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Optimal dual antiplatelet therapy (DAPT) duration for patients undergoing percutaneous coronary intervention (PCI) for coronary bifurcations is an unmet issue. The BIFURCAT registry was obtained by merging two registries on coronary bifurcations. Three groups were compared in a two-by-two fashion: short-term DAPT (≤ 6 months), intermediate-term DAPT (6-12 months) and extended DAPT (>12 months). Major adverse cardiac events (MACE) (a composite of all-cause death, myocardial infarction (MI), target-lesion revascularization and stent thrombosis) were the primary endpoint. Single components of MACE were the secondary endpoints. Events were appraised according to the clinical presentation: chronic coronary syndrome (CCS) versus acute coronary syndrome (ACS). 5537 patients (3231 ACS, 2306 CCS) were included. After a median follow-up of 2.1 years (IQR 0.9-2.2), extended DAPT was associated with a lower incidence of MACE compared with intermediate-term DAPT (2.8% versus 3.4%, adjusted HR 0.23 [0.1-0.54], p

Systematic prescription of beta-blockers after myocardial infarction remains an open question in the era of revascularization, especially for patients with uncomplicated myocardial infarction.To evaluate in a real-life registry the proportion of patients with uncomplicated myocardial infarction (preserved left ventricular ejection fraction and no cardiovascular event within the first 6 months), and to report their characteristics, outcomes and beta-blocker use.We included 1887 consecutive patients with ST-segment elevation myocardial infarction from the prospective ePARIS registry. Patients were divided into three groups: the "uncomplicated myocardial infarction" group (n=1060), defined by a left ventricular ejection fraction ≥ 40% and a 6-month period free from cardiovascular events; the "complicated myocardial infarction" group (n=366), defined by a left ventricular ejection fraction ≥ 40% and a recurrent cardiovascular event in the first 6 months; and the "left ventricular dysfunction" group (n=461), defined by a left ventricular ejection fraction40%.During a median follow-up of 2.7 years (interquartile range 1.0-4.9 years), the "uncomplicated myocardial infarction" group was at low mortality risk compared with the "complicated myocardial infarction" group (hazard ratio 0.38, 95% confidence interval 0.25-0.58; P0.01) and the "left ventricular dysfunction" group (hazard ratio 0.22, 95% confidence interval 0.15-0.32; P0.01). Beta-blockers were prescribed at discharge predominantly in the "uncomplicated myocardial infarction" group (93%) compared with 87% in the "complicated myocardial infarction" group and 81% in the "left ventricular dysfunction" group.Beta-blockers are less prescribed in patients who may need them the most. The benefit of beta-blockers-largely prescribed in lower-risk patients-remains to be shown beyond the first 6 months for these patients with no left ventricular dysfunction and no recurrent events.

International audience; Stratifying prognosis following coronary bifurcation percutaneous coronary intervention (PCI) is an unmet clinical need that may be fulfilled through the adoption of machine learning (ML) algorithms to refine outcome predictions. We sought to develop an ML-based risk stratification model built on clinical, anatomical, and procedural features to predict all-cause mortality following contemporary bifurcation PCI. Multiple ML models to predict all-cause mortality were tested on a cohort of 2393 patients (training, n = 1795; internal validation, n = 598) undergoing bifurcation PCI with contemporary stents from the real-world RAIN registry. Twenty-five commonly available patient-/lesion-related features were selected to train ML models. The best model was validated in an external cohort of 1701 patients undergoing bifurcation PCI from the DUTCH PEERS and BIO-RESORT trial cohorts. At ROC curves, the AUC for the prediction of 2-year mortality was 0.79 (0.74–0.83) in the overall population, 0.74 (0.62–0.85) at internal validation and 0.71 (0.62–0.79) at external validation. Performance at risk ranking analysis, k-center cross-validation, and continual learning confirmed the generalizability of the models, also available as an online interface. The RAIN-ML prediction model represents the first tool combining clinical, anatomical, and procedural features to predict all-cause mortality among patients undergoing contemporary bifurcation PCI with reliable performance.

International audience; Background: The European study MetaCardis aims to investigate the role of the gut microbiota in health and cardiometabolic diseases in France, Germany, and Denmark. To evaluate long-term diet-disease relationships, a food frequency questionnaire (FFQ) was found to be the most relevant dietary assessment method for the MetaCardis study.Objective: The objectives of this study were to describe the development of three semiquantitative online FFQs used in the MetaCardis study-one FFQ per country-and to assess the relative validity of the French MetaCardis FFQ.Design: The layout and format of the MetaCardis FFQ was based on the European Prospective Investigation of Cancer (EPIC)-Norfolk FFQ and the content was based on relevant European FFQs. Portion size and nutrient composition were derived from national food consumption surveys and food composition databases. To assess the validity of the French MetaCardis FFQ, a cross-sectional study design was utilized.Participants/setting: The validation study included 324 adults recruited between September 2013 and June 2015 from different hospitals in Paris, France.Main outcome measures: Food intakes were measured with both the French MetaCardis FFQ and 3 consecutive self-administered web-based 24-hour dietary recalls (DRs).Statistical analyses performed: Several measures of validity of the French MetaCardis FFQ were evaluated: estimations of food groups, energy, and nutrient intakes from the DRs and the FFQ, Spearman and Pearson correlations, cross-classification, and Bland-Altman analyses.Results: The French MetaCardis FFQ tended to report higher food, energy, and nutrient intakes compared with the DRs. Mean correlation coefficient was 0.429 for food, 0.460 for energy, 0.544 for macronutrients, 0.640 for alcohol, and 0.503 for micronutrient intakes. Almost half of participants (44.4%) were correctly classified within tertiles of consumption, whereas 12.9% were misclassified in the opposite tertile. Performance of the FFQ was relatively similar after stratification by sex.Conclusions: The French MetaCardis FFQ was found to have an acceptable level of validity and may be a useful instrument to rank individuals based on their food and nutrient intakes.

