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Coronary Artery Disease: HELP
Articles by Gilles Montalescot
Based on 40 articles published since 2008
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Between 2008 and 2019, G. Montalescot wrote the following 40 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Guideline 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS. 2018

Valgimigli, Marco / Bueno, Héctor / Byrne, Robert A / Collet, Jean-Philippe / Costa, Francesco / Jeppsson, Anders / Jüni, Peter / Kastrati, Adnan / Kolh, Philippe / Mauri, Laura / Montalescot, Gilles / Neumann, Franz-Josef / Petricevic, Mate / Roffi, Marco / Steg, Philippe Gabriel / Windecker, Stephan / Zamorano, Jose Luis / Levine, Glenn N / Anonymous3740973. · ·Eur J Cardiothorac Surg · Pubmed #29045581.

ABSTRACT: -- No abstract --

2 Guideline [2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS.] 2017

Valgimigli, Marco / Bueno, Héctor / Byrne, Robert A / Collet, Jean-Philippe / Costa, Francesco / Jeppsson, Anders / Jüni, Peter / Kastrati, Adnan / Kolh, Philippe / Mauri, Laura / Montalescot, Gilles / Neumann, Franz-Josef / Peticevic, Mate / Roffi, Marco / Steg, Philippe Gabriel / Windecker, Stephan / Zamorano, Jose Luis. ·Cardiology, Inselspital, Bern. marco.valgimigli@insel.ch. ·Kardiol Pol · Pubmed #29251754.

ABSTRACT: -- No abstract --

3 Guideline 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. 2013

Anonymous3190768 / Montalescot, Gilles / Sechtem, Udo / Achenbach, Stephan / Andreotti, Felicita / Arden, Chris / Budaj, Andrzej / Bugiardini, Raffaele / Crea, Filippo / Cuisset, Thomas / Di Mario, Carlo / Ferreira, J Rafael / Gersh, Bernard J / Gitt, Anselm K / Hulot, Jean-Sebastien / Marx, Nikolaus / Opie, Lionel H / Pfisterer, Matthias / Prescott, Eva / Ruschitzka, Frank / Sabaté, Manel / Senior, Roxy / Taggart, David Paul / van der Wall, Ernst E / Vrints, Christiaan J M / Anonymous3200768 / Zamorano, Jose Luis / Achenbach, Stephan / Baumgartner, Helmut / Bax, Jeroen J / Bueno, Héctor / Dean, Veronica / Deaton, Christi / Erol, Cetin / Fagard, Robert / Ferrari, Roberto / Hasdai, David / Hoes, Arno W / Kirchhof, Paulus / Knuuti, Juhani / Kolh, Philippe / Lancellotti, Patrizio / Linhart, Ales / Nihoyannopoulos, Petros / Piepoli, Massimo F / Ponikowski, Piotr / Sirnes, Per Anton / Tamargo, Juan Luis / Tendera, Michal / Torbicki, Adam / Wijns, William / Windecker, Stephan / Anonymous3210768 / Knuuti, Juhani / Valgimigli, Marco / Bueno, Héctor / Claeys, Marc J / Donner-Banzhoff, Norbert / Erol, Cetin / Frank, Herbert / Funck-Brentano, Christian / Gaemperli, Oliver / Gonzalez-Juanatey, José R / Hamilos, Michalis / Hasdai, David / Husted, Steen / James, Stefan K / Kervinen, Kari / Kolh, Philippe / Kristensen, Steen Dalby / Lancellotti, Patrizio / Maggioni, Aldo Pietro / Piepoli, Massimo F / Pries, Axel R / Romeo, Francesco / Rydén, Lars / Simoons, Maarten L / Sirnes, Per Anton / Steg, Ph Gabriel / Timmis, Adam / Wijns, William / Windecker, Stephan / Yildirir, Aylin / Zamorano, Jose Luis. ·The disclosure forms of the authors and reviewers are available on the ESC website www.escardio.org/guidelines. ·Eur Heart J · Pubmed #23996286.

ABSTRACT: -- No abstract --

4 Editorial Can a stable coronary artery disease patient be at high ischaemic risk for scheduled non-cardiac surgery? 2018

Lattuca, Benoit / Cayla, Guillaume / Montalescot, Gilles. ·ACTION Study Group, Cardiology department, Nîmes University Hospital, Montpellier University, place du Pr-Debré, 30029 cedex Nîmes, France; ACTION Study Group, INSERM UMRS 1166, Sorbonne University, Cardiology Institute, Pitié-Salpêtrière (AP-HP) University Hospital, Paris, France. · ACTION Study Group, Cardiology department, Nîmes University Hospital, Montpellier University, place du Pr-Debré, 30029 cedex Nîmes, France. Electronic address: cayla.guillaume@gmail.com. · ACTION Study Group, INSERM UMRS 1166, Sorbonne University, Cardiology Institute, Pitié-Salpêtrière (AP-HP) University Hospital, Paris, France. ·Anaesth Crit Care Pain Med · Pubmed #30055828.

ABSTRACT: -- No abstract --

5 Editorial Moving Toward Eradication of Stent Thrombosis. 2016

Barthélémy, Olivier / Montalescot, Gilles. ·Université Paris 06, ACTION Study Group, INSERM-UMRS 1166, Institut de Cardiologie, Pitié-Salpêtrière University Hospital, Paris, France. · Université Paris 06, ACTION Study Group, INSERM-UMRS 1166, Institut de Cardiologie, Pitié-Salpêtrière University Hospital, Paris, France. Electronic address: gilles.montalescot@psl.aphp.fr. ·J Am Coll Cardiol · Pubmed #26892410.

ABSTRACT: -- No abstract --

6 Editorial The arranged marriage of cangrelor and bivalirudin. 2015

Montalescot, Gilles / Helft, Gérard. ·ACTION Study Group, Institut de Cardiologie (AP-HP), Hôpital Pitié-Salpêtrière, University Paris 6, INSERM UMRS 1166, Paris, France. Electronic address: gilles.montalescot@psl.aphp.fr. · ACTION Study Group, Institut de Cardiologie (AP-HP), Hôpital Pitié-Salpêtrière, University Paris 6, INSERM UMRS 1166, Paris, France. ·JACC Cardiovasc Interv · Pubmed #25703891.

ABSTRACT: -- No abstract --

7 Editorial Blockbuster interactions: are they bad for the patient? 2012

Hulot, Jean-Sébastien / Montalescot, Gilles. · ·Eur Heart J · Pubmed #22613346.

ABSTRACT: -- No abstract --

8 Review Dual antiplatelet therapy: optimal timing, management, and duration. 2015

Sabouret, Pierre / Rushton-Smith, Sophie K / Kerneis, Mathieu / Silvain, Johanne / Collet, Jean-Philippe / Montalescot, Gilles. ·Institut du Cœur, Pitié-Salpêtrière Hospital (AP-HP), Pierre and Marie Curie University, 47-83, boulevard de l'Hôpital, Paris 75013, France, ACTION Group, www.action-coeur.org. · Thrombosis Research Institute, London, UK. · Institut du Cœur, Pitié-Salpêtrière Hospital (AP-HP), Pierre and Marie Curie University, 47-83, boulevard de l'Hôpital, Paris 75013, France, ACTION Group, www.action-coeur.org gilles.montalescot@psl.aphp.fr. ·Eur Heart J Cardiovasc Pharmacother · Pubmed #27533996.

