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ABSTRACT: We have determined the prevalence of hyperhomocysteinemia and tested its relationship with coronary heart disease in Tunisian patients. The study included 70 angiogrphically proven coronary patients and 140 age- and sex-matched healthy subjects. Plasma homocysteine folate and vitamin B12 were analyzed by immunoenzymatic methods. Hyperhomocysteinemia was considered for plasma homocysteine concentration >17 micromol/L. Mean plasma homocysteine concentration and hyperhomocysteinemia prevalence were significantly (p<0.001) higher in patients (16.3 +/- 7.9 micromol/L and 29%) than controls (12.6 +/- 4.0 micromol/L and 10%). The association between hyperhomocysteinemia and coronary heart disease persisted after adjusting on main cardiovascular risk factors (multi adjusted odds ratio, 2.99; 95% CI, 1.18-7.59; p=0.02). No association was observed between hyperhomocysteinemia and coronary disease severity and extent. This study showed an independent association between hyperhomocysteinemia and coronary heart disease, suggesting a role of hyperhomocysteinemia in atherothrombogenesis. However, causal relationship is not yet established. Until results of homocysteine-lowering therapy trials become available, hyperhomocysteinemia should be researched and treated in coronary heart disease patients.
Archives des maladies du coeur et des vaisseaux 09/2006; 99(9):781-5. · 0.40 Impact Factor
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D Carrié,
K Khalifé,
B Citron,
K Izaaz,
M Hamon,
J M Juiliard,
F Leclercq,
J Fourcade,
J Lipiecki,
R Sabatier,
V Boulet,
J P Rinaldi, S Mourali,
M Fatouch,
E El Mokhtar,
G Aboujaoudé,
M Elbaz,
R Grolleau,
P G Steg,
J Puel
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ABSTRACT: The purpose of this study was to compare the effects of stent placement with and without balloon predilatation on duration of the procedure, reduction of procedure-related costs, and clinical outcomes. Although preliminary trials of direct coronary stenting have demonstrated promising results, the lack of randomized studies with long-term follow-up has limited the critical evaluation of the role of direct stenting in the treatment of obstructive coronary artery disease. Between January and September 1999, 338 patients were randomly assigned to either direct stent implantation (DS+; 173 patients) or standard stent implantation with balloon predilatation (DS-; 165 patients). Baseline clinical and angiographic characteristics were similar in the 2 groups. Procedural success was achieved in 98.3% of patients assigned to DS+ and 97.5% of patients assigned to DS- (p = NS), with a crossover rate of 13.9%. Compared with DS-, DS+ conferred a dramatic reduction in procedure-related cost ($956.4 +/- $352.2 vs $1,164.6 +/- $383.9, p <0.0001) and duration of the procedure (424.2 +/- 412.1 vs 634.5 +/- 390.1 seconds, p < 0.0001). At 6-month follow-up, the incidence of major adverse cardiac events including death, angina pectoris, myocardial infarction, congestive heart failure, repeat angioplasty, or coronary artery bypass graft surgery was 5.3% in DS+ and 11.4% in DS- (p = NS). Multivariate analysis demonstrated that major adverse cardiac events rates were related to stent length of 10 mm (relative risk [RR] 3.25, 95% confidence intervals [CI] 1.36 to 7.78; p = 0.008), stent diameter of 3 mm (RR 2.69, 95% CI 1.03 to 7.06; p = 0.043), and complex lesion type C (RR 2.83, 95% CI 1.02 to 7.85; p = 0.045). Thus, in selected patients, this prospective randomized study shows the feasibility of DS+ with reduction in procedural cost and length, and without an increase in in-hospital clinical events and major adverse cardiac events at 6-month follow-up.
The American Journal of Cardiology 04/2001; 87(6):693-8. · 3.37 Impact Factor
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D Carrié,
K Khalifé,
M Hamon,
B Citron,
J P Monassier,
R Sabatier,
J Lipiecky, S Mourali,
L Sarfaty,
M Elbaz,
J Fourcade,
J Puel
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ABSTRACT: The Tenax coronary stent is laser sculpted from high precision 316 L stainless steel using advanced production procedures. An a-SiC: H (hydrogen-rich amorphous silicon carbide) coating reduces its thrombogenicity and improves its biocompatibility. From April to July 1998, 266 stents were implanted in 241 patients (aged 62.7 +/- 10.5 years) in five centers. The clinical indication for intervention was unstable angina (33.2%) and recent myocardial infarction (29.5%) in many cases. Most lesions (53.8%) had complex characteristics (Class B2 or C). The target vessel was the LAD in 42.5% and the right coronary artery in 36.8% of all cases. Four primary stent deployment failures occurred and implantation was successful in 259 (97.4%) of 266 stents. No death and no Q-wave myocardial infarction or emergency CABG occurred during hospital stay. Clinical success, defined as successful deployment without procedural or clinical event, was achieved in 230 (95.4%) of 241 patients. One-year clinical follow-up shows a low need for target lesion revascularization (17/237 [7.1%] patients) and a 15.8% rate of major adverse cardiac events (36/237 patients). The clinical and angiographic outcomes of our study suggest that the hybrid, amorphous hydrogenated silicon carbide coated design is promising and merits further evaluation in larger clinical trials.
Journal of Interventional Cardiology 03/2001; 14(1):1-5. · 1.18 Impact Factor
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ABSTRACT: There have been few clinical reports of the long term results of implantation of long coronary stents. The authors performed a retrospective study of the long term results of 213 implantations of long stents (20 mm long) in 202 patients. These results were compared with those obtained in patients implanted with short stents (< 20 mm long) during the same period (630 implantations in 530 patients). The angiographic and clinical success rates were respectively 96.5 and 95.4% in the "long stent" group compared with 97.2 and 94.9% in the "short stent" group. In the "long stent" group, at 6, 12 and 24 months (follow-up, the cumulative incidence of nex revascularisation procedures of the target lesion were 9.8, 14.3 and 20.6% respectively, whereas the cumulative incidences of major cardiac events (mortality, infarction, angina, coronary bypass surgery and angioplasty) for the same periods were 12.7, 21.1 and 40% respectively. There was no significant differences compared with the "short stent" group concerning all these events. However, after 6 months, there was a tendency for more major cardiac events and for more new revascularisation procedures of the target lesion in the "long stent" group. In multivariate analysis, the independent predictive factors for major cardiac events were: a Jeopardy score > 6 (p = 0.002), and the complex nature of the lesion (B2 or C) (p = 0.045), whereas the indépendant risk factors for a new revascularisation procedure of the target lesion were: minimal luminal diameter after the procedure, a Jeopardy score > 6, complex lesions, diabetes and the reference diameter of the stented arterial segment. The authors conclude that although the length of the stent as such is not a long term predictive factor, the complexity of the lesion and the severity of the coronary disease which are more common in the "long stent" group explain the non-significant tendency for a higher incidence of major cardiac events in this group.
Archives des maladies du coeur et des vaisseaux 02/2000; 93(1):11-8. · 0.40 Impact Factor
