: Gender differences in STEMI

International audienceBACKGROUND: Gender differences in presentation, management and outcome in patients with ST-segment elevation myocardial infarction (STEMI) have been reported. AIM: To determine whether female gender is associated with higher inhospital mortality. METHODS: Data from ORBI, a regional STEMI registry of 5 years' standing, were analysed. The main data on presentation, management, inhospital outcome and prescription at discharge were compared between genders. Various adjusted hazard ratios were then calculated for inhospital mortality (women versus men). RESULTS: The analysis included 5000 patients (mean age 62.6±13 years), with 1174 women (23.5%). Women were on average 8 years older than men, with more frequent co-morbidities. Median ischaemia time was 215 minutes (26 minutes longer in women; P<0.05). Reperfusion strategies in women less frequently involved fibrinolysis, coronary angiography, radial access and thrombo-aspiration. Female gender, especially in patients aged<60 years, was associated with poorer inhospital prognosis (including higher inhospital mortality: 9% vs. 4% in men; P<0.0001), and underutilization of recommended treatments at discharge. Moreover, excess female inhospital mortality was independent of presentation, revascularization time and reperfusion strategy (hazard ratio for women 1.33, 95% confidence interval 1.01-1.76; P=0.04). CONCLUSIONS: One in four patients admitted for STEMI was female, with significant differences in presentation. Female gender was associated with less-optimal treatment, both in the acute-phase and at discharge. Efforts should be made to reduce these differences, especially as female gender was independently associated with an elevated risk of inhospital mortality

Thérapeutique des oiseaux de cage et de volière

LYON1-BU Santé (693882101) / SudocSudocFranceF

Insuffisance cardiaque traitée par resynchronisation (facteurs prédictifs de mortalité, impact de la fibrillation atriale sur le pronostic, incidence de la fibrillation atriale)

BREST-BU Médecine-Odontologie (290192102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Recueil rétrospectif des Accidents hémorragiques admis dans le service des Urgences du CHU de Brest du 07/01/2007 au 29/12/2008 (analyse de la population sous antiagrégant plaquettaire)

L'utilisation des traitements antiagrégant plaquettaire est actuellement devenue incontournable en pathologie cardio-vasculaire ainsi qu'en médecine générale. Comme tout traitement médicamenteux ceux-ci offrent des bénéfices mais exposent également à des effets indésirables notamment des évènment hémorragiques. L'épidémiologie des accidents hémorragiques sous antiagrégant plaquettaire reste très mal connue du fait despopulations incluses au cours des essais cliniques (population à failble risque hémoragique) et du nombre peu important de déclaration à lapharmacovigilance. Dans cette étude, nous avons relevé différentes caractéristiqes de l'ensemble des patients admis aux urgences pour accident hémorragique afin de déterminer la proportion de patient sous antiagrégant plaquettaire, et d'en évaluer les spécificités. Parmi 1797 accdents hémorragiques recueillis au cours de notre étude, les patients sous antiagrégant plaquettaire représentent une faible proportion et ne semblent pas expposés à une surmortalité à court terme. La population sous antiagrégant plaquettaire présente bien entendu un terrain vasculaire alors que le reste de la population se distingue par une consommation d'alcool plus importante ainsi qu'un nombre plus important d'insuffisance hépatique. La majorité des accidents hémorragiques colligés qurviennent chez des patients ne bénéficiant d'aucun traitement anti thrombotique.ROUEN-BU Médecine-Pharmacie (765402102) / SudocSudocFranceF

Procédé de prédiction d'un risque cardiaque et/ou de récidive en fonction d'au moins une valeur d'un paramètre extrapolable d'une onde d'un électrocardiogramme

Méthodes de traitement du signal et de classification appliquées à l'analyse de l'électrocardiogramme des patients en rythme sinusal pour l'évaluation du risque d'avoir subi un épisode de fibrillation auriculaire antérieurement à l'examen. Ces méthodes sont aussi susceptibles d'évaluer le risque de récidive d'un épisode de fibrillation auriculaire postérieurement à l'examen

Mitral and aortic valvular disease associated with benfluorex use.

