- Email: [email protected]
Incidence of radiation-induced skin lesions after percutaneous coronary intervention
416
Abstracts / Annales de Cardiologie et d’Angéiologie 64 (2015) 414–424
contrôles coronarographiques avec test de provocation sous traitement (testing médicamenteux). Un DAI a été implanté dans un seul cas, pour test de provocation restant positif malgré un traitement antispastique maximal et l’arrêt du tabac. Avec une médiane de suivi de 21 mois (extrêmes 2 mois–8 ans), tous les patients sont vivants et asymptomatiques. Aucune récidive de trouble du rythme ventriculaire n’a été enregistrée, y compris dans la mémoire du DAI. Conclusions Notre expérience suggère que, chez les survivants d’un ACEH lié à un angor spastique avec FEVG normale, la pose de DAI ne doit pas être systématique, mais conditionnée à la persistance de la positivité du test de provocation du spasme sous traitement antispastique maximum, comprenant au moins deux inhibiteurs calciques, des dérivés nitrés et l’arrêt complet du tabac. Déclaration d’intérêts Les auteurs déclarent ne pas avoir de conflits d’intérêts en relation avec cet article. http://dx.doi.org/10.1016/j.ancard.2015.09.005 5
Reperfusion in elderly patients with acute ST-elevation myocardial infarction: Results from the RENAU-RESURCOR STEMI network Turk 1 ,
Fourny 2 ,
Debaty 3 ,
Labarere 2 ,
Rata 4 ,
Yayehd 4 ,
J. M. G. J. M. K. A. Ispas 4 , G. Deschanel 1 , M. Latappy 1 , L. Belle 4,∗ 1 Department of emergency medicine, Métropole Savoie Hospital, 73000 Chambéry, France 2 Quality of care unit, University hospital of Grenoble, 38000 Grenoble, France 3 Department of emergency medicine, University hospital of Grenoble, 38000 Grenoble, France 4 Cardiology department, Annecy Hospital, 74000 Annecy, France ∗ Corresponding author. E-mail address: [email protected] (L. Belle) Background Elderly patients with acute ST-elevation myocardial infarction (STEMI) remain undertreated. Purpose To evaluate the management of elderly STEMI patients treated in a formal regional network of care. Methods This prospective analysis, based on data from the ongoing RESURCOR coronary emergency network, involved 6169 patients presenting with an acute STEMI between 2002 and 2011 in the north French Alps. Patients were divided into age groups: < 65, 65–74, 75–84 and ≥ 85 years. Reperfusion rates, types, timing and adjunctive medications were compared. The RESURCOR network advocates primary percutaneous coronary intervention (PPCI) over fibrinolysis and bivalirudin over glycoprotein inhibitors (GPI) in the elderly. Results Lack of reperfusion therapy increased with age (Table 1). The rate of fibrinolysis was higher than that for PPCI in younger patients whereas the situation was reversed in elderly patients. In patients who had PPCI, use of bivalirudin increased and GPI decreased with age, system delays were similar. Conclusion These regional French data indicate that elderly STEMI patients receive appropriate management with timely delivered PPCI and bivalirudin; however, a substantial proportion are still undertreated. Table 1 Reperfusion rates, types, timing and adjunctive medications among the age groups.
