Philippe L. L'Allier

Montreal Heart Institute · Department of Medicine

High-density lipoproteins (HDLs) have several potentially protective vascular effects. Most clinical studies of therapies targeting HDL have failed to show benefits vs. placebo. To investigate the effects of an HDL-mimetic agent on atherosclerosis by intravascular ultrasonography (IVUS) and quantitative coronary angiography (QCA). A prospective, do...

Plaque rupture in atherosclerosis is the primary cause of potentially deadly coronary events, yet about 40% of ruptures occur away from the plaque cap shoulders and cannot be fully explained with the current biomechanical theories. Here, cap buckling is considered as a potential destabilizing factor which increases the propensity of the atheroscler...

Timely transfer for primary percutaneous coronary intervention (PPCI) remains the favoured strategy in ST elevation myocardial infarction (STEMI). In recent years, in the province of Quebec, a direct home-to-cardiac catheterization transfer system has been implemented. Such a system results in improved time for access to medical care but less time...

This editorial refers to ‘Determinants of high cardiovascular risk in relation to plaque composition of a non-culprit coronary segment visualized by near-infrared spectroscopy in patients undergoing percutaneous coronary intervention’[†][1], by S.P.M. de Boer et al. , on page 282 The rupture of an unstable atherosclerotic plaque precedes the majo...

Purpose: P-selectin antagonism could provide anti-inflammatory, anti-thrombotic and anti-atherogenic effects. Inclacumab is a human recombinant monoclonal antibody directed against P-selectin. The SELECT-ACS trial was a multi-center, randomized, placebo-controlled phase 2 study of inclacumab. The placebo-adjusted change in troponin I (TnI) with inc...

AIM: Thrombosis of stents and of saphenous vein grafts (SVG) remains a severe complication of either revascularization techniques that often are present as ST elevation myocardial infarction (STEMI). The aim of this longitudinal cohort study was to compare the 1-year clinical outcomes among STEMI patients requiring primary PCI due to stent thrombos...

BACKGROUND: PPCI is the predominant reperfusion treatment for STEMI in Quebec, Canada. Our systematic field evaluation, during a 6-month period in 2008-9, provided the opportunity to compare patient characteristics, processes of care and 30-day mortality across Quebec’s 13 PPCI centers. METHODS: All STEMI patients, who either presented directly or...

BACKGROUND: In Quebec (Canada), patients with STEMI present to 1 of 4 types of hospitals: 1) primary percutaneous coronary intervention (PPCI) centers; 2) non-PPCI centers that systematically transfer patients for PPCI; 3) ‘mixed centers’ that transfer some patients for PPCI and treat others with fibrinolysis; and 4) centers that exclusively treat...

BACKGROUND: Guidelines recommend that STEMI patients who present to non-PCI centers generally be treated with fibrinolysis instead of untimely transfer for primary PCI (i.e., first medical contact [FMC] to device ≥120 min). Little real-world evidence exists for this recommendation since transfer patients are often excluded from clinical registries....

Objectives: The study aimed to evaluate inclacumab for the reduction of myocardial damage during a percutaneous coronary intervention (PCI) in patients with non-ST-segment elevation myocardial infarction. Background: P-selectin is an adhesion molecule involved in interactions between endothelial cells, platelets, and leukocytes. Inclacumab is a...

Aims: To conduct a meta-analysis of studies comparing immediate versus delayed stenting in populations where primary percutaneous coronary intervention (PCI) or early invasive revascularisation was the initial mode of reperfusion. Methods and results: We identified five non-randomised studies and one randomised trial for a total of 590 patients in...

Atherosclerosis exacts a large toll on society in the form of cardiovascular morbidity, mortality, and resource use and is exacerbated by the epidemics of obesity and diabetes. Consequently, there is a critical need for more-effective methods of diagnosis, treatment, and prevention of the complications of atherosclerosis. Careful and well-conducted...

BACKGROUND: INESSS is a government-funded independent body that aids in evidence-based policy-making. Its cardiology evaluation unit recently completed a second systematic province-wide field evaluation of STEMI care in Quebec during a 6-month period in 2008-2009 in collaboration with a committee of clinical experts. The main objectives were to imp...

Refractory angina (RFA) is a debilitating disease characterized by cardiac pain resistant to conventional treatments for coronary artery disease including nitrates, calcium-channel and β-adrenoceptor blockade, vasculoprotective agents, percutaneous coronary interventions, and coronary artery bypass grafting. The mortality rate of patients living wi...

In the present report, we review the phenotypes of coronary artery disease (CAD) patients unsuitable for revascularization procedures. We then analyze these phenotypes and propose a simple angiographic-based classification for patients with CAD unsuitable for revascularization. Under this classification, the following four distinct angiographic phe...

