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1. Abnormal epicardial coronary vasomotor reactivity is associated with altered outcomes

Author

Hélène, Aélion, Fabien, Picard, Arnaud, Jégou, Philippe, Allouch, and Olivier, Varenne

Subjects
General Medicine, Cardiology and Cardiovascular Medicine
Abstract

The prevalence and significance of abnormal epicardial coronary vasomotor reactivity (ACVR) in patients with symptoms compatible with myocardial ischaemia remains ill-defined. Our diagnostic strategy is to perform a provocative test (PT) in every patient presenting with chest pain at rest, for whom coronary angiography does not reveal significant epicardial coronary artery disease (≥70% stenosis by visual assessment).To evaluate such a strategy in terms of incidence of ACVR, PT safety and patient outcomes.The present study was a retrospective observational study with a median clinical follow-up of 5years. The primary outcome was incidence of ACVR in patients with PT. Risk factors for ACVR and clinical follow-up were obtained, and the rate of major adverse cardiovascular and cerebrovascular events (MACCE; death, cardiovascular mortality, myocardial infarction, stroke and coronary revascularization) was reported.ACVR was documented in 294 (12.4%) of the 2379 patients with PT, out of the 13,654 patients undergoing angiography. Patients with ACVR were more often female (43.9% vs. 30.0%; P0.0001), current smokers (37.4% vs. 8.7%; P0.0001) and had a suspected acute coronary syndrome (36.7% vs. 29.1%; P=0.005) at admittance compared with patients without ACVR. During clinical follow-up, MACCE occurred more frequently in patients with (9.8%) than in those without (3.7%) ACVR (hazard ratio [HR] 4.15, 95% confidence interval [CI] 2.62-6.57; P0.0001), including more myocardial infarctions (4.0% vs. 0.4%; HR 17.8, 95% CI 6.41-49.5; P0.0001) and more myocardial revascularizations (6.1% vs. 1.1%; HR 9.36, 95% CI 4.67-18.74; P0.0001) compared with patients with normal PT at baseline.ACVR is frequent in patients with symptoms compatible with myocardial ischaemia at rest, with no significant coronary stenosis. PT is a safe strategy to identify a population at high risk of recurrent ischaemic events.

Published
2023
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2. Screening coronary artery disease with computed tomography angiogram should limit normal invasive coronary angiogram, regardless of pretest probability

Author

Julien Rosencher, Christophe Caussin, Lea Cacoub, Serge Makowski, Christophe Bensouda, Sonia Houssany-Pissot, Fabrizio Beverelli, Rémy Pillière, Patrice Cacoub, Philippe Allouch, and Simon Elhadad

Subjects
Male, medicine.medical_specialty, Computed Tomography Angiography, Functional testing, Computed tomography, Coronary Artery Disease, 030204 cardiovascular system & hematology, Coronary angiogram, Real life setting, Coronary Angiography, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Humans, 030212 general & internal medicine, Aged, Retrospective Studies, medicine.diagnostic_test, business.industry, Middle Aged, medicine.disease, 3. Good health, Pre- and post-test probability, cardiovascular system, Cardiology, Female, Cardiology and Cardiovascular Medicine, business
Abstract

Performing functional testing (FT) or a computed tomography angiogram (CCTA) before invasive coronary angiogram (ICA) is recommended for coronary artery disease (CAD). We aimed to evaluate, in a real life setting, the rate of strictly normal ICA following a positive noninvasive test result.We included all patients who underwent an ICA with a prior positive FT or CCTA. Patients were categorized in 5 subgroups, according to pretest probability (PTP) of having a CAD. Main results of ICA were defined as normal ICA, nonobstructive CAD (non-oCAD), and obstructive CAD (oCAD).For 4,952 patients who underwent ICA following either a positive FT (3276, 66.2%) or CCTA (1676, 33.8%) result, the PTP was (1) low (15%; n = 968, 19.5%), (2) lower intermediate (15%-35%; n = 1336, 27.0%), (3) higher intermediate (35%-50%; n = 806, 16.3%), (4) high (50%-65%; n = 806, 17.7%), and (5) very high (65%; n = 965, 19.5%). ICA showed no CAD (819 patients, 16.5%), non-oCAD (1,193 patients, 24.1%), or oCAD (2940 patients, 59.4%). Without considering the PTP values, CCTA compared to FT showed less frequently normal ICA (7% vs 16.5%), and more frequently CAD (non-oCAD 27.9% vs 22.2%; oCAD 65.1% vs 56.4%) (all P .0001). When we considered the different PTP values, CCTA always showed lower rates of normal ICA than the FT. In low- and lower intermediate-risk patients, CCTA detected more frequently oCAD compared to FT (P .001).CCTA is a better alternative than FT to limit unnecessary ICA regardless of PTP value, without missing abnormal ICA.

