A simple nomogram for early prediction of myocardial reperfusion after pre-hospital thrombolysis.

Aims: To discriminate early ST-segment elevation myocardial infarction (STEMI) presenters at a high probability of successful pre-hospital thrombolysis (PHT) using a simple nomogram based on independent predictors of complete ST resolution.

Methods And Results: OPTIMAL was an observational, prospective study undertaken at 79 medical centres in France in patients with STEMI undergoing pre-hospital thrombolysis (PHT) within six hours of symptom onset and coronary angiography within six hours of thrombolysis. The baseline and pre-coronary angiography ECGs of 800 patients were analysed.

Gender disparity in 48-hour mortality is limited to emergency percutaneous coronary intervention for ST-elevation myocardial infarction.

Background: Previous studies indicate that mortality from acute coronary syndromes is higher in women than in men, especially in case of interventional strategy.

Aim: To assess whether the in-hospital mortality rate differs between genders during the first 48h after emergency percutaneous coronary intervention for ST-elevation myocardial infarction (emergency PCI-STEMI) or after non-emergency PCI.

Methods: All patients treated with PCI between January 2005 and June 2008 were included.

Relationship between time of day, day of the week and in-hospital mortality in patients undergoing emergency percutaneous coronary intervention.

Background: Previous studies have reported circadian variation in the rate of post-percutaneous coronary intervention (PCI) complications and mortality.

Aim: To assess whether in-hospital outcomes during the first 48h after admission are related to the time or the day when PCI is performed.

Methods: Emergency PCIs (2266 total; 1396 during regular hours and 870 during off hours) performed consecutively during a 3.

Determinants and prognostic impact of compliance with guidelines in reperfusion therapy for ST-segment elevation myocardial infarction: results from the ESTIM Midi-Pyrénées Area.

Background: Early reperfusion therapy has proven benefit in reducing mortality in patients with ST-segment elevation myocardial infarction (STEMI). Expert guideline committees have defined recommendations to improve the management of patients with STEMI and decrease their mortality rates.

Aims: To identify predictors of compliance with American College of Cardiology/American Heart Association guidelines for reperfusion therapy in STEMI and to determine the prognostic impact of compliance.

Drug-eluting or bare-metal stents in subjects over 75 years of age: what is the best therapeutic strategy? Data from 460 consecutive patients with 1-year outcome.

Background: The use of stents has become common in subjects over 75 years of age, but choosing the best type of stent still remains difficult. Our objective was to compare safety and clinical benefits of drug-eluting stent (DES) and bare-metal stent (BMS) at 1 year in this population.

Methods: We included 460 consecutive patients aged 75 or over who had undergone angioplasty with DES (n=167) or BMS (n=293) between January 1 and December 31, 2005, and had 12-month clinical follow-up.

Improvement of Young and Elderly Patient's Knowledge of Heart Failure After an Educational Session.

Background: Interest in the role of patient education sessions for optimizing the management of heart failure (HF) is increasing. We determined whether improvements in young and elderly patients' knowledge of HF and self-care behavior could be analyzed by administering a knowledge test before and after an educational session.

Methods: Stable heart failure patients (n = 115) were enrolled in a prospective cohort study from our Heart Failure educational centre in a university hospital.

Factors predictive for in-hospital mortality following percutaneous coronary intervention.

Background: Despite advances in procedures for percutaneous coronary intervention (PCI) and enhancement of materials and adjunctive therapy, postprocedural mortality remains a possible adverse outcome after PCI.

Aims: To assess factors independently associated with in-hospital mortality in patients referred for PCI.

Methods: Between January 2004 and December 2005, 4074 PCI were performed in our University Hospital, with 70 deaths registered either during the procedure or during the in-hospital stay.

[Myocardial infarction and oral contraceptives].

Shortly after the introduction of oral contraceptives in 1960, myocardial infarction (MI) started to emerge as a major adverse effect. Its mechanism and pathophysiology have remained elusive. Many epidemiological studies identified smoking, hypertension, diabetes and hypercholesterolemia as risk factors for coronary thrombosis in young women using oral contraceptives.

Comparison of thrombolysis followed by broad use of percutaneous coronary intervention with primary percutaneous coronary intervention for ST-segment-elevation acute myocardial infarction: data from the french registry on acute ST-elevation myocardial infarction (FAST-MI).

Background: Intravenous thrombolysis remains a widely used treatment for ST-elevation myocardial infarction; however, it carries a higher risk of reinfarction than primary PCI (PPCI). There are few data comparing PPCI with thrombolysis followed by routine angiography and PCI. The purpose of the present study was to assess contemporary outcomes in ST-elevation myocardial infarction patients, with specific emphasis on comparing a pharmacoinvasive strategy (thrombolysis followed by routine angiography) with PPCI.

Cardiovascular impact of exercise and drug therapy in older hypertensives with coronary heart disease: PREHACOR study.

Our aim in this study was to examine the relationship between regular exercise and major cardiovascular events in hypertensive elderly with established coronary heart disease (CHD) in the primary care setting. The PREHACOR study recruited 3193 hypertensive patients, aged 74 +/- 6 years, 67% male, with CHD. Regular exercise assessed by questionnaire was defined as recreational activity >20 min/day, >3 times/week.

[Myocardial infarction with "angiographycally normal coronary arteries" myth or reality?].

The leading cause of acute myocardial infarction (AMI) in patients with coronary heart disease is plaque rupture. Between 6% and 12% of AMI patients have angiographically normal coronary arteries. However, new procedures have demonstrated the limits of coronarography and challenged the existence of this situation.

Comparison of accuracy of aortic valve area assessment in aortic stenosis by real time three-dimensional echocardiography in biplane mode versus two-dimensional transthoracic and transesophageal echocardiography.

