Olivier Varenne

Hôtel-Dieu de Paris – Hôpitaux universitaires Paris Centre, Lutetia Parisorum, Île-de-France, France

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Publications (55)333.53 Total impact

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    ABSTRACT: The pattern of coronary occlusion might contribute to the onset of ventricular arrhythmia and sudden cardiac death (SCD). We hypothesized that the concentrations of microparticles might differ between SCD and ST-elevation myocardial infarction (STEMI) patients without rhythmic disturbances.
    European heart journal. Acute cardiovascular care. 06/2014;
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    ABSTRACT: La malattia coronarica ha un’elevata incidenza nei paesi industrializzati, dove è associata a tassi di mortalità e di morbilità ancora importanti. Di conseguenza, le sindromi coronariche acute (SCA) costituiscono un motivo di ricovero ricorrente. La diagnosi di SCA presenta un certo numero di difficoltà, a causa di forme cliniche diverse e, a volte, molto fruste. Così, l’evidenziazione di una SCA al momento di una gestione perioperatoria o in un paziente sedato può porre delle difficoltà tanto sul piano diagnostico che per la scelta della gestione terapeutica. Essa richiede, pertanto, un approccio multidisciplinare che associa anestesisti, rianimatori e cardiologi.
    EMC - Anestesia-Rianimazione. 01/2014; 19(2):1–13.
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    ABSTRACT: Background The leading cause of sudden cardiac death is myocardial ischemia. As for uncomplicated acute myocardial infarction (AMI), international guidelines plead for early coronary angiography with, in case of culprit lesion, angioplasty and stent implantation. However after cardiac arrest (CA), shock, hypothermia and changes in antiplatelet pharmacokinetic may promote stent thrombosis (ST). Incidence of ST in this situation has never been studied. Objective The aim of this study was to investigate incidence and determinants of ST after ischemic CA successfully revascularized. Methods We analyzed 208 consecutive patients admitted in our institution for AMI and who underwent PCI with stent implantation. Among these patients, 55 presented a resuscitated CA and were compared to 153 without CA (control group). All patients in the CA group received hypothermia (33 °c for 24 h) following resuscitation and PCI. Results There was no difference between the 2 groups for age, gender, cardiovascular risk factors, coronary lesions and type of stent. In the CA group, patients were less frequently pre-treated with heparin (50,9% vs 98,7%, p < 0,001) and aspirin (52,7% vs 99%, p < 0,001). In the CA group, we observed a significantly higher incidence of confirmed acute or subacute ST than in the control group: 10.9% vs 2.0%, (p = 0,01). None of CA patients had received a dual antiplatelets therapy (0% Vs 99%). LVEF at admission was lower in the CA group (40,3% vs 48%; p < 0,001), and shock was more frequent (83,6% vs 8,5%; p < 0,001). Survival at 28 days was 50,1% in CA group vs 98.0% (p < 0,001). In multivariate analysis, CA before stenting appears to be an independent risk factor for confirmed ST (OR = 12,9; 95%CI 1,3-124,6; p = 0,027). Conclusion In CA patients treated with cooling, stenting for AMI is associated with a high risk of ST. Shock, insufficient antithrombotic treatment, pharmacokinetic changes related to hypothermia may contribute to this higher risk. A strategy aiming to reduce this complication may probably improve prognosis of patients who underwent coronary sudden death.
    Resuscitation 01/2014; · 4.10 Impact Factor
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    ABSTRACT: La prevalencia de la enfermedad coronaria en los países industrializados es alta y se asocia a índices de mortalidad y morbilidad considerables. Los síndromes coronarios agudos (SCA) constituyen, por tanto, un motivo de hospitalización reiterado. El diagnóstico de SCA plantea algunas dificultades debido a la diversidad de las formas clínicas, en ocasiones muy incompletas. Demostrar un SCA en el contexto perioperatorio o en un paciente sedado puede plantear dificultades en términos de diagnóstico y de conducta terapéutica. Necesita, pues, un enfoque multidisciplinario en el que participen anestesistas, especialistas en reanimación y cardiólogos.
    EMC - Anestesia-Reanimación. 01/2014; 40(2):1–14.