International audienceFenfluramine has been associated with an increased risk of pulmonary hypertension and valvular disease. Benfluorex is a fenfluramine derivative approved for the treatment of metabolic syndrome and type 2 diabetes mellitus. To date, only three isolated clinical cases of valvular disease and two recent case-control studies have been reported in patients exposed to benfluorex. Herein, the case is described of a patient with mitral and aortic valvular disease, with both echocardiographic and histopathological findings, who had been receiving benfluorex for several years, without any other etiology of valvular disease. The case is suggestive of toxic valvular lesions, similar to those observed previously during treatment with fenfluramine, pergolide, and cabergolide

Pwave signal analysis is able to recognize with a good accuracy patients with and without previous atrial fibrillation

International audiencePurposeParoxysmal atrial fibrillation (PAF) is a common cardiac arrhythmia but difficult to diagnose: frequently asymptomatic and when symptomatic too sporadic to be captured by electrocardiogram (ECG) or even long duration Holter monitoring. However this diagnosis carries a major importance as it could induce key changes in diagnosis and therapy (anticoagulation). Our aim was to evaluate the accuracy of the P signal wave analysis to discriminate patients with and without previous documented AF

Development of a clinical prediction score for congestive heart failure diagnosis in the emergency care setting: The Brest score.

International audienceTo derive and validate a clinical prediction rule of acute congestive heart failure obtainable in the emergency care setting.Derivation of the score was performed on a retrospective 927 patients cohort admitted to our Emergency Department for dyspnea. The prediction model was externally validated on an independent 206-patient prospective cohort.During the derivation phase, variables associated with acute congestive heart failure were included in a multivariate regression model. Logistic regression coefficients were used to assign scoring points to each variable. During the validation phase, every diagnosis was confirmed by an independent adjudication committee.The score comprised 11 variables: age ≥65 years (1 point), seizure dyspnea (2 points), night outbreak (1 point), orthopnea (1 point), history of pulmonary edema (2 points), chronic pulmonary disease (-2 points), myocardial infarction (1 point), crackles (2 points), leg edema (1 point), ST-segment abnormality (1 point), atrial fibrillation/flutter (1 point) on electrocardiography. In the validation step, 30 patients (14.6%) had a low clinical probability of acute congestive heart failure (score ≤3), of which only 2 (6.7%) had a proven acute cardiogenic pulmonary edema. The prevalence of acute congestive heart failure was 58.5% in the 94 patients with an intermediate probability (score of 4-8) and 91.5% in the 82 patients (39.8%) with a high probability (score ≥9).This score of acute congestive heart failure based on easily available and objective variables is entirely standardized. Applying the score to dyspneic adult emergency patients may enable a more rapid and efficient diagnostic process

008: Management of ST-elevation myocardial infarction in octogenarian patients. Data from ORBI, a prospective registry of 5000 patients

PurposeTo determine the actual management of ST-elevation myocardial infarction (STEMI) in octogenarian patients and more.MethodsWe analyzed data collected in “ORBI”, a 6 years prospective registry of STEMI patients admitted within 24h of symptoms onset to an interventional cardiology centre of Brittany (France). Main data about management and intra hospital outcome were compared between patients older (Group 1) and younger (Group 2) than 80.Results550 of the 5000 patients (11%, mean age 84.6 ±3) constituted group 1, with a larger female prevalence (51 vs 20% in group 2, p<0.0001). Group 1 had a much longer median delay between onset of symptom and call for medical assistance (65 vs 45min.), and between admission and reperfusion (53 vs 45min.). Table 1 presents data about the management in the 2 groups, both in the acute phase and at discharge. Last, intra hospital mortality is much higher in group 1 (16.5 vs 4.1%, p<0.0001).ConclusionsOctogenarian patients and more represent a large part of patient treated for STEMI, with significant differences in their presentation and management, and a high mortality.Table 1 – *Percentages are calculated only in patients undergoing coronary angiography.Group 1 >80years old n=550Group 2 ≤ 80 years old _=4450Initial managementFibrinolysis38 (7%)723 (16%)<0.0001GP IIb/IIIa receptor inhibitors223 (40%)2674 (60%)<0.0001Coronary angiography493 (89%)4402 (99%)<0.0001Radial access*140 (28%)1511 (34%)<0.0001Primary angioplasty*386 (78%)3197 (72%)0.4Thrombo aspiration*163 (33%)1874 (42%)<0.0001Intra hospital outcomeHigh degree AV block40 (7%)140 (3%)<0.0001Atrial fibrillation59 (10%)161 (3.6%)<0.0001Left ventricular ejection fraction (%)47.2±1250.6±10<0.0001Total length of stay (days)8.2±56.8±4<0.0001Prescription at dischargeAspirine439 (95,6%)4167 (97,7%)0,007Clopidogrel/Prasugrel413 (90,0%)4086 (95,8%)<0,0001β blockers394 (85,8%)3895 (91,3%)<0,0001ACE inhibitor290 (63,2%)2853 (66,9%)0,1Statine373 (81,3%)4057 (95,1%)<0,0001Cardiovascular rehabilitation22 (5,3%)1822 (46,6%)<0,000

Evolution of Early Repolarization Patterns after 5 Years in a Military Population at Low Cardiovascular Risk and Practical Implications in Military Medical Expertise

International audienc