Publications by authors named "Laurent Bonello"

Current evidence indicates that dual antiplatelet therapy with aspirin plus a P2Y inhibitor is essential for the prevention of thrombotic events after percutaneous coronary interventions. However, dual antiplatelet therapy is associated with increased bleeding which may outweigh the benefits. This has set the foundations for customizing antiplatelet treatments to the individual patient.

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Background: Despite scarce data, invasive mechanical ventilation (MV) is widely suggested as first-line ventilatory support in cardiogenic shock (CS) patients. We assessed the real-life use of different ventilation strategies in CS and their influence on short and mid-term prognosis.

Methods: FRENSHOCK was a prospective registry including 772 CS patients from 49 centers in France.

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Background: Cardiogenic shock and sepsis are severe haemodynamic states that are frequently present concomitantly, leading to substantial mortality. Despite its frequency and clinical significance, there is a striking lack of literature on the outcomes of combined sepsis and cardiogenic shock.

Methods: FRENSHOCK was a prospective registry including 772 patients with cardiogenic shock from 49 centres.

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Inflammatory processes are involved not only in coronary artery disease but also in heart failure (HF). Cardiogenic shock (CS) and septic shock are classically distinct although intricate relationships are frequent in daily practice. The impact of admission inflammation in patients with CS is largely unknown.

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  • * In a study involving 772 patients with cardiogenic shock, 21.3% had CKD, and these patients were generally older and had more health issues, which contributed to increased mortality.
  • * Renal replacement therapy (RRT) was associated with a higher risk of death regardless of CKD status, highlighting the need for collaborative care between cardiac and kidney specialists to better manage these patients.
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Background: Cardiogenic shock (CS) is the most severe form of acute heart failure. Discrepancies have been reported between sexes regarding delays, pathways and invasive strategies in CS complicating acute myocardial infarction. However, effect of sex on the prognosis of unselected CS remains controversial.

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Background: The effects of pharmacological therapy on cardiogenic shock (CS) survivors have not been extensively studied. Thus, this study investigated the association between guideline-directed heart failure (HF) medical therapy (GDMT) and one-year survival rate in patients who are post-CS.

Methods And Results: FRENSHOCK (French Observatory on the Management of Cardiogenic Shock in 2016) registry was a prospective multicenter observational survey, conducted in metropolitan French intensive care units and intensive cardiac care units.

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Background: Beta blockers (BBs) are a cornerstone for patients with heart failure (HF) and ventricular dysfunction. However, their use in patients recovering from a cardiogenic shock (CS) remains a bone of contention, especially regarding whether and when to reintroduce this class of drugs.

Methods: FRENSHOCK is a prospective multicenter registry including 772 CS patients from 49 centers.

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  • - The beta-adrenergic signaling pathway is crucial in managing heart failure (HF), with beta-blockers (BBs) being the first-line treatment for patients with HF and reduced ejection fraction (HFrEF).
  • - In cases of severe acute heart failure (AHF), particularly those recovering from cardiogenic shock, starting BB therapy can be risky due to a lack of comprehensive data.
  • - An expert consensus has been developed to review existing studies on BB use in severe decompensated AHF and offers a practical algorithm for prescribing and monitoring BB therapy in critical conditions.
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  • The study examines heart failure and cardiogenic shock (CS) in older adults, highlighting that the incidence is rising due to an aging population, with limited data available on this demographic.
  • The research involved a registry called FRENSHOCK, which included 772 CS patients, revealing that 30.6% were over 75 years old, with higher comorbidities and lower treatment intensity compared to younger patients.
  • Results indicated that older adults have more than double the risk of death at 1 month and 1 year post-CS, emphasizing the need for targeted research to determine effective treatment strategies for this age group.
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Objectives: During life-threatening emergencies or risky cardiologic interventions, pharmacology can be limited and the use of appropriate medical devices is then necessary. The Impella™ catheter, CP and 2.5, has been referenced for the exclusive use of the interventional cardiology technical platform at Hôpital Nord (AP-HM) in the absence of rapid access to the Extracorporeal Circulation unit.

