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Systematic detection of polyvascular disease combined with aggressive secondary prevention in patients presenting with severe coronary artery disease: The randomized AMERICA Study

Jean-Philippe Collet 1 Guillaume Cayla 2 Pierre-Vladimir Ennezat 3 Florence Leclercq 4 Thomas Cuisset 5 Simon Elhadad 6 Patrick Henry 7 Loic Belle 8 Ariel Cohen 9 Johanne Silvain 10 Olivier Barthelemy 11 Farzin Beygui 12 Abdourahmane Diallo 13 Eric Vicaut 14 Gilles Montalescot 15, 11 America Investigators
1 ICAN - Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition
2 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
3 CHU Grenoble
4 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
5 C2VN - Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research
6 Service de Cardiologie
7 Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris]
8 Service de Cardiologie
9 Thrombose, atherothrombose et pharmacologie appliquée
10 Institut de cardiologie [CHU Pitié-Salpêtrière]
11 CHU Pitié-Salpêtrière [AP-HP]
12 Service de Cardiologie
13 Hôpital Lariboisière
14 Hôpitaux Universitaire Saint-Louis, Lariboisière, Fernand-Widal
15 SU FM - Sorbonne Université - Faculté de Médecine
Abstract : Background: The prevalence and associated-risk of asymptomatic multisite artery disease (MSAD) in high risk coronary patients are unknown. Whether systematic identification and aggressive management of asymptomatic MSAD is clinically relevant in high risk coronary patients has not been evaluated. Methods: We randomly assigned 521 high risk coronary patients defined by the presence of three-vessel coronary disease (n=304) or recent acute coronary syndrome beyond the age of 75 years (n=215) to either a strategy of systematic detection of asymptomatic MSAD combined with an aggressive secondary prevention (n = 263) or to a more conventional strategy based on treatment of coronary artery disease only with standard of care (n = 258). The primary end point was the time to first occurrence of death, any organ failure or ischemic event leading to re-hospitalization through two years of follow-up. Results: The pro-active strategy identified asymptomatic MSAD in 21.7% of patients with few revascularizations (3.6%); the pro-active pharmacological secondary prevention was obtained in >85% of patients and life-style changes in <60% of patients. At 2-year follow-up, the primary end point occurred in 44.9% of patients in the pro-active group and 43.0% of patients in the conventional group (HR 1.03; 95% confidence interval [CI], 0.80 to 1.34]. The rate of major bleeding did not differ significantly between groups (4.6% vs 5.0%; HR, 0.97; 95% CI, 0.40 to 1.91). Conclusion: In high risk coronary patients, there is no apparent benefit of a systematic detection of asymptomatic extra-coronary atherothrombotic disease and intensified treatment over a 2-year follow-up period. (c) 2017 Elsevier B.V. All rights reserved.
Keywords : Myocardial infarction Atherothrombosis Coronary artery disease
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https://hal-amu.archives-ouvertes.fr/hal-02091399
Contributor : Annick Prémilleux <>
Submitted on : Friday, April 5, 2019 - 4:27:38 PM
Last modification on : Wednesday, December 9, 2020 - 10:52:12 AM

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UNIV-AMU | SORBONNE-UNIVERSITE | INRA | ICAN | UNIV-PARIS7 | SU-MEDECINE | USPC | SU-SCIENCES | INRAE | UNIV-PARIS

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Jean-Philippe Collet, Guillaume Cayla, Pierre-Vladimir Ennezat, Florence Leclercq, Thomas Cuisset, et al.. Systematic detection of polyvascular disease combined with aggressive secondary prevention in patients presenting with severe coronary artery disease: The randomized AMERICA Study. International Journal of Cardiology, Elsevier, 2018, 254, pp.36-42. ⟨10.1016/j.ijcard.2017.11.081⟩. ⟨hal-02091399⟩

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