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1. Cost effectiveness analysis of a fixed dose combination pill for primary prevention of cardiovascular disease from an individual participant data meta-analysisResearch in context

Author

Andre Lamy, Wesley Tong, Philip Joseph, Peggy Gao, Mark D. Huffman, Gholamreza Roshandel, Reza Malekzadeh, Patricio Lopez-Jaramillo, Prem Pais, Denis Xavier, Alvaro Avezum, Antonio L. Dans, Habib Gamra, and Salim Yusuf

Subjects
Cost-effectiveness, Cost implications, Polypill, Fixed dose combination, Primary prevention, Cardiovascular disease, Medicine (General), R5-920
Abstract

Summary: Background: Cardiovascular disease (CVD) continues to impart a large burden on the global population, especially in lower income countries where affordability limits the use of cardiovascular medicines. A fixed dose combination strategy of at least 2 blood pressure lowering medications and a statin with aspirin in a single pill has been shown to reduce the risk of incident CVD by 38% in primary prevention in a recent meta-analysis. We report the in-trial (median follow-up: 5 years) cost-effectiveness of a fixed dose combination (FDC) pill in different income groups based on data from that meta-analysis. Methods: Countries were categorized using World Bank economic groups: Lower Middle Income Countries (LMIC), Upper Middle Income Countries (UMIC) and High Income Countries (HIC). Country specific costs were obtained for hospitalized events, procedures, and non-study medications (2020 USD). FDC price was based on the cheapest equivalent substitute (CES) for each component. Findings: For the CES-FDC pill versus control the difference in cost was $346 (95% CI: $294–$398) per participant in Lower Middle Income Countries, $838 (95% CI: $781–$895) in Upper Middle Income Countries and $42 (95% CI: −$155 to $239) (cost-neutral) in High Income Countries. During the study period the CES-FDC pill was associated with incremental gain in quality-adjusted life years of 0.06 (95% CI: 0.04–0.08) resulting in an incremental cost-effectiveness ratio (ICER) of $5767 (95% CI: 5735–$5799), $13,937 (95% CI: $13,893–$14,041) and $700 (95% CI: $662–$738) respectively. In subgroups analyses, the highest 10 years CVD risk subgroup had ICERs of $2033, $7322 and −$6000/QALY. Interpretation: A FDC pill produced at CES costs is cost-neutral in HIC. Governments of LMI and UMI countries should assess these results based on the ICER threshold accepted in their own country and own specific health care priorities but should consider prioritizing this strategy for patients with high 10 years CVD risk as a first step. Funding: Population Health Research Institute.

Published
2024
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2. National Tunisian Study of Cardiac Implantable Electronic Devices: Design and Protocol for a Nationwide Multicenter Prospective Observational Study

Author

Sonia Chabrak, Abdeddayem Haggui, Emna Allouche, Sana Ouali, Afef Ben Halima, Slim Kacem, Salma Krichen, Sonia Marrakchi, Wafa Fehri, Mohamed Sami Mourali, Zeineb Jabbari, Manel Ben Halima, Elyes Neffati, Aymen Heraiech, Mehdi Slim, Salem Kachboura, Habib Gamra, Majed Hassine, Sondes Kraiem, Sofien Kammoun, Leila Bezdah, Gouider Jridi, Hatem Bouraoui, Samir Kammoun, Rania Hammami, Rafik Chettaoui, Youssef Ben Ameur, Fares Azaiez, Rami Tlili, Kais Battikh, Hedi Ben Slima, Rim Chrigui, Samia Fazaa, Islem Sanaa, Yassine Ellouz, Mohamed Mosrati, Sami Milouchi, Soumaya Jarmouni, Wacef Ayadi, Malek Akrout, Rabie Razgallah, Wissal Neffati, Meriem Drissa, Selma Charfeddine, Salem Abdessalem, Leila Abid, and Lilia Zakhama

Subjects
Medicine, Computer applications to medicine. Medical informatics, R858-859.7
Abstract

BackgroundIn Tunisia, the number of cardiac implantable electronic devices (CIEDs) is increasing, owing to the increase in patient life expectancy and expanding indications. Despite their life-saving potential and a significant reduction in population morbidity and mortality, their increased numbers have been associated with the development of multiple early and late complications related to vascular access, pockets, leads, or patient characteristics. ObjectiveThe study aims to identify the rate, type, and predictors of complications occurring within the first year after CIED implantation. It also aims to describe the demographic and epidemiological characteristics of a nationwide sample of patients with CIED in Tunisia. Additionally, the study will evaluate the extent to which Tunisian electrophysiologists follow international guidelines for cardiac pacing and sudden cardiac death prevention. MethodsThe Tunisian National Study of Cardiac Implantable Electronic Devices (NATURE-CIED) is a national, multicenter, prospectively monitored study that includes consecutive patients who underwent primary CIED implantation, generator replacement, and upgrade procedure. Patients were enrolled between January 18, 2021, and February 18, 2022, at all Tunisian public and private CIED implantation centers that agreed to participate in the study. All enrolled patients entered a 1-year follow-up period, with 4 consecutive visits at 1, 3, 6, and 12 months after CIED implantation. The collected data are recorded electronically on the clinical suite platform (DACIMA Clinical Suite). ResultsThe study started on January 18, 2021, and concluded on February 18, 2023. In total, 27 cardiologists actively participated in data collection. Over this period, 1500 patients were enrolled in the study consecutively. The mean age of the patients was 70.1 (SD 15.2) years, with a sex ratio of 1:15. Nine hundred (60%) patients were from the public sector, while 600 (40%) patients were from the private sector. A total of 1298 (86.3%) patients received a conventional pacemaker and 75 (5%) patients received a biventricular pacemaker (CRT-P). Implantable cardioverter defibrillators were implanted in 127 (8.5%) patients. Of these patients, 45 (3%) underwent CRT-D implantation. ConclusionsThis study will establish the most extensive contemporary longitudinal cohort of patients undergoing CIED implantation in Tunisia, presenting a significant opportunity for real-world clinical epidemiology. It will address a crucial gap in the management of patients during the perioperative phase and follow-up, enabling the identification of individuals at particularly high risk of complications for optimal care. Trial RegistrationClinicalTrials.gov NCT05361759; https://classic.clinicaltrials.gov/ct2/show/NCT05361759 International Registered Report Identifier (IRRID)RR1-10.2196/47525

Published
2024
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3. Relationship between serum interleukin-6 levels and severity of coronary artery disease undergoing percutaneous coronary intervention

Author

Nadia Bouzidi and Habib Gamra

Subjects
IL-6, Coronary artery disease, STEMI, Severity, Gensini score, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Background Cytokines play a potential role in atherosclerosis pathogenesis and progression. We investigated the association of interleukin-6 (IL-6) with the angiographic severity of coronary artery disease (CAD). Methods Three hundred ten angiografically diagnosed CAD patients and 210 controls were enrolled in this study. CAD patients were stratified according to IL-6 cut-off value into high levels IL-6 group (≥ 9.5 pg/mL) and low levels IL-6 group ( 40) but not with stenosis degree and vessel score. GS levels were significantly more elevated in patients with high levels of IL-6 group than in low IL6 levels patients (60.6 ± 39.5 vs 46.7 ± 37.2; p = 0.027). The analysis of the ROC curve performed in myocardial infarction patients showed that IL-6 (AUC: 0.941 (CI 95% 0.886, 0.997; p

Published
2023
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5. Clinical features, socioeconomic status, management, short and long-term outcomes of patients with acute myocardial infarction: Phase I results of PEACE MENA registry

Author

Ayman Al Saleh, Amal Jamee, Kadhim Sulaiman, Mohamed Sobhy, Habib Gamra, Fahad Alkindi, Salim Benkhedda, Ahmed Al-Motarreb, Mohammad I. Amin, Wael Almahmeed, Ayman Hammoudeh, Hadi Skouri, Hasan A. Farhan, Mohammad Al Jarallah, Nadia Fellat, Prashanth Panduranga, Bayan K. Alnajm, Magdy Abdelhamid, Rafik Refaat, Hassen Amor, Salma Messaous, Hosameldin S. Ahmed, Ahcene Chibane, Azzouz AbdulMalek, Nora K. Alsagheer, Sobhi Dada, Zaki Mokhtar, Muhammad Ali, Anhar Ullah, Hanan AlBackr, and Khalid F. Alhabib

Subjects
Medicine, Science
Published
2024

6. The impact of right bundle branch block and SIQIII-type patterns in determining risk levels in acute pulmonary embolism [version 1; peer review: 2 approved]

Author

Ahmed Jamel, Nidhal Bouchahda, Mohamed Yassine Kallala, Majed Hassine, Habib Gamra, Kais Memmi, Najeh Ben Halima, Ines Bouanene, and Marouen Mahjoub

Subjects
Electrocardiogram, Pulmonary embolism, Prognosis, Mortality, eng, Medicine, Science
Abstract

Background: Electrocardiography (ECG) findings in acute pulmonary embolism (PE) are known to be related to various right ventricular (RV) alterations. These abnormalities are not included in risk stratification algorithms despite emerging evidence of their association with patient outcomes. We aimed to analyze the impact of right bundle branch block (RBBB) and/or SIQIII patterns as indicators for determining the level of risk in patients with PE. Methods: We performed a retrospective cohort study including all patients with confirmed acute PE hospitalized from January 2008 to December 2019 in two tertiary care cardiology departments. The first ECG taken at admission was selected and the analysis focused on the presence of a complete or an incomplete RBBB and SIQIII-type patterns. Results: A total of 255 patients were divided into two groups: Group I (47.8%, n=122) included patients with PE without RBBB nor SIQIII patterns, and Group II (52.2%, n=133) included patients with RBBB and/or SIQIII patterns. Patients in group II presented significantly more frequently with acute right heart symptoms (45.1% vs. 18%, p

Published
2023
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7. Epidemiologic features and management of hypertension in Tunisia, the results from the Hypertension National Registry (NaTuRe HTN)

Author

Leila Abid, Rania Hammami, Ikram Chamtouri, Meriam Drissa, Selim Boudiche, MohamedAmine Bahloul, Hedi BenSlima, Khaled Sayahi, Selma Charfeddine, Emna Allouche, Lamia Rais, Badr Kaab, Hassen IbnHadjamor, Lilia BenFatma, Riadh Garbaa, Sabrine Boukhris, Manel Ben Halima, Nesrine Amdouni, Chaima Ghorbel, Sabrine Soudani, Imen Khaled, Syrine Triki, Feten Bouazizi, Imen Jemai, Ouday Abdeljalil, Yemna Ammar, Amani Farah, Adnen Neji, Zeineb Oumayma, Sana Seghaier, Samir Mokrani, Hamza Thawaba, Hela Sarray, Khalil Ouaghlani, Houssem Thabet, Zeineb Mnif, Fatma Boujelban, Mohamed Sghaier, Roueida Khalifa, Sami Fourati, Yasmin Kammoun, Syrine Abid, Chihab Hamza, Syrine Ben Jeddou, Lassaad Sabbah, Rim Lakhdhar, Najla Dammak, Tarek Sellami, Basma Herbegue, Alia Koubaa, Faten Triki, Tarek Ellouz, Aicha Hmoudi, Ikhlas BenAmeur, MohamedMongi Boukhchina, Neila Abid, Wejdene Wachtati, Nizar Nasrallah, Yousra Houidi, Fathia Meghaieth, Elhem Ghodhbane, Mounira Chayeb, Sarra Chenik, Samira Kaabachi, Nizar Saadaoui, Ines BenAmeur, Moufida Affes, Sana Ouali, Mouna Chaker, Hela Naanaa, Meriem Dghim, Mourad Jarrar, Jihene Mnif, Ahmed Turki, Ihsen Zairi, Jamel Langar, Safa Dardouri, Imen Hchaichi, Rafik Chettaoui, Wajih Essmat, Amel Chakroun, Khadija Mzoughi, Rachid Mechmeche, Afef BenHalima, Sahar BenKhala, Slim Chtourou, Abdelkader Maalej, Mohsen Ayari, Moufid Hadrich, Rami Tlili, Fares Azaiez, Imen Bouhlel, Samira Sahnoun, Habib Jerbi, Imtinene BenMrad, Leila Riahi, Mohamed Sahnoun, Abdelhamid BenJemaa, Amel BenSalem, Bassem Rekik, Maroua BenDoudou, Rachid Boujneh, Anissa Joulak, Yosra Mejdoub, Imen Gtif, Gouider Jribi, Elyes Naffeti, Habib Gamra, Soraya BenYousef, Wissem Sdiri, Najeh BenHalima, Youssef BenAmeur, Salem Kachboura, Sondes Kraiem, Wafa Fehri, Leila Bazdeh, MohamedSami Mourali, Sami Milouchi, Habiba Drissa, Faouzi Maatouk, Lilia Zakhama, Faouzi Addad, Samir Kammoun, and Salem Abdesselem

Subjects
Hypertension, Blood pressure control, Epidemiology, Predictors, Registry, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Background Hypertension is the leading cause of morbi-mortality in our country. Thus, we conducted this national survey on hypertension to analyze the profile of the Tunisian hypertensive patient and to assess the level of blood pressure control. Methods Nature HTN is an observational multicentric survey, including hypertensive individuals and consulting their doctors during the period of the study. Blood pressure measurements were conducted during consultation, using a standardized auscultatory or oscillometric sphygmomanometer after at least 15 min of rest. The diagnosis of new hypertension is based on the 2018 ESC/ESH criteria. The primary endpoint of our study was uncontrolled hypertension defined by a systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg. Results Three hundred twenty-one investigators participated in the study. We enrolled 25,890 patients with a female predominance (Sex ratio, 1.21) and an average age of 64.4 ± 12.2 years. Most individuals were treated in the public sector (74%), 39.4% of patients were diabetic, 25.8% were obese, 44.6% were overweight and 14% were smokers. Hypertension was controlled in 51.7% of cases if we consider 140/90 as a BP target, and only in 18.6% if we consider 130/80 as a target. The independent predictors of uncontrolled blood pressure were male sex (OR = 1.09, 95%CI [1.02–1.16]), age > 65 year-old (OR = 1.07, 95% CI[1.01–1.13], diabetes (OR = 1.18, 95% CI [1.11–1.25], Smoking (OR = 1.15, 95% CI [1.05–1.25]), Obesity (OR = 1.14, 95% CI[1.07–1.21]), management in public sector (OR = 1.25, 95% CI [1.16–1.34]), and Heart rate > 80 bpm (OR = 1.59, 95% CI [1.48–1.71]). Contrarily, high educational level (OR = 0.9, 95% CI [0.84–0.97], absence of history of coronary disease (OR = 0.86, 95% CI [0.8–0.93]), salt restriction (OR = 0.48, 95% CI [0.45–0.51]), drug compliance (OR = 0.57, 95% CI[0.52–0.61]), and regular physical activity (OR = 0.77, 95% CI[0.71–0.84]) are strong predictors of blood pressure control. Conclusion NaTuRe HTN showed that blood pressure control was reached in more than half of the Tunisian people. The control remains low in patients with high cardiovascular profiles and in those treated in the public sector. A national health program based on therapeutic education, regular control and continuous support to the public institutions is needed to decrease the burden of hypertension incidence rate.

