Comparison of clinical outcome following coronary stenting or balloon angioplasty in dialysis versus non-dialysis patients.
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Adult↗
Biomedical subjects
F Beygui
Publications and source records attributed to F Beygui.
A comparison of systematic stenting and conventional balloon angioplasty during primary percutaneous transluminal coronary angioplasty for acute myocardial infarction. STENTIM-2 Investigators.
OBJECTIVES: In a multicenter, randomized trial, systematic stenting using the Wiktor stent was compared to conventional balloon angioplasty with provisional stenting for the treatment of acute myocardial infarction (AMI). BACKGROUND: Primary angioplasty in AMI is limited by in-hospital recurrent ischemia and a high restenosis rate. METHODS: A total of 211 patients with AMI <12 h from symptom onset, with an occluded native coronary artery, were randomly assigned to systematic stenting (n = 101) or balloon angioplasty (n = 110). The primary end point was the binary six-month restenosis rate determined by core laboratory quantitative angiographic analysis. RESULTS: Angiographic success (Thrombolysis in Myocardial Infarction [TIMI] flow grade 3 and residual diameter stenosis <50%) was achieved in 86% of the patients in the stent group and in 82.7% of those in the balloon angioplasty group (p = 0.5). Compared with the 3% cross-over in the stent group, cross-over to stenting was required in 36.4% of patients in the balloon angioplasty group (p = 0.0001). Six-month binary restenosis (> or = 50% residual stenosis) rates were 25.3% in the stent group and 39.6% in the balloon angioplasty group (p = 0.04). At six months, the event-free survival rates were 81.2% in the stent group and 72.7% in the balloon angioplasty group (p = 0.14), and the repeat revascularization rates were 16.8% and 26.4%, respectively (p = 0.1). At one year, the event-free survival rates were 80.2% in the stent group and 71.8% in the balloon angioplasty group (p = 0.16), and the repeat revascularization rates were 17.8% and 28.2%, respectively (p = 0.1). CONCLUSIONS: In the setting of primary angioplasty for AMI, as compared with a strategy of conventional balloon angioplasty, systematic stenting using the Wiktor stent results in lower rates of angiographic restenosis.
Angioplasty, Balloon↗
The French Randomized Optimal Stenting Trial: a prospective evaluation of provisional stenting guided by coronary velocity reserve and quantitative coronary angiography. F.R.O.S.T. Study Group.
OBJECTIVES: We sought to make a prospective comparison of systematic stenting with provisional stenting guided by Doppler measurements of coronary velocity reserve and quantitative coronary angiography. BACKGROUND: Despite the increasing use of stents during percutaneous transluminal coronary angioplasty, it is unclear whether systematic stenting is superior to a strategy of provisional stenting in which stents are placed only in patients with unsatisfactory results or as a bail-out procedure. METHODS: Two hundred fifty-one patients undergoing elective coronary angioplasty were randomly assigned either to provisional stenting (group 1, in which stenting was performed if postangioplasty coronary velocity reserve was <2.2 and/or residual stenosis > or =35% or as bail-out) or to systematic stenting (group 2). The primary end point was the six-month angiographic minimal lumen diameter (MLD). Major adverse cardiac events were secondary end points (death, acute myocardial infarction and target lesion revascularization). RESULTS: Stenting was performed in 48.4% of patients in group 1 and 100% of patients in group 2 (p<0.01). Six months after angioplasty, the MLD did not differ between groups (1.90+/-0.79 mm vs. 1.99+/-0.70 mm, p = 0.39), as was the rate of binary restenosis (27.1% vs. 21.4%, p = 0.37). Among patients with restenosis, 13/32 (40.6%) in group 1 but 100% (25/25) in group 2 had in-stent restenosis (p<0.01). Target lesion revascularization (15.1% vs. 14.4% in groups 1 and 2 respectively, p = 0.89) and major adverse cardiac events (15.1% vs. 16.0%, p = 0.85) were not significantly different. CONCLUSIONS: Systematic stenting does not provide superior angiographic results at six months as compared with provisional stenting.
Aged↗
[Coronary angioplasty in hemodialysis patients].
