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Un an après les attentats du 13 novembre 2015, Santé publique France, dans le cadre du programme 13-Novembre, a mis en place l'Enquête de santé publique post-attentats de novembre 2015 (ESPA 13 novembre) en direction des civils et intervenants exposés. Parmi les questions posées par l'enquête, se trouve notre question d'intérêt : « Diriez-vous que l'expérience que vous avez vécue vous a changé, d'une manière ou d'une autre ? Pourriez-vous nous expliquer en quoi ? ». Il s'agit de comprendre les changements éprouvés par les civils et les intervenants et de comparer leurs réponses. Une analyse thématique est proposée pour chacun des deux groupes. Les thématiques leurs sont communes mais apparaissent comme qualitativement différentes. L'analyse qualitative est complétée et affinée par des données chiffrées concernant les caractéristiques sociodémographiques des répondants de chaque groupe. Certains répondants (principalement des intervenants hommes) ne ressentent aucun changement. Ils présentent des facteurs de protection spécifiques. Des changements douloureux au niveau relationnel, émotionnel, et psychique impactent surtout la population des femmes civiles. Certains changements prennent malgré tout la forme d'une résilience, voire d'une croissance post-traumatique. Elles supposent un processus de transformation qui passe par une réappropriation de l'existence (pour un quart des civils comme des intervenants) mais aussi par un nouveau rapport au monde (chez les intervenants ayant travaillé dans la nuit du 13 novembre) et à soi (principalement pour les civils, femmes). L'impact des attentats est plus important pour les civils et particulièrement pour les femmes. Le processus de transformation constaté peut conduire à des issues favorables n'évitant cependant pas la souffrance. Il conviendrait de transposer et développer une partie des facteurs de protections repérées chez les intervenants, aux populations civiles. One year after the attacks of November 13, 2015, Santé publique France, within the framework of the 13-November program, set up the Post-Attacks Public Health Survey of November 2015 (ESPA November 13) aimed at exposed civilians and responders. Several open questions are proposed including our question of interest: "Would you say that the experience you have had has changed you, in one way or another? Could you explain to us how? The aim is to understand the effect of attacks on civilians and responders and to compare their responses. A thematic analysis is proposed for each of the two groups. The themes are common to them but appear to be qualitatively different. The qualitative analysis is supplemented and refined by figures concerning the socio-demographic characteristics of the respondents in each group. Some respondents (mainly male workers) do not feel any change. They have specific protective factors. Painful changes at the relational, emotional, and psychic level impact above all female civilians. Some changes take the form of resilience or even post-traumatic growth. They presuppose a process of transformation, which involves a reappropriation of one's existence (for a quarter of civilians and workers alike) but also a new relationship to the world (among workers who worked on the night of November 13) and to oneself (mainly for civilians, women). The impact of the attacks is greater for civilians and particularly women. The process of transformation observed can lead to favorable outcomes that do not, however, avoid suffering. It would be appropriate to transpose some of the protection factors from the responders to the civilian populations. [ABSTRACT FROM AUTHOR]

BACKGROUND: In patients with multivessel disease with successful primary percutaneous coronary intervention for ST-segment– elevation myocardial infarction, the FLOWER-MI trial (Flow Evaluation to Guide Revascularization in Multivessel ST-Elevation Myocardial Infarction) showed that a fractional flow reserve (FFR)–guided strategy was not superior to an angiography-guided strategy for treatment of noninfarct-related artery lesions regarding the 1-year risk of death from any cause, myocardial infarction, or unplanned hospitalization leading to urgent revascularization. The extension phase of the trial was planned using the same primary outcome to determine whether a difference in outcomes would be observed with a longer follow-up. METHODS: In this multicenter trial, we randomly assigned patients with ST-segment–elevation myocardial infarction and multivessel disease with successful percutaneous coronary intervention of the infarct-related artery to receive complete revascularization guided by either FFR (n=586) or angiography (n=577). RESULTS: After 3 years, a primary outcome event occurred in 52 of 498 patients (9.40%) in the FFR-guided group and in 44 of 502 patients (8.17%) in the angiography-guided group (hazard ratio, 1.19 [95% CI, 0.79–1.77]; P=0.4). Death occurred in 22 patients (4.00%) in the FFR-guided group and in 23 (4.32%) in the angiography-guided group (hazard ratio, 0.96 [95% CI, 0.53–1.71]); nonfatal myocardial infarction in 23 (4.13%) and 14 (2.56%), respectively (hazard ratio, 1.63 [95% CI, 0.84–3.16]); and unplanned hospitalization leading to urgent revascularization in 21 (3.83%) and 18 (3.36%; hazard ratio, 1.15 [95% CI, 0.61–2.16]), respectively CONCLUSIONS: Although event rates in the trial were lower than expected, in patients with ST-segment–elevation myocardial infarction undergoing complete revascularization, an FFR-guided strategy did not have a significant benefit over an angiography-guided strategy with respect to the risk of death, myocardial infarction, or urgent revascularization up to 3 years. [ABSTRACT FROM AUTHOR]