Background: Elderly patients receive bare metal stents instead of drug-eluting stents (DES) to shorten the duration of dual antiplatelet therapy (DAPT). The SENIOR trial compared outcomes between these 2 types of stents combined with a short duration of DAPT. A significant decrease in the number of patients with at least 1 major adverse cardiac and cerebrovascular event (MACCE) was noted in the DES group. Objectives: The objective of this article was to perform an economic evaluation of the SENIOR trial. Methods: This evaluation was performed separately in 5 participating countries using pooled patient-level data from all study patients and country-specific unit costs and utility values. Costs, MACCEs, and quality-adjusted life-years (QALYs) were calculated in both arms at 1 year, and an incremental cost-effectiveness ratio was estimated. Uncertainty was explored by probabilistic bootstrapping. Results: A total of 1200 patients underwent randomization. The average total cost per patient was higher in the DES group. The number of MACCEs and average QALYs were not statistically different between the 2 groups. The 1-year incremental cost-effectiveness ratio for each country of reference ranged from (sic)13 752 to (sic)20 511/MACCE avoided and from (sic)42 835 to (sic)68 231/QALY gained. The scatter plots found a wide dispersion, reflecting a large uncertainty surrounding the results. But in each country studied, 90% of the bootstrap replications indicated a higher cost for greater effectiveness for the DES group. Assuming a willingness to pay of (sic)50000/QALY, there was between a 40% and 50% chance that the use of DES was cost-effective in 4 countries. Conclusion: The use of DES instead of bare metal stents combined with a short duration of DAPT in elderly patients induced higher cost for greater effectiveness in each of the 5 countries studied.

Background: There are limited data regarding the impact of final kissing balloon (FKI) in patients treated with percutaneous coronary intervention using ultrathin stents in left main or bifurcations. Methods: All patients undergoing left main or bifurcations percutaneous coronary intervention enrolled in the RAIN registry (Very Thin Stents for Patients With MAIN or BiF in Real Life: The RAIN, a Multicenter Study) evaluating ultrathin stents were included. Major adverse cardiac event (a composite of all-cause death, myocardial infarction, target lesion revascularization, and stent thrombosis) was the primary end point, while its components, along with target vessel revascularization, were the secondary end points. The main analysis was performed comparing patients with and without FKI after adjustment with inverse probability of treatment weighting. Subgroup analyses were performed according to FKI (short [ Results: Two thousand seven hundred forty-two patients were included. At 16 months (8–20) follow-up, inverse probability of treatment weighting adjusted rates of major adverse cardiac event were similar between FKI and no-FKI group (15.1% versus 15.5%; P =0.967), this result did not change with use of imaging, proximal optimization technique, or routine versus bail-out FKI. In the 2-stent subgroup, FKI was associated with lower rates of target vessel revascularization (7.8% versus 15.9%; P =0.030) and target lesion revascularization (7.3% versus 15.2%; P =0.032). Short overlap FKI was associated with a lower rate of target lesion revascularization compared with no FKI (2.6% versus 5.4%; P =0.034), while long overlap was not (6.8% versus 5.4%; P =0.567). Conclusions: In patients with bifurcations or unprotected left main treated with ultrathin stents, short overlap FKI is associated with less restenosis. In a 2-stent strategy, FKI was associated with less target vessel revascularization and restenosis. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03544294.

ObjectivesContrast-induced acute kidney injury (CI-AKI) is a common and potentially severe complication in patients with ST elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). There is no consensus on the best definition of CI-AKI to identify patients at risk of haemodialysis or death. The objective of this study was to assess the association of CI-AKI, using four definitions, on inhospital mortality, mortality or haemodialysis requirement over 1-year follow-up, in patients with STEMI treated with pPCI.MethodsIn this prospective, observational study, all patients with STEMI referred for pPCI were included. We identified independent variables associated with CI-AKI and mortality.ResultsWe included 1114 consecutive patients with STEMI treated by pPCI. CI-AKI occurred in 18.3%, 12.2%, 15.6% and 10.5% of patients according to the CIN, Acute Kidney Injury Network (AKIN), Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE) Modification of Diet in Renal Disease (MDRD) and RIFLE Chronic Kidney Disease - Epidemiology Collaboration (CKD-EPI) definitions, respectively. The RIFLE (CKD-EPI) definition was the most discriminant definition to identify patients at higher risk of inhospital mortality (27.1% vs 4.0%; adjusted OR 2.7 (95% CI 1.4 to 5.1), p=0.003), 1-year mortality (27.4% vs 6.6%; adjusted OR 2.8 (95% CI 1.5 to 5.3), p=0.002) and haemodialysis requirement at 1-year follow-up (15.6% vs 2.7%; adjusted OR 6.7 (95% CI 3.3 to 13.6), p=0.001). Haemodynamic instability, cardiac arrest, preexisting renal failure, elderly age and a high contrast media volume were independently associated with 1-year mortality. Of interest, contrast-media volume was not correlated to increase of creatininaemia (r=0.06) or decrease in estimated glomerular filtration rate (r=0.05) after percutaneous coronary intervention in our population.ConclusionsCI-AKI is a frequent and serious complication of STEMI treated by pPCI. The RIFLE definition is the most accurate definition to identify patients with CI-AKI at high risk of mortality or haemodialysis.

Aims The differential impact on ischaemic and bleeding events of the type of drug-eluting stent [durable polymer stents [DES] vs. biodegradable polymer stents vs. bioresorbable scaffolds (BRS)] and length of dual antiplatelet therapy (DAPT) remains to be defined. Methods and results Randomized controlled trials comparing different types of DES and/or DAPT durations were selected. The primary endpoint was Major Adverse Cardiovascular Events (MACE) [a composite of death, myocardial infarction (MI), and target vessel revascularization]. Definite stent thrombosis (ST) and single components of MACE were secondary endpoints. The arms of interest were: BRS with 12 months of DAPT (12mDAPT), biodegradable polymer stent with 12mDAPT, durable polymer stent [everolimus-eluting (EES), zotarolimus-eluting (ZES)] with 12mDAPT, EES/ZES with 12 months of DAPT (DAPT > 12 m). Sixty-four studies with 150 arms and 102 735 patients were included. After a median follow-up of 20 months, MACE rates were similar in the different arms of interest. EES/ZES with DAPT > 12 m reported a lower incidence of MI than the other groups, while BRS showed a higher rate of ST when compared to EES/ZES, irrespective of DAPT length. A higher risk of major bleedings was observed for DAPT > 12 m as compared to shorter DAPT. Conclusion Durable and biodegradable polymer stents along with BRS report a similar rate of MACE irrespective of DAPT length. Fewer MI are observed with EES/ZES with DAPT > 12 m, while a higher rate of ST is reported for BRS when compared to EES/ZES, independently from DAPT length. Stent type may partially affect the outcome together with DAPT length.

