- Email: [email protected]
Benefit of switching dual antiplatelet therapy after ACS on dual antiplatelet therapy adherence: A prespecified analysis of the TOPIC randomized study
8
01-Coronary artery disease
Disclosure of interest peting interest.
The authors declare that they have no com-
Disclosure of interest peting interest.
The authors declare that they have no com-
https://doi.org/10.1016/j.acvdsp.2017.11.008
https://doi.org/10.1016/j.acvdsp.2017.11.009
210
066
Can simulator-based teaching improve medical students’ knowledge and competences? Results of a randomized trial using a coronary angiography simulator to learn coronary anatomy
Benefit of switching dual antiplatelet therapy after ACS on dual antiplatelet therapy adherence: A prespecified analysis of the TOPIC randomized study
Q. Fischer ∗ , Y. Sbissa , P. Nhan , J. Adjedj , O. Varenne Cardiology, Cochin, Paris, France ∗ Corresponding author. E-mail address: q.fi[email protected] (Q. Fischer)
P. Deharo 1,∗ , J. Quilci 2 , C. Bassez 1 , G. Bonnet 3 , M. Lambert 1 , P. Morange 1 , M.C. Alessi 1 , L. Fourcade 2 , J. Bonnet 4 , T. Cuisset 1 1 Hôpital laveran, France 2 Hôpital La Timone, Marseille, France 3 Centre hospitalier Gap, Gap, France 4 Maladies coronaires et cardiologie interventionnelle, CHU la Timone, Marseille, France ∗ Corresponding author. E-mail address: [email protected] (P. Deharo)
Background Simulator-based teaching for coronary angiography (CA) is a seductive tool for medical students to improve knowledge and skills. Its pedagogical impact has not been fully evaluated yet. The aim of this study was to compare traditional face-to-face teaching with a simulator-based teaching. Methods Hundred and eighteen students were prospectively randomized in two groups: a control teaching group (n = 59, CONT group) and a simulator (Mentice AB, Sweden) group (n = 59, SIM group). CONT group received a PowerPoint-based course (30 min), consisting of 15 slides encompassing predefined learning objectives (coronary anatomy, different projections, film interpretation). SIM group received a simulator-based course including exactly the same information in an interactive, real 3D environment. After the course, students were evaluated by 40 multiple-choice questions (maximum of 100 points (pts)), including questions on coronary anatomy (part 1:50 pts), on angiographic projections (part 2:10 pts), and real case interpretations (part 3:40 pts). Results Student characteristics were identical in both groups: 52.5% were female; age was 22.6 ± 1.4 years. 35.6% were in their 4th year of medical school, 35.6% in 5th year and 28.8% in 6th year. SIM students scored higher than CONT students irrespective of age and year of medical school (59.5 ± 10.8 pts vs. 43.7 ± 11.3 pts, P < 0.00001) for all parts of the evaluation (part 1: 36.9 ± 6.6 pts vs. 29.6 ± 6.9 pts, P < 0.00001; part 2: 5.9 ± 3.0 pts vs. 3.1 ± 2.8 pts, P < 0.00001; and part 3:16.8 ± 6.9 pts vs. 10.9 ± 6.5 pts, P < 0.00001). Student satisfaction was also higher in SIM group than in CONT group (98% vs. 75%, P < 0.0001) (Fig. 1). Conclusion This prospective, randomized trial suggests that simulator-based teaching in CA significantly improves students’ knowledge in coronary anatomy, angiography projections, but also clinical competence and decision making process. These results should encourage further evaluation of simulator-based teaching in other branches of medicine.