[Display omitted] Transcatheter aortic valve implantation is unfeasible for 10–15% of patients using the conventional transfemoral approach. Other alternative approaches, such as the subclavian approach, have emerged, with no clear recommendation indicating the superiority of one technique over another. To compare the 1-month mortality and postprocedural outcomes of patients undergoing transcatheter aortic valve implantation using a self-expandable valve via transfemoral and subclavian access. This was a retrospective single-centre study including 1496 patients who underwent transcatheter aortic valve implantation between January 2016 and December 2020 at Clermont-Ferrand University Hospital, France. Propensity score matching was used to compare transfemoral and subclavian access. After building two propensity score-matched groups of 221 patients each with either access route (total n = 442), baseline characteristics were similar. The procedure duration was significantly longer in the subclavian access group (53 [45–64] versus 60 [51–72] minutes; P < 0.001), but with a lower amount of contrast agent (138 [118–165] versus 123 [105–150] mL; P < 0.001), fluoroscopy time (11.2 [9–14] versus 9.9 [7–12] minutes; P < 0.001) and radiation dose (397 [264–620] versus 321 [217–485] mGy; P < 0.001). No significant difference was observed concerning 1-month mortality (odds ratio 1.62, 95% confidence interval 0.52–5.03; P = 0.39) or periprocedural complications. Follow-up at 1 year confirmed no difference in longer-term mortality (hazard ratio 0.78, 95% confidence interval 0.52–5.03; P = 0.43). The subclavian approach provides similar results to the transfemoral approach in terms of mortality, efficacy and safety; it is a reasonable and effective alternative when the reference transfemoral approach is impossible or seems complex. [ABSTRACT FROM AUTHOR]

[Display omitted] • France PCI: a multicentre observational percutaneous coronary intervention registry. • Entirely integrated with a variety of local PCI-reporting software. • Onsite local research assistants. • These features allow low-cost high-quality data to be obtained. • Annual online activity reports, scoring and benchmarking tools. • These elements ensure immediate feedback to users to improve clinical practice. • Local pilot experience launched in 2014, and expanded to 47 centres in 2022. • > 170,000 PCI and 80,000 ACS cases collected, with systematic 1-year follow-up. • 15 international publications released, and numerous scientific studies ongoing. • Nested randomized controlled trials and merging with SNDS planned for 2024. Obstructive coronary artery disease is the main cause of death worldwide. By tracking events and gaining feedback on patient management, the most relevant information is provided to public health services to further improve prognosis. To create an inclusive and accurate registry of all percutaneous coronary intervention (PCI) procedures performed in France, to assess and improve the quality of care and create research incentives. Also, to describe the methodology of this French national registry of interventional cardiology, and present early key findings. The France PCI registry is a multicentre observational registry that includes consecutive patients undergoing coronary angiography and/or PCI. The registry was set up to provide online data analysis and structured reports of PCI activity, including process of care measures and assessment of risk-adjusted outcomes in all French PCI centres that are willing to participate. More than 150 baseline data items, describing demographic status, PCI indications and techniques, and in-hospital and 1-year outcomes, are captured into local reporting software by medical doctors and local research technicians, with subsequent encryption and internet transfer to central data servers. Annual activity reports and scoring tools available on the France PCI website enable users to benchmark and improve clinical practices. External validation and consistency assessments are performed, with feedback of data completeness to centres. Between 01 January 2014 and 31 December 2022, participating centres increased from six to 47, and collected 364,770 invasive coronary angiograms and 176,030 PCIs, including 54,049 non-ST-segment elevation myocardial infarction cases and 31,631 ST-segment elevation myocardial infarction cases. Fifteen studies stemming from the France PCI registry have already been published. This fully electronic, daily updated, high-quality, low-cost, national registry is sustainable, and is now expanding. Merging with medicoeconomic databases and nested randomized scientific studies are ongoing steps to expand its scientific potential. [ABSTRACT FROM AUTHOR]

