8 results on '"Diefenbronn, M."'
Search Results
2. Évolution démographique, caractéristiques et suivi clinique intrahospitalier des sujets âgés traités par angioplastie primaire pour syndrome coronarien aigu avec sus-décalage du segment ST
- Author
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Laghlam, D., Diefenbronn, M., Varenne, O., and Picard, F.
- Published
- 2019
- Full Text
- View/download PDF
Catalog
3. P6384Thrombotic-hemorrhagic balance evaluation in STEMI patients with or without associated cardiac arrest: an observational study
- Author
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Picard, F, primary, Diefenbronn, M, additional, Laghlam, D, additional, Llitjos, J F, additional, Sokoloff, A, additional, Varenne, O, additional, Dumas, F, additional, and Cariou, A, additional
- Published
- 2019
- Full Text
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4. Performance of stent thrombosis and bleeding risk scores in out-of-hospital cardiac arrest due to acute coronary syndromes.
- Author
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Seret G, Pham V, Laghlam D, Diefenbronn M, Brunet T, Varenne O, Dumas F, Cariou A, and Picard F
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- Humans, Platelet Aggregation Inhibitors adverse effects, Hemorrhage epidemiology, Risk Factors, Stents adverse effects, Acute Coronary Syndrome diagnosis, Acute Coronary Syndrome therapy, Percutaneous Coronary Intervention adverse effects, Out-of-Hospital Cardiac Arrest diagnosis, Out-of-Hospital Cardiac Arrest therapy, Thrombosis diagnosis, Thrombosis etiology
- Abstract
Background: Patients with out-of-hospital cardiac arrest (OHCA) due to acute coronary syndromes (ACS) who undergo percutaneous coronary intervention (PCI) are at high risk of bleeding and thrombosis. While predictive bleeding and stent thrombosis risk scores have been established, their performance in patients with OHCA has not been evaluated., Methods: All consecutive patients admitted for OHCA due to ACS who underwent PCI between January 2007 and December 2019 were included. The ACTION and CRUSADE bleeding risk scores and the Dangas score for early stent thrombosis risk were calculated for each patient. A C-statistic analysis was performed to assess the performance of these scores., Results: Among 386 included patients, 82 patients (21.2%) experienced severe bleeding and 30 patients (7.8%) experienced stent thrombosis. The predictive performance of the ACTION and CRUSADE bleeding risk scores for major bleeding was poor, with areas under the curve (AUCs) of 0.596 and 0.548, respectively. Likewise, the predictive performance of the Dangas stent thrombosis risk score was poor (AUC 0.513). Using multivariable analysis, prolonged low-flow (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.00-1.05; P=0.025), reduced haematocrit or fibrinogen at admission (OR 0.93, 95% CI 0.88-0.98; P=0.010 and OR 0.61; 95% CI 0.41-0.89; P=0.012, respectively) and the use of glycoprotein IIb/IIIa inhibitors (OR 2.10, 95% CI 1.18-3.73; P=0.011) were independent risk factors for major bleeding., Conclusion: The classic bleeding and stent thrombosis risk scores have poor performance in a population of patients with ACS complicated by OHCA. Other predictive factors might be more pertinent to determine major bleeding and stent thrombosis risks in this specific population., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.) more...
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- 2022
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5. Survivors of out-of-hospital cardiac arrest treated with percutaneous coronary intervention: Thrombotic and bleeding events among different oral P2Y 12 inhibitor regimens.