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    ABSTRACT: Early identification of the cause of out-of-hospital cardiac arrest (OHCA) remains a challenge. Our aim was to determine whether high-sensitivity cardiac troponin T (HsTnT) was useful to diagnose a recent coronary artery occlusion as the cause of OHCA. Retrospective study including OHCA patients evaluated by systematic coronary angiogram at hospital admission. HsTnT was assessed at ICU admission. Predictive factors of a recent coronary occlusion were identified by logistic regression. Net reclassification improvement (NRI) was calculated to estimate the potential enhancement of prediction with HsTnT. During the 5year study period, 272 patients (median age 60y, 76.5% men) were included, and a culprit coronary occlusion was found in 133 (48.9%). The optimum HsTnT cut-off to predict a recent coronary occlusion was 575ng/l (sensitivity 65.4%, specificity 65.5%). In multivariate analysis, current smoking (OR 3.2 95%, 95%CI 1.62-6.33), time from collapse to BLS<3min (OR 2.11, 95%CI 1.10-4.05), initial shockable rhythm (OR 5.29, 95%CI 2.06-13.62), ST-segment elevation (OR 2.44, 95%CI 1.18-5.03), post-resuscitation shock onset (OR 2.03, 95%CI 1.01-4.07) and HsTnT≥575ng/l (OR 2.22, 95%CI 1.16-4.27) were associated with the presence of a recent coronary occlusion. Nevertheless, adding HsTnT to established risk factors of recent coronary occlusion identified above provided a non-significant NRI of -0.43%. Admission HsTnT is increased after OHCA and is an independent factor of a recent coronary occlusion. However, HsTnT does not seem to be a strong enough diagnostic tool to select candidates for emergent coronary angiogram in OHCA survivors.
    International journal of cardiology 10/2013; · 6.18 Impact Factor
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    ABSTRACT: Intravenous enoxaparin did not reduce significantly the primary end point (p = 0.06) compared with unfractionated heparin (UFH) in the randomized Acute Myocardial Infarction Treated with primary angioplasty and intravenous enoxaparin Or unfractionated heparin to Lower ischemic and bleeding events at short- and Long-term follow-up (ATOLL) trial. We present the results of the prespecified per-protocol analysis excluding patients who did not receive the treatment allocated by randomization or received both enoxaparin and UFH. We evaluated all-cause mortality, complication of myocardial infarction, procedural failure, or major bleeding (primary end point) and all-cause mortality, recurrent acute coronary syndrome, or urgent revascularization (main secondary end point). Baseline and procedural characteristics were well balanced between the 2 treatment groups. Of 910 randomized patients, 795 patients (87.4%) were treated according to the protocol with consistent anticoagulation using intravenous enoxaparin (n = 400) or UFH (n = 395). Enoxaparin reduced significantly the rates of the primary end point (relative risk [RR] 0.76, 95% confidence interval [CI] 0.62 to 0.94, p = 0.012) and the main secondary end point (RR 0.37, 95% CI 0.22 to 0.63, p <0.0001). There was less major bleeding with enoxaparin (RR 0.46, 95% CI 0.21 to 1.01, p = 0.050) contributing to the significant improvement of the net clinical benefit (RR 0.46, 95% CI 0.3 to 0.74, p = 0.0002). All-cause mortality was also reduced with enoxaparin (RR 0.36, 95% CI 0.18 to 0.74, p = 0.003). In conclusion, in the per-protocol analysis of the ATOLL trial, pertinent to >87% of the study population, enoxaparin was superior to UFH in reducing ischemic end points and mortality.
    The American journal of cardiology 09/2013; · 3.58 Impact Factor
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    ABSTRACT: Aims: To compare the efficacy of three vasodilators in preventing radial artery spasm (RAS) in patients undergoing transradial percutaneous coronary interventions (PCI). Methods and results: 731 patients were randomized to receive diltiazem 5mg, verapamil 2.5mg, or isosorbide dinitrate (ISDN) 1 mg before coronary intervention. RAS occurred in 20.1% in the whole population and was significantly reduced by verapamil and ISDN compared to diltiazem (16.2%, 17.2%, 26.6 %; respectively; p<0.006). There was also a trend towards less severe pain (more than 8 on a numerical scale from 0 (no pain) to 10 (maximal pain)), and less severe RAS (complete catheter blockage or severe pain), among patients treated by verapamil compared to ISDN and diltiazem (1.3% vs. 2.8% vs. 2.9%, p=0.43 and 5.1% vs. 6.2% vs. 9.5%, respectively p=0.13). No difference was found between the three vasodilators in terms of crossover or safety events. Female gender, failure at first attempt to access the radial artery, emergency procedures and the use of diltiazem were independent predictors of RAS. Conclusion: Verapamil and ISDN considerably reduce the incidence of RAS compared to diltiazem during transradial PCI. © 2013 Wiley Periodicals, Inc.