Background Differences between long-term outcomes among women and men treated by percutaneous intervention (PCI) are unknown. Purpose To compare characteristics mortality and impact of gender on poor outcomes after PCI. Methods Consecutive men and women admitted for PCI between 2008 and 2011 were prospectively included and followed-up until January 2019. Major adverse cardiovascular and cerebrovascular events (MACCE) and causes of death were collected through consultations, calls and death certificates. The primary endpoint was all-cause mortality according to gender. Secondary endpoints were cardiovascular death, non-cardiovascular death and MACCEs. Results A total of 3524 patients including 2720 men (77.1%) and 804 women (22.8%) were followed-up for a median time of 7.0 years (IQ1: 5.4; IQ 3: 7.2) with a follow rate of 97.6%. At baseline, women were older (70 ± 13.1 vs. 64.6 ± 12 years old) and smoked less (18.9% vs. 30.4%), had more frequently hypertension (67.9% vs. 58.1%) and chronic kidney disease (42.6% vs. 22.7%), whereas diabetes rate was similar around 29%. PCI for myocardial infarction at admission represented 23% with no difference according to gender. Prognosis was severe as all-cause death occurred for 30.3% and MACCE for 40.9% of all patients. In unadjusted analyses, women had a higher risk of all-cause mortality (35% vs. 29%, HR = 1.25, 95%CI [1.09–1.43], P = 0.0015) and cardiovascular mortality (61% vs. 57%, HR = 1.31, 95%CI [1.10–1.56]) but there was no difference on occurrence of MACCE (HR = 1.079, 95%CI [0.9271–1.221]). After adjustment for baseline cardiovascular risk factors, presentation and severity of coronary disease, there was no difference between men and women for mortality ( Fig. 1 ). Conclusions In this long-term follow-up, women had a higher risk of all-cause and cardiovascular mortality after PCI in unadjusted analyses. However, gender was not independently associated with mortality after adjustment for cardiovascular risk factors.

Background Thinner stent struts of new DES (drug eluting stent) are associated with shorter time of reendothelialization, a reduction of shear stress and inflammation of coronary walls. Despite this great innovations their clinical safety and efficacy in challenging scenarios as non left main bifurcation coronary lesions has not been tested. Methods RAIN is a multicenter registry enrolling patients treated on bifurcated coronary lesions and left main with thin-strut DES. Baseline characteristics and procedural data were recorded. Target lesion revascularization (TLR) was the primary endpoint, whereas major adverse clinical events (MACE; composite of all-cause death, myocardial infarction (MI), target vessel revascularization (TVR), TLR and stent thrombosis (ST)) along with its single components were the secondary endpoints. A multivariate analysis to identify predictors of TLR and sub-analysis according to stenting strategy (provisional vs 2-stent technique), use of final kissing balloon (FKB) and IVUS/OCT optimization were performed. Results Data from 1803 patients (59% ACS, 61% stable CAD) treated on bifurcations were retrospectively evaluated. Follow up was available for 1685 (94%) patients for a median of 12 months (IQR 7–18). TLR occurred globally in 2.5% of cases (2.2% in provisional stenting, 3.5% in 2-stent technique). The rate of MACE was 9.4%, whereas all-cause death and MI, occurred in 4.1% and 3.2% of cases respectively. TVR and definite ST incidence were 3.7% and 1.1%. At multivariate analysis, chronic kidney disease (CKD) negatively influenced the main endpoint (HR 1.95, 95% CI 1.06–3.6, p=0.03), whereas post-dilatation (HR 0.56, 95% CI 0.3–0.93, p=0.04) and provisional stenting resulted being protective factors. FKB reduced TLR occurrence at FU only in 2-stent technique (p=0.03), whereas intracoronary imaging (performed in 29% of patients) were uninfluential. Conclusion Very thin-strut DES represents a highly effective solution in bifurcation lesions. The risk of TLR is reduced by post-dilatation and provisional stenting. FKB is recommended in 2-stent technique, whereas further studies are required to address the impact of intracoronary imaging in this setting.

Background Comparative long-term outcomes among women and men treated with percutaneous intervention (PCI) are unknown. Objective To describe and compare mortality and predictors of poor outcomes among men and women who underwent PCI. Methods Consecutive men and women admitted for PCI between 2008 and 2011 were prospectively included and followed-up in this cohort study. Major adverse cardiovascular and cerebrovascular events (MACCE) and causes of death were collected through consultations, calls and death certificate. The primary endpoint was all-cause mortality according to gender. Secondary endpoints were cardiovascular death, non-cardiovascular death and MACCEs. Last detailed cardiovascular and vital status were collected in January 2019. Results A total of 3524 patients including 2720 men (77.1%) and 804 women (22.8%) were followed-up for a median time of 7.0 years (IQ1: 5.4; IQ 3: 7.2). The follow-up rate was 97.6%. Women were older at baseline (70±13.1 vs. 64.6±12), smoked less often (18.9% vs. 30.4%) but suffered more frequently of hypertension (67.9% vs. 58.1%) and chronic kidney disease (42.6% vs. 22.7%). All-cause death occurred for 30.3% (n=1070) and MACCE for 40.9% (n=1443) of patients in the cohort. In unadjusted analyses, women had a higher risk of all-cause mortality (35% vs 29%, HR = 1.25, 95% CI [1.09–1.43], p=0.0015) and cardiovascular mortality (61% vs. 57%, HR = 1.31, 95% CI [1.10–1.56]) but there was no difference on occurrence of MACCE (HR = 1.079, 95% CI = [0.9271–1.221]). After adjustments for baseline cardiovascular risk factors, presentation and severity of coronary disease, women and men shared a similar risk of mortality along time (adHR = 0.90, 95% CI [0.77–1.05]). Survival curves in women vs. men Conclusions In this long-term follow-up, women had a higher risk of all-cause and cardiovascular mortality after PCI in unadjusted analyses. However, gender was not independently associated with mortality after adjustment for cardiovascular risk factors.

Background Causes of death after percutaneous coronary intervention (PCI) along multiple time-periods are poorly described. Objective To describe causes and predictors of short-term, intermediate-term, and long-term mortality after PCI. Methods Consecutive men and women admitted for PCI from 2008 to 2011 were prospectively included and followed-up in this cohort study. A dedicated follow-up by independent reviewers was performed to collect the outcomes and adjudicate the causes of death. A log-rank analysis was used to compare the occurrence of cardiovascular and non-cardiovascular death at 30 days, one year and up to 8 years. Last detailed cardiovascular and vital status were collected in January 2019. Results A total of 3524 patients including 2720 men (77.2%) and 804 women (22.8%) were followed-up for a median time of 7.0 years (IQ1: 5.4; IQ 3: 7.2). The rate of complete follow-up was 97.6%. All-cause death occurred for 30.3% (n=1070) of patients in the cohort, in a median time of 2.5 years after PCI, with a rate of 5.3 deaths per 100 patient-years. Overall, mortality was mostly related to cardiovascular causes than non-cardiovascular causes (17.7% versus 12.6%, log-rank Survival after PCI Conclusions In this long-term cohort study, cardiovascular death was more frequent than non-cardiovascular death in patients treated with PCI in the short and intermediate-term but not beyond one year. Cancer accounted for one fifth of the overall mortality.

