O. Nallet

Bio: O. Nallet is an academic researcher. The author has contributed to research in topics: Chest pain & Myocardial infarction. The author has an hindex of 6, co-authored 19 publications receiving 312 citations.

Clinical outcomes according to symptom presentation in patients with acute myocardial infarction: Results from the FAST-MI 2010 registry.

Abstract: BACKGROUND Atypical clinical presentation in acute myocardial infarction (AMI) patients is not uncommon; most studies suggest that it is associated with unfavorable prognosis. HYPOTHESIS Long-term clinical impact differs according to predominant symptom presentation (typical chest pain, atypical chest pain, syncope, cardiac arrest, or dyspnea) in AMI patients. METHODS FAST-MI 2010, a nationwide French registry, included 4169 patients with AMI in 213 centers at the end of 2010 (76% of active centers). Demographics, medical history, hospital management, and outcomes were compared according to predominant symptom presentation. RESULTS Typical chest pain with no other symptom was reported in 3020 patients (68% in STEMI patients, 76% in NSTEMI patients). Atypical chest pain, dyspnea, syncope, and cardiac arrest were reported in 11%, 11%, 5%, and 1%, respectively. Patients with atypical clinical presentation had a higher cardiovascular risk profile and received fewer medications and a less invasive strategy. Using Cox multivariate analysis, atypical chest pain was not associated with higher death rate at 3 years (HR: 0.96, 95% CI: 0.69-1.33, P = 0.78), whereas cardiac arrest (HR: 2.44, 95% CI: 1.00-5.97, P = 0.05), syncope (HR: 1.70, 95% CI: 1.18-2.46, P = 0.005), and dyspnea (HR: 1.66, 95% CI: 1.31-2.10, P < 0.001) were associated with higher long-term mortality compared with patients with typical isolated chest pain. Similar trends were observed in STEMI and NSTEMI populations. CONCLUSIONS Atypical clinical presentation is observed in about 20% of AMI patients. Cardiac arrest, dyspnea, and syncope represent independent predictors of long-term mortality in STEMI and NSTEMI populations.

Compared Outcomes of ST-Elevation Myocardial Infarction Patients with Multivessel Disease Treated with Primary Percutaneous Coronary Intervention and Preserved Fractional Flow Reserve of Non-Culprit Lesions Treated Conservatively and of Those with Low Fractional Flow Reserve Managed Invasively: Insights from the FLOWER MI trial.

Abstract: BACKGROUND In patients with ST-segment-elevation myocardial infarction and multivessel disease, percutaneous coronary intervention (PCI) for nonculprit lesions guided by fractional flow reserve (FFR) is superior to treatment of the culprit lesion alone. Whether deferring nonculprit PCI is safe in this specific context is questionable. We aimed to assess clinical outcomes at 1 year in ST-segment-elevation myocardial infarction patients with multivessel coronary artery disease and an FFR-guided strategy for nonculprit lesions, according to whether or not ≥1 PCI was performed. METHODS Outcomes were analyzed in patients of the randomized FLOWER-MI (Flow Evaluation to Guide Revascularization in Multivessel ST-Elevation Myocardial Infarction) trial in whom, after successful primary PCI, nonculprit lesions were assessed using FFR. The primary outcome was a composite of all-cause death, nonfatal myocardial infarction, and unplanned hospitalization with urgent revascularization at 1 year. RESULTS Among 1171 patients enrolled in this study, 586 were assigned to the FFR-guided group: 388 (66%) of them had ≥1 PCI, and 198 (34%) had no PCI. Mean FFR before decision (ie, PCI or not) of nonculprit lesions was 0.75±0.10 and 0.88±0.06, respectively. During follow-up, a primary outcome event occurred in 16 of 388 patients (4.1%) in patients with PCI and in 16 of 198 patients (8.1%) in patients without PCI (adjusted hazard ratio, 0.42 [95% CI, 0.20-0.88]; P=0.02). CONCLUSIONS In patients with ST-segment-elevation myocardial infarction undergoing complete revascularization guided by FFR measurement, those with ≥1 PCI had lower event rates at 1 year, compared with patients with deferred PCI, suggesting that deferring lesions judged relevant by visual estimation but with FFR >0.80 may not be optimal in this context. Future randomized studies are needed to confirm these data. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02943954. Graphic Abstract: A graphic abstract is available for this article.

