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1. Indirect Transfer to Catheterization Laboratory for ST Elevation Myocardial Infarction Is Associated With Mortality Independent of System Delays: Insights From the France-PCI Registry

Author

Farzin Beygui, Vincent Roule, Fabrice Ivanes, Thierry Dechery, Olivier Bizeau, Laurent Roussel, Philippe Dequenne, Marc-Antoine Arnould, Nicolas Combaret, Jean Philippe Collet, Philippe Commeau, Guillaume Cayla, Gilles Montalescot, Hakim Benamer, Pascal Motreff, Denis Angoulvant, Pierre Marcollet, Stephan Chassaing, Katrien Blanchart, René Koning, and Grégoire Rangé

Subjects
ST-elevation myocardial infarction, Pre-hospital, percutaneous coronary intervention, mortality, system delays, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

BackgroundFirst medical contact (FMC)-to-balloon time is associated with outcome of ST-elevation myocardial infarction (STEMI). We assessed the impact on mortality and the determinants of indirect vs. direct transfer to the cardiac catheterization laboratory (CCL).MethodsWe analyzed data from 2,206 STEMI patients consecutively included in a prospective multiregional percutaneous coronary intervention (PCI) registry. The primary endpoint was 1-year mortality. The impact of indirect admission to CCL on mortality was assessed using Cox models adjusted on FMC-to-balloon time and covariables unequally distributed between groups. A multivariable logistic regression model assessed determinants of indirect transfer.ResultsA total of 359 (16.3%) and 1847 (83.7%) were indirectly and directly admitted for PCI. Indirect admission was associated with higher risk features, different FMCs and suboptimal pre-PCI antithrombotic therapy.At 1-year follow-up, 51 (14.6%) and 137 (7.7%) were dead in the indirect and direct admission groups, respectively (adjusted-HR 1.73; 95% CI 1.22–2.45). The association of indirect admission with mortality was independent of pre-FMC and FMC characteristics. Older age, paramedics- and private physician-FMCs were independent determinants of indirect admission (adjusted-HRs 1.02 per year, 95% CI 1.003–1.03; 5.94, 95% CI 5.94 3.89–9.01; 3.41; 95% CI 1.86–6.2, respectively).ConclusionsOur study showed that, indirect admission to PCI for STEMI is associated with 1-year mortality independent of FMC to balloon time and should be considered as an indicator of quality of care. Indirect admission is associated with higher-risk features and suboptimal antithrombotic therapy. Older age, paramedics-FMC and self-presentation to a private physician were independently associated with indirect admission. Our study, supports population education especially targeting elderly, more adequately dispatched FMC and improved pre-CCL management.

Published
2022
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3. Regression of Q waves and clinical outcomes following primary PCI in anterior STEMI

Author

Mathieu Schaaf, Inesse Boussaha, Claire Jossan, Thomas Bochaton, Sophie Pichot-Lamoureux, Denis Angoulvant, Nathan Mewton, Marc J. Claeys, Michel Ovize, Grégoire Rangé, Yuni de Framond, Olivier Dubreuil, David Garcia Dorado, Gilles Rioufol, CHU Tenon [APHP], Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Department of Cardiology, Hospices Civils de Lyon (HCL), Johns Hopkins University School of Medicine [Baltimore], CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
medicine.medical_specialty, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Population, Myocardial Infarction, Left ventricle remodeling, Stunned myocardium, 030204 cardiovascular system & hematology, Lower risk, Infarct size, QT interval, Ventricular Function, Left, Electrocardiography, 03 medical and health sciences, Percutaneous Coronary Intervention, 0302 clinical medicine, Internal medicine, medicine, Humans, cardiovascular diseases, 030212 general & internal medicine, education, Creatine Kinase, Heart Failure, education.field_of_study, Ejection fraction, biology, Anterior ST-elevation myocardial infarction, business.industry, Percutaneous coronary intervention, Stroke Volume, Q wave regression, medicine.disease, 3. Good health, Heart failure, Conventional PCI, biology.protein, Cardiology, ST Elevation Myocardial Infarction, Creatine kinase, Human medicine, Cardiology and Cardiovascular Medicine, business
Abstract

Background: Pathological Q waves are correlated with infarct size, and Q-wave regression is associated with left ventricular ejection fraction improvement. There are limited data regarding the association of Q-wave regression and clinical outcomes. Our main objective was to assess the association of pathological Q wave evolution after re-perfusion with clinical outcomes after anterior STEMI.Methods: Standard 12-lead electrocardiograms (ECGs) were recorded in 780 anterior STEMI patients treated with primary percutaneous coronary intervention (PCI) from the CIRCUS trial. ECGs were recorded before and 90 min following PCI, as well as at hospitalization discharge and 12 months of follow-up. The number of classic ECG criteria Q waves was scored for each ECG. Patients were classified in the Q wave regression group if they had re-gression of at least one Q wave between the post-PCI, the discharge and/or one year ECGs. Patients were classified in the Q wave persistent group if they had the same number or greater between the post-PCI, the discharge and/ or 1 and one year ECGs. All-cause death and heart failure events were assessed for all patients at one year.Results: There were 323(43%) patients with persistent Q waves (PQ group), 378(49%) patients with Q wave re-gression (RQ group) and 60(8%) patients with non-Q wave MI (NQ group). Infarct size as measured by the peak creatine kinase was significantly greater in the PQ group compared to the RQ and NQ groups (4633 +/- 2784 IU/l vs. 3814 +/- 2595 IU/l vs. 1733 +/- 1583 IU/l respectively, p b 0.0001). At one year, there were 22 deaths (7%) in the PQ-group, 15 (4%) in the RQ-group and none in the NQ-group (p = 0.04). There was a 4-fold increase in the risk of death or heart failure in the PQ compared to the NQ group (HR 4.7 [1.1; 19.3]; p = 0.03), but there was no significant difference between NQ and RQ groups (HR 3.3 [0.8; 13.8]; p = 0.09).Conclusion: Ina population of anterior STEMI patients, persistent Q waves defined according to the classic ECG criteria after reperfusion was associated with a 4-fold increase in the risk of heart failure or death compared to non-Q-wave MI, while Q-wave regression was associated with significantly lower risk of events.(c) 2019 Elsevier Inc. All rights reserved.

Published
2022

5. Notre faux-ami le rayon X - Risques, évaluation, protection, amélioration des pratiques - État des lieux par le registre France- PCI

Author

Jean François Morelle, Pr Jacques Monségu, Grégoire Rangé, Benjamin Honton, Matthieu Perier, V. Tixier, Antoine Py, Pr Gilles Barone-Rochette, P. Motreff, Nicolas Durel, Julien Adjedj, Ali Shararah, Stéphane Rias, Gérard Duheil, Sylvain Chanseaume, Hakim Benamer, Nicolas Amabile, and Gabriel Seret

Subjects
medicine.medical_specialty, Quality management, medicine.diagnostic_test, business.industry, Psychological intervention, Status report, Total occlusion, Internal medicine, Conventional PCI, Cardiology, medicine, Fluoroscopy, Cardiac Catheterization Procedures, Radiation protection, Cardiology and Cardiovascular Medicine, business
Abstract

Although indispensable, radiation exposure during cardiac catheterization procedures can cause specific radiation-induced diseases. These affect the patient but also the interventional cardiologist. Exposure to high or repeated radiation doses causes deterministic effects. Moreover, even low-dose exposure, especially when repeated, produces a risk of stochastic effets. In that respect, it is crucial to improve the radiation safety of cardiac angiography and interventions, to promote radiation protection and to maintain this exposure « As Low As Reasonably Achievable ». Thus, there is a necessity to spread knowledge about safety standards and recommandations to reduces the dose among interventionalists. Data collection and comparaison of practices are precious to this quality improvement process. For the year 2020, France-PCI registry had collected dosimetric datas related to 55 783 coronary angiographic and interventional procedures from 30 centers in France. Mean fluoroscopy time was 4,4 minutes for diagnostic procedures. Mean PDS was 1 767cGy.Cm2 and mean Air Kerma de 257Gy. Coronary percutaneous angioplasty procedures were related to approximately two to three times higher mean exposures. Mean exposure related to chronic coronary total occlusion treatment procedures was also two times higher than exposure related to non-CTO interventions. These data also highlighted wide disparities between centers.

Published
2021

6. Mise au point sur l'athérectomie rotationnelle à haute vitesse par Rotablator en 2021 et données du registre France PCI

Author

P-F. Lesault, Christophe Thuaire, Marie Pascale Decomis, Pierre Marcollet, E. Boiffard, Pr Éric Durand, Stephan Chassaing, Pr Farzin Beygui, Louis Viallard, Matthieu Perier, Hakim Benamer, Sofiène Daniel Gafsi, Grégoire Rangé, Gabriel Seret, Nicolas Combaret, Matthieu Godin, Pr Denis Angoulvant, P. Motreff, Olivier Fichaux, and Thierry Corcos

Subjects
medicine.medical_specialty, Percutaneous, business.industry, medicine.medical_treatment, Perforation (oil well), Lithotripsy, medicine.disease, Balloon, Surgery, Atherectomy, Restenosis, Angioplasty, Conventional PCI, Medicine, Cardiology and Cardiovascular Medicine, business
Abstract

Developed in the late 1980s, rotational atherectomy has raised a lot of hope for its innovative principle of selective ablation, allowing volume reduction (instead of redistribution) of atherosclerotic plaque, while sparing healthy tissue. Long shunned for its disappointing results on restenosis, the Rotablator finally reasserted itself in the 2000s; era of drug eluting stents and coronary angioplasty boom, thus generating emergence of complex lesions. Indeed, the Rotablator has demonstrated an undeniable benefit in complex (type C) and calcified lesions preparation (before stenting), with a procedural success rate of 95%. Although these lesions only represent a small amount (2-3%) of percutaneous coronary interventions (PCI), they remain a technical impasse for plain-old balloon angioplasty strategy, making the Rotablator more suitable for these resistant lesions' treatment. Registry data attest the safety of this therapy, with a rate of peri-procedural complications and in-hospital mortality comparable to conventional angioplasty (France PCI register). However, certain specific, rare but serious complications (burr entrapment, broken Rotawire, coronary perforation) justify trained teams, perfect knowledge of the equipment, and strict compliance with good practice guidelines. In 2018, the rise of a new method of atherectomy by intra-vascular lithotripsy (Shockwave) has coincided with Rotablator decreasing activity (this finding being biased by a general decrease in PCI activity due to Covid pandemic). This therapeutic range's enhancement revolutionizes calcified lesions treatment, tending towards precise targeting of each indication, depending in particular on calcium distribution's anatomy in the plaque.

Published
2021

7. Thrombose de stent : une bataille gagnée ? (Données du registre France PCI)

Author

P. Motreff, Géraud Souteyrand, P. Bonnet, R. Hakim, R. Koning, O. Bar, A. Gamet, Hakim Benamer, A. Canville, E. Boiffard, Philippe Commeau, T. Dechery, Farzin Beygui, Eric Durand, P-F. Lesault, Louis Viallard, C Saint Etienne, Guillaume Cayla, Grégoire Rangé, R. Deballon, and Franck Albert

Subjects
medicine.medical_specialty, education.field_of_study, Acute coronary syndrome, business.industry, medicine.medical_treatment, Incidence (epidemiology), Population, Percutaneous coronary intervention, Context (language use), medicine.disease, Internal medicine, Diabetes mellitus, Angioplasty, Conventional PCI, medicine, Cardiology, Cardiology and Cardiovascular Medicine, business, education
Abstract

Goal The aim of the study is to assess the incidence, risk factors and prognosis of definite stent thrombosis (ST) at 1 year in the France PCI multicenter prospective registry. Patients and methods Only patients who underwent coronary angioplasty with at least one stent implantation between 1st January 2014 and 31 December 2019 were included. The population was separated into 2 groups: the "ST" group with stent thrombosis and the "control" group without stent thrombosis. Results 35,435 patients were included. 256 patients (0.72%) presented a ST at 1 year. The rate of ST decreased significantly in acute coronary syndrome (1.5% in 2014 vs. 0.73% in 2019; p = 0.05) but not in chronic coronary syndrome (0.46% in 2014 vs 0.40%; p = 0.98). The risk factors are young age (65.8 years vs 68.2; p = 0.002), clinical context (35.27% vs 16.68%; p = 0.0001), diabetes (35.2 % vs 26.4%; p = 0.002), renal failure (11.7% vs 8%; p = 0.009) and history of coronary angioplasty (28.63% vs 21.86%; p = 0.009) and peripheral arterial disease (14.5% vs 10.1%; p = 0.021), LV dysfunction (37% vs 27.5%; p = 0.003), mean length (39.6 mm vs 31, 7mm; p Conclusion Since 2014, the incidence of ST at 1 year has been decreasing but remains stuck at a floor level of 0.54% in 2019. The battle for ST seems to have been partly won and its risk factors well identified, but its mortality is still high.

Published
2021

9. [Penetration of endocoronary imaging in France (data from France PCI): The French exception]

Author

Grégoire, Rangé and Radwan, Hakim

Subjects
Percutaneous Coronary Intervention, Treatment Outcome, Humans, Coronary Artery Disease, Coronary Angiography, United States, Ultrasonography, Interventional, Tomography, Optical Coherence
Abstract

Evaluate intravascular coronary imaging (ICI) utilization in France and compare it with other countries.We included in our study all PCI performed between 2014 and 2021 in all participating centers of France PCI registry.The percentage of ICI use during PCI varied from 1.2% to 1% between 2014 and 2020 in the France PCI Registry. In 2021, among 45,227 PCI procedures performed at the 41 participating centers, 768 (1.7%) had an ICI, including 329 (0.7%) with OCT, 341 (0.8%) with IVUS, and 98 (0.2%) undetermined. In "all-comers" PCI, the rate of ICI use was 1.7% in France, 2.5% in the United States, 10% in Sweden, 16.2% in the United Kingdom, and 84.4% in Japan. In left main PCI, the rate was 5.8% in France, 62.3% in Sweden, 66.6% in the UK, and 96.6% in Japan. In the France PCI registry, the rate of ICI use ranged from 0% to 9.5% in all PCI and from 0% to 30% in left main PCI.ICI techniques are exceptionally used in France in routine practice, in contrast to our European neighbors such as Swede or the United Kingdom. Obtaining reimbursement in certain recommended indications and participation in a national interventional cardiology registry with incentive practice indicators should improve this situation.