ABSTRACT: Platelet activation and aggregability play a key role in the genesis of arterial thrombus secondary to plaque rupture. For coronary patients, inhibition of platelet function is crucial to decrease the rate of major adverse cardiac events but may expose them to excess bleeding risk. Switching P2Y12 inhibitors is common, yet the clinical consequences are unknown. The aim of this review is to provide an overview of the evidence from randomized, clinical trials and epidemiological studies, with a focus on the optimal duration of dual antiplatelet therapy (DAPT) and appropriate agent and dose selection. The report discusses the latest evidence regarding switching therapies during DAPT, the potential benefits of a personalized strategy, management of the preoperative period, and other clinical perspectives in this complex and rapidly changing field. Ongoing trials will be useful to answer to some important unresolved questions.

9 Review Coronary revascularization in the diabetic patient. 2014

Silvain, Johanne / Vignalou, Jean-Baptiste / Barthélémy, Olivier / Kerneis, Mathieu / Collet, Jean-Philippe / Montalescot, Gilles. ·From the ACTION Coeur Research Group, Institut de Cardiologie, Pitié-Salpêtrière Hospital (APHP), Sorbonne Universités, (UPMC), INSERM, UMRS 1166, Paris, France. · From the ACTION Coeur Research Group, Institut de Cardiologie, Pitié-Salpêtrière Hospital (APHP), Sorbonne Universités, (UPMC), INSERM, UMRS 1166, Paris, France. gilles.montalescot@psl.aphp.fr. ·Circulation · Pubmed #25199665.

ABSTRACT: -- No abstract --

10 Review Association of clopidogrel pretreatment with mortality, cardiovascular events, and major bleeding among patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis. 2012

Bellemain-Appaix, Anne / O'Connor, Stephen A / Silvain, Johanne / Cucherat, Michel / Beygui, Farzin / Barthélémy, Olivier / Collet, Jean-Philippe / Jacq, Laurent / Bernasconi, François / Montalescot, Gilles / Anonymous2460746. ·Service de Cardiologie-La FontonneHospital, Antibes, France. ·JAMA · Pubmed #23287889.

ABSTRACT: CONTEXT: Clopidogrel pretreatment is recommended for patients with acute coronary syndromes (ACS) and stable coronary artery disease who are scheduled for percutaneous coronary intervention (PCI), but whether using clopidogrel as a pretreatment for PCI is associated with positive clinical outcomes has not been established. OBJECTIVE: To evaluate the association of clopidogrel pretreatment vs no treatment with mortality and major bleeding after PCI. DATA SOURCES: MEDLINE, EMBASE, Cochrane Controlled Trials Register databases, and reference lists of qualifying articles. STUDY SELECTION Studies reporting clinical data on mortality and major bleeding were included. Of the 392 titles identified, 15 articles published between August 2001 and September 2012 met the inclusion criteria: 6 randomized controlled trials (RCTs), 2 observational analyses of RCTs, and 7 observational studies. DATA EXTRACTION: Quality of studies was assessed with the Ottawa Scale and the Jadad Score as appropriate. Results were independently extracted by 2 reviewers. A random-effect model was applied. Pretreatment was defined as the administration of clopidogrel before PCI or catheterization. The main analysis was performed on RCTs and confirmed by observational analyses and observational studies. Prespecified subgroups--clinical presentation and clopidogrel loading dose--were analyzed. The primary efficacy and safety end points were all-cause mortality and major bleeding. Secondary end points included major cardiac events. RESULTS: Of the 37 814 patients included in the meta-analysis, 8608 patients had participated in RCTs; 10,945, in observational analyses of RCTs; and 18,261, in observational studies. Analysis of RCTs showed that clopidogrel pretreatment was not associated with a reduction of death (absolute risk, 1.54% vs 1.97%; OR, 0.80; 95% CI, 0.57-1.11; P = .17) but was associated with a lower risk of major cardiac events (9.83% vs 12.35%; OR, 0 .77; 95% CI, 0.66-0.89; P < .001). There was no significant association between pretreatment and major bleeding overall (3 .57% vs 3.08%; OR, 1.18; 95% CI, 0.93-1.50; P = .18). Analyses from observational analyses of RCTs and observational studies were consistent for all results. CONCLUSIONS: Among patients scheduled for PCI, clopidogrel pretreatment was not associated with a lower risk of mortality but was associated with a lower risk of major coronary events.

11 Clinical Trial Assessment of the clinical effects of cholesteryl ester transfer protein inhibition with evacetrapib in patients at high-risk for vascular outcomes: Rationale and design of the ACCELERATE trial. 2015

Nicholls, Stephen J / Lincoff, A Michael / Barter, Philip J / Brewer, H Bryan / Fox, Keith A A / Gibson, C Michael / Grainger, Christopher / Menon, Venugopal / Montalescot, Gilles / Rader, Daniel / Tall, Alan R / McErlean, Ellen / Riesmeyer, Jeffrey / Vangerow, Burkhard / Ruotolo, Giacomo / Weerakkody, Govinda J / Nissen, Steven E. ·South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, Australia. · Cleveland Clinic Coordinating Center for Clinical Research and Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH. · University of New South Wales, Sydney, Australia. · Medstar Research Institute, Hyattsville, MD. · University of Edinburgh, Edinburgh, Scotland. · Harvard Medical School, Boston, MA. · Duke Clinical Research Institute, Durham, NC. · Pitie-Salpetriere University Hospital, Paris, France. · University of Pennsylvania, Philadelphia, PA. · Columbia University, New York City, NY. · Eli Lilly and Company, Indianapolis, IN. ·Am Heart J · Pubmed #26678626.

ABSTRACT: BACKGROUND: Potent pharmacologic inhibition of cholesteryl ester transferase protein by the investigational agent evacetrapib increases high-density lipoprotein cholesterol by 54% to 129%, reduces low-density lipoprotein cholesterol by 14% to 36%, and enhances cellular cholesterol efflux capacity. The ACCELERATE trial examines whether the addition of evacetrapib to standard medical therapy reduces the risk of cardiovascular (CV) morbidity and mortality in patients with high-risk vascular disease. STUDY DESIGN: ACCELERATE is a phase 3, multicenter, randomized, double-blind, placebo-controlled trial. Patients qualified for enrollment if they have experienced an acute coronary syndrome within the prior 30 to 365 days, cerebrovascular accident, or transient ischemic attack; if they have peripheral vascular disease; or they have diabetes with coronary artery disease. A total of 12,092 patients were randomized to evacetrapib 130 mg or placebo daily in addition to standard medical therapy. The primary efficacy end point is time to first event of CV death, myocardial infarction, stroke, hospitalization for unstable angina, or coronary revascularization. Treatment will continue until 1,670 patients reached the primary end point; at least 700 patients reach the key secondary efficacy end point of CV death, myocardial infarction, and stroke, and the last patient randomized has been followed up for at least 1.5 years. CONCLUSIONS: ACCELERATE will establish whether the cholesteryl ester transfer protein inhibition by evacetrapib improves CV outcomes in patients with high-risk vascular disease.

