Les anti-agrégants plaquettaires au cours du syndrome coronarien aigu. Données des grandes études

Cardiovascular disease is the leading cause of early death and morbidity in developed countries and is becoming a growing problem in many developing countries. Currently, anti-coagulants play a major role in the management of the acute phase in association or not with reperfusion strategies. The combination of clopidogrel and aspirin, in accordance with the results of large randomized trials, is the treatment of reference. However two new drugs, a thienopyridine (prasugrel), and a cyclo-pentyl-triazolo-pyridine (ticagrelor) have shown their interest in major studies in comparison with clopidogrel. As a result, several effective P2Y12 receptor antagonist anti-platelet agents are now availabl…

C022 Experimental approaches of oxidative stress and cardiotoxicity associated with anthracyclines administration

The chronic cardiotoxicity of anthracyclines anticancer drugs is one of the main factors which limits their prolonged use. Clinically, this cardiotoxicity results in a cardiomyopathy with irreversible congestive heart failure with high mortality. The molecular mechanisms, which could explain this cardiac toxicity, are complex but seem distinct from the anticancer mechanism. Several hypotheses were advanced, but it appears that the production of reactive oxygen and nitrogen species (RONS) constitutes the common denominator.In a first study, we evaluated the acute effect of epirubicin administration on the evolution of cardiac functional parameters and production of RONS. Isolated perfused ra…

0128: CHA2DS2-VASc score estimates in-hospital mortality beyond GRACE score after acute myocardial infarction

International audience; Background and aimsCHA2DS2VASc score have recently been suggested to predict death in patients with Atrial Fibrillation (AF). In acute myocardial infarction (AMI), silent AF is more common than symptomatic AF and associated with poor prognosis. In patients with AMI, we aimed to assess the distribution of CHA2DS2VASc score in patients with silent or symptomatic AF and the association of the score with mortality.Methods849 consecutive AMI were prospectively analyzed by continuous ECG monitoring (CEM) 30 sec. Symptomatic AF was defined as any AF occurring on ECG during the hospital stay, resulting in clinical symptoms or need for urgent cardioversion. The population was…

Cardiovascular prevention and at-risk behaviours in a large population of amateur rugby players.

Background and aim We aimed to investigate cardiovascular risk factors and health behaviours prospectively in a large population of French amateur rugby players. Methods An anonymous questionnaire was displayed to rugby players aged over 12 years enrolled in the 2014–2015 French amateur rugby championship from the Burgundy region ( n = 5140). Questions addressed awareness on: (a) cardiovascular prevention; (b) tobacco, alcohol and highly caffeinated beverages consumption; and (c) adherence to prevention guidelines (ECG checks, training in basic life support, avoidance of sports practice during fever/infectious episodes). Results Among the 640 participants who completed the questionnaires, m…

Beta-receptor desensitization evoked by a multistage ultralong distance exercise in the desert?

Background Few studies addressed to the evolution of cardiac function during a multistage ultra-long duration exercise (MULDE). Methods Serial echocardiographic assessment of cardiac function was performed in male healthy subjects during the 2014 Marathon des Sables before the race (T1), at the second (T2) and fifth (T3) arrival (236 km) then after 48 h recovery. Analysis were performed by 2 sonographers blind for the results of the other and the time of measure. Statistical analysis was performed using ANOVA-RM to compare the evolution of the different parameters. Results Among the 20 athletes, 18 completed the study (mean age 42.4, median 42). RR intervals and (Left ventricular End Diasto…

0197: Angiographically visible distal embolization is not linked with culprit lesion but with clinical characteristics

Despite the recent improvements in percutaneous coronary intervention (PCI), angiographically visible distal embolization (AVDE) complicates 6 to 18% of ST elevation myocardial infarction (STEMI) treated with PCI, and is associated with poor clinical outcomes. Culprit lesion characteristics have been proved to be the main predictive factor of AVDE. But data regarding clinical characteristics predicting AVDE are lacking. We aimed to identify predictors of AVDE complicating PCI in STEMI management. 769 consecutive patients admitted for STEMI who underwent PCI were included. Clinical, angiographic and therapeutics characteristics were assessed for each patien. AVDE was defined as an abrupt ves…

0432: Impact of admission hyperglycemia on one-year mortality in non-diabetic patients admitted for rescue PCI: Data from the “Observatoire des infarctus de Côte d’Or”

