Un projet multicentrique suisse pour améliorer la prévention et la récidive après un syndrome coronarien aigu
Cardiologie préventive, 2010
Le syndrome coronarien aigu (SCA) est associé à un risque de récidive d'événement cardiovasc... more Le syndrome coronarien aigu (SCA) est associé à un risque de récidive d'événement cardiovasculaire de 15% à un an. Une étude multicentrique suisse, «Inflammation and acute coronary syndromes (ACS) Novel strategies for prevention and clinical management», soutenue par le ...
Eligibility for marine omega-3 fatty acid supplementation after acute coronary syndromes
Atherosclerosis Plus, 2024
The 2019 European Society of Cardiology guidelines for the management of dyslipidemia consider th... more The 2019 European Society of Cardiology guidelines for the management of dyslipidemia consider the use of high-dose marine omega-3 fatty acid (FA) eicosapentaenoic acid (EPA) supplementation (icosapent ethyl 2 × 2g/day) to lower residual cardiovascular risk in high-risk patients with hypertriglyceridemia. This study aimed to assess the eligibility for omega-3 FA-EPA supplementation in patients with acute coronary syndromes (ACS).
Association Between Patient Sex and Familial Hypercholesterolemia and Long-Term Cardiovascular Risk Factor Management 5 Years After Acute Coronary Syndrome
Circulation. Cardiovascular quality and outcomes, Jun 20, 2024
Case report: desmoplakin cardiomyopathy presenting as an inflammatory cardiomyopathy with repeated sudden cardiac arrests
European heart journal. Case reports, Apr 3, 2024
Impact of the 2021 ESC Prevention Guideline’s stepwise approach for cardiovascular risk factor treatment in patients with established ASCVD
European journal of preventive cardiology, Feb 7, 2024
Drinking patterns of alcohol and risk of major adverse cardiovascular events after an acute coronary syndrome
European Journal of Preventive Cardiology, Nov 22, 2023
Insufficient long-term LDL-cholesterol management in patients with familial hypercholesterolemia 5 years after an acute coronary syndrome
European Heart Journal, Oct 31, 2023
Impact of the stepwise approach to cardiovascular disease prevention in patients with established ASCVD from the 2021 ESC Prevention Guideline
Disclaimer. The ESC Guidelines represent the views of the ESC and were produced after careful con... more Disclaimer. The ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their publication. The ESC is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the ESC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the ESC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic or therapeutic medical strategies; however, the ESC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient's health condition and in consultation with that patient and, where appropriate and/or necessary, the patient's caregiver. Nor do the ESC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient's case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional's responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.
Frontiers in Cardiovascular Medicine, Oct 12, 2023
Background Although the severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) causing coro... more Background Although the severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) causing coronavirus disease 2019 (COVID-19) primarily affects the respiratory system, the disease entity has been associated with cardiovascular complications. This study sought to assess the effect of concomitant SARS-COV-2 infection on clinical outcomes of patients hospitalized primarily for acute cardiac conditions on cardiology wards in Switzerland. Methods In this prospective, observational study conducted in 5 Swiss cardiology centers during the COVID-19 pandemic, patients hospitalized due to acute cardiac conditions underwent a reverse-transcriptase polymerase chain reaction test at the time of admission and were categorized as SARS-COV-2 positive (cases) or negative (controls). Patients hospitalized on cardiology wards underwent treatment for the principal acute cardiac condition according to local practice. Clinical outcomes were recorded in-hospital, at 30 days, and after 1 year and compar...
Long-term exposure to traffic-related PM10 and decreased heart rate variability: Is the association restricted to subjects taking ACE inhibitors?
Environment International, Nov 1, 2012
Alterations in heart rate variability (HRV) are a potential link between exposure to traffic-rela... more Alterations in heart rate variability (HRV) are a potential link between exposure to traffic-related air pollution and cardiovascular mortality. We investigated whether long-term exposure to traffic-related PM(10) (TPM(10)) is associated with HRV in older subjects and/or in participants taking specific cardiovascular treatment or with self-reported heart disease. We included 1607 subjects from the general population aged 50 to 72 years. These participants from the SAPALDIA cohort underwent ambulatory 24-hr electrocardiogram monitoring. Associations of average annual exposure to TPM(10) over 10 years with HRV parameters from time and frequency domains were estimated using multivariable mixed linear models. Effect estimates are expressed as percent changes in geometric means. HRV was only associated with TPM(10) in participants under ACE inhibitor therapy (N=94). A 1 μg/m(3) increment, approximately equivalent to an interquartile range, in 10 year average TPM(10) was associated with decrements of 14.5% (95% confidence interval (CI), -25.9 to -1.3) in high frequency (HF) power, of 4.5% (-8.2 to -0.5) in the standard deviation of all normal-to-normal RR intervals (SDNN), of 10.6% (-18.5 to -1.9) in total power (TP) and an increase of 9.2% (0.8 to 20.2) in the LF/HF power ratio. In the absence of an overall effect our results suggest that alterations in HRV, a measure of autonomic control of the cardiac rhythm, may not be a central mechanism by which long-term exposure to TPM(10) increases cardiovascular mortality. Novel evidence on an effect in persons under ACE inhibitor treatment needs to be confirmed in future studies.
