- Email: [email protected]
Radial artery spasm: prevalence, prevention and safety vasodilators agents in a prospective randomized meta-analysis
24
Archives of Cardiovascular Diseases Supplements (2017) 9, 11-28
442 Effect of rapid desensitization on platelet inhibition and basophil activation in patients with aspirin hypersensitivity and coronary disease S. Manzo-Silberman (*)(1), P. Nicaise-Roland (2), C. Neukirch (3), F. Tubach (4), MG. Huisse (5), S. Chollet-Martin (2), H. Abergel (6), F. Driss (7), T. Alfaiate (4), N. Ajzenberg (5), G. Steg (6) (1) APHP APHP-Hôpital Lariboisière, Cardiologie, Paris, France – (2) APHP-Hôpital Bichat-Claude Bernard, Immunologie auto-immunité et hypersensibilités, Paris, France – (3) APHP-Hôpital Bichat-Claude Bernard, Pneumologie allergologie, Paris, France – (4) APHP-Hôpital Bichat-Claude Bernard, Cardiologie, Paris, France – (5) APHP-Hôpital Bichat-Claude Bernard, Epidémiologie et recherche clinique, CIC-EC 1425, Paris, France 6 – (6) APHP-Hôpital Bichat-Claude Bernard, Hématologie, Paris, France – (7) APHP-Hôpital Bichat-Claude Bernard, Cardiologie, Paris, France – (8) APHP-Hôpital Bichat-Claude Bernard, Biochimie, Paris, France *Corresponding author: [email protected] Background Little is known about antiplatelet efficacy after desensitization in patients with a history of aspirin hypersensitivity. Purpose The primary objective was to test the antiplatelet efficacy of aspirin measured 1 day (D1) and at steady state 6-8 weeks (W6-8) after desensitization, and the reality of antiplatelet protection and also platelet activation. A secondary objective was to determine the efficacy of desensitization on ex vivo basophil reactivity to aspirin 6-8 weeks after desensitization. Methods We conducted a case-control study to evaluate the efficacy of aspirin 1 day (D1) and 6-8 weeks (W6-8) after desensitization. We also assessed ex vivo basophil reactivity to aspirin after desensitization. Results Cases were patients with coronary artery disease (CAD) and documented history of aspirin hypersensitivity who underwent rapid successful oral desensitization to aspirin. Controls were patients with stable CAD without hypersensitivity and receiving aspirin. Among 56 cases, 27 received aspirin for acute coronary syndromes and 29 were treated for stable CAD. Aspirin was effective (defined as light transmission aggregometry induced by arachidonic acid ≤20%) at D1 in 86% of cases (p=0.045 vs controls) and in 95% at W6-8, vs 100% of controls (p=0.39). Urinary excretion of thromboxane B2 diminished substantially in cases (p<0.0001, D0 vs W6-8) but remained higher than in controls (p=0.03). Platelet reactivity was similar in cases between D0 and D1 but decreased at W6-8. Basophil activation was higher in cases at W6-8 than in controls (p=0.0002). Conclusions Following rapid desensitization, aspirin achieves rapid biological efficacy. Persistent basophil activation several weeks after desensitization suggests infraclinical hypersensitivity and the need to continue aspirin to maintain desensitization.