Disclosure of interest The authors declare that they have no conflicts of interest concerning this article. http://dx.doi.org/10.1016/j.ancard.2015.09.006 6
Super-Minimalist Immediate Mechanical Intervention (Super-MIMI) study L. Belle 1,∗ , H. Madiot 1 , H. Bouvaist 1 , N. Delarche 2 , F. Bouisset 3 , P.-Y. Petiteau 4 , Z. Boueri 5 , M. Bdellaoui 6 , C. Durier 7 , O. Dubreuil 8 1 Cardiology department, CH Annecy, 74370 Pringy, France 2 Cardiology department, CH Pau, 64000 Pau, France 3 Cardiology department, CHU de Toulouse, 31400 Toulouse, France 4 Cardiology department, Clinique Saint-Vincent, 25000 Besan¸ con, France 5 Cardiology department, CH Bastia, 20600 Bastia, France 6 Cardiology department, GHM Grenoble, 38000 Grenoble, France 7 Cardiology department, CH Argenteuil, 95107 Argenteuil, France 8 Cardiology department, Clinic Saint-Joseph-Saint-Luc, 69000 Lyon, France ∗ Corresponding author. E-mail address: [email protected] (L. Belle) Purpose To evaluate the safety of extended-delay stenting (> 7 days between procedures) in the setting of percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI). Methods This ongoing prospective observational study is being conducted in STEMI patients with a high thrombus burden in the infarct-related artery (IRA). Patients are enrolled if the operator decides to try to restore the best TIMI flow with the thinnest tool (i.e. wire, aspiration, or thin balloon) and defer stent implantation for > 7 days under optimal anticoagulation to reduce thrombus burden. The primary endpoint is the composite of reocclusion of the IRA or sudden death between the two procedures, and deterioration of the flow (from the final flow achieved after the first procedure to the initial flow at the second procedure). Results Between January 2014 and January 2015, 127 patients (of 135 we will enroll) were enrolled at 14 centres: 110 were men and the mean age ± SD was 57.1 ± 13.0 years. Ninety-eight patients underwent a primary PCI as the first procedure and 29 patients underwent PCI after fibrinolysis. The final TIMI flow at the first procedure was 3 in 119 patients, 2 in 7 patients, and 1 in 1 patient. This final flow was spontaneous (same as initial flow, in the absence of intervention) in 43 patients, and after wire in 3 patients, thrombus aspiration in 60, and with a 1.5–2.5 mm diameter balloon in 21 patients. At the end of the first PCI, the residual culprit lesion was 61 ± 24%. Aspirin, P2Y12 inhibitors, and anticoagulants were used in all patients between the two procedures, and a glycoprotein IIb/IIIa inhibitor in 42 patients. The second procedure was performed between 7 and 26 days after the first. None of the patients died between the two procedures; 1 patient experienced a reocclusion of the IRA 15 min after the first procedure. In all cases, initial TIMI flow in the IRA (at the start of the second procedure) was the same as or better than the final flow after the first procedure. A stent was implanted in 80 patients, whereas no significant lesion was documented in 47 patients. Final results will be presented at the meeting. Conclusions In PCI for acute STEMI, when the thrombus burden is high, stenting delayed by 7–26 days with intensive antithrombotic cover appears safe, with only 1 of 127 patients developing an IRA reocclusion. Disclosure of interest The authors declare that they have no conflicts of interest concerning this article. http://dx.doi.org/10.1016/j.ancard.2015.09.007
Age groups
No reperfusion, n (%) Fibrinolysis, n (%) Primary PCI, n (%) Delay (first medical contact to PPCI), median (IQR), min Bivalirudina , n/N (%) GPIa , n/N (%)
< 65 years n = 3476
65–74 years n = 1238
75–84 years n = 1147
≥ 85 years n = 308
P-value
3.8 1853 (53.3) 1492 (42.9) 80 (58-123)
5.6 593 (47.9) 576 (46.5) 85 (60-125)
8.0 449 (39.2) 606 (52.8) 85 (64-130)
13.6 87 (28.3) 179 (58.1) 84 (60-124)
< 0.001 < 0.001 < 0.001 0.1
81/1197 (6.8) 1375/2695 (51.0)
30/429 (7.0) 48/373 (12.9) 28/121(23.1) 493/963 (51.2) 435/879 (49.5) 85/222 (38.3)
< 0.001 0.003
a Calculated among patients undergoing a coronarography. Bivalirudin has been used since 2008.