Published
2022
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8. Design and Rationale of the National Observational Multicentric Tunisian Registry of Hypertension: Protocol for Evaluating Hypertensive Patient Care in Clinical Practice

Author

Leila Abid, Rania Hammami, Salem Abdesselem, Selim Boudiche, Ben Slima Hédi, Khaled Sayahi, Amine Bahloul, Ikram Chamtouri, Salma Charfeddine, Lamia Rais, Meriem Drissa, Badreddine Ben Kaab, Hassen Ibn hadj amor, Lilia Ben Fatma, Riadh Garbaa, Sabrine Boukhris, Allouche Emna, Manel Ben Halima, Nesrine Amdouni, Shayma Ghorbel, Sabrine Soudani, Imen Khaled, Syrine Triki, Feten Bouazizi, Imen Jemai, Ouday Abdeljalil, Yemna Ammar, Amani Farah, Adnen Neji, Zeineb Oumaya, Sana Seghaier, Samir Mokrani, Hamza Thawaba, Hela Sarray, Khalil Ouaghlani, Houssem Thabet, Zeineb Mnif, Boujelben Masmoudi Fatma, Mohamed Sghaier, Roueida Khalifa, Sami Fourati, Yassmine Kammoun, Syrine Abid, Chiheb Hamza, Syrine Ben Jeddou, Lassaad Sabbah, Rim Lakhdhar, Najla Dammak, Tarak Sellami, Basma Herbegue, Alia Koubaa, Faten Triki, Tarek Ellouze, Aicha Hmoudi, Ikhlas Ben Ameur, Mohamed Mongi Boukhchina, Neila Abid, Wejdene Ouechtati, Nizar Nasrallah, Yousra Houidi, Fathia Mghaieth Zghal, Ghodhbane Elhem, Mounira Chayeb, Chenik Sarra, Samira Kaabachi, Nizar Saadaoui, Ines Ben Ameur, Moufida Affes, Sana Ouali, Mouna Chaker, Hela Naana, Dghim Meriem, Mourad Jarrar, Jihen Mnif, Ahmed Turki, Ihsen Zairi, Jamel Langar, Safa Dardouri, Imen Hachaichi, Rafik Chettaoui, Wajih Smat, Amel Chakroun, Khadija Mzoughi, Rachid Mechmeche, Afef Ben Halima, Sahar Ben Kahla Koubaa, Slim Chtourou, Maalej Mohamed abdelkader, Mohsen Ayari, Moufid Hadrich, Tlili Rami, Fares Azaiez, Imen Bouhlel, Samir Sahnoun, Habib Jerbi, Ben Mrad Imtinene, Leila Riahi, Mohamed Sahnoun, Abdelhamid Ben Jemaa, Amal Ben Salem, Bassem Rekik, Maroua Ben Doudou, Mohamed Rachid Boujnah, Anissa Joulak, Abid Omar, Rabie Razgallah, Milouchi Sami, Elyes Neffati, Habib Gamra, Soraya Ben Youssef, Wissem Sdiri, Nejeh Ben Halima, Youssef Ben Ameur, Salem Kachboura, Sondes Kraiem, Wafa Fehri, Lilia Zakhama, leila Bezdah, Mourali Mohamed Sami, Habiba Drissa, Mohamed Faouzi Maatouk, Samir Kammoun, and Faouzi Addad

Subjects
Medicine, Computer applications to medicine. Medical informatics, R858-859.7
Abstract

BackgroundThis study was designed to evaluate the care of hypertensive patients in daily clinical practice in public and private centers in all Tunisian regions. ObjectiveThis study will provide us an overview of hypertension (HTN) management in Tunisia and the degree of adherence of practitioners to international recommendations. MethodsThis is a national observational cross-sectional multicenter study that will include patients older than 18 years with HTN for a duration of 4 weeks, managed in the public sector from primary and secondary care centers as well as patients managed in the private sector. Every participating patient signed a consent form. The study will exclude patients undergoing dialysis. The parameters that will be evaluated are demographic and anthropometric data, lifestyle habits, blood pressure levels, lipid profiles, treatment, and adherence to treatment. The data are collected via the web interface in the Dacima Clinical Suite. ResultsThe study began on April 15, 2019 and ended on May 15, 2019. During this period, we included 25,890 patients with HTN. Data collection involved 321 investigators from 24 Tunisian districts. The investigators were doctors working in the private and public sectors. ConclusionsObservational studies are extremely useful in improving the management of HTN in developing countries. Trial RegistrationClinicalTrials.gov NCT04013503; https://clinicaltrials.gov/ct2/show/NCT04013503 International Registered Report Identifier (IRRID)DERR1-10.2196/21878

Published
2022
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9. Design and Rationale of the National Tunisian Registry of Percutaneous Coronary Intervention: Protocol for a Prospective Multicenter Observational Study

Author

Rania Hammami, Selim Boudiche, Tlili Rami, Nejeh Ben Halima, Ahmed Jamel, Bassem Rekik, Rym Gribaa, Ben Mrad Imtinene, Salma Charfeddine, Tarek Ellouze, Amine Bahloul, Ben Slima Hédi, Jamel Langar, Habib Ben Ahmed, Zied Ibn Elhadj, Mohamed Hmam, Mohamed Aymen Ben Abdessalem, Sabri Maaoui, Sana Fennira, Laroussi Lobna, Majed Hassine, Sami Ouanes, Drissi Mohamed Faouzi, Souad Mallek, Abdallah Mahdhaoui, Dghim Meriem, Walid Jomaa, Sofien Zayed, Tawfik Kateb, Nidhal Bouchahda, Fares Azaiez, Helmi Ben Salem, Morched Marouen, Aymen Noamen, Salem Abdesselem, Denguir Hichem, Hassen Ibn Hadj Amor, Farhati Abdeljelil, Amine Amara, Karim Bejar, Ben Hamda Khaldoun, Chiheb Hamza, Mohsen Ben Jamaa, Sami Fourati, Faycal Elleuch, Zeineb Grati, Slim Chtourou, Sami Marouene, Mohamed Sahnoun, Morched Hadrich, Maalej Mohamed Abdelkader, Hatem Bouraoui, Kamel Kamoun, Moufid Hadrich, Tarek Ben Chedli, Mohamed Akrem Drissa, Hanene Charfeddine, Nizar Saadaoui, Gargouri Achraf, Siala Ahmed, Mokdad Ayari, Marsit Nabil, Sabeur Mnif, Maher Sahnoun, Helmi Kammoun, Khaled Ben Jemaa, Gharbi Mostari, Nebil Hamrouni, Maazoun Yamen, Yassine Ellouz, Zahreddine Smiri, Amine Hdiji, Jerbi Bassem, Wacef Ayadi, Amir Zouari, Chedly Abbassi, Boujelben Masmoudi Fatma, Kais Battikh, Elyes Kharrat, Imen Gtif, Milouchi Sami, Leila Bezdah, Salem Kachboura, Mohamed Faouzi Maatouk, Sondes Kraiem, Gouider Jeridi, Elyes Neffati, Samir Kammoun, Youssef Ben Ameur, Wafa Fehri, Habib Gamra, Lilia Zakhama, Faouzi Addad, Mourali Mohamed Sami, and Leila Abid

Subjects
Medicine, Computer applications to medicine. Medical informatics, R858-859.7
Abstract

BackgroundCoronary artery diseases remain the leading cause of death in the world. The management of this condition has improved remarkably in the recent years owing to the development of new technical tools and multicentric registries. ObjectiveThe aim of this study is to investigate the in-hospital and 1-year clinical outcomes of patients treated with percutaneous coronary intervention (PCI) in Tunisia. MethodsWe will conduct a prospective multicentric observational study with patients older than 18 years who underwent PCI between January 31, 2020 and June 30, 2020. The primary end point is the occurrence of a major adverse cardiovascular event, defined as cardiovascular death, myocardial infarction, cerebrovascular accident, or target vessel revascularization with either repeat PCI or coronary artery bypass grafting (CABG). The secondary end points are procedural success rate, stent thrombosis, and the rate of redo PCI/CABG for in-stent restenosis. ResultsIn this study, the demographic profile and the general risk profile of Tunisian patients who underwent PCI and their end points will be analyzed. The complexity level of the procedures and the left main occlusion, bifurcation occlusion, and chronic total occlusion PCI will be analyzed, and immediate as well as long-term results will be determined. The National Tunisian Registry of PCI (NATURE-PCI) will be the first national multicentric registry of angioplasty in Africa. For this study, the institutional ethical committee approval was obtained (0223/2020). This trial consists of 97 cardiologists and 2498 patients who have undergone PCI with a 1-year follow-up period. Twenty-eight catheterization laboratories from both public (15 laboratories) and private (13 laboratories) sectors will enroll patients after receiving informed consent. Of the 2498 patients, 1897 (75.9%) are managed in the public sector and 601 (24.1%) are managed in the private sector. The COVID-19 pandemic started in Tunisia in March 2020; 719 patients (31.9%) were included before the COVID-19 pandemic and 1779 (60.1%) during the pandemic. The inclusion of patients has been finished, and we expect to publish the results by the end of 2022. ConclusionsThis study would add data and provide a valuable opportunity for real-world clinical epidemiology and practice in the field of interventional cardiology in Tunisia with insights into the uptake of PCI in this limited-income region. Trial RegistrationClinicaltrials.gov NCT04219761; https://clinicaltrials.gov/ct2/show/NCT04219761 International Registered Report Identifier (IRRID)RR1-10.2196/24595

Published
2022
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11. 2021 Asian Pacific Society of Cardiology Consensus Recommendations on the Use of P2Y12 Receptor Antagonists in the Asia-Pacific Region: Special Populations

Author

Jack Wei Chieh Tan, Derek P Chew, Kin Lam Tsui, Doreen Tan, Dmitry Duplyakov, Ayman Hammoudeh, Bo Zhang, Yi Li, Kai Xu, Paul J Ong, Doni Firman, Habib Gamra, Wael Almahmeed, Jamshed Dalal, Li-Wah Tam, Gabriel Steg, Quang N Nguyen, Junya Ako, Jassim Al Suwaidi, Mark Chan, Mohamed Sobhy, Abdulla Shehab, Wacin Buddhari, Zulu Wang, Alan Yean Yip Fong, Bilgehan Karadag, Byeong-Keuk Kim, Usman Baber, Chee Tang Chin, and Ya Ling Han

Subjects
Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Advanced age, diabetes, and chronic kidney disease not only increase the risk for ischaemic events in chronic coronary syndromes (CCS) but also confer a high bleeding risk during antiplatelet therapy. These special populations may warrant modification of therapy, especially among Asians, who have displayed characteristics that are clinically distinct from Western patients. Previous guidance has been provided regarding the classification of high-risk CCS and the use of newer-generation P2Y12 inhibitors (i.e. ticagrelor and prasugrel) after acute coronary syndromes (ACS) in Asia. The authors summarise evidence on the use of these P2Y12 inhibitors during the transition from ACS to CCS and among special populations. Specifically, they present recommendations on the roles of standard dual antiplatelet therapy, shortened dual antiplatelet therapy and single antiplatelet therapy among patients with coronary artery disease, who are either transitioning from ACS to CCS; elderly; or with chronic kidney disease, diabetes, multivessel coronary artery disease and bleeding events during therapy.

Published
2021
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12. Design and Rationale of the National Tunisian Registry of Heart Failure (NATURE-HF): Protocol for a Multicenter Registry Study

Author

Leila Abid, Ikram Kammoun, Manel Ben Halima, Salma Charfeddine, Hedi Ben Slima, Meriem Drissa, Khadija Mzoughi, Dorra Mbarek, Leila Riahi, Saoussen Antit, Afef Ben Halima, Wejdene Ouechtati, Emna Allouche, Mehdi Mechri, Chedi Yousfi, Ali Khorchani, Omar Abid, Kais Sammoud, Khaled Ezzaouia, Imen Gtif, Sana Ouali, Feten Triki, Sonia Hamdi, Selim Boudiche, Marwa Chebbi, Mouna Hentati, Amani Farah, Habib Triki, Houda Ghardallou, Haythem Raddaoui, Sofien Zayed, Fares Azaiez, Fadwa Omri, Akram Zouari, Zine Ben Ali, Aymen Najjar, Houssem Thabet, Mouna Chaker, Samar Mohamed, Marwa Chouaieb, Abdelhamid Ben Jemaa, Haythem Tangour, Yassmine Kammoun, Mahmoud Bouhlel, Seifeddine Azaiez, Rim Letaief, Salah Maskhi, Aymen Amri, Hela Naanaa, Raoudha Othmani, Iheb Chahbani, Houcine Zargouni, Syrine Abid, Mokdad Ayari, Ines ben Ameur, Ali Gasmi, Nejeh ben Halima, Habib Haouala, Essia Boughzela, Lilia Zakhama, Soraya ben Youssef, Wided Nasraoui, Mohamed Rachid Boujnah, Nadia Barakett, Sondes Kraiem, Habiba Drissa, Ali Ben Khalfallah, Habib Gamra, Salem Kachboura, Leila Bezdah, Hedi Baccar, Sami Milouchi, Wissem Sdiri, Skander Ben Omrane, Salem Abdesselem, Alifa Kanoun, Karima Hezbri, Faiez Zannad, Alexandre Mebazaa, Samir Kammoun, Mohamed Sami Mourali, and Faouzi Addad

Subjects
Medicine, Computer applications to medicine. Medical informatics, R858-859.7
Abstract

BackgroundThe frequency of heart failure (HF) in Tunisia is on the rise and has now become a public health concern. This is mainly due to an aging Tunisian population (Tunisia has one of the oldest populations in Africa as well as the highest life expectancy in the continent) and an increase in coronary artery disease and hypertension. However, no extensive data are available on demographic characteristics, prognosis, and quality of care of patients with HF in Tunisia (nor in North Africa). ObjectiveThe aim of this study was to analyze, follow, and evaluate patients with HF in a large nation-wide multicenter trial. MethodsA total of 1700 patients with HF diagnosed by the investigator will be included in the National Tunisian Registry of Heart Failure study (NATURE-HF). Patients must visit the cardiology clinic 1, 3, and 12 months after study inclusion. This follow-up is provided by the investigator. All data are collected via the DACIMA Clinical Suite web interface. ResultsAt the end of the study, we will note the occurrence of cardiovascular death (sudden death, coronary artery disease, refractory HF, stroke), death from any cause (cardiovascular and noncardiovascular), and the occurrence of a rehospitalization episode for an HF relapse during the follow-up period. Based on these data, we will evaluate the demographic characteristics of the study patients, the characteristics of pathological antecedents, and symptomatic and clinical features of HF. In addition, we will report the paraclinical examination findings such as the laboratory standard parameters and brain natriuretic peptides, electrocardiogram or 24-hour Holter monitoring, echocardiography, and coronarography. We will also provide a description of the therapeutic environment and therapeutic changes that occur during the 1-year follow-up of patients, adverse events following medical treatment and intervention during the 3- and 12-month follow-up, the evaluation of left ventricular ejection fraction during the 3- and 12-month follow-up, the overall rate of rehospitalization over the 1-year follow-up for an HF relapse, and the rate of rehospitalization during the first 3 months after inclusion into the study. ConclusionsThe NATURE-HF study will fill a significant gap in the dynamic landscape of HF care and research. It will provide unique and necessary data on the management and outcomes of patients with HF. This study will yield the largest contemporary longitudinal cohort of patients with HF in Tunisia. Trial RegistrationClinicalTrials.gov NCT03262675; https://clinicaltrials.gov/ct2/show/NCT03262675 International Registered Report Identifier (IRRID)DERR1-10.2196/12262

Published
2021
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13. Correction: Acute Myocardial Infarction and Acute Heart Failure in the Middle East and North Africa: Study Design and Pilot Phase Study Results from the PEACE MENA Registry.

Author

Khalid F Alhabib, Habib Gamra, Wael Almahmeed, Ayman Hammoudeh, Salim Benkhedda, Mohammad Al Jarallah, Ahmed Al-Motarreb, Mothanna Alquraishi, Mohamed Sobhy, Magdi G Yousif, Fahad Alkindi, Nadia Fellat, Mohammad I Amin, Muhammad Ali, Ayman Al Saleh, Anhar Ullah, and Faiez Zannad

Subjects
Medicine, Science
Abstract

[This corrects the article DOI: 10.1371/journal.pone.0236292.].

Published
2021
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14. Epidemiology of heart failure and long-term follow-up outcomes in a north-African population: Results from the NAtional TUnisian REgistry of Heart Failure (NATURE-HF).