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Picard F, Laghlam D, Diefenbronn M, Seret G, Varenne O, Dumas F, and Cariou A
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- Hemorrhage chemically induced, Humans, Platelet Aggregation Inhibitors adverse effects, Prasugrel Hydrochloride adverse effects, Prospective Studies, Purinergic P2Y Receptor Antagonists adverse effects, Survivors, Ticlopidine, Treatment Outcome, Acute Coronary Syndrome, Out-of-Hospital Cardiac Arrest diagnosis, Out-of-Hospital Cardiac Arrest therapy, Percutaneous Coronary Intervention adverse effects, Thrombosis
- Abstract
Background: Survivors of out-of-hospital cardiac arrest undergoing percutaneous coronary intervention are at high thrombotic and bleeding risk. The type of antiplatelet that should be used in these patients remains controversial., Aim: To compare the impact of the use of more potent P2Y
12 receptor inhibitors on thrombotic and bleeding events with that of clopidogrel in survivors of out-of-hospital cardiac arrest undergoing percutaneous coronary intervention., Methods: This was an observational study including consecutive patients treated for out-of-hospital cardiac arrest associated with acute coronary syndrome by percutaneous coronary intervention with stent implantation and dual antiplatelet therapy between January 2007 and December 2017. Baseline characteristics, mortality and in-hospital haemorrhagic and thrombotic events were compared between patients who received clopidogrel and those who received more potent P2Y12 receptor inhibitors., Results: Among the 359 included patients, 197 received clopidogrel and 162 received ticagrelor or prasugrel. The primary composite endpoint of death, definite stent thrombosis or major bleeding was similar in the two groups (57.4% in the clopidogrel group vs. 53.7% in the new P2Y12 receptor inhibitors group; P=0.49). Fewer haemorrhagic events occurred in the clopidogrel group (21.8% vs. 31.5%; P=0.04), whereas similar rates of definite stent thrombosis were observed (5.1% vs. 6.2%; P=0.65). The use of more potent P2Y12 receptor inhibitors was an independent predictor of major bleeding (odds ratio 2.69, 95% confidence interval 1.37-5.25; P=0.004)., Conclusions: In this specific population, the use of more potent P2Y12 receptor inhibitors was not associated with a reduced thrombosis rate compared with clopidogrel, but with a higher haemorrhagic risk. Prospective studies should be performed on the optimal antithrombotic therapy in this subset of patients., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.) more...- Published
- 2021
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6. Safety and benefit of Glycoprotein IIb/IIIa inhibitors in out of hospital cardiac arrest patients treated with percutaneous coronary intervention.
- Author
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Picard F, Sokoloff A, Pham V, Diefenbronn M, Laghlam D, Seret G, Varenne O, Dumas F, and Cariou A
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- Humans, Platelet Aggregation Inhibitors adverse effects, Platelet Glycoprotein GPIIb-IIIa Complex, Retrospective Studies, Treatment Outcome, Out-of-Hospital Cardiac Arrest therapy, Percutaneous Coronary Intervention
- Abstract
Background: Out of hospital cardiac arrest (OHCA) patients requiring percutaneous coronary intervention (PCI) are at higher risk of both stent thrombosis and bleeding. The use of aggressive antiplatelet therapy could lead to a higher risk of bleeding in these patients. Indeed, data on glycoprotein IIb/IIIa inhibitor (GPi) use in this specific indication is scarce., Aim: We sought to evaluate the benefit and safety of GPi use in OHCA patients requiring PCI., Methods and Results: Between January 2007 and December 2017, we retrospectively included all consecutive patients treated with PCI for an OHCA from cardiac cause. Clinical, procedural data and in-hospital outcomes were collected. Three hundred and eighty-five patients were included. GPi were administrated in 41.3% of cases (159 patients). Patients who received GPi were younger, had less prior PCI, more often a TIMI 0 or 1 flow before PCI and thromboaspiration use. There were no differences regarding in-hospital definite stent thrombosis among the two groups (11.9% in the GPi group vs 7.1% in the non-GPi group, p = 0.10) or in-hospital mortality (48.6% vs 49.3%, p = 0.68). The incidence of any bleeding (33.3% vs. 19.6%; p = 0.002), and major bleeding (BARC 3-5) (21.9% vs. 16.8%; p = 0.007) was significantly higher in patients receiving GPi. Indeed, using multivariate analysis, GPi use was predictor of major bleeding (OR: 1.81; 95% CI: 1.06-3.08; p = 0.03)., Conclusions: In patients treated with PCI for OHCA from cardiac cause, GPi use was associated with an increased risk of major bleeding events, without difference on in-hospital stent thrombosis or death., (Copyright © 2020 Elsevier B.V. All rights reserved.) more...
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- 2020
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7. The balance of thrombosis and hemorrhage in STEMI patients with or without associated cardiac arrest: An observational study.
