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International audience; Background: In patients with ST-segment elevation myocardial infarction (STEMI) who have multivessel disease, the FLOWER-MI trial found no significant clinical benefit to fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) compared to angiography-guided PCI. Aims: Our aim was to estimate the cost-effectiveness and cost-utility of FFR-guided PCI, the secondary endpoint of the FLOWER-MI trial. Methods: Costs, major adverse cardiovascular events (composite of all-cause death, non-fatal myocardial infarction [MI], and unplanned hospitalisation leading to urgent revascularisation), and quality-adjusted life years were calculated in both groups. The incremental cost-effectiveness and cost-utility ratios were estimated. Uncertainty was explored by probabilistic bootstrapping. The analysis was conducted from the perspective of the health care provider with a time horizon of one year. Results: At one year, the average cost per patient was 7,560 euro (+/- 2,218) in the FFR-guided group and 7,089 euro (+/- 1,991) in the angiography-guided group (p-value

Heart failure (HF) is the leading cause of hospitalisation in the elderly in France. Early rehospitalisations are common, often through an emergency department. The aim of this study was to assess the impact of a primary care-hospital coordination network, with interventions by coordination nurses (IDEC), on the rehospitalisations after a first hospitalisation for acute decompensation in frail elderly HF patients.From 01/10/2019 to 01/10/2021, 237 patients aged75 years with frailty criteria, hospitalised in 8 departments of 5 private or public hospitals in the Yvelines Sud health territory were followed by an IDEC (hospital visit, telephone contacts, home visit(s)) within 3 months of their return home. This prospective observational study analysed the rate of consultations to the emergency room, rehospitalisations (total and for acute HF), and the number of events avoided at 90 days after discharge.The mean age of the patients was 87 years, 54% were women, 68% had a left ventricular ejection fraction40%, and 70% had atrial fibrillation. Non-cardiac comorbidities were very frequent. At 3-month follow-up, mortality was 9.3% (22/237), only 27 patients (11.3%) consulted the emergency room for acute HF, and the rehospitalisation rate for HF was 19.8%, without difference according to left ventricular ejection fraction. A consultation to the emergency room or a rehospitalisation for heart failure could be avoided for 10% of patients.This study suggests that a primary care-hospital coordination network with dedicated coordination nurses is useful for the management of very elderly frail patients following hospitalisation for heart failure, limiting visits to the emergency room and rehospitalisations.

Outpatient treatment (OT) of patients with low-risk pulmonary embolisms (PE) is recommended. A multidisciplinary OT program including the general practitioner (GP) has been implemented at Versailles hospital in 2019. The objectives of the study were to assess the feasibility, safety and acceptability of the program.The feasibility of, and the inclusion criteria for OT were defined from a retrospective cohort study of PE patients carried out in 2018. In the prospective study, consecutive patients consulting in the emergency department between 2019 and 2021 with confirmed PE were eligible for OT if they had sPESI and HESTIA scores equal to 0, normal troponin and NT-pro-BNP levels, and no right ventricular dilation on imaging. PEs associated with COVID were excluded. The OT program included 4 appointments within 3 months, including 2 with the GP. Events (death, recurrence of PE or venous thromboembolism, bleeding, rehospitalisation) were collected at 3-month follow-up.In the retrospective study, 19% of the 138 PE patients seen in the emergency department were eligible for OT. No complication occurred at Day 90. In the prospective study, 313 consecutive patients with confirmed PE in the emergency department were included, 66 (21%) were eligible for OT. Overall, 43 patients (14%) received OT (39 eligible) and 27 patients eligible for OT were hospitalised (92% because of pulmonary infarction). At 3-month follow-up, there were no death, no recurrence of thromboembolism, and one patient has been early hospitalised for COVID; 3 female patients treated with rivaroxaban had minor bleeding (heavy menstrual bleeding). The satisfaction rate of general practitioner was 95%.This study confirms the feasibility and safety of our OT program for low-risk EP patients, centered on the general practitioner. It reduces the time spent in the emergency department, reduces hospitalisations and strengthens the city-hospital link for care.

Introduction The high prevalence of deep vein thrombosis (DVT) in patients admitted to intensive care unit (ICU) for COVID-19-related acute respiratory distress syndrome (ARDS) would justify systematic screening of these patients or higher therapeutic dose of heparin for thromboprophylaxis. Material and method We performed a systematic echo-Doppler of the lower limb proximal veins during the first 48 h (visit 1) and from 7 to 9 days after visit 1 (visit 2) in consecutive patients admitted to the ICU of a university-affiliated tertiary hospital for severe proven COVID-19 during the second wave. All patients received intermediate-dose heparin (IDH). The primary objective was to determine DVT incidence on venous Doppler ultrasound. Secondary objectives were to determine whether the presence of DVT modifies the anticoagulation regimen, the incidence of major bleeding according to International Society on Thrombosis and Haemostasis (ISTH) criteria, and the mortality rate of patients with and without DVT. Results We included 48 patients (30 [62.5%] men) with a median age of 63 years [IQR, 54–70]. The prevalence of proximal deep vein thrombosis was 4.2% (2/48). In these two patients, after DVT diagnosis, anticoagulation was changed from intermediate to curative dose. Two patients (4.2%) had a major bleeding complication according to ISTH criteria. Among the 48 patients, 9 (18.8%) died before hospital discharge. No DVT or pulmonary embolism was diagnosed in these deceased patients during their hospital stay. Conclusion In critically ill patients with COVID-19, management with IDH results in a low incidence of DVT. Although our study is not designed to demonstrate any difference in outcome, our results do not suggest any signal of harm when using intermediate-dose heparin (IDH) COVID-19 with a frequency of major bleeding complications less than 5%.

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.