12 Article Systematic detection of polyvascular disease combined with aggressive secondary prevention in patients presenting with severe coronary artery disease: The randomized AMERICA Study. 2018

Collet, Jean-Philippe / Cayla, Guillaume / Ennezat, Pierre-Vladimir / Leclercq, Florence / Cuisset, Thomas / Elhadad, Simon / Henry, Patrick / Belle, Loic / Cohen, Ariel / Silvain, Johanne / Barthelemy, Olivier / Beygui, Farzin / Diallo, Abdourahmane / Vicaut, Eric / Montalescot, Gilles / Anonymous6390935. ·Sorbonne Université Paris 6, ACTION Study Group, Institut de Cardiologie Hôpital Pitié-Salpêtrière (APHP), INSERM UMRS, 1166 Paris, France. Electronic address: jean-philippe.collet@psl.aphp.fr. · ACTION Study Group, Cardiologie, CHU Carémeau, Université de Montpellier, Nîmes, France. · Cardiologie, Pôle Thorax et Vaisseaux, CHU La Tronche, Grenoble, France. · Cardiologie, Hôpital Arnaud de Villeneuve-CHU Montpellier, France. · Department of Cardiology, CHU Timone and Aix-Marseille Univ, INSERM UMR1062, INRA UMR1260, Nutrition, Obesity and Risk of Thrombosis, Faculty of Medicine, F-13385 Marseille, France. · Cardiologie, CH de Lagny-Marne la Vallée, Jossigny, France. · Cardiologie, CHU Lariboisière (APHP), Paris, France. · Cardiologie, Centre Hospitalier d'Annecy, France. · Cardiologie, CHU Saint-Antoine (APHP), Paris, France. · Sorbonne Université Paris 6, ACTION Study Group, Institut de Cardiologie Hôpital Pitié-Salpêtrière (APHP), INSERM UMRS, 1166 Paris, France. · Cardiologie, Hôpital de la Côte de Nacre, Caen, France. · ACTION Study Group, Unité de Recherche Clinique-Hôpital Lariboisière (APHP), France and Université Denis Diderot, Paris, France. ·Int J Cardiol · Pubmed #29407124.

ABSTRACT: BACKGROUND: The prevalence and associated-risk of asymptomatic multisite artery disease (MSAD) in high risk coronary patients are unknown. Whether systematic identification and aggressive management of asymptomatic MSAD is clinically relevant in high risk coronary patients has not been evaluated. METHODS: We randomly assigned 521 high risk coronary patients defined by the presence of three-vessel coronary disease (n=304) or recent acute coronary syndrome beyond the age of 75years (n=215) to either a strategy of systematic detection of asymptomatic MSAD combined with an aggressive secondary prevention (n=263) or to a more conventional strategy based on treatment of coronary artery disease only with standard of care (n=258). The primary end point was the time to first occurrence of death, any organ failure or ischemic event leading to re-hospitalization through two years of follow-up. RESULTS: The pro-active strategy identified asymptomatic MSAD in 21.7% of patients with few revascularizations (3.6%); the pro-active pharmacological secondary prevention was obtained in >85% of patients and life-style changes in <60% of patients. At 2-year follow-up, the primary end point occurred in 44.9% of patients in the pro-active group and 43.0% of patients in the conventional group (HR 1.03; 95% confidence interval [CI], 0.80 to 1.34]. The rate of major bleeding did not differ significantly between groups (4.6% vs 5.0%; HR, 0.97; 95% CI, 0.40 to 1.91). CONCLUSION: In high risk coronary patients, there is no apparent benefit of a systematic detection of asymptomatic extra-coronary atherothrombotic disease and intensified treatment over a 2-year follow-up period. (Funded by the Academic Allies in Cardiovascular Trials Initiatives and Organized Networks and Institut de l'Athérothrombose; AMERICA ClinicalTrials.gov number, NCT00445835).

13 Article Outcome after revascularisation of acute myocardial infarction with cardiogenic shock on extracorporeal life support. 2018

Overtchouk, Pavel / Pascal, Julien / Lebreton, Guillaume / Hulot, Jean-Sebastien / Luyt, Charles-Edouard / Combes, Alain / Kerneis, Mathieu / Silvain, Johanne / Barthelemy, Olvier / Leprince, Pascal / Brechot, Nicolas / Montalescot, Gilles / Collet, Jean-Philippe. ·Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Département de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France. ·EuroIntervention · Pubmed #29400656.

ABSTRACT: AIMS: The aim of the study was to identify independent correlates of survival in patients undergoing PCI for refractory cardiogenic shock due to myocardial infarction (RCS-MI) with the need for extracorporeal life support (ECLS). METHODS AND RESULTS: This observational single tertiary centre study enrolled 106 consecutive patients (52.7±10.4 years) with ECLS placed before or after the PCI. Half of the patients had triple vessel disease and PCI was attempted whenever possible (74.5%). The 30-day mortality rate was 63.2%. Left main culprit vessel disease (19% of patients) (adj. HR [95% CI]: 2.31 [1.27-4.18], p=0.006) and sepsis-related organ failure assessment ≥13 (adj. HR 2.17 [1.25-3.75], p=0.005) were independently associated with 30-day mortality. The use of intra-aortic balloon pump (IABP) combined with ECLS was an independent protective factor (adj. HR 0.48 [0.28-0.80], p=0.006). Neither complete (p=0.66) nor successful (p=0.69) myocardial revascularisation was associated with 30-day survival. CONCLUSIONS: RCS in MI patients often reveals a severe multivessel coronary artery disease with no impact of early percutaneous coronary revascularisation on clinical outcome. The survival advantage of IABP when combined with ECLS further suggests that achieving an early effective haemodynamic support should be the major goal in this young patient population.

14 Article PCI Strategies in Patients with Acute Myocardial Infarction and Cardiogenic Shock. 2017

Thiele, Holger / Akin, Ibrahim / Sandri, Marcus / Fuernau, Georg / de Waha, Suzanne / Meyer-Saraei, Roza / Nordbeck, Peter / Geisler, Tobias / Landmesser, Ulf / Skurk, Carsten / Fach, Andreas / Lapp, Harald / Piek, Jan J / Noc, Marko / Goslar, Tomaž / Felix, Stephan B / Maier, Lars S / Stepinska, Janina / Oldroyd, Keith / Serpytis, Pranas / Montalescot, Gilles / Barthelemy, Olivier / Huber, Kurt / Windecker, Stephan / Savonitto, Stefano / Torremante, Patrizia / Vrints, Christiaan / Schneider, Steffen / Desch, Steffen / Zeymer, Uwe / Anonymous351213. ·From Heart Center Leipzig, University Hospital, Leipzig (H.T., M.S., S.D.), Universitätsmedizin Mannheim, Mannheim (I.A.), University Heart Center Lübeck, Lübeck (G.F., S. de Waha, R.M.-S.), German Center for Cardiovascular Research (DZHK) (G.F., S. de Waha, R.M.-S., U.L., C.S., S.B.F., S.D.) and Universitätsklinikum Charité, Campus Benjamin Franklin (U.L., C.S.), Berlin, Universitätsklinikum Würzburg, Würzburg (P.N.), Klinikum der Eberhard-Karls-Universität Tübingen, Tübingen (T. Geisler), Klinikum Links der Weser, Bremen (A.F.), Helios Klinik Erfurt, Erfurt (H.L.), Ernst-Moritz-Arndt-Universität, Greifswald (S.B.F.), Universitäres Herzzentrum Regensburg, Regensburg (L.S.M.), and Institut für Herzinfarktforschung (S. Schneider, U.Z.) and Klinikum Ludwigshafen (U.Z.), Ludwigshafen - all in Germany · Academic Medical Center, Amsterdam (J.J.P.) · University Medical Center Ljubljana, Ljubljana, Slovenia (M.N., T. Goslar) · Institute of Cardiology, Warsaw, Poland (J.S.) · Golden Jubilee National Hospital, Glasgow, United Kingdom (K.O.) · Vilnius University Hospital Santaros Klinikos and Faculty of Medicine, Vilnius University, Vilnius, Lithuania (P.S.) · Sorbonne Université Paris 6, ACTION Study Group, Centre Hospitalier Universitaire Pitié-Salpêtrière (G.M., O.B.), and Applied Research, Technology Transfer, Industrial Collaboration, Société Par Actions Simplifiée (P.T.), Paris · Wilhelminenspital, Department of Cardiology, and Sigmund Freud University, Medical School, Vienna (K.H.) · University of Bern, Inselspital, Bern, Switzerland (S. Windecker) · Manzoni Hospital, Lecco, Italy (S. Savonitto) · and Universitair Ziekenhuis Antwerp, Antwerp, Belgium (C.V.). ·N Engl J Med · Pubmed #29083953.

