Severine Philibert | Université Paris 5 (original) (raw)
Papers by Severine Philibert
Archives of Cardiovascular Diseases Supplements, 2015
Archives of Cardiovascular Diseases Supplements, 2015
Archives of Cardiovascular Diseases Supplements, 2015
Archives of Cardiovascular Diseases Supplements, 2015
Archives of Cardiovascular Diseases Supplements, 2015
Archives of Cardiovascular Diseases, 2015
Purpose: Stroke is a serious complication after acute myocardial infarction (AMI) and is closely ... more Purpose: Stroke is a serious complication after acute myocardial infarction (AMI) and is closely associated with poor prognosis. This study aimed to investigate the frequency, the characteristics and factors associated with in-hospital and postdischarge stroke in patients with AMI. Methods: 8485 consecutive patients admitted in intensive care unit (ICU) between January 2001 and June 2010 were included. Among other major adverse cardiac events (MACE), both stroke and transient ischemic attack (TIA) were collected during one-year follow-up. Results: 168 (1.98%) strokes were recorded during the first year of follow-up after AMI. In-hospital strokes (IHS) occurred in 123 patients (1.4%), and 87% of them in the first five days after admission in ICU. After multivariate logistic regression analysis, IHS was independently associated with female sex (OR: 1.73, 95% CI: 1.19-2.51, p=0.004), previous stroke/TIA (OR: 2.21, 95% CI: 1.28-3.83, p=0.004), LVEF (OR: 0.96, 95% CI: 0.95-0.98, p<0.001), new onset atrial fibril-lation (AF) (OR: 1.99, 95% CI: 1.25-3.16, p=0.004) and C-reactive protein (CRP) (OR 1.006, 95% CI: 1,003-1,009, p<0.001). Patients developing an in-hospital stroke had an increased risk of death at one year after adjustment to other prog-nostic factors (OR: 1.82, 95% CI: 1.05-3.15, p=0.031). Among surviving patients (n=7808), postdischarge stroke (PDS) occurred in 45 patients (0.64%) within one-year follow-up after AMI. After multivariate logistic regression analysis, PDS was independently associated with age (OR: 1.04, 95% CI: 1.01-1.07, p=0.003), previous stroke/TIA (OR: 3.69, 95% CI: 1.83-7.43, p<0.001) and systemic hyper-tension (OR: 2.77, 95% CI: 1.26-6.08, p=0.011). During the entire study period of ten years, the annual rate of stroke post-AMI remained stable. Conclusions: The present study describes specific predictors of in-hospital and postdischarge stroke in patients with AMI, with a marked increase in the risk of death, both during hospitalization and the year after AMI. After hospital discharge, stroke remains a rare event and mostly associated with a high cardiovascular risk. Background: Coronary Artery Anomalies (CAA), including anomalies of coronary origin (ANOCOR) and ectasia or coronary aneurysms (ECTACOR) share common entities. In coronary angiographies or autopsy series, their prevalence range from 0.2 to 1.5%. Case control studies reported an association between CAA and acute myocardial infarction (MI). We aimed to analyze their prevalence, characteristics, therapeutic strategies and prognosis in patients with acute MI. Methods: All the consecutive patients admitted in the intensive care unit of our hospital who underwent coronary angiography for an acute MI from 2001 to 2013 were retrospectively analysed. Results: Among the 9393 patients included during the study period, 80(0.92%) CAA were identified, including 37 (46%), ANOCOR and 43 (54%) ECTACOR. Most were male (86%), with a mean age at 61±14 y, and 2.1±1.4 risk factors. The most frequent localisation of ANOCOR was the circumflex artery (65%). The abnormal artery corresponds to the culprit lesion in 30% of cases, and 46% had significant stenosis. In contrast, ECTACOR were mainly localised on the right coronary artery (58%), and correspond to the culprit lesion in 70% of the cases, and 60% had a significant stenosis. A minority, i.e. 41% of the significant lesions found on ANOCOR and 31% of those on ECTACOR, received only a medical treatment, while 47% and 58% were stented, or 12% and 12% underwent Coronary Artery Bypass Surgery, respectively. After Percutaneous Coronary Intervention (PCI), final flow was TIMI 3 in most cases (94% and 81%, respectively). Only one patient died during the hospital stay. Conclusion: In our large retrospective study, the prevalence of CAAs is consistent with older angiographic series. Culprit lesion was more frequently associated with ECTACOR, but not with ANOCOR. The majority of significant lesions was treated by coronary stenting with a successful angiographic result. Background: Contrast-induced nephropathy (CIN) is a frequent complication in patients undergoing percutaneous coronary intervention (PCI), associated with increased mortality. The impact of metformin, which has potential interactions with renal function, on CIN remains to be investigated.
