Biomedical subjects

Yves Cottin

Publications and source records attributed to Yves Cottin.

24 records · Page 2Linked to original sources

PubMed2004

Beneficial effects of direct call to emergency medical services in acute myocardial infarction.

OBJECTIVES: We investigated the impact of an emergency medical services call on the management of acute myocardial infarction, considering time intervals for intervention and revascularization procedures. METHODS: Data were prospectively collected from January 2001 to October 2002 from 531 patients hospitalized for myocardial infarction with ST segment elevation and a pre-hospital delay of less than 24 h. RESULTS: Only 26% of patients called the emergency medical services at the onset of symptoms (n=140). Other patients (n=391, 74%) called another medical contact. Baseline characteristics and cardiovascular history were similar in the two groups, except for the percutaneous coronary intervention history (10% in the emergency medical services group versus 4% in the other medical contact group, P<0.05). Time intervals from the onset of symptoms of myocardial infarction to call or to medical intervention, as well as the time interval from medical intervention to hospital admission were significantly shorter in the emergency medical services group. The early reperfusion rate was also significantly greater in the emergency medical services group (77%) compared with the other medical contact group (64%), mainly because of a greater incidence of primary percutaneous coronary intervention (36 versus 26%, P<0.03, respectively). Multivariate analysis adjusted for sex and age showed that less than three medical care providers [odds ratio (OR) 5.042, P<0.001], percutaneous coronary intervention history (OR 2.462, P<0.05), as well as rhythmic disorders (OR 2.105, P<0.05) and complete atrioventricular block (OR 2.757, P<0.05) were independent predictors of emergency medical services care. CONCLUSION: This study demonstrated that a call to the emergency medical services is underutilized by patients with symptoms of myocardial infarction, and documented the beneficial effects of an emergency medical services call by reducing pre-hospital delays and increasing early revascularization therapies.

Emergency Medical Services↗

PubMed2003

Predictive value of myocardial tomoscintigraphy in asymptomatic diabetic patients after percutaneous coronary intervention.

OBJECTIVE: This study was designed to assess the prognostic value of myocardial tomoscintigraphy perfusion imaging after percutaneous coronary intervention (PCI) in asymptomatic diabetic patients. METHODS: One hundred and fourteen diabetic patients were followed up during 27+/-16 (mean+/-SD) months after the myocardial tomoscintigraphy. PCI-related events were studied after myocardial tomoscintigraphy stress testing and included major cardiac events (MACE) (cardiovascular death, myocardial infarction) and revascularization (bypass surgery or new PCI). Stress myocardial tomoscintigraphy imaging was performed 5+/-5 months after PCI and ischemia was considered as present if at least 2 contiguous segments were showing reversible defects. RESULTS: Persistent silent ischemia was found in 49/114 (43%) patients. No difference was observed between the two groups for MACE: four among the 65 (6%) non ischemic patients versus 2 among the 49 (4%) ischemic patients (NS). In contrast, 15 (31%) among the ischemic patients and 4 (6%) among the non ischemic patients underwent iterative revascularization (p<0.01). The relative risk of revascularization for patients with significant ischemia was 5.5 versus non ischemic patients (p<0.001). CONCLUSION: After PCI, in asymptomatic diabetic patients followed by myocardial tomoscintigraphy a high frequency of persistent silent ischemia was found and associated with a high risk for repeat interventional procedure, although no increase in major cardiac events was observed.

Aged↗

PubMed2003

Long-term prognosis of patients with acute coronary syndrome and moderate coronary artery stenosis.

We evaluated the clinical outcome and the prognostic factors at 6-year follow-up of patients with acute coronary syndrome without critical coronary arterial narrowing. The mean follow-up was 73 +/- 19 months. Mortality rate was 13%, and 20 patients (12%) had major cardiac event, 8 patients (5%) had stroke and 10 patients (6%) underwent revascularization. Multivariate analysis matched for age and ejection factor showed that moderate disease (stenosis 40-59%) (OR = 2.713, p < 0.024) was an independent predictive factor of major cardiac event.

Acute Disease↗

PubMed2002

Glucose insulin potassium infusion improves systolic function in patients with chronic ischemic cardiomyopathy.

OBJECTIVE: We assessed the effects of glucose-insulin-potassium (GIK) by echocardiography in stable patients with ischemic dysfunction. METHODS: Twelve male patients with stable coronary disease (SCD) and ejection fraction (EF) <45% were studied for systolic function. GIK (glucose 30%, 300 insulin units and KCl 6 g/l) was infused at 1 ml/kg per h over 20 min. Hemodynamic and echocardiographic measurements were recorded at rest (T(0)), at the end (20 min) of GIK infusion (T+20), 20 and 40 min after the end of the infusion (T+40 and T+60). RESULTS: At T+20, a significant decrease in WMSI (wall motion score index) was observed compared with T(0) (2.16+/-0.14 vs. 2.30+/-0.16: P<0.05). An increase in EF was reported at T+40 and T+60 compared with T(0) (44.1+/-7.8% and 53.3+/-11.6% vs. 35.6+/-4.5%, respectively: P<0.01). A decrease in WMSI was observed at T+40 and T+60 compared with rest (2.02+/-0.17 and 1.93+/-0.11 vs. 2.30+/-0.16, respectively: P<0.01). CONCLUSION: Our present work suggests that GIK infusion improves systolic function in patients with SCD and ejection fraction <45%. Further studies are needed to determine if short-term GIK infusion could be useful for therapeutic or diagnostic strategies in these patients.

