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Fischer Q, Pham V, Seret G, Brami P, Picard F, Varenne O. Antiplatelet therapy for treatment of coronary artery disease in older patients. Arch Cardiovasc Dis 2024:S1875-2136(24)00055-X. [PMID: 38658313 DOI: 10.1016/j.acvd.2024.02.008] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/22/2024] [Accepted: 02/26/2024] [Indexed: 04/26/2024]
Abstract
Coronary artery disease in older patients is more frequently diffuse and complex, and is often treated by percutaneous coronary intervention on top of medical therapy. There are currently no specific recommendations for antiplatelet therapy in patients aged≥75 years. Aspirin remains pivotal, and is still indicated as a long-term treatment after percutaneous coronary intervention. In addition, a P2Y12 inhibitor is administered for 6-12 months according to clinical presentation. Age is a minor bleeding risk factor, but because older patients often have several co-morbidities, they are considered as having a high bleeding risk according to different scoring systems. This increased bleeding risk has resulted in different therapeutic strategies for antithrombotic treatment after percutaneous coronary intervention; these include short dual antiplatelet therapy, a switch from potent to less potent antiplatelet therapy or single antiplatelet therapy with a P2Y12 inhibitor instead of aspirin, among others. A patient-centred approach, taking into account health status, functional ability, frailty, cognitive skills, bleeding and ischaemic risks and patient preference, is essential when caring for older adults with coronary artery disease. The present review focuses on the knowledge base, specificities of antiplatelet therapies, a balance between haemorrhagic and ischaemic risk, strategies for antiplatelet therapy and directions for future investigation pertaining to coronary artery disease in older patients.
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Affiliation(s)
- Quentin Fischer
- Service de cardiologie, hôpital Cochin, université Paris Cité, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Vincent Pham
- Service de cardiologie, hôpital Cochin, université Paris Cité, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Gabriel Seret
- Service de cardiologie, hôpital Cochin, université Paris Cité, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Pierre Brami
- Service de cardiologie, hôpital Cochin, université Paris Cité, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Fabien Picard
- Service de cardiologie, hôpital Cochin, université Paris Cité, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Olivier Varenne
- Service de cardiologie, hôpital Cochin, université Paris Cité, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
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Campos CM, Mehran R, Capodanno D, Owen R, Windecker S, Varenne O, Stone GW, Valgimigli M, Hajjar LA, Kalil Filho R, Oldroyd K, Morice MC, Urban P, Abizaid A. Risk Burden of Cancer in Patients Treated With Abbreviated Dual Antiplatelet Therapy After PCI: Analysis of Multicenter Controlled High-Bleeding Risk Trials. Circ Cardiovasc Interv 2024; 17:e013000. [PMID: 38626080 DOI: 10.1161/circinterventions.122.013000] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 01/16/2024] [Indexed: 04/18/2024]
Abstract
BACKGROUND Oncological patients with coronary artery disease face an elevated risk of hemorrhagic and ischemic events following percutaneous coronary intervention. Despite medical guidelines recommending minimal dual antiplatelet therapy (DAPT) duration for patients with cancer, dedicated data on abbreviated DAPT in this population is lacking. This study aims to evaluate the occurrence of ischemic and hemorrhagic events in patients with cancer compared with other high-bleeding risk individuals. METHODS Patient-level data from 4 high-bleeding risk coronary drug-eluting stent studies (ONYX One, LEADERS FREE, LEADERS FREE II, and SENIOR trials) treated with short DAPT were analyzed. The comparison focused on patients with high-bleeding risk with and without cancer, assessing 1-year rates of net adverse clinical events (all-cause death, myocardial infarction, stroke, revascularization, and Bleeding Academic Research Consortium [BARC] types 3 to 5 bleeding) and major adverse clinical events (all-cause death, myocardial infarction, stroke). RESULTS A total of 5232 patients were included, of whom 574 individuals had cancer, and 4658 were at high-bleeding risk without previous cancer. Despite being younger with fewer risk factors, patients with cancer had higher net adverse clinical event (HR, 1.25; P=0.01) and major adverse clinical event (HR, 1.26; P=0.02), primarily driven by all-cause mortality and major bleeding (BARC 3-5), but not myocardial infarction, stroke, stent thrombosis, or repeat revascularization. Cancer was an independent predictor of net adverse clinical event (P=0.005), major adverse clinical event (P=0.01), and major bleeding (P=0.03). CONCLUSIONS The present work is the first report on abbreviated DAPT dedicated to patients with cancer. Cancer is a major marker of adverse outcomes and these events had high lethality. Despite short DAPT, patients with cancer experienced higher rates of major bleeding compared with patients without cancer with high-bleeding risk, which occurred mainly after DAPT discontinuation. These findings reinforce the need for a more detailed and individualized stratification of those patients. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifiers: NCT03344653, NCT01623180, NCT02843633, NCT0284.
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Affiliation(s)
- Carlos M Campos
- Heart Institute (InCor), University of São Paulo Medical School, Brazil (C.M.C., L.A.H., R.K.F., A.A.)
- Instituto Prevent Senior, Sao Paulo, Brazil (C.M.C.)
| | - Roxana Mehran
- Division of Cardiology (R.M.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - Davide Capodanno
- Policlinico "G. Rodolico-San Marco," University of Catania, Italy (D.C.)
| | - Ruth Owen
- London School of Hygiene and Tropical Medicine, United Kingdom (R.O.)
| | - Stephan Windecker
- Department of Cardiology, Inselspital (S.W.), Bern University Hospital, University of Bern, Switzerland
- Department of Cardiology (M.V., S.W.), Bern University Hospital, University of Bern, Switzerland
| | - Olivier Varenne
- Département de Cardiologie, Hôpital Cochin, Paris, France and Université Paris Cité, France (O.V.)
| | - Gregg W Stone
- Zena and Michael A. Wiener Cardiovascular Institute (G.W.S.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marco Valgimigli
- Department of Cardiology (M.V., S.W.), Bern University Hospital, University of Bern, Switzerland
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland (M.V.)
| | - Ludhmila Abrahão Hajjar
- Heart Institute (InCor), University of São Paulo Medical School, Brazil (C.M.C., L.A.H., R.K.F., A.A.)
| | - Roberto Kalil Filho
- Heart Institute (InCor), University of São Paulo Medical School, Brazil (C.M.C., L.A.H., R.K.F., A.A.)
| | - Keith Oldroyd
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (K.O.)
- Golden Jubilee National Hospital, Clydebank, United Kingdom (K.O.)
| | - Marie-Claude Morice
- Cardiovascular European Research Center, Massy, France (M.-C.M.)
- ICV Paris Sud, Ramsay, Massy, France (M.-C.M.)
| | | | - Alexandre Abizaid
- Heart Institute (InCor), University of São Paulo Medical School, Brazil (C.M.C., L.A.H., R.K.F., A.A.)
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Sardella G, Spirito A, Sartori S, Angiolillo DJ, Vranckx P, Hernandez JMDLT, Krucoff MW, Bangalore S, Bhatt DL, Campo G, Cao D, Chehab BM, Choi JW, Feng Y, Ge J, Godfrey K, Hermiller J, Kunadian V, Makkar RR, Maksoud A, Neumann FJ, Picon H, Saito S, Thiele H, Toelg R, Varenne O, Vogel B, Zhou Y, Valgimigli M, Windecker S, Mehran R. 1- Versus 3-Month DAPT in Older Patients at a High Bleeding Risk Undergoing PCI: Insights from the XIENCE Short DAPT Global Program. Am J Cardiol 2024; 214:94-104. [PMID: 38185438 DOI: 10.1016/j.amjcard.2023.12.049] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/15/2023] [Accepted: 12/24/2023] [Indexed: 01/09/2024]
Abstract
This analysis aimed to evaluate the effect of 1- versus 3-month dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in older patients. Data from 3 prospective, single-arm studies (XIENCE Short DAPT Program), including patients with high bleeding risk successfully treated with an everolimus-eluting stent (XIENCE, Abbott) were analyzed. DAPT was discontinued at 1 or at 3 months in patients free from ischemic events and adherent to DAPT. Patients were stratified according to age (≥75 and <75 years). The primary end point was all-cause death or myocardial infarction (MI). The key secondary end point was Bleeding Academic Research Consortium type 2 to 5 bleeding. The outcomes were assessed from 1 to 12 months after index PCI. Of 3,364 patients, 2,241 (66.6%) were aged ≥75 years. The risk of death or MI was similar with 1- versus 3-month DAPT in patients aged ≥75 (8.5% vs 8.0%, adjusted hazard ratio [HR] 0.95, 95% confidence interval [CI] 0.69 to 1.30) and <75 years (6.9% vs 7.8%, adjusted HR 0.97, 95% CI 0.60 to 1.57, interaction p = 0.478). Bleeding Academic Research Consortium type 2 to 5 bleeding was consistently lower with 1- than with 3-month DAPT in patients aged ≥75 years (7.2% vs 9.4%, adjusted HR 0.66, 95% CI 0.48 to 0.91) and <75 years (9.7% vs 11.9%, adjusted HR 0.86, 95% CI 0.57 to 1.29, interaction p = 0.737). In conclusion, in patients at high bleeding risk who underwent PCI, patients older and younger than 75 years derived a consistent benefit from 1- compared with 3-month DAPT in terms of bleeding reduction, with no increase in all-cause death or MI at 1 year.
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Affiliation(s)
| | - Alessandro Spirito
- Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samantha Sartori
- Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai, New York, New York
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Jessa Ziekenhuis, Hasselt & Faculty of Medicine and Life Sciences, University of Hasselt, Hasselt, Belgium
| | | | - Mitchell W Krucoff
- Division of Cardiology, Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina
| | - Sripal Bangalore
- New York University Grossman School of Medicine, New York, New York
| | - Deepak L Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona (FE), Italy
| | - Davide Cao
- Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai, New York, New York; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Bassem M Chehab
- Ascension Via Christi Hospital, Cardiovascular Research Institute of Kansas, Wichita, Kansas
| | - James W Choi
- Texas Health Presbyterian Hospital, Dallas, Texas
| | - Yihan Feng
- Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai, New York, New York
| | - Junbo Ge
- Zhongshan Hospital Fudan University, Shanghai, China
| | - Katherine Godfrey
- Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Vijay Kunadian
- Translational and Clinical Research Institute, Newcastle University and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Raj R Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Aziz Maksoud
- Kansas Heart Hospital and University of Kansas School of Medicine, Wichita, Kansas
| | - Franz-Josef Neumann
- Department of Cardiology and Angiology University Heart Centre Freiburg Bad Krozingen Medical Centre - University of Freiburg, Germany
| | | | | | - Holger Thiele
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, Leipzig, Germany
| | - Ralph Toelg
- Segeberger Kliniken GmbH, Herzzentrum, Bad Segeberg, Germany
| | - Olivier Varenne
- Hôpital Cochin, APHP, Université de Paris Cité, Paris, France
| | - Birgit Vogel
- Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Marco Valgimigli
- Cardiocentro Ticino Institue, Ente Ospedaliero Cantonale, Lugano and Bern University Hospital, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roxana Mehran
- Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai, New York, New York.
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Dusonchet A, Varenne O, Puscas T, Saadi M, Hagege A, Calvet D, Mas J, Turc G. Does Atrial Septal Anatomy Still Matter in the Etiological Evaluation of Ischemic Stroke Beyond the Age of 60? J Am Heart Assoc 2024; 13:e031684. [PMID: 38353217 PMCID: PMC11010114 DOI: 10.1161/jaha.123.031684] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/14/2023] [Indexed: 02/21/2024]
Abstract
BACKGROUND Patent foramen ovale (PFO) is causally associated with stroke in some patients younger than 60 years, especially when it is large or associated with an atrial septal aneurysm (ASA). After 60 years of age, this association is less well understood. We assessed the relationships between detailed atrial septal anatomy and the cryptogenic nature of stroke in this population. METHODS AND RESULTS We reviewed all patients aged 60 to 80 years admitted to our stroke center for ischemic stroke who underwent contrast echocardiography between 2016 and 2021. The atherosclerosis, small-vessel disease, cardiac pathology, other causes, and dissection (ASCOD) classification was used to reevaluate the etiological workup. Associations between cryptogenic stroke and (1) PFO presence or (2) categories of PFO anatomy (nonlarge PFO without ASA, nonlarge PFO with ASA, large PFO without ASA, and large PFO with ASA) were assessed using logistic regression. Among 533 patients (median National Institutes of Health Stroke Scale score=1), PFO was present in 152 (prevalence, 28.5% [95% CI, 24.9-32.5]). Compared with noncryptogenic stroke, cryptogenic stroke (n=218) was associated with PFO presence (44.5% versus 17.5%; P<0.0001). Among patients with a PFO, septal anatomy categories were associated with cryptogenic stroke (P=0.02), with a strong association for patients with both large PFO and ASA (38.1% versus 14.5%, P=0.002). CONCLUSIONS PFO presence remains strongly associated with cryptogenic stroke between 60 and 80 years of age. Large PFO, ASA, and their association were strongly associated with cryptogenic stroke in this age group. Our results support performing contrast echocardiography even after 60 years of age, although the optimal secondary prevention therapy in this population remains to be determined in randomized trials.
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Affiliation(s)
- Antoine Dusonchet
- Department of Neurology, GHU Paris Psychiatrie et NeurosciencesHôpital Sainte‐Anne, Université Paris Cité, INSERM U1266, and FHU NeurovascParisFrance
| | - Olivier Varenne
- Department of CardiologyHôpital Cochin, AP‐HP, Université Paris CitéParisFrance
| | - Tania Puscas
- Department of CardiologyHôpital Européen Georges Pompidou, AP‐HP, Université Paris CitéParisFrance
| | - Malika Saadi
- Department of CardiologyHôpital Cochin, AP‐HP, Université Paris CitéParisFrance
| | - Albert Hagege
- Department of CardiologyHôpital Européen Georges Pompidou, AP‐HP, Université Paris CitéParisFrance
| | - David Calvet
- Department of Neurology, GHU Paris Psychiatrie et NeurosciencesHôpital Sainte‐Anne, Université Paris Cité, INSERM U1266, and FHU NeurovascParisFrance
| | - Jean‐Louis Mas
- Department of Neurology, GHU Paris Psychiatrie et NeurosciencesHôpital Sainte‐Anne, Université Paris Cité, INSERM U1266, and FHU NeurovascParisFrance
| | - Guillaume Turc
- Department of Neurology, GHU Paris Psychiatrie et NeurosciencesHôpital Sainte‐Anne, Université Paris Cité, INSERM U1266, and FHU NeurovascParisFrance
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Lattuca B, Mazeau C, Cayla G, Ducrocq G, Guedeney P, Laredo M, Dumaine R, El Kasty M, Kala P, Nejjari M, Hlinomaz O, Morel O, Varenne O, Leclercq F, Payot L, Spaulding C, Beygui F, Rangé G, Motovska Z, Portal JJ, Vicaut E, Collet JP, Montalescot G, Silvain J. Ticagrelor vs Clopidogrel for Complex Percutaneous Coronary Intervention in Chronic Coronary Syndrome. JACC Cardiovasc Interv 2024; 17:359-370. [PMID: 38355265 DOI: 10.1016/j.jcin.2023.12.011] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 02/16/2024]
Abstract
BACKGROUND Whether ticagrelor in chronic coronary syndrome patients undergoing complex percutaneous coronary intervention (PCI) can prevent cardiovascular events is unknown. OBJECTIVES The authors sought to evaluate outcomes of complex PCI and the efficacy of ticagrelor vs clopidogrel in stable patients randomized in the ALPHEUS (Assessment of Loading with the P2Y12 inhibitor ticagrelor or clopidogrel to Halt ischemic Events in patients Undergoing elective coronary Stenting) trial. METHODS All PCI procedures were blindly reviewed and classified as complex if they had at least 1 of the following criteria: stent length >60 mm, 2-stent bifurcation, left main, bypass graft, chronic total occlusion, use of atherectomy or guiding catheter extensions, multiwire technique, multiple stents. The primary endpoint was a composite of type 4a or b myocardial infarction (MI) and major myocardial injury during the 48 hours after PCI. We compared the event rates according to the presence or not of complex PCI criteria and evaluated the interaction with ticagrelor or clopidogrel. RESULTS Among the 1,866 patients randomized, 910 PCI (48.3%) were classified as complex PCI. The primary endpoint was more frequent in complex PCI (45.6% vs 26.6%; P < 0.001) driven by higher rates of type 4 MI and angiographic complications (12.2% vs 4.8 %; P < 0.001 and 19.3% vs 8.6%; P < 0.05, respectively). The composite of death, MI, and stroke at 48 hours (12.7% vs 5.1 %; P < 0.05) and at 30 days (13.4% vs 5.3%; P < 0.05) was more frequent in complex PCI. No interaction was found between PCI complexity and the randomized treatment for the primary endpoint (Pinteraction = 0.47) nor the secondary endpoints. CONCLUSIONS In chronic coronary syndrome, patients undergoing a complex PCI have higher rates of periprocedural and cardiovascular events that are not reduced by ticagrelor as compared with clopidogrel.
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Affiliation(s)
- Benoit Lattuca
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France; Cardiology Department, Nîmes University Hospital, Montpellier University, ACTION Study Group, Nîmes, France
| | - Cedric Mazeau
- Cardiology Department, Nîmes University Hospital, Montpellier University, ACTION Study Group, Nîmes, France
| | - Guillaume Cayla
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France; Cardiology Department, Nîmes University Hospital, Montpellier University, ACTION Study Group, Nîmes, France
| | - Grégory Ducrocq
- Cardiology Department, Université de Paris, Hôpital Bichat, AP-HP, French Alliance for Cardiovascular Trials (FACT), INSERM U1148, Paris, France
| | - Paul Guedeney
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Mikael Laredo
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Raphaëlle Dumaine
- Les Grands Prés Cardiac Rehabilitation Centre, Villeneuve St Denis, France
| | - Mohamad El Kasty
- Département de Cardiologie, Grand Hôpital de l'Est Francilien site Marne-La-Vallée, Marne-la-Vallée, France
| | - Petr Kala
- University Hospital Brno, Medical Faculty of Masaryk University Brno, Brno, Czech Republic
| | - Mohammed Nejjari
- Cardiology Department, Centre Cardiologique du Nord, Paris, France
| | - Ota Hlinomaz
- University Hospital Brno, Medical Faculty of Masaryk University Brno, Brno, Czech Republic
| | - Olivier Morel
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Olivier Varenne
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Florence Leclercq
- Department of Cardiology, Arnaud de Villeneuve Hospital, Montpellier University, Montpellier, France
| | - Laurent Payot
- Cardiology Department, General Hospital Yves Le Foll, Saint-Brieuc, France
| | - Christian Spaulding
- Department of Cardiology, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris Cité University, Sudden Cardiac Death Expert Center, INSERM U 971, PARCC, Paris, France
| | - Farzin Beygui
- Cardiology Department, Caen University Hospital, ACTION Study Group, Caen, France
| | - Grégoire Rangé
- Cardiology Department, Chartres Hospital, Chartres, France
| | - Zuzana Motovska
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Jean-Jacques Portal
- ACTION Study Group, Unité de Recherche Clinique, Hôpital Fernand Widal (AP-HP), EA 4543, Université Paris 1 Panthéon-Sorbonne Paris, Paris, France
| | - Eric Vicaut
- ACTION Study Group, Unité de Recherche Clinique, Hôpital Fernand Widal (AP-HP), EA 4543, Université Paris 1 Panthéon-Sorbonne Paris, Paris, France
| | - Jean-Philippe Collet
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Gilles Montalescot
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France.
| | - Johanne Silvain
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
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Picard F, Munnich B, Brami P, Sava R, Pham V, Cariou A, Varenne O. Clinical and angiographic characteristics of out-of-hospital cardiac arrest among patients with ST-segment elevation myocardial infarction. Arch Cardiovasc Dis 2024; 117:153-159. [PMID: 38267318 DOI: 10.1016/j.acvd.2023.12.005] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 12/10/2023] [Accepted: 12/12/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) is the most severe complication of ST-segment elevation myocardial infarction (STEMI). Nevertheless, clinical and angiographic characteristics associated with OHCA among patients with STEMI have not been studied extensively. AIM To evaluate the clinical and angiographic characteristics of consecutive patients who presented with STEMI associated or not with OHCA. METHODS This was an observational study including consecutive patients treated for STEMI associated or not with OHCA. Baseline clinical and angiographic characteristics, biological characteristics and mortality were compared between patients with STEMI who experienced OHCA and patients with STEMI who did not. RESULTS Among the 686 included patients with STEMI, 148 (21.6%) presented with concomitant OHCA. Multivariable analysis revealed that culprit lesion localized on the left system (odds ratio [OR] 1.94, 95% confidence interval [CI] 1.24-3.13; P<0.01), culprit lesion at the level of a bifurcation lesion (OR 1.87, 95% CI 1.21-2.88; P<0.01) and the presence of chronic total occlusion on another artery (OR 3.39, 95% CI 1.93-5.99; P<0.001) were associated with the occurrence of OHCA, whereas dyslipidaemia, familial history of coronary artery disease and hypertension were found to be negatively associated with the occurrence of OHCA in patients with STEMI: OR 0.47, 95% CI 0.29-0.75 (P<0.01); OR 0.09, 95% CI 0.02-0.25 (P<0.001); and OR 0.60, 95% CI 0.38-0.93 (P=0.02), respectively. CONCLUSION In this study of consecutive patients with STEMI, culprit lesion localized on the left system, culprit lesion at the level of a bifurcation lesion and the presence of chronic total occlusion on a non-culprit artery were associated with OHCA.