2014 ESC Guidelines on the Diagnosis and Treatment of Aortic Diseases

Abstract: Autores/Miembros del Grupo de Trabajo: Raimund Erbel (Coordinador) (Alemania), Victor Aboyans (Coordinador) (Francia), Catherine Boileau (Francia), Eduardo Bossone (Italia), Roberto Di Bartolomeo (Italia), Holger Eggebrecht (Alemania), Arturo Evangelista (Espana), Volkmar Falk (Suiza), Herbert Frank (Austria), Oliver Gaemperli (Suiza), Martin Grabenwoger (Austria), Axel Haverich (Alemania), Bernard Iung (Francia), Athanasios John Manolis (Grecia), Folkert Meijboom (Paises Bajos), Christoph A. Nienaber (Alemania), Marco Roffi (Suiza), Herve Rousseau (Francia), Udo Sechtem (Alemania), Per Anton Sirnes (Noruega), Regula S. von Allmen (Suiza) y Christiaan J.M. Vrints (Belgica)

2014 ESC Guidelines on the diagnosis and treatment of aortic diseases

Abstract: 3D : three-dimensional AAA : abdominal aortic aneurysm AAS : acute aortic syndrome ACC : American College of Cardiology ACE : angiotensin-converting enzyme AD : Aortic dissection ADAM : Aneurysm Detection and Management AHA : American Heart Association AJAX : Amsterdam Acute Aneurysm AO : aorta AOS : aneurysms-osteoarthritis syndrome ARCH : Aortic Arch Related Cerebral Hazard ATS : arterial tortuosity syndrome BAV : bicuspid aortic valve BSA : body surface area CI : confidence interval CoA : coarctation of the aorta CPG : Committee for Practice Guidelines CSF : cerebrospinal fluid CT : computed tomography DREAM : Dutch Randomized Aneurysm Management DUS : Doppler ultrasound EBCT : electron beam computed tomography ECG : electrocardiogram EDS : Ehlers-Danlos syndrome EDSIV : Ehlers-Danlos syndrome type IV ESC : European Society of Cardiology ESH : European Society of Hypertension EVAR : endovascular aortic repair FDG : 18F-fluorodeoxyglucose FL : false lumen GCA : giant cell arteritis GERAADA : German Registry for Acute Aortic Dissection Type A IAD : iatrogenic aortic dissection IMH : intramural haematoma INSTEAD : Investigation of Stent Grafts in Patients with type B Aortic Dissection IRAD : International Registry of Aortic Dissection IVUS : intravascular ultrasound LCC : left coronary cusp LDS : Loeys-Dietz syndrome MASS : Multicentre Aneurysm Screening Study MESA : Multi-Ethnic Study of Atherosclerosis MPR : multiplanar reconstruction MRA : magnetic resonance angiography MRI : magnetic resonance imaging MSCT : multislice computed tomography NA : not applicable NCC : non-coronary cusp ns-TAAD : non-syndromic thoracic aortic aneurysms and dissection OR : odds ratio OVER : Open Versus Endovascular Repair OxVasc : Oxford Vascular study PARTNER : Placement of AoRtic TraNscathetER Valves PAU : penetrating aortic ulcer PICSS : Patent Foramen Ovale in Cryptogenic Stroke study PET : positron emission tomography RCCA : right common carotid artery RCC : right coronary cusp RCT : randomized, clinical trial RR : relative risk SIRS : systemic inflammatory response SMC : smooth muscle cell TAA : thoracic aortic aneurysm TAAD : thoracic aortic aneurysms and dissection TAI : traumatic aortic injury TEVAR : thoracic endovascular aortic repair TGF : transforming growth factor TI : separate thyroid artery (A. thyroidea) TL : true lumen TOE : transoesophageal echocardiography TS : Turner Syndrome TTE : transthoracic echocardiography UKSAT : UK Small Aneurysm Trial ULP : ulcer-like projection WARSS : Warfarin-Aspirin Recurrent Stroke Study Guidelines summarize and evaluate all available evidence at the time of the writing process, on a particular issue with the aim of assisting health professionals in selecting the best management strategies for an individual patient, with a given condition, taking into account the impact on outcome, as well as the risk-benefit-ratio of particular diagnostic or therapeutic means. Guidelines and recommendations should help the health professionals to make decisions in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate. A great number of Guidelines have been issued in recent years by the European Society of Cardiology (ESC) as well as by other societies and organisations. Because of the impact on clinical practice, quality criteria for the development of guidelines have been established in order to make all decisions …

International Expert Consensus Document on Takotsubo Syndrome (Part II): Diagnostic Workup, Outcome, and Management

Abstract: The clinical expert consensus statement on takotsubo syndrome (TTS) part II focuses on the diagnostic workup, outcome, and management. The recommendations are based on interpretation of the limited clinical trial data currently available and experience of international TTS experts. It summarizes the diagnostic approach, which may facilitate correct and timely diagnosis. Furthermore, the document covers areas where controversies still exist in risk stratification and management of TTS. Based on available data the document provides recommendations on optimal care of such patients for practising physicians.