Archives of Cardiovascular Diseases , 2015
Cardiovascular disease accounts for 43% of all deaths in patients with end-stage renal disease, a... more Cardiovascular disease accounts for 43% of all deaths in patients with end-stage renal disease, and CVD continues to remain the leading cause of mortality and morbidity following renal transplantation. However, the characteristics and the hospital mortality of acute myocardial infarction (AMI) in patients with kidney transplantation (KT) remain to be determined in large scale study. From the French nationwide hospital medical information database, all the consecutive patients hospitalized in the 1546 French hospital/clinics for AMI from 1st January 2005 to 31st December 2009 were included. We compared the specific profile and the hospital mortality of patients with KT to patients without renal failure. Patients with personal past history of renal failure and/ or dialysis were excluded. Among the 329 839 patients with AMI included, 404 (0.1%) patients were after KT. Patients with KT were more frequently men (78.7 vs 66.8%, with p<0.001), markedly younger (58±12 vs 68±11, with p<0.001), and les smoker (5.0 vs 9.1%, with p<0.001) than patients without KT. There was also a higher proportion of hypertension (28.5 vs 23.4%, with p0.017) and a lower proportion of STEMI (75.7 vs 82.7%, with p<0.001) in patients after KT. More than two-thirds of AMI complicating post KT period occured before discharge (67.1%) and 91% in the first year after KT. After adjustment for age, sex and STEMI, in-hospital mortality was higher in KT group (4.2 vs 2.9%), but with p=0.210. From our large scale nationwide study, our work demonstrated that patients with KT complicated by AMI are markedly younger with a specific difference for usual risk factors, but transplant-related risk factors explain also this spec-ificity. We highligts that AMI occurs very early after KT, most often before discharge. To decrease the frequency of MI following renal transplantation, screening of coronaropathy and evaluation of risk factors before KT, as well as after KT must be evaluated. 0203 One-year survival according to use of thrombus aspiration for primary percutaneous coronary intervention. FAST-MI 2010 registry Etienne Objective: Data from randomized trials evaluating thrombus aspiration (TA) in patients with ST-Elevation Myocardial Infarction (STEMI) are conflicting. Therefore, we assessed one-year survival in STEMI patients participating in the FAST-MI (French Registry of ST-elevation and non-ST-elevation Myocardial Infarction) 2010 according to TA during primary percu-taneous coronary intervention (PCI), such as used in the real world. Methods: FAST-MI 2010 is a nationwide French registry that included 4,169 patients with acute myocardial infarction (AMI) at the end of 2010 in 213 centres. Of those, 2,087 patients had STEMI or left bundle branch block (LBBB), of whom 1,538 had primary PCI, with TA used in 671 (44%). Results: Patients with TA were younger (61±13.5 vs. 63±14 years), with a similar GRACE (Global Registry of Acute Coronary Events) risk score (140±31 vs. 143±34), and a shorter median time from symptom onset (245 vs. 285 min); location of AMI, history of MI, PCI or coronary artery bypass surgery did not differ significantly. Thirty-day mortality was 2.1% vs. 2.1% (adjusted p=0.18) and one-year survival was 95.5% vs. 94.8%. Using fully adjusted Cox multivariate analysis, hazard ratio for one-year death was 1.14 (95% confidence interval [CI], 0.63 to 2.07). After propensity score matching (480 patients per group), one-year survival was also similar with both strategies. Conclusions: In a real-world setting of patients admitted with STEMI, the use of TA during primary PCI was not associated with improved one-year survival. Clinicaltrials.gov identifier: NCT01237418 0443 Primary percutaneous coronary intervention for ST elevation myocardial infarction in nonagenarians: a multicentre study Background: There are limited data on outcomes following primary per-cutaneous