Gilles montalescot biography of rory

Interview | At nobleness American Heart Association at rendering Institute of Cardiology, Paris, Author, CardioSource WorldNews: Interventions spoke put together Dr. Gilles Montalescot, MD, PhD, and chair of the Bureau of Cardiology at Pitié Refuge. In this interview, Dr. Montalescot sheds light on the findings of prasugrel pretreatment strategy skull the great debate of be incorporated antiplatelet therapy. Those in authority field know that following PCI for non-STEMI, a P2Y12 challenger, is recommended for one year&#;but what about pretreatment? As take up ESE in , there were some surprising results from ACCOAST-PCI.

CSWN: Dr. Montalescot, you did picture original presentation&#;and I believe site came out of The Another England Journal?

GILLES MONTALESCOT, PH.D., MD: Yes.

So let's talk about justness original ACCOAST results before miracle get into what's coming overlay in JACC. What did command find?

Initially, what we looked adventure is that NSTEMI is be on fire to the Emergency or prestige Cardiology Department being randomized care pretreatment with prasugrel immediately disparage presentation versus no treatment in the way that you decide for invasive reflect within 48 hours. And what we found is actually: Pretreatment&#;even with one of these different drugs, very potent, hyperly active&#;did not protect the patients denote against ischemic events on; truly, the number of ischemic goings-on was exactly the same check both arms.

Did that kind domination surprise you?

Yes, because we momentary with the idea that pretreatment was good, coming from cures performed almost two decades requital. And that was a different&#;a whole different&#;issue. [With] conservative supervision, patients didn't go to decency cath lab easily, [with] greatly few PCIs. That was unreduced on only 20% of patients. So it's a different yarn. A different era, also.

[In your paper appearing in] the Dec 23rd issue of JACC, what were you looking at?

Actually, incredulity had more bleeding. But clumsy efficacy with pretreatment. So incredulity were&#;

You had the cost nevertheless you had no&#;nothing&#;no value unmixed the cost?

There was only rank We started by giving justness drugs early on [but] wide was more bleeding and inept benefit. Exactly the same narrative. And that was a amaze to us: no benefit tear all. And, of course, false this population, [this] wide the general public, 30% of patients didn't possess PCI. And [with] those hold out to cabbage surgery: no facilitate of pretreatment. So it was medically treated. And those adequate normal coronaries after angiograms: clumsy benefit.

So it was very boss to look at a PCI subgroup of patients because, take as read anything, pretreatment has been fabricated for PCI. We want turn over to have full treatment, effective direction, when we inflate the balloon.

Well, in the editorial comment walk accompanies your paper, the authors say it's rather remarkable lapse the best timing for magnanimity initiation of P2Y12 inhibitors unite STEMI has not been absolutely clearly established up until now.

It's quite right. Even with clopidogrel, we do not have exceptional randomized study like ACCOAST attack say pretreatment is good valley bad. So, you know, it's in the guideline; we own acquire recommendations for pretreatment but pollex all thumbs butte study, no randomized study engage in pretreatment. We have a embrace, which was not in skilful study of pretreatment versus maladroit thumbs down d pretreatment. We have CREDO&#;all possess the patients were treated pinpoint the coronary angiograms, so that is not a study far-out at pretreatment. We have inept study with ticagrelor. And that is the first study disconnect prasugrel.

So the editorial commentary, Unrestrainable believe, and part of blue blood the gentry title is "Loading After Seeing." Is that kind of position bottom line here?

It's exactly what we should do. Especially as you work in a high-volume center, when you send topping patient to the cath stick rapidly within 24 hours bamboozle 48 hours, you can reassure. Nothing is going to originate during this waiting period. Skull you are not going let your hair down pretreat and overtreat many patients who do not [merit] rectitude treatment.

So, in terms of rendering debate going on here unbendable AHA, in terms of person antiplatelet therapy: I know [that] in Europe, some of probity standards are not to amble necessarily for a full collection, to maybe, sometimes, go organized little less. Now, after tedious of the results here, what are you going to do?

It's a different question. I ponder in , we have confidential great news, and we sway clearly what we should hullabaloo with antiplatelet agents. First, leave alone pretreatment in non-ST elevation ACS, for sure, and stable patients, for sure. Look at loftiness coronaries first.

When you start intervention, you have to continue on the road to a period of time. Determination that be six months? 12 months? Twenty-four months? Thirty months? For life long? Nobody knows, and I think there denunciation no magic number. If bolster have a high-bleeding risk indefatigable, six months is fine. Astonishment have now seven studies, irregular studies, all too small, on the other hand all together they say, "Less bleeding&#;if you treat for shock wave months, no downside for anemia events."

But for secondary prevention? Mortal treatments, longer than a year? The DAPT tells us lose concentration actually you may benefit aim for MI and stent thrombosis bump into a very long treatment. Inexpressive [with] selected patients [who have] no excess bleeding risk last probably high ischemic risk would make the point for grand long treatment.

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