ABSTRACT: BACKGROUND: In patients who have acute myocardial infarction with cardiogenic shock, early revascularization of the culprit artery by means of percutaneous coronary intervention (PCI) improves outcomes. However, the majority of patients with cardiogenic shock have multivessel disease, and whether PCI should be performed immediately for stenoses in nonculprit arteries is controversial. METHODS: In this multicenter trial, we randomly assigned 706 patients who had multivessel disease, acute myocardial infarction, and cardiogenic shock to one of two initial revascularization strategies: either PCI of the culprit lesion only, with the option of staged revascularization of nonculprit lesions, or immediate multivessel PCI. The primary end point was a composite of death or severe renal failure leading to renal-replacement therapy within 30 days after randomization. Safety end points included bleeding and stroke. RESULTS: At 30 days, the composite primary end point of death or renal-replacement therapy had occurred in 158 of the 344 patients (45.9%) in the culprit-lesion-only PCI group and in 189 of the 341 patients (55.4%) in the multivessel PCI group (relative risk, 0.83; 95% confidence interval [CI], 0.71 to 0.96; P=0.01). The relative risk of death in the culprit-lesion-only PCI group as compared with the multivessel PCI group was 0.84 (95% CI, 0.72 to 0.98; P=0.03), and the relative risk of renal-replacement therapy was 0.71 (95% CI, 0.49 to 1.03; P=0.07). The time to hemodynamic stabilization, the risk of catecholamine therapy and the duration of such therapy, the levels of troponin T and creatine kinase, and the rates of bleeding and stroke did not differ significantly between the two groups. CONCLUSIONS: Among patients who had multivessel coronary artery disease and acute myocardial infarction with cardiogenic shock, the 30-day risk of a composite of death or severe renal failure leading to renal-replacement therapy was lower among those who initially underwent PCI of the culprit lesion only than among those who underwent immediate multivessel PCI. (Funded by the European Union 7th Framework Program and others; CULPRIT-SHOCK ClinicalTrials.gov number, NCT01927549 .).

15 Article Exome sequencing of extreme clopidogrel response phenotypes identifies B4GALT2 as a determinant of on-treatment platelet reactivity. 2016

Scott, S A / Collet, J-P / Baber, U / Yang, Y / Peter, I / Linderman, M / Sload, J / Qiao, W / Kini, A S / Sharma, S K / Desnick, R J / Fuster, V / Hajjar, R J / Montalescot, G / Hulot, J-S. ·Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA. · Sorbonne Universités, UPMC Univ Paris 06, Faculty of Medicine, UMRS_1166 ICAN, Institute of Cardiometabolism and Nutrition, AP-HP, Pitié-Salpêtrière Hospital, Institute of Cardiology, Paris, France. · Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA. · Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. · Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA. ·Clin Pharmacol Ther · Pubmed #27213804.

ABSTRACT: Interindividual variability in platelet aggregation is common among patients treated with clopidogrel and both high on-treatment platelet reactivity (HTPR) and low on-treatment platelet reactivity (LTPR) increase risks for adverse clinical outcomes. CYP2C19 influences clopidogrel response but only accounts for ∼12% of the variability in platelet reactivity. To identify novel variants implicated in on-treatment platelet reactivity, patients with coronary artery disease (CAD) with extreme pharmacodynamic responses to clopidogrel and wild-type CYP2C19 were subjected to exome sequencing. Candidate variants that clustered in the LTPR subgroup subsequently were genotyped across the discovery cohort (n = 636). Importantly, carriers of B4GALT2 c.909C>T had lower on-treatment P2Y12 reaction units (PRUs; P = 0.0077) and residual platelet aggregation (P = 0.0008) compared with noncarriers, which remained significant after adjusting for CYP2C19 and other clinical variables in both the discovery (P = 0.0298) and replication (n = 160; PRU: P = 0.0001) cohorts. B4GALT2 is a platelet-expressed galactosyltransferase, indicating that B4GALT2 c.909C>T may influence clopidogrel sensitivity through atypical cell-surface glycoprotein processing and platelet adhesion.

16 Article Clinical Outcome of First- vs Second-Generation DES According to DAPT Duration: Results of ARCTIC-Generation. 2016

Collet, Jean-Philippe / Silvain, Johanne / Kerneis, Mathieu / Cuisset, Thomas / Meneveau, Nicolas / Boueri, Ziad / Barthélémy, Olivier / Rangé, Grégoire / Cayla, Guillaume / Belle, Eric Van / Elhadad, Simon / Carrié, Didier / Caussin, Christophe / Rousseau, Hélène / Aubry, Pierre / Monségu, Jacques / Sabouret, Pierre / O'Connor, Stephen A / Abtan, Jérémie / Saint-Etienne, Christophe / Beygui, Farzin / Vicaut, Eric / Montalescot, Gilles / Anonymous3920858. ·Univ Paris 06 (UPMC), ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (APHP), Paris, France. · Department of Cardiology, CHU La Timone, Marseille, France. · Department of Cardiology, CHU Jean Minjoz, Besançon, France. · Department of Cardiology, CH de Bastia, France. · Department of Cardiology, Les Hôpitaux de Chartres, Le Coudray, France. · ACTION Study Group, Department of Cardiology, CHU Carémeau, Nîmes, France. · Department of Cardiology, Lille University Hospital, Lille, France. · Department of Cardiology, CH de Lagny-Marne la Vallée, Lagny-sur-Marne, France. · Department of Cardiology, CHU Rangueil, Toulouse, France. · Department of Cardiology, Institut Mutualiste Montsouris, Paris, France. · ACTION Study Group, Unité de Recherche Clinique-Hôpital Lariboisière (APHP), Paris, France. · Université Denis Diderot, Paris, France. · Department of Cardiology, Centre Hospitalier Bichat (APHP), Paris, France. · Department of cardiology, Groupe Hospitalier Mutualiste, Grenoble, France. · Department of Cardiology, CHU Trousseau, Tours, France. · ACTION Study Group, CHU Côte de Nacre, Caen, France. ·Clin Cardiol · Pubmed #26880570.

