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J M Augé

Publications and source records attributed to J M Augé.

At least 19 recordsLinked to original sources
PubMed2001

[Initial results and 6 month clinical follow-up after implantation of a silicon carbide coated coronary stent].

INTRODUCTION AND OBJECTIVES: To present the initial Spanish experience with the Tenax coronary stent, a laser sculpted from high-precision 316L stainless steel coated with hydrogen rich amorphous silicon carbide that reduces thrombogenecity and improves biocompatibility. PATIENTS AND METHODS: From July 1998 to July 1999, 206 patients (62 +/- 5 years) underwent implantation of 231 Tenax stents in 9 centers as the only revascularization procedure. The most frequent clinical indication was unstable angina (66%), and most of the lesions were complex (class B2 and C). The target vessels were the left anterior descending (51%) and right coronary arteries (36%). The ejection fraction was < 0.5 in 19% cases. RESULTS: Revascularization was complete in 70%, elective in 80%, and the implantation was direct in 25% of the cases. The procedure was successful in all the lesions, reducing stenosis from 62 +/- 16 to 16 +/- 10% and increasing the minimal luminal diameter from 0.81 +/- 0.40 to 2.61 +/- 0.59 mm. The TIMI flow was reduced in 30%, but normalized after the stent in all but one case. The incidence of cardiac events was minimal: 1 acute thrombosis (0.5%) resolved by a new angioplasty and 1 non-Q myocardial infarction (0.5%). At the 6-month clinical follow-up 10% of the patients presented complaints of angina greater than class II, and a new angioplasty was carried out in 1.9% of these cases. CONCLUSION: Clinical and angiographic data suggest that the hydrogenated silicon carbide coating of the Tenax coronary stent may indeed play a beneficial role in patient outcome, and should therefore be evaluated by prospective clinical trials.

Angina, Unstable↗
PubMed2001

[Registry of the Activity of the Section of Hemodynamics and Interventional Cardiology of the Spanish Society of Cardiology for the year 2000].

The results of the Registry of the Working Group on Hemodynamics and Interventional Cardiology of the Spanish Society of Cardiology for 2000 are presented. Date came from 100 centers representing all the cardiac catheterization laboratories in Spain; 93 centers performed mainly adult catheterization and 7 carried out only pediatric procedures. In 2000, 88,339 diagnostic catheterization procedures were performed (73,382 coronary angiograms), representing a total increase of 12.5% over 1999. The population-adjusted rate was 1,825 coronary angiograms per 106 inhabitants. With a total of 26,993 procedures and a rate of coronary interventions per 106 inhabitants of 671, coronary intervention increased by 17% over figures for 1999. Coronary stents were the devices used most often, with 29,504 implanted in 2000; stenting accounted for 77.2% of procedures, a 30.5% increase over 1999. The increase in direct stenting without predilatation was noteworthy. Direct stenting was done in 8,778 procedures (38.9% of the total), an increase of 131% compared to 1999. IIb-IIIa glycoprotein were used in 4,700 coronary interventions (17%). Angioplasty, performed in 3,128 cases of acute myocardial infarction, accounted for 11.6% of coronary interventions 33.5% more than in 1999. A decrease of 6.5% in valvuloplastics occurred, attributable to the performance of fewer mitral valve repairs (493 vs 525 in 2000 and 1999, respectively). Pediatric procedures increased by 20.5%, from 678 to 817 cases. In conclusion, we would like to underline the high rate of reporting by laboratories, through which the Registry has been able to compile data that are highly representative of the hemodynamic activity in Spain.

Cardiology↗
PubMed2001

Coronary endothelial dysfunction as a predictor of intimal thickening in the long term after heart transplantation.