Adult↗

PubMedDate not supplied

Specific profile and referral bias of rehabilitated patients after an acute coronary syndrome.

PURPOSE: Cardiac rehabilitation after acute coronary syndrome is an important but underused therapeutic intervention. The aim of the French nationwide PREVENIR survey was to improve knowledge on the management of cardiovascular risk factors, especially during cardiac rehabilitation after acute coronary syndrome. The purpose of this study was to specify the characteristics of patients referred to cardiac rehabilitation. METHODS: The survey was performed in 77 of 501 (15.4%) public or private French coronary care units. All French regions were involved. All the patients admitted to the hospital during January 1998 who survived an acute coronary syndrome were included in the survey. Data on rehabilitation practice were collected from patient medical records, either during an outpatient consultation or from the patient and the general practitioner during the 6-month follow-up period. RESULTS: Of the 1394 patients included in the study (779 with myocardial infarction and 615 with unstable angina), only 310 (22%) underwent cardiac rehabilitation. Significant differences in patient characteristics were found between the cardiac rehabilitation and non-cardiac rehabilitation groups, respectively, in terms of gender (82% male vs 68%; P <.001), age younger than 65 years (56% vs 39%; P <.001), type of acute coronary syndrome (75% myocardial infarction vs 50%; P <.001), left ventricular ejection fraction less than 35% (6% vs 13%; P <.0004), and prevalence of percutaneous intervention (54% vs 46%; P <.02). Two risk factors were more common in the rehabilitated group: dyslipidemia (52% vs 44%; P <.02) and current smoking (51% vs 37%; P <.0001). In the multivariate analysis, female gender (odds ratio [OR], 0.6; 95% confidence interval [CI], 0.44-0.87) and older age (>75 years vs. <65 years; OR, 0.40; 95% CI, 0.3-0.7) predicted decreased cardiac rehabilitation prescription. Conversely, previous history of dyslipidemia (OR,1.4; 95% CI, 1.04-1.8), post-myocardial infarction (OR, 2.8; 95% CI, 2.13-3.89), and a percutaneous intervention (OR,1.9; 95% CI, 1.3-2.7) predicted increased cardiac rehabilitation prescription. Severe left ventricular impairment (< or =35% vs >50%) was not an independent factor for cardiac rehabilitation prescription. At 6-month follow-up assessment, rehabilitation patients had a lower rate of hypertension (18% vs 27%), elevated low-density lipoprotein cholesterol (54% vs 62%), and continued smoking (34% vs 50%). CONCLUSIONS: The results of the PREVENIR survey underscore the low level of cardiac rehabilitation prescription in France, and the relative exclusion of women and elderly people. Among the risk factors, dyslipidemia and current smoking are more frequent among rehabilitated patients. These findings may help to modify the strategy for using cardiac rehabilitation after acute coronary syndrome, although it is an effective intervention for secondary prevention.

Acute Disease↗

PubMedDate not supplied

Factors affecting the management of outcome in elderly patients with acute myocardial infarction particularly with regard to reperfusion. Data from the French regional RICO survey.

BACKGROUND: Acute myocardial infarction (AMI) in elderly patients is often unrecognized and associated with poor prognosis. OBJECTIVES: To investigate management and efficacy of reperfusion therapy to the elderly patients with AMI. METHODS: From the January 1, 2001 to October 31, 2002, 964 patients with AMI were included in the French regional RICO survey. The patients were divided into three groups: younger (<70 years old), elderly (70-79 years old) and very elderly (>or=80 years old). RESULTS: Distribution of groups was 56, 27, and 16%, respectively. The longest time delay to first request for medical attention was found in the very elderly group (30 and 55 vs. 90 min, respectively, p < 0.05). Rate of lysis fell significantly with increasing age (35, 22 and 9%, respectively, p < 0.001) but the time delay to lysis was similar for the 3 groups. The proportion of patients who benefited from primary percutaneaous transluminal coronary angioplasty decreased with age (21, 15, 11%, respectively, p < 0.001), but time delay to balloon angioplasty was similar and no difference in mortality rate was observed between the three groups after reperfusion. The incidence of in-hospital cardiovascular events (cardiogenic shock and recurrent myocardial infarction/ischemia) and in-hospital mortality increased with age (5, 13, 17%, respectively, p < 0.001). Moreover, multivariate analysis showed that only ejection fraction and Killip >1 were independent predictive factors for in-hospital cardiovascular mortality, respectively (OR 5.15, 95% CI 2.08-12.74, p < 0.0001 and OR 3.81, 95% CI 1.90-7.65, p < 0.0001), whereas age, sex, diabetes and anterior location were not significant. CONCLUSION: Our data in an unselected population indicate that very elderly patients were characterized by increased pre-hospital delays and less frequent utilization of reperfusion therapy, although no difference in the mortality in reperfused patients could be observed between the three age groups.

Adult↗