Moyamoya disease is a rare angiopathy characterized by a progressive distal occlusion of the internal carotid arteries and their branches. Extracerebral involvement, including coronary arteries, has been described. We report the case of a patient with moyamoya disease who suffered an out-of-hospital cardiac arrest associated with coronary spasm. We discussed the possible links between coronary spasm and moyamoya, as well as the contribution of multimodal cardiac imaging, combining conventional and intracoronary imaging, cardiac MRI, provocative tests for spasm, in the exploration of out-of-hospital cardiac arrest without obvious electrocardiographic and angiographic cause.

Background: \ud Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndromes (ACS) afflicting predominantly younger to middle-aged women. Observational studies have reported a high prevalence of extracoronary vascular anomalies, especially fibromuscular dysplasia (FMD) and a low prevalence of coincidental cases of atherosclerosis. PHACTR1/EDN1 is a genetic risk locus for several vascular diseases, including FMD and coronary artery disease, with the putative causal noncoding variant at the rs9349379 locus acting as a potential enhancer for the endothelin-1 (EDN1) gene.\ud \ud Objectives: \ud This study sought to test the association between the rs9349379 genotype and SCAD.\ud \ud Methods: \ud Results from case control studies from France, United Kingdom, United States, and Australia were analyzed to test the association with SCAD risk, including age at first event, pregnancy-associated SCAD (P-SCAD), and recurrent SCAD.\ud \ud Results: \ud The previously reported risk allele for FMD (rs9349379-A) was associated with a higher risk of SCAD in all studies. In a meta-analysis of 1,055 SCAD patients and 7,190 controls, the odds ratio (OR) was 1.67 (95% confidence interval [CI]: 1.50 to 1.86) per copy of rs9349379-A. In a subset of 491 SCAD patients, the OR estimate was found to be higher for the association with SCAD in patients without FMD (OR: 1.89; 95% CI: 1.53 to 2.33) than in SCAD cases with FMD (OR: 1.60; 95% CI: 1.28 to 1.99). There was no effect of genotype on age at first event, P-SCAD, or recurrence.\ud \ud Conclusions: \ud The first genetic risk factor for SCAD was identified in the largest study conducted to date for this condition. This genetic link may contribute to the clinical overlap between SCAD and FMD.

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

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.

Takotsubo cardiomyopathy. Takotsubo cardiomyopathy, or transient apical ballooning syndrome of the left ventricle, affects women after menopause often after mental or physical stress. Mimicking clinical, electrocardiographic and biological features of an acute coronary syndrome, it requires admission to the intensive care unit and an immediate coronary angiography, which will show the absence of coronary occlusion or rupture of atheromatous plaque. Echocardiogram, left ventriculography if performed, and magnetic resonance imaging will confirm the left ventricular deformation and impairment of systolic function, and the absence of myocardial infarction. Evolution is usually towards recovery of ventricular deformation, and improvement of systolic function, but complications in the acute phase, and recurrences are possible. Treatment is not yet standardised and should include psychological care.Cardiomyopathie de takotsubo. La cardiomyopathie de Takotsubo ou syndrome de ballonisation apicale transitoire du ventricule gauche touche préférentiellement les femmes après la ménopause, souvent après un stress mental ou physique. Simulant un tableau de syndrome coronaire aigu clinique, électrocardiographique et biologique, elle nécessite l’admission en unité de soins intensifs et la réalisation immédiate d’une coronarographie qui montre l’absence d’occlusion coronaire ou de rupture de plaque athéromateuse. L’échocardiogramme, la ventriculographie éventuelle et l’imagerie par résonance magnétique confirment la déformation et l’altération de la fonction systolique ventriculaire gauche et l’absence d’infarctus myocardique. L’évolution habituelle se fait vers une résolution de la dysmorphie ventriculaire, l’amélioration de la fonction systolique, mais des complications sont possibles à la phase aiguë ainsi que d’éventuelles récidives. Le traitement n’est pas codifié et doit comporter une prise en charge psychologique. K. Yayehd déclare des liens d’intérêts avec Clipa, Menarini, Sanofi et Servier. J.-L. Georges déclare des liens d’intérêts avec Amgen, AstraZeneca, Sanofi et Terumo.

Background Angiotensin-converting enzyme 2 is the receptor that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) uses for entry into lung cells. Because ACE-2 may be modulated by angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs), there is concern that patients treated with ACEIs and ARBs are at higher risk of coronavirus disease 2019 (COVID-19) pneumonia. Aim This study sought to analyze the association of COVID-19 pneumonia with previous treatment with ACEIs and ARBs. Materials and methods We retrospectively reviewed 684 consecutive patients hospitalized for suspected COVID-19 pneumonia and tested by polymerase chain reaction assay. Patients were split into two groups, according to whether (group 1, n = 484) or not (group 2, n = 250) COVID-19 was confirmed. Multivariable adjusted comparisons included a propensity score analysis. Results The mean age was 63.6 ± 18.7 years, and 302 patients (44%) were female. Hypertension was present in 42.6% and 38.4% of patients in groups 1 and 2, respectively (P = 0.28). Treatment with ARBs was more frequent in group 1 than group 2 (20.7% vs. 12.0%, respectively; odds ratio [OR] 1.92, 95% confidence interval [CI] 1.23–2.98; P = 0.004). No difference was found for treatment with ACEIs (12.7% vs. 15.7%, respectively; OR 0.81, 95% CI 0.52–1.26; P = 0.35). Propensity score-matched multivariable logistic regression confirmed a significant association between COVID-19 and previous treatment with ARBs (adjusted OR 2.36, 95% CI 1.38–4.04; P = 0.002). Significant interaction between ARBs and ACEIs for the risk of COVID-19 was observed in patients aged > 60 years, women, and hypertensive patients. Conclusions This study suggests that ACEIs and ARBs are not similarly associated with COVID-19. In this retrospective series, patients with COVID-19 pneumonia more frequently had previous treatment with ARBs compared with patients without COVID-19.