Published
2019

3. Temporal Trends in Transcatheter Aortic Valve Replacement in France

Author

Vincent Auffret, Thierry Lefevre, Eric Van Belle, Hélène Eltchaninoff, Bernard Iung, René Koning, Pascal Motreff, Pascal Leprince, Jean Philippe Verhoye, Thibaut Manigold, Geraud Souteyrand, Dominique Boulmier, Patrick Joly, Frédéric Pinaud, Dominique Himbert, Jean Philippe Collet, Gilles Rioufol, Said Ghostine, Olivier Bar, Alain Dibie, Didier Champagnac, Lionel Leroux, Frédéric Collet, Emmanuel Teiger, Olivier Darremont, Thierry Folliguet, Florence Leclercq, Thibault Lhermusier, Patrick Olhmann, Bruno Huret, Luc Lorgis, Laurent Drogoul, Bernard Bertrand, Christian Spaulding, Laurent Quilliet, Thomas Cuisset, Maxence Delomez, Farzin Beygui, Jean-Philippe Claudel, Alain Hepp, Arnaud Jegou, Antoine Gommeaux, Anfani Mirode, Luc Christiaens, Charles Christophe, Claude Cassat, Damien Metz, Lionel Mangin, Karl Isaaz, Laurent Jacquemin, Philippe Guyon, Christophe Pouillot, Serge Makowski, Vincent Bataille, Josep Rodés-Cabau, Martine Gilard, Hervé Le Breton, Herve Le Breton, Marc Laskar, Bernard Chevalier, Philippe Garot, Thomas Hovasse, Patrick Donzeau Gouge, Arnaud Farge, Mauro Romano, Bertrand Cormier, Erik Bouvier, Jean-Jacques Bauchart, Jean-Christophe Bodart, Cédric Delhaye, David Houpe, Robert Lallemant, Fabrice Leroy, Arnaud Sudre, Francis Juthier, Mohamed Koussa, Thomas Modine, Natacha Rousse, Jean-Luc Auffray, Marjorie Richardson, Jacques Berland, Mathieu Godin, Jean-Paul Bessou, Vincent Letocart, Jean-Christian Roussel, Philippe Jaafar, Nicolas Combaret, Nicolas D’Ostrevy, Andréa Innorta, Guillaume Clerfond, Charles Vorilhon, Marc Bedossa, Guillaume Leurent, Amedeo Anselmi, Majid Harmouche, Jean-Philippe Verhoye, Erwan Donal, Jacques Bille, Rémi Houel, Bertrand Vilette, Wissam Abi Khalil, Stéphane Delepine, Olivier Fouquet, Frédéric Rouleau, Jérémie Abtan, Marina Urena, Soleiman Alkhoder, Walid Ghodbane, Dimitri Arangalage, Eric Brochet, Coppelia Goublaire, Olivier Barthelemy, Rémi Choussat, Jean-Philippe Collet, Guillaume Lebreton, Chiro Mastrioanni, Richard Isnard, Raphael Dauphin, Olivier Dubreuil, Guy Durand De Gevigney, Gérard Finet, Brahim Harbaoui, Sylvain Ranc, Fadi Farhat, Olivier Jegaden, Jean-François Obadia, Matteo Pozzi, Saïd Ghostine, Philippe Brenot, Sahbi Fradi, Alexandre Azmoun, Philippe Deleuze, Martin Kloeckner, Didier Blanchard, Christophe Barbey, Stephan Chassaing, Didier Chatel, Olivier Le Page, Arnaud Tauran, Didier Bruere, Laurent Bodson, Yvon Meurisse, Aurélien Seemann, Nicolas Amabile, Christophe Caussin, Simon Elhaddad, Luc Drieu, Alice Ohanessian, François Philippe, Aurélie Veugeois, Matthieu Debauchez, Konstantinos Zannis, Daniel Czitrom, Chrystelle Diakov, François Raoux, Yves Lienhart, Patrick Staat, Oualid Zouaghi, Vincent Doisy, Jean Philippe Frieh, Fabrice Wautot, Julie Dementhon, Olivier Garrier, Fadi Jamal, Pierre Yves Leroux, Frédéric Casassus, Benjamin Seguy, Laurent Barandon, Louis Labrousse, Julien Peltan, Claire Cornolle, Marina Dijos, Stéphane Lafitte, Gilles Bayet, Claude Charmasson, Alain Vaillant, Jacques Vicat, Marie Paule Giacomoni, Eric Bergoend, Céline Zerbib, Jean Louis Leymarie, Philippe Clerc, Emmanuel Choukroun, Nicolas Elia, Jean-Philippe Grimaud, Jean-Philippe Guibaud, Stéphane Wroblewski, Eric Abergel, Emmanuel Bogino, Christophe Chauvel, Patrick Dehant, Marc Simon, Michel Angioi, Julien Lemoine, Simon Lemoine, Batric Popovic, Pablo Maureira, Olivier Huttin, Christine Selton Suty, Guillaume Cayla, Delphine Delseny, Gilles Levy, Jean Christophe Macia, Eric Maupas, Christophe Piot, François Rivalland, Gabriel Robert, Laurent Schmutz, Frédéric Targosz, Bernard Albat, Arnaud Dubar, Nicolas Durrleman, Thomas Gandet, Emmanuel Munos, Stéphane Cade, Frédéric Cransac, Frédéric Bouisset, Etienne Grunenwald, Bertrand Marcheix, Pauline Fournier, Olivier Morel, Patrick Ohlmann, Michel Kindo, Minh Tam Hoang, Hélène Petit, Hafida Samet, Anne Trinh, Guillaume Lecoq, Jean François Morelle, Pascal Richard, Thierry Derieux, Emmanuel Monier, Cédric Joret, Olivier Bouchot, Jean Christophe Eicher, Pierre Meyer, Stéphane Lopez, Michel Tapia, Jacques Teboul, Jean-Pierre Elbeze, Alain Mihoubi, Gérald Vanzetto, Olivier Wittenberg, Vincent Bach, Cécile Martin, Carole Sauier, Charlotte Casset, Philippe Castellant, Eric Bezon, Jean-Noel Choplain, Ahmed Kallifa, Bahaa Nasr, Yannick Jobic, Antoine Lafont, Jean-Yves Pagny, Ramzi Abi Akar, Jean-Noël Fabiani, Rachid Zegdi, Alain Berrebi, Tania Puscas, Bernard Desveaux, Fabrice Ivanes, Christophe Saint Etienne, Thierry Bourguignon, Blandine Aupy, Romain Perault, Jean-Louis Bonnet, Marc Lambert, Dominique Grisoli, Nicolas Jaussaud, Erwan Salaun, Amine Laghzaoui, Christine Savoye, Mathieu Bignon, Vincent Roule, Rémy Sabatier, Calin Ivascau, Vladimir Saplacan, Eric Saloux, Damien Bouchayer, Guillaume Tremeau, Camille Diab, Joel Lapeze, Franck Pelissier, Thomas Sassard, Catherine Matz, Nicolas Monsarrat, Ivan Carel, Franck Sibellas, Alain Curtil, Grégoire Dambrin, Xavier Favereau, Gabriel Ghorayeb, Laurent Guesnier, Wassim Khoury, Christophe Kucharski, Bruno Pouzet, Claude Vaislic, Riadh Cheikh-Khelifa, Loïc Hilpert, Philippe Maribas, Gery Hannebicque, Philippe Hochart, Marc Paris, Max Pecheux, Olivier Fabre, Laurent Leborgne, Marcel Peltier, Faouzi Trojette, Doron Carmi, Christophe Tribouilloy, Jean Mergy, Pierre Corbi, Pascale Raud Raynier, Sylvain Carillo, Arnaud Hueber, Fédéric Moulin, Georges Pinelli, Nicole Darodes, Francis Pesteil, Chadi Aludaat, Frédéric Torossian, Loïc Belle, Nicolas Chavanis, Chrystelle Akret, Alexis Cerisier, Jean Pierre Favre, Jean François Fuzellier, Romain Pierrard, Olivier Roth, Jean Yves Wiedemann, Nicolas Bischoff, Georghe Gavra, Nicolas Bourrely, Franck Digne, Mohammed Najjari, Victor Stratiev, Nicolas Bonnet, Patrick Mesnildrey, David Attias, Julien Dreyfus, Daniel Karila Cohen, Thierry Laperche, Julien Nahum, Aliocha Scheuble, Geoffrey Rambaud, Eric Brauberger, Michel Ah Hot, Philippe Allouch, Fabrice Beverelli, Julien Rosencher, Stéphane Aubert, Jean Michel Grinda, Thierry Waldman, Service de cardiologie et maladies vasculaires, Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Maladies infectieuses et vecteurs : écologie, génétique, évolution et contrôle ( MIVEGEC ), Université de Montpellier ( UM ) -Centre National de la Recherche Scientifique ( CNRS ) -Institut de Recherche pour le Développement ( IRD [France-Sud] ), Service de cardiologie [Rouen], CHU Rouen-Université de Rouen Normandie ( UNIROUEN ), Normandie Université ( NU ) -Normandie Université ( NU ), Service de cardiologie, Assistance publique - Hôpitaux de Paris (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris]-Université Paris