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Olivier Varenne

Publications and source records attributed to Olivier Varenne.

7 recordsLinked to original sources
PubMed2006

Sirolimus-eluting versus uncoated stents in acute myocardial infarction.

BACKGROUND: Sirolimus-eluting stents reduce rates of restenosis and reintervention, as compared with uncoated stents. Data are limited regarding the safety and efficacy of such stents in primary percutaneous coronary intervention (PCI) for acute myocardial infarction with ST-segment elevation. METHODS: We performed a single-blind, multicenter, prospectively randomized trial to compare sirolimus-eluting stents with uncoated stents in primary PCI for acute myocardial infarction with ST-segment elevation. The trial included 712 patients at 48 medical centers. The primary end point was target-vessel failure at 1 year after the procedure, defined as target-vessel-related death, recurrent myocardial infarction, or target-vessel revascularization. A follow-up angiographic substudy was performed at 8 months among 174 patients from selected centers. RESULTS: The rate of the primary end point was significantly lower in the sirolimus-stent group than in the uncoated-stent group (7.3% vs. 14.3%, P=0.004). This reduction was driven by a decrease in the rate of target-vessel revascularization (5.6% and 13.4%, respectively; P<0.001). There was no significant difference between the two groups in the rate of death (2.3% and 2.2%, respectively; P=1.00), reinfarction (1.1% and 1.4%, respectively; P=1.00), or stent thrombosis (3.4% and 3.6%, respectively; P=1.00). The degree of neointimal proliferation, as assessed by the mean (+/-SD) in-stent late luminal loss, was significantly lower in the sirolimus-stent group (0.14+/-0.49 mm, vs. 0.83+/-0.52 mm in the uncoated stent group; P<0.001). CONCLUSIONS: Among selected patients with acute myocardial infarction, the use of sirolimus-eluting stents significantly reduced the rate of target-vessel revascularization at 1 year. (ClinicalTrials.gov number, NCT00232830 [ClinicalTrials.gov].).

Angioplasty, Balloon, Coronary↗
PubMed2006

Prevention of arterial spasm during percutaneous coronary interventions through radial artery: the SPASM study.

AIMS: Radial artery spasm remains the major limitation of transradial approach for percutaneous coronary interventions. The aim of our study was to evaluate the efficacy of vasodilators in the prevention of radial artery spasm during percutaneous coronary interventions. METHODS AND RESULTS: 1,219 patients were consecutively randomized to receive placebo (n = 198), molsidomine 1 mg (n = 203), verapamil 2.5 mg (n = 409), 5 mg (n = 203) or verapamil 2.5 mg and molsidomine 1 mg (n = 206). All drugs were administered through the arterial sheath. The primary end point was the occurrence of a radial artery spasm defined by the operator as severe limitation of the catheter movement, with or without angiographic confirmation. Main characteristics including age, sex, wrist and arterial sheath diameters and procedure duration were identical across the groups. The rate of radial artery spasm was lowest in patients receiving verapamil and molsidomine (4.9%), compared to verapamil 2.5 mg or 5 mg (8.3 and 7.9%), or molsidomine 1 mg (13.3%); and placebo (22.2%) (P < 0.0001). CONCLUSION: Radial artery spasm during transradial percutaneous interventions was effectively prevented by the administration of vasodilators. The combination of verapamil 2.5 mg and molsidomine 1 mg provided the strongest relative risk reduction of spasm compared to placebo and should therefore be recommended during percutaneous coronary interventions through the radial approach.

Aged↗
PubMed2005

Risk of myocardial infarction and vascular death after transient ischemic attack and ischemic stroke: a systematic review and meta-analysis.

BACKGROUND: Whether stroke patients should be investigated for asymptomatic coronary artery disease remains matter of debate. Absolute risks of myocardial infarction (MI) and vascular death after a stroke have not been accurately assessed. We performed a systematic review and a meta-analysis to determine the risk of MI and nonstroke vascular death after transient ischemic attack (TIA) and ischemic stroke. Cohort studies of TIA or ischemic stroke patients were included if they were published between 1980 and March 2005, reported risk of MI and nonstroke vascular death, enrolled >100 patients, and had at least 1 year of follow-up. We included 39 studies in a total of 65,996 patients with mean follow-up of 3.5 years. Two reviewers independently carried out data extraction using a standardized form. Absolute annual risks were estimated through weighted meta-regressions with a random effect. To test the predictions of expected event rates derived from our analysis, we used individual patient data. SUMMARY OF REVIEW: The annual risks were 2.1% (CI 95%: 1.9 to 2.4) for nonstroke vascular death, 2.2% (1.7 to 2.7) for total MI, 0.9% (0.7 to 1.2) for nonfatal MI and 1.1% (0.8 to 1.5) for fatal MI. The time course of risk was linear. Estimated risks fitted well with observed risks at the individual level. There was no heterogeneity in the absolute risks according to baseline study characteristics. CONCLUSIONS: Patients with TIA or stroke have a relatively high risk of MI and nonstroke vascular death. Additional research is needed to identify the determinants of coronary artery disease in stroke patients.

Aged↗
PubMed2003

[Acute coronary syndrome with ST-segment elevation].

Acute coronary syndromes with ST-segment elevation were known as acute myocardial infarction in the recent past. Their understanding and management are of paramount importance to achieve the earliest reperfusion treatment, using pharmacological (fibrinolysis) or mechanical therapeutics (percutaneous transluminal coronary angioplasty). New fibrinolytics and optimisation of antithrombotic regimen in association with coronary stents have dramatically reduced in-hospital mortality.

Acute Disease↗
PubMed2002

MRI of acute myocarditis: a comprehensive approach based on various imaging sequences.

STUDY OBJECTIVES: To explore the diagnostic performance of MRI for the diagnosis of acute myocarditis, using a comprehensive imaging approach. DESIGN AND SETTINGS: Twenty patients with myocarditis and 7 age-matched and gender-matched control subjects underwent comprehensive MRI. Magnetic resonance (MR) examinations included axial T2-weighted sequences, precontrast and postcontrast ECG-gated T1-weighted sequences in axial and short heart axis, cine-MRI, and serial dynamic turbo fast low-angle shot (turboFLASH) acquisitions in the short axis following Gd injection for a period of 2 min. Precontrast and postcontrast images were postprocessed using subtraction. Two observers read all images qualitatively and quantitatively. Myocardial enhancement was compared between patients and control subjects. PATIENTS: Myocardial involvement was focal in 6 patients examined within 1 week from clinical onset, and diffuse in the remaining 14 patients examined later. RESULTS: Qualitatively, contrast-enhanced T1-weighted subtracted images had 100% sensitivity and specificity for myocardial involvement. Postcontrast T1-weighted images were able to discriminate the early phase (nodular enhancement) from the later phase of myocarditis (diffuse enhancement). Quantitatively, myocardial enhancement was 56% +/- 3.2% in patients, vs 29% +/- 3.1% in control subjects using T1-weighted MRI (p < 0.0001). Serial turboFLASH images displayed greater myocardial enhancement between 25 s and 120 s in patients than in control subjects (p < 0.0001); however, there was marked enhancement of skeletal muscles in both early and late stages of myocarditis compared to control subjects (p < 0.0001). CONCLUSION: On the basis of subtracted cardiac-gated T1-weighted images and serial postinjection turboFLASH images, our study shows that myocarditis is largely, at least in the early stages, a focal process in the myocardium. It also provides evidence of transient skeletal muscle involvement, which may actually be useful for diagnosis.

Acute Disease↗