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1. Coronavirus Disease 2019 Acute Myocarditis and Multisystem Inflammatory Syndrome in Adult Intensive and Cardiac Care Units

Author: Alban Redheuil, Alexis Mathian, Nicolas Bréchot, Juliette Chommeloux, Fleur Cohen-Aubart, Marc Pineton de Chambrun, Sonia Burrel, Gilles Montalescot, Matthieu Schmidt, Johanne Silvain, Pascal Leprince, Mathieu Kerneis, Miguel Hie, Zahir Amoura, Charles-Edouard Luyt, Guillaume Hékimian, Guillaume Lebreton, Michel Zeitouni, Alain Combes, Julien Haroche, and Stéphane Marot
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, Abdominal pain, Myocarditis, biology, business.industry, medicine.medical_treatment, Acute kidney injury, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, medicine.disease, Chest pain, Troponin, Systemic inflammatory response syndrome, 03 medical and health sciences, Diarrhea, 0302 clinical medicine, Internal medicine, Extracorporeal membrane oxygenation, biology.protein, Medicine, 030212 general & internal medicine, medicine.symptom, Cardiology and Cardiovascular Medicine, business
Published: 2021

2. Restrictive vs liberal red blood cell transfusion strategies in patients with acute myocardial infarction and anemia: Rationale and design of the <scp>REALITY</scp> trial

Author: Johanne Silvain, Manuel Martínez-Sellés, Reality Investigators, Gonzalo Calvo, Eric Vicaut, Nicolas Danchin, Cristina Avendaño-Solá, Philippe Gabriel Steg, Gregory Ducrocq, Joan Albert Arnaiz, Alexandra Rousseau, José Ramón González-Juanatey, Carma Karam, Marine Cachanado, Tabassome Simon, Etienne Puymirat, Gilles Lemesle, Isabelle Durand-Zaleski, Laboratoire de Recherche Vasculaire Translationnelle (LVTS (UMR_S_1148 / U1148)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Université Sorbonne Paris Nord, University of Barcelona, Universidade de Santiago de Compostela [Spain] (USC ), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Institut Coeur Poumon [CHU Lille], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Universidad Complutense de Madrid = Complutense University of Madrid [Madrid] (UCM), CEREST-TC [CHU Saint-Antoine], CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital Ambroise Paré [AP-HP], Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil (UVSQ Santé), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Ministère des Affaires Sociales et de la Santé PI15/01543 Instituto de Salud Carlos III, ISCIII Novartis AstraZeneca France Boehringer Ingelheim Pfizer Merck, The study is funded via a grant from the Programme de Recherche Médico‐Economique (PRME) from the French Ministry of Health, and a grant from the Instituto de Salud Carlos III (Spanish Ministry of Economy and Competitiveness), Grant n° PI15/01543., Editorial support was provided by Jenny Lloyd and Sophie Rushton‐Smith, MedLink Healthcare Communications, London, and was funded by the Programme de Recherche Medico‐Economique (PRME) from the Health Ministry in France., Dr Steg reports grants and nonfinancial support (cochair of the ODYSSEY OUTCOMES trial, as such, he received no personal fees, but his institution has received funding for the time he has devoted to trial coordination, and he has received support for travel related to trial meetings) from Sanofi, research grants and personal fees from Bayer (Steering Committee MARINER, grant for epidemiological study), Merck (speaker fees, grant for epidemiological studies), Sanofi (cochair of the ODYSSEY OUTCOMES trial, cochair of the SCORED trial, consulting, speaking), Servier (Chair of the CLARIFY registry, grant for epidemiological research), and Amarin (executive steering committee for the REDUCE‐IT trial [Disease Reduction of Cardiovascular Events With Icosapent Ethyl‐Intervention Trial], consulting), and and personal fees from Amgen, Bristol‐Myers Squibb, Boehringer Ingelheim, Pfizer, Novartis, Regeneron Pharmaceuticals, Lilly, and AstraZeneca. Dr Steg also has a European application number/patent number, issued on 26 October 2016 (no. 15712241.7), for a method for reducing cardiovascular risk.
Subjects: medicine.medical_specialty, Anemia, Cost effectiveness, medicine.medical_treatment, Trial Designs, Enfermedad cardiovascular, Myocardial Infarction, Ischemia, acute myocardial infarction, 030204 cardiovascular system & hematology, Revascularization, Hemoglobins, Tratamiento médico, 03 medical and health sciences, 0302 clinical medicine, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Reacción a la transfusión, Humans, Medicine, Blood Transfusion, cardiovascular diseases, 030212 general & internal medicine, Myocardial infarction, transfusion, Sistema cardiovascular, Transfusión sanguínea, cost effectiveness, business.industry, Insuficiencia cardíaca, General Medicine, medicine.disease, 3. Good health, Sample size determination, Relative risk, Emergency medicine, Erythrocyte Transfusion, Cardiology and Cardiovascular Medicine, business, Mace
Abstract: Background: Anemia is common in patients with acute myocardial infarction (AMI), and is an independent predictor of mortality. The optimal transfusion strategy in these patients is unclear. Hypothesis: We hypothesized that a "restrictive" transfusion strategy (triggered by hemoglobin ≤8 g/dL) is clinically noninferior to a "liberal" transfusion strategy (triggered by hemoglobin ≤10 g/dL), but is less costly. Methods: REALITY is an international, randomized, multicenter, open-label trial comparing a restrictive vs a liberal transfusion strategy in patients with AMI and anemia. The primary outcome is the incremental cost-effectiveness ratio (ICER) at 30 days, using the primary composite clinical outcome of major adverse cardiovascular events (MACE; comprising all-cause death, nonfatal stroke, nonfatal recurrent myocardial infarction, or emergency revascularization prompted by ischemia) as the effectiveness criterion. Secondary outcomes include the ICER at 1 year, and MACE (and its components) at 30 days and at 1 year. Results: The trial aimed to enroll 630 patients. Based on estimated event rates of 11% in the restrictive group and 15% in the liberal group, this number will provide 80% power to demonstrate clinical noninferiority of the restrictive group, with a noninferiority margin corresponding to a relative risk equal to 1.25. The sample size will also provide 80% power to show the cost-effectiveness of the restrictive strategy at a threshold of €50 000 per quality-adjusted life year. Conclusions: REALITY will provide important guidance on the management of patients with AMI and anemia. Sin financiación 3.287 JCR (2021) Q3, 74/143 Cardiac & Cardiovascular Systems 0.983 SJR (2021) Q1, 82/356 Cardiology and Cardiovascular Medicine No data IDR 2021 UEM
Published: 2021

3. Procedural myocardial injury, infarction and mortality in patients undergoing elective PCI: a pooled analysis of patient-level data

Author: Valeria Paradies, Emanuele Barbato, Sze Y Ooi, Sebastiano Gili, Johanne Silvain, Samin K. Sharma, Claudio Cavallini, Gjin Ndrepepa, Allan S. Jaffe, Kristian Thygesen, Heerajnarain Bulluck, Derek J. Hausenloy, Julinda Mehilli, Michel Zeitouni, Gilles Montalescot, Huili L Zheng, Giuseppe Tarantini, Clemens von Birgelen, Dimitri N Feldman, and Health Technology & Services Research
Subjects: Procedural complication, medicine.medical_specialty, medicine.medical_treatment, Population, Myocardial Infarction, Infarction, UNIVERSAL DEFINITION, Coronary Artery Disease, 030204 cardiovascular system & hematology, 03 medical and health sciences, Percutaneous Coronary Intervention, 0302 clinical medicine, HIGH-SENSITIVITY TROPONIN, Clinical Research, Internal medicine, medicine, Humans, 030212 general & internal medicine, Myocardial infarction, Angioplasty, Balloon, Coronary, ELEVATION, education, health care economics and organizations, Percutaneous Coronary Intervention/adverse effects, education.field_of_study, biology, business.industry, NECROSIS, Troponin I, Percutaneous coronary intervention, Odds ratio, Procedural myocardial injury, medicine.disease, Troponin, Confidence interval, 3. Good health, Heart Injuries, Myocardial injury, Conventional PCI, biology.protein, Cardiology, Procedural myocardial infarction, Elective PCI, Cardiology and Cardiovascular Medicine, business, Biomarkers
Abstract: Aims The prognostic importance of cardiac procedural myocardial injury and myocardial infarction (MI) in chronic coronary syndrome (CCS) patients undergoing elective percutaneous coronary intervention (PCI) is still debated. Methods and results We analysed individual data of 9081 patients undergoing elective PCI with normal pre-PCI baseline cardiac troponin (cTn) levels. Multivariate models evaluated the association between post-PCI elevations in cTn and 1-year mortality, while an interval analysis evaluated the impact of the size of the myocardial injury on mortality. Our analysis was performed in the overall population and also according to the type of cTn used [52.0% had high-sensitivity cTn (hs-cTn)]. Procedural myocardial injury, as defined by the Fourth Universal Definition of MI (UDMI) [post-PCI cTn elevation ≥1 × 99th percentile upper reference limit (URL)], occurred in 52.8% of patients and was not associated with 1-year mortality [adj odds ratio (OR), 1.35, 95% confidence interval (CI) (0.84–1.77), P = 0.21]. The association between post-PCI cTn elevation and 1-year mortality was significant starting ≥3 × 99th percentile URL. Major myocardial injury defined by post-PCI ≥5 × 99th percentile URL occurred in 18.2% of patients and was associated with a two-fold increase in the adjusted odds of 1-year mortality [2.29, 95% CI (1.32–3.97), P = 0.004]. In the subset of patients for whom periprocedural evidence of ischaemia was collected (n = 2316), Type 4a MI defined by the Fourth UDMI occurred in 12.7% of patients and was strongly associated with 1-year mortality [adj OR 3.21, 95% CI (1.42–7.27), P = 0.005]. We also present our results according to the type of troponin used (hs-cTn or conventional troponin). Conclusion Our analysis has demonstrated that in CCS patients with normal baseline cTn levels, the post-PCI cTn elevation of ≥5 × 99th percentile URL used to define Type 4a MI is associated with 1-year mortality and could be used to detect ‘major’ procedural myocardial injury in the absence of procedural complications or evidence of new myocardial ischaemia.
Published: 2020

4. Acute Multivessel Coronary Occlusion Revealing COVID-19 in a Young Adult

Author: Jean-Philippe Collet, Johanne Silvain, Gilles Montalescot, Sandra Zendjebil, Nathan El Bèze, Marc Batonga, Paul Guedeney, Michel Zeitouni, Rémi Choussat, Gestionnaire, Hal Sorbonne Université, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut de cardiologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP]
Subjects: 0301 basic medicine, ULN, arterial thrombosis, 030105 genetics & heredity, 0302 clinical medicine, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Myocardial infarction, Respiratory system, Young adult, [SDV.MHEP.ME] Life Sciences [q-bio]/Human health and pathology/Emerging diseases, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, COVID-19, Coronavirus disease 2019, Coronavirus disease 2019, STEMI, ST-segment elevation myocardial infarction, upper limit of normal value, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, 3. Good health, medicine.anatomical_structure, coronavirus-2019, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Cardiology, Acute thrombosis, Cardiology and Cardiovascular Medicine, Acute coronary syndrome, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), SARS-CoV-2, severe acute respiratory syndrome coronavirus 2, Article, acute coronary syndrome, STEMI, 03 medical and health sciences, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Internal medicine, severe acute respiratory syndrome-coronavirus-2, DAPT, Double antiplatelet therapy, medicine, Diseases of the circulatory (Cardiovascular) system, cardiovascular diseases, SARS-CoV-2, business.industry, coronavirus disease-2019, COVID-19, medicine.disease, ULN, Upper limit of normal value, ST-segment elevation myocardial infarction, Coronary arteries, Coronary occlusion, RC666-701, ECG, electrocardiogram, myocardial infarction, business, 030217 neurology & neurosurgery
Abstract: A 42-year-old man was admitted for a ST-segment elevation myocardial infarction revealing an acute thrombosis of the left anterior descending and right coronary arteries. Following this acute multivessel coronary occlusion in a young individual at low cardiovascular risk, he was tested positive for severe acute respiratory syndrome coronavirus 2., Graphical abstract
Published: 2020

5. Selatogrel for Acute Myocardial Infarction

Author: Mathieu Kerneis, Johanne Silvain, and Michel Zeitouni
Subjects: medicine.medical_specialty, business.industry, 030204 cardiovascular system & hematology, Platelet inhibition, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Cardiology, medicine, 030212 general & internal medicine, Myocardial infarction, Cardiology and Cardiovascular Medicine, business, Self-medication
Published: 2020

6. Appropriate criteria for the definition of Type 4a MI

Author: Johanne Silvain, Michel Zeitouni, and Derek J. Hausenloy
Subjects: medicine.medical_specialty, Type (biology), business.industry, Myocardial Infarction, Medicine, Creatine Kinase, MB Form, Humans, Cardiology and Cardiovascular Medicine, business, Intensive care medicine
Published: 2021

7. Single Versus Dual Antiplatelet Therapy Following TAVR

Author: Mathieu Kerneis, Ciro Indolfi, Jean-Philippe Collet, Johanne Silvain, Michel Zeitouni, Sabato Sorrentino, Salvatore De Rosa, Jules Mesnier, Gilles Montalescot, and Paul Guedeney
Subjects: Oncology, medicine.medical_specialty, business.industry, Treatment outcome, MEDLINE, DUAL (cognitive architecture), law.invention, Pharmacotherapy, Randomized controlled trial, law, Meta-analysis, Internal medicine, medicine, Platelet aggregation inhibitor, Cardiology and Cardiovascular Medicine, business
Published: 2021

8. Multivessel PCI Guided by FFR or Angiography for Myocardial Infarction

Author: Etienne, Puymirat, Guillaume, Cayla, Tabassome, Simon, Philippe G, Steg, Gilles, Montalescot, Isabelle, Durand-Zaleski, Alicia, le Bras, Romain, Gallet, Khalife, Khalife, Jean-François, Morelle, Pascal, Motreff, Gilles, Lemesle, Jean-Guillaume, Dillinger, Thibault, Lhermusier, Johanne, Silvain, Vincent, Roule, Jean-Noel, Labèque, Grégoire, Rangé, Grégory, Ducrocq, Yves, Cottin, Didier, Blanchard, Anaïs, Charles Nelson, Bernard, De Bruyne, Gilles, Chatellier, Nicolas, Danchin, and Sebastien, Levesque
Subjects: Male, medicine.medical_specialty, medicine.medical_treatment, Fractional flow reserve, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Coronary Angiography, 03 medical and health sciences, 0302 clinical medicine, Percutaneous Coronary Intervention, Internal medicine, medicine, Confidence Intervals, Myocardial Revascularization, Humans, In patient, Single-Blind Method, cardiovascular diseases, 030212 general & internal medicine, Myocardial infarction, Aged, Proportional Hazards Models, medicine.diagnostic_test, business.industry, Coronary Stenosis, Percutaneous coronary intervention, General Medicine, Multivessel disease, Middle Aged, medicine.disease, Fractional Flow Reserve, Myocardial, surgical procedures, operative, Multicenter study, Conventional PCI, Angiography, Cardiology, ST Elevation Myocardial Infarction, Female, Stents, business, Follow-Up Studies
Abstract: In patients with ST-elevation myocardial infarction (STEMI) who have multivessel disease, percutaneous coronary intervention (PCI) for nonculprit lesions (complete revascularization) is superior to treatment of the culprit lesion alone. However, whether complete revascularization that is guided by fractional flow reserve (FFR) is superior to an angiography-guided procedure is unclear.In this multicenter trial, we randomly assigned patients with STEMI and multivessel disease who had undergone successful PCI of the infarct-related artery to receive complete revascularization guided by either FFR or angiography. The primary outcome was a composite of death from any cause, nonfatal myocardial infarction, or unplanned hospitalization leading to urgent revascularization at 1 year.The mean (±SD) number of stents that were placed per patient for nonculprit lesions was 1.01±0.99 in the FFR-guided group and 1.50±0.86 in the angiography-guided group. During follow-up, a primary outcome event occurred in 32 of 586 patients (5.5%) in the FFR-guided group and in 24 of 577 patients (4.2%) in the angiography-guided group (hazard ratio, 1.32; 95% confidence interval, 0.78 to 2.23; P = 0.31). Death occurred in 9 patients (1.5%) in the FFR-guided group and in 10 (1.7%) in the angiography-guided group; nonfatal myocardial infarction in 18 (3.1%) and 10 (1.7%), respectively; and unplanned hospitalization leading to urgent revascularization in 15 (2.6%) and 11 (1.9%), respectively.In patients with STEMI undergoing complete revascularization, an FFR-guided strategy did not have a significant benefit over an angiography-guided strategy with respect to the risk of death, myocardial infarction, or urgent revascularization at 1 year. However, given the wide confidence intervals for the estimate of effect, the findings do not allow for a conclusive interpretation. (Funded by the French Ministry of Health and Abbott; FLOWER-MI ClinicalTrials.gov number, NCT02943954.).
Published: 2021

9. Do Patients need Lifelong β-Blockers after an Uncomplicated Myocardial Infarction?

Author: Johanne Silvain, Benoit Lattuca, Mathieu Kerneis, Michel Zeitouni, Paul Guedeney, Guillaume Cayla, Gilles Montalescot, Jean-Philippe Collet, Sorbonne Université (SU), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut de cardiologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), and Université de Montpellier (UM)
Subjects: medicine.medical_specialty, Time Factors, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Adrenergic beta-Antagonists, Myocardial Infarction, MEDLINE, 030204 cardiovascular system & hematology, Revascularization, law.invention, 03 medical and health sciences, 0302 clinical medicine, Pharmacotherapy, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Quality of life, Randomized controlled trial, law, medicine, Humans, Pharmacology (medical), 030212 general & internal medicine, Myocardial infarction, Medical prescription, Intensive care medicine, Heart Failure, business.industry, General Medicine, medicine.disease, 3. Good health, Hospitalization, Heart failure, Quality of Life, Cardiology and Cardiovascular Medicine, business
Abstract: International audience; The lifelong use of β-adrenoceptor antagonists (β-blockers) after a myocardial infarction (MI) has been the standard of care based on trials performed before the era of revascularization, when heart failure was common. Large randomized trials in the mid-1980s demonstrated that β-blockers played a major role in improving the in-hospital and long-term survival of patients admitted for MI. However, the implementation of rapid myocardial reperfusion led to a substantial survival benefit and a reduction of heart failure because of reduced infarct size. Modern large longitudinal registries did not provide sufficient evidence to support long-term β-blocker therapy in patients with uncomplicated acute MI. The long-term prescription of this therapy has become a matter of debate given the lack of contemporary evidence, frequent side effects, and treatment adherence issues. Furthermore, this shift into the reperfusion era led to a downgraded recommendation for the use of β-blockers in post-MI patients (class IIa B recommendation) in the 2017 European Society of Cardiology (ESC) recommendations for the treatment of ST-segment elevation MI (STEMI). Three large ongoing multicenter randomized trials (AβYSS, REDUCE-SWEDEHEART, and REBOOT-CNIC) are evaluating early discontinuation of β-blockers after an uncomplicated acute MI. The tested hypothesis is that β-blocker withdrawal is safe versus major adverse cardiovascular events and improves quality of life by reducing side effects. Thus, the present review summarizes the exhaustive evidence-based data for long-term β-blocker use after uncomplicated MI and the ongoing trials.
Published: 2019

