0200: Predictors of angiographically visible distal embolization in ST elevation myocardial infarction patients treated by primary percutaneous coronary intervention and thrombectomy

Aspiration thrombectomy during primary percutaneous coronary intervention (p-PCI) in ST elevation myocardial infarction (STEMI) has been proposed to restore myocardial reperfusion. But important controversies remain concerning the usefulness of thrombectomy to improve this perfusion. Our objective was to evaluate the impact of manual thrombectomy on the occur-rence of angiographically visible distal embolization (AVDE) during p-PCI in STEMI. 346 consecutive patients admitted for STEMI who underwent p-PCI and thrombectomy were included. Clinical, angiographic and therapeutics characteristics were assessed. AVDE was defined as an abrupt vessel closure occurring at any point during the PCI procedure and that was not present at baseline. Patients were divided into 2 groups: with AVDE (59 patients) and without AVDE 287 patients.Comparing the 2 groups, patients with AVDE were more likely to be older than 60 year-old (67 vs. 50%; p=0.014), with a higher proportion of women (34 vs. 20%; p=0,027), of right coronary artery lesion (57 vs. 34.5%; p=0.001).Conversely, smoking and left anterior descending coronary artery lesion were more frequent in patients without AVDE (respectively 63 vs. 46%; p=0.014 and 50 vs. 30%; p=0.005).Univariate analysis identify age>60 (OR[95% CI]:2.09(1.15-3.78), p=0.015), female gender (OR[95% CI]:2.02(1.09-3.73), p=0,024), culprit coronary diameter>3mm (OR[95% CI] as predictors of AVDE during p-PCI for STEMI.By multivariate analysis, culprit coronary diameter>3mm (OR[95% CI]: 1.90 (1.01-3.56); p=0.048) and and the right coronary artery culprit lesion site (OR[95% CI]:2.48(1.36-4.52); p=0.003) were independent factors associated with AVDE. AVDE complicating p-PCI during STEMI is frequent (17%). Strikingly we found that successful thrombectomy does not prevent from AVDE. Conversely, we highlight that patients with culprit coronary artery diameter>3mm and STEMI due to right coronary artery occlusion are more likely to develop AVDE

Complementary and alternative medicine use in glioma patients in France

PURPOSE Complementary and alternative medicine (CAM) use increases in cancer patients, including adult patients with diffuse gliomas. METHODS Questionnaires addressing CAM use were distributed to adult patients with gliomas of WHO grades II-IV and ECOG performance score of 0-2 during hospital visits and filled in anonymously. The study was conducted in nine centers in France from May 2017 to May 2018. Descriptive cohort analyses and comparative analyses according to gender, age, WHO grade, and recurrent versus newly diagnosed disease were conducted. RESULTS Two hundred twenty-seven questionnaires were collected; 135 patients (59%) were male. Median age was 48 years, 105 patients (46%) declared having glioblastoma, 99 patients (43%) declared having recurrent disease. Hundred-three patients (45%) had modified their alimentary habits after the glioma diagnosis. At the time of the questionnaire, 100 patients (44%) were on complementary treatment, mainly vitamins and food supplements, and 73 patients (32%) used alternative medicine approaches, mainly magnetism and acupuncture. In total, 154 patients (68%) declared using at least one of these approaches. Expenditures exceeding 100 € per month were reported by users in 14% for modification of alimentary habits, in 25% for complementary treatment, and in 18% for alternative medicines. All approaches were commonly considered as improving quality of life and experienced as efficient, notably those associated with more expenditures. CONCLUSIONS CAM are frequently used by glioma patients in France. Underlying needs and expectations, as well as potential interactions with tumor-specific treatments, and financial and quality of life burden, should be discussed with patients and caregivers

Etude de la relation entre l'apparition d'anomalies de la dépolarisation sur l'ECG en post infarctus et les données d'imagerie par résonance magnétique cardiaque

DIJON-BU Médecine Pharmacie (212312103) / SudocSudocFranceF

Fréquence et facteurs prédictifs d'un accident vasculaire cérébral après un infarctus du myocarde (caractéristiques selon la survenue intra ou extrahospitalière)

