Impact of arterial access site on outcomes after primary percutaneous coronary intervention: prespecified subgroup analysis from the EUROMAX trial.

Background: In European Ambulance Acute Coronary Syndrome Angiography (EUROMAX), bivalirudin improved 30-day clinical outcomes with reduced major bleeding compared with heparins plus optional glycoprotein IIb/IIIa inhibitors. We assessed whether choice of access site (radial or femoral) had an impact on 30-day outcomes and whether it interacted with the benefit of bivalirudin.

Methods And Results: In EUROMAX, choice of arterial access was left to operator discretion.

Impact of age-adjusted insulin-like growth factor 1 on major cardiovascular events after acute myocardial infarction: results from the fast-MI registry.

Background: The GH/IGF-1 axis is being targeted for therapeutic development in diseases such as short stature, cancer, and metabolic disorders. The impact of IGF-1 in cardiovascular disease remains controversial. We therefore studied whether IGF-1 at admission for acute myocardial infarction (AMI) predicted death, recurrent AMI, and stroke over a 2-year follow-up.

Acute stent thrombosis after primary percutaneous coronary intervention: insights from the EUROMAX trial (European Ambulance Acute Coronary Syndrome Angiography).

Objectives: This study sought to determine clinical, procedural, and treatment factors associated with acute stent thrombosis (AST) in the EUROMAX (European Ambulance Acute Coronary Syndrome Angiography) trial.

Background: Bivalirudin started during transport for primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction significantly reduced major bleeding compared with heparin with or without glycoprotein IIb/IIIa inhibitors (GPI), but it was associated with an increase in AST.

Methods: We compared patients with (n = 12) or without AST (n = 2,184) regarding baseline, clinical, and procedural characteristics and antithrombotic treatment strategies (choice of P2Y12 inhibitor, post-primary PCI bivalirudin infusion dose [0.

Clinical and economic outcomes of infective endocarditis.

Background: In France, the estimated annual incidence of infective endocarditis (IE) is 33.8 cases per million residents. Valvular surgery is frequently undergone.

[Primary coronary angioplasty for myocardial infarction--the view of the cardiologic surgeon].

The aim of this article is not to present a general academic review on primary angioplasty in patients with ST-elevation myocardial infarction, but rather to focus on some practical points that directly concern cardiologists who perform primary percutaneous interventions in these patients. We detail recent data about the use of the radial artery approach, thromboaspiration, new oral inhibitors of P2Y12, selective use of anti-GPIIb/IIIa, high dose of peri-procedural statin therapy, choice of the best stent, and the best approach for treating non-culprit lesions in patients with multivessel coronary artery disease. The changes observed in the overall management of patients undergoing primary PCI for ST-elevation myocardial infarction are likely to have participated in the decrease in mortality observed in several registries.

Improved outcome of cardiogenic shock at the acute stage of myocardial infarction: a report from the USIK 1995, USIC 2000, and FAST-MI French nationwide registries.

Aim: The historical evolution of incidence and outcome of cardiogenic shock (CS) in acute myocardial infarction (AMI) patients is debated. This study compared outcomes in AMI patients from 1995 to 2005, according to the presence of CS.

Method And Results: Three nationwide French registries were conducted 5 years apart, using a similar methodology in consecutive patients admitted over a 1-month period.

French Ministry of Health prospective multicentre study using bio-active stents coated with titanium nitride oxide: the EVIDENCE registry.

Background: Coronary stents have evolved over time, from bare-metal stents to drug-eluting stents, and now to bioactive stents.

Aims: We sought to explore the immediate outcome of the titanium-nitride-oxide-coated bioactive stent, Titan2(®), in real-world practice, and the incidence of major cardiac events at follow-up.

Methods: Consecutive patients admitted for percutaneous intervention for at least one significant (≥50%) lesion in a native coronary artery were treated with Titan2(®) stent implantation.

