Transradial versus transfemoral approach for percutaneous coronary intervention in cardiogenic shock: A radial-first centre experience and meta-analysis of published studies

SummaryBackgroundThe transradial approach for percutaneous coronary intervention (PCI) is associated with a better outcome in myocardial infarction (MI), but patients with cardiogenic shock (CS) were excluded from most trials.AimsTo compare outcomes of PCI for MI-related CS via the transradial versus transfemoral approach.MethodsA prospective cohort of 101 consecutive patients admitted for PCI for MI-related CS were treated via the transradial (n=74) or transfemoral (n=27) approach. Cox proportional hazards models adjusted for prespecified variables and a propensity score for approach were used to compare mortality, death/MI/stroke and bleeding between the two groups. A complementary meta-analysis of six studies was also performed.ResultsPatients in the transradial group were younger (P=0.039), more often male (P=0.002) and had lower GRACE and CRUSADE scores (P=0.003 and 0.001, respectively) and rates of cardiac arrest before PCI (P=0.009) and mechanical ventilation (P=0.006). Rates of PCI success were similar. At a mean follow-up of 756 days, death occurred in 40 (54.1%) patients in the transradial group versus 22 (81.5%) in the transfemoral group (adjusted hazard ratio [HR]: 0.49, 95% confidence interval [CI] 0.28–0.84; P=0.012). The transradial approach was associated with reduced rates of death/MI/stroke (adjusted HR: 0.53, 95%CI: 0.31–0.91; P=0.02) and major bleeding (adjusted HR: 0.34, 95%CI: 0.13–0.87; P=0.02). The meta-analysis confirmed the benefit of transradial access in terms of mortality (relative risk [RR]: 0.63, 95%CI: 0.58–0.68) and major bleeding (RR: 0.43, 95%CI: 0.32–0.59).ConclusionThe transradial approach in the setting of PCI for ischaemic CS is associated with a dramatic reduction in mortality, ischaemic and bleeding events, and should be preferred to the transfemoral approach in radial expert centres

Transradial versus transfemoral approach for percutaneous coronary intervention in cardiogenic shock: A radial-first centre experience and meta-analysis of published studies

SummaryBackgroundThe transradial approach for percutaneous coronary intervention (PCI) is associated with a better outcome in myocardial infarction (MI), but patients with cardiogenic shock (CS) were excluded from most trials.AimsTo compare outcomes of PCI for MI-related CS via the transradial versus transfemoral approach.MethodsA prospective cohort of 101 consecutive patients admitted for PCI for MI-related CS were treated via the transradial (n=74) or transfemoral (n=27) approach. Cox proportional hazards models adjusted for prespecified variables and a propensity score for approach were used to compare mortality, death/MI/stroke and bleeding between the two groups. A complementary meta-analysis of six studies was also performed.ResultsPatients in the transradial group were younger (P=0.039), more often male (P=0.002) and had lower GRACE and CRUSADE scores (P=0.003 and 0.001, respectively) and rates of cardiac arrest before PCI (P=0.009) and mechanical ventilation (P=0.006). Rates of PCI success were similar. At a mean follow-up of 756 days, death occurred in 40 (54.1%) patients in the transradial group versus 22 (81.5%) in the transfemoral group (adjusted hazard ratio [HR]: 0.49, 95% confidence interval [CI] 0.28–0.84; P=0.012). The transradial approach was associated with reduced rates of death/MI/stroke (adjusted HR: 0.53, 95%CI: 0.31–0.91; P=0.02) and major bleeding (adjusted HR: 0.34, 95%CI: 0.13–0.87; P=0.02). The meta-analysis confirmed the benefit of transradial access in terms of mortality (relative risk [RR]: 0.63, 95%CI: 0.58–0.68) and major bleeding (RR: 0.43, 95%CI: 0.32–0.59).ConclusionThe transradial approach in the setting of PCI for ischaemic CS is associated with a dramatic reduction in mortality, ischaemic and bleeding events, and should be preferred to the transfemoral approach in radial expert centres

