Serum brain-derived neurotrophic factor and platelet activation evaluated by soluble P-selectin and soluble CD-40-ligand in patients with acute myocardial infarction

Little is known about the role of neurotrophins (NT) under adult vascular homeostasis in normal and pathological conditions. The NT family, including nerve growth factor and brain-derived neurotrophic factor (BDNF) are expressed in atherosclerotic vessels. Previous studies demonstrated that plasma BDNF levels were increased in the coronary circulation in patients with unstable angina. However, the role of BDNF during the onset and evolution of unstable angina remains to be elucidated. The objective of this study was to evaluate the relationship between BDNF, functional parameters and biological markers associated with inflammatory processes and platelet activation. BDNF serum levels were as…

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…

Psychosocial factors burden in workers with acute cerebro- or cardiovascular events: A multidisciplinary prospective pilot study

Introduction Psychosocial stress at work has been proposed as a risk factor for cerebro- and cardiovascular event (CVE) such as stroke or acute myocardial infarction (MI). However, data on psychosocial factors (PSF) profile in patients with CVE are scarce. In a multidisciplinary approach, we aimed to characterize PSF burden in patients with acute stroke or MI. Patients In a prospective pilot study, 45 patients aged  Results Among the 44 patients included, 77% had acute MI and 23% stroke. Mean age was 50 years, 77% were male, 43% were current smokers, 39% had hypertension, 41% hypercholesterolemia and 36% obesity. Education level was at 4,65 (secondary education), and most (41%) had low soci…

Nitric oxide synthase inhibition and oxidative stress in cardiovascular diseases: Possible therapeutic targets?

International audience; Nitric oxide (• NO) is synthetized enzymatically from L-arginine (L-Arg) by three NO synthase isoforms, iNOS, eNOS and nNOS. The synthesis of NO is selectively inhibited by guanidino-substituted analogs of L-Arg or methylarginines such as asymmetric dimethylarginine (ADMA), which results from protein degradation in cells. Many disease states, including cardiovascular diseases and diabetes, are associated with increased plasma levels of ADMA. The N-terminal catalytic domain of these NOS isoforms binds the heme prosthetic group as well as the redox cofactor, tetrahydrobiopterin (BH 4) associated with a regulatory protein, calmodulin (CaM). The enzymatic activity of NOS…

Involvement of Autonomic Nervous System in New-Onset Atrial Fibrillation during Acute Myocardial Infarction

Background: Atrial fibrillation (AF) is common after acute myocardial infarction (AMI) and associated with in-hospital and long-term mortality. However, the pathophysiology of AF in AMI is poorly understood. Heart rate variability (HRV), measured by Holter-ECG, reflects cardiovascular response to the autonomic nervous system and altered (reduced or enhanced) HRV may have a major role in the onset of AF in AMI patients. Objective: We investigated the relationship between autonomic dysregulation and new-onset AF during AMI. Methods: As part of the RICO survey, all consecutive patients hospitalized for AMI at Dijon (France) university hospital between June 2001 and November 2014 were analyzed …

0326: Prognostic factors and impact of blood pressure level during the first 48 hours after myocardial infarction

Background High blood pressure and low blood pressure are perfectly identified cardio-vascular risk factors, especially in primary prevention. However, their respective role after myocardial infarction is uncertain, with few data available. Objectives To compare cardio-vascular deaths and events after myocardial infarction between the different blood pressure levels observed during the first forty-eight hours. Methods We carried out an observational, prospective, monocentric study, including all consecutive patients admitted in Dijon’s Cardiologic Intensive Care Unit for myocardial infarction, between February 2012 and February 2014. Systolic blood pressure (SBP) was defined as the average …

Atrial fibrillation is associated with a marker of endothelial function and oxidative stress in patients with acute myocardial infarction

IF 4.066; International audience

Evidence of the role of short-term exposure to ozone on ischaemic cerebral and cardiac events: the Dijon Vascular Project (DIVA)

