.L., H.C., L.C., C.G., C.H., P.C.L., E.M., P.-J.T.) and the Department of Cardiology (J.A., G.D., P.G.S.), Assistance Publique-Hôpitaux de Paris (APHP), Bichat Hospital, Laboratory for Vascular Translational Science, INSERM Unité 1148, Département Hospitalo Universitaire-Fibrose Inflammation Remodelage, and the Department of Cardiology, Cochin Hospital (O.V.), University of Paris, the Department of Neurology, Foch Hospital (B.L.), Urgences Cerebrovasculaires (Y.S.), Centre de Pharmacoépidémiologie de l'APHP (N.Y.), and the Department of Endocrinology (E.B.), Hôpital de la Pitié-Salpêtrière, the Department of Biostatistics, APHP, Université Paris Diderot, Sorbonne Paris Cité, Fernand Widal Hospital (É.V.), and the Department of Endocrinology, Sorbonne University (E.B.), Paris, Équipe d'Accueil EA2694, Santé Publique: Epidémiologie et Qualité des Soins (J.L.), and the Department of Neurology, Stroke Unit, University of Lille, Centre Hospitalier Universitaire (CHU) de Lille (D.L.), Lille, the Department of Neurology, University Hospital of Dijon, University of Burgundy, Dijon (Y.B., M.G.), the Stroke Unit, Pasteur Hospital, Nice (M.-H.M.), Hospices Civils de Lyon, Department of Neurology and Stroke Center, Lyon University, Lyon (N.N.), the Department of Neurology, Versailles University Hospital, Versailles (F.P.), the Department of Vascular Neurology, Pellegrin Tripode Hospital, University of Bordeaux, Bordeaux (I.S.), and the Department of Neurology, Université Caen Normandie, CHU Caen Normandie, INSERM Unité 1237, Cyceron, Caen (E.T.) - all in France; Asan Medical Center (J.S.K.), the Department of Neurology, Eunpyeong St. Mary's Hospital, Catholic University of Korea (Y.-J.K.), and the Department of Neurology, Soonchunhyang University College of Medicine (K.-B.L.), Seoul, Dong-a University Hospital (J.-K.C.) and the Department of Neurology and Stroke Center, Pusan National University Hospital (S.M.S.), Busan, and the Department of Neurology, Hallym University Sacred Heart Hospital, Anyang (B.-C.L.) - all in South Korea; and the National Heart and Lung Institute-Imperial College and the Institute of Cardiovascular Medicine and Science-Royal Brompton Hospital, London (P.G.S.)
| | - Bertrand Lapergue
- From the Department of Neurology and Stroke Center (P.A., J.L., H.C., L.C., C.G., C.H., P.C.L., E.M., P.-J.T.) and the Department of Cardiology (J.A., G.D., P.G.S.), Assistance Publique-Hôpitaux de Paris (APHP), Bichat Hospital, Laboratory for Vascular Translational Science, INSERM Unité 1148, Département Hospitalo Universitaire-Fibrose Inflammation Remodelage, and the Department of Cardiology, Cochin Hospital (O.V.), University of Paris, the Department of Neurology, Foch Hospital (B.L.), Urgences Cerebrovasculaires (Y.S.), Centre de Pharmacoépidémiologie de l'APHP (N.Y.), and the Department of Endocrinology (E.B.), Hôpital de la Pitié-Salpêtrière, the Department of Biostatistics, APHP, Université Paris Diderot, Sorbonne Paris Cité, Fernand Widal Hospital (É.V.), and the Department of Endocrinology, Sorbonne University (E.B.), Paris, Équipe d'Accueil EA2694, Santé Publique: Epidémiologie et Qualité des Soins (J.L.), and the Department of Neurology, Stroke Unit, University of Lille, Centre Hospitalier Universitaire (CHU) de Lille (D.L.), Lille, the Department of Neurology, University Hospital of Dijon, University of Burgundy, Dijon (Y.B., M.G.), the Stroke Unit, Pasteur Hospital, Nice (M.-H.M.), Hospices Civils de Lyon, Department of Neurology and Stroke Center, Lyon University, Lyon (N.N.), the Department of Neurology, Versailles University Hospital, Versailles (F.P.), the Department of Vascular Neurology, Pellegrin Tripode Hospital, University of Bordeaux, Bordeaux (I.S.), and the Department of Neurology, Université Caen Normandie, CHU Caen Normandie, INSERM Unité 1237, Cyceron, Caen (E.T.) - all in France; Asan Medical Center (J.S.K.), the Department of Neurology, Eunpyeong St. Mary's Hospital, Catholic University of Korea (Y.-J.K.), and the Department of Neurology, Soonchunhyang University College of Medicine (K.-B.L.), Seoul, Dong-a University Hospital (J.-K.C.) and the Department of Neurology and Stroke Center, Pusan National University Hospital (S.M.S.), Busan, and the Department of Neurology, Hallym University Sacred Heart Hospital, Anyang (B.-C.L.) - all in South Korea; and the National Heart and Lung Institute-Imperial College and the Institute of Cardiovascular Medicine and Science-Royal Brompton Hospital, London (P.G.S.)
| | - Philippa C Lavallée
- From the Department of Neurology and Stroke Center (P.A., J.L., H.C., L.C., C.G., C.H., P.C.L., E.M., P.-J.T.) and the Department of Cardiology (J.A., G.D., P.G.S.), Assistance Publique-Hôpitaux de Paris (APHP), Bichat Hospital, Laboratory for Vascular Translational Science, INSERM Unité 1148, Département Hospitalo Universitaire-Fibrose Inflammation Remodelage, and the Department of Cardiology, Cochin Hospital (O.V.), University of Paris, the Department of Neurology, Foch Hospital (B.L.), Urgences Cerebrovasculaires (Y.S.), Centre de Pharmacoépidémiologie de l'APHP (N.Y.), and the Department of Endocrinology (E.B.), Hôpital de la Pitié-Salpêtrière, the Department of Biostatistics, APHP, Université Paris Diderot, Sorbonne Paris Cité, Fernand Widal Hospital (É.V.), and the Department of Endocrinology, Sorbonne University (E.B.), Paris, Équipe d'Accueil EA2694, Santé Publique: Epidémiologie et Qualité des Soins (J.L.), and the Department of Neurology, Stroke Unit, University of Lille, Centre Hospitalier Universitaire (CHU) de Lille (D.L.), Lille, the Department of Neurology, University Hospital of Dijon, University of Burgundy, Dijon (Y.B., M.G.), the Stroke Unit, Pasteur Hospital, Nice (M.-H.M.), Hospices Civils de Lyon, Department of Neurology and Stroke Center, Lyon University, Lyon (N.N.), the Department of Neurology, Versailles University Hospital, Versailles (F.P.), the Department of Vascular Neurology, Pellegrin Tripode Hospital, University of Bordeaux, Bordeaux (I.S.), and the Department of Neurology, Université Caen Normandie, CHU Caen Normandie, INSERM Unité 1237, Cyceron, Caen (E.T.) - all in France; Asan Medical Center (J.S.K.), the Department of Neurology, Eunpyeong St. Mary's Hospital, Catholic University of Korea (Y.-J.K.), and the Department of Neurology, Soonchunhyang University College of Medicine (K.-B.L.), Seoul, Dong-a University Hospital (J.-K.C.) and the Department of Neurology and Stroke Center, Pusan National University Hospital (S.M.S.), Busan, and the Department of Neurology, Hallym University Sacred Heart Hospital, Anyang (B.-C.L.) - all in South Korea; and the National Heart and Lung Institute-Imperial College and the Institute of Cardiovascular Medicine and Science-Royal Brompton Hospital, London (P.G.S.)
| | - Byung-Chul Lee
- From the Department of Neurology and Stroke Center (P.A., J.L., H.C., L.C., C.G., C.H., P.C.L., E.M., P.-J.T.) and the Department of Cardiology (J.A., G.D., P.G.S.), Assistance Publique-Hôpitaux de Paris (APHP), Bichat Hospital, Laboratory for Vascular Translational Science, INSERM Unité 1148, Département Hospitalo Universitaire-Fibrose Inflammation Remodelage, and the Department of Cardiology, Cochin Hospital (O.V.), University of Paris, the Department of Neurology, Foch Hospital (B.L.), Urgences Cerebrovasculaires (Y.S.), Centre de Pharmacoépidémiologie de l'APHP (N.Y.), and the Department of Endocrinology (E.B.), Hôpital de la Pitié-Salpêtrière, the Department of Biostatistics, APHP, Université Paris Diderot, Sorbonne Paris Cité, Fernand Widal Hospital (É.V.), and the Department of Endocrinology, Sorbonne University (E.B.), Paris, Équipe d'Accueil EA2694, Santé Publique: Epidémiologie et Qualité des Soins (J.L.), and the Department of Neurology, Stroke Unit, University of Lille, Centre Hospitalier Universitaire (CHU) de Lille (D.L.), Lille, the Department of Neurology, University Hospital of Dijon, University of Burgundy, Dijon (Y.B., M.G.), the Stroke Unit, Pasteur Hospital, Nice (M.-H.M.), Hospices Civils de Lyon, Department of Neurology and Stroke Center, Lyon University, Lyon (N.N.), the Department of Neurology, Versailles University Hospital, Versailles (F.P.), the Department of Vascular Neurology, Pellegrin Tripode Hospital, University of Bordeaux, Bordeaux (I.S.), and the Department of Neurology, Université Caen Normandie, CHU Caen Normandie, INSERM Unité 1237, Cyceron, Caen (E.T.) - all in France; Asan Medical Center (J.S.K.), the Department of Neurology, Eunpyeong St. Mary's Hospital, Catholic University of Korea (Y.-J.K.), and the Department of Neurology, Soonchunhyang University College of Medicine (K.-B.L.), Seoul, Dong-a University Hospital (J.-K.C.) and the Department of Neurology and Stroke Center, Pusan National University Hospital (S.M.S.), Busan, and the Department of Neurology, Hallym University Sacred Heart Hospital, Anyang (B.-C.L.) - all in South Korea; and the National Heart and Lung Institute-Imperial College and the Institute of Cardiovascular Medicine and Science-Royal Brompton Hospital, London (P.G.S.)
| | - Kyung-Bok Lee
- From the Department of Neurology and Stroke Center (P.A., J.L., H.C., L.C., C.G., C.H., P.C.L., E.M., P.-J.T.) and the Department of Cardiology (J.A., G.D., P.G.S.), Assistance Publique-Hôpitaux de Paris (APHP), Bichat Hospital, Laboratory for Vascular Translational Science, INSERM Unité 1148, Département Hospitalo Universitaire-Fibrose Inflammation Remodelage, and the Department of Cardiology, Cochin Hospital (O.V.), University of Paris, the Department of Neurology, Foch Hospital (B.L.), Urgences Cerebrovasculaires (Y.S.), Centre de Pharmacoépidémiologie de l'APHP (N.Y.), and the Department of Endocrinology (E.B.), Hôpital de la Pitié-Salpêtrière, the Department of Biostatistics, APHP, Université Paris Diderot, Sorbonne Paris Cité, Fernand Widal Hospital (É.V.), and the Department of Endocrinology, Sorbonne University (E.B.), Paris, Équipe d'Accueil EA2694, Santé Publique: Epidémiologie et Qualité des Soins (J.L.), and the Department of Neurology, Stroke Unit, University of Lille, Centre Hospitalier Universitaire (CHU) de Lille (D.L.), Lille, the Department of Neurology, University Hospital of Dijon, University of Burgundy, Dijon (Y.B., M.G.), the Stroke Unit, Pasteur Hospital, Nice (M.-H.M.), Hospices Civils de Lyon, Department of Neurology and Stroke Center, Lyon University, Lyon (N.N.), the Department of Neurology, Versailles University Hospital, Versailles (F.P.), the Department of Vascular Neurology, Pellegrin Tripode Hospital, University of Bordeaux, Bordeaux (I.S.), and the Department of Neurology, Université Caen Normandie, CHU Caen Normandie, INSERM Unité 1237, Cyceron, Caen (E.T.) - all in France; Asan Medical Center (J.S.K.), the Department of Neurology, Eunpyeong St. Mary's Hospital, Catholic University of Korea (Y.-J.K.), and the Department of Neurology, Soonchunhyang University College of Medicine (K.-B.L.), Seoul, Dong-a University Hospital (J.-K.C.) and the Department of Neurology and Stroke Center, Pusan National University Hospital (S.M.S.), Busan, and the Department of Neurology, Hallym University Sacred Heart Hospital, Anyang (B.-C.L.) - all in South Korea; and the National Heart and Lung Institute-Imperial College and the Institute of Cardiovascular Medicine and Science-Royal Brompton Hospital, London (P.G.S.)
| | - Didier Leys
- From the Department of Neurology and Stroke Center (P.A., J.L., H.C., L.C., C.G., C.H., P.C.L., E.M., P.-J.T.) and the Department of Cardiology (J.A., G.D., P.G.S.), Assistance Publique-Hôpitaux de Paris (APHP), Bichat Hospital, Laboratory for Vascular Translational Science, INSERM Unité 1148, Département Hospitalo Universitaire-Fibrose Inflammation Remodelage, and the Department of Cardiology, Cochin Hospital (O.V.), University of Paris, the Department of Neurology, Foch Hospital (B.L.), Urgences Cerebrovasculaires (Y.S.), Centre de Pharmacoépidémiologie de l'APHP (N.Y.), and the Department of Endocrinology (E.B.), Hôpital de la Pitié-Salpêtrière, the Department of Biostatistics, APHP, Université Paris Diderot, Sorbonne Paris Cité, Fernand Widal Hospital (É.V.), and the Department of Endocrinology, Sorbonne University (E.B.), Paris, Équipe d'Accueil EA2694, Santé Publique: Epidémiologie et Qualité des Soins (J.L.), and the Department of Neurology, Stroke Unit, University of Lille, Centre Hospitalier Universitaire (CHU) de Lille (D.L.), Lille, the Department of Neurology, University Hospital of Dijon, University of Burgundy, Dijon (Y.B., M.G.), the Stroke Unit, Pasteur Hospital, Nice (M.-H.M.), Hospices Civils de Lyon, Department of Neurology and Stroke Center, Lyon University, Lyon (N.N.), the Department of Neurology, Versailles University Hospital, Versailles (F.P.), the Department of Vascular Neurology, Pellegrin Tripode Hospital, University of Bordeaux, Bordeaux (I.S.), and the Department of Neurology, Université Caen Normandie, CHU Caen Normandie, INSERM Unité 1237, Cyceron, Caen (E.T.) - all in France; Asan Medical Center (J.S.K.), the Department of Neurology, Eunpyeong St. Mary's Hospital, Catholic University of Korea (Y.-J.K.), and the Department of Neurology, Soonchunhyang University College of Medicine (K.-B.L.), Seoul, Dong-a University Hospital (J.-K.C.) and the Department of Neurology and Stroke Center, Pusan National University Hospital (S.M.S.), Busan, and the Department of Neurology, Hallym University Sacred Heart Hospital, Anyang (B.-C.L.) - all in South Korea; and the National Heart and Lung Institute-Imperial College and the Institute of Cardiovascular Medicine and Science-Royal Brompton Hospital, London (P.G.S.)
| | - Marie-Hélène Mahagne
- From the Department of Neurology and Stroke Center (P.A., J.L., H.C., L.C., C.G., C.H., P.C.L., E.M., P.-J.T.) and the Department of Cardiology (J.A., G.D., P.G.S.), Assistance Publique-Hôpitaux de Paris (APHP), Bichat Hospital, Laboratory for Vascular Translational Science, INSERM Unité 1148, Département Hospitalo Universitaire-Fibrose Inflammation Remodelage, and the Department of Cardiology, Cochin Hospital (O.V.), University of Paris, the Department of Neurology, Foch Hospital (B.L.), Urgences Cerebrovasculaires (Y.S.), Centre de Pharmacoépidémiologie de l'APHP (N.Y.), and the Department of Endocrinology (E.B.), Hôpital de la Pitié-Salpêtrière, the Department of Biostatistics, APHP, Université Paris Diderot, Sorbonne Paris Cité, Fernand Widal Hospital (É.V.), and the Department of Endocrinology, Sorbonne University (E.B.), Paris, Équipe d'Accueil EA2694, Santé Publique: Epidémiologie et Qualité des Soins (J.L.), and the Department of Neurology, Stroke Unit, University of Lille, Centre Hospitalier Universitaire (CHU) de Lille (D.L.), Lille, the Department of Neurology, University Hospital of Dijon, University of Burgundy, Dijon (Y.B., M.G.), the Stroke Unit, Pasteur Hospital, Nice (M.-H.M.), Hospices Civils de Lyon, Department of Neurology and Stroke Center, Lyon University, Lyon (N.N.), the Department of Neurology, Versailles University Hospital, Versailles (F.P.), the Department of Vascular Neurology, Pellegrin Tripode Hospital, University of Bordeaux, Bordeaux (I.S.), and the Department of Neurology, Université Caen Normandie, CHU Caen Normandie, INSERM Unité 1237, Cyceron, Caen (E.T.) - all in France; Asan Medical Center (J.S.K.), the Department of Neurology, Eunpyeong St. Mary's Hospital, Catholic University of Korea (Y.-J.K.), and the Department of Neurology, Soonchunhyang University College of Medicine (K.-B.L.), Seoul, Dong-a University Hospital (J.-K.C.) and the Department of Neurology and Stroke Center, Pusan National University Hospital (S.M.S.), Busan, and the Department of Neurology, Hallym University Sacred Heart Hospital, Anyang (B.-C.L.) - all in South Korea; and the National Heart and Lung Institute-Imperial College and the Institute of Cardiovascular Medicine and Science-Royal Brompton Hospital, London (P.G.S.)
