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1. PRADOC: A Multicenter Randomized Controlled Trial to Assess the Efficiency of PRADO‐IC, a Nationwide Pragmatic Transition Care Management Plan for Hospitalized Patients With Heart Failure in France

Author: François Roubille, Jean‐Philippe Labarre, Frédéric Georger, Michel Galinier, Fanchon Herman, Philippe Berdague, Erika Nogue, Thibaut Petroni, Quentin Delbaere, Alexandre Malak, Marie Robin, Elvira Prunet, Florence Leclercq, Jean‐Luc Pasquie, Laurence Papinaud, Grégoire Mercier, Jean‐Etienne Ricci, Guillaume Cayla, and Claire Duflos
Subjects: heart failure, mixed‐methods study, readmission, transition program, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Background The PRADO‐IC (Programme de Retour à Domicile après une Insuffisance Cardiaque) is a transition care program designed to improve the coordination of care between hospital and home that was generalized in France in 2014. The PRADO‐IC consists of an administrative assistant who visits patients during hospitalization to schedule follow‐up visits. The aim of the present study was to evaluate the PRADO‐IC program based on the hypotheses provided by health authorities. Methods and Results The PRADOC study is a multicenter, controlled, randomized, open‐label, mixed‐method trial of the transition program PRADO‐IC versus usual management in patients hospitalized with heart failure (standard of care group; NCT03396081). A total of 404 patients were recruited between April 2018 and May 2021. The mean patient age was 75 years (±12 years) in both groups. The 2 groups were well balanced regarding severity indices. At discharge, patients homogeneously received the recommended drugs. There was no difference between groups regarding hospitalizations for acute heart failure at 1 year, with 24.60% in the standard of care group and 25.40% in the PRADO‐IC group during the year following the index hospitalization (hazard ratio, 1.04 [95% CI, 0.69–1.56]; P=0.85) or cardiovascular mortality (hazard ratio, 0.67 [95% CI, 0.34–1.31]; P=0.24). Conclusions The PRADO‐IC has not significantly improved clinical outcomes, though a trend toward reduced cardiovascular mortality is evident. These results will help in understanding how transitional care programs remain to be integrated in pathways of current patients, including telemonitoring, and to better tailor individualized approaches. REGISTRATION URL: https://www.clinicaltrials.gov; Unique Identifier: NCT03396081.
Published: 2024
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2. Vascular Complications and Bleeding After Transfemoral TAVR With Surgical Versus Percutaneous Approach: A Contemporary Prospective Study

Author: Annick Astié Dardaillon, Mariama Akodad, Fabien Huet, Pierre Alain Meunier, Thomas Gandet, Jean-Christophe Macia, Laurent Schmutz, Frederic Targosz, François Roubille, Matthieu Steinecker, Benoit Lattuca, Pierre Robert, Jean-Michel Berdeu, Guillaume Cayla, and Florence Leclercq
Subjects: Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Conclusion: Despite a higher risk profile of patients in the SC group, SC and PC approaches appear safe and effective in TF TAVR, with a high success rate. SC may be considered when vascular access is anticipated as complex, but this strategy might be confirmed in a randomized study.
Published: 2024
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3. Post-discharge and long-term follow-up after an acute coronary syndrome: International Collaborative Group of CNCF position paper.

Author: Pierre Sabouret, Gilles Lemesle, Anne Bellemain-Appaix, Pierre Aubry, Pier-Paolo Bocchino, Erik Rafflenbeul, Loïc Belle, Jim Nolan, Marco Bernardi, Giuseppe Biondi-Zoccai, Michael P. Savage, Maciej Banach, and Guillaume Cayla
Subjects: acute coronary syndrome, follow-up, expert position paper, long-term care, percutaneous coronary intervention, Medicine
Abstract: Introduction Long-term follow-up after an acute coronary syndrome (ACS) presents a crucial challenge due to the high residual cardiovascular risk and the potential for major bleeding events. Although several treatment strategies are available, this article focuses on patients who have undergone percutaneous coronary intervention (PCI) for ACS, which represent a frequent clinical situation. This position paper aims to support physicians in daily practice to improve the management of ACS patients. Material and methods A group of recognized international and French experts in the field, provides an overview of current evidence-based recommendations − supplemented by expert opinion where such evidence is lacking − and a practical guide for the management of patients with ACS after hospital discharge. Results The International Collaborative Group underlines the need of a shared collaborative approach, and a care plan individualized to the patient’s risk profile for both ischemia and bleeding. Each follow-up appointment should be viewed as an opportunity to optimize the personalized approach, to reduce adverse clinical outcomes and improve quality of life. As risks – both ischaemic and haemorrhagic – evolve over time, the risk–benefit balance should be assessed in an ongoing dynamic process to ensure that patients are given the most suitable treatment at each time point. Conclusions This Expert Opinion aims to help clinicians with a practical guide underlying the proven strategies and the remaining gaps of evidence to optimize the management of coronary patients.
Published: 2022
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4. PRADOC: a trial on the efficiency of a transition care management plan for hospitalized patients with heart failure in France

Author: Claire Duflos, Jean‐Philippe Labarre, Roxana Ologeanu, Marie Robin, Guillaume Cayla, Michel Galinier, Frédéric Georger, Thibaut Petroni, Clément Alarcon, Sylvain Aguilhon, Christine Delonca, Pascal Battistella, Audrey Agullo, Florence Leclercq, Jean‐Luc Pasquie, Laurence Papinaud, Grégoire Mercier, Jean‐Etienne Ricci, and François Roubille
Subjects: Heart failure, Readmission, Mixed‐methods study, Transition programme, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Abstract Aims Transition care programmes are designed to improve coordination of care between hospital and home. For heart failure patients, meta‐analyses show a high efficacy but with moderate evidence level. Moreover, difficulties for implementation of such programmes limit their extrapolation. Methods and results We designed a mixed‐method study to assess the implementation of the PRADO‐IC, a nationwide transition programme that aims to be offered to every patient with heart failure in France. This programme consists essentially in an administrative assistance to schedule follow‐up visits and in a nurse follow‐up during 2 to 6 months and aims to reduce the annual heart failure readmission rate by 30%. This study assessed three quantitative aims: the cost to avoid a readmission for heart failure within 1 year (primary aim, intended sample size 404 patients), clinical care pathways, and system economic outcomes; and two qualitative aims: perceived problems and benefits of the PRADO‐IC. All analyses will be gathered at the end of study for a joint interpretation. Strengths of this study design are the randomized controlled design, the population included in six centres with low motivation bias, the primary efficiency analysis, the secondary efficacy analyses on care pathway and clinical outcomes, and the joint qualitative analysis. Limits are the heterogeneity of centres and of intervention in a control group and parallel development of other new therapeutic interventions in this field. Conclusions The results of this study may help decision‐makers to support an administratively managed transition programme.
Published: 2021
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5. Anticoagulant selection in relation to the SAMe-TT2R2 score in patients with atrial fibrillation: The GLORIA-AF registry