Objectives To confirm the effects of short-term exposure to ozone (O 3 ) on ischaemic heart and cerebrovascular disease. Methods Daily levels of urban O 3 pollution, the incidence of first-ever, recurrent, fatal and non-fatal ischaemic cerebrovascular events (ICVE) and myocardial infarction (MI) were correlated using a case-crossover design. The authors analysed 1574 ICVE and 913 MI that occurred in Dijon, France (150 000 inhabitants) from 2001 to 2007. Sulfur dioxide (SO 2 ), nitrogen dioxide (NO 2 ), carbon monoxide (CO) and particulate matter with an aerodiameter of ≤10 μg/m 3 (PM 10 ) were used to create bi-pollutant models. Using the adjusted OR, the effects of O 3 exposure were calcul…

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…

High N-Terminal Pro-B-Type Natriuretic Peptide Levels Are Associated with Reduced Heart Rate Variability in Acute Myocardial Infarction

AIM: We investigated the relationships between the autonomic nervous system, as assessed by heart rate variability (HRV) and levels of N-terminal Pro-B-type Natriuretic Peptide (Nt-proBNP) in patients with acute myocardial infarction (MI). METHODS AND RESULTS: The mean of standard deviation of RR intervals (SDNN), the percentage of RR intervals with >50 ms variation (pNN50), square root of mean squared differences of successive RR intervals (rMSSD), and frequency domain parameters (total power (TP), high frequency and low frequency power ratio (LF/HF)) were assessed by 24 h Holter ECG monitoring. 1018 consecutive patients admitted <24 h for an acute MI were included. Plasma Nt-proBNP (Elecs…

Impact of asymmetric dimethylarginine on mortality after acute myocardial infarction.

Objective— Asymmetrical dimethylarginine (ADMA) is an endogenous competitive inhibitor of nitric oxide (NO) synthases. From a prospective cohort of patients with acute myocardial infarction (MI), we aimed to analyze the predictive value of circulating ADMA concentrations on prognosis. Methods and Results— Blood samples from 249 consecutive patients hospitalized for acute MI &lt;24 hours were taken on admission. Serum levels of ADMA and its stereoisomer, symmetrical dimethylarginine (SDMA), were determined using high-performance liquid chromatography. The independent predictors of ADMA were glomerular filtration rate, female sex, and SDMA ( R 2 =0. 25). Baseline ADMA levels were higher in p…

Safety and efficacy of left atrial appendage occlusion with the ACP or Watchman device guided by intracardiac echocardiography from the left atrium

Abstract Background There is a paucity of randomized data regarding the safety and efficacy of the use of intracardiac echocardiography (ICE) from the left atrium (LA) to guide left atrial appendage occlusion (LAAO) procedures under local anesthesia using either of the available devices. Hypothesis The aim of this study was to compare the efficacy and safety of ICE from the LA with transesophageal echocardiography (TEE) for guidance during transcatheter LAAO procedures. Methods Single‐center, cohort study of patients undergoing LAAO with the Amplatzer Cardiac Plug or Watchman device. Procedures were guided by ICE from the LA with local anesthesia (n = 175) or TEE under general anesthesia (n…

Central Obesity and Survival in Subjects With Coronary Artery Disease

Objectives The aim of this study was to examine the association of central (waist circumference [WC] and waist-hip ratio [WHR]) and total obesity (body mass index [BMI]) measures with mortality in coronary artery disease (CAD) patients. Background The question of which measure of obesity better predicts survival in patients with CAD is controversial. Methods We searched OVID/Medline, EMBASE, CENTRAL, and Web of Science from 1980 to 2008 and asked experts in the field for unpublished data meeting inclusion criteria, in which all subjects had: 1) CAD at baseline; 2) measures of WC or WHR; 3) mortality data; and 4) a minimum follow-up of 6 months. Results From 2,188 studies found, 6 met inclus…

014: Underuse of recommended secondary preventive therapies in current routine clinical practice

Aims Recommendations on the use of antithrombotic agents, antihypertensive drugs and statin for secondary prevention of coronary artery (CAD), ischemic cerebrovacular (CVD), and peripheral arterial (PAD) diseases are now well established. However, there may be a gap between clinical practice and evidence-based guidelines. We aimed to investigate the premorbid use of secondary prevention medications in patients with recurrent cardiovascular events. Methods and results We prospectively recorded all patients with CVD and CAD in Dijon, France from 2006 to 2010. Data about medical history and prior use of treatments were collected. Mutivariate analyses were performed to identify predictors of th…

Pravastatin reverses the membrane cholesterol reorganization induced by myocardial infarction within lipid rafts in CD14(+)/CD16(-) circulating monocytes.