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Affiliation(s)
- Fabien Picard
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, AP-HP, 75014 Paris, France; Université Paris-Cité, 75014 Paris, France.
| | - Benjamin Munnich
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, AP-HP, 75014 Paris, France
| | - Pierre Brami
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, AP-HP, 75014 Paris, France; Université Paris-Cité, 75014 Paris, France
| | - Ruxandra Sava
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, AP-HP, 75014 Paris, France
| | - Vincent Pham
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, AP-HP, 75014 Paris, France
| | - Alain Cariou
- Université Paris-Cité, 75014 Paris, France; Medical Intensive Care Unit, Cochin Hospital, Hôpitaux Universitaire Paris Centre, AP-HP, 75014 Paris, France
| | - Olivier Varenne
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, AP-HP, 75014 Paris, France; Université Paris-Cité, 75014 Paris, France
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Huang F, Khellaf LR, Lefèvre G, Berti A, d'Humières T, Sionis A, Solé AA, Bello F, Bermeo Garrido JA, Crickx E, Delvino P, Emmi G, Gaillet A, Garcia G, Gavand PE, George JL, Gilles F, Golden C, de Groote P, Guffroy A, Martis N, Monti S, Mourlanette P, Pineton de Chambrun M, Prunier F, Regola F, Seret G, Terrier B, Tréfond L, Souteyrand G, Varenne O, Zilio F, Haziza F, Benamer H, Kahn JE, Vallée A, Groh M. Clinical picture, outcomes, and predictors of relapse in eosinophilia-associated coronary vasospasm: data from a European multicentric study. J Allergy Clin Immunol Pract 2024:S2213-2198(24)00138-7. [PMID: 38307204 DOI: 10.1016/j.jaip.2024.01.036] [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] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 02/04/2024]
Affiliation(s)
- Florent Huang
- ACTION Study Group, Department of Cardiology, Foch Hospital, Suresnes, France; French National Reference Center for Hypereosinophilic Syndromes, Department of Internal Medicine, Foch Hospital, Suresnes, France
| | - Lucas Rémi Khellaf
- French National Reference Center for Hypereosinophilic Syndromes, Department of Internal Medicine, Foch Hospital, Suresnes, France
| | - Guillaume Lefèvre
- French National Reference Center for Hypereosinophilic Syndromes, Department of Internal Medicine, Foch Hospital, Suresnes, France; Department of Internal Medicine and Clinical Immunology, University of Lille, CHU de Lille, Lille, France; Inserm U1286 Institute for Translational Research in Inflammation, University of Lille, CHU Lille, Lille, France
| | - Alvise Berti
- Center for Medical Sciences, Department of Cellular, Computational, and Integrative Biology, University of Trento, Trento, Italy; Rheumatology Unit, Santa Chiara Hospital, Azienda Provinciale per i Servizi Sanitari Trento, Trento, Italy
| | - Thomas d'Humières
- Physiology Department, CHU Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France
| | - Alessandro Sionis
- Intensive Cardiac Care Unit, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Albert Ariza Solé
- Intensive Cardiac Care Unit, Cardiology Department, Bellvitge University Hospital, Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Federica Bello
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy; Interdisciplinary Internal Medicine Unit, Behçet Centre and Lupus Clinic, AOU Careggi Hospital of Firenze, Firenze, Italy
| | - Juan Andres Bermeo Garrido
- Intensive Cardiac Care Unit, Cardiology Department, Bellvitge University Hospital, Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Etienne Crickx
- Internal Medicine Department, Centre National de Référence des Cytopénies Auto-immunes de l'Adulte, Hôpital Henri Mondor, Fédération Hospitalo-Universitaire Innovative Therapy for Immune Disorders, Assistance Publique Hôpitaux de Paris, Université Paris Est Créteil, Créteil, France
| | - Paolo Delvino
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy; Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy; Interdisciplinary Internal Medicine Unit, Behçet Centre and Lupus Clinic, AOU Careggi Hospital of Firenze, Firenze, Italy; Centre for Inflammatory Diseases, Department of Medicine, Monash Medical Centre, Monash University, Clayton, Victoria, Australia
| | - Antoine Gaillet
- French National Reference Center for Hypereosinophilic Syndromes, Department of Internal Medicine, Foch Hospital, Suresnes, France; Medical Intensive Care Unit, Hôpitaux Universitaires Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France
| | - Gilles Garcia
- Department of Pulmonology, Antony Private Hospital, Antony, France
| | | | - Jean-Louis George
- Department of Cardiology, Centre Hospitalier de Versailles, André Mignot Hospital, Le Chesnay-Rocquencourt, France
| | - Floriane Gilles
- Department of Cardiology, Centre Hospitalier de Versailles, André Mignot Hospital, Le Chesnay-Rocquencourt, France
| | | | - Pascal de Groote
- French National Reference Center for Hypereosinophilic Syndromes, Department of Internal Medicine, Foch Hospital, Suresnes, France; CHU Lille, Service de Cardiologie, Lille, France; Inserm U1167, Institut Pasteur de Lille, Lille, France
| | - Aurélien Guffroy
- Department of Clinical Immunology and Internal Medicine, National Reference Center for Systemic Autoimmune Diseases (CNR RESO), Tertiary Center for Primary Immunodeficiencies, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Nihal Martis
- Internal Medicine Department, Hôpital de Larchet, University Hospital of Nice, Côte d'Azur University, Nice, France
| | - Sara Monti
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
| | | | - Marc Pineton de Chambrun
- Department of Intensive Care Medicine, APHP, Sorbonne Université, Pitié Salpétrière, Paris, France
| | - Fabrice Prunier
- Department of Cardiology, Universitary Hospital of Angers, Angers, France
| | - Francesca Regola
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Gabriel Seret
- Department of Cardiology, University of Sorbonne-Paris Cité, APHP, Cochin Hospital, Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, Hôpital Cochin, APHP, Paris, France
| | - Ludovic Tréfond
- Internal Medicine, Gabriel Montpied Hospital, Clermond-Ferrand, France
| | - Géraud Souteyrand
- Department of Cardiology, Gabriel Montpied Hospital, Clermond-Ferrand, France
| | - Olivier Varenne
- Department of Cardiology, University of Sorbonne-Paris Cité, APHP, Cochin Hospital, Paris, France
| | - Filippo Zilio
- Department of Cardiology, Santa Chiara Hospital, Azienda Provinciale per i Servizi Sanitari Trento, Trento, Italy
| | - Franck Haziza
- ACTION Study Group, Department of Cardiology, Foch Hospital, Suresnes, France
| | - Hakim Benamer
- ACTION Study Group, Department of Cardiology, Foch Hospital, Suresnes, France
| | - Jean-Emmanuel Kahn
- French National Reference Center for Hypereosinophilic Syndromes, Department of Internal Medicine, Foch Hospital, Suresnes, France; Department of Internal Medicine, University of Paris Saclay, APHP, CHU Ambroise Paré, Boulogne-Billancourt, France
| | - Alexandre Vallée
- Department of Epidemiology and Public Health, Foch Hospital, Suresnes, France
| | - Matthieu Groh
- French National Reference Center for Hypereosinophilic Syndromes, Department of Internal Medicine, Foch Hospital, Suresnes, France.
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Giovachini L, Laghlam D, Geri G, Picard F, Varenne O, Marijon E, Dumas F, Cariou A. Prolonged follow-up after apparently unexplained sudden cardiac arrest: A retrospective study. Resuscitation 2024; 194:110095. [PMID: 38103858 DOI: 10.1016/j.resuscitation.2023.110095] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND We hypothesized that a prolonged follow-up of survivors of unexplained sudden cardiac arrest (USCA) would subsequently unmask electrical heart disorders in a significant proportion of cases. PATIENTS AND METHODS We retrospectively analyzed all out-of-hospital cardiac arrest (OHCA) admitted alive in our cardiac arrest center over 20-years (2002-2022). The diagnosis of USCA was made when no etiology was found after thorough initial hospital investigations. We identified all the new diagnoses established during follow-up, and compared outcomes according to underlying heart diseases. RESULTS Out of the 2482 OHCA patients, 68 (2.7%) were initially classified as USCA and 30 (1.2%) with electrical heart disorders. Compared to other cardiac etiologies of OHCA, both USCA and electrical heart disorders patients were younger (mean age 48.5 and 43.5 year-old respectively, versus 62.5 year-old; p < 0.0001), with a higher rate of family history of SCA (17.6 and 23.3% respectively versus 9.2%; p = 0.003). Six patients in each group were lost to follow-up at discharge (6/68, 8.8% in the USCA group, 6/30 20% in the electrical heart disorders group). During a mean follow-up of 8.1 ± 6.3 years, a diagnosis was eventually established in 24.3% of USCA patients (9/35), most of them as electrical heart disorders (55.6%, 5/9). No post-discharge death occurred in both USCA and electrical heart disorders groups, with approximately 10% of appropriate therapy delivered by the implantable cardioverter defibrillator. CONCLUSION Our findings emphasized that approximately a quarter of patients who had been initially considered as having apparently USCA after index hospital stay actually reveal heart conditions, especially electrical heart disorders.
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Affiliation(s)
- Louis Giovachini
- Medical Intensive Care Unit, Cochin Hospital, AP-HP Centre Université Paris Cité, Paris, France.
| | - Driss Laghlam
- Medical Intensive Care Unit, Cochin Hospital, AP-HP Centre Université Paris Cité, Paris, France
| | - Guillaume Geri
- Department of Cardiology and Critical Care, CMC Ambroise Paré-Hartmann, 48 Ter Boulevard Victor Hugo, 92200 Neuilly-sur-Seine, France
| | - Fabien Picard
- Université Paris Cité, Faculté de Santé, UFR de Médecine, Paris, France; Cardiology, Cochin Hospital, AP-HP Centre Université Paris Cité, Paris, France
| | - Olivier Varenne
- Université Paris Cité, Faculté de Santé, UFR de Médecine, Paris, France; Cardiology, Cochin Hospital, AP-HP Centre Université Paris Cité, Paris, France
| | - Eloi Marijon
- Université Paris Cité, Faculté de Santé, UFR de Médecine, Paris, France; Cardiology, European Georges Pompidou Hospital, AP-HP Centre Université Paris Cité, Paris, France
| | - Florence Dumas
- Université Paris Cité, Faculté de Santé, UFR de Médecine, Paris, France
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin Hospital, AP-HP Centre Université Paris Cité, Paris, France; Université Paris Cité, Faculté de Santé, UFR de Médecine, Paris, France
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9
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Brami P, Fischer Q, Pham V, Seret G, Varenne O, Picard F. Evolution of Coronary Stent Platforms: A Brief Overview of Currently Used Drug-Eluting Stents. J Clin Med 2023; 12:6711. [PMID: 37959177 PMCID: PMC10648187 DOI: 10.3390/jcm12216711] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/16/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023] Open
Abstract
Cardiovascular disease, including ischemic heart disease, is the leading cause of death worldwide, and percutaneous coronary interventions (PCIs) have been demonstrated to improve the prognosis of these patients on top of optimal medical therapy. PCIs have evolved from plain old balloon angioplasty to coronary stent implantation at the end of the last century. There has been a constant technical and scientific improvement in stent technology from bare metal stents to the era of drug-eluting stents (DESs) to overcome clinical challenges such as target lesion failure related to in-stent restenosis or stent thrombosis. A better understanding of the underlying mechanisms of these adverse events has led DESs to evolve from first-generation DESs to thinner and ultrathin third-generation DESs with improved polymer biocompatibility that seems to have reached a peak in efficiency. This review aims to provide a brief historical overview of the evolution of coronary DES platforms and an update on clinical studies and major characteristics of the most currently used DESs.
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Affiliation(s)
- Pierre Brami
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, 75014 Paris, France; (P.B.); (Q.F.); (V.P.); (G.S.); (O.V.)
- Département Santé, Université Paris-Cité, 75006 Paris, France
| | - Quentin Fischer
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, 75014 Paris, France; (P.B.); (Q.F.); (V.P.); (G.S.); (O.V.)
| | - Vincent Pham
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, 75014 Paris, France; (P.B.); (Q.F.); (V.P.); (G.S.); (O.V.)
| | - Gabriel Seret
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, 75014 Paris, France; (P.B.); (Q.F.); (V.P.); (G.S.); (O.V.)
- Département Santé, Université Paris-Cité, 75006 Paris, France
| | - Olivier Varenne
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, 75014 Paris, France; (P.B.); (Q.F.); (V.P.); (G.S.); (O.V.)
- Département Santé, Université Paris-Cité, 75006 Paris, France
| | - Fabien Picard
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, 75014 Paris, France; (P.B.); (Q.F.); (V.P.); (G.S.); (O.V.)
- Département Santé, Université Paris-Cité, 75006 Paris, France
- INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, 75015 Paris, France
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10
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Valgimigli M, Spirito A, Sartori S, Angiolillo DJ, Vranckx P, de la Torre Hernandez JM, Krucoff MW, Bangalore S, Bhatt DL, Campo G, Cao D, Chehab BM, Choi JW, Feng Y, Ge J, Hermiller J, Kunadian V, Lupo S, Makkar RR, Maksoud A, Neumann FJ, Picon H, Saito S, Sardella G, Thiele H, Toelg R, Varenne O, Vogel B, Zhou Y, Windecker S, Mehran R. 1- or 3-Month DAPT in Patients With HBR With or Without Oral Anticoagulant Therapy After PCI. JACC Cardiovasc Interv 2023; 16:2498-2510. [PMID: 37804290 DOI: 10.1016/j.jcin.2023.08.014] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in patients on long-term oral anticoagulation (OAC) therapy is still uncertain. OBJECTIVES The aim of this analysis was to assess the effects of 1- vs 3-month DAPT in patients with and those without concomitant OAC included in the XIENCE Short DAPT program. METHODS The XIENCE Short DAPT program enrolled patients with high bleeding risk who underwent successful PCI with a cobalt-chromium everolimus-eluting stent. DAPT was discontinued at 1 or 3 months in patients free from ischemic events and adherent to treatment. The effect of 1- vs 3-month DAPT was compared in patients with and those without OAC using propensity score stratification. The primary endpoint was all-cause death or any myocardial infarction (MI). The key secondary endpoint was Bleeding Academic Research Consortium (BARC) types 2 to 5 bleeding. Outcomes were assessed from 1 to 12 months after index PCI. RESULTS Among 3,364 event-free patients, 1,462 (43%) were on OAC. Among OAC patients, the risk for death or MI was similar between 1- and 3-month DAPT (7.4% vs 8.8%; adjusted HR: 0.74; 95% CI: 0.49-1.11; P = 0.139), whereas BARC types 2 to 5 bleeding was lower with 1-month DAPT (adjusted HR: 0.71; 95% CI: 0.51-0.99; P = 0.046). These effects were consistent in patients with and those without OAC (P for interaction = NS). CONCLUSIONS Between 1 and 12 months after PCI, 1-month compared with 3-month DAPT was associated with similar rates of all-cause death or MI and a reduced rate of BARC types 2 to 5 bleeding, irrespective of OAC treatment.
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Affiliation(s)
- Marco Valgimigli
- Cardiocentro Ticino Institue, Ente Ospedaliero Cantonale, Lugano and Bern University Hospital, Bern, Switzerland
| | - Alessandro Spirito
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samantha Sartori
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Jessa Ziekenhuis, Hasselt & Faculty of Medicine and Life Sciences, University of Hasselt, Hasselt, Belgium
| | | | - Mitchell W Krucoff
- Division of Cardiology, Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Sripal Bangalore
- New York University, Grossman School of Medicine, New York, New York, USA
| | - Deepak L Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, New York, USA
| | - Gianluca Campo
- Malattie Dell'Apparato Cardiovascolare, Università degli Studi di Ferrara, Ferrara, Italy
| | - Davide Cao
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Bassem M Chehab
- Ascension Via Christi Hospital, Cardiovascular Research Institute of Kansas, Wichita, Kansas, USA
| | | | - Yihan Feng
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Junbo Ge
- Zhongshan Hospital Fudan University, Shanghai, China
| | | | - Vijay Kunadian
- Translational and Clinical Research Institute, Newcastle University and Cardiothoracic Centre, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Sydney Lupo
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Raj R Makkar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Aziz Maksoud
- Kansas Heart Hospital and University of Kansas School of Medicine, Wichita, Kansas, USA
| | - Franz-Josef Neumann
- Department of Cardiology and Angiology University Heart Centre Freiburg · Bad Krozingen Medical Centre - University of Freiburg, Freiburg, Germany
| | - Hector Picon
- Redmond Regional Medical Center, Rome, Georgia, USA
| | | | | | - Holger Thiele
- Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany; Hospital Cochin, Paris, France
| | - Ralph Toelg
- Segeberger Kliniken, Herzzentrum, Bad Segeberg, Germany
| | | | - Birgit Vogel
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roxana Mehran
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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11
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Brami P, Picard F, Seret G, Fischer Q, Pham V, Varenne O. Intracoronary imaging in addition to coronary angiography for patients with out-of-hospital cardiac arrest: More information for better care? Arch Cardiovasc Dis 2023; 116:272-281. [PMID: 37117094 DOI: 10.1016/j.acvd.2023.03.003] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/09/2023] [Accepted: 03/13/2023] [Indexed: 04/30/2023]
Abstract
About 70% of out-of-hospital cardiac arrests are related to an ischaemic heart disease in Western countries. Percutaneous coronary intervention has been shown to improve the prognosis of survivors when an unstable coronary lesion is identified as the potential cause of the cardiac arrest. Acute complete coronary occlusion is often demonstrated among patients with ST-segment elevation on electrocardiogram after the return of spontaneous circulation. In patients without ST-segment elevation, routine coronary angiography has been shown to be not superior to conservative management. However, an electrocardiogram-based decision to perform immediate coronary angiography could be insufficient to identify unstable coronary lesions, which are frequently associated with intermediate coronary stenosis. Intracoronary imaging can be helpful to detect plaque rupture or erosion and intracoronary thrombus, but could also lead to better stent implantation, and help to reduce the risk of stent thrombosis. In patients with coronary lesions without the instability characteristic, conservative management should be the default strategy, and a search for another cause of the cardiac arrest should be systematic. In the present review, we sought to describe the potential benefit of intracoronary imaging in patients with out-of-hospital cardiac arrest.
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Affiliation(s)
- Pierre Brami
- Department of Cardiology, Cochin Hospital, hôpitaux universitaire Paris centre, AP-HP, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France; Université Paris-cité, 75006 Paris, France
| | - Fabien Picard
- Department of Cardiology, Cochin Hospital, hôpitaux universitaire Paris centre, AP-HP, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France; Université Paris-cité, 75006 Paris, France
| | - Gabriel Seret
- Department of Cardiology, Cochin Hospital, hôpitaux universitaire Paris centre, AP-HP, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Quentin Fischer
- Department of Cardiology, Cochin Hospital, hôpitaux universitaire Paris centre, AP-HP, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Vincent Pham
- Department of Cardiology, Cochin Hospital, hôpitaux universitaire Paris centre, AP-HP, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Olivier Varenne
- Department of Cardiology, Cochin Hospital, hôpitaux universitaire Paris centre, AP-HP, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France; Université Paris-cité, 75006 Paris, France; Centre d'expertise sur la mort subite (CEMS), 75015 Paris, France.