Background The Timing Of Platelet Inhibition after acute Coronary Syndrome (TOPIC) trial showed that switching dual antiplatelet (DAPT) from aspirin plus a newer P2Y12 blocker (prasugrel or ticagrelor) to aspirin plus clopidogrel 1 month after an acute coronary syndrome (ACS) led to a reduction in bleeding complications with similar risk of ischemic recurrence. Purpose The objective of this prespecified analysis was to evaluate the impact of switching strategy on DAPT adherence. Methods TOPIC study randomized patients admitted for an ACS without adverse event at 1 month on aspirin and a newer P2Y12 blocker, to aspirin and clopidogrel (switched DAPT) or continuation of their drug regimen (unchanged DAPT). Medical adherence to prescribed DAPT was assessed at 6 months and 1 year. Results Six hundred and forty-six patients were randomized and 645 analyzed, corresponding to 322 patients in the switched DAPT and 323 in the unchanged DAPT group. At 6 months and 1 year, the allocated DAPT regimen was significantly used more often in the switched group than in the unchanged DAPT group: 298 (92.5%) vs. 264 (81.7%) (P < 0.01) at 6 months and 277 (87.7%) vs. and 242 (76.1%) (P < 0.01) at 1 year. The reason for DAPT change was related to an adverse event in 66% of cases corresponding to an ischemic event in 17 patients (14.8%) and bleeding in 59 patients (51.3%) (Fig. 1). In multivariable analysis, unchanged DAPT strategy and ischemic or bleeding events were significantly associated with nonadherence to prescribed DAPT (Table 1). Conclusion A switched DAPT was associated with significant improvement in the number of patients on prescribed DAPT at 6 months and 1 year following ACS. This improved adherence was related to reduction of side effects. Table 1 Factors associated with DAPT nonadherence at 1 year in multivariate analysis.
Unchanged DAPT strategy Bleeding BARC 1 Primary endpoint occurrence
Fig. 1
Total score according to the inclusion group: PPT vs. SIM.
OR
95% CI
P-value
1.83 2.76 3.99
1.17—2.88 1.36—5.63 2.48—6.42
0.008 < 0.001 < 0.001
01-Coronary artery disease
9 increased by at least 50% for the primary effectiveness endpoint; age, a poverty index, ICU stay duration > 5 days and no PCI during index hospitalisation, and congestive heart failure, peripheral arterial disease, ischemic stroke, abnormal renal function, C and P before index hospitalisation were associated with a risk increased by 20—50%; diabetes, hypertension, aspirin before index hospitalisation, and C in the month after discharge (versus T) were associated with a risk increased by 10—20%. Conclusions In this nationwide real-life study, the risk factor most associated with the primary effectiveness endpoint was a Charlson comorbidity index > 5. Disclosure of interest Étude réalisée à la demande des Autorités de Santé, avec un financement inconditionnel du laboratoire AstraZeneca, par la Plateforme Bordeaux PharmacoEpi, et supervisée par un comité scientifique constitué d’experts indépendants. https://doi.org/10.1016/j.acvdsp.2017.11.011
Fig. 1 DAPT adherence at 1 year in the 2 groups and cause for non-adherence. Disclosure of interest
Lecture Fees Sanofi.
https://doi.org/10.1016/j.acvdsp.2017.11.010 039
Risk factors for the primary effectiveness endpoint in secondary prevention of acute coronary syndrome with antiplatelet agents: A cohort in the nationwide French claims and hospitalisation database N. Danchin 1 , P. Blin 2 , B. Falissard 3 , J. Bénichou 4,5 , L. Bonello 6 , C. Dureau-Pournin 2,∗ , J. Jové 2 , R. Lassalle 2 , C. Droz-Perroteau 2 , F. Thomas-Delecourt 7 , J. Dallongeville 8 , N. Moore 2,5 1 Hôpital européen G.