B Jouve

Hôpital d'Aix en Provence, Aix, Provence-Alpes-Côte d'Azur, France

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Publications (13)46.61 Total impact

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    ABSTRACT: The currently recommended duration of dual antiplatelet therapy (DAPT) in drug-eluting stent (DES) recipients is 12 months, to reduce the risk of late stent thrombosis, particularly in acute coronary syndrome. It was hypothesized that antiplatelet treatment with DAPT for 6 versus may be non-inferior to DAPT for 24 months in aspirin-sensitive patients METHODS: A multicenter, randomized study assigned patients undergoing implantation of Xience V (Abbott vascular) to receive 6- or 24-month DAPT with confirmed non-resistance to aspirin. The primary endpoint was a composite of death, myocardial infarction, urgent target vessel revascularization, stroke and major bleeding at 12 months post-stenting. 2,031 patients were enrolled in 70 European and Middle East centers. The trial was prematurely terminated due to problems with recruitment. 941 patients were randomized to 24 month-DAPT and 953 to 6 month-DAPT; 137 patients were resistant to aspirin. The two treatment groups had similar baseline and procedural characteristics. There was no significant difference between the 2 treatment groups regarding the primary endpoint (1.5 vs. 1.6%, p=0.85), even in high-risk (ACS) patients. Non-inferiority was demonstrated for 6-month versus 24-month DAPT, with an absolute risk difference of 0.11% (95% CI: -1.04 to 1.26; p for non-inferiority = 0.0002). There were no significant differences in stent thrombosis and in bleeding complications. In the 792 (44%) high-risk patients with ACS, primary and secondary endpoints did not significantly differ 1.7% [95% CI: 0.519 to 6.057; p=0.361]. Interaction between DAPT duration and ACS was non significant (p=0.305). The ITALIC trial showed that rates of bleeding and of thrombotic events were not significantly different according to 6- versus 24-month DAPT after PCI with new-generation DES in good aspirin responders. Is There A LIfe for DES after discontinuation of Clopidogrel NCT01476020. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
    Journal of the American College of Cardiology 11/2014; · 15.34 Impact Factor
  • Annales de cardiologie et d'angeiologie 11/2013; 62(5):373. · 0.21 Impact Factor
  • Annales de cardiologie et d'angeiologie 11/2012; 61(5):395. · 0.21 Impact Factor
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    ABSTRACT:   Background:  Post-treatment platelet reactivity (PR) is associated with ischemic and bleeding events in patients receiving P2Y12 receptor antagonists. Objectives:  We aimed to study the relationship between post-treatment PR after a 60-mg loading dose (LD) of prasugrel and 1-year thrombotic and bleeding events. Method:  Patients were prospectively included in this multicenter study if they had a successful percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) and received prasugrel. The platelet reactivity index (PRI) was measured using the Vasodilator-Stimulated Phosphoprotein index (VASP) after a prasugrel LD. Endpoints included the rate of thrombotic events and bleeding events at 1 year. Results:  Among the 301 patients enrolled, 9 (3%) were lost to follow-up at 1 year. The rates of thrombotic and bleeding events at 1 year were of 7.5% and 6.8%, respectively. Receiver-operating curve (ROC) analysis demonstrated an optimal cut-off value of 53.5% of PRI to predict thrombotic events at 1 year. Using this cut-off value we observed that patients exhibiting high on-treatment platelet reactivity (HTPR) had a higher rate of thrombotic events (22.4% vs. 2.9%; P < 0.001). In parallel the optimal cut-off value of PRI to predict bleeding was 16%. Patients with a PRI ≤ 16% had a higher rate of bleeding events compared with those with a PRI > 16% (15.6% vs. 3.3%; P < 0.001). In multivariate analysis, the PRI predicted both thrombotic and bleeding events (OR: 1.44, 95% confidence interval [CI]: 1.2-1.72; P < 0.001 and OR: 0.75, 95% CI: 0.59-0.96; P = 0.024 [respectively, per 10% increase]). Conclusion:  Platelet reactivity measurement after a prasugrel LD predicts both ischemic and bleeding events at 1 year follow-up for ACS patients undergoing PCI.