Background: GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic t...

International audience; Radiation overexposure accidents are rare but can have severe health consequences. Evaluating the dose received by the patient is a crucial step in the medical management. For that purpose, for more than 15 years, IRSN has been developing an in-house tool named SESAME for the numerical reconstruction of radiological accidents due to external sources. Recently, two new functionalities were implemented in SESAME to allow accurate reconstructions of interventional radiology (IR) overexposures. The experimental validation of SESAME for the reconstruction of overexposures in IR is presented. First, an anthropomorphic dummy equipped with dosemeters was irradiated following conditions similar to a fluoroscopically guided interventional procedure. Then the procedure was simulated using SESAME. Finally measured doses were compared to calculated doses. Even with a limited amount of data available, SESAME can provide valuable dose information for the medical team in charge of the patient, such as skin dose mapping and dose distribution in depth. © The Author(s) 2019. Published by Oxford University Press. All rights reserved. For Permissions, please email journals.permissions@oup.com.

Background and objectives Whether prolonged dual antiplatelet therapy (DAPT) is more protective in patients with CKD and drug-eluting stents compared with shorter DAPT is uncertain. The purpose of this meta-analysis was to examine whether shorter DAPT in patients with drug-eluting stents and CKD is associated with lower mortality or major adverse cardiovascular event rates compared with longer DAPT. Design, setting, participants, & measurements A Medline literature research was conducted to identify randomized trials in patients with drug-eluting stents comparing different DAPT duration strategies. Inclusion of patients with CKD was also required. The primary outcome was a composite of all-cause mortality, myocardial infarction, stroke, or stent thrombosis (definite or probable). Major bleeding was the secondary outcome. The risk ratio (RR) was estimated using a random-effects model. Results Five randomized trials were included (1902 patients with CKD). Short DAPT (≤6 months) was associated with a similar incidence of the primary outcome, compared with 12-month DAPT among patients with CKD (48 versus 50 events; RR, 0.93; 95% confidence interval [95% CI], 0.64 to 1.36; P=0.72). Twelve-month DAPT was also associated with a similar incidence of the primary outcome compared with extended DAPT (≥30 months) in the CKD subgroup (35 versus 35 events; RR, 1.04; 95% CI, 0.67 to 1.62; P=0.87). Numerically lower major bleeding event rates were detected with shorter versus 12-month DAPT (9 versus 13 events; RR, 0.69; 95% CI, 0.30 to 1.60; P=0.39) and 12-month versus extended DAPT (9 versus 12 events; RR, 0.83; 95% CI, 0.35 to 1.93; P=0.66) in patients with CKD. Conclusions Short DAPT does not appear to be inferior to longer DAPT in patients with CKD and drug-eluting stents. Because of imprecision in estimates (few events and wide confidence intervals), no definite conclusions can be drawn with respect to stent thrombosis.

Background and aim The clinical utility of transesophageal echocardiography (TEE) after brain ischemia (BI) remains a matter of debate. We aimed to evaluate the clinical impact of TEE and to build a score that could help physicians to identify which patients should better benefit from TEE. Methods This prospective, multicenter, observational study included patients over 18 years old, hospitalized for BI. TEE findings were judged discriminant if the results showed important information leading to major changes in the management of patients. Most patients with patent foramen ovale were excluded. Variables independently associated with a discriminant TEE were used to build the prediction model. Results Of the entire population (1479 patients), 255 patients (17%) were classified in the discriminant TEE group. Five parameters were selected as predictors of a discriminant TEE. Accordingly, the ADAM-C score could be calculated as follows: Score = 4 (if age ≥60) + 2 (if diabetes) + 2 (if aortic stenosis from any degrees) + 1 (if multi-territory stroke) + 2 (if history of coronary artery disease). At a threshold lower than 3, the sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of detecting discriminant TEE were 88% (95% CI 85-90), 44% (95% CI 41-47), 21% (95% CI 19-27), and 95% (95% CI 94-97), respectively. Conclusion A simple score based on clinical and transthoracic echocardiographic parameters can help physicians to identify patients who might not benefit from TEE. Indeed, a score lower than 3 has an interesting NPV of 95% (95% CI 94-97).

International audience; The objective of this study was to estimate the French national updated reference levels (RLs) for coronary angiography (CA) and percutaneous coronary intervention (PCI) by a dose audit from a large data set of unselected procedures and in standard sized patients. Kerma-area product (PKA), air kerma at interventional point (Ka,r), fluoroscopy time (FT), and the number of registered frames (NFs) and runs (NRs) were collected from 51 229 CAs and 42 222 PCIs performed over a 12-month period at 61 French hospitals. RLs estimated by the 75th percentile in CAs and PCIs performed in unselected patients were 36 and 78Gy.cm2 for PKA, 498 and 1285 mGy for Ka,r, 6 and 15 min for FT, and 566 and 960 for NF, respectively. These values were consistent with the RLs calculated in standard-sized patients. The large difference in dose between sexes leads us to pro pose specific RLs in males and females. The results suggest a trend for a time-course reduction in RLs for interventional cor onary procedures.