Structured secondary cardiovascular prevention programs (SSCP) following acute coronary syndromes... more Structured secondary cardiovascular prevention programs (SSCP) following acute coronary syndromes (ACS) may reduce major adverse cardiovascular events (MACE) through better adherence to post-ACS recommendations. Through a prospective multicenter cohort study, we compared the outcomes of two sequential post-ACS patient cohorts, the initial one receiving standard care (SC) followed by one receiving additional interventions (SSCP) aimed at improving patient education as well as healthcare provider and hospital systems. The primary endpoint was MACE at one year. Secondary endpoints included adherence to recommended therapies, attendance to cardiac rehabilitation (CR) and successful achievement of cardiovascular risk factor (CVRF) targets. In total, 2498 post-ACS patients from 4 Swiss university hospitals were included: 1210 vs 1288 in the SC and SSCP groups, respectively. The SSCP group demonstrated a significant increase in attendance to CR programs (RR 1.08, 95%CI 1.02-1.14, P = 0.006), despite not
Original research article editorial, see p 710 BACKGROUND: Patients with heterozygous familial hy... more Original research article editorial, see p 710 BACKGROUND: Patients with heterozygous familial hypercholesterolemia (FH) and coronary heart disease have high mortality rates. However, in an era of high-dose statin prescription after acute coronary syndrome (ACS), the risk of recurrent coronary and cardiovascular events associated with FH might be mitigated. We compared coronary event rates between patients with and without FH after ACS. We studied 4534 patients with ACS enrolled in a multicenter, prospective cohort study in Switzerland between 2009 and 2013 who were individually screened for FH on the basis of clinical criteria according to 3 definitions: the American Heart Association definition, the Simon Broome definition, and the Dutch Lipid Clinic definition. We used Cox proportional models to assess the 1-year risk of first recurrent coronary events defined as coronary death or myocardial infarction and adjusted for age, sex, body mass index, smoking, hypertension, diabetes mellitus, existing cardiovascular disease, highdose statin at discharge, attendance at cardiac rehabilitation, and the GRACE (Global Registry of Acute Coronary Events) risk score for severity of ACS. At the 1-year follow-up, 153 patients (3.4%) had died, including 104 (2.3%) of fatal myocardial infarction. A further 113 patients (2.5%) experienced nonfatal myocardial infarction. The prevalence of FH was 2.5% with the American Heart Association definition, 5.5% with the Simon Broome definition, and 1.6% with the Dutch Lipid Clinic definition. Compared with patients without FH, the risk of coronary event recurrence after ACS was similar in patients with FH in unadjusted analyses, although patients with FH were >10 years younger. However, after multivariable adjustment including age, the risk was greater in patients with FH than without, with an adjusted hazard ratio of 2.46 (95% confidence interval, 1.07-5.65; P=0.034) for the American Heart Association definition, 2.73 (95% confidence interval, 1.46-5.11; P=0.002) for the Simon Broome definition, and 3.53 (95% confidence interval, 1.26-9.94; P=0.017) for the Dutch Lipid Clinic definition. Depending on which clinical definition of FH was used, between 94.5% and 99.1% of patients with FH were discharged on statins and between 74.0% and 82.3% on high-dose statins.
To assess the associations of exposure and modifications in exposure (i.e., discontinuation on ad... more To assess the associations of exposure and modifications in exposure (i.e., discontinuation on admission, initiation during hospitalization) to eight common cardiovascular therapies with the risk of in-hospital death among inpatients with coronavirus disease 2019 . In this observational study including 838 hospitalized unvaccinated adult patients with confirmed COVID-19, the use of cardiovascular therapies was assessed using logistic regression models adjusted for potential confounders. No cardiovascular therapy used before hospitalization was associated with an increased risk of in-hospital death. During hospitalization, the use of diuretics (aOR 2.59 [1.68-3.98]) was associated with an increase, and the use of agents acting on the renin-angiotensin system (aOR 0.39 [0.23-0.64]) and lipid-lowering agents (aOR 0.41 [0.24-0.68]) was associated with a reduction in the odds of in-hospital death. Exposure modifications associated with decreased survival were the discontinuation of an agent acting on the renin-angiotensin system (aOR 4.42 [2.08-9.37]), a β-blocker ), a lipid-modifying agent ) or an anticoagulant ), as well as the initiation of a diuretic ) or an antiarrhythmic ). Exposure modification associated with improved survival was the initiation of an agent acting on the renin-angiotensin system (aOR 0.17 [0.03-0.82]).