Author

Leila Abid, Salma Charfeddine, Ikram Kammoun, Manel Ben Halima, Hedi Ben Slima, Meriem Drissa, Khadija Mzoughi, Dorra Mbarek, Leila Riahi, Saoussen Antit, Afef Ben Halima, Wejdene Ouechtati, Emna Allouche, Mehdi Mechri, Chedi Youssfi, Ali Khorchani, Kais Sammoud, Khaled Zaouia, Rami Tlili, Sana Ouali, Faten Triki, Sonia Hamdi, Selim Boudich, Marwa Chebbi, Mouna Hentati, Amani Farah, Habib Triki, H Ghardallou, H Radoui, Sofien Zayed, F Azaiez, Fadoua Omri, Akram Zouari, Zine Ben Ali, A Najjar, Houssem Thabet, Mouna Chaker, Samar Mohammed, Abdelhamid Ben Jmaa, Haithem Tangour, Yassine Kammoun, Mahmoud Cheikh Bouhlel, S Azeiz, R Gtaief, S Mashki, Aymen Amri, Hela Naanea, Raoudha Othmani, Iheb Chahbani, Houcine Zargouni, Syrine Abid, Mokded Ayari, Ines Ben Ameur, Ali Guesmi, Nejeh Ben Halima, Habib Haouala, Wafa Fehri, Essia Boughzela, Lilia Zakhama, Soraya Ben Youssef, Wided Nasraoui, Rachid Boujneh, Nedia Barakett, Sondos Kraiem, Hbiba Drissa, Ali Ben Khalfalah, Habib Gamra, Salem Kachboura, Yosra Majdoub, Elifa Kanoun, Faiez Zannad, Sami Milouchi, Alexandre Mebaza, Samir Kammoun, Sami Mourali, Karima Hezbri, and Faouzi Addad

Subjects
Medicine, Science
Abstract

The NATURE-HF registry was aimed to describe clinical epidemiology and 1-year outcomes of outpatients and inpatients with heart failure (HF). This is a prospective, multicenter, observational survey conducted in Tunisian Cardiology centers. A total of 2040 patients were included in the study. Of these, 1632 (80%) were outpatients with chronic HF (CHF). The mean hospital stay was 8.7 ± 8.2 days. The mortality rate during the initial hospitalization event for AHF was 7.4%. The all-cause 1-year mortality rate was 22.8% among AHF patients and 10.6% among CHF patients. Among CHF patients, the older age, diabetes, anemia, reduced EF, ischemic etiology, residual congestion and the absence of ACEI/ ARBs treatment were independent predictors of 1-year cumulative rates of rehospitalization and mortality. The female sex and the functional status were independent predictors of 1-year all-cause mortality and rehospitalization in AHF patients. This study confirmed that acute HF is still associated with a poor prognosis, while the mid-term outcomes in patients with chronic HF seems to be improved. Some differences across countries may be due to different clinical characteristics and differences in healthcare systems.

Published
2021
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15. Acute myocardial infarction and acute heart failure in the Middle East and North Africa: Study design and pilot phase study results from the PEACE MENA registry.

Author

Khalid F Alhabib, Habib Gamra, Wael Almahmeed, Ayman Hammoudeh, Salim Benkheddah, Mohammad Al Jarallah, Ahmed Al-Motarreb, Mothanna Alquraishi, Mohamed Sobhy, Magdi G Yousif, Fahad Alkindi, Nadia Fellat, Mohammad I Amin, Muhammad Ali, Ayman Al Saleh, Anhar Ullah, and Faiez Zannad

Subjects
Medicine, Science
Abstract

BackgroundThis pilot study describes the overall design and results of the Program for the Evaluation and Management of the Cardiac Events registry for the Middle East and North Africa (MENA) Region.MethodsThis prospective, multi-center, multi-country study included patients hospitalized with acute myocardial infarction (AMI) and/or acute heart failure (AHF). We evaluated the clinical characteristics, socioeconomic and educational levels, management, in-hospital outcomes, and 30-day mortality rate of patients that were admitted to one tertiary-care center in each of 14 Arab countries in the MENA region.ResultsBetween 22 April and 28 August 2018, 543 AMI and 381AHF patients were enrolled from 14 Arab countries (mean age, 57±12 years, 82.5% men). Over half of the patients in both study groups had low incomes with limited health care coverage, and limited education. Nearly half of the cohort had a history of diabetes mellitus, hypertension, or hypercholesterolemia. Among patients with ST-elevation myocardial infarctions, 56.4% received primary percutaneous interventions, 24% received thrombolysis, and 19.5% received no acute reperfusion therapy. The main causes of AHF were ischemic heart diseases (55%) and primary valvular heart diseases (15%). The in-hospital and 30-day mortality rates were 2.0% and 3.5%, respectively, for AMI, and 5.4% and 7.0%, respectively, for AHF.ConclusionsThis pilot study revealed a high prevalence of cardiovascular risk factors in patients with AMI and AHF in Arab countries, and low levels of socioeconomic and educational status. Future phases of the study will improve our understanding of the impact that these factors have on the management and outcomes of cardiac events in these patient populations.

Published
2020
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16. Clinical research in Africa And Middle East: roadmap for reform and harmonisation of the regulatory framework and sustainable capacity development

Author

Faiez Zannad, Mohamed Sobhy, Wael Almahmeed, Mohamed Balghith, Javed Butler, Souad Dziri, Sahar Ebrahim, Ashraf El Fiky, Ahmed Elshal, Ines Fradi, Ziyad Ghazzal, Chokri Jeribi, Zainab Samad, Maciej Kostrubiec, Manal Milhem, Mossad Morsi, Ali Oto, Hany Ragy, Georges Saade, Rana Malkawi, Azza Saleh, Dina Shokri, Karen Sliwa, Habib Gamra, and for the CVCT Regulatory summit Think Tank

Subjects
Public aspects of medicine, RA1-1270
Abstract

The Middle East, Mediterranean, Africa (MEMA) region, is composed of 68 countries, totalling a population of over 1.6 billion ie, 20% of the world. It contributes little to the international effort of health knowledge production, hosting only 6% of the worldwide registered trials. Among the many weaknesses of clinical research in MEMA region is the cultural gap and lack of recognition for the need of developing a sustainable clinical research infrastructure. Very few countries have some developed capacity for research. Lack of a robust, international standards, regulatory framework is the second major hurdle. In addition there is uncertain public confidence and poor awareness of the importance and the objectives of clinical research. However, the region has a number of attractive features, such as population's size and large pool of eligible patients, least trial saturated of all regions, diversity in genetic profile, lifestyle, and eating habits, and large medication-naive patient populations.

Published
2019
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17. Correlation of trans fatty acids with the severity of coronary artery disease lesions

Author

Samia Hadj Ahmed, Wafa Kharroubi, Nadia Kaoubaa, Amira Zarrouk, Fathi Batbout, Habib Gamra, Mohamed Fadhel Najjar, Gérard Lizard, Isabelle Hininger-Favier, and Mohamed Hammami

Subjects
Elaidic acid, Trans C18:2 isomers, Oxidative stress, Lipid peroxidation, Coronary artery disease, Nutritional diseases. Deficiency diseases, RC620-627
Abstract

Abstract Background Nutritional choices, which include the source of dietary fatty acids (FA), have an important significant impact on coronary artery disease (CAD). We aimed to determine on patients with CAD the relationships between Trans fatty acids (Trans FA) and different CAD associated parameters such as inflammatory and oxidative stress parameters in addition to Gensini score as a vascular severity index. Methods Fatty acid profiles were established by gas chromatography from 111 CAD patients compared to 120 age-matched control group. Lipid peroxidation biomarkers, oxidative stress, inflammatory parameters and Gensini score were studied. Results Our study showed a significant decrease of the antioxidant parameters levels such as erythrocyte glutathione peroxydase (GPx) and superoxide dismutase (SOD) activities, plasma antioxidant status (FRAP) and thiol (SH) groups in CAD patients. On the other hand, catalase activity, conjugated dienes and malondialdehyde were increased. Plasmatic and erythrocyte Trans FA were also increased in CAD patients compared to controls. Furthermore, divergent associations of these Trans FA accumulations were observed with low-density lipoprotein-cholesterol/ high-density lipoprotein-cholesterol (LDL-C/HDL-C) ratio, Apolipoprotein B (ApoB), lipid peroxidation parameters, high-sensitivity C Reactive Protein (hs-CRP), Interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-α) and Gensini score. Especially, elaidic acid (C18:1 trans 9), trans C18:2 isomers and trans 11 eicosanoic acid are correlated with these parameters. Trans FA are also associated with oxidative stress, confirmed by a positive correlation between C20:1 trans 11 and GPx in erythrocytes. Conclusions High level of Trans FA was highly associated with the induction of inflammation, oxidative stress and lipoperoxidation which appear to be based on the vascular severity and might be of interest to assess the stage and progression of atherosclerosis. The measurement of these Trans FA would be of great value for the screening of lipid metabolism disorders in CAD patients.

Published
2018
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18. Association of plasma fatty acid alteration with the severity of coronary artery disease lesions in Tunisian patients

Author

Samia Hadj Ahmed, Nadia Kaoubaa, Wafa Kharroubi, Amira Zarrouk, Mohamed Fadhel Najjar, Fathi Batbout, Habib Gamra, Gerard Lizard, and Mohamed Hammami

Subjects
Fatty acid profile, Coronary artery disease, Gensini score, Desaturation index, Nutritional diseases. Deficiency diseases, RC620-627
Abstract

Abstract Background Some factors related to diet are known to be involved in the progression of atherosclerosis in humans. Methods The relationship between plasma fatty acid (FA) levels and the severity of coronary artery disease (CAD), evaluated by Gensini score (GS), was investigated in CAD Tunisian patients compared to controls. Lipid profiles were analyzed, GS was calculated in CAD and non-CAD patients and compared to controls. Results CAD patients showed an alteration of conventional lipid parameters. In fact, a significant increase of plasmatic triglycerides (TG) level, atherogenic lipid ratios (TC/HDL-C,TG/HDL-C, LDL-C/HDL-C); and ApoB/ApoA1 was observed in the CAD group comparatively to controls (p

Published
2017
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19. Case Report: Coronary artery stent infection with mycotic aneurysm secondary to tricuspid valve infective endocarditis [version 1; peer review: 2 approved]

Author

Mejdi Ben Messaoud, Nidhal Bouchahda, Marouane Mahjoub, Badii Hmida, Zohra Dridi, and Habib Gamra

Subjects
Medicine, Science
Abstract

Coronary artery stent infection with mycotic aneurysm is a rare life-threatening complication following coronary angioplasty, usually requiring surgical intervention. Reaching and confirming the diagnosis remains the most challenging aspect of this complication. We describe an unusual case of bare metal stent infection and coronary artery aneurysm in the setting of tricuspid valve infective endocarditis, resulting in ST elevation myocardial infarction, with a favorable outcome after primary angioplasty and antibiotic therapy. In the current era of growth of coronary stent implantation, it’s important for clinicians to consider and to prevent such potentially fatal events. The diagnosis process remains difficult and requires the association of multiple clinical, biological and imaging parameters. Although treatment modalities tend to favor surgery, we showed that coronary angioplasty could be a successful alternative solution.

Published
2019
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20. Case Report: Concomitant coronary stent and femoral artery thrombosis in the setting of heparin-induced thrombocytopenia [version 1; peer review: 2 approved]

Author

Mejdi Ben Messaoud, Mezri Maatouk, Mohamed Mehdi Boussaada, Marouane Mahjoub, Walid Mnari, and Habib Gamra

Subjects
Medicine, Science
Abstract

Heparin induced thrombocytopenia (HIT) is a rare but potentially life threatening adverse drug reaction. We report an unusual case of concomitant subacute coronary stent and femoral artery thrombosis secondary to HIT. In the current era of extensive growth of heparin use and percutaneous coronary interventions, it’s important for clinicians to remember that such complication might occur and should be prevented.

Published
2019
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21. Management of patients with acute ST-elevation myocardial infarction: Results of the FAST-MI Tunisia Registry.

Author

Faouzi Addad, Abdallah Mahdhaoui, Jeridi Gouider, Essia Boughzela, Samir Kamoun, Mohamed Rachid Boujnah, Habib Haouala, Habib Gamra, Faouzi Maatouk, Ali Ben Khalfallah, Salem Kachboura, Hedi Baccar, Nejeh Ben Halima, Ali Guesmi, Khaled Sayahi, Wissem Sdiri, Ali Neji, Ahmed Bouakez, Sami Milouchi, Kais Battikh, Yves Jullieres, Nicolas Danchin, Jean Jacques Monsuez, Genevieve Mulak, Albert Hagege, Vincent Bataille, Rafik Chettaoui, Mohamed Sami Mourali, and FAST-MI Tunisia investigators

Subjects
Medicine, Science
Abstract

BackgroundThe FAST-MI Tunisia registry was set up by the Tunisian Society of Cardiology and Cardiovascular Surgery to assess the demographic and clinical characteristics, management and hospital outcome of patients with ST-elevation myocardial infarction (STEMI).MethodsData for 459 consecutive patients (mean age 60.8 years; 88.5% male) with STEMI, treated in 16 public hospitals (representing 72.2% of public hospitals in Tunisia treating STEMI patients), were collected prospectively.The most common risk factors were smoking (63.6%), hypertension (39.7%), diabetes (32%) and dyslipidaemia (18.2%).ResultsAmong the 459 patients, 61.8% received reperfusion therapy: 30% with primary percutaneous coronary intervention (PPCI) and 31.8% with intravenous fibrinolysis (IF) (28.6% with pre-hospital thrombolysis). The median time from symptom onset to thrombolysis was 185 min and to PPCI was 358 min. In-hospital mortality was 5.3%. Compared with those managed at regional hospitals, patients managed at interventional university hospitals (n = 357) were more likely to receive reperfusion therapy (52.9% vs. 34.1%; pConclusionsData from the FAST-MI Tunisia registry show that a pharmaco-invasive strategy of management for STEMI should be promoted in non-interventional regional hospitals.

Published
2019
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22. Atrial Fibrillation Management Strategies in Routine Clinical Practice: Insights from the International RealiseAF Survey.

Author

Chern-En Chiang, Lisa Naditch-Brûlé, Sandrine Brette, José Silva-Cardoso, Habib Gamra, Jan Murin, Oleg J Zharinov, and Philippe Gabriel Steg

Subjects
Medicine, Science
Abstract

Atrial fibrillation (AF) can be managed with rhythm- or rate-control strategies. There are few data from routine clinical practice on the frequency with which each strategy is used and their correlates in terms of patients' clinical characteristics, AF control, and symptom burden.RealiseAF was an international, cross-sectional, observational survey of 11,198 patients with AF. The aim of this analysis was to describe patient profiles and symptoms according to the AF management strategy used. A multivariate logistic regression identified factors associated with AF management strategy at the end of the visit.Among 10,497 eligible patients, 53.7% used a rate-control strategy, compared with 34.5% who used a rhythm-control strategy. In 11.8% of patients, no clear strategy was stated. The proportion of patients with AF-related symptoms (EHRA Class > = II) was 78.1% (n = 4396/5630) for those using a rate-control strategy vs. 67.8% for those using a rhythm-control strategy (p = II.In the RealiseAF routine clinical practice survey, rate control was more commonly used than rhythm control, and a change in strategy was uncommon, even in symptomatic patients. In almost 12% of patients, no clear strategy was stated. Physician awareness regarding optimal management strategies for AF may be improved.

Published
2016
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25. Association of the methylene-tetrahydrofolate reductase gene rs1801133 C677T variant with serum homocysteine levels, and the severity of coronary artery disease

Author

Habib Gamra, Mejdi Ben Messaoud, Faouzi Maatouk, Nadia Bouzidi, Hajer Fodha, Majed Hassine, and Salima Ferchichi

Subjects
Male, Homocysteine, lcsh:Medicine, Coronary Artery Disease, 030204 cardiovascular system & hematology, Gastroenterology, Severity of Illness Index, Coronary artery disease, chemistry.chemical_compound, 0302 clinical medicine, Genotype, lcsh:Science, Multidisciplinary, biology, Middle Aged, 030220 oncology & carcinogenesis, Female, Interventional cardiology, Adult, medicine.medical_specialty, Hyperhomocysteinemia, Tunisia, Single-nucleotide polymorphism, Polymorphism, Single Nucleotide, Article, 03 medical and health sciences, Young Adult, Internal medicine, Severity of illness, medicine, Humans, Genetic Predisposition to Disease, cardiovascular diseases, Genetic Association Studies, Methylenetetrahydrofolate Reductase (NADPH2), Aged, business.industry, lcsh:R, Case-control study, DNA, Cardiovascular genetics, medicine.disease, chemistry, ROC Curve, Methylenetetrahydrofolate reductase, Case-Control Studies, biology.protein, lcsh:Q, business, Biomarkers
Abstract

This study aimed to investigate whether the single nucleotide polymorphism C677T (rs1801133) of the methylene-tetrahydrofolate reductase (MTHFR) gene was associated with the risk of coronary artery disease (CAD) and circulating homocysteine (Hcy) levels in Tunisian population. 310 angiografically diagnosed CAD patients and 210 controls were enrolled in this study. The MTHFR C677T (rs1801133) polymorphism was genotyped, and the Hcy concentrations were measured. The severity of CAD was evaluated using the Gensini scoring system. Compared to the CC genotype, the TT genotype confers a higher risk for CAD severity with an OR = 9.07 and 95% CI = 3.78–21.8. The T allele was the predisposing allele for CAD and that it was probably associated with CAD severity. The area under the ROC curve for Hcy was 0.764 (95% CI 0.660 to 0.868, p = 0.001). The receiver operating characteristics curve (ROC) for Hcy showed its useful prediction of CAD. Hcy levels were not significantly associated with CAD severity expressed by Gensini Score (GS). The MTHFR C677T (rs1801133) polymorphism influences circulating Hcy levels. The MTHFR C677T polymorphism and hyperhomocysteinemia could have an important role in the prediction of the presence and not the severity expressed by GS of CAD.

