[Long-term outcome of acute myocardial infarction treated with primary angioplasty. Experience of a public center in Alsatia-France]. / Devenir à long terme de patients traités par angioplastie primaire à la phase aiguë d'un infarctus du myocarde. Experience d'un centre hospitalier général alsacien.

OBJECTIVES: Estimation of long-term outcome for patients suffering from acute myocardial infarction treated with primary angioplasty in an alsatian public center. PATIENTS AND METHODS: Two-hundred and ninety-eight patients who underwent an urgent coronarography in a non-university center, with a view to immediate angioplasty, between January 1999 and December 2001. RESULTS: Two-hundred and sixty-four patients (88.6%) were actually treated with urgent angioplasty, which has been successful in 87.1% of cases. Hospital mortality was of 7.7%. The population was composed of 16.4% patients older than 75 and of 11.7% patients with Killip 3 or 4 at admission. Mean follow-up was 34 months, lost to follow-up rate was of 4.7%. The global survival rate was of 78.9% and event-less survival rate of 41.9%. CONCLUSION: Our results confirm the efficiency of angioplasty in real-life conditions as well at short-term as at long-term.

[Primary angioplasty in acute coronary syndromes with ST-segment elevation: experience of three Alsacian centers]. / Angioplastie primaire dans les syndromes coronaires aigus avec sus-decalage du segment ST: experience de 3 centres alsaciens.

The guidelines of the European Society of Cardiology, published in 2003, consider primary angioplasty as the preferred treatment strategy in acute coronary syndromes with ST-segment elevation, if the procedure can be performed within 90 min after first medical contact. We report the experience of three Alsacian centers running a common prospective registry with 2504 consecutive patients enroled between January 1999 and December 2004. The average age of the patients was 62 years with a proportion of 24% women. The time delay "pain to admission" was > or =3 hours in 55.9% of the cases. The treatment delay "door to catheterisation needle" was 59 min and the mean delay "door-to-reperfusion" was 79 min. The study population was representative of the real world including subsets of patients with a particulary high risk profile: age > or =70 years in 33%, a Killip grade > or =3 in 11.5%, rescucitated sudden death in 6.6% and cardiogenic shock in 10.9% of the patients respectively. The immediate procedural success rate (Timi 3 flow) in the treated coronary artery was 96.5%. The overall inhospital mortality-rate was 9.3%. The combinations of rescucitated sudden death--cardiogenic shock or age > or =75 years--cardiogenic shock were associated with a poor clinical outcome and mortality rates of 69% and 72.6% respectively, where as in the absence of abovementioned clinical high risk settings, the mortality rate was as low as 1.4%. The overall bleeding complication rate was 1.4%. The policy of systematic primary angioplasty in acute coronary syndromes with ST-Segment elevation appears to be coherent. The procedural complications and the in-hospital mortality rates were low, except in the presence of above mentioned clinical high risk settings.

[Acute ST-elevation myocardial infarction in the elderly (>75 years). Results from a regional multicenter study]. / Infarctus du myocarde du sujet de plus de 75 ans. Données d'un registre multicentrique régional.

OBJECTIVES: This prospective multicenter study assessed the prevalence and feasibility of percutaneous coronary angioplasty (PTCA) in the acute phase of ST-elevation myocardial infarction (STEMI) in 3 nonacademic interventional cardiology centers (Alsace, France). METHODS: We studied the clinical characteristics, angiographic data, and PCTA results of all STEMI patients and analyzed the revascularization rates and adverse events during hospitalization. We compared patients at least 75 years of age and younger patients for these data and with the literature. RESULTS: Of the 1672 patients admitted for STEMI, 342 (20.45%) were at least 75 years of age. Half the patients in this high-risk subgroup were women. These patients had more co-morbidities (e.g., hypertension and diabetes mellitus) than younger patients, and more of them had three-vessel disease. Mortality rate was high in this subgroup and always higher than for comparable younger subjects, but it varied according to the initial clinical profile. Their global mortality rate was 20.47%, but it fell to 5.41% when we excluded patients with cardiogenic shock or in Killip stage ill, and those who were resuscitated. PTCA is a coronary reperfusion technique especially indicated for elderly patients with STEMI. It is an effective revascularization technique, with a reperfusion rate (exclusively TIMI III flow) reaching 93.88% in the elderly group, only slightly lower than among younger patients (97.18%). CONCLUSION: PTCA is a technique particularly indicated in the elderly in Alsace because of regional geographic and medical specificities: nearby emergency services are available to virtually the entire population of Alsace, and most interventional cardiology teams apply a strategy of exclusive primary PTCA.

[Acute STEMI in old and very old patients. The real life]. / Infarctus du myocarde du 3e et 4e âge. Une expérience de terrain.

