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Le Bras A, Hildick-Smith D, Nze Ossima A, Supplisson O, Egred M, Brunel P, Banning AP, Morice MC, Durand-Zaleski I. Cost-effectiveness of stepwise provisional versus systematic dual stenting strategies in patients with distal bifurcation left main stem lesions: economic analysis of the EBC MAIN trial. Open Heart 2024; 11:e002479. [PMID: 38242557 PMCID: PMC10806460 DOI: 10.1136/openhrt-2023-002479] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/13/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND In patients with distal bifurcation left main stem lesions requiring intervention, the European Bifurcation Club Left Main Coronary Stent Study trial found a non-significant difference in major adverse cardiac events (MACEs, composite of all-cause death, non-fatal myocardial infarction and target lesion revascularisation) favouring the stepwise provisional strategy, compared with the systematic dual stenting. AIMS To estimate the 1-year cost-effectiveness of stepwise provisional versus systematic dual stenting strategies. METHODS Costs in France and the UK, and MACE were calculated in both groups to estimate the incremental cost-effectiveness ratio (ICER). Uncertainty was explored by probabilistic bootstrapping. The analysis was conducted from the perspective of the healthcare provider with a time horizon of 1 year. RESULTS The cost difference between the two groups was €-755 (€5700 in the stepwise provisional group and €6455 in the systematic dual stenting group, p value<0.01) in France and €-647 (€6728 and €7375, respectively, p value=0.08) in the UK. The point estimates for the ICERs found that stepwise provisional strategy was cost saving and improved outcomes with a probabilistic sensitivity analysis confirming dominance with an 80% probability. CONCLUSION The stepwise provisional strategy at 1 year is dominant compared with the systematic dual stenting strategy on both economic and clinical outcomes.
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Affiliation(s)
- Alicia Le Bras
- URCEco DRCI, Assistance Publique - Hopitaux de Paris, Paris, France
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | | | | | - Mohaned Egred
- Cardiology, Freeman Hospital, Newcastle upon Tyne, UK
| | | | | | | | - Isabelle Durand-Zaleski
- URCEco DRCI, Assistance Publique - Hopitaux de Paris, Paris, France
- University of Paris, Paris, France
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Maznyczka A, Arunothayaraj S, Egred M, Banning A, Brunel P, Ferenc M, Hovasse T, Wlodarczak A, Pan M, Schmitz T, Silvestri M, Erglis A, Kretov E, Lassen JF, Chieffo A, Lefevre T, Burzotta F, Cockburn J, Darremont O, Stankovic G, Morice MC, Louvard Y, Hildick-Smith D. Bifurcation left main stenting with or without intracoronary imaging: Outcomes from the EBC MAIN trial. Catheter Cardiovasc Interv 2023; 102:415-429. [PMID: 37473405 DOI: 10.1002/ccd.30785] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/10/2023] [Accepted: 07/12/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND The impact of intracoronary imaging on outcomes, after provisional versus dual-stenting for bifurcation left main (LM) lesions, is unknown. OBJECTIVES We investigated the effect of intracoronary imaging in the EBC MAIN trial (European Bifurcation Club LM Coronary Stent study). METHODS Four hundred and sixty-seven patients were randomized to dual-stenting or a stepwise provisional strategy. Four hundred and fifty-five patients were included. Intravascular ultrasound (IVUS) or optical coherence tomography (OCT) was undertaken at the operator's discretion. The primary endpoint was death, myocardial infarction or target vessel revascularization at 1-year. RESULTS Intracoronary imaging was undertaken in 179 patients (39%; IVUS = 151, OCT = 28). As a result of IVUS findings, operators reintervened in 42 procedures. The primary outcome did not differ with intracoronary imaging versus angiographic-guidance (17% vs. 16%; odds ratio [OR]: 0.92 (95% confidence interval [CI]: 0.51-1.63) p = 0.767), nor for reintervention based on IVUS versus none (14% vs. 16%; OR: 0.88 [95% CI: 0.32-2.43] p = 0.803), adjusted for syntax score, lesion calcification and ischemic symptoms. With angiographic-guidance, primary outcome events were more frequent with dual versus provisional stenting (21% vs. 10%; adjusted OR: 2.11 [95% CI: 1.04-4.30] p = 0.039). With intracoronary imaging, there were numerically fewer primary outcome events with dual versus provisional stenting (13% vs. 21%; adjusted OR: 0.56 [95% CI: 0.22-1.46] p = 0.220). CONCLUSIONS In EBC MAIN, the primary outcome did not differ with intracoronary imaging versus none. However, in patients with angiographic-guidance, outcomes were worse with a dual-stent than provisional strategy When intracoronary imaging was used, there was a trend toward better outcomes with the dual-stent than provisional strategy.
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Affiliation(s)
| | | | | | | | | | - Miroslaw Ferenc
- Universitats-Herzzentrum Bad Krozingem, Bad Krozingen, Germany
| | | | | | - Manuel Pan
- Department of Cardiology, Reina Sofia Hospital, (IMIBIC), University of Cordoba, Cordoba, Spain
| | | | | | | | - Evgeny Kretov
- Sibirsky Federal Biomedical Research Center Novosibrisk, Novosibirsk, Russia
| | | | | | | | - Francesco Burzotta
- Fondazione Policlinico Universitario A. Genelli, Universita Cattolica del Sacro Cuore, Rome, Italy
| | - James Cockburn
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK
| | | | - Goran Stankovic
- Departmenet of Cardiology, Clinical Centre of Serbia, University of Belgrade, Belgrade, Serbia
| | | | - Yves Louvard
- Institute Cardiovasculaire Paris Sud, Massy, France
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK
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Arunothayaraj S, Behan MW, Lefèvre T, Lassen JF, Chieffo A, Stankovic G, Burzotta F, Pan M, Ferenc M, Hovasse T, Spence MS, Brunel P, Cotton JM, Cockburn J, Carrié D, Baumbach A, Maeng M, Louvard Y, Hildick-Smith D. Stepwise provisional versus systematic culotte for stenting of true coronary bifurcation lesions: five-year follow-up of the multicentre randomised EBC TWO Trial. EUROINTERVENTION 2023; 19:EIJ-D-23-00211. [PMID: 37946522 PMCID: PMC10333921 DOI: 10.4244/eij-d-23-00211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 04/28/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The multicentre European Bifurcation Club Trial (EBC TWO) showed no significant differences in 12-month clinical outcomes between patients randomised to a provisional stenting strategy or systematic culotte stenting in non-left main true bifurcations. AIMS This study aimed to investigate the 5-year clinical results of the EBC TWO Trial. METHODS A total of 200 patients undergoing stent implantation for non-left main bifurcation lesions were recruited into EBC TWO. Inclusion criteria required a side branch diameter ≥2.5 mm and side branch lesion length >5 mm. Five-year follow-up was completed for 197 patients. The primary endpoint was the composite of all-cause mortality, myocardial infarction, or target vessel revascularisation. RESULTS The mean side branch stent diameter was 2.7±0.3 mm and mean side branch lesion length was 10.3±7.2 mm. At 5-year follow-up, the primary endpoint occurred in 18.4% of provisional and 23.7% of systematic culotte patients (hazard ratio [HR] 0.75, 95% confidence interval [CI]: 0.41-1.38). No significant differences were identified individually for all-cause mortality (7.8% vs 7.2%, HR 1.11, 95% CI: 0.40-3.05), myocardial infarction (8.7% vs 13.4%, HR 0.64, 95% CI: 0.27-1.50) or target vessel revascularisation (6.8% vs 9.3%, HR 1.12, 95% CI: 0.37-3.34). Stent thrombosis rates were also similar (1.9% vs 3.1%, HR 0.63, 95% CI: 0.11-3.75). There was no significant interaction between the extent of side branch disease and the primary outcome (p=0.34). CONCLUSIONS In large non-left main true bifurcation lesions, the use of a systematic culotte strategy showed no benefit over provisional stenting for the composite outcome of all-cause mortality, myocardial infarction, or target vessel revascularisation at 5 years. The stepwise provisional approach may be considered preferable for the majority of true coronary bifurcation lesions. CLINICALTRIALS gov: NCT01560455.
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Affiliation(s)
| | | | - Thierry Lefèvre
- Institut Cardiovasculaire Paris Sud, Hôpital privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Jens F Lassen
- Department of Cardiology B, Odense University Hospital, Odense, Denmark and University of Southern Denmark, Odense, Denmark
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Goran Stankovic
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Francesco Burzotta
- Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Manuel Pan
- Department of Cardiology, Reina Sofia Hospital, University of Cordoba, (IMIBIC), Cordoba, Spain
| | - Miroslaw Ferenc
- University Heart Center Freiburg - Bad Krozingen, Bad Krozingen, Germany
| | - Thomas Hovasse
- Institut Cardiovasculaire Paris Sud, Hôpital privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Mark S Spence
- Department of Cardiology, Royal Victoria Hospital, Belfast, UK
| | - Philippe Brunel
- Hôpital privé Dijon Bourgogne, Clinique Valmy, Dijon, France
| | - James M Cotton
- Royal Wolverhampton University Hospital NHS Trust, Wolverhampton, UK
| | - James Cockburn
- Sussex Cardiac Centre, University Hospitals Sussex NHS Trust, Brighton, UK
| | - Didier Carrié
- Department of Cardiology, Toulouse University, Rangueil Hospital, Toulouse, France
| | - Andreas Baumbach
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London and Barts Heart Centre, London, UK
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital & Aarhus University, Aarhus, Denmark
| | - Yves Louvard
- Institut Cardiovasculaire Paris Sud, Hôpital privé Jacques Cartier, Ramsay Santé, Massy, France
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Arunothayaraj S, Lassen JF, Clesham GJ, Spence MS, Koning R, Banning AP, Lindsay M, Christiansen EH, Egred M, Cockburn J, Mylotte D, Brunel P, Ferenc M, Hovasse T, Wlodarczak A, Pan M, Silvestri M, Erglis A, Kretov E, Chieffo A, Lefèvre T, Burzotta F, Darremont O, Stankovic G, Morice MC, Louvard Y, Hildick-Smith D. Impact of technique on bifurcation stent outcomes in the European Bifurcation Club Left Main Coronary Trial. Catheter Cardiovasc Interv 2023; 101:553-562. [PMID: 36709485 DOI: 10.1002/ccd.30575] [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: 07/08/2022] [Revised: 08/18/2022] [Accepted: 01/15/2023] [Indexed: 01/30/2023]
Abstract
BACKGROUND Techniques for provisional and dual-stent left main bifurcation stenting require optimization. AIM To identify technical variables influencing procedural outcomes and periprocedural myocardial infarction following left main bifurcation intervention. METHODS Procedural and outcome data were analyzed in 438 patients from the per-protocol cohort of the European Bifurcation Club Left Main Trial (EBC MAIN). These patients were randomized to the provisional strategy or a compatible dual-stent extension (T, T-and-protrude, or culotte). RESULTS Mean age was 71 years and 37.4% presented with an acute coronary syndrome. Transient reduction of side vessel thrombolysis in myocardial infarction flow occurred after initial stent placement in 5% of procedures but was not associated with periprocedural myocardial infarction. Failure to rewire a jailed vessel during any strategy was more common when jailed wires were not used (9.5% vs. 2.5%, odds ratio [OR]: 6.4, p = 0.002). In the provisional cohort, the use of the proximal optimization technique was associated with less subsequent side vessel intervention (23.3% vs. 41.9%, OR: 0.4, p = 0.048). Side vessel stenting was predominantly required for dissection, which occurred more often following side vessel preparation (15.3% vs. 4.4%, OR: 3.1, p = 0.040). Exclusive use of noncompliant balloons for kissing balloon inflation was associated with reduced need for side vessel intervention in provisional cases (20.5% vs. 38.5%, OR: 0.4, p = 0.013), and a reduced risk of periprocedural myocardial infarction across all strategies (2.9% vs. 7.7%, OR: 0.2, p = 0.020). CONCLUSION When performing provisional or compatible dual-stent left main bifurcation intervention, jailed wire use is associated with successful jailed vessel rewiring. Side vessel preparation in provisional patients is linked to increased side vessel dissection requiring stenting. Use of the proximal optimization technique may reduce the need for additional side vessel intervention, and noncompliant balloon use for kissing balloon inflation is associated with a reduction in both side vessel stenting and periprocedural myocardial infarction. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT02497014.
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Affiliation(s)
- Sandeep Arunothayaraj
- Department of Cardiology, Sussex Cardiac Centre, University Hospitals Sussex NHS Trust, Brighton, UK
| | | | - Gerald J Clesham
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, Essex, UK.,Cardiovascular System Block, MTRC, Anglia Ruskin School of Medicine, Chelmsford, Essex, UK
| | - Mark S Spence
- Department of Cardiology, Belfast Health and Social Care Trust, Belfast, UK
| | - René Koning
- Department of Cardiology, Clinique Saint Hilaire, Rouen, France
| | - Adrian P Banning
- Department of Cardiology, Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mitchell Lindsay
- Department of Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | | | - Mohaned Egred
- Department of Cardiology, Freeman Hospital & Newcastle University, Newcastle upon Tyne, UK
| | - James Cockburn
- Department of Cardiology, Sussex Cardiac Centre, University Hospitals Sussex NHS Trust, Brighton, UK
| | - Darren Mylotte
- Department of Cardiology, University Hospital and National University of Ireland, Galway, Ireland
| | - Philippe Brunel
- Interventional Cardiology Unit, Clinique de Fontaine, Dijon, France
| | - Miroslaw Ferenc
- Division of Cardiology and Angiology II, Universitäts-Herzzentrum Bad Krozingem, Bad Krozingen, Germany
| | - Thomas Hovasse
- Department of Cardiology, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France
| | - Adrian Wlodarczak
- Department of Cardiology, Poland Miedziowe Centrum Zdrowia Lubin, Lubin, Poland
| | - Manuel Pan
- Department of Cardiology, Reina Sofia Hospital, University of Cordoba (IMIBIC), Cordoba, Spain
| | - Marc Silvestri
- Department of Cardiology, GCS Axium, Rambot, Aix en Provence, France
| | - Andrejs Erglis
- Department of Cardiology, Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia
| | - Evgeny Kretov
- Interventional Cardiology Unit, Sibirskiy Fеdеrаl Biomedical Research Center Novosibirsk, Novosibirsk, Russia
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Thierry Lefèvre
- Department of Cardiology, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France
| | - Francesco Burzotta
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Olivier Darremont
- Department of Cardiology, Clinique Saint-Augustin-Elsan, Bordeaux, France
| | - Goran Stankovic
- Department of Cardiology, University Clinical Center of Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marie-Claude Morice
- Department of Cardiology, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France
| | - Yves Louvard
- Department of Cardiology, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France
| | - David Hildick-Smith
- Department of Cardiology, Sussex Cardiac Centre, University Hospitals Sussex NHS Trust, Brighton, UK
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Garot P, Brunel P, Dibie A, Morelle JF, Abdellaoui M, Levy R, Carrié D, Karsenty B, Robin C, Berland J, Copt S, Sadozai Slama S, Oldroyd K, Morice MC, Lipiecki J. Comparison of outcomes in patients with or without ARC-HBR criteria undergoing PCI with polymer-free biolimus coated stents: The BioFreedom France study. Catheter Cardiovasc Interv 2023; 101:60-71. [PMID: 36378683 DOI: 10.1002/ccd.30481] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/12/2022] [Accepted: 11/02/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The polymer-free biolimus coated stent (BioFreedom) was shown to be superior to bare metal stents in the LEADERS FREE randomized trial in high bleeding risk (HBR) patients treated with 1-month dual antiplatelet therapy (DAPT). However, there is limited outcome data with this device in an all-comers' population. METHODS We conducted a prospective single-arm study of patients undergoing percutaneous coronary intervention with the polymer-free biolimus coated stent in 25 centers in France with wide inclusion criteria including multivessel disease, complex lesions, and acute coronary syndromes. The primary endpoint was the incidence of target lesion failure (TLF), a composite of cardiac death or target-vessel myocardial infarction (MI) or clinically indicated target lesion revascularization (ci-TLR) at 1-year. The patient population was classified according to the presence (or not) of HBR criteria according to the recent ARC-HBR definition. RESULTS Between April 2019 and April 2020, 1497 patients were enrolled. TLF occurred in 101 (6.9%) patients, including cardiac death in 35 (2.4%), target vessel MI in 20 (1.4%) and ci-TLR in 65 (4.5%) of them. There were 491 HBR patients (32.8%) and 1006 non-HBR patients. The median duration of DAPT was 74 days in the HBR group versus 348 days in the non-HBR group (p < 0.0001). TLF occurred in 44 (9.2%) of the HBR group and in 57 (5.8%) of the non-HBR group (relative risk 1.62 [95% confidence interval: 1.10-2.41], p = 0015). Compared to the non-HBR group, HBR patients had higher rates of cardiac death (4.4% vs. 1.4%, p = 0.0005) and target vessel MI (2.9% vs. 0.6%, p = 0.0003), but similar rates of ci-TLR. BARC 3-5 bleeding occurred in 6.2% of the HBR group versus 1.4% of the non-HBR group (p < 0.0001). CONCLUSION In this multicenter all-comers study, HBR patients treated with a polymer-free biolimus coated stent had, compared to non-HBR patients, an increased risk of cardiac death and MI, and despite a shorter duration of DAPT, continued to have higher rates of BARC 3-5 bleeding.
