Publications by authors named "Raphaelle Dumaine"
Background: The appropriate duration of treatment with beta-blocker drugs after a myocardial infarction is unknown. Data are needed on the safety and efficacy of the interruption of long-term beta-blocker treatment to reduce side effects and improve quality of life in patients with a history of uncomplicated myocardial infarction.
Methods: In a multicenter, open label, randomized, noninferiority trial conducted at 49 sites in France, we randomly assigned patients with a history of myocardial infarction, in a 1:1 ratio, to interruption or continuation of beta-blocker treatment.
Article Synopsis
- The study aimed to assess the effectiveness of ticagrelor versus clopidogrel in preventing cardiovascular events among chronic coronary syndrome patients undergoing complex percutaneous coronary interventions (PCI).
- Among 1,866 patients in the trial, nearly half were identified as having complex PCI, which was associated with significantly higher rates of myocardial infarction and other complications.
- Despite the increased risk associated with complex PCI, ticagrelor did not demonstrate any advantage over clopidogrel in reducing these adverse events.
Article Synopsis
- The study aimed to investigate the effects of the timing of P2Y inhibitor administration on myocardial necrosis during elective percutaneous coronary intervention (PCI), utilizing data from the ALPHEUS trial.
- Results revealed that patients who received P2Y inhibitors closer to the PCI procedure had higher rates of myocardial necrosis compared to those who were given the medication earlier, with improved outcomes seen in groups that received longer loading times.
- While the study found a correlation between timing and myocardial injury, it noted that bleeding complications were minimal and did not vary significantly among the different timing groups, leaving long-term clinical effects unclear.
Background: The long-term use of β-blocker after myocardial infarction (MI) when global left ventricular ejection fraction (LVEF) is preserved has not been studied in the era of modern myocardial reperfusion and secondary prevention therapies. It is unknown whether β-blockers are useful in stable post-MI patients without reduced LVEF and without heart failure.
Methods: The Assessment of β-blocker interruption 1 Year after an uncomplicated myocardial infarction on Safety and Symptomatic cardiac events requiring hospitalization (ABYSS) Trial enrolled in 49 centers in France, 3,700 patients with a prior (>6 months) history of MI and a LVEF >40%, chronically treated with a β-blocker and without any major cardiovascular event (MACE) in the past 6 months.
Article Synopsis
- The ALPHEUS study aimed to determine if ticagrelor is more effective than clopidogrel in reducing heart muscle injury during elective PCI in stable coronary patients.
- Conducted across 49 hospitals in France and the Czech Republic, it involved 1910 participants who were randomly assigned to receive either ticagrelor or clopidogrel before the procedure.
- Results showed no significant difference in the primary endpoint of myocardial injury between the two groups, with about 35% in the ticagrelor group and 36% in the clopidogrel group affected, indicating ticagrelor did not outperform clopidogrel in this context.
Article Synopsis
- Clopidogrel combined with aspirin is the standard treatment for patients undergoing elective PCI, but complications like myocardial infarction can occur.
- Evidence supports the potential benefits of using ticagrelor, a type of P2Y receptor inhibitor, which may help reduce ischemic complications while maintaining a similar safety profile to clopidogrel.
- The ALPHEUS trial will compare the effects of ticagrelor and clopidogrel on patients undergoing elective PCI, focusing on reducing myocardial injury and evaluating major bleeding risks.
Background: Standardization of aortic valve repair by the external ring annuloplasty approach is an alternative to valve replacement to avoid prosthetic valve-related events. Although the benefit of exercise training to improve postoperative exercise tolerance has been demonstrated in many conditions after cardiac surgery, it has never been described after aortic valve repair.
Objectives: To evaluate the feasibility of an early exercise training programme after aortic valve repair.
Background And Objectives: We aimed to assess the incidence and evolution of left ventricular (LV) thrombi in a high-risk population of patients with LV systolic dysfunction after anterior myocardial infarction (ant-MI). We also compared the accuracy of transthoracic echocardiography (TTE) and cardiac magnetic resonance imaging with contrast-delayed enhancement (CMR-DE) in detecting LV thrombi.
Methods: We prospectively included 100 consecutive patients with LV ejection fraction (LVEF) <45% at the first TTE performed <7 days after ant-MI.