ABSTRACT: There is an apparent benefit with extension of dual antiplatelet therapy (DAPT) beyond 1 year after implantation of drug-eluting stents (DES). Assessment by a Double Randomization of a Conventional Antiplatelet Strategy vs a Monitoring-Guided Strategy for Drug-Eluting Stent Implantation, and of Treatment Interruption vs Continuation One Year After Stenting (ARCTIC)-Generation assessed whether there is a difference of outcome between first- vs second-generation DES and if there is an interaction with DAPT duration in the ARCTIC-Interruption study. ARCTIC-Interruption randomly allocated 1259 patients 1 year after stent implantation to a strategy of interruption of DAPT (n = 624), in which aspirin antiplatelet treatment only was maintained, or DAPT continuation (n = 635) for 6 to 18 additional months. The primary endpoint was the composite of death, myocardial infarction, stent thrombosis, stroke, or urgent revascularization. A total of 520 and 722 patients received a first- and a second-generation DES, respectively. After a median follow-up of 17 months (interquartile range, 15-18 months) after randomization, the primary endpoint occurred in 32 (6.2%) and 19 (2.6%) patients with first- and second-generation DES, respectively (hazard ratio: 2.31, 95% confidence interval: 1.31-4.07, P = 0.004). This was observed irrespective of the strategy of interruption or continuation of DAPT and timing of study recruitment. Major bleeding events occurred in 4 (0.8%) and 3 patients (0.4%) with first- and second-generation DES, respectively (hazard ratio: 1.79, 95% confidence interval: 0.40-8.02, P = 0.44). Results did not change after multiple adjustments for potential confounding variables. ARCTIC-Generation showed worse clinical outcome with first- vs second-generation DES, a difference that appeared to persist even with prolonged DAPT.

17 Article Impact of renal failure on all-cause mortality and other outcomes in patients treated by percutaneous coronary intervention. 2015

Loncar, Goran / Barthelemy, Olivier / Berman, Emmanuel / Kerneis, Mathieu / Petroni, Thibault / Payot, Laurent / Choussat, Remi / Silvain, Johanne / Collet, Jean-Philippe / Helft, Gérard / Montalescot, Gilles / Le Feuvre, Claude. ·Institut de cardiologie, université Paris 6, CHU Pitié-Salpêtrière, AP-HP, Paris, France; Cardiology Department, Clinical Hospital Zvezdara, Belgrade, Serbia. · Institut de cardiologie, université Paris 6, CHU Pitié-Salpêtrière, AP-HP, Paris, France. Electronic address: olivier.barthelemy@psl.aphp.fr. · Institut de cardiologie, université Paris 6, CHU Pitié-Salpêtrière, AP-HP, Paris, France. ·Arch Cardiovasc Dis · Pubmed #26184868.

ABSTRACT: BACKGROUND: Patients with renal failure (RF) have been systematically excluded from clinical trials; consequently their outcomes have not been well studied in the setting of percutaneous coronary intervention (PCI). AIMS: To compare cardiovascular outcomes after contemporary PCI in patients with versus without RF, according to clinical presentation (ST-segment elevation myocardial infarction [STEMI], acute coronary syndrome [ACS] or stable coronary artery disease [sCAD]). METHODS: Consecutive patients undergoing PCI with stent were prospectively included from 2007 to 2012. RF was defined as creatinine clearance<60mL/min. The primary endpoint was all-cause mortality; secondary endpoints were major adverse cardiovascular and cerebrovascular events (MACCE: composite of cardiovascular death, myocardial infarction, stroke and target lesion revascularization [TLR]), TLR and Academic Research Consortium definite/probable stent thrombosis (ST) at 1 year. RESULTS: Among 5337 patients, 23% had PCI for STEMI, 34% for ACS and 43% for sCAD, while 27% had RF. RF patients had a higher unadjusted death rate than those with preserved renal function (nRF) in all PCI indication groups (STEMI, 41% vs. 7.5%; ACS, 19% vs. 6%; sCAD, 10% vs. 3%; P<0.0001 for all). The rate of MACCE was also higher in RF patients whatever the PCI indication (STEMI, 45% vs. 15%; ACS, 23% vs. 14%; sCAD, 14% vs. 9%; P<0.05 for all). Rates of TLR (5.5-7.4%) and ST (<2.5%) were similar (P>0.05 for both). sCAD-RF and STEMI-nRF patients had similar rates of mortality (P=0.209) and MACCE (P=0.658). RF was independently associated with mortality, with a doubled relative risk in STEMI versus ACS and sCAD groups (odds ratio 5.3, 95% confidence interval 3.627-7.821 vs. 2.1, 1.465-3.140 and 2.3, 1.507-3.469, respectively; P<0.0001). CONCLUSION: RF is a stronger independent predictor of death after PCI in STEMI than in ACS or sCAD patients. sCAD-RF and STEMI-nRF patients had similar prognoses.

18 Article Omeprazole, pantoprazole, and CYP2C19 effects on clopidogrel pharmacokinetic-pharmacodynamic relationships in stable coronary artery disease patients. 2015

Simon, Nicolas / Finzi, Jonathan / Cayla, Guillaume / Montalescot, Gilles / Collet, Jean-Philippe / Hulot, Jean-Sébastien. ·Aix-Marseille Université, INSERM, UMR912 (SESSTIM), 13003, Marseille, France, nicolas.simon@ap-hm.fr. ·Eur J Clin Pharmacol · Pubmed #26071277.

ABSTRACT: PURPOSE: Proton-pump Inhibitors use and CYP2C19 loss-of-function alleles are associated with reduced responsiveness to standard clopidogrel doses and increased cardiovascular events. METHODS: Post-myocardial infarction patients heterozygous (wild type [wt]/*2, n = 41) or homozygous (*2/*2, n = 7) for the CYP2C19*2 genetic variant were matched with patients not carrying the variant (wt/wt, n = 58). All patients were randomized to a 300- or 900-mg clopidogrel loading dose. A PK/PD model was defined using the variation of the P2Y12 reaction unit relative to baseline. RESULTS: Carriage of CYP2C19*2 allele and the use of omeprazole/esomeprazole were associated with the inter-individual variability in the active metabolite clearance. The relationship between inhibition of platelet aggregation (IPA, %) and the active metabolite AUC (h*μg/L) was described by a sigmoid function (Emax 56 ± 5%; EAUC50 15.9 ± 0.8 h*μg/L) with a gamma exponent (7.04 ± 2.26). CONCLUSION: This on/off shape explains that a small variation of exposure may have a clinical relevance.