Published
2020

26. Epidemiology of heart failure and long-term follow-up outcomes in a north-African population: Results from the NAtional TUnisian REgistry of Heart Failure (NATURE-HF)

Author

Sofien Zayed, Faiez Zannad, Habib Gamra, Marwa Chebbi, Khadija Mzoughi, Aymen Amri, S Mashki, Manel Ben Halima, Hela Naanea, Syrine Abid, Ali Ben Khalfalah, Salma Charfeddine, Samar Mohammed, A Najjar, Sondos Kraiem, Wided Nasraoui, Kais Sammoud, E. Boughzela, Emna Allouche, Nedia Barakett, Abdelhamid Ben Jmaa, Haithem Tangour, Fadoua Omri, S Azeiz, Ali Khorchani, Lilia Zakhama, Akram Zouari, Mokded Ayari, S. Milouchi, Faten Triki, Sami Mourali, Amani Farah, H Radoui, Alexandre Mebaza, Iheb Chahbani, Sana Ouali, Soraya Ben Youssef, Leila Riahi, Rami Tlili, Saoussen Antit, Hedi Ben Slima, Dorra Mbarek, Ines ben Ameur, Habib Haouala, Wafa Fehri, F. Addad, Chedi Youssfi, Khaled Zaouia, Houssem Thabet, Ikram Kammoun, Elifa Kanoun, Afef Ben Halima, Fares Azaiez, Wejdene Ouechtati, Zine Ben Ali, Hbiba Drissa, Mouna Hentati, Mahmoud Cheikh Bouhlel, Ali Guesmi, Houcine Zargouni, Karima Hezbri, Rachid Boujneh, Leila Abid, Mouna Chaker, Yassine Kammoun, Raoudha Othmani, H Ghardallou, Salem Kachboura, Meriem Drissa, Sonia Hamdi, R Gtaief, Yosra Majdoub, Habib Triki, Samir Kammoun, Nejeh Ben Halima, Selim Boudich, Mehdi Mechri, Tunisian Society of Cardiology and Cardiac Surgery, Hedi Chaker Hospital [Sfax], Hôpital Abderrahman Mami, Hôpital La Rabta [Tunis], Menzel Bourguiba Regional Hospital, Habib Thameur Hospital, Centre Hospitalier Universitaire Mongi Slim [La Marsa], Department of cardiology, Hospital of the Internal Security Forces, Hôpital Charles Nicolle [Tunis], Hopital Habib Bourguiba - Habib Bourguiba Hospital [Sfax], Department of cardiology, Principal Military Hospital, Department of cardiology, Habib Thameur Hospital, CHU Fattouma Bourguiba [Monastir] (HFB), Hôpital régional Taher Maamouri [Nabeul], Hôpital Universitaire Sahloul (CHU Sahloul), Hôpital Abderrahmen Mami, Hôpital Habib Thameur [Tunis], Department of cardiology, Mohamed Ben Sassi Hospital, Department of cardiology, Ibn El Jazzar Hospital, Department of cardiology, Kasserine Hospital, Mohamed Tahar Maamouri Hospital [Tunisia], Hôpital de Menzel Bourguiba, Centre National des Sciences et Technologies Nucléaires Sidi Thabet, Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Université de Lorraine (UL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre d'investigation clinique plurithématique Pierre Drouin [Nancy] (CIC-P), Centre d'investigation clinique [Nancy] (CIC), 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 Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy] (INI-CRCT), Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy], French-Clinical Research Infrastructure Network - F-CRIN [Paris] (Cardiovascular & Renal Clinical Trialists - CRCT ), Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), National Institute of Applied Sciences and Technology Tunis, Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), and BOZEC, Erwan

Subjects
Male, 030204 cardiovascular system & hematology, Endocrinology, Medical Conditions, 0302 clinical medicine, Outpatients, Epidemiology, Medicine and Health Sciences, Prospective Studies, Registries, 030212 general & internal medicine, Aged, 80 and over, education.field_of_study, Multidisciplinary, Pharmaceutics, Mortality rate, Anemia, Hematology, Middle Aged, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, 3. Good health, Survival Rate, Medicine, Female, Research Article, Adult, medicine.medical_specialty, Tunisia, Patients, Death Rates, Endocrine Disorders, Science, Population, Cardiology, Disease-Free Survival, 03 medical and health sciences, Population Metrics, Drug Therapy, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Diabetes mellitus, Internal medicine, Diabetes Mellitus, medicine, Humans, education, Aged, Heart Failure, Population Biology, business.industry, Biology and Life Sciences, medicine.disease, Health Care, Metabolic Disorders, Heart failure, Etiology, Observational study, business, Receptor Antagonist Therapy, Follow-Up Studies, Ejection Fraction
Abstract

International audience; The NATURE-HF registry was aimed to describe clinical epidemiology and 1-year outcomes of outpatients and inpatients with heart failure (HF). This is a prospective, multicenter, observational survey conducted in Tunisian Cardiology centers. A total of 2040 patients were included in the study. Of these, 1632 (80%) were outpatients with chronic HF (CHF). The mean hospital stay was 8.7 ± 8.2 days. The mortality rate during the initial hospitalization event for AHF was 7.4%. The all-cause 1-year mortality rate was 22.8% among AHF patients and 10.6% among CHF patients. Among CHF patients, the older age, diabetes, anemia, reduced EF, ischemic etiology, residual congestion and the absence of ACEI/ ARBs treatment were independent predictors of 1-year cumulative rates of rehospitalization and mortality. The female sex and the functional status were independent predictors of 1-year all-cause mortality and rehospitalization in AHF patients. This study confirmed that acute HF is still associated with a poor prognosis, while the mid-term outcomes in patients with chronic HF seems to be improved. Some differences across countries may be due to different clinical characteristics and differences in healthcare systems.

Published
2021

27. Cost-effectiveness of low-dose colchicine after myocardial infarction in the Colchicine Cardiovascular Outcomes Trial (COLCOT)

Author

François Roubille, Simon Kouz, Jean-Claude Tardif, Marie-Pierre Dubé, Rafael Diaz, Aldo P. Maggioni, Wolfgang Koenig, Marie-Claude Guertin, Fausto J. Pinto, Dominic Mitchell, Michelle Samuel, Lucie Blondeau, Nadia Bouabdallaoui, Habib Gamra, Jean Grégoire, Petr Ostadal, Philippe L. L’Allier, Colin Berry, Ghassan S. Kiwan, Andreas Orfanos, Reda Ibrahim, David D. Waters, Jacques LeLorier, Jose Lopez-Sendon, Mylène Provencher, Paul Khairy, Repositório da Universidade de Lisboa, Montreal Heart Institute - Institut de Cardiologie de Montréal, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Division of Cardiology, Zuckerberg San Francisco General Hospital, Department of Medicine, University of California, San Francisco, USA., Cardiology Department, CHULN, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal, Research Center [Associazione Nazionale Medici Cardiologi Ospedalieri] (ANMCO Research Center), Associazione Nazionale Medici Cardiologi Ospedalieri [Firenze] (ANMCO), Department of General Surgery. Surgical Oncology Unit, Reina Sofía University Hospital, Estudios Clinicos Latinoamerica, Rosario, Argentina, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Department of Internal Medicine II – Cardiology, Universität Ulm - Ulm University [Ulm, Allemagne], University of Ulm (UUlm), Department of Cardiology Cardiovascular Center, NaHomolce Hospital, Prague, Czech Republic, Na Homolce Hospital, Prague, Czech Republic., Cardiology department Hospital Universitario La Paz. UAM. IdiPaz. CIBER-CV, Madrid, Spain, CHU Fattouma Bourguiba [Monastir] (HFB), Bellevue Medical Center, Beirut, Lebanon, Montreal Health Innovations Coordinating Center [Montreal Heart Institute] (MHICC), Institut de Cardiologie et Pneumologie de Québec, Quebec City, Université Laval [Québec] (ULaval), Centre Hospitalier Régional de Lanaudière, Joliette, Canada, Service de Chirurgie cardiaque et thoracique [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Université de Tours, Logimetrix Inc, Canada, Montreal Health Innovation Coordination Center, Montreal Heart Institute Coordinating Centre (MHICC), Université de Montréal (UdeM), Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CR CHUM), Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal (UdeM)-Université de Montréal (UdeM), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Université de Tours (UT), MORNET, Dominique, and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Canada, medicine.medical_specialty, Heart disease, Cost effectiveness, Cost-Benefit Analysis, [SDV]Life Sciences [q-bio], 030204 cardiovascular system & hematology, Placebo, Angina, 03 medical and health sciences, 0302 clinical medicine, Myocardial infarction, Internal medicine, medicine, Humans, AcademicSubjects/MED00200, 030212 general & internal medicine, Stroke, health care economics and organizations, ComputingMilieux_MISCELLANEOUS, business.industry, Health Policy, Clopidogrel, medicine.disease, 3. Good health, Quality-adjusted life year, [SDV] Life Sciences [q-bio], Original Article, Quality-Adjusted Life Years, Cardiology and Cardiovascular Medicine, business, Colchicine, medicine.drug
Abstract

© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com, Aims: In the randomized, placebo-controlled Colchicine Cardiovascular Outcomes Trial (COLCOT) of 4745 patients enrolled within 30 days after myocardial infarction (MI), low-dose colchicine (0.5 mg once daily) reduced the incidence of the primary composite endpoint of cardiovascular death, resuscitated cardiac arrest, MI, stroke, or urgent hospitalization for angina leading to coronary revascularization. To assess the in-trial period and lifetime cost-effectiveness of low-dose colchicine therapy compared to placebo in post-MI patients on standard-of-care therapy. Methods and results: A multistate Markov model was developed incorporating the primary efficacy and safety results from COLCOT, as well as healthcare costs and utilities from the Canadian healthcare system perspective. All components of the primary outcome, non-cardiovascular deaths, and pneumonia were included as health states in the model as both primary and recurrent events. In the main analysis, a deterministic approach was used to estimate the incremental cost-effectiveness ratio (ICER) for the trial period (24 months) and lifetime (20 years). Over the in-trial period, the addition of colchicine to post-MI standard-of-care treatment decreased the mean overall per-patient costs by 47%, from $502 to $265 Canadian dollar (CAD), and increased the quality-adjusted life years (QALYs) from 1.30 to 1.34. The lifetime per-patient costs were further reduced (69%) and QALYs increased with colchicine therapy (from 8.82 to 11.68). As a result, both in-trial and lifetime ICERs indicated colchicine therapy was a dominant strategy. Conclusion: Cost-effectiveness analyses indicate that the addition of colchicine to standard-of-care therapy after MI is economically dominant and therefore generates cost savings.

Published
2021

28. 2021 Asian Pacific Society of Cardiology Consensus Recommendations on the Use of P2Y(12) Receptor Antagonists in the Asia-Pacific Region: Special Populations

Author

Habib Gamra, Byeong Keuk Kim, Jassim Al Suwaidi, Usman Baber, Doni Firman, Ya Ling Han, Jack Wei Chieh Tan, Yi Li, Kin Lam Tsui, Li-Wah Tam, Abdulla Shehab, Jamshed Dalal, Gabriel Steg, Quang Ngoc Nguyen, Chee Tang Chin, Ayman Hammoudeh, Zulu Wang, Alan Yean Yip Fong, Bilgehan Karadag, Mohamed Sobhy, Bo Zhang, Doreen S.H. Tan, Wael Almahmeed, Dmitry Duplyakov, Wacin Buddhari, Paul Jau Lueng Ong, Mark Y. Chan, Derek P. Chew, Junya Ako, and Kai Xu

Subjects
medicine.medical_specialty, Prasugrel, Asia, Artery-Disease, Coronary artery disease, P2Y12, Percutaneous Coronary Intervention, Chronic Kidney-Disease, Diabetes mellitus, Internal medicine, Platelet aggregation inhibitors, Clinical-Outcomes, medicine, Diseases of the circulatory (Cardiovascular) system, Cardiovascular Events, P2y12 Inhibitor Monotherapy, business.industry, Elderly-Patients, Drug-Eluting Stents, Elevation Myocardial-Infarction, medicine.disease, Comorbidity, dual antiplatelet therapy, myocardial ischaemia, comorbidity, consensus, RC666-701, Platelet aggregation inhibitor, Cardiology and Cardiovascular Medicine, business, Ticagrelor, medicine.drug, Kidney disease
Abstract

Advanced age, diabetes, and chronic kidney disease not only increase the risk for ischaemic events in chronic coronary syndromes (CCS) but also confer a high bleeding risk during antiplatelet therapy. These special populations may warrant modification of therapy, especially among Asians, who have displayed characteristics that are clinically distinct from Western patients. Previous guidance has been provided regarding the classification of high-risk CCS and the use of newer-generation P2Y(12) inhibitors (i.e. ticagrelor and prasugrel) after acute coronary syndromes (ACS) in Asia. The authors summarise evidence on the use of these P2Y(12) inhibitors during the transition from ACS to CCS and among special populations. Specifically, they present recommendations on the roles of standard dual antiplatelet therapy, shortened dual antiplatelet therapy and single antiplatelet therapy among patients with coronary artery disease, who are either transitioning from ACS to CCS; elderly; or with chronic kidney disease, diabetes, multivessel coronary artery disease and bleeding events during therapy. Asian Pacific Society of Cardiology (APSC); Abbott VascularAbbott Laboratories; AmgenAmgen; AstraZenecaAstraZeneca; BayerBayer AG; Roche Diagnostics; Daiichi SankyoDaiichi Sankyo Company Limited This work was funded through the Asian Pacific Society of Cardiology (APSC) with unrestricted educational grants from Abbott Vascular, Amgen, AstraZeneca, Bayer and Roche Diagnostics. JWCT reports honoraria from AstraZeneca, Bayer, Amgen, Medtronic, Abbott Vascular, Biosensors, Alvimedica, Boehringer Ingelheim and Pfizer; research and educational grants from Medtronic, Biosensors, Biotronik, Philips, Amgen, AstraZeneca, Roche, Otsuka, Terumo and Abbott Vascular; and consulting fees from Elixir and CSL Behring; and is on the European Cardiology Review editorial board; this did not influence peer review. JA reports honoraria from AstraZeneca, Daiichi Sankyo, Bayer and Sanofi; and grants/grants pending from Daiichi Sankyo. DPC reports consulting fees from APSC; support for travel to meetings for the study or otherwise from APSC; grants/grants pending from Roche Diagnostics; payment for development of educational presentations including service on speakers' bureaus from AstraZeneca. JD reports honoraria from Bayer and Pfizer. CTC reports honoraria from Abbott Vascular, AstraZeneca, Boston Scientific, Biotronik, Biosensors, Medtronic; consulting and ad boards from AstraZeneca, Boston Scientific; and research and educational support from AstraZeneca, Eli Lilly. AH reports consulting fee or honorarium from AstraZeneca. MC reports consulting fee or honorarium from AstraZeneca. AYYF reports honoraria and educational support from AstraZeneca. BK reports consulting fee or honorarium from AstraZeneca, Abbott, IE Menarini, Daiichi Sankyo, Sanovel and ARIS. UB reports honoraria from Amgen and AstraZeneca. All other authors have no conflicts of interest to declare.

