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Boivin-Proulx LA, Ieroncig F, Demers SP, Nozza A, Soltani M, Ghersi I, Verreault-Julien L, Alansari Y, Massie C, Simard P, Rosca L, Lalancette JS, Massicotte G, Chen-Tournoux A, Daneault B, Paradis JM, Diodati JG, Pranno N, Jolicoeur M, Potter BJ, Marquis-Gravel G, Pacheco C. Antithrombotic Management and Outcomes of Anterior ST-Elevation Myocardial Infarction With New-Onset Wall Motion Abnormalities in Men and Women. CJC Open 2024; 6:362-369. [PMID: 38487067 PMCID: PMC10935678 DOI: 10.1016/j.cjco.2023.11.008] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 11/10/2023] [Indexed: 03/17/2024] Open
Abstract
Background In patients with anterior ST-elevation myocardial infarction (STEMI) and new-onset antero-apical wall motion abnormalities (WMAs), whether the rate of prophylaxis against left ventricular thrombus and outcomes differ between men and women is unknown. Methods A multicentre retrospective cohort study of patients with STEMI and new-onset antero-apical WMAs treated with primary percutaneous coronary intervention was conducted. Patients with an established indication of oral anticoagulation (OAC) were excluded. The rates of triple therapy (double antiplatelet therapy + OAC) at discharge were compared for women vs men. The rates of net adverse clinical events, a composite of mortality, myocardial infarction, stroke or transient ischemic attack, systemic thromboembolism or Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding at 6 months were compared across sex using a multivariate logistic regression model. Results A total of 1664 patients were included in the primary analysis, of whom 402 (24.2%) were women and 1262 (75.8%) were men. A total of 138 women (34.3%) and 489 men (38.7%) received a triple therapy prescription at discharge (P = 0.11). At 6 months, 33 women (8.2%) and 96 men (7.6%) experienced a net adverse clinical event (adjusted odds ratio 0.82; 95% confidence interval 0.49-1.37). No difference occurred in the risk of bleeding events and ischemic events between men and women, when these were analyzed separately. Conclusions The rates of OAC prescription for left ventricular thrombus prophylaxis and clinical outcomes at 6 months were similar in women and men following anterior STEMI with new-onset antero-apical WMAs.
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Affiliation(s)
- Laurie-Anne Boivin-Proulx
- Division of Cardiology, Interventional Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Fabrice Ieroncig
- Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Simon-Pierre Demers
- Centre intégré universitaire de santé et de services sociaux du Nord-de-l'île-de-Montréal, Sacré-Coeur Hospital, Cardiology Division, Montreal, Quebec, Canada
| | - Anna Nozza
- Montreal Heart Institute, Montreal, Quebec, Canada
| | - Marwa Soltani
- Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | | | | | - Yahya Alansari
- Division of Cardiology, Department of Medicine, Jewish General Hospital, Montreal, Quebec, Canada
| | - Charles Massie
- Centre intégré universitaire de santé et de services sociaux du Nord-de-l'île-de-Montréal, Sacré-Coeur Hospital, Cardiology Division, Montreal, Quebec, Canada
| | - Philippe Simard
- Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Lorena Rosca
- Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, Quebec, Canada
| | | | | | - Annabel Chen-Tournoux
- Division of Cardiology, Department of Medicine, Jewish General Hospital, Montreal, Quebec, Canada
| | - Benoit Daneault
- Sherbrooke University Hospital Center, Sherbrooke, Quebec, Canada
| | | | - Jean G. Diodati
- Centre intégré universitaire de santé et de services sociaux du Nord-de-l'île-de-Montréal, Sacré-Coeur Hospital, Cardiology Division, Montreal, Quebec, Canada
| | | | - Marc Jolicoeur
- Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, Quebec, Canada
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, Québec, Canada
| | - Brian J. Potter
- Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, Quebec, Canada
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, Québec, Canada
| | | | - Christine Pacheco
- Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, Quebec, Canada
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, Québec, Canada
- Hôpital Pierre-Boucher, Centre intégré de soins et de services sociaux de la Montérégie Est, Longueuil, Quebec, Canada