Introduction Incidence and predictors of adverse events after dual antiplatelet therapy (DAPT) cessation in patients treated with ultrathin stents in unprotected left main (ULM) or coronary bifurcation remain undefined. Methods All consecutive patients presenting with a critical lesion of an ULM or a lesion involving a main coronary bifurcation and treated with very thin strut stents were included. MACE (a composite end point of cardiovascular death, myocardial infarction (MI), target lesion revascularization (TLR) and stent thrombosis (ST) was the primary endpoint, while target vessel revascularization (TVR) was the secondary endpoint. Moreover, type and occurrence of ST and occurrence of ST, CV death and MI during DAPT or after DAPT discontinuation were also evaluated. All analyses were performed according to length of DAPT dividing the patients in 3 groups: short DAPT (3-months), intermediate DAPT (3–12 months) and long DAPT (12-months). Results 117 patients were discharged with an indication for DAPT≤3 months (median 1:1–2.5), 200 for DAPT between 3 and 12 months (median 8:7–10) and 1958 with 12 months DAPT. After 12.8 months (8–20), MACE was significantly higher in the 3-month group compared to 3–12 and 12-month groups (9.4% vs. 4.0% vs. 7.2%, p≤0.001), mainly driven by MI (4.4% vs. 1.5% vs. 3%, p≤0.001) and overall ST (4.3% vs. 1.5% vs. 1.8%, p≤0.001). ST post DAPT cessation were comparable (1.7% vs. 0% vs. 0.7%, p=0.42) with a median time to ST post DAPT discontinuation of 1.67 months (0.48–4.7). At multivariate analysis, DAPT of 12-months compared to 3-months reduces the risk of overall ST (OR 0.103: 0.019–0.0563, 95% CI) while only a trend was noted for DAPT between 3 and 12 months (OR 0.61: 0.186–2.005, 95% CI). When analysed by stent strategy a 2-stent strategy predicted ST post DAPT cessation (OR 3.241: 1.048–10.026, 95% CI), which was reduced by use of FKB (OR 0.101:0.01–0.872, 95% CI). Conclusion Even stents with very thin strut when implanted in real-life ULM or coronary bifurcation patients discharged with short DAPT have a relevant risk of ST, which remains high although not significant after DAPT cessation. The correct identification before PCI of the more fragile patients who may receive a shorter DAPT regimen could help identify the safest PCI technique: provisional stenting and use of final kissing balloon (FKB) are the safest options.

Introduction In new generation drug eluting stents (DESs) era, the impact of stent geometry on freedom from recurrent events has been poorly explored. Impact of struts thickness, number of crowns and connectors on clinical outcomes was evaluated in the present study. Methods Randomized controlled trials comparing last generation DESs were selected. The primary endpoint was the rate of target lesion revascularization (TLR), while secondary was Definite Stent Thrombosis (ST). Results 53 studies with 52006 patients were included. A struts thickness ≤81 nm was associated with a lower incidence of TLR (2.9%: 2.4–3.4 vs. 3.6%: 3.0–4.3) and ST (0.8%: 0.6–1.1 vs. 1.3%: 0.9–1.8). A mean number of connectors >2.5 was also associated with a lower incidence of TLR (3.2%: 2.8–3.6 vs. 3.5%: 2.9–4.2) and ST (1.0%:0.8–1.3 vs. 1.3%: 0.9–1.7 vs for ST). On the other hand, stents with average number of crowns Conclusions The findings of the study support that lower struts thickness and higher numbers of connectors have a positive clinical outcome reducing stent thrombosis and target lesion revascularizations, while the average number of stent crowns plays a secondary role.

Background Data concerning long-term mortality after percutaneous coronary intervention (PCI) and factors of poor outcomes are scarce. Objective To describe short-term, intermediate-term, and long-term mortality and their correlates after PCI. Methods In this prospective cohort study, we included and followed-up consecutive patients admitted for PCI from 2008 to 2011. Independent adjudicators reviewed the ischemic outcomes and causes of death until January 2019. A survival analysis was performed to compare the occurrence of cardiovascular and non-cardiovascular death at 30 days, one year and up to 8 years. Results Of the 3524, patients treated with PCI from 2008 to 2011, 2720 (77.2%) were men and 804 (22.8%) were women with a mean age of 65.8 years old. The median follow-up was 7.0 years (IQ1: 5.4; IQ3: 7.2) and complete for 97.6% of the patients. One third of the patients died (30.3%; n = 1070) in a median time of 2.5 years after PCI, with a rate of 5.3 deaths per 100 patient-years. Overall, mortality was mostly related to cardiovascular causes than non-cardiovascular causes (17.7% versus 12.6%, log-rank Fig. 1 ). Cardiovascular death was more frequent within 30 days (4.7% vs. 0.3%, P Conclusions Cardiovascular death was more frequent than non-cardiovascular death in patients treated with PCI in the short and intermediate-term but not beyond one year. Cancer accounted for one fifth of the overall mortality.

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

Background Latent heart failure could be unmasked during exercise. Left atrial (LA) remodeling reflects the cumulative effects of left ventricular (LV) filling pressure over time and is usually determined by measurement of the LA volume indexed to body surface area (LAVi). We hypothesized that an indexation of the LA volume to the LV volume (LA/LV) would be more sensitive to detect abnormal exercise LV filling pressure as an index of early-stage heart failure with preserved ejection fraction (HFpEF) Purpose To assess the value of the LA/LV ratio to detect abnormal exercise LVEDP in patients with preserved LV ejection fraction (LVEF) and to investigate its association with maximal exercise capacity in two different cohorts. Methods We invasively measured LVEDP at rest and during low-level exercise in 45 patients with LVEF > 50% and normal resting LVEDP (LVEDP ≤ 16 mmHg). Correlations and receiver operator characteristic (ROC) curves were used to evaluate the association of LA/LV and LAVi with resting LVEDP, exercise LVEDP and ΔLVEDP (exercise LVEDP–resting LVEDP). The association of LA size indices with maximal exercise capacity during exercise echocardiography was also evaluated in 207 other patients. Results In the invasive study, 27 out of 45 patients had abnormal LV filling pressures during exercise. LA/LV and LAVi were not correlated to resting LVEDP. Among the two, only LA/LV was significantly correlated to exercise LVEDP (r = 0.42, P = 0.004), ΔLVEDP (r = 0.39, P = 0.007), and had a significant diagnostic value to detect early-stage HFpEF (area under the ROC curve 0.74, P = 0.007). In the non-invasive study, LA/LV was significantly associated with exercise capacity in multivariate analysis (β = −0.153, P = 0.012) while LAVi was not in a similar model. Conclusion The relative expansion of the LA over the LV as an early sign of heart remodeling appears more valuable than the conventional LAVi to detect early-stage HFpEF.