Objectives To evaluate practices for the protection from radiation of patients during coronary angiography (CA) and percutaneous coronary intervention (PCI), and to update reference values for the main radiation dose parameters. Background Few multicenter data from large populations exist on radiation doses to patients during CA and PCI. Methods RAY'ACT is a multicenter, nationwide French survey, with retrospective analysis of radiation parameters routinely registered in professional software from 33,937 CAs and 27,826 PCIs performed at 44 centers from January 1, through December 31, 2010. Results Kerma-area product (KAP) was registered in 91.7% (44/48) of centers and in 91.5% of procedures for CA (median, 27.2 Gy·cm2, interquartile range [IQR], 15.5–45.2) and 91.1% for PCI (median, 56.8 Gy·cm2, IQR, 32.8–94.6). Fluoroscopy time was registered in 87.5% (42/48) of centers and in 83.1% of procedures (median, 3.7 min, IQR, 2.3–6.3 for CA; 10.3 min, 6.7–16.2 for PCI). Variability across centers was high. Old equipment and routine left ventriculography were more common and number of registered frames and frame rate were higher in centers delivering high doses. The radial route was associated with lower doses than the femoral route (median KAP 26.8 Gy·cm2 [15.1–44.25] vs. 28.1 [16.4–46.9] for CA, respectively; and 55.6 Gy·cm2 [32.2–92.1] vs. 59.4 [24.6–99.9] for PCI, respectively; P

Objective To evaluate the additional value of StentBoost® (SB), a motion-corrected X-ray technique that enhances stent visualization, for the assessment of stent deployment and procedure optimization during routine percutaneous coronary interventions (PCI). Background Underdeployment and malapposition of stents during PCI may lead to in-stent thrombosis and restenosis. Coronary angiography (CA) is of limited value for the assessment of stent deployment. Intravascular ultrasound and optical imaging techniques are the gold standard, but are used in

Background Literature suggests that radial access is associated with higher radiation doses than femoral access. Aims To compare patient radiation exposure during coronary angiography (CA) and percutaneous coronary intervention (PCI) with radial versus femoral access. Methods RAY'ACT is a nationwide, multicentre, French survey evaluating patient radiation in interventional cardiology. Variables of patient exposure from 21,675CAs and 17,109PCIs performed at 44centres during 2010 were analysed retrospectively. Results Radial access was used in 71% of CAs and 69% of PCIs. Although median fluoroscopy times were longer for radial versus femoral access (CA, 3.8 vs 3.5minutes [P&nbsp

Objectives The aim of this study was to assess whether global longitudinal strain (GLS) measured early during treatment with anthracycline (at a cumulative dose of 150 mg/m2) can predict subsequent alterations in left ventricular ejection fraction (LVEF). Methods and results Eighty-six patients suffering from Hodgkin's disease, non-Hodgkin's lymphoma or acute leukemia and receiving anthracyclines were prospectively included. They underwent complete echocardiography on four separate occasions: baseline (V1); after reaching a cumulative dose of 150 mg/m2 (V2); end of treatment (V3); one year follow-up (V4). Six patients developed cardiotoxicity defined by a decrease in LVEF by more than 10 percentage points to a value of at least less than 53% at V4. Both GLS measured at V1 and at V2 were significantly lower in the cardiotoxicity group compared with the control group (P = 0.042 and P = 0.01, respectively). Compared to GLS at V1, GLS obtained at V2 provided implemental predictive information and appeared to be the strongest predictor of cardiotoxicity (area under the receiver operating characteristic curve, 0.823). At a threshold of -17.45% for GLS measured at V2, the sensitivity and specificity of detecting cardiotoxicity were 67% (95%CI: [33–100%]) and 97% (95%CI: [94–100%]) respectively. Conclusion GLS > -17.45%, obtained after 150 mg/m2 of anthracycline therapy, is a significant predictor of future anthracycline-induced cardiotoxicity. This study should encourage physicians to perform echocardiography earlier during treatment with anthracyclines.

Background Percutaneous coronary interventions (PCIs) use significant doses of ionizing radiation, especially when treating complex lesions. Ionizing radiation may lead to adverse acute or delayed skin lesions in this setting, for which the incidence is not well known. Purpose To assess the incidence of radiation-induced skin lesions following PCI. Methods We conducted a prospective, observational, single-centre study on the incidence of radiation-induced skin lesions at 3-5 days (acute) and at 6 months (subacute) after PCI with a dose-area product (DAP) ≥200Gy.cm 2 , between 1 January and 31 December 2013. Patients consenting to participate were given information on potential skin lesions and were interviewed at 5-7 days and at 6 months after the PCI. Results 1168 PCIs were performed; the radiation dose was available for 937 patients. Of these, 102 underwent PCI with DAP≥200Gy.cm 2 . High body mass index (BMI; OR 6.2, 95% CI 2.8-13.9) and elective (vs emergency) procedures (OR 2.0, 95% CI 1.1-3.4) were independently associated with DAP ≥200Gy.cm 2 . Three patients (3%, 95% CI 0.6-8.4) were diagnosed with acute lesions (DAP of 485Gy.cm 2 , 205Gy.cm 2 , and 201Gy.cm 2 ), two of whom also presented with subacute lesions following PCI with DAP of 485Gy.cm2 (Fig.) and 205Gy.cm 2 . One patient presented with a subacute lesion (DAP 280Gy.cm 2 ) only. Four patients presented with a skin lesion, which represents 4% (95% CI 1.1-9.7) of patients with DAP ≥200Gy.cm 2 and 0.4% (95% CI 0.1-1.1) of all the patients who underwent PCI, irrespective of DAP dose. Conclusions The incidence of radiation-induced acute and subacute skin lesions developing after PCI in this single-centre study was 4% in patients with DAP ≥200Gy.cm 2 , with a total incidence of 0.4%. These data may suggest the need for systematic assessment of skin lesions after high-dose radiation PCI.