    Catheterization and Cardiovascular Interventions 08/2013; · 2.51 Impact Factor
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    ABSTRACT: Aortic stiffness is an independent predictor of coronary events. We assessed the predictive value of aortic stiffness for ≥50% asymptomatic coronary artery disease in a stroke/transient ischemic attack population. We enrolled 300 consecutive patients aged 45-75 years with nondisabling, noncardioembolic ischemic stroke or transient ischemic attack, and no prior history of coronary artery disease. Coronary artery disease was assessed with 64-section computed tomography coronary angiography and all patients had a detailed cervicocephalic arterial work-up. Aortic stiffness was determined from carotid-femoral pulse wave velocity with 9·6 m/s as cutoff value. The predictive value of aortic stiffness was assessed by logistic regression and reclassification tables method after adjustment for the Framingham Risk Score and the presence of cervicocephalic stenosis, which were previously shown to be independent predictor of ≥50% asymptomatic coronary artery disease. Among the 274 included patients who had computed tomography coronary angiography, 26% (95% CI, 21%-32%) had an increased stiffness (pulse wave velocity > 9·6 m/s) and 18% (14%-23%) had ≥50% asymptomatic coronary artery disease. Increased aortic stiffness was associated with the presence of ≥50% asymptomatic coronary artery disease, both in univariate (odds ratio = 3·4 [1·8-6·4]) and multivariate analyses (odds ratio = 2·3 [1·2-4·7]) after adjustment for Framingham Risk Score and presence of cervicocephalic stenosis. After carotid-femoral pulse wave velocity was added to the standard model including Framingham Risk Score and the presence of cervicocephalic stenosis, net reclassification improvement was 12·6% (P < 0·005), integrated discrimination index was 2·51% (P = 0·025), and model fit was improved (likelihood ratio = 4·99, P = 0·025). In stroke/transient ischemic attack patients, aortic pulse wave velocity improves the prediction of ≥50% asymptomatic coronary artery disease beyond classical risk factors.
    International Journal of Stroke 07/2013; · 2.75 Impact Factor
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    ABSTRACT: PURPOSE: External cooling is largely employed to induce hypothermia in comatose survivors of cardiac arrest (CA), but can fail to reach the target temperature in a reasonable time. We aimed to assess the rate of failure of external cooling after CA and to determine failure predictors. METHODS: The study was a retrospective review of a prospectively acquired database in the setting of a 24-bed ICU in a university hospital. All consecutive patients admitted for CA from May 2002 to April 2010 and treated by external cooling were considered. Patients who were already hypothermic on admission, patients dying within 24 h, patients cooled by an internal technique and patients in whom hypothermia had not been attempted were not studied. External cooling failure was defined as the inability to reach a temperature below 34 °C during the first 12 h after CA onset. RESULTS: Among 1,036 patients admitted to the ICU, 594 were included in the analysis and in 191 (32 %) the target temperature could not be achieved within the 12 h following CA. Independent risk factors for external cooling failure were an early coronary angiography intervention (OR 3.75, p < 0.001), a high body weight (OR 1.02 per kilogram, p = 0.007), a high temperature on ICU admission (OR 1.47 per degree, p = 0.001) and a long delay between collapse and the start of cooling (OR 1.15, p = 0.05). Conversely, early haemodialysis (OR 0.27, p < 0.001) and male gender (OR 0.47, p = 0.02) were significantly associated with cooling success. CONCLUSION: External cooling failure occurred in nearly one-third of patients with CA and was associated with easily identified risk factors. This emphasizes the interest in early cooling and alternative techniques in these patients.
