Le NT-proBNP, un marqueur associé à la survenue de néphropathie induite par les produits de contraste à la phase aiguë de l infarctus du myocarde

INTRODUCTION : La néphropathie induite par les produits de contraste (NPC) après angioplastie pour un infarctus du myocarde avec élévation du segment ST (IDM ST+) est fréquente et associée à une augmentation du risque de décès et à une altération de la fonction rénale à long terme. Il parait donc nécessaire d améliorer l identification des facteurs de risques de NPC.BUT : Evaluer l association entre le NT-proBNP, un biomarqueur de dysfonction ventriculaire et d insuffisance rénale, et la survenue de NPC.METHODE : A partir de l obseRvatoire régional des Infarctus de Côte d Or (RICO), tous les patients consécutifs bénéficiant d une angioplastie pour IDM ST+ 26.5 mol/L ou > 50% dans les 48h après l angioplastie par rapport à la valeur de base. Le NT-Pro BNP a été mesuré à l admission.RESULTATS : Parmi les 1243 patients inclus, la NPC est survenue chez 130 patients (10,4%). Les patients qui ont développé une NPC avaient un taux de NT-proBNP 5 fois plus élevé que les patients n ayant pas présenté de NPC (1275(435-4022) vs 247(79-986) pg/mL, p<0.001). La mortalité hospitalière était significativement plus élevée chez les patients présentant une NPC (6.9% vs 1.1%, p<0.001). En analyse univariée, la survenue d une NPC était associée au taux de NT-proBNP, au tabagisme, diabète, aux antécédents d AVC, à l hypertension artérielle, à l'âge, à l altération du débit de filtration glomérulaire de base, à l anémie, à la fréquence cardiaque d admission et à l altération de la FEVG. En analyse multivariée, les niveaux de NT-proBNP restaient associés à la survenue de la NPC, même après ajustement sur les facteurs de risque, les traitements, les données cliniques et biologiques (OR (IC à 95%) : 1.91 (1.40-2.60) p<0.001).CONCLUSION : Dans cette étude prospective avec un effectif important, notre travail suggère que les taux de NT-proBNP à l'admission pourraient aider à identifier les patients à risque de NPC en plus des facteurs de risque traditionnels.DIJON-BU Médecine Pharmacie (212312103) / SudocSudocFranceF

Relation of outcomes to ABC (Atrial Fibrillation Better Care) pathway adherent care in European patients with atrial fibrillation: an analysis from the ESC-EHRA EORP Atrial Fibrillation General Long-Term (AFGen LT) Registry

International audienceAbstract Aims There has been an increasing focus on integrated, multidisciplinary, and holistic care in the treatment of atrial fibrillation (AF). The ‘Atrial Fibrillation Better Care’ (ABC) pathway has been proposed to streamline integrated care in AF. We evaluated the impact on outcomes of an ABC adherent management in a contemporary real-life European-wide AF cohort. Methods and results Patients enrolled in the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry with baseline data to evaluate ABC criteria and available follow-up data were considered for this analysis. Among the original 11 096 AF patients enrolled, 6646 (59.9%) were included in this analysis, of which 1996 (30.0%) managed as ABC adherent. Patients adherent to ABC care had lower CHA2DS2-VASc and HAS-BLED scores (mean ± SD, 2.68 ± 1.57 vs. 3.07 ± 1.90 and 1.26 ± 0.93 vs. 1.58 ± 1.12, respectively; P &lt; 0.001). At 1-year follow-up, patients managed adherent to ABC pathway compared to non-adherent ones had a lower rate of any thromboembolic event (TE)/acute coronary syndrome (ACS)/cardiovascular (CV) death (3.8% vs. 7.6%), CV death (1.9% vs. 4.8%), and all-cause death (3.0% vs. 6.4%) (all P &lt; 0.0001). On Cox multivariable regression analysis, ABC adherent care showed an association with a lower risk of any TE/ACS/CV death [hazard ratio (HR): 0.59, 95% confidence interval (CI): 0.44–0.79], CV death (HR: 0.52, 95% CI: 0.35–0.78), and all-cause death (HR: 0.57, 95% CI: 0.43–0.78). Conclusion In a large contemporary cohort of European AF patients, a clinical management adherent to ABC pathway for integrated care is associated with a significant lower risk for cardiovascular events, CV death, and all-cause death

Global variations in heart failure etiology, management, and outcomes

Importance: Most epidemiological studies of heart failure (HF) have been conducted in high-income countries with limited comparable data from middle- or low-income countries. Objective: To examine differences in HF etiology, treatment, and outcomes between groups of countries at different levels of economic development. Design, Setting, and Participants: Multinational HF registry of 23 341 participants in 40 high-income, upper–middle-income, lower–middle-income, and low-income countries, followed up for a median period of 2.0 years. Main Outcomes and Measures: HF cause, HF medication use, hospitalization, and death. Results: Mean (SD) age of participants was 63.1 (14.9) years, and 9119 (39.1%) were female. The most common cause of HF was ischemic heart disease (38.1%) followed by hypertension (20.2%). The proportion of participants with HF with reduced ejection fraction taking the combination of a β-blocker, renin-angiotensin system inhibitor, and mineralocorticoid receptor antagonist was highest in upper–middle-income (61.9%) and high-income countries (51.1%), and it was lowest in low-income (45.7%) and lower–middle-income countries (39.5%) (P &lt; .001). The age- and sex- standardized mortality rate per 100 person-years was lowest in high-income countries (7.8 [95% CI, 7.5-8.2]), 9.3 (95% CI, 8.8-9.9) in upper–middle-income countries, 15.7 (95% CI, 15.0-16.4) in lower–middle-income countries, and it was highest in low-income countries (19.1 [95% CI, 17.6-20.7]). Hospitalization rates were more frequent than death rates in high-income countries (ratio = 3.8) and in upper–middle-income countries (ratio = 2.4), similar in lower–middle-income countries (ratio = 1.1), and less frequent in low-income countries (ratio = 0.6). The 30-day case-fatality rate after first hospital admission was lowest in high-income countries (6.7%), followed by upper–middle-income countries (9.7%), then lower–middle-income countries (21.1%), and highest in low-income countries (31.6%). The proportional risk of death within 30 days of a first hospital admission was 3- to 5-fold higher in lower–middle-income countries and low-income countries compared with high-income countries after adjusting for patient characteristics and use of long-term HF therapies. Conclusions and Relevance: This study of HF patients from 40 different countries and derived from 4 different economic levels demonstrated differences in HF etiologies, management, and outcomes. These data may be useful in planning approaches to improve HF prevention and treatment globally