BackgroundRescue percutaneous coronary intervention (PCI) is associated with improved clinical outcomes for ST-segment myocardial infarction (STEMI) patients after failed fibrinolysis therapy. Hyperglycemia on admission has been shown to be a powerful predictor of mortality after acute myocardial infarction, particularly in non-diabetic patients. The aim of our study was to assess the predictive value of admission glucose levels on long-term mortality in patients with rescue PCI.Patients and MethodsFrom the “Observatoire des infarctus de Côte d’Or” (RICO) survey, 510 consecutive non-diabetic STEMI patients admitted to the intensive care unit for rescue PCI after failed fibrinolysis therapy …

Iron metabolism markers and l-arginine derivatives in coronary artery disease : highlighting, assessment and role of oxidative stress in acute myocardiae infarction

Myocardial infarction (MI) is mostly caused by complications of atherosclerosis, whose the development would be initiated by a dysfunction of the vascular endothelium, characterized by an inflammatory condition and oxidative stress.In this pathogenesis, iron interacts at different levels and also has a major role in the development of endothelial dysfunction. Hepcidin and erythroferrone (discovered earlier as the myonectin/CTRP 15) participate in a major way in regulating certain stages of iron metabolism.Asymmetric dimethylarginine (ADMA), a marker of endothelial dysfunction is associated with most cardiovascular risk factors. Symmetrical dimethyl-arginine (SDMA), its stereoisomer, has an …

Association between silent atrial fibrillation and heart failure after acute myocardial infarction

SYNTAX score is associated with in-hospital mortality as assessed by GRACE risk score in patients with acute myocardial infarction

Relationship between fragmented QRS and no-reflow, infarct size, and peri-infarct zone assessed using cardiac magnetic resonance in patients with myocardial infarction.

International audience; BACKGROUND: The relation between fragmented QRS complex (fQRS) and cardiac magnetic resonance parameters is poorly documented in ischemic cardiopathy. METHODS: Among 209 consecutive patients, those with fQRS were compared with those without fQRS. Cardiac magnetic resonance studies with late gadolinium-enhanced sequences were done during the week after acute myocardial infarction. RESULTS: fQRS was present in 113 (54%) patients, and associated with a significantly lower left ventricular ejection fraction, increased left ventricular volumes, a larger infarct size (IS), and a larger peri-infarct zone. Microvascular obstruction was more frequent in patients with fQRS (62…

Severe iatrogenic admissions in a coronary care unit:

Introduction: Iatrogenic complications are defined as adverse drug reactions or complications induced by non drug interventions, such as cardiac devices or stimulation techniques. Iatrogenic complications occurring during hospital stay are known to be associated with increased hospital length of stay and mortality. Only few data are available on iatrogenic as cause of hospital admission, particularly in coronary care unit. In patient admitted in coronary care unit for iatrogenic, we aimed a) to analyse their prevalence, type and characteristics, b) to analyse their in-hospital length of stay and mortality and c) to evaluate the predictive factors of severity and mortality. Methods: From 1st…

Dual Diagnostic Role of 123I-MIBG Scintigraphy in Inverted-Takotsubo Pattern Cardiomyopathy

We highlight the dual role of I-MIBG scintigraphy in inverted-Takotsubo pattern cardiomyopathy, the diagnosis of which is sometimes challenging: Firstly, I-MIBG scintigraphy can show myocardial sympathetic dysfunction (low I-MIBG uptake) in the hypokinetic basal segments, sparing the left ventricle apex. It is helpful in the imaging diagnosis of inverted-Takotsubo pattern cardiomyopathy and confirms that acute dysfunction of myocardial sympathetic nerve endings occurs with this cardiomyopathy. Secondly, I-MIBG scintigraphy is an accurate imaging examination to detect and localize pheochromocytoma; it can help in the search for an endogenous cause of this adrenergic stress-related cardiomyop…

Prognostic value of fragmented QRS on a 12-lead ECG in patients with acute myocardial infarction