sugrel were younger (mean age 56 years +/- 9 vs 63 +/- 12, p<0.001). No significant difference was observed between the two groups regarding time to thrombolysis, radial access, use of a GP IIb/IIIa inhibitor, left ventricular ejection fraction, and extent of coronary artery disease. Fewer MACE were observed in the prasugrel group (1.6% vs. 14.3%, p<0.02). TIMI major or minor bleedings were numerically lower without reaching statistical significance in the prasugrel group (1.6% vs. 8.9%, p=0.10). Results from this study suggest that in selected STEMI patients, switching from clopidogrel to prasugrel following thrombolysis is not associated with an increased bleeding risk and might be more efficient than the clopidogrel maintenance dose. Larger studies are needed to confirm these results. The authors hereby declare no conflict of interest
716 What is the optimal duration of dual antiplatelet therapy after acute coronary syndrome in the elderly? A. Lemaitre*, V. Roule, K. Blanchart, P. Ardouin, J. Alexandre, C. Briet, M. Aabouni, J. Wain-Hobson, M. Bignon, R. Sabatier, P. Milliez, F. Beygui *Corresponding author: [email protected] Background Elderly patients have been scarcely represented in trials comparing optimal duration of dual antiplatelet therapy after acute coronary syndrome. The population over 75 years is both at high ischemic and hemorrhagic risk. Handling of dual antiplatelet therapy is difficult and risky in this fragile population. Purpose This study sought to determine the optimal duration of dual antiplatelet therapy after acute coronary syndrome in the elderly. Methods A prospective cohort of 164 consecutive patients over 75 years old, admitted for acute coronary syndrome were treated with percutaneous coronary intervention. Cox proportional hazards models adjusted for DAPT score were used to compare mortality according to the duration of dual antiplatelet therapy (more or less than 3 month). The Kaplan-Meier estimator was used to compare survival between the two groups. Results There were no significant differences between groups of patients alive or deceased one year except the GRACE score (p<0.001), CRUSADE score (p=0.002), KILLIP stage (p=0.03) and creatinine level (p=0.01) that were higher in patient who died. Dual antiplatelet therapy less than 3 month was associated with increased rate of death (adjusted HR 2.49, 95% CI [1.02-6.11], p=0.04). Conclusion After acute coronary syndrome in patients over 75 years treated by angioplasty, it seems preferable to propose an extended dual antiplatelet therapy over 3 months. These results must be confirmed by a randomized study.
The authors hereby declare no conflict of interest Abstract 716 – Table: Cox proportional hazards models Unadjusted
623
HR [CI 95%]
Switching from clopidogrel to prasugrel in ST-elevation myocardial infarction treated with thrombolysis, an observational study T. Chollet*, T. Lhermusier, M. Galinier, D. Carrie *Corresponding author: [email protected]
2.71 [1.20-6.12] 0.01
HR [CI 95%]
p
2.49 [1.02-6.11]
0.04
DAPT: Dual antiplatelet therapy, HR: Hazards ratio, CI: Confidence interval The authors hereby declare no conflict of interest
Prasugrel has proved its superiority over clopidogrel among patients with STelevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) in reducing ischemic events. However, it is associated with an increased risk of bleeding. Data in STEMI patients treated with thrombolysis are scarce. We investigated the safety and efficacy of in-hospital switching from clopidogrel to prasugrel in STEMI patients treated with thrombolysis. We retrospectively analysed 119 consecutive STEMI patients transferred to our center following thrombolysis from September 2013 to December 2015. Patients were categorized into 2 groups: patients treated with clopidogrel and patients switched from clopidogrel to prasugrel during hospitalization. Decision and relevant time for switching was based on physician’s clinical evaluation. In-hospital MACE (cardiovascular death, MI, stroke or unplanned revascularisation) and hemorrhagic events (TIMI classification) were collected. Switching from clopidogrel to prasugrel occured in 63 patients (53%). A 30 mg loading dose was given in 57% of cases, and over half were switched in the first 72 hours. Patients switched to pra-
© Elsevier Masson SAS. All rights reserved.
DAPT <3 month
Adjusted on DAPT score p
368 Radial artery spasm: prevalence, prevention and safety vasodilators agents in a prospective randomized meta-analysis J. Adjedj*, R. Jakamy, A. Diallo, J. Rosencher, P. Degrell, E. Salengro, A. Jegou, P. Allouch, S. Linard, O. Varenne APHP-Hôpital Cochin, Cardiologie, Paris, France *Corresponding author: [email protected] Introduction Radial artery spasm (RAS) remains a major limitation for transradial approach (TRA). The aim of our study was to compare the efficacy and safety of different vasodilators in the prevention of RAS in patients undergoing TRA.