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Affiliation(s)
- Philippe Garot
- Institut Cardiovasculaire Paris-Sud (ICPS), Hôpital Privé Jacques Cartier, Ramsay-Santé, Massy, France
| | - Philippe Brunel
- Institut Cardio-Vasculaire Dijon Bourgogne, Hôpital Privé Dijon Bourgogne, Ramsay-Santé, Dijon, France
| | - Alain Dibie
- Institut Mutualiste Montsouris, Paris, France
| | | | | | - Raphy Levy
- Hôpital Privé Saint-Martin, ELSAN, Bordeaux, France
| | | | | | | | | | - Samuel Copt
- Biosensors International, Morges, Switzerland
| | | | | | - Marie-Claude Morice
- Institut Cardiovasculaire Paris-Sud (ICPS), Hôpital Privé Jacques Cartier, Ramsay-Santé, Massy, France
- Centre Européen de Recherche Cardiovasculaire (CERC), Ramsay-Santé, Massy, France
| | - Janusz Lipiecki
- Clinique des Domes, Pole Santé République, ELSAN, Clermont-Ferrand, France
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Garot P, Brunel P, Dibie A, Morelle JF, Abdellaoui M, Levy R, Carrié D, Karsenty B, Robin C, Berland J, Copt S, Sadozai S, Olroyd K, Morice MC, Lipiecki J. 2 years outcomes in patients with or without ARC-HBR criteria undergoing PCI with polymer-free biolimus coated stents: The Biofreedom France Study. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Maznyczka A, Arunothayaraj S, Egred M, Banning A, Brunel P, Ferenc M, Hovasse T, Wlodarczak A, Pan M, Schmitz T, Silvestri M, Erglis A, Kretov E, Lassen J, Chieffo A, Lefevre T, Burzotta F, Cockburn J, Darremont O, Stankovic G, Morice MC, Louvard Y, Hildick-Smith D. TCT-54 Bifurcation Left Main Coronary Stenting With or Without Intracoronary Imaging: Outcomes From the European Bifurcation Club Left Main Trial. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.066] [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: 10/14/2022]
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Lipiecki J, Brunel P, Dibie A, Morelle J, Abdellauoi M, Levy R, Carrié D, Karsenty B, Robin C, Berland J, Maillard L, Pankert M, Depoli F, Delarche N, Boiffard E, Champagne S, Piot C, Morel O, Chapon P, Garot P. Biofreedom France registry: A prospective evaluation of clinical outcomes in real-world patients treated by coronary angioplasty with Biolimus A9 polymer-free Biofreedom stents. Archives of Cardiovascular Diseases Supplements 2022. [DOI: 10.1016/j.acvdsp.2021.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Eberli FR, Stoll HP, Urban P, Morice MC, Brunel P, Maillard L, Lipiecki J, Cook S, Berland J, Hovasse T, Carrie D, Schütte D, Slama SS, Garot P. Polymer-free Biolimus-A9 coated thin strut stents for patients at high bleeding risk 1-year results from the LEADERS FREE III study. Catheter Cardiovasc Interv 2021; 99:593-600. [PMID: 34241947 PMCID: PMC9544800 DOI: 10.1002/ccd.29869] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/14/2021] [Accepted: 07/01/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND In patients at high bleeding risk (HBR), the LEADERS FREE (LF) trial established the safety and efficacy of a polymer-free drug coated (Biolimus-A9) stainless steel stent (SS-DCS) with 30 days of dual antiplatelet treatment (DAPT). In LEADERS FREE III, we studied a new cobalt-chromium thin-strut stent (CoCr-DCS) in HBR patients. METHODS The CoCr-DCS shares all of the design features of the SS-DCS but has a CoCr stent platform with strut thickness of 84-88 μm. The primary safety endpoint was a composite of cardiac death, myocardial infarction (MI), and definite/probable stent thrombosis. The primary efficacy endpoint was clinically indicated target lesion revascularization. Outcomes were compared to those of LF (non-inferiority to SS-DCS for safety and superiority to SS-BMS for efficacy). Additional propensity-matched comparisons were performed to account for baseline differences. RESULTS We recruited 401 HBR patients using identical criteria to the LF trial. At 1 year, the primary safety endpoint was reached by 31/401 (8.0%) of patients treated with the CoCr-DCS versus 35/401 (8.9%) for the propensity-matched cohort (HR: 0.89, [0.55-1.44], p < 0.001 for non-inferiority, 0.62 for superiority). The efficacy endpoint was reached by 16/401 (4.2%) of CoCr-DCS patients versus 41/401 (10.6%) in the propensity-matched cohort (HR: 0.4 [0.2:0.7]) (p = 0.007 for superiority). There was no statistical difference between CoCr-DCS and SS-DCS in terms of efficacy (HR: 1.46 [0.68-3.15], p = 0.33). CONCLUSIONS The new thin-strut CoCr-DCS proved non-inferior to the SS-DCS for safety, and superior to the BMS for efficacy in HBR patients treated with 30 days of DAPT.
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Affiliation(s)
- Franz R Eberli
- Cardiology Department, Triemli Hospital, Zurich, Switzerland
| | - Hans-Peter Stoll
- Clinical Research, Biosensors Clinical Research, Morges, Switzerland
| | - Philip Urban
- Cardiovascular European Research Center (CERC), Massy, France
| | | | - Philippe Brunel
- Interventional Cardiology Unit, Clinique de Fontaine, Dijon, France
| | - Luc Maillard
- Department of Cardiology, GCS ES Axium-Rambot, Aix-en-Provence, France
| | - Janus Lipiecki
- Department of Cardiology, Pole Sante Republique, Clermont Ferrand, France
| | - Stephane Cook
- Department of Cardiology, University Hospital Fribourg, Fribourg, Switzerland
| | - Jacques Berland
- Department of Cardiology, Clinique Saint Hilaire, Rouen, France
| | - Thomas Hovasse
- Department of Cardiology, Institut Cardiovasculaire Paris-Sud (ICPS), Ramsay-Santé, Hôpital Jacques Cartier, Massy, France
| | - Didier Carrie
- Cardiology Department, Centre Hospitalier Universitaire Rangueil, Toulouse, France
| | - Diana Schütte
- Clinical Research, Biosensors Clinical Research, Morges, Switzerland
| | | | - Philippe Garot
- Ramsay-Santé, Hôpital Claude Galien, Institut Cardiovasculaire Paris-Sud (ICPS), Quincy, France
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Hildick-Smith D, Egred M, Banning A, Brunel P, Ferenc M, Hovasse T, Wlodarczak A, Pan M, Schmitz T, Silvestri M, Erglis A, Kretov E, Lassen JF, Chieffo A, Lefèvre T, Burzotta F, Cockburn J, Darremont O, Stankovic G, Morice MC, Louvard Y. The European bifurcation club Left Main Coronary Stent study: a randomized comparison of stepwise provisional vs. systematic dual stenting strategies (EBC MAIN). Eur Heart J 2021; 42:3829-3839. [PMID: 34002215 DOI: 10.1093/eurheartj/ehab283] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [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: 04/01/2021] [Revised: 04/17/2021] [Accepted: 05/09/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Patients with non-left-main coronary bifurcation lesions are usually best treated with a stepwise provisional approach. However, patients with true left main stem bifurcation lesions have been shown in one dedicated randomized study to benefit from systematic dual stent implantation. METHODS AND RESULTS Four hundred and sixty-seven patients with true left main stem bifurcation lesions requiring intervention were recruited to the EBC MAIN study in 11 European countries. Patients were aged 71 ± 10 years; 77% were male. Patients were randomly allocated to a stepwise layered provisional strategy (n = 230) or a systematic dual stent approach (n = 237). The primary endpoint (a composite of death, myocardial infarction, and target lesion revascularization at 12 months) occurred in 14.7% of the stepwise provisional group vs. 17.7% of the systematic dual stent group (hazard ratio 0.8, 95% confidence interval 0.5-1.3; P = 0.34). Secondary endpoints were death (3.0% vs. 4.2%, P = 0.48), myocardial infarction (10.0% vs. 10.1%, P = 0.91), target lesion revascularization (6.1% vs. 9.3%, P = 0.16), and stent thrombosis (1.7% vs. 1.3%, P = 0.90), respectively. Procedure time, X-ray dose and consumables favoured the stepwise provisional approach. Symptomatic improvement was excellent and equal in each group. CONCLUSIONS Among patients with true bifurcation left main stem stenosis requiring intervention, fewer major adverse cardiac events occurred with a stepwise layered provisional approach than with planned dual stenting, although the difference was not statistically significant. The stepwise provisional strategy should remain the default for distal left main stem bifurcation intervention. STUDY REGISTRATION http://clinicaltrials.gov NCT02497014.
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Affiliation(s)
- David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK
| | | | | | | | - Miroslaw Ferenc
- Universitäts-Herzzentrum Bad Krozingem, Bad Krozingen, Germany
| | | | | | - Manuel Pan
- Department of Cardiology, Reina Sofia Hospital, University of Cordoba, Cordoba, Spain
| | | | | | | | - Evgeny Kretov
- Sibirskiy Fеdеrаl Biomedical Research Center Novosibirsk, Novosibirsk, Russia
| | | | | | | | - Francesco Burzotta
- Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - James Cockburn
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK
| | - Olivier Darremont
- Clinique Saint-Augustin-Elsan, 114 Avenue d'Arès, Bordeaux 33200, France
| | - Goran Stankovic
- Department of Cardiology, Clinical Centre of Serbia, University of Belgrade, Belgrade, Serbia
| | | | - Yves Louvard
- Institute Cardiovasculaire Paris Sud, Massy, France
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Yao H, Farnier M, Tribouillard L, Chague F, Brunel P, Maza M, Brunet D, Rochette L, Bichat F, Cottin Y, Zeller M. Coronary lesion complexity in patients with heterozygous familial hypercholesterolemia hospitalized for acute myocardial infarction: data from the RICO survey. Lipids Health Dis 2021; 20:45. [PMID: 33947397 PMCID: PMC8094609 DOI: 10.1186/s12944-021-01467-z] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although patients with familial heterozygous hypercholesterolemia (FH) have a high risk of early myocardial infarction (MI), the coronary artery disease (CAD) burden in FH patients with acute MI remains to be investigated. METHODS The data for all consecutive patients hospitalized in 2012-2019 for an acute MI and who underwent coronary angiography were collected from a multicenter database (RICO database). FH (n = 120) was diagnosed using Dutch Lipid Clinic Network criteria (score ≥ 6). We compared the angiographic features of MI patients with and without FH (score 0-2) (n = 234) after matching for age, sex, and diabetes (1:2). RESULTS Although LDL-cholesterol was high (208 [174-239] mg/dl), less than half of FH patients had chronic statin treatment. When compared with non-FH patients, FH increased the extent of CAD (as assessed by SYNTAX score; P = 0.005), and was associated with more frequent multivessel disease (P = 0.004), multiple complex lesions (P = 0.022) and significant stenosis location on left circumflex and right coronary arteries. Moreover, FH patients had more multiple lesions, with an increased rate of bifurcation lesions or calcifications (P = 0.021 and P = 0.036, respectively). In multivariate analysis, LDL-cholesterol levels (OR 1.948; 95% CI 1.090-3.480, P = 0.024) remained an independent estimator of anatomical complexity of coronary lesions, in addition to age (OR 1.035; 95% CI 1.014-1.057, P = 0.001). CONCLUSIONS FH patients with acute MI had more severe CAD, characterized by complex anatomical features that are mainly dependent on the LDL-cholesterol burden. Our findings reinforce the need for more aggressive preventive strategies in these high-risk patients, and for intensive lipid-lowering therapy as secondary prevention.
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Affiliation(s)
- Hermann Yao
- Cardiology Department, University Hospital Center Dijon Bourgogne, Dijon, France
| | - Michel Farnier
- Cardiology Department, University Hospital Center Dijon Bourgogne, Dijon, France
| | - Laura Tribouillard
- Cardiology Department, University Hospital Center Dijon Bourgogne, Dijon, France
- PEC2, EA 7460, UFR Health Sciences, University of Bourgogne Franche Comté, Dijon, France
| | - Frédéric Chague
- Cardiology Department, University Hospital Center Dijon Bourgogne, Dijon, France
| | | | - Maud Maza
- Cardiology Department, University Hospital Center Dijon Bourgogne, Dijon, France
| | | | - Luc Rochette
- PEC2, EA 7460, UFR Health Sciences, University of Bourgogne Franche Comté, Dijon, France
| | - Florence Bichat
- Cardiology Department, University Hospital Center Dijon Bourgogne, Dijon, France
| | - Yves Cottin
- Cardiology Department, University Hospital Center Dijon Bourgogne, Dijon, France
| | - Marianne Zeller
- PEC2, EA 7460, UFR Health Sciences, University of Bourgogne Franche Comté, Dijon, France.
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12
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Silvain J, Lattuca B, Beygui F, Rangé G, Motovska Z, Dillinger JG, Boueri Z, Brunel P, Lhermusier T, Pouillot C, Larrieu-Ardilouze E, Boccara F, Labeque JN, Guedeney P, El Kasty M, Laredo M, Dumaine R, Ducrocq G, Collet JP, Cayla G, Blanchart K, Kala P, Vicaut E, Montalescot G. Ticagrelor versus clopidogrel in elective percutaneous coronary intervention (ALPHEUS): a randomised, open-label, phase 3b trial. Lancet 2020; 396:1737-1744. [PMID: 33202219 DOI: 10.1016/s0140-6736(20)32236-4] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 10/16/2020] [Accepted: 10/22/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI)-related myonecrosis is frequent and can affect the long-term prognosis of patients. To our knowledge, ticagrelor has not been evaluated in elective PCI and could reduce periprocedural ischaemic complications compared with clopidogrel, the currently recommended treatment. The aim of the ALPHEUS study was to examine if ticagrelor was superior to clopidogrel in reducing periprocedural myocardial necrosis in stable coronary patients undergoing high-risk elective PCI. METHODS The ALPHEUS study, a phase 3b, randomised, open-label trial, was done at 49 hospitals in France and Czech Republic. Patients with stable coronary artery disease were eligible for the study if they had an indication for PCI and at least one high-risk characteristic. Eligible patients were randomly assigned (1:1) to either ticagrelor (180 mg loading dose, 90 mg twice daily thereafter for 30 days) or clopidogrel (300-600 mg loading dose, 75 mg daily thereafter for 30 days) by use of an interactive web response system, and stratified by centre. The primary outcome was a composite of PCI-related type 4 (a or b) myocardial infarction or major myocardial injury and the primary safety outcome was major bleeding, both of which were evaluated within 48 h of PCI (or at hospital discharge if earlier). The primary analysis was based on all events that occurred in the intention-to-treat population. The trial was registered with ClinicalTrials.gov, NCT02617290. FINDINGS Between Jan 9, 2017, and May 28, 2020, 1910 patients were randomly assigned at 49 sites, 956 to the ticagrelor group and 954 to the clopidogrel group. 15 patients were excluded from the ticagrelor group and 12 from the clopidogrel group. At 48 h, the primary outcome was observed in 334 (35%) of 941 patients in the ticagrelor group and 341 (36%) of 942 patients in the clopidogrel group (odds ratio [OR] 0·97, 95% CI 0·80-1·17; p=0·75). The primary safety outcome did not differ between the two groups, but minor bleeding events were more frequently observed with ticagrelor than clopidogrel at 30 days (105 [11%] of 941 patients in the ticagrelor group vs 71 [8%] of 942 patients in the clopidogrel group; OR 1·54, 95% CI 1·12-2·11; p=0·0070). INTERPRETATION Ticagrelor was not superior to clopidogrel in reducing periprocedural myocardial necrosis after elective PCI and did not cause an increase in major bleeding, but did increase the rate of minor bleeding at 30 days. These results support the use of clopidogrel as the standard of care for elective PCI. FUNDING ACTION Study Group and AstraZeneca.