- Author
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Picard F, Llitjos JF, Diefenbronn M, Laghlam D, Seret G, Sokoloff A, Cariou A, Dumas F, and Varenne O
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- Aged, Anticoagulants administration & dosage, Anticoagulants adverse effects, Case-Control Studies, Comorbidity, Coronary Angiography adverse effects, Drug-Eluting Stents adverse effects, Female, Hemorrhage epidemiology, Humans, Male, Middle Aged, Out-of-Hospital Cardiac Arrest therapy, Retrospective Studies, ST Elevation Myocardial Infarction therapy, Thrombosis epidemiology, Hemorrhage etiology, Out-of-Hospital Cardiac Arrest mortality, ST Elevation Myocardial Infarction mortality, Thrombosis prevention & control
- Abstract
Background: Data is scarce on hemorrhagic and thrombotic complications in patients with ST-elevation myocardial infarction (STEMI) associated with out-of-hospital cardiac arrest (OHCA)., Methods: This is a monocentric, retrospective study conducted from January 2012 to December 2017 in a tertiary university hospital, which serves as a cardiac arrest center for a large urban area. Over the study period, all consecutive patients who were treated with stent implantation for STEMI with or without OHCA were included. Baseline characteristics, treatments, hemorrhagic and thrombotic events were compared between STEMI patients with and without OHCA. Univariate and multivariate analysis were performed in order to identify predictors of 30-day mortality, occurrence of major bleeding (MB), and early stent thrombosis (ST)., Results: A total of 549 patients treated for STEMI without OHCA and 146 patients for STEMI with OHCA were included. The incidence of definite ST and MB after coronary angioplasty was significantly higher in patients with OHCA (2.6% vs. 7.5%, p = 0.004 and 3.3% vs. 19.2%, p < 0.001, respectively). Independent predictors of MB in OHCA patients were anticoagulation therapy (HR = 3.11, 95%CI [1.22-7.98], p = 0.02) and the use of glycoprotein IIb/IIIa inhibitors (HR = 4.16, 95%CI [1.61-10.79], p = 0.003). Independent predictors of mortality in OHCA patients were age (HR = 1.05, 95%CI [1.02-1.09], p = 0.004) and ST (HR = 5.62, 95%CI [1.61-19.65], p = 0.007, with a protective effect of new anti-P2Y12 treatments (HR = 0.20, 95%CI [0.08-0.46], p < 0.001)., Conclusion: Patients treated for STEMI associated with OHCA are at higher-risk of ST and MB than those who did not experience cardiac arrest. In this subset of patients, prospective studies are needed to better evaluate the balance of thrombosis and hemorrhage., (Copyright © 2019 Elsevier B.V. All rights reserved.) more...
- Published
- 2019
- Full Text
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8. [Demographic evolution, clinical characteristics and in-hospital outcomes of older adults treated by primary angioplasty for ST-segment elevation myocardial infarction].
- Author
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Laghlam D, Diefenbronn M, Varenne O, and Picard F
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- Aged, Aged, 80 and over, Clopidogrel therapeutic use, Drug-Eluting Stents statistics & numerical data, Female, France epidemiology, Hospital Mortality, Humans, Male, Middle Aged, Platelet Aggregation Inhibitors therapeutic use, Prognosis, Retrospective Studies, ST Elevation Myocardial Infarction epidemiology, Stroke Volume, Time-to-Treatment, Angioplasty, Balloon, Coronary, ST Elevation Myocardial Infarction therapy
- Abstract
Background: The number of older adults treated for ST-segment elevation myocardial infarction (STEMI) is increasing. Nevertheless, their treatment might not be as optimal as younger adults. This study sought to evaluate demographic evolution, clinical characteristics and in-hospital outcomes of patients of patients aged 75years-old or older treated by primary angioplasty for STEMI., Methods: Retrospective study of all consecutive patients for STEMI between January 2012 and December 2017. Their clinical, biologic, echocardiographic and angiographic data, as well as in-hospital outcomes were collected and compared between two groups: younger and older than 75 year-olds., Results: Five hundred and sixty-eight patients including 99 (17.4%) 75 year-old or older were included in the present study. Patients aged 75 or older had an increased delay of treatment between the time of the chest pain onset and revascularization (7.30±1,16 vs 4.77±0,36hours, P=0.0391), they were more frequently treated with clopidogrel rather than more potent anti P2Y12 antiplatelet therapies (55.6% vs 24.8%, P<0.0001) and received less frequently anti-GP2B3A therapy (44.8% vs 23.2%, P<0.0001). There was a trend for increased in-hospital mortality in the older group, despite non statistically significant (4.04% vs 1.5%, P=0.0847). Older adults had a worse clinical status with decreased post-STEMI left ventricular ejection fraction (44.42±1,38 vs 49.07±0,49, P=0,0019). They were also less treated with drug-eluting stents (51.5% vs 73.9%, P<0.0001)., Conclusion: Adults aged 75 years-old or older represent a subsequent proportion of patients admitted for STEMI. They had a worse initial clinical presentation associated with worse prognostic, as compared to younger adults. They experience delayed reperfusion therapy and suboptimal treatment as compared to younger adults., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.) more...
- Published
- 2019
- Full Text
- View/download PDF
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