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Klein C, Boveda S, De Groote P, Galinier M, Jourdain P, Mansourati J, Pathak A, Roubille F, Sabatier R, Guedon-Moreau L. Remote management in patients with heart failure (from new onset to advanced): A practical guide. Arch Cardiovasc Dis 2024; 117:160-166. [PMID: 38092576 DOI: 10.1016/j.acvd.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 02/20/2024]
Abstract
Heart failure is a chronic condition that affects millions of people worldwide and is associated with high morbidity and mortality. Remote monitoring, which includes the use of non-invasive connected devices, cardiac implantable electronic devices and haemodynamic monitoring systems, has the potential to improve outcomes for patients with heart failure. Despite the conceptual and clinical advantages, there are still limitations in the widespread use of these technologies. Moreover, a significant proportion of studies evaluating the benefit of remote monitoring in heart failure have focused on the limited area of prevention of rehospitalization after an episode of acute heart failure. A group of experts in the fields of heart failure and digital health worked on this topic in order to provide a practical paper for the use of remote monitoring in clinical practice at the different stages of the heart failure syndrome: (1) discovery of heart failure; (2) acute decompensation of chronic heart failure; (3) heart failure in stable period; and (4) advanced heart failure. A careful and critical analysis of the available literature was performed with the aim of providing caregivers with some recommendations on when and how to use remote monitoring in these different situations, specifying which variables are essential, optional or useless.
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Affiliation(s)
- Cédric Klein
- Department of Cardiovascular Medicine, CHU de Lille, 59000 Lille, France.
| | - Serge Boveda
- Heart Rhythm Department, clinique Pasteur, 31076 Toulouse, France
| | - Pascal De Groote
- Department of Cardiovascular Medicine, CHU de Lille, 59000 Lille, France; Inserm U1167, institut Pasteur de Lille, 59000 Lille, France
| | - Michel Galinier
- Cardiology Department, CHU de Toulouse, 31300 Toulouse, France; University Paul-Sabatier - Toulouse III, 31062 Toulouse, France
| | - Patrick Jourdain
- Covidom Regional Telemedicine Platform, AP-HP, Paris, France; Cardiology Department, University Hospital Bicêtre, AP-HP, 94270 Le Kremlin-Bicêtre, France
| | - Jacques Mansourati
- Department of Cardiology, CHU de Brest, 29200 Brest, France; University of Bretagne Occidentale, 29238 Brest, France
| | - Atul Pathak
- Department of Cardiovascular Medicine, Princess Grace Hospital, 98000 Monaco, Monaco
| | - François Roubille
- Cardiology Department, CHU de Montpellier, 34295 Montpellier, France; Inserm, PhyMedExp, CNRS, université de Montpellier, 34295 Montpellier, France
| | - Rémi Sabatier
- Cardiovascular Department, CHU de Caen Normandie, University of Caen-Normandie, 14000 Caen, France
| | - Laurence Guedon-Moreau
- Department of Cardiovascular Medicine, CHU de Lille, 59000 Lille, France; University of Lille, 59000 Lille, France
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Caillon M, Sabatier R, Legallois D, Courouve L, Donio V, Boudevin F, de Chalus T, Hauchard K, Belin A, Milliez P. A telemonitoring programme in patients with heart failure in France: a cost-utility analysis. BMC Cardiovasc Disord 2022; 22:441. [PMID: 36217130 PMCID: PMC9549824 DOI: 10.1186/s12872-022-02878-1] [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] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 09/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Certain telemedicine programmes for heart failure (HF) have been shown to reduce all-cause mortality and heart failure-related hospitalisations, but their cost-effectiveness remains controversial. The SCAD programme is a home-based interactive telemonitoring service for HF, which is one of the largest and longest-running telemonitoring programmes for HF in France. The objective of this cost-utility analysis was to evaluate the cost-effectiveness of the SCAD programme with respect to standard hospital-based care in patients with HF. METHODS A Markov model simulating hospitalisations and mortality in patients with HF was constructed to estimate outcomes and costs. The model included six distinct health states (three 'not hospitalised' states, two 'hospitalisation for heart failure' states, both depending on the number of previous hospitalisations, and one death state). The model lifetime in the base case was 10 years. Model inputs were based on published literature. Outputs (costs and QALYs) were compared between SCAD participants and standard care. Deterministic and probabilistic sensitivity analyses were performed to assess uncertainty in the input parameters of the model. RESULTS The number of quality-adjusted life years (QALYs) was 3.75 in the standard care setting and 4.41 in the SCAD setting. This corresponds to a gain in QALYs provided by the SCAD programme of 0.65 over the 10 years lifetime of the model. The estimated total cost was €30,932 in the standard care setting and €35,177 in the SCAD setting, with an incremental cost of €4245. The incremental cost-effectiveness ratio (ICER) for the SCAD programme over standard care was estimated at €4579/QALY. In the deterministic sensitivity analysis, the variables that had the most impact on the ICER were HF management costs. The likelihood of the SCAD programme being considered cost-effective was 90% at a willingness-to-pay threshold of €11,800. CONCLUSIONS Enrolment of patients into the SCAD programme is highly cost-effective. Extension of the programme to other hospitals and more patients would have a limited budget impact but provide important clinical benefits. This finding should also be taken into account in new public health policies aimed at encouraging a shift from inpatient to ambulatory care.
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Affiliation(s)
| | - Rémi Sabatier
- Service de Cardiologie et de Pathologie Vasculaire, CHU de Caen Normandie, Caen, France.,Université de Caen-Normandie, Caen, France.,APRIC (Association pour l'Amélioration de la Prise en charge de l'Insuffisance Cardiaque), Ouistreham, France
| | - Damien Legallois
- Service de Cardiologie et de Pathologie Vasculaire, CHU de Caen Normandie, Caen, France.,Université de Caen-Normandie, Caen, France
| | | | | | | | | | | | - Annette Belin
- Service de Cardiologie et de Pathologie Vasculaire, CHU de Caen Normandie, Caen, France.,APRIC (Association pour l'Amélioration de la Prise en charge de l'Insuffisance Cardiaque), Ouistreham, France
| | - Paul Milliez
- Service de Cardiologie et de Pathologie Vasculaire, CHU de Caen Normandie, Caen, France.,Université de Caen-Normandie, Caen, France
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Oaknin A, Pothuri B, Gilbert L, Sabatier R, Brown J, Ghamande S, Mathews C, O'Malley D, Boni V, Gravina A, Banerjee S, Miller R, Pikiel J, Mirza M, Duan T, Han X, Zildjian S, Dewal N, J.Veneris, Tinker A. 547P Efficacy of dostarlimab in endometrial cancer (EC) by molecular subtype: A post hoc analysis of the GARNET study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.675] [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: 11/01/2022] Open
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4
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Tinker A, Pothuri B, Gilbert L, Sabatier R, Brown J, Ghamande S, Mathews C, O'Malley D, Boni V, Gravina A, Banerjee S, Miller R, Pikiel J, Mirza M, Duan T, Antony G, Zildjian S, Zografos E, Veneris J, Oaknin A. 548P Progression-free survival (PFS) and overall survival (OS) in advanced/recurrent (AR) mismatch repair deficient/microsatellite instability–high or proficient/stable (dMMR/MSI-H or MMRp/MSS) endometrial cancer (EC) treated with dostarlimab in the GARNET study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.676] [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] Open
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5
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Sabatier R, Legallois D, Jodar M, Courouve L, Donio V, Boudevin F, De Chalus T, Hauchard K, Belin A, Milliez P. Impact of patient engagement in a French telemonitoring programme for heart failure on hospitalization and mortality. ESC Heart Fail 2022; 9:2886-2898. [PMID: 35715956 DOI: 10.1002/ehf2.13978] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 04/20/2022] [Accepted: 05/08/2022] [Indexed: 12/21/2022] Open
Abstract
AIMS Management of patients with recently decompensated heart failure by hospital services is expensive, complicated to plan, and not always effective. Telemedicine programmes in heart failure may improve the quality of care, but their effectiveness is poorly documented in real-world settings. The study aims to evaluate the impact of patient engagement in home-based telemonitoring for heart failure (SCAD programme) on rehospitalization and mortality rates. METHODS AND RESULTS A retrospective observational study was performed in 659 SCAD participants. SCAD is a patient-oriented service of home-based interactive telemonitoring offered to heart failure patients during hospitalization who agree to participate in a therapeutic education programme. Patients were telemonitored for at least 3 months, and rehospitalization and mortality were documented at 12 months and 5 years. During the telemonitoring period, patients provided daily information on health and lifestyle through an internet-based interface. Data were linked on a patient-by-patient basis between the SCAD database and the French national health insurance database (Système National des Données de Santé). Outcomes were compared as a function of use of the programme. Low, intermediate, and high users were classified by tercile of data return during telemonitoring. Patients were followed for a median of 32.9 months. Rehospitalization rates for cardiovascular disease decreased from 79.4% in the year preceding enrolment to 41.1% in the following year and from 52.8% to 18.8% for hospitalizations for heart failure. The 12 month mortality rate was 11.2%. Significant associations were observed between level of use of the SCAD programme and all-cause rehospitalization (P = 0.0085), rehospitalization for cardiovascular disease (P = 0.0010), rehospitalization for heart failure (27.8% in low users, 12.9% in intermediate users, and 13.5% in high users; P < 0.0001), and mortality (26.8%, 15.2%, and 15.9% respectively; P = 0.0157) in the 12 months following enrolment. The mean number of days alive outside hospital were 279 ± 111 in low users, 312 ± 90 in intermediate users, and 304 ± 100 in high users (P = 0.0022). CONCLUSIONS Educational home telemonitoring of patients with heart failure following hospitalization provides long-term clinical benefits in terms of rehospitalization and death in real-world settings, according to the level of use of the programme by the patient. These benefits would be expected to have a major impact on the burden of this disease. Low engagement in telemonitoring could be used as a signal of poor prognosis and taken into account in the management strategy.
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Affiliation(s)
- Rémi Sabatier
- Service de Cardiologie et de Pathologie Vasculaire, CHU Caen Normandie, Avenue Côte de Nacre, 14000, Caen, France
| | - Damien Legallois
- Service de Cardiologie et de Pathologie Vasculaire, CHU Caen Normandie, Avenue Côte de Nacre, 14000, Caen, France
| | - Mouna Jodar
- Service de Cardiologie et de Pathologie Vasculaire, CHU Caen Normandie, Avenue Côte de Nacre, 14000, Caen, France
| | | | | | | | | | | | - Annette Belin
- Service de Cardiologie et de Pathologie Vasculaire, CHU Caen Normandie, Avenue Côte de Nacre, 14000, Caen, France
| | - Paul Milliez
- Service de Cardiologie et de Pathologie Vasculaire, CHU Caen Normandie, Avenue Côte de Nacre, 14000, Caen, France
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6
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Roule V, Rebouh I, Lemaitre A, Sabatier R, Blanchart K, Briet C, Bignon M, Beygui F. Impact of wait times on late postprocedural mortality after successful transcatheter aortic valve replacement. Sci Rep 2022; 12:5967. [PMID: 35395869 PMCID: PMC8993919 DOI: 10.1038/s41598-022-09995-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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 03/21/2022] [Indexed: 11/30/2022] Open
Abstract
Wait times are associated with mortality on waiting list for transcatheter aortic valve replacement (TAVR). Whether longer wait times are associated with long term mortality after successful TAVR remains unassessed. Consecutive patients successfully treated with elective TAVR in our center between January 2013 and August 2019 were included. The primary end point was one-year all-cause mortality. TAVR wait times were defined as the interval from referral date for valve replacement to the date of TAVR procedure. A total of 383 patients were included with a mean wait time of 144.2 ± 83.87 days. Death occurred in 55 patients (14.4%) at one year. Increased wait times were independently associated with a relative increase of 1-year mortality by 2% per week after referral (Adjusted Hazard Ratio 1.02 [1.002–1.04]; p = 0.02) for TAVR. Chronic kidney disease, left ventricular ejection fraction ≤ 30%, access site and STS score were other independent correlates of 1-year mortality. Our study shows that wait times are relatively long in routine practice and associated with increased 1-year mortality after successful TAVR. Such findings underscore the need of strategies to minimize delays in access to TAVR.
