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Background There is limited evidence that fractional flow reserve (FFR) is effective in guiding therapeutic strategy in multivessel coronary artery disease (CAD) beyond prespecified percutaneous coronary intervention or coronary graft surgery candidates. Objectives The FUTURE (FUnctional Testing Underlying coronary REvascularization) trial aimed to evaluate whether a treatment strategy based on FFR was superior to a traditional strategy without FFR in the treatment of multivessel CAD. Methods The FUTURE trial is a prospective, randomized, open-label superiority trial. Multivessel CAD candidates were randomly assigned (1:1) to treatment strategy based on FFR in all stenotic (≥50%) coronary arteries or to a traditional strategy without FFR. In the FFR group, revascularization (percutaneous coronary intervention or surgery) was indicated for FFR ≤0.80 lesions. The primary endpoint was a composite of major adverse cardiac or cerebrovascular events at 1 year. Results The trial was stopped prematurely by the data safety and monitoring board after a safety analysis and 927 patients were enrolled. At 1-year follow-up, by intention to treat, there were no significant differences in major adverse cardiac or cerebrovascular events rates between groups (14.6% in the FFR group vs 14.4% in the control group; hazard ratio: 0.97; 95% confidence interval: 0.69-1.36; P = 0.85). The difference in all-cause mortality was nonsignificant, 3.7% in the FFR group versus 1.5% in the control group (hazard ratio: 2.34; 95% confidence interval: 0.97-5.18; P = 0.06), and this was confirmed with a 24 months’ extended follow-up. FFR significantly reduced the proportion of revascularized patients, with more patients referred to exclusively medical treatment (P = 0.02). Conclusions In patients with multivessel CAD, we did not find evidence that an FFR-guided treatment strategy reduced the risk of ischemic cardiovascular events or death at 1-year follow-up. (Functional Testing Underlying Coronary Revascularisation; NCT01881555 )

International audience; Background: Percutaneous coronary intervention (PCI)-related myonecrosis is frequent and can affect the long-term prognosis of patients. To our knowledge, ticagrelor has not been evaluated in elective PCI and could reduce periprocedural ischaemic complications compared with clopidogrel, the currently recommended treatment. The aim of the ALPHEUS study was to examine if ticagrelor was superior to clopidogrel in reducing periprocedural myocardial necrosis in stable coronary patients undergoing high-risk elective PCI.Methods: The ALPHEUS study, a phase 3b, randomised, open-label trial, was done at 49 hospitals in France and Czech Republic. Patients with stable coronary artery disease were eligible for the study if they had an indication for PCI and at least one high-risk characteristic. Eligible patients were randomly assigned (1:1) to either ticagrelor (180 mg loading dose, 90 mg twice daily thereafter for 30 days) or clopidogrel (300-600 mg loading dose, 75 mg daily thereafter for 30 days) by use of an interactive web response system, and stratified by centre. The primary outcome was a composite of PCI-related type 4 (a or b) myocardial infarction or major myocardial injury and the primary safety outcome was major bleeding, both of which were evaluated within 48 h of PCI (or at hospital discharge if earlier). The primary analysis was based on all events that occurred in the intention-to-treat population. The trial was registered with ClinicalTrials.gov, NCT02617290.Findings: Between Jan 9, 2017, and May 28, 2020, 1910 patients were randomly assigned at 49 sites, 956 to the ticagrelor group and 954 to the clopidogrel group. 15 patients were excluded from the ticagrelor group and 12 from the clopidogrel group. At 48 h, the primary outcome was observed in 334 (35%) of 941 patients in the ticagrelor group and 341 (36%) of 942 patients in the clopidogrel group (odds ratio [OR] 0·97, 95% CI 0·80-1·17; p=0·75). The primary safety outcome did not differ between the two groups, but minor bleeding events were more frequently observed with ticagrelor than clopidogrel at 30 days (105 [11%] of 941 patients in the ticagrelor group vs 71 [8%] of 942 patients in the clopidogrel group; OR 1·54, 95% CI 1·12-2·11; p=0·0070).Interpretation: Ticagrelor was not superior to clopidogrel in reducing periprocedural myocardial necrosis after elective PCI and did not cause an increase in major bleeding, but did increase the rate of minor bleeding at 30 days. These results support the use of clopidogrel as the standard of care for elective PCI.Funding: ACTION Study Group and AstraZeneca.

Distal embolization during primary percutaneous coronary intervention (p-PCI) in the treatment of ST-segment elevation myocardial infarction (STEMI) is associated with a poor prognosis. In this situation, thrombectomy is performed to prevent distal embolization and to restore myocardial reperfusion. The aim of our study was to determine angiographic predictors of angiographically visible distal embolization (AVDE) in patients with STEMI treated by p‑PCI with thrombectomy. This prospective study included all consecutive patients who underwent p‑PCI with thrombectomy for STEMI at our institution between October 2011 and December 2014 AVDE was defined as a distal filling defect with an abrupt cut-off in one of the peripheral coronary branches of the infarct-related artery, distal to the angioplasty site. Thrombectomy was considered positive when it removed thrombi, and successful when it improved coronary flow. Among the 346 patients included, 59 (17%) developed AVDE during p‑PCI. In multivariate analysis, the infarct-related right coronary artery (OR: 2.48, 95% CI: 1.36–4.52; p = 0.003) and a culprit lesion diameter of >3 mm (OR : 1.90, 95% CI: 1.01–3.56; p = 0.048) were identified as independent factors associated with AVDE during p‑PCI with thrombectomy for STEMI. The success of thrombectomy and the Syntax score were not associated with AVDE. AVDE complicating p‑PCI with thrombectomy in STEMI is frequent (17%) and a successful thrombectomy does not rule out AVDE.

Silent atrial fibrillation (AF), assessed by continuous ECG monitoring (CEM), has recently been shown to be common in acute myocardial infarction (AMI), and associated with higher hospital mortality. However, the long-term prognosis is still unknown. We aimed to assess 1-year prognosis in patients experiencing silent AF in AMI.All consecutive patients with AMI who were prospectively analysed by CEM during the first 48 h after admission and who survived at hospital discharge were included. Silent AF was defined as asymptomatic episodes lasting at least 30 s. Patients were followed up at 1 year for cardiovascular (CV) outcomes.Among the 737 patients analysed, 106 (14%) developed silent AF and 32 (4%) symptomatic AF. Compared with the no-AF group, patients with silent AF were markedly older (79 vs 62 years, p0.001), more frequently hypertensive (71% vs 49%, p0.001) and less likely to be smokers (23% vs 37%, p0.001). Also, they were more likely to have impaired LVEF (50% vs 55%, p0.001). Risk factors in patients with silent AF were similar to those in patients with symptomatic AF. However, a history of stroke or AF was less frequent in silent AF than in symptomatic-AF patients (10% vs 25% and 10% vs 38%, respectively). At 1 year, CV events including hospitalisation for heart failure (HF) and CV mortality were markedly higher in silent-AF patients than in no-AF patients (6.6% vs 1.3% and 5.7% vs 2.0%, p0.001, respectively).Our large prospective study showed for the first time that silent AF is associated with worse 1-year prognosis after AMI. Systematic screening and specific management should be investigated in order to improve outcomes of patients after AMI.