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Affiliation(s)
- Johanne Silvain
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Benoit Lattuca
- ACTION Study Group, Cardiology Department, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Farzin Beygui
- ACTION Study Group, Département de Cardiologie, CHU de Caen, Caen, France
| | - Grégoire Rangé
- Département de Cardiologie, CH de Chartres, Chartres, France
| | - Zuzana Motovska
- Third Faculty of Medicine, Charles University and Cardiocentre Kralovske Vinohrady, Prague, Czech Republic
| | - Jean-Guillaume Dillinger
- Université de Paris, Department of Cardiology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, INSERM U942, Paris, France
| | - Ziad Boueri
- ACTION Study Group, Département de Cardiologie, CH de Bastia, Bastia, France
| | - Philippe Brunel
- Hôpital Privé Dijon Bourgogne-Cardiologie Interventionelle GCIDB VALMY, Dijon, France
| | | | | | | | - Franck Boccara
- AP-HP, Hôpitaux de l'Est Parisien, Hôpital Saint-Antoine, Department of Cardiology, Sorbonne Université-INSERM UMR S_938, Centre de Recherche Saint-Antoine, Paris, France
| | | | - Paul Guedeney
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Mohamad El Kasty
- Département de Cardiologie, Grand Hôpital de l'Est Francilien site Marne-La-Vallée, Marne-la-Vallée, 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
| | - Grégory Ducrocq
- Université de Paris, Hôpital Bichat, AP-HP, French Alliance for Cardiovascular Trials (FACT), INSERM U1148, Paris, France
| | - Jean-Philippe Collet
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Guillaume Cayla
- ACTION Study Group, Cardiology Department, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Katrien Blanchart
- ACTION Study Group, Département de Cardiologie, CHU de Caen, Caen, France
| | - Petr Kala
- University Hospital Brno, Medical Faculty of Masaryk University Brno, Brno, Czech Republic
| | - Eric Vicaut
- ACTION Study Group, Unité de Recherche Clinique, Hôpital Fernand Widal (AP-HP), Paris, France; Statistique, Analyse et Modélisation Multidisciplinaire EA 4543, Université Paris 1 Panthéon Sorbonne, Paris, France
| | - Gilles Montalescot
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France.
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Yao H, Farnier M, Salignon-Vernay C, Chague F, Brunel P, Maza M, Brunet D, Bichat F, Beer J, Cottin Y, Zeller M. Coronary lesion complexity in patients with familial hypercholesterolemia hospitalized for an acute myocardial infarction: data from the French RICO Survey. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1495] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/13/2022] Open
Abstract
Abstract
Background
Although patients with familial heterozygous hypercholesterolemia (FH) are at high risk of early myocardial infarction (MI), coronary artery disease (CAD) burden of FH patients with acute MI remains to be investigated.
Methods
All consecutive patients hospitalized for an acute MI in a multicenter database (RICO) from 2012–2017 who underwent coronary angiography were considered. FH (n=86) was diagnosed using Dutch Lipid Clinic Network criteria (score ≥6). The angiographic features of FH patients were compared with patients without FH (score 0–2) (n=166), after matching for age, sex and diabetes (1:2).
Results
When compared with patients without FH, patients with FH had higher prevalence of personal and familial history of CAD (17 vs 5%, and 74 vs 5%, p=0.002 and p<0.001, respectively), and hypertension (54 vs 36%, p=0.006). Chronic statin treatment was used in only 45% of FH patients. At coronary angiography, FH had increased extent of CAD (SYNTAX score 11 (4–21) vs 8 (3–16), p=0.049) and multivessel disease (58% vs 43%, p=0.021). Significant stenosis was more frequent in left and right marginal coronary arteries. FH patients showed a trend toward more complex lesions, with less thrombus (28 vs 39%, p=0.076), but a 2 times higher rate of bifurcation lesions and calcifications (23 vs 12% and 20 vs 10%, p=0.021 and p=0.036).
Conclusions
This study addressing the coronary lesions features of FH patients with acute MI shows that FH patients had more severe CAD burden, and were characterized by complex anatomy features.
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): ARS Bourgogne Franche Comté, CHU Dijon Bourgogne
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Affiliation(s)
- H Yao
- University Hospital Center Dijon Bourgogne, Cardiology Department, Dijon, France
| | - M Farnier
- University Hospital Center Dijon Bourgogne, Cardiology Department, Dijon, France
| | - C Salignon-Vernay
- University Hospital Center Dijon Bourgogne, Cardiology Department, Dijon, France
| | - F Chague
- University Hospital Center Dijon Bourgogne, Cardiology Department, Dijon, France
| | - P Brunel
- Dijon Bourgogne Private Hospital, Cardiology Department, Dijon, France
| | - M Maza
- University Hospital Center Dijon Bourgogne, Cardiology Department, Dijon, France
| | - D Brunet
- Dijon Bourgogne Private Hospital, Cardiology Department, Dijon, France
| | - F Bichat
- University Hospital Center Dijon Bourgogne, Cardiology Department, Dijon, France
| | - J.C Beer
- University Hospital Center Dijon Bourgogne, Cardiology Department, Dijon, France
| | - Y Cottin
- University Hospital Center Dijon Bourgogne, Cardiology Department, Dijon, France
| | - M Zeller
- University Bourgogne Franche Comte, Dijon, France
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14
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Jiménez Díaz VA, Hovasse T, Íñiguez A, Copt S, Byrne J, Brunel P, Morice MC, Abizaid A, Tespilli M, Walters D, Ortiz Sáez A, Bastos Fernández G, Stoll HP, Urban P. Impacto del acceso vascular en el pronóstico tras la angioplastia coronaria en pacientes con alto riesgo hemorrágico: subanálisis predefinido del estudio LEADERS FREE. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2019.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Silvain J, Cayla G, Beygui F, Range G, Lattuca B, Collet JP, Dillinger JG, Boueri Z, Brunel P, Pouillot C, Boccara F, Christiaens L, Labeque JN, Lhermusier T, Georges JL, Bellemain-Appaix A, Le Breton H, Hauguel-Moreau M, Saint-Etienne C, Caussin C, Jourda F, Motovska Z, Guedeney P, El Kasty M, Laredo M, Dumaine R, Ducrocq G, Vicaut E, Montalescot G. Blunting periprocedural myocardial necrosis: Rationale and design of the randomized ALPHEUS study. Am Heart J 2020; 225:27-37. [PMID: 32473356 DOI: 10.1016/j.ahj.2020.04.017] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 04/23/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Clopidogrel associated with aspirin is the recommended treatment for patients undergoing elective percutaneous coronary intervention (PCI). Although severe PCI-related events are rare, evidence suggests that PCI-related myocardial infarction and myocardial injury are frequent complications that can impact the clinical prognosis of the patients. Antiplatelet therapy with a potent P2Y12 receptor inhibitor such as ticagrelor may reduce periprocedural ischemic complications while maintaining a similar safety profile as compared with conventional dual antiplatelet therapy by aspirin and clopidogrel in this setting. METHODS Assessment of Loading with the P2Y12 inhibitor ticagrelor or clopidogrel to Halt ischemic Events in patients Undergoing elective coronary Stenting (ALPHEUS) (NCT02617290) is an international, multicenter, randomized, parallel-group, open-label study in patients with stable coronary artery disease who are planned for an elective PCI. In total, 1,900 patients will be randomized before a planned PCI to a loading dose of ticagrelor 180 mg or a loading dose of clopidogrel (300 or 600 mg) in addition to aspirin. Patients will then receive a dual antiplatelet therapy with aspirin and ticagrelor 90 mg twice daily or clopidogrel 75 mg once daily for 30 days. The primary ischemic end point is PCI-related myocardial infarction (myocardial infarction type 4a or 4b) or major myocardial injury within 48 hours (or at hospital discharge if earlier) after elective PCI/stent. Safety will be evaluated by major bleeding events (Bleeding Academic Research Consortium type 3 or 5) at 48 hours (or discharge if it occurs earlier). CONCLUSION ALPHEUS is the first properly sized trial comparing ticagrelor to clopidogrel in the setting of elective PCI and is especially designed to show a reduction in periprocedural events, a surrogate end point for mortality.
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Affiliation(s)
- Johanne Silvain
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Guillaume Cayla
- Cardiology department, Nîmes university Hospital, Montpellier University, ACTION study group, Nîmes, France
| | - Farzin Beygui
- CHU de Caen-Département de Cardiologie; Caen, France
| | - Grégoire Range
- CH de Chartres-Département de Cardiologie, Chartes, France
| | - Benoit Lattuca
- Cardiology department, Nîmes university Hospital, Montpellier University, ACTION study group, Nîmes, France
| | - Jean-Philippe Collet
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Jean-Guillaume Dillinger
- Department of Cardiology, Inserm U942, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France
| | - Ziad Boueri
- CH de Bastia-Département de Cardiologie, Bastia, France
| | - Philippe Brunel
- Hôpital Privé Dijon Bourgogne-Cardiologie Interventionelle GCIDB VALMY, Dijon, France
| | - Christophe Pouillot
- Clinique Sainte Clotilde, La Réunion-Département de Cardiologie, La Réunion, France
| | - Franck Boccara
- AP-HP, Hôpitaux de l'Est Parisien, Hôpital Saint-Antoine, Department of Cardiology, Sorbonne Université-INSERM UMR S_938, Centre de Recherche Saint-Antoine, Paris, France
| | | | | | | | - Jean-Louis Georges
- CH de Versailles-Service de Cardiologie, Hôpital A. Mignot, Le Chesnay, France
| | - Anne Bellemain-Appaix
- CH d'Antibes Juan-Les-Pins-Département de Cardiologie, Antibes Juan-Les-Pins, France
| | | | - Marie Hauguel-Moreau
- CHU Ambroise Paré (APHP), Université Versailles-Saint Quentin, ACTION study Group, INSERM-U1018 CESP, Boulogne, France-Service de Cardiologie
| | | | - Christophe Caussin
- Institut Mutualiste Montsouris-Département de Cardiologie, Paris, France
| | | | - Zuzana Motovska
- 3rd Faculty of Medicine, Charles University and Cardiocentre Kralovske Vinohrady, Prague, Czech Republic
| | - Paul Guedeney
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Mohamad El Kasty
- Grand Hôpital de l'Est Francilien site Marne-La-Vallée - Département de Cardiologie, Marne La Vallée, France
| | - Mikael Laredo
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Raphaëlle Dumaine
- Les Grands Prés Cardiac Rehabilitation center, Villeneuve St Denis, France
| | - Grégory Ducrocq
- FACT (French Alliance for Cardiovascular Trials), DHU FIRE, Hôpital Bichat, AP-HP, Université de Paris, Inserm U-1148, Paris, France
| | - Eric Vicaut
- Unité de Recherche Clinique, ACTION Study Group, Hôpital Fernand Widal (AP-HP), Paris, France; SAMM - Statistique, Analyse et Modélisation Multidisciplinaire EA 4543, Université Paris 1 Panthéon Sorbonne, Paris, France
| | - Gilles Montalescot
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France.
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Putot A, Chagué F, Manckoundia P, Brunel P, Beer JC, Cottin Y, Zeller M. Post-Infectious Myocardial Infarction: Does Percutaneous Coronary Intervention Improve Outcomes? A Propensity Score-Matched Analysis. J Clin Med 2020; 9:E1608. [PMID: 32466424 PMCID: PMC7355802 DOI: 10.3390/jcm9061608] [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: 04/16/2020] [Revised: 05/23/2020] [Accepted: 05/25/2020] [Indexed: 02/06/2023] Open
Abstract
Acute infection is a frequent trigger of myocardial infarction (MI). However, whether percutaneous coronary intervention (PCI) improves post-infectious MI prognosis is a major but unsolved issue. In this prospective multicenter study from coronary care units, we performed propensity score-matched analysis to compare outcomes in patients with and without PCI for post-infectious MI with angiography-proven significant coronary stenosis (>50%). Among 4573 consecutive MI patients, 476 patients (10%) had a concurrent diagnosis of acute infection at admission, of whom 375 underwent coronary angiography and 321 patients had significant stenosis. Among the 321 patients, 195 underwent PCI. Before the matching procedure, patients without PCI had a similar age and sex ratio but a higher rate of risk factors (hypertension, diabetes, chronic renal failure, and prior coronary artery disease), pneumonia, and SYNTAX score than patients without PCI. After propensity score matching, neither in-hospital mortality (13% with PCI vs. 8% without PCI; p = 0.4) nor one-year mortality (24% with PCI vs. 19% without PCI, p = 0.5) significantly differed between the two groups. In this first prospective cohort of post-infectious MI in coronary care units, PCI might not improve short- and long-term prognosis in patients with angiography-proven significant coronary stenosis. If confirmed, these results do not argue for systematic invasive procedures after post-infectious MI.
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Affiliation(s)
- Alain Putot
- Geriatrics Internal Medicine Department, University Hospital of Dijon Bourgogne, 21079 Dijon CEDEX, France;
- Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2), EA 7460, University of Burgundy and Franche Comté, 21079 Dijon CEDEX, France; (F.C.); (Y.C.); (M.Z.)
| | - Frédéric Chagué
- Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2), EA 7460, University of Burgundy and Franche Comté, 21079 Dijon CEDEX, France; (F.C.); (Y.C.); (M.Z.)
- Cardiology Department, University Hospital of Dijon Bourgogne, 21079 Dijon CEDEX, France;
| | - Patrick Manckoundia
- Geriatrics Internal Medicine Department, University Hospital of Dijon Bourgogne, 21079 Dijon CEDEX, France;
| | - Philippe Brunel
- Cardiology Department, Hopital privé Dijon Bourgogne, 21000 Dijon, France;
| | - Jean-Claude Beer
- Cardiology Department, University Hospital of Dijon Bourgogne, 21079 Dijon CEDEX, France;
| | - Yves Cottin
- Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2), EA 7460, University of Burgundy and Franche Comté, 21079 Dijon CEDEX, France; (F.C.); (Y.C.); (M.Z.)
- Cardiology Department, University Hospital of Dijon Bourgogne, 21079 Dijon CEDEX, France;
| | - Marianne Zeller
- Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2), EA 7460, University of Burgundy and Franche Comté, 21079 Dijon CEDEX, France; (F.C.); (Y.C.); (M.Z.)
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Yao H, Farnier M, Salignon-Vernay C, Chagué F, Brunel P, Maza M, Brunet D, Bichat F, Beer J, Cottin Y, Zeller M. Coronary lesion complexity in patients with familial hypercholesterolemia hospitalized for an acute myocardial infarction: Data from the French RICO Survey. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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18
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Tomaniak M, Chichareon P, Takahashi K, Kogame N, Modolo R, Chang CC, Spitzer E, Neumann FJ, Plante S, Hernández Antolin R, Jambrik Z, Gelev V, Brunel P, Konteva M, Beygui F, Morelle JF, Filipiak KJ, van Geuns RJ, Soliman O, Tijssen J, Rademaker-Havinga T, Storey RF, Hamm C, Steg PG, Windecker S, Onuma Y, Valgimigli M, Serruys PW. Impact of chronic obstructive pulmonary disease and dyspnoea on clinical outcomes in ticagrelor treated patients undergoing percutaneous coronary intervention in the randomized GLOBAL LEADERS trial. European Heart Journal - Cardiovascular Pharmacotherapy 2019; 6:222-230. [DOI: 10.1093/ehjcvp/pvz052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 08/30/2019] [Accepted: 12/09/2019] [Indexed: 12/21/2022]
Abstract
Abstract
Aims
To evaluate long-term safety and efficacy of ticagrelor monotherapy in patients undergoing percutaneous coronary interventions (PCIs) in relation to chronic obstructive pulmonary disease (COPD) at baseline and the occurrence of dyspnoea reported as adverse event (AE) that may lead to treatment non-adherence.