| | - Elena Meseguer
- From the Department of Neurology and Stroke Center (P.A., J.L., H.C., L.C., C.G., C.H., P.C.L., E.M., P.-J.T.) and the Department of Cardiology (J.A., G.D., P.G.S.), Assistance Publique-Hôpitaux de Paris (APHP), Bichat Hospital, Laboratory for Vascular Translational Science, INSERM Unité 1148, Département Hospitalo Universitaire-Fibrose Inflammation Remodelage, and the Department of Cardiology, Cochin Hospital (O.V.), University of Paris, the Department of Neurology, Foch Hospital (B.L.), Urgences Cerebrovasculaires (Y.S.), Centre de Pharmacoépidémiologie de l'APHP (N.Y.), and the Department of Endocrinology (E.B.), Hôpital de la Pitié-Salpêtrière, the Department of Biostatistics, APHP, Université Paris Diderot, Sorbonne Paris Cité, Fernand Widal Hospital (É.V.), and the Department of Endocrinology, Sorbonne University (E.B.), Paris, Équipe d'Accueil EA2694, Santé Publique: Epidémiologie et Qualité des Soins (J.L.), and the Department of Neurology, Stroke Unit, University of Lille, Centre Hospitalier Universitaire (CHU) de Lille (D.L.), Lille, the Department of Neurology, University Hospital of Dijon, University of Burgundy, Dijon (Y.B., M.G.), the Stroke Unit, Pasteur Hospital, Nice (M.-H.M.), Hospices Civils de Lyon, Department of Neurology and Stroke Center, Lyon University, Lyon (N.N.), the Department of Neurology, Versailles University Hospital, Versailles (F.P.), the Department of Vascular Neurology, Pellegrin Tripode Hospital, University of Bordeaux, Bordeaux (I.S.), and the Department of Neurology, Université Caen Normandie, CHU Caen Normandie, INSERM Unité 1237, Cyceron, Caen (E.T.) - all in France; Asan Medical Center (J.S.K.), the Department of Neurology, Eunpyeong St. Mary's Hospital, Catholic University of Korea (Y.-J.K.), and the Department of Neurology, Soonchunhyang University College of Medicine (K.-B.L.), Seoul, Dong-a University Hospital (J.-K.C.) and the Department of Neurology and Stroke Center, Pusan National University Hospital (S.M.S.), Busan, and the Department of Neurology, Hallym University Sacred Heart Hospital, Anyang (B.-C.L.) - all in South Korea; and the National Heart and Lung Institute-Imperial College and the Institute of Cardiovascular Medicine and Science-Royal Brompton Hospital, London (P.G.S.)
| | - Norbert Nighoghossian
- From the Department of Neurology and Stroke Center (P.A., J.L., H.C., L.C., C.G., C.H., P.C.L., E.M., P.-J.T.) and the Department of Cardiology (J.A., G.D., P.G.S.), Assistance Publique-Hôpitaux de Paris (APHP), Bichat Hospital, Laboratory for Vascular Translational Science, INSERM Unité 1148, Département Hospitalo Universitaire-Fibrose Inflammation Remodelage, and the Department of Cardiology, Cochin Hospital (O.V.), University of Paris, the Department of Neurology, Foch Hospital (B.L.), Urgences Cerebrovasculaires (Y.S.), Centre de Pharmacoépidémiologie de l'APHP (N.Y.), and the Department of Endocrinology (E.B.), Hôpital de la Pitié-Salpêtrière, the Department of Biostatistics, APHP, Université Paris Diderot, Sorbonne Paris Cité, Fernand Widal Hospital (É.V.), and the Department of Endocrinology, Sorbonne University (E.B.), Paris, Équipe d'Accueil EA2694, Santé Publique: Epidémiologie et Qualité des Soins (J.L.), and the Department of Neurology, Stroke Unit, University of Lille, Centre Hospitalier Universitaire (CHU) de Lille (D.L.), Lille, the Department of Neurology, University Hospital of Dijon, University of Burgundy, Dijon (Y.B., M.G.), the Stroke Unit, Pasteur Hospital, Nice (M.-H.M.), Hospices Civils de Lyon, Department of Neurology and Stroke Center, Lyon University, Lyon (N.N.), the Department of Neurology, Versailles University Hospital, Versailles (F.P.), the Department of Vascular Neurology, Pellegrin Tripode Hospital, University of Bordeaux, Bordeaux (I.S.), and the Department of Neurology, Université Caen Normandie, CHU Caen Normandie, INSERM Unité 1237, Cyceron, Caen (E.T.) - all in France; Asan Medical Center (J.S.K.), the Department of Neurology, Eunpyeong St. Mary's Hospital, Catholic University of Korea (Y.-J.K.), and the Department of Neurology, Soonchunhyang University College of Medicine (K.-B.L.), Seoul, Dong-a University Hospital (J.-K.C.) and the Department of Neurology and Stroke Center, Pusan National University Hospital (S.M.S.), Busan, and the Department of Neurology, Hallym University Sacred Heart Hospital, Anyang (B.-C.L.) - all in South Korea; and the National Heart and Lung Institute-Imperial College and the Institute of Cardiovascular Medicine and Science-Royal Brompton Hospital, London (P.G.S.)
| | - Fernando Pico
- From the Department of Neurology and Stroke Center (P.A., J.L., H.C., L.C., C.G., C.H., P.C.L., E.M., P.-J.T.) and the Department of Cardiology (J.A., G.D., P.G.S.), Assistance Publique-Hôpitaux de Paris (APHP), Bichat Hospital, Laboratory for Vascular Translational Science, INSERM Unité 1148, Département Hospitalo Universitaire-Fibrose Inflammation Remodelage, and the Department of Cardiology, Cochin Hospital (O.V.), University of Paris, the Department of Neurology, Foch Hospital (B.L.), Urgences Cerebrovasculaires (Y.S.), Centre de Pharmacoépidémiologie de l'APHP (N.Y.), and the Department of Endocrinology (E.B.), Hôpital de la Pitié-Salpêtrière, the Department of Biostatistics, APHP, Université Paris Diderot, Sorbonne Paris Cité, Fernand Widal Hospital (É.V.), and the Department of Endocrinology, Sorbonne University (E.B.), Paris, Équipe d'Accueil EA2694, Santé Publique: Epidémiologie et Qualité des Soins (J.L.), and the Department of Neurology, Stroke Unit, University of Lille, Centre Hospitalier Universitaire (CHU) de Lille (D.L.), Lille, the Department of Neurology, University Hospital of Dijon, University of Burgundy, Dijon (Y.B., M.G.), the Stroke Unit, Pasteur Hospital, Nice (M.-H.M.), Hospices Civils de Lyon, Department of Neurology and Stroke Center, Lyon University, Lyon (N.N.), the Department of Neurology, Versailles University Hospital, Versailles (F.P.), the Department of Vascular Neurology, Pellegrin Tripode Hospital, University of Bordeaux, Bordeaux (I.S.), and the Department of Neurology, Université Caen Normandie, CHU Caen Normandie, INSERM Unité 1237, Cyceron, Caen (E.T.) - all in France; Asan Medical Center (J.S.K.), the Department of Neurology, Eunpyeong St. Mary's Hospital, Catholic University of Korea (Y.-J.K.), and the Department of Neurology, Soonchunhyang University College of Medicine (K.-B.L.), Seoul, Dong-a University Hospital (J.-K.C.) and the Department of Neurology and Stroke Center, Pusan National University Hospital (S.M.S.), Busan, and the Department of Neurology, Hallym University Sacred Heart Hospital, Anyang (B.-C.L.) - all in South Korea; and the National Heart and Lung Institute-Imperial College and the Institute of Cardiovascular Medicine and Science-Royal Brompton Hospital, London (P.G.S.)
| | - Yves Samson
- From the Department of Neurology and Stroke Center (P.A., J.L., H.C., L.C., C.G., C.H., P.C.L., E.M., P.-J.T.) and the Department of Cardiology (J.A., G.D., P.G.S.), Assistance Publique-Hôpitaux de Paris (APHP), Bichat Hospital, Laboratory for Vascular Translational Science, INSERM Unité 1148, Département Hospitalo Universitaire-Fibrose Inflammation Remodelage, and the Department of Cardiology, Cochin Hospital (O.V.), University of Paris, the Department of Neurology, Foch Hospital (B.L.), Urgences Cerebrovasculaires (Y.S.), Centre de Pharmacoépidémiologie de l'APHP (N.Y.), and the Department of Endocrinology (E.B.), Hôpital de la Pitié-Salpêtrière, the Department of Biostatistics, APHP, Université Paris Diderot, Sorbonne Paris Cité, Fernand Widal Hospital (É.V.), and the Department of Endocrinology, Sorbonne University (E.B.), Paris, Équipe d'Accueil EA2694, Santé Publique: Epidémiologie et Qualité des Soins (J.L.), and the Department of Neurology, Stroke Unit, University of Lille, Centre Hospitalier Universitaire (CHU) de Lille (D.L.), Lille, the Department of Neurology, University Hospital of Dijon, University of Burgundy, Dijon (Y.B., M.G.), the Stroke Unit, Pasteur Hospital, Nice (M.-H.M.), Hospices Civils de Lyon, Department of Neurology and Stroke Center, Lyon University, Lyon (N.N.), the Department of Neurology, Versailles University Hospital, Versailles (F.P.), the Department of Vascular Neurology, Pellegrin Tripode Hospital, University of Bordeaux, Bordeaux (I.S.), and the Department of Neurology, Université Caen Normandie, CHU Caen Normandie, INSERM Unité 1237, Cyceron, Caen (E.T.) - all in France; Asan Medical Center (J.S.K.), the Department of Neurology, Eunpyeong St. Mary's Hospital, Catholic University of Korea (Y.-J.K.), and the Department of Neurology, Soonchunhyang University College of Medicine (K.-B.L.), Seoul, Dong-a University Hospital (J.-K.C.) and the Department of Neurology and Stroke Center, Pusan National University Hospital (S.M.S.), Busan, and the Department of Neurology, Hallym University Sacred Heart Hospital, Anyang (B.-C.L.) - all in South Korea; and the National Heart and Lung Institute-Imperial College and the Institute of Cardiovascular Medicine and Science-Royal Brompton Hospital, London (P.G.S.)
| | - Igor Sibon
- From the Department of Neurology and Stroke Center (P.A., J.L., H.C., L.C., C.G., C.H., P.C.L., E.M., P.-J.T.) and the Department of Cardiology (J.A., G.D., P.G.S.), Assistance Publique-Hôpitaux de Paris (APHP), Bichat Hospital, Laboratory for Vascular Translational Science, INSERM Unité 1148, Département Hospitalo Universitaire-Fibrose Inflammation Remodelage, and the Department of Cardiology, Cochin Hospital (O.V.), University of Paris, the Department of Neurology, Foch Hospital (B.L.), Urgences Cerebrovasculaires (Y.S.), Centre de Pharmacoépidémiologie de l'APHP (N.Y.), and the Department of Endocrinology (E.B.), Hôpital de la Pitié-Salpêtrière, the Department of Biostatistics, APHP, Université Paris Diderot, Sorbonne Paris Cité, Fernand Widal Hospital (É.V.), and the Department of Endocrinology, Sorbonne University (E.B.), Paris, Équipe d'Accueil EA2694, Santé Publique: Epidémiologie et Qualité des Soins (J.L.), and the Department of Neurology, Stroke Unit, University of Lille, Centre Hospitalier Universitaire (CHU) de Lille (D.L.), Lille, the Department of Neurology, University Hospital of Dijon, University of Burgundy, Dijon (Y.B., M.G.), the Stroke Unit, Pasteur Hospital, Nice (M.-H.M.), Hospices Civils de Lyon, Department of Neurology and Stroke Center, Lyon University, Lyon (N.N.), the Department of Neurology, Versailles University Hospital, Versailles (F.P.), the Department of Vascular Neurology, Pellegrin Tripode Hospital, University of Bordeaux, Bordeaux (I.S.), and the Department of Neurology, Université Caen Normandie, CHU Caen Normandie, INSERM Unité 1237, Cyceron, Caen (E.T.) - all in France; Asan Medical Center (J.S.K.), the Department of Neurology, Eunpyeong St. Mary's Hospital, Catholic University of Korea (Y.-J.K.), and the Department of Neurology, Soonchunhyang University College of Medicine (K.-B.L.), Seoul, Dong-a University Hospital (J.-K.C.) and the Department of Neurology and Stroke Center, Pusan National University Hospital (S.M.S.), Busan, and the Department of Neurology, Hallym University Sacred Heart Hospital, Anyang (B.-C.L.) - all in South Korea; and the National Heart and Lung Institute-Imperial College and the Institute of Cardiovascular Medicine and Science-Royal Brompton Hospital, London (P.G.S.)
| | - P Gabriel Steg
- From the Department of Neurology and Stroke Center (P.A., J.L., H.C., L.C., C.G., C.H., P.C.L., E.M., P.-J.T.) and the Department of Cardiology (J.A., G.D., P.G.S.), Assistance Publique-Hôpitaux de Paris (APHP), Bichat Hospital, Laboratory for Vascular Translational Science, INSERM Unité 1148, Département Hospitalo Universitaire-Fibrose Inflammation Remodelage, and the Department of Cardiology, Cochin Hospital (O.V.), University of Paris, the Department of Neurology, Foch Hospital (B.L.), Urgences Cerebrovasculaires (Y.S.), Centre de Pharmacoépidémiologie de l'APHP (N.Y.), and the Department of Endocrinology (E.B.), Hôpital de la Pitié-Salpêtrière, the Department of Biostatistics, APHP, Université Paris Diderot, Sorbonne Paris Cité, Fernand Widal Hospital (É.V.), and the Department of Endocrinology, Sorbonne University (E.B.), Paris, Équipe d'Accueil EA2694, Santé Publique: Epidémiologie et Qualité des Soins (J.L.), and the Department of Neurology, Stroke Unit, University of Lille, Centre Hospitalier Universitaire (CHU) de Lille (D.L.), Lille, the Department of Neurology, University Hospital of Dijon, University of Burgundy, Dijon (Y.B., M.G.), the Stroke Unit, Pasteur Hospital, Nice (M.-H.M.), Hospices Civils de Lyon, Department of Neurology and Stroke Center, Lyon University, Lyon (N.N.), the Department of Neurology, Versailles University Hospital, Versailles (F.P.), the Department of Vascular Neurology, Pellegrin Tripode Hospital, University of Bordeaux, Bordeaux (I.S.), and the Department of Neurology, Université Caen Normandie, CHU Caen Normandie, INSERM Unité 1237, Cyceron, Caen (E.T.) - all in France; Asan Medical Center (J.S.K.), the Department of Neurology, Eunpyeong St. Mary's Hospital, Catholic University of Korea (Y.-J.K.), and the Department of Neurology, Soonchunhyang University College of Medicine (K.-B.L.), Seoul, Dong-a University Hospital (J.-K.C.) and the Department of Neurology and Stroke Center, Pusan National University Hospital (S.M.S.), Busan, and the Department of Neurology, Hallym University Sacred Heart Hospital, Anyang (B.-C.L.) - all in South Korea; and the National Heart and Lung Institute-Imperial College and the Institute of Cardiovascular Medicine and Science-Royal Brompton Hospital, London (P.G.S.)
| | - Sang-Min Sung
- From the Department of Neurology and Stroke Center (P.A., J.L., H.C., L.C., C.G., C.H., P.C.L., E.M., P.-J.T.) and the Department of Cardiology (J.A., G.D., P.G.S.), Assistance Publique-Hôpitaux de Paris (APHP), Bichat Hospital, Laboratory for Vascular Translational Science, INSERM Unité 1148, Département Hospitalo Universitaire-Fibrose Inflammation Remodelage, and the Department of Cardiology, Cochin Hospital (O.V.), University of Paris, the Department of Neurology, Foch Hospital (B.L.), Urgences Cerebrovasculaires (Y.S.), Centre de Pharmacoépidémiologie de l'APHP (N.Y.), and the Department of Endocrinology (E.B.), Hôpital de la Pitié-Salpêtrière, the Department of Biostatistics, APHP, Université Paris Diderot, Sorbonne Paris Cité, Fernand Widal Hospital (É.V.), and the Department of Endocrinology, Sorbonne University (E.B.), Paris, Équipe d'Accueil EA2694, Santé Publique: Epidémiologie et Qualité des Soins (J.L.), and the Department of Neurology, Stroke Unit, University of Lille, Centre Hospitalier Universitaire (CHU) de Lille (D.L.), Lille, the Department of Neurology, University Hospital of Dijon, University of Burgundy, Dijon (Y.B., M.G.), the Stroke Unit, Pasteur Hospital, Nice (M.-H.M.), Hospices Civils de Lyon, Department of Neurology and Stroke Center, Lyon University, Lyon (N.N.), the Department of Neurology, Versailles University Hospital, Versailles (F.P.), the Department of Vascular Neurology, Pellegrin Tripode Hospital, University of Bordeaux, Bordeaux (I.S.), and the Department of Neurology, Université Caen Normandie, CHU Caen Normandie, INSERM Unité 1237, Cyceron, Caen (E.T.) - all in France; Asan Medical Center (J.S.K.), the Department of Neurology, Eunpyeong St. Mary's Hospital, Catholic University of Korea (Y.-J.K.), and the Department of Neurology, Soonchunhyang University College of Medicine (K.-B.L.), Seoul, Dong-a University Hospital (J.-K.C.) and the Department of Neurology and Stroke Center, Pusan National University Hospital (S.M.S.), Busan, and the Department of Neurology, Hallym University Sacred Heart Hospital, Anyang (B.-C.L.) - all in South Korea; and the National Heart and Lung Institute-Imperial College and the Institute of Cardiovascular Medicine and Science-Royal Brompton Hospital, London (P.G.S.)
