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Predictive factors of in-stent restenosis after percutaneous coronary intervention for ostial right coronary artery lesions
Coronary heart disease
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Methods From 2010 to 2019, we analyzed the characteristics, and management of 70 consecutive patients admitted for an AMI with CAE at coronary angiography. Patients with ectatic infarctedrelated artery (ERIA) were compared with patients without ectasia on infarcted-related (No ERIA). Results Most (67%) had ERIA. ERIA patients had more frequently diabetes (32 vs. 4%, P = 0.01). The rate of other CV risk factors, and chronic medications, including antiplatelet agents and anticoagulants were similar for the 2 groups. Moreover, no difference was observed between the 2 groups for clinical parameters and biological data. Whatever the group, the ectatic artery is mainly located on the right coronary artery (RCA) (73%), of which most were ERIA (77%). ERIA group had less frequently anterior wall location STEMI (18 vs. 65%, P < 0.001). The rate of diffuse coronary artery disease (91 vs. 92%) and maximum CAE diameter (6.36 (6.00—7.00) mm vs. 6.14 (5.53—7.64) mm, P = 0.571) were similar for the 2 groups. SYNTAX was lower in ERIA patients (9.5 (2.0—18.0) vs. 13.5 (7.0—23.0), P = 0.031). A complete reperfusion was more frequently achieved in no ERIA group (70vs47%, P = 0.073) (Table 1). Conclusion CAE management is strongly dependent on the presence of CAE on IRA. Although rare, the optimal treatment strategy of patients with AMI and CAE remains to be elucidated. The place of intravascular ultrasound imaging needs to be investigated. Table 1 Treatment of culprit lesion
Non ERIA group N = 23
ERIA group N = 47
P-Value
PCI without stent PCI with stent Medication alone CABG Complete reperfusion Death in-hospital
0 (0%) 15(65%) 3 (13%) 5 (22%) 16 (70%) 1 (4.3%)
11(23%) 15(32%) 14 (30%) 4 (9%) 22 (47%) 0 (0%)
0.012 0.011 0.150 0.143 0.073 0.329
Disclosure of interest peting interest.
The authors declare that they have no com-
https://doi.org/10.1016/j.acvdsp.2019.09.035 560
Prevalence of chronic obstructive pulmonary disease among smokers with stable coronary artery disease S. Antit 1,∗ , F. Yangui 2 , A. Touil 2 , I. Boussabeh 1 , L. Zakhama 1 , M.R. Charfi 2 , S. Benyoussef 1 1 Department of Cardiology, Interior Security Forces Hospital, La Marsa, Tunisia, Interior Security Forces Hospital, La Marsa, Tunisia, La Marsa 2 Department of Pneumology, Interior Security Forces Hospital, La Marsa, Tunisie ∗ Corresponding author. Adresse e-mail : [email protected] (S. Antit) Introduction Chronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD) are common chronic diseases with shared risk factors. COPD continues to be largely under diagnosed and undertreated especially in patient with CAD. We aimed to describe the prevalence of COPD in Tunisian smokers with CAD. Methods In a cross-sectional study conducted in FSI hospital in Tunisia, smoking patients (≥ 10 pack-year) with confirmed CAD were recruited. Pre and post-bronchodilator spirometry was undertaken for all participants. COPD was defined according to GOLD criteria, as post-bronchodilator forced expiratory volume in 1 sec/forced vital capacity (FEV1 /FVC) of < 70%.