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Boivin-Proulx LA, Demers SP, Ieroncig F, Nozza A, Soltani M, Alansari Y, Massie C, Simard P, Rosca L, Ghersi I, Verreault-Julien L, Lalancette JS, Massicotte G, Chen-Tournoux A, Daneault B, Paradis JM, Diodati JG, Pranno N, Jolicoeur M, Potter BJ, Marquis-Gravel G. Oral Anticoagulation for the Prevention of Thromboembolic Events in Patients With Anterior ST-Segment Elevation Myocardial Infarction. J Invasive Cardiol 2022; 34:E826-E835. [PMID: 36476819] [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] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The objective is to assess the comparative effectiveness and safety of dual-antiplatelet therapy (DAPT) vs triple therapy (TT) with DAPT + oral anticoagulant (OAC) in patients with anterior ST-segment elevation myocardial infarction (STEMI) and with new-onset anterior/apical wall-motion abnormalities (WMAs) treated with primary percutaneous coronary intervention (PCI). BACKGROUND Patients with STEMI and new-onset anterior/apical WMA may benefit from the addition of OAC to prevent left ventricular thrombus and cardioembolic events. METHODS A multicenter, retrospective cohort study was conducted. Patients with a concomitant indication for OAC were excluded. Patients discharged on TT were compared with patients discharged on DAPT using adjusted Cox proportional hazards analysis and inverse probability of treatment weighting. The primary endpoint was the net adverse clinical event (NACE) rate at 6 months (composite of all-cause mortality, non-fatal MI, stroke, or transient ischemic attack, systemic thromboembolism or type 3 or 5 Bleeding Academic Research Consortium [BARC] bleeding). RESULTS A total of 1666 patients were included, among which 627 were treated with TT and 1039 were treated with DAPT. A NACE occurred in 55 patients (6.03 per 100 patient-years) in the TT group and in 74 patients (7.18 per 100 patient-years) in the DAPT group (adjusted hazard ratio, 0.86; 95% confidence interval, 0.55-1.32). Adjusted risk of the individual components of the primary endpoint, ischemic events, and bleeding events were similar between both groups (P>.05 for all). CONCLUSIONS The addition of OAC to DAPT in anterior STEMI patients with new-onset WMA treated with PCI was not associated with a significant reduction in NACE.
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Proulx LAB, Demers SP, Ieroncig F, Massie C, Ghersi I, Simard P, Verreault-Julien L, Rosca L, Alansari Y, Lancette JS, Massicotte G, Nozza A, Chen-Tournoux A, Daneault B, Paradis JM, Diodati J, Pranno N, Jolicoeur M, Potter B, Marquis-Gravel G. ORAL ANTICOAGULATION FOR THE PREVENTION OF CARDIOGENIC THROMBO-EMBOLIC EVENTS FOLLOWING ST-ELEVATION MYOCARDIAL INFARCTION AND NEW-ONSET ANTERIOR WALL MOTION ABNORMALITIES. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01430-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Rosca L, Robert-Boire V, Delisle JF, Samson Y, Perreault S. Carboplatin and vincristine neurotoxicity in the treatment of pediatric low-grade gliomas. Pediatr Blood Cancer 2018; 65:e27351. [PMID: 30014595 DOI: 10.1002/pbc.27351] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 06/01/2018] [Accepted: 06/01/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pediatric low-grade gliomas (LGG) represent 30-50% of central nervous system pediatric tumors. Over the last decades, the combination of carboplatin and vincristine (CV) has become the first line of treatment in most centers. In a large clinical trial where the efficacy of CV was compared to another regimen, 19% presented grade III neurotoxicity. Despite the fact that CV therapy is widely used for pediatric patients with LGG, no study has reported detailed neurological adverse events and outcome with this treatment regimen. The purpose of this retrospective study is to better understand neurotoxicity associated with CV. PROCEDURE We conducted a retrospective study to better evaluate the incidence and evolution of neurotoxicity associated with CV in patients with LGG. RESULTS Twenty-one pediatric patients were treated with CV at our single institution over 16 years. Most patients had optic glioma. Peripheral neuropathy was present in most patients (86%). Eight patients (38%) had a dose reduction of vincristine due to grade III toxicity (three motor neuropathies, three sensory neuropathies, one constipation, and one dysphagia). Most neurotoxicity occurred during induction or the first maintenance cycle. No ototoxicity was observed during treatment or follow-up. CONCLUSIONS In our study, neurotoxicity with vincristine occurred two times more frequently than in previously published literature. Careful neurological assessment is important to detect neurotoxicity, especially during induction. The high incidence of neurotoxicity should be considered when selecting a chemotherapy regimen for pediatric LGG.
