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Nicolas Danchin

Publications and source records attributed to Nicolas Danchin.

At least 37 records · Page 2Linked to original sources
PubMed2005

Impact of combined secondary prevention therapy after myocardial infarction: data from a nationwide French registry.

BACKGROUND: Several classes of medications improve survival in patients with coronary artery disease. Whether these medications, as used in the real world, have additive efficacy remains speculative. OBJECTIVES: To assess whether patients discharged on combined secondary prevention medications after acute myocardial infarction (AMI) have improved 1-year survival, compared with the action of any single class of medications. DESIGN AND SETTING: Nationwide registry of consecutive patients admitted to intensive care units for AMI in November 2000 in France. Multivariate Cox regression analysis, including a propensity score for the prescription of combined therapy, was used. RESULTS: Of the 2119 patients discharged alive, 1095 (52%) were prescribed a combination of antiplatelet agents, beta-blockers, and statins (triple therapy), of whom 567 (27%) also received angiotensin-converting enzyme inhibitors (quadruple therapy) and 528 (25%) did not. One-year survival was 97% in patients receiving triple combination therapy versus 88% in those who received either none, 1, or 2 of these medications (P < .0001). After multivariate adjustment including the propensity score, the hazard ratio for 1-year mortality in patients with triple combination therapy was 0.52 (95% CI 0.33-0.81). In patients with ejection fraction < or = 35%, beta-blockers and angiotensin-converting enzyme inhibitors were independent predictors of survival, and combination therapy had no additional prognostic value. CONCLUSIONS: Compared with the prescription of any single class of secondary prevention medications, combination therapy offers additional protection in patients with AMI.

Adrenergic beta-Agonists↗
PubMed2005

[Reasons for the under-use of secondary prevention therapies in coronary patients over the age of 70 years].

INTRODUCTION: Although platelet antiaggregants, beta-blockers and statins have proved their efficacy as secondary prevention in all types of patients with arterial and thrombotic disease, these therapeutic categories remain under-used in the elderly. The reasons for this under-prescription are poorly understood. The aim of this study was to determine the reasons for not prescribing the principal secondary prevention therapies in elderly coronary patients. METHODS: Two transversal pharmaco-epidemiological surveys were carried out in a representative sample of French cardiologists. They included 1489 coronary patients aged 35 to 69 years and 1148 patients aged over 70 years, respectively. Risk factors, medical history, current treatments and reasons for non-prescription of the principal therapies were collected. RESULTS: In subjects aged 70 years or over, antiaggregants were not prescribed in 24% of patients, versus 7.5% of younger patients. Statins were not prescribed in 37% of those over 70 years, versus 14% of younger patients. Beta-blockers were not prescribed in 42% of elderly patients versus 23% of younger patients. ACE inhibitors were not prescribed in 57.6% of elderly subjects and 48.2% of younger subjects. Combinations of three or four secondary prevention treatments were half as frequently prescribed in patients over the age of 70. According to the physicians, the main reason for non-prescription in elderly patients was a lack of indication, which concerned 8% of the entire sample with respect to antiaggregants, 9% for beta-blockers and 14% for statins. These very high percentages were not found in younger subjects (1%, 3% and 2.5%, respectively). CONCLUSION: Our results confirm under-use of the principal secondary prevention therapies in elderly subjects, mainly because of a lack of indication, according to the physicians. In these patients, indications for secondary prevention appear to be tributary to numerous factors, such as age, the type of medical history, the availability of lipid parameters or compliance. In response to questions by practitioners, specific recommendations would be useful concerning secondary prevention in elderly coronary patients.

Adrenergic beta-Antagonists↗
PubMed2005

[Combination therapy at hospital discharge in the USIC 2000 survey].

UNLABELLED: We tried to determine the prognostic impact of triple (antiplatelet agents, statins and beta-blockers) and quadruple (the same+ACE inhibitors) combination therapy at hospital discharge after acute myocardial infarction. The USIC 2000 survey is nationwide registry of consecutive patients admitted to intensive care units for acute myocardial infarction in November 2000 in France. Of the 2119 patients discharged alive, 1095 (52%) were prescribed a combination of antiplatelet agents, beta-blockers and statins (triple therapy), including 567 (27%) with a similar combination plus ACE inhibitors (quadruple therapy). One-year survival was 97% in patients receiving triple combination therapy versus 88% in those who received either no, one or two of these medications (p < 0.0001). After multivariate adjustment, the odds ratio for one-year mortality in patients with triple combination therapy was 0.49 (95% confidence interval: 0.32-0.75). Quadruple combination therapy had no additional predictive value in the entire population. In patients with ejection fraction < or = 35%, however, beta-blockers and ACE inhibitors were independent predictors of survival, and combination therapy had no additional prognostic value. CONCLUSIONS: compared with the prescription of any single class of secondary prevention medications, combination therapy offers additional protection in patients with acute myocardial infarction.