Author: George Ntaios, Menno V. Huisman, Hans-Christoph Diener, Jonathan L. Halperin, Christine Teutsch, Sabrina Marler, Venkatesh K. Gurusamy, Milla Thompson, Gregory Y.H. Lip, Brian Olshansky, Dzifa Wosornu Abban, Nasser Abdul, Atilio Marcelo Abud, Fran Adams, Srinivas Addala, Pedro Adragão, Walter Ageno, Rajesh Aggarwal, Sergio Agosti, Piergiuseppe Agostoni, Francisco Aguilar, Julio Aguilar Linares, Luis Aguinaga, Jameel Ahmed, Allessandro Aiello, Paul Ainsworth, Jorge Roberto Aiub, Raed Al-Dallow, Lisa Alderson, Jorge Antonio Aldrete Velasco, Dimitrios Alexopoulos, Fernando Alfonso Manterola, Pareed Aliyar, David Alonso, Fernando Augusto Alves da Costa, José Amado, Walid Amara, Mathieu Amelot, Nima Amjadi, Fabrizio Ammirati, Marianna Andrade, Nabil Andrawis, Giorgio Annoni, Gerardo Ansalone, M.Kevin Ariani, Juan Carlos Arias, Sébastien Armero, Chander Arora, Muhammad Shakil Aslam, M. Asselman, Philippe Audouin, Charles Augenbraun, S. Aydin, Ivaneta Ayryanova, Emad Aziz, Luciano Marcelo Backes, E. Badings, Ermentina Bagni, Seth H. Baker, Richard Bala, Antonio Baldi, Shigenobu Bando, Subhash Banerjee, Alan Bank, Gonzalo Barón Esquivias, Craig Barr, Maria Bartlett, Vanja Basic Kes, Giovanni Baula, Steffen Behrens, Alan Bell, Raffaella Benedetti, Juan Benezet Mazuecos, Bouziane Benhalima, Jutta Bergler-Klein, Jean-Baptiste Berneau, Richard A. Bernstein, Percy Berrospi, Sergio Berti, Andrea Berz, Elizabeth Best, Paulo Bettencourt, Robert Betzu, Ravi Bhagwat, Luna Bhatta, Francesco Biscione, Giovanni BISIGNANI, Toby Black, Michael J. Bloch, Stephen Bloom, Edwin Blumberg, Mario Bo, Ellen Bøhmer, Andreas Bollmann, Maria Grazia Bongiorni, Giuseppe Boriani, D.J. Boswijk, Jochen Bott, Edo Bottacchi, Marica Bracic Kalan, Drew Bradman, Donald Brautigam, Nicolas Breton, P.J.A.M. Brouwers, Kevin Browne, Jordi Bruguera Cortada, A. Bruni, Claude Brunschwig, Hervé Buathier, Aurélie Buhl, John Bullinga, Jose Walter Cabrera, Alberto Caccavo, Shanglang Cai, Sarah Caine, Leonardo Calò, Valeria Calvi, Mauricio Camarillo Sánchez, Rui Candeias, Vincenzo Capuano, Alessandro Capucci, Ronald Caputo, Tatiana Cárdenas Rizo, Francisco Cardona, Francisco Carlos da Costa Darrieux, Yan Carlos Duarte Vera, Antonio Carolei, Susana Carreño, Paula Carvalho, Susanna Cary, Gavino Casu, Claudio Cavallini, Guillaume Cayla, Aldo Celentano, Tae-Joon Cha, Kwang Soo Cha, Jei Keon Chae, Kathrine Chalamidas, Krishnan Challappa, Sunil Prakash Chand, Harinath Chandrashekar, Ludovic Chartier, Kausik Chatterjee, Carlos Antero Chavez Ayala, Aamir Cheema, Amjad Cheema, Lin Chen, Shih-Ann Chen, Jyh Hong Chen, Fu-Tien Chiang, Francesco Chiarella, Lin Chih-Chan, Yong Keun Cho, Jong-Il Choi, Dong Ju Choi, Guy Chouinard, Danny Hoi-Fan Chow, Dimitrios Chrysos, Galina Chumakova, Eduardo Julián José Roberto Chuquiure Valenzuela, Nicoleta Cindea Nica, David J. Cislowski, Anthony Clay, Piers Clifford, Andrew Cohen, Michael Cohen, Serge Cohen, Furio Colivicchi, Ronan Collins, Paolo Colonna, Steve Compton, Derek Connolly, Alberto Conti, Gabriel Contreras Buenostro, Gregg Coodley, Martin Cooper, Julian Coronel, Giovanni Corso, Juan Cosín Sales, Yves Cottin, John Covalesky, Aurel Cracan, Filippo Crea, Peter Crean, James Crenshaw, Tina Cullen, Harald Darius, Patrick Dary, Olivier Dascotte, Ira Dauber, Vicente Davalos, Ruth Davies, Gershan Davis, Jean-Marc Davy, Mark Dayer, Marzia De Biasio, Silvana De Bonis, Raffaele De Caterina, Teresiano De Franceschi, J.R. de Groot, José De Horta, Axel De La Briolle, Gilberto de la Pena Topete, Angelo Amato Vicenzo de Paola, Weimar de Souza, A. de Veer, Luc De Wolf, Eric Decoulx, Sasalu Deepak, Pascal Defaye, Freddy Del-Carpio Munoz, Diana Delic Brkljacic, N. Joseph Deumite, Silvia Di Legge, Igor Diemberger, Denise Dietz, Pedro Dionísio, Qiang Dong, Fabio Rossi dos Santos, Elena Dotcheva, Rami Doukky, Anthony D'Souza, Simon Dubrey, Xavier Ducrocq, Dmitry Dupljakov, Mauricio Duque, Dipankar Dutta, Nathalie Duvilla, A. Duygun, Rainer Dziewas, Charles B. Eaton, William Eaves, L.A. Ebels-Tuinbeek, Clifford Ehrlich, Sabine Eichinger-Hasenauer, Steven J. Eisenberg, Adnan El Jabali, Mahfouz El Shahawy, Mauro Esteves Hernandes, Ana Etxeberria Izal, Rudolph Evonich, III, Oksana Evseeva, Andrey Ezhov, Raed Fahmy, Quan Fang, Ramin Farsad, Laurent Fauchier, Stefano Favale, Maxime Fayard, Jose Luis Fedele, Francesco Fedele, Olga Fedorishina, Steven R. Fera, Luis Gustavo Gomes Ferreira, Jorge Ferreira, Claudio Ferri, Anna Ferrier, Hugo Ferro, Alexandra Finsen, Brian First, Stuart Fischer, Catarina Fonseca, Luísa Fonseca Almeida, Steven Forman, Brad Frandsen, William French, Keith Friedman, Athena Friese, Ana Gabriela Fruntelata, Shigeru Fujii, Stefano Fumagalli, Marta Fundamenski, Yutaka Furukawa, Matthias Gabelmann, Nashwa Gabra, Niels Gadsbøll, Michel Galinier, Anders Gammelgaard, Priya Ganeshkumar, Christopher Gans, Antonio Garcia Quintana, Olivier Gartenlaub, Achille Gaspardone, Conrad Genz, Frédéric Georger, Jean-Louis Georges, Steven Georgeson, Evaldas Giedrimas, Mariusz Gierba, Ignacio Gil Ortega, Eve Gillespie, Alberto Giniger, Michael C. Giudici, Alexandros Gkotsis, Taya V. Glotzer, Joachim Gmehling, Jacek Gniot, Peter Goethals, Seth Goldbarg, Ronald Goldberg, Britta Goldmann, Sergey Golitsyn, Silvia Gómez, Juan Gomez Mesa, Vicente Bertomeu Gonzalez, Jesus Antonio Gonzalez Hermosillo, Víctor Manuel González López, Hervé Gorka, Charles Gornick, Diana Gorog, Venkat Gottipaty, Pascal Goube, Ioannis Goudevenos, Brett Graham, G. Stephen Greer, Uwe Gremmler, Paul G. Grena, Martin Grond, Edoardo Gronda, Gerian Grönefeld, Xiang Gu, Ivett Guadalupe Torres Torres, Gabriele Guardigli, Carolina Guevara, Alexandre Guignier, Michele Gulizia, Michael Gumbley, Albrecht Günther, Andrew Ha, Georgios Hahalis, Joseph Hakas, Christian Hall, Bing Han, Seongwook Han, Joe Hargrove, David Hargroves, Kenneth B. Harris, Tetsuya Haruna, Emil Hayek, Jeff Healey, Steven Hearne, Michael Heffernan, Geir Heggelund, J.A. Heijmeriks, Maarten Hemels, I. Hendriks, Sam Henein, Sung-Ho Her, Paul Hermany, Jorge Eduardo Hernández Del Río, Yorihiko Higashino, Michael Hill, Tetsuo Hisadome, Eiji Hishida, Etienne Hoffer, Matthew Hoghton, Kui Hong, Suk keun Hong, Stevie Horbach, Masataka Horiuchi, Yinglong Hou, Jeff Hsing, Chi-Hung Huang, David Huckins, kathy Hughes, A. Huizinga, E.L. Hulsman, Kuo-Chun Hung, Gyo-Seung Hwang, Margaret Ikpoh, Davide Imberti, Hüseyin Ince, Ciro Indolfi, Shujiro Inoue, Didier Irles, Harukazu Iseki, C. Noah Israel, Bruce Iteld, Venkat Iyer, Ewart Jackson-Voyzey, Naseem Jaffrani, Frank Jäger, Martin James, Sung-Won Jang, Nicolas Jaramillo, Nabil Jarmukli, Robert J. Jeanfreau, Ronald D. Jenkins, Carlos Jerjes Sánchez, Javier Jimenez, Robert Jobe, Tomas Joen-Jakobsen, Nicholas Jones, Jose Carlos Moura Jorge, Bernard Jouve, Byung Chun Jung, Kyung Tae Jung, Werner Jung, Mikhail Kachkovskiy, Krystallenia Kafkala, Larisa Kalinina, Bernd Kallmünzer, Farzan Kamali, Takehiro Kamo, Priit Kampus, Hisham Kashou, Andreas Kastrup, Apostolos Katsivas, Elizabeth Kaufman, Kazuya Kawai, Kenji Kawajiri, John F. Kazmierski, P. Keeling, José Francisco Kerr Saraiva, Galina Ketova, AJIT Singh Khaira, Aleksey Khripun, Doo-Il Kim, Young Hoon Kim, Nam Ho Kim, Dae Kyeong Kim, Jeong Su Kim, June Soo Kim, Ki Seok Kim, Jin bae Kim, Elena Kinova, Alexander Klein, James J. Kmetzo, G. Larsen Kneller, Aleksandar Knezevic, Su Mei Angela Koh, Shunichi Koide, Anastasios Kollias, J.A. Kooistra, Jay Koons, Martin Koschutnik, William J. Kostis, Dragan Kovacic, Jacek Kowalczyk, Natalya Koziolova, Peter Kraft, Johannes A. Kragten, Mori Krantz, Lars Krause, B.J. Krenning, F. Krikke, Z. Kromhout, Waldemar Krysiak, Priya Kumar, Thomas Kümler, Malte Kuniss, Jen-Yuan Kuo, Achim Küppers, Karla Kurrelmeyer, Choong Hwan Kwak, Bénédicte Laboulle, Arthur Labovitz, Wen Ter Lai, Andy Lam, Yat Yin Lam, Fernando Lanas Zanetti, Charles Landau, Giancarlo Landini, Estêvão Lanna Figueiredo, Torben Larsen, Karine Lavandier, Jessica LeBlanc, Moon Hyoung Lee, Chang-Hoon Lee, John Lehman, Ana Leitão, Nicolas Lellouche, Malgorzata Lelonek, Radoslaw Lenarczyk, T. Lenderink, Salvador León González, Peter Leong-Sit, Matthias Leschke, Nicolas Ley, Zhanquan Li, Xiaodong Li, Weihua Li, Xiaoming Li, Christhoh Lichy, Ira Lieber, Ramon Horacio Limon Rodriguez, Hailong Lin, Feng Liu, Hengliang Liu, Guillermo Llamas Esperon, Nassip Llerena Navarro, Eric Lo, Sergiy Lokshyn, Amador López, José Luís López-Sendón, Adalberto Menezes Lorga Filho, Richard S. Lorraine, Carlos Alberto Luengas, Robert Luke, Ming Luo, Steven Lupovitch, Philippe Lyrer, Changsheng Ma, Genshan Ma, Irene Madariaga, Koji Maeno, Dominique Magnin, Gustavo Maid, Sumeet K. Mainigi, Konstantinos Makaritsis, Rohit Malhotra, Rickey Manning, Athanasios Manolis, Helard Andres Manrique Hurtado, Ioannis Mantas, Fernando Manzur Jattin, Vicky Maqueda, Niccolo Marchionni, Francisco Marin Ortuno, Antonio Martín Santana, Jorge Martinez, Petra Maskova, Norberto Matadamas Hernandez, Katsuhiro Matsuda, Tillmann Maurer, Ciro Mauro, Erik May, Nolan Mayer, John McClure, Terry McCormack, William McGarity, Hugh McIntyre, Brent McLaurin, Feliz Alvaro Medina Palomino, Francesco Melandri, Hiroshi Meno, Dhananjai Menzies, Marco Mercader, Christian Meyer, Beat j. Meyer, Jacek Miarka, Frank Mibach, Dominik Michalski, Patrik Michel, Rami Mihail Chreih, Ghiath Mikdadi, Milan Mikus, Davor Milicic, Constantin Militaru, Sedi Minaie, Bogdan Minescu, Iveta Mintale, Tristan Mirault, Michael J. Mirro, Dinesh Mistry, Nicoleta Violeta Miu, Naomasa Miyamoto, Tiziano Moccetti, Akber Mohammed, Azlisham Mohd Nor, Michael Mollerus, Giulio Molon, Sergio Mondillo, Patrícia Moniz, Lluis Mont, Vicente Montagud, Oscar Montaña, Cristina Monti, Luciano Moretti, Kiyoo Mori, Andrew Moriarty, Jacek Morka, Luigi Moschini, Nikitas Moschos, Andreas Mügge, Thomas J. Mulhearn, Carmen Muresan, Michela Muriago, Wlodzimierz Musial, Carl W. Musser, Francesco Musumeci, Thuraia Nageh, Hidemitsu Nakagawa, Yuichiro Nakamura, Toru Nakayama, Gi-Byoung Nam, Michele Nanna, Indira Natarajan, Hemal M. Nayak, Stefan Naydenov, Jurica Nazli, Alexandru Cristian Nechita, Libor Nechvatal, Sandra Adela Negron, James Neiman, Fernando Carvalho Neuenschwander, David Neves, Anna Neykova, Ricardo Nicolás Miguel, George Nijmeh, Alexey Nizov, Rodrigo Noronha Campos, Janko Nossan, Tatiana Novikova, Ewa Nowalany-Kozielska, Emmanuel Nsah, Juan Carlos Nunez Fragoso, Svetlana Nurgalieva, Dieter Nuyens, Ole Nyvad, Manuel Odin de Los Rios Ibarra, Philip O'Donnell, Martin O'Donnell, Seil Oh, Yong Seog Oh, Dongjin Oh, Gilles O'Hara, Kostas Oikonomou, Claudia Olivares, Richard Oliver, Rafael Olvera Ruiz, Christoforos Olympios, Anna omaszuk-Kazberuk, Joaquín Osca Asensi, eena Padayattil jose, Francisco Gerardo Padilla Padilla, Victoria Padilla Rios, Giuseppe Pajes, A. Shekhar Pandey, Gaetano Paparella, F. Paris, Hyung Wook Park, Jong Sung Park, Fragkiskos Parthenakis, Enrico Passamonti, Rajesh J. Patel, Jaydutt Patel, Mehool Patel, Janice Patrick, Ricardo Pavón Jimenez, Analía Paz, Vittorio Pengo, William Pentz, Beatriz Pérez, Alma Minerva Pérez Ríos, Alejandro Pérez-Cabezas, Richard Perlman, Viktor Persic, Francesco Perticone, Terri K. Peters, Sanjiv Petkar, Luis Felipe Pezo, Christian Pflücke, David N. Pham, Roland T. Phillips, Stephen Phlaum, Denis Pieters, Julien Pineau, Arnold Pinter, Fausto Pinto, R. Pisters, Nediljko Pivac, Darko Pocanic, Cristian Podoleanu, Alessandro Politano, Zdravka Poljakovic, Stewart Pollock, Jose Polo Garcéa, Holger Poppert, Maurizio Porcu, Antonio Pose Reino, Neeraj Prasad, Dalton Bertolim Précoma, Alessandro Prelle, John Prodafikas, Konstantin Protasov, Maurice Pye, Zhaohui Qiu, Jean-Michel Quedillac, Dimitar Raev, Carlos Antonio Raffo Grado, Sidiqullah Rahimi, Arturo Raisaro, Bhola Rama, Ricardo Ramos, Maria Ranieri, Nuno Raposo, Eric Rashba, Ursula Rauch-Kroehnert, Ramakota Reddy, Giulia Renda, Shabbir Reza, Luigi Ria, Dimitrios Richter, Hans Rickli, Werner Rieker, Tomas Ripolil Vera, Luiz Eduardo Ritt, Douglas Roberts, Ignacio Rodriguez Briones, Aldo Edwin Rodriguez Escudero, Carlos Rodríguez Pascual, Mark Roman, Francesco Romeo, E. Ronner, Jean-Francois Roux, Nadezda Rozkova, Miroslav Rubacek, Frank Rubalcava, Andrea M. Russo, Matthieu Pierre Rutgers, Karin Rybak, Samir Said, Tamotsu Sakamoto, Abraham Salacata, Adrien Salem, Rafael Salguero Bodes, Marco A. Saltzman, Alessandro Salvioni, Gregorio Sanchez Vallejo, Marcelo Sanmartín Fernández, Wladmir Faustino Saporito, Kesari Sarikonda, Taishi Sasaoka, Hamdi Sati, Irina Savelieva, Pierre-Jean Scala, Peter Schellinger, Carlos Scherr, Lisa Schmitz, Karl-Heinz Schmitz, Bettina Schmitz, Teresa Schnabel, Steffen Schnupp, Peter Schoeniger, Norbert Schön, Peter Schwimmbeck, Clare Seamark, Greg Searles, Karl-Heinz Seidl, Barry Seidman, Jaroslaw Sek, Lakshmanan Sekaran, Carlo SERRATI, Neerav Shah, Vinay Shah, Anil Shah, Shujahat Shah, Vijay Kumar Sharma, Louise Shaw, Khalid H. Sheikh, Naruhito Shimizu, Hideki Shimomura, Dong-Gu Shin, Eun-Seok Shin, Junya Shite, Gerolamo Sibilio, Frank Silver, Iveta Sime, Tim A. Simmers, Narendra Singh, Peter Siostrzonek, Didier Smadja, David W. Smith, Marcelo Snitman, Dario Sobral Filho, Hassan Soda, Carl Sofley, Adam Sokal, Yannie Soo Oi Yan, Rodolfo Sotolongo, Olga Ferreira de Souza, Jon Arne Sparby, Jindrich Spinar, David Sprigings, Alex C. Spyropoulos, Dimitrios Stakos, Clemens Steinwender, George Stergiou, Ian Stiell, Marcus Stoddard, Anastas Stoikov, Witold Streb, Ioannis Styliadis, Guohai Su, Xi Su, Wanda Sudnik, Kai Sukles, Xiaofei Sun, H. Swart, Janko Szavits-Nossan, Jens Taggeselle, Yuichiro Takagi, Amrit Pal Singh Takhar, Angelika Tamm, Katsumi Tanaka, Tanyanan Tanawuttiwat, Sherman Tang, Aylmer Tang, Giovanni Tarsi, Tiziana Tassinari, Ashis Tayal, Muzahir Tayebjee, J.M. ten Berg, Dan Tesloianu, Salem H.K. The, Dierk Thomas, Serge Timsit, Tetsuya Tobaru, Andrzej R. Tomasik, Mikhail Torosoff, Emmanuel Touze, Elina Trendafilova, W. Kevin Tsai, Hung Fat Tse, Hiroshi Tsutsui, Tian Ming Tu, Ype Tuininga, Minang Turakhia, Samir Turk, Wayne Tcurner, Arnljot Tveit, Richard Tytus, C. Valadão, P.F.M.M. van Bergen, Philippe van de Borne, B.J. van den Berg, C. van der Zwaan, M. Van Eck, Peter Vanacker, Dimo Vasilev, Vasileios Vasilikos, Maxim Vasilyev, Srikar Veerareddy, Mario Vega Miño, Asok Venkataraman, Paolo Verdecchia, Francesco Versaci, Ernst Günter Vester, Hubert Vial, Jason Victory, Alejandro Villamil, Marc Vincent, Anthony Vlastaris, Jürgen vom Dahl, Kishor Vora, Robert B. Vranian, Paul Wakefield, Ningfu Wang, Mingsheng Wang, Xinhua Wang, Feng Wang, Tian Wang, Alberta L. Warner, Kouki Watanabe, Jeanne Wei, Christian Weimar, Stanislav Weiner, Renate Weinrich, Ming-Shien Wen, Marcus Wiemer, Preben Wiggers, Andreas Wilke, David Williams, Marcus L. Williams, Bernhard Witzenbichler, Brian Wong, Ka Sing Lawrence Wong, Beata Wozakowska-Kaplon, Shulin Wu, Richard C. Wu, Silke Wunderlich, Nell Wyatt, John (Jack) Wylie, Yong Xu, Xiangdong Xu, Hiroki Yamanoue, Takeshi Yamashita, Ping Yen Bryan Yan, Tianlun Yang, Jing Yao, Kuo-Ho Yeh, Wei Hsian Yin, Yoto Yotov, Ralf Zahn, Stuart Zarich, Sergei Zenin, Elisabeth Louise Zeuthen, Huanyi Zhang, Donghui Zhang, Xingwei Zhang, Ping Zhang, Jun Zhang, Shui Ping Zhao, Yujie Zhao, Zhichen Zhao, Yang Zheng, Jing Zhou, Sergio Zimmermann, Andrea Zini, Steven Zizzo, Wenxia Zong, and L Steven Zukerman
Subjects: SAMe-TT2R2, atrial fibrillation, non-vitamin-K antagonist oral anticoagulants, vitamin-K-antagonist oral anticoagulants, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Aim: The SAMe-TT2R2 score helps identify patients with atrial fibrillation (AF) likely to have poor anticoagulation control during anticoagulation with vitamin K antagonists (VKA) and those with scores >2 might be better managed with a target-specific oral anticoagulant (NOAC). We hypothesized that in clinical practice, VKAs may be prescribed less frequently to patients with AF and SAMe-TT2R2 scores >2 than to patients with lower scores. Methods and results: We analyzed the Phase III dataset of the Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF), a large, global, prospective global registry of patients with newly diagnosed AF and ≥1 stroke risk factor. We compared baseline clinical characteristics and antithrombotic prescriptions to determine the probability of the VKA prescription among anticoagulated patients with the baseline SAMe-TT2R2 score >2 and ≤ 2. Among 17,465 anticoagulated patients with AF, 4,828 (27.6%) patients were prescribed VKA and 12,637 (72.4%) patients an NOAC: 11,884 (68.0%) patients had SAMe-TT2R2 scores 0-2 and 5,581 (32.0%) patients had scores >2. The proportion of patients prescribed VKA was 28.0% among patients with SAMe-TT2R2 scores >2 and 27.5% in those with scores ≤2. Conclusions: The lack of a clear association between the SAMe-TT2R2 score and anticoagulant selection may be attributed to the relative efficacy and safety profiles between NOACs and VKAs as well as to the absence of trial evidence that an SAMe-TT2R2-guided strategy for the selection of the type of anticoagulation in NVAF patients has an impact on clinical outcomes of efficacy and safety. The latter hypothesis is currently being tested in a randomized controlled trial. Clinical trial registration: URL: https://www.clinicaltrials.gov//Unique identifier: NCT01937377, NCT01468701, and NCT01671007.
Published: 2021
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6. Vascular complications and bleeding after balloon aortic valvuloplasty performed with or without heparin: HEPAVALVE randomized study

Author: Mariama Akodad, Jessica Labour, Erika Nogue, Delphine Delseny, Jean-Christophe Macia, Richard Gervasoni, Benoit Lattuca, Nicolas Nagot, François Roubille, Guillaume Cayla, and Florence Leclercq
Subjects: Balloon aortic valvuloplasty, Vascular and bleeding complications, Aortic stenosis, Percutaneous interventions, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Background: Vascular and bleeding events remain the main complications after balloon aortic valvuloplasty (BAV). While BAV is usually performed with per procedural heparin injection, BAV performed without heparin may reduce hemorrhagic events. We aimed to determine whether vascular and bleeding complications may be reduced with BAV performed without heparin. Methods: This randomized, double-blind, placebo-controlled study was conducted from January 2013 to September 2016. Patients were randomly assigned to placebo or intravenous unfractionated heparin (UH) 50 IU/kg bolus during the procedure. The primary endpoint included major vascular, bleeding and ischemic complications (stroke, transient ischemic attack, myocardial infarction) according to VARC-2 criteria. Results: Among 89 randomized patients, 82 completed the study (n = 39 in the UH group and n = 43 in the placebo group). At baseline, diabetes, sex male and renal failure were more frequent in the UH group and peripheral artery disease was more frequent in the placebo group. The primary endpoint was achieved in 7 patients (8.5%), 1 in the placebo group (2.3%) versus 6 in the UH group (15.4%). After adjustment on diabetes, sex, renal failure, peripheral artery disease, percutaneous closure device and chronic obstructive pulmonary disease, UH utilization was associated with a significant risk of major vascular, bleeding and ischemic complications (primary endpoint) (adjOR: 11.9; 95%CI: 1.2–117.2; p = 0.03). Hospitalization length was lower in the placebo group compared to the UH group (p = 0.03). Conclusions: BAV without per procedural UH was associated with a reduction of major VC and bleeding events without increasing the ischemic risk and with a shorter hospitalization length.
Published: 2022
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7. Indirect Transfer to Catheterization Laboratory for ST Elevation Myocardial Infarction Is Associated With Mortality Independent of System Delays: Insights From the France-PCI Registry

Author: Farzin Beygui, Vincent Roule, Fabrice Ivanes, Thierry Dechery, Olivier Bizeau, Laurent Roussel, Philippe Dequenne, Marc-Antoine Arnould, Nicolas Combaret, Jean Philippe Collet, Philippe Commeau, Guillaume Cayla, Gilles Montalescot, Hakim Benamer, Pascal Motreff, Denis Angoulvant, Pierre Marcollet, Stephan Chassaing, Katrien Blanchart, René Koning, and Grégoire Rangé
Subjects: ST-elevation myocardial infarction, Pre-hospital, percutaneous coronary intervention, mortality, system delays, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: BackgroundFirst medical contact (FMC)-to-balloon time is associated with outcome of ST-elevation myocardial infarction (STEMI). We assessed the impact on mortality and the determinants of indirect vs. direct transfer to the cardiac catheterization laboratory (CCL).MethodsWe analyzed data from 2,206 STEMI patients consecutively included in a prospective multiregional percutaneous coronary intervention (PCI) registry. The primary endpoint was 1-year mortality. The impact of indirect admission to CCL on mortality was assessed using Cox models adjusted on FMC-to-balloon time and covariables unequally distributed between groups. A multivariable logistic regression model assessed determinants of indirect transfer.ResultsA total of 359 (16.3%) and 1847 (83.7%) were indirectly and directly admitted for PCI. Indirect admission was associated with higher risk features, different FMCs and suboptimal pre-PCI antithrombotic therapy.At 1-year follow-up, 51 (14.6%) and 137 (7.7%) were dead in the indirect and direct admission groups, respectively (adjusted-HR 1.73; 95% CI 1.22–2.45). The association of indirect admission with mortality was independent of pre-FMC and FMC characteristics. Older age, paramedics- and private physician-FMCs were independent determinants of indirect admission (adjusted-HRs 1.02 per year, 95% CI 1.003–1.03; 5.94, 95% CI 5.94 3.89–9.01; 3.41; 95% CI 1.86–6.2, respectively).ConclusionsOur study showed that, indirect admission to PCI for STEMI is associated with 1-year mortality independent of FMC to balloon time and should be considered as an indicator of quality of care. Indirect admission is associated with higher-risk features and suboptimal antithrombotic therapy. Older age, paramedics-FMC and self-presentation to a private physician were independently associated with indirect admission. Our study, supports population education especially targeting elderly, more adequately dispatched FMC and improved pre-CCL management.
Published: 2022
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8. Atrial fibrillation screening on systematic ambulatory electrocardiogram monitoring after percutaneous patent foramen ovale closure: A prospective study

Author: Florence Leclercq, Xavier Odorico, Gregory Marin, Jean Christophe Macia, Delphine Delseny, Audrey Agullo, Laurence Pages, Pierre Robert, Benoit Lattuca, Guillaume Cayla, François Roubille, Nicolas Gaillard, Caroline Arquizan, and Mariama Akodad
Subjects: Atrial Fibrillation, Holter Monitoring, Patent foramen ovale, Percutaneous closure, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Background: Increased risk of new-onset atrial fibrillation (AF) after patent foramen ovale (PFO) closure was observed in randomized trials without however systematic AF screening. We aimed to evaluate the incidence of AF within 6-month following PFO closure with serial 24-hour ambulatory electrocardiogram (AECG) monitoring. Methods: All patients undergoing PFO closure were prospectively included in 2 centers. AF was defined as irregular rhythm without discernible P waves > 30 s on AECG at day 0, 1-month and 6-month follow-up. Primary endpoint was the incidence of AF within the study period. Secondary endpoints evaluated clinical outcomes within 6-month follow-up. Results: Between February 2018 and March 2019, 62 patients underwent PFO closure including 40 male (64.5%) with a mean age of 48 ± 9.5. Atrial septal aneurysm was observed in 37 patients (64.9%), 57 patients (91.9%) received an Amplatzer Occluder device (Abbott Vascular) and 5 (8.1%) an Occlutech device (Occlutech). After a mean follow-up of 7.7 ± 2.8 months, new-onset AF occurred in 3 patients (4.8%), all within the first month following PFO closure, including one per-procedural, all were asymptomatic and paroxysmal. Two patients with AF (3.2%) required chronic oral anticoagulant therapy. No adverse outcomes occurred at follow-up. No predictive factors of AF were highlighted. A total of 16 patients (25.8%) reported palpitations without AF on the AECGs. Conclusion: In highly selected patients, incidence of AF, evaluated with 3 systematic 24-hour AECG within 6-month following PFO closure, was low (
Published: 2021
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9. Recanalized Coronary Thrombus