Our aim was to validate the clinical feasibility of assessment of the area of the aortic valve orifice (AVA) by real time three-dimensional echocardiography (RT3DE) in biplane mode by planimetry and to compare it with the echo-Doppler methods more commonly used to evaluate valvular aortic stenosis (AS).RT3DE in biplane mode is a novel technique that allows operators to visualize the aortic valve orifice anatomy in any desired plane orientation. Its usefulness and accuracy have not previously been established.

Does Carbofilm coating affect in-stent intimal proliferation? A randomized trial comparing Rx multi-link penta and Tecnic Carbostent Stents: SIROCCO Trial.

Objectives: To compare the volume of in-stent neointimal proliferation, assessed by intravascular ultrasound (IVUS), at 6-month follow-up after implantation of a coronary Carbofilm-coated stent (Tecnic Carbostent, Sorin Biomedica Cardio, Saluggia, Italy) versus a conventional 316 L stent (Rx Multi-Link Penta, Abbott Laboratories, Abbott Park, IL).

Background: Many trials suggest that stent characteristics and coating could be important determinants of restenosis.

Methods: From October 2004 to May 2005, 63 patients were randomized to Tecnic (T, n = 30) or Penta (P, n = 33).

[Coronary syndromes in the elderly].

Acute coronary syndromes (ACS) are frequent in the elderly and carry a poor prognosis. Severe coronary artery disease, frequent comorbidity, late diagnosis, and treatments themselves are responsible for high morbidity and mortality rates. Reluctance to treat elderly patients with new mechanical or chemical revascularization techniques is due to the higher risk profile.

Predischarge C-reactive protein and 1-year outcome after acute coronary syndromes.

Purpose: To investigate the relationship between high-sensitivity C-reactive protein and cardiovascular events following acute coronary syndrome.

Methods: This nationwide, cross-sectional, prospective study involved 439 patients with an acute coronary syndrome who presented to the hospital within 24 hours of symptom onset. Patients with a concomitant inflammatory process were excluded.

Is exercise testing useful to improve the prediction of coronary events in asymptomatic subjects?

Objective: The value of exercise testing (ET) in asymptomatic subjects remains controversial and is unknown in countries with a low coronary heart disease (CHD) incidence. The aim of this study was to investigate the ability of ET to improve the prediction of a first coronary event in such a population.

Methods: Using a prospective cohort study, 1051 consecutive healthy asymptomatic adults were enrolled in a cardiovascular screening program including ET.

Clinical and angiographic outcome of paclitaxel-eluting stent implantation for unprotected left main coronary artery bifurcation narrowing.

Aims: This study was designed to compare the clinical and angiographic outcomes of paclitaxel-eluting stent (PES) and bare metal stent (BMS) implantation for unprotected left main coronary artery (LMCA) bifurcation narrowing.

Methods And Results: From November 2003 to December 2004, the technique of kissing balloon followed by T provisional stenting was applied for distal left main coronary lesion in 49 consecutive patients with PES stents. Data from this group were compared to those from 57 patients treated with BMS during the previous year.

[Nude stents, coated stents].

By making safe the act and decreasing the restenosis risk, the stent had contributed to the development of coronary artery angioplasty which fill nowadays the whole of clinical and coronarographical field of coronary artery disease. The new stent, coated with substances amenable to minimise the best the restenosis risk, holds the hope of the interventional cardiology. The first results are promising.

Clinical and angiographic outcome of stenting of unprotected left main coronary artery bifurcation narrowing.

Purpose: Improvements in techniques and equipments may result in the wider applicability of percutaneous coronary intervention (PCI) for unprotected left main coronary artery (ULMCA) stenosis. This report is a prospective study focused on the feasibility, effectiveness and long-term results of stenting for treatment of ULMCA bifurcation lesions.

Methods: From November 2002 to October 2003, 57 consecutive patients were stented with bare metal stents and the technique of kissing balloon followed by T-provisional stenting was applied for ostial left anterior descending, left circumflex or distal left main coronary lesion.

High frequency of endothelial vasomotor dysfunction after acute coronary syndromes in non-culprit and angiographically normal coronary arteries: a reversible phenomenon.

This study aimed to assess endothelium-dependent vasomotor function in non-culprit coronary vessels in patients with recent acute coronary syndrome (ACS). Endothelial dysfunction can also concern peripheral vessels during ACS, but the frequency of this phenomenon at coronary circulation level is unknown. Endothelial function was assessed by infusion of graded doses of acetylcholine (ACh) in a non-culprit coronary artery of normal appearance in 43 patients having recently suffered from non-ST ACS, and reassessed 6 months later.

[Drug prescription after acute coronary syndrome].

Each year in France, 150,000 to 180,000 new patients are the subject of prescriptions following acute coronary syndrome with or without ST segment elevation. There are two targets of the treatment, 1) atherosclerosis, a diffuse, evolving trouble which, in this situation, is coming out of an unstable phase, and 2) the myocardium, which has often been revascularized and has suffered deterioration of its contractile and electrophysiological characteristics to a greater or lesser extent. Prescriptions, based on proven factors and always centred around hygiene and dietary advice and the use of a combination of statins and aspirin, are adapted to suit the atherosclerotic and myocardial risk assessed for the individual patient.

Is direct coronary stenting the best strategy for long-term outcome? Results of the multicentric randomized benefit evaluation of direct coronary stenting (BET) study.

Background: Preliminary trials of direct coronary stenting have demonstrated the benefits of this approach. It lowers procedural cost, time, and radiation exposure compared with predilatation. Nevertheless, the long-term outcome after direct stenting remains less well known.