10. Evaluation of neutrophil gelatinase-associated lipocalin and cystatin C as biomarkers of acute kidney injury after ST-segment elevation myocardial infarction treated by percutaneous coronary intervention

Author: Jean-Philippe Collet, Gilles Montalescot, Johanne Silvain, Marie Hauguel-Moreau, Lee S. Nguyen, Olivier Barthelemy, Mathieu Kerneis, Vincent Spagnoli, Sorbonne Université (SU), Institut de cardiologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], CHU Pitié-Salpêtrière [AP-HP], and Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)
Subjects: Male, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Contrast Media, 030204 cardiovascular system & hematology, urologic and male genital diseases, Gastroenterology, chemistry.chemical_compound, 0302 clinical medicine, Risk Factors, Prospective Studies, 030212 general & internal medicine, Myocardial infarction, Primary PCI, Aged, 80 and over, biology, Incidence, Acute kidney injury, General Medicine, Middle Aged, female genital diseases and pregnancy complications, Treatment Outcome, Creatinine, Biomarker (medicine), Female, Cystatin, Cardiology and Cardiovascular Medicine, Paris, medicine.medical_specialty, STEMI, 03 medical and health sciences, Percutaneous Coronary Intervention, Lipocalin-2, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Predictive Value of Tests, Internal medicine, medicine, Humans, Contrast volume, Cystatin C, Aged, business.industry, Percutaneous coronary intervention, medicine.disease, chemistry, Conventional PCI, biology.protein, ST Elevation Myocardial Infarction, business, Biomarkers
Abstract: Summary Background Two biomarkers of early acute kidney injury − plasmatic neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C − are not used in routine clinical practice in patients with ST-segment elevation myocardial infarction (STEMI) treated by percutaneous coronary intervention (PCI) because of a lack of supporting data. Aims To evaluate the predictive value of NGAL and cystatin C regarding the incidence of contrast-induced acute kidney injury (CI-AKI) and clinical outcomes after STEMI in patients treated by primary PCI. Methods Plasmatic NGAL and cystatin C were measured on admission, before any contrast exposure, in 701 unselected patients with STEMI. Associations between biomarker concentrations and incidence of CI-AKI (assessed at 48 h), haemodialysis requirement at 1 year and all-cause mortality at 1 year were assessed by logistic regression analyses and receiver operating characteristic area under the curve analysis (c-statistic). Discrimination performance comparison was performed using the DeLong test. Results NGAL and cystatin C had mild discrimination regarding CI-AKI, with c-statistics of 0.60 (P = 0.001) and 0.60 (P = 0.002), respectively. Combining NGAL and cystatin C did not improve their discrimination (c-statistic 0.61; P = 0.001). There was no significant difference in discrimination between NGAL, cystatin C and baseline creatinine (P = 0.57). Regression analyses showed no independent association between NGAL and CI-AKI, haemodialysis or 1-year mortality. Similarly, cystatin C was not associated with these clinical outcomes. Conclusions In this cohort of patients with STEMI treated by primary PCI, plasmatic NGAL and cystatin C did not provide additional value regarding CI-AKI prediction compared with known risk factors such as baseline creatinine.
Published: 2019

11. Association of the PHACTR1/EDN1 Genetic Locus With Spontaneous Coronary Artery Dissection

Author: David Adlam, Timothy M. Olson, Nicolas Combaret, Jason C. Kovacic, Siiri E. Iismaa, Abtehale Al-Hussaini, Megan M. O'Byrne, Sara Bouajila, Adrien Georges, Ketan Mishra, Peter S. Braund, Valentina d’Escamard, Siying Huang, Marios Margaritis, Christopher P. Nelson, Mariza de Andrade, Daniella Kadian-Dodov, Catherine A. Welch, Stephani Mazurkiewicz, Xavier Jeunemaitre, Claire Mei Yi Wong, Eleni Giannoulatou, Michael Sweeting, David Muller, Alice Wood, Lucy McGrath-Cadell, Diane Fatkin, Sally L. Dunwoodie, Richard Harvey, Cameron Holloway, Jean-Philippe Empana, Xavier Jouven, Jeffrey W. Olin, Rajiv Gulati, Marysia S. Tweet, Sharonne N. Hayes, Nilesh J. Samani, Robert M. Graham, Pascal Motreff, Nabila Bouatia-Naji, Loïc Belle, Patrick Dupouy, Pierre Barnay, Nicolas Meneveau, Martine Gilard, Gilles Rioufol, Grégoire Range, Philippe Brunel, Nicolas Delarche, Emmanuelle Filippi, Louis Le Bivic, Brahim Harbaoui, Hakim Benamer, Guillaume Cayla, Olivier Varenne, Stephane Peggy Manzo-Silberman, Johanne Silvain, Christian Spaulding, Christophe Caussin, Edouard Gerbaud, Yann Valy, René Koning, Thibault Lhermusier, Stanislas Champin, Emmanuel Salengro, Arnaud Fluttaz, Amer Zabalawi, Yves Cottin, Emmanuel Teiger, Christophe Saint-Etienne, Grégory Ducrocq, Stéphanie Marliere, Emmanuel Boiffard, Pierre Aubry, Jean Louis Georges, Didier Bresson, Fabien De Poli, Gaëtan Karrillon, Vincent Roule, Laurent Bali, Mathieu Valla, Antoine Gerbay, David Houpe, Olivier Dubreuil, Arsène Monnier, Norbert Mayaud, Aurélie Manchuelle, Philippe Commeau, Marc Bedossa, Majid Nikpay, Anuj Goel, Hong-Hee Won, Leanne M. Hall, Christina Willenborg, Stavroula Kanoni, Danish Saleheen, Theodosios Kyriakou, Jemma C. Hopewell, Thomas R. Webb, Lingyao Zeng, Abbas Dehghan, Maris Alver, Sebastian M. Armasu, Kirsi Auro, Andrew Bjonnes, Daniel I. Chasman, Shufeng Chen, Ian Ford, Nora Franceschini, Christian Gieger, Christopher Grace, Stefan Gustafsson, Jie Huang, Shih-Jen Hwang, Yun Kyoung Kim, Marcus E. Kleber, King Wai Lau, Xiangfeng Lu, Yingchang Lu, Leo P. Lyytikäinen, Evelin Mihailov, Alanna Morrison, Natalia Pervjakova, Liming Qu, Lynda M. Rose, Elias Salfati, Richa Saxena, Markus Scholz, Albert V. Smith, Emmi Tikkanen, Andre Uitterlinden, Xueli Yang, Weihua Zhang, Wei Zhao, Paul S. de Vries, Natalie R. van Zuydam, Sonia S. Anand, Lars Bertram, Frank Beutner, George Dedoussis, Philippe Frossard, Dominique Gauguier, Alison H. Goodall, Omri Gottesman, Marc Haber, Bok-Ghee Han, Jianfeng Huang, Shapour Jalilzadeh, Thorsten Kessler, Inke R. König, Lars Lannfelt, Wolfgang Lieb, Lars Lind, Cecilia M. Lindgren, Maisa Lokki, Patrik K. Magnusson, Nadeem H. Mallick, Narinder Mehra, Thomas Meitinger, Fazal-ur-Rehman Memon, Andrew P. Morris, Markku S. Nieminen, Nancy L. Pedersen, Annette Peters, Loukianos S. Rallidis, Asif Rasheed, Maria Samuel, Svati H. Shah, Juha Sinisalo, Kathleen E. Stirrups, Stella Trompet, Laiyuan Wang, Khan S. Zaman, Diego Ardissino, Eric Boerwinkle, Ingrid B. Borecki, Erwin P. Bottinger, Julie E. Buring, John C. Chambers, Rory Collins, L Adrienne Cupples, John Danesh, Ilja Demuth, Roberto Elosua, Stephen E. Epstein, Tõnu Esko, Mary F. Feitosa, Oscar H. Franco, Maria Grazia Franzosi, Christopher B. Granger, Dongfeng Gu, Vilmundur Gudnason, Alistair S. Hall, Anders Hamsten, Tamara B. Harris, Stanley L. Hazen, Christian Hengstenberg, Albert Hofman, Erik Ingelsson, Carlos Iribarren, J Wouter Jukema, Pekka J. Karhunen, Bong-Jo Kim, Jaspal S. Kooner, Iftikhar J. Kullo, Terho Lehtimäki, Ruth J. Loos, Olle Melander, Andres Metspalu, Winfried März, Colin N. Palmer, Markus Perola, Thomas Quertermous, Daniel J. Rader, Paul M. Ridker, Samuli Ripatti, Robert Roberts, Veikko Salomaa, Dharambir K. Sanghera, Stephen M. Schwartz, Udo Seedorf, Alexandre F. Stewart, David J. Stott, Joachim Thiery, Pierre A. Zalloua, Christopher J. O'Donnell, Muredach P. Reilly, Themistocles L. Assimes, John R. Thompson, Jeanette Erdmann, Robert Clarke, Hugh Watkins, Sekar Kathiresan, Ruth McPherson, Panos Deloukas, Heribert Schunkert, Martin Farrall, Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, Mayo Clinic [Rochester], Service de Cardiologie Maladies Vasculaires [CHU Clermont-Ferrand], CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Icahn School of Medicine at Mount Sinai [New York] (MSSM), Victor Chang Cardiac Research Institute, University of New South Wales [Sydney] (UNSW), St. Vincent’s Clinical School [Sydney, Australia], UNSW Faculty of Medicine [Sydney], University of New South Wales [Sydney] (UNSW)-University of New South Wales [Sydney] (UNSW), Department of Health Sciences Research [Mayo Clinic] (HSR), Mayo Clinic, Paris-Centre de Recherche Cardiovasculaire (PARCC (UMR_S 970/ U970)), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Université Paris Descartes - Faculté de Médecine (UPD5 Médecine), Université Paris Descartes - Paris 5 (UPD5), Sorbonne Université - Faculté de Médecine (SU FM), Sorbonne Université (SU), Service de génétique [CHU HEGP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Department of Cardiovascular Medicine, Mayo Clinic, Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), and Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)
Subjects: Adult, Male, medicine.medical_specialty, Myocardial infarction, Coronary Vessel Anomalies, Fibromuscular dysplasia, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Internal medicine, medicine, Prevalence, Fibromuscular Dysplasia, Humans, 030212 general & internal medicine, Vascular Diseases, Artery dissection, MESH: Australia, United Kingdom, USA, Coronary Vessel Anomalies / epidemiology, Endothelin-1 / genetics, Microfilament proteins / genetics, Genetic association, Aged, Endothelin-1, business.industry, Microfilament Proteins, Australia, Cardiovascular disease in women, Middle Aged, medicine.disease, R1, United States, 3. Good health, [SDV.GEN.GH]Life Sciences [q-bio]/Genetics/Human genetics, Genetic Loci, Case-Control Studies, Cardiology, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Female, France, Cardiology and Cardiovascular Medicine, Scad, business
Abstract: Background: \ud Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndromes (ACS) afflicting predominantly younger to middle-aged women. Observational studies have reported a high prevalence of extracoronary vascular anomalies, especially fibromuscular dysplasia (FMD) and a low prevalence of coincidental cases of atherosclerosis. PHACTR1/EDN1 is a genetic risk locus for several vascular diseases, including FMD and coronary artery disease, with the putative causal noncoding variant at the rs9349379 locus acting as a potential enhancer for the endothelin-1 (EDN1) gene.\ud \ud Objectives: \ud This study sought to test the association between the rs9349379 genotype and SCAD.\ud \ud Methods: \ud Results from case control studies from France, United Kingdom, United States, and Australia were analyzed to test the association with SCAD risk, including age at first event, pregnancy-associated SCAD (P-SCAD), and recurrent SCAD.\ud \ud Results: \ud The previously reported risk allele for FMD (rs9349379-A) was associated with a higher risk of SCAD in all studies. In a meta-analysis of 1,055 SCAD patients and 7,190 controls, the odds ratio (OR) was 1.67 (95% confidence interval [CI]: 1.50 to 1.86) per copy of rs9349379-A. In a subset of 491 SCAD patients, the OR estimate was found to be higher for the association with SCAD in patients without FMD (OR: 1.89; 95% CI: 1.53 to 2.33) than in SCAD cases with FMD (OR: 1.60; 95% CI: 1.28 to 1.99). There was no effect of genotype on age at first event, P-SCAD, or recurrence.\ud \ud Conclusions: \ud The first genetic risk factor for SCAD was identified in the largest study conducted to date for this condition. This genetic link may contribute to the clinical overlap between SCAD and FMD.
Published: 2019

12. Copeptin as a prognostic biomarker in acute myocardial infarction

Author: Pavel Overtchouk, Yan Yan, Johanne Silvain, Benoit Lattuca, Mathieu Kerneis, Michel Zeitouni, Maguy Bernard, Vuthy Sy, Gilles Montalescot, Alexandre Ceccaldi, Jean-Philippe Collet, Nadjib Hammoudi, Lee S. Nguyen, Abdourahmane Diallo, Sorbonne Université (SU), Institut de cardiologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Université de Montpellier (UM), Service de Biochimie Endocrinienne et Oncologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital Lariboisière, Université Paris Diderot - Paris 7 (UPD7)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [APHP]-Sorbonne Université (SU), CHU Pitié-Salpêtrière [APHP], Centre Hospitalier Régional Universitaire de Nîmes (CHRU Nîmes), Service de Biochimie Endocrinienne et Oncologique [CHU Pitié-Salpêtrière], and Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Lariboisière-Université Paris Diderot - Paris 7 (UPD7)
Subjects: Adult, Male, medicine.medical_specialty, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Population, 030204 cardiovascular system & hematology, Severity of Illness Index, STEMI, Electrocardiography, 03 medical and health sciences, Percutaneous Coronary Intervention, 0302 clinical medicine, Copeptin, Cause of Death, Internal medicine, medicine, Humans, Prognostic biomarker, cardiovascular diseases, 030212 general & internal medicine, Myocardial infarction, education, Retrospective Studies, education.field_of_study, business.industry, Glycopeptides, Percutaneous coronary intervention, Middle Aged, Prognosis, medicine.disease, Troponin, 3. Good health, Survival Rate, Heart failure, Cohort, Cardiology, ST Elevation Myocardial Infarction, Biomarker (medicine), Female, France, Cardiology and Cardiovascular Medicine, business, Prognostic value, Biomarkers, Follow-Up Studies
Abstract: International audience; BACKGROUND:Copeptin - the C-terminal section of vasopressin precursor - is a novel biomarker, that has been shown to be a useful prognostic factor in heart failure, ischemic stroke and in acute myocardial infarction (MI) but with restricted population and follow-up in ST-segment elevation MI (STEMI) setting. We evaluated in this study the hypothesis that copeptin measured on admission is an independent predictor of one-year all-cause mortality after a STEMI.METHODS:Copeptin was measured immediately on arrival in the catheterization laboratory in a cohort of unselected STEMI patients and was compared to the peak of cardiac troponin I as a prognosis marker. One-year follow-up was performed.RESULTS:We included 401 STEMI patients (77% of men, mean age 64 ± 14 years) treated by primary percutaneous coronary intervention. Copeptin on admission was significantly higher in patients who died during the one-year follow-up than in survivors (154.8 pmol/L; IQR [63.9-304.8] vs 30.3 pmol/L; IQR [10.8-93.5]); p
Published: 2019

13. Clinical manifestations and outcomes of coronavirus disease‐19 in heart transplant recipients: a multicentre case series with a systematic review and meta‐analysis

Author: Caroline Kerneis, Mathieu Kerneis, Constance Verdonk, Pascal Leprince, Sabato Sorrentino, Soulef Guendouz, Camille Arnaud, Eva Désiré, Richard Dorent, Camille Granger, Paul Guedeney, Guillaume Lebreton, Michel Zeitouni, Camille Legeai, Shaida Varnous, Fanny Hazan, Claire Cimadevilla, Johanne Silvain, and Gilles Montalescot
Subjects: Adult, Male, medicine.medical_specialty, Adolescent, medicine.medical_treatment, 030230 surgery, Severity of Illness Index, law.invention, 03 medical and health sciences, Young Adult, 0302 clinical medicine, COVID-19 Testing, Postoperative Complications, law, COVID‐19, Risk Factors, Internal medicine, Severity of illness, medicine, Humans, Prospective Studies, Prospective cohort study, heart transplant, Aged, Mechanical ventilation, Heart transplantation, Aged, 80 and over, Transplantation, business.industry, Mortality rate, COVID-19, Original Articles, Middle Aged, medicine.disease, Prognosis, Intensive care unit, Respiration, Artificial, immunosuppressive medication, Cohort, Heart Transplantation, 030211 gastroenterology & hepatology, Original Article, Female, France, business, Kidney disease, Follow-Up Studies
Abstract: Summary Available data on clinical presentation and mortality of coronavirus disease‐2019 (COVID‐19) in heart transplant (HT) recipients remain limited. We report a case series of laboratory‐confirmed COVID‐19 in 39 HT recipients from 3 French heart transplant centres (mean age 54.4 ± 14.8 years; 66.7% males). Hospital admission was required for 35 (89.7%) cases including 14/39 (35.9%) cases being admitted in intensive care unit. Immunosuppressive medications were reduced or discontinued in 74.4% of the patients. After a median follow‐up of 54 (19–80) days, death and death or need for mechanical ventilation occurred in 25.6% and 33.3% of patients, respectively. Elevated C‐reactive protein and lung involvement ≥50% on chest computed tomography (CT) at admission were associated with an increased risk of death or need for mechanical ventilation. Mortality rate from March to June in the entire 3‐centre HT recipient cohort was 56% higher in 2020 compared to the time‐matched 2019 cohort (2% vs. 1.28%, P = 0.15). In a meta‐analysis including 4 studies, pre‐existing diabetes mellitus (OR 3.60, 95% CI 1.43–9.06, I 2 = 0%, P = 0.006) and chronic kidney disease stage III or higher (OR 3.79, 95% CI 1.39–10.31, I 2 = 0%, P = 0.009) were associated with increased mortality. These findings highlight the aggressive clinical course of COVID‐19 in HT recipients.
Published: 2021
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14. Bleeding in the Elderly: Risk Factors and Impact on Clinical Outcomes After an Acute Coronary Syndrome, a Sub-study of the Randomized ANTARCTIC Trial

