Floyd and wolfe assert that the benefit of prasugrel was driven mainly by asymptomatic elevations in cardiac enzymes. Objective to determine whether immediate intervention on admission can result in a reduction of. Granger 7, gilles montalescot 8, stephan windecker 9, lars maier 10, pranas serpytis 11, rokas serpytis 11, keith g. A total of 129 patients n 58 enoxaparin and n 71 ufh admitted for stsegment elevation myocardial infarction stemi treated by percutaneous coronary intervention. Background response to clopidogrel differs widely among patients, notably because of cyp2c19 genetic polymorphisms. However, there is frequent discordance between the visual assessment of intermediate stenoses and their consequence on myocardial perfusion 11. Gilles montalescot, md, phd, author at cardioexchange. Read faculty list, the american journal of cardiology on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Ace inhibitors or arbs discontinuation in context of sars. Modulation of cholesterol efflux capacity in patients with. C domains of fibrinogen affect the structure of the fibrin clot, its physical properties, and its susceptibility to fibrinolysis. Objectives the aim of this study was to evaluate prospectively the clinical impact of routine transmission of cyp2c19 genotype in the management of acute stsegment elevation myocardial infarction with primary percutaneous coronary intervention. These recommendations are complex and pose new questions.
Defining standards of care for facilitated and direct. Author links open overlay panel anne bellemainappaix md gilles montalescot md. Invasive coronary angiography has long been considered as the gold standard method for diagnosis of obstructive coronary artery disease. Modulation of cholesterol efflux capacity in patients with m. In gilles montalescot and colleagues report on the subgroup with stsegmentelevation myocardial infarction stemi from tritontimi 38 feb 28, p 723,1 nonfatal myocardial infarction was not adequately defined. This outcome drove most of the reduction in the primary composite endpoint seen with prasugrel versus clopidogrel. Aug 25, 2018 the aim was to compare the periprocedural biomarkers of coagulation and platelet activation in patients randomly allocated to intravenous enoxaparin or unfractionated heparin ufh in the atoll randomized trial nct00718471. Data suggest its pharmacologic effect varies based on cyp2c19 genotype, but there is uncertainty regarding the clinical risk imparted by. Prehospital ticagrelor in stsegment elevation myocardial. Eplerenone reduces primary endpoint in acute myocardial. Best practices for the prevention of radial artery occlusion. Biomarkers of thrombosis in stsegment elevation myocardial.
Beta blocker interruption after uncomplicated myocardial infarction full text view. Slow response to clopidogrel predicts low response. To assess the incidence of and risk factors for adverse clinical outcomes by investigatordetermined aspirin dose in a primary prevention trial. Antithrombotic therapy for patients with left ventricular. After 1 year of followup, we invited patients without major events and who were treated with clopidogrel or. Daniel does research in epidemiology, addiction medicine and cardiology. Blockers and cardiovascular events in patients with and. Anticoagulation in acute coronary syndromestate of the art. Cardiologia, azienda ospedaliera di ferrara verified email at unife. Objectives the purpose of this study was to quantify the effect of anticoagulation therapy on lvt evolution using sequential imaging and to determine the impact of lvt regression on the incidence of thromboembolism, bleeding, and mortality. Interventional cardiologists have a variety of options when it comes. Context international guidelines recommend an early invasive strategy for patients with highrisk acute coronary syndromes without stsegment elevation, but the optimal timing of intervention is uncertain. Publications authored by gilles montalescot pubfacts.
However, its usefulness in the outofhospital setting has been poorly investigated and only by small and singlecentre studies. Since december 2019, a novel coronavirus called sarscov2 severe acute respiratory syndrome coronavirus 2 has caused an international outbreak of respiratory illness described as covid19. Objective to determine whether immediate intervention on admission can result in. Dec 01, 2005 pdf link pdf citation jeanphilippe collet, jennifer l. This has been largely attributed to the fact that, although these drugs are able to raise the hdlc concentration, they have no effect on hdlc atheroprotective function. Anticoagulation, the unknown of the antithrombotic equation after. High ontreatment platelet reactivity as a risk factor for secondary prevention after coronary stent revascularization. Routine cyp2c19 genotyping to adjust thienopyridine. Recherche clinique en cardiologie interventionnelle.
