[Limits of quantitative coronary angiography [QCA] in intermediate stenosis measuring: a correlation and concordance study with intravascular ultrasound [IVUS]]

Although coronarography is still the gold standard to evaluate coronary lesions, it remains a bidimensional representation of a tridimensional complex structure, which can represent a source of error in measurements. To perform a correlation and concordance study between quantitative coronary angiography [QCA] and intravascular ultrasound measurements for intermediate and ambiguous lesions. We analysed 40 patients' coronary arteries from March 2009 to November 2011 by both QCA and intravascular ultrasound to perform then a correlation and concordance study. The correlation study confirmed the limits of the angiogram in providing accurate measurements. The correlation coefficient was yet high in reference diameters [r=0,78, p<0,001] and minimal lumen diameters [r=0,58, p<0,001], but was middling for stenosis percentages [r=0,23, p=0,03]. This coefficient was also high for lesions lengths [r=0,51, p=0,01]. Bland and Altaman diagrams showed however wide limits of agreement, reflecting possibility of large measurements error and confirming the absence of concordance between the two techniques. Coronarography though being the most widespread mean of evaluating coronary lesions lacks to provide accurate measurements, which can influence patient's management, especially in case of intermediate lesions

[Role of intravascular ultrasound [IVUS] in determining the therapeutic strategy for the patients with intermediate coronary lesions]

Coronarography presents some limits in assessing intermediate stenosis. Intravascular ultrasound provides tridimensional measurements of the artery, with more reliable data guiding revascularization decision. To evaluate the impact of intravascular ultrasound measurements on revascularization decision of intermediate and ambiguous coronary lesions. We prospectively analysed 40 patients' coronary arteries from March 2009 to November 2011 by both quantitative coronary angiography [QCA] then intravascular ultrasound, and compared our decision before and after intravascular ultrasound. In the final revascularization decision after intravascular ultrasound, medical treatment rate raised from 22% to 25%, percutaneous coronary intervention dropped from 55% to 50%, and coronary artery bypass graft slightly raised from 23% to 25%. Therapeutic decision changed after intravascular ultrasound in 47% of patients [p=0,01], which reflects an important impact of this technique in management of intermediate coronary lesions. Intravascular ultrasound provided more accurate measurements which permitted a better detection of ischemia and influenced notably our therapeutic strategies

[ rare cause of myocardial infarction: carbon monoxide intoxication]

We describe a 34-year-old man who suffered an acute myocardial infarction after carbon monoxide domestic exposure. The coronary angiogram was normal. The necrosis is explained in part by a severe coronary spasm. The purpose of this work was to assess the pathophysiology and the treatment of this rare cause of myocardial infarction

[Congenital coronary aneurysms three case reports]

Congenital coronary aneurysms are an unusual anatomical entity. Their prognosis appears to be particularly dependent on the presence or absence of aneurysm thrombosis. We report three cases of congenital coronary aneurysms, diagnosed in one case after myocardial infarction. Two patients were treated successfully by an exclusion of the aneurysm and coronary bypass and the third patient was treated medically. The aim of this study is to discuss the clinical features, prognosis and management of this disease