| | - Pierre-Jean Touboul
- From the Department of Neurology and Stroke Center (P.A., J.L., H.C., L.C., C.G., C.H., P.C.L., E.M., P.-J.T.) and the Department of Cardiology (J.A., G.D., P.G.S.), Assistance Publique-Hôpitaux de Paris (APHP), Bichat Hospital, Laboratory for Vascular Translational Science, INSERM Unité 1148, Département Hospitalo Universitaire-Fibrose Inflammation Remodelage, and the Department of Cardiology, Cochin Hospital (O.V.), University of Paris, the Department of Neurology, Foch Hospital (B.L.), Urgences Cerebrovasculaires (Y.S.), Centre de Pharmacoépidémiologie de l'APHP (N.Y.), and the Department of Endocrinology (E.B.), Hôpital de la Pitié-Salpêtrière, the Department of Biostatistics, APHP, Université Paris Diderot, Sorbonne Paris Cité, Fernand Widal Hospital (É.V.), and the Department of Endocrinology, Sorbonne University (E.B.), Paris, Équipe d'Accueil EA2694, Santé Publique: Epidémiologie et Qualité des Soins (J.L.), and the Department of Neurology, Stroke Unit, University of Lille, Centre Hospitalier Universitaire (CHU) de Lille (D.L.), Lille, the Department of Neurology, University Hospital of Dijon, University of Burgundy, Dijon (Y.B., M.G.), the Stroke Unit, Pasteur Hospital, Nice (M.-H.M.), Hospices Civils de Lyon, Department of Neurology and Stroke Center, Lyon University, Lyon (N.N.), the Department of Neurology, Versailles University Hospital, Versailles (F.P.), the Department of Vascular Neurology, Pellegrin Tripode Hospital, University of Bordeaux, Bordeaux (I.S.), and the Department of Neurology, Université Caen Normandie, CHU Caen Normandie, INSERM Unité 1237, Cyceron, Caen (E.T.) - all in France; Asan Medical Center (J.S.K.), the Department of Neurology, Eunpyeong St. Mary's Hospital, Catholic University of Korea (Y.-J.K.), and the Department of Neurology, Soonchunhyang University College of Medicine (K.-B.L.), Seoul, Dong-a University Hospital (J.-K.C.) and the Department of Neurology and Stroke Center, Pusan National University Hospital (S.M.S.), Busan, and the Department of Neurology, Hallym University Sacred Heart Hospital, Anyang (B.-C.L.) - all in South Korea; and the National Heart and Lung Institute-Imperial College and the Institute of Cardiovascular Medicine and Science-Royal Brompton Hospital, London (P.G.S.)
| | - Emmanuel Touzé
- From the Department of Neurology and Stroke Center (P.A., J.L., H.C., L.C., C.G., C.H., P.C.L., E.M., P.-J.T.) and the Department of Cardiology (J.A., G.D., P.G.S.), Assistance Publique-Hôpitaux de Paris (APHP), Bichat Hospital, Laboratory for Vascular Translational Science, INSERM Unité 1148, Département Hospitalo Universitaire-Fibrose Inflammation Remodelage, and the Department of Cardiology, Cochin Hospital (O.V.), University of Paris, the Department of Neurology, Foch Hospital (B.L.), Urgences Cerebrovasculaires (Y.S.), Centre de Pharmacoépidémiologie de l'APHP (N.Y.), and the Department of Endocrinology (E.B.), Hôpital de la Pitié-Salpêtrière, the Department of Biostatistics, APHP, Université Paris Diderot, Sorbonne Paris Cité, Fernand Widal Hospital (É.V.), and the Department of Endocrinology, Sorbonne University (E.B.), Paris, Équipe d'Accueil EA2694, Santé Publique: Epidémiologie et Qualité des Soins (J.L.), and the Department of Neurology, Stroke Unit, University of Lille, Centre Hospitalier Universitaire (CHU) de Lille (D.L.), Lille, the Department of Neurology, University Hospital of Dijon, University of Burgundy, Dijon (Y.B., M.G.), the Stroke Unit, Pasteur Hospital, Nice (M.-H.M.), Hospices Civils de Lyon, Department of Neurology and Stroke Center, Lyon University, Lyon (N.N.), the Department of Neurology, Versailles University Hospital, Versailles (F.P.), the Department of Vascular Neurology, Pellegrin Tripode Hospital, University of Bordeaux, Bordeaux (I.S.), and the Department of Neurology, Université Caen Normandie, CHU Caen Normandie, INSERM Unité 1237, Cyceron, Caen (E.T.) - all in France; Asan Medical Center (J.S.K.), the Department of Neurology, Eunpyeong St. Mary's Hospital, Catholic University of Korea (Y.-J.K.), and the Department of Neurology, Soonchunhyang University College of Medicine (K.-B.L.), Seoul, Dong-a University Hospital (J.-K.C.) and the Department of Neurology and Stroke Center, Pusan National University Hospital (S.M.S.), Busan, and the Department of Neurology, Hallym University Sacred Heart Hospital, Anyang (B.-C.L.) - all in South Korea; and the National Heart and Lung Institute-Imperial College and the Institute of Cardiovascular Medicine and Science-Royal Brompton Hospital, London (P.G.S.)
| | - Olivier Varenne
- From the Department of Neurology and Stroke Center (P.A., J.L., H.C., L.C., C.G., C.H., P.C.L., E.M., P.-J.T.) and the Department of Cardiology (J.A., G.D., P.G.S.), Assistance Publique-Hôpitaux de Paris (APHP), Bichat Hospital, Laboratory for Vascular Translational Science, INSERM Unité 1148, Département Hospitalo Universitaire-Fibrose Inflammation Remodelage, and the Department of Cardiology, Cochin Hospital (O.V.), University of Paris, the Department of Neurology, Foch Hospital (B.L.), Urgences Cerebrovasculaires (Y.S.), Centre de Pharmacoépidémiologie de l'APHP (N.Y.), and the Department of Endocrinology (E.B.), Hôpital de la Pitié-Salpêtrière, the Department of Biostatistics, APHP, Université Paris Diderot, Sorbonne Paris Cité, Fernand Widal Hospital (É.V.), and the Department of Endocrinology, Sorbonne University (E.B.), Paris, Équipe d'Accueil EA2694, Santé Publique: Epidémiologie et Qualité des Soins (J.L.), and the Department of Neurology, Stroke Unit, University of Lille, Centre Hospitalier Universitaire (CHU) de Lille (D.L.), Lille, the Department of Neurology, University Hospital of Dijon, University of Burgundy, Dijon (Y.B., M.G.), the Stroke Unit, Pasteur Hospital, Nice (M.-H.M.), Hospices Civils de Lyon, Department of Neurology and Stroke Center, Lyon University, Lyon (N.N.), the Department of Neurology, Versailles University Hospital, Versailles (F.P.), the Department of Vascular Neurology, Pellegrin Tripode Hospital, University of Bordeaux, Bordeaux (I.S.), and the Department of Neurology, Université Caen Normandie, CHU Caen Normandie, INSERM Unité 1237, Cyceron, Caen (E.T.) - all in France; Asan Medical Center (J.S.K.), the Department of Neurology, Eunpyeong St. Mary's Hospital, Catholic University of Korea (Y.-J.K.), and the Department of Neurology, Soonchunhyang University College of Medicine (K.-B.L.), Seoul, Dong-a University Hospital (J.-K.C.) and the Department of Neurology and Stroke Center, Pusan National University Hospital (S.M.S.), Busan, and the Department of Neurology, Hallym University Sacred Heart Hospital, Anyang (B.-C.L.) - all in South Korea; and the National Heart and Lung Institute-Imperial College and the Institute of Cardiovascular Medicine and Science-Royal Brompton Hospital, London (P.G.S.)
| | - Éric Vicaut
- From the Department of Neurology and Stroke Center (P.A., J.L., H.C., L.C., C.G., C.H., P.C.L., E.M., P.-J.T.) and the Department of Cardiology (J.A., G.D., P.G.S.), Assistance Publique-Hôpitaux de Paris (APHP), Bichat Hospital, Laboratory for Vascular Translational Science, INSERM Unité 1148, Département Hospitalo Universitaire-Fibrose Inflammation Remodelage, and the Department of Cardiology, Cochin Hospital (O.V.), University of Paris, the Department of Neurology, Foch Hospital (B.L.), Urgences Cerebrovasculaires (Y.S.), Centre de Pharmacoépidémiologie de l'APHP (N.Y.), and the Department of Endocrinology (E.B.), Hôpital de la Pitié-Salpêtrière, the Department of Biostatistics, APHP, Université Paris Diderot, Sorbonne Paris Cité, Fernand Widal Hospital (É.V.), and the Department of Endocrinology, Sorbonne University (E.B.), Paris, Équipe d'Accueil EA2694, Santé Publique: Epidémiologie et Qualité des Soins (J.L.), and the Department of Neurology, Stroke Unit, University of Lille, Centre Hospitalier Universitaire (CHU) de Lille (D.L.), Lille, the Department of Neurology, University Hospital of Dijon, University of Burgundy, Dijon (Y.B., M.G.), the Stroke Unit, Pasteur Hospital, Nice (M.-H.M.), Hospices Civils de Lyon, Department of Neurology and Stroke Center, Lyon University, Lyon (N.N.), the Department of Neurology, Versailles University Hospital, Versailles (F.P.), the Department of Vascular Neurology, Pellegrin Tripode Hospital, University of Bordeaux, Bordeaux (I.S.), and the Department of Neurology, Université Caen Normandie, CHU Caen Normandie, INSERM Unité 1237, Cyceron, Caen (E.T.) - all in France; Asan Medical Center (J.S.K.), the Department of Neurology, Eunpyeong St. Mary's Hospital, Catholic University of Korea (Y.-J.K.), and the Department of Neurology, Soonchunhyang University College of Medicine (K.-B.L.), Seoul, Dong-a University Hospital (J.-K.C.) and the Department of Neurology and Stroke Center, Pusan National University Hospital (S.M.S.), Busan, and the Department of Neurology, Hallym University Sacred Heart Hospital, Anyang (B.-C.L.) - all in South Korea; and the National Heart and Lung Institute-Imperial College and the Institute of Cardiovascular Medicine and Science-Royal Brompton Hospital, London (P.G.S.)
| | - Nessima Yelles
- From the Department of Neurology and Stroke Center (P.A., J.L., H.C., L.C., C.G., C.H., P.C.L., E.M., P.-J.T.) and the Department of Cardiology (J.A., G.D., P.G.S.), Assistance Publique-Hôpitaux de Paris (APHP), Bichat Hospital, Laboratory for Vascular Translational Science, INSERM Unité 1148, Département Hospitalo Universitaire-Fibrose Inflammation Remodelage, and the Department of Cardiology, Cochin Hospital (O.V.), University of Paris, the Department of Neurology, Foch Hospital (B.L.), Urgences Cerebrovasculaires (Y.S.), Centre de Pharmacoépidémiologie de l'APHP (N.Y.), and the Department of Endocrinology (E.B.), Hôpital de la Pitié-Salpêtrière, the Department of Biostatistics, APHP, Université Paris Diderot, Sorbonne Paris Cité, Fernand Widal Hospital (É.V.), and the Department of Endocrinology, Sorbonne University (E.B.), Paris, Équipe d'Accueil EA2694, Santé Publique: Epidémiologie et Qualité des Soins (J.L.), and the Department of Neurology, Stroke Unit, University of Lille, Centre Hospitalier Universitaire (CHU) de Lille (D.L.), Lille, the Department of Neurology, University Hospital of Dijon, University of Burgundy, Dijon (Y.B., M.G.), the Stroke Unit, Pasteur Hospital, Nice (M.-H.M.), Hospices Civils de Lyon, Department of Neurology and Stroke Center, Lyon University, Lyon (N.N.), the Department of Neurology, Versailles University Hospital, Versailles (F.P.), the Department of Vascular Neurology, Pellegrin Tripode Hospital, University of Bordeaux, Bordeaux (I.S.), and the Department of Neurology, Université Caen Normandie, CHU Caen Normandie, INSERM Unité 1237, Cyceron, Caen (E.T.) - all in France; Asan Medical Center (J.S.K.), the Department of Neurology, Eunpyeong St. Mary's Hospital, Catholic University of Korea (Y.-J.K.), and the Department of Neurology, Soonchunhyang University College of Medicine (K.-B.L.), Seoul, Dong-a University Hospital (J.-K.C.) and the Department of Neurology and Stroke Center, Pusan National University Hospital (S.M.S.), Busan, and the Department of Neurology, Hallym University Sacred Heart Hospital, Anyang (B.-C.L.) - all in South Korea; and the National Heart and Lung Institute-Imperial College and the Institute of Cardiovascular Medicine and Science-Royal Brompton Hospital, London (P.G.S.)
| | - Eric Bruckert
- From the Department of Neurology and Stroke Center (P.A., J.L., H.C., L.C., C.G., C.H., P.C.L., E.M., P.-J.T.) and the Department of Cardiology (J.A., G.D., P.G.S.), Assistance Publique-Hôpitaux de Paris (APHP), Bichat Hospital, Laboratory for Vascular Translational Science, INSERM Unité 1148, Département Hospitalo Universitaire-Fibrose Inflammation Remodelage, and the Department of Cardiology, Cochin Hospital (O.V.), University of Paris, the Department of Neurology, Foch Hospital (B.L.), Urgences Cerebrovasculaires (Y.S.), Centre de Pharmacoépidémiologie de l'APHP (N.Y.), and the Department of Endocrinology (E.B.), Hôpital de la Pitié-Salpêtrière, the Department of Biostatistics, APHP, Université Paris Diderot, Sorbonne Paris Cité, Fernand Widal Hospital (É.V.), and the Department of Endocrinology, Sorbonne University (E.B.), Paris, Équipe d'Accueil EA2694, Santé Publique: Epidémiologie et Qualité des Soins (J.L.), and the Department of Neurology, Stroke Unit, University of Lille, Centre Hospitalier Universitaire (CHU) de Lille (D.L.), Lille, the Department of Neurology, University Hospital of Dijon, University of Burgundy, Dijon (Y.B., M.G.), the Stroke Unit, Pasteur Hospital, Nice (M.-H.M.), Hospices Civils de Lyon, Department of Neurology and Stroke Center, Lyon University, Lyon (N.N.), the Department of Neurology, Versailles University Hospital, Versailles (F.P.), the Department of Vascular Neurology, Pellegrin Tripode Hospital, University of Bordeaux, Bordeaux (I.S.), and the Department of Neurology, Université Caen Normandie, CHU Caen Normandie, INSERM Unité 1237, Cyceron, Caen (E.T.) - all in France; Asan Medical Center (J.S.K.), the Department of Neurology, Eunpyeong St. Mary's Hospital, Catholic University of Korea (Y.-J.K.), and the Department of Neurology, Soonchunhyang University College of Medicine (K.-B.L.), Seoul, Dong-a University Hospital (J.-K.C.) and the Department of Neurology and Stroke Center, Pusan National University Hospital (S.M.S.), Busan, and the Department of Neurology, Hallym University Sacred Heart Hospital, Anyang (B.-C.L.) - all in South Korea; and the National Heart and Lung Institute-Imperial College and the Institute of Cardiovascular Medicine and Science-Royal Brompton Hospital, London (P.G.S.)
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9
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Fuchs A, Urena Alcazar M, Nguyen C, Brochet E, Abtan J, Fischer Q, Ducrocq G, Iung B, Vahanian A, Himbert D. Transcatheter valve-in-valve or valve-in-ring mitral valve implantation in young women contemplating pregnancy. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.163] [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: 10/25/2022]
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10
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Arangalage D, Abtan J, Gaschignard J, Ceccaldi PF, Remini SA, Etienne I, Ruszniewski P, Plaisance P, De Lastours V, Lefort A, Faye A. Implementation of a large-scale simulation-based cardiovascular clinical examination course for undergraduate medical students - a pilot study. BMC Med Educ 2019; 19:361. [PMID: 31533700 PMCID: PMC6751897 DOI: 10.1186/s12909-019-1750-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 08/13/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND We report the implementation of a large-scale simulation-based cardiovascular diagnostics course for undergraduate medical students. METHODS A simulation-based course was integrated into the curriculum of second-year medical students (> 400 students/year). The first session aimed at teaching cardiac auscultation skills on mannequins and the second at teaching blood pressure measurement, peripheral arterial examination, and the clinical examination of heart failure in a technical skill-based manner and in a scenario. RESULTS A total of 414 (99.8%) and 402 (98.5%) students, as well as 102 and 104 educators, participated during the 2016-2017 and 2017-2018 academic years across both types of sessions. The number of positive appreciations by students was high and improved from the first to the second year (session 1: 77% vs. 98%, session 2: 89% vs. 98%; p < 0.0001). Similar results were observed for educators (session 1: 84% vs. 98%, p = 0.007; session 2: 82% vs. 98%, p = 0.01). Feedbacks by students were positive regarding the usefulness of the course, fulfillment of pedagogical objectives, quality of the teaching method, time management, and educator-student interactivity. In contrast, 95% of students criticized the quality of the mannequins during the first year leading to the replacement of the simulation material the following year. Students most appreciated the auscultation workshop (25%), the practical aspect of the course (22%), and the availability of educators (21%). CONCLUSIONS Despite the need to commit significant human and material resources, the implementation of this large-scale program involving > 400 students/year was feasible, and students and educators reacted favorably.