Author: Flavien Vincent, MD, PhD, Bertrand Ledermann, MD, Jean-Etienne Ricci, MD, Guillaume Cayla, MD, PhD, and Benoit Lattuca, MD, PhD
Subjects: angiographic haziness, coronary artery disease, endocoronary imaging, lotus root, optical coherence tomography, percutaneous coronary intervention, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Pathological studies have revealed spontaneous recanalized coronary thrombi as a frequent evolution of coronary occlusions; however, they are poorly recognized on coronary angiography, and the optimal therapeutic strategy for clinical evolution is unknown. We report the role of optical coherence tomography in identifying a recanalized coronary thrombus causing myocardial ischemia after 11 years of follow-up. (Level of Difficulty: Intermediate.)
Published: 2020
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10. Management of acute heart failure: Contribution of daily bedside echocardiographic assessment on therapy adjustment with impact measure on the 30-day readmission rate (JECICA)

Author: Jean-Etienne Ricci, Eran Kalmanovich, Christelle Robert, Thierry Chevallier, Sylvain Aguilhon, Kamila Solecki, Mariama Akodad, Luc Cornillet, Camille soullier, Guillaume Cayla, Benoit Lattuca, and François Roubille
Subjects: Medicine (General), R5-920
Abstract: There are currently one million heart failure (HF) patients in France and the rate is progressively increases due to population aging. Acute decompensation of HF is the leading cause of hospitalization in people over 65 years of age with a 25% re-hospitalization rate in the first month. Expenses related to the management of HF in France in 2013 amounted to more than one billion euros, of which 65% were for hospitalizations alone. The management of acute decompensation is a challenge, due to the complexity of clinical and laboratory evaluation leading to therapeutic errors, which in turn leads to longer hospitalization, high early re-hospitalization and complications. Therapeutic adjustment, especially diuretic, in the acute phase (during hospitalization) affects early re-hospitalization rates (within 30 days). These adjustments can be based on clinical estimation and laboratory parameters, but echocardiography has been shown to be superior in estimating filling pressures (FP) compared to clinical and laboratory parameters.We hypothesize that a simple daily bedside echocardiographic assessment could provide a reproducible estimation of FP with an evaluation of mitral inflow and the inferior vena cava (IVC). This could allow a more reliable estimate of the true blood volume of the patient and thus lead to a more suitable therapeutic adjustment. This in turn should lead to a decrease in early re-admission rate (primary endpoint) and potentially decrease six-month mortality and rate of complications. Keywords: Heart failure, Doppler echocardiography, Diuretics, Filling pressure, Cava venous, Trans-mitral doppler, Left ventricular ejection fraction
Published: 2018
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11. Myocardial Infarction incidence during national lockdown in two French provinces unevenly affected by COVID-19 outbreak: An observational study

Author: Eric Van Belle, Thibault Manigold, Adeline Piérache, Alain Furber, Nicolas Debry, Anne Luycx-Bore, Jean-Jacques Bauchart, Olivier Nugue, François Huchet, Mathieu Bic, François Vinchon, Smaïn Sayah, Alexandre Fournier, Eric Decoulx, Usman Mouhammad, Jérôme Clerc, Aurélie Manchuelle, Tahar Lazizi, Akram Chmait, Julien Jeannetteau, Pierre Hénon, Mickael Bonin, Marie Dupret-Minet, Ashok Tirouvanziam, David Molcard, Fabien Arabucki, Antoine Py, Fabrice Prunier, Cédric Delhaye, Gilles Lemesle, Guillaume Schurtz, Alessandro Cosenza, Hugues Spillemaeker, Basile Verdier, Tom Denimal, Thibault Pamart, Habib Sylla, Dany Janah, David Aouate, Sina Porouchani, Valérie Guillez, Guillaume Bonnet, Julien Ternacle, Julien Labreuche, Guillaume Cayla, and Flavien Vincent
Subjects: COVID-19 outbreak, Myocardial Infarction, Clinical outcome, Mortality, Public aspects of medicine, RA1-1270
Abstract: Background: A reduction of admission for MI has been reported in most countries affected by COVID-19. No clear explanation has been provided. Methods: To report the incidence of myocardial infarction (MI) admission during COVID-19 pandemic and in particular during national lockdown in two unequally affected French provinces (10-million inhabitants) with a different media strategy, and to describe the magnitude of MI incidence changes relative to the incidence of COVID-19-related deaths. A longitudinal study to collect all MIs from January 1 until May 17, 2020 (study period) and from the identical time period in 2019 (control period) was conducted in all centers with PCI-facilities in northern “Hauts-de-France” province and western “Pays-de-la-Loire” Province. The incidence of COVID-19 fatalities was also collected. Findings: In “Hauts-de-France”, during lockdown (March 18–May 10), 1500 COVID-19-related deaths were observed. A 23% decrease in MI-IR (IRR=0.77;95%CI:0.71–0.84, p
Published: 2021
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12. Plasma proteomic changes in patients with non-valvular atrial fibrillation starting rivaroxaban treatment: A pilot study

Author: Jean-Christophe Gris, Jean-Marc Monneuse, Laurent Borderie, Isabelle Metton, Géraldine Lavigne, Gilbert Skorski, Pierre Winum, Mathieu Granier, and Guillaume Cayla
Subjects: Proteomics, Atrial fibrillation, Rivaroxaban, Inflammation, Hemolysis, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Introduction: Direct oral anticoagulants (DOACs) also influence cell signaling in various cell types, thus affecting biological systems other than coagulation, whose markers are uncertain. Material and methods: To perform a pilot study of variations in plasma protein by means of Liquid chromatography–high resolution tandem mass spectrometry (LC-HRMS/MS) in 5 patients with newly-diagnosed non-valvular atrial fibrillation (NVAF) starting rivaroxaban anti-FXa DOAC treatment. Results: A total of 260 proteins could be identified in plasma samples obtained before treatment and at one month of treatment. A significant sustained variation in their concentrations (doubling or halving) was evidenced in at least one patient. These variations were heterogeneous and inconstant from one patient to another. Their most striking feature was the downregulation of proteins participating in the inflammatory system reaction, and of proteins related to intravascular hemolysis. Other variations were rarer and more erratic. Conclusions: Individual rivaroxaban treatment-associated variations in protein were evidenced in patients with NVAF starting rivaroxaban. This should now be tested and confirmed with a large series of carefully annotated patients. Confirming these established variations would open the door to the search for clinically-relevant correlations and consequences, if any.
Published: 2021
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13. Myocardial Injury After Balloon Predilatation Versus Direct Transcatheter Aortic Valve Replacement: Insights From the DIRECTAVI Trial

Author: Mariama Akodad, François Roubille, Gregory Marin, Benoit Lattuca, Jean‐Christophe Macia, Delphine Delseny, Thomas Gandet, Pierre Robert, Laurent Schmutz, Christophe Piot, Eric Maupas, Gabriel Robert, Frederic Targosz, Bernard Albat, Guillaume Cayla, and Florence Leclercq
Subjects: balloon aortic valvuloplasty, direct implantation, myocardial injury, transcatheter aortic valve replacement, troponin, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Background Myocardial injury is associated with higher mortality after transcatheter aortic valve replacement (TAVR) and might be increased by prior balloon aortic valvuloplasty (BAV). We aimed to evaluate the impact of prior BAV versus direct prosthesis implantation on myocardial injury occurring after (TAVR) with balloon‐expandable prostheses. Methods and Results The DIRECTAVI (Direct Transcatheter Aortic Valve Implantation) trial, an open‐label randomized study, demonstrated noninferiority of TAVR without BAV (direct TAVR group) compared with systematic BAV (BAV group) with the Edwards SAPIEN 3 valve. High‐sensitivity troponin was assessed before and the day after the procedure. Incidence of myocardial injury after the procedure (high‐sensitivity troponin elevation >15× the upper reference limit [14 ng/L]) was the main end point. Impact of myocardial injury on 1‐month adverse events (all‐cause mortality, stroke, major bleeding, major vascular complications, transfusion, acute kidney injury, heart failure, pacemaker implantation, and aortic regurgitation) was evaluated. Preprocedure and postprocedure high‐sensitivity troponin levels were available in 211 patients. The mean age of patients was 83 years (78–87 years), with 129 men (61.1%). Mean postprocedure high‐sensitivity troponin was 124.9±81.4 ng/L in the direct TAVR group versus 170.4±127.7 ng/L in the BAV group (P=0.007). Myocardial injury occurred in 42 patients (19.9%), including 13 patients (12.2%) in the direct TAVR group and 29 (27.9%) in the BAV group (P=0.004). BAV increased by 2.8‐fold (95% CI, 1.4–5.8) myocardial injury probability. Myocardial injury was associated with 1‐month adverse events (P=0.03). Conclusions BAV increased the incidence and magnitude of myocardial injury after TAVR with new‐generation balloon‐expandable valves. Myocardial injury was associated with 1‐month adverse events. These results argue in favor of direct SAPIEN 3 valve implantation. Registration URL: https://www.Clinicaltrials.gov; Unique identifier: NCT02729519.
Published: 2020
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14. Prior balloon valvuloplasty versus DIRECT transcatheter Aortic Valve Implantation (DIRECTAVI): study protocol for a randomized controlled trial

Author: Florence Leclercq, Pierre Robert, Jessica Labour, Benoit Lattuca, Mariama Akodad, Jean-Christophe Macia, Richard Gervasoni, Francois Roubille, Thomas Gandet, Laurent Schmutz, Erika Nogue, Nicolas Nagot, Bernard Albat, and Guillaume Cayla
Subjects: Transcatheter aortic valve implantation (TAVI), Balloon aortic valvuloplasty, Procedural success, Safety, Randomized clinical trial, Medicine (General), R5-920
Abstract: Abstract Background Balloon predilatation of the aortic valve has been regarded as an essential step during the transcatheter aortic valve implantation (TAVI) procedure. However, recent evidence has suggested that aortic valvuloplasty may cause complications and that high success rates may be obtained without prior dilatation of the valve. We hypothesize that TAVI performed without predilatation of the aortic valve and using new-generation balloon-expandable transcatheter heart valves is associated with a better net clinical benefit than TAVI performed with predilatation. Methods/design The transcatheter aortic valve implantation without prior balloon dilatation (DIRECTAVI) trial is a randomized controlled open label trial that includes 240 patients randomized to TAVI performed with prior balloon valvuloplasty (control arm) or direct implantation of the valve (test arm). All patients with an indication for TAVI will be included excepting those requiring transapical access. The trial tests the hypothesis that the strategy of direct implantation of the new-generation balloon-expandable SAPIEN 3 valve is noninferior to current medical practice using predilatation of the valve. The primary endpoint assessing efficacy and safety of the procedure consists of immediate procedural success and secondary endpoints include complications at 30-day follow-up (VARC-2 criteria). A subgroup analysis evaluates neurological ischemic events with cerebral MRI imaging (25 patients in each strategy group) performed before and between 1 and 3 days after the procedure. Discussion This prospective randomized study is designed to assess the efficacy and safety of TAVI performed without prior dilatation of the aortic valve using new-generation balloon-expandable transcatheter heart valves. We aim to provide robust evidence of the advantages of this strategy to allow the interventional cardiologist to use it in everyday practice. Trial registration ClinicalTrials.gov identifier: NCT02729519 . Registered on 15 July 2016.
Published: 2017
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15. Hospital burden of coronary artery disease: Trends of myocardial infarction and/or percutaneous coronary interventions in France 2009-2014.

Author: Jessica Pinaire, Jérôme Azé, Sandra Bringay, Guillaume Cayla, and Paul Landais
Subjects: Medicine, Science
Abstract: BackgroundCurrently, cardiovascular disease (CVD) is widely acknowledged to be the first leading cause of fatality in the world with 31% of all deaths worldwide and is predicted to remain as such in 2030. Furthermore, CVD is also a major cause of morbidity in adults worldwide. Among these diseases, the coronary artery disease (CAD) is the most common cause, accounting for over 40% of CVD deaths. Despite a decline in mortality rates, the consequences of more effective preventive and management programs, the burden of CAD remains significant. Indeed, the rise in the prevalence of modifiable risk factors due to changes in lifestyle and health behaviors has further increased the burden of this epidemic. Our objective was to evaluate the hospital burden of CAD via MI trends and Percutaneous Coronary Intervention (PCI) in the French Prospective Payment System (PPS).MethodsMI/PCI were identified in the national PPS database from 2009 to 2014 for patients aged 20 to 99, living in metropolitan France. We examined hospitalisation, readmission and mortality trends using standardised rates.ResultsOver the six-year period, we identified 678,021 patients, representing 900,121 stays of which, 215,224 had a MI and a PCI. Admission trends increased by nearly 25%. Acute MI cases increased every year, with an alarming increase in women, and more specifically in young women. Men were 3 times more hospitalised than women, who were older. A North-South divide was noted. Twenty seven percent of patients experienced readmission within 1 month. Trajectories of care were significantly different by sex and age. Overall in-hospital death was 3.3%, decreasing by 15% during the period. The highest adjusted mortality rates were observed for inpatients aged 80.ConclusionWe outlined the public health burden of this condition and the importance of improving the trajectories of care as an aid for better care.
Published: 2019
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16. Effect and Safety of Morphine Use in Acute Anterior ST‐Segment Elevation Myocardial Infarction

Author: Mickael Bonin, Nathan Mewton, Francois Roubille, Olivier Morel, Guillaume Cayla, Denis Angoulvant, Meyer Elbaz, Marc J. Claeys, David Garcia‐Dorado, Céline Giraud, Gilles Rioufol, Claire Jossan, Michel Ovize, and Patrice Guerin
Subjects: clinical, morphine, opioid, percutaneous coronary intervention, pharmaceutical safety, ST‐segment elevation myocardial infarction, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: BackgroundMorphine is commonly used to treat chest pain during myocardial infarction, but its effect on cardiovascular outcome has never been directly evaluated. The aim of this study was to examine the effect and safety of morphine in patients with acute anterior ST‐segment elevation myocardial infarction followed up for 1 year. Methods and ResultsWe used the database of the CIRCUS (Does Cyclosporine Improve Outcome in ST Elevation Myocardial Infarction Patients) trial, which included 969 patients with anterior ST‐segment elevation myocardial infarction, admitted for primary percutaneous coronary intervention. Two groups were defined according to use of morphine preceding coronary angiography. The composite primary outcome was the combined incidence of major adverse cardiovascular events, including cardiovascular death, heart failure, cardiogenic shock, myocardial infarction, unstable angina, and stroke during 1 year. A total of 554 (57.1%) patients received morphine at first medical contact. Both groups, with and without morphine treatment, were comparable with respect to demographic and periprocedural characteristics. There was no significant difference in major adverse cardiovascular events between patients who received morphine compared with those who did not (26.2% versus 22.0%, respectively; P=0.15). The all‐cause mortality was 5.3% in the morphine group versus 5.8% in the no‐morphine group (P=0.89). There was no difference between groups in infarct size as assessed by the creatine kinase peak after primary percutaneous coronary intervention (4023±118 versus 3903±149 IU/L; P=0.52). ConclusionsIn anterior ST‐segment elevation myocardial infarction patients treated by primary percutaneous coronary intervention, morphine was used in half of patients during initial management and was not associated with a significant increase in major adverse cardiovascular events at 1 year.
Published: 2018
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17. Rivaroxaban vs Vitamin K Antagonist in Patients With Atrial Fibrillation and Advanced Chronic Kidney Disease

Author: Laetitia, Albano, Catherine, Albert, Joachim, Alexandre, Ayham, Al-Zoebi, Cedric, Annweiler, Johann, Auer, Sanjeet, Balgobin, Joachim, Beige, Ahmed, Berami, Jean-Baptiste, Berneau, Patrick, Biggar, Ralf, Birkemeyer, Christina, Bondke, Renate, Bonin-Schnabel, Hendrik, Bonnemeier, Marc, Bouiller, Anne-Sophie, Boureau, Johannes, Brachmann, Jörg, Brosche, Sebastien, Caudmont, Guillaume, Cayla, Vianney, Charpy, Joel, Constans, Jean-Baptiste, Dally, Guillaume, De Geeter, Fédéric, Debelle, Eric, Decoulx, Nicolas, Delarche, Georg, Delle Karth, Pascal, Delsart, Michael, Derndorfer, Laurent, Desprets, Jean-Guillaume, Dillinger, Camille, Dubart, Katrin, Eberhard, Sabine, Eichinger-Hasenauer, Volker, Eissing, Christiane, Erley, Jean-Baptiste, Esteve, Emile, Ferrari, Virginie, Fossey-Diaz, Stéphane, Fromentin, Karim, Gallouj, Estelle, Gandjbakhch, Anne-Sophie, Garnier, Laure, Gilis, Bertrand, Gondouin, Franziska, Grundmann, Isabelle, Gueffet, Sebastian, Haaß, Didier, Haguenhauer, Thierry, Hannedouche, Georg, Häusler Karl, Gerd-Ulrich, Heinz, Philipp, Herold, Klaus, Hertting, Etienne, Hoffer, Joachim, Hoyer, Burkhard, Hügl, Sybille, Jänsch, Georges, Jean-Louis, Michael, Jeserich, Werner, Jung, Samuel, Kassis, Bernd-Thomas, Kellner, Marcus, Ketteler, Thomas, Kielstein Jan, René, Koning, Fabian, Krämer, Jean-Marie, Krzesinski, Ulrich, Lammers, Jean-Marie, Lefebvre, Eric, Legrand, Matthias, Leschke, Bernhard-Paul, Lodde, Christian, Maalouli, Christian, Mahnkopf, Sebastien, Mailliez, Jacques, Mansourati, Eloi, Marijon, Christian, Meyer, Detlev, Moll, Gilles, Montalescot, Serge, Motte, Vincent, Mouquet, Krassen, Nedeltchev, Anna, Neykova, Jörg, Nothroff, Raphael, Poyet, Roland, Prondzinsky, Ursula, Rauch-Kröhnert, Frank, Richard, Werner, Rieker, Andrea, Rocco, Thomas, Rostock, Daniel, Scherr, Axel, Schlitt, Hans, Schmidt-Gürtler, Norbert, Schön, Johannes, Schwab, Carsten, Schwencke, Peter, Schwimmbeck, G, Schwinger Robert H., Andreas, Schwittay, Igor, Sibon, Ulrike, Spengler, Alexander, Stadelmann, Clemens, Steinwender, Reinhard, Stöhring, Jean-Claude, Stolear, Guillaume, Taldir, Jean-Michel, Tartière, Serge, Treille, Pierre, Tremolieres, Zead, Tubail, Xavier, Warling, Morgane, Wetzstein, Adrian, Zaman, Claudia, Zemmrich, Kreutz, Reinhold, Deray, Gilbert, Floege, Jürgen, Gwechenberger, Marianne, Hahn, Kai, Luft, Andreas R., Persson, Pontus, Axthelm, Christoph, Beer, Juerg Hans, Bergler-Klein, Jutta, Lellouche, Nicolas, Taggeselle, Jens, Coleman, Craig I., and Beyer-Westendorf, Jan
Published: 2024
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18. Rivaroxaban vs Vitamin K Antagonist in Patients With Atrial Fibrillation and Advanced Chronic Kidney Disease