New onset atrial fibrillation post-transcatheter aortic valve implantation (TAVI) is common and is associated with adverse outcomes. However, silent atrial fibrillation (AF) is poorly documented in the context. This study sought to evaluate the incidence, predictive factors, and prognostic value of Silent AF post-TAVI. All the consecutive patients with TAVI were prospectively analyzed by continuous electrocardiogram monitoring≥48 hours after implantation. Silent AF was defined as asymptomatic episodes lasting at least 30 seconds. The population was divided into 3 groups: history of AF, no-AF, and silent AF. Among the 206 patients implanted with TAVI, 19 (16.1%) developed silent AF. Compared with the no-AF group, patients with silent AF shared the same clinical characteristics and cardiovascular risk factors. Procedural success and echography parameters after the device implantation were similar between groups. Left atrial volume was significantly increased (p0.001) in the silent AF group, together with preimplantation C-reactive protein (CRP)3 mg/L and glucose (p = 0.048 and p = 0.002). By multivariate analysis, CRP3 mg/dl and logistic European System for Cardiac Operative Risk Evaluation were identified as independent predictors of silent AF. In-hospital and 1-year mortalities were higher in pre-existing AF patients, whereas no-AF and the silent AF patients share the same prognosis. Our prospective study showed for the first time that silent AF is frequent after TAVI procedures. In conclusion, our work suggests that CRP could help to predict the risk of developing silent AF. However, the onset of silent AF is not associated with worse prognosis in the year following the procedure in our study.

Background Few data are available about BNP variation and left atrium remodeling after left appendage occlusion (LAAO) technique. Methods Prospective study, including all consecutive patients successfully implanted with a LAAO device. Contrast-enhanced cardiac computed tomography (CT) performed before and 6 weeks after the procedure with reverse left atrial remodeling define by an increase in LA volume > 10%, together with blood sampling obtained before, 48hr after device implantation and at the first visit after discharge (30–45 days) for BNP measurement. Results Among the 44 patients implanted with a complete dataset, mean End-diastolic LA volume was 139 ± 64 mL and 141 ± 62 mL at baseline and during follow-up (45 ± 15 days), respectively, showing no statistical difference (P = 0.45). No thrombus was seen on the atrial side of the device. Peridevice leaks (defined as presence of dye in LAA beyond the device) were observed in 17 patients (40%) but were trivial or mild. Reverse atrial remodeling (RAR) at 6 weeks was observed in 6 patients (13%). Despite no difference in BNP levels on admission, median BNP levels at 48 Hs was slightly increased in RAR patients when compared with controls. During FU, BNP levels were strictly identical in both groups. These results were not modified even when each RAR case was matched with 2 controls on age, LVEF, creatinine levels and ACE inhibitors treatment to avoid potential confounders. Conclusion Our study showed that despite the fact that LAAO technique can induce left atrial remodeling measured by CT-scan, it does not seems to impact BNP levels on the follow-up. The results need to be transposed to clinical outcomes of this expanding population, in future studies.

Background Conductive disorders after TAVI remain frequent, leading to a 10-20% risk of permanent pacemaker implantation (PPI). Pre-existing conduction disorders or anatomical features can offer a good prediction of the risk of PPI, however, inflammatory and hemorrhagic process are responsible of transient abnormalities and 1/3 of the patients does not need the pacemaker at follow-up. In this setting, corticosteroid could be an interesting treatment to prevent or reduce the need of PPI. We aim to assess the influence of chronic or acute corticosteroid treatment in the occurrence of PPI after TAVI. Methods All TAVI performed in our center 2013 and 2018 were prospectively included in the study. Patient treated either with chronic or acute corticosteroid before TAVI were gathered through medical database claim of the University Hospital of Dijon, France. They were matched 1:2 on sex, age, and the valve implanted. Preoperative parameters, corticosteroids dose and indication, and PPI rates after TAVI were collected. Results Among the 691 patients included, 18 (2.6%) patients had a corticosteroid prescription before TAVI procedure. 11(61%) had a chronic corticosteroid prescription, when the remaining patients were treated before and a few days after TAVI as prevention of contrast iodinated product allergy. When compared to the matched population (n = 36), no significant difference was found on PPI rates during hospitalization (2 (11%) vs. 6 (17%), P = 0.70). Among others parameters collected, the only significant difference between the two groups was that corticosteroids patients less frequently had previous diabetes (3 (17%) 17 vs. 18(50%), P = 0.021). Conclusion Corticosteroid treatment is uncommon before TAVI, reducing the statistical power of this analysis. Given the safety of this drug prescription on short duration prescription, a prospective randomized study could be performed to confirm our hypothesis.

article Background: Silent atrial fibrillation (AF) has been suggested to be frequent after acute myocardial infarction (MI). Continuous ECG monitoring (CEM) has been shown to improve AF screening in patients at risk of stroke. Objectives: We aimed to assess the incidence and prognosis of silent AF in patients with acute MI. Methods:All the consecutive patients with acute MI were prospectively analyzed by CEM ≥ 48 h after admission. Silent AF was defined as asymptomatic episodes lasting at least 30 s. The population was divided into three groups: no-AF, silent AF and symptomatic AF. Results:Among the 849 patients, 135(16%) developedsilentAF and45(5%)symptomatic AF.Comparedwith the no-AF group, patients with silent AF were markedly older (80 vs. 62 y, p b 0.001), more frequently women (43% vs. 30%, p = 0.006) and less likely to be smokers (20% vs. 36%, p b 0.001). They had impaired left ventricular ejection fraction (LVEF) and left atrial (LA) enlargement. By multivariate analysis, age, history of AF, indexed LA area and LVEF were identified as independent predictors of silent AF. In-hospital heart failure and death rates were markedly higher in silent AF group when compared with no-AF patients (41.8% vs 21.0% and 10.4% vs. 1.3%, respectively). Conclusion: Our large prospective study showed for the fi rst time that silent AF is more frequent than symptomatic AF after MI. Our work suggests that indexed LA area could help to predict the risk of developing silent AF. Moreover, the onset of silent AF is associated with worse hospital prognosis.