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Affiliation(s)
- Dimitri Arangalage
- Department of Cardiology, Bichat Hospital, AP-HP, 46 Rue Henri Huchard, 75018 Paris, France
- Université de Paris, Faculté de Médecine Paris-Diderot, Paris, France
- iLumens Paris-Diderot Simulation Department, Paris, France
- INSERM U1148 (LVTS), Paris, France
| | - Jérémie Abtan
- Department of Cardiology, Bichat Hospital, AP-HP, 46 Rue Henri Huchard, 75018 Paris, France
- Université de Paris, Faculté de Médecine Paris-Diderot, Paris, France
- iLumens Paris-Diderot Simulation Department, Paris, France
| | - Jean Gaschignard
- Department of General Pediatrics, Internal Medicine and Infectious Diseases, Robert Debré University Hospital, Paris, AP-HP France
- Université de Paris, Faculté de Médecine Paris-Diderot, Paris, France
- iLumens Paris-Diderot Simulation Department, Paris, France
- INSERM U1137 (IAME), Paris, France
| | - Pierre-François Ceccaldi
- Department of Obstetrics and Gynecology, Beaujon Hospital, AP-HP, Clichy, France
- Université de Paris, Faculté de Médecine Paris-Diderot, Paris, France
- iLumens Paris-Diderot Simulation Department, Paris, France
| | - Sid-Ahmed Remini
- Université de Paris, Faculté de Médecine Paris-Diderot, Paris, France
- iLumens Paris-Diderot Simulation Department, Paris, France
| | - Isabelle Etienne
- Université de Paris, Faculté de Médecine Paris-Diderot, Paris, France
- iLumens Paris-Diderot Simulation Department, Paris, France
| | - Philippe Ruszniewski
- Department of Gastroenterology and Pancreatology, Beaujon Hospital, AP-HP, Clichy, France
- Université de Paris, Faculté de Médecine Paris-Diderot, Paris, France
- iLumens Paris-Diderot Simulation Department, Paris, France
| | - Patrick Plaisance
- Emergency Department, Lariboisière Hospital AP-HP, Paris, France
- Université de Paris, Faculté de Médecine Paris-Diderot, Paris, France
- iLumens Paris-Diderot Simulation Department, Paris, France
| | - Victoire De Lastours
- Department of Internal Medicine, Beaujon Hospital, AP-HP, Clichy, France
- Université de Paris, Faculté de Médecine Paris-Diderot, Paris, France
- iLumens Paris-Diderot Simulation Department, Paris, France
| | - Agnès Lefort
- Department of Internal Medicine, Beaujon Hospital, AP-HP, Clichy, France
- Université de Paris, Faculté de Médecine Paris-Diderot, Paris, France
- iLumens Paris-Diderot Simulation Department, Paris, France
| | - Albert Faye
- Department of General Pediatrics, Internal Medicine and Infectious Diseases, Robert Debré University Hospital, Paris, AP-HP France
- Université de Paris, Faculté de Médecine Paris-Diderot, Paris, France
- iLumens Paris-Diderot Simulation Department, Paris, France
- INSERM U1123 (ECEVE), Paris, France
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11
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Fischer Q, Urena M, Bouleti C, Abtan J, Brochet E, Carrasco JL, Iung B, Vahanian A, Himbert D. Performing optimal transcatheter aortic valve implantation: The need for tailored use of transcatheter valves. Arch Cardiovasc Dis 2019; 112:512-522. [PMID: 31474571 DOI: 10.1016/j.acvd.2019.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 01/02/2019] [Revised: 03/01/2019] [Accepted: 05/23/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Despite the worldwide development of transcatheter aortic valve implantation (TAVI) over the last decade, strategies that take patient characteristics into account to guide the choice of transcatheter heart valve have not been evaluated. AIM To evaluate the immediate results of TAVI using a tailored choice of balloon-expandable or self-expanding transcatheter heart valve, according to each patient's clinical and anatomical characteristics. METHODS This single-centre observational study included all patients treated with TAVI from 2012 to 2017. The 30-day results were reported according to Valve Academic Research Consortium-2 criteria. A total of 502 patients were included (mean age, 81±9 years; 52% men; mean EuroSCORE II, 7.0±6.5%). Three main variables guided the choice of transcatheter heart valve: the anatomy of the iliofemoral arteries and of the aortic root, and the general condition of the patient. RESULTS A SAPIEN™ balloon-expandable transcatheter heart valve was used in 275 patients (55%) and a CoreValve™ self-expanding transcatheter heart valve in 227 patients (45%). The approach was transfemoral in 427 patients (85%), and only 29 patients (6%) required transthoracic access. At 30-day follow-up, the rates of adverse events were as follows: mortality, 3.2%; stroke, 3.0%; major bleeding, 5.9%; and major vascular complications, 6.0%. Rates of complications at 30 days were similar in the SAPIEN™ and CoreValve™ groups, except for a higher rate of pacemaker implantation in the latter group (29.5% vs. 14.5%; P<0.001). CONCLUSION The choice of balloon-expandable or self-expanding transcatheter heart valve tailored to the patient's clinical and anatomical characteristics allows for maximal use of the transfemoral approach, and is associated with low 30-day rates of major complications and mortality.
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Affiliation(s)
- Quentin Fischer
- Department of Cardiology, Bichat-Claude-Bernard Hospital, AP-HP, 75018 Paris, France; University Paris Diderot, 75013 Paris, France
| | - Marina Urena
- Department of Cardiology, Bichat-Claude-Bernard Hospital, AP-HP, 75018 Paris, France
| | - Claire Bouleti
- Department of Cardiology, Bichat-Claude-Bernard Hospital, AP-HP, 75018 Paris, France
| | - Jérémie Abtan
- Department of Cardiology, Bichat-Claude-Bernard Hospital, AP-HP, 75018 Paris, France
| | - Eric Brochet
- Department of Cardiology, Bichat-Claude-Bernard Hospital, AP-HP, 75018 Paris, France
| | - Jose-Luis Carrasco
- Department of Anaesthesiology, Bichat-Claude-Bernard Hospital, AP-HP, 75877 Paris, France
| | - Bernard Iung
- Department of Cardiology, Bichat-Claude-Bernard Hospital, AP-HP, 75018 Paris, France; Department of Anaesthesiology, Bichat-Claude-Bernard Hospital, AP-HP, 75877 Paris, France
| | - Alec Vahanian
- Department of Cardiology, Bichat-Claude-Bernard Hospital, AP-HP, 75018 Paris, France; University Paris Diderot, 75013 Paris, France
| | - Dominique Himbert
- Department of Cardiology, Bichat-Claude-Bernard Hospital, AP-HP, 75018 Paris, France.
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12
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Chong-Nguyen C, Kerneis C, Matthieu T, Arangalage D, Juliard J, Aubry P, Abtan J, Brochet E. One-year experience of the micro trans esophageal probe in cardiac structural interventions. Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2019.04.005] [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: 10/26/2022]
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13
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Selhane D, Urena-Alcazar M, Veugeois A, Abtan J, Zannis K, Ghodbane W, Lansac E, Vahanian A, Caussin C, Himbert D, Amabile N. P2257Peri-procedural tamponade following transcatheter aortic valve implantation: incidence, predictors and impact on outcome. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D Selhane
- Institut Mutualiste Montsouris, Department of Cardiology, PARIS, France
| | - M Urena-Alcazar
- Hospital Bichat-Claude Bernard, Department of Cardiology, Paris, France
| | - A Veugeois
- Institut Mutualiste Montsouris, Department of Cardiology, PARIS, France
| | - J Abtan
- Hospital Bichat-Claude Bernard, Department of Cardiology, Paris, France
| | - K Zannis
- Institut Mutualiste Montsouris, Department of Cardiac Surgery, Paris, France
| | - W Ghodbane
- Hospital Bichat-Claude Bernard, Department of Cardiology, Paris, France
| | - E Lansac
- Institut Mutualiste Montsouris, Department of Cardiac Surgery, Paris, France
| | - A Vahanian
- Hospital Bichat-Claude Bernard, Department of Cardiology, Paris, France
| | - C Caussin
- Institut Mutualiste Montsouris, Department of Cardiology, PARIS, France
| | - D Himbert
- Hospital Bichat-Claude Bernard, Department of Cardiology, Paris, France
| | - N Amabile
- Institut Mutualiste Montsouris, Department of Cardiology, PARIS, France
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14
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Abtan J, Sorbets E, Popovic B, Elbez Y, Mehta S, Sabatine MS, Wiviott SD, Bode C, Pollack CV, Cohen M, Ducrocq G, Steg PG. P5106Prevalence, clinical characteristics and outcomes of procedural complications of percutaneous coronary intervention in non ST-elevation myocardial infarction: insights from the TAO trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Abtan
- Hospital Bichat-Claude Bernard, Paris, France
| | - E Sorbets
- Hospital Avicenne of Bobigny, Bobigny, France
| | - B Popovic
- Hospital Brabois of Nancy, Vandoeuvre les Nancy, France
| | - Y Elbez
- Hospital Bichat-Claude Bernard, Paris, France
| | - S Mehta
- McMaster University, Hamilton, Canada
| | - M S Sabatine
- Brigham and Women's Hospital, Boston, United States of America
| | - S D Wiviott
- Brigham and Women's Hospital, Boston, United States of America
| | - C Bode
- University of Freiburg, Freiburg, Germany
| | - C V Pollack
- Thomas Jefferson University Hospital, Philadelphia, United States of America
| | - M Cohen
- Newark Beth Israel Medical Center, Newark, United States of America
| | - G Ducrocq
- Hospital Bichat-Claude Bernard, Paris, France
| | - P G Steg
- Hospital Bichat-Claude Bernard, Paris, France
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15
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Popovic B, Sorbets E, Abtan J, Cohen M, Pollack C, Bode C, Wiviott SD, Sabatine M, Mehta SR, Elbez Y, Ducrocq G, Steg PG. P5537Clinical outcomes, mortality, and causes of death in patients with NSTEMI according to heart failure at admission: insights from a large contemporary revascularization trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- B Popovic
- Hospital Brabois of Nancy, Vandoeuvre les Nancy, France
| | - E Sorbets
- Hospital Bichat-Claude Bernard, Paris, France
| | - J Abtan
- Hospital Bichat-Claude Bernard, Paris, France
| | - M Cohen
- Newark Beth Israel Medical Center, Newark, United States of America
| | - C Pollack
- Thomas Jefferson University Hospital, Philadelphia, United States of America
| | - C Bode
- University of Freiburg, Freiburg, Germany
| | - S D Wiviott
- Harvard Medical School, Boston, United States of America
| | - M Sabatine
- Harvard Medical School, Boston, United States of America
| | - S R Mehta
- Hamilton Health Sciences, Hamilton, Canada
| | - Y Elbez
- Hospital Bichat-Claude Bernard, Paris, France
| | - G Ducrocq
- Hospital Bichat-Claude Bernard, Paris, France
| | - P G Steg
- Hospital Bichat-Claude Bernard, Paris, France
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16
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Darmon A, Sorbets E, Ducrocq G, Elbez Y, Abtan J, Popovic B, Magnus Ohman E, Rother J, Wilson PWF, Montalescot G, Zeymer U, Bhatt DL, Steg PG. 5262Identifying higher risk patients among the COMPASS-Eligible population: An analysis from the REduction of atherothrombosis for continued health (REACH) Registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.5262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Darmon
- Hospital Bichat-Claude Bernard, FACT, Department of Cardiology, Paris, France
| | - E Sorbets
- Hospital Avicenne of Bobigny, Université Paris 13, Bobigny, France
| | - G Ducrocq
- Hospital Bichat-Claude Bernard, FACT, Department of Cardiology, Paris, France
| | - Y Elbez
- Hospital Bichat-Claude Bernard, Cardiology, Paris, France
| | - J Abtan
- Hospital Bichat-Claude Bernard, FACT, Department of Cardiology, Paris, France
| | - B Popovic
- Hospital Brabois of Nancy, University Hospital of Nancy, Vandoeuvre les Nancy, France
| | - E Magnus Ohman
- Duke University Medical Center, Division of Cardiovascular Medicine, Durham, United States of America
| | - J Rother
- Asklepios Clinic Altona, Department of Neurology, Hamburg, Germany
| | - P W F Wilson
- Emory University School of Medicine, Medical Center and Cardiology Division, Atlanta, United States of America
| | - G Montalescot
- Hospital Pitie-Salpetriere, ACTION Study Group, Department of Cardiology, Paris, France
| | - U Zeymer
- Klinikum Ludwigshafen, Ludwigshafen Am Rhein, Germany
| | - D L Bhatt
- Brigham and Women's Hospital, Harvard Medical School, Boston, United States of America
| | - P G Steg
- Hospital Bichat-Claude Bernard, FACT, Department of Cardiology, Paris, France
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17
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Urena M, Brochet E, Lecomte M, Kerneis C, Carrasco JL, Ghodbane W, Abtan J, Alkhoder S, Raffoul R, Iung B, Nataf P, Vahanian A, Himbert D. Clinical and haemodynamic outcomes of balloon-expandable transcatheter mitral valve implantation: a 7-year experience. Eur Heart J 2018; 39:2679-2689. [DOI: 10.1093/eurheartj/ehy271] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [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: 11/04/2017] [Accepted: 04/24/2018] [Indexed: 12/22/2022] Open
Affiliation(s)
- Marina Urena
- Department of Cardiology, Bichat Claude Bernard Hospital-Paris VII University, 46 Henri Huchard, Paris, France
| | - Eric Brochet
- Department of Cardiology, Bichat Claude Bernard Hospital-Paris VII University, 46 Henri Huchard, Paris, France
| | - Milena Lecomte
- Department of Cardiology, Bichat Claude Bernard Hospital-Paris VII University, 46 Henri Huchard, Paris, France
| | - Caroline Kerneis
- Department of Cardiology, Bichat Claude Bernard Hospital-Paris VII University, 46 Henri Huchard, Paris, France
| | - Jose Luis Carrasco
- Department of Anesthesiology, Bichat Claude Bernard Hospital-Paris VII University, 46 rue Henri Huchard, Paris, France
| | - Walid Ghodbane
- Department of Cardiac Surgery, Bichat Claude Bernard Hospital-Paris VII University, 46 rue Henri Huchard, Paris, France
| | - Jérémie Abtan
- Department of Cardiology, Bichat Claude Bernard Hospital-Paris VII University, 46 Henri Huchard, Paris, France
| | - Soleiman Alkhoder
- Department of Cardiac Surgery, Bichat Claude Bernard Hospital-Paris VII University, 46 rue Henri Huchard, Paris, France
| | - Richard Raffoul
- Department of Cardiac Surgery, Bichat Claude Bernard Hospital-Paris VII University, 46 rue Henri Huchard, Paris, France
| | - Bernard Iung
- Department of Cardiology, Bichat Claude Bernard Hospital-Paris VII University, 46 Henri Huchard, Paris, France
| | - Patrick Nataf
- Department of Cardiac Surgery, Bichat Claude Bernard Hospital-Paris VII University, 46 rue Henri Huchard, Paris, France
| | - Alec Vahanian
- Department of Cardiology, Bichat Claude Bernard Hospital-Paris VII University, 46 Henri Huchard, Paris, France
| | - Dominique Himbert
- Department of Cardiology, Bichat Claude Bernard Hospital-Paris VII University, 46 Henri Huchard, Paris, France
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Eugène M, Urena M, Abtan J, Carrasco JL, Ghodbane W, Nataf P, Vahanian A, Himbert D. Effectiveness of Rescue Percutaneous Balloon Aortic Valvuloplasty in Patients With Severe Aortic Stenosis and Acute Heart Failure. Am J Cardiol 2018; 121:746-750. [PMID: 29397882 DOI: 10.1016/j.amjcard.2017.11.048] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 10/15/2017] [Revised: 11/25/2017] [Accepted: 11/28/2017] [Indexed: 11/16/2022]
Abstract
The prognosis of patients with cardiogenic shock (CS) or refractory pulmonary edema because of severe aortic stenosis remains poor. The purpose of this study was to assess the outcomes of rescue percutaneous balloon aortic valvuloplasty (PBAV) in the transcatheter aortic valve implantation (TAVI) era. Patients were consecutively included between 2008 and 2016. CS was defined as ≥1 sign of systemic hypoperfusion and need of catecholamines. Refractory pulmonary edema was defined as not controlled by optimal medical treatment. A total of 40 patients, 22 men (55%), aged 79 ± 9 years, were included: 17 with CS (42.5%), 23 with refractory pulmonary edema (57.5%). After PBAV, mean transaortic gradient decreased from 47 ± 16 mm Hg to 32 ± 10 mm Hg (p < 0.001), aortic valve area increased from 0.60 ± 0.18 cm2 to 0.88 ± 0.22 cm2 (p < 0.0001), left ventricular ejection fraction increased from 35 ± 15 to 37 ± 14% (p = 0.02), and systolic pulmonary artery pressure decreased from 61 ± 15 to 48 ± 12 mm Hg (p = 0.002). There was no procedural death. Early death occurred in 12 patients (30%). After PBAV, 16 of the 28 survivors (57%) were bridged to surgical aortic valve replacement (SAVR; n = 7) or TAVI (n = 9), and 12 (43%) were denied definitive therapy. The 2-year estimated survival rate was 71 ± 17% after SAVR, 36 ± 19% after TAVI, and 8 ± 8% after PBAV alone. In conclusion, rescue PBAV is safe in patients with CS and high-risk aortic stenosis or refractory pulmonary edema and may improve their dismal prognosis when followed by TAVI or SAVR.