7
Incidence of radiation-induced skin lesions after percutaneous coronary intervention A. Paziuc 1 , L. Mangin 1 , A. Ispas 1 , M. Rat¸a˘ 1 , B. Lafitte 1 , H. Madiot 1 , S. Vanwalleghem 1 , C. Ricard 1 , J.-L. Georges 2 , L. Belle 1,∗ 1 Cardiology department, CH Annecy, 74370 Pringy, France 2 Cardiology department, CH Versailles, 78150 Le Chesnay, France ∗ Corresponding author. E-mail address: [email protected] (L. Belle)
Abstracts / Annales de Cardiologie et d’Angéiologie 64 (2015) 414–424 Background Percutaneous coronary interventions (PCIs) use significant doses of ionizing radiation, especially when treating complex lesions. Ionizing radiation may lead to adverse acute or delayed skin lesions in this setting, for which the incidence is not well known. Purpose To assess the incidence of radiation-induced skin lesions following PCI. Methods We conducted a prospective, observational, single-centre study on the incidence of radiation-induced skin lesions at 3–5 days (acute) and at 6 months (subacute) after PCI with a dose–area product (DAP) ≥ 200 Gy/cm2 , between 1 January and 31 December 2013. Patients consenting to participate were given information on potential skin lesions and were interviewed at 5–7 days and at 6 months after the PCI. Results In total, 1168 PCIs were performed; the radiation dose was available for 937 patients. Of these, 102 underwent PCI with DAP ≥ 200 Gy/cm2 . High body mass index (BMI; OR 6.2, 95% CI 2.8–13.9) and elective (vs emergency) procedures (OR 2.0, 95% CI 1.1–3.4) were independently associated with DAP ≥ 200 Gy/cm2 . Three patients (3%, 95% CI 0.6–8.4) were diagnosed with acute lesions (DAP of 485 Gy/cm2 , 205 Gy/cm2 , and 201 Gy/cm2 ), two of whom also presented with subacute lesions following PCI with DAP of 485 Gy/cm2 (Fig. 1) and 205 Gy/cm2 . One patient presented with a subacute lesion (DAP 280 Gy/cm2 ) only. Four patients presented with a skin lesion, which represents 4% (95% CI 1.1–9.7) of patients with DAP ≥ 200 Gy/cm2 and 0.4% (95% CI 0.1–1.1) of all the patients who underwent PCI, irrespective of DAP dose. Conclusions The incidence of radiation-induced acute and subacute skin lesions developing after PCI in this single-centre study was 4% in patients with DAP ≥ 200 Gy/cm2 , with a total incidence of 0.4%. These data may suggest the need for systematic assessment of skin lesions after high-dose radiation PCI.
Fig. 1
8
SCA ST+ sur embolie coronaire chez un patient en ACFA
E. Berteau ∗ , W. Menif , P. Damiano , L. Dutoit , M. Font CH Henri-Mondor, 50, avenue de la République, 15000 Aurillac, France ∗ Auteur correspondant. Adresse e-mail : [email protected] (E. Berteau) Introduction Quatre à sept pour cent des patients présentant un infarctus aigu n’ont pas de coronaropathie sous-jacente. Les causes des infarctus à coronaires normales font appel au spasme coronarien, aux états d’hypercoagulabilité, aux embolies coronaires. La coronaire gauche est l’artère la plus souvent touchée. Observation Mr L. 28 ans, tabagique à 10PA, consommation alcoolique 50 verres par semaine, hospitalisé pour SCA ST+ antéro-septo-apical sur un fond de fibrillation atriale à 135 bpm. Coronarographie Coronaires angiographiquement saines. Occlusion aiguë de l’IVA proximale d’allure embolique qui sera thrombo-aspiré. Le résultat angiocoronarographique montre un retard de flux en regard de l’IVA distale mais avec des signes cliniques et électriques de reperfusion. Échographie cardiaque VG dilaté, hypokinésie globale, FEVG 25 %, OG dilatée à 25 cm2 . Contrôle coronarographique Une semaine plus tard montrant un excellent résultat post-thrombectomie de l’IVA proximale sous traitement médical bien conduit. ETO VG sidéré sans thrombus mural, les cavités gauches ne sont pas siège d’un contraste spontané. L’auricule gauche est thrombotique sans flux circulant. Les cavités droites sont également dilatées, siège d’un contraste spontané important au niveau de l’OD, éléments thrombotiques adhérents à la paroi du VD. Biologie Pic troponine 3772, pic CPK 473, sérologies Lyme, toxoplasmose, HIV, hépatites B et C, grippe A et B, chlamydia, mycoplasme et CMV sont négatives. IRM myocardique Pas d’élément en faveur d’une myocardite, aspect de cardiopathie dilatée idiopathique avec une très large séquelle de nécrose antérosepto-apicale correspondant à l’occlusion aiguë de l’IVA. Scanner cérébral, thoraco-abdomino-pelvien injecté. Pas d’embole systémique. Discussion Une étiologie possiblement rythmique est évoquée et le contrôle fréquentiel est obtenu mais la cardioversion n’est pas réalisable étant donné l’éxistence du thrombus intra-auriculaire gauche. Concernant une éventuelle part éthylique, le patient consomme plus de 50 verres par semaine depuis plusieurs années, il s’engage à un sevrage éthylique complet et définitif. Conclusion Nous retenons l’hypothèse d’une cardiomyopathie dilatée très probablement éthylique plus ou moins rythmique compliquée d’un SCA ST+ antérieur sur embole coronaire de l’IVA proximale reperfusée après thombectomie ayant dégradé la fonction VG (Fig. 1–4).
Subacute skin lesion on the back of the chest, measuring 100 × 80 mm.