Background Diabetic patients account for an increasing number of patients undergoing percutaneous coronary intervention (PCI). However, diabetes mellitus (DM) is associated with increased residual platelet activity during dual antiplatelet treatment (DAPT) and DM patients have worse clinical outcomes after PCI as compared to non-DM. Objective To evaluate efficacy and safety of short duration DAPT (S-DAPT) and long duration DAPT (L-DAPT) after drug eluting stent (DES) implantation in DM and non-DM patients. Methods We searched Medline, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) to identify randomized controlled trials (RCTs) assessing the effect of S-DAPT versus L-DAPT after DES implantation in DM and non-DM patients. Efficacy endpoints were all-cause mortality, cardiac mortality, myocardial infarction (MI), stent thrombosis (ST), target vessel revascularization (TVR), and composite end point of net adverse clinical events (NACE) (all-cause mortality, cardiac mortality, MI, ST, TVR, stroke, major bleeding). Safety endpoints were major bleeding and stroke. Event rates were compared using a forest plot of relative risk using a random effects model. Results We included eight RCTs that randomized 28,318 patients to S-DAPT versus L-DAPT (8234 DM and 20,084 non-DM). S-DAPT was associated with an increased rate of ST in non-DM patients [3.67 (2.04, 6.59)]. There was no significant difference in the rate of all-cause mortality, cardiac mortality, ST, MI, TVR, major bleeding, stroke and NACE with S-DAPT and L-DAPT in DM patients [1.19 (0.72–1.95); 1.25 (0.69, 2.25); 1.52 (0.70, 3.29); 1.33 (0.88, 2.01); 1.39 (0.89, 2.17); 0.92 (0.19, 4.42); 0.98 (0.29, 3.28); and 0.94 (0.57, 1.54) respectively]. Further, there was no significant difference in the rate of all-cause mortality, cardiac mortality, MI, TVR, major bleeding, stroke and NACE with S-DAPT and L-DAPT in non-DM patients [0.93 (0.58, 1.48); 0.75 (0.42, 1.35); 1.52 (0.81, 2.83); 0.99 (0.71, 1.39); 0.72 (0.28, 1.84); 1.01 (0.40, 2.56); and 1.01 (0.77, 1.32) respectively]. Conclusion Compared to L-DAPT, S-DAPT was associated with significant increase in rate of ST in non-DM patients. Duration of DAPT had no significant impact on rates of all-cause mortality, cardiac mortality, MI, ST and TVR among DM patients.

Aims To assess the incidence, risk factors and prognosis of periprocedural myocardial infarction (MI) and myocardial injury in patients undergoing elective percutaneous coronary intervention (PCI). Methods and results We included all consecutive patients who underwent elective PCI with a negative troponin level at admission from 1 January 2014 to 31 December 2015. The primary endpoint was defined as the composite of periprocedural MI (Type 4a MI), stent thrombosis (Type 4b MI), and myocardial injury according to the Third universal definition of MI. Multivariable analysis was performed to identify independent predictors of periprocedural MI and myocardial injury and its relation to 30-day and 1-year clinical outcome. Of the 1390 elective PCI patients, the primary endpoint occurred in 28.7% of patients, including 7.0% of Type 4a MI, 0.14% of Type 4b MI, and 21.6% of myocardial injury. Independent risk factors for the occurrence of the primary endpoint were left main PCI, total stent length >30 mm, multiple stenting, chronic kidney disease (estimated glomerular filtration rate 75 years. At 30 days, patients with periprocedural MI and myocardial injury had a higher rate of cardiovascular events [5.5% vs. 1.2%, adjusted hazard ratio (adjHR) = 3.8, 95% confidence interval (CI) 1.9-6.9; P

Background Multiple risk factors of cardiac allograft vasculopathy (CAV) have been described, particularly through the analysis of large northern American cohorts. However, discrepancies in donor selection between the US and European countries are important, particularly concerning donor age. Purpose To evaluate the risk factors for the early development and progression of CAV in a European heart transplantation high volume center. Methods We performed an observational, retrospective single center study. All patients with heart transplantation between 10/01/2008 and 12/31/2013 who had at least one coronary angiography were included. We searched for risk factors of #1 the occurrence of moderate to severe CAV (CAV grades 2 to 3) and #2 the evolution of CAV during follow-up (CAV grade+1 or more compared to baseline) by analyzing the effect of #1 donor risk factors (age, sex, cardiovascular risk factors…), #2 recipient cardiovascular risk factors and #3 recipient transplant-related risk factors (CMV infection, ischemic time, pre-formed donor specific antibodies, biopsy proven rejections…). Results During the study period, 398 patients were transplanted at our center. Among them, 287 had at least one coronary angiogram (analysis of risk factors for CAV 2–3 occurrences) including 206 patients with at least two coronary angiograms (analysis of the evolution of CAV during follow-up). The median follow-up was 5.2 years. After multivariate analyses, only donor risk factors were significantly associated with 1) the risk of occurrence of CAV 2 to 3 (donor age > 40 years: sHR = 6.3, CI = 2–20; smoking: sHR = 2.1, CI = 1.1–4.1; donor sex: female sex: sHR = 0.31, CI = 0.13–0.73) and the risk of CAV progression during follow-up (donor age > 40 years: sHR = 2.9, CI = 1.2–7.2; donor sex: female sex: sHR = 0.2, CI = 0.1–0.6). Conclusion Early moderate to severe CAV occurrence and early CAV progression after heart transplantation were mostly driven by donor characteristics.