New-onset left bundle branch block (LBBB) is one of the most frequent complications after transcatheter aortic valve implantation (TAVI) and is associated with delayed high degree atrioventricular (AV) block. The objectives of this study were to determine the incidence of AV block in such a population and to assess the performance and safety of a risk stratification algorithm on the basis of electrophysiology study (EPS) followed by implantation of a pacemaker or implantable loop recorder (ILR). This was a prospective open-label study with 12-month follow-up. From June 8, 2015, to November 8, 2018, 183 TAVI recipients (mean age 82.3 ± 5.9 years) were included at 10 centers. New-onset LBBB after TAVI persisting for >24 hours was assessed by electrophysiology study during initial hospitalization. High-risk patients (His-ventricle interval ≥70 ms) were implanted with a dual-chamber pacemaker recording AV conduction disturbance episodes. Patients at lower risk were implanted with an ILR with automatic remote monitoring. A high-grade AV conduction disorder was identified in 56 patients (30.6%) at 12 months. Four subjects were symptomatic, all in the ILR group. No complications were associated with the stratification procedure. Patients with His-ventricle interval ≥70 ms displayed more high-grade AV conduction disorders (53.2% [25 of 47] vs 22.8% [31 of 136]; P <.001). In a multivariate analysis, His-ventricle interval ≥70 ms was independently associated with the occurrence of a high-grade conduction disorder (subdistribution hazard ratio 2.4; 95% confidence interval 1.2–4.8; P =.010). New-onset LBBB after TAVI was associated with high rates of high-grade AV conduction disturbances. The stratification algorithm provided safe and valuable aid to management decisions and reliable guidance on pacemaker implantation. [Display omitted] [ABSTRACT FROM AUTHOR]

Central illustration: cumulative major adverse cardiac events (MACE) and bioresorbable vascular scaffold (BVS) thrombosis rates after 1, 2, 3, 4 and 5 years.▪ • Absorb BVS implantation was associated with low rates of 1-year major adverse cardiac events (MACE). • MACE increased significantly at 3-year follow-up after Absorb BVS implantation. • The rates of scaffold thrombosis and MACE after 3 years decreased significantly. Randomized trials comparing the first-generation absorb bioresorbable vascular scaffold (BVS) (Abbott Vascular, Santa Clara, CA, USA) with a drug-eluting stent showed a moderate but significant increase in the rate of 3-year major adverse cardiac events and scaffold thrombosis, followed by a decrease in adverse events after 3 years. The objective of this study was to assess the 5-year outcomes of patients treated with at least one absorb BVS and included in the FRANCE ABSORB registry. All patients treated in France with an absorb BVS were prospectively included in a large nationwide multicentre registry. The primary efficacy outcome was the occurrence of 5-year major adverse cardiac events. Secondary efficacy outcomes were the rates of 5-year target vessel revascularization and definite/probable scaffold thrombosis. Between September 2014 and April 2016, 2,070 patients were included in 86 centres (mean age 55 ± 11 years; 80% men; 49% with acute coronary syndrome). The rates of 1-, 3- and 5-year major adverse cardiac events were 3.9%, 9.4% and 12.1%, respectively (including cardiac death in 2.5% and target vessel revascularization in 10.4%). By multivariable analysis, diabetes, oral anticoagulation, the use of multiple Absorb BVSs and the use of a 2.5 mm diameter absorb BVS were associated with 5-year major adverse cardiac events. The rates of 1-, 3- and 5-year definite/probable scaffold thrombosis were 1.5%, 3.1% and 3.6%, respectively. By multivariable analysis, older age, diabetes, anticoagulation at discharge and the use of a 2.5 mm diameter absorb BVS were associated with 5-year scaffold thrombosis. Absorb BVS implantation was associated with low rates of 1-year major adverse cardiac events, which increased significantly at 3-year follow-up. There was a clear decrease in the rates of scaffold thrombosis and major adverse cardiac events after 3 years. [ABSTRACT FROM AUTHOR]