Abstract Objective To investigate the determinants and the prognostic value of fragmented QRS (fQRS) after AMI. Patients and methods Prospective cohort of 307 consecutive patients with AMI. Main outcomes measured MACE (death plus non-fatal recurrent MI), hospitalization for an episode of heart failure, ventricular arrhythmia (VT or VF) at two years follow-up. Results On the serial 12-lead ECG recorded during the in-hospital stay, 162 (53%) had no fQRS ( no fQRS group ). 145 (47%) presented an fQRS, which was persistent in 108 (34%) patients ( persistent fQRS group ) and transient in 37 (12%) patients ( transient fQRS group ). Patients with a fragmented QRS (transient or persistent) were old…

Incidence and prognostic significance of silent atrial fibrillation in acute myocardial infarction

article Background: Silent atrial fibrillation (AF) has been suggested to be frequent after acute myocardial infarction (MI). Continuous ECG monitoring (CEM) has been shown to improve AF screening in patients at risk of stroke. Objectives: We aimed to assess the incidence and prognosis of silent AF in patients with acute MI. Methods:All the consecutive patients with acute MI were prospectively analyzed by CEM ≥ 48 h after admission. Silent AF was defined as asymptomatic episodes lasting at least 30 s. The population was divided into three groups: no-AF, silent AF and symptomatic AF. Results:Among the 849 patients, 135(16%) developedsilentAF and45(5%)symptomatic AF.Comparedwith the no-AF gro…

Impact of admission hyperglycemia on one-year mortality in non-diabetic patients admitted for rescue PCI

Smokeless tobacco, sport and the heart

SummarySmokeless tobacco (snuff) is a finely ground or shredded tobacco that is sniffed through the nose or placed between the cheek and gum. Chewing tobacco is used by putting a wad of tobacco inside the cheek. Smokeless tobacco is widely used by young athletes to enhance performance because nicotine improves some aspects of physiology. However, smokeless tobacco has harmful health effects, including cardiovascular disorders, linked to nicotine physiological effects, mainly through catecholamine release. Nicotine decreases heart rate variability and the ventricular fibrillation threshold, and promotes the occurrence of various arrhythmias; it also impairs endothelial-dependent vasodilation…

New insights into symptomatic or silent atrial fibrillation complicating acute myocardial infarction

International audience; Atrial fibrillation (AF) is the most frequent heart rhythm disorder in the general population and contributes not only to a major deterioration in quality of life but also to an increase in cardiovascular morbimortality. The onset of AF in the acute phase of myocardial infarction (MI) is a major event that can jeopardize the prognosis of patients in the short-, medium- and long-term, and is a powerful predictor of a poor prognosis after MI. The suspected mechanism underlying the excess mortality is the drop in coronary flow linked to the acceleration and arrhythmic nature of the left ventricular contractions, which reduce the left ventricular ejection fraction. The p…

Outcomes after acute myocardial infarction in HIV-infected patients: analysis of data from a French nationwide hospital medical information database.

Background— We aimed to assess in-hospital case fatality and 1-year prognosis in HIV-infected patients with acute myocardial infarction. Methods and Results— From the PMSI (Program de Medicalisation des Systèmes d’informatique) database, data from 277 303 consecutive acute myocardial infarction patients hospitalized from January 1, 2005, to December 31, 2009, were analyzed. Surviving patients were followed up for 1 year after discharge. HIV-infected patients were compared with uninfected patients. Among the cohort, HIV-infected patients (n=608) accounted for 0.22%. All-cause hospital and 1-year mortality rates were lower in the HIV-infected group than in uninfected patients (3.1% versus 8.…

015: Relation between platelet activation and inflammation indexes measured on admission and new onset atrial fibrillation in patients with acute myocardial infarction

ObjectivePlatelet activation is present in atrial fibrillation (AF), but there is some debate whether this is due to AF itself and/or to underlying cardiovascular diseases. We aim to determine the association between a marker of platelet reactivity (mean platelet volume (MPV)) and systemic inflammation (CRP) measured on admission, and new onset episode of AF in patients with MI.Patients and methodsProspective cohort of 4994 consecutive patients with AMI. Patients with paroxysmal or persistent AF were excluded.Results426 (8.5%) patients were diagnosed with a new onset of AF during the in-hospital-stay (mean stay 3±2 days). These patients were older (75 vs 65, p<0.001), predominantly male, an…

013 Pre-infarction angina and cardiovascular complications in non ST segment elevation myocardial infarction: Data from the RICO survey

BackgroundThe presence of preinfarction angina (PIA) has been shown to confer cardioprotection after ST segment elevation myocardial infarction (MI). However, the impact of PIA in non ST segment elevation (NSTEMI) remains to be determined.Patients and MethodsFrom the obseRvatoire des Infarctus de Côte d’Or (RICO) survey, 1541 consecutive patients admitted in intensive care unit with a first NSTEMI were included in the study. Patients who experienced chest pain 1) and 30-day mortality were collected.ResultsAmong the 1541 patients included in the study, 693 patients presented PIA. Baseline clinical characteristics were similar for the 2 groups. There was no significant difference for the GRAC…

0126: New regulators of iron metabolism, Hepcidin and Erythroferrone, in acute myocardial infarction.