International audience; Large numbers of monocytes are recruited in the infarcted myocardium. Their cell membranes contain cholesterol-rich microdomains called lipids rafts, which participate in numerous signaling cascades. In addition to its cholesterol-lowering effect, pravastatin has several pleiotropic effects and is widely used as secondary prevention treatment after myocardial infarction (MI). The aim of this study was to investigate the effects of pravastatin on the organization of cholesterol within monocyte membrane rafts from patients who had suffered myocardial infarction. Monocytes from healthy donors and acute MI patients were cultured with or without 4μM pravastatin. Lipid raf…

Prise en charge au long cours par les anti-agrégants plaquettaires oraux après un syndrome coronaire aigu

Cardiovascular disease is the primary cause of early death and morbidity in the industrialized world and is becoming a growing problem in many developing countries. Coagulation inhibitors play a major role in the management of the acute phase of ACS whether in association with reperfusion strategies or not. Currently, and in accordance with the results of major randomised studies, for medium and long-term management, the association of Clopidogrel and aspirin is the treatment of choice. However, despite the recognised benefits of this therapeutic strategy and above all the recommendations of learned societies, which have placed this bi-therapy in class I, according to national and internati…

Combining Body Mass Index With Measures of Central Obesity in the Assessment of Mortality in Subjects With Coronary Disease

Objectives This study sought to assess the mortality risk of patients with coronary artery disease (CAD) based on a combination of body mass index (BMI) and measures of central obesity. Background In CAD patients, mortality has been reported to vary inversely with BMI (“obesity paradox”). In contrast, central obesity is directly associated with mortality. Because of this bi-directional relationship, we hypothesized that CAD patients with normal BMI but with central obesity would have worse survival compared with subjects with other combinations of BMI and central adiposity. Methods We included 15,547 participants with CAD who took part in 5 studies from 3 continents. Multivariate stratified…

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 …

Secondary prevention in patients with vascular disease. A population based study on the underuse of recommended medications.

Objectives To investigate the premorbid use of secondary prevention medications in patients with recurrent vascular events. Design Prospective, observational, population based study. Setting The Dijon Stroke Registry and the registry of myocardial infarction of Dijon and Cote d9Or, France. Patients All patients with cerebral ischaemia (ischaemic stroke or transient ischaemic attacks) or coronary artery disease (CAD) and a history of vascular disease (cerebral ischaemia, CAD or peripheral arterial disease (PAD)) in Dijon, France from 2006 to 2010. Main outcome measures Data on medical history and prior use of treatments were collected. Mutivariate analyses were performed to identify predicto…

Prognostic value of ST-segment resolution after rescue percutaneous coronary intervention. Data from the RICO survey

Objectives: The goal of the present study was to test the impact of ST segment resolution (STR) after rescue percutaneous coronary intervention (PCI) on the short-term prognosis. Background: The prognostic value of STR after rescue PCI for acute ST elevation myocardial infarction (STEMI) remains undetermined. Methods: From the French regional database, we analyzed 168 consecutive patients with STEMI and failed lysis, defined by <50 percent STR, who underwent rescue PCI. Patients were classified into two groups according to the degree of STR from the maximal ST-elevation measured on the single worst ECG lead before lysis and after rescue PCI: the without STR group (<50% STR) vs. the with STR…

Telomere length and cardiovascular disease

SummaryTelomeres are structures composed of deoxyribonucleic acid repeats that protect the end of chromosomes, but shorten with each cell division. They have been the subject of many studies, particularly in the field of oncology, and more recently their role in the onset, development and prognosis of cardiovascular disease has generated considerable interest. It has already been shown that these structures may deteriorate at the beginning of the atherosclerotic process, in the onset and development of arterial hypertension or during myocardial infarction, in which their length may be a predictor of outcome. As telomere length by its nature is a marker of cell senescence, it is of particula…

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

High levels of N-terminal pro B-type natriuretic peptide are associated with ST resolution failure after reperfusion for acute myocardial infarction

