0272: Unfractionated heparin addition during percutaneous coronary intervention in acute coronary syndrome patients previously treated with enoxaparin: biological impact

BackgroundThe benefit of anticoagulants (AC) to prevent thrombotic complications during percutaneous coronary intervention (PCI) is well established. In acute coronary syndrome (ACS) patients previously treated with enoxaparin, an additional bolus of AC is not recommended if the last injection was realized within 8 h. In this setting, many interventional cardiologists use unfractionated heparin (UFH) at the time of sheath insertion.ObjectivesThe aim of our study was to describe local current practices for AC use during PCI in patients already treated with enoxaparin and admitted for ACS and to assess the biological impact of UFH addition at the beginning of the procedure.MethodsA standardized survey was sent to the interventional cardiologists of the southwest of France to investigate their practice in terms of periprocedural AC use. In 2 centers, ACS patients previously treated with subcutaneous injection of enoxaparin within 8 h and who received intravenous UFH at the time of sheath insertion were prospectively included and their plasma anti-Xa activity was assessed at the sheath insertion and 30 min after UFH bolus. In-hospital bleeding and ischemic events were collected. The adequate therapeutic window was defined by anti Xa activity (range 0.5 to 0.9 IU/mL). Results: Among the 41 interventional cardiologists who replied, a large majority (75,6%) considered the addition of UFH in patients who received enoxaparin within 8 h as a valid option. 47 ACS patients were enrolled. The dose of the bolus of UFH was highly variable from 20 to 90 UI / kg. Anti-Xa activities were above 0.9 IU/mL in 14,9% of patients at the sheath insertion and in 72,3% of patients 30 min after UFH injection. 2 bleeding complications occurred, both in over-coagulated patients. No ischemic events were reported.ConclusionThe use of UFH in patients who already received enoxaparin may result in over-anticoagulation and lead to bleeding complications

Spectrométrie de Fourier intégrée pour l'astronomie millimétrique

Au cours des dernières décennies, l observation du ciel dans les longueurs d onde millimétriques a permis de faire grandement progresser notre compréhension de l univers, notamment à travers l étude du fond diffus cosmologique. Pour répondre aux besoins actuels des astronomes, nous proposons dans ce rapport un instrument intégré permettant de réaliser des mesures spectrales large-bande dans le domaine millimétrique. Celui-ci se base sur le concept de SWIFTS (Stationary-Wave Fourier-Transform Spectrometer :spectromètre de Fourier à ondes stationnaire), un instrument opérationnel aux longueurs d onde visibles et infrarouges. Notre dispositif " SWIFTS millimétrique " utilise des détecteurs à inductance cinétique (KID pour Kinetic Inductance Detectors) comme détecteurs de lumière. Différents aspects de la conception du SWIFTS millimétrique sont abordés dans ce rapport. Le dimensionnement des éléments clés du dispositif est réalisé à l aide de simulations électromagnétiques. Nous proposons aussi un procédé de fabrication en technologie silicium permettant le dépôt d antennes sur membrane de nitrure de silicium SiN. Les premières caractérisations permettent de confirmer un fonctionnement adapté des détecteurs en configuration SWIFTS et démontre l existence d un couplage entre l antenne et un des détecteurs aux longueurs d onde millimétriques ce qui ouvre la voie à un futur démonstrateur. Parallèlement, la technologie développée pour le SWIFTS millimétrique a rendu possible la fabrication de KID sur membrane. L intérêt est ici d évaluer la membrane comme un moyen de réduire l interaction entre les rayons cosmiques et le détecteur dans la perspective d une utilisation des KID dans l espace. Des mesures comparatives effectuées sur KID déposés sur membrane et sur substrat démontrent des taux d'événements identiques dans les deux cas. La membrane est donc inefficace pour l application envisagée. Le temps de relaxation présente en revanche une dépendance avec la présence du substrat.For the last decades, millimeter wavelength observations allowed a large improvement of our knowledge of the universe in particular with the study of the Cosmic Microwave Background. To meet today astronomers needs, we propose hereby an integrated instrument able to perform wide-band spectral measurements in the millimeter spectrum. It is based on the SWIFTS concept (Stationary-Wave Fourier-Transform Spectrometer) an instrument already demonstrated in the optical and infrared bands. Our device "the millimeterSWIFTS" makes use of Kinetic Inductance Detectors (KID) as light detectors. Multiples aspects of the millimeter SWIFTS development are presented in this report. Design of the key-parts of the device is done with the help of electromagnetic simulations. We also propose a process of fabrication allowing the deposition of an antenna on a silicon nitride membrane SiN. First measurements confirm an adapted behavior of the KID in a SWIFTS design and demonstrate a coupling between the antenna and one of the detectors in themillimeter waves. This opens the way to a future demonstrator. In parallel, the technology developed for the millimeter SWIFTS allowed the deposition of KID on membrane. Main goal here is to assess membranes as a mean to reduce the interaction between cosmic rays and the detector in the case of a space application. Comparative measurements performed on KID deposited on membrane and on substrate demonstrate the same rate of events in both cases. Thus, membrane is not an option for the desired application. However, relaxation time shows a dependency with the presence of substrate.SAVOIE-SCD - Bib.électronique (730659901) / SudocGRENOBLE1/INP-Bib.électronique (384210012) / SudocGRENOBLE2/3-Bib.électronique (384219901) / SudocSudocFranceF

