[Contrast-induced nephropathy after cardiac catheterization: a prospective study of 180 patients]

Contrast-induced nephropathy [CIN] is associated with an increased cardiovascular morbi-mortality. Little is known about the incidence and risk factors of CIN after cardiac catheterization in Tunisian patients. To determine the incidence of CIN and its predictors after coronary angiography as well as its prognostic and therapeutic repercussions in a Tunisian patients' cohort. In this prospective single center study, 180 consecutive patients who underwent cardiac catheterization were enrolled; all patients were followed-up for 3 months. The incidence of CIN defined as an absolute increase in serum creatinine >/= 5 mg/l [44micromol/l] and/or a relative increase in serum creatinine >/= 25%, was 17.2%. In multivariate logistic regression, independent predictors of CIN were: diabetes mellitus [Odds Ratio [OR]=2.26 ; 95% confidence interval [95%CI]: 1.29-3.98, p=0.005], creatinine clearance < 80ml/mn [OR=2.87 ; 95%CI: 1.59-5.19, p<0.001], left ventricular ejection fraction [LVEF] < 45% [OR=2.03 ; 95%CI: 1.22-3.39, p=0.007] and use of a volume of contrast media > 90ml [1.72 ; 95%CI: 0.99-2.99, p=0.05]. Perprocedural hypotension was the strongest independent predictor of CIN in our study [OR=3.99; 95% CI: 1.65-9.66, p=0.002]. CIN was totally regressive within one month in 27 patients [86.7%] while 3 patients [10%] had a residual renal dysfunction at the end of the follow-up period [3 months]. More than one angiocoronarography on 6 resulted in CIN in our population. CIN affects cardiovascular prognosis even if renal function normalization is usually obtained within one month after the investigation. Besides identifying risk factors of CIN in order to apply preventive measures in risky patients, we stress the necessity of insuring a good hemodynamic status while achieving the procedure

[Radiofrequency ablation of accessory atrioventricular pathways. Predictive factors of acute result and outcome]

The purpose of this study was to evaluate safety and efficacy of catheter ablation of accessory pathways [APs] and to identify predictive factors of acute result and outcome. The patient population included 173 patients who had undergone ablation of an AP. The success rate was 91,6%, a major complication occurred in 4 patients [2.3%] and 8 patients [4.9%] developed a recurrence after a successful ablation procedure. Only one factor predicted success [sex], tow variables predicted development of a major complication [septal AP, age < 16 years], and three factors predicted arrhythmia recurrence [mid septal, right free wall, and multiple APs]

Conclusion: the results of this study may serve to identify subgroups of patients most likely to have a favourable result in whom it would be reasonable for clinicians to recommend catheter ablation as first-line therapy

Infarctus du myocarde sur pont myocardique [a propos d'une observation]

The authors report the case of a 44 year old patient who sustained an acute myocardial infarction. Coronary arteriography revealed no atherosclerotic lesion but a myocardial bridge over the left anterior descending artery. This report is exceptional because the myocardial bridge is rare and it's complicated of myocardial infarction in a few cases without associated coronary atherosclerosis. The incidence, predisposing factors gravity, prognosis and different therapeutic approaches of this affect are reviewed