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Background: Few clinical trials have focused on populations with a history of distant myocardial infarction (MI). The PEGASUS trial assessed the impact of dual antiplatelet therapy in such patients, selected by enrichment criteria of high cardiovascular risk. Whether the PEGASUS population reflects the risk of a broader post-MI population is questionable. We analyzed whether 4-year mortality of a routine-practice population would differ according to the inclusion and exclusion criteria used in PEGASUS., Methods: FAST-MI is a nationwide French registry recruiting acute MI patients in November 2005; 2490 patients alive and without recurrent MI at one year were classified into three groups: Group 1 ("PEGASUS-like" population; n=1395; 56%), Group 2 (population having ≥1 exclusion criterion for the trial; n=677; 27%), and group 3 (population meeting neither the PEGASUS inclusion nor exclusion criteria; n=418, 17%)., Results: Group 1 patients were older than Group 3 patients, with higher GRACE scores, more comorbidity, and less STEMI, but were younger than the PEGASUS trial population. Enrichment criteria successfully defined a population at higher risk: 4-year survival 83% in Group 1, 97% in Group 2, and 68% in Group 3 (P<0.001). Among risk-enrichment criteria, age alone was highly discriminant: in PEGASUS-like patients, survival was 78% in those ≥65 versus 94% in those <65years., Conclusions: Enrichment criteria used in PEGAGUS succeed in defining a population at increased risk in patients with prior MI, age being the most discriminant factor. The trial population, however, was notably younger and more masculine than the corresponding real-life population in France. Clinicaltrials.govnumber:NCT00673036., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Percutaneous coronary intervention (PCI) as a treatment of coronary artery disease can be a simple, rapid procedure with a clear benefit for the patient, but it could also become a complex procedure with fatal consequences. These complications depend on the lesion itself, material used and also on operating staff. In this case we report a coronary artery dissection of the circumflex (CX) artery caused by inflation of an oversized balloon. We discuss here the management and evolution of this complication., (2014 BMJ Publishing Group Ltd.)

Aims: Proof-of-concept evidence suggests that mechanical ischaemic post-conditioning (PostC) reduces infarct size when applied immediately after culprit coronary artery re-opening in ST-elevation myocardial infarction (STEMI) patients with thrombolysis in myocardial infarction 0-1 (TIMI 0-1) flow grade at admission. Whether PostC might also be protective in patients with a TIMI 2-3 flow grade on admission (corresponding to a delayed application of the post-conditioning algorithm) remains undetermined., Methods and Results: In this multi-centre, randomized, single-blinded, controlled study, STEMI patients with a 2-3 TIMI coronary flow grade at admission underwent direct stenting of the culprit lesion, followed (PostC group) or not (control group) by four cycles of (1 min inflation/1 min deflation) of the angioplasty balloon to trigger post-conditioning. Infarct size was assessed both by cardiac magnetic resonance at Day 5 (primary endpoint) and cardiac enzymes release (secondary endpoint). Ninety-nine patients were prospectively enrolled. Baseline characteristics were comparable between control and PostC groups. Despite comparable size of area at risk (AAR) (38 ± 12 vs. 38 ± 13% of the LV circumference, respectively, P = 0.89) and similar time from onset to intervention (249 ± 148 vs. 263 ± 209 min, respectively, P = 0.93) in the two groups, PostC did not significantly reduce cardiac magnetic resonance infarct size (23 ± 17 and 21 ± 18 g in the treated vs. control group, respectively, P = 0.64). Similar results were found when using creatine kinase and troponin I release, even after adjustment for the size of the AAR., Conclusion: This study shows that infarct size reduction by mechanical ischaemic PostC is lost when applied to patients with a TIMI 2-3 flow grade at admission. This indicates that the timing of the protective intervention with respect to the onset of reperfusion is a key factor for preventing lethal reperfusion injury in STEMI patients., Clinical Trial Number: NCT01483755., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.)