Background: B-type natriuretic peptide and the N-terminal fragment of its prohormone, N-terminal pro-brain natriuretic peptide (Nt-proBNP), provide valuable prognostic information on short- and long-term mortality in patients with acute coronary syndrome Aim: To investigate the association between plasma NT-proBNP levels and ST-segment resolution (STR) after reperfusion in patients with ST-segment elevation myocardial infarction (STEMI). Methods: Consecutive patients from the French regional RICO survey with STEMI who were treated by primary PCI or lysis <12 h were included. Blood sample was taken on admission to measure plasma NT-proBNP. Maximal ST segment elevation was measured on the sin…

The Free Oxygen Radicals Test (FORT) to assess circulating oxidative stress in patients with acute myocardial infarction

International audience; Background and aim: Reactive oxygen species (ROS) play an important role in the pathogenesis of many diseases including cardiovascular diseases. Several methods have been developed for the direct or indirect measurement of oxygen free radical and its by-products. The current study was designed to validate the new Free Oxygen Radicals Test (FORT) and to investigate the potential relationships between ROS and clinical or biological factors in male patients with acute myocardial infarction (AMI). Methods: We analysed FORT values in samples from 66 patients with AMI. Results: FORT values ranged from 324 to 1198 FORT units, with a median value of 581 (494-754) FORT units.…

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…

Circulating leukocyte telomere length and oxidative stress: A new target for statin therapy

International audience; Objectives: We investigated the relationship between prior statin therapy and leukocyte telomere length (LTL), as well as their interaction with potential new biomarkers of oxidative deoxyribonucleic acid (DNA) lesions and reactive oxygen species-induced inflammation.Methods and results: From patients admitted for an acute myocardial infarction, LTL was assessed by quantitative polymerase chain reaction (Q-PCR), and leukocyte Finkel-Biskis-Jinkins osteosarcoma (FOS) and 8-oxoguanine DNA glycosylase (OGG1) messenger ribonucleic acid (mRNA) levels were measured by retrotranscription Q-PCR. Patients under prior chronic statin therapy were compared with patients without …

Temporal trends in prehospital management of ST-segment elevation myocardial infarction from 2002 to 2010 in Cote d’Or: Data from the RICO registry (obseRvatoire des Infarctus de Cote d’Or)

Summary Background Myocardial infarction with ST-segment elevation (STEMI) is a medical emergency requiring specific management, with the main aim of achieving reperfusion as quickly as possible. Guidelines from medical societies have defined optimal management, with proven efficacy on morbi-mortality. Aims Our study aimed to evaluate trends in practices between 2002 and 2010 in the emergency management of STEMI in a single French department, namely Cote d’Or. Methods All patients admitted with a first STEMI to one of the six participating coronary care units (private or public) in Cote d’Or since January 2001 were included in a prospective registry (obseRvatoire des Infarctus de Cote d’Or …

Underuse of recommended secondary preventive therapies in current routine clinical practice

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…

Cardiac rehabilitation and 5-year mortality after acute coronary syndromes: The 2005 French FAST-MI study.

IF 2.271; International audience; Background. - Clinical studies have shown a beneficial effect of cardiac rehabilitation (CR) on mortality.Objective. - To study the effect of CR prescription at discharge on 5-year mortality in patients with acute myocardial infarction (AMI).Methods. - Participants, from the 2005 French FAST-MI hospital registry, were 2894 survivors at discharge, divided according to AMI type: ST-segment elevation myocardial infarction (STEMI; n=1523) and non-STEMI (NSTEMI; n=1371). The effect of CR prescription on mortality was analysed using a Cox proportional hazards model.Results. - At discharge, 22.1% of patients had a CR prescription. Patients referred to CR were youn…

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…

0131 : Impact of overweight on anthracycline and trastuzumab-induced cardiotoxicity: experimental study in mice

Trastuzumab (TRZ), a humanized monoclonal antibody against Human Epidermal Growth Factor Receptor 2 (HER2) oncogene, is believed to potentiate doxorubicin (DOX) cardiotoxicity, resulting in left ventricular dysfunction. Few data indicate that overweight could influence DOX-induced cardiotoxicity, and no study has already evaluated the impact of moderate overweight on the cardiotoxic effect of DOX alone or in combination with TRZ. Immediately after birth, litters of C57BL/6 mice were either maintained at 10 (normal litter, NL), or reduced to 3 (small litter, SL) in order to induce programming of ~15% overweight through postnatal overfeeding. At 4 months, in order to evaluate the potentiation…