Published
2022

11. Is coronary multivessel disease in acute myocardial infarction patients still associated with worse clinical outcomes at 1‐year?

Author

Grégoire Rangé, Ariel Nakache, Hakim Benamer, Marie-Pascale Decomis, Pierre Marcollet, Olivier Fichaux, Nicolas Danchin, Gilles Montalescot, Christophe Saint Etienne, Pascal Motreff, Guillaume Cayla, Stephan Chassaing, Etienne Puymirat, René Koning, Philippe Commeau, CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), 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), CHU Clermont-Ferrand, Hôpitaux de Chartres [Chartres], 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), Centre Hospitalier Jacques Coeur, Centre Hospitalier Régional d'Orléans (CHRO), Pôle santé Oréliance, Nouvelle Clinique Tourengelle, Polyclinique des fleurs, Service de cardiologie [CHU Rouen], Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Normandie Université (NU), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Clinique de la Roseraie, Clinique Saint-Hilaire [Rouen], and Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)

Subjects
Male, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Clinical Investigations, Myocardial Infarction, acute myocardial infarction, Coronary Artery Disease, Disease, 030204 cardiovascular system & hematology, multivessel disease, 03 medical and health sciences, Percutaneous Coronary Intervention, 0302 clinical medicine, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Internal medicine, medicine, Humans, cardiovascular diseases, 030212 general & internal medicine, Myocardial infarction, Risk factor, Stroke, Retrospective Studies, business.industry, Percutaneous coronary intervention, General Medicine, Multivessel disease, Middle Aged, ST‐elevation myocardial infarction, primary percutaneous coronary intervention, medicine.disease, 3. Good health, Treatment Outcome, Conventional PCI, Cardiology, ST Elevation Myocardial Infarction, Cardiology and Cardiovascular Medicine, business, Mace
Abstract

International audience; BackgroundST‐elevation myocardial infarction (STEMI) patients with multivessel disease (MVD) are associated with a worse prognosis. However, few comparisons are available according to coronary status in the era of modern reperfusion and optimized secondary prevention.HypothesisWe hypothesized that the difference in prognosis according to number of vessel disease in STEMI patients has reduced.MethodsAll consecutive STEMI patients undergoing primary percutaneous coronary intervention (PCI) within 24 h of symptoms onset between January 1, 2014 and June 30, 2016 enrolled in the CRAC (Club Régional des Angioplasticiens de la région Centre) France PCI registry were analyzed. Baseline characteristics, management, and outcomes at 1‐year were analyzed according to coronary status (one‐, two‐, and three‐VD).ResultsA total of 1886 patients (mean age 62.2 ± 14.0 year; 74% of male) were included. Patients with MVD (two or three‐VD) represented 53.7%. They were older with higher cardiovascular risk factor profile. At 1 year, the rate of major adverse cardiovascular events (MACE, defined as all‐cause death, stroke or re‐MI) was 10%, 12%, and 12% in one‐, two, and three‐VD respectively (p = .28). In multivariable adjusted Cox proportional hazard regression model, two‐ and three‐VD were not associated with higher rate of MACE compared to patients with single VD (HR, 1.09; 95%CI 0.76–1.56 for two‐VD; HR, 0.74; 95%CI 0.48–1.14 for three‐VD).ConclusionsMVD still represents an important proportion of STEMI patients but their prognoses were not associated with worse clinical outcomes at 1‐year compared with one‐VD patients in a modern reperfusion area and secondary medication prevention.

Published
2021

12. Indirect Transfer to Catheterization Laboratory for ST Elevation Myocardial Infarction Is Associated With Mortality Independent of System Delays: Insights From the France-PCI Registry

Author

Farzin Beygui, Vincent Roule, Fabrice Ivanes, Thierry Dechery, Olivier Bizeau, Laurent Roussel, Philippe Dequenne, Marc-Antoine Arnould, Nicolas Combaret, Jean Philippe Collet, Philippe Commeau, Guillaume Cayla, Gilles Montalescot, Hakim Benamer, Pascal Motreff, Denis Angoulvant, Pierre Marcollet, Stephan Chassaing, Katrien Blanchart, René Koning, and Grégoire Rangé

Subjects
Cardiology and Cardiovascular Medicine
Abstract

BackgroundFirst medical contact (FMC)-to-balloon time is associated with outcome of ST-elevation myocardial infarction (STEMI). We assessed the impact on mortality and the determinants of indirect vs. direct transfer to the cardiac catheterization laboratory (CCL).MethodsWe analyzed data from 2,206 STEMI patients consecutively included in a prospective multiregional percutaneous coronary intervention (PCI) registry. The primary endpoint was 1-year mortality. The impact of indirect admission to CCL on mortality was assessed using Cox models adjusted on FMC-to-balloon time and covariables unequally distributed between groups. A multivariable logistic regression model assessed determinants of indirect transfer.ResultsA total of 359 (16.3%) and 1847 (83.7%) were indirectly and directly admitted for PCI. Indirect admission was associated with higher risk features, different FMCs and suboptimal pre-PCI antithrombotic therapy.At 1-year follow-up, 51 (14.6%) and 137 (7.7%) were dead in the indirect and direct admission groups, respectively (adjusted-HR 1.73; 95% CI 1.22–2.45). The association of indirect admission with mortality was independent of pre-FMC and FMC characteristics. Older age, paramedics- and private physician-FMCs were independent determinants of indirect admission (adjusted-HRs 1.02 per year, 95% CI 1.003–1.03; 5.94, 95% CI 5.94 3.89–9.01; 3.41; 95% CI 1.86–6.2, respectively).ConclusionsOur study showed that, indirect admission to PCI for STEMI is associated with 1-year mortality independent of FMC to balloon time and should be considered as an indicator of quality of care. Indirect admission is associated with higher-risk features and suboptimal antithrombotic therapy. Older age, paramedics-FMC and self-presentation to a private physician were independently associated with indirect admission. Our study, supports population education especially targeting elderly, more adequately dispatched FMC and improved pre-CCL management.

Published
2021

13. [X-Ray, false friend of the interventional cardiologist - Risks, evaluation, quality improvement - Status report from France-PCI registry]

Author

Dr Matthieu, Périer, Dr Gabriel, Seret, Dr Jean François, Morelle, Dr Nicolas, Amabile, Dr Gérard, Duheil, Pr Jacques, Monségu, Dr Nicolas, Durel, Dr Vincent, Tixier, Dr Benjamin, Honton, Dr Antoine, Py, Pr Gilles, Barone-Rochette, Dr Sylvain, Chanseaume, Dr Stéphane, Rias, Dr Julien, Adjedj, Dr Ali, Shararah, Pr Pascal, Motreff, Dr Grégoire, Rangé, and Dr Hakim, Benamer

Subjects
Cardiologists, Percutaneous Coronary Intervention, X-Rays, Humans, Registries, Coronary Angiography, Radiation Dosage, Radiography, Interventional, Quality Improvement
Abstract

Although indispensable, radiation exposure during cardiac catheterization procedures can cause specific radiation-induced diseases. These affect the patient but also the interventional cardiologist. Exposure to high or repeated radiation doses causes deterministic effects. Moreover, even low-dose exposure, especially when repeated, produces a risk of stochastic effets. In that respect, it is crucial to improve the radiation safety of cardiac angiography and interventions, to promote radiation protection and to maintain this exposure « As Low As Reasonably Achievable ». Thus, there is a necessity to spread knowledge about safety standards and recommandations to reduces the dose among interventionalists. Data collection and comparaison of practices are precious to this quality improvement process. For the year 2020, France-PCI registry had collected dosimetric datas related to 55 783 coronary angiographic and interventional procedures from 30 centers in France. Mean fluoroscopy time was 4,4 minutes for diagnostic procedures. Mean PDS was 1 767cGy.Cm2 and mean Air Kerma de 257Gy. Coronary percutaneous angioplasty procedures were related to approximately two to three times higher mean exposures. Mean exposure related to chronic coronary total occlusion treatment procedures was also two times higher than exposure related to non-CTO interventions. These data also highlighted wide disparities between centers.

Published
2021

14. [Focus on high speed rotational atherectomy by Rotablator in 2021 and datas from France PCI registry]

Author

Dr Gabriel, Seret, Dr Matthieu, Perier, Dr Thierry, Corcos, Pr Denis, Angoulvant, Dr Marie Pascale, Decomis, Dr Pierre, Marcollet, Dr Nicolas, Combaret, Dr Stephan, Chassaing, Dr Christophe, Thuaire, Dr Matthieu, Godin, Dr Olivier, Fichaux, Pr Farzin, Beygui, Dr Louis, Viallard, Dr Sofiène Daniel, Gafsi, Dr P-F, Lesault, Pr Éric, Durand, Dr Emmanuel, Boiffard, Pr Pascal, Motreff, Dr Grégoire, Rangé, and Dr Hakim, Benamer

Subjects
Atherectomy, Coronary, Percutaneous Coronary Intervention, Treatment Outcome, SARS-CoV-2, COVID-19, Humans, Coronary Artery Disease, Registries, Coronary Angiography
Abstract

Developed in the late 1980s, rotational atherectomy has raised a lot of hope for its innovative principle of selective ablation, allowing volume reduction (instead of redistribution) of atherosclerotic plaque, while sparing healthy tissue. Long shunned for its disappointing results on restenosis, the Rotablator finally reasserted itself in the 2000s; era of drug eluting stents and coronary angioplasty boom, thus generating emergence of complex lesions. Indeed, the Rotablator has demonstrated an undeniable benefit in complex (type C) and calcified lesions preparation (before stenting), with a procedural success rate of 95%. Although these lesions only represent a small amount (2-3%) of percutaneous coronary interventions (PCI), they remain a technical impasse for plain-old balloon angioplasty strategy, making the Rotablator more suitable for these resistant lesions' treatment. Registry data attest the safety of this therapy, with a rate of peri-procedural complications and in-hospital mortality comparable to conventional angioplasty (France PCI register). However, certain specific, rare but serious complications (burr entrapment, broken Rotawire, coronary perforation) justify trained teams, perfect knowledge of the equipment, and strict compliance with good practice guidelines. In 2018, the rise of a new method of atherectomy by intra-vascular lithotripsy (Shockwave) has coincided with Rotablator decreasing activity (this finding being biased by a general decrease in PCI activity due to Covid pandemic). This therapeutic range's enhancement revolutionizes calcified lesions treatment, tending towards precise targeting of each indication, depending in particular on calcium distribution's anatomy in the plaque.

Published
2021

15. Optical coherence tomography to guide percutaneous coronary intervention of the left main coronary artery: the LEMON study

Author

Christophe Caussin, Nicolas Meneveau, Radwane Hakim, Mohamed Mehdi Boussaada, Thierry Lefèvre, Géraud Souteyrand, Matthieu Godin, Pascal Motreff, Guillaume Cayla, Nicolas Amabile, Frederic Casassus, Imane Bagdadi, Grégoire Rangé, Institut Mutualiste de Montsouris (IMM), Hôpitaux de Chartres [Chartres], CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, Clinique St Hilaire ( Service de Cardiologie, Rouen), Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( EA 3920) (PCVP / CARDIO), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Clinique Saint Augustin, Institut Cardiovasculaire Paris Sud, and Centre Jacques Cartier

Subjects
medicine.medical_specialty, medicine.medical_treatment, MESH: Ultrasonography, Interventional, 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, Angioplasty, Intravascular ultrasound, medicine, Clinical endpoint, MESH: Coronary Vessels, 030212 general & internal medicine, cardiovascular diseases, MESH: Coronary Artery Disease, MESH: Treatment Outcome, MESH: Aged, MESH: Humans, medicine.diagnostic_test, business.industry, Percutaneous coronary intervention, Stent, medicine.disease, MESH: Pilot Projects, MESH: Coronary Angiography, MESH: Male, MESH: Prospective Studies, 3. Good health, Stenosis, MESH: Stents, MESH: Tomography, Optical Coherence, surgical procedures, operative, Conventional PCI, Radiology, Cardiology and Cardiovascular Medicine, business, MESH: Female, MESH: Percutaneous Coronary Intervention, TIMI
Abstract

International audience; Background: Intravascular ultrasound (IVUS)-guided PCI improves the prognosis of left main stem (LMS) PCI and is currently recommended by international guidelines. Although OCT resolution is greater than that of IVUS, this tool is not yet recommended in LMS angioplasty due to the absence of data.Aims: This pilot study aimed to analyse the feasibility, safety and impact of OCT-guided LMS PCI.Methods: This prospective, multicentre trial investigated whether patients might benefit from OCT-guided PCI for mid/distal LMS according to a pre-specified protocol. The primary endpoint was procedural success defined as follows: residual angiographic stenosis

Published
2021

16. 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

17. SCA sans sus ST chez le nonagénaire : expérience du CRAC

Author

P. Dequenne, Grégoire Rangé, Christophe Thuaire, Stephan Chassaing, J. Akkoyun-Farinez, Pierre Marcollet, C. Saint-Etienne, C. Laure, P. Motreff, R. Hakim, and S. Gautier

Subjects
Gynecology, 03 medical and health sciences, medicine.medical_specialty, 0302 clinical medicine, business.industry, medicine, 030212 general & internal medicine, 030204 cardiovascular system & hematology, Cardiology and Cardiovascular Medicine, business
Abstract

Resume Objectif Evaluer les caracteristiques des patients nonagenaires presentant un SCA ST− a troponine positive et beneficiant d’une coronarographie. Methode Les patients inclus entre 2014 et 2017 dans le registre multicentrique de cardiologie interventionnelle « CRAC » et presentant un SCA ST− a troponine positive ont ete separe en 2 groupes : moins de 90 ans et plus de 90 ans. Ces 2 groupes ont ete compares en analyse bi-variee sur les donnees epidemiologiques, cliniques et procedurales pour l’ensemble de la periode d’inclusion et sur les donnees de suivi uniquement pour la periode de 2014–2015. Resultats Du 1er janvier 2014 au 31 decembre 2017, 5964 patients presentant un SCA sans sus ST a troponine positive dont 133 nonagenaires (2,2 %) ont ete inclus. Le sexe feminin, le faible poids, l’hypertension arterielle, le statut non fumeur et l’antecedent d’angioplastie coronaire etaient plus frequents chez les nonagenaires. Ces patients etaient egalement d’avantage pluritronculaires ou porteurs de lesion du tronc commun et l’implantation de stents nus y etait majoritaire en 2014–2015 (53 %) puis devenue marginale en 2016–2017 (16,3 %). En association avec l’Aspirine, le Clopidogrel etait l’antiagregant plaquettaire le plus utilise apres angioplastie coronaire chez le sujet tres âge (90,3 % versus 38,5 % ; p Conclusion Les nonagenaires presentant un SCA sans sus ST a troponine positive et ayant beneficie d’une coronarographie, bien qu’ayant une coronaropathie plus severe et un pronostic a 1 an beaucoup plus grave, beneficient moins souvent de stents actifs ou des nouveaux P2Y12 que ceux de moins de 90 ans.