Objective of the Study: Bivalirudin, a direct thrombin inhibitor, demonstrated an improvement in the prognosis of acute coronary syndromes by a decrease in major bleeding complications. This observational study evaluated inhospital outcome of patients with acute myocardial infarction treated by prehospital bivalirudin before primary angioplasty., Patients and Methods: We included, from June 2010 to June 2012, all patients with acute myocardial infarction receiving prehospital bivalirudin with bolus of 0.75mg/kg followed by an infusion of 1.75mg/kg per hour until the arrival in the catheterization laboratory. Bivalirudin was possibly continued after primary angioplasty., Results: We included 152 patients aged 57.6±11.6 years. A prehospital 60mg loading dose of prasugrel was given in 77% of patients. Coronary angiography with radial access (77.6%) was performed before a successful angioplasty in 97.3% of cases. The bivalirudin infusion was continued after the procedure in 81.6% of patients. Inhospital outcome showed two deaths (1.3%) and two re-infarctions (1.3%) of which one was related to the single acute stent thrombosis (0.6%). Major bleeding complications were limited irrespective of the Gusto (0.6%), Timi (0.6%) or Horizons-MI (4.6%) classification. Bleeding complications rate was similar when bivalirudin was followed or not after primary angioplasty., Conclusion: The use of bivalirudin in the prehospital setting for primary angioplasty seems to be effective and safe about ischemic and bleeding complications during the inhospital outcome., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Background: The value of prehospital initiation of glycoprotein IIb/IIIa inhibitors remains a controversial issue. We sought to investigate whether in-ambulance initiation of abciximab in patients with ST-segment elevation myocardial infarction (STEMI) improves ST-segment elevation resolution (STR) after primary percutaneous coronary intervention (PCI)., Methods and Results: MISTRAL (Myocardial Infarction with ST-elevation Treated by Primary Percutaneous Intervention Facilitated by Early Reopro Administration in Alsace) is a prospective, randomized, double-blind study. Two hundred and fifty-six patients with acute STEMI were allocated to receive abciximab either in the ambulance (ambulance group, n=127) or in the catheterization laboratory (hospital group, n=129). The primary end point was complete (>70%) STR after PCI. Complete STR was not significantly different between the 2 groups (before PCI, 21.6% versus 15.5%, P=0.28; after PCI, 70.3% versus 65.8%, P=0.49). Thrombolysis In Myocardial Infarction (TIMI) 2 to 3 flow rates before PCI tended to be higher in the ambulance group (46.8% versus 35%, P=0.08) but not after PCI (70.3% versus 65.8%, P=0.49). Slow flow tended to be lower (5.6% versus 13.4%, P=0.07), and distal embolization occurred significantly less often in the ambulance group (8.1% versus 21.1%, P=0.008). One- and 6-month major adverse cardiac event rates were low and similar in both groups., Conclusions: Early ambulance administration of abciximab in STEMI did not improve either STR or TIMI flow rate after PCI. However, it tended to improve TIMI flow pre-PCI and decreased distal embolization during procedure. Larger studies are needed to confirm these results.

Aims of the Study: The study evaluated in-hospital and long-term outcome of patients less than 50 years old with myocardial infarction within 12 hours after symptom onset treated by coronary angioplasty., Patients and Method: This is a retrospective study with survival analysis by Kaplan-Meier method in patients included from December 2003 to February 2008., Results: We included 93 patients aged 42,8+/-5,2 years old with smoking estimated at 27,7+/-12,7 pack-years. Thirty-one patients (33,3%) were dyslipidemic and 36 patients had family history of coronary artery disease. Thirty patients (32,3%) had an anterior myocardial infarction and four patients (4.4%) had Killip greater than 2. Coronary angioplasty was performed within 4.5+/-3.0 hours after symptom onset with TIMI 3 final flow in the culprit vessel in 96.8%. One patient died from cardiogenic shock. With a follow-up of 85 patients during 20.0+/-15.6 months, the survival without death was 98.2% and survival without major cardiac complication was 87.9% at 24 months. Seventy-two patients (85.7%) were taking a betablocker, 81 patients (96.4%) aspirin, 75 patients (89.3%) a statin and 64 patients (76.2%) an angiotensin-converting inhibitor. Only 50 patients (58.8%) were nonsmokers., Conclusion: Thus, young smokers with acute MI treated by coronary angioplasty have a good prognosis during in-hospital stay and long-term outcome. Secondary medical treatment prevention is well followed but there is a low rate of smoking cessation., (Copyright 2010. Published by Elsevier SAS.)