Coronary-Pulmonary Fistulas Involving All Three Major Coronary Arteries Co-Existing With Myocardial Infarction

We report the case of a man who presented with acute anterior myocardial infarction and in whom the coronary angiogram showed tight stenosis of the left anterior descending coronary artery and the right coronary artery associated with substantial coronary-pulmonary fistulas involving all three major coronary arteries. We discuss the possible links between coronary artery fistulas and myocardial infarction

Tako-Tsubo Cardiomyopathy Triggered by Misdirection

Tako-Tsubo cardiomyopathy (TTC), also known as transient left ventricular apical ballooning syndrome or stress-induced cardiomyopathy, is a novel reversible cardiomyopathy mimicking acute myocardial infarction without epicardial coronary artery disease. The exact physiopathology of TTC remains unclear. It is usually precipitated by acute physical or emotional stress and it most commonly affects postmenopausal women. The growing number of clinical cases of TTC have demonstrated a wide field of possible etiologies beyond the emotional stress. We report a case of a 67-year-old postmenopausal woman who was being supplemented by enteral feeding via a nasogastric tube and who developed TTC due to misdirection, probably favored by the mechanical blockade by the nasogastric tube, while swallowing the drug pills

Association of the PHACTR1/EDN1 genetic locus with spontaneous coronary artery dissection

Background: Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndromes (ACS) afflicting predominantly younger to middle-aged women. Observational studies have reported a high prevalence of extracoronary vascular anomalies, especially fibromuscular dysplasia (FMD) and a low prevalence of coincidental cases of atherosclerosis. PHACTR1/EDN1 is a genetic risk locus for several vascular diseases, including FMD and coronary artery disease, with the putative causal noncoding variant at the rs9349379 locus acting as a potential enhancer for the endothelin-1 (EDN1) gene. Objectives: This study sought to test the association between the rs9349379 genotype and SCAD. Methods: Results from case control studies from France, United Kingdom, United States, and Australia were analyzed to test the association with SCAD risk, including age at first event, pregnancy-associated SCAD (P-SCAD), and recurrent SCAD. Results: The previously reported risk allele for FMD (rs9349379-A) was associated with a higher risk of SCAD in all studies. In a meta-analysis of 1,055 SCAD patients and 7,190 controls, the odds ratio (OR) was 1.67 (95% confidence interval [CI]: 1.50 to 1.86) per copy of rs9349379-A. In a subset of 491 SCAD patients, the OR estimate was found to be higher for the association with SCAD in patients without FMD (OR: 1.89; 95% CI: 1.53 to 2.33) than in SCAD cases with FMD (OR: 1.60; 95% CI: 1.28 to 1.99). There was no effect of genotype on age at first event, P-SCAD, or recurrence. Conclusions: The first genetic risk factor for SCAD was identified in the largest study conducted to date for this condition. This genetic link may contribute to the clinical overlap between SCAD and FMD

Caractérisation de la plaque athérothrombotique à la phase aigüe de l'infarctus du myocarde en imagerie endocoronaire et marqueurs biologiques thrombotiques