Published
2018

18. Current indications for the intra-aortic balloon pump: The CP-GARO registry

Author

Denis Angoulvant, Hervé Le Breton, Régis Delaunay, Marc Bedossa, Dominique Boulmier, Grégoire Rangé, Benoit Helleu, Vincent Letocart, Vincent Auffret, Philippe Commeau, Rémi Sabatier, Fabrice Prunier, Martine Gilard, Emmanuelle Filippi, Guillaume Leurent, Stephan Chassaing, 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), Service de cardiologie et maladies vasculaires [Rennes] = Cardiac, Thoracic, and Vascular Surgery [Rennes], CHU Pontchaillou [Rennes], Optimisation des régulations physiologiques (ORPHY (EA 4324)), Université de Brest (UBO)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO), Centre hospitalier universitaire de Nantes (CHU Nantes), Clinique Saint Gatien, Cellules Dendritiques, Immunomodulation et Greffes, Université de Tours (UT), Polyclinique Les Fleurs, Service de cardiologie [Chartres], Les hôpitaux de Chartres [Chartres], Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC), Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Biologie Neurovasculaire et Mitochondriale Intégrée (BNMI), Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université d'Angers (UA), CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Centre hospitalier de Vannes, Centre hospitalier Saint-Brieuc, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), and MitoVasc - Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC)

Subjects
Male, Registry, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Shock, Cardiogenic, Hemodynamics, 030204 cardiovascular system & hematology, Balloon, Revascularization, law.invention, 03 medical and health sciences, 0302 clinical medicine, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Randomized controlled trial, Risk Factors, law, medicine, Humans, Hospital Mortality, Prospective Studies, Registries, 030212 general & internal medicine, Cardiogenic shock, Aged, Intra-aortic balloon pump, Intra-Aortic Balloon Pumping, business.industry, Mortality rate, Assistance circulatoire, Recovery of Function, General Medicine, Middle Aged, medicine.disease, 3. Good health, Surgery, Treatment Outcome, Registre, Etiology, Circulatory assistance, Female, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Cardiology and Cardiovascular Medicine, business, Contre-pulsion par ballonnet intra-aortique, Choc cardiogénique
Abstract

Summary Background Intra-aortic balloon pumps (IABPs) have been used routinely since the 1970s. Recently, large randomized trials failed to show that IABP therapy has meaningful benefit, and international recommendations downgraded its place, particularly in cardiogenic shock. Aims The aim of this registry was to describe the contemporary use of IABP therapy, in light of these new data. Methods This prospective multicentre registry included 172 patients implanted with an IABP in 19 French cardiac centres in 2015. Baseline characteristics, aetiologies leading to IABP use, and IABP-related and disease-related complications were assessed. In-hospital and 1-year mortality rates were studied. Results A total of 172 patients were included (mean age 65.5 ± 12.0 years; 118 men [68.6%]). The reasons for IABP implantation were mainly haemodynamic (n = 107; 62.2%), followed by bridge to revascularization (n = 34; 19.8%) and four other “rare” aetiologies (n = 29 patients; 16.8%). In-hospital and 1-year mortality rates were 40.7% and 45.8%, respectively. Fourteen patients (8.1%) experienced ischaemic or haemorrhagic complications, which were directly related to the IABP in seven patients (4.1%). Conclusions Despite current international guidelines regarding the place of IABPs in ischaemic cardiogenic shock without mechanical complications, this aetiology remains the leading cause for its utilization in the contemporary era.

Published
2018

19. Does helicopter transport delay prehospital transfer for STEMI patients in rural areas? Findings from the CRAC France PCI registry

Author

Christophe Saint Etienne, Pascal Motreff, Leslie Grammatico-Guillon, L. Godillon, R. Hakim, Wael Yafi, Julie Akkoyun-Farinez, Stephan Chassaing, Sandra Gautier, Pierre Marcollet, Christophe Laure, Marie Pascale Decomis, Grégoire Rangé, Denis Angoulvant, René Koning, Eric Revue, and Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)

Subjects
Male, Patient Transfer, Rural Population, medicine.medical_specialty, Emergency Medical Services, Time Factors, Aircraft, medicine.medical_treatment, [SDV]Life Sciences [q-bio], 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, Time-to-Treatment, 03 medical and health sciences, Electrocardiography, 0302 clinical medicine, Percutaneous Coronary Intervention, Risk Factors, medicine, Humans, Myocardial infarction, Symptom onset, Prospective Studies, Registries, Emergency medical system, business.industry, Percutaneous coronary intervention, 030208 emergency & critical care medicine, General Medicine, Middle Aged, medicine.disease, 3. Good health, Survival Rate, Conventional PCI, Emergency medicine, ST Elevation Myocardial Infarction, Female, France, Transport delay, Rural area, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract

Aims: The aim of this study was to analyse delays in emergency medical system transfer of ST-segment elevation myocardial infarction (STEMI) patients to percutaneous coronary intervention (PCI) centres according to transport modality in a rural French region. Methods and results: Data from the prospective multicentre CRAC / France PCI registry were analysed for 1911 STEMI patients: 410 transferred by helicopter and 1501 by ground transport. The primary endpoint was the percentage of transfers with first medical contact to primary percutaneous coronary intervention within the 90 minutes recommended in guidelines. The secondary endpoint was time of first medical contact to primary percutaneous coronary intervention. With helicopter transport, time of first medical contact to primary percutaneous coronary intervention in under 90 minutes was less frequently achieved than with ground transport (9.8% vs. 37.2%; odds ratio 5.49; 95% confidence interval 3.90; 7.73; P Conclusions: Helicopter transport of STEMI patients was five times less effective than ground transport in maintaining the 90-minute first medical contact to primary percutaneous coronary intervention time recommended in guidelines, particularly for transfer distances less than 50 km.

Published
2020

20. COVID-19 et SCA ST+

Author

Pascal Motreff, Grégoire Rangé, and R. Hakim

Subjects
Excess mortality, medicine.medical_specialty, Public information, Coronavirus disease 2019 (COVID-19), business.industry, Ischemic time, 030204 cardiovascular system & hematology, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, Pandemic, Emergency medicine, Conventional PCI, Medicine, In patient, cardiovascular diseases, Myocardial infarction, business, Cardiology and Cardiovascular Medicine
Abstract

The COVID-19 pandemic had an unexpected impact on cardiovascular emergencies, particularly STEMI. The France PCI registry and other studies around the world have highlighted a significant decrease in myocardial infarctions arriving at hospital. This decrease is mainly related to patients' fear of coming to the hospital and being contaminated. Although the STEMI revascularisation time targets (

Published
2020
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21. INCREASED EXPOSURE TO X-RAYS DURING CORONARY ANGIOGRAPHY AND PERCUTANEOUS CORONARY INTERVENTIONS ASSOCIATED WITH FRACTIONAL FLOW RESERVE MEASUREMENT AND ENDOCORONARY IMAGING TECHNIQUES

Author

Olivier Bar, Grégoire Rangé, Ronan Deballon, Pierre Marcollet, Denis Angoulvant, Jean-Louis Georges, Franck Albert, Olivier Fichaux, Reda Bensaid, and Stephan Chassaing

Subjects
Coronary angiography, medicine.medical_specialty, Percutaneous, Fractional flow reserve, Coronary Artery Disease, 030204 cardiovascular system & hematology, Coronary Angiography, 03 medical and health sciences, 0302 clinical medicine, Percutaneous Coronary Intervention, Optical coherence tomography, Internal medicine, Intravascular ultrasound, medicine, Fluoroscopy, Humans, Radiology, Nuclear Medicine and imaging, 030212 general & internal medicine, Prospective Studies, Retrospective Studies, Radiation, Radiological and Ultrasound Technology, medicine.diagnostic_test, Multivariable linear regression, business.industry, X-Rays, Public Health, Environmental and Occupational Health, General Medicine, Fractional Flow Reserve, Myocardial, Treatment Outcome, Conventional PCI, Cardiology, France, business
Abstract

Growing use of fractional flow reserve (FFR) and intracoronary imaging techniques by optical coherence tomography or intravascular ultrasound has raised concerns about additional exposure during coronary angiography and percutaneous coronary interventions (PCIs). Using data from the prospective CRAC-France PCI Prospective Multicentre registry, we sought to evaluate the effect of these new techniques on the radiation dose to patients undergoing coronary procedures. Data on Kerma Area Product (PKA), total air kerma (KAr) and fluoroscopy time from 42 182 coronary procedures were retrospectively compared, using multivariable linear regression, according to whether they included FFR and intracoronary imaging. In coronary angiography, FFR was associated with longer fluoroscopy time and higher PKA (21.0 vs. 18.9 Gy.cm2) and KAr (372 vs. 299 mGy) (all p

Published
2020

22. Clinical impact of FFR-guided PCI compared to angio-guided PCI from the France PCI registry

Author

Grégoire Rangé, Julien Adjedj, Stephan Chassaing, Pierre Marcollet, Jean-Francois Morelle, Christophe Saint Etienne, Pascal Motreff, René Koning, Olivier Fichaux, and Marie Pascale Decomis

Subjects
medicine.medical_specialty, medicine.medical_treatment, Fractional flow reserve, Coronary Artery Disease, Coronary Angiography, Percutaneous Coronary Intervention, Internal medicine, medicine, Clinical endpoint, Humans, Radiology, Nuclear Medicine and imaging, cardiovascular diseases, Myocardial infarction, Registries, Stroke, business.industry, Hazard ratio, Coronary Stenosis, Percutaneous coronary intervention, General Medicine, medicine.disease, Fractional Flow Reserve, Myocardial, Treatment Outcome, Conventional PCI, Cardiology, business, Cardiology and Cardiovascular Medicine, Mace
Abstract

Background: Fractional Flow Reserve (FFR) has become the invasive gold standard to quantify myocardial ischemia generated by a coronary stenosis in patients with chronic coronary syndrome, but in clinical practice it is still underutilised to guide percutaneous coronary intervention (PCI) compared to angiography (angio). Methods: We sought to compare, in a national French registry (France PCI), the clinical impact of FFR-guided PCI compared with angio-guided PCI at one year. We extracted from the France PCI database all chronic coronary syndrome patients treated with PCI for coronary stenosis

Published
2022

23. Coronary events before and after Lubrizol factory fire in Rouen: A retrospective study from the France-PCI registry

Author

R. Koning, J. Hohweyer, Grégoire Rangé, P-F. Lesault, Hélène Eltchaninoff, T. Levesque, P. Bonnet, Pascal Motreff, and Eric Durand

Subjects
medicine.medical_specialty, education.field_of_study, Ambient air pollution, business.industry, Incidence (epidemiology), Population, Retrospective cohort study, Smoke plume, Conventional PCI, Emergency medicine, Medicine, Cardiology and Cardiovascular Medicine, business, education
Abstract

Introduction On September 26, 2019, a fire took place in the Lubrizol factory in Rouen, exposing the population to inhalation of many volatile toxic agents, including carbon monoxide or other toxic agents secondary to combustion. It has been previously demonstrated that long-term exposure to ambient air pollution is associated with increased incidence of coronary events. Objective The objective of this study was to assess the impact of the Lubrizol factory fire on the incidence of coronary events. Method All of the coronary angiograms performed in Rouen and Le Havre, from 05/01/2019 to 12/31/2019 were collected from the prospective FRANCE-PCI registry. The number of coronary events over time was analyzed in Rouen and in a region not exposed to fire (Le Havre). To study the impact of the fire on coronary events, a before/after fire and here/elsewhere analysis was carried out. Home postal codes of patients were also captured, which made it possible to specify the analysis in the Rouen region according to the fallout from the smoke plume. Results A significant increase in overall coronary syndromes was observed in Rouen after the fire [67.5 (63.2;78.5) events per week after vs. 61.5 (58;64) before, P = 0.03]. The increase in events mainly concerned acute coronary syndromes [41.0 (39;45.75) events per week after vs. 37.0 (32.5;44.5) before, P = 0.09] and the peak of occurrence was observed one month after the fire. In contrast, there was no significant variation in Le Havre [33.0 (27.0;36.5) events per week after vs. 30.0 (25.0;33.5) before; P = 0.28]. Interestingly, through analysis of postal codes, we were able to demonstrate that the increase in coronary events in Rouen was greater in the most exposed areas ( Fig. 1 ). Conclusion Our results suggest a delayed increase in coronary events, especially acute ones, after the Lubrizol factory fire in Rouen. Further studies are needed to assess the long-term effect and verify the absence of potential confounding factors.