This study evaluated the hospital outcome of octogenarian patients treated by primary angioplasty for acute myocardial infarction less than 12 hours. The long-term mortality and social outcome were evaluated, social outcome was based on IADL and IADL-E scales corresponding to physical autonomy and level of dependence. We included from 1999 to 2005 47 old patients of 83.5+/-3.2 years. The reperfusion of the obstructed coronary artery was obtained in 45 patients (95.7%) with TIMI 3 flow. Hospital mortality was 25.5% and 4.2% without hemodynamic complication. A multivariate analysis identified a Killip score>1 as predictive factor of hospital mortality (OR=8.9 and p=0.05). The long-term survival without death with a follow-up of 26.3+/-18.3 months was 82.2% at 24 months and 70.6% at 48 months according to the Kaplan-Meier method. In an multivariate analysis, hospitalization exit without aspirine was associated with a higher long term mortality (OR=34.8 and p=0.04). According to the evolution of scores of IADL and IADL-E scales, patients had an excellent autonomy and good capacities before the infarction and they kept them on the long term. Thus octogenarians with acute myocardial infarction treated by primary angioplasty have a high in hospital and long term mortality but the survivors preserve an excellent daily autonomy.

Acute myocardial infarction is a rare complication of dobutamine stress echocardiography (DSE). We report the case of a 60-year-old man with moderate apical sequela of a myocardial infarction (MI) which had an inferior MI complicated with cardiogenic shock and circulatory arrest two hours after a positive DSE in that very circulatory topography. Emergency coronarography objectivizes a dissection of the circumflex artery. The patient required a circulatory assistance device. He survived the episode and left the hospital with 50% left ventricular ejection fraction.

The guidelines of the European Society of Cardiology, published in 2003, consider primary angioplasty as the preferred treatment strategy in acute coronary syndromes with ST-segment elevation, if the procedure can be performed within 90 min after first medical contact. We report the experience of three Alsacian centers running a common prospective registry with 2504 consecutive patients enroled between January 1999 and December 2004. The average age of the patients was 62 years with a proportion of 24% women. The time delay "pain to admission" was > or =3 hours in 55.9% of the cases. The treatment delay "door to catheterisation needle" was 59 min and the mean delay "door-to-reperfusion" was 79 min. The study population was representative of the real world including subsets of patients with a particulary high risk profile: age > or =70 years in 33%, a Killip grade > or =3 in 11.5%, rescucitated sudden death in 6.6% and cardiogenic shock in 10.9% of the patients respectively. The immediate procedural success rate (Timi 3 flow) in the treated coronary artery was 96.5%. The overall inhospital mortality-rate was 9.3%. The combinations of rescucitated sudden death--cardiogenic shock or age > or =75 years--cardiogenic shock were associated with a poor clinical outcome and mortality rates of 69% and 72.6% respectively, where as in the absence of abovementioned clinical high risk settings, the mortality rate was as low as 1.4%. The overall bleeding complication rate was 1.4%. The policy of systematic primary angioplasty in acute coronary syndromes with ST-Segment elevation appears to be coherent. The procedural complications and the in-hospital mortality rates were low, except in the presence of above mentioned clinical high risk settings.

Objectives: This prospective multicenter study assessed the prevalence and feasibility of percutaneous coronary angioplasty (PTCA) in the acute phase of ST-elevation myocardial infarction (STEMI) in 3 nonacademic interventional cardiology centers (Alsace, France)., Methods: We studied the clinical characteristics, angiographic data, and PCTA results of all STEMI patients and analyzed the revascularization rates and adverse events during hospitalization. We compared patients at least 75 years of age and younger patients for these data and with the literature., Results: Of the 1672 patients admitted for STEMI, 342 (20.45%) were at least 75 years of age. Half the patients in this high-risk subgroup were women. These patients had more co-morbidities (e.g., hypertension and diabetes mellitus) than younger patients, and more of them had three-vessel disease. Mortality rate was high in this subgroup and always higher than for comparable younger subjects, but it varied according to the initial clinical profile. Their global mortality rate was 20.47%, but it fell to 5.41% when we excluded patients with cardiogenic shock or in Killip stage ill, and those who were resuscitated. PTCA is a coronary reperfusion technique especially indicated for elderly patients with STEMI. It is an effective revascularization technique, with a reperfusion rate (exclusively TIMI III flow) reaching 93.88% in the elderly group, only slightly lower than among younger patients (97.18%)., Conclusion: PTCA is a technique particularly indicated in the elderly in Alsace because of regional geographic and medical specificities: nearby emergency services are available to virtually the entire population of Alsace, and most interventional cardiology teams apply a strategy of exclusive primary PTCA.