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

Psychosocial factors burden in workers with acute cerebro- or cardiovascular events: A multidisciplinary prospective pilot study

International audience

Comparative Analysis of Patients with Acute Coronary and Cerebrovascular Syndromes from the National French Hospitalization Health Care System Database

&lt;i&gt;Background:&lt;/i&gt; Nationwide evaluations of the epidemiology of acute coronary syndrome (ACS) or cerebrovascular syndrome (CVS) are scarce. We aimed to analyze nationwide French data on patients referred to hospital for either ACS or CVS. &lt;i&gt;Methods:&lt;/i&gt; Using the French national hospital discharge diagnosis records, all patients hospitalized between 2005 and 2008 with a diagnosis of ACS and CVS based on the ICD-10 were identified. We analyzed vascular risk factors and early outcomes in patients with a single hospitalization for ACS or CVS or for both ACV and CVS in a 2-month time window. &lt;i&gt;Results:&lt;/i&gt; 1,187,643 patients were recorded. Among these, 638…

0134 : Atrial fibrillation is associated with a marker of endothelial function and oxidative stress in patients with acute myocardial infarction

Background Atrial fibrillation (AF), whether silent or symptomatic, is a frequent and severe complication of acute myocardial infarction (AMI). Asymmetric dimethylarginine (ADMA), an endogenous eNOS inhibitor, is a risk factor for endothelial dysfunction. We addressed the relationship between ADMA plasma levels and AF occurrence in AMI. Methods 273 patients hospitalized for AMI were included. Continuous electrocardiographic monitoring (CEM) e48 hours was recorded and ADMA was measured by High Performance Liquid Chromatography on admission blood sample. Results The incidence of silent and symptomatic AF was 39(14%) and 29 (11%), respectively. AF patients were markedly older than patients wit…

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…

Atrial Fibrillation Is Associated with a Marker of Endothelial Function and Oxidative Stress in Patients with Acute Myocardial Infarction

International audience; Background Atrial fibrillation (AF), whether silent or symptomatic, is a frequent and severe complication of acute myocardial infarction (AMI). Asymmetric dimethylarginine (ADMA), an endogenous eNOS inhibitor, is a risk factor for endothelial dysfunction. We addressed the relationship between ADMA plasma levels and AF occurrence in AMI.Methods 273 patients hospitalized for AMI were included. Continuous electrocardiographic monitoring (CEM) !48 hours was recorded and ADMA was measured by High Performance Liquid Chromatography on admission blood sample.Results The incidence of silent and symptomatic AF was 39(14%) and 29 (11%), respectively. AF patients were markedly o…

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…

249 Validation of assessment of circulate oxidative stress markers by the Free Oxygen Radicals Testing (FORT) assay among patients with an acute myocardial infarction

BackgroundFree oxygen radicals play an important role in the pathogenesis of many diseases including cardiovascular diseases, diabetes, cancer and aging. Several methods were developed for the direct or indirect measurement of oxygen free radical and its by-products. Using a new Free Oxygen Radicals Testing (FORT) the current study is designed first to validate the device and to investigate the potential relationships between the ROS and clinical or biological factors in human serum from a population of men with an acute myocardial infarction (AMI).MethodsWe first determined the effect of storage, variability and reproducibility of the FORT test in serum. Then we used the test in 66 patient…

Temporal Trends in Transcatheter Aortic Valve Replacement in France

Background - Transcatheter aortic valve replacement (TAVR) is standard therapy for patients with severe aortic stenosis who are at high surgical risk. However, national data regarding procedural characteristics and clinical outcomes over time are limited. Objectives - The aim of this study was to assess nationwide performance trends and clinical outcomes of TAVR during a 6-year period. Methods - TAVRs performed in 48 centers across France between January 2013 and December 2015 were prospectively included in the FRANCE TAVI (French Transcatheter Aortic Valve Implantation) registry. Findings were further compared with those reported from the FRANCE 2 (French Aortic National CoreValve and Edwa…

