Laurent Quilliet

Effect of time to treatment and age on one year mortality in acute STEMI: difference between thrombolysis and primary percutaneous coronary intervention.

CONTEXT Although thrombolysis (THL) and primary percutaneous coronary intervention (PPCI) are two validated options in reperfusion algorithms for ST-elevation myocardial infarction (STEMI), recent papers seems to show that PPCI could be the best therapeutic option irrespective of the time to treatment (TT) and of the cardiovascular risk profile of the patient. The impact of TT and age on reperfusion strategies requires elucidation. The aim of this study was to analyze the effect of time to treatment and age on the 1-year mortality of patients presenting with STEMI, for each reperfusion strategy. MATERIALS AND METHODS The study population consisted in 794 patients directly admitted to the cardiological intensive care unit for STEMI < or =12 hours. The relationship between TT and 1-year mortality was studied using logistic regression models. The models were implemented on the overall population and on 3 different age groups: [<65 years]; [> or =65 and <75 years]; [> or =75 years] for patients undergoing THL (n=299) and for patients undergoing PPCI (n=495). There was no significant between-group difference in all-cause 1-year mortality for the patients [<65 years] and those [> or =65 and <75 years]. In contrast, the 1-year mortality was significantly higher in the patients [> or =75 years] undergoing THL (51.4 vs. 15.3%; p<0.001). The analysis of the curves of mortality suggests that 1- year mortality of patients with STEMI depend not only on reperfusion strategy but so on the time to treatment and on the age of the patients. CONCLUSION In STEMI, on a 1-year mortality criteria, PPCI is not always upper than THL, particularly for patients<65 years treated within the first two hours after symptoms onset. TT and age affects the results of the reperfusion strategies and must be still incorporated in the reperfusion algorithms of STEMI.

Evaluation of left ventricular systolic function by 3D echocardiography: a comparative study with X-ray angiography and radionuclide angiography.

OBJECTIVE the aim of this study was to evaluate left ventricular systolic function by 3D ultrasound as compared to with radionuclide and X-ray angiographies. METHODS one hundred and four patients were examinated by 3D ultrasound (3D-US) but only 72 examinations were successful. Thirty patients were investigated by 3D-US, M-mode US or bidimensional (2D) US, and X-ray angiography (group I) and 42 patients were investigated by 3D-US, M-mode, or 2D, and radionuclide angiography (group II). RESULTS the correlation between ejection fraction (EF) evaluated by 3D-US and reference methods was found to be good and similar for the two groups (r=0.75; P<10(-4) for group I and r=0.76; P<10(-4) for group II). The correlation between EF calculated by conventional 2D-US and by reference methods was lower (r=0.60; P=0.04 for group I and r=0.54; P=0.001 for group II). The correlation between EF evaluated by 3D- and 2D-US was modest (r=0. 55; P=0.001 for the whole group). The correlation between 3D-US left ventricle end-diastolic volume (EDV) and end-systolic volume (ESV) and those evaluated by X-ray angiography was also modest (r=0.33; NS for EDV and r=0.60; P<10(-4) for ESV). The correlations between EDV and ESV in 3D-US, and those evaluated from radionuclide angiography were fairly good and in the same range (r=0.76; P<10(-4) and r=0.87; P<10(-4)). CONCLUSION the 3D-US system using a rotating probe in an apical view is valuable for evaluation of left ventricular systolic function.

Granulomatous mass adherent to a patent foramen ovale occluder

A 70-year-old woman with a history of repeated cerebrovascular events and patent foramen ovale (PFO) closure with PREMERE occluder (St Jude Medical, St Paul, MN, USA) had a recurrence of transient left …

050 Prognostic impact of arterial access site in PCI for acute coronary syndromes

Background Percutaneous coronary intervention (PCI) is the cornerstone of revascularization in acute coronary syndromes (ACS). The radial artery catheterization (RAC) is associated with less bleeding complications. However it is not clear whether the benefit on bleedings associated with RAC could be translated into a reduction of long term major adverse cardiovascular events (MACE). In patients with ST elevation myocardial infarction (STEMI), we have to determine if the use of RAC allows the recanalization of the coronary artery in a timely fashion. We aimed to confirm that RAC reduces haemorrhagic complications and determine if this advantage on bleedings could be translated into a 6 months MACE reduction. We also checked if RAC did not lengthen the time puncture to balloon (TPB) in the subgroup of STEMI patents. Methods All patients hospitalized for an ACS and treated with PCI between 01/2008 and 12/2008 were considered for this study. Predictors of in hospital minor and major bleedings and 6 months MACE were sought by uni and multivariate analysis. Results Altogether, 626 patients were included. 509 treated with RAC and 117 with a femoral artery catheterization (FAC). As compared to FAC, RAC decreased in hospital minor and major bleedings, respectively by 80%(OR=0.2, CI=0.06-0.6, p=0,004) and 74% (OR=0.26, CI=0.1-0.7, p=0,007). In patients with STEMI, there was no difference in TPB whatever the arterial access used (13 min vs 14 min, p=0.7). At 6 months, RAC was found as an independent predictor for less MACE (OR=0.4, CI=0.1-1.1, p=0.05). Conclusion Patients treated by PCI derive benefit from the use of RAC on in-hospital bleedings but also on the reduction of 6 months ischemic events. In STEMI patients it does not extend the TPB. Use of RAC should have a widespread diffusion.