-Pompidou, AP—HP, Paris, France 2 Bordeaux PharmacoEpi, Inserm CIC1401, université de Bordeaux, Bordeaux, France 3 Centre de recherche en épidémiologie et santé des populations, Inserm U1018, Paris, France 4 CHU, Rouen, France 5 Inserm U1219, Bordeaux, France 6 Hôpital Nord, Marseille, France 7 AstraZeneca, Courbevoie, France 8 Institut Pasteur, Inserm U1167, Lille, France ∗ Corresponding author. E-mail address: [email protected] (C. Dureau-Pournin) Background The French HTA agency requested a real-life benefitrisk study of ticagrelor (T) compared to clopidogrel (C) and prasugrel (P) in the secondary prevention of acute coronary syndrome (ACS) (EUPAS5987). Purpose This study aimed to identify the risk factors associated with the primary effectiveness endpoint for patients with antiplatelet agents after a hospitalisation for ACS. Methods Patients hospitalised in 2013 for STEMI, NSTEMI or unstable angina, with intensive care unit (ICU) stay, and followed for 1 year in the nationwide French claims and hospitalisation database, SNIIRAM. Treatment group (T, C, or P ± aspirin) was defined by the first drug dispensed in the month after discharge. The primary effectiveness endpoint was a composite of the first event of ACS with ICU stay, stroke, or all-cause death. Hazard ratios were estimated with Cox proportional hazard risk model (multivariate analysis). Results A total of 41,954 patients were included (19,796 C, 13,916 T, 8242 P) with different characteristics: mean age of 72, 63, 58 years, respectively; 68%, 76%, 86% male; 42%, 55%, 72% STEMI. A Charlson comorbidity index > 5 was associated with a risk
539
Characteristics of patients with first occurrence of ST-segment Elevation Myocardial Infarction in Algeria: The STAMI registry M. Chettibi 1,∗ , D. Nibouche 2 , M.T.C. Bouafia 1 , M. Krim 3 , K. Boussouf 4 , B. Kichou 5 , T. Boumedienne 6 , L. Hammou 7 , B. Bendaoud 8 , M. Ait Athmane 9 , K. Bouchair 10 , S. Kara 11 , H. Hiba 12 , N. Hammoudi 13 1 Cardiologie, CHU Frantz Fanon, Blida, Algeria 2 Cardiologie, CHU Parnet, Algeria 3 Cardiologie, CHU Benimessous, Alger, Algeria 4 Cardiologie, CHU Setif, Setif, Algeria 5 CHU de Tizi-Ouzou, Tizi-Ouzou, Algeria 6 Cardiologie, CHU Mustapha, Alger, Algeria 7 Cardiologie, CHU Oran, Oran, Algeria 8 Cardiologie, CHU Belabes, Belabes, Algeria 9 Cardiologie, CHU Annaba, Annaba, Algeria 10 Cardiologie, CHU Constantine, Constantine, Algeria 11 Cardiologie, hôpital privé Kara, Oran, Algeria 12 Cardiologie, CHU Tiziouzou, Tiziouzou, Algeria 13 Cardiologie, hôpital privé des Oasis, Ghardaia, Algeria ∗ Corresponding author. E-mail address: [email protected] (M. Chettibi) Background Few data are available on the management of acute myocardial infarction (MI) and risk assessment after MI in Algeria. Methods The STAMI registry is a prospective, multicenter, noninterventional study conducted in fourteen public and private hospitals in the central, eastern, western but also in the Sahara containing a cardiac intensive care unit (with and without PCI facilities). Enrollment started in November 2016 for a 2-month period. The primary Outcome Measures major adverse cardiac and cerebrovascular events during hospitalization. Additional outcomes include the delay between onset of symptoms and hospitalization, the types of reperfusion management and MACCE at 1 month and 1 year after discharge from hospital. A total of 327 patients were enrolled. The majority were male 260 (79.5%) and was younger (Men 59.4 ± 11.8 years) women 63.9 ± 13.1 years). Smoking (45,5%, n = 150), hypertension (39,9%, n = 130), and diabetes (35.2%, n = 116) were the main risk factors; a history of coronary dieses was reported in less 5% of the patients. Reperfusion therapy was performed in 285 (86.5%) patients (56.9%, n = 188 thrombolytic therapy and 29.4%, n = 97 primary PCI). The median time since symptom onset to hospitalization is 349mn. A total of 67.8% (n = 224) of the patients were issued from another healthcare facility. Major adverse cardiovascular events occurred in 5.5% (n = 18) and the in-hospital mortality was 2.1%. Conclusion Those first in hospital results on Algerian STEMI patients revealed that a large percentage of patients benefit from a strategy of reperfusion, the thrombolysis remains the most used,
01-Coronary artery disease
Disclosure of interest peting interest.
The authors declare that they have no com-
Disclosure of interest peting interest.
The authors declare that they have no com-
https://doi.org/10.1016/j.acvdsp.2017.11.008
https://doi.org/10.1016/j.acvdsp.2017.11.009
210
066
Can simulator-based teaching improve medical students’ knowledge and competences? Results of a randomized trial using a coronary angiography simulator to learn coronary anatomy
Benefit of switching dual antiplatelet therapy after ACS on dual antiplatelet therapy adherence: A prespecified analysis of the TOPIC randomized study
Q. Fischer ∗ , Y. Sbissa , P. Nhan , J. Adjedj , O. Varenne Cardiology, Cochin, Paris, France ∗ Corresponding author. E-mail address: q.fi[email protected] (Q. Fischer)
P. Deharo 1,∗ , J. Quilci 2 , C. Bassez 1 , G. Bonnet 3 , M. Lambert 1 , P. Morange 1 , M.C. Alessi 1 , L. Fourcade 2 , J. Bonnet 4 , T. Cuisset 1 1 Hôpital laveran, France 2 Hôpital La Timone, Marseille, France 3 Centre hospitalier Gap, Gap, France 4 Maladies coronaires et cardiologie interventionnelle, CHU la Timone, Marseille, France ∗ Corresponding author. E-mail address: [email protected] (P. Deharo)
Background Simulator-based teaching for coronary angiography (CA) is a seductive tool for medical students to improve knowledge and skills. Its pedagogical impact has not been fully evaluated yet. The aim of this study was to compare traditional face-to-face teaching with a simulator-based teaching. Methods Hundred and eighteen students were prospectively randomized in two groups: a control teaching group (n = 59, CONT group) and a simulator (Mentice AB, Sweden) group (n = 59, SIM group). CONT group received a PowerPoint-based course (30 min), consisting of 15 slides encompassing predefined learning objectives (coronary anatomy, different projections, film interpretation). SIM group received a simulator-based course including exactly the same information in an interactive, real 3D environment. After the course, students were evaluated by 40 multiple-choice questions (maximum of 100 points (pts)), including questions on coronary anatomy (part 1:50 pts), on angiographic projections (part 2:10 pts), and real case interpretations (part 3:40 pts). Results Student characteristics were identical in both groups: 52.5% were female; age was 22.6 ± 1.4 years. 35.6% were in their 4th year of medical school, 35.6% in 5th year and 28.8% in 6th year. SIM students scored higher than CONT students irrespective of age and year of medical school (59.5 ± 10.8 pts vs. 43.7 ± 11.3 pts, P < 0.00001) for all parts of the evaluation (part 1: 36.9 ± 6.6 pts vs. 29.6 ± 6.9 pts, P < 0.00001; part 2: 5.9 ± 3.0 pts vs. 3.1 ± 2.8 pts, P < 0.00001; and part 3:16.8 ± 6.9 pts vs. 10.9 ± 6.5 pts, P < 0.00001). Student satisfaction was also higher in SIM group than in CONT group (98% vs. 75%, P < 0.0001) (Fig. 1). Conclusion This prospective, randomized trial suggests that simulator-based teaching in CA significantly improves students’ knowledge in coronary anatomy, angiography projections, but also clinical competence and decision making process. These results should encourage further evaluation of simulator-based teaching in other branches of medicine.