Due to anatomical variability in the distribution and size of septal perforator arteries, not all patients are ideal candidates for alcohol septal ablation. Myocardial contrast echocardiography is essential in selecting the appropriate septal branch. We report a case where the target septal artery did not originate from the left anterior descending...

Pulmonary hypertension is highly prevalent in advanced heart failure (HF) despite optimal medical and device therapies. The objective of this investigation was to report on a single centre's experience of open-label chronic sildenafil therapy in patients with advanced HF. We conducted a retrospective systematic medical record review of all patients...

Background: Primary angioplasty (PPCI) is the predominant reperfusion therapy for ST-elevation myocardial infarction (STEMI) in Quebec where there are 13 PPCI centers. Our systematic province-wide field evaluation examined contemporary practice of PPCI such as arterial access site and use of stents and thrombus aspiration devices. Methods: The 82 h...

Vascular inflammation can lead to plaque instability and acute coronary syndromes (ACS). Viruses produce potent immunomodulating proteins that regulate key inflammatory pathways. A myxoma virus-derived serpin Serp-1 reduces inflammatory cell invasion and plaque growth in vascular injury models. Our objective was to evaluate the safety and efficacy...

The radial approach during percutaneous coronary intervention (PCI) has been reported to reduce the incidence of bleeding complications. However, the radial approach still accounts for <10% of procedures worldwide and only 1% in the United States. Our objective was to compare the effect of radial versus femoral vascular access on the time to reperf...

Left main coronary artery (LMCA) disease influences survival; however, the predictors of LMCA changes over time are incompletely understood. Paired intravascular ultrasound (IVUS) and core laboratory analyses were performed in a standardized fashion in 207 subjects (mean +/- SD age 58 +/- 10 years, 80% men). The average follow-up duration was 18 mo...

We sought to understand the relationships between glycaemic status and both severity and progression of coronary artery disease (CAD), the leading cause of death in diabetes. Baseline fasting blood glucose (FBG) and HbA1c (%)were measured in 426 patients with known or suspected stable CAD, who underwent coronary artery intravascular ultrasound(IVUS...

Production of leukotrienes by 5-lipoxygenase (5-LO) has been linked to unstable atherosclerotic plaques and cardiovascular events. VIA-2291 is a potent 5-LO inhibitor. In a double-blinded study, 191 patients were randomly assigned 3 weeks after an acute coronary syndrome to receive 25, 50, or 100 mg VIA-2291 or placebo daily for 12 weeks. The prima...

Mortality of massive pulmonary embolism remains exceedingly high despite thrombolytic therapy. Despite initial encouraging results, rheolytic thrombectomy has not been considered the first choice of treatment in the current European Guidelines for massive pulmonary embolism, even in cases of major contraindication to thrombolysis. Our objective was...

Recent improvements in multidetector computed tomography (MDCT) with 64-slice scanners have allowed acquisition of a coronary study in 5 s to 6 s, with good temporal and spatial resolution. Previous studies have reported an underestimation of plaque burden by MDCT. Whether shorter scan times can allow correct assessment of plaque volume requires co...

No data exist on the acute effects of statin therapy on human coronary atherosclerotic plaques. The objective of our study was to evaluate the early (<2 months) effects of newly initiated statin therapy on coronary atherosclerosis as evaluated by intravascular ultrasonography. The study population consisted of 74 patients (mean age 58 +/- 8 years)...

Transesophageal echocardiography (TEE) plays a key role in the evaluation of hemodynamic instability, particularly in the diagnosis of left ventricular outflow tract obstruction (LVOTO) where it can completely alter patient management. The purpose of these rounds is to highlight how TEE can be instrumental in ensuring a timely diagnosis of this les...

Refractory angina (RFA) is a debilitating disease characterized by severe, unremitting cardiac pain (1,2). This pain or discomfort, by definition, is resistant to all conventional treatments for coronary artery disease (CAD) including nitrates, calcium channel and beta-adrenoceptor blockade, vasculoprotective agents, percutaneous coronary intervent...

To determine whether catheter-based near-infrared spectroscopy (NIRS) signals obtained with a novel catheter-based system from coronaries of patients are similar to those from autopsy specimens and to assess initial safety of NIRS device. An intravascular NIRS system for detection of lipid core-containing plaques (LCP) has been validated in human c...

Major bleeding was recently identified as an independent predictor of adverse clinical outcomes in patients with acute coronary syndromes. We sought to determine the impact of major bleeding on in-hospital mortality in patients with ST-elevation myocardial infarction (STEMI) and the clinical characteristics associated with major bleeding. AMI-QUEBE...

The optimal hydration strategy for prevention of contrast-induced acute kidney injury (AKI) remains unknown. The purpose of this meta-analysis is to compare the effectiveness of normal saline (NS) versus sodium bicarbonate hydration (NaHCO(3)) for prevention of contrast-induced AKI. We performed a meta-analysis of randomized controlled trials that...