Diderot - Paris 7 ( UPD7 ), CHU Gabriel Montpied ( CHU ), CHU Clermont-Ferrand, Institut Pascal - Clermont Auvergne ( IP ), Sigma CLERMONT ( Sigma CLERMONT ) -Université Clermont Auvergne ( UCA ) -Centre National de la Recherche Scientifique ( CNRS ), Service de chirurgie cardiaque et thoracique [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Pitié-Salpêtrière [APHP], Laboratoire Traitement du Signal et de l'Image ( LTSI ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Service de chirurgie cardio-vasculaire et thoracique, CHU Angers, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition ( ICAN ), CHU Pitié-Salpêtrière [APHP]-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Assistance publique - Hôpitaux de Paris (AP-HP)-Université Pierre et Marie Curie - Paris 6 ( UPMC ), Adaptation cardiovasculaire à l'ischemie, Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Institut Mondor de recherche biomédicale ( IMRB ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ), Service de cardiologie [Toulouse], Université Paul Sabatier - Toulouse 3 ( UPS ) -CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Cochin [AP-HP], Nutrition, obésité et risque thrombotique ( NORT ), Institut National de la Recherche Agronomique ( INRA ) -Aix Marseille Université ( AMU ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), CHU de Poitiers, Epidémiologie et Biostatistique, Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Epidémiologie et analyses en santé publique : risques, maladies chroniques et handicaps [Toulouse], Université Paul Sabatier - Toulouse 3 ( UPS ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), 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 Chimie de la Matière Condensée de Bordeaux ( ICMCB ), Université de Bordeaux ( UB ) -Centre National de la Recherche Scientifique ( CNRS ), Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille ), Institut national de recherches archéologiques préventives ( Inrap ), Hémostase et pathologie cardiovasculaire, EA2693-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université de Lille, Droit et Santé, Belgian Institute for Space Aeronomy / Institut d'Aéronomie Spatiale de Belgique ( BIRA-IASB ), ONERA - The French Aerospace Lab ( Toulouse ), ONERA, Service de chirurgie thoracique cardiaque et vasculaire [Rennes], Institut de cardiologie [CHU Pitié-Salpêtrière], Service de Chirurgie Thoracique et Cardiovasculaire [CHU Pitié-Salpêtrière], Cardioprotection, Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Université de Lyon-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 ), Carnegie Mellon University [Pittsburgh] ( CMU ), Hôpital nord, St Etienne, Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ), Clinique du Tonkin, Unité de recherche Phytopharmacie et Médiateurs Chimiques ( UPMC ), Institut National de la Recherche Agronomique ( INRA ), Département de cardiologie, CHU Bordeaux [Bordeaux]-Hôpital Haut-Lévêque [CHU Bordeaux], CHU Bordeaux [Bordeaux], Centre des Sciences des Littératures en Langue Française ( CSLF ), Université Paris Nanterre ( UPN ), Service de Cardiologie [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Saint-Antoine [APHP], Laboratoire de Chimie Physique - Matière et Rayonnement ( LCPMR ), Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Centre National de la Recherche Scientifique ( CNRS ), Laboratoire d'Informatique Fondamentale de Lille ( LIFL ), Université de Lille, Sciences et Technologies-Institut National de Recherche en Informatique et en Automatique ( Inria ) -Université de Lille, Sciences Humaines et Sociales-Centre National de la Recherche Scientifique ( CNRS ), Défaillance Cardiovasculaire Aiguë et Chronique ( DCAC ), Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université de Lorraine ( UL ), Centre Hospitalier Régional Universitaire de Nîmes ( CHRU Nîmes ), Service de chirurgie thoracique et cardio-vasculaire, Université Montpellier 1 ( UM1 ) -Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ) -Hôpital Arnaud de Villeneuve, Institut des Maladies Métaboliques et Cardiovasculaires ( I2MC ), Université Paul Sabatier - Toulouse 3 ( UPS ) -Hôpital de Rangueil-Institut National de la Santé et de la Recherche Médicale ( INSERM ), École de sages-femmes René Rouchy ( ESF Angers ), Université d'Angers ( UA ) -CHU Angers, Laboratoire de Génie Civil et d'Ingénierie Environnementale ( LGCIE ), 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 ), Agriculture and Agri-Food [Ottawa] ( AAFC ), Centre d'études et de recherche sur les contentieux - EA 3164 ( CERC ), Université de Toulon ( UTLN ), Radiopharmaceutiques biocliniques, Université Joseph Fourier - Grenoble 1 ( UJF ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Clinique de chirurgie cardiaque, Université Joseph Fourier - Grenoble 1 ( UJF ) -CHU Grenoble, Unité Mixte de Recherches sur les Herbivores ( UMR 1213 Herbivores ), VetAgro Sup ( VAS ) -AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Institut National de la Recherche Agronomique ( INRA ), Université Grenoble Alpes - UFR Médecine ( UGA UFRM ), Université Grenoble Alpes ( UGA ), Développement artériel, Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre de recherche en économie et management ( CREM ), Université de Caen Normandie ( UNICAEN ), Normandie Université ( NU ) -Normandie Université ( NU ) -Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Centre National de la Recherche Scientifique ( CNRS ), Université Pierre et Marie Curie - Paris 6 - UFR de Médecine Pierre et Marie Curie ( UPMC ), Université Pierre et Marie Curie - Paris 6 ( UPMC ), Récepteurs nucléaires, maladies cardiovasculaires et diabète ( EGID ), Université de Lille, Droit et Santé-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Institut Pasteur de Lille, Réseau International des Instituts Pasteur ( RIIP ) -Réseau International des Instituts Pasteur ( RIIP ) -Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille ), Edwards Lifesciences Medtronic Lead-Up Medicines Company French Cardiology Federation (Federation Francaise de Cardiologie) Eli Lilly WebMD Biosensor ACIST Abbott Biosensors Terumo Daichii-Sankyo Boston Scientific St. Jude Medical Bristol-Myers Squibb Bayer AstraZeneca French Ministry of Health Abiomed Zoll Medpass Cordis Servier, Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Assistance publique - Hôpitaux de Paris (AP-HP)-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -CHU Pitié-Salpêtrière [APHP], Centre hospitalier universitaire de Poitiers ( CHU Poitiers ), Institut Pasteur de Lille, and Réseau International des Instituts Pasteur ( RIIP ) -Réseau International des Instituts Pasteur ( RIIP ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille )

Subjects
Aortic valve, medicine.medical_specialty, medicine.medical_treatment, national registry, 030204 cardiovascular system & hematology, outcomes, 03 medical and health sciences, 0302 clinical medicine, Valve replacement, Cardiac tamponade, Medicine, 030212 general & internal medicine, ComputingMilieux_MISCELLANEOUS, Aortic dissection, business.industry, Mortality rate, transfemoral, EuroSCORE, [ SDV.MHEP.CSC ] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, medicine.disease, pacemaker, 3. Good health, Surgery, Stenosis, Catheter, medicine.anatomical_structure, Cardiology and Cardiovascular Medicine, business
Abstract

Background - Transcatheter aortic valve replacement (TAVR) is standard therapy for patients with severe aortic stenosis who are at high surgical risk. However, national data regarding procedural characteristics and clinical outcomes over time are limited. Objectives - The aim of this study was to assess nationwide performance trends and clinical outcomes of TAVR during a 6-year period. Methods - TAVRs performed in 48 centers across France between January 2013 and December 2015 were prospectively included in the FRANCE TAVI (French Transcatheter Aortic Valve Implantation) registry. Findings were further compared with those reported from the FRANCE 2 (French Aortic National CoreValve and Edwards 2) registry, which captured all TAVRs performed from January 2010 to January 2012 across 34 centers. Results - A total of 12,804 patients from FRANCE TAVI and 4,165 patients from FRANCE 2 were included in this analysis. The median age of patients was 84.6 years, and 49.7% were men. FRANCE TAVI participants were older but at lower surgical risk (median logistic European System for Cardiac Operative Risk Evaluation [EuroSCORE]: 15.0% vs. 18.4%; p < 0.001). More than 80% of patients in FRANCE TAVI underwent transfemoral TAVR. Transesophageal echocardiography guidance decreased from 60.7% to 32.3% of cases, whereas more recent procedures were increasingly performed in hybrid operating rooms (15.8% vs. 35.7%). Rates of Valve Academic Research Consortium-defined device success increased from 95.3% in FRANCE 2 to 96.8% in FRANCE TAVI (p < 0.001). In-hospital and 30-day mortality rates were 4.4% and 5.4%, respectively, in FRANCE TAVI compared with 8.2% and 10.1%, respectively, in FRANCE 2 (p