Author: Abdourahmane Diallo, Gilles Montalescot, Géraud Souteyrand, Mathieu Kerneis, Benoit Lattuca, Stéphane Manzo-Silberman, Nicolas Delarche, Guillaume Cayla, Didier Carrié, Thomas Cuisset, Paul Guedeney, Florence Leclercq, Johanne Silvain, Rami El Mahmoud, Jean-Philippe Collet, Marie Hauguel-Moreau, Michel Zeitouni, Eric Vicaut, Christophe Saint-Etienne, Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Initial MAnagement and prevention of acute orGan failures IN critically ill patiEnts (IMAGINE), Université de Montpellier (UM), Institut de cardiologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital de la Timone [CHU - APHM] (TIMONE), Nutrition, obésité et risque thrombotique (NORT), Institut National de la Recherche Agronomique (INRA)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre hospitalier de Pau, Hôpital Ambroise Paré [AP-HP], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), CHU Gabriel Montpied [Clermont-Ferrand], and CHU Clermont-Ferrand
Subjects: medicine.medical_specialty, Acute coronary syndrome, Anemia, medicine.medical_treatment, Hemorrhage, 030204 cardiovascular system & hematology, law.invention, 03 medical and health sciences, 0302 clinical medicine, MESH: Aged, 80 and over, Randomized controlled trial, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, law, MESH: Risk Factors, Risk Factors, Internal medicine, medicine, Humans, Pharmacology (medical), 030212 general & internal medicine, Myocardial infarction, Acute Coronary Syndrome, Stroke, MESH: Treatment Outcome, Aged, MESH: Aged, Aged, 80 and over, MESH: Humans, business.industry, Hazard ratio, Percutaneous coronary intervention, General Medicine, medicine.disease, MESH: Acute Coronary Syndrome, Treatment Outcome, [SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, Cardiology and Cardiovascular Medicine, business, Mace, MESH: Hemorrhage
Abstract: International audience; Background: Elderly patients are at high-risk of bleeding, but are under-represented in clinical trials.Objectives: The aims were to determine the incidence and the predictive factors of bleeding and to assess the impact of bleeding on further ischemic outcomes in elderly patients after acute coronary syndrome (ACS) treated with percutaneous coronary intervention.Methods: From the 877 patients aged ≥ 75 years included in the ANTARCTIC randomized trial, data on Bleeding Academic Research Consortium (BARC) bleeding complications and major adverse cardiovascular events (MACE), defined as the composite of cardiovascular death, myocardial infarction, and stroke, were collected over 1 year.Results: Clinically relevant bleeding events (BARC types 2, 3, or 5) were observed in 20.6% of patients (n = 181) at 1 year, of which, one third occurred in the first month. Anemia (adjusted hazard ratio [adj.HR] 3.98, 95% confidence interval [CI] 1.41-11.22; p = 0.009), severe chronic renal failure (adj.HR 1.83, 95% CI 1.12-2.98; p = 0.015), and femoral access (adj.HR 2.54, 95% CI 1.71-3.77; p < 0.001) were independently associated with clinically relevant bleeding events, while age > 85 years (adj.HR 2.22, 95% CI 1.14-4.30; p = 0.018) was independently associated with major bleeding events (BARC types 3 or 5). Patients with a clinically relevant bleeding event had a higher rate of MACE at 1 year (adj.HR 2.04, 95% CI 1.24-3.38; p = 0.005), with a particularly strong effect on stroke (adj.HR 5.55, 95% CI 2.04-15.06; p < 0.001).Conclusions: Clinically relevant bleeding events were observed in one out of five elderly patients undergoing stenting for an ACS and were strongly associated with further stroke occurrence. Rather than the antiplatelet therapy, comorbidities and an age > 85 years predicted bleeding outcomes in this elderly population.Clinical trial registration: Clinicaltrials.gov identifier: NCT01538446. https://www.clinicaltrials.gov .
Published: 2021

15. Clinical Outcomes According to ECG Presentations in Infarct-Related Cardiogenic Shock in the Culprit Lesion Only PCI vs Multivessel PCI in Cardiogenic Shock Trial

Author: Michel Zeitouni, Ibrahim Akin, Steffen Desch, Olivier Barthélémy, Delphine Brugier, Jean-Philippe Collet, Suzanne de Waha-Thiele, John P. Greenwood, Paul Guedeney, Georges Hage, Marie Hauguel-Moreau, Kurt Huber, Mathieu Kerneis, Marko Noc, Keith G. Oldroyd, Jan J. Piek, Stéphanie Rouanet, Stefano Savonitto, Pranas Serpytis, Johanne Silvain, Janina Stepinska, Eric Vicaut, Christiaan J.M. Vrints, Stephan Windecker, Uwe Zeymer, Holger Thiele, Gilles Montalescot, Patrizia Torremante, Roza Meyer-Saraei, Ulrich Tebbe, Jochen Wöhrle, Otmar Pachinger, Clemens Busch, Nathalie Pfeiffer, Alexander Neumer, Steffen Schneider, Taoufik Ouarrak, Thomas Reimer, Christiane Lober, Peter Clemmensen, Ferenc Follath, Karl Wegscheider, O. Barthélémy, M. Zeitouni, P. Overtchouk, P. Guedeney, G. Hage, null Hauguel-Moreau, CULPRIT-SHOCK Trial Investigators, ACS - Microcirculation, ACS - Atherosclerosis & ischemic syndromes, and Cardiology
Subjects: Pulmonary and Respiratory Medicine, Male, medicine.medical_specialty, medicine.medical_treatment, Bundle-Branch Block, Myocardial Infarction, Shock, Cardiogenic, Critical Care and Intensive Care Medicine, Revascularization, STEMI, 03 medical and health sciences, Electrocardiography, 0302 clinical medicine, Percutaneous Coronary Intervention, Culprit lesion, Internal medicine, Medicine, Humans, left bundle branch block, 030212 general & internal medicine, Myocardial infarction, cardiovascular diseases, Risk factor, Aged, business.industry, Left bundle branch block, Cardiogenic shock, cardiogenic shock, Percutaneous coronary intervention, medicine.disease, 3. Good health, NSTEMI, 030228 respiratory system, Conventional PCI, Cardiology, Female, Human medicine, Cardiology and Cardiovascular Medicine, business
Abstract: Background The impact of ECG presentations of acute myocardial infarction (AMI) in cardiogenic shock is unknown. Research Question In myocardial infarction with cardiogenic shock, is there a difference in the outcomes and effect of revascularization strategies between non-ST-segment elevation myocardial infarction (NSTEMI) and left bundle branch block myocardial infarction (LBBBMI) vs ST-segment elevation myocardial infarction (STEMI)? Study Design and Methods Cardiogenic shock patients from the CULPRIT-SHOCK trial with NSTEMI or LBBBMI were compared with STEMI patients for 30-day and 1-year all-cause mortality. The interaction between ECG presentation and the effect of revascularization strategies on outcomes was evaluated. Results Of 665 cardiogenic shock patients analyzed, 55.9% demonstrated STEMI, 29.3% demonstrated NSTEMI, and 14.7% demonstrated LBBBMI. Patients differed in mean age (68.0 years in STEMI patients, 71.0 years in NSTEMI patients, and 73.5 years in LBBBMI patients; P = .015), cardiovascular risk factors, and angiographic severity. No difference was found in the 30-day risk of death between NSTEMI and STEMI patients (48.7% vs 43.0%; adjusted OR [aOR], 1.05; 95% CI, 0.66-1.67; P = .85), nor between LBBBMI and STEMI patients (59.2% vs 43.0%; aOR, 1.31; 95% CI, 0.73-2.34; P = .36). Although the univariate risk of death by 1 year was higher in NSTEMI and LBBBMI patients compared with STEMI patients, ECG presentation was not an independent risk factor of mortality after adjustment (NSTEMI vs STEMI: 56.4% vs 46.8%; aOR, 1.21; 95% CI, 0.76-1.92; P = .42; LBBBMI vs STEMI: 69.4% vs 46.8%; aOR, 1.59; 95% CI, 0.89-2.84; P = .12). ECG presentation did not modify the effect of the revascularization strategy on 30-day and 1-year mortality (P = .91 and P = .97 for interaction). Interpretation In patients with cardiogenic shock, NSTEMI and LBBBMI presentations reflect higher-risk profiles than STEMI presentations, but are not independent risk factors of mortality. ECG presentations did not modify the treatment effect, supporting culprit-lesion-only percutaneous coronary intervention as the preferred strategy across the AMI spectrum.
Published: 2020

16. Reduced Rivaroxaban Dose Versus Dual Antiplatelet Therapy After Left Atrial Appendage Closure: ADRIFT a Randomized Pilot Study

Author: Nicolas Lellouche, Marie Hauguel-Moreau, Didier Klug, Hui Wang, Jean-Michel Juliard, Guillaume Duthoit, Isabelle Martin-Toutain, Eric Vicaut, N. Zannad, Delphine Brugier, Corinne Frere, Jacques Mansourati, Sandrine Deltour, Gregory Ducrocq, Solohaja-Faniaha Dimby, Eric Brochet, Eloi Marijon, Nassim Braik, Luc Lorgis, Nadjib Hammoudi, Johanne Silvain, Christian Spaulding, Batric Popovic, Antoine Lepillier, David Attias, Gilles Montalescot, and Alexandre Ceccaldi
Subjects: Male, medicine.medical_specialty, Cardiac Catheterization, Percutaneous, Time Factors, Antithrombin III, Atrial Appendage, Pilot Projects, 030204 cardiovascular system & hematology, Fibrin Fibrinogen Degradation Products, 03 medical and health sciences, 0302 clinical medicine, Fibrinolytic Agents, Rivaroxaban, Left atrial, Heart Rate, Internal medicine, Atrial Fibrillation, Medicine, Humans, 030212 general & internal medicine, Contraindication, Blood Coagulation, Aged, Appendage, Aged, 80 and over, business.industry, Dual Anti-Platelet Therapy, Atrial fibrillation, Thrombosis, Clopidogrel, medicine.disease, Peptide Fragments, 3. Good health, Treatment Outcome, Cardiology, Atrial Function, Left, Female, Prothrombin, France, Cardiology and Cardiovascular Medicine, business, Biomarkers, Platelet Aggregation Inhibitors, medicine.drug, Factor Xa Inhibitors, Peptide Hydrolases
Abstract: Background: Percutaneous left atrial appendage closure (LAAC) exposes to the risk of device thrombosis in patients with atrial fibrillation who frequently have a contraindication to full anticoagulation. Thereby, dual antiplatelet therapy (DAPT) is usually preferred. No randomized study has evaluated nonvitamin K antagonist oral anticoagulant after LAAC, and we decided to evaluate the efficacy and safety of reduced doses of rivaroxaban after LAAC. Methods: ADRIFT (Assessment of Dual Antiplatelet Therapy Versus Rivaroxaban in Atrial Fibrillation Patients Treated With Left Atrial Appendage Closure) is a multicenter, phase IIb study, which randomized 105 patients after successful LAAC to either rivaroxaban 10 mg (R 10 , n=37), rivaroxaban 15 mg (R 15 , n=35), or DAPT with aspirin 75 mg and clopidogrel 75 mg (n=33). The primary end point was thrombin generation (prothrombin fragments 1+2) measured 2 to 4 hours after drug intake, 10 days after treatment initiation. Thrombin-antithrombin complex, D-dimers, rivaroxaban concentrations were also measured at 10 days and 3 months. Clinical end points were evaluated at 3-month follow-up. Results: The primary end point was reduced with R 10 (179 pmol/L [interquartile range (IQR), 129–273], P 15 (163 pmol/L [IQR, 112–231], P 10 and R 15 while rivaroxaban concentrations increased significantly from 184 ng/mL (IQR, 127–290) with R 10 to 274 ng/mL (IQR, 192–377) with R 15 , P Conclusions: Thrombin generation measured after LAAC was lower in patients treated by reduced rivaroxaban doses than DAPT, supporting an alternative to the antithrombotic regimens currently used after LAAC and deserves further evaluation in larger studies. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT03273322.
Published: 2020

17. 2019 ESC/EAS Guidelines for management of dyslipidaemia: strengths and limitations

Author: Eric Bruckert, Michel Zeitouni, Mathieu Kerneis, Johanne Silvain, Jean-Philippe Collet, Gilles Montalescot, Pierre Sabouret, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut de cardiologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], CHU Pitié-Salpêtrière [AP-HP], and Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)
Subjects: Cardiovascular event, medicine.medical_specialty, [SDV]Life Sciences [q-bio], MEDLINE, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Primary prevention, medicine, Humans, Pharmacology (medical), 030212 general & internal medicine, Intensive care medicine, PCSK9 Inhibitors, Lipoprotein cholesterol, Dyslipidemias, business.industry, Guideline, Cholesterol, LDL, 3. Good health, Risk stratification, European atherosclerosis society, Female, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Proprotein Convertase 9, Cardiology and Cardiovascular Medicine, business
Abstract: In 2019, the European Society of Cardiology and European Atherosclerosis Society released a new guideline document with substantial changes regarding the assessment of cardiovascular risk and treatments. The update of high-risk criteria and categories led to a better detection and primary prevention of patients at risk of a first cardiovascular event. Nonetheless, additional efforts are needed for a better inclusion of risk modifiers, especially specific to women, to improve risk stratification and direct primary prevention. Eventually, we discuss how these new guidelines implement PCSK9 inhibitors for very high-risk individuals and the evidence supporting new low-density lipoprotein cholesterol goals below, such as 55 and 40 mg/dL.
Published: 2020

18. Angiographic predictors of outcome in myocardial infarction patients presenting with cardiogenic shock: a CULPRIT-SHOCK angiographic substudy

Author: Pavel, Overtchouk, Olvier, Barthélémy, Marie, Hauguel-Moreau, Paul, Guedeney, Stéphanie, Rouanet, Michel, Zeitouni, Johanne, Silvain, Jean-Philippe, Collet, Eric, Vicaut, Uwe, Zeymer, Steffen, Desch, Holger, Thiele, Gilles, Montalescot, Georg, Fuernau, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut de cardiologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and University Hospital Leipzig
Subjects: medicine.medical_specialty, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Myocardial Infarction, Shock, Cardiogenic, 030204 cardiovascular system & hematology, Logistic regression, Coronary Angiography, Culprit, 03 medical and health sciences, 0302 clinical medicine, Percutaneous Coronary Intervention, Clinical Research, Internal medicine, medicine, Humans, 030212 general & internal medicine, Myocardial infarction, Renal replacement therapy, cardiovascular diseases, business.industry, Cardiogenic shock, medicine.disease, surgical procedures, operative, Treatment Outcome, Shock (circulatory), Conventional PCI, Cardiology, medicine.symptom, Cardiology and Cardiovascular Medicine, business, TIMI
Abstract: AIMS: The aim of this study was to determine the prognostic impact of pre- and post-PCI TIMI flow grade and TIMI myocardial perfusion grade (TMPG) in a well-defined group of patients with cardiogenic shock due to acute myocardial infarction. METHODS AND RESULTS: Patients with infarct-related cardiogenic shock randomised into the CULPRIT-SHOCK trial were included in the angiographic predictor analysis whenever their TIMI flow grade or TMPG was available in the core lab database (96.9% of cases). A multivariable logistic regression analysis, adjusted on non-angiographic covariates, was performed to investigate whether TIMI flow grade or TMPG was independently associated with all-cause mortality or renal replacement therapy up to one year. Pre-PCI TIMI flow grade and TMPG did not impact on mortality. When analysed in separate multivariable models, post-PCI TIMI 3 flow and TMPG grade 3 were both significantly associated with reduced risk of 30-day mortality: aOR 0.61 (95% CI: 0.38-0.97, p=0.037) and 0.46 (95% CI: 0.29-0.72, p
Published: 2020

