The research led by the ACTION group focuses on answering questions doctors ask daily.

Our objective is to provide better treatment, by searching the best diagnosis tools, optimized protocols and ultimately the best care for patients hospitalized for heart disease.

Acute coronary syndrome

Have influence on patient care with acute coronary syndrome

As an example, several major internationally recognized randomized trials, enrolling 6000 patients, have been conducted by ACTION Group testing new treatment strategies. These trials impacted directly the international recommendations and the daily care of the patients.

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  • ATOLL, investigating the identification of the best anti-coagulation strategy in the pre-hospitalization phase of ST segment elevation myocardial infarction (Montalescot et al. Lancet 2011). The data were used in a meta-analysis study (Silvain et al. BMJ 2012) and directly impacted the European and American cardiology recommendations on treatment of myocardial infarction.
  • ACCOAST, evaluating the best strategy to use prasugrel at patient admission or after coronary angiographyin acute coronary syndrome without ST segment elevation (Montalescot et al. NEJM 2013).
  • More recently ATLANTIC (Montalescot et al. NEJM 2014), the first randomized trial to evaluate the use of ticagrelor as pre-treatment of the myocardial infarction. This publication directly impacted the European and American recommendations on treatment of myocardial infarction.
  • ARCTIC (Collet et al. NEJM 2012) and ANTARCTIC (Cayla et al. Lancet 2016) have studied the individualization of antiplatelet therapy in coronary patients undergoing revascularization with percutaneous coronary stenting. These studies are to date the largest studies and best scientific evidence published in the field.

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Better apprehend the coronary disease

ACTION Group investigates the mechanism and decisive factors of coronary thrombosis. ACTION Group has in particular contributed to a better understanding of the thrombus (blood clot) constituents in the development of acute coronary syndrome with ST segment elevation (Silvain et al. JACC 2010), essential to improve the therapeutic targets.

Better understand treatment reaction

The ACTION Group is part of the research team which discovered genetic resistance to clopidogrel (Hulot et al. Blood 2006, Collet et al. Lancet 2009), a major risk factor of stent thrombosis and event recurrence. (Cayla et al. JAMA 2011), despite good compliance with the prescribed drug. This research has led to various clinical trials by Action Group testing the strategy of a tailored treatment based on the genotype of each patient or the biological response to the treatment, with the objective to improve the prognosis (Collet et al. NEJM 2012, Collet et al. ThrombHaemost. 2015).

Improve treatment of complications

Our research team also investigates new therapies to improve the treatment of complications occurring with acute coronary syndrome. Treatments, such as blood transfusion, used for many decades, are examined in terms of efficiency and safety in the specific field of coronary thrombosis in case of bleeding (Silvain et al. Eur Heart J 2010 and JACC 2014). These investigations established the basis for a designated randomized trial with the purpose of identifying useful solutions for clinical practices.

Interventional cardiology

What is interventional cardiology ?

Truly revolutionary in the field of myocardial infarct treatment, the first implant of an endocoronary stent, a medical device apposed to the coronary wall, narrowed by cholesterol deposit, celebrated it’s 40th anniversary in 2016.
Wether with endocoronary prosthesis, percutaneous valve or auricular closing device, interventional cardiology is the instrumental treatment of cardiac diseases.

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Coronary angioplasty and structural cardiology

ACTION Group studies the new generation stents, which are self-expandable and enable an improved apposition to the coronary artery wall. We also focus on the intracoronary imaging techniques to guarantee the immediate good result of the stent implant and therefore avoid complications, especially stent thrombosis due to wrong apposition.
New discipline not even 15 years old, structural cardiology consists in using percutaneous way to treat narrowed cardiac valves (aortic narrowing) or leakingvalves (mitral insufficiency) or by closing some holes (intra-atrial septal defects) which favour embolismof cardiac origin(and therefore CVA) : it is no longer necessary to anesthetize the patient and open the heart !

Better define the medical treatment associated with the use of those new technologies

ACTION Group and its network of researchers address the problem of finding the best pharmaceutical treatments once the percutaneous valves have been positioned (TAVI) or the left atrial appendages have been closed.

Heart failure

A major stake for everybody involved in public health

Heart failure is a chronic disease which represents a real stake for public health as it concerns over 1 million people in France, with a death rate up to 5% per year. 150 000 people are hospitalized every year with heart failure, which represents 1% of the public health budget, i.e. over 1 billion euro each year. This chronic disease has a functional, psychological and social impact on the patients with several periods of re-hospitalization for cardiac decompensation or associated complications.
Treatment of these patients should cover a global and multidisciplinary strategy : cardiologic follow-up, nutritional aspects consultation, improvement of the quality of life, of the autonomy and the psychological state.

Heart failure : a clinical syndrome of several possible causes

After suffering a myocardial infarction, a valvular pathology or myocarditis, chemiotherapy or a genetic disorder, the function and structure of the heart can be severely damaged. This alteration leads to the disability to secure the necessary blood flow for the functioning of the organism (4 to 5 L/min for women and 5 to 6 L/min for men). As a result patients suffer from breathlessness, leg edema and a substantial alteration of their health. ACTION Group addresses these causal diseases through its research and contributes to the prevention and improved treatments.

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Innovating therapeutic trials with state of the art tools

In 2015 ACTION Group started the therapeutic trial AGENT-HF in 5 french centers, aiming at improving the cardiac function of patients with a severe left ventricular disorder with important symptoms. This trial evaluated the promising and innovating hypothesis of the benefit of intra-coronary transfer of the SERCA2a gene to improve the systolic and diastolic function of the left ventricle.

Myocarditis

A little known pathology

Myocarditis, defined as an inflammation of the cardiac muscle, and the symptoms of which vary from simple chest pain to a state of shock, have been so long a pathology requiring a heart biopsy as a diagnosis. The advent of the MRI resulted in an easier diagnosis and as a result a better care take. Nevertheless, despite the progress made on diagnosis over the last fifteen years, myocarditis still represents the second cause of sudden death in young patients and is likely to cause 10% of dilated cardiomyopathies.
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The causes of myocarditis are diverse : mainly of infectious origin, especially viral, they can also be bacterial, fungal, toxic, allergic or associated with a system disease. If the prognosis of so called fulminant myocarditis is hindered on a short term by a risk of transplantation and death, the long term prognosis is good. The long term evolution of acute myocarditis however remains little known and varies from total recovery of the myocardial function to the evolution towards a dilated cardiomyopathy, rhythm disorder or recurrence.

A research topic to be developed

Because of its large clinical, etiological variability and its globally good prognosis, myocarditis is the poor relation of cardiovascular research compared with coronary disease, arterial hypertension and valve disease. This is reflected by the absence of a specific treatment as well as the very low level of international recommendations.
The ACTION group initiated an academic research trial, ARAMIS, financed by a national PHRC, which is evaluating a treatment by interleukin 1 in acute myocarditis.