[Role of intravascular ultrasound (IVUS) in determining the therapeutic strategy for the patients with intermediate coronary lesions]. / Apport de l'échographie endocoronaire (IVUS) dans la stratégie thérapeutique des lesions coronaires intermédiaires.

BACKGROUND: Coronarography presents some limits in assessing intermediate stenosis. Intravascular ultrasound provides tridimensional measurements of the artery, with more reliable data guiding revascularization decision. AIMS: to evaluate the impact of intravascular ultrasound measurements on revascularization decision of intermediate and ambiguous coronary lesions. METHODS: 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. RESULTS: 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. CONCLUSION: Intravascular ultrasound provided more accurate measurements which permitted a better detection of ischemia and influenced notably our therapeutic strategies.

[Limits of quantitative coronary angiography (QCA) in intermediate stenosis measuring: a correlation and concordance study with intravascular ultrasound (IVUS)]. / Les limites de l'angiographie semi quantitative (QCA) dans l'évaluation des sténoses coronaires intermédiaires: étude de correlation et de concordance avec l'échographie endocoronaire (IVUS).

BACKGROUND: 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. AIMS: to perform a correlation and concordance study between quantitative coronary angiography (QCA) and intravascular ultrasound measurements for intermediate and ambiguous lesions. METHODS: 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. RESULTS: 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 &Altaman diagrams showed however wide limits of agreement, reflecting possibility of large measurements error and confirming the absence of concordance between the two techniques. CONCLUSION: 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.

[Benefits of coronary revascularization in septuagenarian patients with acute coronary syndrome]. / Bénéfice de revascularisation coronaire chez les patients septuagénaires au décours d' un syndrome coronarien aigu.

BACKGROUND: Prognosis of acute coronary syndrome (ACS) in elderly patients is bleak. Also older people tend to receive less invasive treatment than younger patients. AIM: To analyze the impact of coronary revascularization on the mid-term outcome of septuagenarian patients admitted with ACS. METHODS: We retrospectively studied 250 patients 70 years or older hospitalised for ACS between january 2006 to september 2010. RESULTS: This population was more likely to be male with mean age 74 years and 93 % of ACS were inaugural events (60% NSTEMI, 40% STEMI). Coronary angiograms showed complex coronary lesions with a high incidence of multivessel disease, bifurcation lesions, and calcified stenosis. Seventy-six patients were treated medically and 174 underwent percutaneous or surgical revascularization. At six-month clinical follow-up, major adverse cardiac events (MACE) were significantly higher in medically treated than revascularized patients (62% Vs 31.7%, P <0.001). Patients with invasive strategy have significantly higher event free survival rate comparing to those assigned to medical management (64% Vs 49.7%, p: 0.01). CONCLUSION: Our study confirmed the superiority of invasive strategy compared to medical treatment in septuagenarian patients with acute coronary syndromes. Advanced age should not exclude patients from invasive strategy with complete revascularization.

[Coronary angiographic characteristics in septuagenarian patients with acute coronary syndrome]. / Caractéristiques angiographiques des septuagénaires hospitalisés pour syndromes coronariens aigus.

BACKGROUND: Although the prognosis of acute coronary syndrome (ACS) in elderly patients is bleak , elderly population is less well treated both in medical and interventional terms. aims: to analyse angiographic findings in septuagenarian patients admitted with ACS and its impact on the therapeutic strategy. METHODS: We retrospectively analysed 250 patients 70 years or older hospitalised for ACS who underwent a coronary angiography between january 2006 to September 2010. RESULTS: This population was more likely to be male with mean age 74 years and 93 % of ACS were inaugural events (60% N STEM, 40% STEMI).Coronary angiograms showed complex, diffuse coronary lesions with a high incidence of multivessel coronary artery disease , bifurcation lesions , and calcified stenosis. CONCLUSION: Angiographic findings after ACS in elderly were characterised by multivessel disease and complex lesions .Surgical or percutaneous coronary revascularizaion was possible in the majority of these patients.

[Atrial fibrillation following coronary artery bypass grafting: predictors and mid- term outcome]. / La fibrillation atriale aprés chirurgie de pontage aortocoronaire: facteurs prédictifs et pronostic àà moyen terme.

BACKGROUND: Atrial fibrillation (AF) is a frequent complication after coronary artery bypass grafting (CABG) which increase morbidity and hospitalization length. AIM: To identify the predictors of atrial fibrillation and its repercussion on hospital and mid-term outcomes in patients undergoing (CABG). METHODS: We undertook a retrospective review of the data of 224 patients undergoing CABG. The mean age of the patients was 60.8 years. Atrial fibrillation was diagnosed from serial postoperative electrocardiogram. RESULTS: Twenty two patients developed postoperative atrial fibrillation. Multivariate analysis showed that only: age, left circumflex stenosis, sternal wound infection and low cardiac output were predictors of AF following CABG. Hospital mortality was similar in the two groups (5% Vs 9.6 % P=0.7). CONCLUSION: In our study, the incidence of post-CABG atrial fibrillation was 9.8%. Multivariate predictors were age, left circumflex lesion, sternal wound infection and low cardiac output. Hospital mortality and mid-term outcome were similar in the two groups.

[Coronary artery bypass grafting in diabetic patients: early and mid-term outcomes]. / La chirurgie du pontage aorto coronaire chez les diabétiques : Résultats immédiats et à moyen terme.

BACKGROUND: The outcome of coronary artery bypass grafting (CABG) in diabetic patients has traditionally been worse than in nondiabetic patients. Recent studies have suggested an improvement in outcome in diabetic patients undergoing CABG. However, the direct impact of diabetes on mortality and morbidities following CABG remains unclear. AIM: To evaluate the early and mid term outcomes of diabetic patients compared to non-diabetics following CABG. METHODS: We retrospectively analyzed the data of 228 CABG patients from January 2005 to December 2010: one hundred and twenty-six diabetics and 102 non-diabetic.Diabetic patients were more likely to be female(27% Vs 12.7% P=0.009) were less smoker (55.6% Vs 80.4% P<0.0001) with higher rate of three vessel disease(67.5% Vs 42.2% P=0.005) compared to non-diabetics. RESULTS: Hospital mortality was significantly higher among diabetic patients (16% Vs 4.1% P=0.005).Length of care unit stay was more important (2.3 days Vs 2.1 days P=0.048) , but with a similar rate of sternal wound infection even after bilateral internal thoracic artery grafting. After 28 months mean follow- up, mid-term survival of diabetics was significantly decreased compared to no-diabetics (91% Vs 99% p<0.001) .However, Event-free survival was similar in the two groups (76% Vs 80% p=0.82). CONCLUSION: These results suggest that diabetes is associated with poorer early and mid-term outcomes following (CABG).