Published
2021

24. Use and outcomes of the PK Papyrus covered stent in France: SOS PK Papyrus Registry

Author

Fabiel de Poli, Grégoire Rangé, Hende Madiot, Gilles Zemour, Mohamed Abdellaoui, Christophe Piot, Géraud Souteyrand, Jean Armengaud, Benoit Lattuca, Sébastien Levesque, Hakim Benamer, Stéphanie Marlière, E. Boiffard, Richard Gervasoni, Edouard Gerbaud, Max Carre, Loic Belle, Ziad Boueri, Marco Hernández-Enríquez, Philippe Commeau, Nicolas Delarche, Nicolas Boudou, Nicolas Lhoest, Michel Pansieri, Hospital Universitario Quironsalud, Hôpital de Rangueil, CHU Toulouse [Toulouse], Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois], Centre Hospitalier Henri Duffaut (Avignon), CHU Clermont-Ferrand, Centre hospitalier de Haguenau, Clinique du Millénaire - Oc Santé [Montpellier], Oc Santé [Montpellier], Centre Hospitalier de Bastia (G2HC), CHU Bordeaux [Bordeaux], Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon, Hôpital Privé Jacques Cartier [Massy], Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Polyclinique des fleurs, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Hôpitaux de Chartres [Chartres], Cabinet de Cardiologie Foetale Pediatrique et Congenitale Adulte et Groupement d'Exploration Radiologique et Cardiovasculaire, Clinique de l'Orangerie, 67000 Strasbourg, CHU Grenoble, Groupe Hospitalier Mutualiste [Grenoble] (GHM), CHU de Pau, Centre Hospitalier de Cannes, Centre Hospitalier Agen-Nérac, Centre Hospitalier d'Auxerre, and Centre hospitalier universitaire de Poitiers (CHU Poitiers)

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Outcomes, 030204 cardiovascular system & hematology, Prosthesis Design, Covered stent, Coronary Restenosis, 03 medical and health sciences, 0302 clinical medicine, Percutaneous Coronary Intervention, Restenosis, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, medicine, Clinical endpoint, Humans, Radiology, Nuclear Medicine and imaging, 030212 general & internal medicine, Myocardial infarction, Coronary perforation, Prospective Studies, Registries, Prospective cohort study, Coronary Artery Perforation, Aged, Retrospective Studies, Papyrus, Aged, 80 and over, business.industry, Stent, Coronary aneurysm, General Medicine, Middle Aged, medicine.disease, 3. Good health, Surgery, medicine.anatomical_structure, Treatment Outcome, Female, Stents, Cardiology and Cardiovascular Medicine, business, Artery
Abstract

International audience; Objectives: To evaluate the rate of procedural success and long-term outcomes of the PK Papyrus (PKP) covered stent (CS).Background: CS are essential in the treatment of coronary artery perforation (CAP). They have also been used to treat coronary artery aneurysms. Limited evidence is available on clinical outcomes with the PKP.Methods: This was a multicenter, observational, retrospective, and prospective study. Consecutive patients undergoing intentional PKP implantation in 22 centers in France were included. The primary endpoint was the rate of procedural success. Secondary endpoints included rates of death, myocardial infarction (MI), target lesion revascularization (TLR), in-stent restenosis (ISR), and stent thrombosis (ST).Results: Data from 130 patients were analyzed (mean age 72.5 ± 10.5 years; 71% men). The main indication for PKP was CAP, in 84 patients (65%). Delivery success was achieved in 95% and procedural success in 91%. During the in-hospital stay, 15 patients died (12%) and 7 (5%) presented with ST. Data from 127 patients were available at 19.2 ± 12.8 month follow-up. Thirty-three patients died (26%), 15 (12%) had an MI and 21 (17%) presented with TLR. TLR was due to ISR in 12 patients (9%), 10 had definite ST (8%) and 1 patient for stent under-expansion.Conclusions: The principal indication for PKP was CAP. PKP had high rates of delivery and procedural success. At long-term follow-up, there was a high rate of TLR, mainly due to ISR and ST. These results are consistent with previously reported data in these clinical settings.

Published
2020

25. 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

26. TicagRelor Or Clopidogrel in severe or terminal chronic kidney patients Undergoing PERcutaneous coronary intervention for acute coronary syndrome: The TROUPER trial

Author

Laurent Bonello, Gonzalo Quaino, Mathieu Pankert, Matthias Canault, Franck Paganelli, Marc Laine, Grégoire Rangé, Guillaume Cayla, Stéphane Burtey, Gilles Lemesle, Etienne Puymirat, 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), Service de cardiologie [Hôpital Nord - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Les hôpitaux de Chartres [Chartres], Centre Hospitalier de toulon, Centre Hospitalier Henri Duffaut (Avignon), 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), and CCSD, Accord Elsevier

Subjects
Male, Ticagrelor, EVIDENCE-BASED THERAPIES, IMPACT, medicine.medical_treatment, [SDV]Life Sciences [q-bio], 030204 cardiovascular system & hematology, 0302 clinical medicine, Secondary Prevention, ARTERY-DISEASE, 030212 general & internal medicine, Myocardial infarction, TREATMENT PLATELET REACTIVITY, OUTCOMES, Maintenance dose, Middle Aged, Clopidogrel, 3. Good health, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, [SDV] Life Sciences [q-bio], Female, REVASCULARIZATION, Cardiology and Cardiovascular Medicine, medicine.drug, Adult, Acute coronary syndrome, medicine.medical_specialty, RENAL-FUNCTION, Adolescent, Hemorrhage, Loading dose, 03 medical and health sciences, Young Adult, Percutaneous Coronary Intervention, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, RISK-FACTOR, Internal medicine, medicine, Humans, Acute Coronary Syndrome, Renal Insufficiency, Chronic, Aged, business.industry, ELEVATION MYOCARDIAL-INFARCTION, Percutaneous coronary intervention, Thrombosis, DIABETES-MELLITUS, medicine.disease, business, Platelet Aggregation Inhibitors, Kidney disease
Abstract

International audience; Chronic kidney disease (CKD) is associated with an increased risk of acute coronary syndrome (ACS) and cardiovascular death. CKD patients suffering from ACS are exposed to an increased risk of thrombotic recurrences and a higher bleeding rate than patients with normal renal function. However, CKD patients are excluded or underrepresented in clinical trials. Therefore, determining the optimal antiplatelet strategy in this population is of utmost importance. We designed the TicagRelor Or Clopidogrel in severe or terminal chronic kidney patients Undergoing PERcutaneous coronary intervention for acute coronary syndrome (TROUPER) trial: a prospective, controlled, multicenter, randomized trial to investigate the optimal P2Y12 antagonist in CKD patients with ACS. Patients with stage >= 3b CKD are eligible if the diagnosis of ACS is made and invasive strategy scheduled. Patients are randomized 1:1 between a control group with a 600-mg loading dose of clopidogrel followed by a 75-mg/d maintenance dose for 1 year and an experimental group with a 180-mg loading dose of ticagrelor followed by a 90-mg twice daily maintenance dose for the same duration. The primary end point is defined by the rate of major adverse cardiovascular events, including death, myocardial infarction, urgent revascularization, and stroke at 1 year. Safety will be evaluated by the bleeding rate (Bleeding Academic Research Consortium). To demonstrate the superiority of ticagrelor on major adverse cardiovascular events, we calculated that 508 patients are required. The aim of the TROUPER trial is to compare the efficacy of ticagrelor and clopidogrel in stage >3b CKD patients presenting with ACS and scheduled for an invasive strategy.

Published
2020

27. Where have the ST-segment elevation myocardial infarctions gone during COVID-19 lockdown?

Author

Pascal Motreff, R. Hakim, and Grégoire Rangé

Subjects
medicine.medical_specialty, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Pneumonia, Viral, 030204 cardiovascular system & hematology, 03 medical and health sciences, Betacoronavirus, 0302 clinical medicine, Internal medicine, Correspondence, Medicine, ST segment, Humans, 030212 general & internal medicine, Registries, Quality of care, Pandemics, business.industry, SARS-CoV-2, Health Policy, COVID-19, Hospitalization, Cardiology, ST Elevation Myocardial Infarction, France, business, Coronavirus Infections, Emergency Service, Hospital, Cardiology and Cardiovascular Medicine, Facilities and Services Utilization
Abstract

Gregoire Range, MD, Radwan Hakim, MD, Pascal Motreff, MD, PhD; Where have the STEMIs gone during COVID-19 lockdown?, European Heart Journal - Quality of Care a

Published
2020
Full Text
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28. National French Registry of Spontaneous Coronary Artery Dissections: Prevalence of Fibromuscular Dysplasia and Genetic Analyses

Author

Nabila Bouatia-Naji, Géraud Souteyrand, Pascal Motreff, Brahim Harbaoui, Lucie Cassagnes, Sara Bouajila, Grégoire Rangé, Nicolas Meneveau, François Derimay, Takiy Berrandou, Edouard Gerbaud, Benoit Lattuca, Nicolas Combaret, Institut Pascal (IP), SIGMA Clermont (SIGMA Clermont)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Centre National de la Recherche Scientifique (CNRS), Département de cardiologie, CHU Bordeaux [Bordeaux]-Hôpital Haut-Lévêque [CHU Bordeaux], CHU Bordeaux [Bordeaux], Centre de recherche Cardio-Thoracique de Bordeaux [Bordeaux] (CRCTB), Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Institut National de la Santé et de la Recherche Médicale (INSERM), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Image Science for Interventional Techniques (ISIT), Université d'Auvergne - Clermont-Ferrand I (UdA)-Centre National de la Recherche Scientifique (CNRS)-Clermont Université, Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), 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), Hôpitaux de Chartres [Chartres], Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( EA 3920) (PCVP / CARDIO), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL), Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Université de Montpellier (UM), Collaborators: Céline Lambert, Christian Spaulding, Hakim Benamer, Xavier Jeunemaitre, Adrien Georges, Didier Bresson, Lionel Mangin, CarMeN, laboratoire, Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Université d'Auvergne - Clermont-Ferrand I (UdA)-Clermont Université-Centre National de la Recherche Scientifique (CNRS), 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 Paris Cité (UPCité), Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( UR 3920) (PCVP / CARDIO), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)

Subjects
medicine.medical_specialty, Coronary Vessel Anomalies, [SDV]Life Sciences [q-bio], Population, Fibromuscular dysplasia, 030204 cardiovascular system & hematology, Coronary Angiography, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Prevalence, medicine, Fibromuscular Dysplasia, Humans, Registries, Vascular Diseases, 030212 general & internal medicine, education, Letter to the Editor, Retrospective Studies, Genetic association, education.field_of_study, business.industry, Dissection, Odds ratio, Middle Aged, medicine.disease, Coronary Vessels, 3. Good health, [SDV] Life Sciences [q-bio], Cohort, Etiology, Female, Cardiology and Cardiovascular Medicine, Scad, business, Mace
Abstract

BACKGROUND Spontaneous coronary artery dissection (SCAD) is an increasingly reported but poorly understood condition. Few European data are available. AIMS The aims of this study were to obtain European data on SCAD, determine the prevalence of fibromuscular dysplasia (FMD) and enable genetic analyses in this population. METHODS Data from a national French registry of SCAD cases were analysed prospectively and retrospectively. Clinical and angiographic data and management strategy were collected. Major adverse cardiovascular events (MACE) were analysed after one year of follow-up. Subjects were screened for FMD and blood was collected for DNA extraction. RESULTS From June 2016 to August 2018, 373 SCAD cases were confirmed by the core lab. Mean age was 51.5 years. Patients were mostly women (90.6%) and 54.7% of cases had less than two cardiovascular risk factors. At one year, 295 patients (79.1%) were treated conservatively, the MACE rate was 12.3%, and there were no cases of mortality. The recurrence rate of SCAD was 3.3%. FMD was found at ≥1 arterial site in 45.0% of cases. We also confirmed the genetic association between the PHACTR1 locus and SCAD (odds ratio=1.66, p=7.08×10-8). CONCLUSIONS Here we describe the DISCO registry, the largest European SCAD cohort where FMD was found in 45% of cases and the genetic association with PHACTR1 was confirmed. This nationwide cohort is a valuable resource for future clinical and genetic investigation to understand SCAD aetiology.

Published
2020

29. Ticagrelor versus clopidogrel in elective percutaneous coronary intervention (ALPHEUS): a randomised, open-label, phase 3b trial