SummaryBackgroundExposure of patients to radiation from invasive cardiac procedures is high and may be deleterious.AimsTo assess the effectiveness of a dose-reduction programme based on radiation-protection training, according to the recommendations of the Euratom Council, the International Commission on Radiological Protection and the French Society of Cardiology.MethodsIn this single-centre survey, dose-area product (DAP, Gy.cm2), fluoroscopy time (minutes) and number of runs were evaluated in 3285 consecutive procedures (2077 coronary angiographies [CAs], 1208 percutaneous coronary interventions [PCIs]), performed one year before (2005) and two years after (2006 to 2007) implementation of a programme for radiation dose-reduction. The programme included a 2-day training course in radiological protection for all medical and paramedical staff and recommendations for routine use of low fluoroscopic and acquisition pulse rates (6.25 and 12.5 i/s, respectively), large field size (23cm), maximal collimation and optimal X-ray tube/patient/detector distances. Routine left ventriculography was discouraged. The radial approach was used in>80% of the procedures.ResultsCompared with 2005, a significant 50% reduction in DAP was observed in 2006 and 2007 during CA (median [interquartile range] 53 Gy.cm2 [33–84] vs 26 [16–43] and 21 [14–32], respectively; p

Introduction La revascularisation myocardique chirurgicale reste frequente (20 000 pontage/an en France), l’esperance de vie des coronariens pontes augmente, ainsi que les indications de controle chez des patients pontes, souvent âges ou polyvasculaires, multi-explores. Le choix de la voie d’abord arterielle optimale pour le controle angiographique des PAC est determinant, surtout si les deux arteres mammaires internes ont ete utilisees. Cas clinique Dans le cas presente, une double voie ulnaire a ete utilisee pour opacifier une double mammaire chez une femme n’ayant aucun autre abord arteriel possible et chez qui le coroscanner n’a pas ete contributif. Il nous permet de discuter les interets et limites des differentes voies d’abord, et les techniques qui permettent un examen complet des deux greffons mammaires et du reseau coronaire natif en limitant au maximum le nombre d’abords arteriels, le risque hemorragique, le temps d’examen et d’exposition aux rayons X. L’opacification des deux pedicules mammaires internes peut se faire par voie femorale, avec un risque hemorragique, par double abord radial, mais egalement un abord radial droit unique avec quelques astuces techniques (utilisation d’une sonde a forte courbure et d’un long guide d’echange). La voie ulnaire constitue une bonne alternative a la voie radiale. Conclusion La presence d’un pontage aorto-coronarien mammaire interne gauche, ou double mammaire pedicule, ne doit pas faire exclure un abord radial droit. L’etude du pontage controlateral est possible avec de l’experience et quelques astuces techniques. La voie ulnaire est aussi fiable et sure que la voie radiale, y compris pour les procedures d’angioplastie complexe, mais necessite une courbe d’apprentissage plus longue.

International audience; The objective of this study was to propose diagnostic reference levels (DRLs) for coronary computed tomography angiography (CCTA), in the context of a large variability in patient radiation dose, and the lack of European recommendations. Volume Computed Tomography Dose Index (CTDIvol) and dose-length product (DLP) were collected from 460 CCTAs performed over a 3-month period at eight French hospitals. CCTAs (50 per centre) were performed using the routine protocols of the centres, and 64- to 320-detector CT scanners. ECG gating was prospective (n = 199) or retrospective (n = 261). The large gap in dose between these two modes required to propose specific DRLs 26 and 44 mGy for CTDIvol, and 370 and 970 mGy cm for DLP, respectively. This study confirms the large variability in patient doses during CCTA and underlines the need for the optimisation of cardiac acquisition protocols. Availability of national DRLs should be mandatory in this setting. © The Author 2014.

There is growing evidence that interleukin (IL) 6 plays an important role in the atherosclerotic process because of its role in mediating immune and inflammatory responses and inducing cell proliferation. The present study examined whether molecular variations at the IL-6 locus are involved in the predisposition to myocardial infarction. The entire coding region, 1,158 bp of the 5' flanking region and 237 bp of the 3' flanking region of the IL-6 gene were screened. We detected three nucleotide substitutions in the 5' region at positions -174 (G/C), -572 (G/C), and -596 (G/A) from the transcription start site, and one insertion/deletion in the 3' region at position +528 after the Stop codon. These polymorphisms were genotyped in the Etude Cas-Temoin de l'Infarctus du Myocarde study comparing male patients (n=640) and age-matched controls (n=719) from Northern Ireland and France. The IL-6/G-174C and IL-6/G-596A polymorphisms were in nearly complete association. Carriers of the IL-6/-174 C allele were more frequent in patients than in controls. The population-adjusted odds ratio for myocardial infarction associated with genotype CC+CG vs. GG was estimated as 1.34. In French patients the number of coronary arteries with greater than 50% stenosis was assessed by angiography. The IL-6/-174 C allele was more frequent in patients with two or fewer stenosed vessels than in patients with three-vessel lesions. These results suggest that genetic variation at the IL-6 locus is associated with susceptibility to myocardial infarction, especially events occurring on less extended lesions. These findings would be compatible with a lower IL-6 secretion associated with the IL-6/-174 C allele, itself or in combination with other promoter polymorphisms, leading to more unstable plaques.