    Journal of Thrombosis and Haemostasis 08/2012; 10(10):1999-2005. · 6.08 Impact Factor
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    ABSTRACT: Despite the fact that numerous clinical trials investigating infarct size have been completed over the last two to three decades, the methods for treating lethal reperfusion injury efficiently have only become established very recently. After several years of accumulating evidence in experimental preparations that lethal reperfusion injury might exist, the description of the phenomenon of ischaemic post-conditioning in animal models has fully convinced us of the existence and importance of irreversible myocardial damage occurring after reflow. Transfer to the clinics was possible in small phase II trials, provided care was taken to assess the determinants of infarct size and, most importantly, to consider the timing of drug administration with respect to the time of reflow. Technical questions remain to be resolved regarding the assessment of the area at risk in the difficult setting of emergency care for reperfusion therapy. Nevertheless, convincing pharmacological trials are being performed that mark the start of a new era that will, in the future, improve the prognosis of patients with ST-segment elevation myocardial infarction through the prevention of lethal myocardial reperfusion injury. At present, while erythropoietin and adenosine have not proved efficient for alleviation of lethal reperfusion injury, a significant benefit has been reported for cyclosporin and exenatide. New pharmacological agents need to be identified and tested in phase II trials. In the meantime, clinical outcome studies are currently being conducted for cyclosporin.
    Cardiovascular Research 04/2012; 94(2):246-52. · 5.81 Impact Factor
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    ABSTRACT: The aim of this study was to investigate the relationship between platelet reactivity (PR) after a loading dose (LD) of prasugrel and thrombotic events. Post-treatment PR has been shown to be strongly associated with the occurrence of major adverse cardiac events (MACE) after percutaneous coronary intervention (PCI) in the clopidogrel era. Prasugrel is a new P2Y(12)-adenosine diphosphate receptor with a higher potency on PR. A prospective multicenter study included patients who underwent successful PCI for acute coronary syndromes and received prasugrel therapy. Vasodilator-stimulated phosphoprotein (VASP) index was measured after the prasugrel LD. High on-treatment PR was defined as a VASP index ≥50%. MACE included cardiovascular death, myocardial infarction, and definite stent thrombosis at 1 month. Three hundred one patients were enrolled. The mean VASP index after 60 mg of prasugrel was 34.3 ± 23.1%. High on-treatment PR was observed in 76 patients (25.2%). Patients experiencing thrombotic events after PCI had significantly higher VASP indexes compared with those free of events (64.4 ± 14.4% vs. 33.4 ± 22.7%; range: 51% to 64% and 5% to 47.6%, respectively; p = 0.001). Kaplan-Meier analysis comparing good responders and patients with high on-treatment PR demonstrated a significantly higher rate of MACE in patients with suboptimal PR inhibition (log-rank p < 0.001). Receiver-operating characteristic curve analysis found a cutoff value of 53.5% of the VASP index to predict thrombotic events at 1 month (r = 0.86, p < 0.001). Patients with minor or major Thrombolysis In Myocardial Infarction unrelated to coronary artery bypass grafting bleeding and those without had similar VASP indexes (30 ± 17.8% vs. 34.3 ± 23%, p = 0.70). Despite the use of prasugrel, a significant number of patients undergoing PCI in the setting of acute coronary syndromes do not achieve optimal PR inhibition. Such patients have a higher risk for MACE after PCI.
