The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Benefits of Ticagrelor Plus Aspirin According to Diabetes-Related Factors

International audienc

Évaluation de l inhibition plaquettaire du naproxène sur la voie de la cyclo-oxygénase 1 par rapport à l acide acétylsalicylique et à l ibuprofène

PARIS7-Xavier Bichat (751182101) / SudocSudocFranceF

Antithrombotic strategies in elderly patients with acute coronary syndrome

International audienceElderly patients represent a growing proportion of the acute coronary syndrome population in Western countries. However, their frequent atypical symptoms at presentation often lead to delays in management and to misdiagnosis. Furthermore, their prognosis is poorer than that of younger patients because of physiological changes in platelet function, haemostasis and fibrinolysis, but also a higher proportion of comorbidities and frailty, both of which increase the risk of recurrent thrombotic and bleeding events. This complex situation, with ischaemic and haemorrhagic risk factors often being intertwined, may lead to confusion about the required treatment strategy, sometimes resulting in inadequate management or even to therapeutic nihilism. It is therefore critical to provide a comprehensive overview of our understanding of the pathophysiological processes underlying acute coronary syndrome in elderly patients, and to summarise the results from the latest clinical trials to help decision making for these high-risk patients

019 Interest of the SYNTAX Score to predict cardiovascular outcomes after stenting of unprotected left main coronary artery stenosis: 2 Years Follow-up of the ALMA registry

AimsThe SYNTAX (SX) score, an interesting tool to characterize the severity of the coronary artery disease was designed to predict cardiovascular outcomes in patients with three-vessel or unprotected left main coronary artery (ULMCA) disease in the SYNTAX study. However, the prognostic value of SX score in patients undergoing percutaneous coronary intervention (PCI) of ULMCA stenosis needs to be validated in the “real world”. The aim of our study was to evaluate the clinical outcome of all the patients undergoing PCI for ULMCA stenosis according to the SX score in a monocentric registry.Methods and resultsForty-five patients with de novo ULMCA stenosis (mean age 72±10 years; 76% of male) underwent PCI with bare metal stent (BMS) or drug eluting stent (DES) from January 2006 to December 2008 and were included in the ALMA (Angioplasty of Left Main at lAriboisière hospital) registry. Twenty nine percent of patients were diabetics, mean ejection fraction (EF) was 54±10%. EuroSCORE value was 5.4±3.2 and SX score was 22±8. Ostial ULMCA stenosis was involved in 27% and distal ULMCA lesion in 62% of cases. Distal ULMCA stenoses were treated by provisional T stenting in most of the cases, with one stent implantation in 48% of patients and with two stents in 44%. Clinical follow-up was achieved in all patients (25±10 months). In-hospital MACCE occurred in 6.7% of patients (2 death and 1 myocardial infarction). The rate of major adverse cardiac or cerebrovascular events (MACCE) was 35.6%. Cardiac mortality in the registry was 8.8% at two years. Target lesion revascularisation occurred in 15.6% of patients (7.1% in the DES group vs. 19.4% in the BMS group; p=0.31). None of the patients showing restenosis died. SX score was correlated to MACCE and cardiovascular death. A higher SX score (≥33) compared to the lower group (SX score between 0 to 32) is significantly associated with MACCE (83,3% vs. 28,1%; p<0.01) and cardiac mortality (33.3% vs. 7.7%; p=0.04).ConclusionsThe SX score is a useful tool to predict MACCE and cardiac mortality in patients undergoing percutaneous revascularization of the left main coronary artery

Clinical experience of dabigatran and rivaroxaban in electrical cardioversion of atrial fibrillation

Patients scheduled for atrial fibrillation (AF) cardioversion were excluded from clinical trials of novel oral anticoagulants (NOACs). We evaluated efficacy and safety of NOACs in patients undergoing electrical cardioversion for AF. We performed a monocentric study of all patients on NOACs who underwent elective electrical cardioversion for non-valvular AF between January 2012 and December 2014. We analyzed incidence of stroke and bleeding at 30 days. Fifty patients were included, 28 receiving dabigatran, 22 rivaroxaban. Mean age was 65 ± 12 years. Mean CHADS2-VA2SC and HASBLED scores were 3 ± 1.8 and 2.2 ± 1.1 respectively. Transoesophageal echocardiography was performed in 41 (79%) patients, revealing a thrombus in 2 (5%). No clinical evidence of stroke occurred in the 30 days, 1 major gastrointestinal bleeding (2%) in patient on rivaroxaban (led to premature discontinuation) and 3 minor bleedings. NOACs seem to be safe in daily practice of electrical cardioversion in our population

Myocardial Fractional Flow Reserve Measurement Using Contrast Media as a First-Line Assessment of Coronary Lesions in Current Practice

International audienceBackground: Fractional flow reserve (FFR) measurement requires adenosine injection. However, adenosine can induce conductive and rhythmic complications, or be contraindicated in some patients. Contrast-induced hyperemia could provide a simple first-line method (contrast-enhanced FFR; cFFR) to assess coronary lesions. In this study we evaluated the accuracy of cFFR to predict lesion significance. Methods: This prospective study included 104 patients with 138 coronary lesions. Each stenosis was evaluated using resting distal coronary pressure to aortic pressure ratio (Pd/Pa) measurements using intracoronary iodixanol (cFFR) and adenosine (FFR) injection. An FFR value <= 0.8 defined a significant lesion. Results: Dose-ranging analysis (n = 12 lesions) showed that 10 mL iodixanol was required to obtain the lowest cFFR value. Inter-measurement reproducibility of cFFR (n = 18 lesions) showed limited variability and small mean estimated bias (0.001 +/- 0.014). Values of cFFR and FFR were highly correlated in a first series of n = 36 lesions (r = 0.9; P < 0.001). Receiver-operating characteristic curve analysis showed an excellent accuracy of cFFR cutoff value of <= 0.85 in predicting FFR value <= 0.80 (area under the curve, 0.94; 95% confidence interval, 0.90-0.98; sensitivity, 95%; specificity, 73%). This threshold was then tested prospectively in an independent cohort of n = 72 lesions. A cFFR value <= 0.85 correctly identified hemodynamically significant lesions with a sensitivity of 100%, specificity of 78%, positive predictive value of 78%, and negative predictive value of 100%. Conclusions: cFFR is reproducible and can be achieved with usual volumes of contrast. A cFFR threshold value of 0.85 provides excellent sensitivity and negative predictive value in coronary artery stenosis

Impaired biological response to aspirin in therapeutic hypothermia comatose patients resuscitated from out-of-hospital cardiac arrest

International audienc