Abnormal endothelial function occurs in patients with coronary artery disease, and this can be counteracted by angiotensin-converting enzyme inhibition with perindopril. These effects could contribute, at least in part, to explaining the results of the main EUROPA Study.

Background-Although glycoprotein IIb/IIIa inhibitors have been shown to reduce periprocedural and late ischemic events in patients undergoing stent implantation, the relative safety and efficacy of different agents in this class is less established. Also unknown is whether the acuity of the presenting clinical syndrome, which may affect the degree of platelet inhibition required or achieved, influences the response to different antiplatelet agents. Methods and Results-A prospective, multicenter, double-blind, randomized trial was performed in which 4809 patients undergoing planned stenting were randomized to receive abciximab or tirofiban. In patients with acute coronary syndromes (ACS; nϭ3025), abciximab resulted in lower rates of myocardial infarction at 30 days (5.8% versus 8.5%; Pϭ0.004) and 6 months (7.2% versus 9.8%; Pϭ0.013), although 6-month mortality rates were identical (1.39% in both groups; Pϭ0.99). Conversely, in patients without ACS (nϭ1784), myocardial infarction rates were not significantly lower with tirofiban, survival was similar, and target vessel revascularization was reduced, which translated into a trend toward enhanced 6-month event-free survival with tirofiban (89.7% versus 86.6%; Pϭ0.056). Conclusions-In patients with ACS undergoing stent implantation, abciximab use compared with tirofiban results in greater suppression of periprocedural myonecrosis, although a survival benefit has not been demonstrated. Patients with stable coronary syndromes may have equivalent or better outcomes with tirofiban relative to abciximab, with fewer adverse hematologic and hemorrhagic events. These data raise important issues regarding the relative pharmacodynamic inhibition of platelet function required in varying clinical scenarios and have important implications for the cost-effective utilization of glycoprotein IIb/IIIa inhibitors.

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Clinical, exercise, and angiographic variables, and long-term follow-up were compared in patients, who, during maximal Bruce exercise testing after a first acute myocardial infarction (AMI), had positive responses to exercise testing (n = 116, 38% of 303) with (n = 23, group I) or without (n = 93, group II) angina. Group I patients more often (52 vs 19%, P < 0.001) had a history of pre-infarction angina. Group II had a greater proportion (75 vs 52%, P < 0.05) of inferior wall AMI, whereas group I had a greater proportion (30 vs 19%, P < 0.01) of non-Q wave AMI. Total exercise duration was significantly (P < 0.01) longer in group II (7.6 +/- 3.2 vs 5.5 +/- 3.1 min). Maximal exercise heart rate (144 +/- 22 vs 133 +/- 21, beats.min-1 P < 0.05) was also higher in group II. A greater proportion of group II patients (37 vs 9%, P < 0.05) had single-vessel disease, whereas multivessel disease was more common (91 vs 63%, P < 0.03) in group I. Left ventricular function was similar in both groups. During follow-up (48 +/- 22 months) the incidence of cardiac death (group I, 3.3%, group II, 4.8%), of recurrent infarction (group I, 4.8%, group II 3.3%), and of revascularization procedures (group I, 28.5%, group II, 19.8%) were similar in both groups. Although asymptomatic exercise-induced ischaemia was associated with better exercise performance and less extensive coronary disease than symptomatic ischaemia, it had the same long-term prognostic implications.

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Position du problème: La première vague de la COVID-19 a déferlé sur la France au cours du premier trimestre 2020 entrainant une saturation du réseau de soins. Nous avons voulu étudier, au sein d'une antenne médicale militaire française soutenant un des plus grands effectifs des armées, l'impact de la téléconsultation ainsi que de l'isolement systématique de tous les cas possibles, probables et confirmés de COVID-19. Méthodes: Il s'agit d'une étude rétrospective réalisée du 9 mars au 31 mai 2020 à partir de notre registre d'activité. Les variables recueillies étaient notamment le type d'épisode, le statut professionnel, la classification du cas et la date de début des symptômes. Nous avons mis en parallèle notre activité à celle de SOS Médecins et des services d'urgence d'Île-de-France. Résultats et discussion: Au cours de cette période, 1719 épisodes de soins (téléconsultations ou consultations physiques) ont été enregistrés dont 91 % (n=1561) en lien avec la COVID-19. Nous avons identifié 598 cas "suspects" (possibles et probables) et confirmés. Les téléconsultations "isolées" (non suivies d'une consultation médicale en présentiel, d'un prélèvement ou ayant nécessité l'envoi de prompt-secours) ont représenté 86 % des épisodes de soins (n=1482). La comparaison de notre activité et du nombre de nouveaux cas aux bases de données de SOS Médecins et des services d'urgences d'Île-de-France laisse supposer que notre stratégie d’isolement a été rapidement efficace. Conclusion: L'apport de la téléconsultation a été majeur et sécurisant. La téléconsultation permet d'absorber un volume de patients important, est facile à mettre en œuvre et se caractérise par l'absence de risque nosocomial. L'isolement des patients contaminés doit constituer une priorité en période épidémique. Cette attitude doit s'étendre, lorsque l'on veut maitriser rapidement une épidémie, à l'ensemble des patients symptomatiques.

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