Results Spirometry was undertaken for 122 men with mean age of 59.3 ± 9.5 years and mean pack-year of 52.3 ± 28.3. Mean CAD follow-up duration was 3.9 ± 4.5 years. The prevalence of COPD was 19.7%. Of the 24 patients with COPD, 17 patients were newly diagnosed. Of these patients, six had mild COPD, 15 had moderate COPD, two had severe COPD and one had very severe COPD. The average FEV1 in COPD patients was 68.7%. COPD-related symptoms were: chronic cough (56%), dyspnea (76%), and wheezes (28%). Pulmonary arterial hypertension was observed in 36% of COPD patients. The comparison of patients with COPD with those without COPD showed that respiratory symptoms, chest-X-ray abnormality and pulmonary arterial hypertension were significantly more frequent in COPD patients. Conclusions There was a high prevalence of COPD among patients with CAD and most were under diagnosed despite having respiratory symptoms. Smokers with CAD and respiratory symptoms should be evaluated for airflow limitation and the presence of COPD. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2019.09.036 182
Predictive factors of in-stent restenosis after percutaneous coronary intervention for ostial right coronary artery lesions M. Calcaianu ∗ , S. Schiau , D. Bresson , T. El Nazer , J.Y. Wiedemann , O. Roth , L. Jacquemin Cardiologie, CH Mulhouse, GHRMSA, Mulhouse, France ∗ Corresponding author. Adresse e-mail : [email protected] (M. Calcaianu) Objectives We evaluated the predictors of in-stent restenosis (ISR) and the angiographic patterns for ostial lesions of the right coronary artery (RCA) to better identify this population at risk. Background Although the prevalence of ISR of the RCA is diminishing, the mechanisms of restenosis are still unknown. Methods Between January 2003 and December 2017, we recruited 550 consecutives patients undergoing a coronarography for ostial lesion of RCA. 149 angioplasties are realized for acute coronary syndrome (ACS) or stable angina. Restenosis, defined as a stenosis within 5 mm distance, proximal or distal to the previously placed stent, with ≥ 50% diameter stenosis, appeared for 46 patients. These patients were included in the IRS+ group. We defined also an IRS- group composed by 44 patients without restenosis in the initial population. We used Chi square test and Mann Whitney test for univariable analysis of ISR predictors. Multiple logistic regression analysis was used to determine the independent factors of ISR, and the adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) were calculated. Results We diagnosed 46 of 149 patients with RCA-ISR, which were classifiable between 19,8% of restenosis in case of implantation of a drug-eluting stent (DES) and 53,6% of restenosis in case of bare metallic stent (BMS). By univariable analysis we found 7 statistically significant predictors of ISR in our population: mono-troncular lesions, ad-hoc angioplasty, BMS stenting, guiding-catheter diameter, early generation DES, post-dilatation, anti-platelet drugs. After multivariable analysis, ad-hoc angioplasty and the BMS stenting were the only independent predictors of ISR (aOR, 0.23; 95% CI, 0.39—0.58; P = 0.009 and respectively aOR, 0.21; 95% CI, 0.39—0.55; P = 0.002) (Fig. 1). Conclusion We found a high prevalence of RCA-ISR in our study population. The risk of ISR is higher in patients with ad-hoc angioplasty or in case of BMS implantation. Disclosure of interest The authors declare that they have no competing interest.
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Coronary heart disease 413
The predictive value of arterial stiffness for multivessel disease after acute coronary syndrome A. Chetoui ∗ , H. Benahmed , E. Allouche , L. Bezdah Cardiologie, Hôpital Charles-Nicolle Tunis, Tunis, Tunisie ∗ Corresponding author. Adresse e-mail : [email protected] (A. Chetoui)
Fig. 1 BMS: bare metal stent; DES: drug eluting stent; ISR: in-stent restenosis. https://doi.org/10.1016/j.acvdsp.2019.09.037 241