Background Dysfunctional iron storage and transport are common in patients with chronic heart failure and associated with poor prognosis. Body iron could contribute to the pathogenesis of coronary artery disease (CAD) through its ability to induce oxidative stress. However, studies on the relationship between iron metabolism and CAD have yielded conflicting results. Patients and Methods From the obseRvatoire des Infarctus de Cote d’Or (RICO) survey, 31 consecutive patients admitted in Intensive Care Unit for a first AMI were included. Serum concentrations of iron, transferrin, ferritin, the iron-regulatory hormone hepcidin and erythroferrone (a new hepcidin-regulating hormone), transferrin …

The iron-regulatory hormone hepcidin: A possible therapeutic target?

The maintenance of stable extracellular and intracellular iron concentrations requires the coordinated regulation of iron transport into plasma. Iron is a fundamental cofactor for several enzymes involved in oxidation-reduction reactions. The redox ability of iron can lead to the production of oxygen free radicals, which can damage various cellular components. Therefore, the appropriate regulation of systemic iron homeostasis is decisive in vital processes. Hepcidin has emerged as the central regulatory molecule of systemic iron homeostasis. It is synthesized in hepatocytes and in other cells and released into the circulation. It inhibits the release of iron from enterocytes of the duodenum…

Prognosis of silent atrial fibrillation after acute myocardial infarction at 1-year follow-up

Silent atrial fibrillation (AF), assessed by continuous ECG monitoring (CEM), has recently been shown to be common in acute myocardial infarction (AMI), and associated with higher hospital mortality. However, the long-term prognosis is still unknown. We aimed to assess 1-year prognosis in patients experiencing silent AF in AMI.All consecutive patients with AMI who were prospectively analysed by CEM during the first 48 h after admission and who survived at hospital discharge were included. Silent AF was defined as asymptomatic episodes lasting at least 30 s. Patients were followed up at 1 year for cardiovascular (CV) outcomes.Among the 737 patients analysed, 106 (14%) developed silent AF and…

0135 : New regulators of iron metabolism, hepcidin and erythroferrone, in acute myocardial infarction

Background Dysfunctional iron storage and transport are common in patients with chronic heart failure and associated with poor prognosis. Body iron could contribute to the pathogenesis of coronary artery disease (CAD) through its ability to induce oxidative stress. However, studies on the relationship between iron metabolism and CAD have yielded conflicting results. Patients and methods from the obseRvatoire des Infarctus de Cote d’Or (RICO) survey, 31 consecutive patients admitted in Intensive Care Unit for a first AMI were included. Serum concentrations of iron, transferrin, ferritin, the iron-regulatory hormone hepcidin and erythroferrone (a new hepcidinregulating hormone), transferrin s…

Admission glycemia and in-hospital death following cardiac arrest during myocardial infarction outside hospital

0200: Predictors of angiographically visible distal embolization in ST elevation myocardial infarction patients treated by primary percutaneous coronary intervention and thrombectomy

Aspiration thrombectomy during primary percutaneous coronary intervention (p-PCI) in ST elevation myocardial infarction (STEMI) has been proposed to restore myocardial reperfusion. But important controversies remain concerning the usefulness of thrombectomy to improve this perfusion. Our objective was to evaluate the impact of manual thrombectomy on the occur-rence of angiographically visible distal embolization (AVDE) during p-PCI in STEMI. 346 consecutive patients admitted for STEMI who underwent p-PCI and thrombectomy were included. Clinical, angiographic and therapeutics characteristics were assessed. AVDE was defined as an abrupt vessel closure occurring at any point during the PCI pro…

Iron, oxidative stress, and redox signaling in the cardiovascular system.