Author: Kreutz, Reinhold, primary, Deray, Gilbert, additional, Floege, Jürgen, additional, Gwechenberger, Marianne, additional, Hahn, Kai, additional, Luft, Andreas R., additional, Persson, Pontus, additional, Axthelm, Christoph, additional, Beer, Juerg Hans, additional, Bergler-Klein, Jutta, additional, Lellouche, Nicolas, additional, Taggeselle, Jens, additional, Coleman, Craig I., additional, Beyer-Westendorf, Jan, additional, Laetitia, Albano, additional, Catherine, Albert, additional, Joachim, Alexandre, additional, Ayham, Al-Zoebi, additional, Cedric, Annweiler, additional, Johann, Auer, additional, Sanjeet, Balgobin, additional, Joachim, Beige, additional, Ahmed, Berami, additional, Jean-Baptiste, Berneau, additional, Patrick, Biggar, additional, Ralf, Birkemeyer, additional, Christina, Bondke, additional, Renate, Bonin-Schnabel, additional, Hendrik, Bonnemeier, additional, Marc, Bouiller, additional, Anne-Sophie, Boureau, additional, Johannes, Brachmann, additional, Jörg, Brosche, additional, Sebastien, Caudmont, additional, Guillaume, Cayla, additional, Vianney, Charpy, additional, Joel, Constans, additional, Jean-Baptiste, Dally, additional, Guillaume, De Geeter, additional, Fédéric, Debelle, additional, Eric, Decoulx, additional, Nicolas, Delarche, additional, Georg, Delle Karth, additional, Pascal, Delsart, additional, Michael, Derndorfer, additional, Laurent, Desprets, additional, Jean-Guillaume, Dillinger, additional, Camille, Dubart, additional, Katrin, Eberhard, additional, Sabine, Eichinger-Hasenauer, additional, Volker, Eissing, additional, Christiane, Erley, additional, Jean-Baptiste, Esteve, additional, Emile, Ferrari, additional, Virginie, Fossey-Diaz, additional, Stéphane, Fromentin, additional, Karim, Gallouj, additional, Estelle, Gandjbakhch, additional, Anne-Sophie, Garnier, additional, Laure, Gilis, additional, Bertrand, Gondouin, additional, Franziska, Grundmann, additional, Isabelle, Gueffet, additional, Sebastian, Haaß, additional, Didier, Haguenhauer, additional, Thierry, Hannedouche, additional, Georg, Häusler Karl, additional, Gerd-Ulrich, Heinz, additional, Philipp, Herold, additional, Klaus, Hertting, additional, Etienne, Hoffer, additional, Joachim, Hoyer, additional, Burkhard, Hügl, additional, Sybille, Jänsch, additional, Georges, Jean-Louis, additional, Michael, Jeserich, additional, Werner, Jung, additional, Samuel, Kassis, additional, Bernd-Thomas, Kellner, additional, Marcus, Ketteler, additional, Thomas, Kielstein Jan, additional, René, Koning, additional, Fabian, Krämer, additional, Jean-Marie, Krzesinski, additional, Ulrich, Lammers, additional, Jean-Marie, Lefebvre, additional, Eric, Legrand, additional, Matthias, Leschke, additional, Bernhard-Paul, Lodde, additional, Christian, Maalouli, additional, Christian, Mahnkopf, additional, Sebastien, Mailliez, additional, Jacques, Mansourati, additional, Eloi, Marijon, additional, Christian, Meyer, additional, Detlev, Moll, additional, Gilles, Montalescot, additional, Serge, Motte, additional, Vincent, Mouquet, additional, Krassen, Nedeltchev, additional, Anna, Neykova, additional, Jörg, Nothroff, additional, Raphael, Poyet, additional, Roland, Prondzinsky, additional, Ursula, Rauch-Kröhnert, additional, Frank, Richard, additional, Werner, Rieker, additional, Andrea, Rocco, additional, Thomas, Rostock, additional, Daniel, Scherr, additional, Axel, Schlitt, additional, Hans, Schmidt-Gürtler, additional, Norbert, Schön, additional, Johannes, Schwab, additional, Carsten, Schwencke, additional, Peter, Schwimmbeck, additional, G, Schwinger Robert H., additional, Andreas, Schwittay, additional, Igor, Sibon, additional, Ulrike, Spengler, additional, Alexander, Stadelmann, additional, Clemens, Steinwender, additional, Reinhard, Stöhring, additional, Jean-Claude, Stolear, additional, Guillaume, Taldir, additional, Jean-Michel, Tartière, additional, Serge, Treille, additional, Pierre, Tremolieres, additional, Zead, Tubail, additional, Xavier, Warling, additional, Morgane, Wetzstein, additional, Adrian, Zaman, additional, and Claudia, Zemmrich, additional
Published: 2024
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19. βeta blocker interruption after uncomplicated myocardial infarction: rationale and design of the randomized ABYSS trial

Author: Johanne Silvain, Guillaume Cayla, Emile Ferrari, Grégoire Range, Etienne Puymirat, Nicolas Delarche, Jean-Philippe Collet, Raphaelle Dumaine, Michel Slama, Laurent Payot, Mohamad E. Kasty, Karim Aacha, Eric Vicaut, and Gilles Montalescot
Subjects: Cardiology and Cardiovascular Medicine
Published: 2023

20. Clinical Outcomes of Left Main Coronary Artery PCI With Rotational Atherectomy

Author: Frédéric Bouisset, Flavio Ribichini, Vincent Bataille, Krzysztof Reczuch, Thibault Lhermusier, Slawomir Dobrzycki, Markus Meyer-Gessner, Erwan Bressollette, Wojciech Zajdel, Benjamin Faurie, Nikolaos Mezilis, Jorge Palazuelos, Beatriz Vaquerizo, Miroslaw Ferenc, Guillaume Cayla, Emanuele Barbato, and Didier Carrié
Subjects: Atherectomy, Coronary, Percutaneous Coronary Intervention, Treatment Outcome, Humans, Coronary Artery Disease, Coronary Angiography, Vascular Calcification, Cardiology and Cardiovascular Medicine
Abstract: Data regarding rotational atherectomy percutaneous coronary intervention (RA PCI) angioplasty in the left main (LM) coronary artery are scarce, and mostly outdated. We aimed to describe clinical outcomes of RA PCI in LM. Patients requiring RA in 8 European countries and 19 centers were prospectively and consecutively included in the European registry of Cardiac Care of Calcified and Complex patients registry. In-hospital data collection and 1-year follow-up were performed for each patient. Between October 2016 and July 2018, 966 patients with complete data were included. Among them, 241 presented with an LM lesion, and 171 required an LM lesion preparation by RA. The latter, allocated to the LM-RA group, were compared with the 725 patients in the non-LM-RA group. Clinical success of the RA procedure was comparable in both groups, but in-hospital major adverse cardiac events were higher in the RA-LM group (7.6% vs 3.2%, adjusted p = 0.04), mainly driven by a higher in-hospital mortality rate (5.3 vs 0.3%, adjusted p = 0.005). At 1-year follow-up, mortality and major adverse cardiac event rates were comparable in both groups (12.9% vs 8.0%, adjusted p value: 0.821, and 15.8% vs 10.9%, adjusted p value: 0.329, respectively), but the rate of target vessel revascularization remained higher in the RA-LM group (5.3% vs 3.2%, adjusted p = 0.021). In conclusion, RA PCI is an efficient option for calcified LM lesions, providing acceptable outcomes regarding this population with high risk at 1 year, and yields comparable outcomes with RA PCI performed on non-LM lesions.
Published: 2023

21. Immediate versus staged complete myocardial revascularization in patients with ST-segment elevation myocardial infarction and multivessel disease: A post hoc analysis of the randomized FLOWER-MI trial

Author: Victoria Tea, Jean-François Morelle, Romain Gallet, Guillaume Cayla, Gilles Lemesle, Thibault Lhermusier, Jean-Guillaume Dillinger, Grégory Ducrocq, Denis Angouvant, Yves Cottin, Chekrallah Chamandi, Alicia le Bras, Philippe Gabriel Steg, Gilles Montalescot, Anaïs Charles Nelson, Tabassome Simon, Gilles Chatellier, Nicolas Danchin, Etienne Puymirat, Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Hôpital privé Saint-Martin - Ramsay Santé, Service de Cardiologie [Henri Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor, IMRB - 'Biologie du système neuromusculaire' [Créteil] (U955 Inserm - UPEC), École nationale vétérinaire - Alfort (ENVA)-Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Alliance française pour les essais cliniques cardio-vasculaires - French Alliance for Cardiovascular Trials (FACT), Pole Cardio-vasculaire et pulmonaire [CHU Lille], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Récepteurs Nucléaires, Maladies Métaboliques et Cardiovasculaires - U1011 (RNMCD), Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Université Toulouse III Paul Sabatier - Faculté de médecine Purpan (UTPS), Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT), Service Cardiologie [CHU Toulouse], Pôle Cardiovasculaire et Métabolique [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Marqueurs cardiovasculaires en situation de stress (MASCOT (UMR_S_942 / U942)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Service de Chirurgie Thoracique et Vasculaire [Hôpital Bichat], AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Laboratoire de Recherche Vasculaire Translationnelle (LVTS (UMR_S_1148 / U1148)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Physiopathologie et épidémiologie cérébro-cardiovasculaire [Dijon] (PEC2), Université de Bourgogne (UB)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Service de Cardiologie [CHU de Dijon], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Hôpital Hôtel-Dieu [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Groupe Action, Institut de cardiologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-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), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), CIC - HEGP (CIC 1418), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Centre d'investigation clinique Paris Est [CHU Pitié Salpêtrière] (CIC Paris-Est), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Unité de recherche Phytopharmacie et Médiateurs Chimiques (UPMC), Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Hémostase, bio-ingénierie et remodelage cardiovasculaires (LBPC), and Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Institut Galilée-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Fractional flow reserve, Multivessel disease, MESH: Humans, MESH: Percutaneous Coronary Intervention / methods, Acute myocardial infarction, Coronary Artery Disease, General Medicine, MESH: Myocardial Revascularization / methods, MESH: Fractional Flow Reserve, Myocardial, Fractional Flow Reserve, Myocardial, MESH: Coronary Artery Disease / surgery, Percutaneous Coronary Intervention, Treatment Outcome, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Myocardial Revascularization, Humans, ST Elevation Myocardial Infarction, MESH: Coronary Artery Disease / diagnostic imaging, MESH: ST Elevation Myocardial Infarction / diagnostic imaging, Cardiology and Cardiovascular Medicine, MESH: ST Elevation Myocardial Infarction / therapy, MESH: Treatment Outcome
Abstract: International audience; Background: in patients with ST-segment elevation myocardial infarction and multivessel disease, percutaneous coronary intervention for non-culprit lesions is superior to treatment of the culprit lesion alone. The optimal timing for non-infarct-related artery revascularization - immediate versus staged - has not been investigated adequately. Aim: we aimed to assess clinical outcomes at 1 year in patients with ST-segment elevation myocardial infarction with multivessel disease using immediate versus staged non-infarct-related artery revascularization. Methods: outcomes were analysed in patients from the randomized FLOWER-MI trial, in whom, after successful primary percutaneous coronary intervention, non-culprit lesions were assessed using fractional flow reserve or angiography during the index procedure or during a staged procedure during the initial hospital stay, ≤5 days after the index procedure. The primary outcome was a composite of all-cause death, non-fatal myocardial infarction and unplanned hospitalization with urgent revascularization at 1 year. Results: among 1171 patients enrolled in this study, 1119 (96.2%) had complete revascularization performed during a staged procedure, and 44 (3.8%) at the time of primary percutaneous coronary intervention. During follow-up, a primary outcome event occurred in one of the patients (2.3%) with an immediate strategy and in 55 patients (4.9%) with a staged strategy (adjusted hazard ratio 1.44, 95% confidence interval 0.39-12.69; P=0.64). Conclusions: staged non-infarct-related artery complete revascularization was the strategy preferred by investigators in practice in patients with ST-segment elevation myocardial infarction with multivessel disease. This strategy was not superior to immediate revascularization, which, in the context of this trial, was used in a small proportion of patients. Further randomized studies are needed to confirm these observational findings.
Published: 2022

22. Identification of Low- versus High-Risk Acute Coronary Syndrome for a Selective ECG Monitoring Strategy

Author: Leclercq, Mariama Akodad, Pierre-Alain Meunier, Caroline Padovani, Guillaume Cayla, Wassim Zitouni, Jean-Christophe Macia, Pierre Robert, Matthieu Steinecker, François Roubille, and Florence
Subjects: risk stratification, acute coronary syndrome, NSTEMI, STEMI, ECG monitoring, cardiology intensive care unit
Abstract: Background: While admission of patients with acute coronary syndromes (ACS) in cardiology intensive care unit (CICU) is usual, in-hospital major outcomes in lower risk patients may be evaluated after early coronary angiography according to the European guidelines. Methods: Consecutive ACS patients were prospectively included after coronary angiography evaluation within 24 h and percutaneous coronary intervention (PCI), when required. Patients were classified as high- or low-risk according to hemodynamics, rhythmic state, ischemic and bleeding risks. Major in-hospital outcomes were assessed. Results: From January to June 2021, 277 patients were enrolled (62.8% with ST-segment elevation myocardial infarction (STEMI) (n = 174); 37.2% with non-NSTEMI (NSTEMI) (n = 103). PCI was required for 260 patients (93.9%). Seventy-four patients (26.7%) were classified as low-risk (n = 47 NSTEMI; n= 27 STEMI) and 203 patients (73.3%) as high-risk of events. All patients were monitored in CICU. While 38 patients (18.7%) from the high-risk group reached the primary endpoint, mainly related to rhythmic or conduction disorder (n = 24, 11.8%) or unstable hemodynamics (n = 17; 8.4%), only 1 patient (1.3%) in the low-risk group had one major outcome (no fatal bleeding); p < 0.01. The negative predictive value of our patient stratification for the absence of major in-hospital outcome was 100% (CI95%: 100–100%) for STEMI and 97.9% [CI95%: 93.2–100%] for NSTEMI patients. Conclusions: Stratification of ACS patients after early coronary angiography and most of the time PCI, identify a population with very low risk of in-hospital events (1/4 of all ACS and 1/2 of NSTEMI) who may probably not require ECG monitoring and/or CICU admission. (NCT04378504).
Published: 2023
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23. Economic evaluation of fractional flow reserve-guided versus angiography-guided multivessel revascularisation in ST-segment elevation myocardial infarction patients in the FLOWER-MI randomised trial

Author: Alicia Le Bras, Etienne Puymirat, Hasina Rabetrano, Guillaume Cayla, Tabassome Simon, Gabriel Steg, Gilles Montalescot, Olivier Varenne, Laurent Bonello, Pierre Coste, Nicolas Delarche, Jean-Louis Georges, Stephan Chassaing, Vincent Letocart, Gilles Chatellier, Nicolas Danchin, Isabelle Durand-Zaleski, Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), and Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)
Subjects: Cost-Benefit Analysis, [SDV]Life Sciences [q-bio], Coronary Artery Disease, Flowers, Coronary Angiography, multivessel disease, Fractional Flow Reserve, Myocardial, STEMI, Percutaneous Coronary Intervention, Treatment Outcome, myocardial infarction, Clinical Research, Quality of Life, Humans, ST Elevation Myocardial Infarction, fractional flow reserve, Cardiology and Cardiovascular Medicine, cost-effectiveness
Abstract: International audience; Background: In patients with ST-segment elevation myocardial infarction (STEMI) who have multivessel disease, the FLOWER-MI trial found no significant clinical benefit to fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) compared to angiography-guided PCI. Aims: Our aim was to estimate the cost-effectiveness and cost-utility of FFR-guided PCI, the secondary endpoint of the FLOWER-MI trial. Methods: Costs, major adverse cardiovascular events (composite of all-cause death, non-fatal myocardial infarction [MI], and unplanned hospitalisation leading to urgent revascularisation), and quality-adjusted life years were calculated in both groups. The incremental cost-effectiveness and cost-utility ratios were estimated. Uncertainty was explored by probabilistic bootstrapping. The analysis was conducted from the perspective of the health care provider with a time horizon of one year. Results: At one year, the average cost per patient was 7,560 euro (+/- 2,218) in the FFR-guided group and 7,089 euro (+/- 1,991) in the angiography-guided group (p-value
Published: 2022

24. Prevalence, management and outcomes of percutaneous coronary intervention for coronary in-stent restenosis: Insights from the France PCI Registry

Author: Benjamin Duband, Géraud Souteyrand, Jean Michel Clerc, Stephan Chassaing, Olivier Fichaux, Pierre Marcollet, Ronan Deballon, Laurent Roussel, Bruno Pereira, Jean-Philippe Collet, Philippe Commeau, Guillaume Cayla, Rene Koning, Pascal Motreff, Hakim Benamer, and Gregoire Rangé
Subjects: General Medicine, Cardiology and Cardiovascular Medicine
Published: 2023

25. Thrombose de stent : une bataille gagnée ? (Données du registre France PCI)

Author: P. Motreff, Géraud Souteyrand, P. Bonnet, R. Hakim, R. Koning, O. Bar, A. Gamet, Hakim Benamer, A. Canville, E. Boiffard, Philippe Commeau, T. Dechery, Farzin Beygui, Eric Durand, P-F. Lesault, Louis Viallard, C Saint Etienne, Guillaume Cayla, Grégoire Rangé, R. Deballon, and Franck Albert
Subjects: medicine.medical_specialty, education.field_of_study, Acute coronary syndrome, business.industry, medicine.medical_treatment, Incidence (epidemiology), Population, Percutaneous coronary intervention, Context (language use), medicine.disease, Internal medicine, Diabetes mellitus, Angioplasty, Conventional PCI, medicine, Cardiology, Cardiology and Cardiovascular Medicine, business, education
Abstract: Goal The aim of the study is to assess the incidence, risk factors and prognosis of definite stent thrombosis (ST) at 1 year in the France PCI multicenter prospective registry. Patients and methods Only patients who underwent coronary angioplasty with at least one stent implantation between 1st January 2014 and 31 December 2019 were included. The population was separated into 2 groups: the "ST" group with stent thrombosis and the "control" group without stent thrombosis. Results 35,435 patients were included. 256 patients (0.72%) presented a ST at 1 year. The rate of ST decreased significantly in acute coronary syndrome (1.5% in 2014 vs. 0.73% in 2019; p = 0.05) but not in chronic coronary syndrome (0.46% in 2014 vs 0.40%; p = 0.98). The risk factors are young age (65.8 years vs 68.2; p = 0.002), clinical context (35.27% vs 16.68%; p = 0.0001), diabetes (35.2 % vs 26.4%; p = 0.002), renal failure (11.7% vs 8%; p = 0.009) and history of coronary angioplasty (28.63% vs 21.86%; p = 0.009) and peripheral arterial disease (14.5% vs 10.1%; p = 0.021), LV dysfunction (37% vs 27.5%; p = 0.003), mean length (39.6 mm vs 31, 7mm; p Conclusion Since 2014, the incidence of ST at 1 year has been decreasing but remains stuck at a floor level of 0.54% in 2019. The battle for ST seems to have been partly won and its risk factors well identified, but its mortality is still high.
Published: 2021