Introduction Trois antagonistes intraveineux de la GPIIbIIIa peuvent etre utilises dans la prise en charge des syndromes coronariens aigus (SCA) : le Reopro ® (abciximab), l’Integrilin ® (eftifibatide) et l’Agrastat ® (tirofoban ; generique). Dans notre etablissement, les trois molecules etaient referencees en 2015 afin de couvrir toutes les indications (avec et sans sus-decalage du segment ST) et traiter les patients insuffisants renaux (Agrastat ® etant le seul non contre-indique dans l’insuffisance renale severe). A la suite de l’elargissement des indications de l’Agrastat ® et de la nouvelle offre de prix du laboratoire, nous avons etudie l’impact economique du referencement unique de l’Agrastat ® a la place de l’Integrilin ® et du Reopro ® dans notre etablissement. Materiels & methode Etude retrospective sur les consommations de Reopro ® et d’Integrilin ® dans l’unite de coronarographie de notre etablissement en 2015. La population etudiee est constituee de patients admis pour un SCA avec ou sans sus-decalage du segment ST, recevant un bolus puis une perfusion de 12 h (mode d’utilisation des trois anti-GPIIbIIIa). L’economie potentielle est calculee sur les posologies indiquees dans l’AMM pour un poids moyen de 70 kg. Seul le cout total net du traitement a ete pris en compte en se basant sur les prix negocies. L’equipe infirmiere a egalement ete interrogee sur la facilite de manipulation et le gain en temps apporte. Resultats & discussion Les couts des traitements sont les suivants : – pour le Reopro ® , trois flacons de 10 mg sont necessaires, soit un cout total net de 897 euros par patient ; – pour l’Integrilin ® , deux poches de 75 mg sont necessaires, soit un cout total net de 130 euros par patient. – Enfin, pour l’Agrastat ® , une seule poche de 12,5 mg est necessaire, soit un cout total net de 99 euros par patient (109 euros pour le tirofiban generique). Dans notre etablissement, en moyenne 9 patients par mois recoivent du Reopro ® et un patient recoit de l’Integrilin ® , pour un cout total de 98 436 euros par an. En utilisant l’Agrastat ® pour tous les patients, le cout serait de 11 880 euros, soit une economie de plus de 86 500 euros par an. Les infirmiers sont satisfaits de la formation et du benefice apporte par la manipulation d’un seul flacon. Conclusion Cette etude montre l’economie importante du changement de reference de notre anti-GPIIbIIIa. Cette modification s’accompagne d’une economie en temps infirmier (une seule poche d’Agrastat ® est necessaire, versus 3 flacons pour le Reopro ® ) et d’une uniformisation des protocoles puisque l’Agrastat ® est indique chez tous les patients, y compris les insuffisants renaux et dialyses. Apres presentation de cette etude aux cardiologues et au COMEDIMS, prise en compte de l’avis et formation des infirmiers, le referencement de l’Agrastat ® a ete choisi par notre etablissement et de nouveaux protocoles informatiques valides sur notre logiciel de prescription Pharma ® afin de faciliter sa prescription et reduire d’eventuelles erreurs de prescription et d’administration.

Background Interleukin-10 (IL-10) is a cytokine with anti-inflammatory and B-cell-stimulating activity. IL-10 is expressed in human atherosclerotic plaques and recent studies have shown the involvement of IL-10 in the atherosclerotic process. Therefore, we hypothesized that polymorphisms in the IL-10 gene might be associated with a predisposition to coronary heart disease. Materials and methods To identify new polymorphisms in the human IL-10 gene, the entire coding sequence and the 3′ flanking sequence of the gene were screened by polymerase chain reaction–single strand conformation polymorphism (PCR-SSCR ) followed by sequencing. The polymorphisms identified, and three others which have been previously described in the promoter region of the IL-10 gene (G-1082A, C-819T, C-592A), were then investigated in the ECTIM Study, a large population-based case–control study of myocardial infarction. Results Four new polymorphisms were identified: one in exon 1 (G+78/ex1A), which predicts a Glycine to Arginine change at position 15 in the putative signal peptide of the protein, two in the intron 3 (C+19/in3T, T+953/in3C) and one in the 3′ flanking region (C+117T). All the IL-10 polymorphisms were in complete or nearly complete pairwise linkage disequilibrium. No case–control difference was found in genotype or allele frequencies for any of the polymorphisms. Conclusions Our results suggest that IL-10 polymorphisms are not associated with an increased risk of myocardial infarction.

Background Percutaneous coronary interventions (PCIs) use significant doses of ionizing radiation, especially when treating complex lesions. Ionizing radiation may lead to adverse acute or delayed skin lesions in this setting, for which the incidence is not well known. Purpose To assess the incidence of radiation-induced skin lesions following PCI. Methods We conducted a prospective, observational, single-centre study on the incidence of radiation-induced skin lesions at 3–5 days (acute) and at 6 months (subacute) after PCI with a dose–area product (DAP) ≥ 200 Gy/cm 2 , between 1 January and 31 December 2013. Patients consenting to participate were given information on potential skin lesions and were interviewed at 5–7 days and at 6 months after the PCI. Results In total, 1168 PCIs were performed; the radiation dose was available for 937 patients. Of these, 102 underwent PCI with DAP ≥ 200 Gy/cm 2 . High body mass index (BMI; OR 6.2, 95% CI 2.8–13.9) and elective (vs emergency) procedures (OR 2.0, 95% CI 1.1–3.4) were independently associated with DAP ≥ 200 Gy/cm 2 . Three patients (3%, 95% CI 0.6–8.4) were diagnosed with acute lesions (DAP of 485 Gy/cm 2 , 205 Gy/cm 2 , and 201 Gy/cm 2 ), two of whom also presented with subacute lesions following PCI with DAP of 485 Gy/cm 2 ( Fig. 1 ) and 205 Gy/cm 2 . One patient presented with a subacute lesion (DAP 280 Gy/cm 2 ) only. Four patients presented with a skin lesion, which represents 4% (95% CI 1.1–9.7) of patients with DAP ≥ 200 Gy/cm 2 and 0.4% (95% CI 0.1–1.1) of all the patients who underwent PCI, irrespective of DAP dose. Conclusions The incidence of radiation-induced acute and subacute skin lesions developing after PCI in this single-centre study was 4% in patients with DAP ≥ 200 Gy/cm 2 , with a total incidence of 0.4%. These data may suggest the need for systematic assessment of skin lesions after high-dose radiation PCI.