Adult↗
PubMed2005

[Changes in the prescription of cardiovascular prevention drugs in France between 1995 and 2003: factors influencing the gap between evidence base medicine and clinical practice].

Dramatic progresses have occurred during the past 10 years in the field of cardiovascular secondary prevention. Many randomized trials have established the efficacy of statins, antiplatelet agents, beta-blockers and ACE inhibitors for reducing cardiovascular mortality, myocardial infarction and stroke in patients with coronary heart disease. Since 2002, American and European guidelines have emphasized the importance of optimal utilization of those four main therapeutic classes. Nevertheless, drugs prescription registries conducted in France since 1995 revealed a persistent gap between evidence based medicine and clinical practice, only a minority of patient received an optimal treatment. Some factors associated with lower rate prescription have been identified: elderly patients, female gender, missing of LDL-cholesterol measurement, history of peripheral artery disease or stroke, and finally the difficulty of observance. At this time, optimization of management of these patients require a systematic measurement of LDL-cholestererol level for all patients with CAD, PAD or history of stroke, a larger prescription of statins in female patients and in elderly particularly for secondary prevention. Increasing observance which is the main challenge could involved the utilization of fixed drugs associations.

Adrenergic beta-Antagonists↗
PubMed2004

Impact of prehospital thrombolysis for acute myocardial infarction on 1-year outcome: results from the French Nationwide USIC 2000 Registry.

BACKGROUND: Limited data are available on the impact of prehospital thrombolysis (PHT) in the "real-world" setting. METHODS AND RESULTS: Of 443 intensive care units in France, 369 (83%) prospectively collected all cases of infarction (< or =48 hours of symptom onset) in November 2000; 1922 patients (median age, 67 years; 73% men) with ST-segment-elevation infarction were included, of whom 180 (9%) received intravenous thrombolysis before hospital admission (PHT). Patients with PHT were younger than those with in-hospital thrombolysis, primary percutaneous interventions, or no reperfusion therapy. Median time from symptom onset to hospital admission was 3.6 hours for PHT, 3.5 hours for in-hospital lysis, 3.2 hours for primary percutaneous interventions, and 12 hours for no reperfusion therapy. In-hospital death was 3.3% for PHT, 8.0% for in-hospital lysis, 6.7% for primary percutaneous interventions, and 12.2% for no reperfusion therapy. One-year survival was 94%, 89%, 89%, and 79%, respectively. In a multivariate analysis of predictors of 1-year survival, PHT was associated with a 0.49 relative risk of death (95% CI, 0.24 to 1.00; P=0.05). When the analysis was limited to patients receiving reperfusion therapy, the relative risk of death for PHT was 0.52 (95% CI, 0.25 to 1.08; P=0.08). In patients with PHT admitted in < or =3.5 hours, in-hospital mortality was 0% and 1-year survival was 99%. CONCLUSIONS: The 1-year outcome of patients treated with PHT compares favorably with that of patients treated with other modes of reperfusion therapy; this favorable trend persists after multivariate adjustment. Patients with PHT admitted very early have a very high 1-year survival rate.

Adrenergic beta-Antagonists↗
PubMed2004

Aortic pulse pressure is related to the presence and extent of coronary artery disease in men undergoing diagnostic coronary angiography: a multicenter study.

BACKGROUND: In the general population, pulse pressure (PP) is a correlate of cardiovascular outcomes. Few data are available regarding the links between PP and documented coronary artery disease (CAD). METHODS: From July 2000 to January 2002, a total of 1337 patients referred for a first diagnostic coronary angiogram at 75 participating centers were prospectively included. Of these individuals, 280 patients receiving no hypertensive therapy constituted the study population. Pulse pressure was recorded in the aortic root before angiography, and baseline characteristics, medical history, treatment used, and data from coronary angiography were recorded. RESULTS: In the whole population, aortic PP strongly correlated with the presence and extent of CAD in univariate analyses. However, the correlation disappeared in multivariate analysis, and a strong interaction with gender was found. In women (n = 82), aortic PP was not an independent predictor of CAD. However, in men (n = 198) an independent correlation between aortic PP and CAD was found, together with age and hypercholesterolemia. In addition, PP was strongly correlated with the extent of CAD (no disease, 51 +/- 16 mm Hg; one or two stenoses, 54 +/- 18 mm Hg; and more than two stenoses: 64 +/- 20 mm Hg). CONCLUSIONS: In this multicenter study, aortic PP was significantly correlated with the presence and extent of CAD in patients without antihypertensive therapy. This correlation, however, was independent of other risk factors for CAD in men but not in women.

Adult↗
PubMed2004

Drug prescriptions and referral to cardiac rehabilitation after acute coronary events: comparison between men and women in the French PREVENIR Survey.

