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Wellens syndrome: Prospective study of 40 observations
18 Purpose The objective of our study was to analyze the epidemiological, clinical and progressive features of acute myocardial infarction in the young adult in the Monestir Tunisia Cardiology B department. Methods This is a study that included 1525 patients (1433 men and 92 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. Results In our series, 1475 (94.4%) patients were older than 40 years old so 77.4% were men. Eighty-seven patients (5.6%) were under the age of 40, so 90.8% were men (P = 0.003). Diabetes, arterial hypertension and antecedent coronary pathology are the predominant risk factors in the elderly group with p respectively equal to 0.003; < 0.001 and 0.022. Active smoking was present in 85.1% of young people with IDM and 65.7% in older adults (P < 0.001). The inaugural presentation is more frequent in the youth group (75.9% vs. 56.9%, P < 0.05). MI was complicated of atrioventricular block in 9.9% of the elderly vs. 2.3% of the youth (P = 0.019); of ventricular tachycardia (VT) in 3.7% of the elderly, while no youth presented a TV (P = 0.05) and OAP in 37.3% in the elderly vs. 14% in the young (P = 0.01). Mortality was 8.6% in the elderly group and 3.4% in the youth group. Conclusion Males and tobacco are the two leading risk factors in the group of young people presenting a MI. The clinical presentation is often inaugural. The complications are rare but serious with a risk of mortality that remains high. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2019.09.032 642
Predictors of Successful Thrombolysis in an Acute 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 The choice between thrombolysis and primary angioplasty in an acute myocardial infarction (MI) is still a topic of discussion. Objective The objective of our study is to determine the predictive factors of success of thrombolysis in order to facilitate the choice of the therapeutic strategy in front of a MI. Methods This is a study that included 525 patients (433 men and 92 women) thrombolyzed in the acute phase of Acute Coronary Syndromes with ST segment elevation and hospitalized in Fattouma Hospital’s B Cardiology Monastir from January 1998 to September 2015. Factors influencing the response to thrombolytic therapy were investigated and a regression of the ST segment ≥ 50% at one hour after thrombolysis was selected as a re-perfusion criterion. Results Sex, age > 75 years, renal insufficiency and Killip IV heart failure would not be predictive of thrombolysis failure with P equals 0.609; 0.33; 0.081; 0.459,respectively. Anemia, diabetes, high blood pressure and the use of an inotropic agent at admission would be predictive of thrombolysis failure with p equal respectively to 0.03; 0.007; 0.002; < 0.001. Tobacco was also identified as a predictor of the success of fibrinolysis in patients presenting MI (74% vs. 59.8%, P = 0.001). Thrombolysis in less than 4 hours is also a predictor of success (46.8% vs. 27%, P < 0.001). In multivariate analysis, Hypertension (HR = 0.595, 95% CI 0.171—0.970, P = 0.037) and the use of inotropic drugs (HR = 0.293, 95% CI 0.171—0.504, P < 0.001) would be two independent factors of thrombolysis failure. A thrombolysis time of less than 4 hours is a predictive factor of success (HR = 0.516, 95% CI 0.329-0.809, P = 0.004).
Coronary heart disease Conclusion Hypertensive patients and those who required inotropes in the acute phase are less responsive to thrombolytic therapy. During the reperfusion strategy decision, the time factor with a delay of less than 4 hours is decisive in predicting the good results of fibrinolysis. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2019.09.033 098
Wellens syndrome: Prospective study of 40 observations M. Yahia Cherif ∗ , S. Mezereg , K. Khedouci , N. Hammoudi Cardiologie, EHS Dr Maouche Mohand Amokrane, Alger, Algérie ∗ Corresponding author. Adresse e-mail : [email protected] (M. Yahia Cherif) Introduction Wellens syndrome was first described in the early 1980s by Zwann, Wellens, and colleagues, who identified a subset of patients with unstable angina who had specific precordial T-wave changes and subsequently developed a large anterior wall myocardial infarction (MI). Wellens syndrome is also referred to as left anterior descending (LAD) coronary T-wave syndrome. Purpose Highlight the importance of recognizing wellens syndrome in the care of patients. Methods We present a prospective study of 40 patients with Wellens syndome treated between june 2017 and december 2018 at The CNMS Hospital (Algiers). The following parameters were considered in this analysis: Age, gender, cardiovascular risk factors, characteristic of chest pain, Electrocardiographic aspects, Enzymatic profile, location of the coronary lesion, The delay between hospitalization and revascularization. Results There was a clear predominance of men with a sex ratio of 3 men for a woman, and we noticed that the prevalence increased after the age of 60, the main risk factors found in our patients were smoking, high blood pressure and diabetes mellitus, 3/4 of patients complained of typical anginal pain, the most common electrical aspect was Wellens syndrome type 1, the most frequent sites were the proximal and medium left anterior descending coronary artery (LAD), 50 per cent of the patients underwent revascularization within the first 24 hours of hospitalization with active stent placement, while 80 per cent had, within the first 48 hours. Conclusion Wellens syndrome represents a critical LAD disease. Recognition of this ECG abnormality is very important because this syndrome represents a preinfarction stage of coronary artery disease (CAD) that often progresses to an extensive infarction. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2019.09.034 055
Coronary artery ectasia in acute myocardial infarction: To be culprit or not to be? B. Maalem Ben Messaoud 1 , M. Maza 1 , E. Gueniat-Ratheau 1 , H. Debeaumarche 1 , T. Pommier 1 , M. Zeller 2,∗ , Y. Cottin 1 1 Service de Cardiologie, CHU Dijon-Bourgogne 2 PEC2, EA 7460, UFR Sciences de Santé, Université Bourgogne Franche-Comté, Dijon, France ∗ Corresponding author. Adresse e-mail : [email protected] (M. Zeller) Background Coronary artery ectasia (CAE), is found in only 1% of acute myocardial infarction (AMI), but is a clinical challenge for percutaneous coronary intervention (PCI) of the culprit artery. Purpose We aim to assess the impact of CAE as culprit artery on management strategy.