Author

Johanne Silvain, Benoit Lattuca, Farzin Beygui, Grégoire Rangé, Zuzana Motovska, Jean-Guillaume Dillinger, Ziad Boueri, Philippe Brunel, Thibault Lhermusier, Christophe Pouillot, Elisa Larrieu-Ardilouze, Franck Boccara, Jean-Noël Labeque, Paul Guedeney, Mohamad El Kasty, Mikael Laredo, Raphaëlle Dumaine, Grégory Ducrocq, Jean-Philippe Collet, Guillaume Cayla, Katrien Blanchart, Petr Kala, Eric Vicaut, Gilles Montalescot, Johanne SILVAIN, Jean-Philippe COLLET, Gilles MONTALESCOT, Mathieu KERNEIS, Nassim BRAIK, Olivier BARTHELEMY, Gérard HELFT, Claude LEFEUVRE, Rémi CHOUSSAT, Marie HAUGUEL, Michel ZEITOUNI, Thomas CUISSET, Jean-Louis BONNET, Pierre DEHARO, Benoit LATTUCA, Guillaume CAYLA, Luc CORNILLET, Bertrand LEDERMANN, Clément LONJON, Laurent SCHMUTZ, Grégoire RANGE, Franck ALBERT, Thibault DEMICHELI, Laurent ROUSSEL, Reda BENSAID, Christophe THUAIRE, Jean-Guillaume DILLINGER, Patrick HENRY, Stéphane MANZO-SILBERMAN, Georgios SIDERIS, Damien LOGEART, Vincent SPAGNOLI, Léa CACOUB, Christophe POUILLOT, Jean Richard VI-FANE, Jens GLASENAPP, Karim BOUGRINI, Nicolas COMBARET, Pascal MOTREFF, Géraud SOUTEYRAND, Aimé AMONCHOT, Thomas MOUYEN, Thibault LHERMUSIER, Didier CARRIE, Frédéric BOUISSET, Thomas CHOLLET, Francisco CAMPELO-PARADA, Nicolas DELARCHE, François SCHIELE, Mathieu BESUTTI, Marie HAUGUEL-MOREAU, Rami EL MAHMOUD, Christophe CAUSSIN, Mami ZOHEIR, Aurelie VEUGEOIS, Alain DIBIE, Olivier VARENNE, Fabien PICARD, Alexandre LAFONT, Julien ADJEDJ, Philippe DEGRELL, Farzin BEYGUI, Rémi SABATIER, Vincent ROULE, Mathieux BIGNON, Katrien BLANCHART, Pierre ARDOUIN, Adrien LEMAITRE, Clément BRIET, Ziad BOUERI, Pascal GOUBE, Pierre COSTE, Laura CETRAN, Jérôme CLERC, Hervé LE BRETON, Dominique BOULMIER, Vincent AUFFRET, Jean-Noël LABEQUE, Jean-Luc BONAS, Jean-Louis GEORGES, Bernard LIVAREK, Elodie BLICQ, Nicolas BARON, Géraldine GIBAULT-GENTY, Yves COTTIN, Isabelle LHUILLIER, Carole RICHARD, Luc LORGIS, Philippe BUFFET, Christian SPAULDING, Nicole KARAM, Etienne PUYMIRAT, Marco MENNUNI, Emmanuel POULIDAKIS, Lionel BONNEVIE, Franck BOCCARA, Marion CHAUVET, Laurie DUFOUR, Yann ANCEDY, Stéphane EDERHY, Arnaud ETIENNEY, Anne BELLEMAIN-APPAIX, Nathaniel BITTON, Laurent JACQ, Christophe SAINT-ETIENNE, Florence LECLERCQ, François ROUBILLE, Gilles RIOUFOL, François DERIMAY, Marc GORALSKI, Wael YAFI, Emmanuelle FILIPPI, Alain KERMARREC, Christophe LE RAY, Antoine MERLET, Aurelie LOIRAT, Philippe BRUNEL, Damien BRUNET, Jack RAVISY, Laurent MOCK, Guillaume MOLINS, Max CARRE, Erwan BRESSOLLETTE, Luc CHRISTIAENS, Elisa LARRIEU-ARDILOUZE, Romain CADOR CADOR, Eric VAN BELLE, Gilles LEMESLE, Cédric DELHAYE, Flavien VINCENT, Sina POROUCHANI, Hugues SPILLEMAEKER, Katy PETIT, Olivier RESSENCOURT, Vincent HUMEAU, François JOURDA, Marc-Antoine ARNOULD, Stephen CHASSAING, Karl ISAAZ, Laurent PAYOT, Jacques MONTSEGU, Benjamin FAURIE, Michel PANSIERI, Marc METGE, Karim MOUSSA, Mathieu PANKERT, Olivier MOREL, Sébastien HESS, Luc MAILLARD, Thibault MANIGOLD, Vincent LETOCART, Julien PLESSIS, Pauline BERTHOME, Mickael BONIN, François HUCHET, Emmanuel TEIGER, Romain GALLET, Gauthier MOUILLET, Madjid BOUKANTAR, Mohammed NEJJARI, David ATTIAS, Mathieu STEINECKER, Zuzana MOTOVSKA, Martin KOZEL, Zdenko STELMACH, Ota HLINOMAZ, Michal REZEK, Martin NOVAK, Jan SITAR, Jiri SEMENKA, Petr KALA, Otakar BOCEK, Roman ŠTIPAL, Martin POLOCZEK, Jan KANOVSKÝ, Petr JERABEK, Jiří KARASEK, Sylvie HRUSKOVA, Marian BRANNY, Jan MROZEK, Tomas GREZL, Leos PLEVA, Pavel KUKLA, Martin PORZER, Lesnik, Philippe, 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), 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), Hôpital Louis Pasteur [Chartres], Charles University [Prague] (CU), 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 (UPCité)-Université Sorbonne Paris Nord, Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier de Bastia (G2HC), Service de Cardiologie [Hôpital privé Dijon Bourgogne], Hôpital privé Dijon Bourgogne, Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Clinique Sainte Clotilde, Centre hospitalier universitaire de Poitiers (CHU Poitiers), Service de Cardiologie [CHU Saint-Antoine], CHU Saint-Antoine [AP-HP], 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), Le CHCB, Centre Hospitalier de la Côte Basque, Grand Hôpital de l'Est Francilien (GHEF), Centre de Réadaptation Cardiaque Les Grands Prés [Villeneuve Saint Denis] (CRCLGP), Service de cardiologie [CHU Bichat], 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)-Université Paris Diderot, Sorbonne Paris Cité, CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), University Hospital Brno, Masaryk University [Brno] (MUNI), Hopital Saint-Louis [AP-HP] (AP-HP), Erasmus University Medical Center [Rotterdam] (Erasmus MC), ALPHEUS investigators: Johanne Silvain, Jean-Philippe Collet, Gilles Montalescot, Mathieu Kerneis, Nassim Braik, Olivier Barthelemy, Gérard Helft, Claude Lefeuvre, Rémi Choussat, Marie Hauguel, Michel Zeitouni, Thomas Cuisset, Jean-Louis Bonnet, Pierre Deharo, Benoit Lattuca, Guillaume Cayla, Luc Cornillet, Bertrand Ledermann, Clément Lonjon, Laurent Schmutz, Grégoire Range, Franck Albert, Thibault Demicheli, Laurent Roussel, Reda Bensaid, Christophe Thuaire, Jean-Guillaume Dillinger, Patrick Henry, Stéphane Manzo-Silberman, Georgios Sideris, Damien Logeart, Vincent Spagnoli, Léa Cacoub, Christophe Pouillot, Jean Richard Vi-Fane, Jens Glasenapp, Karim Bougrini, Nicolas Combaret, Pascal Motreff, Géraud Souteyrand, Aimé Amonchot, Thomas Mouyen, Thibault Lhermusier, Didier Carrie, Frédéric Bouisset, Thomas Chollet, Francisco Campelo-Parada, Nicolas Delarche, François Schiele, Mathieu Besutti, Marie Hauguel-Moreau, Rami El Mahmoud, Christophe Caussin, Mami Zoheir, Aurelie Veugeois, Alain Dibie, Olivier Varenne, Fabien Picard, Alexandre Lafont, Julien Adjedj, Philippe Degrell, Farzin Beygui, Rémi Sabatier, Vincent Roule, Mathieux Bignon, Katrien Blanchart, Pierre Ardouin, Adrien Lemaitre, Clément Briet, Ziad Boueri, Pascal Goube, Pierre Coste, Laura Cetran, Jérôme Clerc, Hervé LE Breton, Dominique Boulmier, Vincent Auffret, Jean-Noël Labeque, Jean-Luc Bonas, Jean-Louis Georges, Bernard Livarek, Elodie Blicq, Nicolas Baron, Géraldine Gibault-Genty, Yves Cottin, Isabelle Lhuillier, Carole Richard, Luc Lorgis, Philippe Buffet, Christian Spaulding, Nicole Karam, Etienne Puymirat, Marco Mennuni, Emmanuel Poulidakis, Lionel Bonnevie, Franck Boccara, Marion Chauvet, Laurie Dufour, Yann Ancedy, Stéphane Ederhy, Arnaud Etienney, Anne Bellemain-Appaix, Nathaniel Bitton, Laurent Jacq, Christophe Saint-Etienne, Florence Leclercq, François Roubille, Gilles Rioufol, François Derimay, Marc Goralski, Wael Yafi, Emmanuelle Filippi, Alain Kermarrec, Christophe LE Ray, Antoine Merlet, Aurelie Loirat, Philippe Brunel, Damien Brunet, Jack Ravisy, Laurent Mock, Guillaume Molins, Max Carre, Erwan Bressollette, Luc Christiaens, Elisa Larrieu-Ardilouze, Romain Cador Cador, Eric VAN Belle, Gilles Lemesle, Cédric Delhaye, Flavien Vincent, Sina Porouchani, Hugues Spillemaeker, Katy Petit, Olivier Ressencourt, Max Carre, Vincent Humeau, François Jourda, Marc-Antoine Arnould, Stephen Chassaing, Karl Isaaz, Laurent Payot, Jacques Montsegu, Benjamin Faurie, Michel Pansieri, Marc Metge, Karim Moussa, Mathieu Pankert, Olivier Morel, Sébastien Hess, Luc Maillard, Thibault Manigold, Vincent Letocart, Julien Plessis, Pauline Berthome, Mickael Bonin, François Huchet, Emmanuel Teiger, Romain Gallet, Gauthier Mouillet, Madjid Boukantar, Rami El Mahmoud, Mohammed Nejjari, David Attias, Léa Cacoub, Mathieu Steinecker, François Huchet, Zuzana Motovska, Martin Kozel, Zdenko Stelmach, Ota Hlinomaz, Michal Rezek, Martin Novak, Jan Sitar, Jiri Semenka, Petr Kala, Otakar Bocek, Roman Štipal, Martin Poloczek, Jan KanovskÝ, Petr Jerabek, Jiří Karasek, Sylvie Hruskova, Marian Branny, Jan Mrozek, Tomas Grezl, Leos Pleva, Pavel Kukla, Martin Porzer., 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), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), and Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)

Subjects
Male, Ticagrelor, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Population, 030204 cardiovascular system & hematology, Coronary artery disease, 03 medical and health sciences, Percutaneous Coronary Intervention, 0302 clinical medicine, medicine, Humans, cardiovascular diseases, 030212 general & internal medicine, Myocardial infarction, education, ComputingMilieux_MISCELLANEOUS, education.field_of_study, business.industry, Percutaneous coronary intervention, General Medicine, Middle Aged, medicine.disease, Clopidogrel, 3. Good health, [SDV] Life Sciences [q-bio], Treatment Outcome, Action study, Elective Surgical Procedures, Anesthesia, Conventional PCI, Purinergic P2Y Receptor Antagonists, Female, business, Platelet Aggregation Inhibitors, medicine.drug
Abstract

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

Published
2020

30. Immediate Versus Delayed Stenting in Patients with Acute ST-Elevation Myocardial Infarction: A Randomized Open-Label Bayesian Trial

Author

Thomas Engstrøm, Nicolas Delarche, Erick Schampaert, Cheol Woong Yu, Michael McGillion, Nandini Dendukuri, Patrick Bélisle, X. Marcaggi, Géraud Souteyrand, Colin Berry, Guillaume Cayla, E. Marc Jolicoeur, François Roubille, Simon Kouz, Dan Eik Høfsten, Henning Kelbæk, Samer Mansour, Brahim Harbaoui, Grégoire Rangé, Loic Belle, Gilles Zemour, Frédéric Bouisset, James M. Brophy, Lars Køber, David Carrick, and Ziad Boueri

Subjects
medicine.medical_specialty, business.industry, medicine.medical_treatment, Declaration, medicine.disease, law.invention, Randomized controlled trial, law, Angioplasty, Relative risk, Emergency medicine, Clinical endpoint, medicine, Data monitoring committee, In patient, Myocardial infarction, business
Abstract

Background: Stents immediately implanted in thrombus-laden arteries cause embolization, which paradoxically impairs myocardial reperfusion and function. Methods: We conducted a Bayesian open-label randomized trial across 15 centres in France and Canada. Patients with acute ST-elevation myocardial infarction (STEMI) and reperfused by thrombectomy or small-size balloon angioplasty were randomly assigned to immediate stenting or to a bridging anti-thrombin therapy and delayed stenting between 18h to 48h after reperfusion. Using a hierarchical Bayesian analysis, we borrowed data from exchangeable twin trials to form a posterior probability of the risk ratio (RR) for the combined occurrence of cardiovascular death, heart failure, non-fatal myocardial infarction (MI), or target-vessel revascularisation (TVR) over 9 months in the intent-to-treat populations. Findings: Between April 2014 and September 2017, 305 participants were randomly assigned to delayed (n = 152) or immediate stenting (n = 153). In parallel, four similar RCTs were reported that satisfied exchangeability requirements, leading to 1,873 participants, including 930 assigned to delayed and 943 assigned to immediate stenting. The primary endpoint occurred in 167 participants (18.1%) assigned to delayed stenting compared to 194 participants (20.6%) assigned to immediate stenting (RR, 0.91; 95% credible interval [95%CrI], 0.76 to 1.09; probability of superiority, 89%). Delayed stenting led to a meaningful increase in unplanned target revascularization acutely (RR, 1.54; 95% CrI, 0.98 to 2.41, probability of inferiority, 99%). At long term, delayed stenting reduced the combined occurrence of CV death or heart failure (RR, 0.83; 95% CrI, 0.67 to 1.02, probability of superiority, 99%). Interpretation: In patients with STEMI, delayed stenting did not reduce the occurrence of cardiovascular death, non-fatal MI, heart failure and unplanned TVR compared to the immediate stenting. There is a high probability that delayed stenting substantially reduces cardiovascular death and heart failure in the longer-term. Trial Registration: ClinicalTrials.gov identifier: NCT01542385. Funding Statement: The trial was supported by an operating grant from the peer-reviewed, publically funded Canadian Institute of Health Research (CIHR), through the Industry-Partnered Collaborative Research program (grant #298937), in collaboration with Boston Scientific and AstraZeneca (unrestricted grants support). The industry partners played no role in the conduct and oversight of the study. Declaration of Interests: The investigators disclose the following relationships: E. Marc Jolicoeur: Advisory Board: Institut National d’Excellence en Sante et Services Sociaux du Quebec, Servier, Imbria Pharmaceutical, Carre technology; Board of Directors, Societe de Sciences Vasculaires du Quebec; Data Safety Monitoring Board: XyloCor; Research grants; Boston Scientific, AstraZeneca; The University of Glasgow (employer, C Berry) holds research and/or consultancy agreements with AstraZeneca, Abbott Vascular, Boehringer Ingelheim, GSK, HeartFlow, Novartis and Siemens Healthcare; Francois Roubille: Advisory Board: Abbott, Air liquide, Research grants; Boston Scientific, AstraZeneca. Consultancy agreements with AstraZeneca, Abbott Vascular, Air liquide, Amgen, Boehringer Ingelheim, GSK, MSD, Novartis, Sanofi, Novartis, Novonordisk, Vifor; Geraud Souteyrand: Consultancy agreements; Medtronic, Abbott, and Terumo; Guillaume Cayla: Consultancy agreements; Astra Zeneca, Amgen, Abbot Vascular, BMS, Boston, Biotronik, Medtronic, Pfizer, and Sanofi; Nicolas Delarche: Advisory board: Novartis; Samer Mansour: Consultant/Advisory board/Speaker’s Bureau: Abbott vascular, Soundbite, Boehringer Ingelheim, AstraZeneca, Bayer, BMS-Pfizer Alliance, Medtronic, Amgen, Sanofi, Servier, Gilead and Novartis; Erick Schampaert: Consultant/Advisory board/Speaker’s Bureau: Abbott, AstraZeneca, Bayer, BMS-Pfizer Alliance, Medtronic, Philips-Volcano, Servier; Loic Belle: Research Grant: AstraZeneca, Medtronic, Biotronic, Boston Scientific, Abbott Vascular, Terumo Ethics Approval Statement: The protocol complied with the Declaration of Helsinki and was approved by IRB at each participating centers. The trial was coordinated by the Montreal Health Innovation Coordinating Centre under the direction of the executive committee, which was responsible for trial conduct, the integrity of the data analysis, and the reporting of results.