Disclosure of interest The authors declare that they have no conflicts of interest concerning this article. http://dx.doi.org/10.1016/j.ancard.2015.09.008
417
Fig. 1
Abstracts / Annales de Cardiologie et d’Angéiologie 64 (2015) 414–424
contrôles coronarographiques avec test de provocation sous traitement (testing médicamenteux). Un DAI a été implanté dans un seul cas, pour test de provocation restant positif malgré un traitement antispastique maximal et l’arrêt du tabac. Avec une médiane de suivi de 21 mois (extrêmes 2 mois–8 ans), tous les patients sont vivants et asymptomatiques. Aucune récidive de trouble du rythme ventriculaire n’a été enregistrée, y compris dans la mémoire du DAI. Conclusions Notre expérience suggère que, chez les survivants d’un ACEH lié à un angor spastique avec FEVG normale, la pose de DAI ne doit pas être systématique, mais conditionnée à la persistance de la positivité du test de provocation du spasme sous traitement antispastique maximum, comprenant au moins deux inhibiteurs calciques, des dérivés nitrés et l’arrêt complet du tabac. Déclaration d’intérêts Les auteurs déclarent ne pas avoir de conflits d’intérêts en relation avec cet article. http://dx.doi.org/10.1016/j.ancard.2015.09.005 5
Reperfusion in elderly patients with acute ST-elevation myocardial infarction: Results from the RENAU-RESURCOR STEMI network Turk 1 ,
Fourny 2 ,
Debaty 3 ,
Labarere 2 ,
Rata 4 ,
Yayehd 4 ,
J. M. G. J. M. K. A. Ispas 4 , G. Deschanel 1 , M. Latappy 1 , L. Belle 4,∗ 1 Department of emergency medicine, Métropole Savoie Hospital, 73000 Chambéry, France 2 Quality of care unit, University hospital of Grenoble, 38000 Grenoble, France 3 Department of emergency medicine, University hospital of Grenoble, 38000 Grenoble, France 4 Cardiology department, Annecy Hospital, 74000 Annecy, France ∗ Corresponding author. E-mail address: [email protected] (L. Belle) Background Elderly patients with acute ST-elevation myocardial infarction (STEMI) remain undertreated. Purpose To evaluate the management of elderly STEMI patients treated in a formal regional network of care. Methods This prospective analysis, based on data from the ongoing RESURCOR coronary emergency network, involved 6169 patients presenting with an acute STEMI between 2002 and 2011 in the north French Alps. Patients were divided into age groups: < 65, 65–74, 75–84 and ≥ 85 years. Reperfusion rates, types, timing and adjunctive medications were compared. The RESURCOR network advocates primary percutaneous coronary intervention (PPCI) over fibrinolysis and bivalirudin over glycoprotein inhibitors (GPI) in the elderly. Results Lack of reperfusion therapy increased with age (Table 1). The rate of fibrinolysis was higher than that for PPCI in younger patients whereas the situation was reversed in elderly patients. In patients who had PPCI, use of bivalirudin increased and GPI decreased with age, system delays were similar. Conclusion These regional French data indicate that elderly STEMI patients receive appropriate management with timely delivered PPCI and bivalirudin; however, a substantial proportion are still undertreated. Table 1 Reperfusion rates, types, timing and adjunctive medications among the age groups.