BACKGROUND AND AIM: The problem of a possible gender bias in coronary heart disease management is still controversial. We studied gender differences in secondary preventive drug prescriptions and in referral to cardiac rehabilitation after acute coronary events in France. METHODS: An observational survey was carried out in 1998-1999 in 150 French intensive cardiac care units. A sample of 2626 consecutive patients admitted for myocardial infarction or unstable angina and alive at discharge was included. Data were retrospectively collected from medical records after discharge. RESULTS: The sample was composed of 1921 men and 705 women. At discharge, antiplatelet agents were prescribed in 93.4% of men and 91.5% of women (p=0.09), beta-blockers in 73.4% and 63.7% (p<0.0001), angiotensin-converting enzyme (ACE) inhibitors in 39.9% and 44.3% (p<0.05), and statins in 47.0% and 40.7% (p<0.01). The percentage of subjects referred to a cardiac rehabilitation program at discharge was 26.2% in men and 15.5% in women (p<0.0001). In multivariate analysis, taking into account confounding factors, gender did not appear as an independent determinant of drug prescriptions. Conversely, being a woman was independently associated with a lower probability to be referred to a cardiac rehabilitation program at discharge (adjusted female-to-male odds ratio: 0.44 (95% confidence interval: [0.31-0.64], p<0.0001). CONCLUSIONS: In this study, gender was not an independent determinant of secondary preventive drug prescriptions after acute coronary events. Conversely, we found a gender bias in referral to cardiac rehabilitation programs at discharge.

Aged↗
PubMed2004

[Clinical aspects of acute coronary syndromes].

There are two types of acute coronary syndromes : those with or without ST-segment elevation. The former require urgent therapeutic measures to reopen the culprit artery (intravenous thrombolysis or primary percutaneous coronary intervention). For the latter, risk stratification is essential and is based upon clinical and biochemical markers. Among them, recent and repeated anginal attacks, ST-segment modifications on admission electrocardiogram, and increased markers of myonecrosis (particularly increased troponin levels) are strong predictors of untoward outcome. According to the risk profile, the initial management is based upon an invasive strategy with powerful antithrombotic medications and urgent angiography, or upon a non-invasive strategy using stress testing, preferably coupled with myocardial imaging techniques. In all instances, secondary prevention measures are determinant to try and stop the progression of the atherosclerotic disease.

Acute Disease↗
PubMed2003

The safety and efficacy of subcutaneous enoxaparin versus intravenous unfractionated heparin and tirofiban versus placebo in the treatment of acute ST-segment elevation myocardial infarction patients ineligible for reperfusion (TETAMI): a randomized trial.

OBJECTIVES: The aims of the Safety and Efficacy of Subcutaneous Enoxaparin Versus Intravenous Unfractionated Heparin and Tirofiban Versus Placebo in the Treatment of Acute ST-Segment Elevation Myocardial Infarction Patients Ineligible for Reperfusion (TETAMI) study were to demonstrate that enoxaparin was superior to unfractionated heparin (UFH) and that tirofiban was better than placebo in patients with acute ST-segment elevation myocardial infarction (STEMI) who do not receive timely reperfusion. BACKGROUND: An optimal treatment strategy has not been identified for the many STEMI patients ineligible for acute reperfusion. METHODS: A total of 1224 patients were enrolled in 91 centers in 14 countries between July 1999 and July 2002. Patients with STEMI ineligible for reperfusion were randomized to enoxaparin, enoxaparin plus tirofiban, UFH, or UFH plus tirofiban. All patients received oral aspirin. The primary efficacy end point was the 30-day combined incidence of death, reinfarction, or recurrent angina; the primary analysis was the comparison of the pooled enoxaparin and UFH groups. RESULTS: The incidence of the primary efficacy end point was 15.7% enoxaparin versus 17.3% for UFH (odds ratio 0.89 [95% confidence interval CI = 0.66 to 1.21]) and 16.6% for tirofiban versus 16.4% for placebo (odds ratio 1.02 [95% CI 0.75 to 1.38]). The Thrombolysis In Myocardial Infarction (TIMI) major hemorrhage rate was 1.5% for enoxaparin versus 1.3% for UFH (odds ratio 1.16 [95% CI 0.44 to 3.02]) and 1.8% versus 1% for tirofiban versus placebo (odds ratio 1.82 [95% CI 0.67 to 4.95]). CONCLUSIONS: This study did not show that enoxaparin significantly reduced the 30-day incidence of death, reinfarction, and recurrent angina compared with UFH in non-reperfused STEMI patients. However, enoxaparin appears to have a similar safety and efficacy profile to UFH and may be an alternative treatment. Additional therapy with tirofiban did not appear beneficial.

Administration, Oral↗
PubMed2003

[Clinical aspects and risk stratification of acute coronary syndromes without ST-segment elevation].