Published
2020

31. Immediate vs Delayed Stenting in ST-Elevation Myocardial Infarction: Rationale and Design of the International PRIMACY Bayesian Randomized Controlled Trial

Author

Lars Køber, Thomas Engstrøm, Grégoire Rangé, Patrick Bélisle, E. Marc Jolicoeur, Nicolas Delarche, Brahim Harbaoui, Colin Berry, David Carrick, Michael McGillion, Jean-François Tanguay, Géraud Souteyrand, Frédéric Bouisset, François Roubille, Simon Kouz, Samer Mansour, Jean-Claude Tardif, Dan Eik Høfsten, Guillaume Cayla, James M. Brophy, Erick Schampaert, Cheol Woong Yu, Gilles Zemour, Loic Belle, Nandini Dendukuri, Henning Kelbæk, X. Marcaggi, Ziad Boueri, MORNET, Dominique, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada., Centre for Outcomes Research, McGill University Health Centre-Research Institute, Montreal, Quebec, Canada, HOPITAL CHARTRES - DEPT CARDIOL, Montreal Health Innovation Coordination Center, Montreal, Quebec, CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand, Service Cardiologie [CHU Toulouse], Pôle Cardiovasculaire et Métabolique [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Centre Hospitalier de Cannes (Centre Hospitalier de Cannes), Centre Hospitalier de Cannes, Centre hospitalier de Pau, Imagerie Ultrasonore, Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hopital Sacre-Coeur, Interventional Cardiology, Université de Montréal, Montreal, Quebec, Centre Hospitalier Régional de Lanaudiere [Joliette, QC, Canada] (CHRDL), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), 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), Hôpital de Bastia, Ctr Hosp Vichy, Montreal Heart Institute Coordinating Centre (MHICC), Université de Montréal (UdeM), Montreal Heart Institute - Institut de Cardiologie de Montréal, Department of Cardiology, Gentofte University Hospital, Rigshospitalet [Copenhagen], Copenhagen University Hospital, Service de Cardiologie, Centre hospitalier de la région d'Annecy, Service de cardiologie [Toulouse], Hôpital de Rangueil, CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse], Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional de Lanaudiere, Joliette, Quebec, and Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)

Subjects
medicine.medical_specialty, medicine.medical_treatment, [SDV]Life Sciences [q-bio], 030204 cardiovascular system & hematology, Prosthesis Design, law.invention, Time-to-Treatment, 03 medical and health sciences, 0302 clinical medicine, Percutaneous Coronary Intervention, Randomized controlled trial, law, St elevation myocardial infarction, Internal medicine, medicine, Humans, cardiovascular diseases, 030212 general & internal medicine, Myocardial infarction, ComputingMilieux_MISCELLANEOUS, Randomized Controlled Trials as Topic, business.industry, Antithrombin, Stent, Percutaneous coronary intervention, Bayes Theorem, medicine.disease, 3. Good health, [SDV] Life Sciences [q-bio], surgical procedures, operative, medicine.anatomical_structure, Heart failure, Cardiology, ST Elevation Myocardial Infarction, Stents, Cardiology and Cardiovascular Medicine, business, medicine.drug, Artery
Abstract

Background Primary percutaneous coronary intervention is used to restore blood flow in the infarct-related coronary artery, followed by immediate stenting to prevent reocclusion. Stents implanted in thrombus-laden arteries cause distal embolization, which paradoxically impairs myocardial reperfusion and ventricular function. Whether a strategy of delayed stenting improves outcomes in patients with acute ST-elevation myocardial infarction (STEMI) is uncertain. Methods The Primary Reperfusion Secondary Stenting (PRIMACY) is a Bayesian prospective, randomized, open-label, blinded end point trial in which delayed vs immediate stenting in patients with STEMI were compared for prevention of cardiovascular death, nonfatal myocardial infarction, heart failure, or unplanned target vessel revascularization at 9 months. All participants were immediately reperfused, but those assigned to the delayed arm underwent stenting after an interval of 24 to 48 hours. This interval was bridged with antithrombin therapy to reduce thrombus burden. In the principal Bayesian hierarchical random effects analysis, data from exchangeable trials will be combined into a study prior and updated with PRIMACY into a posterior probability of efficacy. Results A total of 305 participants were randomized across 15 centres in France and Canada between April 2014 and September 2017. At baseline, the median age of participants was 59 years, 81% were male, and 3% had a history of percutaneous coronary intervention. Results from PRIMACY will be updated from the patient-level data of 1568 participants enrolled in the Deferred Stent Trial in STEMI (DEFER; United Kingdom), Minimalist Immediate Mechanical Intervention (MIMI; France), Danish Trial in Acute Myocardial Infarction-3 (DANAMI-3; Denmark), and Impact of Immediate Stent Implantation Versus Deferred Stent Implantation on Infarct Size and Microvascular Perfusion in Patients With ST Segment–Elevation Myocardial Infarction (INNOVATION, South Korea) trials. Conclusions We expect to clarify whether delayed stenting can safely reduce the occurrence of adverse cardiovascular end points compared with immediate stenting in patients with STEMI.

Published
2020

32. 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

33. P1739Does helicopter transport delay prehospital transfer for STEMI patients in rural areas? Findings from the CRAC France PCI registry

Author

Leslie Grammatico-Guillon, Pierre Marcollet, Grégoire Rangé, L. Godillon, C Saint Etienne, Sandra Gautier, E Revue, R. Koning, R. Hakim, Marie-Pascale Decomis, Pascal Motreff, W Yafi, Stephan Chassaing, Christophe Laure, and Julie Akkoyun-Farinez

Subjects
medicine.medical_specialty, business.industry, medicine.medical_treatment, Percutaneous coronary intervention, Hospital mortality, Cardiac Care Facilities, Emergency medicine, Conventional PCI, medicine, Symptom onset, Transport delay, Rural area, Cardiology and Cardiovascular Medicine, business
Abstract

Background Whether helicopter transportation for ST-Elevation Myocardial Infarction (STEMI) patients in France is the faster alternative is not known. Data from United States and Europe are controversial and studies have been limited to small series of patients Purpose The aim of this study was to analyse delays in emergency medical system (EMS) transfer of STEMI patients from home to the nearest percutaneous coronary intervention (PCI) centre (primary transfer) or from non-PCI centres to PCI centres (secondary transfer) according to transport modalityin a rural French region. Methods and results Data from the prospective multicentre CRAC France PCI registrywere analysed for 1911 STEMI patients: 410 transferred by helicopter (HEMS) and 1501 by ground transport (GEMS). The primary endpoint was the percentage of transfers with first medical contact (FMC) to primary PCI (PPCI) within the 90-min recommended in guidelines. The secondary endpoint was time FMC–PPCI. With HEMS,FMC-PPCI STEMI patients FMC-PPCI < 90 min Conclusion Helicopter transport of STEMI patients was 5 times less effective than ground transport in maintaining the 90-min FMC-PPCI time recommended in guidelines, particularly for transfer distances Acknowledgement/Funding Regional health agency of CVL, Medtronic, Boston Scientific, Abbot, Biosensor, Terumo, Biotronik, Lilly Daichii Sankyo, Hexacath and Braun.

Published
2019

34. The value of cardiac magnetic resonance imaging in the diagnosis of myocardial infarction with non-occlusive coronary artery: The CRIMINAL prospective registry

Author

P. Couppie, J. Clerc, E. Naoum Nehmé, J. Rischner, J.-L. Georges, C. Jeannot, Franck Barbou, N. Ferrier, A. Boge, C. Dagrenat, H. Madiot, Nicolas Delarche, Régis Delaunay, Loic Belle, Grégoire Rangé, O. Nallet, N. Ketata, Pierre Leddet, L. Michel, and M. Melay

Subjects
medicine.medical_specialty, Myocarditis, medicine.diagnostic_test, business.industry, medicine.disease, Coronary arteries, medicine.anatomical_structure, Cardiac magnetic resonance imaging, Internal medicine, Cohort, cardiovascular system, medicine, Cardiology, cardiovascular diseases, Myocardial infarction, Medical diagnosis, Cardiology and Cardiovascular Medicine, business, Artery, Cohort study
Abstract

Background The systematic performance of cardiac magnetic resonance imaging (CMR) could play a pivotal role in providing the underlying cause of myocardial infarction with non-occlusive coronary arteries (MINOCA). Purpose This study aimed to describe the characteristics of the patients hospitalised for MINOCA and to assess the proportion of patients for whom CMR provided the underlying diagnosis of MINOCA. Methods Between May 2015 and August 2018, 457 patients with MINOCA were prospectively enrolled in an observational cohort study in 15 centres affiliated to the College national des cardiologues des hopitaux (CNCH). Prior to CMR, the cardiologist established one of the following diagnoses: “type 1 MI”, “type 2 MI”, “myocarditis”, “TTS”, “other diagnoses”, and “uncertain diagnosis” (when no diagnosis was established). Using CMR findings, the cardiologist reassigned the patient to one of the 6 subgroups. Results In total, 336 of 457 patients with MINOCA underwent CMR. CMR was able to identify a diagnosis in 90.5% of cases, and changed the underlying cause in 35.7% of patients; 33.7% of type 1 MI were not diagnosed prior to CMR. Patients with a normal CMR had a significantly longer median time to complete the CMR (17 vs. 7 days, P = 4.2E−7) and lower conventional and high sensitivity troponin values (respectively 1.1 vs. 3.6 μG/L, P = 0.002 and 433.3 vs. 707.1 ng/L, P = 0.007). At 1-year follow-up of the CMR cohort, the prevalence of all-cause mortality was 3%, of cardiac mortality 0.6% and of rehospitalisation for cardiac causes 7.8%. No bleeding disorders occurred after increased anti-platelet therapy in patients re-diagnosed with MI ( Fig. 1 ). Conclusion CMR provided a diagnosis in 9 out of 10 patients presenting with MINOCA. The diagnosis differed from the one prior to CMR in 35.7% of patients. The systematic use of CMR plays a pivotal role in identifying the underlying cause of myocardial injury, impacting both individuals, health professionals and society at large.

Published
2021

35. Safety and efficacy of NOAC vs. VKA in patients treated by PCI: a retrospective study of the FRANCE PCI registry

Author

Eric Durand, Thibault Verrez, Andre Gillibert, Thomas Levesque, Thomas Barbe, René Koning, Pascal Motreff, Hélène Eltchaninoff, Jean-Philippe Collet, and Gregoire Rangé

Subjects
PCI, VKA, NOAC, bleeding, atrial fibrillation, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

IntroductionDual antithrombotic therapy (DAT) combining oral anticoagulation (OAC), preferentially Non-vitamin K antagonist OAC (NOAC) and single antiplatelet therapy (SAPT) for a period of 6–12 months is recommended after percutaneous coronary intervention (PCI) in patients with an indication for OAC.ObjectiveTo compare outcomes between vitamin K antagonist (VKA) and NOAC-treated patients in the nation-wide France PCI registry.MethodsAll consecutive patients from the France PCI registry treated by PCI and discharged with OAC between 2014 and 2020 were included and followed one-year. Major bleeding was defined as Bleeding Academic Research Consortium (BARC) classification ≥3 and major adverse cardiac events (MACE) as the composite of all-cause mortality, myocardial infarction (MI), and ischemic stroke. A propensity-score analysis was used.ResultsOf the 7,277 eligible participants, 2,432 (33.4%) were discharged on VKA and 4,845 (66.6%) on NOAC. After propensity-score adjustment, one-year major bleeding was less frequent in NOAC vs. VKA-treated participants [3.1% vs. 5.2%, −2.1% (−3.6% to −0.6%), p = 0.005 as well as the rate of MACE [9.2% vs. 11.9%, −2.7% (−5.0% to −0.4%), p = 0.02]. One-year mortality was also significantly decreased in NOAC vs. VKA-treated participants [7.4% vs. 9.9%, −2.6% (−4.7% to −0.5%), p = 0.02]. The area under ROC curves of the anticoagulant treatment propensity score was estimated at 0.93, suggesting potential indication biasConclusionsNOAC seems to have a better efficacy and safety profile than VKA. However, potential indication bias were found.

Published
2024
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36. Coronary Artery Fenestration

Author

Hakim Benamer, Francesca Sanguineti, Pascal Motreff, Thierry Lefèvre, Grégoire Rangé, Guy Achkouty, Géraud Souteyrand, Thibault Ronchard, Andréa Cianci, Nicolas Combaret, and Georgios Sideris

Subjects
medicine.medical_specialty, medicine.diagnostic_test, business.industry, medicine.medical_treatment, Hemodynamics, Thrombolysis, 030204 cardiovascular system & hematology, medicine.disease, Asymptomatic, 03 medical and health sciences, 0302 clinical medicine, medicine.anatomical_structure, Angioplasty, Internal medicine, Angiography, Cardiology, Medicine, cardiovascular diseases, 030212 general & internal medicine, Myocardial infarction, medicine.symptom, Cardiology and Cardiovascular Medicine, business, TIMI, Artery
Abstract

Spontaneous coronary artery dissection (SCAD) is an underdiagnosed clinical entity with a severe prognosis. Whereas conservative management is followed in asymptomatic patients with reassuring hemodynamic status and TIMI (Thrombolysis In Myocardial Infarction) flow grade 3 on angiography, high-risk

Published
2018

38. TCT CONNECT-313 OCT-Guided Left Main Stem Percutaneous Coronary Interventions: Results of the Multicenter LEMON (Left Main OCT-Guided Interventions) Cohort Study

Author

Grégoire Rangé, Thierry Lefèvre, Géraud Souteyrand, Nicolas Meneveau, Guillaume Cayla, Christophe Caussin, Nicolas Amabile, Frederic Casassus, Imane Bagdadi, and Matthieu Godin

Subjects
medicine.medical_specialty, Percutaneous, business.industry, Psychological intervention, Medicine, Radiology, Cardiology and Cardiovascular Medicine, business, Cohort study
Published
2020

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. 5914De-escalation versus escalation of antiplatelet therapy in elderly ACS patients: insight from the ANTARCTIC trial

Author

G Montalescot, Didier Carrié, Guillaume Cayla, Farzin Beygui, J. Silvain, Florence Leclercq, Patrick Henry, E. Van Belle, Christophe Pouillot, Eric Vicaut, Thomas Cuisset, Grégoire Rangé, B Lattuca, S Manzo Silberman, and J P Collet

Subjects
medicine.medical_specialty, business.industry, Medicine, Cardiology and Cardiovascular Medicine, business, Intensive care medicine
Published
2018

41. P1722Platelet function monitoring for the prediction of clinical outcomes: a pooled analysis of the randomized ARCTIC and ANTARCTIC trials

Author

Simon Elhadad, G Montalescot, J. Silvain, Thomas Cuisset, Yan Yan, Eric Vicaut, B Lattuca, Anne Bellemain-Appaix, Stéphane Manzo-Silberman, J P Collet, Grégoire Rangé, Florence Leclercq, Christophe Pouillot, Guillaume Cayla, and M. Kerneis