The results of balloon coronary angioplasty are very disappointing in haemodialysis patients because of the high restenosis rate. On the other hand, the use of stents in this population had not previously been assessed. This retrospective study compared 63 coronary patients on haemodialysis with a référence group of 63 paired patients with respect to gender, age, and the necessity or not of stent implantation. There was a higher frequency of hypertension (79 vs 39%) and of hypertriglyceridaema (22 vs 8%) in the haemodialysis group than in the controls. However, there was no significant difference with respect to primary success rate of angioplasty (92 and 89% respectively), nor to the development of early cardiovascular complications (4% and 1.9% respectively). After a two-year follow-up, there was no significant difference in the restenosis rate in the haemodialysis patients (33%) compared with the controls (25%). Nevertheless, the mortality rate at 2 years was higher in the dialysis group (15%) compared with the reference group (3.5%, p = 0.03). However, this mortality rate was lower than that reported in the literature in haemodialysis patients after balloon angioplasty. Therefore, haemodialysis does not increase the risk of restenosis when an optimal angiographic results is obtained either by balloon angioplasty or by angioplasty with stenting. Coronary angioplasty is a safe and effective method of revascularisation in coronary haemodialysis patients when the lesions are accessible to stenting.
Aged↗
Trimetazidine as adjunctive therapy to primary PTCA for acute myocardial infarction.
Acute myocardial infarction remains a complex medical problem despite major advances in its management, especially early myocardial reperfusion by percutaneous transluminal coronary angioplasty (PTCA). Situations such as absence of TIMI 3 flow grade and/or persistence of ST segment elevation despite successful PTCA, no-reflow phenomenon and absence of improvement of myocardial regional contractility despite angiographic TIMI 3 flow, probably involve microvascular injury due to neutrophil and platelet activation, free radical generation and myocardial metabolic disorders. Trimetazidine is a well tolerated and efficient antianginal agent, that experimentally reduces ischemia-reperfusion injuries, neutrophil infiltration, platelet aggregation and has antioxidant effects. The Limitation of Infarct Size by trimetazidine Trial (LIST) randomized 94 patients with acute myocardial infarction undergoing primary PTCA into two groups: placebo versus trimetazidine i.v. infusion started before PTCA and continued for 48 hours. Continuous ST segment monitoring was performed during and after primary PTCA. The major results of the study were a significantly more important and faster reduction of ST segment elevation with a trend to less ST segment exacerbation, in the trimetazidine group after PTCA compared to the placebo group. These results suggest that trimetazidine may efficiently reduce ischemia-reperfusion lesions after primary PTCA for acute myocardial infarction.
Angioplasty, Balloon, Coronary↗
The heparin management test: a new device for monitoring anticoagulation during coronary intervention.
Whole blood coagulation analysers are widely used during percutaneous coronary interventions. The precise degree of anticoagulation in patients is important in this setting. The aim of this investigation was to compare the results obtained with ACT (Hemochron) and HMT, the Heparin Management Test (TAS) in patients undergoing percutaneous coronary interventions. Patients (n = 100) were enrolled prospectively. Each patient received 10,000 units of heparin. At the end of the procedure, the mean ACT was 284+/-31 seconds and the mean HMT was 292+/-33 seconds. The correlation between the two methods was highly significant (r = 0.64, p<0.001). The HMT correlates well with ACT values in patients undergoing percutaneous coronary interventions. Its use in the management of these patients should be considered.
Angina, Unstable↗
[New thrombolytic agents in myocardial infarction].
Myocardial infarction is the result of thrombotic coronary artery occlusion. Although present-day thrombolytics have major value by increasing the frequency of reopening of arteries responsible for myocardial infarction, by preserving myocardial function and, thereby, significantly reduce mortality. Nevertheless, they are subject to the following limitations: 1) excellent arterial partency is only obtained in 50% of cases: 2) reocclusion occurs in 5 to 10% of cases; 3) severe complications such as cerebral haemorrhage are observed in about 0.5% of cases. Therefore, the search to improve thrombolytic agents is intense. This article reports the recent advances in concept and production of new thrombolytic agents. The most recent results concern the production of mutants of T-PA (tissue plasmogen activator). Of these mutants, the reteplase (r-PA) has already received authorization for its commercialisation. Other t-PA mutants under development (phase 3) include TNK-t-PA and lanoteplase. Over the last few years, there has been renewed interest in staphylokinase. The results of the initial clinical trials with this agent have also been reported. Paradoxically, the mode of action of thrombolytic agents has an inherent pro-thrombotic effect. This explains some of the interest for anti-thrombotic agents as an adjuvant treatment of thrombolysis. The initial results of the association of thrombolytics with new glycoprotein IIb/IIIa platelet inhibitors and anti-thrombin agents are reported.