Methods and results
This is a non-prespecified, post hoc analysis of the randomized GLOBAL LEADERS trial (n = 15 991), comparing the experimental strategy of 23-month ticagrelor monotherapy following 1-month dual antiplatelet therapy (DAPT) after PCI with the reference strategy of 12-month DAPT followed by 12-month aspirin monotherapy. Impact of COPD and dyspnoea AE (as a time-dependent covariate) on clinical outcomes was evaluated up to 2 years. The primary endpoint was a 2-year all-cause mortality or non-fatal, centrally adjudicated, new Q-wave myocardial infarction. The presence of COPD (n = 832) was the strongest clinical predictor of 2-year all-cause mortality after PCI [hazard ratio (HR) 2.84; 95% confidence interval (CI) 2.21–3.66; P adjusted = 0.001] in this cohort (n = 15 991). No differential treatment effects on 2-year clinical outcomes were found in patients with and without COPD (primary endpoint: HR 0.88; 95% CI 0.58–1.35; P = 0.562; P int = 0.952). Overall, at 2 years dyspnoea was reported as an AE in 2101 patients, more frequently among COPD patients, irrespective of treatment allocation (27.2% in experimental arm vs. 14.5% in reference arm, P = 0.001). Its occurrence was not associated with a higher rate of the primary endpoint (P adjusted = 0.640) in the experimental vs. the reference arm.
Conclusion
In this exploratory analysis, COPD negatively impacted long-term prognosis after PCI. Despite higher incidence of dyspnoea in the experimental arm, in particular among COPD patients, the safety of the experimental treatment strategy appeared not to be affected.
Clinical trial registration unique identifier
NCT01813435.
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Affiliation(s)
- Mariusz Tomaniak
- Department of Cardiology, Erasmus Medical Centre, Erasmus University, Rotterdam, The Netherlands
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Ply Chichareon
- Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | | | - Norihiro Kogame
- Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Rodrigo Modolo
- Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Internal Medicine, Cardiology Division, University of Campinas (UNICAMP), Campinas, Brazil
| | - Chun Chin Chang
- Department of Cardiology, Erasmus Medical Centre, Erasmus University, Rotterdam, The Netherlands
| | - Ernest Spitzer
- Department of Cardiology, Erasmus Medical Centre, Erasmus University, Rotterdam, The Netherlands
- Cardialysis Core Laboratories and Clinical Trial Management, Rotterdam, The Netherlands
| | | | - Sylvain Plante
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | | | - Zoltan Jambrik
- Békés Megyei Pándy Kálmán Kórház County Hospital, Gyula, Hungary
| | | | - Philippe Brunel
- Cardiologie Clinique Valmy Hopital Prive Dijon Bourgogne HPDB Dijon, Dijon, France
| | | | | | | | | | - Robert-Jan van Geuns
- Department of Cardiology, Erasmus Medical Centre, Erasmus University, Rotterdam, The Netherlands
- Department of Cardiology, Radboud UMC, Nijmegen, The Netherlands
| | - Osama Soliman
- Department of Cardiology, National University of Ireland Galway, Galway, Ireland
| | - Jan Tijssen
- Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Cardialysis Core Laboratories and Clinical Trial Management, Rotterdam, The Netherlands
| | | | - Robert F Storey
- Department of Cardiovascular Science, University of Sheffield, Sheffield, UK
| | | | - Philippe Gabriel Steg
- FACT (French Alliance for Cardiovascular Trials), Université Paris Diderot, Hôpital Bichat, Assistance Publique—Hôpitaux de Paris, INSERM U-1148, Paris, France
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland Galway, Galway, Ireland
| | - Marco Valgimigli
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland Galway, Galway, Ireland
- NHLI, Imperial College London, London, UK
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Auffret V, Cottin Y, Leurent G, Gilard M, Beer JC, Zabalawi A, Chagué F, Filippi E, Brunet D, Hacot JP, Brunel P, Mejri M, Lorgis L, Rouault G, Druelles P, Cornily JC, Didier R, Bot E, Boulanger B, Coudert I, Loirat A, Bedossa M, Boulmier D, Maza M, Le Guellec M, Puri R, Zeller M, Le Breton H. Predicting the development of in-hospital cardiogenic shock in patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention: the ORBI risk score. Eur Heart J 2019; 39:2090-2102. [PMID: 29554243 DOI: 10.1093/eurheartj/ehy127] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [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] [Received: 10/28/2017] [Accepted: 02/23/2018] [Indexed: 01/12/2023] Open
Abstract
Aims To derive and validate a readily useable risk score to identify patients at high-risk of in-hospital ST-segment elevation myocardial infarction (STEMI)-related cardiogenic shock (CS). Methods and results In all, 6838 patients without CS on admission and treated by primary percutaneous coronary intervention (pPCI), included in the Observatoire Régional Breton sur l'Infarctus (ORBI), served as a derivation cohort, and 2208 patients included in the obseRvatoire des Infarctus de Côte-d'Or (RICO) constituted the external validation cohort. Stepwise multivariable logistic regression was used to build the score. Eleven variables were independently associated with the development of in-hospital CS: age >70 years, prior stroke/transient ischaemic attack, cardiac arrest upon admission, anterior STEMI, first medical contact-to-pPCI delay >90 min, Killip class, heart rate >90/min, a combination of systolic blood pressure <125 mmHg and pulse pressure <45 mmHg, glycaemia >10 mmol/L, culprit lesion of the left main coronary artery, and post-pPCI thrombolysis in myocardial infarction flow grade <3. The score derived from these variables allowed the classification of patients into four risk categories: low (0-7), low-to-intermediate (8-10), intermediate-to-high (11-12), and high (≥13). Observed in-hospital CS rates were 1.3%, 6.6%, 11.7%, and 31.8%, across the four risk categories, respectively. Validation in the RICO cohort demonstrated in-hospital CS rates of 3.1% (score 0-7), 10.6% (score 8-10), 18.1% (score 11-12), and 34.1% (score ≥13). The score demonstrated high discrimination (c-statistic of 0.84 in the derivation cohort, 0.80 in the validation cohort) and adequate calibration in both cohorts. Conclusion The ORBI risk score provides a readily useable and efficient tool to identify patients at high-risk of developing CS during hospitalization following STEMI, which may aid in further risk-stratification and thus potentially facilitate pre-emptive clinical decision making.
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Affiliation(s)
- Vincent Auffret
- Department of Cardiology and Vascular Diseases, Pontchaillou University Hospital, Center for Clinical Investigation 804, University of Rennes 1, Signal and Image Treatment laboratory (LTSI), National Institute of Health and Medical Research U1099, Rennes, France
| | - Yves Cottin
- Department of Cardiology, University Hospital of Dijon-Burgundy, 5 boulevard Jeanne d'Arc, 21000 Dijon, France
| | - Guillaume Leurent
- Department of Cardiology and Vascular Diseases, Pontchaillou University Hospital, Center for Clinical Investigation 804, University of Rennes 1, Signal and Image Treatment laboratory (LTSI), National Institute of Health and Medical Research U1099, Rennes, France
| | - Martine Gilard
- Department of Cardiology, La Cavale Blanche University Hospital, Optimization of physiological Regulations, Science and Technical Training and ResearchUnit, Boulevard Tanguy Prigent, 29200 Brest, France
| | - Jean-Claude Beer
- Department of Cardiology, University Hospital of Dijon-Burgundy, 5 boulevard Jeanne d'Arc, 21000 Dijon, France
| | - Amer Zabalawi
- Department of Cardiology, General Hospital Yves Le Foll, 10 Rue Marcel Proust, 22000 St-Brieuc, France
| | - Frédéric Chagué
- Department of Cardiology, University Hospital of Dijon-Burgundy, 5 boulevard Jeanne d'Arc, 21000 Dijon, France
| | - Emanuelle Filippi
- Department of Cardiology, General Hospital of Atlantic Brittany, 20 Boulevard du Général Maurice Guillaudot, 56017 Vannes, France
| | - Damien Brunet
- Department of Cardiology, Clinic of Fontaine, 1 Rue des Creots, 21121 Fontaine-lès-Dijon, France
| | - Jean-Philippe Hacot
- Department of Cardiology, General Hospital of South Brittany, 5 Avenue Choiseul, 56322 Lorient, France
| | - Philippe Brunel
- Department of Cardiology, Clinic of Fontaine, 1 Rue des Creots, 21121 Fontaine-lès-Dijon, France
| | - Mourad Mejri
- Department of Cardiology, General Hospital Broussais, St-Malo, 1 Rue de la Marne, 35403 France
| | - Luc Lorgis
- Department of Cardiology, University Hospital of Dijon-Burgundy, 5 boulevard Jeanne d'Arc, 21000 Dijon, France
| | - Gilles Rouault
- Department of Cardiology, General Hospital René Théophile Laennec, 14 bis Avenue Yves Thépot, 29107 Quimper, France
| | - Philippes Druelles
- Department of Cardiology, Clinic St-Laurent, 320 Avenue Général George S. Patton, 35700 Rennes, France
| | - Jean-Christophe Cornily
- Department of Cardiology, Clinic Keraudren-Grand Large, 375 Rue Ernestine de Trémaudan, 29220 Brest, France
| | - Romain Didier
- Department of Cardiology, La Cavale Blanche University Hospital, Optimization of physiological Regulations, Science and Technical Training and ResearchUnit, Boulevard Tanguy Prigent, 29200 Brest, France
| | - Emilie Bot
- Department of Medical Emergency, Pontchaillou University Hospital, 2 Rue Henri Le Guilloux, 35033 Rennes, France
| | - Bertrand Boulanger
- Department of Medical Emergency, General Hospital of Atlantic Brittany, 20 Boulevard du Général Maurice Guillaudot, 56017 Vannes, France
| | - Isabelle Coudert
- Department of Medical Emergency, General Hospital Yves Le Foll, 10 Rue Marcel Proust, 22000 St-Brieuc, France
| | - Aurélie Loirat
- Department of Cardiology and Vascular Diseases, Pontchaillou University Hospital, Center for Clinical Investigation 804, University of Rennes 1, Signal and Image Treatment laboratory (LTSI), National Institute of Health and Medical Research U1099, Rennes, France
| | - Marc Bedossa
- Department of Cardiology and Vascular Diseases, Pontchaillou University Hospital, Center for Clinical Investigation 804, University of Rennes 1, Signal and Image Treatment laboratory (LTSI), National Institute of Health and Medical Research U1099, Rennes, France
| | - Dominique Boulmier
- Department of Cardiology and Vascular Diseases, Pontchaillou University Hospital, Center for Clinical Investigation 804, University of Rennes 1, Signal and Image Treatment laboratory (LTSI), National Institute of Health and Medical Research U1099, Rennes, France
| | - Maud Maza
- Department of Cardiology, University Hospital of Dijon-Burgundy, 5 boulevard Jeanne d'Arc, 21000 Dijon, France
| | - Marielle Le Guellec
- Department of Cardiology and Vascular Diseases, Pontchaillou University Hospital, Center for Clinical Investigation 804, University of Rennes 1, Signal and Image Treatment laboratory (LTSI), National Institute of Health and Medical Research U1099, Rennes, France
| | - Rishi Puri
- Department of Cardiology and Vascular Diseases, Pontchaillou University Hospital, Center for Clinical Investigation 804, University of Rennes 1, Signal and Image Treatment laboratory (LTSI), National Institute of Health and Medical Research U1099, Rennes, France
| | - Marianne Zeller
- EA 7460 Cerebro- and Cardiovascular Physiopathology and Epidemiology, University of Bourgogne-Franche Comté, 7 Boulevard Jeanne d'Arc, 21000 Dijon, France
| | - Hervé Le Breton
- Department of Cardiology and Vascular Diseases, Pontchaillou University Hospital, Center for Clinical Investigation 804, University of Rennes 1, Signal and Image Treatment laboratory (LTSI), National Institute of Health and Medical Research U1099, Rennes, France
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20
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Tomaniak M, Chichareon P, Modolo R, Plante S, Brunel P, Beygui F, Van Geuns RJ, Storey R, Hamm C, Steg PG, Vranckx P, Windecker S, Onuma Y, Valgimigli M, Serruys PW. P6411Dyspnea in ticagrelor treated patients in the all-comer randomized GLOBAL LEADERS study and its association with clinical outcomes. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1005] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] Open
Abstract
Abstract
Background
Dyspnea represents a drug adverse effect reported with a higher frequency for ticagrelor, as compared with other P2Y12 antagonists. The impact of dyspnea on clinical outcomes has not been yet evaluated in the context of aspirin-free therapies after percutaneous coronary intervention (PCI).
Purpose
The study aimed to evaluate the incidence of dyspnea and its associations with demographic characteristics and clinical outcomes in patients undergoing PCI treated with ticagrelor either as monotherapy or as a part of a dual antiplatelet therapy (DAPT) in the GLOBAL LEADERS cohort.
Methods
This is a sub-analysis of the randomized all-comer GLOBAL LEADERS study (n=15991), comparing the experimental strategy of ticagrelor monotherapy following one-month DAPT after PCI with the reference strategy of 12-month DAPT followed by 12-month aspirin monotherapy. The incidence of dyspnea reported as adverse event (AE) and its relation to demographic characteristics and 2-year clinical outcomes was evaluated (intention-to-treat analysis). Multivariable Cox proportional hazards models were performed, including randomized treatment and incidence of first dyspnea event as a time-dependent covariate. The primary endpoint was a composite of 2-year all-cause mortality or centrally adjudicated, new Q-wave myocardial infarction (MI). Patient-oriented clinical endpoints (POCE) comprised all-cause death, any stroke, MI or revascularization, whereas net adverse clinical events (NACE) included POCE and Bleeding Academic Research Consortium (BARC)-defined bleeding type 3 or 5.
Results
Overall, dyspnea was reported as an AE in 2101 patients (13.2%) up to two years of follow-up, with a higher frequency in the experimental arm (16.4%) as compared with the reference group (11.1%) (hazard ratio [HR]1.70, 95% confidence interval [CI] 1.56–1.86, p=0.001).
Predictors of dyspnea AE up to 2 years by multivariate analyses were: chronic obstructive pulmonary disease (HR1.71, 95% CI 1.56–1.87, p=0.001), female gender (HR1.31, 95% CI 1.18–1.44, p=0.001), hypertension (HR1.31, 95% CI 1.19–1.44, p=0.001, prior coronary artery bypass grafting (HR1.30, 95% CI 1.10–1.54, p=0.003), left ventricle ejection fraction below 40% (HR1.22, 95% CI 1.04–1.42, p=0.012), presentation with acute coronary syndrome (HR1.19, 95% CI 1.09–1.29, p=0.001) and body mass index (≥27kg/m2) (HR1.17, 95% CI 1.08–1.28, p=0.001).
In patients who reported dyspnea AE, the two-year rates of the efficacy and safety endpoints in the experimental and reference arm were: for the primary endpoint 3.4% vs. 4.3% (p adjusted=0.807), for POCE 15.8% vs. 17.6% (p adjusted=0.218), for NACE 17.2% vs. 19.6% (p adjusted=0.082), for BARC 3 or 5 type bleeding 17.2% vs. 19.6% (p adjusted=0.082), respectively.
Conclusions
The occurrence of dyspnea AE up to two years after PCI appeared not to affect the safety of the experimental treatment strategy of 23-month ticagrelor monotherapy following one-month DAPT after PCI.
Acknowledgement/Funding
Study founded by European Cardiovascular Research Institute, which received unrestricted grants from Biosensors Int., AstraZeneca, Medicines Company.