19 Article Dual-antiplatelet treatment beyond 1 year after drug-eluting stent implantation (ARCTIC-Interruption): a randomised trial. 2014

Collet, Jean-Philippe / Silvain, Johanne / Barthélémy, Olivier / Rangé, Grégoire / Cayla, Guillaume / Van Belle, Eric / Cuisset, Thomas / Elhadad, Simon / Schiele, François / Lhoest, Nicolas / Ohlmann, Patrick / Carrié, Didier / Rousseau, Hélène / Aubry, Pierre / Monségu, Jacques / Sabouret, Pierre / O'Connor, Stephen A / Abtan, Jérémie / Kerneis, Mathieu / Saint-Etienne, Christophe / Beygui, Farzin / Vicaut, Eric / Montalescot, Gilles / Anonymous6280800. ·ACTION Study Group, Institut de Cardiologie Hôpital Pitié-Salpêtrière (APHP), Université Paris 6, INSERM, Paris, France. · Les Hôpitaux de Chartres, Le Coudray, France. · ACTION Study Group, Cardiologie, CHU Carémeau, Nîmes, France. · CHRU de Lille, Lille, France. · Département de Cardiologie, CHU La Timone, Marseille, France. · Cardiologie, CH de Lagny-Marne-la-Vallée, Lagny-sur-Marne, France. · CHU Jean Minjoz, Besançon, France. · GH du Centre Alsace, France. · CHR Strasbourg, France. · CHU Rangueil, Toulouse, France. · CHRU de Lille, Lille, France; ACTION Study Group, Unité de Recherche Clinique-Hôpital Lariboisière (APHP), and Université Denis Diderot, Paris, France. · Centre Hospitalier Bichat (APHP), Paris, France. · Institut Mutualiste Montsouris, Paris, France. · CHU Trousseau, Tours, France. · ACTION study Group, CHU Caen, France. · ACTION Study Group, Unité de Recherche Clinique-Hôpital Lariboisière (APHP), and Université Denis Diderot, Paris, France. · ACTION Study Group, Institut de Cardiologie Hôpital Pitié-Salpêtrière (APHP), Université Paris 6, INSERM, Paris, France. Electronic address: gilles.montalescot@psl.aphp.fr. ·Lancet · Pubmed #25037988.

ABSTRACT: BACKGROUND: Optimum duration of dual antiplatelet treatment (DAPT) after coronary stenting remains uncertain, with an unknown efficacy to safety ratio of extended treatment leading to discrepancies between international guidelines and clinical practice. We assessed whether DAPT continuation beyond 1 year after coronary stenting is beneficial. METHODS: This analysis was a planned extension of the previously published ARCTIC-Monitoring trial, in which we randomly allocated 2440 patients to a strategy of platelet function testing with antiplatelet treatment adjustment or a conventional strategy after coronary stenting with drug-eluting stent (DES). We recruited patients (aged 18 years or older) scheduled for planned DES implantation at 38 centres in France. After 1 year of follow-up, patients without contraindication to interruption of DAPT were eligible for a second randomisation to this second phase of the study (ARCTIC-Interruption). Using a computer-generated randomisation sequence (1:1; stratified by centre), we allocated patients to a strategy of interruption of DAPT where the thienopyridine was interrupted and single aspirin antiplatelet treatment was maintained (interruption group) or a strategy of DAPT continuation for 6-18 months (continuation group). The primary endpoint was the composite of death, myocardial infarction, stent thrombosis, stroke, or urgent revascularisation, analysed by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00827411. FINDINGS: Between Jan 4, 2011, and March 3, 2012, 1259 eligible patients were randomly allocated to treatment in ARCTIC-Interruption: 624 to the interruption group and 635 to the continuation group. After a median follow-up of 17 months (IQR 15-18), the primary endpoint occurred in 27 (4%) patients in the interruption group and 24 (4%) patients in the continuation group (hazard ratio [HR] 1·17 [95% CI 0·68-2·03]; p=0·58). STEEPLE major bleeding events occurred more often in the continuation group (seven [1%] patients) compared with the interruption group (one [<0·5%] patient; HR 0·15 [0·02-1·20]; p=0·073). Major or minor bleedings were also more common in the continuation group compared with the interruption group (12 [2%] patients vs three [1%] patients; HR 0·26 [0·07-0·91]; p=0·04). INTERPRETATION: Our finding suggests no apparent benefit but instead harm with extension of DAPT beyond 1 year after stenting with DES when no event has occurred within the first year after stenting. No conclusion can be drawn for high-risk patients who could not be randomised. The consistency between findings from all trials of such interruption suggests the need for a reappraisal of guidelines for DAPT after coronary stenting towards shorter duration of treatment. FUNDING: Allies in Cardiovascular Trials Initiatives and Organized Networks (ACTION Study Group), Fondation de France, Sanofi-Aventis, Cordis, Medtronic, Boston Scientific, Fondation SGAM.

20 Article Prasugrel but not high dose clopidogrel overcomes the lansoprazole neutralizing effect of P2Y12 inhibition: Results of the randomized DOSAPI study. 2014

Collet, Jean-Philippe / Hulot, Jean-Sébastien / Abtan, Jérémie / Anzaha, Ghalia / Kerneis, Mathieu / Silvain, Johanne / Cayla, Guillaume / O'Connor, Stephen A / Barthélémy, Olivier / Beygui, Farzin / Galier, Sophie / Brugier, Delphine / Stanek, Eric J / Charland, Scott L / Gallois, Vanessa / Montalescot, Gilles / Anonymous680800. ·ACTION Study Group, Hôpital Pitié-Salpêtrière (APHP), Institut de Cardiologie, INSERM, UMR_S 1166, Pitié-Salpêtrière Hospital (AP-HP), Université Pierre et Marie Curie (UPMC Paris 6), 75013, Paris, France. ·Eur J Clin Pharmacol · Pubmed #25012577.

ABSTRACT: AIMS: The potential negative metabolic interaction between proton pump inhibitors and clopidogrel is an unsolved issue. We hypothesized that doubling the clopidogrel maintenance dose (150 mg) would be less effective than switching to prasugrel 10 mg maintenance dose (MD) to overcome this negative interaction. METHOD AND RESULTS: In a randomized study with a factorial design, 82 stable coronary artery disease patients treated with 75 mg clopidogrel MD and aspirin were assigned to receive in a double blind fashion lansoprazole (30 mg/day) or placebo and to receive in an open fashion 150 mg clopidogrel MD or 10 mg prasugrel MD. The primary endpoint was the relative change in residual platelet reactivity over the 14-day study period [(RPA14day-RPAbaseline)/RPAbaseline]. The effect of doubling the clopidogrel MD on relative change in RPA was neutralized by lansoprazole (-53.6±48.4% versus +0.8±53.7% without and with lansoprazole, respectively, p = 0.02) whereas 10 mg of prasugrel MD dramatically reduced RPA irrespective of lansoprazole co-administration (-81.8 %±24.8% vs. -72.9%±32.9% without and with lansoprazole, respectively, p = NS). Lansoprazole exposure was the only parameter with a significant interaction with RPA among subgroups. CONCLUSION: The higher platelet inhibitory effect obtained by doubling the clopidogrel MD was totally neutralized by the co-administration of lansoprazole. This drug interaction was not observed with prasugrel 10 mg.