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Affiliation(s)
- Marc Eugène
- Department of Cardiology, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Marina Urena
- Department of Cardiology, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Jérémie Abtan
- Department of Cardiology, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - José-Luis Carrasco
- Department of Anesthesiology, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Walid Ghodbane
- Department of Cardiovascular Surgery, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Patrick Nataf
- Department of Cardiovascular Surgery, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Alec Vahanian
- Department of Cardiology, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Dominique Himbert
- Department of Cardiology, Bichat-Claude Bernard Hospital, AP-HP, Paris, France.
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Hyafil F, Chequer R, Sorbets E, Ducrocq G, Abtan J, Rouzet F, Marie P, Le Guludec D. Higher diagnostic performances of 82Rubidium-PET in comparison to SPECT myocardial perfusion scintigraphy for the detection of patients with three-vessel coronary artery disease. Archives of Cardiovascular Diseases Supplements 2018. [DOI: 10.1016/j.acvdsp.2017.11.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abtan J, Silvain J, Kerneis M, O’Connor SA, Barthélémy O, Vignalou JB, Beygui F, Brugier D, Collet JP, Montalescot G. Identification of poor response to P2Y12 inhibitors in ACS patients with a new ELISA-based vasodilator-associated stimulated phosphoprotein (VASP) phosphorylation assay. Thromb Haemost 2017; 110:1055-64. [DOI: 10.1160/th13-03-0203] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 07/07/2013] [Indexed: 11/05/2022]
Abstract
SummaryA new ELISA technique has been developed to measure the vasodilator-associated stimulated phosphoprotein (VASP) platelet reactivity index (PRI) in clopidogrel-treated patients. This technique has not been evaluated in acute coronary syndrome (ACS) patients or in prasugrel-treated patients. We assessed the accuracy of ELISA-VASP to identify high on-treatment platelet reactivity (HPR) in ACS patients in comparison with established platelet function tests. Platelet reactivity was measured in 240 ACS patients treated with clopidogrel (75 or 150 mg) or prasugrel (5 or 10 mg) using flow cytometry (FC-VASP) and the ELISA-VASP technique, light transmission aggregometry (LTA) and VerifyNow-P2Y12 assay (VN-P2Y12). When using the ELISA-VASP PRI, the rate of patients with HPR in the overall ACS population was 15.5%, including a 27% rate in clopidogrel-treated patients and a 4% rate in prasugrel-treated patients. There was a strong correlation between ELISA-VASP PRI and FC-VASP PRI (r = 0.83, r2 = 0.68 p < 0.0001) with an area under the receiver-operating characteristics (ROC) curve to identify HPR (VASP-PRI >50% with FC-VASP) of 0.94, p<0.0001. The threshold of 60% for ELISA-VASP PRI provided the best accuracy (likelihood ratio= 23.67) to identify patients with HPR when compared to FC-VASP, LTA or VN-P2Y12 assays. In conclusion, ELISA-VASP is a fast, easy-to-use and specific test to identify HPR in ACS patients on thienopyridines. A 60% threshold value displays the best accuracy to identify HPR in these patients.
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Darmon A, Bhatt DL, Elbez Y, Aboyans V, Anand S, Bosch J, Branch KR, Connolly SJ, Dyal L, Eikelboom JW, Fox KAA, Keltai K, Probstfield J, Yusuf S, Abtan J, Sorbets E, Eagle KA, Ducrocq G, Steg PG. External applicability of the COMPASS trial: an analysis of the reduction of atherothrombosis for continued health (REACH) registry. Eur Heart J 2017; 39:750-757a. [DOI: 10.1093/eurheartj/ehx658] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [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: 08/17/2017] [Accepted: 10/24/2017] [Indexed: 01/22/2023] Open
Affiliation(s)
- Arthur Darmon
- Département Hospitalo-Universitaire FIRE, FACT French Alliance for Cardiovascular Trials, 46 Rue Henri Huchard, Assistance Publique-Hôpitaux de Paris, 75018 Paris, France
- INSERM U1148, Laboratory for Vascular Translationnal Science, 46 Rue Henri Huchard, 75018 Paris, France
| | - Deepak L Bhatt
- Department of Cardiology, Brigham and Women’s Hospital Heart & Vascular Center, 75 Francis Street, Boston, MA 02115, USA
| | - Yedid Elbez
- Département Hospitalo-Universitaire FIRE, FACT French Alliance for Cardiovascular Trials, 46 Rue Henri Huchard, Assistance Publique-Hôpitaux de Paris, 75018 Paris, France
| | - Victor Aboyans
- Département Hospitalo-Universitaire FIRE, FACT French Alliance for Cardiovascular Trials, 46 Rue Henri Huchard, Assistance Publique-Hôpitaux de Paris, 75018 Paris, France
- Department of Cardiology, CHU Dupuytren, 2 Avenue Martin Luther King, 87000 Limoges, France
| | - Sonia Anand
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - Jackie Bosch
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - Kelley R Branch
- Department of Cardiology, University of Washington, Seattle, WA 98195, USA
| | - Stuart J Connolly
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - Leanne Dyal
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - John W Eikelboom
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - Keith A A Fox
- Center for Cardiovascular Science, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4T, UK
| | - Katalin Keltai
- Semmelweis University, Budapest, Üllői út 26, 1085, Hungary
| | | | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - Jérémie Abtan
- Département Hospitalo-Universitaire FIRE, FACT French Alliance for Cardiovascular Trials, 46 Rue Henri Huchard, Assistance Publique-Hôpitaux de Paris, 75018 Paris, France
- Université Paris-Diderot, Sorbonne Paris Cité, 5 rue Thomas Mann, 75013 Paris, France
| | - Emmanuel Sorbets
- Département Hospitalo-Universitaire FIRE, FACT French Alliance for Cardiovascular Trials, 46 Rue Henri Huchard, Assistance Publique-Hôpitaux de Paris, 75018 Paris, France
- Department of Cardiology, Hôpital Avicenne, AP-HP & Université Paris 13, 25 Rue de Stalingrad, 93000 Bobigny, France
| | - Kim A Eagle
- University of Michigan, Ann Arbor, MI 48109, USA
| | - Gregory Ducrocq
- Département Hospitalo-Universitaire FIRE, FACT French Alliance for Cardiovascular Trials, 46 Rue Henri Huchard, Assistance Publique-Hôpitaux de Paris, 75018 Paris, France
- INSERM U1148, Laboratory for Vascular Translationnal Science, 46 Rue Henri Huchard, 75018 Paris, France
- Université Paris-Diderot, Sorbonne Paris Cité, 5 rue Thomas Mann, 75013 Paris, France
| | - Philippe Gabriel Steg
- Département Hospitalo-Universitaire FIRE, FACT French Alliance for Cardiovascular Trials, 46 Rue Henri Huchard, Assistance Publique-Hôpitaux de Paris, 75018 Paris, France
- INSERM U1148, Laboratory for Vascular Translationnal Science, 46 Rue Henri Huchard, 75018 Paris, France
- Université Paris-Diderot, Sorbonne Paris Cité, 5 rue Thomas Mann, 75013 Paris, France
- Imperial College, Royal Brompton Hospital, London, UK
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Collet JP, Kerneis M, Hulot JS, O’Connor SA, Silvain J, Mansencal N, Brugier D, Abtan J, Barthélémy O, Vignalou JB, Payot L, Rousseau H, Vicaut E, Montalescot G. Point-of-care genetic profiling and/or platelet function testing in acute coronary syndrome. Thromb Haemost 2017; 115:382-91. [DOI: 10.1160/th15-05-0394] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 08/26/2015] [Indexed: 11/05/2022]
Abstract
SummaryOur aim was to demonstrate that the sequential use of the Verigene® rapid CYP2C19 test for genetic profiling and the VerifyNowTM bedside test for platelet function measurement in ACS patients may optimise P2Y12 inhibition. “Rapid” (CYP2C19*1/*1 or CYP2C19*17 carriers, n=211) and “slow” metabolisers (CYP2C19*2 carriers, n=58) were first put on clopidogrel and prasugrel for ≥ 2 weeks, respectively. Patients with low platelet reactivity (PRU< 30) on prasugrel or high platelet reactivity (> 208 PRU) on clopidogrel were then switched to clopidogrel and prasugrel, respectively. Our objectives were (i) to demonstrate that the proportion of “rapid” metabolisers on 75 mg of clopidogrel within 30–208 (PRU) of P2Y12 inhibition is non-inferior to “slow” metabolisers on prasugrel 10 mg and (ii) to evaluate the same end-point after switching drugs. The proportion of “rapid” and “slow” metabolisers within 30–208 PRU of P2Y12 inhibition was 71 % and 56.9 %, respectively, an absolute difference of +14.1 % (95 % CI, –0.05 % to 28.28 %) with a non-inferiority margin greater than the predefined margin of –10 %. Among patients out of target, all but one “slow” metabolisers displayed low-on prasugrel platelet reactivity while the majority of “rapid” metabolisers (68 %) displayed high-on clopidogrel platelet reactivity. After switching, the proportion of patients within 30–208 PRU of P2Y12 inhibition was 83.6 % and 79.3 % in “rapid” and “slow” metabolisers, respectively (+4.3 %, 95 % CI –7.3 % to 15.9 %). In conclusion, this study demonstrates a loose relationship between genotype and platelet function phenotype approaches but that they are complementary to select prasugrel or clopidogrel MD in stented ACS patients.
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Abtan J, Steg PG, Stone GW, Mahaffey KW, Gibson CM, Hamm CW, Price MJ, Abnousi F, Prats J, Deliargyris EN, White HD, Harrington RA, Bhatt DL. Efficacy and Safety of Cangrelor in Preventing Periprocedural Complications in Patients With Stable Angina and Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention: The CHAMPION PHOENIX Trial. JACC Cardiovasc Interv 2017; 9:1905-13. [PMID: 27659566 DOI: 10.1016/j.jcin.2016.06.046] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 06/19/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The purpose of this study was to examine the safety and efficacy of cangrelor in patients with stable angina (SA) or acute coronary syndrome (ACS). BACKGROUND The CHAMPION PHOENIX (A Clinical Trial Comparing Cangrelor to Clopidogrel Standard Therapy in Subjects Who Require Percutaneous Coronary Intervention) trial demonstrated that cangrelor significantly reduced periprocedural ischemic events in all-comer percutaneous coronary intervention with a modest increase in mild and moderate bleeding. Whether this benefit is consistent across SA and ACS has not been explored fully. METHODS The CHAMPION PHOENIX trial compared periprocedural administration of cangrelor or clopidogrel, with either a 300- or 600-mg loading dose for the prevention of periprocedural complications in patients undergoing percutaneous coronary intervention. Among the 10,942 patients in the modified intention to treat population, 6,358 patients were classified as having SA, and 4,584 patients had ACS (including unstable angina, non ST-segment elevation myocardial infarction and ST-segment elevation myocardial infarction) at randomization. The primary composite endpoint was death, myocardial infarction, ischemia-driven revascularization, or stent thrombosis at 48 h. A key secondary endpoint was stent thrombosis, and the primary safety endpoint was GUSTO (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) severe bleeding. RESULTS Cangrelor consistently reduced the primary endpoint in SA and ACS (odds ratio [OR]: 0.83 [95% confidence interval (CI): 0.67 to 1.01] and OR: 0.71 [95% CI: 0.52 to 0.96], respectively; interaction p = 0.41). Cangrelor also consistently reduced stent thrombosis in SA and ACS (OR: 0.55 [95% CI: 0.30 to 1.01] and OR: 0.67 [95% CI: 0.42 to 1.06], respectively; interaction p = 0.62). The impact of cangrelor on GUSTO severe/moderate bleeding was also similar for SA and ACS (OR: 1.49 [95% CI: 0.67 to 3.33] and OR: 1.79 [95% CI: 0.79 to 4.07], respectively; interaction p = 0.75). CONCLUSIONS The benefits and risks of cangrelor were consistent in patients with SA and ACS. (A Clinical Trial Comparing Cangrelor to Clopidogrel Standard Therapy in Subjects Who Require Percutaneous Coronary Intervention [PCI] [CHAMPION PHOENIX] [CHAMPION]; NCT01156571).
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Affiliation(s)
- Jérémie Abtan
- DHU (Département Hospitalo-Universitaire)-FIRE (Fibrosis, Inflammation, REmodelling), Hôpital Bichat, AP-HP (Assistance Publique-Hôpitaux de Paris), Université Paris-Diderot, Sorbonne-Paris Cité, and FACT (French Alliance for Cardiovascular clinical Trials), an F-CRIN network, INSERM U-1148, Paris, France
| | - P Gabriel Steg
- DHU (Département Hospitalo-Universitaire)-FIRE (Fibrosis, Inflammation, REmodelling), Hôpital Bichat, AP-HP (Assistance Publique-Hôpitaux de Paris), Université Paris-Diderot, Sorbonne-Paris Cité, and FACT (French Alliance for Cardiovascular clinical Trials), an F-CRIN network, INSERM U-1148, Paris, France; NLHI, ICMS, Royal Brompton Hospital, Imperial College, London, United Kingdom.
| | - Gregg W Stone
- Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York
| | - Kenneth W Mahaffey
- Stanford Center for Clinical Research (SCCR); Department of Medicine; Stanford School of Medicine, Stanford, California
| | - C Michael Gibson
- Beth Israel Deaconess Medical Center, Division of Cardiology, Harvard Medical School, Boston, Massachusetts
| | | | - Matthew J Price
- Scripps Clinic and Scripps Translational Science Institute, La Jolla, California
| | - Freddy Abnousi
- Scripps Clinic and Scripps Translational Science Institute, La Jolla, California
| | - Jayne Prats
- The Medicines Company, Parsippany, New Jersey
| | | | - Harvey D White
- University of Auckland, Auckland City Hospital, Auckland, New Zealand
| | - Robert A Harrington
- Stanford Center for Clinical Research (SCCR); Department of Medicine; Stanford School of Medicine, Stanford, California
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts
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Urena M, Himbert D, Brochet E, Lecomte M, Carrasco J, Ghodbane W, Alkhoder S, Raffoul R, Cimadevilla C, Abtan J, Messika-Zeitoun D, Iung B, Nataf P, Vahanian A. 4107Results of Transcatheter Mitral Valve Implantation in Patients with Bioprosthesis Or Annuloplasty Failure Or Mitral Annulus Calcification. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.4107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Auffret V, Lefevre T, Van Belle E, Eltchaninoff H, Iung B, Koning R, Motreff P, Leprince P, Verhoye JP, Manigold T, Souteyrand G, Boulmier D, Joly P, Pinaud F, Himbert D, Collet JP, Rioufol G, Ghostine S, Bar O, Dibie A, Champagnac D, Leroux L, Collet F, Teiger E, Darremont O, Folliguet T, Leclercq F, Lhermusier T, Olhmann P, Huret B, Lorgis L, Drogoul L, Bertrand B, Spaulding C, Quilliet L, Cuisset T, Delomez M, Beygui F, Claudel JP, Hepp A, Jegou A, Gommeaux A, Mirode A, Christiaens L, Christophe C, Cassat C, Metz D, Mangin L, Isaaz K, Jacquemin L, Guyon P, Pouillot C, Makowski S, Bataille V, Rodés-Cabau J, Gilard M, Le Breton H, Le Breton H, Eltchaninoff H, Gilard M, Iung B, Le Breton H, Lefevre T, Van Belle E, Laskar M, Leprince P, Iung B, Bataille V, Chevalier B, Garot P, Hovasse T, Lefevre T, Donzeau Gouge P, Farge A, Romano M, Cormier B, Bouvier E, Bauchart JJ, Bodart JC, Delhaye C, Houpe D, Lallemant R, Leroy F, Sudre A, Van Belle E, Juthier F, Koussa M, Modine T, Rousse N, Auffray JL, Richardson M, Berland J, Eltchaninoff H, Godin M, Koning R, Bessou JP, Letocart V, Manigold T, Roussel JC, Jaafar P, Combaret N, Souteyrand G, D’Ostrevy N, Innorta A, Clerfond G, Vorilhon C, Auffret V, Bedossa M, Boulmier D, Le Breton H, Leurent G, Anselmi A, Harmouche M, Verhoye JP, Donal E, Bille J, Joly P, Houel R, Vilette B, Abi Khalil W, Delepine S, Fouquet O, Pinaud F, Rouleau F, Abtan J, Himbert D, Urena M, Alkhoder S, Ghodbane W, Arangalage D, Brochet E, Goublaire C, Barthelemy O, Choussat R, Collet JP, Lebreton G, Leprince P, Mastrioanni C, Isnard R, Dauphin R, Dubreuil O, Durand De Gevigney G, Finet G, Harbaoui B, Ranc S, Rioufol G, Farhat F, Jegaden O, Obadia JF, Pozzi M, Ghostine S, Brenot P, Fradi S, Azmoun A, Deleuze P, Kloeckner M, Bar O, Blanchard D, Barbey C, Chassaing S, Chatel D, Le Page O, Tauran A, Bruere D, Bodson L, Meurisse Y, Seemann A, Amabile N, Caussin C, Dibie A, Elhaddad S, Drieu L, Ohanessian A, Philippe F, Veugeois A, Debauchez M, Zannis K, Czitrom D, Diakov C, Raoux F, Champagnac D, Lienhart Y, Staat P, Zouaghi O, Doisy V, Frieh JP, Wautot F, Dementhon J, Garrier O, Jamal F, Leroux PY, Casassus F, Leroux L, Seguy B, Barandon L, Labrousse L, Peltan J, Cornolle C, Dijos M, Lafitte S, Bayet G, Charmasson C, Collet F, Vaillant A, Vicat J, Giacomoni MP, Teiger E, Bergoend E, Zerbib C, Darremont O, Louis Leymarie J, Clerc P, Choukroun E, Elia N, Grimaud JP, Guibaud JP, Wroblewski S, Abergel E, Bogino E, Chauvel C, Dehant P, Simon M, Angioi M, Lemoine J, Lemoine S, Popovic B, Folliguet T, Maureira P, Huttin O, Selton Suty C, Cayla G, Delseny D, Leclercq F, Levy G, Macia JC, Maupas E, Piot C, Rivalland F, Robert G, Schmutz L, Targosz F, Albat B, Dubar A, Durrleman N, Gandet T, Munos E, Cade S, Cransac F, Bouisset F, Lhermusier T, Grunenwald E, Marcheix B, Fournier P, Morel O, Ohlmann P, Kindo M, Hoang MT, Petit H, Samet H, Trinh A, Huret B, Lecoq G, Morelle JF, Richard P, Derieux T, Monier E, Joret C, Lorgis L, Bouchot O, Eicher JC, Drogoul L, Meyer P, Lopez S, Tapia M, Teboul J, Elbeze JP, Mihoubi A, Bertrand B, Vanzetto G, Wittenberg O, Bach V, Martin C, Sauier C, Casset C, Castellant P, Gilard M, Bezon E, Choplain JN, Kallifa A, Nasr B, Jobic Y, Blanchard D, Lafont A, Pagny JY, Spaulding C, Abi Akar R, Fabiani JN, Zegdi R, Berrebi A, Puscas T, Desveaux B, Ivanes F, Quilliet L, Saint Etienne C, Bourguignon T, Aupy B, Perault R, Bonnet JL, Cuisset T, Lambert M, Grisoli D, Jaussaud N, Salaun E, Delomez M, Laghzaoui A, Savoye C, Beygui F, Bignon M, Roule V, Sabatier R, Ivascau C, Saplacan V, Saloux E, Bouchayer D, Claudel JP, Tremeau G, Diab C, Lapeze J, Pelissier F, Sassard T, Matz C, Monsarrat N, Carel I, Hepp A, Sibellas F, Curtil A, Dambrin G, Favereau X, Jegou A, Ghorayeb G, Guesnier L, Khoury W, Kucharski C, Pouzet B, Vaislic C, Cheikh-Khelifa R, Hilpert L, Maribas P, Gommeaux A, Hannebicque G, Hochart P, Paris M, Pecheux M, Fabre O, Guesnier L, Leborgne L, Mirode A, Peltier M, Trojette F, Carmi D, Tribouilloy C, Christiaens L, Mergy J, Corbi P, Raud Raynier P, Carillo S, Christophe C, Hueber A, Moulin F, Pinelli G, Cassat C, Darodes N, Pesteil F, Metz D, Aludaat C, Torossian F, Belle L, Mangin L, Chavanis N, Akret C, Cerisier A, Isaaz K, Favre JP, Fuzellier JF, Pierrard R, Jacquemin L, Roth O, Wiedemann JY, Bischoff N, Gavra G, Bourrely N, Digne F, Guyon P, Najjari M, Stratiev V, Bonnet N, Mesnildrey P, Attias D, Dreyfus J, Karila Cohen D, Laperche T, Nahum J, Scheuble A, Pouillot C, Rambaud G, Brauberger E, Ah Hot M, Allouch P, Beverelli F, Makowski S, Rosencher J, Aubert S, Grinda JM, Waldman T. Temporal Trends in Transcatheter Aortic Valve Replacement in France. J Am Coll Cardiol 2017; 70:42-55. [DOI: 10.1016/j.jacc.2017.04.053] [Citation(s) in RCA: 207] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 04/05/2017] [Accepted: 04/24/2017] [Indexed: 10/19/2022]
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Abtan J, Bhatt DL, Elbez Y, Sorbets E, Eagle K, Reid CM, Baumgartner I, Wu D, Hanson ME, Hannachi H, Singhal PK, Steg PG, Ducrocq G. Geographic variation and risk factors for systemic and limb ischemic events in patients with symptomatic peripheral artery disease: Insights from the REACH Registry. Clin Cardiol 2017; 40:710-718. [PMID: 28520087 PMCID: PMC6490387 DOI: 10.1002/clc.22721] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [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: 01/12/2017] [Revised: 03/24/2017] [Accepted: 03/30/2017] [Indexed: 01/15/2023] Open
Abstract
Background Patients with symptomatic peripheral artery disease (PAD) are at high risk of ischemic events. However, data about predictors of this risk are limited. Hypothesis We analyzed baseline characteristics and 4‐year follow‐up of patients enrolled in the international REduction of Atherothrombosis for Continued Health (REACH) Registry with symptomatic PAD and no history of stroke/transient ischemic attack to describe annual rates of recurrent ischemic events globally and geographically. Methods The primary outcome was systemic ischemic events (composite of cardiovascular death, myocardial infarction, or stroke) at 4 years. The secondary outcome was limb ischemic events (composite of lower limb amputation, peripheral bypass graft, and percutaneous intervention for PAD) at 2 years. Multivariate analysis identified risk factors associated with recurrent ischemic events. Results The primary endpoint rate reached 4.7% during the first year and increased continuously (by 4%–5% each year) to 17.6% by year 4, driven mainly by cardiovascular mortality (11.1% at year 4). Japan experienced lower adjusted ischemic rates (P < 0.01) vs North America. Renal impairment (P < 0.01), congestive heart failure (P < 0.01), history of diabetes (P < 0.01), history of myocardial infarction (P = 0.01), vascular disease (single or poly, P < 0.01), and older age (P < 0.01) were associated with increased risk of systemic ischemic events, whereas statin use was associated with lower risk (P = 0.03). The limb ischemic event rate was 5.7% at 2 years. Conclusions Four‐year systemic ischemic risk in patients with PAD and no history of stroke or transient ischemic attack remains high, and was mainly driven by cardiovascular mortality.
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Affiliation(s)
- Jérémie Abtan
- FACT (French Alliance for Cardiovascular Trials), French Clinical Research Infrastructure Network, University Hospital Departments-FIRE, Hôpital Bichat, Public Assistance Hospitals of Paris, Paris Diderot University, Sorbonne University Paris Cité, and National Institute of Health and Medical Research, U-1148 Paris, France
| | - Deepak L Bhatt
- Heart and Vascular Center, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Yedid Elbez
- FACT (French Alliance for Cardiovascular Trials), French Clinical Research Infrastructure Network, University Hospital Departments-FIRE, Hôpital Bichat, Public Assistance Hospitals of Paris, Paris Diderot University, Sorbonne University Paris Cité, and National Institute of Health and Medical Research, U-1148 Paris, France
| | - Emmanuel Sorbets
- FACT (French Alliance for Cardiovascular Trials), French Clinical Research Infrastructure Network, University Hospital Departments-FIRE, Hôpital Bichat, Public Assistance Hospitals of Paris, Paris Diderot University, Sorbonne University Paris Cité, and National Institute of Health and Medical Research, U-1148 Paris, France.,Avicenne Hospital Hôpital, Public Assistance Hospitals of Paris, Paris, France
| | - Kim Eagle
- Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Christopher M Reid
- Monash University, Clayton, Victoria, Australia and Curtin University, Bentley, Perth, Western Australia
| | | | - David Wu
- Merck & Co., Inc., Kenilworth, New Jersey
| | | | | | | | - Philippe Gabriel Steg
- FACT (French Alliance for Cardiovascular Trials), French Clinical Research Infrastructure Network, University Hospital Departments-FIRE, Hôpital Bichat, Public Assistance Hospitals of Paris, Paris Diderot University, Sorbonne University Paris Cité, and National Institute of Health and Medical Research, U-1148 Paris, France.,National Heart and Lung Institute, Imperial College School of Medicine, Royal Brompton Hospital, Imperial College, London, United Kingdom
| | - Gregory Ducrocq
- FACT (French Alliance for Cardiovascular Trials), French Clinical Research Infrastructure Network, University Hospital Departments-FIRE, Hôpital Bichat, Public Assistance Hospitals of Paris, Paris Diderot University, Sorbonne University Paris Cité, and National Institute of Health and Medical Research, U-1148 Paris, France
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Hyafil F, Chequer R, Sorbets E, Estellat C, Rouzet F, Ducrocq G, Abtan J, Touati A, Alfaiate T, Leygnac S, Milliner M, Ben Azzouna R, Hartemann A, Roussel R, Montalescot G, Marie P, Le Guludec D. High diagnostic performances of 82 Rubidium-PET for the detection of coronary artery disease as compared to 99 Tc-MIBI with CZT gamma cameras in a population of overweighed patients and women. Archives of Cardiovascular Diseases Supplements 2017. [DOI: 10.1016/s1878-6480(17)30163-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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28
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Desroche L, Safar B, Milleron O, Ou P, Garbarz E, Lavie Badie Y, Abtan J, Millischer D, Jondeau G. Magnetic resonance imaging as the first line imaging in left ventricular dysfunction: evaluation on 305 patients. Archives of Cardiovascular Diseases Supplements 2017. [DOI: 10.1016/s1878-6480(17)30151-9] [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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Cayla G, Cuisset T, Silvain J, Leclercq F, Manzo-Silberman S, Saint-Etienne C, Delarche N, Bellemain-Appaix A, Range G, El Mahmoud R, Carrié D, Belle L, Souteyrand G, Aubry P, Sabouret P, du Fretay XH, Beygui F, Bonnet JL, Lattuca B, Pouillot C, Varenne O, Boueri Z, Van Belle E, Henry P, Motreff P, Elhadad S, Salem JE, Abtan J, Rousseau H, Collet JP, Vicaut E, Montalescot G. Platelet function monitoring to adjust antiplatelet therapy in elderly patients stented for an acute coronary syndrome (ANTARCTIC): an open-label, blinded-endpoint, randomised controlled superiority trial. Lancet 2016; 388:2015-2022. [PMID: 27581531 DOI: 10.1016/s0140-6736(16)31323-x] [Citation(s) in RCA: 261] [Impact Index Per Article: 32.6] [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] [Received: 07/12/2016] [Revised: 07/21/2016] [Accepted: 08/02/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Elderly patients are at high risk of ischaemic and bleeding events. Platelet function monitoring offers the possibility to individualise antiplatelet therapy to improve the therapeutic risk-benefit ratio. We aimed to assess the effect of platelet function monitoring with treatment adjustment in elderly patients stented for an acute coronary syndrome. METHODS We did this multicentre, open-label, blinded-endpoint, randomised controlled superiority study at 35 centres in France. Patients aged 75 years or older who had undergone coronary stenting for acute coronary syndrome were randomly assigned (1:1), via a central interactive voice-response system based on a computer-generated permuted-block randomisation schedule with randomly selected block sizes, to receive oral prasugrel 5 mg daily with dose or drug adjustment in case of inadequate response (monitoring group) or oral prasugrel 5 mg daily with no monitoring or treatment adjustment (conventional group). Randomisation was stratified by centre. Platelet function testing was done 14 days after randomisation and repeated 14 days after treatment adjustment in patients in the monitoring group. Study investigators and patients were not masked to treatment allocation, but allocation was concealed from an independent clinical events committee responsible for endpoint adjudication. The primary endpoint was a composite of cardiovascular death, myocardial infarction, stroke, stent thrombosis, urgent revascularisation, and Bleeding Academic Research Consortium-defined bleeding complications (types 2, 3, or 5) at 12 months' follow-up. We did analysis by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01538446. FINDINGS Between March 27, 2012, and May 19, 2015, we randomly assigned 877 patients to the monitoring group (n=442) or the conventional group (n=435). The primary endpoint occurred in 120 (28%) patients in the monitoring group compared with 123 (28%) patients in the conventional group (hazard ratio [HR], 1·003, 95% CI 0·78-1·29; p=0·98). Rates of bleeding events did not differ significantly between groups. INTERPRETATION Platelet function monitoring with treatment adjustment did not improve the clinical outcome of elderly patients treated with coronary stenting for an acute coronary syndrome. Platelet function testing is still being used in many centres and international guidelines still recommend platelet function testing in high-risk situations. Our study does not support this practice or these recommendations. FUNDING Eli Lilly and Company, Daiichi Sankyo, Stentys, Accriva Diagnostics, Medtronic, and Fondation Coeur et Recherche.
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Affiliation(s)
- Guillaume Cayla
- ACTION Study Group, Service de Cardiologie, Centre Hospitalier Universitaire de Nimes, Université de Montpellier, Nimes, France
| | - Thomas Cuisset
- Department of Cardiology, Centre Hospitalier Universitaire Timone, Marseille, France; INSERM UMR1062, INRA UMR1260, Nutrition, Obesity and Risk of Thrombosis, Faculty of Medicine, Aix-Marseille University, Marseille, France
| | - Johanne Silvain
- Sorbonne Université-Paris 06, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Florence Leclercq
- Département de Cardiologie, Centre Hospitalier Universitaire Montpellier, Montpellier, France
| | | | | | - Nicolas Delarche
- Hôpital Francois Mitterrand, Centre Hospitalier de Pau, Pau, France
| | - Anne Bellemain-Appaix
- ACTION Study Group, Service de Cardiologie, Centre Hospitalier d'Antibes-Juans-Les-Pins, Antibes, France
| | - Grégoire Range
- Service de Cardiologie, Les Hôpitaux de Chartres, Le Coudray, Chartres, France
| | | | - Didier Carrié
- Service de Cardiologie, Centre Hospitalier Universitaire Toulouse, Toulouse, France
| | - Loic Belle
- Service de Cardiologie, Centre Hospitalier d'Annecy, Annecy, France
| | - Geraud Souteyrand
- Service de Cardiologie, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France
| | - Pierre Aubry
- Service de Cardiologie, Hôpital Bichat Claude Bernard, Paris, France
| | - Pierre Sabouret
- Sorbonne Université-Paris 06, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | | | - Farzin Beygui
- ACTION Study Group, Service de Cardiologie, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Jean-Louis Bonnet
- Department of Cardiology, Centre Hospitalier Universitaire Timone, Marseille, France; INSERM UMR1062, INRA UMR1260, Nutrition, Obesity and Risk of Thrombosis, Faculty of Medicine, Aix-Marseille University, Marseille, France
| | - Benoit Lattuca
- ACTION Study Group, Service de Cardiologie, Centre Hospitalier Universitaire de Nimes, Université de Montpellier, Nimes, France
| | | | | | - Ziad Boueri
- Service de Cardiologie de Bastia, Centre Hospitalier de Bastia, Bastia, France
| | - Eric Van Belle
- Service de Cardiologie, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Patrick Henry
- Service de Cardiologie, Hôpital Lariboisière, Paris, France
| | - Pascal Motreff
- Service de Cardiologie, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France
| | - Simon Elhadad
- Centre Hospitalier de Lagny Marne la Vallée, Jossigny, France
| | - Joe-Elie Salem
- Department of Pharmacology, CIC-1421, INSERM U1166-ICAN, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Jérémie Abtan
- Service de Cardiologie, Hôpital Bichat Claude Bernard, Paris, France
| | - Hélène Rousseau
- ACTION Study Group, Unité de Recherche Clinique, Lariboisière, Paris, France
| | - Jean-Philippe Collet
- Sorbonne Université-Paris 06, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Eric Vicaut
- ACTION Study Group, Unité de Recherche Clinique, Lariboisière, Paris, France
| | - Gilles Montalescot
- Sorbonne Université-Paris 06, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France.
