A prospective observational study of treatment practice patterns in acute coronary syndrome patients undergoing percutaneous coronary intervention in Europe

SummaryBackgroundThe AntiPlatelet Therapy Observational Registry (APTOR) was a prospective observational study of acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) in France, Spain, and the UK.AimsTo evaluate patterns of ACS healthcare use, focusing on APTOR results from France.MethodsConsecutive presenting ACS patients requiring PCI were recruited between January and August 2007. Treatments and outcomes were recorded from the qualifying ACS event to 12months follow-up.ResultsIn France, qualifying diagnosis was unstable angina/non-ST-segment elevation myocardial infarction (UA/NSTEMI) in 255(53%) patients and ST-segment elevation myocardial infarction (STEMI) in 228(47%)patients. Ninety-six percent underwent PCI with stent implantation. Drug eluting stents were used less frequently in France(22%) than Spain (54%) or the UK (42%). In France, antiplatelets were more frequently received in the ambulance (21%); a 200–299mg aspirin-loading dose was most frequently received (50%) and more than a third of patients received a clopidogrel-loading dose of over300mg (34%). At 12months in France, 86% were still receiving aspirin, 75% clopidogrel, and 73% combination treatment.ConclusionThere was considerable country-variation in ACS management. These results provide a benchmark of physician practice to compare with guidelines

0015: High LDL cholesterol decreases life expectancy in primary prevention

BackgroundThe 2012 ESC guidelines recommend a LDL-cholesterol (LDL-C) lower than 3mmol/L for subjects at low or moderate risk with a class I/A and a strong grade. According to ESC, statins should be used as the drugs of first choice. The aim of this study was to assess the association between elevated LDL-C with total and cardiovascular (CV) mortality in primary prevention.MethodsOur study population consisted in patients who had been admitted from 1995 to 2011 in a preventive cardiology unit of a large French university hospital. We excluded patients whose age was less than 30 and all patients with previous ischemic heart disease. Vital status in 2011 was checked through the death national database.Results4885 patients were included (59% men; 53±10 yrs). After a mean follow-up of 8.6 years, 129 deaths, including 31 CV deaths, were recorded. The mean LDL-C was 3.98±1.18mmol/L (3.90 in men and 4.11 in women). Among these 4885 patients, 2648 (54.2%) had LDL-C lower than 4mmol/L, 1890 (38.7%) had LDL-C between 4 and 6mmol/L, 347 (7.1%) had LDL-C higher than 6mmol/L, and 1833 (37.5%) were on current lipid-lowering treatment. After adjustment for age, gender, smoking, hypertension and diabetes, an increased LDL-C > 4mmol/L was significantly associated with all cause mortality (hazard ratio (HR) 2.06; 95% confidence interval (CI) [1.42-3.00], p=0.001) and with CV mortality (HR 2.18; 95% CI [1.04-4.57], p=0.04). After adjustment for these classical risk factors and for lipid-lowering treatment, LDL-C remained significantly associated with an increasing risk of all cause mortality; with LDL-C < 4mmol/L as a reference class, LDL-C levels between 4 and 6mmol/L were associated with an increased all cause mortality (HR 1.72; 95% CI [1.17-2.54], p=0.006) as well as LDL-C > 6mmol/L (HR 2.60; 95% CI [1.49-4.85], p=0.001).ConclusionsLDL-C levels higher than 4mmol/L were significantly associated with all-cause and cardiovascular mortality in primary prevention

0098: Erythrocyte membrane phospholipid fatty acids, dairy intakes and cardiovascular risk

IntroductionThe impact of dairy fats on cardiovascular risk has been debated. Circulating Pentadecanoic (15:0) and heptadecanoic (17:0) saturated fatty acids are good biomarkers of dairy product consumption as they are mainly provided by dairy fats. We described the prevalence of cardiovascular risk factors according to erythrocyte membrane phospholipid content in 15:0 and 17:0 fatty acids.Methods402 women and men aged 45-64 were randomly selected in 2005-2007, from the general population of three French areas. Nutritional data were collected through a 3-day food record. Fatty acid content was measured in erythrocyte membrane phospholipids.ResultsErythrocyte membrane contents in 15:0 and 17:0 fatty acids significantly increased with the consumption of dairy products collected during the 3-day food record. Prevalence of hypertension significantly decreased from the lowest to the highest quartile of 15:0 erythrocyte content (48.1%; 33.3%; 29.9%; 25.5%; p=0.005). A similar trend was observed for metabolic syndrome prevalence (39.4%; 28.1%; 25.2%; 21.3%; p=0.029). Prevalence of hypertension, hypertriglyceridaemia, overweight and metabolic syndrome significantly decreased from the lowest to the highest quartile of 17:0 erythrocyte content (44.1%; 36.5%; 28.1%; 25.6%; p=0.020 for hypertension; 30.3%; 15.4%; 16.9%; 16.7%; p=0.017 for hypertriglyceridaemia; 68.1%; 58.7%; 46.6%; 44.4%; p=0.002 for overweight; and 43.2%; 26.9%; 22.5%; 17.8%; p<0.001 for metabolic syndrome). All these relationships remained significant after adjustment for age and gender. The link did not reach significance level for diabetes.ConclusionElevated erythrocyte membrane phospholipid contents in 15:0 and 17:0 saturated fatty acids are associated with a lower prevalence of the metabolic syndrome and several of its components. These results suggest that saturated fat intake should not be systematically associated with high cardiovascular risk and can be considered as part of a balanced diet