Oxidative stress and left ventricular dysfunction following acute coronary syndrome S. Charfeddine 1,∗ , Leila Abid 1 , Z. Ben Ali 1 , C. Yousfi 1 , I. Gtif 2 , R. Hammami 1 , S. Kammoun 1 1 Cardiology, Hedi Chaker University Hospital 2 Biotechnology center, Sfax, Tunisie ∗ Corresponding author. Adresse e-mail : selma [email protected] (S. Charfeddine) Introduction Cardiovascular diseases, acute coronary syndromes and heart failure account for the highest mortality rate worldwide. The major underlying mechanism driving the onset and maintenance of cardiovascular diseases is atherosclerosis. Atherosclerosis is a consequence of Oxidative stress. Purpose We aimed to analyze the influence of superoxide dismutase (SOD) and glutathion peroxidase (GPX) activities on angiographic severity and left ventricular dysfunction in the Acute Coronary Syndrome. Methods SOD and GPX activity levels were evaluated in 117 patients admitted for either ST segment elevated myocardial infarction (STEMI) or non-ST segment elevated myocardial infarction (NSTEMI). Results Lower SOD and GPX activity levels were seen in elderly and patients who presented with STEMI and high risk NSTEMI. There was no significant relation between antioxidant activity, angiographic coronary artery severity and the left ventricular systolic function at admission (SOD: 6.1 vs. 7.5 U/mg, P = 0.17; GPX: 1.27 vs. 1.31 mol/mn/mg, P = 0.79). SOD and GPX activities levels were neither significant in relation to mortality nor to survival rates up to twelve months. Conclusion We found no relationship between reduced levels of SOD and GPX activity post-acute coronary syndrome, left ventricular dysfunction and mortality up to 12-months of follow-up in this study. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2019.09.038
Introduction Acute coronary syndrome (ACS) is a primary cause of morbidity and mortality in the world. Arterial stiffness has been shown to be a predictor of cardiovascular events and mortality. Purpose To assess the association between markers of arterial stiffness and multivessel disease after ACS. Methods This prospective study was conducted from April 2017 to March 2018 in a single cardiac center. A total of 275 patients who were referred for first ACS were enrolled. Arterial stiffness was assessed by carotid to femoral pulse wave velocity (cfPWV), central pulse pressure (cPP) and augmentation index using SphygmoCor® XCEL. Results The mean age was 56.4 ± 10.6 years. Tobacco smoking and diabetes were present in 56.4% and 41.8% of patients, respectively. ST segment elevation myocardial infarction was predominant (54.5%) and 47.6% of patients had multivessel disease. This study showed that cfPWV (OR = 1.272; 95%IC [1.090;1.483]; P = 0.002) and cPP (OR = 1.071; 95%IC [1.024;1.121]; P = 0.003) were the two independent predictors of multivessel disease. The cfVOP threshold for predicting multivessel disease was 12.65 m/s (sensitivity of 48.1% and specificity of 76.4%). Conclusion Arterial stiffness measured by cfPWV and cPP may reflect the extent of coronary artery disease after ACS. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2019.09.039 632
Predicting mortality factors after a myocardial infarction R. Khalifa ∗ , I. Chamtouri , W. Jomaa , K. Ben Hamda , F. Maatouk Cardiologie, service cardiologie Monestir tunisie, Kalaa Kebira, Tunisie ∗ Corresponding author. Adresse e-mail : [email protected] (R. Khalifa) Introduction Myocardial infarction (MI) is the leading cause of death in Tunisia. Purpose We wanted to determine the predictors of mortality in the wake of an IDM to ensure better care. Methods This is a study that included 1562 patients (1221 men and 341 women) hospitalized for Acute Coronary Syndrome with ST segment elevation in the Fattouma Bourguiba Monastir Heart Hospital B ward from January 1998 to September 2015. The predictive factors for 1-month mortality of MI were studied. Results The mortality rate was estimated at 8.3%. Sex was not a