    European Journal of Intensive Care Medicine 01/2013; · 5.17 Impact Factor
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    ABSTRACT: AIM: To compare the feasibility, safety and outcome of IMPELLA Recover LP2.5 cardiac assistance and intra aortic balloon pump (IABP) in patients with post-cardiac arrest shock. BACKGROUND: The high early mortality rate of post-cardiac arrest patients is attributed to a "post cardiac arrest syndrome" characterized by an acute and transient left ventricular (LV) systolic dysfunction. LV assistance with IMPELLA Recover LP2.5 is proposed in most severe patients. METHODS: Retrospective single center registry from January 2007 to October 2010. All survivors of out-of-hospital cardiac arrest with patent or predictive factors for the occurrence of post-resuscitation shock assisted by either IMPELLA or intra aortic balloon pump (IABP) device immediately after the coronary angiogram were included. RESULTS: 78 post-cardiac arrest patients were assisted by one of the devices (35 by IMPELLA and 43 by IABP). Median "no flow" and median "low flow" were similar at admission as were hemodynamic parameters. The feasibility of IMPELLA implantation was good (97%). At 28 days, the survival rate without sequellae was 23.0% in the IMPELLA and 29.5% in the IABP group (p=0.61). Vascular complications were observed equally in both groups (3 vs 2, p=0.9). Serious bleeding complications occurred in 26% of IMPELLA patients vs 9% of IABP patients (p=0.06). CONCLUSION: Early LV assistance by the IMPELLA LP2.5 is feasible in patients with post-resuscitation shock. The rate of complications did not differ substantially in the two groups, except for a trend toward a higher rate of bleeding events with IMPELLA. These encouraging findings must be confirmed in a larger clinical study.
    Resuscitation 10/2012; · 4.10 Impact Factor
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    ABSTRACT: AIMS: Identification of the cause of out-of-hospital cardiac arrest (OHCA) is of paramount importance. We investigated the ability of our imaging strategy to provide an early etiological diagnosis of OHCA and the influence of this strategy on ICU survival. METHODS: Retrospective review of a prospectively acquired ICU database (01/2000-12/2010) including all OHCA patients without obvious extracardiac cause, for which an early diagnosis research was conducted (coronary angiography and/or brain and chest CT scan) within 24h after resuscitation. These procedures could be performed separately or be combined, according to a decision algorithm. RESULTS: Of the 1274 patients admitted after OHCA during this 10-year period, the imaging strategy was applied in 896 patients. Patients who benefited from coronary angiography and/or CT scan were admitted to our ICU after a median delay of 180 [130-220]min after resuscitation. Seven hundred and forty-five coronary angiographies were performed, of which 452 (61%) identified at least one significant coronary lesion deemed responsible for the OHCA. CT-scan was performed in 355 patients and provided a diagnosis in 72 patients (20%), mainly stroke (n=38) and pulmonary embolism (n=19). Overall, this strategy allowed early diagnosis in 524 patients (59%). ICU survival was significantly higher for patients with a diagnosis identified by coronary angiography as compared with CT-scan (43% vs 10%, p<0.001). CONCLUSION: The use of an early diagnosis protocol with immediate coronary angiography and/or CT scan provided the etiology of nearly two thirds of OHCA cases. In this large retrospective database, coronary angiography yielded a better diagnostic value than brain and/or chest CT-scan.
    Resuscitation 08/2012; · 4.10 Impact Factor
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    ABSTRACT: BACKGROUND: To assess the impact of impaired renal function (IRF) and timing of catheterization (immediate versus delayed intervention) on outcomes in intermediate/high risk NSTE-ACS patients. METHODS: We performed a post-hoc analysis of the randomized ABOARD population to compare 1) patients with vs. without IRF and 2) the two intervention strategies in patients with IRF. A creatinine clearance <60mL/min defined IRF. The primary endpoint was the in-hospital peak troponin I value; the secondary endpoints were a) the composite of death, myocardial infarction, urgent revascularization or recurrent ischemia (death/MI/UR/RI) and b) STEEPLE major bleeding (MB) at 1-month follow-up. RESULTS: Among the 345 patients, 75 (21.7%) had IRF. Patients with IRF were older, had more comorbidities and were at higher cardiovascular risk. Radial catheterization was predominant (84%). Among IRF patients, 37 (49%) and 38 (51%) patients were randomized to an immediate and delayed strategy, respectively. The primary and secondary endpoints rates were not different for the two comparisons. IRF was associated with more death (5.3% vs. 1.1%, p=0.043) and non-CABG MB (9.3% vs. 2.2%, p=0.001). In patients with IRF, a delayed strategy was associated with more recurrent ischemia (28.9% vs. 8.1%, p=0.021). Absence of clopidogrel pretreatment, insulin therapy and left main culprit lesion were independently associated with death/MI/UR/RI, while age and CABG surgery were related with MB. CONCLUSION: IRF is associated with worse outcomes in NSTE-ACS patients. The primary results of the ABOARD study apply also to patients with IRF in which the timing of catheterization does not impact hard outcomes.