OBJECTIVES: From a prospective multicenter registry, we evaluated in three non-academic interventional cardiologic centers (Alsace/France), the coverage and the feasibility of the percutaneous coronary angioplasty (PTCA) in the acute phase of STEMI in the elderly (patients 75-years old and more). METHODS: We studied clinical characteristics and angiographic data of patients older than 75 years, and the PTCA results: the revascularisation rates and the intrahospital events were analysed. These data were compared with those of the younger patients and confronted with the literature data. RESULTS: Of a total of 1672 patients admitted for a STEMI, 342 (20.45%) were older than 75 years. These patients represented a high-risk group with a high proportion of women (50%), and many co-morbidities (e.g.: hypertension and diabetes mellitus), and three-vessel disease was found more often than in younger patients. Mortality rate was high in this subgroup and always more severe as compared to younger subjects, but remains variable according to the initial clinical profile. The global mortality was 20.47% but fell to 5.41% if we excluded the patients with cardiogenic shock, in Killip III and after resuscitation. PTCA is a coronary reperfusion technique particularly indicated in the management of the elderly presenting a STEMI. It is an effective technique in term of revascularisation, the reperfusion success (exclusively TIMI III flow) was indeed raised in the elderly even though it is lower than in younger patients (93.88 vs 97.18%). It is a quickly accessible technique, cath-lab accessibility provided, allowing a fast reperfusion and reducing hospitalization to a minimum. The management of the elderly presenting a STEMI has to focus on reducing the preadmission delay since this subgroup of patients hesitates to call the emergency (SMUR) when presenting an acute coronary symptomatology. The shorter the delay till admittance, the better the outcome. CONCLUSION: PTCA is a technique particularly indicated in the elderly in Alsace because of regional specificities: first of all geographic (proximity of the SMUR for virtually all the population of Alsace), and secondly the medical infrastructure since the strategy of exclusive primary PTCA is granted by numerous interventional cardiologic teams. In Alsace, the proportion of elderly patients (> or = 75 years) is going to increase significantly with a parallel rise of STEMI--"a frightening perspective". We have to take into account this evolution, this reperfusion technique presenting numerous advantages and very few complications.

[Primary cardiogenic shock in the acute phase of myocardial infarction treated by angioplasty: experience of three non-university public centers in Alsace]. / Choc cardiogénique primaire à la phase aiguë de l'infarctus traité par angioplastie: expérience de trois centres alsaciens publics non universitaires.

OBJECTIVE AND METHOD: Evaluation of angioplasty for primary cardiogenic shock in acute myocardial infarction in three non-universitary alsacians centres between 1999 and 2002. RESULTS: One hundred and eighty-two patients were included. Hospitalisation survival rate is 43.96% after hospital discharge. One hundred and forty-nine patients were treated by primary angioplasty. Angioplasty is successful in 79.12%. The predictives factors of death are: age > 75, TIMI = 0 at the admission, three vessels disease. Twenty-four months survival is 91% (follow-up data available on 28.75% of the patients alive at hospital discharge). CONCLUSION: Angioplasty seems to be the right choice in case of acute myocardial infarction complicated by cardiogenic shock, the results are better than medical treatment at short- and mid-term.

Coil embolization treatment in pulmonary artery branch rupture during Swan-Ganz catheterization.

Rupture of the pulmonary artery or one of its branches during Swan-Ganz catheterization is a complication that is rare but remains fatal in almost 50% of cases. The risk factors and mechanisms involved in the pathogenesis of this accident have been widely reported. Management is twofold: resuscitation procedures and specific medical or even surgical treatment. We report a case of pulmonary artery rupture occurring during Swan-Ganz catheterization that was treated by coil embolization. This technique, which is quick and simple to use, would appear to be very promising. This is the first case of successful emergency treatment of pulmonary artery rupture using an endovascular technique.

[Rupture of a branch of the pulmonary artery during Swan-Ganz catheterization. Treatment by coil embolization]. / Rupture d'une branche de l'artère pulmonaire au cours d'un cathétérisme de Swan-Ganz. Traitement par embolisation de coils.

Rupture of the pulmonary artery or of one of its branches during a Swan-Ganz catheterisation is a rare complication which remains lethal in about 50% of cases. The risk factors and mechanisms of this complication have been previously described. There are two means of treatment: intensive care and specific medical or surgical treatment. In this case, the rupture of the pulmonary artery occurred during Swan-Ganz catheterisation and was treated by coil embolisation. This simple and rapid technique seems to be very promising.

[Fetal supraventricular tachycardia associated with anasarca: poor prognosis despite treatment. Apropos of two cases]. / Tachycardies supraventriculaires foetales avec anasarque: mauvais pronostic malgré le traitement. A propos de deux cas.

Two cases of foetal supraventricular tachycardia with hydrops with fatal outcomes illustrate the poor general prognosis of this condition. The absence of therapeutic consensus, of large series in the existing literature, does not prevent logical and reasonable management based on rhythmological, pharmacological and prognostic criteria. A combined approach associating antiarrhythmic therapy by the transplacental and intrafunicular approaches seems acceptable now that funicular puncture can be undertaken easily, and certain antiarrhythmic molecules suggest encouraging results. It is important to try to assess the haemodynamic tolerance by foetal Doppler echocardiography because the foetal prognosis depends on ischaemic cerebral lesions induced by anoxia, difficult to diagnose in utero: when observed, aggressive and occasionally dangerous therapies to foetus and mother may be justified in these extreme situations of foetoplacental hydrops.