25
Archives of Cardiovascular Diseases Supplements (2017) 9, 11-28
Methods We performed between May 2003 and August 2012 three successive randomized controlled trials evaluating different vasodilator agents compared to placebo in the prevention of RAS with a common endpoint. A total of 1,950 patients were consecutively randomized to receive placebo, molsidomine 1mg, verapamil (2.5mg, 5mg or verapamil plus molsidomine 1mg), isosorbide dinitrate (ISDN) 1mg, or diltiazem (5mg) through the arterial sheath after radial artery catheterization for coronary angiogram procedures. The primary endpoint in the three SPASM studies was the occurrence of a RAS. Secondary endpoint was severe hypotension. We performed pooled analysis of the three SPASM studies. Results Within the 1,950 patients included we used radial sheath 5 or 6F respectively in 67.2% and 32.8% of the cases. In the whole population RAS occurred in 22.2%, 13.3%, 7.1%, 7.9%, 4.9%, 6.6% and 9.1% of patients treated respectively with placebo, molsidomine (1mg), verapamil (2,5mg), verapamil (5mg), verapamil (2.5mg) plus molsidomine (1mg), ISDN (1mg) and diltiazem (5mg) respectively. After adjustment for confounding factors (age and sex), multivariate analysis confirms that verapamil, molsidomine, diltiazem and ISDN were more effective than placebo for RAS prevention (p<0.02 for all). Severe hypotension was more observed after ISDN and diltiazem compared to others vasodilators drugs or placebo (p<0.05). No significant difference was found between groups in terms of severe pain, crossover and safety events. Conclusion Verapamil and ISDN are more effective that diltiazem to prevent RAS. These results suggest that verapamil 2.5mg could be considered as the first choice strategy to prevent RAS for TRA.
population. Moreover, few studies assessed the prognosis of AHF according to its timing. This study evaluated incidence, predictors and impact of AHF according to its timing in a homogeneous STEMI patients’ population treated by primary percutaneous coronary intervention (pPCI). Methods Data from 6282 patients included in a prospective multicenter registry were analyzed. Patients with AHF (Killip class > I) were compared to patients without AHF and patients with admission AHF were compared to patients who developed in-hospital AHF. In-hospital mortality was the primary endpoint of the study. Propensity-score matching and multivariable regression were used to adjust for confounders. Results A total of 1328 patients (21.1%) presented AHF: 739 on admission and 589 during hospitalization. AHF was associated with a markedly increased in-hospital mortality rate (19.9% vs. 0.8%, p<0.001). There was a gradual excess risk with each Killip class and admission AHF patients displayed the highest crude mortality rate (24.1%). By multivariable analysis, AHF was the strongest independent predictor of in-hospital mortality (HR=3.852 (2.303-6.442), p<0.001) without evidence of any difference according to its timing (HR=0.947 (0.638-1.372), p=0.767). These results were consistent after extensive adjustment on baseline characteristics in the matched cohorts. Among other predictors, pPCI beyond guidelines-recommended delays and stent thrombosis were independently associated with AHF. Conclusion AHF regardless of its timing remains a common and dreadful complication of STEMI in the contemporary era.
Abstract 072 – Figure Trends in rates of AHF, mechanical circulatory assistances use, radial access and drug-eluting stents implantation along with total number of patients by year of inclusion. AHF=Acute Heart Failure; DES=Drugeluting Stent.