    International journal of cardiology 07/2012; · 6.18 Impact Factor
  • Hepatology 05/2012; · 12.00 Impact Factor
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    ABSTRACT: Recent guidelines recommend the immediate performance of a coronary angiography when an acute myocardial infarction is suspected as a cause of out-of-hospital cardiac arrest. However, prehospital factors such as postresuscitation electrocardiogram pattern or clinical features are poorly sensitive in this setting. We searched to evaluate if an early measurement of cardiac troponin I can help to detect a recent coronary occlusion in out-of-hospital cardiac arrest. Retrospective analysis of a prospective electronic registry database. University cardiac arrest center. Between January 2003 and December 2008, 422 out-of-hospital cardiac arrest survivors without obvious extra-cardiac cause have been consecutively studied. An immediate coronary angiography has been systematically performed. The primary outcome was the finding of a recent coronary occlusion. First, blood cardiac troponin I levels at admission were analyzed to assess the optimum cutoff for identifying a recent coronary occlusion. Second, a logistic regression was performed to determine early predictive factors of a recent coronary occlusion (including cardiac troponin I) and their respective contribution. An ST-segment elevation was present in 127 of 422 patients (30%). During coronary angiography, a recent occlusion has been detected in 193 of 422 patients (46%). The optimum cardiac troponin I threshold was determined at 4.66 ng·mL(-1) (sensitivity 66.7%, specificity 66.4%). In multivariate analyses, in addition of smoking and epinephrine initial dose, cardiac troponin I (odds ratio 3.58 [2.03-6.32], p < .001) and ST-segment elevation (odds ratio 10.19 [5.39-19.26], p < .001) were independent predictive factors of a recent coronary occlusion. In this large cohort of out-of-hospital cardiac arrest patients, isolated early cardiac troponin I measurement is modestly predictive of a recent coronary occlusion. Furthermore, the contribution of this parameter even in association with other factors does not seem helpful to predict recent occlusion. As a result and given the high benefit of percutaneous coronary intervention for such patients, the dosage of cardiac troponin I at admission could not help in the decision of early coronary angiogram.
    Critical care medicine 04/2012; 40(6):1777-84. · 6.37 Impact Factor
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    ABSTRACT: This study sought to compare the safety and efficacy of 2 dose formulations of SYNERGY, a novel bioabsorbable polymer everolimus-eluting stent (EES) (Boston Scientific Corp., Natick, Massachusetts) compared with the durable polymer PROMUS Element EES (Boston Scientific Corp.). Durable polymer coatings on drug-eluting stents have been associated with chronic inflammation and impaired healing. Bioabsorbable polymer-coated drug-delivery systems may reduce the risk of late adverse events, including stent thrombosis, and thus the need for prolonged dual-antiplatelet therapy. A total of 291 patients with a de novo lesion ≤28 mm in length, in a coronary artery of ≥2.25 to ≤3.5 mm diameter, were enrolled in the EVOLVE study, a prospective, randomized, single-blind, noninferiority trial. Patients were randomly assigned in a 1:1:1 ratio to PROMUS Element, SYNERGY, or SYNERGY half dose. The primary clinical endpoint was the 30-day rate of target lesion failure, defined as cardiac death or myocardial infarction related to the target vessel, or target lesion revascularization. The primary angiographic endpoint was 6-month in-stent late loss measured by quantitative coronary angiography. The 30-day primary clinical endpoint of target lesion failure occurred in 0%, 1.1%, and 3.1% of patients in the PROMUS Element, SYNERGY, and SYNERGY half dose groups, respectively. The 6-month in-stent late loss was 0.15 ± 0.34 mm for PROMUS Element, 0.10 ± 0.25 mm for SYNERGY, and 0.13 ± 0.26 mm for SYNERGY half dose (SYNERGY, difference -0.06, upper 95.2% confidence limit: 0.02, p for noninferiority <0.001; SYNERGY half dose, difference -0.03, upper 95.2% confidence limit: 0.05, p for noninferiority <0.001). Clinical event rates remained low and comparable between groups, with no stent thromboses in any group at 6 months. The EVOLVE trial confirms the effective delivery of everolimus by a unique directional bioabsorbable polymer system utilizing the SYNERGY stent. (A Prospective Randomized Multicenter Single-Blind Noninferiority Trial to Assess the Safety and Performance of the Evolution Everolimus-Eluting Monorail Coronary Stent System [Evolution Stent System] for the Treatment of a De Novo Atherosclerotic Lesion [EVOLVE]; NCT01135225).