predictor of mortality (7.3% vs. 12%, P = 0.055). The history of coronary artery disease or heart failure was not a predictor of death with p equal to 0.553 and 0.575, respectively. Age over 75, diabetes, hypertension, use of an inotropic agent at admission, the occurrence of a complete atrioventricular block, complicated MI of a severe rhythm disorder (ventricular tachycardia or ventricular fibrillation) and the occurrence of severe acute mitral insufficiency would be predictive of mortality with p respectively equal to 0.03; < 0.001; 0.002; < 0.001; < 0, 001; < 0.001; 0.001. The infarct territory was also a predictor of mortality: the death rate was 10.6% in the anterior MIs, 7.6% in the inferior MIs and 2.5% in the lateral MIs (P < 0.001). Conclusion The advanced age, the diabetes, the HTA, the use of an inotropic agent at the admission, the occurrence of a serious
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Methods From 2010 to 2019, we analyzed the characteristics, and management of 70 consecutive patients admitted for an AMI with CAE at coronary angiography. Patients with ectatic infarctedrelated artery (ERIA) were compared with patients without ectasia on infarcted-related (No ERIA). Results Most (67%) had ERIA. ERIA patients had more frequently diabetes (32 vs. 4%, P = 0.01). The rate of other CV risk factors, and chronic medications, including antiplatelet agents and anticoagulants were similar for the 2 groups. Moreover, no difference was observed between the 2 groups for clinical parameters and biological data. Whatever the group, the ectatic artery is mainly located on the right coronary artery (RCA) (73%), of which most were ERIA (77%). ERIA group had less frequently anterior wall location STEMI (18 vs. 65%, P < 0.001). The rate of diffuse coronary artery disease (91 vs. 92%) and maximum CAE diameter (6.36 (6.00—7.00) mm vs. 6.14 (5.53—7.64) mm, P = 0.571) were similar for the 2 groups. SYNTAX was lower in ERIA patients (9.5 (2.0—18.0) vs. 13.5 (7.0—23.0), P = 0.031). A complete reperfusion was more frequently achieved in no ERIA group (70vs47%, P = 0.073) (Table 1). Conclusion CAE management is strongly dependent on the presence of CAE on IRA. Although rare, the optimal treatment strategy of patients with AMI and CAE remains to be elucidated. The place of intravascular ultrasound imaging needs to be investigated. Table 1 Treatment of culprit lesion
Non ERIA group N = 23
ERIA group N = 47
P-Value
PCI without stent PCI with stent Medication alone CABG Complete reperfusion Death in-hospital
0 (0%) 15(65%) 3 (13%) 5 (22%) 16 (70%) 1 (4.3%)
11(23%) 15(32%) 14 (30%) 4 (9%) 22 (47%) 0 (0%)
0.012 0.011 0.150 0.143 0.073 0.329
Disclosure of interest peting interest.
The authors declare that they have no com-
https://doi.org/10.1016/j.acvdsp.2019.09.035 560
Prevalence of chronic obstructive pulmonary disease among smokers with stable coronary artery disease S. Antit 1,∗ , F. Yangui 2 , A. Touil 2 , I. Boussabeh 1 , L. Zakhama 1 , M.R. Charfi 2 , S. Benyoussef 1 1 Department of Cardiology, Interior Security Forces Hospital, La Marsa, Tunisia, Interior Security Forces Hospital, La Marsa, Tunisia, La Marsa 2 Department of Pneumology, Interior Security Forces Hospital, La Marsa, Tunisie ∗ Corresponding author. Adresse e-mail : [email protected] (S. Antit) Introduction Chronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD) are common chronic diseases with shared risk factors. COPD continues to be largely under diagnosed and undertreated especially in patient with CAD. We aimed to describe the prevalence of COPD in Tunisian smokers with CAD. Methods In a cross-sectional study conducted in FSI hospital in Tunisia, smoking patients (≥ 10 pack-year) with confirmed CAD were recruited. Pre and post-bronchodilator spirometry was undertaken for all participants. COPD was defined according to GOLD criteria, as post-bronchodilator forced expiratory volume in 1 sec/forced vital capacity (FEV1 /FVC) of < 70%.
