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Background: Although coronarography is still the gold standard to evaluate coronary lesions, it remains a bidimensional representation of a tridimensional complex structure, which can represent a source of error in measurements., Aims: to perform a correlation and concordance study between quantitative coronary angiography (QCA) and intravascular ultrasound measurements for intermediate and ambiguous lesions., Methods: We analysed 40 patients' coronary arteries from March 2009 to November 2011 by both QCA and intravascular ultrasound to perform then a correlation and concordance study., Results: the correlation study confirmed the limits of the angiogram in providing accurate measurements. The correlation coefficient was yet high in reference diameters (r=0,78, p<0,001) and minimal lumen diameters (r=0,58, p<0,001), but was middling for stenosis percentages (r=0,23, p=0,03). This coefficient was also high for lesions lengths (r=0,51, p=0,01). Bland &Altaman diagrams showed however wide limits of agreement, reflecting possibility of large measurements error and confirming the absence of concordance between the two techniques., Conclusion: Coronarography though being the most widespread mean of evaluating coronary lesions lacks to provide accurate measurements, which can influence patient's management, especially in case of intermediate lesions.

Coronary anomalies are a rare entity. The gold standard remains the coronary angiogram. However, the identification of the origin and the course of aberrant coronary arteries using angiography may be difficult. We report two cases regarding two patients who underwent coronary angiography in order to evaluate coronary heart disease. In the first case, angiography has shown a left anterior descending artery (LAD) originating from the right anterior sinus. A multidetector CT scan (MDCT) showed an inter-aortopulmonary course of the LAD. In the second case, selective catheterization of the right coronary artery could not be done. A MDCT scan was performed. An abnormal origin of the right coronary artery was detected. It originates from the left sinus with a separate ostium of the left main coronary artery. This artery had an inter-aortopulmonary course. The 64 MDCT scan can be useful as a complementary tool for the diagnosis of coronary artery anomalies. Detection of the inter-aortopulmonary course is essential, since this situation will require surgical treatment to avoid sudden cardiac death., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Background: Although the prognosis of acute coronary syndrome (ACS) in elderly patients is bleak , elderly population is less well treated both in medical and interventional terms. aims: to analyse angiographic findings in septuagenarian patients admitted with ACS and its impact on the therapeutic strategy., Methods: We retrospectively analysed 250 patients 70 years or older hospitalised for ACS who underwent a coronary angiography between january 2006 to September 2010., Results: This population was more likely to be male with mean age 74 years and 93 % of ACS were inaugural events (60% N STEM, 40% STEMI).Coronary angiograms showed complex, diffuse coronary lesions with a high incidence of multivessel coronary artery disease , bifurcation lesions , and calcified stenosis., Conclusion: Angiographic findings after ACS in elderly were characterised by multivessel disease and complex lesions .Surgical or percutaneous coronary revascularizaion was possible in the majority of these patients.

Spontaneous coronary artery dissection (SCAD) is a non-traumatic non-iatrogenic coronary dissection. It's a frequent cause of acute coronary syndrome (ACS) in women without or with few traditional cardiovascular risk factors. We report an unusual case of multivessel SCAD in a middle-aged woman with successful medical management. [ABSTRACT FROM AUTHOR]

La rigidité artérielle représente un facteur prédictif majeur de cardiopathie ischémique. Certaines études ont suggéré une corrélation entre la rigidité artérielle et la diffusion et la sévérité de la maladie coronaire chez les coronariens stables, cependant cette relation est moins bien établie au décours d'un syndrome coronarien aigu (SCA). Étudier la relation entre les paramètres de rigidité artérielle, et la sévérité de la maladie coronaire chez des patients admis pour un SCA de novo. Il s'agit d'une étude analytique portant sur 275 patients hospitalisés pour un SCA de novo. Les paramètres de la rigidité artérielle, ont été mesurés directement par la vitesse de l'onde de pouls carotidofémorale (VOPcf) et indirectement par la pression pulsée centrale (PPc) et l'index d'augmentation (Aix). La sévérité de la maladie coronaire à été évaluée par le nombre du tronc artériel épicardique atteint par une ou plusieurs sténoses dépassant 70 % de réduction du calibre de référence. L'âge moyen des patients était de 56,4 ± 10,6 ans avec une nette prédominance masculine (77,5 %). Cent quinze patients étaient diabétiques et 97 étaient hypertendus. Le motif de la coronarographie était principalement un infarctus du myocarde avec sus-décalage du segment ST (IDM ST (+)) chez 150 patients (54,5 %) et un infarctus du myocarde sans sus-décalage du segment ST (IDM ST (−))chez 103 patients (37,5 %). Le statut monotronculaire était identifié chez 36 % des cas et une atteinte multitronculaire était retrouvée chez 131 patients (47,6 %). L'analyse multivariée à montré une corrélation positive statistiquement significative entre la VOPcf et le nombre de tronc coronaire atteint (B = 0,081 ; IC 95 % [0,019 ; 0,142] ; p = 0,010). Cette relation n'a pas été objectivée avec la PPc (B = −0,001 ; IC 95 % [−0,203 ; 0,020] ; p = 0,891) et avec l'Aix (B = −0,002 ; IC 95 % [−0,025 ; 0,021] ; p = 0,872). Par ailleurs, la VOPcf (OR = 1,272 ; IC95 % [1,090 ; 1,483] ; p = 0,002) et la PPc (OR = 1,071 ; IC95 % [1,024 ; 1,121] ; p = 0,003) étaient les deux facteurs prédictifs indépendants d'une atteinte coronaire multitronculaire. Chez des patients hospitalisés pour un SCA de novo, il existe une corrélation positive entre le nombre de tronc coronaire atteint et la VOPcf. Cette dernière avec la PPc étaient les deux facteurs prédictifs indépendants d'une atteinte coronaire multitronculaire. The association between arterial stiffness (AS) and stable coronary artery disease (CAD) has been previously demonstrated. Whether increased arterial stiffness is associated with severe CAD in patients with acute coronary syndrome (ACS) is less explored. We aim to investigate the relationship between AS parameters and the extent and severity of CAD in patients with ACS. The study population consisted of 275 patients with ACS. We measured various AS parameters including pulse wave velocity (PWV), augmentation index (AIx), and central pulse pressure (cPP). CAD extent and severity was evaluated by the number of vessels with greater than 70% stenosis. The study population was predominantly men (77, 5%) with an average age of 56, 4 ± 10, 6 years. One hundred and fifteen patients were diabetic and 97 were hypertensive. One hundred fifty patients were admitted for ST elevation myocardial infarction (54, 5%) and 37, 5% for non ST elevation myocardial infarction. Thirty six percent of patients had single vessel disease and 47, 6% of the study population had multivessel disease. At the multivariate analysis, a positive correlation was observed between the number of coronary vessels disease and PWV. PWV (OR = 1,272; IC95% [1,090; 1,483]; p = 0,002) and cPP (OR = 1,071; IC95% [1,024; 1,121]; p = 0,003) were also independent predictors of multivessel disease. In patient with ACS, PWV is correlated with the extent of coronary artery disease, as measured by the number of vessels disease. PWV and cPP were also independent predictors of multivessel disease. [ABSTRACT FROM AUTHOR]