    Journal of the American College of Cardiology 02/2012; 59(15):1362-70. · 14.09 Impact Factor
  • International journal of cardiology 09/2011; 152(3):410-1. · 6.18 Impact Factor
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    ABSTRACT: Although frequent, little is known about early-onset pneumonia that occurs in the postresuscitation period. Although induced hypothermia is recommended as a method of improving neurological outcome, its influence on the occurrence of early-onset pneumonia is not well defined. To describe the incidence, risk factors, causative agents, and impact on outcome of early-onset pneumonia occurring within 3 days after out-of-hospital cardiac arrest (OHCA). Retrospective analysis of a large cohort study of all patients successfully resuscitated after OHCA and admitted from July 2002 to March 2008 in two medical intensive care units (ICUs). Patients who presented accidental hypothermia or a known pneumonia before OHCA, or patients who died within the first 24 hours, were excluded. During this 6-year period, 845 patients were admitted after OHCA, and 641 consecutive patients were included. A total of 500 patients (78%) were treated with therapeutic hypothermia. In the first 3 days, 419 (65%) presented early-onset pneumonia. Multivariate analysis disclosed therapeutic hypothermia as the single independent risk factor of early-onset pneumonia (odds ratio, 1.90; 95% confidence interval, 1.28-2.80; P = 0.001). Early-onset pneumonia increased length of mechanical ventilation (5.7 ± 5.9 vs. 4.7 ± 6.2 d; P = 0.001) and ICU stay (7.9 ± 7.2 versus 6.7 ± 7.6 d; P = 0.001), but did not influence incidence of ventilator-associated pneumonia (P = 0.25), favorable neurologic outcome (P = 0.35), or ICU mortality (P = 0.26). After OHCA, therapeutic hypothermia is associated with an increased risk of early-onset pneumonia. This complication was associated with prolonged respiratory support and ICU stay, but did not significantly influence ICU mortality.
    American Journal of Respiratory and Critical Care Medicine 08/2011; 184(9):1048-54. · 11.04 Impact Factor
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    ABSTRACT: Although the level of evidence of improvement is significant in cardiac arrest patients resuscitated from a shockable rhythm (ventricular fibrillation or pulseless ventricular tachycardia [VF/Vt]), the use of therapeutic mild hypothermia (TMH) is more controversial in nonshockable patients (pulseless electric activity or asystole [PEA/asystole]). We therefore assessed the prognostic value of hypothermia for neurological outcome at hospital discharge according to first-recorded cardiac rhythm in a large cohort. Between January 2000 and December 2009, data from 1145 consecutive out-of-hospital cardiac arrest patients in whom a successful resuscitation had been achieved were prospectively collected. The association of TMH with a good neurological outcome at hospital discharge (cerebral performance categories level 1 or 2) was quantified by logistic regression analysis. TMH was induced in 457/708 patients (65%) in VF/Vt and in 261/437 patients (60%) in PEA/asystole. Overall, 342/1145 patients (30%) reached a favorable outcome (cerebral performance categories level 1 or 2) at hospital discharge, respectively 274/708 (39%) in VF/Vt and 68/437 (16%) in PEA/asystole (P<0.001). After adjustment, in VF/Vt patients, TMH was associated with increased odds of good neurological outcome (adjusted odds ratio, 1.90; 95% confidence interval, 1.18 to 3.06) whereas in PEA/asystole patients, TMH was not significantly associated with good neurological outcome (adjusted odds ratio, 0.71; 95% confidence interval, 0.37 to 1.36). In this large cohort of cardiac arrest patients, hypothermia was independently associated with an improved outcome at hospital discharge in patients presenting with VF/Vt. By contrast, TMH was not associated with good outcome in nonshockable patients. Further investigations are needed to clarify this lack of efficiency in PEA/asystole.