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Abtan J, Bhatt DL, Elbez Y, Sorbets E, Eagle K, Ikeda Y, Wu D, Hanson ME, Hannachi H, Singhal PK, Steg PG, Ducrocq G. Residual Ischemic Risk and Its Determinants in Patients With Previous Myocardial Infarction and Without Prior Stroke or TIA: Insights From the REACH Registry. Clin Cardiol 2016; 39:670-677. [PMID: 27588731 DOI: 10.1002/clc.22583] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [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: 04/22/2016] [Revised: 07/05/2016] [Accepted: 07/12/2016] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Although the rate of in-hospital ischemic events after myocardial infarction (MI) has dramatically decreased, long-term residual risk may remain substantial. However, most of the information on current residual risk is derived from highly selected randomized trials. HYPOTHESIS In patients with previous MI and no prior ischemic stroke/transient ischemic attack (TIA), residual ischemic risk increases over time. METHODS Using the international Reduction of Atherothrombosis for Continued Health (REACH) registry, we analyzed baseline characteristics and 4-year follow-up of patients with previous MI and no history of stroke/TIA to describe annual rates of recurrent ischemic events globally and by geography. The primary outcome was the composite of cardiovascular death, MI, or stroke. Multivariate analysis identified risk factors associated with recurrent ischemic events. RESULTS Data from 16 770 patients enrolled at 5587 sites in 44 countries were analyzed. The rate of the primary outcome increased annually from 4.7% during year 1 to reach a 4-year rate of 15.1%. Compared with North America, Japan experienced lower ischemic event rates (P < 0.01), whereas Eastern Europe (P < 0.01) and the Middle East (P = 0.01) experienced higher ischemic event rates. The presence of congestive heart failure, polyvascular disease, diabetes, atrial fibrillation or flutter, and older age were associated with increased residual risk (all P < 0.01). Statin use was associated with lower ischemic risk (P < 0.01). CONCLUSIONS In this study, residual ischemic risk after MI accrued progressively up to 4 years of follow-up, emphasizing the value of intensive secondary prevention strategies to minimize residual risk.
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Affiliation(s)
- Jérémie Abtan
- French Alliance for Cardiovascular Clinical Trials (FACT), DHU-FIRE, Hôpital Bichat (Assistance Publique-Hôpitaux de Paris), Université Paris-Diderot, Sorbonne-Paris Cité and INSERM U-1148, Paris, France.,Hôpital Avicenne (Assitance Publique-Hôpitaux de Paris) and Université Paris 13, Bobigny, France
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts
| | - Yedid Elbez
- French Alliance for Cardiovascular Clinical Trials (FACT), DHU-FIRE, Hôpital Bichat (Assistance Publique-Hôpitaux de Paris), Université Paris-Diderot, Sorbonne-Paris Cité and INSERM U-1148, Paris, France.,Hôpital Avicenne (Assitance Publique-Hôpitaux de Paris) and Université Paris 13, Bobigny, France
| | - Emmanuel Sorbets
- French Alliance for Cardiovascular Clinical Trials (FACT), DHU-FIRE, Hôpital Bichat (Assistance Publique-Hôpitaux de Paris), Université Paris-Diderot, Sorbonne-Paris Cité and INSERM U-1148, Paris, France.,Hôpital Avicenne (Assitance Publique-Hôpitaux de Paris) and Université Paris 13, Bobigny, France
| | - Kim Eagle
- University of Michigan Cardiovascular Center, Ann Arbor, Michigan
| | - Yasuo Ikeda
- Department of Internal Medicine, Graduate School of Medicine Keio University, Tokyo, Japan
| | - David Wu
- Merck & Co., Inc., Kenilworth, New Jersey
| | | | | | | | - Philippe Gabriel Steg
- French Alliance for Cardiovascular Clinical Trials (FACT), DHU-FIRE, Hôpital Bichat (Assistance Publique-Hôpitaux de Paris), Université Paris-Diderot, Sorbonne-Paris Cité and INSERM U-1148, Paris, France.,Hôpital Avicenne (Assitance Publique-Hôpitaux de Paris) and Université Paris 13, Bobigny, France.,National Heart and Lung Institute, Institute of Cardiovascular Medicine and Science, Royal Brompton Hospital, Imperial College, London, United Kingdom
| | - Gregory Ducrocq
- French Alliance for Cardiovascular Clinical Trials (FACT), DHU-FIRE, Hôpital Bichat (Assistance Publique-Hôpitaux de Paris), Université Paris-Diderot, Sorbonne-Paris Cité and INSERM U-1148, Paris, France.,Hôpital Avicenne (Assitance Publique-Hôpitaux de Paris) and Université Paris 13, Bobigny, France
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31
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O'Connor SA, Amour J, Mercadier A, Martin R, Kerneis M, Abtan J, Brugier D, Silvain J, Barthélémy O, Leprince P, Montalescot G, Collet JP. Efficacy of ex vivo autologous and in vivo platelet transfusion in the reversal of P2Y12 inhibition by clopidogrel, prasugrel, and ticagrelor: the APTITUDE study. Circ Cardiovasc Interv 2016; 8:e002786. [PMID: 26553698 DOI: 10.1161/circinterventions.115.002786] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [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] [Indexed: 12/22/2022]
Abstract
BACKGROUND Allogenic platelet transfusions (PT) are administered to treat excessive bleeding in patients on P2Y12 receptor inhibitors (RI). We assessed the effect of ex vivo and in vivo PT on platelet activation and aggregation in patients on dual antiplatelet therapy. METHODS AND RESULTS In the Antagonize P2Y12 Treatment Inhibitors by Transfusion of Platelets in an Urgent or Delayed Timing After Acute Coronary Syndrome or Percutaneous Coronary Intervention Presentation-Acute Coronary Syndrome (APTITUDE-ACS) study, patients presenting with acute coronary syndrome or for elective percutaneous coronary intervention, receiving loading doses of clopidogrel (600 mg, n=13 or 900 mg, n=12), prasugrel 60 mg (n=10), or ticagrelor 180 mg (n=10) were included. PT was performed ex vivo by mixing platelet-rich plasma from blood sampling performed at baseline in increasing proportions with platelet-rich plasma sampled 4 hours after loading dose. The percentage restoration of residual platelet aggregation achieved with 80% proportion PT (residual platelet aggregation 80% PT mix/residual platelet aggregation baseline×100) significantly decreased with increasing potency of P2Y12 RI (83.9±11%, 73±14%, 66.3±15%, 40.9±19% for clopidogrel 600 mg, clopidogrel 900 mg, prasugrel, and ticagrelor, respectively; P for trend <0.0001). In the APTITUDE-Coronary Artery Bypass Graft (APTITUDE-CABG) study, vasodilator-stimulated phosphoprotein-platelet reactivity index, a specific marker of the P2Y12 RI drug-effect, was assessed before and after in vivo PT administered for excessive bleeding in patients undergoing cardiac surgery while on a maintenance dose of aspirin and clopidogrel (n=45), prasugrel (n=6), or ticagrelor (n=3). When compared with baseline, there was a significant relative increase of 23.1% in platelet activation after PT transfusion (42.2±23.6% versus 56.6±18.2%; P=0.0008). CONCLUSIONS PT restores platelet reactivity in patients with acute coronary syndrome/percutaneous coronary intervention and in patients undergoing cardiac surgery on P2Y12 RI while bleeding with a less effect with increasing potency of P2Y12 inhibition. CLINICAL TRIAL REGISTRATION URL: http://www.recherche-biomedicale.sante.gouv.fr/pro/comites/coordonnees.htm and http://www.cnil.fr/. Unique identifiers: No. 301111 and No. 1547216v0.
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Affiliation(s)
- Stephen A O'Connor
- From the Sorbonne Université UMPC (Paris 6), INSERM_UMRS1166 (S.A.O., R.M., M.K., J.A., D.B., J.S., O.B., P.L., G.M., J.-P.C.), ACTION Study Group, Paris, France (S.A.O., R.M., M.K., J.A., D.B., J.S., O.B., G.M., J.-P.C.), Département d'Anesthésie et de Réanimation (J.A., R.M.), Etablissement Français Sang (A.M.), and Institut de Cardiologie and Chirurgie Cardiaque (S.A.O., M.K., J.A., D.B., J.S., O.B., P.L., G.M., J.-P.C.), Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - Julien Amour
- From the Sorbonne Université UMPC (Paris 6), INSERM_UMRS1166 (S.A.O., R.M., M.K., J.A., D.B., J.S., O.B., P.L., G.M., J.-P.C.), ACTION Study Group, Paris, France (S.A.O., R.M., M.K., J.A., D.B., J.S., O.B., G.M., J.-P.C.), Département d'Anesthésie et de Réanimation (J.A., R.M.), Etablissement Français Sang (A.M.), and Institut de Cardiologie and Chirurgie Cardiaque (S.A.O., M.K., J.A., D.B., J.S., O.B., P.L., G.M., J.-P.C.), Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - Anne Mercadier
- From the Sorbonne Université UMPC (Paris 6), INSERM_UMRS1166 (S.A.O., R.M., M.K., J.A., D.B., J.S., O.B., P.L., G.M., J.-P.C.), ACTION Study Group, Paris, France (S.A.O., R.M., M.K., J.A., D.B., J.S., O.B., G.M., J.-P.C.), Département d'Anesthésie et de Réanimation (J.A., R.M.), Etablissement Français Sang (A.M.), and Institut de Cardiologie and Chirurgie Cardiaque (S.A.O., M.K., J.A., D.B., J.S., O.B., P.L., G.M., J.-P.C.), Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - Réjane Martin
- From the Sorbonne Université UMPC (Paris 6), INSERM_UMRS1166 (S.A.O., R.M., M.K., J.A., D.B., J.S., O.B., P.L., G.M., J.-P.C.), ACTION Study Group, Paris, France (S.A.O., R.M., M.K., J.A., D.B., J.S., O.B., G.M., J.-P.C.), Département d'Anesthésie et de Réanimation (J.A., R.M.), Etablissement Français Sang (A.M.), and Institut de Cardiologie and Chirurgie Cardiaque (S.A.O., M.K., J.A., D.B., J.S., O.B., P.L., G.M., J.-P.C.), Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - Mathieu Kerneis
- From the Sorbonne Université UMPC (Paris 6), INSERM_UMRS1166 (S.A.O., R.M., M.K., J.A., D.B., J.S., O.B., P.L., G.M., J.-P.C.), ACTION Study Group, Paris, France (S.A.O., R.M., M.K., J.A., D.B., J.S., O.B., G.M., J.-P.C.), Département d'Anesthésie et de Réanimation (J.A., R.M.), Etablissement Français Sang (A.M.), and Institut de Cardiologie and Chirurgie Cardiaque (S.A.O., M.K., J.A., D.B., J.S., O.B., P.L., G.M., J.-P.C.), Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - Jérémie Abtan
- From the Sorbonne Université UMPC (Paris 6), INSERM_UMRS1166 (S.A.O., R.M., M.K., J.A., D.B., J.S., O.B., P.L., G.M., J.-P.C.), ACTION Study Group, Paris, France (S.A.O., R.M., M.K., J.A., D.B., J.S., O.B., G.M., J.-P.C.), Département d'Anesthésie et de Réanimation (J.A., R.M.), Etablissement Français Sang (A.M.), and Institut de Cardiologie and Chirurgie Cardiaque (S.A.O., M.K., J.A., D.B., J.S., O.B., P.L., G.M., J.-P.C.), Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - Delphine Brugier
- From the Sorbonne Université UMPC (Paris 6), INSERM_UMRS1166 (S.A.O., R.M., M.K., J.A., D.B., J.S., O.B., P.L., G.M., J.-P.C.), ACTION Study Group, Paris, France (S.A.O., R.M., M.K., J.A., D.B., J.S., O.B., G.M., J.-P.C.), Département d'Anesthésie et de Réanimation (J.A., R.M.), Etablissement Français Sang (A.M.), and Institut de Cardiologie and Chirurgie Cardiaque (S.A.O., M.K., J.A., D.B., J.S., O.B., P.L., G.M., J.-P.C.), Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - Johanne Silvain
- From the Sorbonne Université UMPC (Paris 6), INSERM_UMRS1166 (S.A.O., R.M., M.K., J.A., D.B., J.S., O.B., P.L., G.M., J.-P.C.), ACTION Study Group, Paris, France (S.A.O., R.M., M.K., J.A., D.B., J.S., O.B., G.M., J.-P.C.), Département d'Anesthésie et de Réanimation (J.A., R.M.), Etablissement Français Sang (A.M.), and Institut de Cardiologie and Chirurgie Cardiaque (S.A.O., M.K., J.A., D.B., J.S., O.B., P.L., G.M., J.-P.C.), Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - Olivier Barthélémy
- From the Sorbonne Université UMPC (Paris 6), INSERM_UMRS1166 (S.A.O., R.M., M.K., J.A., D.B., J.S., O.B., P.L., G.M., J.-P.C.), ACTION Study Group, Paris, France (S.A.O., R.M., M.K., J.A., D.B., J.S., O.B., G.M., J.-P.C.), Département d'Anesthésie et de Réanimation (J.A., R.M.), Etablissement Français Sang (A.M.), and Institut de Cardiologie and Chirurgie Cardiaque (S.A.O., M.K., J.A., D.B., J.S., O.B., P.L., G.M., J.-P.C.), Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - Pascal Leprince
- From the Sorbonne Université UMPC (Paris 6), INSERM_UMRS1166 (S.A.O., R.M., M.K., J.A., D.B., J.S., O.B., P.L., G.M., J.-P.C.), ACTION Study Group, Paris, France (S.A.O., R.M., M.K., J.A., D.B., J.S., O.B., G.M., J.-P.C.), Département d'Anesthésie et de Réanimation (J.A., R.M.), Etablissement Français Sang (A.M.), and Institut de Cardiologie and Chirurgie Cardiaque (S.A.O., M.K., J.A., D.B., J.S., O.B., P.L., G.M., J.-P.C.), Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - Gilles Montalescot
- From the Sorbonne Université UMPC (Paris 6), INSERM_UMRS1166 (S.A.O., R.M., M.K., J.A., D.B., J.S., O.B., P.L., G.M., J.-P.C.), ACTION Study Group, Paris, France (S.A.O., R.M., M.K., J.A., D.B., J.S., O.B., G.M., J.-P.C.), Département d'Anesthésie et de Réanimation (J.A., R.M.), Etablissement Français Sang (A.M.), and Institut de Cardiologie and Chirurgie Cardiaque (S.A.O., M.K., J.A., D.B., J.S., O.B., P.L., G.M., J.-P.C.), Pitié-Salpêtrière Hospital (AP-HP), Paris, France.
| | - Jean-Philippe Collet
- From the Sorbonne Université UMPC (Paris 6), INSERM_UMRS1166 (S.A.O., R.M., M.K., J.A., D.B., J.S., O.B., P.L., G.M., J.-P.C.), ACTION Study Group, Paris, France (S.A.O., R.M., M.K., J.A., D.B., J.S., O.B., G.M., J.-P.C.), Département d'Anesthésie et de Réanimation (J.A., R.M.), Etablissement Français Sang (A.M.), and Institut de Cardiologie and Chirurgie Cardiaque (S.A.O., M.K., J.A., D.B., J.S., O.B., P.L., G.M., J.-P.C.), Pitié-Salpêtrière Hospital (AP-HP), Paris, France
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Zarka S, Bouleti C, Arangalage D, Chopra H, Chillon S, Henry-Feugeas MC, Abtan J, Juliard JM, Iung B, Vahanian A, Laissy JP, Ou P. Usefulness of Subepicardial Hyperemia on Contrast-Enhanced First-Pass Magnetic Resonance Perfusion Imaging for Diagnosis of Acute Myocarditis. Am J Cardiol 2016; 118:440-5. [PMID: 27296557 DOI: 10.1016/j.amjcard.2016.05.022] [Citation(s) in RCA: 6] [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: 03/11/2016] [Revised: 05/04/2016] [Accepted: 05/04/2016] [Indexed: 11/16/2022]
Abstract
Hyperemia is a major criterion for the diagnosis of acute myocarditis on cardiac magnetic resonance imaging but its assessment is challenging and time consuming. We evaluated the usefulness of the contrast-enhanced first-pass perfusion (FPP) on magnetic resonance imaging for detecting subepicardial hyperemia in acute myocarditis. Forty-seven consecutive patients (mean age: 42 ± 15.6 years; 35 men) with a definite diagnosis of acute myocarditis according to the state-of-the-art guidelines were included and compared with 16 control subjects. FPP was evaluated by 2 blinded observers and compared with the reference late gadolinium enhancement. Detection of hyperemia was performed on both qualitative and quantitative methods. Relative increased signal intensity (SI) in the subepicardial hyperemic layer was measured with SI ratio (SI of the subepicardial layer/SI of the immediately adjacent subendocardial layer). Twenty-four patients (51%) with acute myocarditis exhibited subepicardial hyperemia, detected with a good interobserver reproducibility (kappa coefficient: 0.75). The SI in the myocardium of myocarditis patients was increased compared with controls (1.08 ± 0.03 vs 0.945 ± 0.04, p = 0.03) and the SI in myocarditis patients with hyperemia compared with those without hyperemia (1.22 ± 0.04 vs 0.94 ± 0.04, p <0.0001). Sensitivity, specificity, positive predictive, and negative predictive values of FPP for detecting hyperemia were 85%, 94%, 85%, and 93%, respectively. In conclusion, contrast-enhanced first-pass magnetic resonance imaging is a fast and useful method for assessing myocardial hyperemia in patients with acute myocarditis.
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Affiliation(s)
- Samuel Zarka
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
| | - Claire Bouleti
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France; Paris-Diderot University, DHU FIRE, Paris, France
| | - Dimitri Arangalage
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France; Paris-Diderot University, DHU FIRE, Paris, France
| | - Houzefa Chopra
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
| | - Sylvie Chillon
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
| | | | - Jérémie Abtan
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France; Paris-Diderot University, DHU FIRE, Paris, France
| | - Jean-Michel Juliard
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France; Paris-Diderot University, DHU FIRE, Paris, France
| | - Bernard Iung
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France; Paris-Diderot University, DHU FIRE, Paris, France
| | - Alec Vahanian
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France; Paris-Diderot University, DHU FIRE, Paris, France
| | - Jean-Pierre Laissy
- Paris-Diderot University, DHU FIRE, Paris, France; Department of Radiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
| | - Phalla Ou
- Paris-Diderot University, DHU FIRE, Paris, France; Department of Radiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France; INSERM U1148 Bichat Hospital, Paris, France.