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12
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Pham V, Varenne O, Cariou A, Picard F. Prognosis of out-of-hospital cardiac arrest due to acute myocardial infarction with or without ST-segment elevation in patients treated with percutaneous coronary intervention. Arch Cardiovasc Dis 2023; 116:227-229. [PMID: 36858910 DOI: 10.1016/j.acvd.2023.01.007] [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: 10/18/2022] [Revised: 12/30/2022] [Accepted: 01/02/2023] [Indexed: 02/15/2023]
Affiliation(s)
- Vincent Pham
- Department of Cardiology, hôpital Cochin, hôpitaux universitaire Paris centre, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
| | - Olivier Varenne
- Department of Cardiology, hôpital Cochin, hôpitaux universitaire Paris centre, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Université Paris Cité, 75006 Paris, France
| | - Alain Cariou
- Université Paris Cité, 75006 Paris, France; Medical Intensive Care Unit, hôpital Cochin, hôpitaux universitaire Paris centre, AP-HP, 75014 Paris, France; Inserm U970, Paris Cardiovascular Research Center (PARCC), Georges-Pompidou European Hospital, 75015 Paris, France
| | - Fabien Picard
- Department of Cardiology, hôpital Cochin, hôpitaux universitaire Paris centre, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Université Paris Cité, 75006 Paris, France; Inserm U970, Paris Cardiovascular Research Center (PARCC), Georges-Pompidou European Hospital, 75015 Paris, France
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13
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Aélion H, Picard F, Jégou A, Allouch P, Varenne O. Abnormal epicardial coronary vasomotor reactivity is associated with altered outcomes. Arch Cardiovasc Dis 2023; 116:33-40. [PMID: 36526570 DOI: 10.1016/j.acvd.2022.10.006] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND The prevalence and significance of abnormal epicardial coronary vasomotor reactivity (ACVR) in patients with symptoms compatible with myocardial ischaemia remains ill-defined. Our diagnostic strategy is to perform a provocative test (PT) in every patient presenting with chest pain at rest, for whom coronary angiography does not reveal significant epicardial coronary artery disease (≥70% stenosis by visual assessment). AIM To evaluate such a strategy in terms of incidence of ACVR, PT safety and patient outcomes. METHODS The present study was a retrospective observational study with a median clinical follow-up of 5years. The primary outcome was incidence of ACVR in patients with PT. Risk factors for ACVR and clinical follow-up were obtained, and the rate of major adverse cardiovascular and cerebrovascular events (MACCE; death, cardiovascular mortality, myocardial infarction, stroke and coronary revascularization) was reported. RESULTS ACVR was documented in 294 (12.4%) of the 2379 patients with PT, out of the 13,654 patients undergoing angiography. Patients with ACVR were more often female (43.9% vs. 30.0%; P<0.0001), current smokers (37.4% vs. 8.7%; P<0.0001) and had a suspected acute coronary syndrome (36.7% vs. 29.1%; P=0.005) at admittance compared with patients without ACVR. During clinical follow-up, MACCE occurred more frequently in patients with (9.8%) than in those without (3.7%) ACVR (hazard ratio [HR] 4.15, 95% confidence interval [CI] 2.62-6.57; P<0.0001), including more myocardial infarctions (4.0% vs. 0.4%; HR 17.8, 95% CI 6.41-49.5; P<0.0001) and more myocardial revascularizations (6.1% vs. 1.1%; HR 9.36, 95% CI 4.67-18.74; P<0.0001) compared with patients with normal PT at baseline. CONCLUSIONS ACVR is frequent in patients with symptoms compatible with myocardial ischaemia at rest, with no significant coronary stenosis. PT is a safe strategy to identify a population at high risk of recurrent ischaemic events.
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Affiliation(s)
- Hélène Aélion
- Cardiology Department, Cochin Hospital, AP-HP, 75014 Paris, France; Faculty of Medicine, University of Paris Cité, 75014 Paris, France
| | - Fabien Picard
- Cardiology Department, Cochin Hospital, AP-HP, 75014 Paris, France; Faculty of Medicine, University of Paris Cité, 75014 Paris, France; Paris Sudden Death Expertise Centre, 75015 Paris, France
| | - Arnaud Jégou
- Cardiology Department, Cochin Hospital, AP-HP, 75014 Paris, France
| | - Philippe Allouch
- Cardiology Department, Cochin Hospital, AP-HP, 75014 Paris, France
| | - Olivier Varenne
- Cardiology Department, Cochin Hospital, AP-HP, 75014 Paris, France; Faculty of Medicine, University of Paris Cité, 75014 Paris, France; Paris Sudden Death Expertise Centre, 75015 Paris, France.
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Lascarrou JB, Dumas F, Bougouin W, Legriel S, Aissaoui N, Deye N, Beganton F, Lamhaut L, Jost D, Vieillard-Baron A, Nichol G, Marijon E, Jouven X, Cariou A, Agostinucci J, Aissaoui-Balanant N, Algalarrondo V, Alla F, Alonso C, Amara W, Annane D, Antoine C, Aubry P, Azoulay E, Beganton F, Billon C, Bougouin W, Boutet J, Bruel C, Bruneval P, Cariou A, Carli P, Casalino E, Cerf C, Chaib A, Cholley B, Cohen Y, Combes A, Coulaud J, Da Silva D, Das V, Demoule A, Denjoy I, Deye N, Diehl J, Dinanian S, Domanski L, Dreyfuss D, Dubois-Rande J, Dumas F, Duranteau J, Empana J, Extramiana F, Fagon J, Fartoukh M, Fieux F, Gandjbakhch E, Geri G, Guidet B, Halimi F, Henry P, Jabre P, Joseph L, Jost D, Jouven X, Karam N, Lacotte J, Lahlou-Laforet K, Lamhaut L, Lanceleur A, Langeron O, Lavergne T, Lecarpentier E, Leenhardt A, Lellouche N, Lemiale V, Lemoine F, Linval F, Loeb T, Ludes B, Luyt C, Mansencal N, Mansouri N, Marijon E, Maury E, Maxime V, Megarbane B, Mekontso-Dessap A, Mentec H, Mira J, Monnet X, Narayanan K, Ngoyi N, Perier M, Piot O, Plaisance P, Plaud B, Plu I, Raphalen J, Raux M, Revaux F, Ricard J, Richard C, Riou B, Roussin F, Santoli F, Schortgen F, Sharshar T, Sideris G, Spaulding C, Teboul J, Timsit J, Tourtier J, Tuppin P, Ursat C, Varenne O, Vieillard-Baron A, Voicu S, Wahbi K, Waldmann V. Differential Effect of Targeted Temperature Management Between 32 °C and 36 °C Following Cardiac Arrest According to Initial Severity of Illness: Insights From Two International Data Sets. Chest 2022; 163:1120-1129. [PMID: 36445800 DOI: 10.1016/j.chest.2022.10.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 06/05/2022] [Revised: 10/10/2022] [Accepted: 10/23/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Recent guidelines have emphasized actively avoiding fever to improve outcomes in patients who are comatose following resuscitation from cardiac arrest (ie, out-of-hospital cardiac arrest). However, whether targeted temperature management between 32 °C and 36 °C (TTM32-36) can improve neurologic outcome in some patients remains debated. RESEARCH QUESTION Is there an association between the use of TTM32-36 and outcome according to severity assessed at ICU admission using a previously derived risk score? STUDY DESIGN AND METHODS Data prospectively collected in the Sudden Death Expertise Center (SDEC) registry (France) between May 2011 and December 2017 and in the Resuscitation Outcomes Consortium Continuous Chest Compressions (ROC-CCC) trial (United States and Canada) between June 2011 and May 2015 were used for this study. Severity at ICU admission was assessed through a modified version of the Cardiac Arrest Hospital Prognosis (mCAHP) score, divided into tertiles of severity. The study explored associations between TTM32-36 and favorable neurologic status at hospital discharge by using multiple logistic regression as well as in tertiles of severity for each data set. RESULTS A total of 2,723 patients were analyzed in the SDEC data set and 4,202 patients in the ROC-CCC data set. A favorable neurologic status at hospital discharge occurred in 728 (27%) patients in the French data set and in 1,239 (29%) patients in the North American data set. Among the French data set, TTM32-36 was independently associated with better neurologic outcome in the tertile of patients with low (adjusted OR, 1.63; 95% CI, 1.15-2.30; P = .006) and high (adjusted OR, 1.94; 95% CI, 1.06-3.54; P = .030) severity according to mCAHP at ICU admission. Similar results were observed in the North American data set (adjusted ORs of 1.36 [95% CI, 1.05-1.75; P = .020] and 2.42 [95% CI, 1.38-4.24; P = .002], respectively). No association was observed between TTM32-36 and outcome in the moderate groups of the two data sets. INTERPRETATION TTM32-36 was significantly associated with a better outcome in patients with low and high severity at ICU admission assessed according to the mCAHP score. Further studies are needed to evaluate individualized temperature control following out-of-hospital cardiac arrest.
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Affiliation(s)
- Jean Baptiste Lascarrou
- Université Paris Cité, INSERM, PARCC, Paris, France; Médecine Intensive Réanimation, University Hospital Center, Nantes, France; AfterROSC Network Group, Paris, France.
| | - Florence Dumas
- Université Paris Cité, INSERM, PARCC, Paris, France; Emergency Department, Cochin University Hospital, APHP, Paris, France
| | - Wulfran Bougouin
- Université Paris Cité, INSERM, PARCC, Paris, France; AfterROSC Network Group, Paris, France; Medical-Surgical Intensive Care Unit, Hopital Privé Jacques Cartier, Massy, France
| | - Stephane Legriel
- Université Paris Cité, INSERM, PARCC, Paris, France; AfterROSC Network Group, Paris, France; Medical Surgical Intensive Care Unit, Mignot Hospital, Le Chesnay, France
| | - Nadia Aissaoui
- Université Paris Cité, INSERM, PARCC, Paris, France; AfterROSC Network Group, Paris, France; Medical Intensive Care Unit, Cochin Hospital (APHP) and University of Paris, Paris, France
| | - Nicolas Deye
- AfterROSC Network Group, Paris, France; Medical Intensive Care Unit, Lariboisière University Hospital, INSERM U942, Paris, France
| | | | - Lionel Lamhaut
- AfterROSC Network Group, Paris, France; SAMU de Paris-DAR Necker University Hospital-Assistance, Paris, France
| | - Daniel Jost
- Brigade des Sapeurs-Pompiers de Paris, Paris, France
| | - Antoine Vieillard-Baron
- Medical Intensive Care Unit, Ambroise Paré University Hospital, APHP, Boulogne-Billancourt, France
| | - Graham Nichol
- University of Washington-Harborview Center for Prehospital Emergency Care, University of Washington, Seattle, WA
| | - Eloi Marijon
- Université Paris Cité, INSERM, PARCC, Paris, France
| | | | - Alain Cariou
- Université Paris Cité, INSERM, PARCC, Paris, France; AfterROSC Network Group, Paris, France; Medical Intensive Care Unit, Cochin Hospital (APHP) and University of Paris, Paris, France
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Bohm P, Meyer T, Narayanan K, Schindler M, Weizman O, Beganton F, Schmied C, Bougouin W, Barra S, Dumas F, Varenne O, Cariou A, Karam N, Jouven X, Marijon E. Sports-related sudden cardiac arrest in young adults. Europace 2022; 25:627-633. [PMID: 36256586 PMCID: PMC9935050 DOI: 10.1093/europace/euac172] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/08/2022] [Indexed: 01/14/2023] Open
Abstract
AIMS Data on sports-related sudden cardiac arrest (SrSCA) among young adults in the general population are scarce. We aimed to determine the overall SrSCA incidence, characteristics, and outcomes in young adults. METHODS AND RESULTS Prospective cohort study of all cases of SrSCA between 2012 and 2019 in Germany and Paris area, France, involving subjects aged 18-35 years. Detection of SrSCA was achieved via multiple sources, including emergency medical services (EMS) reporting and web-based screening of media releases. Cases and aetiologies were centrally adjudicated. Overall, a total of 147 SrSCA (mean age 28.1 ± 4.8 years, 95.2% males) occurred, with an overall burden of 4.77 [95% confidence interval (CI) 2.85-6.68] cases per million-year, including 12 (8.2%) cases in young competitive athletes. While bystander cardiopulmonary resuscitation (CPR) was initiated in 114 (82.6%), automated external defibrillator (AED) use by bystanders occurred only in a minority (7.5%). Public AED use prior to EMS arrival (odds ratio 6.25, 95% CI 1.48-43.20, P = 0.02) was the strongest independent predictor of survival at hospital discharge (38.1%). Among cases that benefited from both immediate bystander CPR and AED use, survival rate was 90.9%. Coronary artery disease was the most frequent aetiology (25.8%), mainly through acute coronary syndrome (86.9%). CONCLUSION Sports-related sudden cardiac arrest in the young occurs mainly in recreational male sports participants. Public AED use remains disappointingly low, although survival may reach 90% among those who benefit from both bystander CPR and early defibrillation. Coronary artery disease is the most prevalent cause of SrSCA in young adults.
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Affiliation(s)
- Philipp Bohm
- Institute of Sports and Preventive Medicine, Saarland University, 66123 Saarbrücken, Germany,Department of Cardiology, University Heart Center Zurich, HerzZentrum Hirslanden Zurich Witellikerstrasse 36, CH-8008 Zurich, Switzerland
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, 66123 Saarbrücken, Germany
| | - Kumar Narayanan
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France,Cardiology Department, Medicover Hospitals, Madhapur, Hyderabad, Telangana 500081, India
| | - Matthias Schindler
- Department of Cardiology, University Heart Center Zurich, HerzZentrum Hirslanden Zurich Witellikerstrasse 36, CH-8008 Zurich, Switzerland
| | - Orianne Weizman
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France
| | - Frankie Beganton
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France
| | - Christian Schmied
- Department of Cardiology, University Heart Center Zurich, HerzZentrum Hirslanden Zurich Witellikerstrasse 36, CH-8008 Zurich, Switzerland
| | - Wulfran Bougouin
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France,Intensive Care Unit, Jacques cartier Hospital, 6 Av. du Noyer Lambert, 91300 Massy, France
| | - Sergio Barra
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France,Cardiology Department, Hospital da Luz Arrábida, V. N. PCT de Henrique Moreira 150, 4400-346 Vila Nova de Gaia, Portugal
| | - Florence Dumas
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France,Intensive Care Unit, Jacques cartier Hospital, 6 Av. du Noyer Lambert, 91300 Massy, France,Emergency Department, Cochin Hospital, 25 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Olivier Varenne
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France,Intensive Care Unit, Jacques cartier Hospital, 6 Av. du Noyer Lambert, 91300 Massy, France,Cardiology Department, Cochin Hospital, 25 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Alain Cariou
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France,Intensive Care Unit, Jacques cartier Hospital, 6 Av. du Noyer Lambert, 91300 Massy, France,Intensive Care Unit, Cochin Hospital, 25 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Nicole Karam
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France,University of Paris, 103, Boulevard Saint-Michel, Paris, France,Cardiology Department, European Georges Pompidou Hospital, 20 rue Leblanc, 75015 Paris, France
| | - Xavier Jouven
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France,University of Paris, 103, Boulevard Saint-Michel, Paris, France,Cardiology Department, European Georges Pompidou Hospital, 20 rue Leblanc, 75015 Paris, France
| | - Eloi Marijon
- Corresponding author. Tel: +33 6 6283 3848; fax: +33 1 5609 3047. E-mail address:
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Seret G, Pham V, Laghlam D, Diefenbronn M, Brunet T, Varenne O, Dumas F, Cariou A, Picard F. Performance of stent thrombosis and bleeding risk scores in out-of-hospital cardiac arrest due to acute coronary syndromes. Arch Cardiovasc Dis 2022; 115:552-561. [DOI: 10.1016/j.acvd.2022.06.008] [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] [Received: 12/28/2021] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 11/02/2022]
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Piccolo R, Bonaa KH, Efthimiou O, Varenne O, Baldo A, Urban P, Kaiser C, de Belder A, Lemos PA, Wilsgaard T, Reifart J, Ribeiro EE, Serruys PW, Byrne RA, de la Torre Hernandez JM, Esposito G, Wijns W, Jüni P, Windecker S, Valgimigli M. Individual Patient Data Meta-analysis of Drug-eluting Versus Bare-metal Stents for Percutaneous Coronary Intervention in Chronic Versus Acute Coronary Syndromes. Am J Cardiol 2022; 182:8-16. [PMID: 36075755 DOI: 10.1016/j.amjcard.2022.07.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 05/05/2022] [Revised: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 11/27/2022]
Abstract
New-generation drug-eluting stents (DES) strongly reduce restenosis and repeat revascularization compared with bare-metal stents (BMS) for percutaneous coronary intervention. There is residual uncertainty as to whether other prognostically relevant outcomes are affected by DES versus BMS concerning initial presentation (chronic coronary syndrome [CCS] vs acute coronary syndrome [ACS]). We performed an individual patient data meta-analysis of randomized trials comparing new-generation DES versus BMS (CRD42017060520). The primary outcome was the composite of cardiac death or myocardial infarction (MI). Outcomes were examined at maximum follow-up and with a 1-year landmark. Risk estimates are expressed as hazard ratio (HR) with 95% confidence interval (CI). A total of 22,319 patients were included across 14 trials; 7,691 patients (34.5%) with CCS and 14,628 patients (65.5%) with ACS. We found evidence that new-generation DES versus BMS consistently reduced the risk of cardiac death or MI in both patients with CCS (HR 0.83, 95% CI 0.70 to 0.98, p <0.001) and ACS (HR 0.83, 95% CI 0.75 to 0.92, p <0.001) (p-interaction = 0.931). This benefit was mainly driven by a similar reduction in the risk of MI (p-interaction = 0.898) for both subsets (HRCCS 0.80, 95% CI 0.65 to 0.97; HRACS 0.79, 95% CI 0.70 to 0.89). In CCS and ACS, we found a time-dependent treatment effect, with the benefit from DES accumulating during 1-year follow-up, without offsetting effects after that. In conclusion, patients with CCS were slightly underrepresented in comparative clinical trials. Still, they benefited similarly to patients with ACS from new-generation DES instead of BMS with a sustained reduction of cardiac death or MI because of lower event rates within 1 year.
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Affiliation(s)
- Raffaele Piccolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Kaare H Bonaa
- Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Orestis Efthimiou
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Olivier Varenne
- Department of Cardiology, Hôpital Cochin, AP-HP, Paris, France; Université Paris Descartes, Faculté de Médecine, Paris, France
| | - Andrea Baldo
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Christoph Kaiser
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Adam de Belder
- Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom
| | - Pedro A Lemos
- Heart Institute (InCor), University of São Paulo Medical School, Brazil and Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Tom Wilsgaard
- Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Jörg Reifart
- Department of Cardiology, Kerckhoff Klinik, Bad Nauheim, Germany
| | | | - Patrick Wjc Serruys
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College, London, London, United Kingdom
| | - Robert A Byrne
- Cardiology Department, Cardiovascular Institute (ICCV), Deutsches Herzzentrum München, Technische Universität München and DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, both Munich, Germany
| | | | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway, Ireland
| | - Peter Jüni
- Applied Health Research Centre of the Li Ka Shing Knowledge Institute, Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marco Valgimigli
- Université Paris Descartes, Faculté de Médecine, Paris, France; Instituto Cardiocentro Ticino, Lugano, Switzerland.
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Pham V, Varenne O, Cariou A, Picard F. Performance of CASS, PHR-RS, and SARICA scores to predict survival in acute coronary syndromes complicated by out-of-hospital cardiac arrest. Eur Heart J Acute Cardiovasc Care 2022; 11:651-652. [PMID: 35808976 DOI: 10.1093/ehjacc/zuac083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Vincent Pham
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Olivier Varenne
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
- Université Paris Cité, Faculté de Médecine, 75006 Paris, France
| | - Alain Cariou
- Université Paris Cité, Faculté de Médecine, 75006 Paris, France
- Medical Intensive Care Unit, Cochin Hospital, Hôpitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, Paris 75014, France
- INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris 75015, France
| | - Fabien Picard
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
- Université Paris Cité, Faculté de Médecine, 75006 Paris, France
- INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris 75015, France
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Hauw-Berlemont C, Lamhaut L, Diehl JL, Andreotti C, Varenne O, Leroux P, Lascarrou JB, Guerin P, Loeb T, Roupie E, Daubin C, Beygui F, Boissier F, Marjanovic N, Christiaens L, Vilfaillot A, Glippa S, Prat JD, Chatellier G, Cariou A, Spaulding C. Emergency vs Delayed Coronary Angiogram in Survivors of Out-of-Hospital Cardiac Arrest: Results of the Randomized, Multicentric EMERGE Trial. JAMA Cardiol 2022; 7:700-707. [PMID: 35675081 DOI: 10.1001/jamacardio.2022.1416] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [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: 11/14/2022]
Abstract
Importance Although an emergency coronary angiogram (CAG) is recommended for patients who experience an out-of-hospital cardiac arrest (OHCA) with ST-segment elevation on the postresuscitation electrocardiogram (ECG), this strategy is still debated in patients without ST-segment elevation. Objective To assess the 180-day survival rate with Cerebral Performance Category (CPC) 1 or 2 of patients who experience an OHCA without ST-segment elevation on ECG and undergo emergency CAG vs delayed CAG. Design, Setting, and Participants The Emergency vs Delayed Coronary Angiogram in Survivors of Out-of-Hospital Cardiac Arrest (EMERGE) trial randomly assigned survivors of an OHCA without ST-segment elevation on ECG to either emergency or delayed (48 to 96 hours) CAG in 22 French centers. The trial took place from January 19, 2017, to November 23, 2020. Data were analyzed from November 24, 2020, to July 30, 2021. Main Outcomes and Measures The primary outcome was the 180-day survival rate with CPC of 2 or less. The secondary end points were occurrence of shock, ventricular tachycardia, and/or fibrillation within 48 hours, change in left ventricular ejection fraction between baseline and 180 days, CPC scale at intensive care unit discharge and day 90, survival rate, and hospital length of stay. Results A total of 279 patients (mean [SD] age, 64.7 [14.6] years; 195 men [69.9%]) were enrolled, with 141 (50.5%) in the emergency CAG group and 138 (49.5%) in the delayed CAG group. The study was underpowered. The mean (SD) time delay between randomization and CAG was 0.6 (3.7) hours in the emergency CAG group and 55.1 (37.2) hours in the delayed CAG group. The 180-day survival rates among patients with a CPC of 2 or less were 34.1% (47 of 141) in the emergency CAG group and 30.7% (42 of 138) in the delayed CAG group (hazard ratio [HR], 0.87; 95% CI, 0.65-1.15; P = .32). There was no difference in the overall survival rate at 180 days (emergency CAG, 36.2% [51 of 141] vs delayed CAG, 33.3% [46 of 138]; HR, 0.86; 95% CI, 0.64-1.15; P = .31) and in secondary outcomes between the 2 groups. Conclusions and Relevance In this randomized clinical trial, for patients who experience an OHCA without ST-segment elevation on ECG, a strategy of emergency CAG was not better than a strategy of delayed CAG with respect to 180-day survival rate and minimal neurologic sequelae. Trial Registration ClinicalTrials.gov Identifier: NCT02876458.