    Circulation 02/2011; 123(8):877-86. · 15.20 Impact Factor
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    ABSTRACT: The aim of this study was to assess the long-term safety and efficacy of the CYPHER (Cordis, Johnson and Johnson, Bridgewater, New Jersey) sirolimus-eluting coronary stent (SES) in percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Concern over the safety of drug-eluting stents implanted during PCI for STEMI remains, and long-term follow-up from randomized trials are necessary. TYPHOON (Trial to assess the use of the cYPHer sirolimus-eluting stent in acute myocardial infarction treated with ballOON angioplasty) randomized 712 patients with STEMI treated by primary PCI to receive either SES (n = 355) or bare-metal stents (BMS) (n = 357). The primary end point, target vessel failure at 1 year, was significantly lower in the SES group than in the BMS group (7.3% vs. 14.3%, p = 0.004) with no increase in adverse events. A 4-year follow-up was performed. Complete data were available in 501 patients (70%), and the survival status is known in 580 patients (81%). Freedom from target lesion revascularization (TLR) at 4 years was significantly better in the SES group (92.4% vs. 85.1%; p = 0.002); there were no significant differences in freedom from cardiac death (97.6% and 95.9%; p = 0.37) or freedom from repeat myocardial infarction (94.8% and 95.6%; p = 0.85) between the SES and BMS groups. No difference in definite/probable stent thrombosis was noted at 4 years (SES: 4.4%, BMS: 4.8%, p = 0.83). In the 580 patients with known survival status at 4 years, the all-cause death rate was 5.8% in the SES and 7.0% in the BMS group (p = 0.61). In the 70% of patients with complete follow-up at 4 years, SES demonstrated sustained efficacy to reduce TLR with no difference in death, repeat myocardial infarction or stent thrombosis. (The Study to Assess AMI Treated With Balloon Angioplasty [TYPHOON]; NCT00232830).
    JACC. Cardiovascular Interventions 01/2011; 4(1):14-23. · 1.07 Impact Factor
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    ABSTRACT: Optimal management of coronary artery disease in very old patients – over eighty years of age – remains unclear due to the absence of large randomized trials in this high-risk subgroup and the benefit/risk ratio of percutaneous coronary intervention (PCI) is difficult to assess in clinical practice. Aim The aim of our study was to evaluate the in-hospital and mid- term outcomes of PCI in octogenarians in a retrospective registry including patients with clinical presentation ranging from stable angina refractory to medical treatment to cardiogenic shock and to identify the criteria of our decision-making process. Methodes and Results Between 2003 and 2009, 582 octogenarians were admitted for coronary events. 336 patients benefit from a coronary angiogram; PCI was performed in 232. Mean age was 82 ± 2.6 and 45% were women. The procedures were unplanned due to ST elevation myocardial infarction (STEMI) (32.8%), cardiogenic shock complicating STEMI (9%), and non ST elevation myocardial infarction (NSTEMI) (30.6%). 36.6% of procedures were performed for stable angina refractory to optimal medical therapy. Radial access was used in 87% of cases. Primary success rate was 93%. Three criteria for invasive strategy refusal were identified in our clinical practice: renal insufficiency, anemia and cognitive disorders. Rates of in hospital mortality were respectively 12.5% in all patients; 85.7% in cardiogenic shock, 14.5% in patients with STEMI without shock, 2.8% in those with NSTEMI and 2.35% in patients with stable angina. The overall three years mortality rate is significantly lower with PCI than with conservative strategy (35% versus 58%, p = 0,0002). Conclusion In octogenarians, in hospital outcome is strongly related to the clinical presentation at admission. PCI display significantly beneficial effects on mid- term overall mortality in these old patients provided an easy to do selection regards three pitfalls: renal dysfunction, anemia and cognitive impairment.
    Archives of Cardiovascular Diseases Supplements 01/2011; 3(1):13-13.

Publication Stats

845 Citations
333.53 Total Impact Points

Institutions

  • 2014
    • Hôtel-Dieu de Paris – Hôpitaux universitaires Paris Centre
      Lutetia Parisorum, Île-de-France, France
  • 2007–2014
    • Assistance Publique – Hôpitaux de Paris
      Lutetia Parisorum, Île-de-France, France
  • 2013
    • Université Paris Descartes
      • Faculté de Médecine
      Lutetia Parisorum, Île-de-France, France
  • 2007–2013
    • Centre Hospitalier Sainte Anne
      Lutetia Parisorum, Île-de-France, France
  • 2005–2013
    • Université René Descartes - Paris 5
      • • Faculté de Médecine
      • • Faculté de Médecine
      Lutetia Parisorum, Île-de-France, France
  • 2005–2012
    • Hôpital Cochin (Hôpitaux Universitaires Paris Centre)
      • Service de Cardiologie
      Lutetia Parisorum, Île-de-France, France
  • 2010
    • Centre Hospitalier Universitaire de Nantes
      Naoned, Pays de la Loire, France