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Affiliation(s)
- M Tomaniak
- Erasmus Medical Centre, Rotterdam, Medical University of Warsaw, Warsaw, Poland
| | - P Chichareon
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands (The)
| | - R Modolo
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands (The)
| | - S Plante
- Southlake Regional Health Centre, Newmarket, Canada
| | - P Brunel
- Clinique de Fontaine, Paris, France
| | | | - R.-J Van Geuns
- Erasmus Medical Centre, Rotterdam, Radboud UMC, Nijmegen, Netherlands (The)
| | - R Storey
- University of Sheffield, Sheffield, United Kingdom
| | - C Hamm
- University of Giessen, Giessen, Germany
| | - P G Steg
- FACT (French Alliance for Cardiovascular Trials), Université Paris Diderot, Hôpital Bichat, Paris, France
| | - P Vranckx
- Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, Belgium
| | - S Windecker
- Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Y Onuma
- Erasmus Medical Centre, ThoraxCenter, Rotterdam, Netherlands (The)
| | - M Valgimigli
- Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - P W Serruys
- NHLI, Imperial College London, London, United Kingdom
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21
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Jiménez Díaz VA, Hovasse T, Íñiguez A, Copt S, Byrne J, Brunel P, Morice MC, Abizaid A, Tespilli M, Walters D, Ortiz Sáez A, Bastos Fernández G, Stoll HP, Urban P. Impact of vascular access on outcome after PCI in patients at high bleeding risk: a pre-specified sub-analysis of the LEADERS FREE trial. ACTA ACUST UNITED AC 2019; 73:536-545. [PMID: 31563471 DOI: 10.1016/j.rec.2019.07.010] [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: 02/05/2019] [Accepted: 07/22/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION AND OBJECTIVES The prognostic impact of bleeding in high bleeding risk (HBR) patients depending on the location of bleeding and prognosis in nonaccess site bleeding is unknown. We aimed to assess the impact of vascular access site on bleeding complications after percutaneous coronary interventions for HBR patients at 30-day and 2-year follow-up. METHODS The LEADERS FREE trial included 2432 HBR PCI patients. A Biolimus A9 drug-coated stent was superior to a bare-metal stent for safety and efficacy. This is a predefined sub-analysis of the LEADERS FREE trial. RESULTS Transradial access (TRA) was used in 1454 patients (59.8%) and transfemoral access (TFA) in 978 (40.2%), according to operator preference. The safety and benefits of drug-coated stents over bare-metal stents were independent of vascular access. At 30 days and 2 years, major bleeding had occurred in 2.4% and 7.5% of TRA patients and 4.6% and 10.9% of TFA patients (P=.003), respectively. Most of these events in both groups (2.1% and 7.0% for TRA; 3.2% and 9.4% for TFA, respectively) were nonaccess site-related. TRA was associated with a significant reduction in adjusted rates of major bleeding both at 30 days (HR, 1.98; 95%CI, 1.25-3.11; P=.003) and at 2 years of follow-up (HR, 1.51; 95%CI, 1.14-2.01; P=.003). This difference was driven by both access and nonaccess bleeding. CONCLUSIONS Operators preferred TRA for most HBR patients, which was associated with a significant reduction in major bleeding events. However, most of these events in this population are unrelated to vascular access.
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Affiliation(s)
- Víctor Alfonso Jiménez Díaz
- Departamento de Cardiología, Hospital Álvaro Cunqueiro, Hospital Universitario de Vigo, Vigo, Pontevedra, Spain
| | - Thomas Hovasse
- Cardiology Department, Hôpital Privé Jacques Cartier, Massy, France
| | - Andrés Íñiguez
- Departamento de Cardiología, Hospital Álvaro Cunqueiro, Hospital Universitario de Vigo, Vigo, Pontevedra, Spain
| | | | - Jonathan Byrne
- Cardiology Department, King's College, London, United Kingdom
| | | | | | - Alex Abizaid
- Cardiology Department, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | | | - Darren Walters
- Cardiology Department, Prince Charles Hospital, Queensland, Australia
| | - Alberto Ortiz Sáez
- Departamento de Cardiología, Hospital Álvaro Cunqueiro, Hospital Universitario de Vigo, Vigo, Pontevedra, Spain
| | - Guillermo Bastos Fernández
- Departamento de Cardiología, Hospital Álvaro Cunqueiro, Hospital Universitario de Vigo, Vigo, Pontevedra, Spain
| | | | - Philip Urban
- Cardiology Department, Hôpital de la Tour, Geneva, Switzerland.
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22
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Farnier M, Salignon-Vernay C, Yao H, Chague F, Brunel P, Maza M, Brunet D, Bichat F, Beer JC, Cottin Y, Zeller M. Prevalence, risk factor burden, and severity of coronary artery disease in patients with heterozygous familial hypercholesterolemia hospitalized for an acute myocardial infarction: Data from the French RICO survey. J Clin Lipidol 2019; 13:601-607. [PMID: 31324593 DOI: 10.1016/j.jacl.2019.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 03/01/2019] [Revised: 05/14/2019] [Accepted: 06/11/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Individuals with heterozygous familial hypercholesterolemia (FH) are at high risk of early myocardial infarction (MI). However, coronary artery disease (CAD) burden of FH remains not well described, especially for French patients. OBJECTIVE The objective of this study was to assess the prevalence of FH and severity of CAD from a large database of a French regional registry of acute MI. METHODS All consecutive patients hospitalized for an acute MI in a multicenter database from 2001 to 2017 were considered. FH was diagnosed using an algorithm adapted from the Dutch Lipid Clinic Network criteria. The prevalence and clinical features of FH and the severity of CAD were assessed. RESULTS Among the 11,624 patients included in the study, the proportion of "probable/definite", "possible", and "unlikely" FH in patients with MI was 2.1% (n = 249), 20.7% (n = 2405), and 77.2% (n = 8970), respectively. When compared with patients with "unlikely" FH, patients with "probable/definite" FH were 20 years younger (51 vs 71, P < .001), with a lower rate of diabetes (17% vs 25%, P = .007) and a higher prevalence of personal and familial history of CAD. Chronic statin treatment was only used in 48% of FH patients and ezetimibe in 8%. After adjustment for age, sex, and diabetes, patients with FH were characterized by increased extent of CAD (SYNTAX score 11 vs 7, P < .001) and multivessel disease (55% vs 40%, P < .001). CONCLUSIONS In this large cohort of French individuals, FH was common in patients with MI, associated with markedly early age of MI and severity of CAD burden and limited use of preventive lipid-lowering therapy.
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Affiliation(s)
- Michel Farnier
- Lipid Clinic, Point Medical, Dijon, France; Department of Cardiology, CHU Dijon Bourgogne, Dijon, France.
| | | | - Hermann Yao
- Department of Cardiology, CHU Dijon Bourgogne, Dijon, France
| | - Frédéric Chague
- Department of Cardiology, CHU Dijon Bourgogne, Dijon, France
| | - Philippe Brunel
- Department of Cardiology, Hopital Privé Dijon Bourgogne, Dijon, France
| | - Maud Maza
- Department of Cardiology, CHU Dijon Bourgogne, Dijon, France
| | - Damien Brunet
- Department of Cardiology, Hopital Privé Dijon Bourgogne, Dijon, France
| | - Florence Bichat
- Department of Cardiology, CHU Dijon Bourgogne, Dijon, France
| | | | - Yves Cottin
- Department of Cardiology, CHU Dijon Bourgogne, Dijon, France
| | - Marianne Zeller
- Equipe PEC2, EA 7460, UFR Sciences de Santé, Université de Bourgogne Franche Comté, Dijon, France
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Tamisier N, Maillard N, Brunel P, Roussel M, Botelho-Nevers E, Gagneux-Brunon A. Incidence de la cristallurie à l’amoxicilline dans le traitement des endocardites infectieuses (EI) en 2018 au sein d’un CHU. Med Mal Infect 2019. [DOI: 10.1016/j.medmal.2019.04.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Porot G, Chagué F, Robert R, Avondo A, Ray P, Brunel P, Gudjoncik A, Beer J, Maza M, Cottin Y, Zeller M. Management of acute myocardial infarction occurring during sport practice: Contemporary data from the ‘obseRvatoire des Infarctus de Côte d’Or’ (RICO) survey. Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2018.10.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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25
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Auffret V, Cottin Y, Leurent G, Gilard M, Beer J, Zabalawi A, Filippi E, Brunet D, Hacot J, Brunel P, Mejri M, Lorgis L, Rouault G, Druelles P, Didier R, Loirat A, Bedossa M, Boulmier D, Zeller M, Le Breton H. Predicting the development of in-hospital cardiogenic shock in patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention: The ORBI risk score. Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2018.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lipiecki J, Brunel P, Morice MC, Roguelov C, Walsh SJ, Richardt G, Eerdmans P, Zambahari R, Berland J, Copt S, Stoll HP, Urban P. Biolimus A9 polymer-free coated stents in high bleeding risk patients undergoing complex PCI: evidence from the LEADERS FREE randomised clinical trial. EUROINTERVENTION 2018; 14:e418-e425. [DOI: 10.4244/eij-d-18-00293] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Putot A, Laborde C, Fichot M, Brunel P, Deidda M, Guepet H, Manckoundia P. Falls and Delirium: Platypnea-Orthodeoxia Syndrome. Am J Med 2018; 131:250-252. [PMID: 29157648 DOI: 10.1016/j.amjmed.2017.11.003] [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: 09/05/2017] [Revised: 11/07/2017] [Accepted: 11/07/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Alain Putot
- Service de Médecine interne gériatrie, Pôle Personnes Âgées, Centre Hospitalier Universitaire, Dijon, France.
| | - Caroline Laborde
- Service de Médecine interne gériatrie, Pôle Personnes Âgées, Centre Hospitalier Universitaire, Dijon, France
| | - Marie Fichot
- Service de Cardiologie, Centre Hospitalier Universitaire, Dijon, France
| | - Philippe Brunel
- Service de Cardiologie, Clinique de Fontaine, Fontaine les Dijon, France
| | - Martha Deidda
- Service de Médecine interne gériatrie, Pôle Personnes Âgées, Centre Hospitalier Universitaire, Dijon, France
| | - Hélène Guepet
- Service de Médecine interne gériatrie, Pôle Personnes Âgées, Centre Hospitalier Universitaire, Dijon, France
| | - Patrick Manckoundia
- Service de Médecine interne gériatrie, Pôle Personnes Âgées, Centre Hospitalier Universitaire, Dijon, France; Institut National de la Santé et de la Recherche Médicale U1093 Cognition Action Plasticité, Université de Bourgogne Franche-Comté, Dijon, France
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Hildick-Smith D, Behan MW, Lassen JF, Chieffo A, Lefèvre T, Stankovic G, Burzotta F, Pan M, Ferenc M, Bennett L, Hovasse T, Spence MJ, Oldroyd K, Brunel P, Carrie D, Baumbach A, Maeng M, Skipper N, Louvard Y. The EBC TWO Study (European Bifurcation Coronary TWO): A Randomized Comparison of Provisional T-Stenting Versus a Systematic 2 Stent Culotte Strategy in Large Caliber True Bifurcations. Circ Cardiovasc Interv 2017; 9:CIRCINTERVENTIONS.115.003643. [PMID: 27578839 DOI: 10.1161/circinterventions.115.003643] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 07/15/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND For the treatment of coronary bifurcation lesions, a provisional strategy is superior to systematic 2-stent techniques for the most bifurcation lesions. However, complex anatomies with large side branches (SBs) with significant ostial disease length are considered by expert consensus to warrant a 2-stent technique upfront. This consensus view has not been scientifically assessed. METHODS AND RESULTS Symptomatic patients with large caliber true bifurcation lesions (SB diameter ≥2.5 mm) and significant ostial disease length (≥5 mm) were randomized to either a provisional T-stent strategy or a dual stent culotte technique. Two hundred patients aged 64±10 years, 82% male, were randomized in 20 European centers. The clinical presentations were stable coronary disease (69%) and acute coronary syndromes (31%). SB stent diameter (2.67±0.27 mm) and length (20.30±5.89 mm) confirmed the extent of SB disease. Procedural success (provisional 97%, culotte 94%) and kissing balloon inflation (provisional 95%, culotte 98%) were high. Sixteen percent of patients in the provisional group underwent T-stenting. The primary end point (a composite of death, myocardial infarction, and target vessel revascularization at 12 months) occurred in 7.7% of the provisional T-stent group versus 10.3% of the culotte group (hazard ratio, 1.02; 95% confidence interval, 0.78-1.34; P=0.53). Procedure time, x-ray dose, and cost all favored the simpler procedure. CONCLUSIONS When treating complex coronary bifurcation lesions with large stenosed SBs, there is no difference between a provisional T-stent strategy and a systematic 2-stent culotte strategy in a composite end point of death, myocardial infarction, and target vessel revascularization at 12 months. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT 01560455.
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Affiliation(s)
- David Hildick-Smith
- From the Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (D.H.-S., L.B., N.S.); Edinburgh Heart Centre, United Kingdom (M.W.B.); Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.F.L., M.M.); Department of Cardiology, San Raffaele Scientific Institute, Milan, Italy (A.C.); Institute Cardiovasculaire Paris Sud, Hospital Privé Jacques Cartier, Massy, France (T.L., T.H., Y.L.); Department of Cardiology, Clinical Centre of Serbia, Belgrade (G.S.); Medical Faculty, University of Belgrade, Serbia (G.S.); Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (F.B.); Department of Cardiology, Reina Sofia Hospital, University of Cordoba, Spain (M.P.); University Heart Center Freiburg, Bad Krozingen, Germany (M.F.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (M.J.S.); Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom (K.O.); Department of Cardiology, Clinique de Fontaine-les-Djon, France (P.B.); Department of Cardiology, Rangueil Hospital, Toulouse, France (D.C.); and Bristol Heart Institute, United Kingdom (A.B.)
| | - Miles W Behan
- From the Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (D.H.-S., L.B., N.S.); Edinburgh Heart Centre, United Kingdom (M.W.B.); Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.F.L., M.M.); Department of Cardiology, San Raffaele Scientific Institute, Milan, Italy (A.C.); Institute Cardiovasculaire Paris Sud, Hospital Privé Jacques Cartier, Massy, France (T.L., T.H., Y.L.); Department of Cardiology, Clinical Centre of Serbia, Belgrade (G.S.); Medical Faculty, University of Belgrade, Serbia (G.S.); Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (F.B.); Department of Cardiology, Reina Sofia Hospital, University of Cordoba, Spain (M.P.); University Heart Center Freiburg, Bad Krozingen, Germany (M.F.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (M.J.S.); Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom (K.O.); Department of Cardiology, Clinique de Fontaine-les-Djon, France (P.B.); Department of Cardiology, Rangueil Hospital, Toulouse, France (D.C.); and Bristol Heart Institute, United Kingdom (A.B.).
| | - Jens F Lassen
- From the Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (D.H.-S., L.B., N.S.); Edinburgh Heart Centre, United Kingdom (M.W.B.); Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.F.L., M.M.); Department of Cardiology, San Raffaele Scientific Institute, Milan, Italy (A.C.); Institute Cardiovasculaire Paris Sud, Hospital Privé Jacques Cartier, Massy, France (T.L., T.H., Y.L.); Department of Cardiology, Clinical Centre of Serbia, Belgrade (G.S.); Medical Faculty, University of Belgrade, Serbia (G.S.); Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (F.B.); Department of Cardiology, Reina Sofia Hospital, University of Cordoba, Spain (M.P.); University Heart Center Freiburg, Bad Krozingen, Germany (M.F.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (M.J.S.); Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom (K.O.); Department of Cardiology, Clinique de Fontaine-les-Djon, France (P.B.); Department of Cardiology, Rangueil Hospital, Toulouse, France (D.C.); and Bristol Heart Institute, United Kingdom (A.B.)
| | - Alaide Chieffo
- From the Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (D.H.-S., L.B., N.S.); Edinburgh Heart Centre, United Kingdom (M.W.B.); Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.F.L., M.M.); Department of Cardiology, San Raffaele Scientific Institute, Milan, Italy (A.C.); Institute Cardiovasculaire Paris Sud, Hospital Privé Jacques Cartier, Massy, France (T.L., T.H., Y.L.); Department of Cardiology, Clinical Centre of Serbia, Belgrade (G.S.); Medical Faculty, University of Belgrade, Serbia (G.S.); Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (F.B.); Department of Cardiology, Reina Sofia Hospital, University of Cordoba, Spain (M.P.); University Heart Center Freiburg, Bad Krozingen, Germany (M.F.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (M.J.S.); Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom (K.O.); Department of Cardiology, Clinique de Fontaine-les-Djon, France (P.B.); Department of Cardiology, Rangueil Hospital, Toulouse, France (D.C.); and Bristol Heart Institute, United Kingdom (A.B.)