Background There are limited data on outcomes following primary percutaneous coronary intervention (PCI) for ST-segment elevation acute myocardial infarction (STEMI) in nonagenarian patients. Methods and Results We conducted a multicentre retrospective study between 2006 and 2013 in 5 international high-volume centers and included 145 nonagenarians treated with primary PCI for STEMI. Cardiogenic shock was present at admission in 21%. Mean delay between symptom onset and balloon was 5,8±7,6 hours and 60% of procedures were performed through the transradial approach. Successful revascularization of the culprit vessel was obtained in 86% of the cases (TIMI flow of 2 or 3). Major or clinically-relevant bleeding was observed in 4% of patients. Mean cardiac troponin Ic was 65±79 ng/ml and mean LVEF post-PCI was 42±13%. The in-hospital mortality was 24% with 6 months and 1 year survival of 58% and 49% respectively. Conclusions In our study, primary PCI in nonagenarians with STEMI was successful and feasible through a transradial approach. It is associated with a high rate of successful reperfusion of the infarct-related artery and nearly 50% survival at one year. These results suggest that primary PCI should be offered in selected nonagenarians with acute myocardial infarction (table next page). Abstract 0443 – Table Procedural Findings Time from symtoms to PCI (h) 5.8±7.6 Catheterizzation access (%) Radial 60 Single Vessel Coronary Disease (%) 53 Single Vessel Coronary PCI (%) 74 Infarct-related coronary artery (%) Left main 4 Left anterior descending 41 Circumflex 14 Right 45 CABG 3 Thrombus aspiration (%) 14 TMI flow grade after procedure (%) 0 12 1 1 2 6 3 81 Coronary stenting (%) BMS 75 DES 9 POBA 10 Procedure success (%) Successful PCI 86 Failed PCI 11 Complicated PCI 3 Use of protection device (%) 2 IABP (%) 0 Use of inotropes during procedure (%) 26

ObjectiveIn an earlier report, we suggested that a polymorphism located in the 3′ untranslated region of the angiotensin II type 1 receptor gene (AT1R+1166 A/C) might interact with the angiotensin I converting enzyme (ACE) insertion/deletion (I/D) polymorphism to increase the risk of myocardial infa

To evaluate the additional value of StentBoost® (SB), a motion-corrected X-ray technique that enhances stent visualization, for the assessment of stent deployment and procedure optimization during routine percutaneous coronary interventions (PCI).Underdeployment and malapposition of stents during PCI may lead to in-stent thrombosis and restenosis. Coronary angiography (CA) is of limited value for the assessment of stent deployment. Intravascular ultrasound and optical imaging techniques are the gold standard, but are used in10% of routine PCIs.We retrospectively analyzed 260 coronary lesions treated by stent implantation and assessed by SB during 168 consecutive PCI procedures. The immediate results of SB analysis and CA were assessed by 2 independent interventional cardiologists and compared.A total of 275 stents were implanted; 45% were drug-eluting stents (DES). Direct stenting was performed in 78%. Results of SB and angiography were concordant for 210 lesions: 194 stents were correctly deployed (75%) and 16 were underdeployed (6%), shown by both techniques. In 47 patients (18%), SB detected an underdeployment of the stent whereas the angiographic result was good. Postdilatation was performed on the basis of SB in 89% of these cases. The additional contribution of SB was higher for left main lesions and for DES, and was not affected by coronary calcifications.This study confirmed the usefulness of the stent visualization enhancement technique StentBoost® in current PCI practice. SB revealed about 20% underdeployed stents not detected by CA, and allowed for optimizing PCI by ad hoc effective postdilatation.

To evaluate practices for the protection from radiation of patients during coronary angiography (CA) and percutaneous coronary intervention (PCI), and to update reference values for the main radiation dose parameters.Few multicenter data from large populations exist on radiation doses to patients during CA and PCI.RAY'ACT is a multicenter, nationwide French survey, with retrospective analysis of radiation parameters routinely registered in professional software from 33,937 CAs and 27,826 PCIs performed at 44 centers from January 1, through December 31, 2010.Kerma-area product (KAP) was registered in 91.7% (44/48) of centers and in 91.5% of procedures for CA (median, 27.2 Gy·cm(2) , interquartile range [IQR], 15.5-45.2) and 91.1% for PCI (median, 56.8 Gy·cm(2) , IQR, 32.8-94.6). Fluoroscopy time was registered in 87.5% (42/48) of centers and in 83.1% of procedures (median, 3.7 min, IQR, 2.3-6.3 for CA; 10.3 min, 6.7-16.2 for PCI). Variability across centers was high. Old equipment and routine left ventriculography were more common and number of registered frames and frame rate were higher in centers delivering high doses. The radial route was associated with lower doses than the femoral route (median KAP 26.8 Gy·cm(2) [15.1-44.25] vs. 28.1 [16.4-46.9] for CA, respectively; and 55.6 Gy·cm(2) [32.2-92.1] vs. 59.4 [24.6-99.9] for PCI, respectively; P0.01).This survey showed a very high rate of compliance with dose registration during CA and PCI in French nonacademic hospitals. Updated diagnostic reference values are established for the main dose parameters (KAP, 45 Gy·cm(2) for CA, 95 Gy·cm(2) for PCI).

To better characterize the role of the lipoprotein lipase (LPL) gene in the determination of triglyceride levels in healthy subjects, a study was performed in 193 nuclear families (384 parents, means age = 42.0 ± 5.2 years; 399 offspring, mean age = 14.6 ± 4.3 years) volunteering to have a free health checkup examination. The pattern of familial resemblance was compatible with a zero correlation between spouses, a weak father-offspring correlation (0.099 ± 0.054; P < 0.07), and significant mother-offspring (0.235 ± 0.053; P < 10−4) and sib-sib (0.294 ± 0.064; P < 10−4) correlations. Associations of triglyceride levels with the LPL HindIII and PvuII polymorphisms were investigated by a familial measured genotype analysis, specifying sex- and age-dependent polymorphism effects. The effects associated with both polymorphisms were significant only in fathers, the H+ and P+ alleles being associated with raised triglyceride levels. The HindIII and PvuII polymorphisms explained 3.5% and 3%, respectively, of the variability of triglycerides in fathers. The relationship was weakened after prior adjustment on body mass index, but remained significant for PvuII. Because of the lack of effect in mothers and offspring, the polymorphisms did not contribute to the covariance of triglyceride levels in relatives. In conclusion, this family study showed a weak relationship of the HindIII and PvuII polymorphisms to plasma triglyceride levels in young healthy male subjects. The effects detectable only in fathers suggest a possible modulation of the LPL expression by hormonal or lifestyle factors. © 1996 Wiley-Liss, Inc.