19. Blunting periprocedural myocardial necrosis: Rationale and design of the randomized ALPHEUS study

Author: François Jourda, Christophe Saint-Etienne, Luc Christiaens, Grégoire Rangé, Benoit Lattuca, Philippe Brunel, Paul Guedeney, Hervé Le Breton, Marie Hauguel-Moreau, Eric Vicaut, Anne Bellemain-Appaix, Jean-Louis Georges, Guillaume Cayla, Christophe Pouillot, Christophe Caussin, Gregory Ducrocq, Ziad Boueri, Farzin Beygui, Johanne Silvain, Thibault Lhermusier, Gilles Montalescot, Jean-Noël Labèque, Jean-Philippe Collet, Zuzana Motovska, Franck Boccara, Mohamad El Kasty, Raphaelle Dumaine, Jean-Guillaume Dillinger, Mikael Laredo, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases [IHU ICAN], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Service de cardiologie et de pathologie vasculaire [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Service de cardiologie [Chartres], Les hôpitaux de Chartres [Chartres], Marqueurs cardiovasculaires en situation de stress (MASCOT (UMR_S_942 / U942)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPC)-Université Sorbonne Paris Nord, Hôpital de Bastia, Service de Cardiologie [Hôpital privé Dijon Bourgogne], Hôpital privé Dijon Bourgogne, Clinique Sainte Clotilde, Centre de Recherche Saint-Antoine (CRSA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Service de cardiologie [CHU de Poitiers], Centre hospitalier universitaire de Poitiers (CHU Poitiers), Service de cardiologie [Centre Hospitalier de la Côte Basque, Bayonne], Centre Hospitalier de la Côte Basque, CHU Toulouse [Toulouse], Centre Hospitalier de Versailles André Mignot (CHV), Cardiology Department, Centre Hospitalier d'Antibes Juan les Pins, Antibes, Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Trousseau [APHP], Institut Mutualiste de Montsouris (IMM), Hôpital d'Auxerre, Partenaires INRAE, Grand Hôpital de l'Est Francilien (GHEF), Laboratoire de Recherche Vasculaire Translationnelle (LVTS (UMR_S_1148 / U1148)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPC)-Université Sorbonne Paris Nord, AstraZeneca France Novartis Daiichi-Sankyo Bristol-Myers Squibb, BMS Eli Lilly and Company Bayer AstraZeneca France Boston Scientific Corporation, BSC Abbott Laboratories Medtronic Biotronik Fédération Française de Cardiologie, FFC, The ALPHEUS and the Bio-ALPHEUS studies are funded by the Fond de dotation ACTION ( www.action-fonds.org ) and a grant from AstraZeneca . The Bio-ALPHEUS study is also funded by the Institute of Cardiometabolism and Nutrition . The first draft of the paper was developed by Dr Silvain and Dr Montalescot, and all authors subsequently contributed to its development and final content and are solely responsible for the design and conduct of this study, all study analyses, the drafting and editing of the paper, and its final contents. AstraZeneca reviewed the manuscript and was allowed to make suggestions, but final content was determined by the authors., Dr Silvain reports receiving consulting and lecture or travel support from AstraZeneca, Bayer HealthCare SAS, Biotronik, BPI France, Boehringer Ingelheim France, CSL Behring SA, Gilead Science, Sanofi-Aventis France, Terumo France SAS, Abbott Medical France SAS, and Zoll and is a stockholder of Pharmaseeds. Dr Cayla reports speaker or congress fees and has received research grants/consultant fees/lectures fees from Amgen, AstraZeneca, Abbott, Bayer, Biotronik, Bristol-Myers Squibb, Pfizer, and Sanofi-Aventis. Dr Beygui reports receiving consulting and lecture fees from Astrazeneca, Bristol-Myers Squibb, Medtronic, Biosensors, Boston Scientific Institutional and research grants from Medtronic, Biosensors, Acist, and Boston scientific. Dr Rangé reports receiving speaker’s and/or consulting fees from Abbott. Dr Lattuca has received research grants from Biotronik, Boston Scientific, Daiichi-Sankyo, Fédération Française de Cardiologie, and Institute of CardioMetabolism and Nutrition, consultant fees from Daiichi-Sankyo and Eli Lilly, and lecture fees from AstraZeneca, Medtronic, and Novartis. Dr Collet reports receiving consulting and lecture fees from AstraZeneca, Bayer, Bristol-Myers Squibb, Fédération Française de Cardiologie, Lead-Up, Medtronic, MSD, Sanofi-Aventis, and WebMD. Dr Dillinger reports receiving consulting and lecture fees from AstraZeneca, Bayer, Boehringer-Ingelheim, Bristol-Myers Squibb/Pfizer, and Sanofi and grants from Bayer, Bristol-Myers Squibb/Pfizer, and Biosensors. Dr Boueri reports receiving consulting and lecture fees from Novartis and Astra Zeneca. Dr Boccara reports consulting or speaker fees from Amgen, Gilead, ViiV Healthcare, Amgen, Sanofi, MSD, and Servier outside the submitted work. Dr Christiaens reports consulting or speaker fees from Astra Zeneca. Dr Lhermusier reports consulting or speaker fees from Astra Zeneca, Boston Scientifics, and Abbott and a research grant from Astra Zeneca. Dr Georges reports consulting or speaker fees from AstraZeneca France, Sanofi-Aventis, Amgen, and Merck Sharpe and Dohme. Dr Bellemain-Appaix reports consulting or speaker fees from Astra Zeneca, Novartis, and Pfizer. Dr Saint-Etienne reports consulting or speaker fees from Abbott, Medtronic, Edwards, and Biotronik. Dr Motovska reports consulting or speaker fees from Astrazeneca. Dr Laredo reports fellowship grants from Medtronic, Biotronik, and Boston Scientific. Dr Ducrocq reports consulting or speaker fees from Amgen, Astra Zeneca, Bayer, BMS, Janssen, Sanofi, and Terumo, proctoring: Boston scientific, CEC: Novo Nordisk, and travel fees: Astra Zeneca, Bayer, and BMS. Dr Vicaut reports consulting or speaker fees from Abbott, Bristol Myers Squibb, Celgene, Edwards, Pfizer, Sanofi, and Novartis. Dr Montalescot reports consulting or speaker fees from Abbott, AIM group, Amgen, Actelion, American College of Cardiology Foundation, Astrazeneca, Axis-Santé, Bayer, Boston-Scientific, Bristol-Myers Squibb, Beth Israel Deaconess Medical, Brigham Women’s Hospital, Fréquence Médicale, ICOM, Idorsia, Elsevier, Fédération Française de Cardiologie, Fréquence Médicale, Institute of Cardiometabolism and Nutrition, Lead-Up, Menarini, Medtronic, MSD, Novo-Nordisk, Pfizer, Quantum Genomics, Sanofi-Aventis, SCOR global life, Servier, and WebMD. Other authors have no conflict of interest to report., Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université de Paris (UP)-Université Sorbonne Paris Nord, Centre de Recherche Saint-Antoine (CR Saint-Antoine), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Université Sorbonne Paris Nord, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Centre Hospitalier de la Côte Basque (CHCB), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier d'Auxerre (CHA), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord
Subjects: medicine.medical_specialty, Ticlopidine, medicine.medical_treatment, Myocardial Infarction, Coronary Disease, 030204 cardiovascular system & hematology, Coronary Angiography, Loading dose, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Percutaneous Coronary Intervention, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Internal medicine, medicine, Humans, 030212 general & internal medicine, Myocardial infarction, cardiovascular diseases, Aged, Aspirin, business.industry, Percutaneous coronary intervention, medicine.disease, Clopidogrel, 3. Good health, Conventional PCI, Cardiology, Purinergic P2Y Receptor Antagonists, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Cardiology and Cardiovascular Medicine, business, Ticagrelor, Platelet Aggregation Inhibitors, medicine.drug
Abstract: International audience; Background: Clopidogrel associated with aspirin is the recommended treatment for patients undergoing elective percutaneous coronary intervention (PCI). Although severe PCI-related events are rare, evidence suggests that PCI-related myocardial infarction and myocardial injury are frequent complications that can impact the clinical prognosis of the patients. Antiplatelet therapy with a potent P2Y12 receptor inhibitor such as ticagrelor may reduce periprocedural ischemic complications while maintaining a similar safety profile as compared with conventional dual antiplatelet therapy by aspirin and clopidogrel in this setting. Methods: Assessment of Loading with the P2Y12 inhibitor ticagrelor or clopidogrel to Halt ischemic Events in patients Undergoing elective coronary Stenting (ALPHEUS) (NCT02617290) is an international, multicenter, randomized, parallel-group, open-label study in patients with stable coronary artery disease who are planned for an elective PCI. In total, 1,900 patients will be randomized before a planned PCI to a loading dose of ticagrelor 180 mg or a loading dose of clopidogrel (300 or 600 mg) in addition to aspirin. Patients will then receive a dual antiplatelet therapy with aspirin and ticagrelor 90 mg twice daily or clopidogrel 75 mg once daily for 30 days. The primary ischemic end point is PCI-related myocardial infarction (myocardial infarction type 4a or 4b) or major myocardial injury within 48 hours (or at hospital discharge if earlier) after elective PCI/stent. Safety will be evaluated by major bleeding events (Bleeding Academic Research Consortium type 3 or 5) at 48 hours (or discharge if it occurs earlier). Conclusion: ALPHEUS is the first properly sized trial comparing ticagrelor to clopidogrel in the setting of elective PCI and is especially designed to show a reduction in periprocedural events, a surrogate end point for mortality.
Published: 2020

20. Radial versus femoral artery access for percutaneous coronary artery intervention in patients with acute myocardial infarction and multivessel disease complicated by cardiogenic shock: Subanalysis from the CULPRIT-SHOCK trial

Author: Suzanne de Waha-Thiele, Paul Guedeney, Jan J. Piek, Ulf Landmesser, Jean-Philippe Collet, Ibrahim Akin, Olivier Barthelemy, Johanne Silvain, Uwe Zeymer, Marie Hauguel-Moreau, Stefan Baumann, Georg Fuernau, Marcus Sandri, Michel Zeitouni, Steffen Desch, Holger Thiele, Stéphanie Rouanet, Benoit Lattuca, Mathieu Kerneis, Stephan Windecker, Gilles Montalescot, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut de cardiologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], University Hospital Leipzig, Medical Faculty [Mannheim], University of Heidelberg, Medical Faculty, VU University Medical Center [Amsterdam], Charité - UniversitätsMedizin = Charité - University Hospital [Berlin], Bern University Hospital [Berne] (Inselspital), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Leipzig University, University of Mannheim, Heidelberg University, Universität zu Lübeck = University of Lübeck [Lübeck], StatEthic, Amsterdam UMC - Amsterdam University Medical Center, Klinikum Ludwigshafen [Germany], CCSD, Accord Elsevier, Cardiology, ACS - Atherosclerosis & ischemic syndromes, and ACS - Microcirculation
Subjects: Male, medicine.medical_specialty, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Myocardial Infarction, Shock, Cardiogenic, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Culprit, 03 medical and health sciences, Percutaneous Coronary Intervention, 0302 clinical medicine, Internal medicine, medicine, Humans, 030212 general & internal medicine, Myocardial infarction, Stroke, Aged, Chi-Square Distribution, business.industry, Cardiogenic shock, Percutaneous coronary intervention, Odds ratio, Middle Aged, medicine.disease, 3. Good health, Femoral Artery, [SDV] Life Sciences [q-bio], Logistic Models, Treatment Outcome, Radial Artery, Conventional PCI, Cardiology, Myocardial infarction complications, Female, Cardiology and Cardiovascular Medicine, business
Abstract: International audience; Background: The use and impact of transradial artery access (TRA) compared to transfemoral artery access (TFA) in patients undergoing percutaneous coronary intervention (PCI) for acute myocardial infarction (MI) complicated by cardiogenic shock (CS) remain unclear.Methods: This is a post hoc analysis of the CULPRIT-SHOCK trial where patients presenting with MI and multivessel disease complicated by CS were randomized to a strategy of culprit-lesion-only or immediate multivessel PCI. Arterial access was left at operator's discretion. Adjudicated outcomes of interest were the composite of death or renal replacement therapy (RRT) at 30 days and 1 year. Multivariate logistic models were used to assess the association between the arterial access and outcomes.Results: Among the 673 analyzed patients, TRA and TFA were successfully performed in 118 (17.5%) and 555 (82.5%) patients, respectively. Compared to TFA, TRA was associated with a lower 30-day rate of death or RRT (37.3% vs 53.2%, adjusted odds ratio [aOR]: 0.57; 95% confidence interval [CI] 0.34-0.96), a lower 30-day rate of death (34.7% vs 49.7%; aOR: 0.56; 95% CI 0.33-0.96), and a lower 30-day rate of RRT (5.9% vs 15.9%; aOR: 0.40; 95% CI 0.16-0.97). No significant differences were observed regarding the 30-day risks of type 3 or 5 Bleeding Academic Research Consortium bleeding and stroke. The observed reduction of death or RRT and death with TRA was no longer significant at 1 year (44.9% vs 57.8%; aOR: 0.85; 95% CI 0.50-1.45 and 42.4% vs 55.5%, aOR: 0.78; 95% CI 0.46-1.32, respectively).Conclusions: In patients undergoing PCI for acute MI complicated by CS, TRA may be associated with improved early outcomes, although the reason for this finding needs further research.
Published: 2020

21. Relationship between stent expansion and fractional flow reserve after percutaneous coronary intervention: a post hoc analysis of the DOCTORS trial

Author: Pascal Motreff, Olivier Morel, Johanne Silvain, Mohamed Mehdi Boussaada, Nicolas Meneveau, Benoit Guillon, Nicolas Amabile, Vincent Descotes-Genon, Salim Belguidoum, Yohann Lefrançois, and Patrick Ohlman
Subjects: Male, medicine.medical_specialty, medicine.medical_treatment, Population, Fractional flow reserve, Coronary Artery Disease, Coronary Angiography, Percutaneous Coronary Intervention, Clinical Research, Internal medicine, Post-hoc analysis, medicine, Humans, In patient, education, Male gender, Aged, education.field_of_study, business.industry, Percutaneous coronary intervention, Stent, Middle Aged, Fractional Flow Reserve, Myocardial, Treatment Outcome, Conventional PCI, Cardiology, Stents, Cardiology and Cardiovascular Medicine, business
Abstract: BACKGROUND: The best criteria for adequate stent expansion assessment by intracoronary imaging remain debated and their correlation with post-PCI FFR values is unknown. AIMS: This study aimed to analyse the relationship between stent expansion criteria using optical coherence tomography (OCT) analysis and the final PCI functional result. METHODS: This post hoc analysis of the DOCTORS study included non-ST-elevation segment ACS patients undergoing OCT-guided PCI. The procedure functional result was assessed by the measurement of fractional flow reserve (FFR). Stent expansion was assessed on OCT runs according to the DOCTORS criteria and ILUMIEN III criteria. RESULTS: The study included N=116 patients (age: 60.8±11.5 years; male gender: 71%). The final expansion was considered optimal in 10%, acceptable in 9% and unacceptable in 81% of the stents according to ILUMIEN III criteria, although being successful in 70% of the patients according to the DOCTORS criteria. Hypertension and larger proximal reference segment dimension were independent predictors of inadequate device ILUMIEN III expansion. FFR values were, respectively, 0.93 (0.91-0.95) versus 0.95 (0.92-0.97) in patients with optimal+acceptable versus unacceptable ILUMIEN III expansion (p=0.22), 0.94 (0.91-0.97) versus 0.95 (0.93-0.97) in patients with optimal versus non-optimal DOCTORS expansion (p=0.23), and 0.95 (0.92-0.97) versus 0.92 (0.90-0.95) in patients with minimal stent area ≥4.5 mm(2) versus
Published: 2020

22. Antithrombotic Therapy for Patients With Left Ventricular Mural Thrombus

Author: Johanne Silvain, Michel Zeitouni, Eric Vicaut, Richard Isnard, Nadjib Hammoudi, A Mameri, Mathieu Kerneis, Benoit Lattuca, Jean-Jacques Portal, Paul Guedeney, N. Bouziri, Gilles Montalescot, Jiannong Zhou, Marie Hauguel-Moreau, F. Pousset, Jean-Philippe Collet, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Institut de cardiologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Département de Biostatistique, Santé Publique et Information Médicale [CHU Pitié-Salpêtrière] (BIOSPIM ), CHU Pitié-Salpêtrière [AP-HP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)
Subjects: medicine.medical_specialty, [SDV]Life Sciences [q-bio], Population, direct oral anticoagulant, 030204 cardiovascular system & hematology, antithrombotic, 03 medical and health sciences, 0302 clinical medicine, Interquartile range, Internal medicine, Medicine, thrombus regression, 030212 general & internal medicine, Myocardial infarction, Thrombus, education, Stroke, education.field_of_study, business.industry, left ventricular thrombus, Hazard ratio, Left ventricular thrombus, medicine.disease, mortality, 3. Good health, myocardial infarction, Cardiology, Cardiology and Cardiovascular Medicine, business, Mace
Abstract: International audience; Background: Contemporary data are lacking regarding the prognosis and management of left ventricular thrombus (LVT).Objectives: The purpose of this study was to quantify the effect of anticoagulation therapy on LVT evolution using sequential imaging and to determine the impact of LVT regression on the incidence of thromboembolism, bleeding, and mortality.Methods: From January 2011 to January 2018, a comprehensive computerized search of LVT was conducted using 90,065 consecutive echocardiogram reports. Only patients with a confirmed LVT were included after imaging review by 2 independent experts. Major adverse cardiovascular events (MACE), which included death, stroke, myocardial infarction, or acute peripheral artery emboli, were determined as well as major bleeding events (BARC ≥3) and all-cause mortality rates.Results: There were 159 patients with a confirmed LVT. Patients were treated with vitamin K antagonists (48.4%), parenteral heparins (27.7%), and direct oral anticoagulants (22.6%). Antiplatelet therapy was used in 67.9% of the population. A reduction of the LVT area from baseline was observed in 121 patients (76.1%), and total LVT regression occurred in 99 patients (62.3%) within a median time of 103 days (interquartile range: 32 to 392 days). The independent correlates of LVT regression were a nonischemic cardiomyopathy (hazard ratio [HR]: 2.74; 95% confidence interval [CI]: 1.43 to 5.26; p = 0.002) and a smaller baseline thrombus area (HR: 0.66; 95% CI: 0.45 to 0.96; p = 0.031). The frequency of MACE was 37.1%; mortality 18.9%; stroke 13.3%; and major bleeding 13.2% during a median follow-up of 632 days (interquartile range: 187 to 1,126 days). MACE occurred in 35.4% and 40.0% of patients with total LVT regression and those with persistent LVT (p = 0.203). A reduced risk of mortality was observed among patients with total LVT regression (HR: 0.48; 95% CI: 0.23 to 0.98; p = 0.039), whereas an increased major bleeding risk was observed among patients with persistent LVT (9.1% vs. 12%; HR 0.34; 95% CI: 0.14 to 0.82; p = 0.011). A left ventricular ejection fraction ≥35% (HR: 0.46; 95% CI: 0.23 to 0.93; p = 0.029) and anticoagulation therapy >3 months (HR: 0.42; 95% CI: 0.20 to 0.88; p = 0.021) were independently associated with less MACE.Conclusions: The presence of LVT was associated with a very high risk of MACE and mortality. Total LVT regression, obtained with different anticoagulant regimens, was associated with reduced mortality.
Published: 2020