21 Article High on-treatment platelet reactivity as a risk factor for secondary prevention after coronary stent revascularization: A landmark analysis of the ARCTIC study. 2014

Montalescot, Gilles / Rangé, Grégoire / Silvain, Johanne / Bonnet, Jean-Louis / Boueri, Ziad / Barthélémy, Olivier / Cayla, Guillaume / Belle, Loic / Van Belle, Eric / Cuisset, Thomas / Elhadad, Simon / Pouillot, Christophe / Henry, Patrick / Motreff, Pascal / Carrié, Didier / Rousseau, Hélène / Aubry, Pierre / Monségu, Jacques / Sabouret, Pierre / O'Connor, Stephen A / Abtan, Jérémie / Kerneis, Mathieu / Saint-Etienne, Christophe / Beygui, Farzin / Vicaut, Eric / Collet, Jean-Philippe / Anonymous6300790. ·From the ACTION Study Group, Institut de Cardiologie (AP-HP), INSERM UMRS 1166, Université Paris 6, Paris, France (G.M., J.S., O.B., P.S., S.A.O., M.K., J.-P.C.) · Hôpital Louis Pasteur, Le Coudray, France (G.R.) · Hôpital de la Timone, Marseille, France (J.-L.B., T.C.) · CH de Bastia, Bastia, France (Z.B.) · CHU Carémeau, Nîmes, France (G.C.) · CH de la Région Annecienne, Annecy, France (L.B.) · Hôpital Cardiologique, Lille, France (E.V.B.) · CH de Lagny, Marne-la-Vallée, France (S.E.) · Clinique Sainte-Clothilde, La Réunion, France (C.P.) · Hôpital Lariboisière, Paris, France (P.H.) · CHU Clermont-Ferrand, Clermont-Ferrand, France (P.M.) · Hôpital de Rangueil, Toulouse, France (D.C.) · Unite de Recherche Clinique, Hôpital Lariboisière, ACTION Study Group, Paris, France (H.R., E.V.) · Hôpital Bichat, Paris, France (P.A.) · HIA du Val-du-Grâce, Paris, France (J.M.) · Hôpital Bichat, ACTION Study Group, Paris, France (J.A.) · Hôpital Trousseau, Chambray-lès-Tours, ACTION Study Group, Paris, France (C.S.-E.) · and CHU Côte de Nacre, Caen, ACTION Study Group, Caen, France (F.B.). ·Circulation · Pubmed #24718568.

ABSTRACT: BACKGROUND: Individualizing antiplatelet therapy after platelet function testing did not improve outcome after coronary stenting in the Assessment by a Double Randomization of a Conventional Antiplatelet Strategy Versus a Monitoring-Guided Strategy for Drug-Eluting Stent Implantation and of Treatment Interruption Versus Continuation One Year After Stenting (ARCTIC) study. Whether results are different during the phase of secondary prevention starting after hospital discharge, when periprocedural events have been excluded, is unknown. METHODS AND RESULTS: In ARCTIC, 2440 patients were randomized before coronary stenting to a strategy of platelet function monitoring (VerifyNow P2Y12/aspirin point-of-care assay) with drug adjustment in suboptimal responders to antiplatelet therapy or to a conventional strategy without monitoring and without drug or dose changes. We performed a landmark analysis starting at the time of hospital discharge evaluating the primary end point of death, myocardial infarction, stent thrombosis, stroke, or urgent revascularization through 1 year. After discharge, the primary end point occurred in 8.6% of patients in the monitoring arm and 7.9% in the conventional arm (hazard ratio, 1.105; 95% confidence interval, 0.835-1.461; P=0.48). Stent thrombosis or urgent revascularization occurred in 4.4% and 4.5% in the monitoring and conventional arms, respectively (P=0.99). There was no difference for any of the other ischemic end points. Major bleeding event rates were 1.8% in the monitoring arm and 2.8% in the conventional arm (P=0.11), whereas major or minor bleeding event rates were 2.3% and 3.4%, respectively (P=0.10). CONCLUSIONS: Detection of platelet hyper-reactivity by platelet function testing in patients undergoing coronary stenting with further therapeutic adjustment does not reduce ischemic recurrences after intervention. On-treatment platelet hyperreactivity cannot be considered as a risk factor requiring intervention for secondary prevention after percutaneous coronary revascularization. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00827411.

22 Article Impact of red blood cell transfusion on platelet aggregation and inflammatory response in anemic coronary and noncoronary patients: the TRANSFUSION-2 study (impact of transfusion of red blood cell on platelet activation and aggregation studied with flow cytometry use and light transmission aggregometry). 2014

Silvain, Johanne / Abtan, Jérémie / Kerneis, Mathieu / Martin, Réjane / Finzi, Jonathan / Vignalou, Jean-Baptiste / Barthélémy, Olivier / O'Connor, Stephen A / Luyt, Charles-Edouard / Brechot, Nicolas / Mercadier, Anne / Brugier, Delphine / Galier, Sophie / Collet, Jean-Philippe / Chastre, Jean / Montalescot, Gilles. ·Institut de Cardiologie, Institut National de la Santé et de la Recherche Médicale CMR937, Allies in Cardiovascular Trials Initiatives and Organized Networks Group, Pitié-Salpêtrière Hospital (Assistance Publique - Hôpitaux de Paris), Université Pierre et Marie Curie, Paris, France. · Service de Réanimation Médicale, Pitié-Salpêtrière Hospital (Assistance Publique - Hôpitaux de Paris), Université Pierre et Marie Curie, Paris, France. · Etablissement Français du Sang Ile-de-France, CR4, Pitié-Salpêtrière Hospital (Assistance Publique - Hôpitaux de Paris), Paris, France. · Institut de Cardiologie, Institut National de la Santé et de la Recherche Médicale CMR937, Allies in Cardiovascular Trials Initiatives and Organized Networks Group, Pitié-Salpêtrière Hospital (Assistance Publique - Hôpitaux de Paris), Université Pierre et Marie Curie, Paris, France. Electronic address: gilles.montalescot@psl.aphp.fr. ·J Am Coll Cardiol · Pubmed #24361322.

ABSTRACT: OBJECTIVES: This study sought to determine whether red blood cell (RBC) transfusion increases in vivo platelet aggregation and inflammation in coronary and noncoronary patients. BACKGROUND: RBC transfusion increases in vitro platelet activation and aggregation in healthy volunteers, providing a possible explanation for the increase in recurrent ischemic events and mortality reported after RBC transfusion in patients with acute coronary syndromes (ACS). METHODS: Platelet reactivity was measured before and after RBC transfusion in 61 patients (33 with ACS patients and 28 without ACS). Relative changes between baseline and post-transfusion measurements of maximal and residual platelet aggregation were considered with different agonists as well as changes in vasodilator-stimulated phosphoprotein platelet reactivity index and P-selectin expression. Inflammatory and thrombotic biomarkers were also measured before and after transfusion. RESULTS: After RBC transfusion, platelet reactivity was increased when measured using adenosine diphosphate-induced light transmission aggregometry (11.6% relative increase in maximal platelet aggregation, p = 0.004; 10.8% increase in residual platelet aggregation, p = 0.005) and vasodilator-stimulated phosphoprotein platelet reactivity index (20.7% relative increase, p = 0.002), and there was a nonsignificant trend toward an increase in P-selectin expression. Similar results were found with the nonspecific agonist thrombin receptor-activated peptide (relative increases of 11.7% for maximal platelet aggregation, p = 0.04, and 12.7% for residual platelet aggregation, p = 0.02) but not with collagen or arachidonic acid agonists. There were no significant differences in inflammatory and thrombotic biomarkers before and after transfusion. CONCLUSIONS: After RBC transfusion, there is an increase in platelet reactivity, especially with tests measuring the adenosine diphosphate-P2Y12 receptor pathway, without significant variations in inflammatory or thrombotic biomarkers. This in vivo effect may account for the excess of ischemic events observed in the context of patients with ACS treated using percutaneous coronary intervention and P2Y12 inhibitors.