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Affiliation(s)
- Vincent Roule
- CHU de Caen Normandie, Service de Cardiologie, 14000, Caen, France. .,INSERM UMRS 1237, GIP Cyceron, 14000, Caen, France. .,Cardiology Department, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France.
| | - Idir Rebouh
- CHU de Caen Normandie, Service de Cardiologie, 14000, Caen, France
| | - Adrien Lemaitre
- CHU de Caen Normandie, Service de Cardiologie, 14000, Caen, France
| | - Rémi Sabatier
- CHU de Caen Normandie, Service de Cardiologie, 14000, Caen, France
| | | | - Clément Briet
- CHU de Caen Normandie, Service de Cardiologie, 14000, Caen, France
| | - Mathieu Bignon
- CHU de Caen Normandie, Service de Cardiologie, 14000, Caen, France
| | - Farzin Beygui
- CHU de Caen Normandie, Service de Cardiologie, 14000, Caen, France.,INSERM UMRS 1237, GIP Cyceron, 14000, Caen, France.,ACTION Study Group, Cardiology Department, Pitié-Salpêtrière University Hospital, Paris, France
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7
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Oaknin A, Gilbert L, Tinker A, Brown J, Mathews C, Press J, Sabatier R, O'Malley D, Samouelian V, Boni V, Duska L, Ghamande S, Ghatage P, Kristeleit R, Leath C, Han X, Kumar S, Duan T, Im E, Pothuri B. 76P Analysis of antitumor activity of dostarlimab by tumor mutational burden (TMB) in patients (pts) with endometrial cancer (EC) in the GARNET trial. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.356] [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: 10/20/2022] Open
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8
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Joly E, Duval-Modeste A, Sabatier R, Arhant G, Cellier L, Mouthon M, Comoz F, Joly P, Dompmartin A. Intralesional rituximab treatment for atypical refractory granuloma faciale. Ann Dermatol Venereol 2021; 148:272-274. [PMID: 34456047 DOI: 10.1016/j.annder.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/25/2021] [Accepted: 06/01/2021] [Indexed: 11/24/2022]
Affiliation(s)
- E Joly
- Dermatology Department, CHU Caen, 14033 Caen, France; Université de Caen Basse-Normandie, Faculté de médecine, 14000 Caen, France.
| | | | - R Sabatier
- Cardiology Department, CHU Caen, 14033 Caen, France
| | - G Arhant
- Pathology Department, CHU Rouen, 76000 Rouen, France
| | - L Cellier
- Pathology Department, CHU Rouen, 76000 Rouen, France
| | - M Mouthon
- Pathology Department, CHU Caen, 14033 Caen, France
| | - F Comoz
- Pathology Department, CHU Caen, 14033 Caen, France
| | - P Joly
- Dermatology Department, CHU Rouen, 76000 Rouen, France
| | - A Dompmartin
- Dermatology Department, CHU Caen, 14033 Caen, France; Université de Caen Basse-Normandie, Faculté de médecine, 14000 Caen, France
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9
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Roule V, Schwob L, Briet C, Lemaitre A, Bignon M, Ardouin P, Sabatier R, Blanchart K, Beygui F. Residual platelet reactivity, thrombus burden and myocardial reperfusion in patients treated by PCI after successful pre-hospital fibrinolysis compared to primary PCI. J Thromb Thrombolysis 2021; 50:858-866. [PMID: 32306289 DOI: 10.1007/s11239-020-02113-8] [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] [Indexed: 11/28/2022]
Abstract
We compared residual platelet reactivity and post PCI atherothrombotic burden using OFDI in patients successfully treated by primary PCI versus pharmacoinvasive approach (PI) defined as PCI after successful pre-hospital fibrinolysis. Despite pre-hospital P2Y12-inhibitor loading dose, high rates of high on-treatment platelet reactivity were found at the time of PCI in both groups. Primary PCI patients had higher post stenting thrombus burden and lower rates of final normal myocardial blush grade compared to PI. These findings support the use of a pharmacoinvasive reperfusion strategy especially when primary PCI cannot be timely performed.
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Affiliation(s)
- Vincent Roule
- CHU de Caen Normandie, Service de Cardiologie, Caen, 14000, France. .,UNICAEN, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, Normandie Univ, Caen, 14000, France.
| | - Lin Schwob
- CHU de Caen Normandie, Service de Cardiologie, Caen, 14000, France
| | - Clément Briet
- CHU de Caen Normandie, Service de Cardiologie, Caen, 14000, France
| | - Adrien Lemaitre
- CHU de Caen Normandie, Service de Cardiologie, Caen, 14000, France
| | - Mathieu Bignon
- CHU de Caen Normandie, Service de Cardiologie, Caen, 14000, France
| | - Pierre Ardouin
- CHU de Caen Normandie, Service de Cardiologie, Caen, 14000, France
| | - Rémi Sabatier
- CHU de Caen Normandie, Service de Cardiologie, Caen, 14000, France
| | | | - Farzin Beygui
- CHU de Caen Normandie, Service de Cardiologie, Caen, 14000, France.,UNICAEN, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, Normandie Univ, Caen, 14000, France
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10
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Blanchart K, Heudel T, Ardouin P, Lemaitre A, Briet C, Bignon M, Sabatier R, Legallois D, Roule V, Beygui F. Glycoprotein IIb/IIIa inhibitors use in the setting of primary percutaneous coronary intervention for ST elevation myocardial infarction in patients pre-treated with newer P2Y12 inhibitors. Clin Cardiol 2021; 44:1080-1088. [PMID: 34114653 PMCID: PMC8364724 DOI: 10.1002/clc.23654] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 05/07/2021] [Accepted: 05/18/2021] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES We sought to investigate the safety and potential benefit of administrating glycoprotein IIb-IIIa inhibitors (GPIs) on top of more potent P2Y12 inhibitors. BACKGROUND A number of clinical trials, performed at a time when pretreatment and potent platelet inhibition was not part of routine clinical practice, have documented clinical benefits of GPI in ST-segment elevation myocardial infarction (STEMI) patients at the cost of a higher risk of bleeding. METHODS We used the data of a prospective, ongoing registry of patients admitted for STEMI in our center. For the purpose of this study only patients presenting for primary percutaneous coronary intervention and pretreated with new P2Y12 inhibitors (prasugrel or ticagrelor) were included. We compared patients who received GPI with those who did not. RESULTS Eight hundred twenty-four STEMI patients were included in our registry; GPIs were used in 338 patients (41%). GPI patients presented more often with cardiogenic shock and Thrombolysis in myocardial infarction (TIMI) flow grade <3. GPI use was not associated with an increase in in-hospital or 3-month mortality. Bleeding endpoints were similar in both groups. CONCLUSIONS Our study suggests that GPI may be used safely in combination with recent P2Y12 inhibitors in STEMI patients in association with modern primary percutaneous coronary intervention strategies (radial access and anticoagulation with enoxaparin) with similar bleeding and mortality rates at hospital discharge and 3-month follow-up.
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Affiliation(s)
| | | | | | | | - Clément Briet
- CHU de Caen Normandie, Service de CardiologieCaenFrance
| | | | - Rémi Sabatier
- CHU de Caen Normandie, Service de CardiologieCaenFrance
| | - Damien Legallois
- CHU de Caen Normandie, Service de CardiologieCaenFrance
- Normandie Univ, UNICAEN, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie‐reperfusion myocardiqueCaenFrance
| | - Vincent Roule
- CHU de Caen Normandie, Service de CardiologieCaenFrance
- Normandie Univ, UNICAEN, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie‐reperfusion myocardiqueCaenFrance
| | - Farzin Beygui
- CHU de Caen Normandie, Service de CardiologieCaenFrance
- Normandie Univ, UNICAEN, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie‐reperfusion myocardiqueCaenFrance
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11
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Roule V, Lemaitre A, Pommier W, Bignon M, Sabatier R, Blanchart K, Beygui F. Safety and efficacy of very short dual antiplatelet therapy followed by P2Y12 inhibitor monotherapy in older patients undergoing percutaneous coronary intervention: meta-analysis of randomised controlled trials. Age Ageing 2021; 50:1102-1107. [PMID: 33755049 DOI: 10.1093/ageing/afab047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND older patients undergoing percutaneous coronary intervention (PCI) represent a growing population sharing both a high ischemic and bleeding risk. Dual antiplatelet therapy (DAPT) reduces the incidence of thrombotic events but exposes patients to an increased risk of bleeding and subsequent mortality. Its optimal duration after PCI remains unclear. OBJECTIVE to assess the impact of short-duration DAPT on both bleeding and ischemic events in the specific population of older patients undergoing PCI. METHODS we performed a meta-analysis of randomised controlled trials comparing the safety and efficacy of standard versus very short duration (≤ 3 months, followed by P2Y12 inhibitor monotherapy) DAPT after PCI with a drug-eluting stent in older patients. RESULTS four studies, representing 8,961 older patients, were finally included. Compared with standard duration, short-duration DAPT was associated with similar rates of major bleeding (relative risks, RR 0.70 [0.47; 1.05]) and the composite efficacy endpoint (RR 0.85 [0.63; 1.14]). There was a high level of heterogeneity between the studies (I2 = 68%) regarding major bleeding. CONCLUSION our meta-analysis suggests that short DAPT may be a valid option in older patients after PCI but it also highlights the need for specific studies in such patients on optimal duration of antiplatelet therapy.
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Affiliation(s)
- Vincent Roule
- CHU de Caen Normandie, Service de Cardiologie, 14000 Caen, France
- Normandie Univ, UNICAEN, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, 14000 Caen, France
| | - Adrien Lemaitre
- CHU de Caen Normandie, Service de Cardiologie, 14000 Caen, France
| | - Wilhelm Pommier
- CHU de Caen Normandie, Service de Gériatrie, 14000 Caen, France
| | - Mathieu Bignon
- CHU de Caen Normandie, Service de Cardiologie, 14000 Caen, France
| | - Rémi Sabatier
- CHU de Caen Normandie, Service de Cardiologie, 14000 Caen, France
| | | | - Farzin Beygui
- CHU de Caen Normandie, Service de Cardiologie, 14000 Caen, France
- Normandie Univ, UNICAEN, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, 14000 Caen, France
- ACTION Academic Group, Pitié Salpêtrière University Hospital, 75013, Paris, France
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12
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Sabatier R, Legallois D, Jodar M, Donio V, Courouve L, Hauchard K, Boudevin F, De Chalus T, Belin A, Milliez P. Cost-effectiveness analysis of a telemonitoring program on patients with heart failure in Normandy: an 8-year retrospective analysis (2009–2017). Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
SCAD is a 3-month telemonitoring program for HF patients, associated with therapeutic education, proposed after an acute HF episode. SCAD is based on an interactive algorithm allowing to generate educative messages and alarms based on patients' responses registered on a digital tablet. It is funded by the French Health Insurance through a pilot program: ETAPES (470€/patient).
Purpose
To describe the profile of patients using SCAD & assess the medico-economic impact of the SCAD system.
Methods
Multicenter retrospective cohort study using SCAD data matched with French Health Insurance data. All patients telemonitored by SCAD in 7 centers have been included, since 01/01/2010 to 12/31/2016. Only direct costs were considered, estimated from a societal perspective limited to reimbursements. Analyses were performed to assess the difference in healthcare consumptions and costs between the year before and the year after inclusion in the SCAD program. Patients who died in the 12 months after SCAD initiation were excluded.
Results
627 patients benefited from SCAD program between 01/01/2010 and 12/31/2016 and were retrieved in French Health Insurance data through probabilistic matching. Out of the 627 patients, 99 died in the 12 months after SCAD initiation. Analyses were performed on 528 patients.72.2% were male, mean age was 66.0 years old and mean BMI 28.2. HFrEF represented 51.9% of patients, HFmrEF 25.9% and HFpEF 22.2%. 58.0% were in NYHA class 2 at baseline, 29.2% in class 3, 8.5% in class 1 and 4.3% in class 4. Mean Charlson Comorbidity Index score was 2.6 at baseline. Patients reported their level of fatigue (10 representing significant fatigue) and morale (10 = good morale) at baseline: mean fatigue=4.0/10 & mean morale=7.4/10. Medico economic results are presented in table 1 and show an important & significant decrease of hospitalizations costs and some transfer of cost toward ambulatory care.