Abstract 368 – Figure
The authors hereby declare no conflict of interest
The authors hereby declare no conflict of interest
072
635
Incidence, timing, predictors and impact of acute heart failure complicating ST-segment elevation myocardial infarction in patients treated by primary percutaneous coronary intervention
Prognosis of acute right ventricular failure as the primary cause of cardiogenic shock complicating ST-segment elevation myocardial infarction
V. Auffret (*)(1), G. Leurent (1), M. Gilard (2), JP. Hacot (3), E. Filippi (4), R. Delaunay (5), A. Rialan (6), G. Rouault (7), P. Druelles (8), P. Castellant (2), I. Coudert (5), B. Boulanger (4), J. Treuil (2), E. Bot (1), M. Bedossa (1), D. Boulmier (1), M. Le Guellec (1), E. Donal (1), H. Le Breton (1) (1) CHU Rennes, Rennes, France – (2) CHU Brest, Cardiologie, Brest, France – (3) CH Bretagne Sud, Lorient, France – (4) CHN; Bretagne Atlantique, Vannes, France – (5) CH Yves Le Foll, St-Brieuc, France – (6) CH Broussais, St-Malo, France – (7) CH Cornouaille, Quimper, France – (8) Clinique St-Laurent, Rennes, France *Corresponding author: [email protected]
S. Boudiche*, F. El Ayech, S. Hannachi, M. Ben Halima, H. Aloui, N. Khader, S. Ouali, F. Mghaeith, N. Larbi, MS. Mourali *Corresponding author: [email protected]
Aims Acute heart failure (AHF) complicating ST-segment elevation myocardial infarction (STEMI) is recognized as an ominous complication. Previous studies mostly reported outcomes of heterogeneous, non-contemporary
Introduction The extension to the right ventricle (RV) usually occurs in relation to acute inferior myocardial infarction (MI) following proximal occlusion of the right coronary artery (RCA). Cardiogenic shock (CS) is the most severe presentation of the RV infarction. It accounts for a major independent predictor of short-term mortality. Methods In this single center retrospective registry, we included, between April 2009 and April 2015, 86 consecutive patients with CS complicating an acute ST-elevation MI. We excluded patients with mechanical complications of MI. We aimed to evaluate the 30-day all-cause mortality in patients with RV failure (n=20) vs. left ventricle (LV) failure (n=66) as the primary cause of CS.
© Elsevier Masson SAS. All rights reserved.
Archives of Cardiovascular Diseases Supplements (2017) 9, 11-28
442 Effect of rapid desensitization on platelet inhibition and basophil activation in patients with aspirin hypersensitivity and coronary disease S. Manzo-Silberman (*)(1), P. Nicaise-Roland (2), C. Neukirch (3), F. Tubach (4), MG. Huisse (5), S. Chollet-Martin (2), H. Abergel (6), F. Driss (7), T. Alfaiate (4), N. Ajzenberg (5), G. Steg (6) (1) APHP APHP-Hôpital Lariboisière, Cardiologie, Paris, France – (2) APHP-Hôpital Bichat-Claude Bernard, Immunologie auto-immunité et hypersensibilités, Paris, France – (3) APHP-Hôpital Bichat-Claude Bernard, Pneumologie allergologie, Paris, France – (4) APHP-Hôpital Bichat-Claude Bernard, Cardiologie, Paris, France – (5) APHP-Hôpital Bichat-Claude Bernard, Epidémiologie et recherche clinique, CIC-EC 1425, Paris, France 6 – (6) APHP-Hôpital Bichat-Claude Bernard, Hématologie, Paris, France – (7) APHP-Hôpital Bichat-Claude Bernard, Cardiologie, Paris, France – (8) APHP-Hôpital Bichat-Claude Bernard, Biochimie, Paris, France *Corresponding author: [email protected] Background Little is known about antiplatelet efficacy after desensitization in patients with a history of aspirin hypersensitivity. Purpose The primary objective was to test the antiplatelet efficacy of aspirin measured 1 day (D1) and at steady state 6-8 weeks (W6-8) after desensitization, and the reality of antiplatelet protection and also platelet activation. A secondary objective was to determine the efficacy of desensitization on ex vivo basophil reactivity to aspirin 6-8 weeks after desensitization. Methods We conducted a case-control study to evaluate the efficacy of aspirin 1 day (D1) and 6-8 weeks (W6-8) after desensitization. We also assessed ex vivo basophil reactivity to aspirin after desensitization. Results Cases were patients with coronary artery disease (CAD) and documented history of aspirin hypersensitivity who underwent rapid successful oral desensitization to aspirin. Controls were patients with stable CAD without hypersensitivity and receiving aspirin. Among 56 cases, 27 received aspirin for acute coronary syndromes and 29 were treated for stable CAD. Aspirin was effective (defined as light transmission aggregometry induced by arachidonic acid ≤20%) at D1 in 86% of cases (p=0.045 vs controls) and in 95% at W6-8, vs 100% of controls (p=0.39). Urinary excretion of thromboxane B2 diminished substantially in cases (p<0.0001, D0 vs W6-8) but remained higher than in controls (p=0.03). Platelet reactivity was similar in cases between D0 and D1 but decreased at W6-8. Basophil activation was higher in cases at W6-8 than in controls (p=0.0002). Conclusions Following rapid desensitization, aspirin achieves rapid biological efficacy. Persistent basophil activation several weeks after desensitization suggests infraclinical hypersensitivity and the need to continue aspirin to maintain desensitization.
sugrel were younger (mean age 56 years +/- 9 vs 63 +/- 12, p<0.001). No significant difference was observed between the two groups regarding time to thrombolysis, radial access, use of a GP IIb/IIIa inhibitor, left ventricular ejection fraction, and extent of coronary artery disease. Fewer MACE were observed in the prasugrel group (1.6% vs. 14.3%, p<0.02). TIMI major or minor bleedings were numerically lower without reaching statistical significance in the prasugrel group (1.6% vs. 8.9%, p=0.10). Results from this study suggest that in selected STEMI patients, switching from clopidogrel to prasugrel following thrombolysis is not associated with an increased bleeding risk and might be more efficient than the clopidogrel maintenance dose. Larger studies are needed to confirm these results. The authors hereby declare no conflict of interest
716 What is the optimal duration of dual antiplatelet therapy after acute coronary syndrome in the elderly? A. Lemaitre*, V. Roule, K. Blanchart, P. Ardouin, J. Alexandre, C. Briet, M. Aabouni, J. Wain-Hobson, M. Bignon, R. Sabatier, P. Milliez, F. Beygui *Corresponding author: [email protected] Background Elderly patients have been scarcely represented in trials comparing optimal duration of dual antiplatelet therapy after acute coronary syndrome. The population over 75 years is both at high ischemic and hemorrhagic risk. Handling of dual antiplatelet therapy is difficult and risky in this fragile population. Purpose This study sought to determine the optimal duration of dual antiplatelet therapy after acute coronary syndrome in the elderly. Methods A prospective cohort of 164 consecutive patients over 75 years old, admitted for acute coronary syndrome were treated with percutaneous coronary intervention. Cox proportional hazards models adjusted for DAPT score were used to compare mortality according to the duration of dual antiplatelet therapy (more or less than 3 month). The Kaplan-Meier estimator was used to compare survival between the two groups. Results There were no significant differences between groups of patients alive or deceased one year except the GRACE score (p<0.001), CRUSADE score (p=0.002), KILLIP stage (p=0.03) and creatinine level (p=0.01) that were higher in patient who died. Dual antiplatelet therapy less than 3 month was associated with increased rate of death (adjusted HR 2.49, 95% CI [1.02-6.11], p=0.04). Conclusion After acute coronary syndrome in patients over 75 years treated by angioplasty, it seems preferable to propose an extended dual antiplatelet therapy over 3 months. These results must be confirmed by a randomized study.