Abstract 15491: Effects of Intensive Smoking Cessation Counseling After Acute Coronary Syndrome on 5-year Incidence of Major Adverse Cardiovascular Events and Smoking Abstinence
Circulation, Nov 17, 2020
Introduction: Smoking cessation is recommanded after an acute coronary syndrome (ACS). Long-term ... more Introduction: Smoking cessation is recommanded after an acute coronary syndrome (ACS). Long-term cardiovascular benefits of smoking cessation counseling during a hospitalization and shortly after discharge for an ACS remains unknown. We aimed to study the 5-year incidence of major adverse cardiovascular events (MACE, defined as cardiovascular death, myocardial infarction, stroke, unplanned coronary revascularization or hospitalization due to angina) and smoking abstinence after ACS, comparing usual care to an intensive smoking cessation counseling intervention in hospital and after discharge. Methods: We studied 951 smokers from the SPUM-ACS cohort hospitalized for ACS between 2009 and 2014 in a multicenter prospective study with information available at the 5-year follow-up visit on incident MACE. At baseline in 4 study centers, a non-randomized part of smokers with ACS received proactive in-hospital smoking cessation counseling along with several telephone counseling over a 2 months period after discharge. We compared this intensive counseling group to the usual care group, regarding the incidence of MACE at 5 years. We used a multivariate adjusted Cox-proportional hazards model to estimate hazard ratios (HR) and 95% confidence intervals (CI). The secondary outcome was smoking cessation rate 5 years post-ACS. Results: Out of 951 smokers with ACS, 228 (35%) received the intensive in-hospital smoking intervention, of which 186 (82%) accepted to receive counseling after discharge. After multivariable adjustment for age, sex, education and study site, the 5-year risk of a recurrent MACE was comparable between the intensive counseling group and the usual care group, with a multivariable HR of 1.02 (95% CI 0.71-1.46, p=0.92). Among 669 patients alive 5 years post-ACS with known smoking status, 95 (56%) had stopped smoking in the intensive counseling group and 234 (47%) in the usual care group, with a multivariate odds ratio of 0.69 (95% CI 0.47-1.03; p=0.07). Conclusions: In this observational study, an intensive smoking cessation intervention during hospitalization for ACS with post-discharge telephone counseling did not reduce 5-year recurrence of MACE. However, this early intervention may confer a benefit for long-term smoking abstinence.
Bleeding incidence in a contemporary ACS cohort adjudicated by three different classifications
European Heart Journal, Aug 2, 2013
Purpose: Bleeding constitutes an important adverse event of therapy after an acute coronary syndr... more Purpose: Bleeding constitutes an important adverse event of therapy after an acute coronary syndrome (ACS). Currently there is no classification uniformly used to ascertain bleeding events rendering the comparison of different clinical trials difficult. This work addresses i) the incidence of bleeding events occurring within 30 days after an ACS ii) the concordance of three classifications currently used (BARC, GUSTO and TIMI) in a prospectively recruited large patient cohort. Methods: All patients aged ≥18 years presenting within 5 days after pain onset with the main diagnosis of STEMI, NSTEMI or unstable angina were included in the study. Patients had symptoms compatible with angina pectoris and at least one of the following inclusion criteria a) ST-segment elevation or depression, T inversion or dynamic ECG changes, new LBBB; b) evidence of positive Troponin; c) known coronary artery disease (status after myocardial infarction, CABG or PCI or newly documented during the acute catheterization). Exclusion criteria comprised severe physical disability, dementia or less than 1 year of life expectancy for non-cardiac reasons. Adjudicated 30-day bleeding incidence after an ACS was determined according to GUSTO, TIMI and BARC (overt bleeding) criteria in 1470 patients prospectively enrolled between 12/2009 and 12/2011 at 4 Swiss University Hospitals. MACE was defined as composite of death, recurrent myocardial infarction and stroke. 30-day follow-up comprised all enrolled patients including deceased individuals. Concordance between classifications was determined by Kendall's tau-b correlation test. Results: Among 1470 patients enrolled with ACS, 4.2% had unstable angina; 41.8% had NSTEMI and 54.0% had STEMI. 1451 patients (98.7%) had a complete 30-day follow-up. Adjudicated 30-day bleeding incidence was 3.9% (n=57 first events). Adjudicated 30-day MACE rate was 3.2% (n=47). Medications prescribed at hospital discharge to 1452 patients were aspirin in 99.2%, clopidogrel in 53.7%, prasugrel in 38.9% and/or coumadin in 6.1%. Comparison of the 3 classifications yielded a high concordance for bleeding severity between TIMI vs. BARC (Kendall tau-b 0.75, p<0.001) but only a moderate concordance between TIMI vs. GUSTO and between GUSTO vs. BARC (Kendall tau-b 0.58, p<0.001 and 0.62, p<0.001, respectively; n=66 first to third bleedings). Conclusions: The 30-day bleeding incidence in this contemporary cohort was low compared with previous studies. The best correlation was found for TIMI and BARC underscoring the distinct aspects of bleeding events reflected by the three classifications evaluated.