International audience; We report the molecular detection of Borrelia afzelii (11%) and Bartonella spp. (56%) in 447 bank voles trapped in a suburban forest in France. Adult voles were infected by significantly more Borrelia afzelii than juveniles (p

Cardiovascular disease is the leading cause of early death and morbidity in developed countries and is becoming a growing problem in many developing countries. Currently, anti-coagulants play a major role in the management of the acute phase in association or not with reperfusion strategies. The combination of clopidogrel and aspirin, in accordance with the results of large randomized trials, is the treatment of reference. However two new drugs, a thienopyridine (prasugrel), and a cyclo-pentyl-triazolo-pyridine (ticagrelor) have shown their interest in major studies in comparison with clopidogrel. As a result, several effective P2Y12 receptor antagonist anti-platelet agents are now available in the therapeutic arsenal, and the cardiologist have to tailored the best drug scheme according the balance between the risk of hemorrhage and the benefits with regard to the ischemia to determine the optimal prescription for every patient.

Summary Background Thrombus aspiration is applicable in a large majority of patients with acute myocardial infarction (AMI) and results in better reperfusion and clinical outcomes compared with percutaneous coronary intervention alone. Some aspiration procedures are, however, ineffective. To date, few clinical data are available on the predictors of successful thrombectomy in the acute phase of myocardial infarction. Aims To determine the baseline clinical and angiographic characteristics associated with successful thrombectomy. Methods Consecutive patients with ST elevation myocardial infarction with a baseline TIMI flow of 0 or 1, who underwent thrombus aspiration and primary or rescue angioplasty, were included. The main criterion for evaluation was an effective or ineffective aspiration defined, respectively, by the presence or absence of atherothrombotic material in the aspirate samples. Results Among the 180 patients included, material was collected in 155 patients (86%). Patients with the presence of material were younger (61 vs 74 years, P = 0.015), less frequently hypertensive (41% vs 68%, P = 0.023) and had a lower systolic blood pressure at admission (135 vs 148 mmHg, P = 0.031). No difference was observed between the two groups for angiographic parameters except for visible thrombus (61% vs 28%, P = 0.005) and calcification (37% vs 60%, P = 0.048). In multivariable analysis, the ability to remove the clot was affected by: age greater than 70 years (odds ratio 0.18, 95% confidence interval 0.06–0.51; P = 0.001), admission systolic blood pressure (0.97, 0.95–0.99; P = 0.003) and thrombus seen on angiography (4.54, 1.54–13.45, P = 0.006). Conclusion The present study showed that manual thrombus aspiration is effective in most, but not all, patients. Further studies are needed to develop more efficient aspiration techniques and other aspiration devices to improve the results of such procedures.

Cardiovascular disease is one of the major causes of early morbidity and death in the developed world, and is becoming a serious public health concern in many developing countries. Over the last 30 years, in the USA and France, coronary angioplasty has become a standard treatment for stable angina, and this despite the recommendations of Learned Societies concerning the treatment of this condition. Today, 85 % of angioplasty procedures are performed on patients with stable angina. This study presents meta-analyses that compare medical treatment with angioplasty, and examine the impact of these strategies on more specific populations such as the elderly and post-myocardial infarction patients. To our minds, this synthesis seems to be of particular importance as the COURAGE study has rekindled the debate by showing that improvements in medical treatment and way of life reduced mortality and the recurrence of MI at five years, whereas there was no positive impact of an invasive strategy in any of the subgroups. Nevertheless, as a whole, studies on this subject underscore the value of angioplasty in the medium term for symptom relief in the case of ineffective medical treatment, notably during an acute coronary syndrome both in patients under medical treatment and in those who underwent invasive therapy at the initial phase.

Epidemiological data concerning acute coronary syndromes in Europe are based on national registries, studies by the European Society of Cardiology within the framework of the EuroHeart Survey and on the study of European population sub-groups in large international cohorts. In this article, recently published studies will be reviewed, and the principal developments in different countries as well as the characteristics and particularities of the most recent epidemiological data will be highlighted. In Europe, the presentation of acute coronary syndromes (ACS) has evolved considerably over the last ten years. This evolution is characterized by a reduction in the proportion of acute coronary syndromes with ST-segment elevation (STEMI) and by ageing populations.

Cardiovascular disease is the primary cause of early death and morbidity in the industrialized world and is becoming a growing problem in many developing countries. Coagulation inhibitors play a major role in the management of the acute phase of ACS whether in association with reperfusion strategies or not. Currently, and in accordance with the results of major randomised studies, for medium and long-term management, the association of Clopidogrel and aspirin is the treatment of choice. However, despite the recognised benefits of this therapeutic strategy and above all the recommendations of learned societies, which have placed this bi-therapy in class I, according to national and international registries it is still underused. Moreover, all of these registries have confirmed, in the real world, the negative impact of not prescribing this antiplatelet therapy on morbidity and mortality after both ST and non-ST elevation acute coronary syndrome. which shows the difficulty of applying to everyday clinical practice the results of major randomised cohorts.

The patients presenting acute coronary syndrome with or without ST segment elevation form a heterogeneous population and thus the short and long-term risk of death or recurrent ischemic events can vary considerably. During ACS without ST elevation (unstable angina and non-ST elevation MI), the evaluation of risk is an essential step in the management of such patients, because it determines ulterior strategy. This evaluation is simple and reliable, and is principally based on three scores: the TIMI, the GRACE Score or the PURSUIT. Thanks to this stratification, high and medium-risk patients are able to benefit from early invasive management (stents and anti-GPIIb/IIIa) as recent studies have clearly shown. Even if immediate management of patients with non-ST elevation ACS does not take account of risk stratification, using such information in the medium and long-term does help determine the prognosis. Finally, the risk profile score, whatever the score used is today an essential tool, which helps qualify and especially compare patients included in international clinical studies.

Background Few data are available about clinical consequences of BNP variation after left appendage occlusion (LAAO) technique. Methods In all consecutive patients successfully implanted with a LAAO device, blood samples were obtained before, 48 h after device implantation and at the first visit after discharge (30–45 days) for BNP measurement. Clinical and echocardiography parameters were gathered. Patients diagnosed with symptoms of heart failure according to the ESC guidelines were classified as HF group. Results Among the 58 patients implanted, 6 (10%) complain with new HF symptoms, mainly breathlessness, and were classified in NYHA class II or III during the FU visit. Symptomatic patients were older, however procedural success and echo parameters after the device implantation were similar between groups. Despite no difference in NTproBNP levels on admission and after 48 h, median NTproBNP levels was increased by about 20% at time of FU in HF patients when compared with asymptomatic patients. To avoid potential confounders, each HF case was matched with 2 controls on age, LVEF and creatinine levels. After matching, the median NTproBNP levels was significantly increased in the HF group vs. control (1048 vs. 521 pg/mL, respectively, P Conclusion Our prospective study showed for the first time that LAAO modifies BNP levels and that trends of variation can have clinical impact during FU. The pathophysiological mechanisms of these findings need to be further investigated.