23. Wearable cardioverter-defibrillator to reduce the transient risk of sudden cardiac death in coronary artery disease

Author: Serge Boveda, Jean-Claude Deharo, Eloi Marijon, Kumar Narayanan, Mario Njeim, Christophe Leclercq, Julia W. Erath-Honold, François Roubille, Johanne Silvain, Pascal Defaye, Claude S. Elayi, Rui Providência, Reza Jabbari, Sérgio Barra, University of Florida [Gainesville] (UF), Frankfurt University, Frankfurt, Germany., ispebjerg Hospital, Copenhagen University, Copenhagen, Denmark., Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Institut de cardiologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hospital da Luz Arrabida, V. N. Gaia, Portugal, Barts Heart Centre [London, UK] (St Bartholomew’s Hospital), Barts Health NHS Trust [London, UK], Hôpital Hôtel Dieu de France [Beirut, Lebanon] (2HDF), Medicover Hospitals, Hyderabad, India, Aix Marseille Université (AMU), Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Département de Cardiologie [Hôpital de la Timone - APHM], Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), Pasteur Clinic, Toulouse, France, Clinique Pasteur et Groupe Rythmologie Stimulation Cardiaque/SFC, Clinique Pasteur [Toulouse], Grenoble University Hospital, Grenoble, France, Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Rennes University Hospital, Rennes, France, Paris-Centre de Recherche Cardiovasculaire (PARCC - UMR-S U970), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Cardiac Electrophysiology Section, European Georges Pompidou Hospital and Paris University, 20 Rue Leblanc, 75908 Paris Cedex 15, France., Clinical sciences, 1University of Florida, Gainesville, FL, USA, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], Hotel Dieu Hospital, Beirut, Lebanon., Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases [IHU ICAN], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)
Subjects: medicine.medical_specialty, Consensus, [SDV]Life Sciences [q-bio], Electric Countershock, Coronary Artery Disease, 030204 cardiovascular system & hematology, Sudden cardiac death, acute coronary syndrome, Coronary artery disease, 03 medical and health sciences, Wearable Electronic Devices, 0302 clinical medicine, Physiology (medical), Internal medicine, medicine, Humans, 030212 general & internal medicine, Death, Sudden, Cardiac/epidemiology, ComputingMilieux_MISCELLANEOUS, business.industry, Arrhythmias, Cardiac, medicine.disease, 3. Good health, Death, Sudden, Cardiac, Cardiology, Transient (oscillation), Coronary Artery Disease/diagnosis, business, Cardiology and Cardiovascular Medicine, Wearable cardioverter defibrillator, Defibrillators
Abstract: International audience
Published: 2020

24. Efficacy and Safety of Glycoprotein IIb/IIIa Inhibitors on Top of Ticagrelor in STEMI: A Subanalysis of the ATLANTIC Trial

Author: Robert F. Storey, Angel Cequier, Shaun G. Goodman, Uwe Zeymer, Atlantic Investigators, Jean P. Collet, Anne H. Tavenier, Eric Vicaut, Abdourahmane Diallo, Jurriën M. ten Berg, Renicus S Hermanides, Enrico Fabris, Frank F. Willems, Arnoud W J van 't Hof, Jens Flensted Lassen, Patrick Ecollan, Béla Merkely, Christian W. Hamm, Mohamed Chettibi, Christopher J. Hammett, Warren J. Cantor, Magnus Janzon, Leonardo Bolognese, Johanne Silvain, Kurt Huber, Frédéric Lapostolle, Gilles Montalescot, University of Trieste, SAMU 93 [Bobigny], Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), St. Antonius Hospital [Nieuwegein], University of Toronto, Institut d'Investigació Biomèdica de Bellvitge [Barcelone] (IDIBELL), Linköpings universitet, Semmelweis University of Medicine [Budapest], University of Sheffield [Sheffield], Hôpital Lariboisière-Fernand-Widal [APHP], Maastricht University Medical Centre (MUMC), Maastricht University [Maastricht], Tavenier, A. H., Hermanides, R. S., Fabris, E., Lapostolle, F., Silvain, J., Ten Berg, J. M., Lassen, J. F., Bolognese, L., Cantor, W. J., Cequier, A., Chettibi, M., Goodman, S. G., Hammett, C. J., Huber, K., Janzon, M., Merkely, B., Storey, R. F., Zeymer, U., Ecollan, P., Collet, J. -P., Willems, F. F., Diallo, A., Vicaut, E., Hamm, C. W., Montalescot, G., Van 'T Hof, A. W. J., Cardiologie, MUMC+: MA Med Staf Spec Cardiologie (9), and RS: Carim - H01 Clinical atrial fibrillation
Subjects: 0301 basic medicine, Male, st-segment elevation, tirofiban, medicine.medical_treatment, [SDV]Life Sciences [q-bio], high-dose tirofiban, PRIMARY ANGIOPLASTY, 030204 cardiovascular system & hematology, glycoprotein IIb/IIIa inhibitors, 0302 clinical medicine, Postoperative Complications, Myocardial infarction, iiia inhibitors, eptifibatide, Hematology, Middle Aged, Clopidogrel, primary percutaneous coronary intervention, 3. Good health, Treatment Outcome, Cardiology, Drug Therapy, Combination, Female, lipids (amino acids, peptides, and proteins), Ticagrelor, medicine.drug, medicine.medical_specialty, ACUTE MYOCARDIAL-INFARCTION, glycoprotein IIb/IIIa inhibitor, PERCUTANEOUS CORONARY INTERVENTION, Hemorrhage, Platelet Glycoprotein GPIIb-IIIa Complex, Revascularization, ticagrelor, STEMI, 03 medical and health sciences, abciximab, bailout, Double-Blind Method, IIB-IIIA INHIBITORS, Internal medicine, STENT THROMBOSIS, medicine, PREHOSPITAL INITIATION, Humans, cardiovascular diseases, Aged, INDIVIDUAL PATIENTS DATA, business.industry, Percutaneous coronary intervention, Thrombosis, Odds ratio, medicine.disease, Survival Analysis, platelet inhibition, 030104 developmental biology, Glycoprotein IIb/IIIa inhibitors, Conventional PCI, ST Elevation Myocardial Infarction, glycoprotein IIb, business, Platelet Aggregation Inhibitors
Abstract: Background Glycoprotein IIb/IIIa inhibitors (GPIs) in combination with clopidogrel improve clinical outcome in ST-elevation myocardial infarction (STEMI); however, finding a balance that minimizes both thrombotic and bleeding risk remains fundamental. The efficacy and safety of GPI in addition to ticagrelor, a more potent P2Y12-inhibitor, have not been fully investigated. Methods 1,630 STEMI patients who underwent primary percutaneous coronary intervention (PCI) were analyzed in this subanalysis of the ATLANTIC trial. Patients were divided in three groups: no GPI, GPI administration routinely before primary PCI, and GPI administration in bailout situations. The primary efficacy outcome was a composite of death, myocardial infarction, urgent target revascularization, and definite stent thrombosis at 30 days. The safety outcome was non-coronary artery bypass graft (CABG)-related PLATO major bleeding at 30 days. Results Compared with no GPI (n = 930), routine GPI (n = 525) or bailout GPI (n = 175) was not associated with an improved primary efficacy outcome (4.2% no GPI vs. 4.0% routine GPI vs. 6.9% bailout GPI; p = 0.58). After multivariate analysis, the use of GPI in bailout situations was associated with a higher incidence of non-CABG-related bleeding compared with no GPI (odds ratio [OR] 2.96, 95% confidence interval [CI] 1.32–6.64; p = 0.03). However, routine GPI use compared with no GPI was not associated with a significant increase in bleeding (OR 1.78, 95% CI 0.88–3.61; p = 0.92). Conclusion Use of GPIs in addition to ticagrelor in STEMI patients was not associated with an improvement in 30-day ischemic outcome. A significant increase in 30-day non-CABG-related PLATO major bleeding was seen in patients who received GPIs in a bailout situation.
Published: 2020

25. Indirect comparison of the efficacy and safety of alirocumab and evolocumab: a systematic review and network meta-analysis

Author: Birgit Vogel, Edouard Ollier, Céline Chapelle, Sabato Sorrentino, Johanne Silvain, Michel Zeitouni, Paul Guedeney, Salvatore De Rosa, Roxana Mehran, Bimmer E. Claessen, Gilles Montalescot, Jean-Philippe Collet, Ciro Indolfi, Silvy Laporte, Benoit Lattuca, Gennaro Giustino, Mathieu Kerneis, Anton Camaj, Deborah N. Kalkman, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut de cardiologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Icahn School of Medicine at Mount Sinai [New York] (MSSM), Università degli Studi 'Magna Graecia' di Catanzaro [Catanzaro, Italie] (UMG), Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne), and University of Amsterdam [Amsterdam] (UvA)
Subjects: medicine.medical_specialty, [SDV]Life Sciences [q-bio], Network Meta-Analysis, Lipid-lowering therapy, 030204 cardiovascular system & hematology, Placebo, Antibodies, Monoclonal, Humanized, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, lipid lowering therapy, Internal medicine, Injection site reaction, medicine, Humans, Pharmacology (medical), 030212 general & internal medicine, Alirocumab, business.industry, PCSK9 Inhibitors, medicine.disease, Evolocumab, Confidence interval, 3. Good health, Meta-analysis, Relative risk, Proprotein Convertase 9, Cardiology and Cardiovascular Medicine, business
Abstract: Aims Although alirocumab and evolocumab have both been associated with improved outcomes in patients with dyslipidaemia or established atherosclerotic cardiovascular disease, data on their respective performances are scarce. This study aimed at providing an indirect comparison of the efficacy and safety of alirocumab vs. evolocumab. Methods and results We conducted a systematic review and network meta-analysis of randomized trials comparing alirocumab or evolocumab to placebo with consistent background lipid-lowering therapy up to November 2018. We estimated the relative risk (RR) and the 95% confidence intervals (CIs) using fixed-effect model in a frequentist pairwise and network meta-analytic approach. A total of 30 trials, enrolling 59 026 patients were included. Eligibility criteria varied significantly across trials evaluating alirocumab and evolocumab. Compared with evolocumab, alirocumab was associated with a significant reduction in all-cause death (RR 0.80, 95% CI 0.66–0.97) but not in cardiovascular death (RR 0.83, 95% CI 0.65–1.05). This study did not find any significant differences in myocardial infarction (RR 1.15, 95% CI 0.99–1.34), stroke (RR 0.96, 95% CI 0.71–1.28), or coronary revascularization (RR 1.13, 95% CI 0.99–1.29) between the two agents. Alirocumab was associated with a 27% increased risk of injection site reaction compared to evolocumab; however, no significant differences were found in terms of treatment discontinuations, systemic allergic reaction, neurocognitive events, ophthalmologic events, or new-onset of or worsening of pre-existing diabetes. Conclusion Alirocumab and evolocumab share a similar safety profile except for injection site reaction. No significant differences were observed across the efficacy endpoints, except for all-cause death, which may be related to the heterogeneity of the studied populations treated with the two drugs.
Published: 2019

26. On- Versus Off-Hours Presentation and Mortality of ST-Segment Elevation Myocardial Infarction Patients Treated With Primary Percutaneous Coronary Intervention

Author: Mathieu Kerneis, Claude Le Feuvre, Gérard Helft, Johanne Silvain, Rémi Choussat, Jean-Philippe Collet, Anis Saib, Benoit Lattuca, Olivier Barthelemy, Gilles Montalescot, Laurent Payot, Lee S. Nguyen, Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut de cardiologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Service de Chirurgie cardiaque et thoracique [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CCSD, Accord Elsevier, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP]
Subjects: Male, medicine.medical_specialty, Time Factors, medicine.medical_treatment, 030204 cardiovascular system & hematology, Revascularization, 03 medical and health sciences, Patient Admission, 0302 clinical medicine, After-Hours Care, Admission time, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Risk Factors, Cause of Death, Internal medicine, medicine, Humans, ST segment, Hospital Mortality, Registries, 030212 general & internal medicine, Myocardial infarction, cardiovascular diseases, admission time, Aged, business.industry, Cardiogenic shock, percutaneous coronary intervention, Percutaneous coronary intervention, Middle Aged, medicine.disease, mortality, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Treatment Outcome, surgical procedures, operative, myocardial infarction, Conventional PCI, ST Elevation Myocardial Infarction, Female, revascularization, Presentation (obstetrics), Cardiology and Cardiovascular Medicine, business, Hospitals, High-Volume
Abstract: Objectives The authors sought to assess the association between admission time with patient’s care, procedure characteristics, and clinical outcomes within a contemporary ST-segment elevation myocardial infarction (STEMI) network of patients referred for primary percutaneous coronary intervention (PCI). Background The effect of admission time on STEMI patient9s outcomes remains controversial when primary PCI is the preferred reperfusion strategy. Methods Characteristics and clinical outcomes of 2,167 consecutive STEMI patients admitted in a tertiary PCI-capable center were collected. On-hours were defined as admission from Monday through Friday between 8 am and 6 pm and off-hours as admission during night shift, weekend, and nonworking holidays. In-hospital and 1-year all-cause mortality were assessed as well as key time delays. Results A total of 1,048 patients (48.3%) were admitted during on-hours, and 1,119 patients (51.7%) during off-hours. Characteristics were well-balanced between the 2 groups, including rates of cardiac arrest (7.9% vs. 8.8%; p = 0.55) and cardiogenic shock (12.3% vs. 14.7%; p = 0.16). Median symptom-to-first medical contact time and median first medical contact-to-sheath insertion time did not differ according to on- versus off-hours admission (120 min vs. 126 min; p = 0.25 and 90 min vs. 93 min; p = 0.58, respectively), as well as the rate of radial access for catheterization (85.6% vs. 87.5%; p = 0.27). There was no association between on- versus off-hours groups and in-hospital (8.1% vs. 7.0%; p = 0.49) or 1-year mortality (11.0% vs. 11.1%; p = 0.89), respectively. Conclusions In a contemporary organized STEMI network, patients admitted in a high-volume tertiary primary PCI center during on-hours or off-hours had similar management and 1-year outcomes.
Published: 2019

27. Reasons for the Failure of Platelet Function Testing to Adjust Antiplatelet Therapy

Author: Yan Yan, Benoit Lattuca, Christophe Pouillot, Eric Vicaut, Thibault Lhermusier, Grégoire Rangé, Simon Elhadad, Pascal Motreff, Guillaume Cayla, Gilles Montalescot, Patrick Henry, Johanne Silvain, Jean-Philippe Collet, Didier Carrié, Thomas Cuisset, Abdourahmane Diallo, and Ziad Boueri
Subjects: Blood Platelets, Male, medicine.medical_specialty, Time Factors, Randomization, Platelet Function Tests, medicine.medical_treatment, Clinical Decision-Making, Myocardial Infarction, Hemorrhage, 030204 cardiovascular system & hematology, Risk Assessment, 03 medical and health sciences, Percutaneous Coronary Intervention, 0302 clinical medicine, Predictive Value of Tests, Risk Factors, Internal medicine, medicine, Humans, Stent implantation, Platelet, 030212 general & internal medicine, Myocardial infarction, Aged, business.industry, Coronary Thrombosis, Percutaneous coronary intervention, Drug-Eluting Stents, Middle Aged, Platelet Activation, medicine.disease, Clopidogrel, Thrombosis, Receptors, Purinergic P2Y12, 3. Good health, The arctic, Stroke, Treatment Outcome, Purinergic P2Y Receptor Antagonists, Cardiology, Female, Drug Monitoring, Cardiology and Cardiovascular Medicine, business, Platelet Aggregation Inhibitors, medicine.drug
Abstract: Background: In the ARCTIC trial (Assessment by a Double Randomization of a Conventional Antiplatelet Strategy Versus a Monitoring-Guided Strategy for Drug-Eluting Stent Implantation and of Treatment Interruption Versus Continuation One Year After Stenting), treatment adjustment following platelet function testing failed to improve clinical outcomes. However, high-on-treatment platelet reactivity (HPR) is considered as a predictor of poor ischemic outcome. This prespecified substudy evaluated clinical outcomes according to the residual platelet reactivity status after antiplatelet therapy adjustment. Methods: We analyzed the 1213 patients assigned to the monitoring arm of the ARCTIC trial in whom platelet reactivity was evaluated by the VerifyNow P2Y 12 test before percutaneous coronary intervention and during the maintenance phase (at 14 days). HPR was defined as platelet reaction unit≥235U. The primary ischemic end point, a composite of death, myocardial infarction, stent thrombosis, stroke, or urgent revascularization and the safety end point of major bleeding were assessed according to the platelet reactivity status. Results: Before percutaneous coronary intervention, 35.7% of patients displayed HPR (n=419). During the acute phase, between percutaneous coronary intervention and the 14-day platelet function testing, ischemic (adjusted hazard ratio, 0.94 [95% CI, 0.74–1.18]; P =0.58) and safety outcomes (hazard ratio, 1.28 [95% CI, 0.22–7.59]; P =0.78) were similar in HPR and non-HPR patients. During the maintenance phase, the proportion of HPR patients (n=186, 17.4%) decreased by 56%. At 1-year, there was no difference for the ischemic end point (5.9% versus 6.0%; adjusted hazard ratio, 0.79 [95% CI, 0.40–1.58]; P =0.51) and a nonsignificant higher rate of major bleedings (2.7% versus 1.0%, hazard ratio, 2.83 [95% CI, 0.96–8.41]; P =0.06) in HPR versus non-HPR patients. Conclusions: The proportion of HPR was halved after platelet function testing and treatment adjustment but without significant ischemic benefit at 1 year. HPR seems more as a modifiable risk marker than a risk factor of ischemic outcome. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT00827411.
Published: 2019

28. Outcome after revascularisation of acute myocardial infarction with cardiogenic shock on extracorporeal life support

Author: Johanne Silvain, Alain Combes, Charles-Edouard Luyt, Jean-Sébastien Hulot, Jean-Philippe Collet, Gilles Montalescot, Guillaume Lebreton, Pavel Overtchouk, Julien Pascal, Nicolas Bréchot, Mathieu Kerneis, Pascal Leprince, and O. Barthelemy
Subjects: medicine.medical_specialty, business.industry, Cardiogenic shock, Mortality rate, 030208 emergency & critical care medicine, 030204 cardiovascular system & hematology, medicine.disease, Culprit, Extracorporeal, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Life support, Conventional PCI, medicine, Cardiology, Myocardial infarction, Cardiology and Cardiovascular Medicine, business
Abstract: AIMS The aim of the study was to identify independent correlates of survival in patients undergoing PCI for refractory cardiogenic shock due to myocardial infarction (RCS-MI) with the need for extracorporeal life support (ECLS). METHODS AND RESULTS This observational single tertiary centre study enrolled 106 consecutive patients (52.7±10.4 years) with ECLS placed before or after the PCI. Half of the patients had triple vessel disease and PCI was attempted whenever possible (74.5%). The 30-day mortality rate was 63.2%. Left main culprit vessel disease (19% of patients) (adj. HR [95% CI]: 2.31 [1.27-4.18], p=0.006) and sepsis-related organ failure assessment ≥13 (adj. HR 2.17 [1.25-3.75], p=0.005) were independently associated with 30-day mortality. The use of intra-aortic balloon pump (IABP) combined with ECLS was an independent protective factor (adj. HR 0.48 [0.28-0.80], p=0.006). Neither complete (p=0.66) nor successful (p=0.69) myocardial revascularisation was associated with 30-day survival. CONCLUSIONS RCS in MI patients often reveals a severe multivessel coronary artery disease with no impact of early percutaneous coronary revascularisation on clinical outcome. The survival advantage of IABP when combined with ECLS further suggests that achieving an early effective haemodynamic support should be the major goal in this young patient population.
Published: 2018