    Journal of the American College of Cardiology 07/2011; 58(5):467-73. · 15.34 Impact Factor
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    ABSTRACT: The primary objective of the present study was to assess the feasibility and the safety of the Seaquence stent (CathNet-Science) deployment for the treatment of coronary artery disease and the event-free survival of patients treated with this coronary stent. The study was conducted as a multicenter, prospective, observational registry. Patients with stable or unstable angina pectoris who were candidates for percutaneous coronary intervention with elective stenting of one single de novo lesion in a native coronary artery > or =3 mm in diameter were included in the study. Clinical follow-up was performed at 1 month and 9 months. Major adverse coronary events (MACE), that is, cardiac death, myocardial infarction, and target vessel revascularization (re-PTCA or CABG), were recorded over a period of 9 months. Using this stent, a 99% in-hospital success rate was achieved. A total of 17 patients presented MACE (8.7%) during the whole follow-up period and target lesion revascularization was needed for 14 (7.1%) patients. Using multivariate analysis only some clinical parameters (patients treated for unstable angina, with a history of CABG or of female gender) were found as independent predictors of MACE after coronary stenting. Procedural related factors, angiographic characteristics, or reference diameter were not found to influence clinical outcome. Because the study was performed in patients with a high proportion of complex lesions (relative high-risk nonselected population with nearly one third calcified lesions, many long and type B2 and C lesions) we can conclude that the coronary Seaquence stent can be considered as a stent of reference in routine practice.
    Journal of Interventional Cardiology 03/2004; 17(1):9-15. · 1.32 Impact Factor
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    ABSTRACT: One hundred and ninety one consecutive patients over 70 years of age (127 men and 64 women, average age 75.6 years) underwent percutaneous transluminal coronary angioplasty (PTCA) between January 1986 and February 1989. One hundred and sixty patients had severe angina (20 Class III and 140 Class IV), 72 patients had previous myocardial infarction, 36 of which were recent (less than 1 month), and 6 patients had previously undergone coronary bypass surgery. The coronary lesions affected one vessel in 67 patients and more than one vessel in 124 patients. The left ventricular ejection fraction was less than 50% in 15 patients. Angioplasty was attempted on 245 lesions (228 stenoses and 17 occlusions): 1 lesion in 141 patients, 2 lesions in 46 patients, 3 lesions in 4 patients, with a primary success rate of 81% in stenotic and 41% in occluded arteries. There were 9 deaths (4.7%) 6 of which occurred in patients with multivessel disease and unstable angina; there were 6 Q-wave infarctions (3.1%), 8 non Q-wave infarctions (4.2%) and 3 emergency coronary bypass operations (1.6%). The first 123 patients of this series were followed up for an average of 18.8 months (7 to 37 months). Follow-up of the 100 patients successfully dilated (4 lost to follow-up) showed that 55 remained improved (53 asymptomatic), 25 had recurrent angina after the initial improvement due to restenosis in 19, progression of coronary athero-sclerosis in 3, restenosis and an evolution of coronary atherosclerosis in 1 and a lesion which had been neglected in 2 cases.(ABSTRACT TRUNCATED AT 250 WORDS)
    Archives des maladies du coeur et des vaisseaux 10/1990; 83(10):1501-6. · 0.40 Impact Factor
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    ABSTRACT: A prospective study was carried out from May 1984 to July 1987 to determine the prognostic value of the results of programmed electrical stimulation (PES) in patients with complex ventricular ectopy. The study population comprised 118 patients, 80 with and 38 without apparent underlying cardiac disease. The PES consisted in at most 3 extrastimuli delivered to the right ventricular apex during 2 imposed basal rhythms. Two groups of patients were identified: Group I (n = 35; 29.6%) in which a significant ventricular arrhythmia was induced (sustained ventricular tachycardia (11 cases), non-sustained VT (21 cases) and ventricular fibrillation (3 cases); and Group II (n = 83; 70.3%) in which no significant arrhythmia could be induced. During follow-up (average 28.7 +/- 11.7 months, range 6 to 48 months) there were 10 cardiac deaths, 8 of which occurred suddenly. Sudden death only occurred in patients with cardiac disease and usually with LV ejection fraction of less than 0.40; the prevalence of sudden death in Group I (11.5%) was higher than in Group II (4.8%) but the difference was not statistically significant. The prognosis of patients in Group II was the same as that of the general population. The results of this study suggest that PES enables identification of a subgroup of patients with complex ventricular ectopy in which ventricular tachyarrhythmias cannot be induced and the risk of sudden death is low; the management of patients with inducible ventricular tachyarrhythmias and normal LV function has to be determined case by case.