International audience; Atrial fibrillation (AF) is the most frequent heart rhythm disorder in the general population and contributes not only to a major deterioration in quality of life but also to an increase in cardiovascular morbimortality. The onset of AF in the acute phase of myocardial infarction (MI) is a major event that can jeopardize the prognosis of patients in the short-, medium- and long-term, and is a powerful predictor of a poor prognosis after MI. The suspected mechanism underlying the excess mortality is the drop in coronary flow linked to the acceleration and arrhythmic nature of the left ventricular contractions, which reduce the left ventricular ejection fraction. The principal causes of AF-associated death after MI are linked to heart failure. Moreover, the excess risk of death in these heart failure patients has also been associated with the onset of sudden death. Whatever its form, AF has a major negative effect on patient prognosis. In recent studies, symptomatic AF was associated with inhospital mortality of 17.8%, to which can be added mortality at 1year of 18.8%. Surprisingly, silent AF also has a negative effect on the prognosis, as it is associated with an inhospital mortality rate of 10.4%, which remains high at 5.7% at 1year. Moreover, both forms of AF are independent predictors of mortality beyond traditional risk factors. The frequency and seriousness of silent AF in the short- and long-term, which were until recently rarely studied, raises the question of systematically screening for it in the acute phase of MI. Consequently, the use of continuous ECG monitoring could be a simple, effective and inexpensive solution to improve screening for AF, even though studies are still necessary to validate this strategy. Finally, complementary studies also effect of oxidative stress and endothelial dysfunction, which seem to play a major role in triggering this rhythm disorder.

BackgroundCurrent guidelines for the management of patients with acute myocardial infarction (AMI) recommend the GRACE score for risk stratification with assessment of admission variables. The syntax score (SS) is a comprehensive angiographic scoring system that is derived entirely from the coronary anatomy and lesion characteristics. We investigated the relationship between severity of coronary artery disease (CAD) assessed with SYNTAX Score (SS) and GRACE Score (GS) in patients with AMI.Patients and MethodsFrom the obseRvatoire des Infarctus de Côte d’Or (RICO) survey, 614 consecutive patients hospitalized for an AMI from 1st march 2011 to 30 august 2012 and who underwent coronary angiography were included. Patients were analyzed into 3 tertiles of risk based on GS.ResultsThe tertiles of risk were defined as low (n=205)(GS165). Age and co-morbidities increase gradually with increased GS risk. Also, the number of diseased vessels on coronary angiography increased across the tertiles (p

International audience; Among the 33 confirmed Bartonella species to date, more than half are hosted by rodent species, and at least five of them have been involved in human illness causing diverse symptoms including fever, myocarditis, endocarditis, lymphadenitis and hepatitis. In almost all countries, wild rodents are infected by extremely diverse Bartonella strains with a high prevalence. In the present paper, in light of new knowledge on rodent-adapted Bartonella species genomics, we bring together knowledge gained in recent years to have an overview of the impact of rodent-adapted Bartonella infection on humans and to determine how diversity of Bartonella helps to understand their mechanisms of adaptation to rodents and the consequences on human health.

International audience; BACKGROUND: The relation between fragmented QRS complex (fQRS) and cardiac magnetic resonance parameters is poorly documented in ischemic cardiopathy. METHODS: Among 209 consecutive patients, those with fQRS were compared with those without fQRS. Cardiac magnetic resonance studies with late gadolinium-enhanced sequences were done during the week after acute myocardial infarction. RESULTS: fQRS was present in 113 (54%) patients, and associated with a significantly lower left ventricular ejection fraction, increased left ventricular volumes, a larger infarct size (IS), and a larger peri-infarct zone. Microvascular obstruction was more frequent in patients with fQRS (62% vs 45%; P = 0.014) and the extent of the microvascular obstruction was significantly larger (1.6% [range, 0.0-4.4] vs 0.0 [range, 0.0-2.1]; P = 0.004). Finally, the transmurality score in the 2 study populations was identical (48% vs 47%; P = 0.895). In multivariate logistic regression analysis, only IS (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.03-1.09; P < 0.001), systolic blood pressure (OR, 1.02; 95% CI, 1.01-1.04; P < 0.001), and left ventricular end-systolic volume (OR, 1.02; 95% CI, 1.00-1.03; P = 0.013) remained independent predictors of fQRS. CONCLUSIONS: This study revealed that fQRS was associated with increased IS, myocardial perfusion abnormalities, decreased left ventricular ejection fraction, and increased left heart volumes. These findings show that fQRS is a reliable marker of infarct size and acute ventricular remodelling.

Periodontal disease, including bone loss, is thought to be involved in coronary artery disease. Multiple complex coronary lesions relate to multifocal destabilization of coronary plaques. We investigated whether bone loss could be associated with the presence of multiple complex coronary lesions.This cross-sectional study included 150 patients with recent myocardial infarction (1 month). Multiple complex coronary lesions were determined at coronary angiography. A panoramic dental X-ray including bone loss50% was performed. Patients with no or simple complex lesions were compared to patients with multiple complex lesions.Over 20% of patients had multiple complex coronary lesions. Patients with multiple complex lesion were less likely to be women and more likely to have multivessel disease or elevated C-reactive protein (CRP) than patients with no or single complex lesion. Bone loss50% tended to be more frequent in patients with multiple complex lesions (p = 0.063). In multivariate analysis, multivessel disease, gender and CRP were associated with multiple complex lesion. Bone loss50% increased the risk of multiple complex lesion.Bone loss was associated with complex multiple coronary lesions, beyond systemic inflammation. These findings may bear important clinical implications for the prevention and treatment of coronary artery disease.

To examine the influence of obesity on the predictive value of the pro-B-type natriuretic peptide (NT-proBNP) assay in acute myocardial infarction.Prospective observational study.All intensive care units in one region of France. Patients 2217 consecutive patients admitted for an acute myocardial infarction matched with respect to age, gender, Killip class and renal function.Cardiovascular death at one year.There were three groups (according to body mass index (BMI): obese, overweight and normal) of 739 matched patients. Median levels of NT-proBNP were considerably lower in high BMI patients, by about 20% in overweight and by 60% in obese patients, compared with normal BMI patients. An inverse relationship between the propeptide values and BMI was found in the overall study population (r = -0.20, p0.0001), and for both genders. In multivariate linear regression, BMI as a continuous variable was a predictor of the log NT-proBNP level, even when adjusted for potential confounders. CV mortality at 1-year follow-up was similar for the three BMI groups (p = 0.691). In multivariate logistic regression analysis, log NT-proBNP predicted mortality in normal (OR (95% CI) 3.48 (2.00 to 6.12)) and overweight (OR (95% CI) 3.96 (1.95 to 8.06)) patients, even when adjusted for confounders (GRACE risk score, left ventricular ejection fraction). However, in obese patients, propeptide levels failed to retain their independent prognostic value (OR (95% CI) 1.34 (0.86 to 2.08)).In this large population of patients with myocardial infarction, circulating NT-proBNP levels were considerably lower in obese patients; the significance of the propeptide level as an independent prognostic factor is severely compromised.

International audience; Background and aim: Reactive oxygen species (ROS) play an important role in the pathogenesis of many diseases including cardiovascular diseases. Several methods have been developed for the direct or indirect measurement of oxygen free radical and its by-products. The current study was designed to validate the new Free Oxygen Radicals Test (FORT) and to investigate the potential relationships between ROS and clinical or biological factors in male patients with acute myocardial infarction (AMI). Methods: We analysed FORT values in samples from 66 patients with AMI. Results: FORT values ranged from 324 to 1198 FORT units, with a median value of 581 (494-754) FORT units. In univariate analysis, FORT values were positively related only to LVEF

Over 4 yr, 102 consecutive patients more than 75 yr old (56 men, 46 women; mean age 78 +/- 3 years, range: 76-89 years) underwent 120 percutaneous transluminal coronary angioplasty procedures. At baseline, 86% had severe anginal symptoms (Canadian class III or IV), 43% had a history of prior myocardial infarction; 61% had multivessel coronary artery disease, and mean left ventricular ejection fraction was 60 +/- 11%. Calcifications were observed on 66% of the dilated arteries. A total of 158 vessels (1.3 vessel per procedure) were attempted: 1 vessel in 89 procedures (74%), 2 vessels in 24 (20%) and 3 vessels in 7 (6%). The primary success rate was 80% per lesion (126/158) and 77% per procedure (92/120). Complications included 3 deaths (3%), 9 Q-wave infarctions (7.5%) and there was no emergency coronary bypass surgery. The primary success rate was significantly related to the absence of coronary calcifications on the dilated segment (88% versus 75%, p0.05) and to the initial patency of the dilated artery (subtotal stenosis: 83% versus total occlusion: 53%, p0.05). Follow-up data were obtained in the 79 consecutive patients with a duration of follow-up exceeding 8 months. The mean duration of follow-up was 23 +/- 13 months (range 8 to 61 months). No patient was lost to follow-up; 11 patients died (cardiac causes: 7), 2 had a non-fatal infarction, 7 had aortocoronary bypass surgery and 18 had repeat percutaneous transluminal coronary angioplasty.(ABSTRACT TRUNCATED AT 250 WORDS)

Objective: To determine the prevalence of chronic oral anticoagulant drug treatment (COA) among patients with acute myocardial infarction (AMI) and its impact on management and outcome. Methods: All patients with ST segment elevation AMI on the RICO (a French regional survey for AMI) database were included in this analysis. COA was defined as continuous use ⩾ 48 hours before AMI. Results: Among the 2112 patients with ST elevation myocardial infarction (STEMI), 93 (4%) patients were receiving COA. These patients were older and more likely to have a history of hypertension, diabetes and prior myocardial infarction than patients without COA. In addition, fewer patients who received COA underwent reperfusion therapy or received an antiplatelet agent (aspirin/thienopyridines). Moreover, patients receiving COA experienced a higher incidence of in-hospital major adverse events (death, recurrent myocardial infarction or major bleeding, p = 0.005). Multivariate analysis showed that only ejection fraction, current smoking and multiple vessel disease, but not COA, were independent predictive factors for major adverse events. In contrast, COA was an independent predictive factor for heart failure when adjusted for age, diabetes, creatinine clearance, reperfusion, heparin and glycoprotein IIb/IIIa inhibitors (odds ratio 2.06, CI 95% 1.23 to 3.43, p = 0.005). Conclusion: In this population based registry, patients with STEMI with prior use of COA constituted a fairly large group (4%) with an overall higher baseline risk profile than that of patients without COA. Fewer in the COA group received reperfusion therapy or aggressive antithrombotic treatment and they experienced more adverse in-hospital outcomes. Thus, further studies are warranted to develop specific management strategies for this high risk group.

To the Editor: The Ixodes ricinus tick is a predominant vector of a large variety of pathogens of veterinary and medical consequence in Europe (1). The most prevalent I. ricinus–borne infection of persons in Europe is Lyme borreliosis, a multisystemic disorder caused by spirochetes of the Borrelia burgdorferi sensu lato complex (2). Persons bitten by ticks can also become infected with many other pathogens, such as bacteria (Anaplasma spp., Francisella spp., Coxiella burnetii, Bartonella spp., Rickettsiae spp., and Neoerhlichia mikurensis); parasites (Babesia spp., Theileria spp.); and arboviruses (tick-borne encephalitis virus, Crimean-Congo hemorrhagic fever virus, and Eyach virus) (1). Symptoms induced by such pathogens are often diverse and nonspecific, complicating accurate diagnosis of the disease. In Romania, cases of Lyme disease and tick-borne encephalitis (caused by tick-borne encephalitis virus) have been identified (3). However, little is known about the public health impact of these diseases, and none of the other tick-borne pathogens present in Europe have been reported as causes of infection in Romania. Although I. ricinus is the most abundant and widespread tick in Romania (3), the public health impact of I. ricinus–borne disease is likely to be underestimated. Therefore, the first step in evaluating the distribution of these potential pathogens is to establish their presence in ticks from previously unexplored areas. We conducted a study to identify the main tick-borne bacterial and parasitic human pathogens known to be present in Europe but not previously detected in Romania. We tested for the presence of DNA from spotted fever group Rickettsia spp., Anaplasma spp., Francisella tularensis, and Babesia spp. in 147 I. ricinus ticks collected from roe deer and goats at 2 sites in eastern Romania: Bacau (46°35′0″N, 26°55′0″E) and Galati (45°26′22″N, 28°2′4″E). Specimens were tested by PCR, using specific primers for each pathogen or group of pathogens, as described (4). Sequences obtained from Eurofins MWG Operon (Ebersberg, Germany) were identified by using BLAST (www.ncbi.nlm.nih.gov/BLAST) and compared with sequences available in GenBank. DNA from Rickettsia spp. was detected in 20 (13.6%) ticks. Sequence analyses revealed that 9 (6.1%) sequences were related to the R. monacensis strain IRd/Serbia glta gene (99%–100% nt similarity) (GenBank accession no. {"type":"entrez-nucleotide","attrs":{"text":"GQ925820","term_id":"262181579","term_text":"GQ925820"}}GQ925820) and 11 (7.48%) were related to R. helvetica gltA gene (99%–100% nt similarity) (GenBank accession no. {"type":"entrez-nucleotide","attrs":{"text":"AM418450","term_id":"118918333","term_text":"AM418450"}}AM418450). DNA from Anaplasma spp. was identified in 33 (22.4%) ticks. Analysis revealed that 30 of the 33 amplified fragments showed 100% identity to the 16S rDNA gene of a symbiont in the family Anaplasmataceae, Candidatus Midichloria mitochondrii (GenBank accession no. {"type":"entrez-nucleotide","attrs":{"text":"EU780455","term_id":"190607147","term_text":"EU780455"}}EU780455), and the remaining 3 were related to known pathogenic species identified in Romania: 2 (1.4%) exhibited 100% identity to Anaplasma phagocytophilum (GenBank accession no. {"type":"entrez-nucleotide","attrs":{"text":"EU982548","term_id":"197360744","term_text":"EU982548"}}EU982548), and 1 (0.7%) showed 99% similarity to Ehrlichia muris (GenBank accession no. {"type":"entrez-nucleotide","attrs":{"text":"GU358691","term_id":"284975291","term_text":"GU358691"}}GU358691). Francisella tularensis–specific DNA was amplified from 4 DNA extracts (2.7%). All 4 sequences were identical and shared 99% similarity with the F. tularensis peptidyl-propyl cis-trans isomerase gene (GenBank accession no. {"type":"entrez-nucleotide","attrs":{"text":"CP003048","term_id":"377828067","term_text":"CP003048"}}CP003048). Babesia spp.–specific DNA was amplified in 1 DNA extract (0.7%), and it shared 99% sequence identity with the Babesia sp. EU1 18S rDNA gene (GenBank accession no. {"type":"entrez-nucleotide","attrs":{"text":"HQ830266","term_id":"317383279","term_text":"HQ830266"}}HQ830266). This is a report on the identification of the human pathogens R. monacensis, R. helvetica, A. phagocytophilum, E. muris, and Babesia EU1 in Romania. R. monacensis (also known as the Cadiz agent or Rickettsia IRS3 and IRS4) was first identified in I. ricinus tick samples from Germany (5) and was recently recognized as the cause of Mediterranean spotted fever-like rickettsiosis in Spain (6). R. helvetica was isolated from I. ricinus ticks in Switzerland in 1979, and, since then, it has been isolated in many other European countries (7). R. helvetica was associated with human infections in the late 1990s (8). The role of animals as reservoirs for these pathogens is unknown. A. phagocytophilum is the causative agent of granulocytic anaplasmosis in humans, cattle, horses, and dogs, and is widespread throughout Europe (8). E. muris has been detected in ticks from Finland and European Russia and from ticks and rodents from Slovakia. In 2009, E. muris was also detected in patients with febrile illness in the United States (9). Babesia sp. EU1 has been detected in roe deer and ticks in several countries, and in 2003 was associated with human disease in Italy and Austria (4,10). Tularemia is known to be present in Romania and is thought to be exclusively and directly transmitted by hares. However, detection of F. tularensis DNA in I. ricinus ticks suggests that this bacterium might also be tick-borne. In conclusion, the detection of DNA of various human pathogens in ticks in Romania strongly suggests that these microorganisms circulate in the country. Because all of these pathogens affect humans, our study highlights the urgent requirement for further research to assess their impact on public health in Romania.

A case-controlled study assessed right ventricular (RV) systolic function in 10 patients with idiopathic dilated cardiomyopathy (IDC) and in 10 with healed anterior wall myocardial infarction associated with atherosclerotic coronary artery disease (CAD). Each patient was matched for sex, left ventricular ejection fraction +/- 5% and pulmonary artery mean pressure +/- 5 mm Hg. All patients had sinus rhythm and a left ventricular ejection fraction < 45%. A new, well-validated thermodilution technique was used to assess RV ejection fraction and volumes. RV ejection fraction was lower in the IDC than in the CAD group (25 +/- 14% vs 36 +/- 11%; p < 0.02). Linear correlations between RV parameters and pulmonary artery pressure were significantly present in both groups. However, the slopes of the equations were not statistically different. In comparison with healed anterior wall myocardial infarction with CAD and for similar levels of left ventricular dysfunction, RV systolic function appeared to be more altered in IDC.

ObjectivesThe aims of our study were to assess ventricular tachycardia or fibrillation (VT or VF) occurrence after AMI and to analyse the relationship with either symptomatic or silent AF occurrence.BackgroundSilent or symptomatic AF are known to be common after AMI and to impair patients prognosis. But the reasons of this worse prognosis remain discussed.Methods849 consecutive AMI were prospectively analyzed by continuous ECG monitoring (CEM) during the first 48 hours after admission. All AF, VT or VF episodes were confirm by standard ECG and sytematically reviewed by two investigators. The population was studied into three groups: No AF, Silent AF, and symptomatic AF after AMI.ResultsForty five patients (5%) developed symptomatic AF and one hundred and thirty five developed silent AF (15.9%). Compared with the no AF group, patients with AF were markedly older 80 (67-85) and 81(71-88) vs. 62 (53-75) years; with p

We evaluated the clinical outcome and the prognostic factors at 6-year follow-up of patients with acute coronary syndrome without critical coronary arterial narrowing. The mean follow-up was 73 ± 19 months. Mortality rate was 13%, and 20 patients (12%) had major cardiac event, 8 patients (5%) had stroke and 10 patients (6%) underwent revascularization. Multivariate analysis matched for age and ejection factor showed that moderate disease (stenosis 40–59%) (OR = 2.713, p < 0.024) was an independent predictive factor of major cardiac event.

The role of right ventricular (RV) function has been proven to be important in various cardiac diseases, including coronary artery disease1,2 or dilated cardiomyopathy. The use of Doppler echocardiography to measure RV inflow has permitted assessment of RV diastolic function in various diseases.3 However, the Doppler echocardiographic approach of RV systolic function remains neglected. A Doppler-derived rate of left ventricular pressure rise using the mitral regurgitant flow velocity pattern, recorded by continuous-wave Doppler echocardiography, has proved to be correlated with peak dP dt obtained at cardiac catheterization.4,5 Because tricuspid regurgitation (TR) is often found in a variety of cardiac diseases and in normal subjects,6 we hypothesized that the rate of RV pressure rise could be predicted from the continuous-wave TR signal, in a way similar to that used for the rate of left ventricular pressure rise. Therefore, the purpose of the present study was to correlate Doppler-derived RV dP dt with dP dt obtained simultaneously from invasive measurements.