26. Mechanical complications of acute myocardial infarction: a not 'mechanical' preventive and therapeutic strategy

Author: Benoit, Lattuca and Guillaume, Cayla
Subjects: Pulmonary and Respiratory Medicine
Published: 2022

27. Fractional Flow Reserve to Guide Treatment of Patients With Multivessel Coronary Artery Disease

Author: Gilles Rioufol, François Dérimay, François Roubille, Thibault Perret, Pascal Motreff, Denis Angoulvant, Yves Cottin, Ludovic Meunier, Laura Cetran, Guillaume Cayla, Brahim Harbaoui, Jean-Yves Wiedemann, Éric Van Belle, Christophe Pouillot, Nathalie Noirclerc, Jean-François Morelle, François-Xavier Soto, Christophe Caussin, Bernard Bertrand, Thierry Lefèvre, Patrick Dupouy, Pierre-François Lesault, Franck Albert, Olivier Barthelemy, René Koning, Laurent Leborgne, Pierre Barnay, Philippe Chapon, Sébastien Armero, Antoine Lafont, Christophe Piot, Camille Amaz, Bernadette Vaz, Lakhdar Benyahya, Yvonne Varillon, Michel Ovize, Nathan Mewton, Gérard Finet, Alexandre Fournier, Geneviève Jarry, François Leleu, Dorothée Malaquin, Anfani Mirode, Loïc Belle, Lionel Mangin, Jean-Lou Hirsch, Marc Metge, Michel Pansiery, FrançoisXavier Soto, Antoine Boge, Kamel HadjHamou, Ichem Miliani, Guillaume Molins, Stéphane Mourot, Marion Pelletier, Olivier Ressencourt, Frédéric Schaad, Pierre Coste, Warren Chasseriaud, Pierre Poustis, Jean-Francois Morelle, Thibaud Demicheli, Grégroire Range, Christophe Thuaire, Nicolas Barber-Chamoux, Nicolas Combaret, Guilhem Malclès, Géraud Souteyrand, Philippe Buffet, Aurélie Gudjonvick, Isabelle L’Huillier, Luc Lorgis, Carole Richard, Gilles Baronne-Rochette, Hélène Bouvaist, Stéphanie Marlière, Olivier Ormezzano, Gérald Vanzetto, Charlotte Trouillet, Yann Valy, Eric VanBelle, Christophe Bauters, Cédric Delhaye, Gilles Lemesle, Riadh Rihani, Pierre Graux, Jean-Michel Lemahieu, Cyril Besnard, Pierre-Yves Courand, Raphaël Dauphin, Pierre Lantelme, Jean-Raymond Caignault, Olivier Dubreuil, Sylvain Ranc, Bernard Ritz, Cyrille Bergerot, Thomas Bochaton, Eric Bonnefoy-Cudraz, Didier Bresson, Julie Dementhon, François Derimay, Lisa Green, Cyril Prieur, Ingrid Sanchez, Oualid Zouaghi, Sébastien Arméro, Hakim Ben-Amer, Bernard Chevalier, Philippe Garot, Thomas Hovasse, Yves Louvard, Marie-Claude Morice, Oscar Tavolaro, Thierry Unterseeh, DinhThienTri Cung, Jean-Christophe Macia, Gilles Levy, Olivier Roth, Laurent Jacquemin, Luc Cornillet, Bertrand Ledermann, Laurent Schmutz, Nicole Karam, Saliha Rahal, Nicolas Amabile, Philippe Girard, Aurélie Veugeois, Olivier Barthélémy, Jean-Philippe Collet, Gilles Montalescot, Jacques Berland, Matthieu Godin, Quentin Landolff, Bilel Zoghlami, Karim Bougrini, Christophe Geyer, Jens Glanenapp, Patrick Mascarel, Geoffray Rambaud, Richard ViFane, Bernard Desveaux, Fabrice Ivanes, Gérard Pacouret, Laurent-Emmanuel Quilliet, Christophe SaintEtienne, Christophe Bretelle, Stanislas Champin, 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), and Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)
Subjects: Male, medicine.medical_specialty, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Long Term Adverse Effects, Coronary Artery Disease, Fractional flow reserve, 030204 cardiovascular system & hematology, Coronary Angiography, Revascularization, Risk Assessment, Severity of Illness Index, Coronary artery disease, 03 medical and health sciences, Percutaneous Coronary Intervention, Postoperative Complications, 0302 clinical medicine, Predictive Value of Tests, Internal medicine, Clinical endpoint, Humans, Medicine, 030212 general & internal medicine, Coronary Artery Bypass, ComputingMilieux_MISCELLANEOUS, Aged, Intention-to-treat analysis, business.industry, Hazard ratio, Coronary Stenosis, Percutaneous coronary intervention, medicine.disease, Coronary Vessels, 3. Good health, Fractional Flow Reserve, Myocardial, Coronary arteries, medicine.anatomical_structure, Early Termination of Clinical Trials, Cardiology, Female, Cardiology and Cardiovascular Medicine, business
Abstract: Background There is limited evidence that fractional flow reserve (FFR) is effective in guiding therapeutic strategy in multivessel coronary artery disease (CAD) beyond prespecified percutaneous coronary intervention or coronary graft surgery candidates. Objectives The FUTURE (FUnctional Testing Underlying coronary REvascularization) trial aimed to evaluate whether a treatment strategy based on FFR was superior to a traditional strategy without FFR in the treatment of multivessel CAD. Methods The FUTURE trial is a prospective, randomized, open-label superiority trial. Multivessel CAD candidates were randomly assigned (1:1) to treatment strategy based on FFR in all stenotic (≥50%) coronary arteries or to a traditional strategy without FFR. In the FFR group, revascularization (percutaneous coronary intervention or surgery) was indicated for FFR ≤0.80 lesions. The primary endpoint was a composite of major adverse cardiac or cerebrovascular events at 1 year. Results The trial was stopped prematurely by the data safety and monitoring board after a safety analysis and 927 patients were enrolled. At 1-year follow-up, by intention to treat, there were no significant differences in major adverse cardiac or cerebrovascular events rates between groups (14.6% in the FFR group vs 14.4% in the control group; hazard ratio: 0.97; 95% confidence interval: 0.69-1.36; P = 0.85). The difference in all-cause mortality was nonsignificant, 3.7% in the FFR group versus 1.5% in the control group (hazard ratio: 2.34; 95% confidence interval: 0.97-5.18; P = 0.06), and this was confirmed with a 24 months’ extended follow-up. FFR significantly reduced the proportion of revascularized patients, with more patients referred to exclusively medical treatment (P = 0.02). Conclusions In patients with multivessel CAD, we did not find evidence that an FFR-guided treatment strategy reduced the risk of ischemic cardiovascular events or death at 1-year follow-up. (Functional Testing Underlying Coronary Revascularisation; NCT01881555 )
Published: 2021

28. Percutaneous Myocardial Revascularization in Late-Presenting Patients With STEMI

Author: Etienne Puymirat, Gilles Lemesle, Clément Delmas, Vincent Bataille, Frédéric Bouisset, Jean Ferrières, Didier Blanchard, Fast-Mi investigators, Francois Schiele, Pierre Coste, Nadia Aissaoui, Pascal Motreff, Guillaume Cayla, Edouard Gerbaud, Nicolas Danchin, Tabassome Simon, and Loic Belle
Subjects: Male, medicine.medical_specialty, Acute coronary syndrome, Myocardial revascularization, Percutaneous, medicine.medical_treatment, Revascularization, Time-to-Treatment, Percutaneous Coronary Intervention, Internal medicine, Fibrinolysis, medicine, Humans, Registries, Myocardial infarction, Aged, business.industry, Mortality rate, Middle Aged, medicine.disease, Cardiology, ST Elevation Myocardial Infarction, Female, Observational study, France, Cardiology and Cardiovascular Medicine, business
Abstract: The optimal management of patients with ST-segment elevation myocardial infarction (STEMI) presenting late-12 hours following symptom onset-is still under debate.The purpose of this study was to describe characteristics, temporal trends, and impact of revascularization in a large population of latecomer STEMI patients.The authors analyzed the data of 3 nationwide observational studies from the FAST-MI (French Registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction) program, conducted over a 1-month period in 2005, 2010, and 2015. Patients presenting between 12 and 48 hours after symptom onset were classified as latecomers.A total of 6,273 STEMI patients were included in the 3 cohorts, 1,169 (18.6%) of whom were latecomers. After exclusion of patients treated with fibrinolysis and patients deceased within 2 days after admission, 1,077 patients were analyzed, of whom 729 (67.7%) were revascularized within 48 hours after hospital admission. At 30-day follow-up, all-cause death rate was significantly lower among revascularized latecomers (2.1% vs 7.2%; P 0.001). After a median follow-up of 58 months, the rate of all-cause death was 30.4 (95% CI: 25.7-35.9) per 1,000 patient-years in the revascularized latecomers group vs 78.7 (95% CI: 67.2-92.3) per 1,000 patient-years in the nonrevascularized latecomers group (P 0.001). In multivariate analysis, revascularization of latecomer STEMI patients was independently associated with a significant reduction of mortality occurrence during follow-up (HR: 0.65 [95% CI: 0.50-0.84]; P = 0.001).Coronary revascularization of latecomer STEMI patients is associated with better short and long-term clinical outcomes.
Published: 2021

29. Long-Term Prognosis Value of Paravalvular Leak and Patient–Prosthesis Mismatch following Transcatheter Aortic Valve Implantation: Insight from the France-TAVI Registry

Author: Pierre Deharo, Lionel Leroux, Alexis Theron, Jérome Ferrara, Antoine Vaillier, Nicolas Jaussaud, Alizée Porto, Pierre Morera, Vlad Gariboldi, Bernard Iung, Thierry Lefevre, Philippe Commeau, Margaux Gouysse, Florence du Chayla, Nicolas Glatt, Guillaume Cayla, Herve Le Breton, Hakim Benamer, Sylvain Beurtheret, Jean Philippe Verhoye, Helene Eltchaninoff, Martine Gilard, Jean Philippe Collet, Nicolas Dumonteil, Frederic Collart, Thomas Modine, Thomas Cuisset, Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Hôpital de la Timone [CHU - APHM] (TIMONE), Aix-Marseille Université - École de médecine (AMU SMPM MED), Aix-Marseille Université - Faculté des sciences médicales et paramédicales (AMU SMPM), Aix Marseille Université (AMU)-Aix Marseille Université (AMU), Médico-Chirurgical de Valvulopathies et Cardiomyopathies, Chirurgie Cardiaque Adulte, Cardiologie Interventionnelle Structurelle Adulte [CHU Bordeaux], CHU Bordeaux [Bordeaux], Département de Cardiologie [Hôpital de la Timone - APHM], Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), Service de cardiologie [CHU Bichat], AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot, Sorbonne Paris Cité, Laboratoire de Recherche Vasculaire Translationnelle (LVTS (UMR_S_1148 / U1148)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Hôpital Privé Jacques Cartier [Massy], Polyclinique Les Fleurs - ELSAN [Ollioules] (PLF), Clinityx, Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), CHU Pontchaillou [Rennes], Hôpital Saint-Joseph [Marseille], Service de cardiologie [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Hôpital de la Cavale Blanche - CHRU Brest (CHU - BREST ), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), 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)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Clinique Pasteur, Clinique Pasteur [Toulouse], and ANR-16-RHUS-0003,STOP-AS,STOP-AS(2016)
Subjects: TAVI, Mismatch, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, General Medicine, mismatch, paravalvular leak, Paravalvular leak
Abstract: Background: Transcatheter aortic valve implantation (TAVI) is the preferred treatment for symptomatic severe aortic stenosis (AS) in a majority of patients across all surgical risks. Patients and methods: Paravalvular leak (PVL) and patient–prosthesis mismatch (PPM) are two frequent complications of TAVI. Therefore, based on the large France-TAVI registry, we planned to report the incidence of both complications following TAVI, evaluate their respective risk factors, and study their respective impacts on long-term clinical outcomes, including mortality. Results: We identified 47,494 patients in the database who underwent a TAVI in France between 1 January 2010 and 31 December 2019. Within this population, 17,742 patients had information regarding PPM status (5138 with moderate-to-severe PPM, 29.0%) and 20,878 had information regarding PVL (4056 with PVL ≥ 2, 19.4%). After adjustment, the risk factors for PVL ≥ 2 were a lower body mass index (BMI), a high baseline mean aortic gradient, a higher body surface area, a lower ejection fraction, a smaller diameter of TAVI, and a self-expandable TAVI device, while for moderate-to-severe PPM we identified a younger age, a lower BMI, a larger body surface area, a low aortic annulus area, a low ejection fraction, and a smaller diameter TAVI device (OR 0.85; 95% CI, 0.83–0.86) as predictors. At 6.5 years, PVL ≥ 2 was an independent predictor of mortality and was associated with higher mortality risk. PPM was not associated with increased risk of mortality. Conclusions: Our analysis from the France-TAVI registry showed that both moderate-to-severe PPM and PVL ≥ 2 continue to be frequently observed after the TAVI procedure. Different risk factors, mostly related to the patient’s anatomy and TAVI device selection, for both complications have been identified. Only PVL ≥ 2 was associated with higher mortality during follow-up.
Published: 2022
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30. TAVR Patients Requiring Anticoagulation

Author: Jean Philippe Verhoye, Thibaut Manigold, Alain Cribier, Nicolas Dumonteil, Patrick Ohlmann, Dominique Himbert, Hervé Le Breton, Frederic Collet, Philippe Guyon, Nicolas Meneveau, Xavier Favereau, Didier Carrié, Stéphane Delépine, Thomas Cuisset, Francois Bourlon, Emmanuel Teiger, Farzin Beygui, Olivier Bar, Bernard Albat, Bernard Bertrand, Martine Gilard, Géraud Souteyrand, Bernard Iung, France-TAVI, Arnaud Sudre, Remi Houel, Vincent Auffret, Philippe Commeau, Romain Didier, Louis Labrousse, Antoine Gommeaux, Guillaume Cayla, Thierry Lefèvre, Jean-Philippe Collet, Hélène Eltchaninoff, Didier Blanchard, Sylvain Beurtheret, Jean-Philippe Claudel, Vincent Doisy, Thibault Lhermusier, Gilles Rioufol, Stop-As, and Said Ghostine
Subjects: medicine.medical_specialty, business.industry, medicine.drug_class, medicine.medical_treatment, Anticoagulant, Hazard ratio, 030204 cardiovascular system & hematology, Vitamin K antagonist, Confidence interval, 3. Good health, 03 medical and health sciences, 0302 clinical medicine, Valve replacement, Internal medicine, Propensity score matching, Oral anticoagulant, Medicine, 030212 general & internal medicine, Cardiology and Cardiovascular Medicine, business, Major bleeding
Abstract: Objectives Using French transcatheter aortic valve replacement (TAVR) registries linked with the nationwide administrative databases, the study compared the rates of long-term mortality, bleeding, and ischemic events after TAVR in patients requiring oral anticoagulation with direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs). Background The choice of optimal drug for anticoagulation after TAVR remains debated. Methods Data from the France-TAVI and FRANCE-2 registries were linked to the French national health single-payer claims database, from 2010 to 2017. Propensity score matching was used to reduce treatment-selection bias. Two primary endpoints were death from any cause (efficacy) and major bleeding (safety). Results A total of 24,581 patients who underwent TAVR were included and 8,962 (36.4%) were treated with OAC. Among anticoagulated patients, 2,180 (24.3%) were on DOACs. After propensity matching, at 3 years, mortality (hazard ratio [HR]: 1.37; 95% confidence interval [CI]: 1.12-1.67; P Conclusions In these large multicenter French TAVR registries with an exhaustive clinical follow-up, the long-term mortality and major bleeding were lower with DOACs than VKAs at discharge. The present study supports preferential use of DOACs rather than VKAs in patients requiring oral anticoagulation therapy after TAVR.
Published: 2021

31. One-Year Follow-Up of Patients Admitted for Emergency Coronary Angiography after Resuscitated Cardiac Arrest

Author: Quentin Delbaere, Myriam Akodad, François Roubille, Benoît Lattuca, Guillaume Cayla, Florence Leclercq, Hôpital Arnaud de Villeneuve [CHRU Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM), Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), and MORNET, Dominique
Subjects: quality of life, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, sudden cardiac death, coronary angiography, neurological sequelae, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], General Medicine, [SDV.NEU] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system
Abstract: (1) Background: Despite the improvement of the in-hospital survival rate after aborted sudden cardiac death (SCD), cerebral anoxia may have severe neurologic consequences and may impair long-term outcome and quality of life of surviving patients. The aim of this study was to assess neurological outcomes at one year after resuscitated cardiac arrest; (2) Methods: This prospective, observational, and multicentre study included patients >18 yo admitted in the catheterisation laboratory for coronary angiography after aborted SCD between 1 May 2018 and 31 May 2020. Only patients who were discharged alive from hospital were evaluated. The primary endpoint was survival without neurological sequelae at one-year follow-up defined by a cerebral performance category (CPC) of one or two. Secondary end points included all-cause mortality, New York Heart Association (NYHA) functional class, neurologic evaluation at discharge, three-month and one-year follow-up using the CPC scale, and quality of life at 1 year using the Quality of Life after Brain Injury (QOLIBRI) questionnaire; (3) Results: Among 143 patients admitted for SCD within the study period, 61 (42.7%) were discharged alive from hospital, among whom 55 (90.1%) completed the one-year follow-up. No flow and low flow times were 1.9 ± 2.4 min and 16.5 ± 10.4 min, respectively. For 93.4% of the surviving patients, an initial shockable rhythm (n = 57) was observed and acute coronary syndrome was diagnosed in 75.4% of them (n = 46). At 1 year, survival rate without neurologic sequelae was 87.2% (n = 48). Patients with poor outcome were older (69.3 vs. 57.4 yo; p = 0.04) and had lower body mass index (22.4 vs. 26.7; p = 0.013) and a lower initial Left Ventricle Ejection Fraction (LVEF) (32.1% vs. 40.3%; p = 0.046). During follow-up, neurological status improved in 36.8% of patients presenting sequelae at discharge, and overall quality of life was satisfying for 66.7% of patients according to the QOLIBRI questionnaire; (4) Conclusions: Among patients admitted to the catheterisation laboratory for aborted SCD, mainly related to Acute Coronary Syndrom (ACS), less than a half of them were alive at discharge. However, the one-year survival rate without neurological sequelae was high and overall quality of life was good.
Published: 2022
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32. Is coronary multivessel disease in acute myocardial infarction patients still associated with worse clinical outcomes at 1‐year?

