Frequency of migraine attacks following stroke starts to decrease before PFO closure.
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Adult↗
Biomedical subjects
J-M Juliard
Publications and source records attributed to J-M Juliard.
Bypassing the emergency room reduces delays and mortality in ST elevation myocardial infarction: the USIC 2000 registry.
OBJECTIVE: To study the impact on outcomes of direct admission versus emergency room (ER) admission in patients with ST-segment elevation myocardial infarction (STEMI) DESIGN: Nationwide observational registry of STEMI patients SETTING: 369 intensive care units in France. INTERVENTIONS: Patients were categorised on the basis of the initial management pathway (direct transfer to the coronary care unit or catheterisation laboratory versus transfer via the ER). MAIN OUTCOME MEASURES: Delays between symptom onset, admission and reperfusion therapy. Mortality at five days and one year. RESULTS: Of 1204 patients enrolled, 66.9% were admitted direct and 33.1% via the ER. Bypassing the ER was associated with more frequent use of reperfusion (61.7% v 53.1%; p = 0.001) and shorter delays between symptom onset and admission (244 (interquartile range 158) v 292 (172) min; p < 0.001), thrombolysis (204 (150) v 258 (240) min; p < 0.01), hospital thrombolysis (228 (156) v 256 (227) min, p = 0.22), and primary percutaneous coronary intervention (294 (246) v 402 (312) min; p < 0.005). Five day mortality rates were lower in patients who bypassed the ER (4.9% v 8.6%; p = 0.01), regardless of the use and type of reperfusion therapy. After adjusting for the simplified Thrombolysis in Myocardial Infarction (TIMI) risk score, admission via the ER was an independent predictor of five day mortality (odds ratio 1.67, 95% confidence interval 1.01 to 2.75). CONCLUSIONS: In this observational analysis, bypassing the ER was associated with more frequent and earlier use of reperfusion therapy, and with an apparent survival benefit compared with admission via the ER.
Aged↗
Primary percutaneous coronary intervention in acute myocardial infarction: time, time, and time!
Longer door-to-balloon times, total duration of ischaemia, and time of presentation relative to symptom onset all have an impact on outcome following primary percutaneous coronary intervention.
Angioplasty, Balloon, Coronary↗
[Restenosis estimation at the clinical level: methodologic and angiographic aspects].
Quantitative coronary angiography is the most objective and reproducible method for estimating restenosis after coronary angioplasty. Unfortunately, it does not strictly reflect the clinical restenosis. Numerous angiographic criteria have been defined, from the binary restenosis (>50% stenosis at the site dilated) routinely used by the clinician, to more sophisticated quantitative criteria in order to quantify the intimal hyperplasia, more objective but requiring rigorous criteria. However, new quantitative coronary analysis softwares have not been developed during the last years and each team had to evaluate its intra and inter observer variability. However, angiographic method is still the gold standard method for restenosis estimation, the ideal would be to defined an angiographic restenosis clinically consistent and well correlated with major cardiovascular events.
Angioplasty, Balloon, Coronary↗