Oxidative stress and inflammation are involved in the pathophysiology of atherosclerosis. Our aim was to assess the effects of the antioxidant succinobucol (AGI-1067) on cardiovascular outcomes in patients with recent acute coronary syndromes already managed with conventional treatments. After an acute coronary syndrome occurring 14-365 days before...

The objective of this study was to compare the level of platelet inhibition achieved by 3 different clopidogrel loading regimens in patients undergoing elective angiography and percutaneous coronary intervention when appropriate. Optimal platelet inhibition is a key therapeutic goal for patients undergoing percutaneous coronary intervention. Althou...

The antioxidant AGI-1067 was shown to reduce experimental atherosclerosis. The present study originally intended to study restenosis as a primary endpoint but was subsequently modified to primarily investigate the effects of AGI-1067 on coronary atherosclerosis. This placebo-controlled randomized trial assessed the effects of AGI-1067 280 mg qd sta...

The relative merits of quantitative coronary analysis (QCA) and intravascular ultrasound (IVUS) for the assessment of progression/regression in coronary artery disease are uncertain. To explore this subject further, we analyzed the angiographic and IVUS data derived from a contemporary clinical trial population. We investigated the relationships be...

High-density lipoprotein (HDL) cholesterol is an inverse predictor of coronary atherosclerotic disease. Preliminary data have suggested that HDL infusions can induce atherosclerosis regression. To investigate the effects of reconstituted HDL on plaque burden as assessed by intravascular ultrasound (IVUS). A randomized placebo-controlled trial was c...

Collateral arteries are a common but inconsistent finding in coronary heart disease (CHD). We endeavoured to review the methods for coronary artery collateral assessment, the predictors and clinical importance of collateral blood flow, and the potential for therapeutic augmentation of collateral anastomoses. While many methods have been used to ass...

We assessed vascular changes during atherosclerosis regression. Compensatory enlargement of coronary arteries accommodates plaque burden during atherosclerosis development. Lipid-lowering therapy has altered the natural history of coronary atherosclerosis, but the arterial changes that occur during disease regression need to be clarified. Intravasc...

Epidemiological information on patients with acute coronary syndromes managed in specialized cardiac centres is limited. To report the evolution of demographics, treatment and outcome of patients admitted to a tertiary coronary care unit (CCU) over a 17-year period. A prospective database of 18,719 patients admitted from April 1986 to March 2003 in...

Diabetes is associated with a two- to fourfold increase in cardiovascular morbidity and mortality, and clinical manifestations of atherosclerosis are the leading causes of death in diabetic populations. Because there are reports of benefits associated with active treatment of ischemia, including revascularization, findings from pathological and ang...

Clinicians involved in the care of patients with cardiovascular conditions have recently been confronted with an important body of literature linking inflammation and cardiovascular disease. Indeed, the level of systemic inflammation as measured by circulating levels of C-reactive protein (CRP) has been linked to prognosis in patients with atherosc...

We studied the incidence of atrial fibrillation in hypertensive patients who were taking angiotensin-converting enzyme (ACE) inhibitors or calcium channel blocking agents. The patients taking ACE inhibitors were found to have a lower incidence of atrial fibrillation. These results suggest that ACE inhibitors have significant antiarrhythmic properti...

Percutaneous coronary intervention induces an early inflammatory reaction. The intensity of such a reaction as measured by high-sensitivity C-reactive protein has been correlated with recurrent ischemic events, but its association with restenosis remains uncertain. To characterize the type and duration of the postangioplasty inflammatory reaction a...

The goal of this study was to demonstrate that intravascular ultrasound (IVUS) examination of native coronary arteries does not result in an acceleration of the atherosclerotic process. Intravascular ultrasound is increasingly used to assess the effects of pharmacologic agents on atherosclerosis. Intravascular ultrasound examinations of one coronar...

Inhibition of the acyl coenzyme A:cholesterol acyltransferase (ACAT) enzyme may prevent excess accumulation of cholesteryl esters in macrophages. The ACAT inhibitor avasimibe was shown to reduce experimental atherosclerosis. This study was designed to investigate the effects of avasimibe on human coronary atherosclerosis. This randomized, double-bl...

Atherosclerosis is a systemic disease in which vascular inflammation plays a key role. Indeed, inflammation is closely linked to atherosclerotic disease at all stages, from silent progression to clinical manifestations. There is now strong epidemiologic evidence that mediators of inflammation, like C-reactive protein, predict cardiovascular risk in...

The objective of this study was to determine the effects of angiotensin-converting enzyme inhibition (ACEI) versus long-acting calcium-channel blockade (CCB) on atrial fibrillation (AF) in patients with hypertension. Atrial fibrillation is the most common significant cardiac arrhythmia, and angiotensin II has been implicated in its pathophysiology....