29. Acute Myocardial Infarction

Author: Patrick Goldstein, Meyer Elbaz, Johanne Silvain, Khalife Khalife, Gilles Lemesle, Nadia Aissaoui, Pascal Gueret, Nicolas Danchin, Jean Noel Labèque, Loic Belle, Francois Schiele, Christophe Le Ray, Tabassome Simon, Yves Cottin, Pascal Motreff, Pierre Coste, Guillaume Cayla, Patrick Peycher, Bernard Jouve, L. Orion, Didier Blanchard, Batric Popovic, Jean Ferrières, Etienne Puymirat, Philippe Gabriel Steg, and Thibaut Perret
Subjects: medicine.medical_specialty, business.industry, medicine.medical_treatment, ST elevation, Percutaneous coronary intervention, 030204 cardiovascular system & hematology, medicine.disease, Obesity, 3. Good health, 03 medical and health sciences, 0302 clinical medicine, Reperfusion therapy, Physiology (medical), Intensive care, Internal medicine, Diabetes mellitus, Cardiology, medicine, In patient, cardiovascular diseases, 030212 general & internal medicine, Myocardial infarction, Cardiology and Cardiovascular Medicine, business
Abstract: Background: ST-segment–elevation myocardial infarction (STEMI) and non–ST-segment–elevation myocardial infarction (NSTEMI) management has evolved considerably over the past 2 decades. Little information on mortality trends in the most recent years is available. We assessed trends in characteristics, treatments, and outcomes for acute myocardial infarction in France between 1995 and 2015. Methods: We used data from 5 one-month registries, conducted 5 years apart, from 1995 to 2015, including 14 423 patients with acute myocardial infarction (59% STEMI) admitted to cardiac intensive care units in metropolitan France. Results: From 1995 to 2015, mean age decreased from 66±14 to 63±14 years in patients with STEMI; it remained stable (68±14 years) in patients with NSTEMI, whereas diabetes mellitus, obesity, and hypertension increased. At the acute stage, intended primary percutaneous coronary intervention increased from 12% (1995) to 76% (2015) in patients with STEMI. In patients with NSTEMI, percutaneous coronary intervention ≤72 hours from admission increased from 9% (1995) to 60% (2015). Six-month mortality consistently decreased in patients with STEMI from 17.2% in 1995 to 6.9% in 2010 and 5.3% in 2015; it decreased from 17.2% to 6.9% in 2010 and 6.3% in 2015 in patients with NSTEMI. Mortality still decreased after 2010 in patients with STEMI without reperfusion therapy, whereas no further mortality gain was found in patients with STEMI with reperfusion therapy or in patients with NSTEMI, whether or not they were treated with percutaneous coronary intervention. Conclusions: Over the past 20 years, 6-month mortality after acute myocardial infarction has decreased considerably for patients with STEMI and NSTEMI. Mortality figures continued to decline in patients with STEMI until 2015, whereas mortality in patients with NSTEMI appears stable since 2010.
Published: 2017

30. Contrast-induced acute kidney injury and mortality in ST elevation myocardial infarction treated with primary percutaneous coronary intervention

Author: Gilles Montalescot, Olivier Barthelemy, Claude Le Feuvre, Lee S. Nguyen, Nicolas Vignolles, Jean-Philippe Collet, Johanne Silvain, Vincent Spagnoli, Gérard Helft, Paul Guedeney, Kristel Cosker, Mathieu Kerneis, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de Département d'Information Médicale [CHU Pitié-Salpêtrière] (DIM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and Lesnik, Philippe
Subjects: Male, medicine.medical_specialty, [SDV]Life Sciences [q-bio], medicine.medical_treatment, percutaneous coronary intervention, Population, Contrast Media, acute myocardial infarction, Renal function, 030204 cardiovascular system & hematology, 03 medical and health sciences, Percutaneous Coronary Intervention, 0302 clinical medicine, Renal Dialysis, Internal medicine, medicine, Risk of mortality, Humans, acute coronary syndromes, Rifle, Hospital Mortality, Prospective Studies, 030212 general & internal medicine, Myocardial infarction, education, education.field_of_study, business.industry, Acute kidney injury, Percutaneous coronary intervention, Acute Kidney Injury, Middle Aged, medicine.disease, Heart Arrest, [SDV] Life Sciences [q-bio], Cardiology, Kidney Failure, Chronic, ST Elevation Myocardial Infarction, Female, Cardiology and Cardiovascular Medicine, business, Kidney disease
Abstract: ObjectivesContrast-induced acute kidney injury (CI-AKI) is a common and potentially severe complication in patients with ST elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). There is no consensus on the best definition of CI-AKI to identify patients at risk of haemodialysis or death. The objective of this study was to assess the association of CI-AKI, using four definitions, on inhospital mortality, mortality or haemodialysis requirement over 1-year follow-up, in patients with STEMI treated with pPCI.MethodsIn this prospective, observational study, all patients with STEMI referred for pPCI were included. We identified independent variables associated with CI-AKI and mortality.ResultsWe included 1114 consecutive patients with STEMI treated by pPCI. CI-AKI occurred in 18.3%, 12.2%, 15.6% and 10.5% of patients according to the CIN, Acute Kidney Injury Network (AKIN), Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE) Modification of Diet in Renal Disease (MDRD) and RIFLE Chronic Kidney Disease - Epidemiology Collaboration (CKD-EPI) definitions, respectively. The RIFLE (CKD-EPI) definition was the most discriminant definition to identify patients at higher risk of inhospital mortality (27.1% vs 4.0%; adjusted OR 2.7 (95% CI 1.4 to 5.1), p=0.003), 1-year mortality (27.4% vs 6.6%; adjusted OR 2.8 (95% CI 1.5 to 5.3), p=0.002) and haemodialysis requirement at 1-year follow-up (15.6% vs 2.7%; adjusted OR 6.7 (95% CI 3.3 to 13.6), p=0.001). Haemodynamic instability, cardiac arrest, preexisting renal failure, elderly age and a high contrast media volume were independently associated with 1-year mortality. Of interest, contrast-media volume was not correlated to increase of creatininaemia (r=0.06) or decrease in estimated glomerular filtration rate (r=0.05) after percutaneous coronary intervention in our population.ConclusionsCI-AKI is a frequent and serious complication of STEMI treated by pPCI. The RIFLE definition is the most accurate definition to identify patients with CI-AKI at high risk of mortality or haemodialysis.
Published: 2017

31. Thrombus composition in sudden cardiac death from acute myocardial infarction

Author: Olivier Varenne, Chandrasekaran Nagaswami, Jean-Philippe Collet, Johanne Silvain, Christian Spaulding, Stéphane Manzo-Silberman, Xavier Jouven, Carole Maupain, Chantal M. Boulanger, Delphine Brugier, John W. Weisel, Paul Guedeney, Nicolas Vignolles, Muriel Tafflet, Gilles Montalescot, Jean-Philippe Empana, Mathieu Kerneis, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Service de Cardiologie [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Department of Cell and Developmental Biology [Philadelphia], Perelman School of Medicine, University of Pennsylvania-University of Pennsylvania, Dpt Cardiologie [CHU Georges Pompidou], Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Paris-Centre de Recherche Cardiovasculaire (PARCC - UMR-S U970), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Paris Sudden Death Expertise Centre, Biomarqueurs CArdioNeuroVASCulaires (BioCANVAS), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), University of Pennsylvania [Philadelphia]-University of Pennsylvania [Philadelphia], Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition ( ICAN ), Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Assistance publique - Hôpitaux de Paris (AP-HP)-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -CHU Pitié-Salpêtrière [APHP], CHU Cochin [AP-HP]-Assistance publique - Hôpitaux de Paris (AP-HP), University of Pennsylvania School of Medicine, Hôpital Européen Georges Pompidou [APHP] ( HEGP ), Paris-Centre de Recherche Cardiovasculaire ( PARCC - U970 ), Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Hôpital Européen Georges Pompidou [APHP] ( HEGP ), Biomarqueurs CArdioNeuroVASCulaires ( BioCANVAS ), Université Paris 13 ( UP13 ) -Université Paris Diderot - Paris 7 ( UPD7 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), and HAL-UPMC, Gestionnaire
Subjects: Male, medicine.medical_specialty, medicine.medical_treatment, 030204 cardiovascular system & hematology, Emergency Nursing, Coronary Angiography, Sudden death, Time-to-Treatment, Sudden cardiac death, 03 medical and health sciences, Percutaneous Coronary Intervention, 0302 clinical medicine, Coronary thrombosis, [ SDV.MHEP ] Life Sciences [q-bio]/Human health and pathology, Internal medicine, Outcome Assessment, Health Care, medicine, Humans, Prospective Studies, cardiovascular diseases, 030212 general & internal medicine, Myocardial infarction, Coronary thrombus, Thrombus, Non-ST Elevated Myocardial Infarction, Aged, Thrombectomy, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, business.industry, Coronary Thrombosis, Percutaneous coronary intervention, Middle Aged, medicine.disease, ST elevated myocardial infarction, 3. Good health, Death, Sudden, Cardiac, Coronary occlusion, Glycoprotein IIb/IIIa inhibitors, Microscopy, Electron, Scanning, Emergency Medicine, Cardiology, ST Elevation Myocardial Infarction, Female, France, Cardiology and Cardiovascular Medicine, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, medicine.drug
Abstract: International audience; Background and aimIt was hypothesized that the pattern of coronary occlusion (thrombus composition) might contribute to the onset of ventricular arrhythmia and sudden cardiac death (SCD) in myocardial infarction (MI).MethodsThe TIDE (Thrombus and Inflammation in sudden DEath) study included patients with angiographically-proven acute coronary occlusion as the cause of a ST elevation MI (STEMI) complicated by Sudden Cardiac Death (SCD group) or not (STEMI group). Thrombi were obtained by thrombo-aspiration before primary percutaneous coronary stenting and analyzed with a quantitative method using scanning electron microscopy. We compared the composition of the thrombi responsible for the coronary occlusion between the two groups and evaluated factors influencing its composition.ResultsWe included 121 patients and found that thrombus composition was not different between the SCD group (n = 23) and the STEMI group (n = 98) regarding content of fibrin fibers (60.3 ± 18.4% vs. 62.4 ± 18.4% respectively, p = 0.68), platelets (16.3 ± 19.2% vs. 15.616.7 ±%, p = 0.76), erythrocytes (14.6 ± 12.5% vs. 13 ± 12.1%, p = 0.73) and leukocytes (0.6 ± 0.9% vs. 0.8 ± 1.5%, p = 0.93). Thrombus composition did not differ between patients receiving upstream-use of glycoprotein IIb/IIIa platelet receptor inhibitors (GPI) and patients free of GPI. The only factor found to influence thrombus composition was the ischemic time from symptom onset to primary PCI, with a decreased content in fibrin fibers (57.8 ± 18.5% vs. 71.9 ± 10.1%, p = 0.0008) and a higher platelet content (19.2 ± 19.1% vs. 7.9 ± 5.7% p = 0.014) in early presenters (6 h of ischemic time).ConclusionComposition of intracoronary thrombi in STEMI patients does not differ between those presenting with and without SCD. Time from symptom onset to coronary reperfusion seems to be the strongest factor influencing thrombus composition in M
Published: 2017

32. Long-Term Evolution of Premature Coronary Artery Disease

Author: Yoan Lavie-Badie, Michel Zeitouni, Daniel Thomas, Olivier Barthelemy, Benoit Lattuca, Jean-Baptiste Esteve, Abdourahmane Diallo, Gilles Montalescot, Eric Vicaut, N Procopi, Laurent Payot, Mathieu Kerneis, Izolina Lopes, Johanne Silvain, Delphine Brugier, Jean-Philippe Collet, Jean-Sébastien Hulot, Institut de cardiologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Sorbonne Université (SU), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Paris-Centre de Recherche Cardiovasculaire (PARCC - UMR-S U970), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Université Sorbonne Paris Cité (USPC), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Hôpital Lariboisière, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), CCSD, Accord Elsevier, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Hôpital de Rangueil, and CHU Toulouse [Toulouse]
Subjects: Male, [SDV]Life Sciences [q-bio], Disease, Coronary Artery Disease, 030204 cardiovascular system & hematology, Coronary Angiography, 0302 clinical medicine, Recurrence, Risk Factors, Clinical endpoint, Myocardial Revascularization, 030212 general & internal medicine, Myocardial infarction, Prospective Studies, Registries, Family history, premature coronary artery disease, Hazard ratio, Smoking, Middle Aged, Prognosis, 3. Good health, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Stroke, [SDV] Life Sciences [q-bio], Treatment Outcome, myocardial infarction, recurrent event, Cardiology, Female, Cardiology and Cardiovascular Medicine, long-term outcomes, Adult, medicine.medical_specialty, 03 medical and health sciences, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Internal medicine, medicine, Humans, Angina, Stable, Coronary atherosclerosis, Proportional Hazards Models, Inflammation, business.industry, young, Anticoagulants, medicine.disease, Confidence interval, Concomitant, business, Follow-Up Studies
Abstract: International audience; BACKGROUND:The long-term evolution of premature coronary artery disease (CAD) is unknown.OBJECTIVES:The objective of this study was to describe the evolution of coronary atherosclerosis in young patients and identify the risk factors of poor outcomes.METHODS:Participants age ≤45 years with acute or stable obstructive CAD were prospectively enrolled and followed. The primary endpoint was all-cause death, myocardial infarction (MI), refractory angina requiring coronary revascularization, and ischemic stroke.RESULTS:Eight hundred-eighty patients with premature CAD were included. They were age 40.1 ± 5.7 years, mainly men, smokers, with a family history of CAD or hypercholesterolemia. At baseline presentation, 91.2% underwent coronary revascularization, predominantly for acute MI (78.8%). Over a follow-up of 20 years, one-third (n = 264) of patients presented with a total of 399 ischemic events, and 36% had at least a second recurrent event. MI was the most frequent first recurrent event (n = 131 of 264), mostly related to new coronary lesions (17.3% vs. 7.8%; p = 0.01; hazard ratio [HR]:1.45; 95% confidence interval [CI]: 1.09 to 1.93 for new vs. initial culprit lesion). All-cause death (n = 55; 6.3%) occurred at 8.4 years (median time). Ethnic origin (sub-Saharan African vs. Caucasian, adjusted hazard ratio [adjHR]: 1.95; 95% CI: 1.13 to 3.35; p = 0.02), inflammatory disease (adjHR: 1.58; 95% CI: 1.05 to 2.36; p = 0.03), and persistent smoking (adjHR: 2.32; 95% CI: 1.63 to 3.28; p < 0.01) were the strongest correlates of a first recurrent event. When considering all recurrent events, the same factors and Asian ethnicity predicted poor outcome, but persistent smoking had the greatest impact on prognosis.CONCLUSIONS:Premature CAD is an aggressive disease despite the currently recommended prevention measures, with high rates of recurrent events and mortality. Ethnicity and concomitant inflammatory disease are associated with poor prognoses, along with insufficient control of risk factors.
Published: 2019

33. Investigator Versus Core Laboratory Evaluation of Coronary Flow and Related Mortality in the CULPRIT-SHOCK Trial

Author: Uwe Zeymer, Mathieu Kerneis, Delphine Brugier, Stéphanie Rouanet, Jean-Philippe Collet, Paul Guedeney, Marie Hauguel-Moreau, Johanne Silvain, Gilles Montalescot, Michel Zeitouni, Steffen Desch, Olivier Barthelemy, Georges Hage, Holger Thiele, Eric Vicaut, Nicolas Vignolles, Pavel Overtchouk, Sorbonne Université (SU), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut de cardiologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Hôpital Lariboisière, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Leipzig University, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [APHP]-Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], and Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Lariboisière-Université Paris Diderot - Paris 7 (UPD7)
Subjects: medicine.medical_specialty, medicine.medical_treatment, [SDV]Life Sciences [q-bio], shock, 030204 cardiovascular system & hematology, Culprit, 03 medical and health sciences, 0302 clinical medicine, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Internal medicine, cardiogenic, medicine, 030212 general & internal medicine, ComputingMilieux_MISCELLANEOUS, Coronary flow, business.industry, percutaneous coronary intervention, Percutaneous coronary intervention, 3. Good health, Shock (circulatory), Cardiology, medicine.symptom, Core laboratory, Cardiology and Cardiovascular Medicine, business, Thrombolysis in Myocardial Infarction flow
Abstract: International audience
Published: 2019

