Karim Stamboul
Bourgogne - Franche Comté, Côte d'or, Graduate Student
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Research Interests: Cardiology, Medicine, Multivariate Analysis, Humans, Internal Medicine, and 15 moreDiabetes mellitus, Female, Male, Perfusion, Left Ventricular Dysfunction, Clinical Sciences, Aged, Middle Aged, Myocardial Infarction, Reproducibility of Results, Physiological Stress Markers, Myocardial Perfusion Imaging, Ejection Fraction, Reperfusion, and Stress Physiological
Research Interests: Events, Medicine, France, Cardiac Surgery, Humans, and 15 moreInternal Medicine, Intervention, Female, Male, Mace, Guidelines, Acute Coronary Syndromes, Aged, Coronary Angiography, Chi Square Distribution, Hemorrhage, Logistic Models, Guideline Adherence, Decision Support Techniques, and Cardiovascular medicine and haematology
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Research Interests: Nursing, Cardiology, Survival Analysis, Medicine, Electrocardiography, and 15 moreHeart Failure, Prospective studies, Humans, Internal Medicine, Female, Male, Mace, Recurrence, Aged, Middle Aged, Cardiac Arrhythmias, Myocardial Infarction, Prognosis, Logistic Models, and Cardiovascular medicine and haematology
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Background and aims CHA2DS2VASc score have been suggested to predict death in patients with Atrial Fibrillation (AF). In acute myocardial infarction (AMI), silent AF is common and associated with poor prognosis. In patients with AMI, we... more
Background and aims CHA2DS2VASc score have been suggested to predict death in patients with Atrial Fibrillation (AF). In acute myocardial infarction (AMI), silent AF is common and associated with poor prognosis. In patients with AMI, we aimed to assess the CHA2DS2VASc score of patients with silent or symptomatic AF. Methods 849 consecutive AMI were prospectively analyzed by continuous ECG monitoring (CEM) 30 sec. Symptomatic AF was defined as any AF occurring on ECG during the hospital stay, resulting in clinical symptoms or need for urgent cardioversion. Results 135 (16%) developed silent AF and 45(5%) had symptomatic AF. Compared with the no AF group, patients with silent AF were markedly older (80 vs. 62 years; p Conclusion Patients with silent AF have level of CHA2DS2VASc risk similar to patients with symptomatic AF. A high CHA2DS2VASc score is associated with mortality, even when adjusted for GRACE risk score. These data suggest that CHA2DS2VASc score could improve risk stratification after AMI. The author hereby declares no conflict of interest
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Research Interests: Cardiology, Oxidative Stress, Medicine, Heart Failure, Humans, and 13 moreInternal Medicine, Atrial Fibrillation, Heart rate, Vascular endothelium, Risk factors, Clinical Sciences, Myocardial Infarction, Prognosis, Coronary Circulation, Risk Factors, Ejection Fraction, Hospital Mortality, and Asymptomatic Diseases.
Research Interests: Cardiology, Medicine, Electrocardiography, Heart Failure, Stroke, and 15 moreHumans, Internal Medicine, Hospitalization, Female, Male, Atrial Fibrillation, Heart, Aged, Middle Aged, Myocardial Infarction, Prognosis, Ejection Fraction, Asymptomatic, Prospective Cohort Study, and Cardiovascular medicine and haematology
Management of antithrombotic therapy in patients with atrial fibrillation (AF) and coronary stenting remains challenging, and there is a need for efficient tools to predict their risk of different types of cardiovascular events and death.... more
Management of antithrombotic therapy in patients with atrial fibrillation (AF) and coronary stenting remains challenging, and there is a need for efficient tools to predict their risk of different types of cardiovascular events and death. Several scores exist such as the CHA2DS2-VASc score, the Global Registry of Acute Coronary Events (GRACE) score, the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score, the Anatomical and Clinical Syntax II Score and the Reduction of Atherothrombosis for Continued Health score. These 5 scores were investigated in patients with AF with coronary stenting with the aim of determining which was most predictive for stroke/thromboembolic (TE) events, nonlethal coronary events, all-cause mortality, and major adverse cardiac events (MACE). Among 845 patients with AF with coronary stenting seen from 2000 to 2014, 440 (52%) were admitted for acute coronary syndrome and 405 (48%) for elective percutaneous coronary intervention. The rate of cardiovascular complication was at 14.1% per year, and nonlethal coronary events were the most frequent complications with a yearly rate of 6.5%. CHA2DS2-VASc score was the best predictor of stroke/TE events with a c-statistic of 0.604 (95% CI 0.567 to 0.639) and a best cut-off point of 5. SYNTAX score was better to predict nonlethal coronary events and MACE with c-statistics of 0.634 (95% CI 0.598 to 0.669) and 0.612 (95% CI 0.575 to 0.647), respectively, with a best cut-off point of 9. GRACE score appeared to be the best to predict all-cause mortality with a c-statistic of 0.682 (95% CI 0.646 to 0.717) and a best cut-off point of 153. In conclusions, among validated scores, none is currently robust enough to simultaneously predict stroke/TE events, nonlethal coronary events, death, and MACE in patients with AF with stents. The CHA2DS2-VASc score remained the best score to assess stroke/TE risk, as was the SYNTAX score for nonlethal coronary events and MACE, and finally, the GRACE score for all-cause mortality in this study population.
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Aims Silent and symptomatic atrial fibrillation (AF) are common during acute myocardial infarction (AMI), and associated with higher in-hospital and 1-year mortality. Are silent and symptomatic AF associated with higher rates of AF... more
Aims Silent and symptomatic atrial fibrillation (AF) are common during acute myocardial infarction (AMI), and associated with higher in-hospital and 1-year mortality. Are silent and symptomatic AF associated with higher rates of AF recurrence after hospitalization for AMI? Methods and results All consecutive patients admitted for AMI between January 2012 and August 2015 were prospectively analysed by continuous electrocardiogram monitoring <48 h after admission. Silent AF was defined as asymptomatic episodes lasting at least 30 s. The population was divided into three groups: no-AF, silent AF, and symptomatic AF. Altogether, 1621 patients were included in the prospective study and discharged alive from hospital. After excluding those with previous AF, permanent AF since the AMI and coronary artery bypass grafting surgeries and those lost to follow-up, 1282 remained. During the AMI, 1058 patients (83%) had a persistent sinus rhythm (SR), 168 (13%) had silent AF, and 55 (4%) had symptomatic AF. After a median follow-up of 1037 days (interquartile range 583-1342), new AF episodes were recorded in 59 patients (6%) of the SR group, 21 (13%) in the silent AF group, and 13 (24%) in the symptomatic AF group (P < 0.001). After Cox multivariate analysis, AF during AMI, indexed left atrial volume, age, and creatinine at discharge were identified as independent risk factors of AF after AMI. Conclusion The results of our large-scale study suggest that patients experiencing paroxysmal new-onset AF (silent or symptomatic) during AMI are at higher risk of AF at follow-up. Our data raise the question of implementing anticoagulation therapy following these brief and often neglected episodes.
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We aimed to investigate whether SDMA- symmetric dimethylarginine -the symmetrical stereoisomer of ADMA- might be a marker of left ventricular function in AMI. Asymmetric dimethylarginine (ADMA) has been implicated in the prognosis after... more
We aimed to investigate whether SDMA- symmetric dimethylarginine -the symmetrical stereoisomer of ADMA- might be a marker of left ventricular function in AMI. Asymmetric dimethylarginine (ADMA) has been implicated in the prognosis after acute myocardial infarction (AMI) and heart failure (HF). Cross sectional prospective study from 487 consecutive patients hospitalized <24 hours after AMI. Patients with HF on admission were excluded. Serum levels of ADMA, SDMA and L-arginine were determined using HPLC. Glomerular filtration rate (eGFR) was estimated based on creatinine levels. Outcomes were in-hospital severe HF, as defined by Killip class >2, and death. Patients were analysed based on SDMA tertiles. Sex, diabetes, dyslipidemia, and prior MI were similar for all tertiles. In contrast, age and hypertension increased across the tertiles (p<0.001). From the first to the last tertile, GRACE risk score was elevated while LVEF and eGFR was reduced. The rate of severe HF and death...
Research Interests: Cardiology, Performance, Mortality, Medicine, Multidisciplinary, and 15 moreMarker, Heart Failure, Internal Medicine, Disease, Impact, Metaanalysis, PLoS one, Renal Function, Artery, Myocardial Infarction, Chronic Heart Failure, Dyslipidemia, Ejection Fraction, Serum Asymmetric Dimethylarginine (ADMA), and Creatinine
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Stroke is a serious complication after acute myocardial infarction (AMI) and is associated with an increased risk of death. Though the pathophysiological mechanisms are not exactly known, increased inflammation and platelet reactivity... more
Stroke is a serious complication after acute myocardial infarction (AMI) and is associated with an increased risk of death. Though the pathophysiological mechanisms are not exactly known, increased inflammation and platelet reactivity could play an important role in the occurrence of stroke during AMI. We aimed to investigate the relationship between both mean platelet volume (MPV), a parameter of platelet function, and C-reactive protein (CRP) and the occurrence of in-hospital ischemic stroke (IHS) after AMI. Data were obtained from a French regional survey for AMI that included 5976 patients admitted to an intensive care unit (ICU) between 2001 and 2010. Patients were divided into two groups according to the occurrence of IHS. MPV, platelet count (PC), and CRP were routinely measured at admission to the ICU; 99 (1.6%) IHSs were recorded during hospitalization after admission for AMI. In multivariate analysis, IHS was independently associated with a history of stroke (OR: 1.99%, CI...
Research Interests: Cardiology, Biomarkers, Medicine, Comorbidity, Humans, and 15 moreInternal Medicine, Hospitalization, Female, Male, Acute Myocardial Infarction, Clinical Sciences, Intensive Care Unit, Aged, Middle Aged, C reactive protein, Myocardial Infarction, Odds ratio, Ejection Fraction, Mean platelet volume, and Blood platelets
Management of antithrombotic therapy in patients with atrial fibrillation (AF) and coronary stenting remains challenging, and there is a need for efficient tools to predict their risk of different types of cardiovascular events and death.... more
Management of antithrombotic therapy in patients with atrial fibrillation (AF) and coronary stenting remains challenging, and there is a need for efficient tools to predict their risk of different types of cardiovascular events and death. Several scores exist such as the CHA2DS2-VASc score, the Global Registry of Acute Coronary Events (GRACE) score, the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score, the Anatomical and Clinical Syntax II Score and the Reduction of Atherothrombosis for Continued Health score. These 5 scores were investigated in patients with AF with coronary stenting with the aim of determining which was most predictive for stroke/thromboembolic (TE) events, nonlethal coronary events, all-cause mortality, and major adverse cardiac events (MACE). Among 845 patients with AF with coronary stenting seen from 2000 to 2014, 440 (52%) were admitted for acute coronary syndrome and 405 (48%) for elective percutaneous coronary ...
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<p>Arterial blood samples were harvested after anesthesia (IND), just before starting CPB (pre-CPB), just after removing the cross clamp (UNCLAMP), after surgery upon arrival in the ICU (Post-SURG) and after 24 hours at the... more
<p>Arterial blood samples were harvested after anesthesia (IND), just before starting CPB (pre-CPB), just after removing the cross clamp (UNCLAMP), after surgery upon arrival in the ICU (Post-SURG) and after 24 hours at the cardiovascular intensive care unit (ICU). Markers of oxidative stress, inflammation, organ failure and clinical criteria were collected.</p
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Atrial fibrillation (AF) is the most frequent heart rhythm disorder in the general population and contributes not only to a major deterioration in quality of life but also to an increase in cardiovascular morbimortality. The onset of AF... more
Atrial fibrillation (AF) is the most frequent heart rhythm disorder in the general population and contributes not only to a major deterioration in quality of life but also to an increase in cardiovascular morbimortality. The onset of AF in the acute phase of myocardial infarction (MI) is a major event that can jeopardize the prognosis of patients in the short-, medium- and long-term, and is a powerful predictor of a poor prognosis after MI. The suspected mechanism underlying the excess mortality is the drop in coronary flow linked to the acceleration and arrhythmic nature of the left ventricular contractions, which reduce the left ventricular ejection fraction. The principal causes of AF-associated death after MI are linked to heart failure. Moreover, the excess risk of death in these heart failure patients has also been associated with the onset of sudden death. Whatever its form, AF has a major negative effect on patient prognosis. In recent studies, symptomatic AF was associated ...
Research Interests: Cardiology, Oxidative Stress, Medicine, Heart Failure, Humans, and 13 moreInternal Medicine, Atrial Fibrillation, Heart rate, Vascular endothelium, Risk factors, Clinical Sciences, Myocardial Infarction, Prognosis, Coronary Circulation, Risk Factors, Ejection Fraction, Hospital Mortality, and Asymptomatic Diseases.
Atrial fibrillation (AF), whether silent or symptomatic, is a frequent and severe complication of acute myocardial infarction (AMI). Asymmetric dimethylarginine (ADMA), an endogenous eNOS inhibitor, is a risk factor for endothelial... more
Atrial fibrillation (AF), whether silent or symptomatic, is a frequent and severe complication of acute myocardial infarction (AMI). Asymmetric dimethylarginine (ADMA), an endogenous eNOS inhibitor, is a risk factor for endothelial dysfunction. We addressed the relationship between ADMA plasma levels and AF occurrence in AMI. 273 patients hospitalized for AMI were included. Continuous electrocardiographic monitoring (CEM) ≥48 hours was recorded and ADMA was measured by High Performance Liquid Chromatography on admission blood sample. The incidence of silent and symptomatic AF was 39(14%) and 29 (11%), respectively. AF patients were markedly older than patients without AF (≈ 20 y). There was a trend towards higher ADMA levels in patients with symptomatic AF than in patients with silent AF or no AF (0.53 vs 0.49 and 0.49 μmol/L, respectively, p = 0.18,). After matching on age, we found that patients with symptomatic AF had a higher heart rate on admission and a higher rate of patients...