Syndromes coronaires aigus chez les patients greffés rénaux (analyse à partir d une base de données nationale française)

Introduction: Le risque de syndrome coronaire aigu (SCA) est augmenté chez les patients greffés rénaux mais le profil et la mortalité hospitalière restent à déterminer. Objectif: Dans ce travail, nous avons étudié les caractéristiques et la mortalité hospitalière de ces patients au cours du SCA. Méthodes: A partir de la base de données nationale française d information médicale, tous les patients admis pour SCA dans les 1546 structures de soins, du 1er janvier 2006 au 31 décembre 2011, ont été analysés. Nous avons comparé les caractéristiques des SCA, regroupant les infarctus du myocarde avec sus-décalage du ST (STEMI) et infarctus du myocarde sans sus-décalage du segment ST (NSTEMI), chez les greffés rénaux par rapport à la population générale. Les patients aux antécédents d insuffisance rénale chronique terminale et/ou dialysés ont été exclus. Résultats: Parmi les 329 839 patients inclus, 404 (0.9%) patients greffés rénaux ont fait un syndrome coronaire aigu (SCA). On compte 318 (78%) hommes contre 220 470 (66%), d âge moyen de 58 ans chez les patients greffés, contre 68 ans dans la population de référence (p<0,0001). Ils étaient deux fois moins fumeurs (5% contre 13% p<0.0001), plus hypertendus, diabétiques et artéritiques (28%, 13% et 2.5% contre 22%, 9% et 1% respectivement, p<0.05). La mortalité hospitalière était supérieure chez les patients transplantés mais non significative (4.2% versus 2.9%, p=0.2101). Enfin, 67.1 % des SCA se produisent au cours de la même hospitalisation, et 91 % au cours de la première année. Conclusion: Les patients greffés rénaux sont plus à risque de SCA que la population générale avec une mortalité hospitalière qui tend à être augmentée. L incidence de SCA, d emblée maximale le premier mois qui suit la greffe, suggère des stratégies diagnostiques et thérapeutiques différentes de celles employées actuellement.DIJON-BU Médecine Pharmacie (212312103) / SudocSudocFranceF

0168: Myocardial infarction after kidney transplantation: age related profile. Analysis from a French nationwide hospital medical information database

Cardiovascular disease accounts for 43% of all deaths in patients with endstage renal disease, and CVD continues to remain the leading cause of mortality and morbidity following renal transplantation. However, the characteristics and the hospital mortality of acute myocardial infarction (AMI) in patients with kidney transplantation (KT) remain to be determined in large scale study. From the French nationwide hospital medical information database, all the consecutive patients hospitalized in the 1546 French hospital/clinics for AMI from 1st January 2005 to 31st December 2009 were included. We compared the specific profile and the hospital mortality of patients with KT to patients without renal failure. Patients with personal past history of renal failure and/ or dialysis were excluded.Among the 329 839 patients with AMI included, 404 (0.1%) patients were after KT. Patients with KT were more frequently men (78.7 vs 66.8%, with p<0.001), markedly younger (58±12 vs 68±11, with p<0.001), and les smoker (5.0 vs 9.1%, with p<0.001) than patients without KT. There was also a higher proportion of hypertension (28.5 vs 23.4%, with p0.017) and a lower proportion of STEMI (75.7 vs 82.7%, with p<0.001) in patients after KT. More than two-thirds of AMI complicating post KT period occured before discharge (67.1%) and 91% in the first year after KT. After adjustment for age, sex and STEMI, in-hospital mortality was higher in KT group (4.2 vs 2.9%), but with p=0.210.From our large scale nationwide study, our work demonstrated that patients with KT complicated by AMI are markedly younger with a specific difference for usual risk factors, but transplant-related risk factors explain also this specificity. We highligts that AMI occurs very early after KT, most often before discharge. To decrease the frequency of MI following renal transplantation, screening of coronaropathy and evaluation of risk factors before KT, as well as after KT must be evaluated

Biomasse microbienne carbonée et activités enzymatiques : gammes de valeurs obtenues pour différents sols agricoles français et belges

International audienc

Asymptomatic left circumflex artery stenosis is associated with higher arrhythmia recurrence after persistent atrial fibrillation ablation