34. Elderly Patients with ST-Segment Elevation Myocardial Infarction: A Patient-Centered Approach

Author: Jean-Philippe Collet, Mathieu Kerneis, Benoit Lattuca, Johanne Silvain, Michel Zeitouni, Guillaume Cayla, Gilles Montalescot, Paul Guedeney, Sorbonne Université (SU), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut de cardiologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), and Université de Montpellier (UM)
Subjects: Male, medicine.medical_specialty, Acute coronary syndrome, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Population, law.invention, 03 medical and health sciences, Percutaneous Coronary Intervention, 0302 clinical medicine, Pharmacotherapy, Randomized controlled trial, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, law, Patient-Centered Care, Internal medicine, Antithrombotic, medicine, Risk of mortality, Humans, Pharmacology (medical), 030212 general & internal medicine, Myocardial infarction, education, Aged, education.field_of_study, business.industry, Percutaneous coronary intervention, medicine.disease, 3. Good health, Treatment Outcome, Practice Guidelines as Topic, ST Elevation Myocardial Infarction, Female, Geriatrics and Gerontology, business, 030217 neurology & neurosurgery
Abstract: International audience; Large registries and epidemiologic studies have demonstrated that elderly patients (≥ 75 years old) represent a growing proportion of the acute coronary syndrome (ACS) population and are exposed to a high risk of both bleeding and ischemic events. In this setting, most of the randomized trials excluded elderly patients while evaluating therapeutic strategies in ACS and only few trials specifically dedicated their design to the elderly population, leading to a paucity of data. Elderly patients are less likely to be treated with an invasive strategy or potent antithrombotic drugs compared with younger patients, while they are exposed to a greater risk of mortality. Nevertheless, the benefit of an invasive approach in ST-segment elevation myocardial infarction (STEMI) has been consistently demonstrated in non-dedicated large percutaneous coronary intervention randomized trials, regardless of the patient's age. European clinical practice guidelines recommend that STEMI in elderly patients should not be treated differently than in younger patients. However, the therapeutic decision should be based on a combined evaluation of both (1) the patient's frailty, including functional or cognitive impairment, and (2) the balance between bleeding and ischemic risks. This review outlines the evidence on the optimal reperfusion and antithrombotic strategies among STEMI elderly patients, suggesting a patient-centered approach to apprehend the balanced therapeutic decision in the very old patient.
Published: 2019

35. Interval From Initiation of Prasugrel to Coronary Angiography in Patients With Non–ST-Segment Elevation Myocardial Infarction

Author: Patrick Goldstein, Leonardo Bolognese, Petr Widimsky, Dariusz Dudek, Debra L. Miller, Johanne Silvain, Zhenyu Liu, Accoast Investigators, Jean-Jacques Portal, Jean-François Tanguay, Jean-Philippe Collet, Christian W. Hamm, Jur ten Berg, Benoit Lattuca, Tomasz Rakowski, Eric Vicaut, Gilles Montalescot, Sorbonne Université (SU), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut de cardiologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Uniwersytet Jagielloński w Krakowie = Jagiellonian University (UJ), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Peking Union Medical College Hospital [Beijing] (PUMCH), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Justus-Liebig-Universität Gießen (JLU), Montreal Heart Institute - Institut de Cardiologie de Montréal, St. Antonius Hospital [Nieuwegein], Charles University [Prague] (CU), Eli Lilly and Company [Indianapolis], Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [APHP]-Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], CHU Pitié-Salpêtrière [APHP], Jagiellonian University [Krakow] (UJ), Centre Hospitalier Régional Universitaire de Nîmes (CHRU Nîmes), Hôpital Lariboisière, and Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Lariboisière-Université Paris Diderot - Paris 7 (UPD7)
Subjects: Male, medicine.medical_specialty, Acute coronary syndrome, Prasugrel, Time Factors, medicine.medical_treatment, [SDV]Life Sciences [q-bio], 030204 cardiovascular system & hematology, Placebo, Coronary Angiography, acute coronary syndrome, 03 medical and health sciences, Electrocardiography, 0302 clinical medicine, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Internal medicine, Cause of Death, Medicine, ST segment, Humans, In patient, 030212 general & internal medicine, Myocardial infarction, cardiovascular diseases, Non-ST Elevated Myocardial Infarction, Dose-Response Relationship, Drug, business.industry, percutaneous coronary intervention, Percutaneous coronary intervention, Middle Aged, pretreatment, medicine.disease, 3. Good health, prasugrel, Survival Rate, Treatment Outcome, myocardial infarction, Conventional PCI, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Prasugrel Hydrochloride, Platelet Aggregation Inhibitors, medicine.drug, Follow-Up Studies
Abstract: International audience; BACKGROUND:In the ACCOAST (A Comparison of Prasugrel at PCI or Time of Diagnosis of Non-ST Elevation Myocardial Infarction) trial, the prasugrel pre-treatment strategy versus placebo was associated with excess bleeding complications and no improved ischemic outcome in non-ST-segment elevation myocardial infarction (MI). Whether patients with the longest pre-treatment duration had an ischemic benefit is unknown.OBJECTIVES:This pre-specified analysis of the ACCOAST trial aimed to assess the effect of pre-treatment duration with prasugrel (time from randomization to angiography) on outcomes.METHODS:Within the 4,033 patients randomized in the ACCOAST trial, pre-treatment duration was available in 4,001 patients (99.2%). The population of the trial was divided into quartiles of pre-treatment duration (0.1 to 2.5 h, 2.5 to 3.9 h, 3.9 to 13.6 h, and >13.6 h) with an evaluation of the primary efficacy endpoint of cardiovascular death, MI, stroke, urgent revascularization or glycoprotein IIb/IIIa inhibitor bailout use. Secondary efficacy outcomes including cardiovascular death, MI, or stroke; all-cause death; stent thrombosis and safety outcomes (all coronary artery bypass graft [CABG] or non-CABG TIMI [Thrombolysis In Myocardial Infarction] major bleeding) were also evaluated at 7 days.RESULTS:The primary efficacy outcome of cardiovascular death, MI, stroke, urgent revascularization or glycoprotein IIb/IIIa inhibitor bailout use did not differ between the quartiles of pre-treatment duration in the trial population (p = 0.17 for interaction). None of the secondary efficacy outcomes were found to be dependent on pre-treatment duration. The safety outcome of all CABG or non-CABG TIMI major bleeding did not differ between the quartiles of pre-treatment duration (p = 0.37 for interaction).CONCLUSIONS:In non-ST-segment elevation MI patients, the excess risk of bleeding and the absence of ischemic benefit were consistent across the quartiles of increasing duration of prasugrel pre-treatment. (A Comparison of Prasugrel at PCI or Time of Diagnosis of Non-ST Elevation Myocardial Infarction [ACCOAST]; NCT01015287).
Published: 2019

36. Modulation of cholesterol efflux capacity in patients with myocardial infarction

Author: Mathieu Kerneis, Johanne Silvain, Gilles Montalescot, Maryse Guerin, Institut de cardiologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Sorbonne Université (SU), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Service de Cardiologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)
Subjects: medicine.medical_specialty, Low HDL-cholesterol, [SDV]Life Sciences [q-bio], Myocardial Infarction, Coronary Artery Disease, 030204 cardiovascular system & hematology, law.invention, Coronary artery disease, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Randomized controlled trial, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, law, Internal medicine, medicine, Humans, In patient, 030212 general & internal medicine, Myocardial infarction, business.industry, Cholesterol, Cholesterol, HDL, Reverse cholesterol transport, medicine.disease, Plaque, Atherosclerotic, 3. Good health, chemistry, Cardiology, cardiovascular system, lipids (amino acids, peptides, and proteins), Efflux, Cardiology and Cardiovascular Medicine, business
Abstract: International audience; PURPOSE OF REVIEW:Epidemiologic studies consistently demonstrated that patients with coronary artery disease (CAD) and low HDL cholesterol (HDL-C) are more likely to develop major adverse cardiovascular events as compared with those with normal or high HDL. However, several large randomized trials failed to demonstrate that a substantial, pharmacological-based, increase of HDL-C concentrations results in a clinically significant reduction of ischemic outcomes. This has been largely attributed to the fact that, although these drugs are able to raise the HDL-C concentration, they have no effect on HDL-C atheroprotective function. Subsequently, the 'HDL hypothesis' evolved, and the focus shifted from raising the concentration of HDL-C to raising the reverse cholesterol transport (RCT) function by increasing patients cholesterol efflux capacity (CEC) instead. Indeed, new data suggest that HDL-C metabolism and the ability of the HDL molecule to transport cholesterol from the atherosclerotic plaque to the liver, measured by the CEC, is more important than steady-state HDL-C levels. Modulation of the CEC has become, therefore, a promising therapeutic target in CAD patients. This article reviews the current data on the 'cholesterol efflux hypothesis' and discuss its ability to be modulated has a potential therapeutic target.RECENT FINDINGS:Recent data have demonstrated that impaired serum CEC was associated with increased mortality after a myocardial infarction (MI). Thus, therapeutic intervention aiming to improve CEC and RCT may reduce the risk of recurrent events. Early phase clinical studies targeting CEC showed promising results and a megatrial is ongoing testing the hypothesis that an improved RCT trough a modulation of the CEC can modify patient's prognosis after an acute MI.SUMMARY:The 'cholesterol efflux hypothesis' is now supported by several clinical studies and is being tested with a therapeutic candidate in a megatrial enrolling high-risk patient with MI.
Published: 2019

37. Optical Coherence Tomography to Optimize Results of Percutaneous Coronary Intervention in Patients with Non–ST-Elevation Acute Coronary Syndrome

Author: Olivier Morel, Géraud Souteyrand, Nicolas Meneveau, Yoann Lefrançois, Marion Chatot, Christophe Caussin, Romain Chopard, Johanne Silvain, Eric Van Belle, Pascal Motreff, Vincent Descotes-Genon, Nassim Braik, Patrick Ohlmann, Nicolas Amabile, Francois Schiele, Fiona Ecarnot, Hélène Tauzin, and Loic Belle
Subjects: Acute coronary syndrome, medicine.medical_specialty, medicine.diagnostic_test, business.industry, medicine.medical_treatment, ST elevation, Percutaneous coronary intervention, Stent, 030204 cardiovascular system & hematology, medicine.disease, law.invention, 03 medical and health sciences, 0302 clinical medicine, Optical coherence tomography, Randomized controlled trial, law, Physiology (medical), Internal medicine, Conventional PCI, medicine, Cardiology, In patient, 030212 general & internal medicine, Cardiology and Cardiovascular Medicine, business
Abstract: Background: No randomized study has investigated the value of optical coherence tomography (OCT) in optimizing the results of percutaneous coronary intervention (PCI) for non–ST-segment elevation acute coronary syndromes. Methods: We conducted a multicenter, randomized study involving 240 patients with non–ST-segment elevation acute coronary syndromes to compare OCT-guided PCI (use of OCT pre- and post-PCI; OCT-guided group) to fluoroscopy-guided PCI (angiography-guided group). The primary end point was the functional result of PCI assessed by the measure of post PCI fractional flow reserve. Secondary end points included procedural complications and type 4a periprocedural myocardial infarction. Safety was assessed by the rate of acute kidney injury. Results: OCT use led to a change in procedural strategy in 50% of the patients in the OCT-guided group. The primary end point was improved in the OCT-guided group, with a significantly higher fractional flow reserve value (0.94±0.04 versus 0.92±0.05, P =0.005) compared with the angiography-guided group. There was no significant difference in the rate of type 4a myocardial infarction (33% in the OCT-group versus 40% in the angiography-guided group, P =0.28). The rates of procedural complications (5.8%) and acute kidney injury (1.6%) were identical in each group despite longer procedure time and use of more contrast medium in the OCT-guided group. Post-PCI OCT revealed stent underexpansion in 42% of patients, stent malapposition in 32%, incomplete lesion coverage in 20%, and edge dissection in 37.5%. This led to the more frequent use of poststent overdilation in the OCT-guided group versus the angiography-guided group (43% versus 12.5%, P P =0.01). Conclusions: In patients with non–ST-segment elevation acute coronary syndromes, OCT-guided PCI is associated with higher postprocedure fractional flow reserve than PCI guided by angiography alone. OCT did not increase periprocedural complications, type 4a myocardial infarction, or acute kidney injury. Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT01743274.
Published: 2016

38. Early Aldosterone Blockade in Acute Myocardial Infarction

Author: Eric Vicaut, Patrick Ecollan, Damien Legallois, Faiez Zannad, Michel Galinier, Nicolas Delarche, Farzin Beygui, Hélène Rousseau, Vincent Roule, Pascal Motreff, Guillaume Cayla, Alain Furber, Albatross Investigators, Patrick Goldstein, Johanne Silvain, François Roubille, Gilles Montalescot, Jacques Machecourt, Loic Belle, Eric Van Belle, Alain Lebon, Jean-Philippe Collet, and Luc Cornillet
Subjects: medicine.medical_specialty, Hyperkalemia, business.industry, Hazard ratio, Infarction, 030204 cardiovascular system & hematology, Implantable defibrillator, medicine.disease, 3. Good health, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, chemistry, Heart failure, Internal medicine, Potassium canrenoate, Spironolactone, Cardiology, Medicine, 030212 general & internal medicine, Myocardial infarction, medicine.symptom, Cardiology and Cardiovascular Medicine, business, medicine.drug
Abstract: Background Mineralocorticoid receptor antagonists (MRA) improve outcome in the setting of post–myocardial infarction (MI) heart failure (HF). Objectives The study sought to assess the benefit of an early MRA regimen in acute MI irrespective of the presence of HF or left ventricular (LV) dysfunction. Methods We randomized 1,603 patients to receive an MRA regimen with a single intravenous bolus of potassium canrenoate (200 mg) followed by oral spironolactone (25 mg once daily) for 6 months in addition to standard therapy or standard therapy alone. The primary outcome of the study was the composite of death, resuscitated cardiac arrest, significant ventricular arrhythmia, indication for implantable defibrillator, or new or worsening HF at 6-month follow-up. Key secondary/safety outcomes included death and other individual components of the primary outcome and rates of hyperkalemia at 6 months. Results The primary outcome occurred in 95 (11.8%) and 98 (12.2%) patients in the treatment and control groups, respectively (hazard ratio [HR]: 0.97; 95% confidence interval [CI]: 0.73 to 1.28). Death occurred in 11 (1.4%) and 17 (2.1%) patients in the treatment and control groups, respectively (HR: 0.65; 95% CI: 0.30 to 1.38). In a non–pre-specified exploratory analysis, the odds of death were reduced in the treatment group (3 [0.5%] vs. 15 [2.4%]; HR: 0.20; 95% CI: 0.06 to 0.70) in the subgroup of ST-segment elevation MI (n = 1,229), but not in non–ST-segment elevation MI (p for interaction = 0.01). Hyperkalemia >5.5 mmol/l–1 occurred in 3% and 0.2% of patients in the treatment and standard therapy groups, respectively (p Conclusions The study failed to show the benefit of early MRA use in addition to standard therapy in patients admitted for MI. (Aldosterone Lethal effects Blockade in Acute myocardial infarction Treated with or without Reperfusion to improve Outcome and Survival at Six months follow-up; NCT01059136).
Published: 2016

39. Clinical Outcome of First- vs Second-Generation DES According to DAPT Duration: Results of ARCTIC-Generation

Author: Christophe Caussin, Grégoire Rangé, Jacques Monsegu, Christophe Saint-Etienne, Eric Vicaut, Nicolas Meneveau, Mathieu Kerneis, Pierre Aubry, Farzin Beygui, Thomas Cuisset, Simon Elhadad, Jérémie Abtan, Gilles Montalescot, Pierre Sabouret, Guillaume Cayla, Didier Carrié, Hélène Rousseau, Stephen A. O’Connor, Olivier Barthelemy, Eric Van Belle, Ziad Boueri, Johanne Silvain, and Jean-Philippe Collet
Subjects: medicine.medical_specialty, Randomization, business.industry, Hazard ratio, General Medicine, 030204 cardiovascular system & hematology, medicine.disease, Confidence interval, Surgery, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Interquartile range, law, Clinical endpoint, Medicine, 030212 general & internal medicine, Cardiology and Cardiovascular Medicine, business, Prospective cohort study, Stroke
Abstract: There is an apparent benefit with extension of dual antiplatelet therapy (DAPT) beyond 1 year after implantation of drug-eluting stents (DES). Assessment by a Double Randomization of a Conventional Antiplatelet Strategy vs a Monitoring-Guided Strategy for Drug-Eluting Stent Implantation, and of Treatment Interruption vs Continuation One Year After Stenting (ARCTIC)-Generation assessed whether there is a difference of outcome between first- vs second-generation DES and if there is an interaction with DAPT duration in the ARCTIC-Interruption study. ARCTIC-Interruption randomly allocated 1259 patients 1 year after stent implantation to a strategy of interruption of DAPT (n = 624), in which aspirin antiplatelet treatment only was maintained, or DAPT continuation (n = 635) for 6 to 18 additional months. The primary endpoint was the composite of death, myocardial infarction, stent thrombosis, stroke, or urgent revascularization. A total of 520 and 722 patients received a first- and a second-generation DES, respectively. After a median follow-up of 17 months (interquartile range, 15-18 months) after randomization, the primary endpoint occurred in 32 (6.2%) and 19 (2.6%) patients with first- and second-generation DES, respectively (hazard ratio: 2.31, 95% confidence interval: 1.31-4.07, P = 0.004). This was observed irrespective of the strategy of interruption or continuation of DAPT and timing of study recruitment. Major bleeding events occurred in 4 (0.8%) and 3 patients (0.4%) with first- and second-generation DES, respectively (hazard ratio: 1.79, 95% confidence interval: 0.40-8.02, P = 0.44). Results did not change after multiple adjustments for potential confounding variables. ARCTIC-Generation showed worse clinical outcome with first- vs second-generation DES, a difference that appeared to persist even with prolonged DAPT.
Published: 2016

40. Potent P2Y12 Inhibitors in Low-Risk Patients

Author: Johanne Silvain, Mathieu Kerneis, and Gilles Montalescot
Subjects: Acute coronary syndrome, medicine.medical_specialty, Prasugrel, Prasugrel Hydrochloride, business.industry, 030204 cardiovascular system & hematology, medicine.disease, Clopidogrel, 03 medical and health sciences, 0302 clinical medicine, P2Y12, Internal medicine, medicine, Cardiology, Platelet aggregation inhibitor, 030212 general & internal medicine, Ticlopidine, Cardiology and Cardiovascular Medicine, business, Ticagrelor, medicine.drug
Abstract: The oral P2Y12 inhibitors prasugrel and ticagrelor have demonstrated biological and clinical superiority over clopidogrel, with a faster onset of action and greater potency, which translate into improved clinical outcomes in patients with acute coronary syndrome (ACS) [(1,2)][1]. They have very
Published: 2016