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Affiliation(s)
- Lorena Rosca
- Department of Pediatrics, Division of Child Neurology, CHU Sainte-Justine, Montreal, Canada
| | - Viviane Robert-Boire
- Department of Pediatrics, Division of Child Neurology, CHU Sainte-Justine, Montreal, Canada
| | | | - Yvan Samson
- Department of Pediatrics, Division of Hemato-Oncology, CHU Sainte-Justine, Montreal, Canada
| | - Sébastien Perreault
- Department of Pediatrics, Division of Child Neurology, CHU Sainte-Justine, Montreal, Canada
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Robert-Boire V, Rosca L, Samson Y, Ospina LH, Perreault S. Clinical Presentation and Outcome of Patients With Optic Pathway Glioma. Pediatr Neurol 2017; 75:55-60. [PMID: 28847625 DOI: 10.1016/j.pediatrneurol.2017.06.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [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: 04/20/2017] [Revised: 06/29/2017] [Accepted: 06/30/2017] [Indexed: 01/29/2023]
Abstract
BACKGROUND Optic pathway gliomas (OPGs) occur sporadically or in patients with neurofibromatosis type 1 (NF1). The purpose of this study was to evaluate the clinical presentation at diagnosis and at progression of patients with OPGs. METHODS We conducted a chart review of patients with OPGs diagnosed in a single center over a period of 15 years. Demographic data including age, sex, NF1 status, clinical presentation, and outcome were collected. RESULTS Of the 40 patients who were identified, 23 had sporadic tumors (57.5%) and 17 had NF1-related tumors (42.5%). Among the children with NF1, there was a significant overrepresentation of girls (82.3%) (P = 0.02), while among the children without NF1, there were slightly more boys (56.5%) than girls (43.5%). The presence of nystagmus was strongly associated with sporadic optic pathway gliomas. Poor visual outcome was related to tumor affecting both optic pathways, hydrocephalus at diagnosis, and optic nerve atrophy. Of the 40 patients, five died of OPG complications (12.5%) and all had sporadic tumors. CONCLUSIONS Our cohort is one of the largest with OPGs and a detailed description of the clinical presentation both at diagnosis and at progression. We observed a significant difference between sporadic and NF1 optic pathway gliomas in terms of demographics, clinical presentation, and outcome.
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Affiliation(s)
- Viviane Robert-Boire
- Department of Pediatrics, Division of Child Neurology, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Lorena Rosca
- Department of Pediatrics, Division of Child Neurology, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Yvan Samson
- Department of Pediatrics, Division of Hemato-Oncology, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Luis H Ospina
- Department of Ophthalmology, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Sébastien Perreault
- Department of Pediatrics, Division of Child Neurology, CHU Sainte-Justine, Montreal, Quebec, Canada.