Results Spirometry was undertaken for 122 men with mean age of 59.3 ± 9.5 years and mean pack-year of 52.3 ± 28.3. Mean CAD follow-up duration was 3.9 ± 4.5 years. The prevalence of COPD was 19.7%. Of the 24 patients with COPD, 17 patients were newly diagnosed. Of these patients, six had mild COPD, 15 had moderate COPD, two had severe COPD and one had very severe COPD. The average FEV1 in COPD patients was 68.7%. COPD-related symptoms were: chronic cough (56%), dyspnea (76%), and wheezes (28%). Pulmonary arterial hypertension was observed in 36% of COPD patients. The comparison of patients with COPD with those without COPD showed that respiratory symptoms, chest-X-ray abnormality and pulmonary arterial hypertension were significantly more frequent in COPD patients. Conclusions There was a high prevalence of COPD among patients with CAD and most were under diagnosed despite having respiratory symptoms. Smokers with CAD and respiratory symptoms should be evaluated for airflow limitation and the presence of COPD. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2019.09.036 182
Predictive factors of in-stent restenosis after percutaneous coronary intervention for ostial right coronary artery lesions M. Calcaianu ∗ , S. Schiau , D. Bresson , T. El Nazer , J.Y. Wiedemann , O. Roth , L. Jacquemin Cardiologie, CH Mulhouse, GHRMSA, Mulhouse, France ∗ Corresponding author. Adresse e-mail : [email protected] (M. Calcaianu) Objectives We evaluated the predictors of in-stent restenosis (ISR) and the angiographic patterns for ostial lesions of the right coronary artery (RCA) to better identify this population at risk. Background Although the prevalence of ISR of the RCA is diminishing, the mechanisms of restenosis are still unknown. Methods Between January 2003 and December 2017, we recruited 550 consecutives patients undergoing a coronarography for ostial lesion of RCA. 149 angioplasties are realized for acute coronary syndrome (ACS) or stable angina. Restenosis, defined as a stenosis within 5 mm distance, proximal or distal to the previously placed stent, with ≥ 50% diameter stenosis, appeared for 46 patients. These patients were included in the IRS+ group. We defined also an IRS- group composed by 44 patients without restenosis in the initial population. We used Chi square test and Mann Whitney test for univariable analysis of ISR predictors. Multiple logistic regression analysis was used to determine the independent factors of ISR, and the adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) were calculated. Results We diagnosed 46 of 149 patients with RCA-ISR, which were classifiable between 19,8% of restenosis in case of implantation of a drug-eluting stent (DES) and 53,6% of restenosis in case of bare metallic stent (BMS). By univariable analysis we found 7 statistically significant predictors of ISR in our population: mono-troncular lesions, ad-hoc angioplasty, BMS stenting, guiding-catheter diameter, early generation DES, post-dilatation, anti-platelet drugs. After multivariable analysis, ad-hoc angioplasty and the BMS stenting were the only independent predictors of ISR (aOR, 0.23; 95% CI, 0.39—0.58; P = 0.009 and respectively aOR, 0.21; 95% CI, 0.39—0.55; P = 0.002) (Fig. 1). Conclusion We found a high prevalence of RCA-ISR in our study population. The risk of ISR is higher in patients with ad-hoc angioplasty or in case of BMS implantation. Disclosure of interest The authors declare that they have no competing interest.
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Coronary heart disease 413
The predictive value of arterial stiffness for multivessel disease after acute coronary syndrome A. Chetoui ∗ , H. Benahmed , E. Allouche , L. Bezdah Cardiologie, Hôpital Charles-Nicolle Tunis, Tunis, Tunisie ∗ Corresponding author. Adresse e-mail : [email protected] (A. Chetoui)
Fig. 1 BMS: bare metal stent; DES: drug eluting stent; ISR: in-stent restenosis. https://doi.org/10.1016/j.acvdsp.2019.09.037 241