BACKGROUND: This study assessed if invasive coronary angiogram (CA) could be replaced by multislice (64- or 256-row) computed tomography (MSCT) to systematically rule out coronary allograft vasculopathy in heart transplant patients. METHODS: Electrocardiogram-gated contrast-enhanced MSCT (64-row for the first 25 patients and 256row for the others) was compared with CA. MSCT parameters, adapted to the patient’s weight, included 120 kV, 800 mAs, 0.625-mm slice thickness, and 0.42/0.27-second rotation time. The primary end point was the negative predictive value (NPV) of MSCT for the detection of significant (4 50%) coronary stenosis. Secondary end points were the comparison of X-ray (mSv) and iodine contrast agent (ml) exposures. RESULTS: The study prospectively included 102 patients (mean age, 53 14 years). Transplantation occurred 6 5 years before inclusion. At CA, 41.8% had stenosis r 50% and 8% had stenosis 4 50%. Among the 1,308 angiographic coronary segments Z 1.5 mm, 1,250 (95.6%) were evaluable by MSCT. The NPV of MSCT was 96.6% by patient analysis and 99.7% by segment analysis. The positive predictive value (PPV) was 45.5%. The total volume of contrast agent was 139 43 vs 91 12 vs 56 19 ml (p o 0.05) with 64-row MSCT, 256-row MSCT, and CA, respectively. The effective radiation dose was higher using retrospective gating (17.8 5.5 mSv, p o 0.05), but similar with prospective gating (6.2 1.9 mSv, p ¼ 0.571) compared with CA (6.0 3.5 mSv). CONCLUSION: Newer generations of MSCT (64- or 256-row) have a good NPV and may represent an alternative to invasive CA to rule out significant (4 50%) coronary vasculopathy in heart transplant patients, despite a low PPV. J Heart Lung Transplant 2012; 31: 1262‐68 r 2012 International Society for Heart and Lung Transplantation. All rights reserved.

To evaluate the potential benefit and risk of addition of vorapaxar to standard medical therapy in patients who underwent coronary revascularization with either percutaneous coronary revascularization (PCI) or coronary artery bypass graft surgery (CABG). We searched PubMed, EMBASE, the Cochrane

We aim to evaluate the potential benefit and risk of addition of vorapaxar to standard medical therapy in patients who underwent coronary revascularization with either percutaneous coronary revascularization or coronary artery bypass graft surgery. We searched PubMed, EMBASE, the Cochrane Central Register of Controlled trials, and the clinical trial registry maintained at clinicaltrials.gov for randomized control trials evaluating the safety and efficacy of vorapaxar in patients who underwent coronary revascularization procedures with either percutaneous coronary revascularization or coronary artery bypass graft surgery. Event rates were compared using a Forest plot of relative risk using a random-effects model. The 5 studies (n = 24,025) that met all criteria were included in the final analysis. After coronary revascularization procedures, addition of vorapaxar to standard medical therapy was associated with reduction in the risk of myocardial infarction (MI; risk ratio 0.83 [0.75 to 0.92]) and ischemic stroke (0.011 [0.007 to 0.016]); however, it also resulted in significant increase risk of hemorrhagic stroke (1.57 [1.01 to 2.44]) and Thrombolysis In Myocardial Infarction major and minor bleeds (1.36 [1.07 to 1.70]). There was no significant difference in the risk of cardiovascular mortality (0.90 [0.73 to 1.09]), repeat revascularization (0.78 [0.23 to 2.70]), and stent thrombosis (0.95 [0.62 to 1.45]) in the vorapaxar and control groups. In conclusion, after coronary revascularization procedures, addition of vorapaxar to standard medical therapy was associated with reduction in the risk of MI and ischemic stroke and increase in risk of hemorrhagic stroke and Thrombolysis In Myocardial Infarction major and minor bleeds.

Elderly patients regularly receive bare-metal stents (BMS) instead of drug-eluting stents (DES) to shorten the duration of double antiplatelet therapy (DAPT). In the SENIOR trial, at one year, the use of latest generation DES with short DAPT (1-month in stable and 6-month in unstable patients) lead

Elderly patients regularly receive bare-metal stents (BMS) instead of drug-eluting stents (DES) to shorten the duration of double antiplatelet therapy (DAPT). In the SENIOR trial, at one year, the use of latest generation DES with short DAPT (1-month in stable and 6-month in unstable patients) lead

Les troubles cognitifs d'origine vasculaire (TCV) sont des troubles cognitifs qui partagent entre eux une cause vasculaire presumee. Ils representent un groupe heterogene, d'etiologies diverses et augmentent avec l'âge. Une proportion relativement elevee de ces troubles cognitifs pourrait etre prevenue ou retardee. Bien que l'âge soit le facteur de risque le plus important, les facteurs de risques cardiovasculaires et les antecedents de maladies cardiovasculaires sont etablis comme etant des facteurs de risque d'un declin cognitif et de demence. L'effet preventif d'un traitement antihypertenseur sur le declin cognitif est maintenant bien etabli ; en revanche, l'effet du traitement des dyslipidemies sur la reduction du declin cognitif et la demence n'est pas concluant. Les strategies de depistage des TCV ne sont pas standardisees et des etudes sur du long terme sont necessaires pour etablir les conduites a tenir.

Antiplatelet treatment (platelet aggregation inhibitors) is essential in cardiovascular medicine today. Aspirin and, more recently, clopidogrel are among the most important treatments of cardiovascular diseases. Although the benefit/risk ratio is generally favorable as secondary prevention, and justifies the treatment, it is less so in primary prevention and indeed, sometimes difficult to establish. Although the combination of two treatments seems attractive, it has been shown effective only for some indications. The principal risk of an antiplatelet treatment that inhibits clotting is bleeding, and the risk almost doubles when two treatments are combined. New platelet aggregation inhibitors, undoubtedly more efficacious, but also more likely to induce bleedings, will probably emerge.

Background Despite improvement in management of coronary artery disease (CAD), recurrent coronary events remain frequent. The aim of this study is to assess predictive factors of plaque rupture, leading to an acute coronary syndrome (ACS) by combining metabolic evaluation and coronary plaque imaging. Methods This study involved two cohorts of patients, one concerning stable CAD and one ACS patients. In both groups of patients, plaque imaging was performed with standard coronary angiogram and optimal coherence tomography (OCT) in the 3 main coronary vessels defined by diameter superior to 2.5 mm. Recurrent major adverse cardiac events were collected during follow-up. Comparison of stable and unstable CAD patients will be performed to try to characterize criteria of plaque vulnerability. Results The preliminary results regarding the ACS cohort are presented in this abstract. We included 48 patients with mean age of 60.5 years and 87.3% of men. A three-vessel atherosclerotic disease was found in 42% of patients. A total of 142 non-culprit coronary lesions were analysed by OCT for a mean run of 60.4 mm by artery and total of 5854 mm. B2/C complex lesions (AHA/ACC classification) were represented in 28.2% of patients. OCT analysis allowed to define coronary lesions with mean distance from ostium of 22.6 mm, mean stenosis length of 11.9 mm and mean minimum lumen area (MLA) of 3.95 mm2 with 66.1% of patients with MLA Conclusion OCT analysis of non-culprit coronary lesions is feasible and allows to highlight vulnerable lesions such as asymptomatic plaque ruptures. Analysis of stable cohort, biomarkers and follow-up of patients are necessary to define predictive factors of plaque rupture.