Subjects
medicine.medical_specialty, Pooled analysis, Arctic, business.industry, Internal medicine, medicine, Function (mathematics), Cardiology and Cardiovascular Medicine, business
Published
2018

42. TCT-251 SOS PK Papyrus, an Observational Study of Patients With Covered PK Papyrus Stent

Author

Grégoire Rangé, Philippe Commeau, Nicolas Delarche, Edouard Gerbaud, Marco Hernandez Enriquez, H. Madiot, Richard Gervasoni, Benoit Lattuca, Sébastien Levesque, Nicolas Boudou, Gilles Zemour, Loic Belle, Ziad Boueri, Géraud Souteyrand, Christophe Piot, and E. Boiffard

Subjects
medicine.medical_specialty, business.industry, medicine.medical_treatment, Papyrus, Stent, Percutaneous coronary intervention, 030204 cardiovascular system & hematology, engineering.material, Surgery, 03 medical and health sciences, 0302 clinical medicine, medicine, engineering, Observational study, 030212 general & internal medicine, Cardiology and Cardiovascular Medicine, Complication, business, Coronary Artery Perforation, Covered stent
Abstract

Coronary artery perforation is a rare complication of percutaneous coronary intervention associated with a high level of morbidity and mortality. The development of covered stents with better deliverability, such as the PK Papyrus (Biotronik) should facilitate treatment of coronary perforations with

Published
2019

43. Characteristics of stent thrombosis in bifurcation lesions analysed by optical coherence tomography

Author

Thierry Lefèvre, Lionel Mangin, Christophe Caussin, Nicolas Amabile, Grégoire Rangé, Charlotte Trouillet, Mohamed Yahya Bechiri, Nicolas Meneveau, Pascal Motreff, Guillaume Cayla, Géraud Souteyrand, François Derimay, Institut Mutualiste de Montsouris (IMM), CHU Clermont-Ferrand, Image Science for Interventional Techniques (ISIT), Université d'Auvergne - Clermont-Ferrand I (UdA)-Centre National de la Recherche Scientifique (CNRS)-Clermont Université, Hôpital Privé Jacques Cartier [Massy], CH La Rochelle, HOPITAL CHARTRES - DEPT CARDIOL, Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Université de Montpellier (UM), Hospices Civils de Lyon (HCL), Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois], Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( EA 3920) (PCVP / CARDIO), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Institut Pascal (IP), SIGMA Clermont (SIGMA Clermont)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Centre National de la Recherche Scientifique (CNRS), Université d'Auvergne - Clermont-Ferrand I (UdA)-Clermont Université-Centre National de la Recherche Scientifique (CNRS), and Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( UR 3920) (PCVP / CARDIO)

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, 030204 cardiovascular system & hematology, Main branch, 03 medical and health sciences, Percutaneous Coronary Intervention, 0302 clinical medicine, Optical coherence tomography, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Predictive Value of Tests, Risk Factors, Side branch, Culprit lesion, Humans, Medicine, Registries, 030212 general & internal medicine, Stent thrombosis, Acute Coronary Syndrome, Aged, Retrospective Studies, medicine.diagnostic_test, business.industry, Coronary Thrombosis, Stent, Middle Aged, 3. Good health, Treatment Outcome, Cohort, Female, Stents, France, Radiology, National registry, Cardiology and Cardiovascular Medicine, business, Tomography, Optical Coherence
Abstract

International audience; AIMS:This work aimed to investigate a cohort of patients presenting with stent thrombosis (ST) explored by optical coherence tomography (OCT) to identify the underlying mechanical abnormalities in case of bifurcation lesions.METHODS AND RESULTS:The PESTO study was a prospective national registry involving 29 French catheterisation facilities. Patients with acute coronary syndromes were prospectively screened for presence of definite ST and analysed by OCT after culprit lesion reopening. The cohort involved 120 subjects, including 21 patients (17.5% of the global PESTO group; median age: 62.6 yrs; 76% male) with bifurcation lesions. The clinical presentation was acute or subacute ST in 34%, late ST in 5% and very late ST in 62% of the patients. The main underlying mechanisms were strut malapposition in 33%, stent underexpansion in 19% and isolated strut uncoverage in 19% of the cases. The proximal main branch was involved in 71%, distal main branch in 52% and jailed side branch in 5% of the patients.CONCLUSIONS:In this cohort, bifurcation lesions represented a limited number of all ST cases. Different sections of the bifurcation could be involved. Although the underlying mechanisms were various, strut malapposition was the most frequently observed cause.

Published
2018

44. Factors associated with delay in transfer of patients with ST-segment elevation myocardial infarction from first medical contact to catheterization laboratory: Lessons from CRAC, a French prospective multicentre registry

Author

Jean Capsec, Pelle Stolt, Leslie Grammatico-Guillon, Sandra Gautier, Stephan Chassaing, Christophe Saint Etienne, Pascal Motreff, Grégoire Rangé, Pierre Marcollet, Philippe Dequenne, Franck Albert, L. Godillon, Christophe Laure, R. Hakim, Hôpital Louis Pasteur [Chartres], CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre Hospitalier Jacques Coeur, Clinique Saint Gatien, Hôpitaux de Chartres [Chartres], Éducation Éthique Santé EA 7505 (EES), Université de Tours (UT), Maglia Rotta, Institut Pascal (IP), SIGMA Clermont (SIGMA Clermont)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Centre National de la Recherche Scientifique (CNRS), and Unité d'Épidémiologie des données cliniques [Tours] (EpiDcliC)

Subjects
Male, Patient Transfer, medicine.medical_specialty, Cardiac Catheterization, Time Factors, medicine.medical_treatment, Comorbidity, 030204 cardiovascular system & hematology, Coronary Angiography, [SHS]Humanities and Social Sciences, Time-to-Treatment, 03 medical and health sciences, 0302 clinical medicine, Percutaneous Coronary Intervention, Catchment Area, Health, Risk Factors, Internal medicine, Angioplasty, Diabetes mellitus, medicine, ST segment, Humans, 030212 general & internal medicine, Myocardial infarction, Prospective Studies, Registries, ComputingMilieux_MISCELLANEOUS, Killip class, Aged, Interventional cardiology, business.industry, Percutaneous coronary intervention, General Medicine, Odds ratio, Middle Aged, medicine.disease, Treatment Outcome, Cardiology, ST Elevation Myocardial Infarction, Female, France, Cardiology and Cardiovascular Medicine, business
Abstract

It is critical to minimize the time between the first medical contact and primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction.To identify factors associated with a delay of120min between first medical contact and primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction.Data were analysed from a regional French registry of patients undergoing coronary angioplasty for ST-segment elevation myocardial infarction24h after symptom onset. Patients (n=2081) were grouped according to transfer times from first medical contact to primary percutaneous coronary intervention:120min; or≤120min. Independent predictors of delay were identified by univariate and multivariable analyses.The median transfer time from first medical contact to primary percutaneous coronary intervention was 112min; 892 patients (42.9%) had a transfer time120min. A delay of120min was significantly associated with:≥75km distance from interventional cardiology centre at symptom onset (odds ratio 7.9); more than one medical practitioner involved before interventional cardiology centre (odds ratio 4.5); first admission to a hospital without an interventional cardiology centre (odds ratio 2.9); absence of emergency call (odds ratio 1.6); ≥90min between symptom onset and first medical contact (odds ratio 1.3); Killip class at admission1 (odds ratio 1.8); lateral ischaemia (odds ratio 1.8); diabetes mellitus (odds ratio 1.6); and hypertension (odds ratio 1.3).In ST-segment elevation myocardial infarction, a transfer time from first medical contact to primary percutaneous coronary intervention of120min was associated with geographic, systemic and comorbid factors, several of which appear reasonably actionable.

Published
2018

45. Cyclosporine before PCI in Patients with Acute Myocardial Infarction

Author

Marc Metge, Gérald Vanzetto, David Garcia-Dorado, Martine Gilard, Philippe Dubois, Fabrice Prunier, Frédéric Moulin, Thierry Unterseeh, Gilles Grollier, Marie-Claude Morice, Arnaud Sudre, Philippe Gabriel Steg, Pierre Coste, Nathan Mewton, Thien-Tri Cung, P. Staat, Fabien de Poli, Marc J. Claeys, Meier Elbaz, Inesse Boussaha, Hervé Le Breton, Jean-Luc Dubois-Randé, Cyrille Bergerot, Patrice Guerin, Pascal Motreff, Guillaume Cayla, Denis Angoulvant, Olivier Roth, Nicolas Delarche, Michel Ovize, Christophe Piot, Grégoire Rangé, Jean-François Aupetit, Magnus Hansson, Eric Bonnefoy-Cudraz, Yves Cottin, P Coussement, Paul Barragan, Thierry Beard, Loic Belle, Olivier Morel, Vincent Malquarti, Didier Blanchard, Christophe Tron, Geneviève Derumeaux, Patrice Colin, Bernard Jouve, Omar Ider, Jean-Noël Labèque, Jérôme Clerc, Eskil Elmér, Claire Jossan, Gilles Rioufol, Hôpital Arnaud de Villeneuve [CHRU Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Les Hôpitaux Universitaires de Strasbourg (HUS), Université de Montpellier (UM), Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon (HCL), Cellules Dendritiques, Immunomodulation et Greffes, Université de Tours (UT), Service Cardiologie [CHU Toulouse], Pôle Cardiovasculaire et Métabolique [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Department of Cardiology (Cardio - BORDEAUX), CHU Bordeaux [Bordeaux], Radiopharmaceutiques biocliniques, Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de cardiologie [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Service de cardiologie, 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), Hémostase, bio-ingénierie et remodelage cardiovasculaires (LBPC), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Institut Galilée-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Lipides - Nutrition - Cancer (U866) (LNC), Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Ecole Nationale Supérieure de Biologie Appliquée à la Nutrition et à l'Alimentation de Dijon (ENSBANA), CHU Dijon, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Service de Cardiologie, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Laboratoire de Protection et Remodelage du Myocarde (PMRM), Université d'Angers (UA)-Université d'Angers (UA), Service de Cardiologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre hospitalier de la région d'Annecy, Centre Hospitalier Privé Beauregard. (CHPB), Centre hopitalier Privé, Optimisation des régulations physiologiques (ORPHY (EA 4324)), Université de Brest (UBO)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO), Institut de Génomique Fonctionnelle (IGF), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), INSERM U955, équipe 3, Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), CHU Pontchaillou [Rennes], Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Pôle Cardiologie Interventionnelle / Coro-scanner / IRM Cardiaque, Clinique Saint Gatien, Hôpital Louis Pradel, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM), Cardioprotection, Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM), Department of Cardiology, University Hospital of Rangueil, Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, 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), Université Paris Diderot - Paris 7 (UPD7)-Université Paris 13 (UP13)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Galilée, Université de Montpellier (UM)-Université Montpellier 1 (UM1)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Montpellier 2 - Sciences et Techniques (UM2)-Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-IFR10-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-IFR10, 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), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), Hôpital Arnaud de Villeneuve, Université de Tours, Université Paris Diderot - Paris 7 (UPD7)-AP-HP - Hôpital Bichat - Claude Bernard [Paris]-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ), Hospices Civils de Lyon ( HCL ), Department of Cardiology ( Cardio - BORDEAUX ), Université Joseph Fourier - Grenoble 1 ( UJF ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Service de cardiologie [Rouen], CHU Rouen-Université de Rouen Normandie ( UNIROUEN ), Normandie Université ( NU ) -Normandie Université ( NU ), Assistance publique - Hôpitaux de Paris (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris]-Université Paris Diderot - Paris 7 ( UPD7 ), Hémostase, bio-ingénierie et remodelage cardiovasculaires ( LBPC ), Université Paris Diderot - Paris 7 ( UPD7 ) -Université Paris 13 ( UP13 ) -Université Sorbonne Paris Cité ( USPC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Institut Galilée, Lipides - Nutrition - Cancer (U866) ( LNC ), Université de Bourgogne ( UB ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Ecole Nationale Supérieure de Biologie Appliquée à la Nutrition et à l'Alimentation de Dijon ( ENSBANA ), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), CHU Angers-PRES Université Nantes Angers Le Mans ( UNAM ), Laboratoire de Protection et Remodelage du Myocarde ( PMRM ), Université d'Angers ( UA ) -Université d'Angers ( UA ), Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ), Centre Hospitalier Privé Beauregard. ( CHPB ), Optimisation des régulations physiologiques ( ORPHY (EA 4324) ), Université de Brest ( UBO ) -Institut Brestois du Numérique et des Mathématiques ( IBNM ), Université de Brest ( UBO ) -Université de Brest ( UBO ), Institut de Génomique Fonctionnelle ( IGF ), Centre National de la Recherche Scientifique ( CNRS ) -Université Montpellier 2 - Sciences et Techniques ( UM2 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université Montpellier 1 ( UM1 ) -Université de Montpellier ( UM ), Institut Mondor de Recherche Biomédicale ( IMRB ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ), 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 ), Cardiovasculaire, métabolisme, diabétologie et nutrition ( CarMeN ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Hospices Civils de Lyon ( HCL ) -Institut National des Sciences Appliquées de Lyon ( INSA Lyon ), Université de Lyon-Institut National des Sciences Appliquées ( INSA ) -Université de Lyon-Institut National des Sciences Appliquées ( INSA ) -Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Institut National de la Recherche Agronomique ( INRA ), Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Hôpital Rangueil, CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris]-Université Paris Diderot - Paris 7 (UPD7), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Bourgogne (UB)-Ecole Nationale Supérieure de Biologie Appliquée à la Nutrition et à l'Alimentation de Dijon (ENSBANA)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), and Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Myocardial Infarction, Infarction, Heart failure, Kaplan-Meier Estimate, Injections, Cyclophilins, Electrocardiography, Double-Blind Method, General & Internal Medicine, Internal medicine, medicine, Humans, [ SDV.IB ] Life Sciences [q-bio]/Bioengineering, cardiovascular diseases, Myocardial infarction, Mortality, Enzyme Inhibitors, Ventricular remodeling, Stroke, Aged, Ventricular Remodeling, Unstable angina, business.industry, percutaneous coronary intervention, Percutaneous coronary intervention, 11 Medical And Health Sciences, General Medicine, Middle Aged, medicine.disease, Combined Modality Therapy, 3. Good health, Injections, Intravenous, Conventional PCI, Cyclosporine, Cardiology, Female, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Human medicine, Intravenous, business
Abstract

International audience; BACKGROUND: Experimental and clinical evidence suggests that cyclosporine may attenuate reperfusion injury and reduce myocardial infarct size. We aimed to test whether cyclosporine would improve clinical outcomes and prevent adverse left ventricular remodeling. METHODS: In a multicenter, double-blind, randomized trial, we assigned 970 patients with an acute anterior ST-segment elevation myocardial infarction (STEMI) who were undergoing percutaneous coronary intervention (PCI) within 12 hours after symptom onset and who had complete occlusion of the culprit coronary artery to receive a bolus injection of cyclosporine (administered intravenously at a dose of 2.5 mg per kilogram of body weight) or matching placebo before coronary recanalization. The primary outcome was a composite of death from any cause, worsening of heart failure during the initial hospitalization, rehospitalization for heart failure, or adverse left ventricular remodeling at 1 year. Adverse left ventricular remodeling was defined as an increase of 15% or more in the left ventricular end-diastolic volume. RESULTS: A total of 395 patients in the cyclosporine group and 396 in the placebo group received the assigned study drug and had data that could be evaluated for the primary outcome at 1 year. The rate of the primary outcome was 59.0% in the cyclosporine group and 58.1% in the control group (odds ratio, 1.04; 95% confidence interval [CI], 0.78 to 1.39; P=0.77). Cyclosporine did not reduce the incidence of the separate clinical components of the primary outcome or other events, including recurrent infarction, unstable angina, and stroke. No significant difference in the safety profile was observed between the two treatment groups. CONCLUSIONS: In patients with anterior STEMI who had been referred for primary PCI, intravenous cyclosporine did not result in better clinical outcomes than those with placebo and did not prevent adverse left ventricular remodeling at 1 year. (Funded by the French Ministry of Health and NeuroVive Pharmaceutical; CIRCUS ClinicalTrials.gov number, NCT01502774; EudraCT number, 2009-013713-99.)