Disclosure of interest The authors declare that they have no conflicts of interest concerning this article. http://dx.doi.org/10.1016/j.ancard.2015.09.006 6
Super-Minimalist Immediate Mechanical Intervention (Super-MIMI) study L. Belle 1,∗ , H. Madiot 1 , H. Bouvaist 1 , N. Delarche 2 , F. Bouisset 3 , P.-Y. Petiteau 4 , Z. Boueri 5 , M. Bdellaoui 6 , C. Durier 7 , O. Dubreuil 8 1 Cardiology department, CH Annecy, 74370 Pringy, France 2 Cardiology department, CH Pau, 64000 Pau, France 3 Cardiology department, CHU de Toulouse, 31400 Toulouse, France 4 Cardiology department, Clinique Saint-Vincent, 25000 Besan¸ con, France 5 Cardiology department, CH Bastia, 20600 Bastia, France 6 Cardiology department, GHM Grenoble, 38000 Grenoble, France 7 Cardiology department, CH Argenteuil, 95107 Argenteuil, France 8 Cardiology department, Clinic Saint-Joseph-Saint-Luc, 69000 Lyon, France ∗ Corresponding author. E-mail address: [email protected] (L. Belle) Purpose To evaluate the safety of extended-delay stenting (> 7 days between procedures) in the setting of percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI). Methods This ongoing prospective observational study is being conducted in STEMI patients with a high thrombus burden in the infarct-related artery (IRA). Patients are enrolled if the operator decides to try to restore the best TIMI flow with the thinnest tool (i.e. wire, aspiration, or thin balloon) and defer stent implantation for > 7 days under optimal anticoagulation to reduce thrombus burden. The primary endpoint is the composite of reocclusion of the IRA or sudden death between the two procedures, and deterioration of the flow (from the final flow achieved after the first procedure to the initial flow at the second procedure). Results Between January 2014 and January 2015, 127 patients (of 135 we will enroll) were enrolled at 14 centres: 110 were men and the mean age ± SD was 57.1 ± 13.0 years. Ninety-eight patients underwent a primary PCI as the first procedure and 29 patients underwent PCI after fibrinolysis. The final TIMI flow at the first procedure was 3 in 119 patients, 2 in 7 patients, and 1 in 1 patient. This final flow was spontaneous (same as initial flow, in the absence of intervention) in 43 patients, and after wire in 3 patients, thrombus aspiration in 60, and with a 1.5–2.5 mm diameter balloon in 21 patients. At the end of the first PCI, the residual culprit lesion was 61 ± 24%. Aspirin, P2Y12 inhibitors, and anticoagulants were used in all patients between the two procedures, and a glycoprotein IIb/IIIa inhibitor in 42 patients. The second procedure was performed between 7 and 26 days after the first. None of the patients died between the two procedures; 1 patient experienced a reocclusion of the IRA 15 min after the first procedure. In all cases, initial TIMI flow in the IRA (at the start of the second procedure) was the same as or better than the final flow after the first procedure. A stent was implanted in 80 patients, whereas no significant lesion was documented in 47 patients. Final results will be presented at the meeting. Conclusions In PCI for acute STEMI, when the thrombus burden is high, stenting delayed by 7–26 days with intensive antithrombotic cover appears safe, with only 1 of 127 patients developing an IRA reocclusion. Disclosure of interest The authors declare that they have no conflicts of interest concerning this article. http://dx.doi.org/10.1016/j.ancard.2015.09.007
Age groups
No reperfusion, n (%) Fibrinolysis, n (%) Primary PCI, n (%) Delay (first medical contact to PPCI), median (IQR), min Bivalirudina , n/N (%) GPIa , n/N (%)
< 65 years n = 3476
65–74 years n = 1238
75–84 years n = 1147
≥ 85 years n = 308
P-value
3.8 1853 (53.3) 1492 (42.9) 80 (58-123)
5.6 593 (47.9) 576 (46.5) 85 (60-125)
8.0 449 (39.2) 606 (52.8) 85 (64-130)
13.6 87 (28.3) 179 (58.1) 84 (60-124)
< 0.001 < 0.001 < 0.001 0.1
81/1197 (6.8) 1375/2695 (51.0)
30/429 (7.0) 48/373 (12.9) 28/121(23.1) 493/963 (51.2) 435/879 (49.5) 85/222 (38.3)
< 0.001 0.003
a Calculated among patients undergoing a coronarography. Bivalirudin has been used since 2008.
7
Incidence of radiation-induced skin lesions after percutaneous coronary intervention A. Paziuc 1 , L. Mangin 1 , A. Ispas 1 , M. Rat¸a˘ 1 , B. Lafitte 1 , H. Madiot 1 , S. Vanwalleghem 1 , C. Ricard 1 , J.-L. Georges 2 , L. Belle 1,∗ 1 Cardiology department, CH Annecy, 74370 Pringy, France 2 Cardiology department, CH Versailles, 78150 Le Chesnay, France ∗ Corresponding author. E-mail address: [email protected] (L. Belle)
Abstracts / Annales de Cardiologie et d’Angéiologie 64 (2015) 414–424 Background Percutaneous coronary interventions (PCIs) use significant doses of ionizing radiation, especially when treating complex lesions. Ionizing radiation may lead to adverse acute or delayed skin lesions in this setting, for which the incidence is not well known. Purpose To assess the incidence of radiation-induced skin lesions following PCI. Methods We conducted a prospective, observational, single-centre study on the incidence of radiation-induced skin lesions at 3–5 days (acute) and at 6 months (subacute) after PCI with a dose–area product (DAP) ≥ 200 Gy/cm2 , between 1 January and 31 December 2013. Patients consenting to participate were given information on potential skin lesions and were interviewed at 5–7 days and at 6 months after the PCI. Results In total, 1168 PCIs were performed; the radiation dose was available for 937 patients. Of these, 102 underwent PCI with DAP ≥ 200 Gy/cm2 . High body mass index (BMI; OR 6.2, 95% CI 2.8–13.9) and elective (vs emergency) procedures (OR 2.0, 95% CI 1.1–3.4) were independently associated with DAP ≥ 200 Gy/cm2 . Three patients (3%, 95% CI 0.6–8.4) were diagnosed with acute lesions (DAP of 485 Gy/cm2 , 205 Gy/cm2 , and 201 Gy/cm2 ), two of whom also presented with subacute lesions following PCI with DAP of 485 Gy/cm2 (Fig. 1) and 205 Gy/cm2 . One patient presented with a subacute lesion (DAP 280 Gy/cm2 ) only. Four patients presented with a skin lesion, which represents 4% (95% CI 1.1–9.7) of patients with DAP ≥ 200 Gy/cm2 and 0.4% (95% CI 0.1–1.1) of all the patients who underwent PCI, irrespective of DAP dose. Conclusions The incidence of radiation-induced acute and subacute skin lesions developing after PCI in this single-centre study was 4% in patients with DAP ≥ 200 Gy/cm2 , with a total incidence of 0.4%. These data may suggest the need for systematic assessment of skin lesions after high-dose radiation PCI.