As they state, the results suggest a stronger pharmacogenetic effect of the cyp2c19 lossoffunction genetic variants during the acute phase of acute coronary syndrome, which is different from what was noted in the triton trial. Tailoring antithrombotic therapy to optimize outcomes. The new england journal of medicine 1708 n engl j med 354. Optimal timing of intervention in non stelevation acute coronary syndromes without pretreatment. Recherche clinique en cardiologie interventionnelle gilles. Background the longterm evolution of premature coronary artery disease cad is unknown. Prasugrel stemi subgroup analysis authors reply the lancet. Boehringeringelheimmodest, leadupmodest, bayermodest, bmsmodest, webmdmodest, astrazenecamodest, pfizermodest, medtronic. We congratulate lars wallentin and colleagues oct 16, p 201 for their important scientific contribution in the plato genetics substudy. Outcomes associated with respiratory failure for patients with cardiogenic shock and acute myocardial. Beta blocker interruption after uncomplicated myocardial.
Gilles montalescot carlos brotons, bernard cosyns, harry j. Diabetes mellitus dm remains an important predictor for mortality in patients with stsegment elevation myocardial infarction stemi although the use of reperfusion therapy has resulted in a con. Pretreatment with prasugrel in nonstsegment elevation. Objectives the objective of this study was to describe the evolution of coronary atherosclerosis in young patients and identify the risk factors of poor outcomes. Immediate vs delayed intervention for acute coronary syndromes. Objective to determine the efficacy and safety of enoxaparin compared with unfractionated heparin during percutaneous coronary intervention. As an organization accredited by the accme, medscape, llc, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. Gilles montalescot, md american college of cardiology. Radial artery occlusion rao is the most frequent postprocedural complication of tra, restricting the use of the same radial artery for future procedures and as a conduit for coronary artery bypass. Inappropriate platelet activation can lead to thrombosis and ischemic events. Sd wiviott, e braunwald, ch mccabe, g montalescot, w ruzyllo. Impact of preprocedural timi flow on clinical outcome in.
Reappraisal of thienopyridine pretreatment in patients. The false illusion of coronary thrombus devicemanagement. Continuous positive airway pressure cpap is a useful treatment for patients with acute cardiogenic pulmonary oedema cpe. Transradial access tra is increasingly used worldwide for percutaneous interventional procedures and associated with lower bleeding and vascular complications than transfemoral artery access. Dualantiplatelet treatment beyond 1 year after drugeluting stent. Cannon deepak l bhatt, jonas oldgren, gregory yh lip, stephen g ellis, takeshi kimura, michael maeng. Study selection randomised and nonrandomised studies comparing enoxaparin with unfractionated heparin during. C domains of fibrinogen affect the structure of the. Crijns, armando dangelo, ludovic drouet, franz eberli, deirdre a lane, eric vicaut. Confocal microscopy a confocal microscopy sub analysis was performed in a.
Studydrug assignment was performed centrally by an interactive voiceresponse system on the. Gilles montalescot s 887 research works with 53,778 citations and 11,651 reads, including. The intraindividual variability of this technique was calculated to 9. The extent of p2y12 inhibition during coronary intervention is an important determinant of ischemic complications. Efficacy and safety of enoxaparin versus unfractionated.
The optimal aspirin dose for the prevention of cardiovascular events remains controversial. Our objective was to determine the pharmacodynamic pd doseantiplatelet response relationship and the pharmacokinetics of mdco. Content clopidogrel, one of the most commonly prescribed medications, is a prodrug requiring cyp450 biotransformation. Outcomes associated with respiratory failure for patients. The currently available oral p2y12 inhibitors are limited by a relatively slow onset of action and variable ontreatment response. Gilles montalescot, lead investigator of the accoast trial, discusses why prasugrel pretreatment did not benefit patients with nonstsegment elevation acute coronary syndromes.