Introduction : La survenue d un accident vasculaire cérébral après un infarctus du myocarde est une complication sévère et associée à un risque accru de décès, mais ses mécanismes physiopathologiques sont encore mal connus. L objectif de cette étude était d évaluer la fréquence, les caractéristiques et les facteurs prédictifs d accident vasculaire cérébral chez des patients admis pour infarctus du myocarde, selon leur survenue à la phase intra ou extrahospitalière. Méthodes : A partir de l obseRvatoire régional des Infarctus de Côte d Or (RICO), 8485 patients consécutifs admis aux soins intensifs de cardiologie pour infarctus du myocarde entre janvier 2001 et juillet 2010 ont été inclus. Parmi d autres évènements cardiaques majeurs, la survenue d un accident vasculaire cérébral (ischémique ou hémorragique) ou d un accident ischémique transitoire était collectée de façon prospective pendant une année de suivi.Résultats : 168 (1.98%) accidents vasculaires cérébraux ont été enregistrés sur la période d un an de suivi après la survenue de l infarctus du myocarde. 123 patients (1.4%) ont présenté cet accident vasculaire cérébral à la phase intra-hospitalière, dont pour 87% d entre eux dans les 5 premiers jours après leur admission. En analyse multivariée, les facteurs prédictifs indépendants d accident vasculaire cérébral intra-hospitalier étaient le sexe féminin (OR: 1.99, IC 95%: 1.19-2.51, p=0.004), un antécédent d accident vasculaire cérébral (OR: 2.21, IC 95%: 1.28-3.83, p=0.004), la fraction d éjection ventriculaire gauche (OR: 0.96, 95% IC: 0.95-0.98, p<0.001), la fibrillation atriale de novo (OR: 1.99, IC 95%: 1.25-3.16, p=0.004) et la CRP à l admission (OR: 1.006, IC 95%: 1.003-1.009, p<0.001). Après ajustement à de multiples facteurs pronostiques, la survenue d un accident vasculaire cérébral intra-hospitalier était toujours associée à une augmentation significative de la mortalité à 1 an (OR: 1.82, IC 95%: 1.05-3.15, p=0.031). Parmi les survivants (n=7808), 45 patients ont présentés un accident vasculaire cérébral extrahospitalier (0.64%) dans l année post-infarctus. En analyse multivariée, les facteurs prédictifs indépendants d accident vasculaire cérébral extrahospitalier étaient l âge (OR:1.04, IC 95%: 1.01-1.07, p=0.003), un antécédent d accident vasculaire cérébral (OR: 3.69, IC 95%: 1.83-7.43, p<0.001) et l hypertension artérielle (OR: 2.77, IC 95%: 1.26-6.08, p=0.011). De 2001 à 2010, le taux annuel d accident vasculaire cérébral post infarctus du myocarde est resté stable, sans variation temporelle significative. Conclusions : Cette étude décrit la fréquence et les facteurs prédictifs d accident vasculaire cérébral post-infarctus du myocarde, complication responsable d une mortalité à un an très élevée. Les caractéristiques différentes selon leur survenue intra ou extrahospitalière suggèrent des mécanismes physiopathologiques distincts. Cependant, au cours du suivi, la survenue d un accident vasculaire cérébral reste un évènement rare et principalement associée à un haut risque cardiovasculaire.DIJON-BU Médecine Pharmacie (212312103) / SudocSudocFranceF

Should we predict post-operative atrial fibrillation with atrial cardiomyopathy biomarkers?

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Vascular BDNF expression and oxidative stress during aging and the development of chronic hypertension

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0326: Prognostic factors and impact of blood pressure level during the first 48 hours after myocardial infarction

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Nitric oxide synthase inhibition and oxidative stress in cardiovascular diseases: Possible therapeutic targets?

International audienceNitric oxide (• NO) is synthetized enzymatically from L-arginine (L-Arg) by three NO synthase isoforms, iNOS, eNOS and nNOS. The synthesis of NO is selectively inhibited by guanidino-substituted analogs of L-Arg or methylarginines such as asymmetric dimethylarginine (ADMA), which results from protein degradation in cells. Many disease states, including cardiovascular diseases and diabetes, are associated with increased plasma levels of ADMA. The N-terminal catalytic domain of these NOS isoforms binds the heme prosthetic group as well as the redox cofactor, tetrahydrobiopterin (BH 4) associated with a regulatory protein, calmodulin (CaM). The enzymatic activity of NOS depends on substrate and cofactor availability. The importance of BH 4 as a critical regulator of eNOS function suggests that BH 4 may be a rational therapeutic target in vascular disease states. BH 4 oxidation appears to be a major contributor to vascular dysfunction associated with hypertension, ischemia/reperfusion injury, diabetes and other cardiovascular diseases as it leads to the increased formation of oxygen-derived radicals due to NOS uncoupling rather than NO. Accordingly, abnormalities in vascular NO production and transport result in endothelial dysfunction leading to various cardiovascular disorders. However, some disorders including a wide range of functions in the neuronal, immune and cardiovascular system were associated with the overproduction of NO. Inhibition of the enzyme should be a useful approach to treat these pathologies. Therefore, it appears that both a lack and excess of NO production in diseases can have various important pathological implications. In this context, NOS modulators (exogenous and endogenous) and their therapeutic effects are discussed

0134 : Atrial fibrillation is associated with a marker of endothelial function and oxidative stress in patients with acute myocardial infarction

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