957-108 Does Reperfusion Induced by Angioplasty Confer the Same Benefit as Thrombolysis in Terms of Late Potentials?

Angioplasty or thrombolysis (T) during acute myocardial infarction (MI) are two effective methods for achieving reperfusion, but whether reperfusion induced by angioplasty confers the same protection against the presence of late potentials on signal-averaged electrocardiography (SAE) as that induced by T remains debated. We studied retrospectively 102 consecutive Pts with successful reperfusion (TIMI grade 3 patency in acute phase), obtained by T, primary angioplasty (P), or rescue angioplasty (R) during the first 6 hours of MI. T Pts all had angiography at 90min to prove reperfusion. All had SAE >6 days later. Late potentials were defined as, ≥2 of the following criteria: QRS >120msec, RMS40 <20μV, LAS> 38msec. Results are (mean±SD):TPRPnumber of Pts354027Age (years)59.9±1160.5±1453±13<0.04% males868593NS% anterior545846NSTime to treatment (min)169±72212±79171±76NSTime to reperfusion (min)285±75*261±90280±98NSEjection fraction°(%)53±845±1546±14NS% Late potentials431011<0.001*time to 90min angiography with proven reperfusion°radionuclide left ventricular ejection fraction at dischargeThus, after MI, the prevalence of late potentials appears lower when acute reperfusion is obtained by angioplasty rather than by thrombolysis. This difference does not appear related to differences in time to treatment, time to reperfusion, left ventricular function or other patient characteristics

Patent Foramen Ovale Closure or Anticoagulation vs. Antiplatelets after Stroke

BACKGROUND Trials of patent foramen ovale (PFO) closure to prevent recurrent stroke have been inconclusive. We investigated whether patients with cryptogenic stroke and echocardiographic features representing risk of stroke would benefit from PFO closure or anticoagulation, as compared with antiplatelet therapy. METHODS In a multicenter, randomized, open-label trial, we assigned, in a 1:1:1 ratio, patients 16 to 60 years of age who had had a recent stroke attributed to PFO, with an associated atrial septal aneurysm or large interatrial shunt, to transcatheter PFO closure plus long-term antiplatelet therapy (PFO closure group), antiplatelet therapy alone (antiplatelet-only group), or oral anticoagulation (anticoagulation group) (randomization group 1). Patients with contraindications to anticoagulants or to PFO closure were randomly assigned to the alternative noncontraindicated treatment or to antiplatelet therapy (randomization groups 2 and 3). The primary outcome was occurrence of stroke. The comparison of PFO closure plus antiplatelet therapy with antiplatelet therapy alone was performed with combined data from randomization groups 1 and 2, and the comparison of oral anticoagulation with antiplatelet therapy alone was performed with combined data from randomization groups 1 and 3. RESULTS A total of 663 patients underwent randomization and were followed for a mean (+/- SD) of 5.3 +/- 2.0 years. In the analysis of randomization groups 1 and 2, no stroke occurred among the 238 patients in the PFO closure group, whereas stroke occurred in 14 of the 235 patients in the antiplatelet-only group (hazard ratio, 0.03; 95% confidence interval, 0 to 0.26; P<0.001). Procedural complications from PFO closure occurred in 14 patients (5.9%). The rate of atrial fibrillation was higher in the PFO closure group than in the antiplatelet-only group (4.6% vs. 0.9%, P = 0.02). The number of serious adverse events did not differ significantly between the treatment groups (P = 0.56). In the analysis of randomization groups 1 and 3, stroke occurred in 3 of 187 patients assigned to oral anticoagulants and in 7 of 174 patients assigned to antiplatelet therapy alone. CONCLUSIONS Among patients who had had a recent cryptogenic stroke attributed to PFO with an associated atrial septal aneurysm or large interatrial shunt, the rate of stroke recurrence was lower among those assigned to PFO closure combined with antiplatelet therapy than among those assigned to antiplatelet therapy alone. PFO closure was associated with an increased risk of atrial fibrillation

Epidémiologie des infarctus intra-hospitaliers à partir d un registre de 2100 patients

PARIS7-Xavier Bichat (751182101) / SudocSudocFranceF

“Guidelines Recommendations on the Treatment of Tricuspid Regurgitation. Where Are We and Where Do We Go With Transcatheter Valve Intervention”

Tricuspid regurgitation (TR) is an important clinical problem because it is frequent and carries a poor prognosis when it is left uncorrected. However, there is still a lack of awareness of tricuspid disease in the medical community. The indications for evaluation and surgical interventions in patients with TR were recently updated in the ESC/EACTS guidelines. Transcatheter tricuspid valve intervention (TTVI), almost exclusively valve repair, is at an early stage of development as only a few hundreds of patients have been treated. The first-in-man valve implantation was very recently performed. The recent ESC/EACTS Guidelines state that “The potential role of transcatheter tricuspid valve treatment in high-risk patients needs to be determined”. We shall review here which lessons of interest for TTVI can be learned from the Guidelines as regards evaluation and indications for surgery and try to imagine what could be the place of TTVI in the Guidelines in the future

Transcatheter closure of patent foramen ovale to prevent stroke recurrence in patients with otherwise unexplained ischaemic stroke: Expert consensus of the French Neurovascular Society and the French Society of Cardiology

International audienc