Background: Exercise capacity, best reflected by peak exercise oxygen consumption (peak VO(2)), is a powerful prognostic factor in patients with chronic heart failure (CHF). However, the optimal time to assess exercise capacity for prognosis remains unclear and whether an exercise training program (ETP) to improve exercise capacity alters the prognostic value of cardiopulmonary exercise (CPX) testing variables in CHF is unknown.
Methods And Results: CHF patients who underwent an ETP in two cardiac rehabilitation centers between 2004 and 2009 were prospectively included, and CPX testing was performed before and after ETP completion.
Background: Although prior data showed an association between chronic kidney disease (CKD) and atherothrombotic events, little is known about the risk profile and specific outcomes of atherothrombotic outpatients with CKD.
Methods: More than 69,000 outpatients at risk of atherothrombotic events were enrolled in the REACH Registry. Creatinine clearance (CrCl) was available for 51,208 patients divided into 4 groups: normal (CrCl > or =90 mL/min, n = 13,949), mild (60-89 mL/min, n = 19,474), moderate (30-59 mL/min, n = 15,883), and severe CKD (CrCl <30 mL/min, n = 1902).
Background: Despite its limitations, unfractionated heparin (UFH) is the recommended anticoagulant during percutaneous coronary intervention (PCI). Few randomized trials have compared low-molecular-weight heparin (LMWH) and UFH, and most lacked the power to detect a difference between the 2 anticoagulants in terms of safety or efficacy. Our objective was to perform a meta-analysis of randomized trials comparing the efficacy and safety of LMWH vs UFH as anticoagulants in the setting of PCI.
View Article and Find Full Text PDFBackground: Aldosterone, the final mediator of the renin-angiotensin-aldosterone pathway, is at its highest plasma levels at presentation for ST-elevation myocardial infarction (STEMI). Whether aldosterone level at presentation for STEMI is associated with adverse outcome remains unknown.
Methods And Results: Plasma aldosterone levels were measured at presentation in consecutive patients referred for primary percutaneous coronary intervention for STEMI.
Chronic hypertension is a well established risk factor for the development of cardiovascular disease; however, its prognostic significance after a non-ST-segment elevation acute coronary syndrome remains to be established. Data from 15,414 patients included in six randomized Thrombolysis in Myocardial Infarction (TIMI) trials (TIMI 3B, TIMI 11A, TIMI 11B, TIMI 12, the Orbofiban in Patients With Unstable Coronary Syndromes [OPUS]-TIMI 16, and the Treat Angina With Aggrastat and Determine Cost of Therapy With an Invasive or Conservative Strategy [TACTICS]-TIMI 18) were analyzed. A history of hypertension was present in 10,998 (71.
View Article and Find Full Text PDFIt has become increasingly apparent that epicardial blood flow restoration is necessary, but not sufficient, to achieve optimal clinical outcomes in the setting of acute coronary syndromes. Indeed, clinical outcomes are strongly associated with myocardial perfusion. The diagnostic tools available to assess myocardial perfusion following acute myocardial infarction and their association with clinical outcomes are reviewed here.
View Article and Find Full Text PDFThis prospective, multicenter, observational study was designed to assess the in-hospital prognostic importance of renal insufficiency among patients presenting with acute coronary syndrome (ACS). One third of patients with ACS presented with renal insufficiency. After adjustment for potential confounders, decreasing renal function was independently associated with in-hospital death, bleeding, and contrast-induced nephropathy.
View Article and Find Full Text PDFAims: To determine the association of glomerular filtration rate (GFR) with clinical outcomes in the setting of non-ST-segment elevation acute coronary syndromes (NSTE-ACS).
Methods And Results: Data were pooled from five NSTE-ACS TIMI trials (TIMI 11A and B, TIMI 12, OPUS-TIMI 16 and TACTICS-TIMI 18) and were available in 13 307 patients. GFR was assessed as a continuous and a categorical variable (normal: > or = 90 mL/min/1.
Objectives: In the present study, we describe the characteristics and examine the anticoagulation levels and safety of subcutaneous enoxaparin in unstable angina (UA)/non-ST-segment elevation myocardial infarction (NSTEMI) patients who would not have been eligible in the Efficacy Safety Subcutaneous Enoxaparin in Non-Q-wave Coronary Events (ESSENCE) and Thrombolysis In Myocardial Infarction (TIMI)-11B trials.
Background: It is not known whether the benefit shown with enoxaparin in the selected population of pivotal trials can be extended to the real world.
Methods: In our center, all patients with UA/NSTEMI are anticoagulated with subcutaneous enoxaparin adjusted to creatinine clearance.