Predictors of Successful Thrombolysis in an Acute 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 The choice between thrombolysis and primary angioplasty in an acute myocardial infarction (MI) is still a topic of discussion. Objective The objective of our study is to determine the predictive factors of success of thrombolysis in order to facilitate the choice of the therapeutic strategy in front of a MI. Methods This is a study that included 525 patients (433 men and 92 women) thrombolyzed in the acute phase of Acute Coronary Syndromes with ST segment elevation and hospitalized in Fattouma Hospital’s B Cardiology Monastir from January 1998 to September 2015. Factors influencing the response to thrombolytic therapy were investigated and a regression of the ST segment ≥ 50% at one hour after thrombolysis was selected as a re-perfusion criterion. Results Sex, age > 75 years, renal insufficiency and Killip IV heart failure would not be predictive of thrombolysis failure with P equals 0.609; 0.33; 0.081; 0.459,respectively. Anemia, diabetes, high blood pressure and the use of an inotropic agent at admission would be predictive of thrombolysis failure with p equal respectively to 0.03; 0.007; 0.002; < 0.001. Tobacco was also identified as a predictor of the success of fibrinolysis in patients presenting MI (74% vs. 59.8%, P = 0.001). Thrombolysis in less than 4 hours is also a predictor of success (46.8% vs. 27%, P < 0.001). In multivariate analysis, Hypertension (HR = 0.595, 95% CI 0.171—0.970, P = 0.037) and the use of inotropic drugs (HR = 0.293, 95% CI 0.171—0.504, P < 0.001) would be two independent factors of thrombolysis failure. A thrombolysis time of less than 4 hours is a predictive factor of success (HR = 0.516, 95% CI 0.329-0.809, P = 0.004).
Coronary heart disease Conclusion Hypertensive patients and those who required inotropes in the acute phase are less responsive to thrombolytic therapy. During the reperfusion strategy decision, the time factor with a delay of less than 4 hours is decisive in predicting the good results of fibrinolysis. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2019.09.033 098
Wellens syndrome: Prospective study of 40 observations M. Yahia Cherif ∗ , S. Mezereg , K. Khedouci , N. Hammoudi Cardiologie, EHS Dr Maouche Mohand Amokrane, Alger, Algérie ∗ Corresponding author. Adresse e-mail : [email protected] (M. Yahia Cherif) Introduction Wellens syndrome was first described in the early 1980s by Zwann, Wellens, and colleagues, who identified a subset of patients with unstable angina who had specific precordial T-wave changes and subsequently developed a large anterior wall myocardial infarction (MI). Wellens syndrome is also referred to as left anterior descending (LAD) coronary T-wave syndrome. Purpose Highlight the importance of recognizing wellens syndrome in the care of patients. Methods We present a prospective study of 40 patients with Wellens syndome treated between june 2017 and december 2018 at The CNMS Hospital (Algiers). The following parameters were considered in this analysis: Age, gender, cardiovascular risk factors, characteristic of chest pain, Electrocardiographic aspects, Enzymatic profile, location of the coronary lesion, The delay between hospitalization and revascularization. Results There was a clear predominance of men with a sex ratio of 3 men for a woman, and we noticed that the prevalence increased after the age of 60, the main risk factors found in our patients were smoking, high blood pressure and diabetes mellitus, 3/4 of patients complained of typical anginal pain, the most common electrical aspect was Wellens syndrome type 1, the most frequent sites were the proximal and medium left anterior descending coronary artery (LAD), 50 per cent of the patients underwent revascularization within the first 24 hours of hospitalization with active stent placement, while 80 per cent had, within the first 48 hours. Conclusion Wellens syndrome represents a critical LAD disease. Recognition of this ECG abnormality is very important because this syndrome represents a preinfarction stage of coronary artery disease (CAD) that often progresses to an extensive infarction. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2019.09.034 055
Coronary artery ectasia in acute myocardial infarction: To be culprit or not to be? B. Maalem Ben Messaoud 1 , M. Maza 1 , E. Gueniat-Ratheau 1 , H. Debeaumarche 1 , T. Pommier 1 , M. Zeller 2,∗ , Y. Cottin 1 1 Service de Cardiologie, CHU Dijon-Bourgogne 2 PEC2, EA 7460, UFR Sciences de Santé, Université Bourgogne Franche-Comté, Dijon, France ∗ Corresponding author. Adresse e-mail : [email protected] (M. Zeller) Background Coronary artery ectasia (CAE), is found in only 1% of acute myocardial infarction (AMI), but is a clinical challenge for percutaneous coronary intervention (PCI) of the culprit artery. Purpose We aim to assess the impact of CAE as culprit artery on management strategy.