Heart failure in acute myocardial infarction: a comparison between patients with or without heart failure criteria from the FAST-MI registry.

Introduction And Objectives: To compare acute myocardial infarction patients with or without congestive heart failure in the French FAST-MI registry.

Methods: The French FAST-MI registry included 374 centers and 3059 patients over a 1-month period at the end of 2005, with 1-year follow-up. Among this population, patients with at least one congestive heart failure criterion constituted group 1 (n=1149; 37.

Impact of type of preadmission sulfonylureas on mortality and cardiovascular outcomes in diabetic patients with acute myocardial infarction.

Background: The impact of antidiabetic medications on clinical outcomes in patients developing acute myocardial infarction (MI) is controversial. We sought to determine whether in-hospital outcomes in patients who were on sulfonylureas (SUs) when they developed their MIs differed from that of diabetic patients not receiving SUs and whether clinical outcomes were related to the pancreatic cells specificity of SUs.

Methods And Results: We analyzed the outcomes of the 1310 diabetic patients included in the nationwide French Registry of Acute ST-Elevation and Non-ST-Elevation Myocardial Infarction in 2005.

Late results with bioprosthetic valves in the elderly.

Aim: We report the long-term outcome of aortic and mitral bioprostheses in patients over 65 years of age at the time of implantation. The aim was to determine actuarial patient survival, causes of death, and the rate of documented primary structural deterioration.

Methods: One hundred ten patients > or = 65 years of age (mean, 73.

[Tolerance of amlodipine in left ventricular dysfunction of ischemic origin].

The aim of this study was to assess the effects of amlodipine on left ventricular function at rest and on effort, at least 30 days after myocardial infarction. The 30 patients included in the study had resting isotopic ejection fractions of 40 to 60%. At inclusion and after 15 days treatment with 10 mg of amlodipine, the patients underwent exercise stress testing with a standard Bruce protocol and resting and exercise isotopic left ventricular ejection fractions were measured.

[Influence of post-infarction myocardial revascularization on the prevalence of delayed potentials].

It has been shown that the presence of ventricular late potentials is a predictive factor of ventricular tachycardia and sudden death after myocardial infarction. The value of thrombolysis in the reduction of the prevalence of ventricular late potentials is now well established. However, the effects of other modes of revascularisation is less well known and more controversial.

Bioprosthetic valve replacement in the elderly.

One hundred and ten patients aged more than 65 years (mean, 73.4; range, 65-82) underwent successful bioprosthetic valve replacement (aortic, n = 71; mitral, n = 32; both, n = 7) from 1979 to 1985. The valve was pericardial in 39 cases and porcine in 78.

[Thrombolysis after 75 years of age: benefits, risks, indications].

Hospital mortality of myocardial infarction in patients over 75 years of age ranges from 25 to 33% without thrombolysis. Large scale trials of intravenous thrombolytic therapy including elderly patients showed that age itself is not a contra-indication to thrombolytic therapy. However, on the one hand, contra-indications are more common, and, on the other, the characteristics of infarction in the elderly are unsuitable so that thrombolysis is rarely used: in the MITI study, only 15% of over 75 years old patients would have benefitted from this therapy.

Comparison of tolerance to intravenous nitroglycerin during nicorandil and intermittent nitroglycerin patch in healthy volunteers.

Background: Nitrate tolerance is associated with a loss in the hemodynamic response to nitrate during repeated administration. Nicorandil is a new potassium channel agonist with additional nitrate properties. The aim of this study was to determine whether 7-day nicorandil (10 mg orally twice a day) administration attenuates the response to single-dose intravenous nitroglycerin (0.

[Coronary angioplasty, a privileged method of myocardial revascularization of the elderly].

Coronary angioplasty is a myocardial revascularisation technique of choice in the elderly, avoiding the need for general anesthesia as well as the complications of thoracotomy and extracorporeal circulation. Used in a continuous series of 62 patients, it provided a 79% primary success rate in this situation, where reaching the coronary artery and penetrating the stenosis may be difficult. Femoral complications (hematoma, false aneurysm) are commoner in this age group, but appear to be beneficially influenced by the replacement of heparin by ticlopidine peri-operatively.