Published
2017
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4. How to limit radial artery spasm during percutaneous coronary interventions: The spasmolytic agents to avoid spasm during transradial percutaneous coronary interventions (SPASM3) study

Author

Julien Rosencher, Marc-Antoine Arnould, Arnaud Jégou, Philippe Allouch, Aures Chaib, Franck Barbou, Arthur Huber, Fadila Mihoub, Emmanuel Salengro, Olivier Varenne, and Stéphane Zuily

Subjects
medicine.medical_specialty, education.field_of_study, Percutaneous, business.industry, medicine.medical_treatment, Population, Percutaneous coronary intervention, General Medicine, medicine.artery, Internal medicine, Anesthesia, Conventional PCI, medicine, Cardiology, Verapamil, Radiology, Nuclear Medicine and imaging, Diltiazem, Radial artery, Isosorbide dinitrate, Cardiology and Cardiovascular Medicine, education, business, medicine.drug
Abstract

Aims: To compare the efficacy of three vasodilators in preventing radial artery spasm (RAS) in patients undergoing transradial percutaneous coronary interventions (PCI). Methods and Results: 731 patients were randomized to receive diltiazem 5 mg, verapamil 2.5 mg, or isosorbide dinitrate (ISDN) 1 mg before coronary intervention. RAS occurred in 20.1% in the whole population and was significantly reduced by verapamil and ISDN compared to diltiazem (16.2, 17.2, and 26.6%, respectively; P < 0.006). There was also a trend towards less severe pain (more than 8 on a numerical scale from 0 [no pain] to 10 [maximal pain]), and less severe RAS (complete catheter blockage or severe pain), among patients treated by verapamil compared to ISDN and diltiazem (1.3% vs. 2.8% vs. 2.9%, P = 0.43 and 5.1% vs. 6.2% vs. 9.5%, respectively, P = 0.13). No difference was found between the three vasodilators in terms of crossover or safety events. Female gender, failure at first attempt to access the radial artery, emergency procedures, and the use of diltiazem were independent predictors of RAS. Conclusion: Verapamil and ISDN considerably reduce the incidence of RAS compared to diltiazem during transradial PCI. © 2013 Wiley Periodicals, Inc.

Published
2014
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5. Radial artery spasm: prevalence, prevention and safety vasodilators agents in a prospective randomized meta-analysis

Author

S. Linard, R. Jakamy, J. Adjedj, Arnaud Jégou, J. Rosencher, Philippe Allouch, Emmanuel Salengro, Olivier Varenne, P. Degrell, and A. Diallo

Subjects
medicine.medical_specialty, business.industry, Internal medicine, Meta-analysis, medicine.artery, Anesthesia, medicine, Cardiology, Vasodilation, Radial artery, Cardiology and Cardiovascular Medicine, business
Published
2017
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6. Prognostic significance of renal insufficiency in patients presenting with acute coronary syndrome (the Prospective Multicenter SYCOMORE study)

Author

Pierre-Louis Michel, Philippe Gabriel Steg, Patrick Henry, Gilles Montalescot, Marie-Laure Tanguy, Patrice Colin, Eric Durand, Jean-Philippe Collet, Raphaelle Dumaine, Nicolas Mansencal, Ariel Cohen, Jean-Luc Dubois-Randé, and Philippe Allouch

Subjects
Male, medicine.medical_specialty, Acute coronary syndrome, Contrast Media, Renal function, Coronary Disease, urologic and male genital diseases, Nephropathy, Internal medicine, medicine, Humans, In patient, Prospective Studies, Renal Insufficiency, Prospective cohort study, business.industry, Confounding, Syndrome, Middle Aged, Prognosis, medicine.disease, Cardiology, Female, Observational study, Cardiology and Cardiovascular Medicine, business, Kidney disease
Abstract

This prospective, multicenter, observational study was designed to assess the in-hospital prognostic importance of renal insufficiency among patients presenting with acute coronary syndrome (ACS). One third of patients with ACS presented with renal insufficiency. After adjustment for potential confounders, decreasing renal function was independently associated with in-hospital death, bleeding, and contrast-induced nephropathy.