Fig. 1
8
SCA ST+ sur embolie coronaire chez un patient en ACFA
E. Berteau ∗ , W. Menif , P. Damiano , L. Dutoit , M. Font CH Henri-Mondor, 50, avenue de la République, 15000 Aurillac, France ∗ Auteur correspondant. Adresse e-mail : [email protected] (E. Berteau) Introduction Quatre à sept pour cent des patients présentant un infarctus aigu n’ont pas de coronaropathie sous-jacente. Les causes des infarctus à coronaires normales font appel au spasme coronarien, aux états d’hypercoagulabilité, aux embolies coronaires. La coronaire gauche est l’artère la plus souvent touchée. Observation Mr L. 28 ans, tabagique à 10PA, consommation alcoolique 50 verres par semaine, hospitalisé pour SCA ST+ antéro-septo-apical sur un fond de fibrillation atriale à 135 bpm. Coronarographie Coronaires angiographiquement saines. Occlusion aiguë de l’IVA proximale d’allure embolique qui sera thrombo-aspiré. Le résultat angiocoronarographique montre un retard de flux en regard de l’IVA distale mais avec des signes cliniques et électriques de reperfusion. Échographie cardiaque VG dilaté, hypokinésie globale, FEVG 25 %, OG dilatée à 25 cm2 . Contrôle coronarographique Une semaine plus tard montrant un excellent résultat post-thrombectomie de l’IVA proximale sous traitement médical bien conduit. ETO VG sidéré sans thrombus mural, les cavités gauches ne sont pas siège d’un contraste spontané. L’auricule gauche est thrombotique sans flux circulant. Les cavités droites sont également dilatées, siège d’un contraste spontané important au niveau de l’OD, éléments thrombotiques adhérents à la paroi du VD. Biologie Pic troponine 3772, pic CPK 473, sérologies Lyme, toxoplasmose, HIV, hépatites B et C, grippe A et B, chlamydia, mycoplasme et CMV sont négatives. IRM myocardique Pas d’élément en faveur d’une myocardite, aspect de cardiopathie dilatée idiopathique avec une très large séquelle de nécrose antérosepto-apicale correspondant à l’occlusion aiguë de l’IVA. Scanner cérébral, thoraco-abdomino-pelvien injecté. Pas d’embole systémique. Discussion Une étiologie possiblement rythmique est évoquée et le contrôle fréquentiel est obtenu mais la cardioversion n’est pas réalisable étant donné l’éxistence du thrombus intra-auriculaire gauche. Concernant une éventuelle part éthylique, le patient consomme plus de 50 verres par semaine depuis plusieurs années, il s’engage à un sevrage éthylique complet et définitif. Conclusion Nous retenons l’hypothèse d’une cardiomyopathie dilatée très probablement éthylique plus ou moins rythmique compliquée d’un SCA ST+ antérieur sur embole coronaire de l’IVA proximale reperfusée après thombectomie ayant dégradé la fonction VG (Fig. 1–4).
Subacute skin lesion on the back of the chest, measuring 100 × 80 mm.
Disclosure of interest The authors declare that they have no conflicts of interest concerning this article. http://dx.doi.org/10.1016/j.ancard.2015.09.008
417
Fig. 1