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RésuméL’évaluation du risque cardiovasculaire (RCV) chez le patient à risque intermédiaire pourrait être améliorée par les nouvelles techniques d’imagerie évaluant l’athérosclérose infraclinique. La dilatation médiée par le flux de l’artère humérale (Flow Mediated Dilatation : FMD), l’épaisseur intima média carotidienne (EIMc), la détection des plaques carotidiennes, et le score calcique font l’objet de nombreux travaux de rechercheNous discuterons les résultats présents dans la littérature pour évaluer l’apport de l’imagerie de l’athérosclérose infra clinique dans l’évaluation du RCV.L’intérêt de la FMD semble limité dans les études à cause d’une importante inter et intra variabilité de la mesure. L’addition de la mesure de l’EIMc au modèle classique d’évaluation du RCV améliore son évaluation mais avec des résultats cliniquement significatifs seulement dans certaines études. La mesure des plaques carotidiennes et surtout l’évaluation du score calcique semblent améliorer de façon indiscutable l’évaluation du RCV notamment chez les personnes à risque intermédiaire. Une reclassification chez les personnes à risque intermédiaire a été rapportée dans 17 à 55%, après addition de l’évaluation des plaques carotidiennes au modèle classique d’évaluation du RCV ou du score calcique, respectivement (p

Background It has been suggested that delays, quality and outcome of reperfusion therapy provided to ST-Elevation Myocardial Infarction (STEMI) patients during OFF-hours (nights and weekend) are worse than during ON-hours (day working hours). Methods We studied 736 consecutive STEMI patients transferred for primary percutaneous intervention (PCI) to a single large volume urban Primary PCI center. Characteristics and clinical outcome of patients admitted during ON-hours (Monday through Friday 8 am-6 pm) were compared to OFF-hours patients (admitted during night shifts and weekends). Clinical outcome was 1 year death and death or MI. Results STEMI patients undergoing primary PCI were admitted more frequently during OFF-hours (n = 449; 61.1%) than ON-hours (n = 287; 38.9%), with no major differences in characteristics or treatment between the two groups. Use of radial approach and the rate of stenting during PCI was 83.3% and 86.1% in ON-hours patients vs. 88.2%.and 88.1% in OFF-hours patients. There was no impact of time of admission on in-hospital mortality before or after adjustment for baseline characteristics OR 1.54; CI [0.71–3.35]. Time from symptom onset to first medical contact was shorter during OFF-hours than ON-hours (105 min [50–225] vs. 114 min [60–367]; p = 0.06). Time from first medical contact to sheath insertion was also identical between the 2 groups (101 min [80–155] and 105 min [78–155]; p = 0.61 respectively). Time to TIMI 3 flow and duration of procedure were also similar. At one year, all cause mortality and the composite end point of death or MI was 8.3% and 12.2% for OFF-hours patients vs. 7.0% and 10,8% in ON-hours patients, p = 0.4 and p = 0.3 respectively. Conclusion In a well-organized urban STEMI network, were 61% of patients referred for primary PCI are admitted during “OFF” hours, admission time does not impact quality of care or outcomes. Download : Download full-size image Death or MI after one year of follow-up

Background Cardiac troponin is the gold standard for the diagnosis and risk stratification in acute coronary syndrome (ACS). Troponin elevation associated with symptomatic paroxysmal reentrant supraventricular tachycardia (PSVT) has been described in short series but long term prognosis has not been yet reported. Download : Download full-size image Overall survival in patients with and without ACS The aim of the present study was to evaluate the diagnostic and prognostic value of troponin I elevation following PSVT. Methods and results From January 2003 to September 2009, all consecutive patients (n = 27, 52% females, median age 52 years) admitted for PSVT and troponin I elevation (mean 0.42 μg/l, range: 0.19–5.9) were included. None of the patients had a history of CAD. Thirteen patients (48.1%) were current smokers and 9 (33.3%) had no cardiovascular risk factor. All patients had narrow QRS during PSVT and the aetiology was nodal reentrant tachycardia in all except for one patient with preexcitation morphology in sinus rhythm. Coronary angiogram has been performed in 25 patients. Twenty three had angiographically normal coronary arteries. A single vessel disease (coronary stenosis >50%) was found in 2 patients and maximal stress echocardiography was normal in both patients. Two patients who declined coronary angiogram had normal maximal stress echocardiography. During follow-up (median 43 months, range: 4–82), none of the patients experienced ACS or cardiac death. One of the patients died from cancer after 63 months of follow up. Recurrence of PSVT requiring medical intervention occurred in 4 (14.8%) patients, atrial fibrillation in 3 (11%) patients and radiofrequency catheter ablation of atrioventricular nodal reciprocating tachycardia had been performed in 5 (18.5%) patients. Conclusions Troponin I elevation following PSVT is common, not related to obstructive CAD or plaque rupture and is not associated with adverse short and long term prognosis.