IntroductionThe syntax score (SS) was developed in 2005 by the team of the Rotterdam Thorax Center to characterize the complexity of the coronary network by taking into account:1/the number of lesions and their impact on function,2/the location of the lesions, and3/theircomplexity. However, patients in this study had multivessel disease and stable angina. In patients with acute myocardial infarction (AMI), we aim to study thecharacteristics of the SS in diabetic patients and todetermine the predictive value of the SS as compared with the GRACE score for inhospital death.Materials and methodsOur study analysed 1107 consecutive patients, including 873 non-diabetic patients and 234 diabetic patients, hospitalized for AMI in the intensive coronary care unit ofDijon from September 2011 to December 2012 and whohad undergone coronary angiography. The SYNTAX and GRACE scores were both calculated for each patient.ResultsMedian SS was significantly higher in diabetic patients (11 (4–15) vs. 8(4–15), p

BackgroundRescue percutaneous coronary intervention (PCI) is associated with improved clinical outcomes for ST-segment myocardial infarction (STEMI) patients after failed fibrinolysis therapy. Hyperglycemia on admission has been shown to be a powerful predictor of mortality after acute myocardial infarction, particularly in non-diabetic patients. The aim of our study was to assess the predictive value of admission glucose levels on long-term mortality in patients with rescue PCI.Patients and MethodsFrom the “Observatoire des infarctus de Côte d’Or” (RICO) survey, 510 consecutive non-diabetic STEMI patients admitted to the intensive care unit for rescue PCI after failed fibrinolysis therapy were included in the study. We analyzed one-year cardiovascular mortality in these patients. Rescue PCI was deemed necessary in patients with ST-segment resolution

BackgroundThe presence of preinfarction angina (PIA) has been shown to confer cardioprotection after ST segment elevation myocardial infarction (MI). However, the impact of PIA in non ST segment elevation (NSTEMI) remains to be determined.Patients and MethodsFrom the obseRvatoire des Infarctus de Côte d’Or (RICO) survey, 1541 consecutive patients admitted in intensive care unit with a first NSTEMI were included in the study. Patients who experienced chest pain 1) and 30-day mortality were collected.ResultsAmong the 1541 patients included in the study, 693 patients presented PIA. Baseline clinical characteristics were similar for the 2 groups. There was no significant difference for the GRACE risk score (p=0.942). However, PIA was associated with a lower creatine kinase peak, as a reflect of infarct size (231(109-520) vs. 322(148-844) IU/L, p100 ULN (31% vs. 39%, p

ObjectiveRecent findings reported intriguing relationships between obesity and natriuretic peptides. In patients with acute myocardial infarction (MI), we aimed to investigate the relation between body mass index (BMI) and N-Terminal pro Brain Natriuretic Peptide (NT-proBNP) level.Patients and methodsFrom a French regional survey for acute MI, we formed 739 triplets of patients (n=2217) with an acute MI, matched with respect to age, gender, and renal function (MDRD, modification of diet in renal disease), each classified for BMI groups as obese (BMI> 30 kg/m2), overweight (BMI 25-29.9 kg/m2) and normal (BMI 20-24.9 kg/m2). Blood samples were taken on admission to assess NT-proBNP levels.ResultsAmong the 2217 participants, mean age was 68±12 years, 80% were male and MDRD was 75±26 ml/min/1.73m_. Higher prevalence of CV risk factors (hypertension, diabetes and dyslipidemia) was found across the overweight and obese groups. Admission CRP levels were increased in obese patients. Clinical heart failure on admission and LVEF were similar for the 3 groups. When compared with normal BMI, levels of NT-proBNP dramatically decreased by about 20% in overweight and by 60% in obese patients (1046 vs 839 and 444 pg/ml, respectively, p

ObjectivePlatelet activation is present in atrial fibrillation (AF), but there is some debate whether this is due to AF itself and/or to underlying cardiovascular diseases. We aim to determine the association between a marker of platelet reactivity (mean platelet volume (MPV)) and systemic inflammation (CRP) measured on admission, and new onset episode of AF in patients with MI.Patients and methodsProspective cohort of 4994 consecutive patients with AMI. Patients with paroxysmal or persistent AF were excluded.Results426 (8.5%) patients were diagnosed with a new onset of AF during the in-hospital-stay (mean stay 3±2 days). These patients were older (75 vs 65, p

Among 7467 consecutive coronary angiograms performed during an 8-year period, 61 patients had a myocardial bridge of the left anterior descending coronary artery. The overall prevalence of myocardial bridges was 0.82% (from 0.41% to 1.16% per year). Among these patients, 26 had coronary artery disease, 4 had valvular heart disease, and 3 had cardiomyopathy. We studied the long-term outcome (11 +/- 3 years) of the other 28 patients with isolated milking at baseline. Two groups were constituted according to the percentage of systolic reduction of the left anterior descending coronary artery lumen: group A,50% (15 patients) and group B,or = 50% (13 patients). During follow-up, 1 group A patient (cancer) and 2 group B patients (1 cancer and 1 suicide) died. Moreover, 1 group B patient was lost to follow-up. None of the patients sustained a myocardial infarction during follow-up. In group A patients, 71% felt very well or well and 50% had clinical symptoms; 64% took antianginal medications. In group B patients, 50% felt well and 70% had clinical symptoms; 50% took antianginal drugs. The long-term prognosis of isolated myocardial bridges of the left anterior descending coronary artery is good and is independent of the severity of systolic narrowing of internal lumen diameter.

BACKGROUND: The presence of pre-infarction angina (PIA) has been shown to confer cardioprotection after ST-segment elevation myocardial infarction (STEMI). However, the clinical impact of PIA in non-ST-segment elevation myocardial infarction (NSTEMI) remains to be determined. METHODS AND RESULTS: From the obseRvatoire des Infarctus de Côte d'Or (RICO) survey, 1541 consecutive patients admitted in intensive care unit with a first NSTEMI were included. Patients who experienced chest pain

Over an 11-year period, the initial and late outcomes of percutaneous transluminal coronary angioplasty (PTCA) were studied in 140 consecutive patients younger than 40 years of age (mean, 34 +/- 3 years; range, 23 to 39 years; 132 men). Before the procedure, 28% of the patients had unstable angina, and 44% had a history of prior myocardial infarction. Mean left ventricular ejection fraction was 64% +/- 10%, and 75% of the patients had one-vessel disease. Primary success was 86% (77% for the first 70 patients vs 93% for the last 70, p < 0.02). Complications were nine periprocedural myocardial infarctions, eight emergency coronary surgical procedures, and no deaths. During follow-up (mean, 6 +/- 3 years; range, 1 to 12 years), 39 (28%) of the 104 patients who had repeat coronary angiography had angiographic restenosis (all < 6 months after PTCA). Late events were 13 elective coronary surgical procedures (11 for restenosis, one for failed PTCA, and one for progression of coronary artery disease), 13 PTCAs on a new site, five deaths, and four nonfatal myocardial infarctions. Ten-year survival was 96% +/- 1%, and 10-year event-free survival (without myocardial infarction, elective coronary surgery, or repeat PTCA) was 58% +/- 6%. Among survivors, 88% were free of angina, and 93% had returned to work. In patients younger than 40 years of age, PTCA yields excellent long-term survival, provided that the eventuality of repeat procedures during the first months is accepted. In addition, PTCA for progression on a new site is not unusual after several years.