Background: The pathophysiology of persistent atrial fibrillation (AF) remains unclear. While several studies have demonstrated an association between myocardial infarction and atrial fibrillation, the role of stable coronary artery disease (CAD) is still unknown. As a result, we aimed to assess the association between CAD obstruction and AF recurrence after persistent AF ablation in patients with no history of CAD. Materials and methods: This observational retrospective study included consecutive patients who underwent routine preprocedural cardiac computed tomography (CCT) before persistent AF ablation between September 2015 and June 2018 in 5 European University Hospitals. Exclusion criteria were CAD or coronary revascularization previously known or during follow-up. Obstructive CAD was defined as luminal stenosis ≥ 50%. Results: All in all, 496 patients (mean age 61.8 ± 10.0 years, 76.2% males) were included. CHA2DS2-VASc score was 0 or 1 in 225 (36.3%) patients. Obstructive CAD was present in 86 (17.4%) patients. During the follow-up (24 ± 19 months), 207 (41.7%) patients had AF recurrence. The recurrence rate was not different between patients with and without obstructive CAD (43.0% vs. 41.5%, respectively; P = 0.79). When considering the location of the stenosis, the recurrence rate was higher in the case of left circumflex obstruction: 56% vs. 32% at 2 years (log-rank P ≤ 0.01). After Cox multivariate analysis, circumflex artery obstruction (HR 2.32; 95% CI 1.36-3.98; P < 0.01) was independently associated with AF recurrence. Conclusion: Circumflex artery obstruction detected with CCT was independently associated with 2-fold increase in the risk of AF recurrence after persistent AF ablation. Further research is necessary to evaluate this pathophysiological relationship

Recurrences of Atrial Fibrillation Despite Durable Pulmonary Vein Isolation: The PARTY-PVI Study

International audienceBACKGROUND: Recurrences of atrial fibrillation (AF) after pulmonary vein isolation (PVI) are mainly due to pulmonary vein reconnection. However, a growing number of patients have AF recurrences despite durable PVI. The optimal ablative strategy for these patients is unknown. We analyzed the impact of current ablation strategies in a large multicenter study. METHODS: Patients undergoing a redo ablation for AF and presenting durable PVI were included. The freedom from atrial arrhythmia after pulmonary vein-based, linear-based, electrogram-based, and trigger-based ablation strategies were compared. RESULTS: Between 2010 and 2020, 367 patients (67% men, 63±10 years, 44% paroxysmal) underwent a redo ablation for AF recurrences despite durable PVI at 39 centers. After durable PVI was confirmed, linear-based ablation was performed in 219 (60%) patients, electrogram-based ablation in 168 (45%) patients, trigger-based ablation in 101 (27%) patients, and pulmonary vein-based ablation in 56 (15%) patients. Seven patients (2%) did not undergo any additional ablation during the redo procedure. After 22±19 months of follow-up, 122 (33%) and 159 (43%) patients had a recurrence of atrial arrhythmia at 12 and 24 months, respectively. No significant difference in arrhythmia-free survival was observed between the different ablation strategies. Left atrial dilatation was the only independent factor associated with arrhythmia-free survival (HR, 1.59 [95% CI, 1.13–2.23]; P =0.006). CONCLUSIONS: In patients with recurrent AF despite durable PVI, no ablation strategy used alone or in combination during the redo procedure appears to be superior in improving arrhythmia-free survival. Left atrial size is a significant predictor of ablation outcome in this population

Économie et société de la fin de la Préhistoire : Actualité de la recherche

Les 7e Rencontres méridionales de Préhistoire récente, tenues à Bron, sur le campus de l'Université Lumière-Lyon 2, les 3 et 4 novembre 2006, ont réuni plus de 150 préhistoriens venus du Sud de la France et des régions alentour. Ces Rencontres biennales représentent le lien majeur de la communauté des chercheurs pour les périodes allant du Mésolithique à l'Âge du Bronze dans la moitié sud de la France. Les Actes présentés ici regroupent 24 contributions réparties en deux sections : l'actualité de la recherche, présentant les principaux résultats des fouilles et programmes récents, et le thème spécifique choisi pour cette session « Économie et société à la fin de la Préhistoire ». Cette thématique large est abordée au fil de 9 contributions très ciblées portant sur les économies de subsistance, de production et d'échange ainsi que sur l'analyse de structures immobilières qui en témoignent, où l'on voit que l'idéel et le matériel ne sont jamais très éloignés dans ces sociétés du passé

Analgesic use - prevalence, biomonitoring and endocrine and reproductive effects

International audienceParacetamol and NSAIDs, in particular acetylsalicylic acid (aspirin) and ibuprofen, are among the most used and environmentally released pharmaceutical drugs. The differences in international trends in the sale and consumption of mild analgesics reflect differences in marketing, governmental policies, habits, accessibility, disease patterns and the age distribution of each population. Biomonitoring indicates ubiquitous and high human exposure to paracetamol and to salicylic acid, which is the main metabolite of acetylsalicylic acid. Furthermore, evidence suggests that analgesics can have endocrine disruptive properties capable of altering animal and human reproductive function from fetal life to adulthood in both sexes. Medical and public awareness about these health concerns should be increased, particularly among pregnant women

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