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Affiliation(s)
- Caroline Hauw-Berlemont
- Medical Intensive Care Unit, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Lionel Lamhaut
- Paris Cité University, Paris, France.,Service d'Aide Médicale D'Urgence 75, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,INSERM U970; Paris Cardiovascular Research Centre, Paris, France
| | - Jean-Luc Diehl
- Medical Intensive Care Unit, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France.,INSERM Unité Mixte de Recherche-S1140, Paris Cité University, Paris, France
| | - Christophe Andreotti
- Service Mobile d'Urgence et de Réanimation, Emergency Department Cochin Hôtel Dieu, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Olivier Varenne
- Interventional Cardiology, Department of Cardiology, Groupe Hospitalier Cochin-Saint Vincent de Paul-Hôtel Dieu, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pierre Leroux
- Service d'Aide Médicale d' Urgence 44, University Hospital of Nantes, Nantes, France
| | | | - Patrice Guerin
- Unité d'Hémodynamique, L'Institut du Thorax, University Hospital of Nantes, Nantes, France
| | - Thomas Loeb
- Service d'Aide Médicale d'Urgence 92, Hôpitaux Universitaires Paris-Saclay, Site Raymond Poincaré, Garches, France
| | - Eric Roupie
- Service d'Aide Médicale d'Urgence 14, University Hospital of Caen, Caen, France
| | - Cédric Daubin
- Medical Intensive Care Unit, University Hospital of Caen, Caen, France
| | - Farzin Beygui
- Department of Cardiology, University Hospital of Caen, Caen, France
| | - Florence Boissier
- Medical Intensive Care Unit, University Hospital of Poitiers, INSERM CIC 1402, Poitiers University, Poitiers, France
| | - Nicolas Marjanovic
- Service d'Aide Médicale d'Urgence 86, University of Poitiers, Poitiers, France
| | - Luc Christiaens
- Cardiology Department Poitiers University Hospital, University of Poitiers, Poitiers, France
| | - Aurélie Vilfaillot
- INSERM CIC1418 and Département d'Informatique, Biostatistique et Santé Publique, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sophie Glippa
- INSERM CIC1418 and Département d'Informatique, Biostatistique et Santé Publique, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Juliette Djadi Prat
- INSERM CIC1418 and Département d'Informatique, Biostatistique et Santé Publique, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Gilles Chatellier
- INSERM CIC1418 and Département d'Informatique, Biostatistique et Santé Publique, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Cité University, Paris, France
| | - Christian Spaulding
- Department of Cardiology, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris Cité University, Sudden Cardiac Death Expert Center, INSERM U 971, PARCC, Paris, France
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Sharifzadehgan A, Gaye B, Bougouin W, Narayanan K, Dumas F, Karam N, Rischard J, Plu I, Waldmann V, Algalarrondo V, Gandjbakhch E, Bruneval P, Beganton Date Curation F, Alonso C, Moubarak G, Piot O, Lamhaut L, Jost D, Sideris G, Mansencal N, Deye N, Voicu S, Megarbane B, Geri G, Vieillard-Baron A, Lellouche N, Extramiana F, Wahbi K, Varenne O, Cariou A, Jouven X, Marijon E. Lack of Early Etiologic Investigations in Young Sudden Cardiac Death. Resuscitation 2022; 179:197-205. [PMID: 35788021 DOI: 10.1016/j.resuscitation.2022.06.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 04/26/2022] [Revised: 06/09/2022] [Accepted: 06/26/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Since majority of sudden cardiac arrest (SCA) victims die in the intensive care unit (ICU), early etiologic investigations may improve understanding of SCA and targeted prevention. METHODS In this prospective, population-based registry all SCA admitted alive across the 48 hospitals of the Paris area were enrolled. We investigated the extent of early etiologic work-up among young SCD cases (<45 years) eventually dying within the ICU. RESULTS From May 2011 to May 2018, 4,314 SCA patients were admitted alive. Among them, 3,044 died in ICU, including 484 (15.9%) young patients. SCA etiology was established in 233 (48.1%) and remained unexplained in 251 (51.9%). Among unexplained (compared to explained) cases, coronary angiography (17.9 vs. 49.4%, P<0.001), computed tomography scan (24.7 vs. 46.8%, P<0.001) and trans-thoracic echocardiography (31.1 vs. 56.7%, P<0.001) were less frequently performed. Only 22 (8.8%) patients with unexplained SCD underwent all three investigations. SCDs with unexplained status decreased significantly over the 7 years of the study period (from 62.9 to 35.2%, P=0.005). While specialized TTE and CT scan performances have increased significantly, performance of early coronary angiography did not change. Autopsy, genetic analysis and family screening were performed in only 48 (9.9%), 5 (1.0%) and 14 cases (2.9%) respectively. CONCLUSIONS More than half of young SCD dying in ICU remained etiologically unexplained; this was associated with a lack of early investigations. Improving early diagnosis may enhance both SCA understanding and prevention, including for relatives. Failure to identify familial conditions may result in other preventable deaths within these families.
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Affiliation(s)
- Ardalan Sharifzadehgan
- European Georges Pompidou Hospital, Cardiology Department, Paris, France; Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; University of Paris, Paris, France.
| | - Bamba Gaye
- Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; University of Paris, Paris, France
| | - Wulfran Bougouin
- Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Jacques Cartier Hospital, Intensive Care Unit, Massy, France
| | - Kumar Narayanan
- Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Medicover Hospitals, Cardiology Department, Hyderabad, India
| | - Florence Dumas
- Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; University of Paris, Paris, France; Cochin Hospital, Emergency Department, Paris, France
| | - Nicole Karam
- European Georges Pompidou Hospital, Cardiology Department, Paris, France; Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; University of Paris, Paris, France
| | - Julien Rischard
- European Georges Pompidou Hospital, Cardiology Department, Paris, France; Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France
| | | | - Victor Waldmann
- European Georges Pompidou Hospital, Cardiology Department, Paris, France; Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; University of Paris, Paris, France
| | - Vincent Algalarrondo
- Bichat-Claude-Bernard Hospital, Cardiology Department, Paris, France; Groupe Parisien Universitaire de Rythmologie (G.P.U.R.)
| | - Estelle Gandjbakhch
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.); La Pitié Salpêtrière University Hospital, Cardiology Department, Paris, France
| | - Patrick Bruneval
- University of Paris, Paris, France; European Georges Pompidou Hospital, Pathology Department, Paris, France
| | | | - Christine Alonso
- Centres Médico Chirurgicaux Ambroise Paré, Neuilly-sur-Seine, France
| | - Ghassan Moubarak
- Centres Médico Chirurgicaux Ambroise Paré, Neuilly-sur-Seine, France
| | - Olivier Piot
- Centre Cardiologique du Nord, Saint Denis, France
| | - Lionel Lamhaut
- Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; University of Paris, Paris, France; Emergency Medical Services (SAMU) 75, Necker University Hospital, APHP, Paris, France
| | - Daniel Jost
- Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris Firefighters Brigade (BSPP), Paris, France
| | | | - Nicolas Mansencal
- Ambroise Paré Hospital, Cardiology Intensive Care Unit, Paris, France
| | - Nicolas Deye
- Lariboisiere Hospital, Intensive Care Unit, Paris, France
| | | | | | - Guillaume Geri
- Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Ambroise Paré Hospital, Intensive Care Unit, Paris, France
| | | | - Nicolas Lellouche
- University Hospital Henri Mondor, Cardiology Department, Créteil, France
| | - Fabrice Extramiana
- Bichat-Claude-Bernard Hospital, Cardiology Department, Paris, France; Groupe Parisien Universitaire de Rythmologie (G.P.U.R.)
| | - Karim Wahbi
- University of Paris, Paris, France; Cochin Hospital, Cardiology Intensive Care Unit, Paris, France
| | - Olivier Varenne
- University of Paris, Paris, France; Cochin Hospital, Cardiology Intensive Care Unit, Paris, France
| | - Alain Cariou
- Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; University of Paris, Paris, France; Cochin Hospital, Intensive Care Unit, Paris, France
| | - Xavier Jouven
- European Georges Pompidou Hospital, Cardiology Department, Paris, France; Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; University of Paris, Paris, France
| | - Eloi Marijon
- European Georges Pompidou Hospital, Cardiology Department, Paris, France; Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; University of Paris, Paris, France
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21
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Le Bras A, Puymirat E, Rabetrano H, Cayla G, Simon T, Steg G, Montalescot G, Varenne O, Bonello L, Coste P, Delarche N, Georges JL, Chassaing S, Letocart V, Chatellier G, Danchin N, Durand-Zaleski I. Economic evaluation of fractional flow reserve-guided versus angiography-guided multivessel revascularisation in ST-segment elevation myocardial infarction patients in the FLOWER-MI randomised trial. EUROINTERVENTION 2022; 18:235-241. [PMID: 35191838 PMCID: PMC9980404 DOI: 10.4244/eij-d-21-00867] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 11/23/2022]
Abstract
BACKGROUND In patients with ST-segment elevation myocardial infarction (STEMI) who have multivessel disease, the FLOWER-MI trial found no significant clinical benefit to fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) compared to angiography-guided PCI. AIMS Our aim was to estimate the cost-effectiveness and cost-utility of FFR-guided PCI, the secondary endpoint of the FLOWER-MI trial. METHODS Costs, major adverse cardiovascular events (composite of all-cause death, non-fatal myocardial infarction [MI], and unplanned hospitalisation leading to urgent revascularisation), and quality-adjusted life years were calculated in both groups. The incremental cost-effectiveness and cost-utility ratios were estimated. Uncertainty was explored by probabilistic bootstrapping. The analysis was conducted from the perspective of the health care provider with a time horizon of one year. RESULTS At one year, the average cost per patient was 7,560€ (±2,218) in the FFR-guided group and 7,089€ (±1,991) in the angiography-guided group (p-value<0.01). The point estimates for the incremental cost-effectiveness and cost-utility ratios found that the angiography-guided strategy was cost saving and improved outcomes, with a probabilistic sensitivity analysis confirming dominance. CONCLUSIONS The FFR-guided strategy at one year is unlikely to be cost effective compared to the angiography-guided strategy on both clinical and quality of life outcomes.
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Affiliation(s)
- Alicia Le Bras
- Unité de Recherche Clinique en Économie de la Santé, Hôpital Hôtel Dieu AP-HP, 1 Parvis Notre-Dame, 75004 Paris, France
| | - Etienne Puymirat
- Department of Cardiology, Hôpital Européen Georges Pompidou AP-HP, Paris, France,Université de Paris, Paris, France,French Alliance for Cardiovascular Trials (FACT), Paris, France
| | - Hasina Rabetrano
- Clinical Research Unit Eco Ile de France, Hôpital Hôtel Dieu AP-HP, Paris, France
| | | | - Tabassome Simon
- French Alliance for Cardiovascular Trials (FACT), Paris, France,Department of Clinical Pharmacology, Hôpital Saint Antoine AP-HP, Paris, France,Université Pierre et Marie Curie (UPMC), Paris, France
| | - Gabriel Steg
- French Alliance for Cardiovascular Trials (FACT), Paris, France,Université Paris-Diderot, Sorbonne Paris Cité, Paris, France,Hôpital Bichat – Claude Bernard AP-HP, Paris,France
| | - Gilles Montalescot
- ACTION Groupe, Institut de Cardiologie (AP-HP) and INSERM UMRS 1166, Hôpital Pitié-Salpêtrière, Paris, France
| | - Olivier Varenne
- Université de Paris, Paris, France,Department of Cardiology, Hôpital Cochin AP-HP, Paris, France
| | - Laurent Bonello
- Mediterranean Association for research and studies in cardiology (MARS CARDIO) and Centre for cardiovascular and nutrition research, INSERM 1263, INRA 1260, Marseille, France,Cardiology Department, Hôpital Nord, Marseille, France
| | - Pierre Coste
- Intensive Cardiology Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut-Lévêque, Pessac, France
| | - Nicolas Delarche
- Department of Cardiology, Centre Hospitalier de Pau, Pau, France
| | - Jean-Louis Georges
- Cardiology Department, Centre Hospitalier de Versailles, Le Chesnay-Rocquencourt, France
| | | | - Vincent Letocart
- Department of Cardiology, Thorax Institute, Nantes University Hospital, Nantes, France
| | - Gilles Chatellier
- Clinical Research Unit and CIC 1418 INSERM, Hôpital Européen Georges Pompidou AP-HP, Paris, France
| | - Nicolas Danchin
- Department of Cardiology, Hôpital Européen Georges Pompidou AP-HP, Paris, France,Université de Paris, Paris, France,French Alliance for Cardiovascular Trials (FACT), Paris, France
| | - Isabelle Durand-Zaleski
- Clinical Research Unit Eco Ile de France, Hôpital Hôtel Dieu AP-HP, Paris, France,Université de Paris Est Creteil (UPEC), Créteil, France
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22
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Pham V, Bonnet M, Varenne O, Lafont A, Darmon A, Feldman L, Rioufol G, Derimay F, Harbaoui B, Picard F. In-stent use of Intravascular Coronary Lithotripsy for restenosis and stent underexpansion, a multicenter experience. Can J Cardiol 2022; 38:1474-1475. [DOI: 10.1016/j.cjca.2022.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/13/2022] [Accepted: 05/20/2022] [Indexed: 01/16/2023] Open
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23
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Lipiecki J, Rampat R, Piot C, Benamer H, Brunelle F, Lefèvre T, El Mahmoud R, Varenne O, Gommeaux A, Malquarti V, Angoulvant D, Cruchon C, Oldroyd K, Spaulding C. Clinical Outcomes in Patients Treated With Biodegradable-Polymer Biolimus-Eluting Stents and 6 Months of Dual-Antiplatelet Therapy: The French eBiomatrix 6-Month DAPT Registry. J Invasive Cardiol 2022; 34:E363-E368. [PMID: 35451995] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Dual-antiplatelet treatment (DAPT) has conventionally been prescribed for 1 year after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation. Recent evidence suggests that a duration of only 6 months may be equally safe and effective when using contemporary DES options. OBJECTIVE The aim of this study was to assess clinical outcomes in patients treated with the BioMatrix biodegradable-polymer coated biolimus-eluting stent (BP-BES; Biosensors International) who received only 6 months of DAPT. METHODS This prospective "all-comers" registry enrolled 2038 patients in France. Following PCI, DAPT was started for a recommended period of 6 months. Patients were followed up at 6 and 24 months. The primary endpoint of major adverse cardiac and cerebrovascular event (MACCE) was a composite of all-cause death, cerebrovascular accidents, non-fatal myocardial infarction, or clinically driven target-vessel revascularization. Secondary endpoints included stent thrombosis (ST) and major bleeding (MB). RESULTS The mean age of the study population was 67 ± 10.5 years and 77% of patients were male. Follow-up data were available in 96.9% and 95.3% of patients at 6 and 24 months, respectively. At 6 months, the incidences of MACCE, ST, and MB were 3.1%, 0.3%, and 0.4%, respectively. At 24 months, 21.2% of patients were still on DAPT and the cumulative incidences of MACCE, ST, and MB were 9.7%, 0.54%, and 0.79%, respectively. CONCLUSIONS In this unselected population of patients undergoing PCI with a BP-BES, a 6-month duration of DAPT after implantation is safe and effective.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Christian Spaulding
- Département de Cardiologie, Hôpital Européen Georges Pompidou, 20 rue Leblanc 75015 Paris, France.
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24
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Valgimigli M, Cao D, Angiolillo DJ, Bangalore S, Bhatt DL, Ge J, Hermiller J, Makkar RR, Neumann FJ, Saito S, Picon H, Toelg R, Maksoud A, Chehab BM, Choi JW, Campo G, De la Torre Hernandez JM, Kunadian V, Sardella G, Thiele H, Varenne O, Vranckx P, Windecker S, Zhou Y, Krucoff MW, Ruster K, Zheng Y, Mehran R. Duration of Dual Antiplatelet Therapy for Patients at High Bleeding Risk Undergoing PCI. J Am Coll Cardiol 2021; 78:2060-2072. [PMID: 34794687 DOI: 10.1016/j.jacc.2021.08.074] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [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: 06/08/2021] [Revised: 08/02/2021] [Accepted: 08/31/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) among patients at high bleeding risk (HBR) is unknown. OBJECTIVES The purpose of this analysis was to compare 1 vs 3 months of DAPT in HBR patients undergoing drug-eluting stent implantation. METHODS The XIENCE Short DAPT program comprised 3 prospective, multicenter, single-arm studies of HBR patients treated with a short DAPT course followed by aspirin monotherapy after PCI with a cobalt-chromium everolimus-eluting stent. In this exploratory analysis, patients who received 1-month DAPT (XIENCE 28 USA and 28 Global) were compared with those on 3-month DAPT (XIENCE 90) using propensity score stratification. Ischemic and bleeding outcomes were assessed between 1 and 12 months after index PCI. RESULTS A total of 3,652 patients were enrolled and 1,392 patients after 1-month DAPT and 1,972 patients after 3-month DAPT were eligible for the analyses. The primary endpoint of all-cause mortality or myocardial infarction was similar between the 2 groups (7.3% vs 7.5%; difference -0.2%; 95% CI: -2.2% to 1.7%; P = 0.41). The key secondary endpoint of BARC (Bleeding Academic Research Consortium) type 2-5 bleeding was lower with 1-month DAPT compared with 3-month DAPT (7.6% vs 10.0%; difference -2.5%; 95% CI: -4.6% to -0.3%; P = 0.012). Major BARC type 3-5 bleeding did not differ at 12 months (3.6% vs 4.7%; difference -1.1%; 95% CI: -2.6% to 0.4%; P = 0.082), but was lower with 1-month DAPT at 90 days (1.0% vs 2.1%; P = 0.015). CONCLUSIONS Among HBR patients undergoing PCI, 1 month of DAPT, compared with 3 months of DAPT, was associated with similar ischemic outcomes and lower bleeding risk. (XIENCE 90 Study; NCT03218787; XIENCE 28 USA Study; NCT03815175; XIENCE 28 Global Study; NCT03355742).
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Affiliation(s)
- Marco Valgimigli
- Cardiocentro Ticino Institue, Ente Ospedaliero Cantonale, Lugano and Bern University Hospital, Bern, Switzerland
| | - Davide Cao
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Sripal Bangalore
- New York University-Langone Medical Center, New York, New York, USA
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Junbo Ge
- Zhongshan Hospital Fudan University, Shanghai, China
| | - James Hermiller
- St Vincent's Medical Center of Indiana, Indianapolis, Indiana, USA
| | - Raj R Makkar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | | | - Hector Picon
- Redmond Regional Medical Center, Rome, Georgia, USA
| | - Ralph Toelg
- Segeberger Kliniken GmbH, Herzzentrum, Bad Segeberg, Germany
| | - Aziz Maksoud
- Kansas Heart Hospital and University of Kansas School of Medicine, Wichita, Kansas, USA
| | | | - James W Choi
- Baylor Scott and White Heart and Vascular Hospital, Dallas, Texas, USA
| | - Gianluca Campo
- Azienda Ospedaliero-Universitaria di Ferrara, Cona (FE), Italy
| | | | - Vijay Kunadian
- Translational and Clinical Research Institute, Newcastle University and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | | | - Holger Thiele
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | | | - Pascal Vranckx
- Heart Centre Hasselt and University of Hasselt, Hasselt, Belgium
| | | | | | - Mitchell W Krucoff
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | - Yan Zheng
- Abbott, Santa Clara, California, USA
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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25
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Chong Nguyen C, Duboc D, Rainteau D, Sokol H, Humbert L, Seksik P, Bellino A, Abdoul H, Bouazza N, Treluyer JM, Saadi M, Wahbi K, Soliman H, Coffin B, Bado A, Le Gall M, Varenne O, Duboc H. Circulating bile acids concentration is predictive of coronary artery disease in human. Sci Rep 2021; 11:22661. [PMID: 34811445 PMCID: PMC8608912 DOI: 10.1038/s41598-021-02144-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 11/09/2021] [Indexed: 12/14/2022] Open
Abstract
Synthetized by the liver and metabolized by the gut microbiota, BA are involved in metabolic liver diseases that are associated with cardiovascular disorders. Animal models of atheroma documented a powerful anti-atherosclerotic effect of bile acids (BA). This prospective study examined whether variations in circulating BA are predictive of coronary artery disease (CAD) in human. Consecutive patients undergoing coronary angiography were enrolled. Circulating and fecal BA were measured by high pressure liquid chromatography and tandem mass spectrometry. Of 406 screened patients, 80 were prospectively included and divided in two groups with (n = 45) and without (n = 35) CAD. The mean serum concentration of total BA was twice lower in patients with, versus without CAD (P = 0.005). Adjusted for gender and age, this decrease was an independent predictor of CAD. In a subgroup of 17 patients, statin therapy doubled the serum BA concentration. Decreased serum concentrations of BA were predictors of CAD in humans. A subgroup analysis showed a possible correction by statins. With respect to the anti-atherosclerotic effect of BA in animal models, and their role in human lipid metabolism, this study describe a new metabolic disturbance associated to CAD in human.