23 Article Ambulatory transradial percutaneous coronary intervention: a safe, effective, and cost-saving strategy. 2013

Le Corvoisier, Philippe / Gellen, Barnabas / Lesault, Pierre-François / Cohen, Remy / Champagne, Stéphane / Duval, Anne-Marie / Montalescot, Gilles / Elhadad, Simon / Montagne, Olivier / Durand-Zaleski, Isabelle / Dubois-Randé, Jean-Luc / Teiger, Emmanuel. ·Inserm, Centre d'Investigation Clinique 006, U955 équipe 3, Créteil, France. philippe.lecorvoisier@hmn.aphp.fr ·Catheter Cardiovasc Interv · Pubmed #22744871.

ABSTRACT: OBJECTIVES: The aim of this prospective, multicenter study was to assess the safety, feasibility, acceptance, and cost of ambulatory transradial percutaneous coronary intervention (PCI) under the conditions of everyday practice. BACKGROUND: Major advances in PCI techniques have considerably reduced the incidence of post-procedure complications. However, overnight admission still constitutes the standard of care in most interventional cardiology centers. METHODS: Eligibility for ambulatory management was assessed in 370 patients with stable angina referred to three high-volume angioplasty centers. On the basis of pre-specified clinical and PCI-linked criteria, 220 patients were selected for ambulatory PCI. RESULTS: The study population included a substantial proportion of patients with complex procedures: 115 (52.3%) patients with multivessel coronary artery disease, 50 (22.7%) patients with multilesion procedures, and 60 (21.5%) bifurcation lesions. After 4-6 hr observation period, 213 of the 220 patients (96.8%) were cleared for discharge. The remaining seven (3.2%) patients were kept overnight for unstable angina (n = 1), atypical chest discomfort (n = 2), puncture site hematoma (n = 1), or non-cardiovascular reasons (n = 3). Within 24 hr after discharge, no patients experienced readmission, stent occlusion, recurrent ischemia, or local complications. Furthermore, 99% of patients were satisfied with ambulatory management and 85% reported no anxiety. The average non-procedural cost was lower for ambulatory PCI than conventional PCI (1,230 ± 98 Euros vs. 2,304 ± 1814 Euros, P < 10(-6)). CONCLUSIONS: Ambulatory PCI in patients with stable coronary artery disease is safe, effective, and well accepted by the patients. It may both significantly reduce costs and optimize hospital resource utilization.

24 Article Aldosterone, atherosclerosis and vascular events in patients with stable coronary artery disease. 2013

Hillaert, Marieke A / Lentjes, Eef G / Kemperman, Hans / van der Graaf, Yolanda / Nathoe, Hendrik M / Beygui, Farzin / Montalescot, Gilles / Doevendans, Pieter A / Wassink, Annemarie M / van Belle, Eric / Anonymous5030729. ·Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands. ·Int J Cardiol · Pubmed #22727970.

ABSTRACT: BACKGROUND AND AIMS: Plasma aldosterone has been associated with all-cause and cardiovascular mortality in high-risk cardiovascular populations, including patients with heart failure, myocardial infarction and high-risk coronary artery disease (CAD) patients. In the present study, we evaluated the association of plasma aldosterone levels with vascular events in a large prospective cohort of stable CAD patients recruited in an outpatient setting. Moreover, we investigated the relationship between aldosterone and atherosclerotic burden. METHODS AND RESULTS: Baseline plasma aldosterone levels were measured in 2699 subjects with CAD (mean age 60 ± 10 years, 82% male). During a median follow-up of 4.7 years, 308 (11%) patients died, of which 203 were from a vascular cause. Vascular endpoints of myocardial infarction, ischemic stroke or vascular death occurred in 355 (13%) patients. Multivariable Cox regression analysis was performed, adjusting for multiple confounders. Aldosterone (median 96 pg/mL, interquartile range 70-138 pg/mL, normal range 58-362 pg/mL) was independently associated with major vascular events (hazard ratio (HR) 1.56, 95% confidence interval (CI) 1.13-2.15) and vascular mortality (HR 1.95, 95% CI 1.27-3.00). By multivariable regression analysis, aldosterone was also associated with the presence of atherosclerosis in additional vascular territories (cerebrovascular disease and/or peripheral artery disease) (p=0.026). CONCLUSIONS: In patients with stable coronary artery disease, plasma aldosterone is independently associated with the risk of major vascular events and vascular mortality and with atherosclerotic burden.

25 Article Atopaxar and its effects on markers of platelet activation and inflammation: results from the LANCELOT CAD program. 2012

O'Donoghue, Michelle L / Bhatt, Deepak L / Flather, Marcus D / Goto, Shinya / Angiolillo, Dominick J / Goodman, Shaun G / Zeymer, Uwe / Aylward, Philip E / Montalescot, Gilles / Ziecina, Rafal / Kobayashi, Hiroyuki / Ren, Fang / Wiviott, Stephen D. ·Cardiovascular Division and TIMI Study Group, Brigham and Women's Hospital, 350 Longwood Avenue, 1st floor, Boston, MA 02115, USA. modonoghue@partners.org ·J Thromb Thrombolysis · Pubmed #22653705.

ABSTRACT: Atopaxar is a reversible protease activated receptor (PAR)-1 thrombin receptor antagonist that interferes with platelet signaling. The effects of PAR-1 antagonists on biomarkers remain unknown. The primary objective was to assess the effects of atopaxar on biomarkers of inflammation and platelet activation. The LANCELOT-CAD trial randomized 720 subjects to atopaxar (50, 100, or 200 mg daily) or matching placebo for 24 weeks. Biomarkers were assessed at serial time points. A linear mixed model to account for repeated measures was used to evaluate the change in biomarker concentration from randomization across time to week 24. Least square means were determined from the linear mixed models. The concentration of sCD40L decreased on average over time by -553 (95 % CI -677, -429) ng/L in the combined atopaxar group versus -30.3 (-249 to 189) ng/L fall in the placebo arm (P < 0.001) and a dose-dependent trend was seen across treatment groups (P < 0.001 for trend). In contrast, Lp-PLA(2) mass rose on average over time by 12.6 (95 % CI 10.0, 15.3) ng/ml in the combined atopaxar group as compared with 2.6 (95 % CI -2.1, 7.3) ng/ml in the placebo arm (P < 0.001). Similarly, the concentration of IL-18 rose by 17.5 (95 % CI 12.4, 22.6) pg/ml in the atopaxar group versus a -1.2 (95 % CI -10.2, 7.8) pg/ml fall in the placebo group (P < 0.001). The effects of atopaxar on Lp-PLA(2) and IL-18 appeared to be dose-dependent (P < 0.001 for trend) and were observed in J-LANCELOT. Atopaxar did not have a significant effect on other inflammatory markers. In conclusion, atopaxar appeared to decrease sCD40L, but did not demonstrate an anti-inflammatory effect in patients with stable CAD. Although atopaxar increased the concentration of Lp-PLA(2) and IL-18, the clinical relevance of these findings remains unknown and warrants further investigation and validation.

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