Published
2021

29. Pharmacogenomics of the Efficacy and Safety of Colchicine in COLCOT

Author

François Roubille, Simon Kouz, Colin Berry, Habib Gamra, Rafael Diaz, Wolfgang Koenig, Ian Mongrain, Marc-André Legault, René Fouodjio, Amina Barhdadi, Marie-Pierre Dubé, Ghassan S. Kiwan, Lucie Blondeau, Aldo P. Maggioni, Marie-Claude Guertin, Fausto J. Pinto, Michelle Samuel, Anick Dubois, Maxine Sun, Philippe L. L’Allier, Jean-Claude Tardif, Nadia Bouabdallaoui, Audrey Lemaçon, David Rhainds, Géraldine Asselin, Louis-Philippe Lemieux Perreault, Sylvie Provost, Simon de Denus, David D. Waters, Jose Lopez-Sendon, Mariève Cossette, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), and Repositório da Universidade de Lisboa

Subjects
Male, Gastrointestinal Diseases, [SDV]Life Sciences [q-bio], Association Studies, Cardiovascular, chemistry.chemical_compound, 0302 clinical medicine, Clinical Studies, Colchicine, Myocardial infarction, Randomized Controlled Trials as Topic, pharmacogenetics, 0303 health sciences, Single Nucleotide, General Medicine, Middle Aged, 3. Good health, Treatment Outcome, myocardial infarction, Heart Disease, Gastrointestinal disorder, Cardiovascular Diseases, 6.1 Pharmaceuticals, ComputingMethodologies_DOCUMENTANDTEXTPROCESSING, Cardiology, Female, Patient Safety, Acute coronary syndrome, Cardiovascular outcomes, Cardiovascular event, medicine.medical_specialty, Genotype, Clinical Trials and Supportive Activities, Polymorphism, Single Nucleotide, colchicine, acute coronary syndrome, 03 medical and health sciences, Genetic, Clinical Research, Internal medicine, Genetics, medicine, Humans, Polymorphism, Heart Disease - Coronary Heart Disease, Gastrointestinal diseases, Proportional Hazards Models, Aged, 030304 developmental biology, business.industry, Phosphotransferases, Human Genome, Evaluation of treatments and therapeutic interventions, Original Articles, Placebo Effect, medicine.disease, chemistry, Pharmacogenetics, Pharmacogenomics, Digestive Diseases, business, Acute Coronary Syndromes, 030217 neurology & neurosurgery, Genome-Wide Association Study
Abstract

Supplemental Digital Content is available in the text., Background: The randomized, placebo-controlled COLCOT (Colchicine Cardiovascular Outcomes Trial) has shown the benefits of colchicine 0.5 mg daily to lower the rate of ischemic cardiovascular events in patients with a recent myocardial infarction. Here, we conducted a post hoc pharmacogenomic study of COLCOT with the aim to identify genetic predictors of the efficacy and safety of treatment with colchicine. Methods: There were 1522 participants of European ancestry from the COLCOT trial available for the pharmacogenomic study of COLCOT trial. The pharmacogenomic study’s primary cardiovascular end point was defined as for the main trial, as time to first occurrence of cardiovascular death, resuscitated cardiac arrest, myocardial infarction, stroke, or urgent hospitalization for angina requiring coronary revascularization. The safety end point was time to the first report of gastrointestinal events. Patients’ DNA was genotyped using the Illumina Global Screening array followed by imputation. We performed a genome-wide association study in colchicine-treated patients. Results: None of the genetic variants passed the genome-wide association study significance threshold for the primary cardiovascular end point conducted in 702 patients in the colchicine arm who were compliant to medication. The genome-wide association study for gastrointestinal events was conducted in all 767 patients in the colchicine arm and found 2 significant association signals, one with lead variant rs6916345 (hazard ratio, 1.89 [95% CI, 1.52–2.35], P=7.41×10−9) in a locus which colocalizes with Crohn disease, and one with lead variant rs74795203 (hazard ratio, 2.51 [95% CI, 1.82–3.47]; P=2.70×10−8), an intronic variant in gene SEPHS1. The interaction terms between the genetic variants and treatment with colchicine versus placebo were significant. Conclusions: We found 2 genomic regions associated with gastrointestinal events in patients treated with colchicine. Those findings will benefit from replication to confirm that some patients may have genetic predispositions to lower tolerability of treatment with colchicine.

Published
2021

30. Acute myocardial infarction and acute heart failure in the Middle East and North Africa: Study design and pilot phase study results from the PEACE MENA registry

Author

Muhammad Ali, Fahad Alkindi, Ayman Al Saleh, Wael Almahmeed, Khalid F. AlHabib, Ahmed Al-Motarreb, Mohammad I. Amin, Mothanna Alquraishi, Nadia Fellat, Ayman Hammoudeh, Mohamed Sobhy, Magdi G. Yousif, Salim Benkheddah, Anhar Ullah, Faiez Zannad, Habib Gamra, Mohammad Al Jarallah, Bodescot, Myriam, King Saud University [Riyadh] (KSU), Université de Monastir - University of Monastir (UM), Cleveland Clinic Abu Dhabi [Abou Dabi, Émirats arabes unis], Istishari Hospital [Amman, Jordanie], Université d'Alger 1 (Benyoucef Benkhedda), Sabah Al-Ahmad Cardiac Center [Ville de Koweït, Koweït], Sana'a University, Ibn Al-Bitar Hospital for Cardiac Surgery [Bagdad, Irak], International Cardiac Center [Alexandrie, Égypte] (ICC), Sudan Heart Centre [Khartoum, Soudan], Hamad Medical Corporation [Doha, Qatar], Ibn Sina University Hospital [Rabat, Maroc], Sh. Mohammad Bin Khalifa Cardiac Centre [Awali, Bahreïn], Saudi Heart Association [Riyad, Arabie saoudite], Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Université de Lorraine (UL), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), HG, WA, AH, SB, MJ, AM, MS, MGY, FA, NF, MIA, AS. 30 $ for each submitted online CRF for data collection. funder name: by Roche Diagnostic Middle East FZCO. https://www.rochemiddleeast.com, and Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Male, Cardiovascular Procedures, medicine.medical_treatment, Myocardial Infarction, Pilot Projects, 030204 cardiovascular system & hematology, Vascular Medicine, 0302 clinical medicine, Africa, Northern, Risk Factors, Prevalence, Medicine and Health Sciences, Coronary Heart Disease, Hospital Mortality, Prospective Studies, Registries, 030212 general & internal medicine, Myocardial infarction, Prospective cohort study, Coronary Artery Bypass Grafting, Multidisciplinary, Mortality rate, 1. No poverty, Thrombolysis, Middle Aged, Hospitals, 3. Good health, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Research Design, Cohort, Medicine, Female, Risk assessment, Research Article, medicine.medical_specialty, Patients, Death Rates, Science, Cardiology, Surgical and Invasive Medical Procedures, Proof of Concept Study, Risk Assessment, Middle East, 03 medical and health sciences, Reperfusion therapy, Population Metrics, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, medicine, Humans, Aged, Heart Failure, Population Biology, business.industry, Correction, Biology and Life Sciences, medicine.disease, Health Care, Health Care Facilities, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Heart failure, Emergency medicine, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business
Abstract

BackgroundThis pilot study describes the overall design and results of the Program for the Evaluation and Management of the Cardiac Events registry for the Middle East and North Africa (MENA) Region.MethodsThis prospective, multi-center, multi-country study included patients hospitalized with acute myocardial infarction (AMI) and/or acute heart failure (AHF). We evaluated the clinical characteristics, socioeconomic and educational levels, management, in-hospital outcomes, and 30-day mortality rate of patients that were admitted to one tertiary-care center in each of 14 Arab countries in the MENA region.ResultsBetween 22 April and 28 August 2018, 543 AMI and 381AHF patients were enrolled from 14 Arab countries (mean age, 57±12 years, 82.5% men). Over half of the patients in both study groups had low incomes with limited health care coverage, and limited education. Nearly half of the cohort had a history of diabetes mellitus, hypertension, or hypercholesterolemia. Among patients with ST-elevation myocardial infarctions, 56.4% received primary percutaneous interventions, 24% received thrombolysis, and 19.5% received no acute reperfusion therapy. The main causes of AHF were ischemic heart diseases (55%) and primary valvular heart diseases (15%). The in-hospital and 30-day mortality rates were 2.0% and 3.5%, respectively, for AMI, and 5.4% and 7.0%, respectively, for AHF.ConclusionsThis pilot study revealed a high prevalence of cardiovascular risk factors in patients with AMI and AHF in Arab countries, and low levels of socioeconomic and educational status. Future phases of the study will improve our understanding of the impact that these factors have on the management and outcomes of cardiac events in these patient populations.

Published
2020

31. Efficacy and safety of low-dose colchicine after myocardial infarction

Author

Lucie Blondeau, Mylène Provencher, Olivier F. Bertrand, Aldo P. Maggioni, José López-Sendón, Jean-Claude Tardif, François Roubille, Simon Kouz, Wolfgang Koenig, Marie-Pierre Dubé, Rafael Diaz, Andreas Orfanos, Reda Ibrahim, Denis Angoulvant, Petr Ostadal, Fausto J. Pinto, Jean Grégoire, Ghassan S. Kiwan, Marie-Claude Guertin, David D. Waters, Marc-André Lavoie, David Rhainds, Colin Berry, Habib Gamra, Philippe L. L’Allier, Montreal Heart Institute Coordinating Centre (MHICC), Université de Montréal (UdeM), Montreal Heart Institute, Montreal, Canada, Université Laval [Québec] (ULaval), Division of Cardiology, Zuckerberg San Francisco General Hospital, Department of Medicine, University of California, San Francisco, USA., Institut de Cardiologie et Pneumologie de Québec, Quebec City, ECLAEstudios Clínicos Latino América & Instituto Cardiovascular de Rosario), Rosario, Argentina, Research Center [Associazione Nazionale Medici Cardiologi Ospedalieri] (ANMCO Research Center), Associazione Nazionale Medici Cardiologi Ospedalieri [Firenze] (ANMCO), Cardiology Department, CHULN, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal, Montrea l Heart Institute, Université de Montréal, Montreal, Canada, CHU Fattouma Bourguiba [Monastir] (HFB), Bellevue Medical Center, Beirut, Lebanon, Institute of Cardiovascular and Medical Sciences, University of Glasgow, British Heart Foundation Glasgow Cardiovascular Research Centre (BHF GCRC), University of Glasgow-NHS Greater Glasgow and Clyde, Cardiology department Hospital Universitario La Paz. UAM. IdiPaz. CIBER-CV, Madrid, Spain, Department of Cardiology Cardiovascular Center, NaHomolce Hospital, Prague, Czech Republic, Department of Internal Medicine II – Cardiology, Universität Ulm - Ulm University [Ulm, Allemagne], München, Technische Universität München, German Research Center for Cardiovascular Disease (DZHK), Partner site Munich Heart Alliance, Institute of Epidemiology and Medical Biometry, University of Ulm, Munich, Germany, Cellules Dendritiques, Immunomodulation et Greffes, Université de Tours (UT), Centre Hospitalier Universitaire (CHU) de Tours and Équipe d'Accueil 4245 Transplantation Immunité Inflammation Loire Valley Cardiovascular Collaboration, Tours University, Tours, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Montreal Heart Institute - Institut de Cardiologie de Montréal, Montreal Health Innovations Coordinating Center [Montreal Heart Institute] (MHICC), Montreal Health Innovation Coordination Center, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), MORNET, Dominique, Repositório da Universidade de Lisboa, Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université de Tours, and Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS)

Subjects
Male, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Myocardial Infarction, Anti-Inflammatory Agents, Inflammation, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Pharmacology, Medical and Health Sciences, law.invention, Angina Pectoris, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Percutaneous Coronary Intervention, Randomized controlled trial, Double-Blind Method, law, Recurrence, General & Internal Medicine, medicine, Colchicine, Humans, 030212 general & internal medicine, Myocardial infarction, Proportional Hazards Models, Aged, Intention-to-treat analysis, business.industry, Incidence, Low dose, Percutaneous coronary intervention, General Medicine, Middle Aged, medicine.disease, 3. Good health, Intention to Treat Analysis, Stroke, [SDV] Life Sciences [q-bio], C-Reactive Protein, chemistry, Clinical evidence, Cardiovascular Diseases, Female, medicine.symptom, business, Biomarkers
Abstract

Copyright © 2019 Massachusetts Medical Society. All rights reserved., Background: Experimental and clinical evidence support the role of inflammation in atherosclerosis and its complications. Colchicine is an orally administered, potent antiinflammatory medication that is indicated for the treatment of gout and pericarditis. Methods: We performed a randomized, double-blind trial involving patients recruited within 30 days after a myocardial infarction. The patients were randomly assigned to receive either low-dose colchicine (0.5 mg once daily) or placebo. The primary efficacy end point was a composite of death from cardiovascular causes, resuscitated cardiac arrest, myocardial infarction, stroke, or urgent hospitalization for angina leading to coronary revascularization. The components of the primary end point and safety were also assessed. Results: A total of 4745 patients were enrolled; 2366 patients were assigned to the colchicine group, and 2379 to the placebo group. Patients were followed for a median of 22.6 months. The primary end point occurred in 5.5% of the patients in the colchicine group, as compared with 7.1% of those in the placebo group (hazard ratio, 0.77; 95% confidence interval [CI], 0.61 to 0.96; P = 0.02). The hazard ratios were 0.84 (95% CI, 0.46 to 1.52) for death from cardiovascular causes, 0.83 (95% CI, 0.25 to 2.73) for resuscitated cardiac arrest, 0.91 (95% CI, 0.68 to 1.21) for myocardial infarction, 0.26 (95% CI, 0.10 to 0.70) for stroke, and 0.50 (95% CI, 0.31 to 0.81) for urgent hospitalization for angina leading to coronary revascularization. Diarrhea was reported in 9.7% of the patients in the colchicine group and in 8.9% of those in the placebo group (P = 0.35). Pneumonia was reported as a serious adverse event in 0.9% of the patients in the colchicine group and in 0.4% of those in the placebo group (P = 0.03). Conclusions: Among patients with a recent myocardial infarction, colchicine at a dose of 0.5 mg daily led to a significantly lower risk of ischemic cardiovascular events than placebo. (Funded by the Government of Quebec and others; COLCOT ClinicalTrials.gov number, NCT02551094.).

Published
2019

32. The International Polycap Study-3 (TIPS-3): Design, baseline characteristics and challenges in conduct

Author

Jessica Tyrwhitt, Koon K. Teo, Jackie Bosch, Prem Pais, Antonio L. Dans, Shamim Talukder, Salim Yusuf, Patricio Lopez-Jaramillo, Habib Gamra, Karen Yeates, Peggy Gao, Paul Anthony Camacho López, Anwar Santoso, Denis Xavier, Philip Joseph, and Khalid Yusoff

Subjects
Male, medicine.medical_specialty, Simvastatin, Statin, Challenges in conduct, medicine.drug_class, Population, Angiotensin-Converting Enzyme Inhibitors, 030204 cardiovascular system & hematology, Placebo, Global Health, Article, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Double-Blind Method, Ramipril, law, Internal medicine, medicine, Humans, 030212 general & internal medicine, education, Polypill, Diuretics, Antihypertensive Agents, Retrospective Studies, education.field_of_study, Polycap, Framingham Risk Score, business.industry, International Polycap Study-3, Incidence, Middle Aged, Adrenergic beta-1 Receptor Antagonists, 3. Good health, Primary Prevention, Drug Combinations, Hydrochlorothiazide, Atenolol, Cardiovascular Diseases, Population study, Female, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Cardiology and Cardiovascular Medicine, business
Abstract

8 p., BACKGROUND: It is hypothesized that in individuals without clinical cardiovascular disease (CVD), but at increased CVD risk, a 50% to 60% reduction in CVD risk could be achieved using fixed dose combination (FDC) therapy (usually comprised of multiple blood-pressure agents and a statin [with or without aspirin]) in a single "polypill". However, the impact of a polypill in preventing clinical CV events has not been evaluated in a large randomized controlled trial. METHODS: TIPS-3 is a 2x2x2 factorial randomized controlled trial that will examine the effect of a FDC polypill on major CV outcomes in a primary prevention population. This study aims to determine whether the Polycap (comprised of atenolol, ramipril, hydrochlorothiazide, and a statin) reduces CV events in persons without a history of CVD, but who are at least at intermediate CVD risk. Additional interventions in the factorial design of the study will compare the effect of (1) aspirin versus placebo on CV events (and cancer), (2) vitamin D versus placebo on the risk of fractures, and (3) the combined effect of aspirin and the Polycap on CV events. RESULTS: The study has randomized 5713 participants across 9 countries. Mean age of the study population is 63.9 years, and 53% are female. Mean INTERHEART risk score is 16.8, which is consistent with a study population at intermediate CVD risk. CONCLUSION: Results of the TIP-3 study will be key to determining the appropriateness of FDC therapy as a strategy in the global prevention of CVD.