Published
2004
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7. A 'UFO' in the right pulmonary artery after cardiac surgery

Author

Philippe Allouch, Alix Aubry, Pierre Squara, and Antoine Vieillard-Baron

Subjects
medicine.medical_specialty, business.industry, Pain medicine, Critical Care and Intensive Care Medicine, medicine.disease, Right pulmonary artery, Cardiac surgery, Internal medicine, medicine.artery, Anesthesiology, Pulmonary artery, medicine, Cardiology, Endocarditis, business, Foreign Bodies
Published
2016
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8. Intramural neovascularization and haemorrhages are major long‐term effects of intravascularγ‐radiation after stenting

Author

David Busseuil, L. Martin, Philippe Allouch, P. Maingon, C. Vergely, F. Piard, L. Rochette, Y. Cottin, François Briot, J. E. Wolf, Marianne Zeller, I. Barillot, and Alain Lalande

Subjects
Male, Pathology, medicine.medical_specialty, Brachytherapy, Hemorrhage, Inflammation, Matrix metalloproteinase, Coronary Restenosis, Neovascularization, Hemosiderin Deposition, Von Willebrand factor, Reference Values, medicine, Animals, Radiology, Nuclear Medicine and imaging, Aorta, Abdominal, Vascular Diseases, γ radiation, Neovascularization, Pathologic, Radiological and Ultrasound Technology, biology, business.industry, Structural integrity, Intravascular brachytherapy, Gamma Rays, Metalloproteases, biology.protein, Stents, Collagen, Rabbits, medicine.symptom, business
Abstract

Structural changes that might influence the structural integrity of the vessel in response to intravascular brachytherapy (IVB) and stenting were examined, focus being on the importance of neovascularization in rabbit stented arteries. Stents were implanted in the infrarenal aortas of rabbits, immediately followed by gamma IVB or a sham radiation procedure, and the arteries harvested at 6 months. Labelling for von Willebrand factor showed an increase in adventitial and medial neovascularization in irradiated versus control arteries group (5.04+/-0.89 versus 1.51+/-0.23 mm(-2), respectively; p=0.004). Moreover, intramedial haemorrhages (free hemosiderin deposition) and inflammation (macrophages) were only observed in irradiated arteries. No significant change in expression of matrix metalloproteinase 1, 2 or 3 was observed between the irradiated and control group while collagen content decreased in the irradiated versus the control group (10.05%+/-1.48% versus 31.92%+/-3.12%, respectively; p

Published
2003
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9. TCT-317 Systematic detection of coronary vasospasm by methylergonovine-based provocative test in 2,397 patients

Author

Arnaud Jégou, Philippe Allouch, Olivier Varenne, Stéphane Manzo-Silberman, Marie Caroline Chenilleau, Naïm Bouazza, Alain Cariou, Julien Rosencher, and Hélène Aelion

Subjects
Coronary angiography, medicine.medical_specialty, business.industry, Provocative test, medicine.disease, medicine.anatomical_structure, Internal medicine, Coronary vasospasm, medicine, Cardiology, Methylergonovine, business, Cardiology and Cardiovascular Medicine, Artery
Abstract

In the absence of clear-cut indications for provocative test (PT), coronary artery spasm (CAS) may be underdiagnosed whereas the widespread use of early coronary angiography has found that acute ischemic syndromes are not always related to atherosclerotis. The objective of the present study was to

Published
2014
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10. How to limit radial artery spasm during percutaneous coronary interventions: The spasmolytic agents to avoid spasm during transradial percutaneous coronary interventions (SPASM3) study

Author

Julien, Rosencher, Aurès, Chaïb, Franck, Barbou, Marc-Antoine, Arnould, Arthur, Huber, Emmanuel, Salengro, Arnaud, Jégou, Philippe, Allouch, Stéphane, Zuily, Fadila, Mihoub, and Olivier, Varenne

Subjects
Male, Analysis of Variance, Cardiac Catheterization, Spasm, Vasodilator Agents, Coronary Stenosis, Isosorbide Dinitrate, Middle Aged, Coronary Angiography, Diltiazem, Logistic Models, Treatment Outcome, Verapamil, Vasoconstriction, Multivariate Analysis, Radial Artery, Humans, Female, Prospective Studies, Angioplasty, Balloon, Coronary, Aged, Follow-Up Studies
Abstract

To compare the efficacy of three vasodilators in preventing radial artery spasm (RAS) in patients undergoing transradial percutaneous coronary interventions (PCI).731 patients were randomized to receive diltiazem 5 mg, verapamil 2.5 mg, or isosorbide dinitrate (ISDN) 1 mg before coronary intervention. RAS occurred in 20.1% in the whole population and was significantly reduced by verapamil and ISDN compared to diltiazem (16.2, 17.2, and 26.6%, respectively; P0.006). There was also a trend towards less severe pain (more than 8 on a numerical scale from 0 [no pain] to 10 [maximal pain]), and less severe RAS (complete catheter blockage or severe pain), among patients treated by verapamil compared to ISDN and diltiazem (1.3% vs. 2.8% vs. 2.9%, P = 0.43 and 5.1% vs. 6.2% vs. 9.5%, respectively, P = 0.13). No difference was found between the three vasodilators in terms of crossover or safety events. Female gender, failure at first attempt to access the radial artery, emergency procedures, and the use of diltiazem were independent predictors of RAS.Verapamil and ISDN considerably reduce the incidence of RAS compared to diltiazem during transradial PCI.

Published
2013

11. Mise en évidence d’un spasme coronaire par le test au Méthergin®

Author

Faycal Belaouchi, Simon Weber, Alice Ohanessian, Philippe Allouch, Emmanuel Salengro, and Christian Spaulding

Subjects
Coronary angiography, medicine.medical_specialty, medicine.diagnostic_test, business.industry, MEDLINE, General Medicine, medicine.disease, Test (assessment), Coronary vasospasm, Internal medicine, Cardiology, medicine, Methylergonovine, Differential diagnosis, business, Electrocardiography
Published
2004
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12. 039 The outcome of PCI in the elderly is mostly related to the clinical presentation at admission: insights from a registry study

Author

Emmanuel Salengro, Philippe Allouch, Olivier Varenne, Arnaud Jégou, Stéphane Manzo-Silberman, Anne-Céline Martin, Aurel Chaib, and Christian Spaulding