Un projet multicentrique suisse pour améliorer la prévention et la récidive après un syndrome coronarien aigu
Revue médicale suisse, 2010
Le syndrome coronarien aigu (SCA) est associé à un risque de récidive d'événement cardiovasc... more Le syndrome coronarien aigu (SCA) est associé à un risque de récidive d'événement cardiovasculaire de 15% à un an. Une étude multicentrique suisse, «Inflammation and acute coronary syndromes (ACS) Novel strategies for prevention and clinical management», soutenue par le ...
Intensified lipid lowering using ezetimibe after publication of the IMPROVE-IT trial: A contemporary analysis from the SPUM-ACS cohort
International Journal of Cardiology, Mar 1, 2020
BACKGROUND The relevance of the IMPROVE-IT trial on real-life practice has not been explored in p... more BACKGROUND The relevance of the IMPROVE-IT trial on real-life practice has not been explored in patients with ACS. METHODS A prospective Swiss cohort of 6266 patients hospitalized for ACS between 2009 and 2017 with a one-year follow-up. The primary endpoints were the ezetimibe use overall or in combination with high-intensity statin at discharge and at one year after ACS. Secondary endpoint was LDL-C target achievement at one year in a subsample of 2984 patients. Relative Ratios (RR) were used to assess changes in primary endpoints before and after the publication of IMPROVE-IT, adjusting for age, sex, diabetes, prior myocardial infarction, LDL-C and attendance to cardiac rehabilitation. RESULTS The period following the publication of the IMPROVE-IT trial was associated with a steady increase in the use of ezetimibe at discharge (from 1.8% to 3.8%, P < 0.001, adjusted RR 2.85, 95% CI 1.90-4.25) and at one year (from 5.0% to 13.8%, P < 0.001, adjusted RR 3.00, 95% CI 2.40-3.75). The combination of high-intensity statin and ezetimibe rose from 0.9% to 2.1% at discharge (P < 0.001, adjusted RR 3.35, 95% CI 1.90-5.89) and from 2.1% to 7.8% at one year (P < 0.001, adjusted RR 3.98, 95% CI 2.90-5.47). The period following the publication of the IMPROVE-IT trial was associated with an improvement of LDL-C target <1.8 mmol/L (adjusted RR 1.37, 95% CI 1.12-1.68). CONCLUSIONS After the publication of the IMPROVE-IT trial, the use of ezetimibe was increased by three-fold in a large contemporary cohort of ACS patients, concomitant with an improved LDL-C target achievement.
The prognostic value of pulmonary hypertension (PH) estimated by echocardiography in unselected p... more The prognostic value of pulmonary hypertension (PH) estimated by echocardiography in unselected patients with acute decompensated heart failure (ADHF) is poorly studied. Between November 2014 and September 2018, 657 patients were recruited in a prospective registry of ADHF (ClinicalTrials.gov NCT02444416). The probability of pulmonary hypertension was based on European Society of Cardiology (ESC) guidelines for echocardiographic evaluation. The median survival without all-cause mortality or readmission was 7 months. During the median follow-up period of 15 months, there were 450 events including 185 deaths. In multivariate analysis, the hazard ratio (HR) of all-cause mortality or readmission for patients with a high probability of PH was 1.67 (95% CI 1.29-2.17, p < 0.001) as compared to patients with a low or intermediate probability. The left ventricular ejection fraction (LVEF) and right ventricular function (RVF) were not associated with the primary outcome-HR 1.02 (95% CI 0.81-1.29; p = 0.84) and 0.96 (95% CI 0.76-1.23; p = 0.77) respectively. In patients admitted for ADHF, a high probability of PH as evaluated by echocardiography provided the highest independent prognostic value for mortality and readmission, whereas LVEF and RVF were not associated with prognosis. The identification of patients at high risk of PH by non-invasive measurement conveys important prognostic information and may guide management.
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Papers by David Carballo