coronary intervention (PCI) for ST-segment elevation acute myo-cardial infarction (STEMI) in nonagenarian patients. Methods and Results: We conducted a multicentre retrospective study between 2006 and 2013 in 5 international high-volume centers and included 145 nonagenarians treated with primary PCI for STEMI. Cardiogenic shock was present at admission in 21%. Mean delay between symptom onset and balloon was 5,8±7,6 hours and 60% of procedures were performed through the transradial approach. Successful revascularization of the culprit vessel was obtained in 86% of the cases (TIMI flow of 2 or 3). Major or clinically-relevant bleeding was observed in 4% of patients. Mean cardiac troponin Ic was 65±79 ng/ml and mean LVEF post-PCI was 42±13%. The in-hospital mortality was 24% with 6 months and 1 year survival of 58% and 49% respectively. Conclusions: In our study, primary PCI in nonagenarians with STEMI was successful and feasible through a transradial approach. It is associated with a high rate of successful reperfusion of the infarct-related artery and nearly 50% survival at one year. These results suggest that primary PCI should be offered in selected nonagenarians with acute myocardial infarction (table next page).
JCCR, 2019
We report a case of a 19-year old man with incessant right atrial tachycardia (AT) resulting in s... more We report a case of a 19-year old man with incessant right atrial tachycardia (AT) resulting in severe biventricular systolic dysfunction. Successful catheter ablation was obtained by cryo-energy applications at two right atrial exits and it was followed by full recovery of ventricular contractility at 3 months evaluation.
Archives of Cardiovascular Diseases Supplements, 2015
Archives of Cardiovascular Diseases Supplements, 2015
Archives of Cardiovascular Diseases Supplements, 2015
Archives of Cardiovascular Diseases Supplements, 2015
Archives of Cardiovascular Diseases Supplements, 2015
Archives of Cardiovascular Diseases, 2015
Purpose: Stroke is a serious complication after acute myocardial infarction (AMI) and is closely ... more Purpose: Stroke is a serious complication after acute myocardial infarction (AMI) and is closely associated with poor prognosis. This study aimed to investigate the frequency, the characteristics and factors associated with in-hospital and postdischarge stroke in patients with AMI. Methods: 8485 consecutive patients admitted in intensive care unit (ICU) between January 2001 and June 2010 were included. Among other major adverse cardiac events (MACE), both stroke and transient ischemic attack (TIA) were collected during one-year follow-up. Results: 168 (1.98%) strokes were recorded during the first year of follow-up after AMI. In-hospital strokes (IHS) occurred in 123 patients (1.4%), and 87% of them in the first five days after admission in ICU. After multivariate logistic regression analysis, IHS was independently associated with female sex (OR: 1.73, 95% CI: 1.19-2.51, p=0.004), previous stroke/TIA (OR: 2.21, 95% CI: 1.28-3.83, p=0.004), LVEF (OR: 0.96, 95% CI: 0.95-0.98, p<0.001), new onset atrial fibril-lation (AF) (OR: 1.99, 95% CI: 1.25-3.16, p=0.004) and C-reactive protein (CRP) (OR 1.006, 95% CI: 1,003-1,009, p<0.001). Patients developing an in-hospital stroke had an increased risk of death at one year after adjustment to other prog-nostic factors (OR: 1.82, 95% CI: 1.05-3.15, p=0.031). Among surviving patients (n=7808), postdischarge stroke (PDS) occurred in 45 patients (0.64%) within one-year follow-up after AMI. After multivariate logistic regression analysis, PDS was independently associated with age (OR: 1.04, 95% CI: 1.01-1.07, p=0.003), previous stroke/TIA (OR: 3.69, 95% CI: 1.83-7.43, p<0.001) and systemic hyper-tension (OR: 2.77, 95% CI: 1.26-6.08, p=0.011). During the entire study period of ten years, the annual rate of stroke post-AMI remained stable. Conclusions: The present study describes specific predictors of in-hospital and postdischarge stroke in patients with AMI, with a marked increase in the risk of