| | - Thierry Lefèvre
- From the Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (D.H.-S., L.B., N.S.); Edinburgh Heart Centre, United Kingdom (M.W.B.); Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.F.L., M.M.); Department of Cardiology, San Raffaele Scientific Institute, Milan, Italy (A.C.); Institute Cardiovasculaire Paris Sud, Hospital Privé Jacques Cartier, Massy, France (T.L., T.H., Y.L.); Department of Cardiology, Clinical Centre of Serbia, Belgrade (G.S.); Medical Faculty, University of Belgrade, Serbia (G.S.); Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (F.B.); Department of Cardiology, Reina Sofia Hospital, University of Cordoba, Spain (M.P.); University Heart Center Freiburg, Bad Krozingen, Germany (M.F.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (M.J.S.); Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom (K.O.); Department of Cardiology, Clinique de Fontaine-les-Djon, France (P.B.); Department of Cardiology, Rangueil Hospital, Toulouse, France (D.C.); and Bristol Heart Institute, United Kingdom (A.B.)
| | - Goran Stankovic
- From the Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (D.H.-S., L.B., N.S.); Edinburgh Heart Centre, United Kingdom (M.W.B.); Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.F.L., M.M.); Department of Cardiology, San Raffaele Scientific Institute, Milan, Italy (A.C.); Institute Cardiovasculaire Paris Sud, Hospital Privé Jacques Cartier, Massy, France (T.L., T.H., Y.L.); Department of Cardiology, Clinical Centre of Serbia, Belgrade (G.S.); Medical Faculty, University of Belgrade, Serbia (G.S.); Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (F.B.); Department of Cardiology, Reina Sofia Hospital, University of Cordoba, Spain (M.P.); University Heart Center Freiburg, Bad Krozingen, Germany (M.F.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (M.J.S.); Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom (K.O.); Department of Cardiology, Clinique de Fontaine-les-Djon, France (P.B.); Department of Cardiology, Rangueil Hospital, Toulouse, France (D.C.); and Bristol Heart Institute, United Kingdom (A.B.)
| | - Francesco Burzotta
- From the Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (D.H.-S., L.B., N.S.); Edinburgh Heart Centre, United Kingdom (M.W.B.); Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.F.L., M.M.); Department of Cardiology, San Raffaele Scientific Institute, Milan, Italy (A.C.); Institute Cardiovasculaire Paris Sud, Hospital Privé Jacques Cartier, Massy, France (T.L., T.H., Y.L.); Department of Cardiology, Clinical Centre of Serbia, Belgrade (G.S.); Medical Faculty, University of Belgrade, Serbia (G.S.); Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (F.B.); Department of Cardiology, Reina Sofia Hospital, University of Cordoba, Spain (M.P.); University Heart Center Freiburg, Bad Krozingen, Germany (M.F.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (M.J.S.); Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom (K.O.); Department of Cardiology, Clinique de Fontaine-les-Djon, France (P.B.); Department of Cardiology, Rangueil Hospital, Toulouse, France (D.C.); and Bristol Heart Institute, United Kingdom (A.B.)
| | - Manuel Pan
- From the Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (D.H.-S., L.B., N.S.); Edinburgh Heart Centre, United Kingdom (M.W.B.); Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.F.L., M.M.); Department of Cardiology, San Raffaele Scientific Institute, Milan, Italy (A.C.); Institute Cardiovasculaire Paris Sud, Hospital Privé Jacques Cartier, Massy, France (T.L., T.H., Y.L.); Department of Cardiology, Clinical Centre of Serbia, Belgrade (G.S.); Medical Faculty, University of Belgrade, Serbia (G.S.); Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (F.B.); Department of Cardiology, Reina Sofia Hospital, University of Cordoba, Spain (M.P.); University Heart Center Freiburg, Bad Krozingen, Germany (M.F.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (M.J.S.); Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom (K.O.); Department of Cardiology, Clinique de Fontaine-les-Djon, France (P.B.); Department of Cardiology, Rangueil Hospital, Toulouse, France (D.C.); and Bristol Heart Institute, United Kingdom (A.B.)
| | - Miroslaw Ferenc
- From the Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (D.H.-S., L.B., N.S.); Edinburgh Heart Centre, United Kingdom (M.W.B.); Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.F.L., M.M.); Department of Cardiology, San Raffaele Scientific Institute, Milan, Italy (A.C.); Institute Cardiovasculaire Paris Sud, Hospital Privé Jacques Cartier, Massy, France (T.L., T.H., Y.L.); Department of Cardiology, Clinical Centre of Serbia, Belgrade (G.S.); Medical Faculty, University of Belgrade, Serbia (G.S.); Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (F.B.); Department of Cardiology, Reina Sofia Hospital, University of Cordoba, Spain (M.P.); University Heart Center Freiburg, Bad Krozingen, Germany (M.F.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (M.J.S.); Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom (K.O.); Department of Cardiology, Clinique de Fontaine-les-Djon, France (P.B.); Department of Cardiology, Rangueil Hospital, Toulouse, France (D.C.); and Bristol Heart Institute, United Kingdom (A.B.)
| | - Lorraine Bennett
- From the Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (D.H.-S., L.B., N.S.); Edinburgh Heart Centre, United Kingdom (M.W.B.); Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.F.L., M.M.); Department of Cardiology, San Raffaele Scientific Institute, Milan, Italy (A.C.); Institute Cardiovasculaire Paris Sud, Hospital Privé Jacques Cartier, Massy, France (T.L., T.H., Y.L.); Department of Cardiology, Clinical Centre of Serbia, Belgrade (G.S.); Medical Faculty, University of Belgrade, Serbia (G.S.); Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (F.B.); Department of Cardiology, Reina Sofia Hospital, University of Cordoba, Spain (M.P.); University Heart Center Freiburg, Bad Krozingen, Germany (M.F.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (M.J.S.); Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom (K.O.); Department of Cardiology, Clinique de Fontaine-les-Djon, France (P.B.); Department of Cardiology, Rangueil Hospital, Toulouse, France (D.C.); and Bristol Heart Institute, United Kingdom (A.B.)
| | - Thomas Hovasse
- From the Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (D.H.-S., L.B., N.S.); Edinburgh Heart Centre, United Kingdom (M.W.B.); Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.F.L., M.M.); Department of Cardiology, San Raffaele Scientific Institute, Milan, Italy (A.C.); Institute Cardiovasculaire Paris Sud, Hospital Privé Jacques Cartier, Massy, France (T.L., T.H., Y.L.); Department of Cardiology, Clinical Centre of Serbia, Belgrade (G.S.); Medical Faculty, University of Belgrade, Serbia (G.S.); Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (F.B.); Department of Cardiology, Reina Sofia Hospital, University of Cordoba, Spain (M.P.); University Heart Center Freiburg, Bad Krozingen, Germany (M.F.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (M.J.S.); Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom (K.O.); Department of Cardiology, Clinique de Fontaine-les-Djon, France (P.B.); Department of Cardiology, Rangueil Hospital, Toulouse, France (D.C.); and Bristol Heart Institute, United Kingdom (A.B.)
| | - Mark J Spence
- From the Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (D.H.-S., L.B., N.S.); Edinburgh Heart Centre, United Kingdom (M.W.B.); Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.F.L., M.M.); Department of Cardiology, San Raffaele Scientific Institute, Milan, Italy (A.C.); Institute Cardiovasculaire Paris Sud, Hospital Privé Jacques Cartier, Massy, France (T.L., T.H., Y.L.); Department of Cardiology, Clinical Centre of Serbia, Belgrade (G.S.); Medical Faculty, University of Belgrade, Serbia (G.S.); Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (F.B.); Department of Cardiology, Reina Sofia Hospital, University of Cordoba, Spain (M.P.); University Heart Center Freiburg, Bad Krozingen, Germany (M.F.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (M.J.S.); Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom (K.O.); Department of Cardiology, Clinique de Fontaine-les-Djon, France (P.B.); Department of Cardiology, Rangueil Hospital, Toulouse, France (D.C.); and Bristol Heart Institute, United Kingdom (A.B.)
| | - Keith Oldroyd
- From the Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (D.H.-S., L.B., N.S.); Edinburgh Heart Centre, United Kingdom (M.W.B.); Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.F.L., M.M.); Department of Cardiology, San Raffaele Scientific Institute, Milan, Italy (A.C.); Institute Cardiovasculaire Paris Sud, Hospital Privé Jacques Cartier, Massy, France (T.L., T.H., Y.L.); Department of Cardiology, Clinical Centre of Serbia, Belgrade (G.S.); Medical Faculty, University of Belgrade, Serbia (G.S.); Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (F.B.); Department of Cardiology, Reina Sofia Hospital, University of Cordoba, Spain (M.P.); University Heart Center Freiburg, Bad Krozingen, Germany (M.F.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (M.J.S.); Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom (K.O.); Department of Cardiology, Clinique de Fontaine-les-Djon, France (P.B.); Department of Cardiology, Rangueil Hospital, Toulouse, France (D.C.); and Bristol Heart Institute, United Kingdom (A.B.)
| | - Philippe Brunel
- From the Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (D.H.-S., L.B., N.S.); Edinburgh Heart Centre, United Kingdom (M.W.B.); Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.F.L., M.M.); Department of Cardiology, San Raffaele Scientific Institute, Milan, Italy (A.C.); Institute Cardiovasculaire Paris Sud, Hospital Privé Jacques Cartier, Massy, France (T.L., T.H., Y.L.); Department of Cardiology, Clinical Centre of Serbia, Belgrade (G.S.); Medical Faculty, University of Belgrade, Serbia (G.S.); Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (F.B.); Department of Cardiology, Reina Sofia Hospital, University of Cordoba, Spain (M.P.); University Heart Center Freiburg, Bad Krozingen, Germany (M.F.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (M.J.S.); Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom (K.O.); Department of Cardiology, Clinique de Fontaine-les-Djon, France (P.B.); Department of Cardiology, Rangueil Hospital, Toulouse, France (D.C.); and Bristol Heart Institute, United Kingdom (A.B.)
| | - Didier Carrie
- From the Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (D.H.-S., L.B., N.S.); Edinburgh Heart Centre, United Kingdom (M.W.B.); Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.F.L., M.M.); Department of Cardiology, San Raffaele Scientific Institute, Milan, Italy (A.C.); Institute Cardiovasculaire Paris Sud, Hospital Privé Jacques Cartier, Massy, France (T.L., T.H., Y.L.); Department of Cardiology, Clinical Centre of Serbia, Belgrade (G.S.); Medical Faculty, University of Belgrade, Serbia (G.S.); Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (F.B.); Department of Cardiology, Reina Sofia Hospital, University of Cordoba, Spain (M.P.); University Heart Center Freiburg, Bad Krozingen, Germany (M.F.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (M.J.S.); Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom (K.O.); Department of Cardiology, Clinique de Fontaine-les-Djon, France (P.B.); Department of Cardiology, Rangueil Hospital, Toulouse, France (D.C.); and Bristol Heart Institute, United Kingdom (A.B.)
| | - Andreas Baumbach
- From the Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (D.H.-S., L.B., N.S.); Edinburgh Heart Centre, United Kingdom (M.W.B.); Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.F.L., M.M.); Department of Cardiology, San Raffaele Scientific Institute, Milan, Italy (A.C.); Institute Cardiovasculaire Paris Sud, Hospital Privé Jacques Cartier, Massy, France (T.L., T.H., Y.L.); Department of Cardiology, Clinical Centre of Serbia, Belgrade (G.S.); Medical Faculty, University of Belgrade, Serbia (G.S.); Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (F.B.); Department of Cardiology, Reina Sofia Hospital, University of Cordoba, Spain (M.P.); University Heart Center Freiburg, Bad Krozingen, Germany (M.F.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (M.J.S.); Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom (K.O.); Department of Cardiology, Clinique de Fontaine-les-Djon, France (P.B.); Department of Cardiology, Rangueil Hospital, Toulouse, France (D.C.); and Bristol Heart Institute, United Kingdom (A.B.)
| | - Michael Maeng
- From the Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (D.H.-S., L.B., N.S.); Edinburgh Heart Centre, United Kingdom (M.W.B.); Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.F.L., M.M.); Department of Cardiology, San Raffaele Scientific Institute, Milan, Italy (A.C.); Institute Cardiovasculaire Paris Sud, Hospital Privé Jacques Cartier, Massy, France (T.L., T.H., Y.L.); Department of Cardiology, Clinical Centre of Serbia, Belgrade (G.S.); Medical Faculty, University of Belgrade, Serbia (G.S.); Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (F.B.); Department of Cardiology, Reina Sofia Hospital, University of Cordoba, Spain (M.P.); University Heart Center Freiburg, Bad Krozingen, Germany (M.F.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (M.J.S.); Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom (K.O.); Department of Cardiology, Clinique de Fontaine-les-Djon, France (P.B.); Department of Cardiology, Rangueil Hospital, Toulouse, France (D.C.); and Bristol Heart Institute, United Kingdom (A.B.)
| | - Nicola Skipper
- From the Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (D.H.-S., L.B., N.S.); Edinburgh Heart Centre, United Kingdom (M.W.B.); Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.F.L., M.M.); Department of Cardiology, San Raffaele Scientific Institute, Milan, Italy (A.C.); Institute Cardiovasculaire Paris Sud, Hospital Privé Jacques Cartier, Massy, France (T.L., T.H., Y.L.); Department of Cardiology, Clinical Centre of Serbia, Belgrade (G.S.); Medical Faculty, University of Belgrade, Serbia (G.S.); Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (F.B.); Department of Cardiology, Reina Sofia Hospital, University of Cordoba, Spain (M.P.); University Heart Center Freiburg, Bad Krozingen, Germany (M.F.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (M.J.S.); Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom (K.O.); Department of Cardiology, Clinique de Fontaine-les-Djon, France (P.B.); Department of Cardiology, Rangueil Hospital, Toulouse, France (D.C.); and Bristol Heart Institute, United Kingdom (A.B.)
| | - Yves Louvard
- From the Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (D.H.-S., L.B., N.S.); Edinburgh Heart Centre, United Kingdom (M.W.B.); Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.F.L., M.M.); Department of Cardiology, San Raffaele Scientific Institute, Milan, Italy (A.C.); Institute Cardiovasculaire Paris Sud, Hospital Privé Jacques Cartier, Massy, France (T.L., T.H., Y.L.); Department of Cardiology, Clinical Centre of Serbia, Belgrade (G.S.); Medical Faculty, University of Belgrade, Serbia (G.S.); Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (F.B.); Department of Cardiology, Reina Sofia Hospital, University of Cordoba, Spain (M.P.); University Heart Center Freiburg, Bad Krozingen, Germany (M.F.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (M.J.S.); Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom (K.O.); Department of Cardiology, Clinique de Fontaine-les-Djon, France (P.B.); Department of Cardiology, Rangueil Hospital, Toulouse, France (D.C.); and Bristol Heart Institute, United Kingdom (A.B.)
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Vaillant A, Chague F, Laurent Y, Beer J, Brunel P, Morel G, Cottin Y, Zeller M. P2485Log Book as a new tool for the secondary prevention of coronary artery disease. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Burnier M, Lin S, Ruilope L, Brunel P. P1348The role of angiotensin receptor blockers in the treatment of patients with hypertension and chronic kidney disease: a systematic review of clinical trials. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Zuber C, Bazzoli S, Brunel P, Burillo M, Fronty JP, Gontier D, Goulmy C, Moreau I, Oudot G, Rubbelynck C, Soullié G, Stemmler P, Trosseille C. Performance of Laser Megajoule's x-ray streak camera. Rev Sci Instrum 2016; 87:11E303. [PMID: 27910354 DOI: 10.1063/1.4959165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A prototype of a picosecond x-ray streak camera has been developed and tested by Commissariat à l'Énergie Atomique et aux Énergies Alternatives to provide plasma-diagnostic support for the Laser Megajoule. We report on the measured performance of this streak camera, which almost fulfills the requirements: 50-μm spatial resolution over a 15-mm field in the photocathode plane, 17-ps temporal resolution in a 2-ns timebase, a detection threshold lower than 625 nJ/cm2 in the 0.05-15 keV spectral range, and a dynamic range greater than 100.