OBJECTIVES: The mechanisms of cardiac allograft vasculopathy and its predisposing factors are multifactorial and as yet not well established. To determine the influence of endothelial dysfunction on the development of intimal thickening, we prospectively analyzed the vasomotor response to acetylcholine and nitroglycerin, as well as other donor and recipient variables. Findings were correlated with the coronary intimal thickness, which was evaluated by means of intravascular ultrasonography. METHODS: Nineteen patients who had undergone heart transplantation 4.89 +/- 2.35 years previously and who had angiographically normal coronary arteries were included. Endothelial function was analyzed by quantitative coronary analysis of the vasomotor response of the left anterior descending artery to acetylcholine. An intimal thickness index, reflecting the percentage of intima obstructing the coronary lumen, was calculated. RESULTS: Nine (47%) patients showed endothelial dysfunction, and the remaining 10 (53%) patients had a normal response. Four (44%) of 9 patients with a weight gain of greater than 20% after the operation showed endothelial dysfunction compared with none of the 10 patients with normal responses (P <.04). The severity of the intimal thickness correlated with the years after transplant (r = 0.45, P <.05). Patients with endothelial dysfunction had more intimal thickening than those without (32% +/- 17% vs 17% +/- 12%, respectively; P <.05). Furthermore, the degree of intimal thickening correlated with the magnitude of the vasomotor response to acetylcholine (r = -0.60, P =.006). No relationship was found between intimal thickness and the vasodilatory response to nitroglycerin. As independent variables for intimal thickness, multivariate analysis detected the magnitude of the response to acetylcholine (P =.0005), years after transplant (P =.01), and ischemic time (P =.03). CONCLUSIONS: Cardiac allograft vasculopathy is a multifactorial disease the severity of which increases over time. Endothelial dysfunction is a predictive factor of intimal thickening severity. Predisposing factors that provoke endothelial injury, such as perioperative ischemic time and obesity, may contribute to the development of allograft vasculopathy.

Acetylcholine↗
PubMed2000

Influence of residual stenosis in determining restenosis after cutting balloon angioplasty.

The cutting balloon is a new device for coronary angioplasty, which, by the combination of incision and dilatation of the plaque, is believed to minimize arterial wall trauma, the neoproliferative response, and subsequent restenosis. In this study, we sought to determine predictors of the restenosis using this technique. Seventy-seven patients underwent successful coronary angioplasty with cutting balloon alone. In 67 of these patients (87%), we performed a control angiogram at 6-month follow-up. Pre-, post-, and late angiographic results were evaluated by quantitative coronary analysis. Clinical and angiographic variables were correlated with restenosis as a binary variable and a continuous variable (late loss and late minimum luminal diameter). Univariate analysis showed that the immediate postprocedure minimum luminal diameter (MLD) was smaller in the restenotic group (defined as MLD > 50% by quantitative coronary angiography) than in the nonrestenotic group (1.90 +/- 0.47 mm vs. 2.19 +/- 0.56 mm, P < 0.05). In addition, the immediate percentage of stenosis was higher in the restenotic group than in the nonrestenotic group (37% +/- 10% vs. 27% +/- 11%, P < 0. 003). Multivariate analysis identified the immediate postcutting balloon percentage of stenosis as an independent determinant of binary restenosis (P < 0.008). When restenosis was defined as a continuous variable, the immediate postprocedure MLD was an independent predictor of late loss (P < 0.02) and of late MLD (P < 0. 0002). No clinical, preprocedure angiographic, or technical variables tested were associated with restenosis. The degree of postprocedural residual stenosis after cutting balloon angioplasty is predictive of late restenosis.

Adult↗
PubMed2000

Combined therapeutic strategy for multiple coronary thromboemboli.

A female with mitral valvular disease presented an acute myocardial infarction. She suddenly complained of recurrent chest pain with symptoms of pulmonary edema. The angiogram evidenced multiple coronary thromboemboli. A combined strategy using intracoronary thrombolysis, a platelet glycoprotein IIb/IIIa antagonist (abciximab) and percutaneous transluminal coronary angioplasty to help disrupt the thrombus was performed. Clinical and angiographic signs of coronary reperfusion were rapidly achieved. No bleeding complications appeared.

Abciximab↗
PubMed1999

Expanding subintimal coronary dissection under a stent-covered arterial segment: serial intravascular ultrasound observations.

A patient with an angiographically unrecognized minor coronary dissection in a stent-covered coronary segment in which a type D spiral dissection extended submedially to the distal artery is described. This complication occurred 6 months after stent implantation and was ascribed to injury of the stented vessel wall during an intravascular ultrasound study.

Aortic Dissection↗
PubMed1998

Significance of angiographic coronary dissection after cutting balloon angioplasty.