Background The Timing Of Platelet Inhibition after acute Coronary Syndrome (TOPIC) trial showed that switching dual antiplatelet (DAPT) from aspirin plus a newer P2Y12 blocker (prasugrel or ticagrelor) to aspirin plus clopidogrel 1 month after an acute coronary syndrome (ACS) led to a reduction in bleeding complications with similar risk of ischemic recurrence. Purpose The objective of this prespecified analysis was to evaluate the impact of switching strategy on DAPT adherence. Methods TOPIC study randomized patients admitted for an ACS without adverse event at 1 month on aspirin and a newer P2Y12 blocker, to aspirin and clopidogrel (switched DAPT) or continuation of their drug regimen (unchanged DAPT). Medical adherence to prescribed DAPT was assessed at 6 months and 1 year. Results Six hundred and forty-six patients were randomized and 645 analyzed, corresponding to 322 patients in the switched DAPT and 323 in the unchanged DAPT group. At 6 months and 1 year, the allocated DAPT regimen was significantly used more often in the switched group than in the unchanged DAPT group: 298 (92.5%) vs. 264 (81.7%) (P < 0.01) at 6 months and 277 (87.7%) vs. and 242 (76.1%) (P < 0.01) at 1 year. The reason for DAPT change was related to an adverse event in 66% of cases corresponding to an ischemic event in 17 patients (14.8%) and bleeding in 59 patients (51.3%) (Fig. 1). In multivariable analysis, unchanged DAPT strategy and ischemic or bleeding events were significantly associated with nonadherence to prescribed DAPT (Table 1). Conclusion A switched DAPT was associated with significant improvement in the number of patients on prescribed DAPT at 6 months and 1 year following ACS. This improved adherence was related to reduction of side effects. Table 1 Factors associated with DAPT nonadherence at 1 year in multivariate analysis.
Unchanged DAPT strategy Bleeding BARC 1 Primary endpoint occurrence
Fig. 1
Total score according to the inclusion group: PPT vs. SIM.
OR
95% CI
P-value
1.83 2.76 3.99
1.17—2.88 1.36—5.63 2.48—6.42
0.008 < 0.001 < 0.001
01-Coronary artery disease
9 increased by at least 50% for the primary effectiveness endpoint; age, a poverty index, ICU stay duration > 5 days and no PCI during index hospitalisation, and congestive heart failure, peripheral arterial disease, ischemic stroke, abnormal renal function, C and P before index hospitalisation were associated with a risk increased by 20—50%; diabetes, hypertension, aspirin before index hospitalisation, and C in the month after discharge (versus T) were associated with a risk increased by 10—20%. Conclusions In this nationwide real-life study, the risk factor most associated with the primary effectiveness endpoint was a Charlson comorbidity index > 5. Disclosure of interest Étude réalisée à la demande des Autorités de Santé, avec un financement inconditionnel du laboratoire AstraZeneca, par la Plateforme Bordeaux PharmacoEpi, et supervisée par un comité scientifique constitué d’experts indépendants. https://doi.org/10.1016/j.acvdsp.2017.11.011
Fig. 1 DAPT adherence at 1 year in the 2 groups and cause for non-adherence. Disclosure of interest
Lecture Fees Sanofi.
https://doi.org/10.1016/j.acvdsp.2017.11.010 039
Risk factors for the primary effectiveness endpoint in secondary prevention of acute coronary syndrome with antiplatelet agents: A cohort in the nationwide French claims and hospitalisation database N. Danchin 1 , P. Blin 2 , B. Falissard 3 , J. Bénichou 4,5 , L. Bonello 6 , C. Dureau-Pournin 2,∗ , J. Jové 2 , R. Lassalle 2 , C. Droz-Perroteau 2 , F. Thomas-Delecourt 7 , J. Dallongeville 8 , N. Moore 2,5 1 Hôpital européen G.