41. INCIDENCE AND PROGNOSIS OF CARDIAC ALLOGRAFT VASCULOPATHY IN HEART TRANSPLANT PATIENTS

Author: Mathieu Kerneis, Matthieu Steinecker, Benoit Lattuca, Shaida Varnous, Olivier Barthelemy, Jean-Philippe Collet, Michel Zeitouni, Gilles Montalescot, Johanne Silvain, N Procopi, Guillaume Lebreton, Guillaume Coutance, Guillaume Godeau, Pascal Leprince, Stéphanie Rouanet, and Lee S. Nguyen
Subjects: medicine.medical_specialty, business.industry, Internal medicine, Incidence (epidemiology), cardiovascular system, medicine, Cardiology, Early detection, Transplant patient, Cardiology and Cardiovascular Medicine, business, Cardiac allograft vasculopathy
Abstract: Early detection of cardiac allograft vasculopathy (CAV) is a cornerstone of the follow-up of heart transplant patients. This study aims to describe the incidence of advanced CAV and its impact on mortality. The progression of CAV according to ISHLT criteria was evaluated in consecutive patients
Published: 2020

42. Periprocedural Cardiac Troponin and Mortality in Stable Patients Undergoing PCI

Author: Johanne Silvain, Michel Zeitouni, Derek J. Hausenloy, Heerajnarain Bulluck, Valeria Paradies, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], and Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)
Subjects: medicine.medical_specialty, Cardiac troponin, [SDV]Life Sciences [q-bio], medicine.medical_treatment, 030204 cardiovascular system & hematology, Creatine, law.invention, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Randomized controlled trial, law, Internal medicine, Medicine, 030212 general & internal medicine, ComputingMilieux_MISCELLANEOUS, biology, business.industry, Percutaneous coronary intervention, Troponin, 3. Good health, Pooled analysis, chemistry, Conventional PCI, biology.protein, Cardiology, Biomarker (medicine), Cardiology and Cardiovascular Medicine, business
Abstract: We read with great interest the pooled analysis by Garcia-Garcia et al. ([1][1]) on the impact of periprocedural biomarker elevation on mortality following elective percutaneous coronary intervention. Data were obtained from 5 randomized controlled trials and 1 registry (13,452 patients). Creatine
Published: 2020

43. Impact of age on the effect of pre-hospital P2Y12 receptor inhibition in primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: the ATLANTIC-Elderly analysis

Author: Jean-Philippe Collet, Mathieu Kerneis, Benoit Lattuca, Yan Yan, Guillaume Cayla, Johanne Silvain, Frédéric Lapostolle, Patrick Ecollan, Abdourahmane Diallo, Eric Vicaut, Christian W. Hamm, Arnoud W. Van ‘t Hof, Gilles Montalescot, Jens Flensted Lassen, Leonardo Bolognese, Warren J. Cantor, Àngel Cequier, Mohamed Chettibi, Shaun G. Goodman, Christopher J. Hammett, Kurt Huber, Magnus Janzon, Béla Merkely, Robert F. Storey, Jurrien M. ten Berg, Uwe Zeymer, Muriel Licour, Anne Tsatsaris, Sorbonne Université (SU), CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)
Subjects: medicine.medical_specialty, Adenosine, medicine.medical_treatment, Myocardial Infarction, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Percutaneous Coronary Intervention, Double-Blind Method, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Internal medicine, medicine, ST segment, Humans, 030212 general & internal medicine, Myocardial infarction, Stroke, Aged, business.industry, Percutaneous coronary intervention, medicine.disease, 3. Good health, Regimen, Treatment Outcome, Heart failure, Cardiology, Purinergic P2Y Receptor Antagonists, ST Elevation Myocardial Infarction, Female, Cardiology and Cardiovascular Medicine, business, Ticagrelor, TIMI, medicine.drug
Abstract: International audience; AIMS:The aim of the study was to examine the main results of the ATLANTIC trial in patients with ST-elevation myocardial infarction (STEMI), randomised to pre- versus in-hospital ticagrelor, according to age.METHODS AND RESULTS:Patients were evaluated by age class (
Published: 2018

44. Biomarkers of Thrombosis in ST-Segment Elevation Myocardial Infarction: A Substudy of the ATOLL Trial Comparing Enoxaparin Versus Unfractionated Heparin

Author: Mathieu Kerneis, Eric Vicaut, Patrick Ecollan, Delphine Brugier, Pavel Overtchouk, Michel Zeitouni, Jean-Philippe Collet, Marie Hauguel-Moreau, Gilles Montalescot, Stephen A. O’Connor, A. Ankri, Johanne Silvain, Yan Yan, Sophie Galier, Sorbonne Université (SU), CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)
Subjects: Male, medicine.medical_specialty, medicine.medical_treatment, Lipoproteins, Antithrombin III, CD40 Ligand, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Tissue factor pathway inhibitor, Percutaneous Coronary Intervention, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Internal medicine, von Willebrand Factor, medicine, ST segment, Humans, Pharmacology (medical), 030212 general & internal medicine, Platelet activation, Myocardial infarction, Enoxaparin, Aged, business.industry, Heparin, Percutaneous coronary intervention, Anticoagulants, General Medicine, Middle Aged, medicine.disease, Thrombosis, 3. Good health, Conventional PCI, Factor Xa, [SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, Cardiology, ST Elevation Myocardial Infarction, Female, Partial Thromboplastin Time, Prothrombin, Cardiology and Cardiovascular Medicine, business, Biomarkers, medicine.drug, Peptide Hydrolases
Abstract: International audience; BACKGROUND:The aim was to compare the peri-procedural biomarkers of coagulation and platelet activation in patients randomly allocated to intravenous enoxaparin or unfractionated heparin (UFH) in the ATOLL randomized trial (NCT00718471).METHODS AND RESULTS:A total of 129 patients (n = 58 enoxaparin and n = 71 UFH) admitted for ST-segment elevation myocardial infarction (STEMI) treated by percutaneous coronary intervention (PCI) were included in this substudy of the ATOLL trial. Activated partial thromboplastin time ratio, anti-Xa activity, von Willebrand factor antigen, prothrombin fragment 1 + 2 (F1 + 2), thrombin-antithrombin complex (TAT), tissue factor pathway inhibitor and soluble CD40 ligand were measured at sheath insertion (T1) and at the end of the PCI (T2) and correlated with 1-month clinical outcomes. Target anticoagulation levels at T2 were more readily achieved in patients receiving enoxaparin compared to those receiving UFH (80.3 vs 18.2%, p
Published: 2018

45. 6127Type of P2Y12 inhibitor at the acute stage and one-year mortality in acute myocardial infarction. The FAST-MI programme

Author: Jean Ferrières, Etienne Puymirat, Nicholas Danchin, Gregory Ducrocq, François Roubille, Fast-Mi investigators, Vincent Bataille, N Naccache, Tabassome Simon, Francois-Xavier Soto, Francois Schiele, Johanne Silvain, F De Poli, and Elodie Drouet
Subjects: One year mortality, medicine.medical_specialty, P2Y12, business.industry, Internal medicine, Cardiology, medicine, Myocardial infarction, Cardiology and Cardiovascular Medicine, medicine.disease, business, Acute stage
Published: 2018

46. Low-molecular-weight heparin

Author: Mathieu Kerneis, Gilles Montalescot, Jean-Philippe Collet, Johanne Silvain, and Paul Guedeney
Subjects: medicine.medical_specialty, Endocrinology, medicine.drug_class, Chemistry, Internal medicine, medicine, Low molecular weight heparin
Abstract: Low-molecular-weight heparins (LMWHs) are an therapeutic alternative to unfractionated heparin (UFH) for parenteral anticoagulation, with more reliable pharmacological properties and also an easier practical use. LMWHs are recommended for acute coronary syndrome and thromboembolic diseases.
Published: 2018

47. The efficacy of early versus delayed P2Y12 inhibition in percutaneous coronary intervention for ST-elevation myocardial infarction: a systematic review and meta-analysis

Author: Kenneth Ducci, Stephen D. Wiviott, Johanne Silvain, Céline Bégué, Deepak L. Bhatt, Anne Bellemain-Appaix, Jean-Philippe Collet, Robert A. Harrington, Michel Cucherat, Gilles Montalescot, François Bernasconi, Matthew T. Roe, Service de cardiologie, Université Paris Diderot - Paris 7 (UPD7)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), VA Boston Healthcare System, Brigham & Women’s Hospital [Boston] (BWH), Harvard Medical School [Boston] (HMS), Evaluation et modélisation des effets thérapeutiques, Département biostatistiques et modélisation pour la santé et l'environnement [LBBE], Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Génomique cardiovasculaire, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Université Paris Diderot - Paris 7 (UPD7)-AP-HP - Hôpital Bichat - Claude Bernard [Paris]-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), and Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [APHP]
Subjects: medicine.medical_specialty, medicine.medical_treatment, Myocardial Infarction, Platelet Glycoprotein GPIIb-IIIa Complex, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Percutaneous Coronary Intervention, Internal medicine, medicine, Clinical endpoint, Humans, cardiovascular diseases, 030212 general & internal medicine, Myocardial infarction, ComputingMilieux_MISCELLANEOUS, business.industry, Percutaneous coronary intervention, Thrombolysis, medicine.disease, 3. Good health, Meta-analysis, Conventional PCI, Cardiology, [SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, Purinergic P2Y Receptor Antagonists, ST Elevation Myocardial Infarction, Cardiology and Cardiovascular Medicine, business, TIMI, Mace, Platelet Aggregation Inhibitors
Abstract: Aims The aim of this meta-analysis was to compare the benefit of "early" vs. "delayed" P2Y12 inhibition in patients undergoing percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). Methods and results We conducted a meta-analysis including seven randomised controlled trials (RCTs) which compared early vs. delayed P2Y12inhibition in STEMI patients scheduled for PCI, providing data on major adverse cardiac events (MACE), all-cause death, and major bleeding. The primary endpoint was MACE. Secondary endpoints included stent thrombosis and the use of GP IIb/IIIa inhibitors (GPI). All endpoints were analysed at the shortest follow-up available. A total of 9,648 patients were included ("early"=4,792, "delayed"=4,856). "Early" P2Y12 inhibition was associated with a significant reduction in MACE rate (OR 0.73, 95% CI: 0.61-0.88, p=0.0008), myocardial infarction (OR 0.71, 95% CI: 0.57-0.90, p=0.004), bail-out GPI use (OR 0.87, 95% CI: 0.75-1.00, p=0.04) and improved coronary reperfusion before PCI (OR for Thrombolysis In Myocardial Infarction [TIMI] flow grade 2-3=1.12, 95% CI: 1.00-1.26, p=0.04). Major bleeding was not increased (OR 0.87, 95% CI: 0.62-1.21, p=0.41). Conclusions A strategy of early effective P2Y12 inhibition in PCI of STEMI appears to improve coronary reperfusion before PCI, and reduce MACE, MI and bail-out GPI use without increase of major bleeding.
Published: 2018

48. Anticoagulation in Acute Coronary Syndrome-State of the Art

Author: Jean-Philippe Collet, Johanne Silvain, Gilles Montalescot, Tarek Nafee, Michel Zeitouni, and Mathieu Kerneis
Subjects: medicine.medical_specialty, Acute coronary syndrome, medicine.drug_class, medicine.medical_treatment, Low molecular weight heparin, 030204 cardiovascular system & hematology, Fondaparinux, 03 medical and health sciences, 0302 clinical medicine, Coronary thrombosis, Internal medicine, medicine, Bivalirudin, Humans, 030212 general & internal medicine, Myocardial infarction, Acute Coronary Syndrome, business.industry, Anticoagulant, Percutaneous coronary intervention, Anticoagulants, medicine.disease, Patient Care Management, Treatment Outcome, Cardiology, Cardiology and Cardiovascular Medicine, business, medicine.drug
Abstract: Early intravenous anticoagulation is the corner stone treatment of patients admitted with an acute coronary syndrome: it antagonizes the ongoing coronary thrombosis and facilitates the percutaneous coronary intervention, hence a reduction of mortality and acute stent thrombosis. Unfractionated heparin, enoxaparin, bivalirudin and fondaparinux have been extensively studied in large randomized control trials and meta-analyses with the same objective: reducing the ischemic burden without hiking hemorrhagic events. This conundrum is evolving along the generalization of the radial-artery access, the use of potent P2Y12 and the trend towards a tailored approach regarding the ischemic and bleeding balance. In this systematic review, we aimed at presenting the evidence based data and strategies for each anticoagulant in the setting of acute coronary syndrome with and without ST-segment elevation.
Published: 2018

49. Association of Serum Cholesterol Efflux~Capacity With Mortality in Patients~With ST-Segment~Elevation Myocardial Infarction

Author: Michel Zeitouni, Myriam Berthet, Mathieu Kerneis, Jean-Philippe Collet, Julie Gall, Marie Hauguel-Moreau, Johanne Silvain, Philippe Lesnik, Benoit Lattuca, Maryse Guerin, Maryam Darabi, Delphine Brugier, Eric Frisdal, Gilles Montalescot, Sorbonne Université (SU), CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)
Subjects: Male, [SDV]Life Sciences [q-bio], 030204 cardiovascular system & hematology, Cohort Studies, chemistry.chemical_compound, 0302 clinical medicine, Interquartile range, HDL cholesterol, 80 and over, 030212 general & internal medicine, Myocardial infarction, Prospective Studies, Aged, 80 and over, biology, Reverse cholesterol transport, Hazard ratio, Middle Aged, 3. Good health, Cholesterol, myocardial infarction, lipids (amino acids, peptides, and proteins), Female, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, HDL, LDL, 03 medical and health sciences, Internal medicine, Cholesterylester transfer protein, CETP, medicine, Humans, Triglycerides, Aged, Triglyceride, business.industry, Cholesterol, HDL, Cholesterol, LDL, medicine.disease, mortality, Cholesterol Ester Transfer Proteins, Endocrinology, chemistry, biology.protein, ST Elevation Myocardial Infarction, business, cholesterol efflux, Biomarkers, Lipoprotein, Follow-Up Studies
Abstract: International audience; BACKGROUND: Serum cholesterol efflux capacity, a biomarker that integrates contributors and modulators of the initial step of the reverse cholesterol transport, has been associated with atherosclerosis independently of high-density lipoprotein (HDL) cholesterol level. OBJECTIVES: The authors evaluated the prognostic impact of serum cholesterol efflux capacity on mortality in a large cohort of patients hospitalized for an acute myocardial infarction (MI). METHODS: Serum cholesterol efflux capacity, cholesteryl ester transfer protein (CETP) activity, total cholesterol, low-density lipoprotein cholesterol, HDL cholesterol, and triglyceride levels were measured in 1,609 consecutive patients admitted with an acute MI. The primary endpoint was all-cause mortality evaluated at 6 years with a median follow-up of 1.9 years (interquartile range: 1.5 to 4.2 years). An analysis by quartile of serum cholesterol efflux capacity was also performed. RESULTS: In a fully adjusted model that included age, sex, traditional cardiovascular risk factors including lipid levels, and prognostic factors of MI, serum cholesterol efflux capacity was a strong predictor of survival (adjusted hazard ratio for mortality per 1-SD increase in serum cholesterol efflux capacity, 0.79; 95% confidence interval: 0.66 to 0.95; p~=~0.0132). Patients displaying an elevated serum cholesterol efflux capacity had a marked lower rate of mortality at 6~years (adjusted hazard ratio: 0.54 [0.32 to 0.89]; p~=~0.0165) as compared with patients with reduced serum cholesterol efflux capacity. CONCLUSIONS: Serum cholesterol efflux capacity, an integrative marker of reverse cholesterol transport pathway and efficacy, was inversely associated with all-cause mortality in MI patients independently of HDL cholesterol level and other risk factors.
Published: 2018

50. Platelet effect of prasugrel and ticagrelor in patients with ST-segment elevation myocardial infarction

Author: Delphine Brugier, Mathieu Kerneis, Sophie Galier, Jérémie Abtan, Gilles Montalescot, Laurent Payot, Olivier Barthelemy, Johanne Silvain, Jean-Philippe Collet, and Marie Hauguel
Subjects: Male, Ticagrelor, Adenosine, Time Factors, Prasugrel, Platelet Aggregation, medicine.medical_treatment, Myocardial Infarction, Platelet, Prospective Studies, Myocardial infarction, Platelet function testing, Maintenance dose, Microfilament Proteins, General Medicine, Middle Aged, Receptors, Purinergic P2Y12, Treatment Outcome, Anesthesia, Cardiology, Female, Cardiology and Cardiovascular Medicine, medicine.drug, Blood Platelets, medicine.medical_specialty, Acute coronary syndrome, Platelet Function Tests, P2Y12 receptor antagonist, Drug Administration Schedule, STEMI, Percutaneous Coronary Intervention, Predictive Value of Tests, Internal medicine, Tests de fonction plaquettaire, medicine, Humans, business.industry, Antagoniste du récepteur P2Y12, Percutaneous coronary intervention, Phosphoproteins, SCA, medicine.disease, Conventional PCI, Purinergic P2Y Receptor Antagonists, business, Cell Adhesion Molecules, Prasugrel Hydrochloride, Platelet Aggregation Inhibitors
Abstract: Summary Background Recent studies have suggested that ticagrelor 90 mg twice daily provides stronger platelet inhibition than prasugrel 10 mg once daily in acute coronary syndrome patients undergoing percutaneous coronary intervention. Objectives To compare the effects of ticagrelor 90 mg twice daily and prasugrel 10 mg once daily on platelet reactivity in patients with ST-segment elevation myocardial infarction (STEMI), using: the VerifyNow ® P2Y 12 (VN-P2Y 12 ) assay, expressed in P2Y 12 reaction units (PRU); measurement of the vasodilator-stimulated phosphoprotein platelet reactivity index (VASP-PRI; %); and light transmission aggregometry (LTA), expressed as residual platelet aggregation (RPA; %). Methods Platelet reactivity was evaluated prospectively using the three assays 30 days after primary PCI in 118 patients with STEMI on a maintenance dose of prasugrel 10 mg once daily ( n = 60) or ticagrelor 90 mg twice daily ( n = 58). Results On-treatment platelet reactivity, assessed by the VN-P2Y 12 assay, was lower for ticagrelor compared with prasugrel (20.91 ± 4.59 PRU vs. 43.50 ± 6.98 PRU; P = 0.008) but was not significantly different when using the more specific VASP-PRI assay (13.05 ± 1.61% vs. 17.44 ± 1.97%; P = 0.09) or RPA assessed by LTA (10.49 ± 1.44% vs. 7.20 ± 1.27%; P = 0.09). Conclusions The difference in platelet reactivity between ticagrelor and prasugrel varies according to the platelet function test in patients with STEMI. The differences observed may be related more to the tests than to the drugs used.
Published: 2015
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