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Affiliation(s)
- Caroline Chong Nguyen
- Centre de Recherche Sur I'inflammation, Inserm, UMR 1149, Université de Paris, 75018, Paris, France.,Cardiology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, 75014, Paris, France.,Department of Hepato Gastro Enterology and University of Paris, Louis Mourier Hospital, APHP, 92700, Colombes, France.,Inserm, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Hôpital Saint Antoine, Service de Gastroentérologie, Sorbonne Université, 75012, Paris, France
| | - Denis Duboc
- Cardiology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, 75014, Paris, France
| | - Dominique Rainteau
- Inserm, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Hôpital Saint Antoine, Service de Gastroentérologie, Sorbonne Université, 75012, Paris, France
| | - Harry Sokol
- Inserm, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Hôpital Saint Antoine, Service de Gastroentérologie, Sorbonne Université, 75012, Paris, France
| | - Lydie Humbert
- Inserm, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Hôpital Saint Antoine, Service de Gastroentérologie, Sorbonne Université, 75012, Paris, France
| | - Philippe Seksik
- Inserm, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Hôpital Saint Antoine, Service de Gastroentérologie, Sorbonne Université, 75012, Paris, France
| | - Adèle Bellino
- Unite de Recherche Clinique-Centre Dinvestigation Clinique Necker/Cochin, Hôpital Tarnier, Université de Paris, 75006, Paris, France
| | - Hendy Abdoul
- Unite de Recherche Clinique-Centre Dinvestigation Clinique Necker/Cochin, Hôpital Tarnier, Université de Paris, 75006, Paris, France
| | - Naïm Bouazza
- Unite de Recherche Clinique-Centre Dinvestigation Clinique Necker/Cochin, Hôpital Tarnier, Université de Paris, 75006, Paris, France
| | - Jean-Marc Treluyer
- Unite de Recherche Clinique-Centre Dinvestigation Clinique Necker/Cochin, Hôpital Tarnier, Université de Paris, 75006, Paris, France
| | - Malika Saadi
- Cardiology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, 75014, Paris, France
| | - Karim Wahbi
- Cardiology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, 75014, Paris, France
| | - Heithem Soliman
- Department of Hepato Gastro Enterology and University of Paris, Louis Mourier Hospital, APHP, 92700, Colombes, France
| | - Benoit Coffin
- Centre de Recherche Sur I'inflammation, Inserm, UMR 1149, Université de Paris, 75018, Paris, France.,Department of Hepato Gastro Enterology and University of Paris, Louis Mourier Hospital, APHP, 92700, Colombes, France
| | - André Bado
- Centre de Recherche Sur I'inflammation, Inserm, UMR 1149, Université de Paris, 75018, Paris, France
| | - Maude Le Gall
- Centre de Recherche Sur I'inflammation, Inserm, UMR 1149, Université de Paris, 75018, Paris, France
| | - Olivier Varenne
- Cardiology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, 75014, Paris, France
| | - Henri Duboc
- Centre de Recherche Sur I'inflammation, Inserm, UMR 1149, Université de Paris, 75018, Paris, France. .,Cardiology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, 75014, Paris, France. .,Department of Hepato Gastro Enterology and University of Paris, Louis Mourier Hospital, APHP, 92700, Colombes, France. .,INSERM UMRS 1149, Université de Paris, 16 rue Henri Huchard, 75890, Paris Cedex 18, France.
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26
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Piccolo R, Bonaa KH, Efthimiou O, Varenne O, Urban P, Kaiser C, Räber L, de Belder A, Remkes W, Van't Hof AWJ, Stankovic G, Lemos PA, Wilsgaard T, Reifart J, Rodriguez AE, Ribeiro EE, Serruys PWJC, Abizaid A, Sabaté M, Byrne RA, de la Torre Hernandez JM, Wijns W, Esposito G, Jüni P, Windecker S, Valgimigli M. Drug-Eluting or Bare-Metal Stents for Left Anterior Descending or Left Main Coronary Artery Revascularization. J Am Heart Assoc 2021; 10:e018828. [PMID: 34622669 PMCID: PMC8751874 DOI: 10.1161/jaha.120.018828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background New-generation drug-eluting stents (DES) reduce target-vessel revascularization compared with bare-metal stents (BMS), and recent data suggest that DES have the potential to decrease the risk of myocardial infarction and cardiovascular mortality. We evaluated the treatment effect of DES versus BMS according to the target artery (left anterior descending [LAD] and/or left main [LM] versus other territories [no-LAD/LM]). Methods and Results The Coronary Stent Trialist (CST) Collaboration gathered individual patient data of randomized trials of DES versus BMS for the treatment of coronary artery disease. The primary outcome was the composite of cardiac death or myocardial infarction. Hazard ratios (HRs) with 95% CIs were derived from a 1-stage individual patient data meta-analysis. We included 26 024 patients across 19 trials: 13 650 (52.4%) in the LAD/LM and 12 373 (47.6%) in the no-LAD/LM group. At 6-year follow-up, there was strong evidence that the treatment effect of DES versus BMS depended on the target vessel (P-interaction=0.024). Compared with BMS, DES reduced the risk of cardiac death or myocardial infarction to a greater extent in the LAD/LM (HR, 0.76; 95% CI, 0.68-0.85) than in the no-LAD/LM territories (HR, 0.93; 95% CI, 0.83-1.05). This benefit was driven by a lower risk of cardiac death (HR, 0.83; 95% CI, 0.70-0.98) and myocardial infarction (HR, 0.74; 95% CI, 0.65-0.85) in patients with LAD/LM disease randomized to DES. An interaction (P=0.004) was also found for all-cause mortality with patients with LAD/LM disease deriving benefit from DES (HR, 0.86; 95% CI, 0.76-0.97). Conclusions As compared with BMS, new-generation DES were associated with sustained reduction in the composite of cardiac death or myocardial infarction if used for the treatment of LAD or left main coronary stenoses. Registration URL: https://www.crd.york.ac.uk/PROSPERO; Unique identifier: CRD42017060520.
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Affiliation(s)
- Raffaele Piccolo
- Department of Advanced Biomedical Sciences University of Naples Federico II Naples Italy
| | - Kaare H Bonaa
- Department of Community Medicine University of Tromsø-The Arctic University of Norway Tromsø Norway
| | - Orestis Efthimiou
- Institute of Social and Preventive Medicine University of Bern Switzerland
| | - Olivier Varenne
- Department of Cardiology Hôpital CochinAP-HP Paris France.,Faculté de Médecine Université de Paris France
| | | | - Christoph Kaiser
- Department of Cardiology University Hospital BaselUniversity of Basel Switzerland
| | - Lorenz Räber
- Department of Cardiology Bern University HospitalUniversity of Bern Switzerland
| | - Adam de Belder
- Department of Cardiology Sussex Cardiac Centre Brighton and Sussex University Hospitals Brighton United Kingdom
| | - Wouter Remkes
- Department of Cardiology Isala Heart Centre Zwolle the Netherlands
| | - Arnoud W J Van't Hof
- Department of Cardiology Maastricht University Medical Center Maastricht the Netherlands.,Department of Cardiology Zuyderland Medical Center Heerlen the Netherlands
| | - Goran Stankovic
- Department of Cardiology Clinical Center of Serbia University of Belgrade Serbia
| | - Pedro A Lemos
- Heart Institute (InCor) University of São Paulo Medical School São Paulo Brazil.,Hospital Israelita Albert Einstein Sao Paulo-SP Brazil
| | - Tom Wilsgaard
- Department of Community Medicine University of Tromsø-The Arctic University of Norway Tromsø Norway
| | - Jörg Reifart
- Department of Cardiology Kerckhoff Klinik Bad Nauheim Germany
| | - Alfredo E Rodriguez
- Cardiac Unit Cardiology Fellow Training Program Otamendi HospitalBuenos Aires School of Medicine Buenos Aires Argentina
| | | | - Patrick W J C Serruys
- International Centre for Circulatory Health National Heart and Lung InstituteImperial College, London London United Kingdom
| | - Alex Abizaid
- Department of Invasive Cardiology Institute Dante Pazzanese of Cardiology São Paulo Brazil
| | - Manel Sabaté
- Cardiology Department Cardiovascular Institute (ICCV) and Hospital ClínicIDIBAPSUniversity of Barcelona Spain
| | - Robert A Byrne
- Dublin Cardiovascular Research Institute Mater Private Hospital Dublin Ireland.,School of Pharmacy and Biomolecular Sciences Royal College of Surgeons in Ireland Dublin Ireland
| | | | - William Wijns
- The Lambe Institute for Translational Medicine and Curam Galway Ireland.,Department of Cardiology National University of Ireland Galway Galway Ireland
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences University of Naples Federico II Naples Italy
| | - Peter Jüni
- Department of Medicine Applied Health Research Centre of the Li Ka Shing Knowledge Institute St Michael's HospitalUniversity of Toronto Ontario Canada
| | - Stephan Windecker
- Department of Cardiology Bern University HospitalUniversity of Bern Switzerland
| | - Marco Valgimigli
- Department of Cardiology Bern University HospitalUniversity of Bern Switzerland.,CardioCentro Ticino Lugano Switzerland
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Gall E, Lafont A, Varenne O, Dumas F, Cariou A, Picard F. Balancing thrombosis and bleeding after out-of-hospital cardiac arrest related to acute coronary syndrome: A literature review. Arch Cardiovasc Dis 2021; 114:667-679. [PMID: 34565694 DOI: 10.1016/j.acvd.2021.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 05/26/2021] [Revised: 07/29/2021] [Accepted: 07/31/2021] [Indexed: 12/29/2022]
Abstract
Balance between thrombosis and bleeding is now well recognized in patients treated for acute coronary syndrome, with impact on short- and long-term prognosis, including survival. Recent data suggest that patients who are resuscitated after out-of-hospital cardiac arrest related to myocardial infarction are at an even higher risk of bleeding and thrombosis than those with uncomplicated acute coronary syndrome. Delayed enteral absorption of medication due to induced hypothermia and systemic inflammation increases thrombosis risk, whereas transfemoral access site, cardiopulmonary resuscitation manoeuvres and mechanical circulatory support devices increase bleeding risk. In addition, post-resuscitation syndrome and renal or hepatic impairment are potential risk factors for both bleeding and thrombotic complications. There are currently no randomized controlled trials comparing various P2Y12 inhibitor and/or anticoagulation strategies in the setting of out-of-hospital cardiac arrest, and current practice is largely derived from management of patients with uncomplicated acute coronary syndrome. The aim of this review is therefore to describe the bleeding and thrombosis risk factors in this specific population, and to review recent data on antithrombotic drugs in this patient subset.
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Affiliation(s)
- Emmanuel Gall
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, AP-HP, 75014 Paris, France
| | - Alexandre Lafont
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, AP-HP, 75014 Paris, France; Université de Paris, 75006 Paris, France
| | - Olivier Varenne
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, AP-HP, 75014 Paris, France; Université de Paris, 75006 Paris, France
| | - Florence Dumas
- Université de Paris, 75006 Paris, France; INSERM U970, Paris Cardiovascular Research Centre (PARCC), Georges-Pompidou European Hospital, 75015 Paris, France; Emergency Department, Cochin Hospital, Hôpitaux Universitaire Paris Centre, AP-HP, 75014 Paris, France
| | - Alain Cariou
- Université de Paris, 75006 Paris, France; INSERM U970, Paris Cardiovascular Research Centre (PARCC), Georges-Pompidou European Hospital, 75015 Paris, France; Medical Intensive Care Unit, Cochin Hospital, Hôpitaux Universitaire Paris Centre, AP-HP, 75014 Paris, France
| | - Fabien Picard
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, AP-HP, 75014 Paris, France; Université de Paris, 75006 Paris, France; INSERM U970, Paris Cardiovascular Research Centre (PARCC), Georges-Pompidou European Hospital, 75015 Paris, France.
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28
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Mehran R, Cao D, Angiolillo DJ, Bangalore S, Bhatt DL, Ge J, Hermiller J, Makkar RR, Neumann FJ, Saito S, Picon H, Toelg R, Maksoud A, Chehab BM, De la Torre Hernandez JM, Kunadian V, Sardella G, Thiele H, Varenne O, Vranckx P, Windecker S, Zhou Y, Krucoff MW, Ruster K, Wang J, Valgimigli M. 3- or 1-Month DAPT in Patients at High Bleeding Risk Undergoing Everolimus-Eluting Stent Implantation. JACC Cardiovasc Interv 2021; 14:1870-1883. [PMID: 34503737 DOI: 10.1016/j.jcin.2021.07.016] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/10/2021] [Accepted: 07/08/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate 2 abbreviated dual-antiplatelet therapy (DAPT) regimens in patients at high bleeding risk (HBR) undergoing percutaneous coronary intervention (PCI). BACKGROUND Current-generation drug-eluting stents are preferred over bare-metal stents for HBR patients, but their optimal DAPT management remains unknown. METHODS The XIENCE Short DAPT program included 3 prospective, multicenter, single-arm studies enrolling HBR patients who underwent successful PCI with a cobalt-chromium everolimus-eluting stent. After 1 month (XIENCE 28 USA and XIENCE 28 Global) or 3 months (XIENCE 90) of DAPT, event-free patients discontinued the P2Y12 inhibitor. The postmarketing approval XIENCE V USA study was used as historical control in a propensity score-stratified analysis. RESULTS A total of 3,652 patients were enrolled. The propensity-adjusted rate of the primary endpoint of all-cause mortality or myocardial infarction was 5.4% among 1,693 patients on 3-month DAPT versus 5.4% in the 12-month DAPT historical control (Pnoninferiority = 0.0063) and 3.5% among 1,392 patients on 1-month DAPT versus 4.3% in the 6-month DAPT historical control (Pnoninferiority = 0.0005). Bleeding Academic Research Consortium (BARC) types 2 to 5 bleeding was not significantly lower with 3- or 1-month DAPT, while BARC types 3 to 5 bleeding was reduced in both experimental groups. The rate of definite or probable stent thrombosis was 0.2% in XIENCE 90 (P < 0.0001 for the performance goal of 1.2%) and 0.3% in XIENCE 28. CONCLUSIONS Among HBR patients undergoing PCI with cobalt-chromium everolimus-eluting stents, DAPT for 1 or 3 months was noninferior to 6 or 12 months of DAPT for ischemic outcomes and may be associated with less major bleeding and a low incidence of stent thrombosis.
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Affiliation(s)
- Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Davide Cao
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Sripal Bangalore
- New York University Langone Medical Center, New York, New York, USA
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Junbo Ge
- Zhongshan Hospital Fudan University, Shanghai, China
| | - James Hermiller
- St. Vincent's Medical Center of Indiana, Indianapolis, Indiana, USA
| | - Raj R Makkar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | | | - Hector Picon
- Redmond Regional Medical Center, Rome, Georgia, USA
| | - Ralph Toelg
- Segeberger Kliniken, Herzzentrum, Bad Segeberg, Germany
| | - Aziz Maksoud
- Kansas Heart Hospital and University of Kansas School of Medicine, Wichita, Kansas, USA
| | | | | | - Vijay Kunadian
- Translational and Clinical Research Institute, Newcastle University and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | | | - Holger Thiele
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | | | - Pascal Vranckx
- Heart Centre Hasselt and University of Hasselt, Hasselt, Belgium
| | | | | | - Mitchell W Krucoff
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | - Jin Wang
- Abbott, Santa Clara, California, USA
| | - Marco Valgimigli
- Cardiocentro Ticino, Lugano and Bern University Hospital, Bern, Switzerland
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29
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Pham V, Laghlam D, Varenne O, Dumas F, Cariou A, Picard F. Performance of OHCA, NULL-PLEASE and CAHP scores to predict survival in Out-of-Hospital Cardiac Arrest due to acute coronary syndrome. Resuscitation 2021; 166:31-37. [PMID: 34302930 DOI: 10.1016/j.resuscitation.2021.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/26/2021] [Accepted: 07/09/2021] [Indexed: 10/20/2022]
Abstract
AIM Out-of-hospital Cardiac Arrest (OHCA) carries a poor prognostic with high mortality rates and multiple scoring systems have been developed to assess its prognostic. This study sought to evaluate the performance of three prognostic scores to predict survival in OHCA patients due to acute coronary syndrome (ACS). METHODS AND RESULTS This is an observational, monocentric study including 386 consecutive patients treated for OHCA due to ACS, treated by percutaneous coronary intervention, between 2007 and 2019. The OHCA, NULL-PLEASE and CAHP scores were calculated respectively for 370 patients (95.9%), 371 patients (96.1%) and 350 patients (90.7%). A C-statistic analysis was performed to determine score performance. The areas under the curve for the OHCA, NULL-PLEASE and CAHP scores were 0.861 (95% CI, 0.823-0.898), 0.789 (95% CI, 0.744-0.834) and 0.830 (95% CI, 0.788-0.872) respectively demonstrating good performance. The OHCA score performed better than the NULL-PLEASE score (p = 0.001), and there was no difference between the CAHP and the NULL-PLEASE score (p = 0.062) nor between the OHCA and the CAHP score (p = 0.105). CONCLUSION The OHCA score, the NULL-PLEASE score and the CAHP score performed well in predicting in-hospital death in patients presenting OHCA secondary to ACS. The NULL-PLEASE score is the easiest to use but performed less accurately than the OHCA score.
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Affiliation(s)
- Vincent Pham
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Driss Laghlam
- Medical Intensive Care Unit, Cochin Hospital, Hôpitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Olivier Varenne
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France; INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France
| | - Florence Dumas
- Université de Paris, Paris, France; INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Emergency Department, Cochin Hospital, Hôpitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin Hospital, Hôpitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France; INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France
| | - Fabien Picard
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France; INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France.
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30
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Dumas F, Paoli A, Paul M, Savary G, Jaubert P, Chocron R, Varenne O, Mira JP, Charpentier J, Bougouin W, Cariou A. Association between previous health condition and outcome after cardiac arrest. Resuscitation 2021; 167:267-273. [PMID: 34245838 DOI: 10.1016/j.resuscitation.2021.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 03/02/2021] [Revised: 06/14/2021] [Accepted: 06/24/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Overall survival of patients with out-of-hospital cardiac arrest (OHCA) remains low, even in those with return of spontaneous circulation (ROSC). In addition to usual prognostic characteristics, patients' medical history may also influence their outcome. This study aimed to investigate the role of pre-arrest comorbidities on hospital survival, neurological outcome and mode of death in OHCA patients with successful ROSC. METHODS From Jan 2012 to Sep 2017, all consecutive non-traumatic OHCA adults, admitted with a stable ROSC were included. Utstein characteristics, circumstances of arrest and interventions were prospectively recorded. Prior comorbidities were measured using the Charlson Comorbidity Index (CCI), and the population was divided into 3 groups (CCI 0, CCI 1-3 and CCI ≥ 4). The association of CCI with early and long-term mortality was assessed using logistic regression and association with withdrawal-of-life sustaining treatments (WLST) or another cause of death using multinomial regression. RESULTS During the study period, 777 patients were analyzed and 483 (62%) died before hospital discharge, with death rate of 49%, 60% and 70% in CCI 0, CCI 1-3 and CCI ≥ 4 respectively. After adjustment, an increase CCI was significantly associated with in-hospital mortality (OR = 2.47 [1.35-4.52], p = 0.001 for CCI 1-3; OR = 2.82 [1.49-5.33], p = 0.003 for CCI ≥ 4; ref = CCI 0). Other independent predictors were non-shockable rhythm (OR = 3.23 [2.08-5]), lack of bystander CPR (OR = 1.96 [1.22-3.13]), epinephrine dose ≥ 2 mg (OR = 5.56 [3.70-8.33]), CA to CPR ≥ 5 min (OR = 1.96 [1.28-3.03]) and CPR to ROSC ≥ 20 min (OR = 2.13 [1.39-3.23]). Using multinomial regression, an increase in CCI was associated with all modes of in-hospital death, particularly with WLST-related death (RRadj = 2.48 [1.26-4.90], p = 0.01 for CCI = 1-3 and 3.75 [1.85-8.7.58], p < 0.001 for CCI ≥ 4, reference CCI = 0). CONCLUSION Alteration of chronic health status, as assessed by an elevated CCI, was associated with a higher mortality and a worse neurological outcome in OHCA patients. Presence and burden of comorbidities should be considered in the evaluation of the prognosis in patients admitted in hospital after cardiac arrest.