The clinical classification of acute coronary syndromes without ST-segment elevation has long been a topic of debate. Braunwald's classification, however, is now widely adopted and permits to recognize the most severe forms of acute coronary syndromes. Risk stratification is essential and is based upon clinical and biological markers. Among them, recent and repeated anginal attacks, ST-segment modifications on admission electrocardiogram, and increased markers of myonecrosis (particularly increased troponine levels) are strong predictors of untoward outcome. These variables can be used to construct risk scores, among which the Timi risk score is the most widely used.

Acute Disease↗
PubMed2003

Prognostic significance of elevated creatine kinase MB after coronary bypass surgery and after an acute coronary syndrome: results from the GUARDIAN trial.

OBJECTIVE: To determine if the correlation between magnitude of creatine kinase-myocardial band release after coronary artery bypass surgery and 6-month mortality is comparable to that of patients admitted with an acute coronary syndrome. METHODS: The GUARDIAN trial tested the efficacy of cariporide, an Na+/H+ exchange inhibitor, on reduction of myocardial ischemia or death in high-risk patients. We compared 6-month survival in a cohort of 2332 GUARDIAN patients scheduled for coronary artery bypass surgery at entry with 4233 acute coronary syndrome patients stratified by level of creatine kinase-myocardial band release. Cumulative 6-month survival by creatine kinase-myocardial band categories was performed using life table analysis, adjusting for variables known to impact prognosis using Cox regression. RESULTS: The 6-month mortality rates for coronary artery bypass surgery patients with peak creatine kinase-myocardial band ratios of <1, > or =1 and <5, > or =5 and <10, and > or =10 upper limits of normal (ULN) were 5.8, 2.8, 5.9, and 12.0%, respectively (P <.0001). The 6-month mortality rates for acute coronary syndrome patients with peak creatine kinase-myocardial band ratios of <1, > or =1 and <5, > or =5 and <10, and > or =10 ULN were 6.3, 9.8, 10.0, and 12.3%, respectively (P <.0001). Patients with coronary artery bypass surgery or acute coronary syndrome had similar adjusted 6-month survival estimates at normal creatine kinase-myocardial band levels and when the creatine kinase-myocardial band level was > or =10 ULN. Patients with coronary artery bypass surgery had significantly better survival at intermediate enzyme levels (> or =1 and <10 ULN; P <.001). CONCLUSIONS: Modest elevations of creatine kinase-myocardial band release (> or =1 and <10 ULN) after coronary artery bypass surgery are not associated with adverse 6-month survival, in contrast to that seen in acute coronary syndrome patients. Routine creatine kinase-myocardial band sampling should be considered in all higher-risk patients undergoing coronary artery bypass surgery procedures to identify the sizable cohort of patients with creatine kinase-myocardial band release > or =10 ULN; these patients may benefit from postoperative angiotensin-converting enzyme inhibitor and beta-blocker therapy. Newer cardioprotective agents that reduce the number of patients with marked creatine kinase-myocardial band release are currently being tested in large randomized controlled clinical trials.

Acute Disease↗
PubMed2003

Ischemic heart disease in type 2 diabetes.

Type 2 diabetes has reached epidemic proportions and an increasing proportion of patients with coronary artery disease (CAD) are diabetics. CAD in diabetics has specificities and, in particular, more extensive atherosclerosis; diabetic patients are also more frequently asymptomatic, with silent myocardial ischemia, which makes the diagnosis of CAD more difficult. In addition, diabetic patients with CAD have poorer outcomes than nondiabetics. The management of diabetic patients with CAD is based on intensive intervention on lifestyle and risk factors, together with the mandatory use of medications of proven benefit as regards secondary prevention in coronary patients: antiplatelet agents, statins, beta-blockers, and angiotensin-converting enzyme (ACE) inhibitors. Glycemic control is also essential; although the use of sulfonylureas has been controversial, there is now a vast amount of data suggesting a beneficial effect, in particular when agents more specific for the pancreatic adenosine triphosphate-dependent potassium (K(ATP)) channels are used. At the acute stage of myocardial infarction, the Diabetes mellitus, Insulin Glucose infusion in Acute Myocardial Infarction (DIGAMI) trial suggested a beneficial effect of insulin therapy prolonged for 3 months after hospital discharge; these data will have to be confirmed by larger intervention trials. Finally, the respective roles of coronary angioplasty and coronary surgery in diabetics are debated; a post hoc analysis of the Bypass Angioplasty Revascularization Investigation (BARI) trial data showed increased mortality in diabetics with multivessel CAD treated with angioplasty compared with surgery, but the results of the more recent trials using intracoronary stents appear more balanced; in this regard, the effects of drug-eluting stents, which dramatically decrease the incidence of re-stenosis, seem promising.

Adrenergic beta-Antagonists↗