The redox state of the cell is predominantly dependent on an iron redox couple and is maintained within strict physiological limits. Iron is an essential metal for hemoglobin synthesis in erythrocytes, for oxidation-reduction reactions, and for cellular proliferation. The maintenance of stable iron concentrations requires the coordinated regulation of iron transport into plasma from dietary sources in the duodenum, from recycled senescent red cells in macrophages, and from storage in hepatocytes. The absorption of dietary iron, which is present in heme or nonheme form, is carried out by mature villus enterocytes of the duodenum and proximal jejunum. Multiple physiological processes are invo…

L’association inhibiteur de l’enzyme de conversion et antagoniste calcique. Quelle place chez le patient coronarien stable ?

Resume Les maladies cardiovasculaires representent l’une des plus importantes cause de mortalite et de morbidite precoce dans le monde industriel et deviennent un probleme de sante publique croissant dans de nombreux pays en voie de developpement. Les recommandations americaine et europeenne soulignent que le traitement medical associe a la correction des facteurs de risque et aux modifications de style de vie sont la pierre angulaire du traitement de cette pathologie. En raison de leur impact sur le pronostic, les inhibiteurs de l’enzyme de conversion (IEC) sont systematiques chez le coronarien stable. Recemment, plusieurs grands essais ont demontre l’interet de l’adjonction d’un antagonis…

Frequency and predictors of stroke after acute myocardial infarction: specific aspects of in-hospital and postdischarge events.

Background and Purpose— Stroke is a serious complication after acute myocardial infarction (AMI) and is closely associated with decreased survival. This study aimed to investigate the frequency, characteristics, and factors associated with in-hospital and postdischarge stroke in patients with AMI. Methods— Eight thousand four hundred eighty-five consecutive patients admitted to a cardiology intensive care unit for AMI, between January 2001 and July 2010. Stroke/transient ischemic attack were collected during 1-year follow-up. Results— One hundred twenty-three in-hospital strokes were recorded: 65 (52.8%) occurred on the first day after admission for AMI, and 108 (87%) within the first 5 da…

Les admissions pour iatrogénie sévère en unité de soins intensifs de cardiologie : étude prospective sur 7244 patients

Resume Introduction Les complications iatrogeniques sont definies comme des reactions nocives induites par l’utilisation d’un medicament, mais aussi comme complications suite aux techniques invasives ou a l’implantation de materiel. Les complications iatrogenes survenant durant un sejour hospitalier sont bien connues et associees a une augmentation de la duree du sejour hospitalier et de la mortalite. En revanche, il existe peu de donnees concernant la iatrogenie comme motif d’admission a l’hopital ; particulierement en soins intensifs cardiologiques. Les objectifs de cette etude sont : (a) d’analyser la prevalence de la iatrogenie et ses caracterisques ; (b) de connaitre le retentissement …

Pre-Infarction Angina and Outcomes in Non-ST-Segment Elevation Myocardial Infarction: Data from the RICO Survey

BACKGROUND: The presence of pre-infarction angina (PIA) has been shown to confer cardioprotection after ST-segment elevation myocardial infarction (STEMI). However, the clinical impact of PIA in non-ST-segment elevation myocardial infarction (NSTEMI) remains to be determined. METHODS AND RESULTS: From the obseRvatoire des Infarctus de Côte d'Or (RICO) survey, 1541 consecutive patients admitted in intensive care unit with a first NSTEMI were included. Patients who experienced chest pain <7 days before the episode leading to admission were defined as having PIA and were compared with patients without PIA. Incidence of in-hospital ventricular arrhythmias (VAs), heart failure and 30-day mortali…

Silent atrial fibrillation during the acute phase of myocardial infarction

0437: SYNTAX score is associated with in-hospital mortality as assessed by GRACE risk score in patients with acute myocardial infarction

BackgroundCurrent guidelines for the management of patients with acute myocardial infarction (AMI) recommend the GRACE score for risk stratification with assessment of admission variables. The syntax score (SS) is a comprehensive angiographic scoring system that is derived entirely from the coronary anatomy and lesion characteristics. We investigated the relationship between severity of coronary artery disease (CAD) assessed with SYNTAX Score (SS) and GRACE Score (GS) in patients with AMI.Patients and MethodsFrom the obseRvatoire des Infarctus de Côte d’Or (RICO) survey, 614 consecutive patients hospitalized for an AMI from 1st march 2011 to 30 august 2012 and who underwent coronary angiogr…