    Archives des maladies du coeur et des vaisseaux 09/1990; 83(9):1381-7. · 0.40 Impact Factor
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    ABSTRACT: The authors report the case of a 23 year old man who presented with a continuous murmur five years after closed chest trauma. The electrocardiographic and echocardiographic findings indicated previous apical myocardial infarction. The underlying diagnosis was first suggested by continuous wave Doppler which showed systolo-diastolic flow in the septo-apical region directed towards the left ventricle (LV) in diastole. Color Doppler flow studies showed a mosaic pattern opposite a dilated left anterior descending (LAD) artery. These signs of LAD-LV fistula with a single orific were confirmed at coronary arteriography. The patient's previous history was in favour of a traumatic etiology. In the absence of left ventricular failure and myocardial ischaemia by coronary steal, surgery was deferred; Doppler echocardiography would seem to be a good method of following up the fistula and its consequences on left ventricular function. A traumatic left coronary to left ventricular fistula is an extremely rare condition and merits publication. The authors review the literature and describe the physiopathology, diagnosis and therapeutic indications of these fistulae.
    Archives des maladies du coeur et des vaisseaux 03/1990; 83(2):267-70. · 0.40 Impact Factor
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    ABSTRACT: Between 1977 and 1987, 27 consecutive patients (16 men, 11 women, mean age 66 years, range 54 to 75 years) with ventricular septal rupture complicating acute myocardial infarction underwent surgical repair. The purpose of this retrospective study was to analyse the post-operative mortality factors from clinical, haemodynamic and operative data in all patients and also from coronary angiographic data in 23/27 patients whose haemodynamic status allowed this type of exploration. Seventeen patients (63 p. 100) died during the first post-operative month, 10 survived and were discharged. Factors that influenced the prognosis were: (1) inferiorly-located necrosis associated with a 75 p. 100 mortality rate (9 out of 12 patients), as opposed to 53 p. 100 (8 out of 15 patients) with anterior necrosis; (2) right ventricular dysfunction, observed in 83 p. 100 of patients with inferior necrosis and 53 p. 100 with anterior necrosis, which was responsible for 7 out of 9 deaths in the inferior necrosis subgroup and contributed to 3 out of 8 deaths in the anterior necrosis subgroup; this established a cause-effect relationship between right ventricular function and the overmortality of patients with inferior necrosis; (3) independently of the haemodynamic status, two- and three-vessel lesions (56 p. 100 of all lesions) which had an 84 p. 100 mortality rate as opposed to 40 p. 100 with one-vessel lesions; (4) the presence of a state of shock which was associated with a 78 p. 100 mortality rate as opposed to 55 p. 100 in patients without shock. We conclude that when permitted by the patient's haemodynamic status coronary angiography should be part of the pre-operative evaluation to assess the operative risk and guide the surgical procedure.
    Archives des maladies du coeur et des vaisseaux 04/1989; 82(3):337-43. · 0.40 Impact Factor
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    ABSTRACT: Between December 1986 and August 1987, 34 patients referred for aortic valvuloplasty, undergo before catheterization an ultrasonocardiography with continuous and pulsed Doppler study and a phonocardiography for 22 of them. They all present functional and physical signs of aortic stenosis. The cardiac Doppler enables a positive diagnosis in all patients, while the phonocardiography recordings fail to recognize a tight aortic stenosis. On the other hand, the Doppler enables a diagnosis of severity well correlated with the catheterization (r = 0.88 for maximum instantaneous gradients) in 30 patients: in four patients, the correlation could not be calculated because of technical problems related to the catheterization (2 patients) or the ultrasonic examination (2 patients). From this study, it results that the cardiac Doppler may perfectly select patients who are to undergo an aortic valvuloplasty, unlike phonocardiography.
    Annales de Cardiologie et d Angéiologie 06/1988; 37(5):233-6. · 0.30 Impact Factor
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    ABSTRACT: An intra-arterial infusion of streptokinase successfully dissolved a large thrombus of the renal artery in a 54-year old male patient with old-standing mitral stenosis. This case illustrates the effectiveness of fibrinolysis in situ. This method provides complete arterial recanalization and preserves the renal function, thus enabling surgical embolectomy to be performed.
    Archives des maladies du coeur et des vaisseaux 82(8):1473-6. · 0.40 Impact Factor