This study compared the acute occlusion and complication rates within 24 hours of coronary angioplasty in three groups of patients. In group 1, 178 procedures were performed by one operator who administered 30 mg of dipyridamole intravenously over 1 hour, starting immediately before the procedure; in group 2, 200 procedures were performed by the same operator before he administered dipyridamole; and in group 3, 599 procedures were performed during the same time period in the same catheterization laboratory by two other operators who did not administer dipyridamole. All patients received an intravenous bolus of heparin and aspirin. Baseline variables were similar in the three groups. The acute closure rate was 2.8% in group 1, 7.5% in group 2, and 5.2% in group 3 (p0.05 between groups 1 and 2); acute thrombosis was observed in 0.6%, 3.5%, and 3% of patients, respectively, in the three groups (p0.05 between group 1 and both groups 2 and 3), and acute dissection was noted in 2.2%, 4%, and 2% of patients, respectively (p = not significant). The cumulative rate of acute complications (death, acute myocardial infarction, or emergency coronary bypass surgery) was lower in group 1 (1.7%) than in group 2 (5.5%, p0.05) and group 3 (3.5%, p = not significant). Therefore in this retrospective study, adjunctive antithrombotic treatment with intravenously administered dipyridamole resulted in lower acute thrombosis and complication rates during the 24-hour period after the procedure than when heparin and aspirin therapy were used alone.

The acute and long-term results of percutaneous transluminal coronary angioplasty (PTCA) of the left coronary artery in 106 patients (group 1) with chronic occlusion of the right coronary artery were compared with those of 106 patients matched for sex (92 male) and age (56 +/- 10 years) undergoing left PTCA with a normal right coronary artery (group 2). Before the procedure, group 1 had more unstable angina (42 vs 29%; p0.05), more frequent prior myocardial infarction (80 vs 25%; p0.001), and a lower left ventricular ejection fraction (56 +/- 10% vs 65 +/- 11%; p0.005). Acute results were not different in the 2 groups with respect to primary success (group 1: 93%; and group 2: 89%) and complications (group 1: 2 with emergency coronary surgery, and 4 with periprocedural myocardial infarction and no death; and group 2: 1 with emergency coronary surgery, 1 death, and 3 with periprocedural myocardial infarction). At 6 months, 79 patients in group 1 and 71 patients in group 2 had reangiography; the rate of restenosis was 35% in group 1 and 42% in group 2. In both groups, left ventricular ejection fraction increased significantly in patients without restenosis (58 +/- 12% vs 63 +/- 10%, p0.001 [n = 44] in group 1; and 66 +/- 9% vs 70 +/- 10%, p0.001 [n = 29] in group 2). In group 1, improvement was significant only for patients without collaterals to the occluded right coronary artery (59 +/- 10% vs 66 +/- 7%; p0.003 [n = 24]).(ABSTRACT TRUNCATED AT 250 WORDS)

Objective To examine the influence of age on the predictive value of N-terminal pro-brain natriuretic (NT-proBNP) peptide assay in acute myocardial infarction. Design Prospective observational study. Setting All intensive care units in one French region. Participants 3291 consecutive patients admitted for an acute myocardial infarction, from the RICO survey (a French regional survey for acute myocardial infarction). Main outcome measure Cardiovascular death at 1 year. Results Among the 3291 participants, mean age was 68 (SD 14) years and 2356 (72%) were men. In the study population, the median NT-proBNP concentration was 1053 (interquartile range 300-3472) pg/ml. Median values for age quarters 1 to 4 were 367 (119-1050), 696 (201-1950), 1536 (534-4146), and 3774 (1168-9724) pg/ml (P

Summary Background Myocardial infarction with ST-segment elevation (STEMI) is a medical emergency requiring specific management, with the main aim of achieving reperfusion as quickly as possible. Guidelines from medical societies have defined optimal management, with proven efficacy on morbi-mortality. Aims Our study aimed to evaluate trends in practices between 2002 and 2010 in the emergency management of STEMI in a single French department, namely Cote d’Or. Methods All patients admitted with a first STEMI to one of the six participating coronary care units (private or public) in Cote d’Or since January 2001 were included in a prospective registry (obseRvatoire des Infarctus de Cote d’Or [RICO]). Based on these data, we analysed trends in prehospital times between 2002 and 2010. Results A total of 4114 patients were included in this analysis. Between 2002 and 2010, there was an increase in the proportion of patients who contacted the emergency services (by dialling 15) as first medical contact; however, the time from onset of symptoms to first medical contact remained stable over the study period. Overall, there was little change in prehospital management times but we noted a slight reduction in time to reperfusion. Conclusion Despite some improvement in prehospital management practices between 2002 and 2010 in Cote d’Or, there is still significant room for improvement to achieve earlier reperfusion in STEMI patients.

Background Thrombus aspiration is applicable in a large majority of patients with ST-segment elevation myocardial infarction (STEMI), and it results in better reperfusion and clinical outcomes than conventional PCI. However, some aspiration procedures remain none productive. Then, the aim of the present study was to determine the baseline clinical and/or angiographic characteristics of a none effective thrombectomy. Methods Consecutive patients who benefited from thrombus aspiration and primary or rescue angioplasty, were included. The end point was effective or none effective aspiration defined by the presence of atherothrombotic material in the aspirate samples. Results Among the 180 patients included, material was collected in 155 patients (86%). The baseline characteristics are presented in table 1. Table 1 . Baseline characteristics Thrombectomy Not effective Effective p Men (%) 80% 69% NS Age (years, mean ± SD) 70 ± 15 62 ± 14 Heart Rate (mean ± SD) 81 ± 23 74 ± 21 NS Systolic Blood pressure (mm Hg, mean ± SD) 150 ± 32 134 ± 27 Delay symptoms-reperfusion (min, mean ± SD) 504 ± 572 641 ± 1064 NS Culprit lesion (%) Left anterior artery 48% 35% NS Circumflex artery 8% 9% NS Right artery 36% 52% NS AHA classification AHA A 0% 3% NS AHA B1 24% 27% NS AHA B2 76% 70% NS AHA C 0% 1% NS Visible thrombus (%) 28% 61% 0.005 Length (mm) 0% 3% NS 10 – 20 mm 48% 47% NS > 10 mm 52% 50% N Calcification (%) 60% 37% 0.048 In multivariate analysis, the ability to remove the clot is negatively influenced by: a) age>70 years [OR(95%CI): 5.459 (1.943–15.339); p = 0.001 b) admission systolic blood pressure [OR(95%CI): 1.028 (1.010–1.048); p = 0.003] and c) no thrombus seen on the angiography [OR(95%CI): 0.220 (0.074–0.651), p = 0.006] Conclusion The present study demonstrated that manual thrombus aspiration is effective in a majority but not in all the patients. Others studies are then needed to develop more efficient aspiration techniques and other aspiration devices to improve the results of such procedures.