Background Obstructive sleep apnea (OSA) may lead to myocardial preconditioning by increasing coronary collateral vessel recruitment in patients with acute coronary occlusion. Aim To determine the relationship between the severity of obstructive sleep apnea and coronary collaterality during acute myocardial infarction. Methods This study prospectively included 71 patients with an inaugural myocardial infarction who had undergone a coronary angiography within 24 h of onset. All patients underwent an overnight polygraph before discharge and were classified according to the apnea–hypopnea index (AHI). Coronary collaterals were scored by visual analyses and according to the Rentrop grading system. Results Mean age was 59 ± 11 years and 83% of patients were men. All patients had complete or subtotal occlusion of the infarct-related artery. After the sleep study, patients were divided into two groups: 25 were suffering from OSA (AHI > 15/h). Patients with OSA showed better collateral vessel development (Rentrop score ≥ 1) compared to non-OSA patients (68 vs. 41%, P = 0.032). AHI was significantly higher in patients with developed coronary collaterals (Rentrop ≥ 1) compared to those without collaterality (17.74 ± 13.2 vs. 12.24 ± 10.9, P = 0.025). Conclusion Coronary collateral development may be increased in OSA patients who are presenting with a first myocardial infarction. [ABSTRACT FROM AUTHOR]

The aim of our study was to assess the clinical, electrical, angiographic and therapeutic characteristics of young patients with acute myocardial infarction and to describe the prevalence of in-hospital complications. FromJanuary 2014 to May 2017, we retrospectively studied data of patients with acute myocardial infarction younger than 45 years old in the department of cardiology of Charles Nicolle hospital of Tunis. We enrolled 108 patients in the study. The prevalence of myocardial infarction in young patients was 8.5%. The mean age was 39.5 ± 5.5 years with a sex-ratio of 11. The most frequent cardiovascular risk factors were smoking (88%) and dyslipidaemia (51.9%). We reported 75 cases of ST segment elevation myocardial infarction. Primary angioplasty was performed in 41.3% of cases while lytic therapy was administered for the rest of the patients. It was successful in 75% of cases. Among 33 patients who presented with non-ST segment elevation myocardial infarction, percutaneous coronary angioplasty was performed in 60.6% of patients while 15.2% have undergone coronary artery bypass surgery and 24.2% received medical treatment only. In-hospital complications occurred in 39.8% of cases. In-hospital mortality was 1.9 %. Acute myocardial infarction in the young represents a serious health problem. Primary preventive measures aimed at preventing our youth from adopting tobacco use and developing dyslipidemia should be implemented to delay and even to avoid the onset of coronary artery disease. [ABSTRACT FROM AUTHOR]

Résumé: Les anomalies de naissance des artères coronaires sont une entité rare. L’examen de référence reste à ce jour la coronarographie. Cependant, l’identification de l’origine et du trajet des artères coronaires aberrantes par la coronarographie peut se révéler difficile. Nous vous présentons deux observations de patients ayant bénéficié d’une coronarographie dans le cadre de l’exploration d’une maladie coronaire. Chez le premier patient, la coronarographie a montré une inter-ventriculaire antérieure (IVA) naissant à partir du sinus antérieur droit. Un complément scannographique a décrit un trajet inter-aortopulmonaire de l’IVA. Chez le second patient, le cathétérisme sélectif de la coronaire droite n’a pu être réalisé. Un complément d’imagerie par scanner multibarrettes a détecté une anomalie de naissance de la coronaire droite à partir du sinus gauche par un ostium séparé de la coronaire gauche avec un trajet inter-aortopulmonaire. Le scanner 64 barrettes se place comme un outil complémentaire de diagnostique et thérapeutique dans la prise en charge des anomalies de naissance des artères coronaires. [ABSTRACT FROM AUTHOR]