Synthesis of functionalized magnetic nanoparticles (NPs) for biomedical applications represents a current challenge. In this paper we present the synthesis and characterization of water-dispersible sugar-coated iron oxide NPs specifically designed as magnetic fluid hyperthermia heat mediators and negative contrast agents for magnetic resonance imaging. In particular, the influence of the inorganic core size was investigated. To this end, iron oxide NPs with average size in the range of 4-35 nm were prepared by thermal decomposition of molecular precursors and then coated with organic ligands bearing a phosphonate group on one side and rhamnose, mannose, or ribose moieties on the other side. In this way a strong anchorage of the organic ligand on the inorganic surface was simply realized by ligand exchange, due to covalent bonding between the Fe(3+) atom and the phosphonate group. These synthesized nanoobjects can be fully dispersed in water forming colloids that are stable over very long periods. Mannose, ribose, and rhamnose were chosen to test the versatility of the method and also because these carbohydrates, in particular rhamnose, which is a substrate of skin lectin, confer targeting properties to the nanosystems. The magnetic, hyperthermal, and relaxometric properties of all the synthesized samples were investigated. Iron oxide NPs of ca. 16-18 inn were found to represent an efficient bifunctional targeting system for theranostic applications, as they have very good transverse relaxivity (three times larger than the best currently available commercial products) and large heat release upon application of radio frequency (RF) electromagnetic radiation with amplitude and frequency close to the human tolerance limit. The results have been rationalized on the basis of the magnetic properties of the investigated samples.

The aim of this study was to evaluate the prognosis and functional outcome of mitral regurgitation caused by ischemic papillary muscle dysfunction with respect to treatment, and to determine the role of coronary angioplasty in this context. Thirty patients with severe ischemic mitral regurgitation were followed up for 33 ± 3 months. Thirteen patients were treated medically (group I) and 17 patients underwent surgery or angioplasty (group II). The 3-year survival was 59.5% (45.6% in group I and 70.2% in group II). Angioplasty was only used in paroxysmal mitral regurgitation caused by papillary muscle ischemia. This technique resulted in spectacular immediate results in three patients with pulmonary edema caused by mitral regurgitation during myocardial ischemia. Surgical correction of mitral regurgitation should be considered without delay if angioplasty is not feasible or if the regurgitation is permanent or severe. Widening the indications of surgery or angioplasty should result in an improvement of the prognosis of these high-risk patients.

Takotsubo cardiomyopathy can complicate several conditions including neurological emergencies. A few recurrent cases associated with seizures have been reported, but none of the patients had status epilepticus. The pathophysiology of takotsubo syndrome, although debated, may involve stunning of the myocardium by a catecholamine storm triggered by stress. Patients with epilepsy may be at increased risk for takotsubo syndrome, which may occur repeatedly.We report on a postmenopausal woman with symptomatic epilepsy who experienced recurrent takotsubo cardiomyopathy triggered by convulsive status epilepticus. Brief seizures were not associated with takotsubo syndrome. The relevant literature was reviewed.Over a 1-year period, she experienced two episodes of convulsive status epilepticus with complete neurological recovery after treatment. Echocardiography showed latero-septo-apical hypokinesia and apical ballooning. The cardiac abnormalities resolved fully and she recovered her baseline level of self-sufficiency. During the same period, she experienced several brief seizures, with no cardiac manifestations.The occurrence of takotsubo cardiomyopathy in association with convulsive status epilepticus, but not with brief seizures, supports neurogenically mediated myocardial stunning related to direct toxicity of endogenous catecholamines. Neuro-intensivists must be aware of this potentially fatal but fully reversible cardiac complication, which may be among the causes of death in patients with status epilepticus.

Purpose Patient exposure to radiation from interventional coronary procedures (ICPs) is high. Dose optimization is in part based on comparison with reference levels (RLs). Current RLs, however, have been deduced from small or old multicentre studies. The purpose of this study was to evaluate current practices for patient radiation protection (RP) in French non-university public hospitals, which represent >30% of the national activity for ICPs, and 60% of the emergency cases. Methods RAY’ACT was a nationwide, multicentre survey. RP parameters from 35,257 coronary angiographies (CAs) and 28,604 percutaneous coronary interventions (PCIs) performed at 48 centres during 2010 and routinely registered in professional software were extracted and analysed retrospectively. Dose-area product (DAP), fluoroscopy time (FT), number of acquired frames (NF) and runs (NR), and cumulative dose to interventional reference point (CD-IRP) were analysed separately for CAs and PCIs (elective and ad hoc pooled). Emergency and complex procedures, associated with a high level of radiation, were not excluded. Results The table shows the new RLs, based on the 75th percentiles of the values for CA and PCI, and comparison with previous RLs. RLs from RAY’ACT (2010) SENTINEL (2008) EAIA (2007) GACI-PDS (2006) DIMOND (2003) CA N 31,067 672 2,265 496 600 DAP, Gy. cm 2 45.2 45 49.4 57 56 FT, min 6.3 8 9 6 7 NF 769 700 1003 1270 876 CD-IRP, mGy 695 650 1900 – – PCI N 25,356 662 1,844 317 600 DAP, Gy. cm 2 94.6 85 122 94 110 FT, min 16.2 15 21 16 15 NF 1193 1000 1691 1355 1325 CD-IRP, mGy 1788 1500 2800 – – Conclusions The RAY’ACT survey has allowed the definition of new RLs for DAP, FT, NF and CD-IRP for CA and PCI, based on a large study population. It confirms the trend toward a decrease in radiation doses and FT during CA. The lack of decrease in DAP and FT during PCI should be interpreted according to the likely increase in procedure complexity.