Author: Grégoire Rangé, Ariel Nakache, Hakim Benamer, Marie-Pascale Decomis, Pierre Marcollet, Olivier Fichaux, Nicolas Danchin, Gilles Montalescot, Christophe Saint Etienne, Pascal Motreff, Guillaume Cayla, Stephan Chassaing, Etienne Puymirat, René Koning, Philippe Commeau, CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Institut de cardiologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), CHU Clermont-Ferrand, Hôpitaux de Chartres [Chartres], Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Centre Hospitalier Jacques Coeur, Centre Hospitalier Régional d'Orléans (CHRO), Pôle santé Oréliance, Nouvelle Clinique Tourengelle, Polyclinique des fleurs, Service de cardiologie [CHU Rouen], Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Normandie Université (NU), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Clinique de la Roseraie, Clinique Saint-Hilaire [Rouen], and Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)
Subjects: Male, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Clinical Investigations, Myocardial Infarction, acute myocardial infarction, Coronary Artery Disease, Disease, 030204 cardiovascular system & hematology, multivessel disease, 03 medical and health sciences, Percutaneous Coronary Intervention, 0302 clinical medicine, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Internal medicine, medicine, Humans, cardiovascular diseases, 030212 general & internal medicine, Myocardial infarction, Risk factor, Stroke, Retrospective Studies, business.industry, Percutaneous coronary intervention, General Medicine, Multivessel disease, Middle Aged, ST‐elevation myocardial infarction, primary percutaneous coronary intervention, medicine.disease, 3. Good health, Treatment Outcome, Conventional PCI, Cardiology, ST Elevation Myocardial Infarction, Cardiology and Cardiovascular Medicine, business, Mace
Abstract: International audience; BackgroundST‐elevation myocardial infarction (STEMI) patients with multivessel disease (MVD) are associated with a worse prognosis. However, few comparisons are available according to coronary status in the era of modern reperfusion and optimized secondary prevention.HypothesisWe hypothesized that the difference in prognosis according to number of vessel disease in STEMI patients has reduced.MethodsAll consecutive STEMI patients undergoing primary percutaneous coronary intervention (PCI) within 24 h of symptoms onset between January 1, 2014 and June 30, 2016 enrolled in the CRAC (Club Régional des Angioplasticiens de la région Centre) France PCI registry were analyzed. Baseline characteristics, management, and outcomes at 1‐year were analyzed according to coronary status (one‐, two‐, and three‐VD).ResultsA total of 1886 patients (mean age 62.2 ± 14.0 year; 74% of male) were included. Patients with MVD (two or three‐VD) represented 53.7%. They were older with higher cardiovascular risk factor profile. At 1 year, the rate of major adverse cardiovascular events (MACE, defined as all‐cause death, stroke or re‐MI) was 10%, 12%, and 12% in one‐, two, and three‐VD respectively (p = .28). In multivariable adjusted Cox proportional hazard regression model, two‐ and three‐VD were not associated with higher rate of MACE compared to patients with single VD (HR, 1.09; 95%CI 0.76–1.56 for two‐VD; HR, 0.74; 95%CI 0.48–1.14 for three‐VD).ConclusionsMVD still represents an important proportion of STEMI patients but their prognoses were not associated with worse clinical outcomes at 1‐year compared with one‐VD patients in a modern reperfusion area and secondary medication prevention.
Published: 2021

33. Transcarotid versus transfemoral access in patients undergoing transcatheter aortic valve replacement with complex aortofemoral anatomy

Author: Romuald Choteau, Mariama Akodad, Guillaume Cayla, Delphine Delseny, Florence Leclercq, Benoit Lattuca, Thomas Gandet, Jean-Christophe Macia, Youcef Lounes, Chloé Chamard, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Université de Montpellier (UM), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), 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), Herrada, Anthony, and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Time Factors, medicine.medical_treatment, complex anatomy, TAVR, 030204 cardiovascular system & hematology, Risk Assessment, Ventricular Function, Left, vascular complication, Transcatheter Aortic Valve Replacement, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Valve replacement, Risk Factors, medicine.artery, medicine, Clinical endpoint, Humans, Radiology, Nuclear Medicine and imaging, In patient, 030212 general & internal medicine, Stroke, Aged, Retrospective Studies, Aged, 80 and over, transcarotid, Ejection fraction, business.industry, Incidence (epidemiology), Abdominal aorta, transfemoral, Stroke Volume, Aortic Valve Stenosis, General Medicine, Anatomy, medicine.disease, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, 3. Good health, Femoral Artery, Treatment Outcome, Aortic Valve, Cardiology and Cardiovascular Medicine, business
Abstract: International audience; Aims: While major vascular complications (MVC) remains an issue after Transfemoral (TF) transcatheter aortic valve replacement (TAVR), we compared outcomes in TF versus transcarotid (TC) approaches in patients with complex vascular anatomy.Methods and results: Among patients undergoing TAVR in our center between 2015 and 2018, we evaluated patients with complex vascular anatomy defined on CT scan as: (a) iliofemoral diameter between 5.5 and 6 mm or
Published: 2020

34. Simplified TAVR Procedure: How Far Is It Possible to Go?

Author: Florence Leclercq, Pierre Alain Meunier, Thomas Gandet, Jean-Christophe Macia, Delphine Delseny, Philippe Gaudard, Marc Mourad, Laurent Schmutz, Pierre Robert, François Roubille, Guillaume Cayla, Mariama Akodad, CHU Montpellier, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM), and MORNET, Dominique
Subjects: [SDV] Life Sciences [q-bio], [SDV]Life Sciences [q-bio], simplification, tailored approach, General Medicine, TAVR
Abstract: International audience; Increasing operators’ experience and improvement of the technique have resulted in a drastic reduction in complications following transcatheter aortic valve replacement (TAVR) in patients with lower surgical risk. In parallel, the procedure was considerably simplified, with a routine default approach including local anesthesia in the catheterization laboratory, percutaneous femoral approach, radial artery as the secondary access, prosthesis implantation without predilatation, left ventricle wire pacing and early discharge. Thus, the “simplified” TAVR adopted in most centers nowadays is a real revolution of the technique. However, simplified TAVR must be accompanied upstream by a rigorous selection of patients who can benefit from a minimalist procedure in order to guarantee its safety. The minimalist strategy must not become dogmatic and careful pre-, per- and post-procedural evaluation of patients with well-defined protocols guarantee optimal care following TAVR. This review aims to evaluate the benefits and limits of the simplified TAVR procedure in a current and future vision.
Published: 2022

35. Transcatheter aortic valve implantation in patients with uninterrupted vitamin K antagonists

Author: Pierre Robert, Mariama Akodad, Benoit Lattuca, Thomas Gandet, Jean‐Christophe Macia, Laurent Schmutz, Delphine Delseny, Christophe Piot, Florence Leclercq, and Guillaume Cayla
Subjects: Aged, 80 and over, Male, Vitamin K, Heparin, Anticoagulants, Hemorrhage, General Medicine, Aortic Valve Stenosis, Transcatheter Aortic Valve Replacement, Treatment Outcome, Fibrinolytic Agents, Aortic Valve, Humans, Radiology, Nuclear Medicine and imaging, Female, Cardiology and Cardiovascular Medicine
Abstract: Bridging of vitamin K antagonist (VKA) with heparin is usually not promoted during interventional or surgical procedures related to increased risk of bleeding and thrombotic events but this strategy has not been evaluated during transcatheter aortic valve implantation (TAVI).The aim of this study was to evaluate the rate of major bleeding and vascular complications after TAVI performed in patients with uninterrupted VKA.From January 2016 to October 2017, consecutive patients who underwent TAVI with uninterrupted VKA (International Normalized Ratio [INR] between 1.5 and 3.5) were prospectively included in a monocentric registry. TAVI was performed according to current guidelines and a 50 U/kg bolus of heparin was injected at the beginning of the procedure for all patients. Vascular and bleeding complications were assessed using the Valve Academic Research Consortium 3 (VARC3) and the Bleeding Academic Research Consortium (BARC) definitions at a 30-day follow-up.A total of 88 patients were included with a median age of 84 years (81.8-87.0), 42% being female. The median society of thoracic surgeons score was 5.1 (4.1-7.5), the median CHADS2-VASc was 5.5 (5-6) and 60.2% had a chronic kidney failure. Median INR at the time of implantation was 2.1 (1.8-2.6). The main VKA indication was atrial fibrillation. Transfemoral access was used in 88.6% of the patients. Major bleeding (BARC ≥ 3b) occurred in five patients (5.7%) and major vascular complications occurred in seven patients (8.0%). At 1 month follow-up, major bleeding (BARC ≥ 3) or vascular complications occurred in 10 patients (11.4%). In patients with major bleeding peripheral arterial disease (RR = 10.95; 95% confidence interval (CI) 1.63-73.75; p = 0.014) and carotid access (RR = 8.56; 95% CI 1.19-1.51; p = 0.033) were more common. INR 2.5 was significantly associated with vascular complications (RR = 7.14; 95% CI 1.29-39.63; p = 0.025). At 30 days, mortality and stroke rates were 2.3% and 4.5%, respectively.TAVI with uninterrupted VKA treatment seems feasible and safe with a low risk of major bleeding and vascular complications in this first single-center experience. Particular caution is advocated in high body mass index patients and to keep INR 2.5.
Published: 2022

36. Ticagrelor versus clopidogrel in elective percutaneous coronary intervention (ALPHEUS): a randomised, open-label, phase 3b trial

Author: Johanne Silvain, Benoit Lattuca, Farzin Beygui, Grégoire Rangé, Zuzana Motovska, Jean-Guillaume Dillinger, Ziad Boueri, Philippe Brunel, Thibault Lhermusier, Christophe Pouillot, Elisa Larrieu-Ardilouze, Franck Boccara, Jean-Noël Labeque, Paul Guedeney, Mohamad El Kasty, Mikael Laredo, Raphaëlle Dumaine, Grégory Ducrocq, Jean-Philippe Collet, Guillaume Cayla, Katrien Blanchart, Petr Kala, Eric Vicaut, Gilles Montalescot, Johanne SILVAIN, Jean-Philippe COLLET, Gilles MONTALESCOT, Mathieu KERNEIS, Nassim BRAIK, Olivier BARTHELEMY, Gérard HELFT, Claude LEFEUVRE, Rémi CHOUSSAT, Marie HAUGUEL, Michel ZEITOUNI, Thomas CUISSET, Jean-Louis BONNET, Pierre DEHARO, Benoit LATTUCA, Guillaume CAYLA, Luc CORNILLET, Bertrand LEDERMANN, Clément LONJON, Laurent SCHMUTZ, Grégoire RANGE, Franck ALBERT, Thibault DEMICHELI, Laurent ROUSSEL, Reda BENSAID, Christophe THUAIRE, Jean-Guillaume DILLINGER, Patrick HENRY, Stéphane MANZO-SILBERMAN, Georgios SIDERIS, Damien LOGEART, Vincent SPAGNOLI, Léa CACOUB, Christophe POUILLOT, Jean Richard VI-FANE, Jens GLASENAPP, Karim BOUGRINI, Nicolas COMBARET, Pascal MOTREFF, Géraud SOUTEYRAND, Aimé AMONCHOT, Thomas MOUYEN, Thibault LHERMUSIER, Didier CARRIE, Frédéric BOUISSET, Thomas CHOLLET, Francisco CAMPELO-PARADA, Nicolas DELARCHE, François SCHIELE, Mathieu BESUTTI, Marie HAUGUEL-MOREAU, Rami EL MAHMOUD, Christophe CAUSSIN, Mami ZOHEIR, Aurelie VEUGEOIS, Alain DIBIE, Olivier VARENNE, Fabien PICARD, Alexandre LAFONT, Julien ADJEDJ, Philippe DEGRELL, Farzin BEYGUI, Rémi SABATIER, Vincent ROULE, Mathieux BIGNON, Katrien BLANCHART, Pierre ARDOUIN, Adrien LEMAITRE, Clément BRIET, Ziad BOUERI, Pascal GOUBE, Pierre COSTE, Laura CETRAN, Jérôme CLERC, Hervé LE BRETON, Dominique BOULMIER, Vincent AUFFRET, Jean-Noël LABEQUE, Jean-Luc BONAS, Jean-Louis GEORGES, Bernard LIVAREK, Elodie BLICQ, Nicolas BARON, Géraldine GIBAULT-GENTY, Yves COTTIN, Isabelle LHUILLIER, Carole RICHARD, Luc LORGIS, Philippe BUFFET, Christian SPAULDING, Nicole KARAM, Etienne PUYMIRAT, Marco MENNUNI, Emmanuel POULIDAKIS, Lionel BONNEVIE, Franck BOCCARA, Marion CHAUVET, Laurie DUFOUR, Yann ANCEDY, Stéphane EDERHY, Arnaud ETIENNEY, Anne BELLEMAIN-APPAIX, Nathaniel BITTON, Laurent JACQ, Christophe SAINT-ETIENNE, Florence LECLERCQ, François ROUBILLE, Gilles RIOUFOL, François DERIMAY, Marc GORALSKI, Wael YAFI, Emmanuelle FILIPPI, Alain KERMARREC, Christophe LE RAY, Antoine MERLET, Aurelie LOIRAT, Philippe BRUNEL, Damien BRUNET, Jack RAVISY, Laurent MOCK, Guillaume MOLINS, Max CARRE, Erwan BRESSOLLETTE, Luc CHRISTIAENS, Elisa LARRIEU-ARDILOUZE, Romain CADOR CADOR, Eric VAN BELLE, Gilles LEMESLE, Cédric DELHAYE, Flavien VINCENT, Sina POROUCHANI, Hugues SPILLEMAEKER, Katy PETIT, Olivier RESSENCOURT, Vincent HUMEAU, François JOURDA, Marc-Antoine ARNOULD, Stephen CHASSAING, Karl ISAAZ, Laurent PAYOT, Jacques MONTSEGU, Benjamin FAURIE, Michel PANSIERI, Marc METGE, Karim MOUSSA, Mathieu PANKERT, Olivier MOREL, Sébastien HESS, Luc MAILLARD, Thibault MANIGOLD, Vincent LETOCART, Julien PLESSIS, Pauline BERTHOME, Mickael BONIN, François HUCHET, Emmanuel TEIGER, Romain GALLET, Gauthier MOUILLET, Madjid BOUKANTAR, Mohammed NEJJARI, David ATTIAS, Mathieu STEINECKER, Zuzana MOTOVSKA, Martin KOZEL, Zdenko STELMACH, Ota HLINOMAZ, Michal REZEK, Martin NOVAK, Jan SITAR, Jiri SEMENKA, Petr KALA, Otakar BOCEK, Roman ŠTIPAL, Martin POLOCZEK, Jan KANOVSKÝ, Petr JERABEK, Jiří KARASEK, Sylvie HRUSKOVA, Marian BRANNY, Jan MROZEK, Tomas GREZL, Leos PLEVA, Pavel KUKLA, Martin PORZER, Lesnik, Philippe, Institut de cardiologie [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), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Service de cardiologie et de pathologie vasculaire [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Hôpital Louis Pasteur [Chartres], Charles University [Prague] (CU), Marqueurs cardiovasculaires en situation de stress (MASCOT (UMR_S_942 / U942)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier de Bastia (G2HC), Service de Cardiologie [Hôpital privé Dijon Bourgogne], Hôpital privé Dijon Bourgogne, Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Clinique Sainte Clotilde, Centre hospitalier universitaire de Poitiers (CHU Poitiers), Service de Cardiologie [CHU Saint-Antoine], CHU Saint-Antoine [AP-HP], Centre de Recherche Saint-Antoine (CRSA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Le CHCB, Centre Hospitalier de la Côte Basque, Grand Hôpital de l'Est Francilien (GHEF), Centre de Réadaptation Cardiaque Les Grands Prés [Villeneuve Saint Denis] (CRCLGP), Service de cardiologie [CHU Bichat], AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot, Sorbonne Paris Cité, CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), University Hospital Brno, Masaryk University [Brno] (MUNI), Hopital Saint-Louis [AP-HP] (AP-HP), Erasmus University Medical Center [Rotterdam] (Erasmus MC), ALPHEUS investigators: Johanne Silvain, Jean-Philippe Collet, Gilles Montalescot, Mathieu Kerneis, Nassim Braik, Olivier Barthelemy, Gérard Helft, Claude Lefeuvre, Rémi Choussat, Marie Hauguel, Michel Zeitouni, Thomas Cuisset, Jean-Louis Bonnet, Pierre Deharo, Benoit Lattuca, Guillaume Cayla, Luc Cornillet, Bertrand Ledermann, Clément Lonjon, Laurent Schmutz, Grégoire Range, Franck Albert, Thibault Demicheli, Laurent Roussel, Reda Bensaid, Christophe Thuaire, Jean-Guillaume Dillinger, Patrick Henry, Stéphane Manzo-Silberman, Georgios Sideris, Damien Logeart, Vincent Spagnoli, Léa Cacoub, Christophe Pouillot, Jean Richard Vi-Fane, Jens Glasenapp, Karim Bougrini, Nicolas Combaret, Pascal Motreff, Géraud Souteyrand, Aimé Amonchot, Thomas Mouyen, Thibault Lhermusier, Didier Carrie, Frédéric Bouisset, Thomas Chollet, Francisco Campelo-Parada, Nicolas Delarche, François Schiele, Mathieu Besutti, Marie Hauguel-Moreau, Rami El Mahmoud, Christophe Caussin, Mami Zoheir, Aurelie Veugeois, Alain Dibie, Olivier Varenne, Fabien Picard, Alexandre Lafont, Julien Adjedj, Philippe Degrell, Farzin Beygui, Rémi Sabatier, Vincent Roule, Mathieux Bignon, Katrien Blanchart, Pierre Ardouin, Adrien Lemaitre, Clément Briet, Ziad Boueri, Pascal Goube, Pierre Coste, Laura Cetran, Jérôme Clerc, Hervé LE Breton, Dominique Boulmier, Vincent Auffret, Jean-Noël Labeque, Jean-Luc Bonas, Jean-Louis Georges, Bernard Livarek, Elodie Blicq, Nicolas Baron, Géraldine Gibault-Genty, Yves Cottin, Isabelle Lhuillier, Carole Richard, Luc Lorgis, Philippe Buffet, Christian Spaulding, Nicole Karam, Etienne Puymirat, Marco Mennuni, Emmanuel Poulidakis, Lionel Bonnevie, Franck Boccara, Marion Chauvet, Laurie Dufour, Yann Ancedy, Stéphane Ederhy, Arnaud Etienney, Anne Bellemain-Appaix, Nathaniel Bitton, Laurent Jacq, Christophe Saint-Etienne, Florence Leclercq, François Roubille, Gilles Rioufol, François Derimay, Marc Goralski, Wael Yafi, Emmanuelle Filippi, Alain Kermarrec, Christophe LE Ray, Antoine Merlet, Aurelie Loirat, Philippe Brunel, Damien Brunet, Jack Ravisy, Laurent Mock, Guillaume Molins, Max Carre, Erwan Bressollette, Luc Christiaens, Elisa Larrieu-Ardilouze, Romain Cador Cador, Eric VAN Belle, Gilles Lemesle, Cédric Delhaye, Flavien Vincent, Sina Porouchani, Hugues Spillemaeker, Katy Petit, Olivier Ressencourt, Max Carre, Vincent Humeau, François Jourda, Marc-Antoine Arnould, Stephen Chassaing, Karl Isaaz, Laurent Payot, Jacques Montsegu, Benjamin Faurie, Michel Pansieri, Marc Metge, Karim Moussa, Mathieu Pankert, Olivier Morel, Sébastien Hess, Luc Maillard, Thibault Manigold, Vincent Letocart, Julien Plessis, Pauline Berthome, Mickael Bonin, François Huchet, Emmanuel Teiger, Romain Gallet, Gauthier Mouillet, Madjid Boukantar, Rami El Mahmoud, Mohammed Nejjari, David Attias, Léa Cacoub, Mathieu Steinecker, François Huchet, Zuzana Motovska, Martin Kozel, Zdenko Stelmach, Ota Hlinomaz, Michal Rezek, Martin Novak, Jan Sitar, Jiri Semenka, Petr Kala, Otakar Bocek, Roman Štipal, Martin Poloczek, Jan KanovskÝ, Petr Jerabek, Jiří Karasek, Sylvie Hruskova, Marian Branny, Jan Mrozek, Tomas Grezl, Leos Pleva, Pavel Kukla, Martin Porzer., Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), 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), and Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)
Subjects: Male, Ticagrelor, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Population, 030204 cardiovascular system & hematology, Coronary artery disease, 03 medical and health sciences, Percutaneous Coronary Intervention, 0302 clinical medicine, medicine, Humans, cardiovascular diseases, 030212 general & internal medicine, Myocardial infarction, education, ComputingMilieux_MISCELLANEOUS, education.field_of_study, business.industry, Percutaneous coronary intervention, General Medicine, Middle Aged, medicine.disease, Clopidogrel, 3. Good health, [SDV] Life Sciences [q-bio], Treatment Outcome, Action study, Elective Surgical Procedures, Anesthesia, Conventional PCI, Purinergic P2Y Receptor Antagonists, Female, business, Platelet Aggregation Inhibitors, medicine.drug
Abstract: International audience; Background: Percutaneous coronary intervention (PCI)-related myonecrosis is frequent and can affect the long-term prognosis of patients. To our knowledge, ticagrelor has not been evaluated in elective PCI and could reduce periprocedural ischaemic complications compared with clopidogrel, the currently recommended treatment. The aim of the ALPHEUS study was to examine if ticagrelor was superior to clopidogrel in reducing periprocedural myocardial necrosis in stable coronary patients undergoing high-risk elective PCI.Methods: The ALPHEUS study, a phase 3b, randomised, open-label trial, was done at 49 hospitals in France and Czech Republic. Patients with stable coronary artery disease were eligible for the study if they had an indication for PCI and at least one high-risk characteristic. Eligible patients were randomly assigned (1:1) to either ticagrelor (180 mg loading dose, 90 mg twice daily thereafter for 30 days) or clopidogrel (300-600 mg loading dose, 75 mg daily thereafter for 30 days) by use of an interactive web response system, and stratified by centre. The primary outcome was a composite of PCI-related type 4 (a or b) myocardial infarction or major myocardial injury and the primary safety outcome was major bleeding, both of which were evaluated within 48 h of PCI (or at hospital discharge if earlier). The primary analysis was based on all events that occurred in the intention-to-treat population. The trial was registered with ClinicalTrials.gov, NCT02617290.Findings: Between Jan 9, 2017, and May 28, 2020, 1910 patients were randomly assigned at 49 sites, 956 to the ticagrelor group and 954 to the clopidogrel group. 15 patients were excluded from the ticagrelor group and 12 from the clopidogrel group. At 48 h, the primary outcome was observed in 334 (35%) of 941 patients in the ticagrelor group and 341 (36%) of 942 patients in the clopidogrel group (odds ratio [OR] 0·97, 95% CI 0·80-1·17; p=0·75). The primary safety outcome did not differ between the two groups, but minor bleeding events were more frequently observed with ticagrelor than clopidogrel at 30 days (105 [11%] of 941 patients in the ticagrelor group vs 71 [8%] of 942 patients in the clopidogrel group; OR 1·54, 95% CI 1·12-2·11; p=0·0070).Interpretation: Ticagrelor was not superior to clopidogrel in reducing periprocedural myocardial necrosis after elective PCI and did not cause an increase in major bleeding, but did increase the rate of minor bleeding at 30 days. These results support the use of clopidogrel as the standard of care for elective PCI.Funding: ACTION Study Group and AstraZeneca.
Published: 2020