Differences in patients and lesion and procedure characteristics depending on the age of the coronary chronic total occlusion

Introduction: Whether duration of chronic total occlusion (CTO) affects lesion and procedural characteristics remains largely unknown. Aim: To investigate whether CTO duration influences lesion characteristics and revascularization success. Material and methods: EuroCTO Registry data on patients who had CTO percutaneous coronary intervention between January 2015 and April 2017 were analyzed. Three groups were created based on occlusion age: 3 to 6 months (n = 1415), 7 to 12 months (n = 973), > 12 months (n = 1656). Results: Patients with greater CTO duration were older (63.0 (56.0–70.0); 63.0 (56.0–71.0); 66.0 (59.0–73.0) years respectively; p 20 mm (OR 1.77; 95% CI 1.49–2.10; p < 0.001), and collateral circulation Werner type 2 (OR = 1.20; 95% CI: 1.01–1.43; p = 0.041). The CTO duration was associated with lower procedural success (OR for success 0.60; 95% CI: 0.46–0.79; p < 0.001). In multivariate analysis in-hospital adverse events did not differ according to duration of CTO. Conclusions: Coronary artery CTO duration is associated with greater extent of calcification, lesion length, development of collateral circulation and, most importantly, with lower procedural success

Gender differences in percutaneous coronary intervention for chronic total occlusions from the ERCTO study

Gender-specific data addressing percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) in female patients are scarce and based on small sample size studies.We aimed to analyze gender-differences regarding in-hospital clinical outcomes after CTO-PCI.Data from 35,449 patients enrolled in the prospective European Registry of CTOs were analyzed. The primary outcome was the comparison of procedural success rate in the two cohorts (women vs. men), defined as a final residual stenosis less than 20%, with Thrombolysis In Myocardial Infarction grade flow = 3. In-hospital major adverse cardiac and cerebrovascular events (MACCEs) and procedural complications were deemed secondary outcomes.Women represented 15.2% of the entire study population. They were older and more likely to have hypertension, diabetes, and renal failure, with an overall lower J-CTO score. Women showed a higher procedural success rate (adjusted OR [aOR] = 1.115, confidence interval [CI]: 1.011-1.230, p = 0.030). Apart from previous myocardial infarction and surgical revascularization, no other significant gender differences were found among predictors of procedural success. Antegrade approach with true-to-true lumen techniques was more commonly used than retrograde approach in females. No gender differences were found regarding in-hospital MACCEs (0.9% vs. 0.9%, p = 0.766), although a higher rate of procedural complications was observed in women, such as coronary perforation (3.7% vs. 2.9%, p < 0.001) and vascular complications (1.0% vs. 0.6%, p < 0.001).Women are understudied in contemporary CTO-PCI practice. Female sex is associated with higher procedural success after CTO-PCI, yet no sex differences were found in terms of in-hospital MACCEs. Female sex was associated with a higher rate of procedural complications

Derivation and Validation of a Chronic Total Coronary Occlusion Intervention Procedural Success Score From the 20,000-Patient EuroCTO Registry: The EuroCTO (CASTLE) Score.

OBJECTIVES: The aim was to establish a contemporary scoring system to predict the outcome of chronic total occlusion coronary angioplasty. BACKGROUND: Interventional treatment of chronic total coronary occlusions (CTOs) is a developing subspecialty. Predictors of technical success or failure have been derived from datasets of modest size. A robust scoring tool could facilitate case selection and inform decision making. METHODS: The study analyzed data from the EuroCTO registry. This prospective database was set up in 2008 and includes >20,000 cases submitted by CTO expert operators (>50 cases/year). Derivation (n = 14,882) and validation (n = 5,745) datasets were created to develop a risk score for predicting technical failure. RESULTS: There were 14,882 patients in the derivation dataset (with 2,356 [15.5%] failures) and 5,745 in the validation dataset (with 703 [12.2%] failures). A total of 20.2% of cases were done retrogradely, and dissection re-entry was performed in 9.3% of cases. We identified 6 predictors of technical failure, collectively forming the CASTLE score (Coronary artery bypass graft history, Age (≥70 years), Stump anatomy [blunt or invisible], Tortuosity degree [severe or unseen], Length of occlusion [≥20 mm], and Extent of calcification [severe]). When each parameter was assigned a value of 1, technical failure was seen to increase from 8% with a CASTLE score of 0 to 1, to 35% with a score ≥4. The area under the curve (AUC) was similar in both the derivation (AUC: 0.66) and validation (AUC: 0.68) datasets. CONCLUSIONS: The EuroCTO (CASTLE) score is derived from the largest database of CTO cases to date and offers a useful tool for predicting procedural outcome