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…

Left Atrial Remodeling and Brain Natriuretic Peptide Levels Variation after Left Atrial Appendage Occlusion

Background: Few data are available about brain natriuretic peptide (BNP) variation and left atrial remodeling after the left atrial appendage occlusion (LAAO) technique. Methods: Prospective study included all consecutive patients successfully implanted with an LAAO device. Contrast-enhanced cardiac computed tomography (CT) was performed before and 6 weeks after the procedure with reverse left atrial remodeling defined by an increase in LA volume &gt

Comparative epidemiology of stroke and acute myocardial infarction: the Dijon Vascular Project (DIVA)

Despite a common pathophysiological mechanism (ie, atherosclerosis) and similar vascular risk factors, few reliable studies have compared the epidemiology of stroke and acute myocardial infarction (AMI).All first ever cases of stroke and AMI in Dijon, France (151 846 inhabitants) from 2001 to 2006 were prospectively recorded. The 30 day case fatality rates (CFRs) and vascular risk factors were assessed in both groups.Over the 6 years, 1660 events (1020 strokes and 640 AMI) were recorded. Crude incidence of stroke was higher than that of AMI (112 vs 70.2/100 000/year; p0.001). With regard to sex, the relative incidence of stroke compared with AMI was 0.88 (95% CI 0.60 to 1.29; p = 0.51) in w…

Impact du diamètre et de l’âge du thrombus sur la thromboaspiration. Étude expérimentale

Resume Introduction La thrombectomie coronarienne est frequemment integree aux procedures de prise en charge du syndrome coronarien aigu. De nombreuses etudes ont evalue son benefice dans ce contexte, mais peu suggerent une influence des caracteristiques des coronaires sur son efficacite. L’objectif de ce travail est d’evaluer les facteurs morphologiques qui pourraient expliquer le succes ou l’echec d’une thromboaspiration, a partir d’une etude experimentale. Materiels et methodes Des tubes en verre de 150 mm de long ont ete utilises, avec cinq diametres differents : 2,0 ; 2,6 ; 3,0 ; 3,6 et 4 mm ; et pour chaque diametre, nous avions trois angles differents : pas d’angle, angle a 90° et an…

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…

Incidence, Predictive Factors, and Prognostic Impact of Silent Atrial Fibrillation After Transcatheter Aortic Valve Implantation.

New onset atrial fibrillation post-transcatheter aortic valve implantation (TAVI) is common and is associated with adverse outcomes. However, silent atrial fibrillation (AF) is poorly documented in the context. This study sought to evaluate the incidence, predictive factors, and prognostic value of Silent AF post-TAVI. All the consecutive patients with TAVI were prospectively analyzed by continuous electrocardiogram monitoring≥48 hours after implantation. Silent AF was defined as asymptomatic episodes lasting at least 30 seconds. The population was divided into 3 groups: history of AF, no-AF, and silent AF. Among the 206 patients implanted with TAVI, 19 (16.1%) developed silent AF. Compared…

Incremental predictive value of mean platelet volume/platelet count ratio in in-hospital stroke after acute myocardial infarction.

IF 2.558; International audience; Stroke is a serious complication after acute myocardial infarction (AMI) and is associated with an increased risk of death. Though the pathophysiological mechanisms are not exactly known, increased inflammation and platelet reactivity could play an important role in the occurrence of stroke during AMI. We aimed to investigate the relationship between both mean platelet volume (MPV), a parameter of platelet function, and C-reactive protein (CRP) and the occurrence of in-hospital ischemic stroke (IHS) after AMI. Data were obtained from a French regional survey for AMI that included 5976 patients admitted to an intensive care unit (ICU) between 2001 and 2010. …

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

0127: Atrial fibrillation is associated with a marker of endothelial function and oxidative stress in patients with acute myocardial infarction

Background Atrial fibrillation (AF), whether silent or symptomatic, is a frequent and severe complication of acute myocardial infarction (AMI). Asymmetric dimethylarginine (ADMA), an endogenous eNOS inhibitor, is a risk factor for endothelial dysfunction. We addressed the relationship between ADMA plasma levels and AF occurrence in AMI. Methods 273 patients hospitalized for AMI were included. Continuous electrocardiographic monitoring (CEM) ≥48 hours was recorded and ADMA was measured by High Performance Liquid Chromatography on admission blood sample. Results The incidence of silent and symptomatic AF was 39(14%) and 29 (11%), respectively. AF patients were markedly older than patients wit…