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Marquis-Gravel G, Ieroncig F, Demers S, Ghersi I, Rosca L, Simard P, Massie C, Massicotte G, Lalancette J, Bastiany A, El-Turaby F, Diodati J, Paradis J, Daneault B, L'Allier P.L, Potter B, Jolicoeur M. CONTEMPORARY INCIDENCE OF MURAL THROMBUS FOLLOWING ACUTE ANTERIOR STEMI COMPLICATED BY NEW ANTERO/APICAL WALL MOTION ABNORMALITIES: INSIGHTS FROM THE MULTICENTER MAGIC REGISTRY. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Abu-Sanad A, Wang Y, Hasheminasab F, Panasci J, Noë A, Rosca L, Davidson D, Amrein L, Sharif-Askari B, Aloyz R, Panasci L. Simultaneous inhibition of ATR and PARP sensitizes colon cancer cell lines to irinotecan. Front Pharmacol 2015; 6:147. [PMID: 26257651 PMCID: PMC4510998 DOI: 10.3389/fphar.2015.00147] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 07/02/2015] [Indexed: 11/21/2022] Open
Abstract
Enhanced DNA damage repair is one mechanism involved in colon cancer drug resistance. Thus, targeting molecular components of repair pathways with specific small molecule inhibitors may improve the efficacy of chemotherapy. ABT-888 and VE-821, inhibitors of poly-ADP-ribose-polymerase (PARP) and the serine/threonine-kinase Ataxia telangiectasia related (ATR), respectively, were used to treat colon cancer cell lines in combination with the topoisomerase-I inhibitor irinotecan (SN38). Our findings show that each of these DNA repair inhibitors utilized alone at nontoxic single agent concentrations resulted in sensitization to SN38 producing a 1.4–3 fold reduction in the 50% inhibitory concentration (IC50) of SN38 in three colon cancer cell lines. When combined together, nontoxic concentrations of ABT-888 and VE-821 produced a 4.5–27 fold reduction in the IC50 of SN38 with the HCT-116 colon cancer cells demonstrating the highest sensitization as compared to LoVo and HT-29 colon cancer cells. Furthermore, the combination of all three agents was associated with maximal G2 −M arrest and enhanced DNA-damage (γH2AX) in all three colon cancer cell lines. The mechanism of this enhanced sensitization was associated with: (a) maximal suppression of SN38 induced PARP activity in the presence of both inhibitors and (b) ABT-888 producing partial abrogation of the VE-821 enhancement of SN38 induced DNA-PK phosphorylation, resulting in more unrepaired DNA damage; these alterations were only present in the HCT-116 cells which have reduced levels of ATM. This novel combination of DNA repair inhibitors may be useful to enhance the activity of DNA damaging chemotherapies such as irinotecan and help produce sensitization to this drug in colon cancer.
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Affiliation(s)
- Atlal Abu-Sanad
- Montreal Centre for Experimental Therapeutics in Cancer, Segal Cancer Center, Lady Davis Institute, Jewish General Hospital, McGill University Montréal, QC, Canada
| | - Yunzhe Wang
- Montreal Centre for Experimental Therapeutics in Cancer, Segal Cancer Center, Lady Davis Institute, Jewish General Hospital, McGill University Montréal, QC, Canada
| | - Fatemeh Hasheminasab
- Montreal Centre for Experimental Therapeutics in Cancer, Segal Cancer Center, Lady Davis Institute, Jewish General Hospital, McGill University Montréal, QC, Canada
| | - Justin Panasci
- Montreal Centre for Experimental Therapeutics in Cancer, Segal Cancer Center, Lady Davis Institute, Jewish General Hospital, McGill University Montréal, QC, Canada
| | - Alycia Noë
- Montreal Centre for Experimental Therapeutics in Cancer, Segal Cancer Center, Lady Davis Institute, Jewish General Hospital, McGill University Montréal, QC, Canada
| | - Lorena Rosca
- Montreal Centre for Experimental Therapeutics in Cancer, Segal Cancer Center, Lady Davis Institute, Jewish General Hospital, McGill University Montréal, QC, Canada
| | - David Davidson
- Montreal Centre for Experimental Therapeutics in Cancer, Segal Cancer Center, Lady Davis Institute, Jewish General Hospital, McGill University Montréal, QC, Canada
| | - Lilian Amrein
- Montreal Centre for Experimental Therapeutics in Cancer, Segal Cancer Center, Lady Davis Institute, Jewish General Hospital, McGill University Montréal, QC, Canada
| | - Bahram Sharif-Askari
- Montreal Centre for Experimental Therapeutics in Cancer, Segal Cancer Center, Lady Davis Institute, Jewish General Hospital, McGill University Montréal, QC, Canada
| | - Raquel Aloyz
- Montreal Centre for Experimental Therapeutics in Cancer, Segal Cancer Center, Lady Davis Institute, Jewish General Hospital, McGill University Montréal, QC, Canada
| | - Lawrence Panasci
- Montreal Centre for Experimental Therapeutics in Cancer, Segal Cancer Center, Lady Davis Institute, Jewish General Hospital, McGill University Montréal, QC, Canada
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