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Affiliation(s)
- C Zuber
- CEA, DAM, DIF, F-91297 Arpajon, France
| | - S Bazzoli
- CEA, DAM, DIF, F-91297 Arpajon, France
| | - P Brunel
- CEA, DAM, DIF, F-91297 Arpajon, France
| | - M Burillo
- CEA, DAM, DIF, F-91297 Arpajon, France
| | - J P Fronty
- Photonis France SAS, Avenue Roger Roncier, BP 520, 19106 Brive Cedex, France
| | - D Gontier
- CEA, DAM, DIF, F-91297 Arpajon, France
| | - C Goulmy
- Photonis France SAS, Avenue Roger Roncier, BP 520, 19106 Brive Cedex, France
| | - I Moreau
- CEA, DAM, DIF, F-91297 Arpajon, France
| | - G Oudot
- CEA, DAM, DIF, F-91297 Arpajon, France
| | | | - G Soullié
- CEA, DAM, DIF, F-91297 Arpajon, France
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Zuber C, Bazzoli S, Brunel P, Fronty JP, Gontier D, Goulmy C, Raimbourg J, Rubbelynck C, Trosseille C. Picosecond X-ray streak camera dynamic range measurement. Rev Sci Instrum 2016; 87:093501. [PMID: 27782554 DOI: 10.1063/1.4962243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Streak cameras are widely used to record the spatio-temporal evolution of laser-induced plasma. A prototype of picosecond X-ray streak camera has been developed and tested by Commissariat à l'Énergie Atomique et aux Énergies Alternatives to answer the Laser MegaJoule specific needs. The dynamic range of this instrument is measured with picosecond X-ray pulses generated by the interaction of a laser beam and a copper target. The required value of 100 is reached only in the configurations combining the slowest sweeping speed and optimization of the streak tube electron throughput by an appropriate choice of high voltages applied to its electrodes.
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Affiliation(s)
- C Zuber
- CEA, DAM, DIF, F-91297 Arpajon, France
| | - S Bazzoli
- CEA, DAM, DIF, F-91297 Arpajon, France
| | - P Brunel
- CEA, DAM, DIF, F-91297 Arpajon, France
| | - J-P Fronty
- Photonis SAS, Avenue Roger Roncier, BP 520, 19106 Brive Cedex, France
| | - D Gontier
- CEA, DAM, DIF, F-91297 Arpajon, France
| | - C Goulmy
- Photonis SAS, Avenue Roger Roncier, BP 520, 19106 Brive Cedex, France
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Rosch R, Trosseille C, Caillaud T, Allouche V, Bourgade JL, Briat M, Brunel P, Burillo M, Casner A, Depierreux S, Gontier D, Jadaud JP, Le Breton JP, Llavador P, Loupias B, Miquel JL, Oudot G, Perez S, Raimbourg J, Rousseau A, Rousseaux C, Rubbelynck C, Stemmler P, Troussel P, Ulmer JL, Wrobel R, Beauvais P, Pallet M, Prevot V. First set of gated x-ray imaging diagnostics for the Laser Megajoule facility. Rev Sci Instrum 2016; 87:033706. [PMID: 27036783 DOI: 10.1063/1.4942930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The Laser Megajoule (LMJ) facility located at CEA/CESTA started to operate in the early 2014 with two quadruplets (20 kJ at 351 nm) focused on target for the first experimental campaign. We present here the first set of gated x-ray imaging (GXI) diagnostics implemented on LMJ since mid-2014. This set consists of two imaging diagnostics with spatial, temporal, and broadband spectral resolution. These diagnostics will give basic measurements, during the entire life of the facility, such as position, structure, and balance of beams, but they will also be used to characterize gas filled target implosion symmetry and timing, to study x-ray radiography and hydrodynamic instabilities. The design requires a vulnerability approach, because components will operate in a harsh environment induced by neutron fluxes, gamma rays, debris, and shrapnel. Grazing incidence x-ray microscopes are fielded as far as possible away from the target to minimize potential damage and signal noise due to these sources. These imaging diagnostics incorporate microscopes with large source-to-optic distance and large size gated microchannel plate detectors. Microscopes include optics with grazing incidence mirrors, pinholes, and refractive lenses. Spatial, temporal, and spectral performances have been measured on x-ray tubes and UV lasers at CEA-DIF and at Physikalisch-Technische Bundesanstalt BESSY II synchrotron prior to be set on LMJ. GXI-1 and GXI-2 designs, metrology, and first experiments on LMJ are presented here.
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Affiliation(s)
- R Rosch
- CEA-DAM Ile de France, Bruyères-le-Châtel, 91297 Arpajon Cedex, France
| | - C Trosseille
- CEA-DAM Ile de France, Bruyères-le-Châtel, 91297 Arpajon Cedex, France
| | - T Caillaud
- CEA-DAM Ile de France, Bruyères-le-Châtel, 91297 Arpajon Cedex, France
| | - V Allouche
- CEA-DAM Ile de France, Bruyères-le-Châtel, 91297 Arpajon Cedex, France
| | - J L Bourgade
- CEA-DAM Ile de France, Bruyères-le-Châtel, 91297 Arpajon Cedex, France
| | - M Briat
- CEA-DAM Ile de France, Bruyères-le-Châtel, 91297 Arpajon Cedex, France
| | - P Brunel
- CEA-DAM Ile de France, Bruyères-le-Châtel, 91297 Arpajon Cedex, France
| | - M Burillo
- CEA-DAM Ile de France, Bruyères-le-Châtel, 91297 Arpajon Cedex, France
| | - A Casner
- CEA-DAM Ile de France, Bruyères-le-Châtel, 91297 Arpajon Cedex, France
| | - S Depierreux
- CEA-DAM Ile de France, Bruyères-le-Châtel, 91297 Arpajon Cedex, France
| | - D Gontier
- CEA-DAM Ile de France, Bruyères-le-Châtel, 91297 Arpajon Cedex, France
| | - J P Jadaud
- CEA-DAM Ile de France, Bruyères-le-Châtel, 91297 Arpajon Cedex, France
| | - J P Le Breton
- CEA-DAM Ile de France, Bruyères-le-Châtel, 91297 Arpajon Cedex, France
| | - P Llavador
- CEA-DAM Ile de France, Bruyères-le-Châtel, 91297 Arpajon Cedex, France
| | - B Loupias
- CEA-DAM Ile de France, Bruyères-le-Châtel, 91297 Arpajon Cedex, France
| | - J L Miquel
- CEA-DAM Ile de France, Bruyères-le-Châtel, 91297 Arpajon Cedex, France
| | - G Oudot
- CEA-DAM Ile de France, Bruyères-le-Châtel, 91297 Arpajon Cedex, France
| | - S Perez
- CEA-DAM Ile de France, Bruyères-le-Châtel, 91297 Arpajon Cedex, France
| | - J Raimbourg
- CEA-DAM Ile de France, Bruyères-le-Châtel, 91297 Arpajon Cedex, France
| | - A Rousseau
- CEA-DAM Ile de France, Bruyères-le-Châtel, 91297 Arpajon Cedex, France
| | - C Rousseaux
- CEA-DAM Ile de France, Bruyères-le-Châtel, 91297 Arpajon Cedex, France
| | - C Rubbelynck
- CEA-DAM Ile de France, Bruyères-le-Châtel, 91297 Arpajon Cedex, France
| | - P Stemmler
- CEA-DAM Ile de France, Bruyères-le-Châtel, 91297 Arpajon Cedex, France
| | - P Troussel
- CEA-DAM Ile de France, Bruyères-le-Châtel, 91297 Arpajon Cedex, France
| | - J L Ulmer
- CEA-DAM Ile de France, Bruyères-le-Châtel, 91297 Arpajon Cedex, France
| | - R Wrobel
- CEA-DAM Ile de France, Bruyères-le-Châtel, 91297 Arpajon Cedex, France
| | - P Beauvais
- CEA-CESTA, 15 Avenue des Sablières, 33114 Le Barp, France
| | - M Pallet
- CEA-CESTA, 15 Avenue des Sablières, 33114 Le Barp, France
| | - V Prevot
- CEA-CESTA, 15 Avenue des Sablières, 33114 Le Barp, France
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Heerspink HJL, Ninomiya T, Persson F, Brenner BM, Brunel P, Chaturvedi N, Desai AS, Haffner SM, Mcmurray JJV, Solomon SD, Pfeffer MA, Parving HH, de Zeeuw D. Is a reduction in albuminuria associated with renal and cardiovascular protection? A post hoc analysis of the ALTITUDE trial. Diabetes Obes Metab 2016; 18:169-77. [PMID: 26511599 DOI: 10.1111/dom.12600] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [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: 08/19/2015] [Revised: 10/24/2015] [Accepted: 10/24/2015] [Indexed: 01/23/2023]
Abstract
AIMS To investigate whether the degree of albuminuria reduction observed in the ALTITUDE trial is associated with renal and cardiovascular protection, and secondly, whether the reduction in albuminuria was too small to afford clinical benefit. METHODS In a post hoc analysis of the ALTITUDE trial in 8561 patients with type 2 diabetes and chronic kidney disease or cardiovascular disease we examined the effect of albuminuria changes at 6 months on renal and cardiovascular outcomes using Cox proportional hazard regression. RESULTS The median change in albuminuria in the first 6 months in the aliskiren arm of the trial was -12% (25th to 75th percentile: -48.7_to_ +41.9%) and 0.0% (25th to 75th percentile: -40.2_to_55%) in the placebo arm. Changes in albuminuria in the first 6 months were linearly associated with renal and cardiovascular endpoints: a >30% reduction in albuminuria in the first 6 months was associated with a 62% reduction in renal risk and a 25% reduction in cardiovascular risk compared with an increase in albuminuria. The association between changes at 6 months in albuminuria and renal or cardiovascular endpoints was similar in the two treatment groups (p for interaction >0.1 for both endpoints). CONCLUSIONS The addition of aliskiren to angiotensin-converting enzyme inhibitor/angiotensin receptor blocker therapy resulted in albuminuria changes that were associated with renal and cardiovascular risk changes. This did not translate into renal or cardiovascular protection because the overall reduction in albuminuria in the aliskiren arm was too small and nearly similar to that in the placebo arm.
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Affiliation(s)
- H J L Heerspink
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - T Ninomiya
- Division of Research Management, Center for Cohort Studies Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - F Persson
- Steno Diabetes Centre, Gentofte, Denmark
| | - B M Brenner
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - P Brunel
- Novartis Pharma AB, Global Medical Affairs, Basel, Switzerland
| | - N Chaturvedi
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - A S Desai
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - S M Haffner
- Department of Medicine and Clinical Epidemiology, University of Texas Health Science Center, San Antonio, TX, USA
| | - J J V Mcmurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - S D Solomon
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - M A Pfeffer
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - H-H Parving
- Department of Medical Endocrinology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - D de Zeeuw
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Pouche M, Ruidavets JB, Ferrières J, Iliou MC, Douard H, Lorgis L, Carrié D, Brunel P, Simon T, Bataille V, Danchin N. Cardiac rehabilitation and 5-year mortality after acute coronary syndromes: The 2005 French FAST-MI study. Arch Cardiovasc Dis 2015; 109:178-87. [PMID: 26711546 DOI: 10.1016/j.acvd.2015.09.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [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: 07/23/2015] [Revised: 09/28/2015] [Accepted: 09/30/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Clinical studies have shown a beneficial effect of cardiac rehabilitation (CR) on mortality. OBJECTIVE To study the effect of CR prescription at discharge on 5-year mortality in patients with acute myocardial infarction (AMI). METHODS Participants, from the 2005 French FAST-MI hospital registry, were 2894 survivors at discharge, divided according to AMI type: ST-segment elevation myocardial infarction (STEMI; n=1523) and non-STEMI (NSTEMI; n=1371). The effect of CR prescription on mortality was analysed using a Cox proportional hazards model. RESULTS At discharge, 22.1% of patients had a CR prescription. Patients referred to CR were younger (62.4 vs. 67.5years), were more frequently men and more had presented with STEMI (67.8% vs. 48.3%) than non-referred patients. Ninety-four (14.7%) deaths occurred among patients referred to CR and 585 (25.9%) among non-referred patients (P<0.001). After multivariable adjustment, the association between CR and mortality remained significant (hazard ratio [HR] 0.76, 95% confidence interval [CI] 0.60-0.96). Analyses stratified by sex, age (<60 vs.≥60years) and AMI type showed that the inverse association was stronger in men (HR 0.64, 95% CI 0.48-0.87) than in women (HR 0.95, 95% CI 0.64-1.39), in younger (HR 0.34, 95% CI 0.15-0.77) than in older patients (HR 0.84, 95% CI 0.65-1.07) and in NSTEMI (HR 0.63, 95% CI 0.46-0.88) than in STEMI (HR 0.99, 95% CI 0.69-1.40). CONCLUSION After hospitalization for AMI, referral to CR remains a significant predictor of improved patient survival; some subgroups seem to gain greater benefit.
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Affiliation(s)
- Marion Pouche
- Department of Epidemiology, Health Economics and Public Health, UMR1027 Inserm-University of Toulouse III, Toulouse University Hospital (CHU), 31073 Toulouse cedex 7, France
| | - Jean-Bernard Ruidavets
- Department of Epidemiology, Health Economics and Public Health, UMR1027 Inserm-University of Toulouse III, Toulouse University Hospital (CHU), 31073 Toulouse cedex 7, France.
| | - Jean Ferrières
- Department of Epidemiology, Health Economics and Public Health, UMR1027 Inserm-University of Toulouse III, Toulouse University Hospital (CHU), 31073 Toulouse cedex 7, France; Department of Cardiology B, Toulouse Rangueil University Hospital (CHU), 31059 Toulouse cedex 9, France
| | - Marie-Christine Iliou
- Department of Cardiac Rehabilitation, AP-HP, Corentin-Celton Hospital, 92130 Issy-les Moulineaux, France
| | - Hervé Douard
- Department of Cardiology, Bordeaux University Hospital, 33604 Pessac, France
| | - Luc Lorgis
- Department of Cardiology, University Hospital, Laboratory of Cardiometabolic Physiopathology and Pharmacology, Inserm U866, University of Burgundy, 21034 Dijon, France
| | - Didier Carrié
- Department of Cardiology B, Toulouse Rangueil University Hospital (CHU), 31059 Toulouse cedex 9, France
| | - Philippe Brunel
- Department of Cardiology, Nouvelles Cliniques Nantaises, 44277 Nantes cedex 2, France
| | - Tabassome Simon
- Department of Pharmacology and Clinical Research Unit (URCEST), AP-HP, Saint-Antoine Hospital, Pierre-and-Marie-Curie University (UPMC-Paris 06), Inserm U970, 75012 Paris, France
| | - Vincent Bataille
- Department of Epidemiology, Health Economics and Public Health, UMR1027 Inserm-University of Toulouse III, Toulouse University Hospital (CHU), 31073 Toulouse cedex 7, France
| | - Nicolas Danchin
- Department of Cardiology, AP-HP, Georges-Pompidou European Hospital, René-Descartes University, Inserm U970, 75908 Paris, France
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Urban P, Meredith IT, Abizaid A, Pocock SJ, Carrié D, Naber C, Lipiecki J, Richardt G, Iñiguez A, Brunel P, Valdes-Chavarri M, Garot P, Talwar S, Berland J, Abdellaoui M, Eberli F, Oldroyd K, Zambahari R, Gregson J, Greene S, Stoll HP, Morice MC. Polymer-free Drug-Coated Coronary Stents in Patients at High Bleeding Risk. N Engl J Med 2015; 373:2038-47. [PMID: 26466021 DOI: 10.1056/nejmoa1503943] [Citation(s) in RCA: 587] [Impact Index Per Article: 65.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Patients at high risk for bleeding who undergo percutaneous coronary intervention (PCI) often receive bare-metal stents followed by 1 month of dual antiplatelet therapy. We studied a polymer-free and carrier-free drug-coated stent that transfers umirolimus (also known as biolimus A9), a highly lipophilic sirolimus analogue, into the vessel wall over a period of 1 month. METHODS In a randomized, double-blind trial, we compared the drug-coated stent with a very similar bare-metal stent in patients with a high risk of bleeding who underwent PCI. All patients received 1 month of dual antiplatelet therapy. The primary safety end point, tested for both noninferiority and superiority, was a composite of cardiac death, myocardial infarction, or stent thrombosis. The primary efficacy end point was clinically driven target-lesion revascularization. RESULTS We enrolled 2466 patients. At 390 days, the primary safety end point had occurred in 112 patients (9.4%) in the drug-coated-stent group and in 154 patients (12.9%) in the bare-metal-stent group (risk difference, -3.6 percentage points; 95% confidence interval [CI], -6.1 to -1.0; hazard ratio, 0.71; 95% CI, 0.56 to 0.91; P<0.001 for noninferiority and P=0.005 for superiority). During the same time period, clinically driven target-lesion revascularization was needed in 59 patients (5.1%) in the drug-coated-stent group and in 113 patients (9.8%) in the bare-metal-stent group (risk difference, -4.8 percentage points; 95% CI, -6.9 to -2.6; hazard ratio, 0.50; 95% CI, 0.37 to 0.69; P<0.001). CONCLUSIONS Among patients at high risk for bleeding who underwent PCI, a polymer-free umirolimus-coated stent was superior to a bare-metal stent with respect to the primary safety and efficacy end points when used with a 1-month course of dual antiplatelet therapy. (Funded by Biosensors Europe; LEADERS FREE ClinicalTrials.gov number, NCT01623180.).