Oxidative stress and left ventricular dysfunction following acute coronary syndrome S. Charfeddine 1,∗ , Leila Abid 1 , Z. Ben Ali 1 , C. Yousfi 1 , I. Gtif 2 , R. Hammami 1 , S. Kammoun 1 1 Cardiology, Hedi Chaker University Hospital 2 Biotechnology center, Sfax, Tunisie ∗ Corresponding author. Adresse e-mail : selma [email protected] (S. Charfeddine) Introduction Cardiovascular diseases, acute coronary syndromes and heart failure account for the highest mortality rate worldwide. The major underlying mechanism driving the onset and maintenance of cardiovascular diseases is atherosclerosis. Atherosclerosis is a consequence of Oxidative stress. Purpose We aimed to analyze the influence of superoxide dismutase (SOD) and glutathion peroxidase (GPX) activities on angiographic severity and left ventricular dysfunction in the Acute Coronary Syndrome. Methods SOD and GPX activity levels were evaluated in 117 patients admitted for either ST segment elevated myocardial infarction (STEMI) or non-ST segment elevated myocardial infarction (NSTEMI). Results Lower SOD and GPX activity levels were seen in elderly and patients who presented with STEMI and high risk NSTEMI. There was no significant relation between antioxidant activity, angiographic coronary artery severity and the left ventricular systolic function at admission (SOD: 6.1 vs. 7.5 U/mg, P = 0.17; GPX: 1.27 vs. 1.31 mol/mn/mg, P = 0.79). SOD and GPX activities levels were neither significant in relation to mortality nor to survival rates up to twelve months. Conclusion We found no relationship between reduced levels of SOD and GPX activity post-acute coronary syndrome, left ventricular dysfunction and mortality up to 12-months of follow-up in this study. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2019.09.038
Introduction Acute coronary syndrome (ACS) is a primary cause of morbidity and mortality in the world. Arterial stiffness has been shown to be a predictor of cardiovascular events and mortality. Purpose To assess the association between markers of arterial stiffness and multivessel disease after ACS. Methods This prospective study was conducted from April 2017 to March 2018 in a single cardiac center. A total of 275 patients who were referred for first ACS were enrolled. Arterial stiffness was assessed by carotid to femoral pulse wave velocity (cfPWV), central pulse pressure (cPP) and augmentation index using SphygmoCor® XCEL. Results The mean age was 56.4 ± 10.6 years. Tobacco smoking and diabetes were present in 56.4% and 41.8% of patients, respectively. ST segment elevation myocardial infarction was predominant (54.5%) and 47.6% of patients had multivessel disease. This study showed that cfPWV (OR = 1.272; 95%IC [1.090;1.483]; P = 0.002) and cPP (OR = 1.071; 95%IC [1.024;1.121]; P = 0.003) were the two independent predictors of multivessel disease. The cfVOP threshold for predicting multivessel disease was 12.65 m/s (sensitivity of 48.1% and specificity of 76.4%). Conclusion Arterial stiffness measured by cfPWV and cPP may reflect the extent of coronary artery disease after ACS. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2019.09.039 632
Predicting mortality factors after a myocardial infarction R. Khalifa ∗ , I. Chamtouri , W. Jomaa , K. Ben Hamda , F. Maatouk Cardiologie, service cardiologie Monestir tunisie, Kalaa Kebira, Tunisie ∗ Corresponding author. Adresse e-mail : [email protected] (R. Khalifa) Introduction Myocardial infarction (MI) is the leading cause of death in Tunisia. Purpose We wanted to determine the predictors of mortality in the wake of an IDM to ensure better care. Methods This is a study that included 1562 patients (1221 men and 341 women) hospitalized for Acute Coronary Syndrome with ST segment elevation in the Fattouma Bourguiba Monastir Heart Hospital B ward from January 1998 to September 2015. The predictive factors for 1-month mortality of MI were studied. Results The mortality rate was estimated at 8.3%. Sex was not a predictor of mortality (7.3% vs. 12%, P = 0.055). The history of coronary artery disease or heart failure was not a predictor of death with p equal to 0.553 and 0.575, respectively. Age over 75, diabetes, hypertension, use of an inotropic agent at admission, the occurrence of a complete atrioventricular block, complicated MI of a severe rhythm disorder (ventricular tachycardia or ventricular fibrillation) and the occurrence of severe acute mitral insufficiency would be predictive of mortality with p respectively equal to 0.03; < 0.001; 0.002; < 0.001; < 0, 001; < 0.001; 0.001. The infarct territory was also a predictor of mortality: the death rate was 10.6% in the anterior MIs, 7.6% in the inferior MIs and 2.5% in the lateral MIs (P < 0.001). Conclusion The advanced age, the diabetes, the HTA, the use of an inotropic agent at the admission, the occurrence of a serious