death, both during hospitalization and the year after AMI. After hospital discharge, stroke remains a rare event and mostly associated with a high cardiovascular risk. Background: Coronary Artery Anomalies (CAA), including anomalies of coronary origin (ANOCOR) and ectasia or coronary aneurysms (ECTACOR) share common entities. In coronary angiographies or autopsy series, their prevalence range from 0.2 to 1.5%. Case control studies reported an association between CAA and acute myocardial infarction (MI). We aimed to analyze their prevalence, characteristics, therapeutic strategies and prognosis in patients with acute MI. Methods: All the consecutive patients admitted in the intensive care unit of our hospital who underwent coronary angiography for an acute MI from 2001 to 2013 were retrospectively analysed. Results: Among the 9393 patients included during the study period, 80(0.92%) CAA were identified, including 37 (46%), ANOCOR and 43 (54%) ECTACOR. Most were male (86%), with a mean age at 61±14 y, and 2.1±1.4 risk factors. The most frequent localisation of ANOCOR was the circumflex artery (65%). The abnormal artery corresponds to the culprit lesion in 30% of cases, and 46% had significant stenosis. In contrast, ECTACOR were mainly localised on the right coronary artery (58%), and correspond to the culprit lesion in 70% of the cases, and 60% had a significant stenosis. A minority, i.e. 41% of the significant lesions found on ANOCOR and 31% of those on ECTACOR, received only a medical treatment, while 47% and 58% were stented, or 12% and 12% underwent Coronary Artery Bypass Surgery, respectively. After Percutaneous Coronary Intervention (PCI), final flow was TIMI 3 in most cases (94% and 81%, respectively). Only one patient died during the hospital stay. Conclusion: In our large retrospective study, the prevalence of CAAs is consistent with older angiographic series. Culprit lesion was more frequently associated with ECTACOR, but not with ANOCOR. The majority of significant lesions was treated by coronary stenting with a successful angiographic result. Background: Contrast-induced nephropathy (CIN) is a frequent complication in patients undergoing percutaneous coronary intervention (PCI), associated with increased mortality. The impact of metformin, which has potential interactions with renal function, on CIN remains to be investigated.
Archives of Cardiovascular Diseases , 2015
Cardiovascular disease accounts for 43% of all deaths in patients with end-stage renal disease, a... more Cardiovascular disease accounts for 43% of all deaths in patients with end-stage renal disease, and CVD continues to remain the leading cause of mortality and morbidity following renal transplantation. However, the characteristics and the hospital mortality of acute myocardial infarction (AMI) in patients with kidney transplantation (KT) remain to be determined in large scale study. From the French nationwide hospital medical information database, all the consecutive patients hospitalized in the 1546 French hospital/clinics for AMI from 1st January 2005 to 31st December 2009 were included. We compared the specific profile and the hospital mortality of patients with KT to patients without renal failure. Patients with personal past history of renal failure and/ or dialysis were excluded. Among the 329 839 patients with AMI included, 404 (0.1%) patients were after KT. Patients with KT were more frequently men (78.7 vs 66.8%, with p<0.001), markedly younger (58±12 vs 68±11, with p<0.001), and les smoker (5.0 vs 9.1%, with p<0.001) than patients without KT. There was also a higher proportion of hypertension (28.5 vs 23.4%, with p0.017) and a lower proportion of STEMI (75.7 vs 82.7%, with p<0.001) in patients after KT. More than two-thirds of AMI complicating post KT period occured before discharge (67.1%) and 91% in the first year after KT. After adjustment for age, sex and STEMI, in-hospital mortality was higher in KT group (4.2 vs 2.9%), but with p=0.210. From our large scale nationwide study, our work demonstrated that patients with KT complicated by AMI are markedly younger with a specific difference for usual risk factors, but transplant-related risk factors explain also this spec-ificity. We highligts that AMI occurs very early after KT, most often before discharge. To decrease the frequency of MI following renal transplantation, screening of coronaropathy and evaluation of risk factors before KT, as well as after KT must be evaluated. 