The authors hereby declare no conflict of interest Abstract 716 – Table: Cox proportional hazards models Unadjusted
623
HR [CI 95%]
Switching from clopidogrel to prasugrel in ST-elevation myocardial infarction treated with thrombolysis, an observational study T. Chollet*, T. Lhermusier, M. Galinier, D. Carrie *Corresponding author: [email protected]
2.71 [1.20-6.12] 0.01
HR [CI 95%]
p
2.49 [1.02-6.11]
0.04
DAPT: Dual antiplatelet therapy, HR: Hazards ratio, CI: Confidence interval The authors hereby declare no conflict of interest
Prasugrel has proved its superiority over clopidogrel among patients with STelevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) in reducing ischemic events. However, it is associated with an increased risk of bleeding. Data in STEMI patients treated with thrombolysis are scarce. We investigated the safety and efficacy of in-hospital switching from clopidogrel to prasugrel in STEMI patients treated with thrombolysis. We retrospectively analysed 119 consecutive STEMI patients transferred to our center following thrombolysis from September 2013 to December 2015. Patients were categorized into 2 groups: patients treated with clopidogrel and patients switched from clopidogrel to prasugrel during hospitalization. Decision and relevant time for switching was based on physician’s clinical evaluation. In-hospital MACE (cardiovascular death, MI, stroke or unplanned revascularisation) and hemorrhagic events (TIMI classification) were collected. Switching from clopidogrel to prasugrel occured in 63 patients (53%). A 30 mg loading dose was given in 57% of cases, and over half were switched in the first 72 hours. Patients switched to pra-
© Elsevier Masson SAS. All rights reserved.
DAPT <3 month
Adjusted on DAPT score p
368 Radial artery spasm: prevalence, prevention and safety vasodilators agents in a prospective randomized meta-analysis J. Adjedj*, R. Jakamy, A. Diallo, J. Rosencher, P. Degrell, E. Salengro, A. Jegou, P. Allouch, S. Linard, O. Varenne APHP-Hôpital Cochin, Cardiologie, Paris, France *Corresponding author: [email protected] Introduction Radial artery spasm (RAS) remains a major limitation for transradial approach (TRA). The aim of our study was to compare the efficacy and safety of different vasodilators in the prevention of RAS in patients undergoing TRA.
25
Archives of Cardiovascular Diseases Supplements (2017) 9, 11-28
Methods We performed between May 2003 and August 2012 three successive randomized controlled trials evaluating different vasodilator agents compared to placebo in the prevention of RAS with a common endpoint. A total of 1,950 patients were consecutively randomized to receive placebo, molsidomine 1mg, verapamil (2.5mg, 5mg or verapamil plus molsidomine 1mg), isosorbide dinitrate (ISDN) 1mg, or diltiazem (5mg) through the arterial sheath after radial artery catheterization for coronary angiogram procedures. The primary endpoint in the three SPASM studies was the occurrence of a RAS. Secondary endpoint was severe hypotension. We performed pooled analysis of the three SPASM studies. Results Within the 1,950 patients included we used radial sheath 5 or 6F respectively in 67.2% and 32.8% of the cases. In the whole population RAS occurred in 22.2%, 13.3%, 7.1%, 7.9%, 4.9%, 6.6% and 9.1% of patients treated respectively with placebo, molsidomine (1mg), verapamil (2,5mg), verapamil (5mg), verapamil (2.5mg) plus molsidomine (1mg), ISDN (1mg) and diltiazem (5mg) respectively. After adjustment for confounding factors (age and sex), multivariate analysis confirms that verapamil, molsidomine, diltiazem and ISDN were more effective than placebo for RAS prevention (p<0.02 for all). Severe hypotension was more observed after ISDN and diltiazem compared to others vasodilators drugs or placebo (p<0.05). No significant difference was found between groups in terms of severe pain, crossover and safety events. Conclusion Verapamil and ISDN are more effective that diltiazem to prevent RAS. These results suggest that verapamil 2.5mg could be considered as the first choice strategy to prevent RAS for TRA.