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Background: Cardiogenic shock (CS) is the most severe form of heart failure (HF), resulting in high early and long-term mortality. Characteristics of CS secondary to supraventricular tachycardia (SVT) are poorly reported. Based on a large registry of unselected CS, we aimed to compare 1-year outcomes between SVT-triggered and non-SVT-triggered CS.

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Idiopathic dilated cardiomyopathy (IDCM) is one of the most common forms of nonischemic cardiomyopathy worldwide, possibly leading to cardiogenic shock (CS). Despite this heavy burden, the outcomes of CS in IDCM are poorly reported. Based on a large registry of unselected CS, our aim was to shed light on the 1-year outcomes after CS in patients with and without IDCM.

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  • The study investigates the impact of skin mottling on patients with cardiogenic shock, finding that nearly 39% of patients showed mottling at admission, which is linked to worse outcomes.
  • In a cohort of 772 patients, those with mottling had higher rates of invasive support, longer hospital stays, and increased mortality at both 30 days and 1 year compared to those without mottling.
  • The study concludes that skin mottling can be a valuable assessment tool in guiding therapy for cardiogenic shock patients, indicating the need for more aggressive treatment to improve survival chances.
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  • Despite advancements in treating acute myocardial infarction complicated by cardiogenic shock (AMICS), patients still face high incidence and mortality rates, prompting investigation into better treatment options.
  • The ULYSS trial plans to evaluate the effectiveness of the IMPELLA CP device in enhancing patient outcomes compared to standard treatment during percutaneous coronary intervention.
  • This study will focus on short-term outcomes like death and the need for advanced support at one month, while also reviewing long-term safety, efficacy, and costs of the treatment.
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  • Cardiogenic shock is a rare condition in adults with congenital heart disease (ACHD), making up only 0.9% of cases in a nationwide registry study in France.
  • The study found that ACHD patients were younger and had fewer risk factors for cardiovascular issues compared to non-ACHD patients, but they still experienced a high rate of severe outcomes after one year, similar to non-ACHD patients.
  • Management strategies differed significantly, with ACHD patients more likely to receive catheterizations and device implantations while less likely to use temporary circulatory support or invasive ventilation.
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  • This study explored the characteristics, management, and outcomes of patients with active cancer who were admitted for cardiogenic shock, finding that they made up about 6.6% of the 772 enrolled patients.
  • Although active cancer patients had similar initial in-hospital outcomes as non-cancer patients, they required more intensive drug management but received less mechanical support.
  • While both groups had similar 30-day mortality rates, the active cancer group had significantly higher long-term mortality rates at 1 year, indicating that active cancer dramatically impacts survival after initial treatment for cardiogenic shock.
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Background: Cardiogenic shock (CS) is a life-threatening condition carrying poor prognosis, potentially triggered by ventricular arrhythmia (VA). Whether the occurrence of VA as trigger of CS worsens the prognosis compared to non-VA triggers  remains  unclear.  The  aim  of  this  study  was  to  evaluate  1-year  outcomes [mortality, heart transplantation, ventricular assist devices (VAD)] between VA-triggered and non-VA-triggered CS.

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In addition to appropriate patient screening, pre-procedural preparation is essential to optimize both technical success and patient outcome for protected percutaneous coronary intervention (PCI). A critical component of optimization is the identification and preparation of a suitable femoral access site. Here, we describe several options for both imaging and image-guided access to optimize the approach.

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There is a large heterogeneity among patients presenting with cardiogenic shock (CS). It is crucial to better apprehend this heterogeneity in order to adapt treatments and improve prognoses in these severe patients. Notably, the presence (or absence) of a pre-existing history of chronic heart failure (CHF) at time of CS onset may be a significant part of this heterogeneity, and data focusing on this aspect are lacking.

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Fcγ receptors (FcγRs) interact with the C-reactive protein (CRP) and mediate activation of inflammation-related pathogenic mechanisms affecting cardiovascular health. Our study evaluated whether FcγRIIA and FcγRIIIA profiles are associated with the recurrence of adverse cardiovascular events during the first year after a primary acute coronary syndrome (ACS). The primary endpoint was the recurrence of cardiovascular events (RCE), identified as a composite outcome comprising acute heart failure (AHF) and major adverse cardiovascular events (MACE).

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