Subjects
medicine.medical_specialty, business.industry, Anemia, medicine.medical_treatment, Cardiogenic shock, Mortality rate, Percutaneous coronary intervention, medicine.disease, law.invention, Coronary artery disease, Randomized controlled trial, law, Relative risk, Internal medicine, Conventional PCI, Cardiology, Medicine, cardiovascular diseases, business, Cardiology and Cardiovascular Medicine
Abstract

Optimal management of coronary artery disease in very old patients – over eighty years of age – remains unclear due to the absence of large randomized trials in this high-risk subgroup and the benefit/risk ratio of percutaneous coronary intervention (PCI) is difficult to assess in clinical practice. Aim The aim of our study was to evaluate the in-hospital and mid- term outcomes of PCI in octogenarians in a retrospective registry including patients with clinical presentation ranging from stable angina refractory to medical treatment to cardiogenic shock and to identify the criteria of our decision-making process. Methodes and Results Between 2003 and 2009, 582 octogenarians were admitted for coronary events. 336 patients benefit from a coronary angiogram; PCI was performed in 232. Mean age was 82 ± 2.6 and 45% were women. The procedures were unplanned due to ST elevation myocardial infarction (STEMI) (32.8%), cardiogenic shock complicating STEMI (9%), and non ST elevation myocardial infarction (NSTEMI) (30.6%). 36.6% of procedures were performed for stable angina refractory to optimal medical therapy. Radial access was used in 87% of cases. Primary success rate was 93%. Three criteria for invasive strategy refusal were identified in our clinical practice: renal insufficiency, anemia and cognitive disorders. Rates of in hospital mortality were respectively 12.5% in all patients; 85.7% in cardiogenic shock, 14.5% in patients with STEMI without shock, 2.8% in those with NSTEMI and 2.35% in patients with stable angina. The overall three years mortality rate is significantly lower with PCI than with conservative strategy (35% versus 58%, p = 0,0002). Conclusion In octogenarians, in hospital outcome is strongly related to the clinical presentation at admission. PCI display significantly beneficial effects on mid- term overall mortality in these old patients provided an easy to do selection regards three pitfalls: renal dysfunction, anemia and cognitive impairment.

Published
2011
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13. [Untitled]

Author

David Busseuil, Jean-Claude Horiot, Luc Rochette, Jean-Eric Wolf, Laurent Arnould, Gabrielle Michalowicz, Maryvonne Moisant, Yves Cottin, Marianne Zeller, I. Barillot, Philippe Maingon, S. Naudy, and Philippe Allouch

Subjects
Pharmacology, Pathology, medicine.medical_specialty, Lagomorpha, Intimal hyperplasia, biology, Vascular disease, business.industry, medicine.medical_treatment, Stent, General Medicine, medicine.disease, biology.organism_classification, Thrombosis, Restenosis, Angioplasty, medicine, Rabbit model, Pharmacology (medical), Cardiology and Cardiovascular Medicine, business
Published
2000
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14. [Revelation of a coronary spasm using the Méthergin test]

Author

Christian, Spaulding, Faycal, Belaouchi, Emmanuel, Salengro, Alice, Ohanessian, Philippe, Allouch, and Simon, Weber

Subjects
Diagnosis, Differential, Electrocardiography, Methylergonovine, Oxytocics, Coronary Vasospasm, Humans, Coronary Angiography
Published
2004

15. Late neointimal tissue growth behind the stent after intravascular gamma-radiation

Author

Luc Rochette, David Busseuil, Jean-Eric Wolf, Isabelle Barillot, Tibor Ponnelle, François Briot, Marianne Zeller, Philippe Maingon, Philippe Allouch, Antoine Bril, and Yves Cottin

Subjects
Male, Cancer Research, medicine.medical_specialty, medicine.medical_treatment, Brachytherapy, Constriction, Pathologic, Constriction, Restenosis, medicine.artery, medicine, Animals, Radiology, Nuclear Medicine and imaging, Aorta, Abdominal, Aorta, Radiation, γ radiation, business.industry, Stent, Incomplete stent apposition, medicine.disease, Oncology, Intravascular brachytherapy, Gamma Rays, Stents, Radiology, Rabbits, business, Tunica Intima
Abstract

To determine the nature of the changes of the vascular wall after intravascular brachytherapy in stented arteries leading to incomplete stent apposition.Stents were implanted in the infrarenal aortas of rabbits, and gamma-intravascular brachytherapy (18 Gy) or a sham radiation procedure was immediately implemented. The arteries were harvested at 6 months for histologic analyses.The external elastic lamina area, as well as the vascular wall area behind the stent, were significantly greater in irradiated vs. control arteries (8.94 +/- 0.68 mm2 vs. 6.87 +/- 0.40 mm2 [p0.001] and 1.56 +/- 0.13 mm2 vs. 0.72 +/- 0.07 mm2 [p0.001], respectively). The ratio of the intimal area behind the stent related to the total intimal area was greater in the irradiated segments (control vs. irradiated: 9.0% +/- 5.9% vs. 55.3% +/- 15.5%, p0.05). Neointimal growth of the irradiated vessels outside the stent was characterized by marked fibrin depositions and an inflammatory response around the stent struts.Our study revealed the presence of a neointimal layer specifically located behind the stent, which represented the result of an unhealed fibrin-rich tissue growth process 6 months after intravascular brachytherapy.