Resume Introduction Le scanner spirale multicoupes est un outil diagnostique prometteur, offrant une visualisation non invasive des arteres coronaires. Les travaux sur le sujet sont en majorite monocentriques et presentent des resultats obtenus sur des cohortes de patients hautement selectionnes. Objectif Evaluation des capacites diagnostiques du scanner coronaire au sein d’une population de patients ayant beneficie d’un scanner coronaire et adresses pour coronarographie. Materiels et methodes Cinquante-deux patients ont ete inclus de maniere retrospective. Ils avaient ete adresses pour la realisation d’un scanner spirale multicoupes (16, 40 et 64 barettes) dans dix centres differents : centre hospitalier general, universitaire ou centres prives, pour suspicion clinique de stenose coronaire. La precision diagnostique du scanner pour detecter des stenoses coronaires significatives (superieure ou egale a 50 %) a ete determinee en comparaison avec la coronarographie conventionnelle. Resultats La sensibilite, la specificite, la valeur predictive positive et negative, la precision diagnostique du scanner coronaire pour detecter les stenoses coronaires significatives sont respectivement egales a 91,4 %, 17,7 %, 69,6 %, 50,0 % et 67,3 % en analyse par patient, et 55,3 %, 85,6 %, 30,3 %, 94,4 % et 82,5 % en analyse par segment. Conclusion L’utilisation du scanner spirale multicoupes reste limitee en pratique courante par ses nombreux faux positifs, quand il est realise au sein d’une population de patients non selectionnes, pour lesquels il existe une forte suspicion de coronaropathie et dans des centres dont la qualite d’expertise est heterogene. Sa place au sein de l’arsenal diagnostique de la maladie coronaire reste a definir par de larges etudes multicentriques avant de faire l’objet de recommandations precises encadrant sa pratique.

Objectives: To assess safety and feasibility of using radial artery access for percutaneous coronary intervention (PCI) in patients on oral anticoagulation without interrupting therapy. Background: The radial artery approach for PCI is intuitively attractive for patients receiving chronic oral anticoagulation with vitamin K antagonists (VKAs) but little data exist concerning feasibility or safety of this approach in this population. The main advantage of this strategy would be to avoid bridging therapy with heparin that increases risk of thrombotic and bleeding events. Methods: In this prospective observational study, 50 consecutive patients referred for coronary angiography underwent PCI without interrupting oral anticoagulant therapy. The main outcome measures were bleeding and thrombotic complications. Results: The indications for permanent oral anticoagulation were as follows: atrial fibrillation in 62%, mechanical prosthesis in 24%, and venous thromboembolism in 14%. Seventy-two percent were elective cases and 28% presented with acute coronary syndromes. PCI was performed with an INR range of 1.4–3.4 with mean of 2.2 ± 0.6. Seventy-six percent of the patients were on dual antiplatelet therapy before the procedure. No thrombotic events or excess bleeding were observed at 1 month. Only one patient had a minor hemorrhage 8 days after procedure. Conclusions: This series suggests that for patients treated with VKAs, the use of radial artery access is feasible and safe for PCI on dual antiplatelet therapy without interrupting oral anticoagulant treatment. © 2008 Wiley-Liss, Inc.

Points essentiels Le traitement anticoagulant oral par les antivitamines K (AVK) est prescrit a un nombre croissant de patients. Or, les AVK sont une des premieres causes de iatrogenie en medecine. Il est essentiel de controler de facon etroite l’intensite de l’anticoagulation par une mesure biologique (INR) pour diminuer la frequence des evenements thrombotiques et hemorragiques qui peuvent survenir en cas d’anticoagulation insuffisante ou excessive. Les modalites actuelles de surveillance de l’INR sont perfectibles. L’automesure de l’INR et la surveillance par le patient du traitement anticoagulant oral offrent un avantage sur d’autres approches plus conventionnelles. L’automesure serait realisable chez la plupart des patients capables de mener une vie autonome quels que soient le statut social et le niveau d’education. En depit de l’existence de dispositifs d’automesure existants et fiables, la France est tres en retard dans l’utilisation de ces dispositifs qui permettent une meilleure prise en charge et une amelioration de la morbimortalite inherente au traitement anticoagulant oral.

SummaryTo assess the feasibility and safety of coronary angiography combined, where necessary, with ad hoc angioplasty in an outpatient setting; a prospective, single-center study. The first 172 patients (154 men, 59±11 years) considered at low risk for complications were enrolled for outpatient-coronary angiography with or without angioplasty via a radial approach. The inclusion criteria were clinical, not based on angiography. After angiography/angioplasty, creatinine and troponin were assayed (outside the hospital) within 24h and patients were telephoned and asked about their clinical condition. Angioplasty was performed in 69 (40%) patients and 130 patients (75.6%) were discharged on the same day. In the angioplasty group, a history of coronary dilatation was more common in patients discharged on the same day (p=0.05), whereas bifurcation lesions were more frequent in subjects who were kept in hospital (p

SummaryIntroductionConflicting data exist on the risk of stent thrombosis with drug-eluting stents (DES) versus bare-metal stents (BMS). Little is known about the potential different characteristics and outcomes of DES versus BMS thrombosis.ObjectiveTo compare the characteristics, timing and outcomes of patients with angiographic stent thrombosis according to type of stent implanted.MethodsThe population comprised consecutive patients who underwent BMS or DES implantation (January 2003-April 2007) at Pitié-Salpêtrière Hospital. Data from patients with and without a stent thrombosis were compared to identify predictors of thrombosis. Timing of thrombosis (acute, 30 days; very late, >1 year), clinical, angiographic and procedural characteristics, and outcomes were compared between patients with a BMS or DES thrombosis.ResultsA total of 3579 patients received a BMS (2815 lesions, 2318 patients) or a DES (1536 lesions, 1261 patients). Documented angiographic stent thrombosis occurred in 52 (1.4%) patients, 16 (1.3%) with a DES and 36 (1.6%) with a BMS. Rates of acute (0.1% versus 0.2%), subacute (1% versus 0.7%), late (both 0.2%) and very late (both 0.2%) thrombosis were similar in patients with BMS and DES thrombosis. Factors predictive of stent thrombosis were similar, including left ventricular failure (P