270 Increased hospital mortality in HIV-infected patients with acute coronary or cerebrovascular syndromes. Analysis from a French nationwide hospital medical information database

Background After more than two decades of the AIDS epidemic, the spectrum of HIV-associated vascular diseases has considerably evolved from infectious disease with improved survival, to premature atherosclerosis. As a consequence, acute atherosclerosis complications, such as acute coronary and cerebrovascular syndromes (ACS and CVS) are currently growing. However, only few data are available on HIV-infected patients in the setting of ACS/CVS. The aim of the present study was to determine the prevalence of HIV, as well as the characteristics and hospital case fatality of HIV-infected patients with CVS and ACS. Methods From the French nationwide hospital medical information database, data fro…

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…

Reduced Rivaroxaban Dose Versus Dual Antiplatelet Therapy After Left Atrial Appendage Closure: ADRIFT a Randomized Pilot Study.

Background: Percutaneous left atrial appendage closure (LAAC) exposes to the risk of device thrombosis in patients with atrial fibrillation who frequently have a contraindication to full anticoagulation. Thereby, dual antiplatelet therapy (DAPT) is usually preferred. No randomized study has evaluated nonvitamin K antagonist oral anticoagulant after LAAC, and we decided to evaluate the efficacy and safety of reduced doses of rivaroxaban after LAAC. Methods: ADRIFT (Assessment of Dual Antiplatelet Therapy Versus Rivaroxaban in Atrial Fibrillation Patients Treated With Left Atrial Appendage Closure) is a multicenter, phase IIb study, which randomized 105 patients after successful LAAC to eith…

High Serum Cholesteryl Ester Transfer Rates and Small High-Density Lipoproteins Are Associated With Young Age in Patients With Acute Myocardial Infarction

Objectives Our aim was to characterize cholesteryl ester transfer protein (CETP) activity in the early phase of acute myocardial infarction (MI). Background Cholesteryl ester transfer protein catalyzes the transfer of cholesteryl esters from high-density lipoprotein (HDL) donors to apolipoprotein B-containing lipoprotein acceptors. Methods The CETP concentration, lipid profiles, and the rate of cholesteryl ester transfer (CET) from a tracer dose of radiolabeled HDL toward endogenous lipoproteins were determined within 24 h after symptom onset. Results Among 347 patients with first MI, CETP concentration, triglycerides, and non–HDL-cholesterol increased across tertiles of the CET rate, where…

274 Comparative analysis of patients with acute coronary and cerebrovascular syndromes from the national French hospitalisation heath care system database

Objective To compare vascular risk factor profiles and early outcomes in all French patients hospitalized for either acute coronary (ACS), or cerebrovascular syndromes (CVS), or both, between 2005 and 2008. Setting All French hospitals. Design Retrospective analysis. Data sources National database called “Hospital Discharge Diagnosis Records”. Main outcomes measured Number and annual rates, vascular risk factors, and early outcome of hospitalized patients for a unique stay for ACS or CVS or for both ACV and CVS in a 2-month time window. Results Over the 4-year study-period, 1,189,043 patients were hospitalized for CVS and/or ACS. Among these, 638,061 (53.7%) had CVS alone, 525,419 (44.3%) h…

002 Impact of diverting general practitioner's after-hours calls to emergency medical dispatch centers on time delays and acute revascularization procedures for patients with STsegment-elevation myocardia

Jean Ferrieres [Orateur] (1), Guy Berkenboom (2), Zdenek Coufal (3), Stefan James (4), Attila MohaCsi (5), Gregory Pavlides (6), Kirsi Norrbacka (7), Magali Sartral (8), Marie-Ange Paget (8), Molly Tomlin (9), Uwe Zeymer (10) (1) CHU Rangueil, Cardiologie B, Toulouse, France – (2) ULB Erasme University Hospital, Department of Cardiology, Brussels, Belgium – (3) Batova Krajska Nemocnice Zlin, Department of Cardiology, Zlin, Republique Tcheque – (4) Uppsala University Hospital, Dept. of Cardiology and Uppsala Clinical Research Center, Uppsala, Suede – (5) Gottsegen Institute of Hungarian Cardiology, Budapest, Hungaria – (6) Onassis Cardiac Surgery Center, Kallithea, Grece – (7) Lilly Research…

Obesity and new-onset atrial fibrillation in acute myocardial infarction: a gender specific risk factor

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…

Cost-effectiveness analysis of patent foramen ovale closure with Amplatzer plus medical therapy compared to medical therapy in patients with a history of stroke in France.