Published
2018

33. Relationship of activin A levels with clinical presentation, extent, and severity of coronary artery disease

Author

Fethi Betbout, Faouzi Maatouk, Abdelhedi Miled, Salima Ferchichi, Nadia Bouzidi, and Habib Gamra

Subjects
0301 basic medicine, Adult, Male, medicine.medical_specialty, Population, severity, Coronary Artery Disease, 030204 cardiovascular system & hematology, Coronary Angiography, Severity of Illness Index, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, Risk Factors, Internal medicine, Severity of illness, medicine, Humans, Myocardial infarction, cardiovascular diseases, education, Original Investigation, education.field_of_study, Framingham Risk Score, Predictive marker, Unstable angina, business.industry, Case-control study, Activin A, Middle Aged, medicine.disease, Activins, extent, 030104 developmental biology, Case-Control Studies, Cardiology, ST Elevation Myocardial Infarction, Female, Cardiology and Cardiovascular Medicine, business, Biomarkers
Abstract

Objective We aimed to evaluate the relationship of serum activin A levels with risk factors, clinical presentation, biochemical marker levels, extent, and severity of atherosclerotic coronary artery disease (CAD). Methods In total, 310 CAD patients [92 with ST-segment elevation myocardial infarction (STEMI), 111 with non-STEMI (NSTEMI), and 107 with unstable angina (UA)] and 207 healthy subjects (controls) were enrolled. Activin A levels in all participants were measured using ELISA. Angiographic measurements were performed in patients and not in the healthy subjects. Results Activin A levels were higher in all patient groups than in controls (patients vs. controls, p=0.041; NSTEMI vs. UA, p=0.744; STEMI vs. UA, p=0.172; NSTEMI vs. STEMI, p=0.104). According to the cut-off value of activin A level, patients with high and low activin A levels had a similar distribution of clinical and biochemical variables but the prevalence of severe stenosis was observed in groups with high activin A levels. Our results revealed that activin A levels did not decrease as thrombolysis in myocardial infarction (risk score increased (p=0.590). The area under the ROC curve for activin A levels in patients was 0.590±0.047 (95% CI: 0.439-0.591, p=0.193). In multiple analysis of the overall population, male gender (s=-0.260; 95% CI: -617.39 to -110.04; p=0.005) was an independent predictor of activin A levels. Conclusion This study indicated that activin A can not be a predictive marker in CAD and is not associated with extensive and severe CAD. In contrast, the increase in activin A levels in patients, especially in patients with different clinical groups of acute coronary syndromes, suggested its involvement in atherosclerosis.

Published
2017

34. Case Report: Coronary artery stent infection with mycotic aneurysm secondary to tricuspid valve infective endocarditis

Author

Badii Hmida, Mejdi Ben Messaoud, Nidhal Bouchahda, Marouane Mahjoub, Habib Gamra, and Zohra Dridi

Subjects
0301 basic medicine, Bare-metal stent, Male, medicine.medical_specialty, Acute coronary syndrome, coronary aneurysm, medicine.medical_treatment, Case Report, General Biochemistry, Genetics and Molecular Biology, acute coronary syndrome, 03 medical and health sciences, 0302 clinical medicine, Angioplasty, Coronary stent, medicine, Humans, cardiovascular diseases, General Pharmacology, Toxicology and Pharmaceutics, Aged, Coronary artery aneurysm, Tricuspid valve, General Immunology and Microbiology, Endocarditis, business.industry, General Medicine, Articles, Mycotic aneurysm, medicine.disease, Coronary Vessels, infection, Surgery, 030104 developmental biology, medicine.anatomical_structure, stents, Infective endocarditis, Tricuspid Valve, business, Aneurysm, Infected, 030217 neurology & neurosurgery
Abstract

Coronary artery stent infection with mycotic aneurysm is a rare life-threatening complication following coronary angioplasty, usually requiring surgical intervention. Reaching and confirming the diagnosis remains the most challenging aspect of this complication. We describe an unusual case of bare metal stent infection and coronary artery aneurysm in the setting of tricuspid valve infective endocarditis, resulting in ST elevation myocardial infarction, with a favorable outcome after primary angioplasty and antibiotic therapy. In the current era of growth of coronary stent implantation, it’s important for clinicians to consider and to prevent such potentially fatal events. The diagnosis process remains difficult and requires the association of multiple clinical, biological and imaging parameters. Although treatment modalities tend to favor surgery, we showed that coronary angioplasty could be a successful alternative solution.

Published
2019

35. Correlation of trans fatty acids with the severity of coronary artery disease lesions

Author

Gérard Lizard, Habib Gamra, Mohamed Hammami, Wafa Kharroubi, Isabelle Hininger-Favier, Amira Zarrouk, Samia Hadj Ahmed, Nadia Kaoubaa, Mohamed Fadhel Najjar, Fathi Batbout, Université de Monastir - University of Monastir (UM), CHU Fattouma Bourguiba [Monastir] (HFB), Laboratoire Bio-PeroxIL. Biochimie du peroxysome, inflammation et métabolisme lipidique [Dijon] (BIO-PEROXIL), Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Laboratory of Fundamental and Applied Bioenergetics = Laboratoire de bioénergétique fondamentale et appliquée (LBFA), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])

Subjects
0301 basic medicine, Male, Apolipoprotein B, Endocrinology, Diabetes and Metabolism, [SDV]Life Sciences [q-bio], Clinical Biochemistry, Oleic Acids, Coronary Artery Disease, 030204 cardiovascular system & hematology, medicine.disease_cause, Severity of Illness Index, Antioxidants, Lipid peroxidation, chemistry.chemical_compound, 0302 clinical medicine, Endocrinology, Malondialdehyde, lcsh:RC620-627, ComputingMilieux_MISCELLANEOUS, chemistry.chemical_classification, biology, Middle Aged, Trans Fatty Acids, Elaidic acid, 3. Good health, lcsh:Nutritional diseases. Deficiency diseases, lipids (amino acids, peptides, and proteins), Female, Adult, medicine.medical_specialty, 03 medical and health sciences, Internal medicine, medicine, Trans C18:2 isomers, Humans, Triglycerides, Aged, Cholesterol, Research, Biochemistry (medical), C-reactive protein, Cholesterol, HDL, Fatty acid, Cholesterol, LDL, Oxidative Stress, 030104 developmental biology, chemistry, biology.protein, Oxidative stress, Biomarkers, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Oleic Acid
Abstract

Background Nutritional choices, which include the source of dietary fatty acids (FA), have an important significant impact on coronary artery disease (CAD). We aimed to determine on patients with CAD the relationships between Trans fatty acids (Trans FA) and different CAD associated parameters such as inflammatory and oxidative stress parameters in addition to Gensini score as a vascular severity index. Methods Fatty acid profiles were established by gas chromatography from 111 CAD patients compared to 120 age-matched control group. Lipid peroxidation biomarkers, oxidative stress, inflammatory parameters and Gensini score were studied. Results Our study showed a significant decrease of the antioxidant parameters levels such as erythrocyte glutathione peroxydase (GPx) and superoxide dismutase (SOD) activities, plasma antioxidant status (FRAP) and thiol (SH) groups in CAD patients. On the other hand, catalase activity, conjugated dienes and malondialdehyde were increased. Plasmatic and erythrocyte Trans FA were also increased in CAD patients compared to controls. Furthermore, divergent associations of these Trans FA accumulations were observed with low-density lipoprotein-cholesterol/ high-density lipoprotein-cholesterol (LDL-C/HDL-C) ratio, Apolipoprotein B (ApoB), lipid peroxidation parameters, high-sensitivity C Reactive Protein (hs-CRP), Interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-α) and Gensini score. Especially, elaidic acid (C18:1 trans 9), trans C18:2 isomers and trans 11 eicosanoic acid are correlated with these parameters. Trans FA are also associated with oxidative stress, confirmed by a positive correlation between C20:1 trans 11 and GPx in erythrocytes. Conclusions High level of Trans FA was highly associated with the induction of inflammation, oxidative stress and lipoperoxidation which appear to be based on the vascular severity and might be of interest to assess the stage and progression of atherosclerosis. The measurement of these Trans FA would be of great value for the screening of lipid metabolism disorders in CAD patients.