SummaryAims of the studyTo assess mortality in people ≥75 years of age 6 months after myocardial infarction complicated by cardiogenic shock and treated by angioplasty with complete revascularisation and optimal anti-thrombotic treatment; to compare results to those of younger patients with or without shock and to analyse predictive factors for death.Materials and methodsThe study is based on 1011 consecutive patients with myocardial infarction admitted for primary angioplasty, subdivided into four groups by age and the presence or absence of cardiogenic shock: group 1 (75 years of age (P

The ability to modify the enzymatic processes involved in promoting atherosclerotic plaque disruption and to serially monitor atherosclerotic evolution could provide novel information in the management of patients with atherosclerosis. We studied the effects of a statin (atorvastatin) and its combination with an acyl-CoA:cholesterol O-acyltransferase (ACAT) inhibitor (avasimibe) on atherosclerotic regression and plaque stability as measured by matrix metalloproteinase 1 and 3 (MMP-1 and MMP-3) levels. Watanabe Heritable Hyperlipidemic (WHHL) rabbits treated with atorvastatin alone experienced an attenuated increase in atherosclerotic burden versus controls as determined by MR imaging. The mean vessel wall area (VWA) prior to drug therapy was 5.57 ± 0.01 mm2. The VWA increased to 6.71 ± 0.03 and 7.16 ± 0.03 mm2, respectively, in atorvastatin-treated and control groups (p < 0.0001 for both). The combination of atorvastatin and avasimibe induced a significant regression of the previously established atherosclerotic lesions, with the VWA decreasing to 4.54 ± 0.04 mm2 (p = 0.009). Atorvastatin alone induced a nonsignificant reduction in the percent staining of MMP-1 in atherosclerotic lesions, but the combination treatment with avasimibe led to a significant reduction versus controls (p = 0.005). However, a reduction in MMP-3 staining was significant for rabbits treated with both atorvastatin alone (p = 0.007) and in combination with avasimibe (p = 0.04) versus controls. In this animal model, the addition of avasimibe to atorvastatin has beneficial effects on both atherosclerotic plaque regression and stabilization.

Purpose Cardiac allograft vasculopathy (CAV) constitues a primary cause of death after heart transplantation. Bare metal stents (BMS) have been used for revascularization, but they are associated with a high-risk of restenosis. Abstract 0474 – Figure: Kaplan-Meier estimates of one-year mortality Figure options Download full-size image Download as PowerPoint slide Limited data have shown favourable results with percutaneous coronary interventions (PCI) using drug-eluting stents (DES) in this specific population. Our study focuses on intra-stent restenosis (ISR) for DES in CAV, on new revascularisation and mortality. Methods 97 consecutive heart transplant recipients with successful PCI were treated with DES (n=106) and BMS (n=25). They were prospectively followed-up at one year after PCI. An angiographic lesion-based analysis at 12-month follow-up and a patient-based survival analysis were performed. Results The lesion-based analysis within 12 months after PCI showed an ISR rate with BMS of 12% and an ISR rate with DES of 3.8%. The target lesion revascularization (TLR) was 8% for BMS and 2.8% for DES. However, the target vessel revascularization was higher (16.5%) and the remote lesion revascularization was 8.7%, indicating the rapid occurrence of new significant lesions. Cardiac mortality at one year was 9.7% and extra- cardiac mortality was 2.9%. Conclusions DES are associated with a low rate of TLR and can safely be used in heart transplant recipients with coronary artery disease. However, new significant lesions occurred at one year indicating a progression of CAV.

Objectives: Our study aimed to compare the isosmolar nonionic dimer iodixanol and the low osmolar ionic agent ioxaglate in the current era of percutaneous coronary intervention (PCI), using clopidogrel, enoxaparine, direct stenting, and drug eluting stent. Background: Previous studies have suggested an association between thrombus-related events and type of contrast media. Methods: Our prospective single-center study included 498 consecutive patients who were assigned to receive either iodixanol (n = 231) or ioxaglate (n = 267). The primary endpoint was the cumulative rate of in-hospital major adverse clinical events (MACE). A secondary endpoint was the rate of angiographic or procedural complications. Results: Clinical and angiographic baseline characteristics and procedural data were similar in the 2 groups. A peak anti-Xa >0.5 IU/ml was obtained in 97% in both groups. Glycoprotein IIb/IIIa inhibitors were used in 42% of patients. Coronary stenting was performed in 91% of patients, with direct stenting in 70%, and drug-eluting stent in 28% of patients. In-hospital MACE was more frequent in patients receiving iodixanol compared with those receiving ioxaglate (4.8% vs. 0.3%, P < 0.005). This difference was mainly related to the appearance of a large thrombus during PCI (6% with iodixanol vs. 0.3% with ioxaglate, P < 0.0001). In multivariate analysis, independent predictors of in-hospital MACE were use of iodixanol (P < 0.01), the higher number of stent used (P < 0.008), bifurcation/ostial lesion (P < 0.01), and balloon dilation before stenting (p < 0.001). Conclusions: In our study reflecting the current era of PCI, thrombus-related events are more frequent with the isosmolar nonionic dimer iodixanol than with the low osmolar ionic agent ioxaglate. © 2006 Wiley-Liss, Inc.

SummaryBackgroundWhether outcomes differ for women and men after percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) remains controversial.AimTo compare 1-year outcomes after primary PCI in women and men with STEMI, matched for age and diabetes.MethodsConsecutive women with STEMI of0.05 for all). After exclusion of patients with shock (10.7%) and out-of-hospital cardiac arrest (6.6%), death rates were even more similar (11.3% vs 11.8%; P=0.10). Female sex was not independently associated with death (odds ratio 1.01, 95% confidence interval 0.55–1.87; P=0.97).ConclusionIn our consecutive unselected patient population, women had similar 1-year outcomes to men matched for age and diabetes, after contemporary primary PCI for STEMI, despite having a higher risk profile at baseline.

Resume L'imagerie par resonance magnetique (IRM) et la tomodensitometrie multibarrettes sont des techniques d'imagerie tridimensionnelles et non invasives permettant d'acquerir des images cardiaques de haute resolution. L'IRM permet une evaluation anatomique et fonctionnelle de toutes les structures cardiaques. L'imagerie de perfusion myocardique et l'etude du contraste myocardique tardif en font la methode la plus simple et la plus rapide de recherche d'ischemie et de viabilite myocardique. La tomodensitometrie multibarrettes est devenue quant a elle la methode d'imagerie coronaire non invasive de reference.