We studied 2 groups of patients with (n = 14) and without (n = 42) minor coronary dissections following cutting balloon angioplasty. Patients with a minor dissection had a longer length of lesion, higher percentage of stenosis, and greater acute gain after angioplasty; at 6-month follow-up both groups had a similar net gain and restenosis rate, suggesting that minor dissection after cutting balloon angioplasty has no influence on restenosis.

Adult↗
PubMed1998

[Initial results with the Multi-Link coronary stent].

INTRODUCTION AND OBJECTIVES: The Multi-Link intracoronary stent is a balloon-expandable stainless steel stent with an interconnected ring structure designed to provide a high degree of compressive resistance while preserving longitudinal flexibility. We present the results of our initial experience with the implantation of this stent. PATIENTS AND METHODS: From May 1996 to April 1997, 124 Multi-link stents were implanted in 97 patients. Mean age 62.2 +/- 11 years. All patients included had a coronary artery diameter > 2.7 mm. Clinical presentation includes stable angina in 20, unstable angina in 72, and myocardial infarction in 5 patients. According to the ACC/AHA classification 6 lesions were type A, 72 type B and 19 type C. The implantation of the stent was for "de novo" lesions in 85 patients and for restenosis in 12. Patients were treated after the procedure with a combination of aspirin and ticlopidine, except six of them who received aspirin and acenocumarol. 16 patients were treated additionally with Abciximab. The degree of stenosis was determined by quantitative angiography. RESULTS: The delivery of the stent was successful in all patients. The degree of stenosis before the procedure was 79.6 +/- 13.1%, and after the stent deployment was 17.7 +/- 11.4%. Three patients presented a non-Q-wave myocardial infarction, two patients had a subacute stent thrombosis, one of them died due to heart failure. During a follow-up of 4.7 +/- 2.6 months five patients were readmitted with recurrent angina (4 due to restenosis and one for vessel occlusion) and one patient with heart failure after myocardial infarction died suddenly three weeks after the dilatation. CONCLUSIONS: The Multi-Link stent was implanted successfully in all patients with a low incidence of complications, showing at the follow-up a reduced rate of clinical restenosis.

Coronary Disease↗
PubMed1998

[Coronary stent placement for recurrent angina secondary to myocardial bridging].

Myocardial bridging of the epicardic coronary arteries is not an uncommon finding in angiographic or necropsic studies. Patients who have symptoms usually improve with medical treatment. However, in refractory patients a surgical myotomy of overlying myocardium and/or a coronary bypass may be needed. We report two patients with long myocardial bridges in the mid-left anterior descending coronary artery, who had recurrent angina refractory to conventional treatment. In both patients two consecutive coronary stents were successfully implanted. At five and six months follow-up they are asymptomatic and with good exercise tolerance.

Aged↗
PubMed1997

Spectrum of alcohol-induced myocardial damage detected by indium-111-labeled monoclonal antimyosin antibodies.