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Affiliation(s)
- Florence Dumas
- Emergency Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, France; University of Paris, Paris, France; Inserm U970, Team 4, PARCC, Paris Sudden Death Expertise Center, France.
| | - Audrey Paoli
- Medical Intensive Care Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marine Paul
- Medical Intensive Care Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Guillaume Savary
- Medical Intensive Care Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Paul Jaubert
- Medical Intensive Care Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Richard Chocron
- Inserm U970, Team 4, PARCC, Paris Sudden Death Expertise Center, France; Emergency Department, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, France
| | - Olivier Varenne
- University of Paris, Paris, France; Cardiology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-Paul Mira
- University of Paris, Paris, France; Medical Intensive Care Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Julien Charpentier
- Medical Intensive Care Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Wulfran Bougouin
- Inserm U970, Team 4, PARCC, Paris Sudden Death Expertise Center, France; Medical-Surgical Intensive Care Unit, Ramsay Générale de Santé, Hôpital Privé Jacques Cartier, Massy, France
| | - Alain Cariou
- University of Paris, Paris, France; Inserm U970, Team 4, PARCC, Paris Sudden Death Expertise Center, France; Medical Intensive Care Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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31
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Adjedj J, Picard F, Mogi S, Bize A, Sambin L, Muller O, Varenne O, De Bruyne B, Ghaleh B. Accurate assessment of coronary blood flow by continuous thermodilution technique: Validation in a swine model. Catheter Cardiovasc Interv 2021; 99:836-843. [PMID: 34080778 DOI: 10.1002/ccd.29802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 02/01/2021] [Revised: 04/26/2021] [Accepted: 05/20/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess the accuracy of coronary thermodilution measurements made with the RayFlow® infusion catheter. BACKGROUND Measurements of absolute coronary blood flow (ABF) and absolute microvascular resistance (Rμ ) by continuous coronary thermodilution can be obtained in humans but their accuracy using a novel dedicated infusion catheter has not yet been validated. We compared ABF values obtained at different infusion rates to coronary blood flow (CBF) values obtained using flow probes, in swine. METHODS Twelve domestic swine were instrumented with coronary flow probes placed around the left anterior descending and circumflex coronary arteries. ABF was assessed with the RayFlow® infusion catheter during continuous saline infusion at fixed rates of 5 (n = 14), 10 (n = 15), 15 (n = 19), and 20 (n = 12) ml/min. RESULTS In the 60 measurements, ABF measured using thermodilution averaged 41 ± 17 ml/min (range from 17 to 90) and CBF values obtained with the coronary flow probes averaged 37 ± 18 ml/min (range from 8 to 87). The corresponding Rμ values were 1532 ± 791 (range from 323 to 5103) and 1903 ± 1162 (range from 287 to 6000) Woods units using thermodilution and coronary flow probe assessments, respectively. ABF and Rμ values measured using thermodilution were significantly correlated with the corresponding measurements obtained using coronary flow probes (R = 0.84 [0.73-0.95] and R = 0.80 [0.69-0.88], respectively). CONCLUSIONS ABF and Rμ assessed by continuous saline infusion through a RayFlow® catheter closely correlate with measurements obtained with the gold standard coronary flow probes in a swine model.
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Affiliation(s)
- Julien Adjedj
- Arnault Tzanck Institute, Department of Cardiology, Saint Laurent du Var, France.,Paris Descartes University, Faculty of Medicine, Paris, France.,Cardiology Department, Université Paris Est Créteil, INSERM, IMRB, Créteil, France.,Cardiology Department, École Nationale Vétérinaire d'Alfort, IMRB, Maisons-Alfort, France.,Lausanne University Hospital, Department of Cardiology, Lausanne, Switzerland
| | - Fabien Picard
- Arnault Tzanck Institute, Department of Cardiology, Saint Laurent du Var, France.,Paris Descartes University, Faculty of Medicine, Paris, France
| | - Satoshi Mogi
- Arnault Tzanck Institute, Department of Cardiology, Saint Laurent du Var, France.,Paris Descartes University, Faculty of Medicine, Paris, France
| | - Alain Bize
- Cardiology Department, Université Paris Est Créteil, INSERM, IMRB, Créteil, France.,Cardiology Department, École Nationale Vétérinaire d'Alfort, IMRB, Maisons-Alfort, France
| | - Lucien Sambin
- Cardiology Department, Université Paris Est Créteil, INSERM, IMRB, Créteil, France.,Cardiology Department, École Nationale Vétérinaire d'Alfort, IMRB, Maisons-Alfort, France
| | - Olivier Muller
- Lausanne University Hospital, Department of Cardiology, Lausanne, Switzerland
| | - Olivier Varenne
- Arnault Tzanck Institute, Department of Cardiology, Saint Laurent du Var, France.,Paris Descartes University, Faculty of Medicine, Paris, France
| | - Bernard De Bruyne
- Lausanne University Hospital, Department of Cardiology, Lausanne, Switzerland.,Cardiology Department, Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Bijan Ghaleh
- Cardiology Department, Université Paris Est Créteil, INSERM, IMRB, Créteil, France.,Cardiology Department, École Nationale Vétérinaire d'Alfort, IMRB, Maisons-Alfort, France
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32
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Urban P, Gregson J, Owen R, Mehran R, Windecker S, Valgimigli M, Varenne O, Krucoff M, Saito S, Baber U, Chevalier B, Capodanno D, Morice MC, Pocock S. Assessing the Risks of Bleeding vs Thrombotic Events in Patients at High Bleeding Risk After Coronary Stent Implantation: The ARC-High Bleeding Risk Trade-off Model. JAMA Cardiol 2021; 6:410-419. [PMID: 33404627 PMCID: PMC7788509 DOI: 10.1001/jamacardio.2020.6814] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [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: 12/31/2022]
Abstract
Importance Patients who are candidates for percutaneous coronary intervention (PCI) and are at high bleeding risk constitute a therapeutic challenge because they often also face an increased risk of thrombotic complications. Objectives To develop and validate models to predict the risks of major bleeding (Bleeding Academic Research Consortium [BARC] types 3 to 5 bleeding) and myocardial infarction (MI) and/or stent thrombosis (ST) for individual patients at high bleeding risk and provide assistance in defining procedural strategy and antithrombotic regimens. Design, Setting, and Participants This prognostic study used individual patient data from 6 studies conducted from July 1, 2009, to September 5, 2017, for 6641 patients at more than 200 centers in Europe, the US, and Asia who underwent PCI and were identified as being at high bleeding risk using the Academic Research Consortium criteria. In 1 year of follow-up (excluding periprocedural events), individual patient risks of MI and/or ST and major bleeding were evaluated using 33 baseline variables. To validate these models, a subgroup of 1458 patients at high bleeding risk from the ONYX ONE trial were analyzed. Statistical analysis was performed from February 1, 2019, to April 30, 2020. Exposures All patients underwent PCI with bare metal, drug-coated, or drug-eluting stent implants. Main Outcomes and Measures Forward, stepwise multivariable proportional hazards models were used to identify highly significant predictors of MI and/or ST and BARC types 3 to 5 bleeding. Results A total of 6641 patients (4384 men [66.0%]; median age, 77.9 years [interquartile range, 70.0-82.6 years]) were included in this study. Over 365 days, nonperiprocedural MI and/or ST occurred in 350 patients (5.3%), and BARC types 3 to 5 bleeding occurred in 381 patients (5.7%). Eight independent baseline predictors of risk of MI and/or ST and 8 predictors for risk of BARC types 3 to 5 bleeding were identified. Four of these predictors were in both risk models. Both risk models showed moderate discrimination: C statistic = 0.69 for predicting MI and/or ST and 0.68 for predicting BARC types 3 to 5 bleeding. Applying these same models to the validation cohort gave a similar strength of discrimination (C statistic = 0.74 for both MI and/or ST and BARC types 3-5 bleeding). Patients with MI and/or ST had a mortality hazard ratio of 6.1 (95% CI, 4.8-7.7), and those with BARC types 3 to 5 bleeding had a mortality hazard ratio of 3.7 (95% CI, 2.9-4.8) compared with patients free of both events. Taking these data into account, the risk scores facilitate investigation of the individual patient trade-off between these 2 risks: 2931 patients (44.1%) at high bleeding risk in the 6 studies had a greater risk of MI and/or ST than of BARC 3 to 5 bleeding, 1555 patients (23.4%) had a greater risk of BARC 3 to 5 bleeding than of MI and/or ST, and 2155 (32.4%) had a comparable risk of both events. Conclusions and Relevance In a large cohort of patients at high bleeding risk undergoing PCI, 2 prognostic models have been developed to identify individual patients' risk of major coronary thrombotic and bleeding events. In future clinical practice, using an application on a smartphone to evaluate the trade-off between these 2 quantifiable risks for each patient may help clinicians choose the most appropriate revascularization strategy and tailor the duration and intensity of antithrombotic regimens.
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Affiliation(s)
| | - John Gregson
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ruth Owen
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Roxana Mehran
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marco Valgimigli
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Olivier Varenne
- Service de Cardiologie, DMU CARTE, Hôpital Cochin, Assistance Publique–Hôpitaux de Paris, Paris, France
- Cardiology Department, Université Paris Descartes, Sorbonne Paris-Cité, Paris, France
| | - Mitchell Krucoff
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | | | - Usman Baber
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Bernard Chevalier
- Hôpital Privé Jacques Cartier, Institut Cardiovasculaire Paris-Sud Ramsay-Générale de Santé, Massy, France
| | - Davide Capodanno
- Cardio-Thoracic-Vascular Department, Centro Alte Specialità e Trapianti, Catania, Italy
- Azienda Ospedaliero Universitario “Vittorio Emanuele-Policlinico,” University of Catania, Catania, Italy
| | | | - Stuart Pocock
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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33
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Lafont A, Sinnaeve PR, Cuisset T, Cook S, Sideris G, Kedev S, Carrie D, Hovasse T, Garot P, El Mahmoud R, Spaulding C, Helft G, Diaz Fernandez JF, Brugaletta S, Pinar-Bermudez E, Ferre JM, Commeau P, Teiger E, Bogaerts K, Sabate M, Morice MC, Varenne O. Two-year outcomes after percutaneous coronary intervention with drug-eluting stents or bare-metal stents in elderly patients with coronary artery disease. Catheter Cardiovasc Interv 2021; 97:E607-E613. [PMID: 32761890 DOI: 10.1002/ccd.29159] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/09/2020] [Accepted: 07/09/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Report the results at 2 years of the patients included in the SENIOR trial. BACKGROUND Patients above 75 years of age represent a fast-growing population in the cathlab. In the SENIOR trial, patients treated by percutaneous coronary intervention (PCI) with drug eluting stent (DES) and a short duration of P2Y12 inhibitor (1 and 6 months for stable and unstable coronary syndromes, respectively) compared with bare metal stents (BMS) was associated with a 29% reduction in the rate of all-cause mortality, myocardial infarction (MI), stroke, and ischaemia-driven target lesion revascularization (ID-TLR) at 1 year. The results at 2 years are reported here. METHODS AND RESULTS We randomly assigned 1,200 patients (596[50%] to the DES group and 604[50%] to the BMS group). At 2 years, the composite endpoint of all-cause mortality, MI, stroke and ID-TLR had occurred in 116 (20%) patients in the DES group and 131 (22%) patients in the BMS group (RR 0.90 [95%CI 0.72-1.13], p = .37). IDTLR occurred in 14 (2%) patients in the DES group and 41 (7%) patients in the BMS group (RR 0.35 [95%CI 0.16-0.60], p = .0002). Major bleedings (BARC 3-5) occurred in 27(5%) patients in both groups (RR 1.00, [95%CI 0.58-1.75], p = .99). Stent thrombosis rates were low and similar between DES and BMS (0.8 vs 1.3%, (RR 0.52 [95%CI 0.01-1.95], p = .27). CONCLUSION Among elderly PCI patients, a strategy combining a DES together with a short duration of DAPT is associated with a reduction in revascularization up to 2 years compared with BMS with very few late events and without any increased in bleeding complications or stent thrombosis.
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Affiliation(s)
- Alexandre Lafont
- Cardiology Department Hôpital Cochin, Assistance Publique-Hôpitaux de Paris and, Université de Paris, Paris, France
| | - Peter R Sinnaeve
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Thomas Cuisset
- Cardiology Department, Centre Hospitalier Universitaire Timone, Marseille, France
| | - Stéphane Cook
- Cardiology Department, University and Hospital Fribourg, Fribourg, Switzerland
| | - Giorgios Sideris
- Cardiology Department Service de Cardiologie-Institut national de la santé et de la recherche médicale U942, Hôpital Lariboisiere, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, Paris, France
| | - Sasko Kedev
- Cardiology Department, University St Cyril and Methodius, Skopje, Macedonia
| | - Didier Carrie
- Service de Cardiologie, Centre hospitalier universitaire Toulouse Rangueil, Université Paul Sabatier, Toulouse, France
| | - Thomas Hovasse
- Institut Cardiovasculaire Paris-Sud, Ramsay Générale de Santé, Massy, France
| | - Philippe Garot
- Institut Cardiovasculaire Paris-Sud, Ramsay Générale de Santé, Massy, France
| | - Rami El Mahmoud
- Hôpital Ambroise Paré Assistance Publique-Hôpitaux de Paris, Université Versailles-Saint Quentin en Yvelines, Versailles, France
| | - Christian Spaulding
- Service de Cardiologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université de Paris and Sudden Death Expert Center, Institut national de la santé et de la recherche médicale U990, Paris, France
| | - Gérard Helft
- Institut de Cardiologie, Hôpital Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie et Institut hospitalo-universitaire, Institute of Cardiometabolism and Nutrition, Hôpital Pitié-Salpétrière, Paris, France
| | | | - Salvatore Brugaletta
- Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | | | - Josepa Mauri Ferre
- Cardiology department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Philippe Commeau
- Département de Cardiologie Interventionnelle, Polyclinique Les Fleurs, France
| | - Emmanuel Teiger
- Service de Cardiologie, Hôpital Henri Mondor Assistance Publique-Hôpitaux de Paris, Université Paris Est Créteil, Créteil, France
| | - Kris Bogaerts
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BioStat), Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium, and Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BioStat), University Hasselt, Hasselt, Belgium
| | - Manel Sabate
- Interventional Cardiology Unit, Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | | | - Olivier Varenne
- Cardiology Department Hôpital Cochin, Assistance Publique-Hôpitaux de Paris and, Université de Paris, Paris, France
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Weizman O, Sharifzadehgan A, Bougouin W, Narayanan K, Tence N, Dumas F, Waldmann V, Lamhaut L, Jost D, Wahbi K, Varenne O, Garcia R, Karam N, Cariou A, Jouven X, Marijon E. Sudden Cardiac Arrest in Young Women. Circulation 2021; 143:758-760. [PMID: 33587656 DOI: 10.1161/circulationaha.120.052219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Orianne Weizman
- University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.)
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- Nancy University Hospital, Cardiology Department, France (O.W.)
| | - Ardalan Sharifzadehgan
- University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.)
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- European Georges Pompidou Hospital, Cardiology Department, Paris, France (A.S., N.T., N.K., V.W., X.J., E.M.)
| | - Wulfran Bougouin
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- Jacques Cartier Hospital, Intensive Care Unit, Massy, France (W.B.)
| | - Kumar Narayanan
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- Medicover Hospitals, Cardiology Department, Hyderabad, India (K.N.)
| | - Noémie Tence
- University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.)
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- European Georges Pompidou Hospital, Cardiology Department, Paris, France (A.S., N.T., N.K., V.W., X.J., E.M.)
| | - Florence Dumas
- University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.)
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- Cochin Hospital, Emergency Department, Paris, France (F.D.)
| | - Victor Waldmann
- University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.)
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- European Georges Pompidou Hospital, Cardiology Department, Paris, France (A.S., N.T., N.K., V.W., X.J., E.M.)
| | - Lionel Lamhaut
- University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.)
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- Emergency Medical Services 75, Necker University Hospital, APHP, Paris, France (L.L.)
| | - Daniel Jost
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- Paris Firefighters Brigade, France (D.J.)
| | - Karim Wahbi
- University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.)
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- Cochin Hospital, Cardiology Intensive Care Unit (K.W., O.V.), Paris, France
| | - Olivier Varenne
- University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.)
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- Cochin Hospital, Cardiology Intensive Care Unit (K.W., O.V.), Paris, France
| | - Rodrigue Garcia
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- Cardiovascular Center, University Hospital La Milétrie, Poitiers, France (R.G.)
- University of Poitiers, France (R.G.)
| | - Nicole Karam
- University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.)
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- European Georges Pompidou Hospital, Cardiology Department, Paris, France (A.S., N.T., N.K., V.W., X.J., E.M.)
| | - Alain Cariou
- University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.)
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- Intensive Care Unit (A.C.), Paris, France
| | - Xavier Jouven
- University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.)
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- European Georges Pompidou Hospital, Cardiology Department, Paris, France (A.S., N.T., N.K., V.W., X.J., E.M.)
| | - Eloi Marijon
- University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.)
- Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.)
- European Georges Pompidou Hospital, Cardiology Department, Paris, France (A.S., N.T., N.K., V.W., X.J., E.M.)
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35
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Picard F, Sokoloff A, Pham V, Diefenbronn M, Laghlam D, Seret G, Varenne O, Dumas F, Cariou A. Safety and benefit of Glycoprotein IIb/IIIa inhibitors in out of hospital cardiac arrest patients treated with percutaneous coronary intervention. Resuscitation 2020; 157:91-98. [PMID: 33129912 DOI: 10.1016/j.resuscitation.2020.10.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/02/2020] [Revised: 10/12/2020] [Accepted: 10/19/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Out of hospital cardiac arrest (OHCA) patients requiring percutaneous coronary intervention (PCI) are at higher risk of both stent thrombosis and bleeding. The use of aggressive antiplatelet therapy could lead to a higher risk of bleeding in these patients. Indeed, data on glycoprotein IIb/IIIa inhibitor (GPi) use in this specific indication is scarce. AIM We sought to evaluate the benefit and safety of GPi use in OHCA patients requiring PCI. METHODS AND RESULTS Between January 2007 and December 2017, we retrospectively included all consecutive patients treated with PCI for an OHCA from cardiac cause. Clinical, procedural data and in-hospital outcomes were collected. Three hundred and eighty-five patients were included. GPi were administrated in 41.3% of cases (159 patients). Patients who received GPi were younger, had less prior PCI, more often a TIMI 0 or 1 flow before PCI and thromboaspiration use. There were no differences regarding in-hospital definite stent thrombosis among the two groups (11.9% in the GPi group vs 7.1% in the non-GPi group, p = 0.10) or in-hospital mortality (48.6% vs 49.3%, p = 0.68). The incidence of any bleeding (33.3% vs. 19.6%; p = 0.002), and major bleeding (BARC 3-5) (21.9% vs. 16.8%; p = 0.007) was significantly higher in patients receiving GPi. Indeed, using multivariate analysis, GPi use was predictor of major bleeding (OR: 1.81; 95% CI: 1.06-3.08; p = 0.03). CONCLUSIONS In patients treated with PCI for OHCA from cardiac cause, GPi use was associated with an increased risk of major bleeding events, without difference on in-hospital stent thrombosis or death.
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Affiliation(s)
- Fabien Picard
- Department of Cardiology, Cochin Hospital, Hôitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, Paris, France; Université de Paris, Faculté de Médecine, Paris, France; INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France.
| | - Anastasia Sokoloff
- Department of Cardiology, Cochin Hospital, Hôitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Vincent Pham
- Department of Cardiology, Cochin Hospital, Hôitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Marine Diefenbronn
- Department of Cardiology, Cochin Hospital, Hôitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Driss Laghlam
- Department of Cardiology, Cochin Hospital, Hôitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Gabriel Seret
- Department of Cardiology, Cochin Hospital, Hôitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Olivier Varenne
- Department of Cardiology, Cochin Hospital, Hôitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, Paris, France; Université de Paris, Faculté de Médecine, Paris, France
| | - Florence Dumas
- Université de Paris, Faculté de Médecine, Paris, France; INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Emergency Department, Cochin Hospital, Hôpitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Alain Cariou
- Université de Paris, Faculté de Médecine, Paris, France; INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Medical Intensive Care Unit, Cochin Hospital, Hôpitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, Paris, France
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36
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Urban P, Mehran R, Colleran R, Angiolillo DJ, Byrne RA, Capodanno D, Cuisset T, Cutlip D, Eerdmans P, Eikelboom J, Farb A, Gibson CM, Gregson J, Haude M, James SK, Kim HS, Kimura T, Konishi A, Laschinger J, Leon MB, Magee PFA, Mitsutake Y, Mylotte D, Pocock S, Price MJ, Rao SV, Spitzer E, Stockbridge N, Valgimigli M, Varenne O, Windhoevel U, Yeh RW, Krucoff MW, Morice MC. Defining high bleeding risk in patients undergoing percutaneous coronary intervention: a consensus document from the Academic Research Consortium for High Bleeding Risk. Eur Heart J 2020; 40:2632-2653. [PMID: 31116395 PMCID: PMC6736433 DOI: 10.1093/eurheartj/ehz372] [Citation(s) in RCA: 296] [Impact Index Per Article: 74.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Identification and management of patients at high bleeding risk undergoing percutaneous
coronary intervention are of major importance, but a lack of standardization in defining
this population limits trial design, data interpretation, and clinical decision-making.
The Academic Research Consortium for High Bleeding Risk (ARC-HBR) is a collaboration among
leading research organizations, regulatory authorities, and physician-scientists from the
United States, Asia, and Europe focusing on percutaneous coronary intervention–related
bleeding. Two meetings of the 31-member consortium were held in Washington, DC, in April
2018 and in Paris, France, in October 2018. These meetings were organized by the
Cardiovascular European Research Center on behalf of the ARC-HBR group and included
representatives of the US Food and Drug Administration and the Japanese Pharmaceuticals
and Medical Devices Agency, as well as observers from the pharmaceutical and medical
device industries. A consensus definition of patients at high bleeding risk was developed
that was based on review of the available evidence. The definition is intended to provide
consistency in defining this population for clinical trials and to complement clinical
decision-making and regulatory review. The proposed ARC-HBR consensus document represents
the first pragmatic approach to a consistent definition of high bleeding risk in clinical
trials evaluating the safety and effectiveness of devices and drug regimens for patients
undergoing percutaneous coronary intervention.