Published
2003

16. TCT-412 Diltiazem, verapamil or dinitrate isosorbid for prevention of radial artery spasm in percutaneous coronary intervention

Author

Philippe Allouch, Aures Chaib, Julien Rosencher, Arnaud Jégou, Olivier Varenne, Jacques Monsegu, Marc Antoine Arnould, Emmanuel Salengro, Patrick Schiano, and Arthur Huber

Subjects
medicine.medical_specialty, Percutaneous, business.industry, medicine.medical_treatment, Percutaneous coronary intervention, Internal medicine, medicine.artery, Conventional PCI, medicine, Cardiology, Verapamil, cardiovascular diseases, Diltiazem, Radial artery, Cardiology and Cardiovascular Medicine, business, medicine.drug
Abstract

Radial artery spasm (RAS) remains the major limitation of transradial approach for percutaneous coronary interventions (PCI). We have previously demonstrated efficacy of verapamil to reduce RAS but recently, supply problems have occurred and many cathlab have changed verapamil to another calcium

Published
2012
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17. TCT-491 High incidence of stent thrombosis with new P2Y12 inhibitors after percutaneous coronary intervention in patients survivors of out-of-hospital cardiac arrest

Author

Reda Jakamy, Olivier Varenne, Julien Rosencher, Wulfran Bougouin, Jérémie Joffre, Guillaume Gouffran, Alain Cariou, Arnaud Jégou, and Philippe Allouch

Subjects
medicine.medical_specialty, business.industry, medicine.medical_treatment, Percutaneous coronary intervention, Hypothermia, Out of hospital cardiac arrest, P2Y12, Internal medicine, Shock (circulatory), Conventional PCI, Cardiology, Medicine, In patient, cardiovascular diseases, High incidence, medicine.symptom, Cardiology and Cardiovascular Medicine, business
Abstract

Acute coronary syndromes (ACS) remain the leading cause of out-of-hospital cardiac arrest (OHCA). Current guidelines plead for early coronary angiography and ad-hoc primary percutaneous coronary intervention (PCI). But after cardiac arrest, shock, hypothermia and modification in antiplatelet

Published
2014
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19. Impact of an extension tube on operator radiation exposure during coronary procedures performed through the radial approach

Author

Nicolas Marque, Olivier Varenne, Philippe Allouch, Arnaud Jégou, Olivier Margot, Emmanuel Salengro, and Christian Spaulding

Subjects
Male, Health Knowledge, Attitudes, Practice, Time Factors, Attitude of Health Personnel, Coronary Angiography, Radiation Dosage, Radiography, Interventional, Coronary arteries, Radiation Protection, Operator (computer programming), Radiation Monitoring, fashion, Occupational Exposure, medicine, Humans, Tube (fluid conveyance), Prospective Studies, Irradiation, Angioplasty, Balloon, Coronary, Radiation Injuries, Occupational Health, Abord radial, Aged, Dosimeter, Radial approach, business.industry, Radiation exposure, Equipment Design, General Medicine, Dosimètre, Awareness, Middle Aged, Coronaires, Occupational Diseases, Catheter, medicine.anatomical_structure, fashion.garment, Radial Artery, Lead apron, Female, business, Nuclear medicine, Cardiology and Cardiovascular Medicine
Abstract

Summary Background Operator radiation exposure is high during coronary procedures. The radial access decreases the rate of local vascular complications but increases operator radiation exposure. As the X-ray exposure is related to the distance between the operator and the radiation source, the use of an extension tube between the proximal part of the coronary catheter and the ‘injection device’ might decrease operator radiation exposure. Aims To demonstrate that the use of an extension tube during coronary procedures performed through the radial approach decreases operator radiation. Methods Overall, 230 patients were included consecutively and randomized to procedures performed with or without an extension tube. Radiation exposure measures were obtained using two electronic dosimeters, one under the lead apron and the other exposed on the physician's left arm. Results A non-significant trend towards lower left-arm operator exposure was noted in the extension tube group (28.7 ± 31.0 μSv vs 38.4 ± 44.2 μSv, p = 0.0739). No significant difference was noted according to the type of procedure. Radiation levels were low compared with the series published previously and decreased for each operator during the study. Conclusion The use of an extension tube did not reduce operator radiation exposure during procedures performed through the radial approach. However, physician awareness was increased during the study due to the use of an exposed electronic dosimeter. The use of exposed electronic dosimeters could therefore be recommended to allow operators to improve their protection techniques.

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20. CAN THE SYNTAX SCORE BE USED IN CLINICAL PRACTICE? RESULTS OF A INTER- AND INTRA-OBSERVER VARIABILITY STUDY

Author

Philippe Allouch, Nicolas Marque, Obay Oulmane, Christophe Goetz, Christian Spaulding, Zoheir Mami, Stéphane Zuily, Julien Rosencher, Alain Pavie, Olivier Varenne, Stéphane Manzo-Silberman, and Olivier Bical

Subjects
Clinical Practice, endocrine system, Syntax (programming languages), business.industry, Medicine, Artificial intelligence, cardiovascular diseases, Cardiology and Cardiovascular Medicine, business, computer.software_genre, Intra observer, computer, Natural language processing
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21. TCT-820 How to limit radial artery spasm in patients treated by transradial interventions

Author

Olivier Varenne, Arnaud Jégou, Reda Jakamy, Philippe Allouch, Julien Rosencher, and Aliou Diallo

Subjects
medicine.medical_specialty, business.industry, Psychological intervention, surgical procedures, operative, medicine.artery, Internal medicine, medicine, Cardiology, In patient, Limit (mathematics), cardiovascular diseases, Radial artery, business, Cardiology and Cardiovascular Medicine
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