Coronary angioplasty in patients 75 years and older; comparison with coronary bypass surgery.

From November 1988 to May 1992, 108 patients (79 men, 29 women) 75 years or older (mean 78 +/- 3, range 75-90 years) underwent coronary angioplasty (group I: n = 62) or coronary bypass surgery (group II: n = 46). Group II patients were younger (76 +/- 2 vs 79 +/- 4, P = 0.002) and had a higher proportion of multivessel disease.

[Concept of causal implication in unexpected effects of drugs. An example of cardiotoxicity caused by anthracyclines].

Over the last 30 years, considerable progress have been made in developing methodologies to analyze unwanted drug effects. The aim of this study is to explain the French method utilized to impute the side effects of a drug. An example of anthracycline cardiotoxicity will be discussed.

[Third angioplasty, and after that?].

The authors studied retrospectively a series of 39 patients with a documented second restenosis after coronary angioplasty between January 1987 and November 1992, 33 of whom (31 men, 2 women) underwent a third procedure. The artery dilated was the left anterior descending (n = 17 including 9 proximal stenoses), the right coronary (n = 10), the left circumflex or its branches (n = 5) and the left main stem (n = 1). The lesions were confirmed to one vessel in 25 cases (75%) and affected two vessels in 8 cases (25%).

[Mid-term results of bioprosthesis in patients over 65 years].

Between 1979 and 1985, 79 patients over 65 years of age (mean 70.8; range 65-82 years) underwent valvular replacement with a bioprosthesis (aortic: 48, mitral: 26, aortic and mitral: 5). Of the 84 valves implanted, 56 were porcine and 28 were pericardial bioprostheses.

[A rare course of spastic angina with normal coronary arteries].

The authors report the case of a 65-year-old woman smoker monitored for spastic angina. A first coronary arteriogram in 1986 failed to reveal any significant coronary lesion and was complicated by reversible occlusive spasm of the anterior interventricular artery. A second coronary arteriogram 6 years later because of recurrence of angina revealed the development of 70% stenosis of the coronary segment affected by the spasm.

Percutaneous coronary angioplasty in patients over 75 years old: immediate and mid-term results.

Ninety-five patients 75 years or older (range 75-90, mean 79) underwent PTCA from 1987 to 1991. Forty-two patients were 80 years or older. Forty-four had prior MI, 5% had prior coronary bypass surgery (CBS), 13% had a prior history of recent cardiac failure, and 81% (77/95) presented with unstable angina, refractory to intravenous treatment in 31 cases.

[Silent myocardial ischemia].

The frequency of silent myocardial ischemia (SMI) is 2 to 5% in an asymptomatic population, 25 to 30% after a myocardial infarction and 40% in stable angina. Although the prognosis of coronary insufficiency is related to the number of stenosed vessels and to left ventricular function, the presence of a silent ischemia constitutes an additive risk factor. The beneficial effect bypass surgery in terms of survival has been demonstrated in high risk patients (main coronary artery stenosis, three branch lesions with left ventricular insufficiency), while in the absence of symptoms those of medical treatment, and coronary angioplasty, have still to be demonstrated.

[Can patients with severe left ventricular dysfunction be treated by coronary artery bypass surgery?].

Forty three men and 3 women, with an average age of 59 years (13 to 78 years) underwent aorto-coronary bypass surgery despite severe left ventricular dysfunction (ejection fraction < 35%); 96% of the patients had previous infarction; 60% (N = 28) had unstable angina, 52% (N = 24) had had pulmonary oedema or an episode of congestive cardiac failure. The average ejection fraction was 29 +/- 4%, range 17 to 35%. Thirteen patients had ventricular aneurysms, 4 had grade 3 or 4 mitral regurgitation.