Published
2018

36. Prasugrel versus clopidogrel for acute coronary syndromes without revascularization

Author

L. Wang, T. Stys, William E. Boden, R. H. Urbano, D. M. Olinic, Karen S. Pieper, A. Kuijper, E. Soh, J. Nicolau, Jadwiga Nessler, William J. Rogers, Ernesto Rivera, R. Braam, H. Kadr, J. Csikasz, B. Boichev, Prafulla Kerkar, I. Kraiz, R. Babu, Ali Aydinlar, D. Safley, O. Nguyen-Khac, P. Chua, W. Buchanan, C. A. Morales, A. Abyankar, A. Srinivas, S. Genth-Zotz, J. Rocha Faria Neto, D. Drenning, L. Moretti, S. Varma, D. Roth, C. Matei, Jane E. Onken, H. Tumbev, P. Keeling, Xian Li, N. Ciglenecki, Shahyar M. Gharacholou, P. P. Goh, D. Sporn, M. Chang, Marcin Gruchała, R. Foreman, Bogdan Minescu, S. Nawaz, N. Alexeeva, Y. Shalev, C. Fastabend, L. van Zyl, J. F. Certic, J. Longo, J. Wang, K. Dave, Olivier Morel, F. Maatouk, Y. El Rakshy, J. Giacomini, P. Lazov, R. Marino, Dimitar Raev, M. Y. Chan, L. Z. Dextre, Y. Hao, P. Sepulveda, K. Ramshev, C. Bayron, Ameer Kabour, Alon Marmor, Luciano Moreira Baracioli, H. Marais, Rajendra H. Mehta, R. Breedveld, A. Ben Khalfallah, Kurtulus Ozdemir, I. Westendorp, J. A. Quion, Daniel J. George, D. F. Garcia, J.-P Bassand, G. Szalai, Huw Griffiths, O. Ushakov, M. Tzekova, E. Suprun, A. Mowafy, N. El Mansour, Gail V.W. Johnson, Tereshchenko Sn, W. T. Lai, Petr Widimsky, Hany Ragy, V. R. Castillo, M. Padour, Gilles Montalescot, Louie Tirador, Deepak L. Bhatt, M. Marrinan, S. Promisloff, A. Nambiar, Reginald G.E.J. Groutars, S. R. Lee, J. Cabrera, S. Zhang, András Jánosi, K. Wita, R. Sciborski, Annabelle Rodriguez, P. Sedlon, Jaroslaw D. Kasprzak, A. Faynyk, A. Romero Acuña, M. C. Ramirez, Rakesh Gupta, R. Saligrama, Jacek Gniot, Y. Ke, John H. Alexander, X. Liu, E. Baranov, R. Grzywna, Mukul Sharma, A. Linka, Jarosław Wójcik, Haroon Rashid, M. S. Sanchez, M. Gadkari, B. Rao, James S. Zebrack, Paul W. Armstrong, Francois Schiele, Gracita O. Topacio, Peter J. Casterella, A. Belhassane, P. Golino, F. Plat, P. Roberts-Thomson, K. S. Kim, Stephen D. Wiviott, Mathew T. Roe, Y. D. Chen, I. A. Khan, S. Thanvi, S. Isserman, G. Falck, R. M. Coching, S. C. Stamate, M. Ogorek, K. Danisa, Poul Anders Hansen, M. Medvegy, Amos Katz, R. K. Seerangachar, B. Farah, V. Kale, B. Kusnick, Maurice Pye, M. Mosseri, M. Vatutin, D. Weinstein, Norma Keller, A. Mihov, Ewa Mirek-Bryniarska, N. Adjei, S. Sethi, A. Irimpen, M. Broeders, T. Huynh, K. Niezgoda, P. Samardzic, D. Ziperman, Stuart J. Pocock, T. Arad, J. Lewczuk, M. Amuchastegui, R. Moscoso, B. Dimov, W. A. Ahmad, E. Dalli, P. Laothavorn, S. Shaikh, Helmut U. Klein, J. Menon, H. Colombo, L. Fattore, G. Zarrella, Dorairaj Prabhakaran, N. Viboolkitvarakul, Judith D. Goldberg, Neetika Garg, Y. Hasin, F. Rossi Dos Santos, S. J. Vigo, L. Horbach, O. Prokhorov, H. Moellmann, T. R. Vera, C. E. Botta, Domitilla Russo, M. Rossovskaya, David C. Henderson, Rebecca B. Costello, V. Shcherbak, C. J.P.J. Werter, W. Kus, I. Dobre, P. Marechal, T. Nair, H. Nielsen, J. Waites, J. B. Moraes Junior, T. Römer, J. Senior, P. Ionescu, S. Kalashetti, R. N. Ortega, Gail E. Hafley, G. A. Dan, Apur R. Kamdar, Ruth Ann Greenfield, David F. Kong, J. Bergallo, O. Barnum, Antonis S. Manolis, Sumeet Subherwal, S. Schaefer, A. Figueredo, Habib Gamra, S. Bandyopadhyay, V. Miloradovic, Imran Arif, Peter R. Carroll, M. Demirtas, S. Guidera, G. Rogelio, Naseem Jaffrani, N. Mulvihill, Marvin J. Slepian, Darren K. McGuire, Rohit Kalra, Luís A. Providência, F. Van de Werf, Andras Vertes, J. Xu, C. F. Gamio, R. G. Xuereb, R. F. Ramos, E. Kis, N. Bustros, M. De Luca, S. Zhurba, T. Connelly, S. Singhi, F. Gredler, Serdar Kucukoglu, Francesco Fedele, C. Chavez, Christoph Kadel, Antônio Carlos Sobral Sousa, S. Srimahachota, Igor Kaidashev, J. H. Garcia, I. Teodorescu, Birute Petrauskiene, O. Kracoff, Liwa T. Younis, Alain Bouchard, P. Osmancik, Y. Sun, C. Hammett, S. Sabri, William Wallace, Mehmet Yazici, L. Ermoshkina, Harish Chandna, G. Ramos-Lopez, M. Bronisz, Sergio Luiz Zimmermann, Giuseppe Ambrosio, V. Hergeldjieva, César A. Jardim, A. Rifai, H. Lui, A. Lee, J. Scholz Issa, A. Blenkhorn, P. Micale, V. Barbarich, C. Maccallum, Peter J. Grant, G. Topacio, N. Budassi, J. Yan, Keith A.A. Fox, Y. Xia, Jan H. Cornel, A. Rafael, Paul Hermany, S. Potthoff, Mohsin A.F. Khan, Pierre Coste, Neal Ready, N. T. Duda, M. Reyes, A. Chandran, I. G. Gordeev, Anne W. Beaven, B. J.B. Hamer, C. Treasure, Pravin Manga, M. R. Babarskiene, T. Devedzhiev, Alberto Menozzi, L. Lenarz, N. Llerena, Thomas F. Lüscher, Giovânio Vieira da Silva, Y. Malynovsky, L. Ramanathan, M. Belicova, M. O. Ibarra, D. Chew, R. Castillo, M. Kesselbrenner, A. H. Li, E. Baldjiev, M. El-Harari, S. H. Hur, S. Chiaramida, C. E. Chiang, Viliam Fridrich, L. R. Cartasegna, A. Yagensky, Steven E. Hearne, Gregory Pavlides, Witold Rużyłło, Y. Chandrashekhar, S. Welka, H. Petijean, Jose L. Leiva-Pons, Shaul Atar, Andrzej Lubiński, S. Zhao, János Tomcsányi, Narinder Singh, D. Banker, T. Boyek, H. Ebinc, N. Calambur, A. Mouhaffel, M. Creteanu, H. Huang, J. O. Jeong, E. Goudreau, D. Alexopoulos, E. Duronto, S. Car, O. Bashkirtsev, J. Mandak, V. Papademetriou, David O. Williams, Oscar Pereira Dutra, R. Baman, T. J. Hong, J. O. Ibañez, D. L. Gomez, R. K. Jain, R. Jozwa, L. Di Lorenzo, Matthew Wilson, Christian W. Hamm, A. Buakhamsri, Nikitas Moschos, Ashok Kumar, A. Kadiiski, C. Y. Lee, M. Opazo, J. Tang, E. Ferrari, P. Colon-Hernandez, Jean-Pierre Déry, B. Goloborodko, L. Gimple, Diego Ardissino, M. Bergovec, S. Thew, Dariusz Dudek, K. Tang, P. A.G. Zwart, A. Deshpande, S. Sathe, Yves Cottin, V. Pai, O. Koval, J. Lesnik, Pavan S. Reddy, A. Espinoza, Rungroj Krittayaphong, Carisi Anne Polanczyk, E. Kukuy, L. Tejada, J. Nobel, Renato D. Lopes, J. Bagatin, A. Manolova, E. Boudriot, A. Godoy, N. Perepech, Christopher D. Olympios, A. E. Guimarães, James Harris, Aref Rahman, D. Foley, H. J. Kruik, J. Bruguera I Cortada, I. Fotiadis, A. Bharani, Petar Otasevic, Eileen Brown, N. Gratsiansky, J. E. Poulard, Vladimir Gašparović, Habib Haouala, A. de Belder, J. Schmedtje, Lilia Nigro Maia, J. Cobos, Werner Benzer, E. Korban, A. U. Quraishi, X. Hong, A. Bazzi, P. Kotha, L. Gubolino, H. Ingersoll, Debra Marshall, Udo Sechtem, Sandipan Dutta, G. Frago, Anthony Mathur, Shaun G. Goodman, William Bachinsky, A. Hamer, Jaime Gomez, Patrizio Lancellotti, Vance Wilson, L. White, P.P. Mohanan, Aleksandar Knezevic, Sorin J. Brener, Susanna R. Stevens, H. Luquez, S. K. Lee, P. E. Leaes, P. Benjarge, T. Tu, Z. Coufal, N. Koliopoulos, Mahmut Şahin, X. Huang, S. Boldueva, J. De Souza, N. Chidambaram, S. Zolyomi, K. G. Shyu, H. Montecinos, A. Piombo, Wladmir Faustino Saporito, R. L. Kulkarni, I. Szakal, G. Arminio, M. Elbaz, Samir Pancholy, Jang Ho Bae, Giuseppe Musumeci, S. B. Zouari, A. Chois, D. Wojciechowski, A. Bakbak, E. Bozkurt, Kenneth J. Winters, R. Raugaliene, D. Sarkar, J. M. Alegret, Hubertus Heuer, E. Bobescu, E. Roncallo, R. Carlsson, R. Craig McLendon, L K Newby, K. Zrazhevskiy, João Pedro Ferreira, A. Haidar, D. Tellez, Robert Olszewski, Shmuel Gottlieb, H. Jure, A. Garcia Escudero, S. Sengupta, V. Ochean, W. Kostuk, G. Range, F. Leroy, G. Parale, R. Fernandez, M. Fulwani, M. Padovan, Y. Dovgalevskiy, Kreton Mavromatis, H. Hart, Y. G. Ko, F. Seixo, V. Bisne, J. McGarvey, Kimberly L. Blackwell, John H. Strickler, Sanjay Kumar, A. Bordonava, L. Egorova, C. Patocchi, A. Karczmarczyk, Chiara Melloni, Piyamitr Sritara, M. Anastasiou-Nana, Roman Szełemej, K. Penchev, D. Morales, M. Tokmakova, Krzysztof Zmudka, Rakesh Yadav, E. Bressollette, D. Nul, A. L. Astesiano, M. Urban, Abdulhay Albirini, C. T. Chin, F. Moulin, I. M. Coman, R. Watkin, J. Abanilla, J. Brønnum-Schou, J. Anusauskiene, P. Andrade Lotufo, Joseph G. Rogers, M. Bessen, P. C. Sartori, Paulo Roberto Ferreira Rossi, K. Atassi, H. V. Anderson, B. Klugherz, Bateshwar Prasad Singh, Mirza S. Baig, Z. Yusof, J. H. Geertman, A. Labroo, P. Nash, Freek W.A. Verheugt, Nancy J. Brown, M. A. Alcocer, A. Neskovic, L. Francek, Judith S. Hochman, A. Hoffmann, R. Dran, A. Podczeck-Schweighofer, Jeffry Katz, Josh Roberts, Roger E. McLendon, Ronald Rodriguez, T. Downes, A. Roth, L. E. Mayorga, Armagan Altun, José-Luis López-Sendón, M. Krotin, N. van der Merwe, O. Gigliotti, C. Park, G. Brigden, M. Kumbla, D. C G Basart, D. Erdogan, R. van Kranen, J. Beloscar, Johny Joseph, Pierluigi Tricoci, J. Marino, N. Mahon, S. Dani, I. Kovalskyy, Ioannis Nanas, V. Volkov, M. I. Edmilao, J. Kruells-Muench, F. Alamgir, R. Rinaldi, W. E. Mogrovejo, J. Mirat, C. Staniloae, S. Borromeo, H. Kozman, H. Zhang, Y. Zhou, S. Shurmur, A. Manari, M. A. Barrera, A. Vasylenko, D. Keedy, Paul A. Gurbel, Ali Oto, Charles R. Lambert, V. G. Ribeiro, A. Quintero, H. Joshi, L. Tang, J. Allan, C. S. Díaz, F. Carvalho Neuenschwander, Mircea Cintezǎ, M. Kokles, G. Piovaccari, Z. Kovacs, W. Li, C. Beauloye, E. J. Ramos, D. Bertolim Precoma, J. Burstein, G. Covelli, E. C. Zambrano, Assen Goudev, A. Tang, F. Henriquez, S. Tangsuntornwiwat, C. Kirma, GR Aycock, Kenneth W. Mahaffey, M. Ardnt, Jose C. Nicolau, O. Barbarash, E. K. Shin, P. Potapenko, T. Supryadkina, Asok Venkataraman, W. Mogrovejo, M. Acikel, R. Bohorquez, M. Syvänne, M. Chan, H. Mardikar, H. Berlin, O. Quintana, K. Heintz, J. M. Bastos, Guillermo Llamas Esperon, G. Aroney, J. Chen, Nancy H. Collins, C. Ahsan, G. Heins, F. Baer, V. Kondle, Nicholas Danchin, G. Shetty, Sergio Berti, Philip E. Aylward, James Cotton, G. S. Vallejo, Massimo Volpe, Z. Vasiljevic-Pokrajcic, C. Bugueño, Seung Woon Rha, S. Ilic, G. E. Stanciulescu, Z. Li, D. Nassiacos, R. Sciberras, S. Kuanprasert, Denilson Campos de Albuquerque, M. Pavlovic, Craig S. Barr, Mohammed R. Essop, John G. Canto, David T. Roberts, M. Ozdemir, Jacquelyn Miller, T. K. Ong, Sian E. Harding, V. Bose, J. Yoon, R. Syan, M. A. Paz, O. Maskon, Dennis V. Cokkinos, L. Kraus, Z. Masud, K. Amosova, M. Boyarkin, L. Mos, Dmitry Zamoryakhin, Arif Anis Khan, Jeffrey A. Breall, A. Gallino, Ivo Petrov, F. A. Alves da Cost, Saul Vizel, Hugo Vargas Filho, P. Kaewsuwanna, G. Antonelli, Chuen Den Tseng, I. Vakaliuk, J. Miklin, A. El Hawary, Ashok Jacob, D. Gumm, Kurt Huber, G. Pajes, N. Jathappa, Stanislaw Bartus, P. V. Lavhe, C. Romero, J. Balkin, T. Gould, R. Durgaprasad, Felipe Martinez, Henning Ebelt, A. Puri, D. K. Agarwal, E. E. Buyukoner, R. Mora Junior, P. Poliacik, A. Dande, X. Zhao, J. Floro, A. Bagriy, Yuliya Lokhnygina, M. Atieh, V. Batushkin, Valentin Markov, O. Karpenko, Peter Clemmensen, P. Castro, L. Paloscia, F. Florenzano, J. L. Accini, Tony Schibler, J. Arneja, W. Wu, B. Andruszkiewicz, Michael A. Morse, P. Vojtisek, D. Sadler, S. Frischwasser, M. Cayli, W N Leimbach, E. Flores, B. Wang, A Sosa Liprandi, Y. Michalaros, H. C. Finimundi, Raul D. Santos, N. Vijay, E. Magnus Ohman, Y. Karpenko, J. Sirotiakova, Z. Shogenov, D A Zateyshchikov, Eric P. Viergever, R. Bach, Gary S. Niess, D. C. Acosta, G. Piegari, J. B. Gupta, J. Shanes, E. Ronner, J. Arter, Claudio Cavallini, M. A. Hominal, V. Bugan, S. D. Varini, K. Nyman, B. G. Castillo, Sinan Aydoğdu, N. Novikova, D. Wang, P. Simpson, Y. Huang, Taral Patel, Gabriel Tatu-Chitoiu, D. Silva Junior, H. Theron, C. Alvarez, Anikó Ilona Nagy, T. Chua, P. Georgiev, D. Rittoo, G. De Luca, R. Blonder, Alberto Caccavo, D. Koganti, E. Manenti, N. Ghaisas, G. Letcher, D. Platogiannis, Arshed A. Quyyumi, J. Dy, Z. Ples, W. Kunz Sebba Barroso de Souza, Hamid Taheri, S. Kammoun, A. Salvioni, B. Stockins, K. Sutalo, J. C. Post, Merih Kutlu, Vijay K. Chopra, C. Mathis, Stephen M. Schwartz, Manish Jain, D. Coisne, A. Goudev, A. Dalby, João Morais, P. van Kalmthout, Andrzej Budaj, I. Dotani, L. Mircoli, R. Vicari, J. P. Herrman, M. Moran, G. Lupkovics, Alexander Parkhomenko, J. Heath, Andrew Moriarty, C. Pop, J. Y. Hwang, S. Kassam, R. Martingano, I. Nikolskaya, Z. Zheng, Johann S. de Bono, M. Izzo, R. Labonte, E. H. Forte, W. Moleerergpoom, Piera Angelica Merlini, D. Lee, W. Macias, G. Syan, S. Zhou, S. W. Kim, T. Duris, E. Shaoulian, Andreas U. Wali, Marco Antonio Mota Gomes, Pritibha Singh, M. Ovize, M. Del Core, W. Bowden, B. Xu, Ravi Bhagwat, C. Wongvipaporn, J. Vojacek, Steven Lindsay, F. McGrew, J. Gorny, J. D. Pappas, R. Vuyyuru, J. Chahin, Ashraf Reda, T. Lau, E. Conn, J. Meisner, S. Meymandi, A. D. Hrabar, M. Slanina, D. Jarasuniene, C. Lang, A. Vo, Christian Hamm, H. Gogia, Z. Yuan, T. Mathew, A. Van Dorpe, J. Kettner, M. Barbiero, Harvey D. White, L. Rudenko, V. Jain, M. Carter, David Erlinge, G. Ma, V. Sierkova, D. K. Kim, Steven O. Smith, R. K. Premchand, P. Jetty, J. Y. Hou, V. Simanenkov, T. Kaelsch, David P. Foley, A. Francis, Piotr Ponikowski, Ramón Corbalán, D. Connolly, J. Tuma, R. Zambahari, Miodrag Ostojic, R. Lamich, A. Rabelo Alves, V. Tseluyko, G. Moises Azize, L. Khaisheva, G. Pencheva, C. Ingram, J. Cooke, A. Prado, M. De Tollenaere, M. Kim, Alan Rees, Melanie B. Turner, Mark B. Abelson, H. L. Luciardi, L. Illyes, R. Sarma, L. Manriquez, J. A. Marin Neto, D. Iordachescu-Petica, G. Hoedemaker, Victor S. Gurevich, F. Ridocci, J. Grman, F. Waxman, Jorge F. Saucedo, E. Boughzala, B. S. Jagadesa, Heba Abdullah, A. Weiss, N. Bichan, L. Tami, Y. Bouzid, N. I. Gomez, Zafar Sy, Béla Merkely, J. P. Albisu, L. Rodriguez-Ospina, John C. Chambers, L. L. Lobo Marquez, R. Guan, Steven Georgeson, M. K. Sarna, L. Nogueira Liberato de Sousa, Mika Laine, P. Pimentel Filho, Teresa Kawka-Urbanek, G P Arutyunov, S. Elhadad, A. Dambrauskaite, R. Leon de la Fuente, Audes D. M. Feitosa, P. Baetslé, Abraham Al Ahmad, José Francisco Kerr Saraiva, Roland P.T. Troquay, J. Berlingieri, Margaret Arstall, J. L. Coronado, K. Yang, S. V. Shalaev, Bernard J. Gersh, A. El-Etreby, Elżbieta Zinka, F. De Valais, John E.A. Blair, P. Fajardo, M. Rodriguez, R. Boujnah, H. Hammerman, Y. S. Chong, Stigi Joseph, M. H. Jeong, J. Ge, Q. He, Robert S Iwaoka, Bimal R. Shah, J. Sawhney, T. Sakulsaengprapha, G. Werner, Jill Anderson, M. Hondl, Meinrad Gawaz, Gilmar Reis, M. Dalkowski, Tomáš Janota, M. Damiao Gomes Seabra, A. Dharmadhikari, Aleš Linhart, John Elliott, Kodangudi B. Ramanathan, Doron Zahger, Dilek Ural, L. Regos, F. R. Bolohan, Marcello Galvani, B. Zakhary, N. Qureshi, D. Deac, Maria Emília Figueiredo Teixeira, T. Venter, Santosh Gupta, W. Wright, P. Telekes, A. Furber, V. Nykonov, Zhu Junren, M. Cinteza, I. Lang, S. Junejo, D. Martins, Mauro Esteves Hernandes, G. Ishmurzin, Anthony J. Dalby, R. Scioli, P. Babu, R. Habaluyas, V. Mendoza, G. B. Scaro, Matthew T. Roe, M. Senaratne, D. J. van der Heijden, T. Pillay, Yoav Turgeman, J. Moreira, C. Cuccia, C. Astarita, S. De Servi, Robert G. Wilcox, M. C. Constantinescu, Kardiyoloji, Roe Matthew, T., Armstrong Paul, W., Fox Keith, A. A., White Harvey, D., Prabhakaran, Dorairaj, Goodman Shaun, G., Cornel Jan, H., Bhatt Deepak, L., Clemmensen, Peter, Martinez, Felipe, Ardissino, Diego, Nicolau Jose, C., Boden William, E., Gurbel Paul, A., Ruzyllo, Witold, Dalby Anthony, J., McGuire Darren, K., Leiva Pons Jose, L., Parkhomenko, Alexander, Gottlieb, Shmuel, Topacio Gracita, O., Hamm, Christian, Pavlides, Gregory, Goudev Assen, R., Oto, Ali, Tseng Chuen, Den, Merkely, Bela, Gasparovic, Vladimir, Corbalan, Ramon, Cinteza, Mircea, McLendon R., Craig, Winters Kenneth, J., Brown Eileen, B., Lokhnygina, Yuliya, Aylward Philip, E., Huber, Kurt, Hochman Judith, S., Ohman E., Magnu, and Golino, Paolo

Subjects
Male, Prasugrel, Myocardial Infarction, Kaplan-Meier Estimate, Piperazines, Purinergic P2 Receptor Antagonists, Myocardial infarction, education.field_of_study, Cardiovascular diseases [NCEBP 14], Acute Coronary Syndrome, Aged, Angina, Unstable, Aspirin, Cardiovascular Diseases, Double-Blind Method, Drug Therapy, Combination, Female, Follow-Up Studies, Humans, Middle Aged, Platelet Aggregation Inhibitors, Prasugrel Hydrochloride, Stroke, Thiophenes, Ticlopidine, Medicine (all), Hazard ratio, Clopidogrel, Acute Coronary Syndromes, General Medicine, Angina, Combination, Cardiology, medicine.drug, medicine.medical_specialty, Acute coronary syndrome, Population, Unstable, Drug Therapy, General & Internal Medicine, Internal medicine, medicine, cardiovascular diseases, education, Acute coronary syndromes, Revascularisation, Unstable angina, business.industry, medicine.disease, REVASCULARIZAÇÃO MIOCÁRDICA, business
Abstract

Item does not contain fulltext BACKGROUND: The effect of intensified platelet inhibition for patients with unstable angina or myocardial infarction without ST-segment elevation who do not undergo revascularization has not been delineated. METHODS: In this double-blind, randomized trial, in a primary analysis involving 7243 patients under the age of 75 years receiving aspirin, we evaluated up to 30 months of treatment with prasugrel (10 mg daily) versus clopidogrel (75 mg daily). In a secondary analysis involving 2083 patients 75 years of age or older, we evaluated 5 mg of prasugrel versus 75 mg of clopidogrel. RESULTS: At a median follow-up of 17 months, the primary end point of death from cardiovascular causes, myocardial infarction, or stroke among patients under the age of 75 years occurred in 13.9% of the prasugrel group and 16.0% of the clopidogrel group (hazard ratio in the prasugrel group, 0.91; 95% confidence interval [CI], 0.79 to 1.05; P=0.21). Similar results were observed in the overall population. The prespecified analysis of multiple recurrent ischemic events (all components of the primary end point) suggested a lower risk for prasugrel among patients under the age of 75 years (hazard ratio, 0.85; 95% CI, 0.72 to 1.00; P=0.04). Rates of severe and intracranial bleeding were similar in the two groups in all age groups. There was no significant between-group difference in the frequency of nonhemorrhagic serious adverse events, except for a higher frequency of heart failure in the clopidogrel group. CONCLUSIONS: Among patients with unstable angina or myocardial infarction without ST-segment elevation, prasugrel did not significantly reduce the frequency of the primary end point, as compared with clopidogrel, and similar risks of bleeding were observed. (Funded by Eli Lilly and Daiichi Sankyo; TRILOGY ACS ClinicalTrials.gov number, NCT00699998.).