0203 One-year survival according to use of thrombus aspiration for primary percutaneous coronary intervention. FAST-MI 2010 registry Etienne Objective: Data from randomized trials evaluating thrombus aspiration (TA) in patients with ST-Elevation Myocardial Infarction (STEMI) are conflicting. Therefore, we assessed one-year survival in STEMI patients participating in the FAST-MI (French Registry of ST-elevation and non-ST-elevation Myocardial Infarction) 2010 according to TA during primary percu-taneous coronary intervention (PCI), such as used in the real world. Methods: FAST-MI 2010 is a nationwide French registry that included 4,169 patients with acute myocardial infarction (AMI) at the end of 2010 in 213 centres. Of those, 2,087 patients had STEMI or left bundle branch block (LBBB), of whom 1,538 had primary PCI, with TA used in 671 (44%). Results: Patients with TA were younger (61±13.5 vs. 63±14 years), with a similar GRACE (Global Registry of Acute Coronary Events) risk score (140±31 vs. 143±34), and a shorter median time from symptom onset (245 vs. 285 min); location of AMI, history of MI, PCI or coronary artery bypass surgery did not differ significantly. Thirty-day mortality was 2.1% vs. 2.1% (adjusted p=0.18) and one-year survival was 95.5% vs. 94.8%. Using fully adjusted Cox multivariate analysis, hazard ratio for one-year death was 1.14 (95% confidence interval [CI], 0.63 to 2.07). After propensity score matching (480 patients per group), one-year survival was also similar with both strategies. Conclusions: In a real-world setting of patients admitted with STEMI, the use of TA during primary PCI was not associated with improved one-year survival. Clinicaltrials.gov identifier: NCT01237418 0443 Primary percutaneous coronary intervention for ST elevation myocardial infarction in nonagenarians: a multicentre study Background: There are limited data on outcomes following primary per-cutaneous coronary intervention (PCI) for ST-segment elevation acute myo-cardial infarction (STEMI) in nonagenarian patients. Methods and Results: We conducted a multicentre retrospective study between 2006 and 2013 in 5 international high-volume centers and included 145 nonagenarians treated with primary PCI for STEMI. Cardiogenic shock was present at admission in 21%. Mean delay between symptom onset and balloon was 5,8±7,6 hours and 60% of procedures were performed through the transradial approach. Successful revascularization of the culprit vessel was obtained in 86% of the cases (TIMI flow of 2 or 3). Major or clinically-relevant bleeding was observed in 4% of patients. Mean cardiac troponin Ic was 65±79 ng/ml and mean LVEF post-PCI was 42±13%. The in-hospital mortality was 24% with 6 months and 1 year survival of 58% and 49% respectively. Conclusions: In our study, primary PCI in nonagenarians with STEMI was successful and feasible through a transradial approach. It is associated with a high rate of successful reperfusion of the infarct-related artery and nearly 50% survival at one year. These results suggest that primary PCI should be offered in selected nonagenarians with acute myocardial infarction (table next page).
JCCR, 2019
We report a case of a 19-year old man with incessant right atrial tachycardia (AT) resulting in s... more We report a case of a 19-year old man with incessant right atrial tachycardia (AT) resulting in severe biventricular systolic dysfunction. Successful catheter ablation was obtained by cryo-energy applications at two right atrial exits and it was followed by full recovery of ventricular contractility at 3 months evaluation.