Prof gilles montalescot, institut du coeur, centre hospitalier universitaire pitiesalpetriere, 750 paris, france gilles. May 30, 2009 in response to james floyd and sidney wolfe, the definitions and composites of clinical endpoints in tritontimi 38 were prespecified1 and accepted as valid by the us food and drug administration and the european medicines agency before the start of the trial. Supplementary appendix this appendix has been provided by the authors to give readers additional information about their work. He develops medical research focused on thrombotic phenomena and has created a dedicated inserm unit on thrombosis and its treatments. Cpap for acute cardiogenic pulmonary oedema damien logeart. Individual participant data analysis of two trials on. Coronary artery bypass graft surgery guided by ffr jacc. Intravenous clopidogrel mdco157 compared with oral.
Eplerenone reduces primary endpoint in acute myocardial infarction patients found to be safe and well tolerated in randomised clinical trial. Clopidogrel and aspirin versus aspirin alone for the. Whether aldosterone level at presentation for stemi is associated with adverse outcome remains unknown. The task force on the management of stable coronary artery disease of the european society of cardiology. See the article clinical impact of direct stenting and interaction with thrombus aspiration in patients with stsegment elevation myocardial infarction undergoing percutaneous coronary intervention. Adir, amgen, astrazeneca, bayer, berlin chimie ag, boehringer ingelheim, bristolmyers squibb, beth israel deaconess medical, brigham womens hospital, cardiovascular research foundation, celladon, cme resources, daiichi. Montalescot reports research grants to the institution or consultinglecture fees from. High plasma aldosterone levels on admission are associated. First, they lag behind the evidence, which now comes from four positive independent studies and several consistent metaanalyses including the one published in this issue, showing the superiority of dt over tt from the point of view of the net clinical benefit, which is the patients point of view. Background contemporary data are lacking regarding the prognosis and management of left ventricular thrombus lvt. Methods and resultsthis is post hoc analysis from the clopidogrel for high. The acute reperfusion management of stemi in patients with. Gilles montalescot, md, phd backgroundaldosterone, the final mediator of the reninangiotensinaldosterone pathway, is at its highest plasma levels at presentation for stelevation myocardial infarction stemi. High ontreatment platelet reactivity as a risk factor for.
Aug, 2015 the arctic study randomized 2440 patients scheduled for stent implantation to a strategy of platelet function monitoring with drug adjustment in patients who had a poor response to antiplatelet therapy or to a conventional strategy without monitoring and drug adjustment. Dualantiplatelet treatment beyond 1 year after drug. The new engl and journal of medicine 2002 n engl j med 357. Routine cyp2c19 genotyping to adjust thienopyridine treatment. Faculty list, the american journal of cardiology 10. Olivier barthelemy, anne bellemainappaix, johanne silvain. The arctic study randomized 2440 patients scheduled for stent implantation to a strategy of platelet function monitoring with drug adjustment in patients who had a poor response to antiplatelet therapy or to a conventional strategy without monitoring and drug adjustment. No significant improvement in clinical outcomes with platelet function monitoring was observed.
Platelets are key mediators in the pathophysiology of atherothrombotic disease. September 1st, 20 inside the accoast trial of pretreatment prasugrel gilles montalescot, md, phd, john ryan, md, richard a. Intravenous enoxaparin or unfractionated heparin in. Action recherche clinique en cardiologie interventionnelle.
Publications home of jama and the specialty journals of. Best practices for the prevention of radial artery. Individuals with a history of cardiovascular disease develop a more severe illness and. Oct 15, 2019 background the longterm evolution of premature coronary artery disease cad is unknown. Gilles montalescot, filippo crea, the year in cardiology 2015. Defining standards of care for facilitated and direct percutaneous coronary intervention. Longterm evolution of premature coronary artery disease. Study selection randomised and nonrandomised studies comparing enoxaparin with. Radial artery occlusion rao is the most frequent postprocedural complication of tra, restricting the use of the same radial artery for future procedures and as a conduit for coronary artery.
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