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Affiliation(s)
- Philip Urban
- La Tour Hospital, Geneva, Switzerland.,Cardiovascular European Research Center, Massy, France
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Roisin Colleran
- Deutsches Herzzentrum München, Technische Universität München, Germany
| | | | - Robert A Byrne
- Deutsches Herzzentrum München, Technische Universität München, Germany
| | - Davide Capodanno
- Cardio-Thoracic-Vascular Department, Centro Alte Specialità e Trapianti, Catania, Italy.,Azienda Ospedaliero Universitario "Vittorio Emanuele-Policlinico," University of Catania, Italy
| | - Thomas Cuisset
- Département de Cardiologie, Centre Hospitalier Universitaire Timone and Inserm, Inra, Centre de recherche en cardiovasculaire et nutrition, Faculté de Médecine, Aix-Marseille Université, Marseille, France
| | - Donald Cutlip
- Cardiology Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | | | - John Eikelboom
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Andrew Farb
- US Food and Drug Administration, Silver Spring, MD
| | - C Michael Gibson
- Harvard Medical School, Boston, MA.,Baim Institute for Clinical Research, Brookline, MA
| | - John Gregson
- London School of Hygiene and Tropical Medicine, UK
| | - Michael Haude
- Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Germany
| | - Stefan K James
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden
| | - Hyo-Soo Kim
- Cardiovascular Center, Seoul National University Hospital, Korea
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Japan
| | - Akihide Konishi
- Office of Medical Devices 1, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | | | - Martin B Leon
- Columbia University Medical Center, New York, NY.,Cardiovascular Research Foundation, New York, NY
| | | | - Yoshiaki Mitsutake
- Office of Medical Devices 1, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Darren Mylotte
- University Hospital and National University of Ireland, Galway
| | | | | | - Sunil V Rao
- Duke Clinical Research Institute, Durham, NC
| | - Ernest Spitzer
- Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands.,Cardialysis, Clinical Trial Management and Core Laboratories, Rotterdam, the Netherlands
| | | | - Marco Valgimigli
- Department of Cardiology, Inselspital, University of Bern, Switzerland
| | - Olivier Varenne
- Service de Cardiologie, Hôpital Cochin, Assistance publique - hôpitaux de Paris, Paris, France.,Université Paris Descartes, Sorbonne Paris-Cité, France
| | | | - Robert W Yeh
- Beth Israel Deaconess Medical Center, Boston, MA
| | - Mitchell W Krucoff
- Duke Clinical Research Institute, Durham, NC.,Duke University Medical Center, Durham, NC
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37
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Capodanno D, Morice MC, Angiolillo DJ, Bhatt DL, Byrne RA, Colleran R, Cuisset T, Cutlip D, Eerdmans P, Eikelboom J, Farb A, Gibson CM, Gregson J, Haude M, James SK, Kim HS, Kimura T, Konishi A, Leon MB, Magee PFA, Mitsutake Y, Mylotte D, Pocock SJ, Rao SV, Spitzer E, Stockbridge N, Valgimigli M, Varenne O, Windhovel U, Krucoff MW, Urban P, Mehran R. Trial Design Principles for Patients at High Bleeding Risk Undergoing PCI: JACC Scientific Expert Panel. J Am Coll Cardiol 2020; 76:1468-1483. [PMID: 32943165 DOI: 10.1016/j.jacc.2020.06.085] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/26/2020] [Indexed: 01/22/2023]
Abstract
Investigating the balance of risk for thrombotic and bleeding events after percutaneous coronary intervention (PCI) is especially relevant for patients at high bleeding risk (HBR). The Academic Research Consortium for HBR recently proposed a consensus definition in an effort to standardize the patient population included in HBR trials. The aim of this consensus-based document, the second initiative from the Academic Research Consortium for HBR, is to propose recommendations to guide the design of clinical trials of devices and drugs in HBR patients undergoing PCI. The authors discuss the designs of trials in HBR patients undergoing PCI and various aspects of trial design specific to HBR patients, including target populations, intervention and control groups, primary and secondary outcomes, and timing of endpoint reporting.
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Affiliation(s)
- Davide Capodanno
- Division of Cardiology, Azienda Ospedaliero Universitario "Policlinico G. Rodolico-San Marco", University of Catania, Catania, Italy.
| | - Marie-Claude Morice
- Cardiovascular European Research Center, Massy, France. https://twitter.com/mc_morice
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts. https://twitter.com/DLBhattMD
| | - Robert A Byrne
- Cardiovascular Research Institute Dublin, Mater Private Hospital, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland. https://twitter.com/robebyrne
| | - Roisin Colleran
- Cardiovascular Research Institute Dublin, Mater Private Hospital, Dublin, Ireland; Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Thomas Cuisset
- Département de Cardiologie, Centre Hospitalier Universitaire Timone and Inserm, Inra, Centre de Recherche en Cardiovasculaire et Nutrition, Faculté de Médecine, Aix-Marseille Université, Marseille, France. https://twitter.com/CuissetDr
| | - Donald Cutlip
- Cardiology Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. https://twitter.com/DonaldCutlip
| | | | - John Eikelboom
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Andrew Farb
- U.S. Food and Drug Administration, Silver Spring, Maryland
| | - C Michael Gibson
- Harvard Medical School, Boston, Massachusetts; Baim Institute for Clinical Research, Brookline, Massachusetts. https://twitter.com/CMichaelGibson
| | - John Gregson
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Michael Haude
- Städtische Kliniken Neuss, Lukaskrankenhaus, Neuss, Germany
| | - Stefan K James
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Hyo-Soo Kim
- Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akihide Konishi
- Office of Medical Devices 1, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Martin B Leon
- Columbia University Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York. https://twitter.com/MartyMleon
| | - P F Adrian Magee
- U.S. Food and Drug Administration, Silver Spring, Maryland. https://twitter.com/dmylotte
| | - Yoshiaki Mitsutake
- Office of Medical Devices 1, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Darren Mylotte
- University Hospital and National University of Ireland, Galway, Ireland
| | - Stuart J Pocock
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sunil V Rao
- Duke Clinical Research Institute, Durham, North Carolina. https://twitter.com/SVRaoMD
| | - Ernest Spitzer
- Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands; Cardialysis, Clinical Trial Management and Core Laboratories, Rotterdam, the Netherlands. https://twitter.com/ernest_spitzer
| | | | - Marco Valgimigli
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland. https://twitter.com/vlgmrc
| | - Olivier Varenne
- Service de Cardiologie, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, Paris, France; Université Paris Descartes, Sorbonne Paris-Cité, Paris, France
| | - Ute Windhovel
- Cardiovascular European Research Center, Massy, France. https://twitter.com/Urphi
| | - Mitchel W Krucoff
- Duke Clinical Research Institute, Durham, North Carolina; Duke University Medical Center, Durham, North Carolina. https://twitter.com/mwkrucoff
| | | | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, New York. https://twitter.com/Drroxmehran
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Affiliation(s)
- Arthur Clement
- Cardiology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Fabien Picard
- Cardiology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France .,Université de Paris, Paris, France
| | - Olivier Varenne
- Cardiology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.,Université de Paris, Paris, France
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Pechmajou L, Marijon E, Varenne O, Dumas F, Beganton F, Jost D, Lamhaut L, Lecarpentier E, Loeb T, Agostinucci JM, Sideris G, Riant E, Baudinaud P, Hagege A, Bougouin W, Spaulding C, Cariou A, Jouven X, Karam N. Impact of Coronary Lesion Stability on the Benefit of Emergent Percutaneous Coronary Intervention After Sudden Cardiac Arrest. Circ Cardiovasc Interv 2020; 13:e009181. [PMID: 32895006 DOI: 10.1161/circinterventions.119.009181] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 11/16/2022]
Abstract
BACKGROUND Conflicting data exist regarding the benefit of urgent coronary angiogram and percutaneous coronary intervention (PCI) after sudden cardiac arrest, particularly in the absence of ST-segment elevation. We hypothesized that the type of lesions treated (stable versus unstable) influences the benefit derived from PCI. METHODS Data were taken between May 2011 and 2014 from a prospective registry enrolling all sudden cardiac arrest in Paris and suburbs (6.7 million inhabitants). Patients undergoing emergent coronary angiogram were included. Decision to perform PCI was left to the discretion of local teams. We assessed the impact of emergent PCI on survival at discharge according to whether the treated lesion was angiographically unstable or stable, and we investigated the predictive factors for unstable coronary lesions. RESULTS Among 9265 sudden cardiac arrests occurring during the study period, 1078 underwent emergent coronary angiogram (median age: 59.6 years, 78.3% males): 463 (42.9%) had an unstable lesion, 253 (23.5%) only stable lesions, and 362 (33.6%) no significant lesions. Emergent PCI was performed in 478 patients (91.4% of unstable and 21.7% of stable lesions). At discharge, PCI of unstable lesions was associated with twice-higher survival rate compared with untreated unstable lesions (47.9% versus 25.6%, P=0.013), while stable lesions PCI did not improve survival (25.5% versus 26.3%, P=1.00). After adjustment, PCI of unstable coronary lesions was independently associated with improved survival (odds ratio, 2.09 [95% CI, 1.42-3.09], P<0.001), contrary to PCI of stable lesions (odds ratio, 0.92 [95% CI. 0.44-1.87], P=0.824). Angina, initial shockable rhythm, ST-segment elevation, and absence of known coronary artery disease were independent predictors of unstable lesions. CONCLUSIONS Emergent PCI of unstable lesions is associated with improved survival after sudden cardiac arrest, contrary to PCI of stable lesions. Accordingly, early PCI should only be performed in patients with unstable lesions. Four factors (chest pain, ST-elevation, absence of coronary artery disease history, and shockable initial rhythm) could help identify patients with unstable lesions who would, therefore, benefit from emergent coronary angiogram.
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Affiliation(s)
- Louis Pechmajou
- Université de Paris, PARCC, INSERM, F-75015 Paris, France (L.P., E.M., O.V., F.D., F.B., L.L., P.B., W.B., A.C., X.J., N.K.).,Cardiology Department, European Hospital Georges Pompidou, Paris, France (L.P., E.M., E.R., P.B., A.H., C.S., X.J., N.K.)
| | - Eloi Marijon
- Université de Paris, PARCC, INSERM, F-75015 Paris, France (L.P., E.M., O.V., F.D., F.B., L.L., P.B., W.B., A.C., X.J., N.K.).,Cardiology Department, European Hospital Georges Pompidou, Paris, France (L.P., E.M., E.R., P.B., A.H., C.S., X.J., N.K.)
| | - Olivier Varenne
- Université de Paris, PARCC, INSERM, F-75015 Paris, France (L.P., E.M., O.V., F.D., F.B., L.L., P.B., W.B., A.C., X.J., N.K.).,Cardiology Department (O.V.), Cochin Hospital, Paris, France
| | - Florence Dumas
- Université de Paris, PARCC, INSERM, F-75015 Paris, France (L.P., E.M., O.V., F.D., F.B., L.L., P.B., W.B., A.C., X.J., N.K.).,Emergency Department (F.D.), Cochin Hospital, Paris, France
| | - Frankie Beganton
- Université de Paris, PARCC, INSERM, F-75015 Paris, France (L.P., E.M., O.V., F.D., F.B., L.L., P.B., W.B., A.C., X.J., N.K.)
| | | | - Lionel Lamhaut
- Université de Paris, PARCC, INSERM, F-75015 Paris, France (L.P., E.M., O.V., F.D., F.B., L.L., P.B., W.B., A.C., X.J., N.K.).,SAMU 75, Necker Hospital, Paris, France (L.L.)
| | | | - Thomas Loeb
- SAMU 92, Raymond Poincaré Hospital, Garches, France (T.L.)
| | | | - Georgios Sideris
- Cardiology Department, Lariboisiere Hospital, Paris, France (G.S.)
| | - Elisabeth Riant
- Cardiology Department, European Hospital Georges Pompidou, Paris, France (L.P., E.M., E.R., P.B., A.H., C.S., X.J., N.K.)
| | - Pierre Baudinaud
- Université de Paris, PARCC, INSERM, F-75015 Paris, France (L.P., E.M., O.V., F.D., F.B., L.L., P.B., W.B., A.C., X.J., N.K.).,Cardiology Department, European Hospital Georges Pompidou, Paris, France (L.P., E.M., E.R., P.B., A.H., C.S., X.J., N.K.)
| | - Albert Hagege
- Cardiology Department, European Hospital Georges Pompidou, Paris, France (L.P., E.M., E.R., P.B., A.H., C.S., X.J., N.K.)
| | - Wulfran Bougouin
- Université de Paris, PARCC, INSERM, F-75015 Paris, France (L.P., E.M., O.V., F.D., F.B., L.L., P.B., W.B., A.C., X.J., N.K.)
| | - Christian Spaulding
- Cardiology Department, European Hospital Georges Pompidou, Paris, France (L.P., E.M., E.R., P.B., A.H., C.S., X.J., N.K.)
| | - Alain Cariou
- Université de Paris, PARCC, INSERM, F-75015 Paris, France (L.P., E.M., O.V., F.D., F.B., L.L., P.B., W.B., A.C., X.J., N.K.).,Intensive Care Unit (A.C.), Cochin Hospital, Paris, France
| | - Xavier Jouven
- Université de Paris, PARCC, INSERM, F-75015 Paris, France (L.P., E.M., O.V., F.D., F.B., L.L., P.B., W.B., A.C., X.J., N.K.).,Cardiology Department, European Hospital Georges Pompidou, Paris, France (L.P., E.M., E.R., P.B., A.H., C.S., X.J., N.K.)
| | - Nicole Karam
- Université de Paris, PARCC, INSERM, F-75015 Paris, France (L.P., E.M., O.V., F.D., F.B., L.L., P.B., W.B., A.C., X.J., N.K.).,Cardiology Department, European Hospital Georges Pompidou, Paris, France (L.P., E.M., E.R., P.B., A.H., C.S., X.J., N.K.)
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Adjedj J, Picard F, Collet C, Bruneval P, Fournier S, Bize A, Sambin L, Berdeaux A, Varenne O, De Bruyne B, Ghaleh B. Intracoronary Saline-Induced Hyperemia During Coronary Thermodilution Measurements of Absolute Coronary Blood Flow: An Animal Mechanistic Study. J Am Heart Assoc 2020; 9:e015793. [PMID: 32689859 PMCID: PMC7792254 DOI: 10.1161/jaha.120.015793] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Absolute hyperemic coronary blood flow and microvascular resistances can be measured by continuous thermodilution with a dedicated infusion catheter. We aimed to determine the mechanisms of this hyperemic response in animal. Methods and Results Twenty open chest pigs were instrumented with flow probes on coronary arteries. The following possible mechanisms of saline‐induced hyperemia were explored compared with maximal hyperemia achieve with adenosine by testing: (1) various infusion rates; (2) various infusion content and temperature; (3) NO production inhibition with L‐arginine methyl ester and endothelial denudation; (4) effects of vibrations generated by rotational atherectomy and of infusion through one end‐hole versus side‐holes. Saline infusion rates of 5, 10 and 15 mL/min did not reach maximal hyperemia as compared with adenosine. Percentage of coronary blood flow expressed in percent of the coronary blood flow after adenosine were 48±17% at baseline, 57±18% at 5 mL/min, 65±17% at 10 mL/min, 82±26% at 15 mL/min and 107±18% at 20 mL/min. Maximal hyperemia was observed during infusion of both saline at body temperature and glucose 5%, after endothelial denudation, l‐arginine methyl ester administration, and after stent implantation. The activation of a Rota burr in the first millimeters of the epicardial artery also induced maximal hyperemia. Maximal hyperemia was achieved by infusion through lateral side‐holes but not through an end‐hole catheter. Conclusions Infusion of saline at 20 mL/min through a catheter with side holes in the first millimeters of the epicardial artery induces maximal hyperemia. The data indicate that this vasodilation is related neither to the composition/temperature of the indicator nor is it endothelial mediated. It is suggested that it could be elicited by epicardial wall vibrations.
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Affiliation(s)
- Julien Adjedj
- Department of Cardiology Institut Arnault Tzanck Saint Laurent du Var France.,Department of Cardiology Lausanne University Center Hospital Lausanne Switzerland.,U955-IMRB Equipe 03 Inserm UPEC Ecole Nationale Vétérinaire d'Alfort Maisons-Alfort France.,Université Paris Est UMR_S955 UPEC Ecole Nationale Vétérinaire d'Alfort Créteil France.,Faculté de Médecine Paris Descartes Université Paris Descartes Paris France
| | - Fabien Picard
- Faculté de Médecine Paris Descartes Université Paris Descartes Paris France.,AP-HP, Hôpital Cochin Paris France
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Clinic Aalst Belgium
| | - Patrick Bruneval
- UMR 970 Inserm Paris Cardiovascular Research Center Hôpital Européen Georges Pompidou Paris France
| | - Stephane Fournier
- Department of Cardiology Lausanne University Center Hospital Lausanne Switzerland.,Cardiovascular Center Aalst, OLV Clinic Aalst Belgium
| | - Alain Bize
- U955-IMRB Equipe 03 Inserm UPEC Ecole Nationale Vétérinaire d'Alfort Maisons-Alfort France.,Université Paris Est UMR_S955 UPEC Ecole Nationale Vétérinaire d'Alfort Créteil France
| | - Lucien Sambin
- U955-IMRB Equipe 03 Inserm UPEC Ecole Nationale Vétérinaire d'Alfort Maisons-Alfort France.,Université Paris Est UMR_S955 UPEC Ecole Nationale Vétérinaire d'Alfort Créteil France
| | - Alain Berdeaux
- U955-IMRB Equipe 03 Inserm UPEC Ecole Nationale Vétérinaire d'Alfort Maisons-Alfort France.,Université Paris Est UMR_S955 UPEC Ecole Nationale Vétérinaire d'Alfort Créteil France
| | - Olivier Varenne
- Faculté de Médecine Paris Descartes Université Paris Descartes Paris France.,AP-HP, Hôpital Cochin Paris France
| | - Bernard De Bruyne
- Department of Cardiology Lausanne University Center Hospital Lausanne Switzerland.,Cardiovascular Center Aalst, OLV Clinic Aalst Belgium
| | - Bijan Ghaleh
- U955-IMRB Equipe 03 Inserm UPEC Ecole Nationale Vétérinaire d'Alfort Maisons-Alfort France.,Université Paris Est UMR_S955 UPEC Ecole Nationale Vétérinaire d'Alfort Créteil France
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Guillemet L, Jamme M, Bougouin W, Geri G, Deye N, Vivien B, Varenne O, Pène F, Mira JP, Barat F, Treluyer JM, Hermine O, Carli P, Coste J, Cariou A. Effects of early high-dose erythropoietin on acute kidney injury following cardiac arrest: exploratory post hoc analyses from an open-label randomized trial. Clin Kidney J 2020; 13:413-420. [PMID: 32699621 PMCID: PMC7367106 DOI: 10.1093/ckj/sfz068] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/29/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is frequent in patients resuscitated from cardiac arrest (CA) and may worsen outcome. Experimental data suggest a renoprotective effect by treating these patients with a high dose of erythropoietin (Epo) analogues. We aimed to evaluate the efficacy of epoetin alpha treatment on renal outcome after CA. METHODS We did a post hoc analysis of the Epo-ACR-02 trial, which randomized patients with a persistent coma after a witnessed out-of-hospital CA. Only patients admitted in one intensive care unit were analysed. In the intervention group, patients received five intravenous injections of Epo spaced 12 h apart during the first 48 h, started as soon as possible after resuscitation. In the control group, patients received standard care without Epo. The main endpoint was the proportion of patients with persistent AKI defined by Kidney Disease: Improving Global Outcomes criteria at Day 2. Secondary endpoints included the occurrence of AKI through Day 7, estimated glomerular filtration rate (eGFR) at Day 28, haematological indices and adverse events. RESULTS A total of 162 patients were included in the primary analysis (74 in the Epo group, 88 in the control group). Baseline characteristics were similar in the two groups. At Day 2, 52.8% of the patients (38/72) in the intervention group had an AKI, as compared with 54.4% of the patients (46/83) in the control group (P = 0.74). There was no significant difference between the two groups regarding the proportion of patients with AKI through Day 7. Among patients with persistent AKI at Day 2, 33% (4/12) in the intervention group had an eGFR <75 mL/min/1.73 m2 compared with 25% (3/12) in the control group at Day 28 (P = 0.99). We found no significant differences in haematological indices or adverse events. CONCLUSION After CA, early administration of Epo did not confer any renal protective effect as compared with standard therapy.