Platelet activity plays a key role in the pathophysiology of ST-segment elevation myocardial infarction (STEMI). Platelet reactivity is enhanced after STEMI treated with primary percutaneous coronary intervention (PCI) or successful thrombolysis. The relationship between residual platelet reactivity after pre-treatment, the atherothrombotic burden and the quality of reperfusion remains poorly described in STEMI. Optical coherence tomography (OCT) and optical frequency domain imaging (OFDI) provide high resolution imaging allowing identification and accurate quantification of intracoronary atherothrombotic burden (ATB). Residual in-stent ATB may help to better understand the relation between platelet reactivity and reperfusion. First, we assessed the accuracy of the point-of-care tests VerifyNow and PFA in comparison to light transmittance aggregometry to detect high on-treatment platelet reactivity (HPR) in the particular setting of STEMI successfully treated with fibrinolysis. We also described the characteristics of ATB before and after PCI according to the underlying presence of rupture or erosion in patients successfully treated with fibrinolysis. Then, we assessed the relationship between residual platelet reactivity (in response to ticagrelor and aspirin) using VerifyNow and myocardial reperfusion in primary PCI patients. In parallel, we studied the relationship between myocardial reperfusion and residual in-stent ATB in the same cohort.L’activité plaquettaire joue un rôle clé dans la physiopathologie de l’infarctus du myocarde avec sus-décalage du segment ST (IDM ST+). La réactivité plaquettaire est augmentée lors d’un IDM ST+, traité par angioplastie primaire ou par fibrinolyse avec succès. La relation entre la réactivité plaquettaire résiduelle après un pré-traitement, la charge athérothrombotique et la qualité de la reperfusion myocardique reste peu décrite dans le cadre des IDM ST+. La tomographie par cohérence optique et celle plus récente par domaine de fréquence offrent une imagerie de haute résolution permettant l’identification et la quantification précise de la charge athérothrombotique intracoronaire (CAT). La CAT résiduelle intra-stent peut aider à mieux comprendre la relation entre la réactivité plaquettaire et la reperfusion. Dans un premier temps, nous avons évalué la précision des tests VerifyNow et PFA en comparaison à l’agrégométrie optique pour la détection de l’hyperréactivité plaquettaire dans le contexte particulier des IDM ST+ traités par fibrinolyse avec succès. Nous avons aussi décrit les caractéristiques de la CAT avant et après angioplastie selon la présence d’une rupture de plaque ou d’une érosion coronaire chez des patients traités par fibrinolyse avec succès. Ensuite, nous avons étudié la relation entre la réactivité plaquettaire résiduelle (en réponse au ticagrelor et à l’aspirine) mesurée par VerifyNow et la reperfusion myocardique chez des patients traités par angioplastie primaire. En parallèle, nous avons décrit la relation entre la reperfusion myocardique et la CAT résiduelle intra-stent dans la même cohorte

Caractérisation de la plaque athérothrombotique à la phase aigüe de l'infarctus du myocarde en imagerie endocoronaire et marqueurs biologiques thrombotiques

Platelet activity plays a key role in the pathophysiology of ST-segment elevation myocardial infarction (STEMI). Platelet reactivity is enhanced after STEMI treated with primary percutaneous coronary intervention (PCI) or successful thrombolysis. The relationship between residual platelet reactivity after pre-treatment, the atherothrombotic burden and the quality of reperfusion remains poorly described in STEMI. Optical coherence tomography (OCT) and optical frequency domain imaging (OFDI) provide high resolution imaging allowing identification and accurate quantification of intracoronary atherothrombotic burden (ATB). Residual in-stent ATB may help to better understand the relation between platelet reactivity and reperfusion. First, we assessed the accuracy of the point-of-care tests VerifyNow and PFA in comparison to light transmittance aggregometry to detect high on-treatment platelet reactivity (HPR) in the particular setting of STEMI successfully treated with fibrinolysis. We also described the characteristics of ATB before and after PCI according to the underlying presence of rupture or erosion in patients successfully treated with fibrinolysis. Then, we assessed the relationship between residual platelet reactivity (in response to ticagrelor and aspirin) using VerifyNow and myocardial reperfusion in primary PCI patients. In parallel, we studied the relationship between myocardial reperfusion and residual in-stent ATB in the same cohort.L’activité plaquettaire joue un rôle clé dans la physiopathologie de l’infarctus du myocarde avec sus-décalage du segment ST (IDM ST+). La réactivité plaquettaire est augmentée lors d’un IDM ST+, traité par angioplastie primaire ou par fibrinolyse avec succès. La relation entre la réactivité plaquettaire résiduelle après un pré-traitement, la charge athérothrombotique et la qualité de la reperfusion myocardique reste peu décrite dans le cadre des IDM ST+. La tomographie par cohérence optique et celle plus récente par domaine de fréquence offrent une imagerie de haute résolution permettant l’identification et la quantification précise de la charge athérothrombotique intracoronaire (CAT). La CAT résiduelle intra-stent peut aider à mieux comprendre la relation entre la réactivité plaquettaire et la reperfusion. Dans un premier temps, nous avons évalué la précision des tests VerifyNow et PFA en comparaison à l’agrégométrie optique pour la détection de l’hyperréactivité plaquettaire dans le contexte particulier des IDM ST+ traités par fibrinolyse avec succès. Nous avons aussi décrit les caractéristiques de la CAT avant et après angioplastie selon la présence d’une rupture de plaque ou d’une érosion coronaire chez des patients traités par fibrinolyse avec succès. Ensuite, nous avons étudié la relation entre la réactivité plaquettaire résiduelle (en réponse au ticagrelor et à l’aspirine) mesurée par VerifyNow et la reperfusion myocardique chez des patients traités par angioplastie primaire. En parallèle, nous avons décrit la relation entre la reperfusion myocardique et la CAT résiduelle intra-stent dans la même cohorte