37. Proposal for a standardized discharge letter after hospital stay for acute myocardial infarction

Author: Francois Schiele, Gilles Lemesle, Denis Angoulvant, Michel Krempf, Serge Kownator, Saida Cheggour, Loic Belle, Jean Ferrières, Christophe Bauters, Cyrille Bergerot, Farzin Beygui, Franck Boccara, Eric Bonnefoy, Eric Bruckert, Guillaume Cayla, Jean-Philippe Collet, Pierre Coste, Vincent Descotes-Genon, Gregory Ducrocq, Meyer Elbaz, Michel Farnier, Emile Ferrari, Dominique Guedj, Laszlo Levai, Jacques Mansourati, Nicolas Mansencal, Nicolas Meneveau, Christophe Meune, Olivier Morel, Patrick Ohlmann, Francois Paillard, Christophe Piot, Etienne Puymirat, Gilles Rioufol, François Roubille, Pierre Sabouret, Emmanuel Teiger, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Centre Hospitalier Universitaire de Lille (CHU de Lille), Université Francois Rabelais [Tours], Physiopathologie des Adaptations Nutritionnelles (PhAN), Université de Nantes (UN)-Institut National de la Recherche Agronomique (INRA), Centre Cardiologique et Vasculaire, Partenaires INRAE, Centre Hospitalier Henri Duffaut (Avignon), Centre Hospitalier d'Annecy Genevois, Hôpital de Rangueil, and CHU Toulouse [Toulouse]
Subjects: medicine.medical_specialty, Consensus, Primary care, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Antithrombotic, Humans, Medicine, 030212 general & internal medicine, Myocardial infarction, Risk management, communication, business.industry, discharge, primary care, General Medicine, [SDV.MHEP.EM]Life Sciences [q-bio]/Human health and pathology/Endocrinology and metabolism, medicine.disease, Patient Discharge, 3. Good health, Residual risk, Regimen, Emergency medicine, Cardiology and Cardiovascular Medicine, business, Risk assessment, Fibrinolytic agent
Abstract: In patients admitted for acute myocardial infarction, the communication and transition from specialists to primary care physicians is often delayed, and the information imparted to subsequent healthcare providers (HCPs) may be sub-optimal. A French group of cardiologists, lipidologists and diabetologists decided to establish a consensus to optimize the discharge letter after hospitalization for acute myocardial infarction. The aim is to improve both the timeframe and the quality of the content transmitted to subsequent HCPs, including information regarding baseline assessment, procedures during hospitalization, residual risk, discharge treatments, therapeutic targets and follow-up recommendations in compliance with European Society of Cardiology guidelines. A consensus was obtained regarding a template discharge letter, to be released within two days after patient’s discharge, and containing the description of the patient’s history, risk factors, acute management, risk assessment, discharge treatments and follow-up pathway. Specifically for post acute MI patients, tailored details are necessary regarding the antithrombotic regimen, lipid-lowering and anti-diabetic treatments, including therapeutic targets. Lastly, the follow-up pathway needs to be precisely mentioned in the discharge letter. Additional information such as technical descriptions, imaging, and quality indicators may be provided separately. A template for a standardized discharge letter based on 8 major headings could be useful for implementation in routine practice and help to improve the quality and timing of information transmission between HCPs after acute MI.
Published: 2020

38. Clinical outcomes of PCI with rotational atherectomy: the European multicentre Euro4C registry

Author: Markus Meyer-Gessner, Wojciech Zajdel, Emanuele Barbato, Didier Carrié, Jorge Palazuelos Molinero, Krzysztof Reczuch, Sławomir Dobrzycki, Thibault Lhermusier, Miroslaw Ferenc, Erwan Bressollette, Guillaume Cayla, Frédéric Bouisset, Flavio Ribichini, Hôpital de Rangueil, CHU Toulouse [Toulouse], 'Federico II' University of Naples Medical School, University of Wrocław [Poland] (UWr), University of Bialystok, Augusta Krankenhaus, Nouvelles Cliniques Nantaises - NCN [Nantes], Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Uniwersytet Jagielloński w Krakowie = Jagiellonian University (UJ), Hospital Central de la Defensa Gomez Ulla, University Heart Centre Freiburg - Bad Krozingen, University of Verona (UNIVR), Bouisset, F., Barbato, E., Reczuch, K., Dobrzycki, S., Meyer-Gessner, M., Bressollette, E., Cayla, G., Lhermusier, T., Zajdel, W., Molinero, J. P., Ferenc, M., Ribichini, F., and Carrie, D.
Subjects: Atherectomy, Coronary, Male, Registrie, Atherectomy, MESH: Registries, medicine.medical_treatment, Coronary Artery Disease, 030204 cardiovascular system & hematology, MESH: Stroke Volume, Ventricular Function, Left, MESH: Aged, 80 and over, 0302 clinical medicine, Retrospective Studie, Undilatable lesion, Prospective Studies, Registries, 030212 general & internal medicine, Myocardial infarction, Stroke, MESH: Atherectomy, Coronary / instrumentation, MESH: Treatment Outcome, Aged, 80 and over, education.field_of_study, Ejection fraction, Calcified stenosi, Multiple vessel disease, 3. Good health, Europe, Treatment Outcome, Cardiology, Female, Cardiology and Cardiovascular Medicine, MESH: Percutaneous Coronary Intervention, Rotablator, Human, MESH: Atherectomy, Coronary / methods, medicine.medical_specialty, Acute coronary syndrome, MESH: Coronary Artery Disease / diagnosis, Population, MESH: Ventricular Function, Left / physiology, 03 medical and health sciences, Percutaneous Coronary Intervention, MESH: Coronary Artery Disease / surgery, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Internal medicine, Left main, medicine, Humans, education, Retrospective Studies, Aged, Interventional cardiology, business.industry, Percutaneous coronary intervention, Stroke Volume, MESH: Retrospective Studies, medicine.disease, MESH: Prospective Studies, Prospective Studie, MESH: Europe, business, Mace
Abstract: International audience; Aims: Despite the use of rotational atherectomy (RA) in interventional cardiology for over three decades, data regarding factors affecting the clinical outcomes of the RA procedure remain scarce. The aim of the present study was to describe the contemporary use and outcomes of RA in Europe.Methods and results: We conducted, for the first time, a prospective international registry in 8 European countries and 19 centres and included patients treated by percutaneous coronary intervention with RA. Between October 2016 and July 2018, 966 patients with complete data were recruited. Mean age was 74.5 years, 72.4% were male and 43.4% had diabetes. Initial presentation was an acute coronary syndrome (ACS) for 25.1% of the patients. Clinical success was observed in 91.9% of the procedures. The rate of in-hospital major adverse cardiac events (MACE) - defined as cardiovascular death, myocardial infarction, target lesion revascularisation, stroke and coronary artery bypass grafting - was 4.7%. At one year, the rate of MACE was 13.2%. Factors independently associated with the occurrence of MACE at one year were female gender, renal failure, ACS at admission, depressed left ventricular ejection fraction (LVEF) and presence of a significant left main coronary artery (LMCA) lesion.Conclusions: Despite the high level of complexity of the studied population, RA turned out to be an effective procedure with a low rate of in-hospital complications and demonstrated good immediate and midterm results.
Published: 2020

39. Routine CYP2C19 Genotyping to Adjust Thienopyridine Treatment After Primary PCI for STEMI

Author: Jean-Sébastien Hulot, Bernard Chevalier, Loic Belle, Guillaume Cayla, Khalife Khalife, François Funck, Romain Berthier, Christophe Piot, Muriel Tafflet, Gilles Montalescot, Loïc Belle, Hervé Le Breton, Emmanuel Teiger, Grégoire Dambrin, K. Khalife, L. Schmutz, F. Funck, R. Berthier, C. Piot, G. Hannebicque, G. Montalescot, T. Lognone, F. De Poli, B. Chevalier, N. Lhoest, M. Schneeberger, N. Delarche, A. Faure, H. Aelion, M. Godin, M. Gilard, B. Ritz, P. Barraud, P. Barnay, L.N. Saïdi, O. Le Dref, P. Garot, G. Range, J. Georges, C. Robin, Y. Cottin, L. Belle, G. Souteyrand, A. Lafont, A. Fournier, P. Dupouy, J. Shayne, P. Chapon, C. Boureux, J.P. Faure, H. Ben Amer, A. Furber, O. Ormezzano, G. Bayet, G. Karrillon, L. Maillard, A. Grenzinger, A. Avran, R. Koning, D. Dumant, X. Lamit, R. Dauphin, L. Drogoul, T. Cuisset, O. Wittenberg, J.P. Peyre, P. Laury, and R. Robert
Subjects: medicine.medical_specialty, Thienopyridine, business.industry, Cyp2c19 genotype, CYP2C19, 030204 cardiovascular system & hematology, medicine.disease, Clopidogrel, Real life setting, 3. Good health, 03 medical and health sciences, surgical procedures, operative, 0302 clinical medicine, Internal medicine, Conventional PCI, medicine, cardiovascular diseases, 030212 general & internal medicine, Myocardial infarction, Cardiology and Cardiovascular Medicine, business, Genotyping, medicine.drug
Abstract: @DrHulot_PARCC Anti-platelet therapy adjustment guided by CYP2C19 genotyping can be done in
Published: 2020

40. Republication de : Accidents hémorragiques graves sous antiplaquettaires : que faire ?

Author: Bertrand Ledermann, Luc Cornillet, Clément Lonjon, Benoit Lattuca, Guillaume Cayla, and Laurent Schmutz
Subjects: 03 medical and health sciences, 0302 clinical medicine, Emergency Medicine, 030212 general & internal medicine, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine
Abstract: Resume Le traitement antiplaquettaire est la pierre angulaire du traitement et de la prevention de la maladie coronaire. L'association d'aspirine et d'inhibiteur du recepteur P2Y12 est recommandee dans le syndrome coronarien aigu et apres une angioplastie coronaire. La duree optimale de la bitherapie antiplaquettaire depend du risque ischemique et hemorragique du patient. Les accidents hemorragiques associes a la bitherapie antiplaquettaire restent les complications les plus frequentes des agents antiplaquettaires bien qu'elles soient generalement minimes ou moderees. Au-dela de l'evaluation individualisee du risque hemorragique, la prise en charge des patients presentant des complications hemorragiques graves est une situation difficile qui necessite des recommandations generales et specifiques. La principale adaptation therapeutique reste l'arret de la bitherapie avec la poursuite d'une monotherapie au decours.
Published: 2020

41. TIcagrelor in Rotational Atherectomy to Reduce TROPonin Enhancement: The TIRATROP Study, A Randomized Controlled Trial

Author: Thibault Lhermusier, Pascal Motreff, Vincent Bataille, Guillaume Cayla, Bruno Farah, Jerome Roncalli, Meyer Elbaz, Nicolas Boudou, Fransisco Campello-Parada, Frederic Bouisset, Geraud Souteyrand, Emilie Berard, Vanina Bongard, and Didier Carrie
Subjects: clopidogrel, percutaneous coronary intervention, General Medicine, coronary artery disease, rotational atherectomy, ticagrelor
Abstract: Background: Because rotational atherectomy (RA) is associated with arterial trauma and platelet activation, patients treated with RA may benefit from more potent antiplatelet drugs. The aim of this trial was to assess the superiority of ticagrelor over clopidogrel in reducing post procedure troponin release. Methods: TIRATROP (TIcagrelor in Rotational Atherectomy to reduce TROPonin enhancement) is a multicenter double-blind randomized controlled trial that included 180 patients with severe calcified lesions requiring RA who received either clopidogrel (300 mg loading dose, then 75 mg/d) or ticagrelor (loading dose 180 mg then 90 mg twice daily). Blood samples were collected at the beginning (T0), and 6, 12, 18, 24 and 36 h after the procedure. Primary end point was troponin release within the first 24 h using area under the curve analysis (troponin level as a function of time). Results: The mean age of patients was 76 ± 10 years, 35% had diabetes. RA was used to treat 1, 2 or 3 calcified lesions in 72%, 23% and 5% of patients, respectively. Troponin release within the first 24 h was similar in both the ticagrelor (adjusted mean ±SD of ln AUC 8.85 ± 0.33) and the clopidogrel (8.77 ± 0.34, p = 0.60) arms. Independent predictors for troponin enhancement were acute coronary syndrome presentation, renal failure, elevated C-Reactive protein and multiple lesions treated with RA. Conclusion: Troponin release did not differ among treatment arms. Our results suggest that greater platelet inhibition does not affect periprocedural myocardial necrosis in the setting of RA.
Published: 2023

42. Is Stent Thrombosis a Genetic Disease?

Author: Guillaume Cayla and Benoit Lattuca
Published: 2023

43. À quel patient proposer un TAVI en 2019 ?