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Collet JP, Silvain J, Kerneis M, Cuisset T, Meneveau N, Boueri Z, Barthélémy O, Rangé G, Cayla G, Belle EV, Elhadad S, Carrié D, Caussin C, Rousseau H, Aubry P, Monségu J, Sabouret P, O'Connor SA, Abtan J, Saint-Etienne C, Beygui F, Vicaut E, Montalescot G. Clinical Outcome of First- vs Second-Generation DES According to DAPT Duration: Results of ARCTIC-Generation. Clin Cardiol 2016; 39:192-200. [PMID: 26880570 DOI: 10.1002/clc.22512] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 11/25/2015] [Indexed: 12/26/2022] Open
Abstract
There is an apparent benefit with extension of dual antiplatelet therapy (DAPT) beyond 1 year after implantation of drug-eluting stents (DES). Assessment by a Double Randomization of a Conventional Antiplatelet Strategy vs a Monitoring-Guided Strategy for Drug-Eluting Stent Implantation, and of Treatment Interruption vs Continuation One Year After Stenting (ARCTIC)-Generation assessed whether there is a difference of outcome between first- vs second-generation DES and if there is an interaction with DAPT duration in the ARCTIC-Interruption study. ARCTIC-Interruption randomly allocated 1259 patients 1 year after stent implantation to a strategy of interruption of DAPT (n = 624), in which aspirin antiplatelet treatment only was maintained, or DAPT continuation (n = 635) for 6 to 18 additional months. The primary endpoint was the composite of death, myocardial infarction, stent thrombosis, stroke, or urgent revascularization. A total of 520 and 722 patients received a first- and a second-generation DES, respectively. After a median follow-up of 17 months (interquartile range, 15-18 months) after randomization, the primary endpoint occurred in 32 (6.2%) and 19 (2.6%) patients with first- and second-generation DES, respectively (hazard ratio: 2.31, 95% confidence interval: 1.31-4.07, P = 0.004). This was observed irrespective of the strategy of interruption or continuation of DAPT and timing of study recruitment. Major bleeding events occurred in 4 (0.8%) and 3 patients (0.4%) with first- and second-generation DES, respectively (hazard ratio: 1.79, 95% confidence interval: 0.40-8.02, P = 0.44). Results did not change after multiple adjustments for potential confounding variables. ARCTIC-Generation showed worse clinical outcome with first- vs second-generation DES, a difference that appeared to persist even with prolonged DAPT.
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Affiliation(s)
- Jean-Philippe Collet
- Univ Paris 06 (UPMC), ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (APHP), Paris, France
| | - Johanne Silvain
- Univ Paris 06 (UPMC), ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (APHP), Paris, France
| | - Mathieu Kerneis
- Univ Paris 06 (UPMC), ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (APHP), Paris, France
| | - Thomas Cuisset
- Department of Cardiology, CHU La Timone, Marseille, France
| | | | - Ziad Boueri
- Department of Cardiology, CH de Bastia, France
| | - Olivier Barthélémy
- Univ Paris 06 (UPMC), ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (APHP), Paris, France
| | - Grégoire Rangé
- Department of Cardiology, Les Hôpitaux de Chartres, Le Coudray, France
| | - Guillaume Cayla
- ACTION Study Group, Department of Cardiology, CHU Carémeau, Nîmes, France
| | - Eric Van Belle
- Department of Cardiology, Lille University Hospital, Lille, France
| | - Simon Elhadad
- Department of Cardiology, CH de Lagny-Marne la Vallée, Lagny-sur-Marne, France
| | - Didier Carrié
- Department of Cardiology, CHU Rangueil, Toulouse, France
| | | | - Hélène Rousseau
- ACTION Study Group, Unité de Recherche Clinique-Hôpital Lariboisière (APHP), Paris, France.,Université Denis Diderot, Paris, France
| | - Pierre Aubry
- Department of Cardiology, Centre Hospitalier Bichat (APHP), Paris, France
| | - Jacques Monségu
- Department of cardiology, Groupe Hospitalier Mutualiste, Grenoble, France
| | - Pierre Sabouret
- Univ Paris 06 (UPMC), ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (APHP), Paris, France
| | - Stephen A O'Connor
- Univ Paris 06 (UPMC), ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (APHP), Paris, France
| | - Jérémie Abtan
- Univ Paris 06 (UPMC), ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (APHP), Paris, France
| | | | | | - Eric Vicaut
- ACTION Study Group, Unité de Recherche Clinique-Hôpital Lariboisière (APHP), Paris, France.,Université Denis Diderot, Paris, France
| | - Gilles Montalescot
- Univ Paris 06 (UPMC), ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (APHP), Paris, France
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Velders MA, Abtan J, Angiolillo DJ, Ardissino D, Harrington RA, Hellkamp A, Himmelmann A, Husted S, Katus HA, Meier B, Schulte PJ, Storey RF, Wallentin L, Gabriel Steg P, James SK. Safety and efficacy of ticagrelor and clopidogrel in primary percutaneous coronary intervention. Heart 2016; 102:617-25. [DOI: 10.1136/heartjnl-2015-308963] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 12/30/2015] [Indexed: 11/03/2022] Open
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Kerneis M, Silvain J, Abtan J, Hauguel M, Barthélémy O, Payot L, Brugier D, Galier S, Collet JP, Montalescot G. Platelet effect of prasugrel and ticagrelor in patients with ST-segment elevation myocardial infarction. Arch Cardiovasc Dis 2015; 108:502-10. [DOI: 10.1016/j.acvd.2015.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 03/17/2015] [Accepted: 04/15/2015] [Indexed: 11/26/2022]
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Collet JP, Silvain J, Barthélémy O, Rangé G, Cayla G, Van Belle E, Cuisset T, Elhadad S, Schiele F, Lhoest N, Ohlmann P, Carrié D, Rousseau H, Aubry P, Monségu J, Sabouret P, O'Connor SA, Abtan J, Kerneis M, Saint-Etienne C, Beygui F, Vicaut E, Montalescot G. Dual-antiplatelet treatment beyond 1 year after drug-eluting stent implantation (ARCTIC-Interruption): a randomised trial. Lancet 2014; 384:1577-85. [PMID: 25037988 DOI: 10.1016/s0140-6736(14)60612-7] [Citation(s) in RCA: 233] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Optimum duration of dual antiplatelet treatment (DAPT) after coronary stenting remains uncertain, with an unknown efficacy to safety ratio of extended treatment leading to discrepancies between international guidelines and clinical practice. We assessed whether DAPT continuation beyond 1 year after coronary stenting is beneficial. METHODS This analysis was a planned extension of the previously published ARCTIC-Monitoring trial, in which we randomly allocated 2440 patients to a strategy of platelet function testing with antiplatelet treatment adjustment or a conventional strategy after coronary stenting with drug-eluting stent (DES). We recruited patients (aged 18 years or older) scheduled for planned DES implantation at 38 centres in France. After 1 year of follow-up, patients without contraindication to interruption of DAPT were eligible for a second randomisation to this second phase of the study (ARCTIC-Interruption). Using a computer-generated randomisation sequence (1:1; stratified by centre), we allocated patients to a strategy of interruption of DAPT where the thienopyridine was interrupted and single aspirin antiplatelet treatment was maintained (interruption group) or a strategy of DAPT continuation for 6-18 months (continuation group). The primary endpoint was the composite of death, myocardial infarction, stent thrombosis, stroke, or urgent revascularisation, analysed by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00827411. FINDINGS Between Jan 4, 2011, and March 3, 2012, 1259 eligible patients were randomly allocated to treatment in ARCTIC-Interruption: 624 to the interruption group and 635 to the continuation group. After a median follow-up of 17 months (IQR 15-18), the primary endpoint occurred in 27 (4%) patients in the interruption group and 24 (4%) patients in the continuation group (hazard ratio [HR] 1·17 [95% CI 0·68-2·03]; p=0·58). STEEPLE major bleeding events occurred more often in the continuation group (seven [1%] patients) compared with the interruption group (one [<0·5%] patient; HR 0·15 [0·02-1·20]; p=0·073). Major or minor bleedings were also more common in the continuation group compared with the interruption group (12 [2%] patients vs three [1%] patients; HR 0·26 [0·07-0·91]; p=0·04). INTERPRETATION Our finding suggests no apparent benefit but instead harm with extension of DAPT beyond 1 year after stenting with DES when no event has occurred within the first year after stenting. No conclusion can be drawn for high-risk patients who could not be randomised. The consistency between findings from all trials of such interruption suggests the need for a reappraisal of guidelines for DAPT after coronary stenting towards shorter duration of treatment. FUNDING Allies in Cardiovascular Trials Initiatives and Organized Networks (ACTION Study Group), Fondation de France, Sanofi-Aventis, Cordis, Medtronic, Boston Scientific, Fondation SGAM.
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Affiliation(s)
- Jean-Philippe Collet
- ACTION Study Group, Institut de Cardiologie Hôpital Pitié-Salpêtrière (APHP), Université Paris 6, INSERM, Paris, France
| | - Johanne Silvain
- ACTION Study Group, Institut de Cardiologie Hôpital Pitié-Salpêtrière (APHP), Université Paris 6, INSERM, Paris, France
| | - Olivier Barthélémy
- ACTION Study Group, Institut de Cardiologie Hôpital Pitié-Salpêtrière (APHP), Université Paris 6, INSERM, Paris, France
| | | | - Guillaume Cayla
- ACTION Study Group, Cardiologie, CHU Carémeau, Nîmes, France
| | | | - Thomas Cuisset
- Département de Cardiologie, CHU La Timone, Marseille, France
| | - Simon Elhadad
- Cardiologie, CH de Lagny-Marne-la-Vallée, Lagny-sur-Marne, France
| | | | | | | | | | - Hélène Rousseau
- CHRU de Lille, Lille, France; ACTION Study Group, Unité de Recherche Clinique-Hôpital Lariboisière (APHP), and Université Denis Diderot, Paris, France
| | | | | | - Pierre Sabouret
- ACTION Study Group, Institut de Cardiologie Hôpital Pitié-Salpêtrière (APHP), Université Paris 6, INSERM, Paris, France
| | - Stephen A O'Connor
- ACTION Study Group, Institut de Cardiologie Hôpital Pitié-Salpêtrière (APHP), Université Paris 6, INSERM, Paris, France
| | - Jérémie Abtan
- ACTION Study Group, Institut de Cardiologie Hôpital Pitié-Salpêtrière (APHP), Université Paris 6, INSERM, Paris, France
| | - Mathieu Kerneis
- ACTION Study Group, Institut de Cardiologie Hôpital Pitié-Salpêtrière (APHP), Université Paris 6, INSERM, Paris, France
| | | | | | - Eric Vicaut
- ACTION Study Group, Unité de Recherche Clinique-Hôpital Lariboisière (APHP), and Université Denis Diderot, Paris, France
| | - Gilles Montalescot
- ACTION Study Group, Institut de Cardiologie Hôpital Pitié-Salpêtrière (APHP), Université Paris 6, INSERM, Paris, France.
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Abtan J, Elbez Y, Bhatt DL, Steg PG. Lack of negative interaction between use of β-blockers and statins on cardiovascular outcomes among patients with or at risk for atherothrombosis. J Am Coll Cardiol 2014; 64:845-7. [PMID: 25145532 DOI: 10.1016/j.jacc.2014.04.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 04/21/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Jérémie Abtan
- Département Hospitalo-Universitaire Fibrosis-Inflammation-REmodelling: Hôpital Bichat (Assistance Publique-Hôpitaux de Paris), and INSERM U-1148, Université Paris-Diderot, Paris, France
| | - Yedid Elbez
- Département Hospitalo-Universitaire Fibrosis-Inflammation-REmodelling: Hôpital Bichat (Assistance Publique-Hôpitaux de Paris), and INSERM U-1148, Université Paris-Diderot, Paris, France
| | - Deepak L Bhatt
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Philippe Gabriel Steg
- Département Hospitalo-Universitaire Fibrosis-Inflammation-REmodelling: Hôpital Bichat (Assistance Publique-Hôpitaux de Paris), and INSERM U-1148, Université Paris-Diderot, Paris, France; National Heart and Lung Institute, Institute of Cardiovascular Medicine and Science, Royal Brompton Hospital, Imperial College, London, United Kingdom.
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O'Connor S, Rejane M, Amour J, Abtan J, Kerneis M, Silvain J, Brugier D, Leprince P, Montalescot G, Collet JP. Restoration of platelet function with platelet transfusion in cardiac surgery patients on dual antiplatelet therapy. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p4873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abtan J, Kerneis M, Boccara A, Chaib A, Payot L, Sayah S, Alperin S, Passefort S, Koubbi A, Gryman R. CathLab procedures change induce great improvements in radiation safety for patients and healthcare professionals. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kerneis M, Abtan J, Silvain J, O'Connor SA, Barthelemy O, Vignalou JB, Brugier D, Collet J, Montalescot G. Ticagrelor or prasugrel in STEMI patients: a pharmacodynamic evaluation. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p4893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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O'Connor S, Kerneis M, Ankri A, Abtan J, Brugier D, Silvain J, Ecollan P, Vicaut E, Collet JP, Montalescot G. More predictable anticoagulation with intravenous enoxaparin than with unfractionated heparin in patients undergoing primary percutaneous coronary intervention: a substudy of the ATOLL trial. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Van Belle E, Collet JP, O'Connor S, Abtan J, Saint-Etienne C, Kerneis M, Rousseau H, Sylvain J, Vicaut E, Montalescot G. Despite a mixed reactivity to antiplatelet agents, obese patients have no benefit of platelet function monitoring: insight from the ARCTIC study. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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O'Connor S, Ankri A, Kerneis M, Abtan J, Brugier D, Galier S, Silvain J, Vicaut E, Collet JP, Montalescot G. Peri-procedural thrombin generation predicts ischemic complications in primary percutaneous coronary intervention of ST-elevation myocardial infarction: a substudy of the ATOLL trial. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.4530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kerneis M, Silvain J, Abtan J, Cayla G, O'Connor SA, Barthélémy O, Vignalou JB, Beygui F, Brugier D, Martin R, Collet JP, Montalescot G. Switching Acute Coronary Syndrome Patients From Prasugrel to Clopidogrel. JACC Cardiovasc Interv 2013; 6:158-65. [DOI: 10.1016/j.jcin.2012.09.012] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 08/30/2012] [Accepted: 09/28/2012] [Indexed: 10/27/2022]
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Collet JP, Cuisset T, Rangé G, Cayla G, Elhadad S, Pouillot C, Henry P, Motreff P, Carrié D, Boueri Z, Belle L, Van Belle E, Rousseau H, Aubry P, Monségu J, Sabouret P, O'Connor SA, Abtan J, Kerneis M, Saint-Etienne C, Barthélémy O, Beygui F, Silvain J, Vicaut E, Montalescot G. Bedside monitoring to adjust antiplatelet therapy for coronary stenting. N Engl J Med 2012; 367:2100-9. [PMID: 23121439 DOI: 10.1056/nejmoa1209979] [Citation(s) in RCA: 698] [Impact Index Per Article: 58.2] [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] [Indexed: 01/05/2023]
Abstract
BACKGROUND Patients' responses to oral antiplatelet therapy are subject to variation. Bedside monitoring offers the opportunity to improve outcomes after coronary stenting by individualizing therapy. METHODS We randomly assigned 2440 patients scheduled for coronary stenting at 38 centers to a strategy of platelet-function monitoring, with drug adjustment in patients who had a poor response to antiplatelet therapy, or to a conventional strategy without monitoring and drug adjustment. The primary end point was the composite of death, myocardial infarction, stent thrombosis, stroke, or urgent revascularization 1 year after stent implantation. For patients in the monitoring group, the VerifyNow P2Y12 and aspirin point-of-care assays were used in the catheterization laboratory before stent implantation and in the outpatient clinic 2 to 4 weeks later. RESULTS In the monitoring group, high platelet reactivity in patients taking clopidogrel (34.5% of patients) or aspirin (7.6%) led to the administration of an additional bolus of clopidogrel, prasugrel, or aspirin along with glycoprotein IIb/IIIa inhibitors during the procedure. The primary end point occurred in 34.6% of the patients in the monitoring group, as compared with 31.1% of those in the conventional-treatment group (hazard ratio, 1.13; 95% confidence interval [CI], 0.98 to 1.29; P=0.10). The main secondary end point, stent thrombosis or any urgent revascularization, occurred in 4.9% of the patients in the monitoring group and 4.6% of those in the conventional-treatment group (hazard ratio, 1.06; 95% CI, 0.74 to 1.52; P=0.77). The rate of major bleeding events did not differ significantly between groups. CONCLUSIONS This study showed no significant improvements in clinical outcomes with platelet-function monitoring and treatment adjustment for coronary stenting, as compared with standard antiplatelet therapy without monitoring. (Funded by Allies in Cardiovascular Trials Initiatives and Organized Networks and others; ARCTIC ClinicalTrials.gov number, NCT00827411.).
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Affiliation(s)
- Jean-Philippe Collet
- Institut de Cardiologie Hôpital Pitié–Salpêtrière and Université Pierre et Marie Curie, Paris, France
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