Intracoronary imaging characterization of atherothrombotic plaque in acute myocardial infarction and biological markers of thrombosis

L’activité plaquettaire joue un rôle clé dans la physiopathologie de l’infarctus du myocarde avec sus-décalage du segment ST (IDM ST+). La réactivité plaquettaire est augmentée lors d’un IDM ST+, traité par angioplastie primaire ou par fibrinolyse avec succès. La relation entre la réactivité plaquettaire résiduelle après un pré-traitement, la charge athérothrombotique et la qualité de la reperfusion myocardique reste peu décrite dans le cadre des IDM ST+. La tomographie par cohérence optique et celle plus récente par domaine de fréquence offrent une imagerie de haute résolution permettant l’identification et la quantification précise de la charge athérothrombotique intracoronaire (CAT). La CAT résiduelle intra-stent peut aider à mieux comprendre la relation entre la réactivité plaquettaire et la reperfusion. Dans un premier temps, nous avons évalué la précision des tests VerifyNow et PFA en comparaison à l’agrégométrie optique pour la détection de l’hyperréactivité plaquettaire dans le contexte particulier des IDM ST+ traités par fibrinolyse avec succès. Nous avons aussi décrit les caractéristiques de la CAT avant et après angioplastie selon la présence d’une rupture de plaque ou d’une érosion coronaire chez des patients traités par fibrinolyse avec succès. Ensuite, nous avons étudié la relation entre la réactivité plaquettaire résiduelle (en réponse au ticagrelor et à l’aspirine) mesurée par VerifyNow et la reperfusion myocardique chez des patients traités par angioplastie primaire. En parallèle, nous avons décrit la relation entre la reperfusion myocardique et la CAT résiduelle intra-stent dans la même cohorte.Platelet activity plays a key role in the pathophysiology of ST-segment elevation myocardial infarction (STEMI). Platelet reactivity is enhanced after STEMI treated with primary percutaneous coronary intervention (PCI) or successful thrombolysis. The relationship between residual platelet reactivity after pre-treatment, the atherothrombotic burden and the quality of reperfusion remains poorly described in STEMI. Optical coherence tomography (OCT) and optical frequency domain imaging (OFDI) provide high resolution imaging allowing identification and accurate quantification of intracoronary atherothrombotic burden (ATB). Residual in-stent ATB may help to better understand the relation between platelet reactivity and reperfusion. First, we assessed the accuracy of the point-of-care tests VerifyNow and PFA in comparison to light transmittance aggregometry to detect high on-treatment platelet reactivity (HPR) in the particular setting of STEMI successfully treated with fibrinolysis. We also described the characteristics of ATB before and after PCI according to the underlying presence of rupture or erosion in patients successfully treated with fibrinolysis. Then, we assessed the relationship between residual platelet reactivity (in response to ticagrelor and aspirin) using VerifyNow and myocardial reperfusion in primary PCI patients. In parallel, we studied the relationship between myocardial reperfusion and residual in-stent ATB in the same cohort

Thrombus sur coronaires normales (revue de la littérature et étude rétrospective de 1998 à 2008)

CAEN-BU Médecine pharmacie (141182102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF