« Paradoxe des fumeurs » et stratégie de reperfusion à la phase aiguë de l’infarctus du myocarde

Addad, Faouzi; Dridi, Zohra; Jemmali, M.; Mzoughi, Khadija; Hassine, Mohsen; Ghrissi, I.; Hamdi, Sonia; Mahjoub, M.; Betbout, Fethi; Farhat, M. Ben; Gamra, Habib

doi:10.1016/j.ancard.2010.07.006

Cited by 6 publications

(1 citation statement)

References 25 publications

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“…As compared with the FAST-MI French registry [8], the mean age of Tunisian patients was younger (60 vs. 63 years); this was due not only to the demographic characteristics of the Tunisian population (mean age 31 years in the 2014 census), but also to the higher prevalence of cardiovascular risk factors such as active smoking (64% vs. 40%) and diabetes (32% vs. 17%). Indeed, it is known that these two risk factors are particularly associated with AMI in younger patients [9]. Conversely, the prevalence of hypertension (40% vs. 48%) and hypercholesterolemia (18% vs. 40%) was lower because these two factors are more frequently observed in an older population.…”

Section: Discussionmentioning

confidence: 99%

Management of patients with acute ST-elevation myocardial infarction: Results of the FAST-MI Tunisia Registry

et al. 2019

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Background The FAST-MI Tunisia registry was set up by the Tunisian Society of Cardiology and Cardiovascular Surgery to assess the demographic and clinical characteristics, management and hospital outcome of patients with ST-elevation myocardial infarction (STEMI). Methods Data for 459 consecutive patients (mean age 60.8 years; 88.5% male) with STEMI, treated in 16 public hospitals (representing 72.2% of public hospitals in Tunisia treating STEMI patients), were collected prospectively.The most common risk factors were smoking (63.6%), hypertension (39.7%), diabetes (32%) and dyslipidaemia (18.2%). Results Among the 459 patients, 61.8% received reperfusion therapy: 30% with primary percutaneous coronary intervention (PPCI) and 31.8% with intravenous fibrinolysis (IF) (28.6% with pre-hospital thrombolysis). The median time from symptom onset to thrombolysis was 185 min and to PPCI was 358 min. In-hospital mortality was 5.3%. Compared with those managed at regional hospitals, patients managed at interventional university hospitals ( n = 357) were more likely to receive reperfusion therapy (52.9% vs. 34.1%; p<0.001), with less IF (28.6% vs. 43.1%; p = 0.002) but more PPCI (37.8% vs. 3.9%; p<0.0001). However, in-hospital mortality in the two types of hospitals was similar (5.3% vs. 5.1%; p = 0.866). Conclusions Data from the FAST-MI Tunisia registry show that a pharmaco-invasive strategy of management for STEMI should be promoted in non-interventional regional hospitals.

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Section: Discussionmentioning

confidence: 99%

Management of patients with acute ST-elevation myocardial infarction: Results of the FAST-MI Tunisia Registry

et al. 2019

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Cigarette Smoking and Clopidogrel Interaction

et al. 2013

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Dual antiplatelet therapy (DAPT) with aspirin and an adenosine diphosphate receptor antagonist is central to the modern management of acute coronary syndromes and percutaneous revascularization. The most widely used adenosine diphosphate receptor antagonist, clopidogrel therapy is limited by inter-individual variability in platelet inhibition. Recent data suggest a potential role of smoking in the metabolism of clopidogrel and high on-treatment platelet reactivity. Pharmacodynamic studies and post-hoc analyses of large clinical trials support a link between smoking status and the efficacy of clopidogrel therapy. The mechanism of the interaction between smoking status and clopidogrel efficacy remains unclear but may be mediated by cytochrome P450 (CYP)1A2. There is less evidence available on the influence of smoking status on platelet reactivity and clinical outcomes during prasugrel and ticagrelor therapy.

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