-Pompidou, AP—HP, Paris, France 2 Bordeaux PharmacoEpi, Inserm CIC1401, université de Bordeaux, Bordeaux, France 3 Centre de recherche en épidémiologie et santé des populations, Inserm U1018, Paris, France 4 CHU, Rouen, France 5 Inserm U1219, Bordeaux, France 6 Hôpital Nord, Marseille, France 7 AstraZeneca, Courbevoie, France 8 Institut Pasteur, Inserm U1167, Lille, France ∗ Corresponding author. E-mail address: [email protected] (C. Dureau-Pournin) Background The French HTA agency requested a real-life benefitrisk study of ticagrelor (T) compared to clopidogrel (C) and prasugrel (P) in the secondary prevention of acute coronary syndrome (ACS) (EUPAS5987). Purpose This study aimed to identify the risk factors associated with the primary effectiveness endpoint for patients with antiplatelet agents after a hospitalisation for ACS. Methods Patients hospitalised in 2013 for STEMI, NSTEMI or unstable angina, with intensive care unit (ICU) stay, and followed for 1 year in the nationwide French claims and hospitalisation database, SNIIRAM. Treatment group (T, C, or P ± aspirin) was defined by the first drug dispensed in the month after discharge. The primary effectiveness endpoint was a composite of the first event of ACS with ICU stay, stroke, or all-cause death. Hazard ratios were estimated with Cox proportional hazard risk model (multivariate analysis). Results A total of 41,954 patients were included (19,796 C, 13,916 T, 8242 P) with different characteristics: mean age of 72, 63, 58 years, respectively; 68%, 76%, 86% male; 42%, 55%, 72% STEMI. A Charlson comorbidity index > 5 was associated with a risk
539
Characteristics of patients with first occurrence of ST-segment Elevation Myocardial Infarction in Algeria: The STAMI registry M. Chettibi 1,∗ , D. Nibouche 2 , M.T.C. Bouafia 1 , M. Krim 3 , K. Boussouf 4 , B. Kichou 5 , T. Boumedienne 6 , L. Hammou 7 , B. Bendaoud 8 , M. Ait Athmane 9 , K. Bouchair 10 , S. Kara 11 , H. Hiba 12 , N. Hammoudi 13 1 Cardiologie, CHU Frantz Fanon, Blida, Algeria 2 Cardiologie, CHU Parnet, Algeria 3 Cardiologie, CHU Benimessous, Alger, Algeria 4 Cardiologie, CHU Setif, Setif, Algeria 5 CHU de Tizi-Ouzou, Tizi-Ouzou, Algeria 6 Cardiologie, CHU Mustapha, Alger, Algeria 7 Cardiologie, CHU Oran, Oran, Algeria 8 Cardiologie, CHU Belabes, Belabes, Algeria 9 Cardiologie, CHU Annaba, Annaba, Algeria 10 Cardiologie, CHU Constantine, Constantine, Algeria 11 Cardiologie, hôpital privé Kara, Oran, Algeria 12 Cardiologie, CHU Tiziouzou, Tiziouzou, Algeria 13 Cardiologie, hôpital privé des Oasis, Ghardaia, Algeria ∗ Corresponding author. E-mail address: [email protected] (M. Chettibi) Background Few data are available on the management of acute myocardial infarction (MI) and risk assessment after MI in Algeria. Methods The STAMI registry is a prospective, multicenter, noninterventional study conducted in fourteen public and private hospitals in the central, eastern, western but also in the Sahara containing a cardiac intensive care unit (with and without PCI facilities). Enrollment started in November 2016 for a 2-month period. The primary Outcome Measures major adverse cardiac and cerebrovascular events during hospitalization. Additional outcomes include the delay between onset of symptoms and hospitalization, the types of reperfusion management and MACCE at 1 month and 1 year after discharge from hospital. A total of 327 patients were enrolled. The majority were male 260 (79.5%) and was younger (Men 59.4 ± 11.8 years) women 63.9 ± 13.1 years). Smoking (45,5%, n = 150), hypertension (39,9%, n = 130), and diabetes (35.2%, n = 116) were the main risk factors; a history of coronary dieses was reported in less 5% of the patients. Reperfusion therapy was performed in 285 (86.5%) patients (56.9%, n = 188 thrombolytic therapy and 29.4%, n = 97 primary PCI). The median time since symptom onset to hospitalization is 349mn. A total of 67.8% (n = 224) of the patients were issued from another healthcare facility. Major adverse cardiovascular events occurred in 5.5% (n = 18) and the in-hospital mortality was 2.1%. Conclusion Those first in hospital results on Algerian STEMI patients revealed that a large percentage of patients benefit from a strategy of reperfusion, the thrombolysis remains the most used,