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Affiliation(s)
- Lucie Guillemet
- Medical Intensive Care Unit, Cochin Hospital (AP-HP), Paris, France
- Paris Descartes University, Paris, France
| | - Matthieu Jamme
- Medical Intensive Care Unit, Cochin Hospital (AP-HP), Paris, France
| | - Wulfran Bougouin
- Medical Intensive Care Unit, Cochin Hospital (AP-HP), Paris, France
- Paris Descartes University, Paris, France
- INSERM U970 (Team 4), Parisian Cardiovascular Research Center, Paris Descartes University, Paris, France
| | - Guillaume Geri
- Medical Intensive Care Unit, Cochin Hospital (AP-HP), Paris, France
- Paris Descartes University, Paris, France
- INSERM U970 (Team 4), Parisian Cardiovascular Research Center, Paris Descartes University, Paris, France
| | - Nicolas Deye
- Medical Intensive Care Unit, Lariboisière Hospital (AP-HP) and INSERM U942, Paris, France
| | - Benoît Vivien
- Paris Descartes University, Paris, France
- SAMU 75, Necker Hospital (AP-HP), Paris, France
| | - Olivier Varenne
- Paris Descartes University, Paris, France
- Cardiology Department, Cochin University Hospital (AP-HP), Paris, France
| | - Frédéric Pène
- Medical Intensive Care Unit, Cochin Hospital (AP-HP), Paris, France
- Paris Descartes University, Paris, France
| | - Jean-Paul Mira
- Medical Intensive Care Unit, Cochin Hospital (AP-HP), Paris, France
- Paris Descartes University, Paris, France
| | - Florence Barat
- Clinical Trial Unit, Central Pharmacy, AP-HP, Paris, France
| | - Jean-Marc Treluyer
- Paris Descartes University, Paris, France
- Clinical Research Unit, Paris Centre and Paris Descartes University, Paris, France
| | - Olivier Hermine
- Paris Descartes University, Paris, France
- Hematology Department, Necker Hospital (AP-HP)—Imagine institute—INSERM U1123 CNRS erl 8654 - Labex des Globules Rouges Grex, Paris, France
| | - Pierre Carli
- Paris Descartes University, Paris, France
- SAMU 75, Necker Hospital (AP-HP), Paris, France
| | - Joël Coste
- Paris Descartes University, Paris, France
- Biostatistics and Epidemiology Unit, Hôtel-Dieu Hospital (AP-HP), Paris, France
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin Hospital (AP-HP), Paris, France
- Paris Descartes University, Paris, France
- INSERM U970 (Team 4), Parisian Cardiovascular Research Center, Paris Descartes University, Paris, France
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42
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Picard F, Cariou A, Dumas F, Varenne O. Reply to: The significance of door-to-balloon time in the patients with ST-elevation myocardial infarction. Resuscitation 2020; 148:281-282. [PMID: 31926257 DOI: 10.1016/j.resuscitation.2019.12.026] [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] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 12/21/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Fabien Picard
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France; INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France.
| | - Alain Cariou
- Université de Paris, Paris, France; INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Medical Intensive Care Unit, Cochin Hospital, Hôpitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Florence Dumas
- Université de Paris, Paris, France; INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Emergency Department, Cochin Hospital, Hôpitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Olivier Varenne
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
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43
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Karam N, Pechmajou L, Marijon E, Varenne O, Dumas F, Beganton F, Jost D, Lamhaut L, Lecarpentier E, Loeb T, Adnet F, Agostinucci M, Bougouin W, Spaulding C, Cariou A, Jouven X. IMPACT OF CORONARY LESION STABILITY ON THE BENEFIT OF EMERGENT PERCUTANEOUS CORONARY INTERVENTION AFTER SUDDEN CARDIAC ARREST. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)30933-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Waldmann V, Karam N, Rischard J, Bougouin W, Sharifzadehgan A, Dumas F, Narayanan K, Sideris G, Voicu S, Gandjbakhch E, Jost D, Lamhaut L, Ludes B, Plu I, Beganton F, Wahbi K, Varenne O, Megarbane B, Algalarrondo V, Extramiana F, Lellouche N, Celermajer DS, Spaulding C, Lafont A, Cariou A, Jouven X, Marijon E. Low rates of immediate coronary angiography among young adults resuscitated from sudden cardiac arrest. Resuscitation 2020; 147:34-42. [PMID: 31857140 DOI: 10.1016/j.resuscitation.2019.12.005] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 11/29/2019] [Accepted: 12/04/2019] [Indexed: 11/27/2022]
Abstract
AIM Coronary artery disease (CAD) has recently been emphasized as a major cause of sudden cardiac arrest (SCA) in young adults. We aim to assess the rate of immediate coronary angiography performance in young patients resuscitated from SCA. METHODS From May 2011 to May 2017, all cases of out-of-hospital SCA aged 18-40 years alive at hospital admission were prospectively included in 48 hospitals of the Great Paris area. Cardiovascular causes of SCA were centrally adjudicated, and management including immediate coronary angiography performance was assessed. RESULTS Out of 3579 SCA admitted alive, 409 (11.4%) patients were under 40 years of age (32.3 ± 6.2 years, 69.7% males), with 244 patients having a definite cause identified. Among those, CAD accounted for 72 (29.5%) cases, of which 64 (88.9%) were acute coronary syndromes. The rate of immediate coronary angiography was only 41.7% compared to 65.1% among those ≥40-years (P < 0.001). During the study period, while the rate of immediate coronary angiography increased from 60.5% to 70.3% (P < 0.001) in patients aged ≥40 years, the rate in patients aged less than 40 years remained stable (43.5% to 45.3%, P = 0.795). Patients younger than 40 years were significantly less likely to undergo immediate coronary angiography (OR = 0.34, 95% CI: 0.25-0.47), although early angiography was associated with survival at hospital discharge (OR = 2.68, 95% CI: 1.21-6.00). CONCLUSION CAD is the first cause of SCA in young adults aged less than 40 years. The observed low rates of immediate coronary angiography suggest a missed opportunity for early intervention.
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Affiliation(s)
- Victor Waldmann
- AP-HP, European Georges Pompidou Hospital, Cardiology Department, Paris, France; Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris University, Paris, France
| | - Nicole Karam
- AP-HP, European Georges Pompidou Hospital, Cardiology Department, Paris, France; Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris University, Paris, France
| | - Julien Rischard
- AP-HP, European Georges Pompidou Hospital, Cardiology Department, Paris, France; Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France
| | - Wulfran Bougouin
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris University, Paris, France; Ramsay Générale de Santé, Hôpital privé Jacques Cartier, Intensive Care Unit, Massy, France
| | - Ardalan Sharifzadehgan
- AP-HP, European Georges Pompidou Hospital, Cardiology Department, Paris, France; Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris University, Paris, France
| | - Florence Dumas
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris University, Paris, France; AP-HP, Cochin-Hotel Hospital, Emergency Department, Paris, France
| | - Kumar Narayanan
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Medicover Hospitals, Hyderabad, India
| | - Georgios Sideris
- AP-HP, Lariboisière Hospital, Cardiology Department, Paris, France
| | - Sebastian Voicu
- AP-HP, Lariboisière Hospital, Intensive Care Unit, Paris, France
| | - Estelle Gandjbakhch
- AP-HP, La Pitié Salpêtrière University Hospital, Cardiology Department, Paris, France; Groupe Parisien Universitaire de Rythmologie (G.P.U.R.), France
| | | | | | | | - Isabelle Plu
- AP-HP, La Pitié Salpêtrière University Hospital, Anatomopathology Department, Paris, France
| | - Frankie Beganton
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France
| | - Karim Wahbi
- Paris University, Paris, France; AP-HP, Cochin Hospital, Cardiology Department, Paris, France
| | - Olivier Varenne
- Paris University, Paris, France; AP-HP, Cochin Hospital, Cardiology Department, Paris, France
| | - Bruno Megarbane
- AP-HP, Lariboisière Hospital, Intensive Care Unit, Paris, France
| | - Vincent Algalarrondo
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.), France; AP-HP, Bichat-Claude-Bernard Hospital, Cardiology Department, Paris, France
| | - Fabrice Extramiana
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.), France; AP-HP, Bichat-Claude-Bernard Hospital, Cardiology Department, Paris, France
| | - Nicolas Lellouche
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.), France; AP-HP, Henri Mondor Hospital, Cardiology Department, Créteil, France
| | | | - Christian Spaulding
- AP-HP, European Georges Pompidou Hospital, Cardiology Department, Paris, France; Paris University, Paris, France
| | - Antoine Lafont
- AP-HP, European Georges Pompidou Hospital, Cardiology Department, Paris, France; Paris University, Paris, France
| | - Alain Cariou
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris University, Paris, France; AP-HP, Cochin Hospital, Intensive Care Unit, Paris, France
| | - Xavier Jouven
- AP-HP, European Georges Pompidou Hospital, Cardiology Department, Paris, France; Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris University, Paris, France
| | - Eloi Marijon
- AP-HP, European Georges Pompidou Hospital, Cardiology Department, Paris, France; Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris University, Paris, France; Groupe Parisien Universitaire de Rythmologie (G.P.U.R.), 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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Pham V, Hemptinne QD, Grinda JM, Duboc D, Varenne O, Picard F. Giant coronary aneurysms, from diagnosis to treatment: A literature review. Arch Cardiovasc Dis 2020; 113:59-69. [DOI: 10.1016/j.acvd.2019.10.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/17/2019] [Accepted: 10/23/2019] [Indexed: 12/26/2022]
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Bulsei J, Butel T, Varenne O, Cook S, Cuisset T, Carrié D, Hovasse T, Morice MC, Sinnaeve PR, Durand-Zaleski I. Cost-Effectiveness of Drug-Eluting Stents in Elderly Patients With Coronary Artery Disease: The SENIOR Trial. Value Health 2019; 22:1355-1361. [PMID: 31806191 DOI: 10.1016/j.jval.2019.07.008] [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: 12/05/2018] [Revised: 06/13/2019] [Accepted: 07/15/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Elderly patients receive bare metal stents instead of drug-eluting stents (DES) to shorten the duration of dual antiplatelet therapy (DAPT). The SENIOR trial compared outcomes between these 2 types of stents combined with a short duration of DAPT. A significant decrease in the number of patients with at least 1 major adverse cardiac and cerebrovascular event (MACCE) was noted in the DES group. OBJECTIVES The objective of this article was to perform an economic evaluation of the SENIOR trial. METHODS This evaluation was performed separately in 5 participating countries using pooled patient-level data from all study patients and country-specific unit costs and utility values. Costs, MACCEs, and quality-adjusted life-years (QALYs) were calculated in both arms at 1 year, and an incremental cost-effectiveness ratio was estimated. Uncertainty was explored by probabilistic bootstrapping. RESULTS A total of 1200 patients underwent randomization. The average total cost per patient was higher in the DES group. The number of MACCEs and average QALYs were not statistically different between the 2 groups. The 1-year incremental cost-effectiveness ratio for each country of reference ranged from €13 752 to €20 511/MACCE avoided and from €42 835 to €68 231/QALY gained. The scatter plots found a wide dispersion, reflecting a large uncertainty surrounding the results. But in each country studied, 90% of the bootstrap replications indicated a higher cost for greater effectiveness for the DES group. Assuming a willingness to pay of €50 000/QALY, there was between a 40% and 50% chance that the use of DES was cost-effective in 4 countries. CONCLUSION The use of DES instead of bare metal stents combined with a short duration of DAPT in elderly patients induced higher cost for greater effectiveness in each of the 5 countries studied.
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Affiliation(s)
- Julie Bulsei
- AP-HP URC Eco IdF, Unité de recherche clinique en économie de la santé d'Ile de France, Paris, France.
| | - Thibault Butel
- AP-HP URC Eco IdF, Unité de recherche clinique en économie de la santé d'Ile de France, Paris, France
| | - Olivier Varenne
- AP-HP Hôpital Cochin, Paris, France; Cardiology Department, Université Paris Descartes, Sorbonne Paris-Cité, Paris, France
| | - Stéphane Cook
- Cardiology Department, University and Hospital of Fribourg, Fribourg, Switzerland
| | - Thomas Cuisset
- Département de Cardiologie, Centre hospitalier universitaire Timone, Marseille, France
| | - Didier Carrié
- Service de Cardiologie, Centre hospitalier universitaire Toulouse Rangueil, Université Paul Sabatier, Toulouse, France
| | - Thomas Hovasse
- Institut Cardiovasculaire Paris-Sud, Ramsay Générale de Santé, Massy and Quincy, France
| | | | - Peter R Sinnaeve
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Isabelle Durand-Zaleski
- AP-HP URC Eco IdF, Unité de recherche clinique en économie de la santé d'Ile de France, Paris, France
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Picard F, Llitjos JF, Diefenbronn M, Laghlam D, Seret G, Sokoloff A, Cariou A, Dumas F, Varenne O. The balance of thrombosis and hemorrhage in STEMI patients with or without associated cardiac arrest: An observational study. Resuscitation 2019; 145:83-90. [DOI: 10.1016/j.resuscitation.2019.10.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 09/25/2019] [Accepted: 10/23/2019] [Indexed: 01/21/2023]
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Picard F, Alansari O, Mogi S, Van't Veer M, Varenne O, Adjedj J. In vitro test-retest repeatability of invasive physiological indices to assess coronary flow. Catheter Cardiovasc Interv 2019; 94:677-683. [PMID: 30838771 DOI: 10.1002/ccd.28177] [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: 09/08/2018] [Revised: 01/02/2019] [Accepted: 02/18/2019] [Indexed: 11/11/2022]
Abstract
AIMS Several invasive techniques are available in clinical practice to assess coronary flow. Nevertheless, the test-retest repeatability of these techniques in a controlled setting has not been reported. Therefore, we sought to evaluate fractional flow reserve (FFR), coronary flow reserve (CFR), index of microvascular resistance (IMR), and absolute coronary blood flow (ABF) with absolute microvascular resistance (AMR) test-retest repeatability using a coronary flow simulator. METHODS AND RESULTS Using a coronary flow simulator (FFR WetLab version 2.0; Abbott Vascular, Santa Clara, CA), we created stenoses ranging from 0% to 70%, with 10% increments. Three different flows were established with their hyperemic phases, and two consecutive measurements were obtained, evaluating the following indices: FFR, CFR, IMR, ABF, and AMR, using a pressure/temperature wire and an infusion catheter. One hundred and thirty-eight pairs of measurements were performed. Test-retest reliability was compared in 48 FFR, 18 CFR, 24 IMR, 24 ABF, and 24 AMR. Test-retest repeatability showed excellent reproducibility for FFR, ABF, and AMR; respectively 0.98 (0.97-0.99), 0.92 (0.81-0.97) and 0.91 (0.79-0.96) (P < 0.0001 for all). However, test-retest repeatability was weaker for IMR and poor for CFR; respectively 0.53 (0.16-0.77) (P = 0.006) and 0.27 (-0.26-0.67) (P = 0.30). CONCLUSIONS Using a coronary flow simulator, FFR and ABF with AMR had excellent test-retest reliability. IMR and CFR demonstrated weaker test-retest reliability.
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Affiliation(s)
- Fabien Picard
- Department of Cardiology, Hôpital Cochin, AP-HP, Paris, France.,Faculté de Médecine Paris Descartes, Université Paris Descartes, Paris, France
| | - Omar Alansari
- Department of Cardiology, Hôpital Cochin, AP-HP, Paris, France
| | - Satoshi Mogi
- Department of Cardiology, Hôpital Cochin, AP-HP, Paris, France
| | - Marcel Van't Veer
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.,Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Olivier Varenne
- Department of Cardiology, Hôpital Cochin, AP-HP, Paris, France.,Faculté de Médecine Paris Descartes, Université Paris Descartes, Paris, France
| | - Julien Adjedj
- Department of Cardiology, Hôpital Cochin, AP-HP, Paris, France.,Faculté de Médecine Paris Descartes, Université Paris Descartes, Paris, France
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50
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Bougouin W, Dumas F, Lamhaut L, Marijon E, Carli P, Combes A, Pirracchio R, Aissaoui N, Karam N, Deye N, Sideris G, Beganton F, Jost D, Cariou A, Jouven X, Adnet F, Agostinucci JM, Aissaoui-Balanant N, Algalarrondo V, Alla F, Alonso C, Amara W, Annane D, Antoine C, Aubry P, Azoulay E, Beganton F, Benhamou D, Billon C, Bougouin W, Boutet J, Bruel C, Bruneval P, Cariou A, Carli P, Casalino E, Cerf C, Chaib A, Cholley B, Cohen Y, Combes A, Crahes M, Da Silva D, Das V, Demoule A, Denjoy I, Deye N, Dhonneur G, Diehl JL, Dinanian S, Domanski L, Dreyfuss D, Duboc D, Dubois-Rande JL, Dumas F, Empana JP, Extramiana F, Fartoukh M, Fieux F, Gabbas M, Gandjbakhch E, Geri G, Guidet B, Halimi F, Henry P, Hidden Lucet F, Jabre P, Jacob L, Joseph L, Jost D, Jouven X, Karam N, Kassim H, Lacotte J, Lahlou-Laforet K, Lamhaut L, Lanceleur A, Langeron O, Lavergne T, Lecarpentier E, Leenhardt A, Lellouche N, Lemiale V, Lemoine F, Linval F, Loeb T, Ludes B, Luyt CE, Maltret A, Mansencal N, Mansouri N, Marijon E, Marty J, Maury E, Maxime V, Megarbane B, Mekontso-Dessap A, Mentec H, Mira JP, Monnet X, Narayanan K, Ngoyi N, Perier MC, Piot O, Pirracchio R, Plaisance P, Plu I, Raux M, Revaux F, Ricard JD, Richard C, Riou B, Roussin F, Santoli F, Schortgen F, Sharifzadehgan A, Sideris G, Spaulding C, Teboul JL, Timsit JF, Tourtier JP, Tuppin P, Ursat C, Varenne O, Vieillard-Baron A, Voicu S, Wahbi K, Waldmann V. Extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest: a registry study. Eur Heart J 2019; 41:1961-1971. [DOI: 10.1093/eurheartj/ehz753] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [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: 12/28/2018] [Revised: 03/26/2019] [Accepted: 10/01/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
Out-of-hospital cardiac arrest (OHCA) without return of spontaneous circulation (ROSC) despite conventional resuscitation is common and has poor outcomes. Adding extracorporeal membrane oxygenation (ECMO) to cardiopulmonary resuscitation (extracorporeal-CPR) is increasingly used in an attempt to improve outcomes.
Methods and results
We analysed a prospective registry of 13 191 OHCAs in the Paris region from May 2011 to January 2018. We compared survival at hospital discharge with and without extracorporeal-CPR and identified factors associated with survival in patients given extracorporeal-CPR. Survival was 8% in 525 patients given extracorporeal-CPR and 9% in 12 666 patients given conventional-CPR (P = 0.91). By adjusted multivariate analysis, extracorporeal-CPR was not associated with hospital survival [odds ratio (OR), 1.3; 95% confidence interval (95% CI), 0.8–2.1; P = 0.24]. By conditional logistic regression with matching on a propensity score (including age, sex, occurrence at home, bystander CPR, initial rhythm, collapse-to-CPR time, duration of resuscitation, and ROSC), similar results were found (OR, 0.8; 95% CI, 0.5–1.3; P = 0.41). In the extracorporeal-CPR group, factors associated with hospital survival were initial shockable rhythm (OR, 3.9; 95% CI, 1.5–10.3; P = 0.005), transient ROSC before ECMO (OR, 2.3; 95% CI, 1.1–4.7; P = 0.03), and prehospital ECMO implantation (OR, 2.9; 95% CI, 1.5–5.9; P = 0.002).
Conclusions
In a population-based registry, 4% of OHCAs were treated with extracorporeal-CPR, which was not associated with increased hospital survival. Early ECMO implantation may improve outcomes. The initial rhythm and ROSC may help select patients for extracorporeal-CPR.
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Affiliation(s)
- Wulfran Bougouin
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Medical-Surgical Intensive Care Unit, Ramsay Générale de Santé, Hôpital Privé Jacques Cartier, 6 Avenue du Noyer Lambert, 91300 Massy, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- AfterROSC network, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Florence Dumas
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Emergency Department, Cochin-Hotel-Dieu Hospital, APHP, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Lionel Lamhaut
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- AfterROSC network, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Intensive Care Unit - SAMU 75, Necker-Enfants-Malades Hospital, APHP, 149 Rue de Sèvres, 75015 Paris, France
| | - Eloi Marijon
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Cardiology Department, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015 Paris, France
| | - Pierre Carli
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Intensive Care Unit - SAMU 75, Necker-Enfants-Malades Hospital, APHP, 149 Rue de Sèvres, 75015 Paris, France
| | - Alain Combes
- Medical-Surgical Intensive Care Unit, iCAN, Institute of Cardiometabolism and Nutrition, Pitié-Salpétrière Hospital, APHP, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - Romain Pirracchio
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Surgical ICU, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015 Paris, France
| | - Nadia Aissaoui
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- AfterROSC network, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Medical ICU, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015 Paris, France
| | - Nicole Karam
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Cardiology Department, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015 Paris, France
| | - Nicolas Deye
- AfterROSC network, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
- Medical ICU, Lariboisière Hospital, AP-HP, 2 Rue Ambroise Paré, 75010 Paris, France
| | - Georgios Sideris
- Cardiology Department, Lariboisière Hospital, AP-HP, 2 Rue Ambroise Paré, 75010 Paris, France
| | - Frankie Beganton
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
| | - Daniel Jost
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- Brigade de Sapeurs Pompiers de Paris (BSPP), 1 Place Jules Renard, 75017 Paris, France
| | - Alain Cariou
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- AfterROSC network, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Medical Intensive Care Unit, Cochin Hospital, APHP, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Xavier Jouven
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Cardiology Department, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015 Paris, France
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