Published
2015

46. Antiplatelet Drug Regimen in Patients With Stent Thrombosis ― Insights From the PESTO French Optical Coherence Tomography Registry ―

Author

Charlotte Trouillet, Olivier Dubreuil, Lionel Mangin, Grégoire Rangé, Christophe Caussin, Nicolas Meneveau, Géraud Souteyrand, Pascal Motreff, Guillaume Cayla, Estelle Vautrin, Nicolas Amabile, François Derimay, Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, Institut Pascal (IP), SIGMA Clermont (SIGMA Clermont)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Centre National de la Recherche Scientifique (CNRS), Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Général, Cardioprotection, Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Grenoble Alpes - UFR Médecine (UGA UFRM), Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Service de cardiologie, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Institut Mutualiste de Montsouris (IMM), Hôpital nord, St Etienne, SIGMA Clermont (SIGMA Clermont)-Centre National de la Recherche Scientifique (CNRS)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020]), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées, ROUX, SYLVIE, and Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Male, medicine.medical_specialty, Percutaneous, Antiplatelet drug, medicine.medical_treatment, 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, Humans, Prospective Studies, Registries, 030212 general & internal medicine, business.industry, Stent, Thrombosis, General Medicine, Middle Aged, medicine.disease, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, 3. Good health, Discontinuation, Regimen, Conventional PCI, Cardiology, Female, Stents, Observational study, Radiology, Cardiology and Cardiovascular Medicine, business, Platelet Aggregation Inhibitors, Tomography, Optical Coherence
Abstract

International audience; Thrombosis) French multicenter prospective observational registry reported that a stent mechanical abnormality was present in 97% of subjects with ST explored by intracoro-nary optical coherence tomography (OCT) imaging. 5 Premature discontinuation and incomplete individual response to APT have previously been reported as major risk factors for ST. 6,7 However, the interactions between APT regimen and potential underlying stent abnormalities remain largely unknown, even though different mechanical substrates could favor a rheological environment that might promote thrombosis. For example, uncovered/poorly healed struts behave as foreign bodies that induce platelet A lthough its frequency has decreased over the recent past years, stent thrombosis (ST) remains a major complication of percutaneous coronary interventions (PCI) and still carries a high mortality. 1 ST is a mul-tifaceted process that can be triggered by different factors such as the patient's clinical characteristics, efficacy of anti-platelet therapy (APT) or underlying mechanical stent abnormalities. 2 However, coronary angiography has limited sensitivity to correctly identify these latter mechanisms and recent studies suggest that intracoronary imaging is a valuable option to achieve this purpose. 3,4 Therefore, the PESTO (Morphological Parameters Explaining Stent

Published
2017

47. P2345Characteristics of stent thrombosis in bifurcation lesions analyzed by optical coherence tomography

Author

Sébastien Levesque, Grégoire Rangé, Christophe Caussin, Thierry Lefèvre, Pascal Motreff, Nicolas Amabile, Charlotte Trouillet, Géraud Souteyrand, Lionel Mangin, Nicolas Meneveau, and M.Y. Bechiri

Subjects
medicine.medical_specialty, Optical coherence tomography, medicine.diagnostic_test, business.industry, Medicine, Stent thrombosis, Radiology, Cardiology and Cardiovascular Medicine, business, Bifurcation
Published
2017

48. Thrombotic and bleeding events after coronary stenting according to clopidogrel and aspirin platelet reactivity: VerifyNow French Registry (VERIFRENCHY)

Author

Nicolas Delarche, Jean-Philippe Claudel, René Koning, Emmanuel Teiger, Jean-Philippe Collet, Gilles Montalescot, Philippe Brunel, Marie-Pascale Decomis, Franck Barbou, Fabien De Poli, Pierre Cazaux, Romain Berthier, Patrick Dupouy, Grégoire Rangé, Franck Albert, Komlavi Yayehd, Christophe Thuaire, Pascal Richard, Farzin Beygui, Stephan Chassaing, and Loic Belle

Subjects
Male, VerifyNow, Myocardial Infarction, Risk Factors, Saignements, Prospective Studies, Registries, Myocardial infarction, education.field_of_study, Aspirin, Hazard ratio, General Medicine, Middle Aged, Clopidogrel, Treatment Outcome, Évènements ischémiques, VerifyNow assay, Cardiology, Drug Therapy, Combination, Female, Stents, France, Cardiology and Cardiovascular Medicine, medicine.drug, Acute coronary syndrome, medicine.medical_specialty, Ticlopidine, On-platelet reactivity, Platelet Function Tests, Population, Hemorrhage, Percutaneous Coronary Intervention, Predictive Value of Tests, Internal medicine, medicine, Humans, cardiovascular diseases, education, Aged, Réactivité plaquettaire, business.industry, Coronary Thrombosis, Bleeding, medicine.disease, Ischaemic events, Confidence interval, Conventional PCI, business, Platelet Aggregation Inhibitors
Abstract

Summary Background Dual antiplatelet therapy, comprising aspirin and clopidogrel, is recommended in patients undergoing coronary stenting to avoid the occurrence of stent thrombosis and others ischaemic events. Interindividual response to clopidogrel varies, however, with poor response associated with an increased risk of ischaemic events. New assays are available for testing aspirin and clopidogrel response routinely at the bedside. Aim To evaluate the prognostic value of testing antiplatelet response in an intermediate-risk population undergoing stent implantation. Methods We prospectively assessed clopidogrel and aspirin response using the VerifyNow assay at the time of coronary stenting in 1001 patients who presented with stable coronary disease or non-ST-segment elevation acute coronary syndrome. The main ischaemic endpoint was the composite of definite and probable stent thrombosis, cardiovascular death or spontaneous myocardial infarction at one year. The safety endpoint was major bleeding. Results Overall, 36.0% of patients had high on-clopidogrel platelet reactivity (OCR) and 8.6% had high on-aspirin platelet reactivity (OAR). The main ischaemic composite endpoint occurred in 3.9% of patients with high vs. 2.3% of patients with normal OCR (hazard ratio 1.66, 95% confidence interval 0.78–3.54; P = 0.18). Definite or probable stent thrombosis occurred in 1.1% of patients with high vs. 0.3% of patients with normal OCR ( P = 0.86). There was no significant difference in ischaemic endpoints according to OAR and there was no difference in rates of major bleeding between patients with high versus normal on-treatment platelet reactivity. Conclusions On-treatment platelet reactivity was not associated with 1-year ischaemic or bleeding events in an intermediate-risk population undergoing stent implantation.

Published
2014

49. Platelet function monitoring for the prediction of clinical outcomes: A pooled analysis of the randomized ARCTIC and ANTARCTIC trials

Author

Thomas Cuisset, Simon Elhadad, Grégoire Rangé, Florence Leclercq, J. Silvain, B Lattuca, Christophe Pouillot, Guillaume Cayla, Yan Yan, Stéphane Manzo-Silberman, Eric Vicaut, M. Kerneis, Gilles Montalescot, J P Collet, and Anne Bellemain-Appaix

Subjects
medicine.medical_specialty, education.field_of_study, business.industry, Population, medicine.disease, law.invention, Coronary artery disease, Pooled analysis, P2Y12, Randomized controlled trial, law, Internal medicine, Clinical endpoint, Medicine, Platelet, Risk factor, Cardiology and Cardiovascular Medicine, business, education
Abstract

Background Platelet function testing offers the possibility to individualize antiplatelet therapy in coronary artery disease patients but failed to improve clinical outcomes in randomized trials. However, high-on-treatment platelet reactivity (HPR) remains a risk factor for recurrent ischemic events and low-on-treatment platelet reactivity (LPR) is a risk factor for bleedings. Methods We collected data of patients assigned to the monitoring arm of the randomized ARCTIC and ANTARCTIC trials that evaluated the platelet reactivity by the VerifyNow P2Y12 test two weeks after coronary stenting. HPR was defined by PRU ≥ 208, LPR by PRU ≤ 85 and optimal platelet reactivity (OPR) by 85. Results Among the 1418 patients included, HPR was present in 269 patients (18.9%), OPR was reached in 681 patients (48.0%) and LPR in 468 patients (33.0%). The primary composite endpoint occurred in 9.7%, 11.5% and 14.3% respectively. There was no significant difference in the net clinical benefit between HPR and OPR patients (adjusted HR: 0.91(0.48–1.72); P = 0.77) and between LPR and OPR patients (adjusted HR: 1.13 (0.67–1.90); P = 0.64). There were no difference in the individual clinical endpoints between the three groups. ROC curve analysis demonstrated that PRU when used for treatment adjustment has a limited ability to discriminate net clinical benefit, ischemic or bleeding complications (curve–c index = 0.55, 0.51 or 0.59, respectively). Conclusion Two weeks after stenting, an optimal platelet reactivity was obtained in less than half of the population. The net clinical benefit of these patients was not different from that of patients with HPR and LPR who had treatment adjustment.

Published
2019

50. Mechanical abnormalities associated with first- and second-generation drug-eluting stent thrombosis analyzed by optical coherence tomography in the national PESTO French registry

Author

Grégoire Rangé, Christophe Caussin, Thibault Lhermusier, Nicolas Amabile, Loic Belle, Géraud Souteyrand, François Derimay, Régis Delaunay, Pascal Motreff, Nicolas Combaret, Michel Pansieri, Charlotte Trouillet, Sébastien Levesque, Claire Marie Tissot, Nicolas Meneveau, Hôpital nord, St Etienne, Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées, Service de cardiologie, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Service de Cardiologie, Centre hospitalier de la région d'Annecy, Institut de Chimie de la Matière Condensée de Bordeaux (ICMCB), Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Institut Polytechnique de Bordeaux-Université de Bordeaux (UB), Centre Hospitalier Général, Laboratoire de Chimie Physique - Matière et Rayonnement (LCPMR), Centre National de la Recherche Scientifique (CNRS)-Institut de Chimie du CNRS (INC)-Université Pierre et Marie Curie - Paris 6 (UPMC), Service de cardiologie [Toulouse], Hôpital de Rangueil, CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse], CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, Institut Pascal (IP), SIGMA Clermont (SIGMA Clermont)-Centre National de la Recherche Scientifique (CNRS)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020]), Institut Mutualiste de Montsouris (IMM), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service Cardiologie [CHU Toulouse], Pôle Cardiovasculaire et Métabolique [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), and SIGMA Clermont (SIGMA Clermont)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Centre National de la Recherche Scientifique (CNRS)

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, 030204 cardiovascular system & hematology, Coronary Angiography, Prosthesis Design, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Optical coherence tomography, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, medicine, Humans, 030212 general & internal medicine, Stent thrombosis, Prospective Studies, Registries, Acute Coronary Syndrome, Angioplasty, Balloon, Coronary, ComputingMilieux_MISCELLANEOUS, Aged, medicine.diagnostic_test, business.industry, Coronary Thrombosis, Significant difference, Coronary Stenosis, Drug-Eluting Stents, Middle Aged, medicine.disease, Thrombosis, Survival Analysis, 3. Good health, Surgery, Prosthesis Failure, Drug-eluting stent, Conventional PCI, Angiography, Female, Radiology, National registry, France, Cardiology and Cardiovascular Medicine, business, Tomography, Optical Coherence, Follow-Up Studies
Abstract

DES thrombosis may be triggered by different mechanisms that are difficult to identify by angiography alone. This work aimed to investigate and compare the characteristics of stent thrombosis (ST) between 1st- and 2nd-generation drug-eluting stents (DES) among a large cohort of patients explored by optical coherence tomography (OCT).The PESTO study was a prospective national registry involving 29 French catheterization facilities. Patients with acute coronary syndromes were prospectively screened for presence of definite ST and analyzed by OCT after culprit lesion deocclusion. The analysis involved 71 subjects including 34 patients with 1st-generation DES (DES1G) and 35 patients with 2nd-generation DES (DES2G). Most patients (80%) presented with very late stent thrombosis. The median time between initial PCI and ST was longer in DES1G than DES2G patients (3.8 [2.6-6.5] years vs. 1.1 [0.04-2.3] years, p0.0001). OCT identified an underlying morphological abnormality in 96% of the cases. Significant malapposition was the main abnormality observed either in DES1G (26%) or DES2G patients (35%). Ruptured neoatherosclerotic lesions were more frequently observed with DES1G than with DES2G (26% vs. 3%, p=0.008). There was no significant difference in percentage of malapposed struts and uncovered struts between groups.In this registry, DES thrombosis mainly occurred ≥1year after initial PCI. OCT identified a mechanical abnormality in the vast majority of the cases. Similar causes were observed between DES1G and DES2G, but neoatherosclerotic lesions were more common in DES1G.

Published
2016

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