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Affiliation(s)
- Philip Urban
- From Hôpital de la Tour, Geneva (P.U.), Triemli Hospital, Zurich (F.E.), and Biosensors Europe, Morges (S.G., H.-P.S.) - all in Switzerland; MonashHeart and Monash University, Melbourne, VIC, Australia (I.T.M.); Instituto Dante Pazzanese de Cardiologia, São Paulo (A.A.); London School of Hygiene and Tropical Medicine, London (S.J.P., J.G.), the Dorset Heart Centre Royal Bournemouth Hospital, Bournemouth (S.T.), and West of Scotland Regional Heart and Lung Centre Golden Jubilee National Hospital, Glasgow (K.O.) - all in the United Kingdom; Toulouse Rangueil Hospital, Toulouse (D.C.), Pôle Santé République, Clermont-Ferrand (J.L.), Clinique de la Fontaine, Dijon (P.B.), Hôpital Claude Galien, Institut Cardiovasculaire Paris Sud (ICPS), Générale de Santé, Quincy-sous-Sénart (P.G.), Clinique Saint Hilaire, Rouen (J.B.), Groupe Hospitalier Mutualiste de Grenoble, Grenoble (M.A.), and ICPS, Générale de Santé, Massy (M.-C.M.) - all in France; Contilia Heart and Vascular Center, Elisabeth Krankenhaus, Essen (C.N.), and Herzzentrum Segeberger Kliniken, Bad Segeberg (G.R.) - both in Germany; Complejo Hospital Meixoeiro, Vigo, (A.I.), and Arrixaca University Hospital, Murcia (M.V.-C.) - both in Spain; and the Institute Jantung Negara, Kuala Lumpur, Malaysia (R.Z.)
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Vaillant A, Dentan G, Laurent Y, Aurélie G, Beer JC, Germin F, Boch É, Casillas JM, Brunel P, Touzery C, Cottin Y, Zeller M, Morel G. The Log book for the secondary prevention of coronary artery disease: A pilot study. Presse Med 2015; 44:e301-9. [PMID: 26144276 DOI: 10.1016/j.lpm.2014.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 07/08/2014] [Accepted: 11/05/2014] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION In secondary prevention (SP) of coronary artery disease (CAD), in particular after an acute myocardial infarction (MI), a better knowledge and self-management by the patient may have various supports. The Log book (LB) for CAD patients in Côte d'Or, was created in 2010 by a multidisciplinary team of healthcare professionals of Côte d'Or, from a regional care network. This pilot study evaluated LB as novel support for SP after acute MI. METHODS A prospective study on 183 patients hospitalised for an acute MI in the region of Côte d'Or from 1st May to 30th October 2010. Patients were randomized in 91 patients who received an LB at the time of their hospitalisation (LB+ group), and 92 patients who were not given an LB (LB- group). The follow up (FU) was performed at 4 months and 1 year. RESULTS Baseline characteristics were similar in the 2 groups, except for smoking, which was more frequent in the LB-group than in the LB+ group. At FU, LB was usually well accepted by both patients and their general practitioners (GP). At 4 months FU, the patients LB+ were more prone to see their general practitioners than patients LB- (100% vs 85% in the LB- group, P=0.007). Moreover, in LB+ group, there was a trend towards a more frequent physical activity, including exercise bike (P=0.009) and an increase in HDL-cholesterol (HDL-c) (P=0.165). At 1 year FU, body mass index from LB+ was more reduced than in patients LB- (P=0.029). Finally, there was a trend towards lower morbi-mortality (hospitalisation for cardiovascular cause or death) in the LB+ group than in the LB- group (11 vs 22%, P=0.083). CONCLUSION This pilot study showed the feasibility of LB as a support for SP and its interest in post MI management in a local care network setting. In addition, our study provides encouraging data on the potential benefits of this pioneer tool for SP.
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Affiliation(s)
- Aurélien Vaillant
- Département de médecine générale, UFR sciences de santé, 7, boulevard Jeanne-d'Arc, 21000 Dijon, France
| | - Gilles Dentan
- Clinique de Fontaine, service de cardiologie, rue des Créots,Fontaine-les-Dijon, Dijon, France
| | - Yves Laurent
- CHU de Dijon, centre de réeducation-réadaptation, Dijon, France
| | | | - Jean-Claude Beer
- CHU Bocage, service de cardiologie, boulevard Mal-de-Lattre-de-Tassigny, 21034 Dijon, France
| | - Frédéric Germin
- CHU Bocage, service de cardiologie, boulevard Mal-de-Lattre-de-Tassigny, 21034 Dijon, France
| | - Élodie Boch
- CHU Bocage, service de cardiologie, boulevard Mal-de-Lattre-de-Tassigny, 21034 Dijon, France
| | | | - Philippe Brunel
- Clinique de Fontaine, service de cardiologie, rue des Créots,Fontaine-les-Dijon, Dijon, France
| | - Claude Touzery
- Département de médecine générale, UFR sciences de santé, 7, boulevard Jeanne-d'Arc, 21000 Dijon, France
| | - Yves Cottin
- CHU Bocage, service de cardiologie, boulevard Mal-de-Lattre-de-Tassigny, 21034 Dijon, France
| | - Marianne Zeller
- Laboratoire de physiopathologie et pharmacologie cardiométaboliques, Inserm UMR866, UFR sciences de santé, 7, boulevard Jeanne-d'Arc, 21079 Dijon cedex, France.
| | - Gilles Morel
- Département de médecine générale, UFR sciences de santé, 7, boulevard Jeanne-d'Arc, 21000 Dijon, France
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Barral M, Mounsef F, Grasset L, Brunel P. GM-011 Centralised preparation of argatroban syringes: medico-economic assessment after 18 months. Eur J Hosp Pharm 2015. [DOI: 10.1136/ejhpharm-2015-000639.279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Goussot S, Darbani S, Stamboul K, Brunel P, Brunet D, Touzery C, Maza M, Cottin Y, Zeller M. 0120: B-type Nt-proBNP as a marker for contrast induced nephropathy in patients with primary percutaneous coronary intervention for ST segment elevation myocardial infarction. Archives of Cardiovascular Diseases Supplements 2015. [DOI: 10.1016/s1878-6480(15)71530-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Grasset L, Mounsef F, Maréchal I, Brunel P. P068: Evaluer, améliorer, puis ré-évaluer nos préparations pharmaceutiques : résultats d’évaluation des pratiques sur le secteur de préparation des MNP (3e tour d’audit) et sur le secteur de préparation complet (1er tour). NUTR CLIN METAB 2014. [DOI: 10.1016/s0985-0562(14)70711-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Trosseille C, Aubert D, Auger L, Bazzoli S, Beck T, Brunel P, Burillo M, Chollet C, Gazave J, Jasmin S, Maruenda P, Moreau I, Oudot G, Raimbourg J, Soullié G, Stemmler P, Zuber C. Overview of the ARGOS X-ray framing camera for Laser MegaJoule. Rev Sci Instrum 2014; 85:11D620. [PMID: 25430196 DOI: 10.1063/1.4891057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Commissariat à l'Énergie Atomique et aux Énergies Alternatives has developed the ARGOS X-ray framing camera to perform two-dimensional, high-timing resolution imaging of an imploding target on the French high-power laser facility Laser MegaJoule. The main features of this camera are: a microchannel plate gated X-ray detector, a spring-loaded CCD camera that maintains proximity focus in any orientation, and electronics packages that provide remotely-selectable high-voltages to modify the exposure-time of the camera. These components are integrated into an "air-box" that protects them from the harsh environmental conditions. A miniaturized X-ray generator is also part of the device for in situ self-testing purposes.
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Affiliation(s)
| | - D Aubert
- CEA, DAM, DIF, F-91297 Arpajon, France
| | - L Auger
- CEA, DAM, DIF, F-91297 Arpajon, France
| | - S Bazzoli
- CEA, DAM, DIF, F-91297 Arpajon, France
| | - T Beck
- CEA, DEN, CADARACHE, F-13108 St Paul lez Durance, France
| | - P Brunel
- CEA, DAM, DIF, F-91297 Arpajon, France
| | - M Burillo
- CEA, DAM, DIF, F-91297 Arpajon, France
| | - C Chollet
- CEA, DAM, DIF, F-91297 Arpajon, France
| | - J Gazave
- CEA, DAM, CESTA, F-33116 Le Barp, France
| | - S Jasmin
- CEA, DAM, DIF, F-91297 Arpajon, France
| | | | - I Moreau
- CEA, DAM, DIF, F-91297 Arpajon, France
| | - G Oudot
- CEA, DAM, DIF, F-91297 Arpajon, France
| | | | - G Soullié
- CEA, DAM, DIF, F-91297 Arpajon, France
| | | | - C Zuber
- CEA, DAM, DIF, F-91297 Arpajon, France
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Gudjoncik A, Richet S, Derrou A, Hamblin J, Ravisy J, Buffet P, Mock L, Brunel P, Brunet D, Claes S, Zeller M, Cottin Y. 0437: SYNTAX score is associated with in-hospital mortality as assessed by GRACE risk score in patients with acute myocardial infarction. Archives of Cardiovascular Diseases Supplements 2014. [DOI: 10.1016/s1878-6480(14)71266-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Pouche M, Ruidavets JB, Iliou MC, Douard H, Lorgis L, Brunel P, Saadouni EH, Simon T, Ferrieres J, Danchin N. Cardiac rehabilitation and five-year mortality after an acute coronary syndrome: the 2005 French FAST-MI registry. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gudjoncik A, Lorgis L, Ravisy J, Buffet P, Brunel P, Janin-Manificat L, Beer JC, Brunet D, Zeller M, Cottin Y. Impact of admission hyperglycemia on one-year mortality in non-diabetic patients admitted for rescue PCI. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p4826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gudjoncik A, Richet S, Derrou A, Hamblin J, Mock L, Buffet P, Brunel P, Brunet D, Zeller M, Cottin Y. SYNTAX score is associated with in-hospital mortality as assessed by GRACE risk score in patients with acute myocardial infarction. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lorgis L, Gudjoncik A, Richard C, Mock L, Buffet P, Brunel P, Janin-Manificat L, Beer JC, Brunet D, Touzery C, Rochette L, Cottin Y, Zeller M. Pre-infarction angina and outcomes in non-ST-segment elevation myocardial infarction: data from the RICO survey. PLoS One 2012; 7:e48513. [PMID: 23272043 PMCID: PMC3525639 DOI: 10.1371/journal.pone.0048513] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 09/26/2012] [Indexed: 11/30/2022] Open
Abstract
Background The presence of pre-infarction angina (PIA) has been shown to confer cardioprotection after ST-segment elevation myocardial infarction (STEMI). However, the clinical impact of PIA in non-ST-segment elevation myocardial infarction (NSTEMI) remains to be determined. Methods and Results From the obseRvatoire des Infarctus de Côte d'Or (RICO) survey, 1541 consecutive patients admitted in intensive care unit with a first NSTEMI were included. Patients who experienced chest pain <7 days before the episode leading to admission were defined as having PIA and were compared with patients without PIA. Incidence of in-hospital ventricular arrhythmias (VAs), heart failure and 30-day mortality were collected. Among the 1541 patients included in the study, 693 (45%) patients presented PIA. PIA was associated with a lower creatine kinase peak, as a reflection of infarct size (231(109–520) vs. 322(148–844) IU/L, p<0.001) when compared with the group without PIA. Patients with PIA developed fewer VAs, by 3 fold (1.6% vs. 4.0%, p = 0.008) and heart failure (18.0% vs. 22.4%, p = 0.040) during the hospital stay. Overall, there was a decrease in early CV events by 26% in patients with PIA (19.2% vs. 25.9%, p = 0.002). By multivariate analysis, PIA remained independently associated with less VAs. Conclusion From this large contemporary prospective study, our work showed that PIA is very frequent in patients admitted for a first NSTEMI, and is associated with a better prognosis, including reduced infarct size and in hospital VAs. Accordingly, protecting the myocardium by ischemic or pharmacological conditioning not only in STEMI, but in all type of MI merits further attention.
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Affiliation(s)
- Luc Lorgis
- Department of Cardiology, University Hospital, Dijon, France
- Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM U866, SFR Santé University of Burgundy, Dijon, France
| | - Aurélie Gudjoncik
- Department of Cardiology, University Hospital, Dijon, France
- Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM U866, SFR Santé University of Burgundy, Dijon, France
| | - Carole Richard
- Department of Cardiology, University Hospital, Dijon, France
- Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM U866, SFR Santé University of Burgundy, Dijon, France
| | - Laurent Mock
- Department of Cardiology, Clinique de Fontaine-lès-Dijon, Fontaine-lès-Dijon, France
| | - Philippe Buffet
- Department of Cardiology, University Hospital, Dijon, France
| | - Philippe Brunel
- Department of Cardiology, Clinique de Fontaine-lès-Dijon, Fontaine-lès-Dijon, France
| | | | | | - Damien Brunet
- Department of Cardiology, Clinique de Fontaine-lès-Dijon, Fontaine-lès-Dijon, France
| | - Claude Touzery
- Department of Cardiology, University Hospital, Dijon, France
| | - Luc Rochette
- Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM U866, SFR Santé University of Burgundy, Dijon, France
| | - Yves Cottin
- Department of Cardiology, University Hospital, Dijon, France
- Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM U866, SFR Santé University of Burgundy, Dijon, France
| | - Marianne Zeller
- Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM U866, SFR Santé University of Burgundy, Dijon, France
- * E-mail:
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Eveillard M, Joly-Guillou ML, Brunel P. Correlation between glove use practices and compliance with hand hygiene in a multicenter study with elderly patients. Am J Infect Control 2012; 40:387-8. [PMID: 21864940 DOI: 10.1016/j.ajic.2011.05.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 05/12/2011] [Accepted: 05/12/2011] [Indexed: 11/26/2022]
Abstract
In a study conducted in 11 health care settings for elderly patients, we demonstrated a significant negative correlation between the proportion of glove use outside any risk of exposure to body fluids and compliance with hand hygiene (P < .02). This result underscores a major limitation of strategies for controlling the spread of multidrug-resistant bacteria that recommend systematic glove use for each contact with carriers or their environment.
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Gabriel L, Grasset L, Brunel P. P173 Apports en oligo-éléments dans les mélanges de nutrition parentérale « à la carte » : élaboration de recommandations en fonction des besoins de chaque âge. NUTR CLIN METAB 2011. [DOI: 10.1016/s0985-0562(11)70240-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Talavera S, Grasset L, Alary S, Verdier E, Brunel P. P169 Administration des médicaments par sonde de nutrition entérale : de l’audit de pratiques à l’élaboration d’outils pour aider le personnel soignant. NUTR CLIN METAB 2011. [DOI: 10.1016/s0985-0562(11)70236-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Joannet B, Grasset L, Brunel P. P135 Un exemple de perte de stabilité d’un mélange de nutrition parentérale « à la carte ». NUTR CLIN METAB 2011. [DOI: 10.1016/s0985-0562(11)70202-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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