Author: Camille Soullier, C. Robert, Laurent Schmutz, Benoit Lattuca, A.L. Goger, M. Cambon-Viala, Jean-Etienne Ricci, and Guillaume Cayla
Subjects: medicine.medical_specialty, Percutaneous, business.industry, medicine.medical_treatment, 030204 cardiovascular system & hematology, medicine.disease, Surgical risk, Surgery, 03 medical and health sciences, Stenosis, 0302 clinical medicine, Valve replacement, Heart team, Medicine, Cardiology and Cardiovascular Medicine, business
Abstract: The therapeutic management of aortic stenosis has been drastically changed by the advent of percutaneous valve replacement (TAVI). Since the first implantation, the indications have progressively been extended from the inoperable patient to the patient at low surgical risk. The main objective of this review is to describe the currently recommended main indications of TAVI depending on an individualized assessment of each patient's risk, technical characteristics and anatomical valvular criteria.
Published: 2019

44. Accidents hémorragiques graves sous antiplaquettaires : que faire ?

Author: Clément Lonjon, Luc Cornillet, Bertrand Ledermann, Benoit Lattuca, Laurent Schmutz, and Guillaume Cayla
Subjects: medicine.medical_specialty, Acute coronary syndrome, Aspirin, business.industry, medicine.medical_treatment, Percutaneous coronary intervention, General Medicine, 030204 cardiovascular system & hematology, medicine.disease, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, P2Y12, Pharmacotherapy, Severity of illness, medicine, 030212 general & internal medicine, business, Intensive care medicine, Complication, medicine.drug
Abstract: Antiplatelet therapy is the cornerstone of coronary artery disease treatment and prevention. Combination of aspirin and P2Y12 inhibitor is recommended after acute coronary syndrome and after elective percutaneous coronary intervention. The optimal duration of dual antiplatelet therapy depends on the individual ischemic and bleeding risk of the patient. Bleeding on dual anti platelet therapy remains the most frequent complication of antiplatelet therapy even is mostly minimal or moderate. Beyond individualized evaluation of patients' bleeding risk, management of patients with severe bleeding complications is a challenging situation and requires general and specific recommendations with interruption of the dual antiplatelet therapy in the vast majority of the cases.
Published: 2019

45. Mechanical complications in ST-elevation myocardial infarction: The impact of pre-hospital delay

Author: Jean Ferrières, Philippe Commeau, Antoine Deney, Frédéric Bouisset, Vassili Panagides, Mathieu Becker, Julien Adjedj, Guillaume Bonnet, Cedric Yvorel, Hakim Benamer, Nicolas Riviere, Guillaume Cayla, Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Aix-Marseille Université - École de médecine (AMU SMPM MED), Aix-Marseille Université - Faculté des sciences médicales et paramédicales (AMU SMPM), Aix Marseille Université (AMU)-Aix Marseille Université (AMU), Centre hospitalier régional Metz-Thionville (CHR Metz-Thionville), Hôpital Haut-Lévêque [CHU Bordeaux], CHU Bordeaux [Bordeaux], Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), Institut Arnault Tzanck, Hôpital Privé Jacques Cartier [Massy], Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), and Université de Montpellier (UM)
Subjects: medicine.medical_specialty, medicine.medical_treatment, Free wall rupture, Revascularization, Ventricular Septal Rupture, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, MESH: Risk Factors, Internal medicine, Latecomer, medicine, Ventricular septal rupture, MESH: COVID-19, MESH: SARS-CoV-2, Myocardial infarction, Mechanical complication, MESH: ST Elevation Myocardial Infarction, MESH: Treatment Outcome, MESH: Aged, MESH: Humans, MESH: Middle Aged, business.industry, Mortality rate, Papillary muscle rupture, Percutaneous coronary intervention, medicine.disease, MESH: Hospitals, MESH: Male, ST-elevation myocardial infarction, Conventional PCI, Cardiology, Cardiology and Cardiovascular Medicine, business, MESH: Female, MESH: Percutaneous Coronary Intervention, Dyslipidemia, TIMI
Abstract: International audience; Aims: Mechanical complications (MC) (i.e., free wall rupture (FWR), papillary muscle rupture (PMR) and ventricular septal rupture (VSR)) are rare complications of ST- elevation acute myocardial infarction (STEMI). Incidence of MC according to pre-hospital delay remains unknown. We aimed to determine the rates of MC according to pre-hospital delay.Methods: Analysis was conducted on the MODIF registry data. Patients were allocated to four groups according to pre-hospital delay: 0 to 12 h, 12 to 24 h, 24 to 36 h and 36 to 48 h.Results: 6185 patients with complete data were analyzed. Mean age was 64.1 years old and 75.7% of patients were males. Eighty-three patients (1.34%) presented with MC: 44 (0.71%) experienced a FWR, 17 (0.27%) a PMR, and 22 (0.36%) a VSR. Global rates of MC were 0.82%, 1.43%, 1.24% and 5.07% in the four groups of pre-hospital delays - 0 to 12 h, 12 to 24 h, 24 to 36 h and 36 to 48 h - respectively (p < 0.001). In-hospital mortality rates were high: 44.2%, 47.1% and 54.6% for FWR, PMR and VSR, respectively. In multivariate analysis, factors independently related to the occurrence of MC were older age, female sex, simultaneous COVID-19 infection, absence of dyslipidemia, initial TIMI flow 0 or 1 in the culprit artery, 36 to 48 h-pre-hospital delay and absence of revascularization by percutaneous coronary intervention (PCI) with stent implantation.Conclusion: The probability of MC in STEMI increases with pre-hospital delay. Mechanical complications of STEMI remain associated with a very poor prognosis.
Published: 2021

46. Atrial fibrillation screening on systematic ambulatory electrocardiogram monitoring after percutaneous patent foramen ovale closure: A prospective study

Author: Caroline Arquizan, Pierre Robert, François Roubille, Grégory Marin, Mariama Akodad, Laurence Pages, Jean Christophe Macia, Florence Leclercq, Guillaume Cayla, Delphine Delseny, Xavier Odorico, Audrey Agullo, Benoit Lattuca, Nicolas Gaillard, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre d’Ecologie Fonctionnelle et Evolutive (CEFE), Université Paul-Valéry - Montpellier 3 (UPVM)-École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD [France-Sud])-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Institut Agro - Montpellier SupAgro, Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), 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), Institut de Génomique Fonctionnelle (IGF), Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro), Herrada, Anthony, CHU Montpellier, Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), and Université Paul-Valéry - Montpellier 3 (UPVM)-École Pratique des Hautes Études (EPHE)
Subjects: Percutaneous, ASA, atrial septum aneurysm, Transthoracic echocardiography, [SDV]Life Sciences [q-bio], 030204 cardiovascular system & hematology, DSC, 0302 clinical medicine, Ambulatory electrocardiogram, PFO, Palpitations, Clinical endpoint, Prospective cohort study, Transient ischemic attack, Transesophageal echocardiography, Incidence (epidemiology), AIS, acute ischemic stroke, AIS, Atrial fibrillation, TEE, transesophageal echocardiography, 3. Good health, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, TTE, transthoracic echocardiography, Cardiology, cardiovascular system, TTE, medicine.symptom, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, TIA, transient ischemic attack, ASA, AF, atrial fibrillation, PFO, patent foramen ovale, Acute ischemic stroke, Asymptomatic, 03 medical and health sciences, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Internal medicine, AECG, ambulatory electrocardiogram, medicine, Diseases of the circulatory (Cardiovascular) system, DSC, decompression sickness, Holter Monitoring, Original Paper, AECG, Decompression sickness, business.industry, TIA, Percutaneous closure, AF, medicine.disease, Patent foramen ovale, TEE, RC666-701, Atrial septum aneurysm, business, 030217 neurology & neurosurgery
Abstract: Highlights • Incidence of atrial fibrillation (AF) following patent foramen ovale (PFO) closure is low (, Background Increased risk of new-onset atrial fibrillation (AF) after patent foramen ovale (PFO) closure was observed in randomized trials without however systematic AF screening. We aimed to evaluate the incidence of AF within 6-month following PFO closure with serial 24-hour ambulatory electrocardiogram (AECG) monitoring. Methods All patients undergoing PFO closure were prospectively included in 2 centers. AF was defined as irregular rhythm without discernible P waves > 30 s on AECG at day 0, 1-month and 6-month follow-up. Primary endpoint was the incidence of AF within the study period. Secondary endpoints evaluated clinical outcomes within 6-month follow-up. Results Between February 2018 and March 2019, 62 patients underwent PFO closure including 40 male (64.5%) with a mean age of 48 ± 9.5. Atrial septal aneurysm was observed in 37 patients (64.9%), 57 patients (91.9%) received an Amplatzer Occluder device (Abbott Vascular) and 5 (8.1%) an Occlutech device (Occlutech). After a mean follow-up of 7.7 ± 2.8 months, new-onset AF occurred in 3 patients (4.8%), all within the first month following PFO closure, including one per-procedural, all were asymptomatic and paroxysmal. Two patients with AF (3.2%) required chronic oral anticoagulant therapy. No adverse outcomes occurred at follow-up. No predictive factors of AF were highlighted. A total of 16 patients (25.8%) reported palpitations without AF on the AECGs. Conclusion In highly selected patients, incidence of AF, evaluated with 3 systematic 24-hour AECG within 6-month following PFO closure, was low (
Published: 2021

47. Erratum to 'Evolution of TAVI patients and techniques over the past decade: The French TAVI registries' [Arch. Cardiovasc. Dis. 115 (4) (2022) 206–13]

Author: Romain Didier, Herve Le Breton, Hélène Eltchaninoff, Guillaume Cayla, Philippe Commeau, Jean-Philippe Collet, Thomas Cuisset, Nicolas Dumonteil, Jean-Philippe Verhoye, Sylvain Beurtheret, Thierry Lefèvre, Bernard Iung, and Martine Gilard
Subjects: General Medicine, Cardiology and Cardiovascular Medicine
Published: 2022

48. Abstract 10554: One Year Follow-up After Resuscitated Cardiac Arrest Admitted For Emergency Coronary Angiography: A Prospective, Observational Registry

Author: QUENTIN DELBAERE, Florence Leclercq, Mariama Akodad, BenoÃ®t Lattuca, and Guillaume Cayla
Subjects: Physiology (medical), Cardiology and Cardiovascular Medicine
Abstract: Introduction: Despite improvement of in-hospital survival rate after aborted sudden cardiac death (SCD), cerebral anoxia may have severe neurologic consequences and may impair long term outcome and quality of life of surviving patients. Methods: This prospective, observational and multicentre (Montpellier and Nimes) study included patients > 18 yo admitted in the cathlab for CA after aborted SCD between May 1, 2018 to May 31, 2020. Only patients who were discharged alive from hospital were evaluated. The primary end point was survival without neurological sequelae at one year follow-up defined by Cerebral Performance Category (CPC) of 1 or 2. Secondary end points included global mortality, NYHA functional class, neurologic evaluation at discharge, 3-months and 1 year follow-up using the CPC scale, and quality of life at 1 year using the QOLIBRI (Quality of LIfe after BRain Injury) questionnaire. Results: Among 143 patients included during the study period, 61 (43%) were discharged alive from hospital and 55 (90%) of them completed follow-up at 1 year. Patients were young (59.4 +/- 14.1), mainly male (77%), with few cardiovascular risk factors. Duration of no and low flow period was short (1.9 +/- 2.4 and 16.5 +/- 10.4 minutes respectively). For 93% of the surviving patients, an initial shockable rhythm (n=57) was observed and acute coronary syndrome (ACS) was diagnosed in 75% of them (n=46). At 1 year, survival rate without neurologic sequelae was 87% (n=48). There were few recurrences of rhythm disorder (5%) or ischemic event (4%). Patients with poor outcome were older (p=0.036), have lower body mass index (p=0.013) and a lower initial LVEF (p=0.046). During follow-up, neurological status improved in 37% of patients presenting sequelae at discharge and overall quality of life was globally satisfying for 66% of patients according to the QOLIBRI questionnaire. No death from cardiac cause was reported, and mean LVEF at 1 year was improved (51.5 ± 9.2 vs 47.5 ± 11.5, p < 0.01). Conclusion: Among patients admitted to the cathlab for aborted SCD, mainly related to ACS, less than half of them were alive at discharge. However, their 1-year survival rate without neurological sequelae was high and their overall quality of life was good.
Published: 2021

49. Compared Outcomes of ST-Segment–Elevation Myocardial Infarction Patients With Multivessel Disease Treated With Primary Percutaneous Coronary Intervention and Preserved Fractional Flow Reserve of Nonculprit Lesions Treated Conservatively and of Those With Low Fractional Flow Reserve Managed Invasively: Insights From the FLOWER-MI Trial

Author: Alicia Le Bras, Philippe Gabriel Steg, Gilles Montalescot, Tabassome Simon, Isabelle Durand-Zaleski, Hervé Le Breton, Francois Schiele, Gérald Vanzetto, Nicolas Danchin, Yann Valy, Denis Angoulvant, Pierre Denormandie, François Roubille, Etienne Puymirat, Gilles Chatellier, Pascal Goube, Guillaume Cayla, Thomas Cuisset, Anaïs Charles-Nelson, Sébastien Levesque, O. Nallet, Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université Pierre et Marie Curie - Paris 6 (UPMC), Hémostase, bio-ingénierie et remodelage cardiovasculaires (LBPC), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Institut Galilée-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Université de Montpellier (UM), Laboratoire de Recherche Vasculaire Translationnelle (LVTS (UMR_S_1148 / U1148)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Alliance française pour les essais cliniques cardio-vasculaires - French Alliance for Cardiovascular Trials (FACT), Université Paris Cité (UPCité), Sorbonne Université (SU), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), 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)-CHU Pitié-Salpêtrière [AP-HP], Hôpital Hôtel-Dieu [Paris], Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Rennes (UR), CHU Pontchaillou [Rennes], Service de Cardiologie La Rochelle (CHU La Rochelle), Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( UR 3920) (PCVP / CARDIO), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Nutrition, obésité et risque thrombotique (NORT), Institut National de la Recherche Agronomique (INRA)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital de la Timone [CHU - APHM] (TIMONE), Aix Marseille Université (AMU), Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Radiopharmaceutiques biocliniques (LRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes (UGA), Centre Hospitalier Universitaire [Grenoble] (CHU), Université Grenoble Alpes (UGA), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Centre Hospitalier Sud Francilien, Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, EA4245 - Transplantation, Immunologie, Inflammation [Tours] (T2i), Université de Tours (UT), CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), 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), CIC - HEGP (CIC 1418), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), MORNET, Dominique, Université Paris Diderot - Paris 7 (UPD7)-Université Paris 13 (UP13)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Galilée, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Université Sorbonne Paris Nord, Université de Paris (UP), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Université de Rennes (UNIV-RENNES), Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( EA 3920) (PCVP / CARDIO), Université Grenoble Alpes (UGA)-Institut National de la Santé et de la Recherche Médicale (INSERM), CH Evry-Corbeil, Université de Tours, Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Aix Marseille Université (AMU)-Institut National de la Recherche Agronomique (INRA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Hôpital Européen Georges Pompidou [APHP] (HEGP), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)
Subjects: medicine.medical_specialty, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Myocardial Infarction, Context (language use), Fractional flow reserve, 030204 cardiovascular system & hematology, Coronary Angiography, Revascularization, Culprit, Coronary artery disease, cause of death, 03 medical and health sciences, Percutaneous Coronary Intervention, 0302 clinical medicine, Internal medicine, medicine, cardiovascular diseases, 030212 general & internal medicine, Myocardial infarction, humans, business.industry, Percutaneous coronary intervention, medicine.disease, follow-up studies, Fractional Flow Reserve, Myocardial, [SDV] Life Sciences [q-bio], surgical procedures, operative, Treatment Outcome, Conventional PCI, Cardiology, ST Elevation Myocardial Infarction, Cardiology and Cardiovascular Medicine, business, coronary artery disease, hospitalization
Abstract: Background: In patients with ST-segment–elevation myocardial infarction and multivessel disease, percutaneous coronary intervention (PCI) for nonculprit lesions guided by fractional flow reserve (FFR) is superior to treatment of the culprit lesion alone. Whether deferring nonculprit PCI is safe in this specific context is questionable. We aimed to assess clinical outcomes at 1 year in ST-segment–elevation myocardial infarction patients with multivessel coronary artery disease and an FFR-guided strategy for nonculprit lesions, according to whether or not ≥1 PCI was performed. Methods: Outcomes were analyzed in patients of the randomized FLOWER-MI (Flow Evaluation to Guide Revascularization in Multivessel ST-Elevation Myocardial Infarction) trial in whom, after successful primary PCI, nonculprit lesions were assessed using FFR. The primary outcome was a composite of all-cause death, nonfatal myocardial infarction, and unplanned hospitalization with urgent revascularization at 1 year. Results: Among 1171 patients enrolled in this study, 586 were assigned to the FFR-guided group: 388 (66%) of them had ≥1 PCI, and 198 (34%) had no PCI. Mean FFR before decision (ie, PCI or not) of nonculprit lesions was 0.75±0.10 and 0.88±0.06, respectively. During follow-up, a primary outcome event occurred in 16 of 388 patients (4.1%) in patients with PCI and in 16 of 198 patients (8.1%) in patients without PCI (adjusted hazard ratio, 0.42 [95% CI, 0.20–0.88]; P =0.02). Conclusions: In patients with ST-segment–elevation myocardial infarction undergoing complete revascularization guided by FFR measurement, those with ≥1 PCI had lower event rates at 1 year, compared with patients with deferred PCI, suggesting that deferring lesions judged relevant by visual estimation but with FFR >0.80 may not be optimal in this context. Future randomized studies are needed to confirm these data. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02943954. Graphic Abstract: A graphic abstract is available for this article.
Published: 2021

50. Indirect Transfer to Catheterization Laboratory for ST Elevation Myocardial Infarction Is Associated With Mortality Independent of System Delays: Insights From the France-PCI Registry

Author: Farzin Beygui, Vincent Roule, Fabrice Ivanes, Thierry Dechery, Olivier Bizeau, Laurent Roussel, Philippe Dequenne, Marc-Antoine Arnould, Nicolas Combaret, Jean Philippe Collet, Philippe Commeau, Guillaume Cayla, Gilles Montalescot, Hakim Benamer, Pascal Motreff, Denis Angoulvant, Pierre Marcollet, Stephan Chassaing, Katrien Blanchart, René Koning, and Grégoire Rangé
Subjects: Cardiology and Cardiovascular Medicine
Abstract: BackgroundFirst medical contact (FMC)-to-balloon time is associated with outcome of ST-elevation myocardial infarction (STEMI). We assessed the impact on mortality and the determinants of indirect vs. direct transfer to the cardiac catheterization laboratory (CCL).MethodsWe analyzed data from 2,206 STEMI patients consecutively included in a prospective multiregional percutaneous coronary intervention (PCI) registry. The primary endpoint was 1-year mortality. The impact of indirect admission to CCL on mortality was assessed using Cox models adjusted on FMC-to-balloon time and covariables unequally distributed between groups. A multivariable logistic regression model assessed determinants of indirect transfer.ResultsA total of 359 (16.3%) and 1847 (83.7%) were indirectly and directly admitted for PCI. Indirect admission was associated with higher risk features, different FMCs and suboptimal pre-PCI antithrombotic therapy.At 1-year follow-up, 51 (14.6%) and 137 (7.7%) were dead in the indirect and direct admission groups, respectively (adjusted-HR 1.73; 95% CI 1.22–2.45). The association of indirect admission with mortality was independent of pre-FMC and FMC characteristics. Older age, paramedics- and private physician-FMCs were independent determinants of indirect admission (adjusted-HRs 1.02 per year, 95% CI 1.003–1.03; 5.94, 95% CI 5.94 3.89–9.01; 3.41; 95% CI 1.86–6.2, respectively).ConclusionsOur study showed that, indirect admission to PCI for STEMI is associated with 1-year mortality independent of FMC to balloon time and should be considered as an indicator of quality of care. Indirect admission is associated with higher-risk features and suboptimal antithrombotic therapy. Older age, paramedics-FMC and self-presentation to a private physician were independently associated with indirect admission. Our study, supports population education especially targeting elderly, more adequately dispatched FMC and improved pre-CCL management.
Published: 2021

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