Published
2012

38. Intracardiac thrombus in Behçet's disease: Two case reports

Author

Radhia Brahem, Khaldoun Ben-Hamda, Mohamed Ben Farhat, Sonia Hammami, Habib Gamra, and Silvia Mahjoub

Subjects
medicine.medical_specialty, Hyperhomocysteinemia, lcsh:RC633-647.5, business.industry, Case Report, lcsh:Diseases of the blood and blood-forming organs, Hematology, Behcet's disease, Intracardiac thrombus, Chest pain, medicine.disease, Thrombosis, Pulmonary embolism, Internal medicine, medicine, Cardiology, cardiovascular system, cardiovascular diseases, medicine.symptom, Thrombus, Complication, business, Angiology
Abstract

Intracardiac thrombus in Behçet's disease is an extremely rare manifestation. We report two such cases. A 20-year-old man presented with dyspnoea, cough and haemoptysis. Right heart thrombus associated with pulmonary artery aneurysm and thromboembolism was identified by helical CT and transoesophageal echocardiography. The second case was a 29-year-old male admitted for fever and chest pain. A diagnosis of right atrial thrombosis associated with pulmonary embolism and hyperhomocysteinemia was made. Due to the absence of haemodynamic compromise, medical management consisting of immunosupressive and anticoagulation therapy was adopted which resulted in complete dissolution of the thrombus with dramatic clinical improvement in both cases of clinical status. Conclusion intracardiac thrombus is a rare complication of Behçet's disease. As shown in our patients, medical treatment should be considered as the first line.

Published
2005

40. What are the differences in presentation of candidates for percutaneous mitral commissurotomy across the world and do they influence the results of the procedure?

Author

Alec Vahanian, Chien Vo Thanh, Joel Kamblock, Ana-Olga Mocumbi, Eloi Marijon, César A. Esteves, Bernard Iung, Igor F. Palacios, and Habib Gamra

Subjects
Adult, Male, medicine.medical_specialty, Percutaneous, Heart disease, Adolescent, Young Adult, Sténose mitrale, Balloon mitral commissurotomy, Mitral valve, Internal medicine, medicine.artery, Streptococcal Infections, Rhumatisme articulaire aigu, medicine, Humans, Mitral Valve Stenosis, Rheumatic fever, Cardiac Surgical Procedures, Child, Aged, Body surface area, Aged, 80 and over, Mitral stenosis, Commissurotomie mitrale percutanée, business.industry, Rheumatic Heart Disease, General Medicine, Middle Aged, medicine.disease, Surgery, Stenosis, medicine.anatomical_structure, Treatment Outcome, Pulmonary artery, Cardiology, Female, business, Commissurotomy, Cardiology and Cardiovascular Medicine
Abstract

Background Despite marked global differences in the prevalence of rheumatic heart disease, little is known about geographic variations in the characteristics of patients with severe mitral stenosis. Aim To determine if differences in rheumatic fever epidemiology influence the characteristics of patients with mitral stenosis and the immediate results of percutaneous mitral commissurotomy (PMC). Methods We compared 350 patients (mean age: 41 ± 17 years, 81% women) scheduled for PMC in five non-Western and two Western countries. Fifty consecutive patients were included in each centre. All presented a mitral valve area less than 1.5 cm2 and were in New York Heart Association (NYHA) functional class greater or equal to II, with no contraindications to PMC. Results The 250 patients from non-Western countries were younger than the 100 patients from Western countries (35 ± 12 vs 57 ± 15 years, p

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41. 0276: Balloon mitral valvotomy for patients with mitral stenosis in atrial fibrillation: immediate and long term prognosis

Author

Nidhal Bouchahda, Marouen Mahjoub, Ghassen Chniti, Majed Hassine, Habib Gamra, Ibtihel Mechri, Zohra Dridi, Fethi Betbout, and Mejdi Ben Massoud

Subjects
medicine.medical_specialty, Balloon mitral valvotomy, business.industry, medicine.medical_treatment, Mitral valve replacement, Atrial fibrillation, medicine.disease, Surgery, Stenosis, Restenosis, Internal medicine, medicine, Cardiology, In patient, business, Adverse effect, Cardiology and Cardiovascular Medicine, Normal Sinus Rhythm
Abstract

BackgroundAtrial fibrillation (AF) is a common finding in patients with severe mitral stenosis requiring Balloon Mitral Valvotomy (BMV). Its immediate and long term prognosis remains controversial.ObjectivesWe sought to evaluate the effect of AF on the immediate and long-term (23 years) outcome of patients undergoing BMV.MethodsThe immediate procedural and the long-term clinical outcome after BMV of 139 patients with AF were collected and compared with those of 381 patients in normal sinus rhythm (NSR).ResultsPatients with AF were older (43.3 vs. 29.7 years; p < 0.001), had frequently a history of systemic embolism (9.4% vs. 1.6%, p> 0.001) and of mitral commissurotomy (28.1% vs. 19.4%, p=0.035). Patients with AF had more frequently a Wilkins score > 8 (51.4% vs. 30.9%, p

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42. 062 Evolution over time of transport of STEMI patients to the hospital: Insight from the MIRAMI registry

Author

Ayoub Ghrairi, Ismail Ghrissi, Semi Bouraoui, Fethi Betbout, Habib Gamra, Walid Saieb, Samer Hamayel, Meriem Khrouf, Zohra Dridi, Fatma Ben Amor, Wiem Selmi, Amine Hdiji, and Abdennaim Hajlaoui

Subjects
medicine.medical_specialty, business.industry, Emergency medicine, Medicine, Medical emergency, business, medicine.disease, Cardiology and Cardiovascular Medicine
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43. 279 Prevalence of cardiovascular risk factors in coronary patients from the Sahel region of Tunisia

Author

Faouzi Maatoug, Essia Boughezala, Naziha Kaabachi, Yosra Sédiri, Riadh Jemaa, Habib Ammar, Habib Gamra, Abdelhamid Ben Othmane, Ghabbara Abderraouf, and Amani Kallel

Subjects
Pediatrics, medicine.medical_specialty, Unstable angina, business.industry, Cardiovascular risk factors, Disease, medicine.disease, Epidemiological transition, Blood pressure, Epidemiology, medicine, Myocardial infarction, Risk factor, business, Cardiology and Cardiovascular Medicine
Abstract

IntroductionCardiovascular diseases are the leading cause of mortality in the western countries at the same time they are beginning to appear with increasing frequency in developing countries. With the epidemiological transition phenomenon, Tunisia is now facing the growing prevalence of chronic diseases. The Tunisian epidemiological data on cardiovascular disease in the hospital environment are scare. The aim of this study was to evaluate the prevalence of cardiovascular risk factors and their association in patients in Sahel (Tunisia), hospitalised for coronary disease in coronary care units at Sahloul and Farhat Hached (Sousse), fattouma Bourguiba (Monastir) and Tahar Sfar (Mahdia) hospitals, over the period 1994–1998.Patients and methodsThe clinical features of 4138 patients (71.9% men with a mean age of 60.5 years, 2039 myocardial infarction, 2099 unstable angina) on hospital admission were analysed.ResultsThe prevalence of smoking was 57.7%, with a statistically significant difference between men (78.7%) and women (2.5%). The prevalence of hypertension (blood pressure 140/90mmHg) was 38.4%. There is a statically significant difference in the prevalence of hypertension (p 1.26g/l) was 44.9%. The prevalence was higher in women (55.3%) than in men (40.8%, p 2.5g/l and/or TG >1.5g/l) was 37.2%. The percentage was higher in women (39.5%) than in men (36.2%). Twenty six percent of the patients had one cardiovascular risk factor, 30% had two, 21.6% had three factors and 10% had four or more factors.ConclusionWith this risk factor profile a national strategy of primary prevention and heart promotion is needed in Tunisia.

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44. 0234: Drug-eluting stents versus bare-metal stent in large coronary arteries

Author

Habib Gamra, Marouen Mahjoub, Fethi Betbout, Zohra Dridi, Mejdi Ben Massoud, Mehdi Boussada, and Majed Hassine

Subjects
Bare-metal stent, medicine.medical_specialty, business.industry, medicine.medical_treatment, Stent, Percutaneous coronary intervention, medicine.disease, Coronary arteries, medicine.anatomical_structure, Restenosis, Internal medicine, Conventional PCI, Clinical endpoint, Cardiology, Medicine, cardiovascular diseases, Cardiology and Cardiovascular Medicine, business, Mace
Abstract

BackgroundAlthough drug-eluting stents (DES) have been shown to dramatically reduce restenosis and improve the rate of event-free survival, the benefit of DES appears to be limited to restenosis. In this retrospective, single-center study we aimed to compare the long-term outcomes of DES versus bare-metal stent (BMS) in large coronary arteries (diameter≥3.5mm).MethodsA total of 164 consecutive patients (mean age 60 years) required percutaneous coronary intervention with stents≥3.5mm in diameter, 84 were BMS and 80 DES. The primary endpoint was major adverse cardiac events (MACE) defined as angiographically defined in-stent restenosis (ISR), stent thrombosis and death from any cause.ResultsA mean clinical follow up of 28 months was obtained. The DES group had higher rates of diabetes (63% vs 37%, p=0.001), previous CAD (74% vs 25%, p=0.001) and previous PCI (69% vs 31%, p=

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45. Mitral regurgitant jets after valvuloplasty—II

Author

Habib Gamra, Richard A. Clugston, He Ping Zhang, John W. Allen, Carlos E. Ruiz, and John P. O'Shea

Subjects
medicine.medical_specialty, medicine.diagnostic_test, business.industry, Internal medicine, MEDLINE, Balloon dilation, medicine, Cardiology, Doppler echocardiography, business, Cardiology and Cardiovascular Medicine
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46. 0190: Predictive factors of intrahospital mortality in patients with right ventricular myocardial infarction

Author

Zohra Dridi, Habib Gamra, Fethi Betbout, Marouen Mahjoub, Dorsafm Layah, Ghassen Chniti, Mejdi Ben Massoud, and Majed Hassine

Subjects
medicine.medical_specialty, business.industry, medicine.medical_treatment, ST elevation, Infarction, Thrombolysis, medicine.disease, Coronary artery disease, Angioplasty, Heart failure, Internal medicine, medicine, Cardiology, cardiovascular diseases, Myocardial infarction, Cardiology and Cardiovascular Medicine, business, TIMI
Abstract

IntroductionRight ventricular (RV) infarction is a serious and life threatening condition which mainly complicates an inferior wall myocardial infarction (MI). In the literature, data for predictive factors of mortality in this setting remains scarce.Aim to study predictive factors of intrahospital mortality in patients with RV infarction.Methods and resultsData was collected from a monocenter registry including all patients with AMI admitted in our department between January 1995 and March 2013. 1483 patients were enrolled in our registry. RV infarction was diagnosed in 160 (10.7%) patients, always complicating an inferior wall MI. 37 (23.1%) patients presented with right sided heart failure while the remaining patients presented with isolated features of RV involvement on the ECG with ST elevation in the right leads. Intrahospital death occurred in 20 patients (12.5%) and was significantly higher in patients with RV heart failure (p=0.02). Among all deaths included in our registry, RV infarction was responsible for 14.5%. The reperfusion strategy was Thrombolysis in 48 patients (30%), angioplasty in 62 patients (38.8%), a combined approach in 10 cases (6.3%) and conservative treatment in 40 cases (25%). There was no difference in mortality among all strategies (p: 0.556). In patients who had angioplasty, post procedural TIMI flow 0 or 1 was associated with a higher mortality (p130umol/l (OR: 8.22; 95% CI [1.33-50.9]; p: 0.023), triple vessel disease (OR: 7.09; 95% CI [1.738-28.93]; p: 0.006) and left ventricular failure with KILLIP>1 (p: 0.004).ConclusionOur data support the fact that several factors may predict intra-hospital mortality after RV myocardial infarction among which renal impairment, the extent of coronary artery disease and left ventricular heart failure are most the powerful predictors.

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47. 084 Immediate and midterm outcomes after angioplasty with stenting of the left main coronary artery

Author

Fethi Betbout, Ayoub Ghrairi, Zohra Dridi, Meriem Khrouf, Semi Bouraoui, Ismail Ghrissi, Habib Gamra, Wiem Selmi, Amine Hdiji, Abdennaim Hajlaoui, and Fatma Ben Amor

Subjects
medicine.medical_specialty, medicine.anatomical_structure, business.industry, Internal medicine, Angioplasty, medicine.medical_treatment, medicine, Cardiology, otorhinolaryngologic diseases, business, Cardiology and Cardiovascular Medicine, Artery
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48. 079: Heart failure in native valve infective endocarditis: characteristics, prognosis, and results of surgical treatment

Author

Fethi Betbout, Mehdi Khlif, Zohra Dridi, Fatma Ben Amor, Mejdi Ben Messaoud, Mohamed Ben Doudouh, Fehmi Karoui, Habib Gamra, Ismail Ghrissi, Sami Ouanes, Amine Hdiji, and Mohamed Majed Hassine

Subjects
Aortic valve, medicine.medical_specialty, business.industry, Anemia, Regurgitation (circulation), medicine.disease, medicine.anatomical_structure, Native valve, Heart failure, Infective endocarditis, Internal medicine, medicine, Heart murmur, Cardiology, cardiovascular system, cardiovascular diseases, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Surgical treatment
Abstract

Background Although congestive heart failure (CHF) represents the most common cause of death in native valve infective endocarditis (IE), recent data on the outcome of IE complicated by CHF are lacking. Objective We aimed to analyse the characteristics and prognosis of patients with left-sided native valve IE complicated by CHF and to evaluate the impact of early surgery on 1 year outcome. Methods and results Two hundred and twenty consecutive patients with definite left-sided native valve IE according to the Duke criteria were included in this analysis. When compared with patients without CHF (n=144), new heart murmur, high comorbidity index, aortic valve IE, and severe valve regurgitation were more frequently observed in CHF patients (n=76, 34.5%). Aortic valve IE, elderly patients were more frequent in CHF patients. Congestive heart failure was independently predictive of in-hospital [OR 3.8 (1.7-9.0); P=0.0013] and 1 year mortality [HR 1.8 (1.1-3.0); P=0.007]. Early surgery was performed in 63% of CHF patients with a peri-operative mortality of 15%. In the CHF group, comorbidity index, anemia, uncontrolled infection, and major neurological events were multivariate predictors of 1 year mortality. Early surgery was independently associated with improved 1 year survival [HR 0.45 (0.22-0.93); P=0.03]. Conclusion Native valve IE complicated by CHF is more frequent in aortic IE and is associated with severe regurgitation. Congestive heart failure is an independent predictor of in-hospital and 1 year mortality. In CHF patients, early surgery is independently associated with reduced mortality and should be widely considered to improve outcome.

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49. 028 Do mortality predictors differ according to reperfusion strategy in acute myocardial infarction patients?

Author

Ismail Ghérissi, Semi Bouraoui, Ayoub Ghrairi, Habib Gamra, Fatma Ben Amor, Wiem Selmi, Samer Hamayel, Meriem Khrouf, Amine Hdiji, Walid Saieb, Abdennaim Hajlaoui, Fethi Betbout, Zohra Dridi, and M. Hassine

Subjects
medicine.medical_specialty, business.industry, macromolecular substances, medicine.disease, nervous system, Internal medicine, parasitic diseases, medicine, Cardiology, Myocardial infarction, cardiovascular diseases, Cardiology and Cardiovascular Medicine, business, health care economics and organizations
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50. Stenosis and aneurysm of coronary arteries in a patient with Behçet's Disease.

Author

Sonia H, Khaldoun BH, Sylvia M, Faouzi M, Habib G, and Mohamed BF

Abstract

Coronary artery disease is extremely rare in patients with Behçet's disease. We report the case of a patient with a history of Behçet's disease who was admitted in our hospital with instable angina pectoris. The patient's electrocardiogram was normal. Coronary angiography revealed aneurysm of the distal right coronary artery with a tight stenosis of the proximal part of the posterolateral branch. These two conditions were initially treated with immunosuppressive treatment. Three years later coronary angiography showed a total occlusion of the right coronary artery treated with medical therapy. More than fourteen cases of coronary involvement were reported in the literature but the etiopathogeny and the treatment are yet unknown.

Published
2008
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