OBJECTIVES: We sought to determine the prevalence, intensity and evolving changes of myocardial damage detected by myocardial uptake of antimyosin antibodies in patients with alcohol-induced dilated cardiomyopathy, alcohol addicts attending a detoxification unit and healthy subjects with short-term alcohol consumption. BACKGROUND: Evidence of alcohol-induced myocardial damage may be provided by myocardial uptake of indium-111-labeled monoclonal antimyosin antibodies. The spectrum of such damage in patients who are heavy drinkers (> 100 g for > 10 years), with or without cardiomyopathy, and the impact of short-term alcohol ingestion on antimyosin antibody uptake have not been adequately explored. METHODS: One hundred twenty antimyosin studies were performed in 56 patients with dilated cardiomyopathy (group I), 15 alcohol addicts attending a detoxification unit (group II) and 6 volunteers for short-term alcohol ingestion (group III). Estimation of antibody uptake was calculated through a heart/lung ratio (HLR) (normal < 1.55). RESULTS: The 56 patients in group I (54 men, 2 women; mean [+/-SD] age 46 +/- 11 years) had consumed 123 +/- 60 g/day of alcohol for 21 +/- 9 years, for a cumulative intake of 914 +/- 478 kg. Mean duration of symptoms was 46 +/- 49 months. Mean left ventricular end-diastolic diameter was 71 +/- 10 mm, and mean ejection fraction was 28 +/- 12%. No differences in New York Heart Association functional class, ventricular size or ejection fraction were noted between 28 active and 28 past consumers, except for the prevalence and intensity of antibody uptake (75% vs. 32%, p < 0.001) and HLR (1.75 +/- 0.26 vs. 1.49 +/- 0.17, p = 0.0001). In 19 patients in the active group restudied after alcohol withdrawal, antibody uptake decreased (from 1.76 +/- 0.17 to 1.55 +/- 0.19, p < 0.001), and ejection fraction improved (from 30 +/- 12% to 43 +/- 16%, (p < 0.001). No changes occurred in the 15 past consumers restudied. The 15 male patients in group II (mean age 36 +/- 4 years) had consumed 156 +/- 59 g/day for 17 +/- 5 years, for a cumulative alcohol intake of 978 +/- 537 kg, an amount similar to that in patients in group I, but antimyosin antibody uptake was detected in only 3 (20%) of 15 patients. None of six group III subjects developed antibody uptake after short-term ethanol ingestion. Despite the small sample size, the power to detect clinically relevant differences in most variables that did not reach statistical significance was amply sufficient. CONCLUSIONS: In alcohol-induced dilated cardiomyopathy, alcohol withdrawal is associated with the reduction or disappearance of myocardial damage and improvement of function. The difference in prevalence of antimyosin antibody uptake in patients with and without cardiac disease who consume similar amounts of alcohol suggests the presence of those with different myocardial susceptibilities to alcohol. Short-term ethanol ingestion in healthy subjects does not induce detectable uptake of antimyosin antibodies.

Adult↗
PubMed1995

Percutaneous transluminal coronary angioplasty as alternative treatment to coronary artery bypass surgery in iatrogenic stenosis of the left main coronary artery.

The present report describes three patients with iatrogenic left main coronary artery after aortic valve replacement. All three patients were successfully treated by percutaneous transluminal coronary angioplasty. No clinical or angiographic signs of restenosis were seen during the long-term follow-up (4, 6, and 11 years). These patients show the feasibility of percutaneous transluminal coronary angioplasty in iatrogenic left main coronary artery stenosis as alternative of coronary artery bypass surgery. However, it should be only considered in patients who would otherwise be deemed inoperable, refused reoperation, and are willing to take the risk involved.

Adult↗
PubMed1993

Active myocardial damage without attending inflammatory response in dilated cardiomyopathy.

OBJECTIVES: This study aimed to compare indium-111 (111In)-monoclonal antimyosin antibody uptake in patients with dilated cardiomyopathy before heart transplantation with the histologic findings in the explanted hearts. BACKGROUND: A high prevalence of 111In-monoclonal antimyosin antibody uptake has been described in patients with dilated cardiomyopathy, suggesting the presence of active, ongoing myocyte damage; however, no correlation between monoclonal antimyosin antibodies and histologic findings is available in these patients. METHODS: A consecutive series of 21 patients with dilated cardiomyopathy awaiting heart transplantation were studied with monoclonal antimyosin antibodies before the operation, and the results were compared with the histologic analysis of the explanted hearts. The interval between monoclonal antimyosin antibody studies and transplantation was 1 to 90 days (mean 58 +/- 31). RESULTS: Using a semiquantitative method (heart/lung ratio), monoclonal antimyosin antibody uptake was present in 15 (71%) of 21 patients, but active myocarditis in the explanted hearts was detected in only 7. In 11 patients, intense monoclonal antimyosin antibody uptake coexisting with absent myocyte damage or cellular infiltration of explanted hearts was noted. One patient who showed preoperative monoclonal antimyosin antibody uptake underwent transplantation 11 h later, and ex vivo diffuse myocardial antimyosin uptake was detected, but active myocarditis was seen only at cardiectomy in only a small area of the heart; the rest of the myocardium showed no signs of myocyte damage. CONCLUSIONS: In dilated cardiomyopathy, monoclonal antimyosin antibody uptake cannot be equated with the presence of an inflammatory response detected in the myocardium of the explanted heart.

Adult↗