Frequency of fruit and vegetable consumption and coronary heart disease in France and Northern Ireland: the PRIME study

Fruit and vegetable consumption is associated with low CHD risk in the USA and Northern Europe. There is, in contrast, little information about these associations in other regions of Europe. The goal of the present study was to assess the relationship between frequency of fruit and vegetable intake and CHD risk in two European populations with contrasting cardiovascular incidence rates; France and Northern Ireland. The present prospective study was in men aged 50-59 years, free of CHD, who were recruited in France (n 5982) and Northern Ireland (n 2105). Fruit and vegetable intake was assessed by a food-frequency questionnaire. Incident cases of acute coronary events and angina were recorded over a 5-year follow-up. During follow-up there was a total of 249 ischaemic events. After adjustment on education level, smoking, physical activity, alcohol consumption, employment status, BMI, blood pressure, serum total and HDL-cholesterol, the relative risks (RR) of acute coronary events were 0·67 (95% CI 0·44, 1·03) and 0·64 (95% CI 0·41, 0·99) in the 2nd and 3rd tertiles of citrus fruit consumption, respectively (P for trend <0·03). Similar results were observed in France and Northern Ireland. In contrast, the RR of acute coronary events for ‘other fruit' consumption were 0·70 (95% CI 0·31, 1·56) and 0·52 (95% CI 0·24, 1·14) respectively in Northern Ireland (trend P<0·05) and 1·29 (95% CI 0·69, 2·4) and 1·15 (95% CI 0·68, 1·94) in France (trend P=0·5; interaction P<0·04). There was no evidence for any association between vegetable intake and total CHD events. In conclusion, frequency of citrus fruit, but not other fruits, intake is associated with lower rates of acute coronary events in both France and Northern Ireland, suggesting that geographical or related factors might affect the relationship between fruit consumption and CHD ris

The major element of 1-year prognosis in acute coronary syndromes is severity of initial clinical presentation: Results from the French MONICA registries

SummaryBackgroundWhile the death rate from acute coronary syndromes (ACS) has been in decline for more than 50years, out-of-hospital mortality remains high despite improvements in care.AimTo evaluate the importance of out-of-hospital mortality and identify the main predictors of in-hospital and 1-year mortality in France.MethodsAnalyses were based on data from the French MONICA population-based registry, which included all cases of ACS occurring in people aged 35–74years during 2006 in three geographic areas in France. We first evaluated out-of-hospital mortality; then, using data from patients with incident ACS who reached hospital alive, Cox models were performed to determine the main predictors of 1-year mortality. The number of attributable deaths was assessed for variables of interest.ResultsAfter 1-year follow-up, case-fatality was 29.3% for incident events (n=2547); the proportion of out-of-hospital deaths was 70.3%, and 91.5% of deaths occurred in the 28days following the ACS. On multivariable analysis, the number of attributable deaths associated with three scenarios (out-of-hospital life-and-death emergency, hospitalization before ACS occurrence, and lack of coronary angiography) was 130 (accounting for 59% of deaths occurring after reaching the hospital) during 1-year follow-up. These scenarios corresponded to patients with an initial severe clinical presentation in whom rates of use of specific treatments and invasive procedures were very low.ConclusionA large proportion of fatalities after an ACS occurs in the out-of-hospital phase. Moreover, the major component of 1-year mortality is associated with a poor prognosis at initial presentation. This finding highlights the importance of cardiovascular prevention, population education and better out-of-hospital emergency management in improving prognosis after an ACS

Systematic mapping of regions of human cardiac troponin I involved in binding to cardiac troponin C: N- and C-terminal low affinity contributing regions

AbstractThe Spot method of multiple peptide synthesis was used to map in a systematic manner regions of the human cardiac troponin I sequence (hcTnI) involved in interactions with its physiological partner, troponin C (cTnC). Ninety-six 20-mer peptides describing the entire hcTnI sequence were chemically assembled; their reactivity with [125I]cTnC, in the presence of 3 mM Ca2+, enabled the assignment of six sites of interaction (residues 19–32, 45–54, 129–138, 145–164, 161–178 and 191–210). For several sites, a good correlation with literature data was obtained, thus validating this methodological approach. Synthetic peptides, each containing in their sequence an interaction site, were prepared. As assessed by BIACORE, all of them exhibited an affinity for cTnC in the range of 10−6–10−7 M, except for hcTnI [39–58] which showed a nanomolar affinity. This peptide was also able to block the interaction between hcTnI and cTnC. We therefore postulate that despite the existence of multiple cTnC interaction sites on the hcTnI molecule, only that region of hcTnI allows a stabilization of the complex. Residues 19–32 from the N-terminal cardio-specific extension of hcTnI were also found to be involved in interaction with cTnC; residues 19–32 may correspond to the minimal sequence of the extension which could switch between the N- and C-terminal TnC domains, depending on its phosphorylation state. Finally, two Ca2+-dependent cTnC binding domains within the C-terminal part of hcTnI (residues 164–178 and 191–210) were also mapped. The latter site may be linked with the cardiac dysfunction observed in stunned myocardium