Conclusion
On the year following remote monitoring, total health expenditure has been reduced by 18% on average (mean=3 210€/patient) and 42% in median (5 500€/patient) vs 12 months before.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): This analysis has been funded through an institutional grant from Amgen
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Affiliation(s)
- R Sabatier
- Association pour l'Amélioration de la PRise en charge de l'Insuffisance Cardiaque (APRIC), Caen, France
| | - D Legallois
- University Hospital of Caen, Cardiology Department, Caen, France
| | - M Jodar
- University Hospital of Caen, Cardiology Department, Caen, France
| | - V Donio
- Cemka, Bourg la Reine, France
| | | | - K Hauchard
- Groupement Régional d'Appui au Développement de la e-Santé en Normandie (GRADES), Caen, France
| | | | | | - A Belin
- Association pour l'Amélioration de la PRise en charge de l'Insuffisance Cardiaque (APRIC), Caen, France
| | - P Milliez
- University Hospital of Caen, Cardiology Department, Caen, France
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13
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Briet C, Lacote C, Peron C, Blanchart K, Lemaitre A, Bignon M, Sabatier R, Ardouin P, Roule V, Beygui F. Bedside assessment of the risk of non-compliance to medication is associated with mortality in elderly patients admitted for acute coronary syndromes. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1344] [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: 11/12/2022] Open
Abstract
Abstract
Background
Elderly patients are at high risk of mortality in the setting of acute coronary syndromes (ACS).
Purpose
We investigated whether compliance assessed by Compliance Evaluation Test (CET) in elderly patients admitted for acute coronary syndromes was associated with higher risk of one-year mortality.
Methods
We used the data from a prospective, open, ongoing cohort of patients ≥75 years old admitted for ACS to a tertiary center. The CET is a validated 6 item test easily performed at bedside. Non-compliance is defined by ≥ “Yes” answers.
We used a Cox model, un-adjusted and adjusted on predefined correlates of mortality (age, gender, and GRACE score) to assess the relationship between the risk of non-compliance and 1-year mortality.
Results
Two hundred fifty-five consecutive patients (age 83±5, female gender 59.6%, GRACE score 175±24) with CET assessment within 48 hours after admission and 1 year follow-up were included in the analysis. 225 (88%) were identified as compliant and 30 (12%) as non-compliant based on the CET.
Thirthy-six deaths occurred at 1 year follow-up, 24 (10.6%) and 12 (30%) in compliant and non-compliant patients respectively.
There was an almost 4-fold increase in the risk of one-year mortality in association with non-compliance (HR 4.16; 95% CI 2.03 to 8.5, p<0.0001) and adj-HR 3.93; 95% CI 1.87 to 8.3, p=0.003), independent of other covariables.
Conclusions
In elderly patients admitted for ACS, the risk of non-compliance assessed by the simple bedside test is associated with a 4-fold increase in the risk of 1-year mortality independent of other correlates of mortality. Our results support specific measures to improve compliance in such patients.
Survival based on compliance test
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- C Briet
- University Hospital of Caen, Department of Cardiology, Caen, France
| | - C Lacote
- University Hospital of Caen, Department of Cardiology, Caen, France
| | - C Peron
- University Hospital of Caen, Department of Cardiology, Caen, France
| | - K Blanchart
- University Hospital of Caen, Department of Cardiology, Caen, France
| | - A Lemaitre
- University Hospital of Caen, Department of Cardiology, Caen, France
| | - M Bignon
- University Hospital of Caen, Department of Cardiology, Caen, France
| | - R Sabatier
- University Hospital of Caen, Department of Cardiology, Caen, France
| | - P Ardouin
- University Hospital of Caen, Department of Cardiology, Caen, France
| | - V Roule
- University Hospital of Caen, Department of Cardiology, Caen, France
| | - F Beygui
- University Hospital of Caen, Department of Cardiology, Caen, France
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14
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Hanker LC, Oaknin A, Tinker A, Gilbert L, Samouëlian V, Mathews C, Brown J, Guo W, Danaee H, Im E, Sabatier R. Safety and efficacy of the anti-PD-1 monoclonal antibody dostarlimab in patients with recurrent or advanced dMMR endometrial cancer. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- LC Hanker
- AGO & University Hospital Schleswig-Holstein, Campus Lübeck, Department of Gynecology & Obstetrics
| | | | | | - L Gilbert
- Vall d’Hebron University Hospital, Vall d´Hebron Institute of Oncology (VHIO)
| | - V Samouëlian
- Gynecologic Oncology Service, Centre Hospitalier de l’Université de Montréal, Department of Obstetrics and Gynecology
| | - C Mathews
- Women and Infants Hospital of Rhode Island
| | - J Brown
- Levine Cancer Institute, Carolinas HealthCare System, Division of Gynecologic Oncology
| | | | | | | | - R Sabatier
- Aix-Marseille University, Department of Medical Oncology
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15
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Oaknin A, Tinker A, Gilbert L, Samouëlian V, Mathews C, Brown J, Guo W, Danaee H, Im E, Sabatier R. Safety and efficacy of the anti–PD-1 monoclonal antibody dostarlimab in patients with recurrent or advanced dMMR endometrial cancer. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.06.011] [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: 10/23/2022]
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16
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Oaknin A, Gilbert L, Tinker A, Sabatier R, Boni V, O'Malley D, Ghamande S, Duska L, Ghatage P, Guo W, Im E, Pothuri B. LBA36 Safety and antitumor activity of dostarlimab in patients (pts) with advanced or recurrent DNA mismatch repair deficient (dMMR) or proficient (MMRp) endometrial cancer (EC): Results from GARNET. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2266] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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17
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Allain F, Loizeau V, Chaufourier L, Hallouche M, Herrou L, Hodzic A, Blanchart K, Belin A, Manrique A, Milliez P, Sabatier R, Legallois D. Usefulness of a personalized algorithm-based discharge checklist in patients hospitalized for acute heart failure. ESC Heart Fail 2020; 7:1217-1223. [PMID: 32320135 PMCID: PMC7261525 DOI: 10.1002/ehf2.12604] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 11/29/2019] [Accepted: 12/08/2019] [Indexed: 11/20/2022] Open
Abstract
Aims The aim of this study is to evaluate the usefulness of a personalized discharge checklist (PCL) based on simple baseline characteristics on mortality, readmission for heart failure (HF), and quality of care in patients hospitalized for acute HF. Methods and results We designed an algorithm to generate PCL, based on 2016 HF European Society of Cardiology Guidelines and the screening of common comorbidities in elderly HF patients. We prospectively included 139 patients hospitalized for HF from May 2018 to October 2018. A PCL was fulfilled for each patient at admission and 24 to 48 hours before the planned discharge. A control cohort of 182 consecutive patients was retrospectively included from May 2017 to October 2017. The primary composite endpoint was mortality or readmission for HF at 6 months. The secondary endpoints were mortality, readmission for HF, and quality of care (evidence‐based medications, management of HF comorbidities, and planned care plan). There was no difference among baseline characteristics between PCL and control cohorts; mean age was 78.1 ± 12.2 vs. 79.0 ± 12.5 years old (P = 0.46) and 61 patients (43.9%) vs. 63 (34.6%) had HF with left ventricular ejection fraction (LVEF) <40% (P = 0.24). During the 6 month follow‐up period, 59 patients (42.4%) reached the primary endpoint in the PCL cohort vs. 92 patients (50.5%) in the control cohort [hazard ratio (HR): 0.79, 95% confidence interval (CI) (0.57–1.09), P = 0.15]. Subgroup analysis including only patients with either altered (<40%) or mid‐range or preserved (≥40%) LVEF showed no significant difference among groups. There was a non‐significant trend toward a reduction in HF readmission rate in the PCL group [38 patients (27.3%) vs. 64 patients (35.2%), HR: 0.73, 95%CI (0.49–1.09), P = 0.13]. There was no difference regarding survival or the use of evidence‐based medications. A higher proportion of patients were screened and treated for iron and vitamin D deficiencies (53.2% vs. 35.7%, P < 0.01 and 73.4% vs. 29.7%, P < 0.01, respectively), as well as malnutrition supplemented in the PCL group. There was a higher referral to HF follow‐up programme in the PCL group but not to telemedicine or cardiac rehabilitation programs. Conclusions In this preliminary study, the use of a PCL did not improve outcomes at 6 months in patients hospitalized for acute HF. There was a non‐significant trend towards a reduction in HF readmission rate in the PCL group. In addition, the management of HF comorbidities was significantly improved by PCL with a better referral to follow‐up programme. A multicentre study is warranted to assess the usefulness of a simple costless personalized checklist in a large HF patients' population.
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Affiliation(s)
- Florent Allain
- Department of Cardiology, Normandie University, UNICAEN, CHU de Caen Normandie, Caen, France
| | - Virginie Loizeau
- Department of Cardiology, Normandie University, UNICAEN, CHU de Caen Normandie, Caen, France
| | | | - Maya Hallouche
- Department of Cardiology, Normandie University, UNICAEN, CHU de Caen Normandie, Caen, France
| | - Laurence Herrou
- Department of Cardiology, Normandie University, UNICAEN, CHU de Caen Normandie, Caen, France
| | - Amir Hodzic
- Department of Clinical Physiology, Normandie University, UNICAEN, CHU de Caen Normandie, INSERM Comete, Caen, France
| | - Katrien Blanchart
- Department of Cardiology, Normandie University, UNICAEN, CHU de Caen Normandie, Caen, France
| | - Annette Belin
- Department of Cardiology, Normandie University, UNICAEN, CHU de Caen Normandie, Caen, France
| | - Alain Manrique
- Department of Nuclear Medicine, Normandie University, UNICAEN, CHU de Caen Normandie, EA4650 Signalisation, Electrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique (SEILIRM), FHU REMOD-VHF, Caen, France.,GIP Cyceron, Investigations chez l'Homme, Campus Jules Horowitz, Caen, France
| | - Paul Milliez
- Department of Cardiology, Normandie University, UNICAEN, CHU de Caen Normandie, EA4650 Signalisation, Electrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique (SEILIRM), FHU REMOD-VHF, Caen, France
| | - Rémi Sabatier
- Department of Cardiology, Normandie University, UNICAEN, CHU de Caen Normandie, Caen, France
| | - Damien Legallois
- Department of Cardiology, Normandie University, UNICAEN, CHU de Caen Normandie, EA4650 Signalisation, Electrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique (SEILIRM), FHU REMOD-VHF, Caen, France
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18
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Abstract
AIM Oral anticoagulants are the first-line drugs for treating thrombotic disorders related to nonvalvular atrial fibrillation and for treating deep vein thrombosis, diseases that increase in prevalence with age. Older patients have a greater risk of thrombotic and hemorrhagic events and are more prone to drug interactions. Given this backdrop, we wanted to determine the factors associated with the prescription of direct oral anticoagulants and vitamin K antagonists in older patients. METHODS We performed a cross-sectional observational study using a hospital prescription database. The study population consists of 405 older patients who were given oral anticoagulants. The 2 variables of interest were the prescription of 1 of the 2 classes of oral anticoagulants (direct oral anticoagulants vs vitamin K antagonists) and appropriateness of oral anticoagulant prescribing according to Summary of Product Characteristics (potentially inappropriate vs appropriate). RESULTS The factors associated with direct oral anticoagulant prescribing were the female gender (odds ratio [OR]: 1.87, 95% confidence interval [CI]: 1.22-2.88) and initiation during hospital stay (OR: 2.56, 95% CI: [1.52-4.32]). Stage 4 and 5 chronic kidney diseases (OR: 0.39, 95% CI: [0.19-0.79] and OR: 0.07, 95% CI: [0.01-0.53]) were factors favoring vitamin K antagonist prescription. Being 90 years of age or more (OR: 2.05, 95% CI: [1.06-3.98]) was a factor for potentially inappropriate anticoagulant prescribing. The gastroenterology department (OR: 2.91, 95% CI: [1.05-8.11]) was associated with potentially inappropriate anticoagulant prescribing. CONCLUSIONS Direct oral anticoagulants are the drugs of choice for anticoagulant treatment, including in older adults. The female gender and the initiation during hospital stay increased the chances of being prescribed a direct oral anticoagulant in older adults. Stage 4 and 5 chronic kidney disease increased the likelihood of having a vitamin K antagonist prescribed. Our study also revealed a persistence of potentially inappropriate oral anticoagulant prescriptions in older patients.
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Affiliation(s)
- Arnaud Pagès
- Department of Pharmacy, Toulouse University Hospital, Toulouse, France
- UMR 1027, Inserm, UPS Toulouse III University, Toulouse, France
| | - Rémi Sabatier
- Department of Pharmacy, Toulouse University Hospital, Toulouse, France
| | - Brigitte Sallerin
- Department of Pharmacy, Toulouse University Hospital, Toulouse, France
- UMR 1048, Inserm, UPS Toulouse III University, Toulouse, France
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19
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Roule V, Verdier L, Blanchart K, Ardouin P, Lemaitre A, Bignon M, Sabatier R, Alexandre J, Beygui F. Systematic review and meta-analysis of the prognostic impact of cancer among patients with acute coronary syndrome and/or percutaneous coronary intervention. BMC Cardiovasc Disord 2020; 20:38. [PMID: 32000685 PMCID: PMC6993442 DOI: 10.1186/s12872-020-01352-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/20/2020] [Indexed: 12/22/2022] Open
Abstract
Background Patients with cancer admitted for an acute coronary syndrome (ACS) and/or percutaneous coronary intervention (PCI) represent a growing and high-risk population. The influence of co-existing cancer on mortality remains unclear in such patients. We aimed to assess the impact of cancer on early and late, all-cause and cardiac mortality in the setting of ACS and/or PCI. Methods We performed a systematic review and meta-analysis of studies comparing outcomes of patients with and without a history of cancer admitted for ACS and/or PCI. Results Six studies including 294,528 ACS patients and three studies including 39,973 PCI patients were selected for our meta-analysis. Patients with cancer had increased rates of in-hospital all-cause death (RR 1.74 [1.22; 2.47]), cardiac death (RR 2.44 [1.73; 3.44]) and bleeding (RR 1.64 [1.35; 1.98]) as well as one-year all-cause death (RR 2.62 [1.2; 5.73]) and cardiac death (RR 1.89 [1.25; 2.86]) in ACS studies. Rates of long term all-cause (RR 1.96 [1.52; 2.53]) but not cardiac death were higher in cancer patients admitted for PCI. Conclusion Cancer patients represent a high-risk population both in the acute phase and at long-term after an ACS or PCI. The magnitude of the risk of mortality should however be tempered by the heterogeneity among studies. Early and long term optimal management of such patients should be promoted in clinical practice.
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Affiliation(s)
- Vincent Roule
- CHU de Caen Normandie, Service de Cardiologie, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France. .,Normandie Univ, UNICAEN, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, 14000, Caen, France.
| | - Laurine Verdier
- CHU de Caen Normandie, Service de Cardiologie, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Katrien Blanchart
- CHU de Caen Normandie, Service de Cardiologie, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Pierre Ardouin
- CHU de Caen Normandie, Service de Cardiologie, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Adrien Lemaitre
- CHU de Caen Normandie, Service de Cardiologie, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Mathieu Bignon
- CHU de Caen Normandie, Service de Cardiologie, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Rémi Sabatier
- CHU de Caen Normandie, Service de Cardiologie, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Joachim Alexandre
- Normandie Univ, UNICAEN, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, 14000, Caen, France.,CHU de Caen Normandie, Service de Pharmacologie, 14000, Caen, France
| | - Farzin Beygui
- CHU de Caen Normandie, Service de Cardiologie, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France.,Normandie Univ, UNICAEN, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, 14000, Caen, France
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20
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Moro-Sibilot D, Cozic N, Pérol M, Mazières J, Otto J, Souquet PJ, Bahleda R, Wislez M, Zalcman G, Guibert SD, Barlési F, Mennecier B, Monnet I, Sabatier R, Bota S, Dubos C, Verriele V, Haddad V, Ferretti G, Cortot A, De Fraipont F, Jimenez M, Hoog-Labouret N, Vassal G. Crizotinib in c-MET- or ROS1-positive NSCLC: results of the AcSé phase II trial. Ann Oncol 2019; 30:1985-1991. [PMID: 31584608 DOI: 10.1093/annonc/mdz407] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND In 2013, the French National Cancer Institute initiated the AcSé program to provide patients with secure access to targeted therapies outside of their marketed approvals. Efficacy and safety was then assessed using a two-stage Simon phase II trial design. When the study design was designed, crizotinib was approved only as monotherapy for adults with anaplastic lymphoma kinase plus non-small-cell lung cancers (NSCLC). PATIENTS AND METHODS Advanced NSCLC patients with c-MET ≥6 copies, c-MET-mutated, or ROS-1-translocated tumours were enrolled in one of the three cohorts. Patients were treated with crizotinib 250 mg twice daily. Efficacy was assessed using the objective response rate (ORR) after two cycles of crizotinib as primary outcome. Secondary outcomes included disease control rate at four cycles, best ORR, progression-free survival, overall survival, and drug tolerance. RESULTS From August 2013 to March 2018, 5606 patients had their tumour tested for crizotinib targeted molecular alterations: 252 patients had c-MET ≥6 copies, 74 c-MET-mutation, and 78 ROS-1-translocated tumour. Finally, 25 patients in the c-MET ≥6 copies cohort, 28 in the c-MET-mutation cohort, and 37 in the ROS-1-translocation cohort were treated in the phase II trial. The ORR was 16% in the c-MET ≥6 copies cohort, 10.7% in the mutated, and 47.2% in the ROS-1 cohort. The best ORR during treatment was 32% in the c-MET-≥6 copies cohort, 36% in the c-MET-mutated, and 69.4% in the ROS-1-translocation cohort. Safety data were consistent with that previously reported. CONCLUSIONS Crizotinib activity in patients with ROS1-translocated tumours was confirmed. In the c-MET-mutation and c-MET ≥6 copies cohorts, despite insufficient ORR after two cycles of crizotinib, there are signs of late response not sufficient to justify the development of crizotinib in this indication. The continued targeting of c-MET with innovative therapies appears justified. CLINICAL TRIAL NUMBER NCT02034981.
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Affiliation(s)
- D Moro-Sibilot
- Thoracic Oncology Unit, Grenoble-Alpes University Hospital, Grenoble; Intergroupe Francophone de Cancérologie Thoracique (IFCT), Paris.
| | - N Cozic
- Department of Biostatistics and Epidemiology, Gustave Roussy Cancer Campus, INSERM U1018, ESP, Paris-Saclay and Paris-Sud Universities, Villejuif
| | - M Pérol
- Department of Medical Oncology, Léon Bérard Cancer Centre, Lyon
| | - J Mazières
- Pneumology Department, Toulouse University Hospital and Paul Sabatier University, Toulouse
| | - J Otto
- Department of Medicine, Antoine Lacassagne Cancer Centre, Nice
| | - P J Souquet
- Department of Pneumology and Thoracic Oncology, Lyon Sud Hospital Center, Hospices Civils de Lyon, Pierre Bénite
| | - R Bahleda
- Drug Development Department (DITEP), Gustave Roussy Cancer Campus, Villejuif
| | - M Wislez
- Pneumology Department, Tenon Hospital, AP-HP and "Pierre and Marie Curie" University, Paris
| | - G Zalcman
- Thoracic Oncology Department-CIC INSERM 1425, Bichat University Hospital, AP-HP, Paris; Paris-Diderot University, Paris
| | | | - F Barlési
- Multidisciplinary Oncology & Therapeutic Innovations Department, APHM and Aix Marseille University, INSERM, CNRS, CRCM, Marseille
| | - B Mennecier
- Pneumology Department, Strasbourg University Hospital, Strasbourg
| | - I Monnet
- Pneumology Department, CHIC Creteil, Créteil
| | - R Sabatier
- Department of Medical Oncology, Inserm 1068, CNRS UMR7258, CRCM, Paoli-Calmettes Institute and Aix-Marseille University, Marseille
| | - S Bota
- Pneumology Department, Charles Nicolle Hospital, Rouen University Hospital, Rouen
| | - C Dubos
- Pneumology Department, François Baclesse Cancer Centre, Caen
| | - V Verriele
- Anatomy and Pathological Cytologies Department, Paul Papin Cancer Centre, ICO, Angers
| | - V Haddad
- Department of Tumour Biology, Léon Bérard Cancer Centre, Lyon
| | - G Ferretti
- Radiology and Medical Imaging Department, Grenoble-Alpes University Hospital, Grenoble
| | - A Cortot
- Department of Thoracic Oncology, Lille University Hospital and University of Lille, Lille
| | - F De Fraipont
- Molecular Genetic Unit: Hereditary Diseases and Oncology, Grenoble-Alpes University Hospital, Grenoble
| | - M Jimenez
- Research and Development UNICANCER, Paris
| | | | - G Vassal
- Clinical Research Division, Gustave Roussy Cancer Campus, Villejuif, France
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21
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Roule V, Heudel T, Lemaitre A, Bignon M, Ardouin P, Sabatier R, Blanchart K, Beygui F. P329Residual platelet reactivity after pre-treatment with ticagrelor prior to primary percutaneous coronary intervention is associated with suboptimal myocardial reperfusion. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0164] [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
The evidence of a clinical benefit of P2Y12 inhibitor pre-treatment in primary percutaneous coronary intervention (PCI) and the relation between the level of platelet inhibition and myocardial reperfusion with newer potent P2Y12 inhibitors remain unclear.
Objectives
We aimed to assess the relationship between platelet reactivity at the time of primary PCI after pre-treatment with aspirin and ticagrelor and the post-PCI myocardial blush grade (MBG).
Methods
We prospectively included 61 patients. Platelet reaction units for ticagrelor (PRU) and aspirin reaction units (ARU) were measured using the point-of-care test VerifyNow before PCI. The high on-ticagrelor (PRU >208) and on-aspirin (ARU ≥550) platelet reactivity (HPR and HaPR) were assessed. Patients were divided into two groups according to MBG 3 or <3.
Results
MBG 3 was identified in 28 (46%) patients. Mean PRU was lower in such patients as compared to those with MBG <3 (155.82±90.91 vs 227.42±65.18; p=0.001) while mean ARU was similar between groups. HPR and HaPR were observed in 30 (49.2%) and 11 patients (18%), respectively. HPR but not HaPR was more frequent in the group with impaired MBG (66.7 vs 28.6%; p=0.003 and 21.2 vs 14.3%; p=0.48 respectively).
Table 1. Platelet reactivity results Verify Now at admission All Final Blush <3 Final Blush 3 p n=61 (100%) n=33 (54%) n=28 (46%) PRU P2Y12 194.56±85.32 227.42±65.18 155.82±90.91 0.001 Base 193.54±49.01 194.79±45.68 192.07±53.48 0.83 Inhibition of platelet aggregation (%) 15.61±29.85 5.7±17.55 27.29±36.79 0.007 ARU 463.97±76.45 472.58±72.5 453.82±81 0.34 PRU >208 30 (49.1%) 22 (66.7%) 8 (28.6%) 0.003 ARU ≥550 11 (18%) 7 (21.2%) 4 (14.3%) 0.48 Verify Now at day 1 n=57 n=30 n=27 p PRU P2Y12 40.86±41.43 47.27±45.87 33.74±35.35 0.21 Base 196.98±36.19 193.67±30.67 200.81±41.97 0.47 Inhibition of platelet aggregation (%) 79.8±17.96 76.37±20.54 83.77±13.78 0.11 ARU = Aspirin reaction units; PRU = P2Y12 reaction units.
Conclusion
In conclusion, our study shows that higher PRU and the subsequent HPR at the time of primary PCI, after pretreatment with ticagrelor, are the only correlates of post PCI MBG. These findings support the earliest possible loading with ticagrelor prior to primary PCI.
Acknowledgement/Funding
The study was supported by grants from Terumo. The funder has no role in any step of the study.
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Affiliation(s)
- V Roule
- University Hospital of Caen, cardiology, Caen, France
| | - T Heudel
- University Hospital of Caen, cardiology, Caen, France
| | - A Lemaitre
- University Hospital of Caen, cardiology, Caen, France
| | - M Bignon
- University Hospital of Caen, cardiology, Caen, France
| | - P Ardouin
- University Hospital of Caen, cardiology, Caen, France
| | - R Sabatier
- University Hospital of Caen, cardiology, Caen, France
| | - K Blanchart
- University Hospital of Caen, cardiology, Caen, France
| | - F Beygui
- University Hospital of Caen, cardiology, Caen, France
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Roule V, Schwob L, Lemaitre A, Bignon M, Ardouin P, Sabatier R, Blanchart K, Beygui F. P3591Residual atherothrombotic burden after primary percutaneous coronary intervention and myocardial reperfusion - An optical frequency domain imaging study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0451] [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: 11/15/2022] Open
Abstract
Abstract
Background
The clinical significance of residual in-stent atherothrombotic burden (ATB) after primary percutaneous coronary intervention (PCI) remains unclear. Several methods of ATB quantification using optical frequency domain imaging (OFDI) exist.
Objectives
We aimed to assess the relationship between residual ATB after primary PCI measured in OFDI using different methods and myocardial blush grade (MBG).
Methods
We prospectively included 60 ST-elevation myocardial infarction patients pre-treated with aspirin and ticagrelor. OFDI volumetric quantification using planimetry (with intervals every frame or every millimeter) and semi-quantitative score were used to determine ATB. Patients were divided into two groups according to final MBG 3 or <3.
Results
MBG 3 was identified in 28 (46%) patients. Altogether, 13318 OFDI cross-sections were analyzed. The mean ATB was 10.08±5.21%. ATB was lower in patients with normal final MBG compared to those with impaired MBG, regardless of the method used (8.15±5.58 vs 11.77±4.28%; p=0.007 for quantification per frame; 7.8±5.19 vs 11.07±4.07%; p=0.009 for quantification per mm and 11.21±11.75 vs 22.91±17.35; p=0.003 for the semi-quantitative thrombus score, respectively).
Table 1. Post stenting OFDI findings OFDI measures All Final Blush <3 Final Blush 3 p n=60 (100%) n=32 (53%) n=28 (47%) Stent volume (mm3) 219.42±135.76 226.08±168.69 211.82±86.57 0.68 Evaluation per frame Atherothrombotic volume (mm3) 21.66±16.81 25.83±18.86 16.89±12.83 0.035 Atherothrombotic burden (%) 10.08±5.21 11.77±4.28 8.15±5.58 0.007 Evaluation per millimeter Atherothrombotic volume (mm3) 20.71±16.16 24.57±18.15 16.29±12.43 0.042 Atherothrombotic burden (%) 9.5±4.88 11.07±4.07 7.8±5.19 0.009 Thrombus score 17.45±16 22.91±17.35 11.21±11.75 0.003
Optical frequency domain imaging example
Conclusion
Residual post-stenting ATB remains substantial after primary PCI in STEMI patients, even when pre-treated with ticagrelor and aspirin. Mostly, it appears as an important surrogate of clinical outcome as patients with normal myocardial reperfusion presented lower residual ATB.
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Affiliation(s)
- V Roule
- University Hospital of Caen, Cardiology, Caen, France
| | - L Schwob
- University Hospital of Caen, Cardiology, Caen, France
| | - A Lemaitre
- University Hospital of Caen, Cardiology, Caen, France
| | - M Bignon
- University Hospital of Caen, Cardiology, Caen, France
| | - P Ardouin
- University Hospital of Caen, Cardiology, Caen, France
| | - R Sabatier
- University Hospital of Caen, Cardiology, Caen, France
| | - K Blanchart
- University Hospital of Caen, Cardiology, Caen, France
| | - F Beygui
- University Hospital of Caen, Cardiology, Caen, France
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Bidard FC, Callens C, Pistilli B, Dalenc F, de La Motte Rouge T, Sabatier R, Frenel JS, Ladoire S, Dubot C, Ferrero JM, Clatot F, Nierges D, Everhard S, Lemonnier J, Bieche I, Pradines A, Pierga JY, Berger F, Bachelot T, Delaloge S. Emergence of ESR1 mutation in cell-free DNA during first line aromatase inhibitor and palbociclib: An exploratory analysis of the PADA-1 trial. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz242.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Roule V, Schwob L, Lemaitre A, Bignon M, Ardouin P, Sabatier R, Blanchart K, Beygui F. Residual atherothrombotic burden after primary percutaneous coronary intervention and myocardial reperfusion-An optical frequency domain imaging study. Catheter Cardiovasc Interv 2019; 96:91-97. [PMID: 31410965 DOI: 10.1002/ccd.28429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/08/2019] [Accepted: 07/27/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVES We aimed to assess the relationship between residual in-stent atherothrombotic burden (ATB) after primary percutaneous coronary intervention (PCI) measured by optical frequency domain imaging (OFDI) using different measurement methods and myocardial blush grade (MBG). BACKGROUND The impact of residual ATB after primary PCI on myocardial reperfusion remains unclear. METHODS We prospectively included 60 ST-elevation myocardial infarction patients pretreated with aspirin and ticagrelor. OFDI volumetric quantification using planimetry (with intervals every frame or every millimeter) and semiquantitative score were used to determine ATB. Patients were divided into two groups according to final MBG 3 or <3. RESULTS The mean ATB was 10.08 ± 5.21%. ATB was lower in patients with final MBG 3 compared to those with impaired MBG, regardless of the measurement method (8.15 ± 5.58 vs. 11.77 ± 4.28%; p = .007 for quantification per frame; 7.8 ± 5.19 vs. 11.07 ± 4.07%; p = .009 for quantification per mm and 11.21 ± 11.75 vs. 22.91 ± 17.35; p = .003 for the semiquantitative thrombus score, respectively). CONCLUSION Residual post-stenting ATB remains substantial after primary PCI in STEMI patients, even when pretreated with ticagrelor and aspirin. ATB appears as a significant correlate of suboptimal myocardial reperfusion, a known surrogate of clinical outcome.
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Affiliation(s)
- Vincent Roule
- CHU de Caen Normandie, Service de Cardiologie, Caen, France.,Normandie Univ, UNICAEN, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, Caen, France
| | - Lin Schwob
- CHU de Caen Normandie, Service de Cardiologie, Caen, France
| | | | - Mathieu Bignon
- CHU de Caen Normandie, Service de Cardiologie, Caen, France
| | - Pierre Ardouin
- CHU de Caen Normandie, Service de Cardiologie, Caen, France
| | - Rémi Sabatier
- CHU de Caen Normandie, Service de Cardiologie, Caen, France
| | | | - Farzin Beygui
- CHU de Caen Normandie, Service de Cardiologie, Caen, France.,Normandie Univ, UNICAEN, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, Caen, France
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25
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Roule V, Heudel T, Lemaitre A, Bignon M, Ardouin P, Sabatier R, Blanchart K, Beygui F. Residual platelet reactivity after pre-treatment with ticagrelor prior to primary percutaneous coronary intervention is associated with suboptimal myocardial reperfusion. Eur Heart J Acute Cardiovasc Care 2019; 10:2048872619860214. [PMID: 31402681 DOI: 10.1177/2048872619860214] [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] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 06/08/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The evidence of a clinical benefit of P2Y12 inhibitor pre-treatment in primary percutaneous coronary intervention (PCI) and the relation between the level of platelet inhibition and myocardial reperfusion with newer potent P2Y12 inhibitors remain unclear. We aimed to assess the relationship between platelet reactivity at the time of primary PCI after pre-treatment with aspirin and ticagrelor and the post-PCI myocardial blush grade (MBG). METHODS We prospectively included 61 patients. Platelet reaction units for ticagrelor (PRU) and aspirin reaction units (ARU) were measured using the point-of-care test VerifyNow before PCI. The high on-ticagrelor (PRU >208) and on-aspirin (ARU ⩾ 550) platelet reactivity (HPR and HaPR) were assessed. Patients were divided into two groups according to MBG 3 or <3. RESULTS MBG 3 was identified in 28 (46%) patients. Mean PRU was lower in such patients as compared with those with MBG <3 (155.82 ± 90.91 vs. 227.42 ± 65.18; p=0.001) while mean ARU was similar between groups. HPR and HaPR were observed in 30 (49.2%) and 11 patients (18%), respectively. HPR but not HaPR was more frequent in the group with impaired MBG (66.7 vs. 28.6%; p=0.003 and 21.2 vs. 14.3%; p=0.48 respectively). CONCLUSION Our study shows that higher PRU and the subsequent HPR at the time of primary PCI, after pretreatment with ticagrelor, are the only correlates of post PCI MBG. These findings support the earliest possible loading with ticagrelor prior to primary PCI.
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Affiliation(s)
- Vincent Roule
- 1 Department of Cardiology, Caen University Hospital, France
- 2 EA 4650, Normandie Université-Caen, France
| | - Thibaut Heudel
- 1 Department of Cardiology, Caen University Hospital, France
| | - Adrien Lemaitre
- 1 Department of Cardiology, Caen University Hospital, France
| | - Mathieu Bignon
- 1 Department of Cardiology, Caen University Hospital, France
| | - Pierre Ardouin
- 1 Department of Cardiology, Caen University Hospital, France
| | - Rémi Sabatier
- 1 Department of Cardiology, Caen University Hospital, France
| | | | - Farzin Beygui
- 1 Department of Cardiology, Caen University Hospital, France
- 2 EA 4650, Normandie Université-Caen, France
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Legallois D, Chaufourier L, Blanchart K, Parienti JJ, Belin A, Milliez P, Sabatier R. Improving quality of care in patients with decompensated acute heart failure using a discharge checklist. Arch Cardiovasc Dis 2019; 112:494-501. [DOI: 10.1016/j.acvd.2019.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 02/22/2019] [Accepted: 05/21/2019] [Indexed: 01/31/2023]
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Dumont B, Ryschawy J, Duru M, Benoit M, Chatellier V, Delaby L, Donnars C, Dupraz P, Lemauviel-Lavenant S, Méda B, Vollet D, Sabatier R. Review: Associations among goods, impacts and ecosystem services provided by livestock farming. Animal 2019; 13:1773-1784. [PMID: 30333070 PMCID: PMC6639720 DOI: 10.1017/s1751731118002586] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 08/28/2018] [Indexed: 12/19/2022] Open
Abstract
Livestock is a major driver in most rural landscapes and economics, but it also polarises debate over its environmental impacts, animal welfare and human health. Conversely, the various services that livestock farming systems provide to society are often overlooked and have rarely been quantified. The aim of analysing bundles of services is to chart the coexistence and interactions between the various services and impacts provided by livestock farming, and to identify sets of ecosystem services (ES) that appear together repeatedly across sites and through time. We review three types of approaches that analyse associations among impacts and services from local to global scales: (i) detecting ES associations at system or landscape scale, (ii) identifying and mapping bundles of ES and impacts and (iii) exploring potential drivers using prospective scenarios. At a local scale, farming practices interact with landscape heterogeneity in a multi-scale process to shape grassland biodiversity and ES. Production and various ES provided by grasslands to farmers, such as soil fertility, biological regulations and erosion control, benefit to some extent from the functional diversity of grassland species, and length of pasture phase in the crop rotation. Mapping ES from the landscape up to the EU-wide scale reveals a frequent trade-off between livestock production on one side and regulating and cultural services on the other. Maps allow the identification of target areas with higher ecological value or greater sensitivity to risks. Using two key factors (livestock density and the proportion of permanent grassland within utilised agricultural area), we identified six types of European livestock production areas characterised by contrasted bundles of services and impacts. Livestock management also appeared to be a key driver of bundles of services in prospective scenarios. These scenarios simulate a breakaway from current production, legislation (e.g. the use of food waste to fatten pigs) and consumption trends (e.g. halving animal protein consumption across Europe). Overall, strategies that combine a reduction of inputs, of the use of crops from arable land to feed livestock, of food waste and of meat consumption deliver a more sustainable food future. Livestock as part of this sustainable future requires further enhancement, quantification and communication of the services provided by livestock farming to society, which calls for the following: (i) a better targeting of public support, (ii) more precise quantification of bundles of services and (iii) better information to consumers and assessment of their willingness to pay for these services.
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Affiliation(s)
- B. Dumont
- Université Clermont Auvergne, INRA, VetAgro Sup, UMR Herbivores, 63122 Saint-Genès-Champanelle, France
| | - J. Ryschawy
- UMR AGIR, INRA, Université de Toulouse, INPT, 31324 Castanet-Tolosan, France
| | - M. Duru
- UMR AGIR, INRA, Université de Toulouse, INPT, 31324 Castanet-Tolosan, France
| | - M. Benoit
- Université Clermont Auvergne, INRA, VetAgro Sup, UMR Herbivores, 63122 Saint-Genès-Champanelle, France
| | - V. Chatellier
- UMRSMART-LERECO, Agrocampus Ouest, INRA, 44000 Nantes, France
| | - L. Delaby
- PEGASE, Agrocampus Ouest, INRA, 35590 Saint-Gilles, France
| | | | - P. Dupraz
- UMR SMART-LERECO, Agrocampus Ouest, INRA, 35000 Rennes, France
| | | | - B. Méda
- BOA, INRA, Université de Tours, 37380 Nouzilly, France
| | - D. Vollet
- Université Clermont Auvergne, AgroParisTech, INRA, Irstea, VetAgro Sup, UMR Territoires, 63000 Clermont-Ferrand, France
| | - R. Sabatier
- UR Ecodéveloppement, INRA, 84914 Avignon, France
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Roule V, Ardouin P, Briet C, Lemaitre A, Bignon M, Sabatier R, Champ‐Rigot L, Milliez P, Blanchart K, Beygui F. Vitamin K antagonist vs direct oral anticoagulants with antiplatelet therapy in dual or triple therapy after percutaneous coronary intervention or acute coronary syndrome in atrial fibrillation: Meta-analysis of randomized controlled trials. Clin Cardiol 2019; 42:839-846. [PMID: 31290171 PMCID: PMC6727878 DOI: 10.1002/clc.23224] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 06/19/2019] [Accepted: 06/27/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The combination of vitamin K antagonists (VKA) for atrial fibrillation (AF) and antiplatelet agents following percutaneous coronary intervention (PCI) is associated with an increased bleeding risk. HYPOTHESIS Direct oral anticoagulants (DOAC) are associated with a greater safety profile but the optimal antithrombotic treatment strategy, especially when considering ischemic events, is unclear. METHODS We performed a meta-analysis of randomized controlled trials comparing outcomes in AF patients following PCI and/or acute coronary syndrome (ACS) when treated with DOAC vs VKA, both in combination with one (dual) or two (triple) antiplatelet regimens. A systematic review was performed by searches of electronic databases MEDLINE (source PubMed) and the Cochrane Controlled Clinical Trials Register Database as well as Cardiology annual meetings. Three studies were finally included. RESULTS Compared to VKA triple therapy, the use of DOAC was associated with a decreased risk of any bleeding (relative risk [RR] 0.68 [0.62; 0.74]), major bleeding (RR 0.61 [0.51; 0.75]) and intracranial bleeding (RR 0.33 [0.17; 0.66]) and similar rates of the composite efficacy endpoint (RR 1.0 [0.87; 1.14]) and its components. Similar and consistent results were observed with both dual and triple therapy including a DOAC compared to VKA. CONCLUSION Our meta-analysis supports the use of dual therapy combining a DOAC and clopidogrel as the default regimen in most AF patients after PCI and/or ACS.
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Affiliation(s)
- Vincent Roule
- CHU de Caen Normandie, Service de CardiologieCaenFrance,Normandie Univ, UNICAEN, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie‐reperfusion myocardiqueCaenFrance
| | | | - Clément Briet
- CHU de Caen Normandie, Service de CardiologieCaenFrance
| | | | | | - Rémi Sabatier
- CHU de Caen Normandie, Service de CardiologieCaenFrance
| | - Laure Champ‐Rigot
- CHU de Caen Normandie, Service de CardiologieCaenFrance,Normandie Univ, UNICAEN, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie‐reperfusion myocardiqueCaenFrance
| | - Paul Milliez
- CHU de Caen Normandie, Service de CardiologieCaenFrance
| | | | - Farzin Beygui
- CHU de Caen Normandie, Service de CardiologieCaenFrance,Normandie Univ, UNICAEN, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie‐reperfusion myocardiqueCaenFrance,ACTION Academic GroupPitié Salpêtrière University HospitalParisFrance
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Sabatier R, Charafe-Jauffret E, Pierga JY, Curé H, Lambaudie E, Houvenaeghel G, Ginestier C, Sfumato P, Extra JM, Gonçalves A. Abstract P2-10-02: AVASTEM – Stem cells inhibition by bevacizumab in combination with neoadjuvant chemotherapy for locally advanced breast cancers: A prospective proof of concept randomized phase II trial. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-10-02] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background. Preclinical works have suggested that conventional cytotoxic chemotherapies may increase the number of cancer stem cells. Angiogenesis inhibition has been described in vitro to have an impact on stem cells proliferation. We developed a proof of concept clinical trial to explore Bevacizumab-chemotherapy activity on breast cancer stem cells for patients treated in the neoadjuvant setting.
Patients and Methods. Breast cancer patients requiring preoperative chemotherapy were included in this open-label, randomized, prospective, multicentre phase II trial. All received FEC-docetaxel combination for a maximum of 8 cycles, and patients randomized in the experimental arm received concomitant Bevacizumab (15 mg/kg Q3W). The primary endpoint was to describe aldehyde dehydrogenase (ALDH1, identified by immunohistochemistry) positive tumour cells rate before treatment and after the 4th cycle. Secondary objectives included safety, pathological complete response (pCR) rate, disease-free survival (DFS), relapse-free survival (RFS), and overall survival (OS).
Results. Seventy-five patients were included from March 2010 to July 2012, including 50 in the experimental arm. More than 80% of patients received all planned chemotherapy cycles. ALDH1 expression could be assessed both before treatment and after the fourth cycle of chemotherapy for 32 patients. The absence of a significant increase (> 5%) in ALDH1+ cells rate after chemotherapy was demonstrated in the Bevacizumab arm (n=19, Median=-0.125, one-sided 95%CI=[-∞-0], p=0.001).Yet, the same was observed in the control arm (n=13, Median=-0.25, one-sided 95%CI=[-∞-0],, p=0.006). Grade 3 or 4 adverse events, including haematological, digestive, and cutaneous disorders, were observed for 94% of the patients in the experimental arm and 88% in the control arm. A non-significant increase in pCR was observed in the Bevacizumab arm (OR=2.24, 95CI [0.77-6.54], p=0.14), but survival was not improved (OS: p=0.89 for the whole cohort; DFS: p=0.45; and RFS: p=0.68 for non-metastatic cases) . ALDH1 status at inclusion was not correlated to efficacy.
Conclusions. We observed that the rate of ALDH1+ tumour cells did not increase after Bevacizumab-based chemotherapy. However, as similar results were observed with chemotherapy only, Bevacizumab impact on breast cancer stem cells cannot be confirmed.
Citation Format: Sabatier R, Charafe-Jauffret E, Pierga J-Y, Curé H, Lambaudie E, Houvenaeghel G, Ginestier C, Sfumato P, Extra J-M, Gonçalves A. AVASTEM – Stem cells inhibition by bevacizumab in combination with neoadjuvant chemotherapy for locally advanced breast cancers: A prospective proof of concept randomized phase II trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-10-02.
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Affiliation(s)
- R Sabatier
- Institut Paoli-Calmettes, Marseille, France; Aix Marseille Univ, CNRS U7258, INSERM U1068, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut Curie, Paris, France; Institut Jean Godinot, Reims, France; Department of Clinical Research and Innovation, Biostatistics Unit, Marseille, France
| | - E Charafe-Jauffret
- Institut Paoli-Calmettes, Marseille, France; Aix Marseille Univ, CNRS U7258, INSERM U1068, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut Curie, Paris, France; Institut Jean Godinot, Reims, France; Department of Clinical Research and Innovation, Biostatistics Unit, Marseille, France
| | - J-Y Pierga
- Institut Paoli-Calmettes, Marseille, France; Aix Marseille Univ, CNRS U7258, INSERM U1068, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut Curie, Paris, France; Institut Jean Godinot, Reims, France; Department of Clinical Research and Innovation, Biostatistics Unit, Marseille, France
| | - H Curé
- Institut Paoli-Calmettes, Marseille, France; Aix Marseille Univ, CNRS U7258, INSERM U1068, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut Curie, Paris, France; Institut Jean Godinot, Reims, France; Department of Clinical Research and Innovation, Biostatistics Unit, Marseille, France
| | - E Lambaudie
- Institut Paoli-Calmettes, Marseille, France; Aix Marseille Univ, CNRS U7258, INSERM U1068, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut Curie, Paris, France; Institut Jean Godinot, Reims, France; Department of Clinical Research and Innovation, Biostatistics Unit, Marseille, France
| | - G Houvenaeghel
- Institut Paoli-Calmettes, Marseille, France; Aix Marseille Univ, CNRS U7258, INSERM U1068, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut Curie, Paris, France; Institut Jean Godinot, Reims, France; Department of Clinical Research and Innovation, Biostatistics Unit, Marseille, France
| | - C Ginestier
- Institut Paoli-Calmettes, Marseille, France; Aix Marseille Univ, CNRS U7258, INSERM U1068, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut Curie, Paris, France; Institut Jean Godinot, Reims, France; Department of Clinical Research and Innovation, Biostatistics Unit, Marseille, France
| | - P Sfumato
- Institut Paoli-Calmettes, Marseille, France; Aix Marseille Univ, CNRS U7258, INSERM U1068, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut Curie, Paris, France; Institut Jean Godinot, Reims, France; Department of Clinical Research and Innovation, Biostatistics Unit, Marseille, France
| | - J-M Extra
- Institut Paoli-Calmettes, Marseille, France; Aix Marseille Univ, CNRS U7258, INSERM U1068, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut Curie, Paris, France; Institut Jean Godinot, Reims, France; Department of Clinical Research and Innovation, Biostatistics Unit, Marseille, France
| | - A Gonçalves
- Institut Paoli-Calmettes, Marseille, France; Aix Marseille Univ, CNRS U7258, INSERM U1068, Institut Paoli-Calmettes, CRCM, Marseille, France; Institut Curie, Paris, France; Institut Jean Godinot, Reims, France; Department of Clinical Research and Innovation, Biostatistics Unit, Marseille, France
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Roule V, Briet C, Lemaitre A, Ardouin P, Bignon M, Sabatier R, Blanchart K, Beygui F. Plaque erosion versus rupture characterization by optical frequency domain imaging before and after coronary stenting following successful fibrinolysis for ST-segment elevation myocardial infarction. Heart Vessels 2018; 34:401-409. [PMID: 30191317 DOI: 10.1007/s00380-018-1258-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 08/31/2018] [Indexed: 10/28/2022]
Abstract
Intracoronary thrombus burden affects the quality of myocardial reperfusion in the setting of ST-elevation myocardial infarction (STEMI). We aimed to study the characteristics of the plaque and thrombus assessed by intracoronary optical frequency domain imaging (OFDI) according to the presence of plaque rupture or erosion in STEMI patients treated with successful fibrinolysis. Pre-stenting thrombus and post-stenting atherothrombotic burden were compared between plaque rupture and erosion. Twenty-seven consecutive patients were included: 17 (63%) had OFDI-plaque rupture and 10 (37%) had OFDI-erosion. Thrombus volume and burden were significantly higher in case of rupture compared to erosion at baseline (13.4 ± 18.4 vs 2.8 ± 2.3 mm3; p = 0.03 and 33.8 ± 17.5 vs 17.5 ± 9.9%; p = 0.007, respectively). In the rupture group, the core of the thrombus consisted dominantly of red thrombus evenly distributed along the entire culprit plaque. In the erosion group, it consisted dominantly of white thrombus with a focal distribution near the minimal lumen area zone. After stenting, the atherothrombotic volume, burden and its distribution, as well as angiographic estimators of myocardial reperfusion were similar between groups. Our study showed that pre-PCI thrombus amount, typesetting and distribution are mainly linked to the underlying mechanism of STEMI. After stenting, the atherothrombotic burden and its distribution were similar between the groups.
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Affiliation(s)
- Vincent Roule
- Department of Cardiology, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France. .,EA 4650, Normandie Université-Caen, Caen, France.
| | - Clément Briet
- Department of Cardiology, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Adrien Lemaitre
- Department of Cardiology, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Pierre Ardouin
- Department of Cardiology, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Mathieu Bignon
- Department of Cardiology, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Rémi Sabatier
- Department of Cardiology, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Katrien Blanchart
- Department of Cardiology, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Farzin Beygui
- Department of Cardiology, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France.,EA 4650, Normandie Université-Caen, Caen, France
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Sabatier R, Pomel C, Colombo PE, Narducci F, Garnier S, Carbuccia N, Guille A, Birnbaum D, Zemmour C, Lambaudie E. Circulating tumour DNA as an early marker of recurrence and treatment efficacy in ovarian carcinoma, the CIDOC study. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy316.007] [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: 11/14/2022] Open
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Sabatier R, Garnier S, Carbuccia N, Guille A, Tarpin C, Goncalves A, Birnbaum D. RETROSPHER. ERBB2 amplification detection in the plasma at diagnosis for early high-risk HER2-positive breast cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy316.001] [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: 11/13/2022] Open
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Seguin L, Chaffanet M, Sabatier R, Jose A, Garnier S, Carbuccia N, Guille A, Birnbaum D, Bertucci F, Goncalves A. A major response to carboplatin in a metastatic triple-negative breast cancer patient with somatic mutation of BRCA1 and RAD51B: When chemotherapy meets precision medicine. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy314.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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34
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Briet C, Blanchart K, Roule V, Lemaitre A, Bignon M, Ardouin P, Sabatier R, Beygui F. P2707Bedside mental status assessment as an independent correlate of mortality in elderly patients admitted for Acute Coronary Syndromes. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C Briet
- University Hospital of Caen, Cardiology, Caen, France
| | - K Blanchart
- University Hospital of Caen, Cardiology, Caen, France
| | - V Roule
- University Hospital of Caen, Cardiology, Caen, France
| | - A Lemaitre
- University Hospital of Caen, Cardiology, Caen, France
| | - M Bignon
- University Hospital of Caen, Cardiology, Caen, France
| | - P Ardouin
- University Hospital of Caen, Cardiology, Caen, France
| | - R Sabatier
- University Hospital of Caen, Cardiology, Caen, France
| | - F Beygui
- University Hospital of Caen, Cardiology, Caen, France
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Joly F, Sabatier R, Hubert B. Modelling interacting plant and livestock renewal dynamics helps disentangle equilibrium and nonequilibrium aspects in a Mongolian pastoral system. Sci Total Environ 2018; 625:1390-1404. [PMID: 29996436 DOI: 10.1016/j.scitotenv.2017.12.215] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 12/19/2017] [Accepted: 12/19/2017] [Indexed: 06/08/2023]
Abstract
The interplay of livestock density dependence drivers and climate hazards is thought to cause pasture deterioration and poverty in Mongolian pastoral systems. We assessed their relative weights in a system of the Gobi exposed to high rainfall variability and harsh winters, which suggests that climate is the main system's driver. In this aim we modelled how interacting plant and livestock renewal dynamics impact herder performances, under the influence of climate. Plant dynamics was studied through an underground biomass sub-model because local pastures are dominated by perennial species. This approach enabled us studying pastoral issues in a holistic way, by integrating plant underground organs, livestock populations, herder income, and climate drivers. Models described that current grazing practices can significantly reduce underground biomass (-30% after 20years), but not entirely deplete it. They also showed that competition between herders could trap the smallest ones in poverty, by preventing the growth of their herds. This competition operates through density dependent factors affecting livestock productivity and vulnerability to climate shocks. This competition effect is all the more important since small herders could grow their herd and escape poverty if they were alone in the system. This result shows that density dependent factors could significantly impact herder performances and suggests that forage resource allocation is a driver as powerful as climate, even in the local harsh bioclimatic configuration of the Mongolian Gobi.
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Affiliation(s)
- F Joly
- Association pour le cheval de Przewalski: TAKH, Station Biologique de la Tour du Valat, Le Sambuc, 13200 Arles, France; ABIES/AgroParisTech, 19 avenue du Maine, 75015 Paris, France.
| | - R Sabatier
- AgroParisTech/INRA, UMR 1048 SADAPT, 16 rue Claude Bernard, 75005 Paris, France.
| | - B Hubert
- INRA, Unité d'Ecodéveloppement, Site Agroparc, 84914 Avignon, France.
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Roule V, Ardouin P, Repessé Y, Le Querrec A, Blanchart K, Lemaitre A, Sabatier R, Borel-Derlon A, Beygui F. Point of Care Tests VerifyNow P2Y12 and INNOVANCE PFA P2Y Compared to Light Transmittance Aggregometry After Fibrinolysis. Clin Appl Thromb Hemost 2018; 24:1109-1116. [PMID: 29719963 PMCID: PMC6714754 DOI: 10.1177/1076029618772354] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Detection of high on-treatment platelet reactivity (HPR) by point-of-care tests has not been validated after successful fibrinolysis for ST-elevation myocardial infarction. We assessed the validity of the point-of-care VerifyNow P2Y12 (VN) and INNOVANCE PFA P2Y (PFA) tests on HPR compared to light transmittance aggregometry (LTA) in these patients. The HPR was identified in 10 (34.5%) patients, 15 (51.7%) patients, and 14 (50%) patients using LTA, VN, and PFA, respectively. Discrepancies were observed between the tests despite significant correlations between platelet reactivity measures by LTA and VN (r = 0.74; P < .0001) and LTA and PFA (r = .75; P < .0001). Compared to LTA, VN and PFA were associated with a 92% and 53% and 92% and 64% positive predictive value (PPV) and negative predictive value (NPV), respectively, in detecting HPR. When combined, VN and PFA results yielded 90% and 100% PPV and NPV values if discrepancies between the 2 tests were considered as non-HPR. The VN or PFA identify patients without HPR correctly but overestimate the proportion of HPR patients. The association of the 2 tests, in case of HPR, improves the accuracy of the detection of HPR.
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Affiliation(s)
- Vincent Roule
- 1 Department of Cardiology, Caen University Hospital, Caen, France.,2 Normandie Université-Caen, Caen, France
| | - Pierre Ardouin
- 1 Department of Cardiology, Caen University Hospital, Caen, France
| | - Yohan Repessé
- 3 Department of Haemostasis and Hematology, Caen University Hospital, Caen, France
| | - Agnès Le Querrec
- 3 Department of Haemostasis and Hematology, Caen University Hospital, Caen, France
| | | | - Adrien Lemaitre
- 1 Department of Cardiology, Caen University Hospital, Caen, France
| | - Rémi Sabatier
- 1 Department of Cardiology, Caen University Hospital, Caen, France
| | - Annie Borel-Derlon
- 3 Department of Haemostasis and Hematology, Caen University Hospital, Caen, France
| | - Farzin Beygui
- 1 Department of Cardiology, Caen University Hospital, Caen, France.,2 Normandie Université-Caen, Caen, France
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Roule V, Blanchart K, Lemaitre A, Bignon M, Sabatier R, Beygui F. Recurrent unexpected myocardial infarction in a young woman: Insights on spontaneous coronary artery dissection and multimodality imaging. Cardiovascular Revascularization Medicine 2018; 19:123-125. [DOI: 10.1016/j.carrev.2017.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 07/12/2017] [Accepted: 07/13/2017] [Indexed: 11/26/2022]
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Almeras C, Loison G, Tollon C, Gautier J, Sabatier R, Zanoun L, Cid E, Brudo L. Évaluation du coût en structure privée d’une ablation de sonde double J en externe à l’aide d’un fibroscope re-stérilisable. Prog Urol 2017. [DOI: 10.1016/j.purol.2017.07.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sabatier R, Meskine A, Cappiello M, Extra JM, Tarpin C, Rousseau F, Provansal M, Bertucci F, Viens P, Gonçalves A. Untreated hormone receptor positive/HER2-negative metastatic breast cancer survival with front-line chemotherapy and maintenance endocrine therapy. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx365.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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De Nonneville A, Gonçalves A, Zemmour C, Cohen M, Classe J, Reyal F, Colombo P, Jouve E, Giard S, Barranger E, Sabatier R, Bertucci F, Boher J, Houvenaeghel G. Adjuvant chemotherapy in pT1ab node-negative triple negative breast carcinomas: Results of a national multi-institutional retrospective study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx362.024] [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: 11/13/2022] Open
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41
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Roule V, Placente A, Sabatier R, Bignon M, Saplacan V, Ivascau C, Milliez P, Beygui F. Angles between the aortic root and the left ventricle assessed by MDCT are associated with the risk of aortic regurgitation after transcatheter aortic valve replacement. Heart Vessels 2017; 33:58-65. [DOI: 10.1007/s00380-017-1032-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 07/28/2017] [Indexed: 10/19/2022]
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de Nonneville A, Gonçalves A, Zemmour C, Cohen M, Classe JM, Reyal F, Colombo PE, Jouve E, Giard S, Barranger E, Sabatier R, Bertucci F, Boher JM, Houvenaeghel G. Adjuvant chemotherapy in pT1ab node-negative triple-negative breast carcinomas: Results of a national multi-institutional retrospective study. Eur J Cancer 2017; 84:34-43. [PMID: 28780480 DOI: 10.1016/j.ejca.2017.06.043] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/19/2017] [Accepted: 06/27/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Triple-negative breast cancers (TNBCs) are considered as associated with poor outcome, but prognosis of subcentimetric, node-negative disease remains controversial and evidence that adjuvant chemotherapy (CT) is effective in these small tumours remains limited. PATIENTS AND METHODS Our objective was to investigate the impact of CT on survival in pT1abN0M0 TNBC. Patients were retrospectively identified from a cohort of 22,475 patients who underwent primary surgery in 15 French centres between 1987 and 2013. As rare pathological types may display very particular prognoses in these tumours, we retained only the invasive ductal carcinomas of no special type according to the last World Health Organisation (WHO) classification which is the most common TNBC histological type. End-points were disease-free survival (DFS) and metastasis-free survival (MFS). A propensity score for receiving CT was estimated using a logistic regression including age, tumour size, Scarff Bloom and Richardson (SBR) grade and lymphovascular invasion. RESULTS Of a total of 284 patients with pT1abN0M0 ductal TNBC, 144 (51%) received CT and 140 (49%) did not. Patients receiving CT had more adverse prognostic features, such as tumour size, high grade, young age, and lymphovascular invasion. CT was not associated with a significant benefit for DFS (Hazard ratio, HR = 0.77 [0.40-1.46]; p = 0.419, log-rank test) or MFS (HR = 1.00 [0.46-2.19]; p = 0.997), with 5-year DFS and MFS in the group with CT versus without of 90% [81-94%] versus 84% [74-90%], and 90% [81-95%] versus 90% [83%-95%], respectively. Results were consistent in all supportive analyses including multivariate Cox model and the use of the propensity score for adjustment and as a matching factor for case-control analyses. CONCLUSIONS This study did not identify a significant DFS or MFS advantage for CT in subcentimetric, node-negative ductal TNBC. Although current consensus guidelines recommend consideration of CT in all TNBC larger than 5 mm, clinicians should carefully discuss benefit/risk ratio with patients, given the unproven benefits.
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Affiliation(s)
- A de Nonneville
- Aix-Marseille University, CNRS, INSERM, Institut Paoli-Calmettes, Department of Medical Oncology, CRCM, Marseille, France.
| | - A Gonçalves
- Aix-Marseille University, CNRS, INSERM, Institut Paoli-Calmettes, Department of Medical Oncology, CRCM, Marseille, France.
| | - C Zemmour
- Department of Clinical Research and Investigation, Biostatistics and Methodology Unit, Institut Paoli-Calmettes, Aix Marseille University, INSERM, IRD, SESSTIM, Marseille, France
| | - M Cohen
- Aix-Marseille University, CNRS, INSERM, Institut Paoli-Calmettes, Department of Surgical Oncology, CRCM, Marseille, France
| | - J M Classe
- Institut René Gauducheau, Saint-Herblain, France
| | - F Reyal
- Institut Curie, Paris, France
| | | | - E Jouve
- Institut Claudius Regaud, Toulouse, France
| | - S Giard
- Centre Oscar Lambret, Lille, France
| | | | - R Sabatier
- Aix-Marseille University, CNRS, INSERM, Institut Paoli-Calmettes, Department of Medical Oncology, CRCM, Marseille, France
| | - F Bertucci
- Aix-Marseille University, CNRS, INSERM, Institut Paoli-Calmettes, Department of Medical Oncology, CRCM, Marseille, France
| | - J M Boher
- Department of Clinical Research and Investigation, Biostatistics and Methodology Unit, Institut Paoli-Calmettes, Aix Marseille University, INSERM, IRD, SESSTIM, Marseille, France
| | - G Houvenaeghel
- Aix-Marseille University, CNRS, INSERM, Institut Paoli-Calmettes, Department of Surgical Oncology, CRCM, Marseille, France
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Ribstein P, Daubin C, Roule V, Goursaud S, Blanchart K, Lemaitre A, Sabatier R, Roupie E, Ducheyron D, Beygui F. 3870Impact of the timing of coronary angiography in patients with resuscitated out of hospital cardiac arrest on survival. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.3870] [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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Dahan B, Lemaitre A, Blanchart K, Bignon M, Roule V, Sabatier R, Roupie E, Goldstein P, Beygui F. P6423Physician- versus paramedic-based pre-hospital management of out-of-hospital cardiac arrest: a systematic review and meta-analysis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6423] [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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Boudin L, Gonçalves A, Sabatier R, Moretta J, Sfumato P, Asseeva P, Livon D, Bertucci F, Extra JM, Tarpin C, Houvenaeghel G, Lambaudie E, Tallet A, Resbeut M, Sobol H, Charafe-Jauffret E, Calmels B, Lemarie C, Boher JM, Viens P, Eisinger F, Chabannon C. Highly favorable outcome in BRCA-mutated metastatic breast cancer patients receiving high-dose chemotherapy and autologous hematopoietic stem cell transplantation. Bone Marrow Transplant 2017; 52:498. [PMID: 28092355 DOI: 10.1038/bmt.2016.291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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46
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Lemaitre A, Roule V, Blanchart K, Ardouin P, Alexandre J, Briet C, Aabouni M, Wain-Hobson J, Bignon M, Sabatier R, Milliez P, Beygui F. What is the optimal duration of dual antiplatelet therapy after acute coronary syndrome in the elderly? Archives of Cardiovascular Diseases Supplements 2017. [DOI: 10.1016/s1878-6480(17)30099-x] [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: 11/17/2022]
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47
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Isnard R, Bauer F, Cohen-Solal A, Damy T, Donal E, Galinier M, Hagège A, Jourdain P, Leclercq C, Sabatier R, Trochu JN, Cohen A. Non-vitamin K antagonist oral anticoagulants and heart failure. Arch Cardiovasc Dis 2016; 109:641-650. [PMID: 27836786 DOI: 10.1016/j.acvd.2016.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 04/04/2016] [Revised: 07/14/2016] [Accepted: 08/05/2016] [Indexed: 12/31/2022]
Abstract
Thromboembolism contributes to morbidity and mortality in patients with heart failure (HF), and atrial fibrillation (AF) is one of the main factors promoting this complication. As they share many risk factors, HF and AF frequently coexist, and patients with both conditions are at a particularly high risk of thromboembolism. Non-vitamin K antagonist oral anticoagulants (NOACs) are direct antagonists of thrombin (dabigatran) and factor Xa (rivaroxaban, apixaban and edoxaban), and were designed to overcome the limitations of vitamin K antagonists. Compared with warfarin in non-valvular AF, NOACs demonstrated non-inferiority with better safety, most particularly for intracranial haemorrhages. Therefore, the European Society of Cardiology guidelines recommend NOACs for most patients with non-valvular AF. Subgroups of patients with both AF and HF from the pivotal studies investigating the safety and efficacy of NOACs have been analysed and, for each NOAC, results were similar to those of the total analysis population. A recent meta-analysis of these subgroups has confirmed the better efficacy and safety of NOACs in patients with AF and HF - particularly the 41% decrease in the incidence of intracranial haemorrhages. The prothrombotic state associated with HF suggests that patients with HF in sinus rhythm could also benefit from treatment with NOACs. However, in the absence of clinical trial data supporting this indication, current guidelines do not recommend anticoagulant treatment of patients with HF in sinus rhythm. In conclusion, recent analyses of pivotal studies support the use of NOACs in accordance with their indications in HF patients with non-valvular AF.
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Affiliation(s)
- Richard Isnard
- Department of Cardiology, AP-HP, Pitié-Salpêtrière Hospital, Faculty of Medicine Pierre-et-Marie-Curie, University Paris 6, UMRS Inserm-UPMC 1166 and Institute of Cardiometabolism and Nutrition (ICAN), 75013 Paris, France.
| | - Fabrice Bauer
- Department of Cardiology, Inserm U1096, Rouen University Hospital, 76031 Rouen, France
| | - Alain Cohen-Solal
- Department of Cardiology, Paris Diderot University, Sorbonne Paris Centre, UMRS 942, Lariboisière Hospital, 75013 Paris, France
| | - Thibaud Damy
- UPEC, Mondor Amyloidosis Network, Department of Cardiology, AP-HP, Henri-Mondor Teaching Hospital, Inserm U955, DHU ATVB, 94010 Créteil, France
| | - Erwan Donal
- Department of Cardiology, Rennes University Hospital, University of Rennes 1, LTSI, Inserm UMR 1099, University of Rennes 1, 35033 Rennes, France
| | - Michel Galinier
- Équipe 7 « Obésité et Insuffisance Cardiaque : Approches Moléculaires et Cliniques », Inserm UMR 1048 - I2MC, Faculty of Medicine, University Paul-Sabatier - Toulouse 3, 31432 Toulouse, France
| | - Albert Hagège
- Department of Cardiology, AP-HP, Georges-Pompidou European Hospital, Paris Descartes University, PRES Paris Cité, 75015 Paris, France
| | - Patrick Jourdain
- École du Cœur et des Anticoagulants, UTIC, CHR Dubos, 95300 Pontoise, France
| | - Christophe Leclercq
- Department of Cardiology, Rennes University Hospital, CIC-IT, 35033 Rennes, France
| | - Rémi Sabatier
- Department of Cardiology, Caen University Hospital, 14003 Caen, France
| | - Jean-Noël Trochu
- Department of Cardiology and Vascular Diseases, Inserm UMR 1087, CIC 1413, Nantes University, Institut du Thorax, CHU de Nantes, 44093 Nantes, France
| | - Ariel Cohen
- Faculty of Medicine Pierre-et-Marie-Curie, University Paris 6, Department of Cardiology, AP-HP, Saint-Antoine Hospital, 75012 Paris, France
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Roule V, Ardouin P, Blanchart K, Lemaitre A, Wain-Hobson J, Legallois D, Alexandre J, Sabatier R, Milliez P, Beygui F. Prehospital fibrinolysis versus primary percutaneous coronary intervention in ST-elevation myocardial infarction: a systematic review and meta-analysis of randomized controlled trials. Crit Care 2016; 20:359. [PMID: 27814743 PMCID: PMC5097407 DOI: 10.1186/s13054-016-1530-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 10/14/2016] [Indexed: 11/26/2022]
Abstract
Background Primary percutaneous coronary intervention (PPCI) is the preferred reperfusion strategy in patients with ST-elevation myocardial infarction (STEMI), but its benefit over prehospital fibrinolysis (FL) is not clear. Methods We performed a systematic review and meta-analysis of randomized controlled trials in which outcomes of patients with STEMI managed with FL early in the prehospital setting versus PPCI were compared. Results Compared with PPCI, FL was consistently associated with similar rates of short-term (30–90 days) death (relative risk [RR] 0.94, 95 % CI 0.67–1.31) and cardiovascular death (RR 0.95, 95 % CI 0.64–1.4), a decreased risk of cardiogenic shock (RR 0.67, 95 % CI 0.48–0.95), and an increased risk of any stroke (RR 3.57, 95 % CI 1.39–9.17) and hemorrhagic stroke (RR 4.37, 95 % CI 1.25–15.26). FL was also associated with similar rates of 1-year mortality (RR 1.01, 95 % CI 0.75–1.34) and major bleeding (RR 1.31, 95 % CI 0.96–1.78) in comparison with PPCI, but with a notable level (I2 index 30.5 % and 59.8 %) of heterogeneity among studies. Conclusions Our study suggests that, compared with PPCI, FL performed in the early prehospital setting is associated with similar mortality rates, lower rates of cardiogenic shock, and higher rates of stroke in patients with STEMI. Although the number of studies comparing the two strategies is relatively low, our results support prehospital FL and transfer to hub percutaneous coronary intervention (PCI) centers as a valid alternative to PPCI, allowing potential limitation of resources allocated to developing proximity 24/7 PCI facilities. Electronic supplementary material The online version of this article (doi:10.1186/s13054-016-1530-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Vincent Roule
- Department of Cardiology, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France.
| | - Pierre Ardouin
- Department of Cardiology, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Katrien Blanchart
- Department of Cardiology, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Adrien Lemaitre
- Department of Cardiology, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Julien Wain-Hobson
- Department of Cardiology, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Damien Legallois
- Department of Cardiology, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Joachim Alexandre
- Department of Cardiology, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Rémi Sabatier
- Department of Cardiology, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Paul Milliez
- Department of Cardiology, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Farzin Beygui
- Department of Cardiology, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
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Boudin L, Chabannon C, Sabatier R, Bertucci F, Sfumato P, Tarpin C, Provansal M, Houvenaegel G, Lambaudie E, Tallet A, Michel R, Charafe-Jauffret E, Calmels B, Lemarie C, Jean-Marie B, Extra JM, Viens P, Gonçalves A. High-dose chemotherapy for inflammatory breast cancer: impact of immunohistochemical status on survival outcome. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw365.76] [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: 11/13/2022] Open
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50
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Houvenaeghel G, Sabatier R, Reyal F, Classe JM, Giard S, Charitansky H, Rouzier R, Faure C, Garbay JR, Daraï E, Hudry D, Gimbergues P, Villet R, Lambaudie E. Axillary lymph node micrometastases decrease triple-negative early breast cancer survival. Br J Cancer 2016; 115:1024-1031. [PMID: 27685443 PMCID: PMC5117781 DOI: 10.1038/bjc.2016.283] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 03/01/2016] [Revised: 07/19/2016] [Accepted: 08/09/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Triple-negative breast cancers (TNBCs) are the most deadly form of breast cancer (BC) subtypes. Axillary lymph node involvement (ALNI) has been described to be prognostic in BC taken as a whole, but its prognostic value in each subtype is unclear. We explored the prognostic impact of ALNI and especially of small size axillary metastases in early TNBCs. METHODS We analysed in this multicentre study all patients treated for early TNBC in 12 French cancer centres. We explored the correlation between clinicopathological data and ALNI, with a specific focus on the dichotomisation between macrometastases and occult metastases, which is defined as the presence of isolated tumour cells or micrometastases. The prognostic value of ALNI both in terms of disease-free survival (DFS) and overall survival (OS) was also explored. RESULTS We included 1237 TNBC patients. Five-year DFS and OS were 83.7% and 88.5%, respectively. The identified independent prognostic features for DFS were tumour size >20 mm (hazard ratio (HR)=1.86; 95% CI: 1.11-3.10, P=0.018), lymphovascular invasion (HR=1.69; 95% CI: 1.21-2.34, P=0.002) and ALNI both in case of macrometastases (HR=1.97; 95% CI: 1.38-2.81, P<0.0001) and occult metastases (HR=1.72; 95% CI: 1.1-2.71, P=0.019). DFS and OS were similar between tumours with occult metastases and macrometastases. Tumours presenting at least two pejorative features (out of ALNI, lymphovascular invasion and large tumour size) displayed a significantly poorer DFS in both the training set and validation set, independently of chemotherapy administration. Tumours with no more than one of the above-cited pejorative features had a 5-year OS of ⩾90% vs 70% for other cases (P<0.0001). CONCLUSIONS Axillary lymph node involvement is a key prognostic feature for early TNBC when isolated tumour cells were identified in lymph nodes. This impact is independent of chemotherapy use.
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Affiliation(s)
- G Houvenaeghel
- Institut Paoli Calmettes and Centre de Recherche en Cancérologie de Marseille, INSERM U1068, CNRS U7258, 232 Bd Ste Marguerite, Marseille, France
| | - R Sabatier
- Institut Paoli Calmettes and Centre de Recherche en Cancérologie de Marseille, INSERM U1068, CNRS U7258, 232 Bd Ste Marguerite, Marseille, France
| | - F Reyal
- Institut Curie, Paris, France
| | - J M Classe
- Institut René Gauducheau, Site hospitalier Nord, St Herblain, France
| | - S Giard
- Centre Oscar Lambret, 3 rue Frédéric Combenal, Lille, France
| | - H Charitansky
- Centre Claudius Regaud, 20-24 rue du Pont St Pierre, Toulouse, France
| | - R Rouzier
- Centre René Huguenin, 35 rue Dailly, Saint Cloud, France
| | - C Faure
- Centre Léon Bérard, 28 rue Laennec, Lyon, France
| | - J R Garbay
- Institut Gustave Roussy, 114 rue Edouard Vaillant, Villejuif, France
| | - E Daraï
- Hôpital Tenon, 4 rue de la Chine, Paris, France
| | - D Hudry
- Centre Georges François Leclerc, 1 rue du Professeur Marion, Dijon, France
| | - P Gimbergues
- Centre Jean Perrin, 58 rue Montalembert, Clermont Ferrand, France
| | - R Villet
- Hôpital des Diaconnesses, 18 rue du Sergent Bauchat, Paris, France
| | - E Lambaudie
- Institut Paoli Calmettes and Centre de Recherche en Cancérologie de Marseille, INSERM U1068, CNRS U7258, 232 Bd Ste Marguerite, Marseille, France
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