Abstract Background A patent foramen ovale (PFO) is formed when the ovale foramen does not close spontaneously or re-opens leaving the right and left atrium connected. The present study was conducted to analyze the cost-effectiveness of PFO closure with Amplatzer device plus medical therapy (MT) compared to MT alone in the French reimbursement system for PFO patients with a prior history of stroke, using the RESPECT study data. Methods A multi-state Markov model was used. The analysis was conducted from a collective perspective over a 10-year time horizon with 4% discount applied for costs and health effects. The simulated population included adult patients with PFO. Sub-group analysis was …

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…

225 Comparative analysis of patients with acute coronary and cerebrovascular syndromes from the national French hospitalisation heath care system database

ObjectiveTo compare vascular risk factor profiles and early outcomes in all French patients hospitalized for either acute coronary (ACS), or cerebrovascular syndromes (CVS), or both, between 2005 and 2008.SettingAll French hospitals.DesignRetrospective analysis.Data sourcesNational database called “Hospital Discharge Diagnosis Records”.Main outcomes measuredNumber and annual rates, vascular risk factors, and early outcome of hospitalized patients for a unique stay for ACS or CVS or for both ACV and CVS in a 2-month time window.ResultsOver the 4-year study-period, 1,189,043 patients were hospitalized for CVS and/or ACS. Among these, 638,061 (53.7%) had CVS alone, 525,419 (44.3%) had ACS alon…

Prognostic value of N-terminal pro-brain natriuretic peptide in elderly people with acute myocardial infarction: prospective observational study

Objective To examine the influence of age on the predictive value of N-terminal pro-brain natriuretic (NT-proBNP) peptide assay in acute myocardial infarction. Design Prospective observational study. Setting All intensive care units in one French region. Participants 3291 consecutive patients admitted for an acute myocardial infarction, from the RICO survey (a French regional survey for acute myocardial infarction). Main outcome measure Cardiovascular death at 1 year. Results Among the 3291 participants, mean age was 68 (SD 14) years and 2356 (72%) were men. In the study population, the median NT-proBNP concentration was 1053 (interquartile range 300-3472) pg/ml. Median values for age quart…

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…

Smoking and FOS expression from blood leukocyte transcripts in patients with coronary artery disease.

International audience; OBJECTIVE: Analysis of the leukocyte transriptome, in particular the Finkel-Biskis-Jinkins Osteosarcoma (c-Fos) gene, which has a prominent role in inflammation, provides new insights into atherosclerosis mechanisms. Although smoking is a major risk factor, the links between smoking status and coronary artery disease (CAD) remains unclear. We aimed to analyze the relationship between smoking status and c-Fos expression in circulating leukocytes of patients with CAD. METHODS: c-Fos expression was measured by RT-Q-PCR, from blood leukocytes of 239 consecutive patients after acute myocardial infarction (MI). The patients were asked about their smoking status and stratif…

Silent atrial fibrillation during the acute phase of myocardial infarction

Épidémiologie du syndrome coronaire aigu en Europe

Epidemiological data concerning acute coronary syndromes in Europe are based on national registries, studies by the European Society of Cardiology within the framework of the EuroHeart Survey and on the study of European population sub-groups in large international cohorts. In this article, recently published studies will be reviewed, and the principal developments in different countries as well as the characteristics and particularities of the most recent epidemiological data will be highlighted. In Europe, the presentation of acute coronary syndromes (ACS) has evolved considerably over the last ten years. This evolution is characterized by a reduction in the proportion of acute coronary s…

003 Pericardial effusion in acute myocardial infarction: new insights from the French regional RICO survey