Coronary Disease↗
Comparison of activated clotting times to heparin management test for adequacy of heparin anticoagulation in percutaneous transluminal coronary angioplasty.
The aim of this study was to compare the activated clotting time (ACT) obtained with the Hemochron device and the Heparin Management Test (HMT) on a new automated whole-blood coagulometer, the Thrombolytic Assessment System, in patients undergoing angioplasty. Fifty patients undergoing balloon angioplasty were prospectively enrolled. The mean ACT after a 10,000 unit bolus of heparin was 283 +/- 39 sec at the end of the procedure. The mean HMT after 10,000 units of heparin was 286 +/- 31 sec at the end of the procedure in the same patients. The correlation between the two methods was significant (r = 0.6; P < 0.01). The HMT appears to correlate well with standard values obtained with the Hemochron ACT monitor in patients undergoing percutaneous transluminal coronary angioplasty.
Angioplasty, Balloon, Coronary↗
[Staphylokinase].
Myocardial infarction is due to thrombotic occlusion of a coronary artery. Current thrombolytic agents have demonstrated their major value by inducing a significant reduction of mortality, but they nevertheless present certain limits: 1) excellent arterial patency is obtained in only about 50% of cases; 2) reocclusions persist in 5 to 10% of cases; 3) very severe complications, such as cerebral haemorrhages, have not disappeared (about 0.5% of cases). There is therefore a large field of action for development of the optimal thrombolytic agent. Research concerning staphylokinase, classified among third generation thrombolytic agents, is therefore situated in this context. Staphylokinase is a protein known to possess profibrinolytic properties for more than four decades, but has been the subject of renewed interest over recent years. This article reviews the characteristics, mechanism of action and fibrinolytic properties of staphylokinase. It recalls the main results obtained in animal models and summarizes the main clinical trials in man.
Animals↗
Determination of left ventricular mass with electron beam computed tomography in deformed, hypertrophic human hearts.
This study firstly determined the accuracy of left ventricular mass (LVM) determination by electron beam CT in normal and distorted human cadaver hearts, and secondly the in vivo reproducibility of these measurements, in normal subjects and patients with various cardiac diseases, over a wide range of LVM (104-631 g). In cadaver hearts, there was a close correlation between electron beam CT and autopsy LVM values: r = 0.97, SEE = 16 g. Intra-observer variability: results of LVM measurements obtained in cadaver hearts by observer 1 and in in vivo studies by observer 2 were y = 1.001 x -1.34, r = 0.99, SEB = 6 g and y = 0.99 x +3.78, r = 0.99, SEE = 19 g, respectively. Inter-observer variability: results in cadaver and in vivo studies were y = 1.05 x -5.94, r = 0.98, SEE = 14 g and y = 1.13 x -23, r = 0.99, SEE = 28 g, respectively. Thus, these results over a wide LVM range provide extensive validation of electron beam CT measurements in hearts with marked left ventricular distortion. This method should play a valuable role, within the scope of clinical research, in assessing left ventricular remodelling in various conditions in which echocardiographic data are inaccurate.
Adult↗
[Mass and geometry of the left ventricle. Contribution of ultrafast computed x-ray tomography and magnetic resonance imaging].
Ultrafast computed tomography and magnetic resonance imaging are two new methods of cardiac imaging. Measurements of left ventricular volume (end-diastolic, end-systolic volume, stroke volume) and mass have been validated with both methods. The calculations are independent of the geometric shape of the ventricle. Although regional analysis is difficult because of the complex movement of the left ventricle in the tomographic cuts, these methods present a number of advantages: excellent temporospatial tomographic resolution, approximately the same in all dimensions, appreciation of endocardial movement from an epicardial centre, the potential to record their transform spatial data in 3 dimensions from initial planar acquisition. However, all potential regional measurements are still being validated as they are operator-dependent and require visual identification and manual tracing of the cardiac contours or local infrastructures which affect the results of these techniques which are still relatively little used in cardiac imaging. In the context of clinical evaluation, these relatively non-invasive methods will become extremely accurate in the appreciation of parameters of left ventricular geometry and function. They will become very useful in the determination of the myocardial effects of drugs, surgery or other interventional procedures in different models of cardiac disease.
Cardiac Volume↗