population. Moreover, few studies assessed the prognosis of AHF according to its timing. This study evaluated incidence, predictors and impact of AHF according to its timing in a homogeneous STEMI patients’ population treated by primary percutaneous coronary intervention (pPCI). Methods Data from 6282 patients included in a prospective multicenter registry were analyzed. Patients with AHF (Killip class > I) were compared to patients without AHF and patients with admission AHF were compared to patients who developed in-hospital AHF. In-hospital mortality was the primary endpoint of the study. Propensity-score matching and multivariable regression were used to adjust for confounders. Results A total of 1328 patients (21.1%) presented AHF: 739 on admission and 589 during hospitalization. AHF was associated with a markedly increased in-hospital mortality rate (19.9% vs. 0.8%, p<0.001). There was a gradual excess risk with each Killip class and admission AHF patients displayed the highest crude mortality rate (24.1%). By multivariable analysis, AHF was the strongest independent predictor of in-hospital mortality (HR=3.852 (2.303-6.442), p<0.001) without evidence of any difference according to its timing (HR=0.947 (0.638-1.372), p=0.767). These results were consistent after extensive adjustment on baseline characteristics in the matched cohorts. Among other predictors, pPCI beyond guidelines-recommended delays and stent thrombosis were independently associated with AHF. Conclusion AHF regardless of its timing remains a common and dreadful complication of STEMI in the contemporary era.
Abstract 072 – Figure Trends in rates of AHF, mechanical circulatory assistances use, radial access and drug-eluting stents implantation along with total number of patients by year of inclusion. AHF=Acute Heart Failure; DES=Drugeluting Stent.
Abstract 368 – Figure
The authors hereby declare no conflict of interest
The authors hereby declare no conflict of interest
072
635
Incidence, timing, predictors and impact of acute heart failure complicating ST-segment elevation myocardial infarction in patients treated by primary percutaneous coronary intervention
Prognosis of acute right ventricular failure as the primary cause of cardiogenic shock complicating ST-segment elevation myocardial infarction
V. Auffret (*)(1), G. Leurent (1), M. Gilard (2), JP. Hacot (3), E. Filippi (4), R. Delaunay (5), A. Rialan (6), G. Rouault (7), P. Druelles (8), P. Castellant (2), I. Coudert (5), B. Boulanger (4), J. Treuil (2), E. Bot (1), M. Bedossa (1), D. Boulmier (1), M. Le Guellec (1), E. Donal (1), H. Le Breton (1) (1) CHU Rennes, Rennes, France – (2) CHU Brest, Cardiologie, Brest, France – (3) CH Bretagne Sud, Lorient, France – (4) CHN; Bretagne Atlantique, Vannes, France – (5) CH Yves Le Foll, St-Brieuc, France – (6) CH Broussais, St-Malo, France – (7) CH Cornouaille, Quimper, France – (8) Clinique St-Laurent, Rennes, France *Corresponding author: [email protected]
S. Boudiche*, F. El Ayech, S. Hannachi, M. Ben Halima, H. Aloui, N. Khader, S. Ouali, F. Mghaeith, N. Larbi, MS. Mourali *Corresponding author: [email protected]
Aims Acute heart failure (AHF) complicating ST-segment elevation myocardial infarction (STEMI) is recognized as an ominous complication. Previous studies mostly reported outcomes of heterogeneous, non-contemporary
Introduction The extension to the right ventricle (RV) usually occurs in relation to acute inferior myocardial infarction (MI) following proximal occlusion of the right coronary artery (RCA). Cardiogenic shock (CS) is the most severe presentation of the RV infarction. It accounts for a major independent predictor of short-term mortality. Methods In this single center retrospective registry, we included, between April 2009 and April 2015, 86 consecutive patients with CS complicating an acute ST-elevation MI. We excluded patients with mechanical complications of MI. We aimed to evaluate the 30-day all-cause mortality in patients with RV failure (n=20) vs. left ventricle (LV) failure (n=66) as the primary cause of CS.
© Elsevier Masson SAS. All rights reserved.