The objective of the study was to assess the frequency of late stent-thrombosis-related acute myocardial infarction in patients with LAD stents. A series of 930 PCI procedures involving LAD stenting were performed in 920 patients (mean age: 63 years, 667 men) from January 1999 to December 2001. Among those 14 patients had late (> 30 days), thrombosis-related acute myocardial infarction after a mean delay of 135 +/- 131 days. Three-year thrombosis-free survival was 97.6%. By univariate analysis, risk of late thrombosis was associated with LAD-diagonal bifurcation stenting, placement of a stent on the ostium of a diagonal branch and number of stents implanted on the LAD. Patients with these risk factors might be appropriate candidates for long-term combined antiplatelet therapy.

Objectives: From a prospective multicenter registry, we evaluated in three non-academic interventional cardiologic centers (Alsace/France), the coverage and the feasibility of the percutaneous coronary angioplasty (PTCA) in the acute phase of STEMI in the elderly (patients 75-years old and more)., Methods: We studied clinical characteristics and angiographic data of patients older than 75 years, and the PTCA results: the revascularisation rates and the intrahospital events were analysed. These data were compared with those of the younger patients and confronted with the literature data., Results: Of a total of 1672 patients admitted for a STEMI, 342 (20.45%) were older than 75 years. These patients represented a high-risk group with a high proportion of women (50%), and many co-morbidities (e.g.: hypertension and diabetes mellitus), and three-vessel disease was found more often than in younger patients. Mortality rate was high in this subgroup and always more severe as compared to younger subjects, but remains variable according to the initial clinical profile. The global mortality was 20.47% but fell to 5.41% if we excluded the patients with cardiogenic shock, in Killip III and after resuscitation. PTCA is a coronary reperfusion technique particularly indicated in the management of the elderly presenting a STEMI. It is an effective technique in term of revascularisation, the reperfusion success (exclusively TIMI III flow) was indeed raised in the elderly even though it is lower than in younger patients (93.88 vs 97.18%). It is a quickly accessible technique, cath-lab accessibility provided, allowing a fast reperfusion and reducing hospitalization to a minimum. The management of the elderly presenting a STEMI has to focus on reducing the preadmission delay since this subgroup of patients hesitates to call the emergency (SMUR) when presenting an acute coronary symptomatology. The shorter the delay till admittance, the better the outcome., Conclusion: PTCA is a technique particularly indicated in the elderly in Alsace because of regional specificities: first of all geographic (proximity of the SMUR for virtually all the population of Alsace), and secondly the medical infrastructure since the strategy of exclusive primary PTCA is granted by numerous interventional cardiologic teams. In Alsace, the proportion of elderly patients (> or = 75 years) is going to increase significantly with a parallel rise of STEMI--"a frightening perspective". We have to take into account this evolution, this reperfusion technique presenting numerous advantages and very few complications.

Objective and Method: Evaluation of angioplasty for primary cardiogenic shock in acute myocardial infarction in three non-universitary alsacians centres between 1999 and 2002., Results: One hundred and eighty-two patients were included. Hospitalisation survival rate is 43.96% after hospital discharge. One hundred and forty-nine patients were treated by primary angioplasty. Angioplasty is successful in 79.12%. The predictives factors of death are: age > 75, TIMI = 0 at the admission, three vessels disease. Twenty-four months survival is 91% (follow-up data available on 28.75% of the patients alive at hospital discharge)., Conclusion: Angioplasty seems to be the right choice in case of acute myocardial infarction complicated by cardiogenic shock, the results are better than medical treatment at short- and mid-term.

The aim of this study was to investigate the ability of troponin I (cTnI) levels to predict myocardial infarction size in patients with ST-segment elevation acute myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). In 87 patients with STEMI undergoing primary PCI, serial plasma concentrations of cTnI and alpha-hydroxybutyrate deshydrogenase (HBDH) were measured before PCI and over the following 72 h. Enzymatic infarct size was estimated by the cumulative release of HBDH during the 72 h following PCI (QHBDH72). Delayed radionuclide left ventricular ejection fraction (LVEF) was measured in 63 patients. While cTnI concentrations at admission did not correlate with QHBDH72 or with LVEF, from the 3rd to the 72nd h following PCI, they did correlated with QHBDH72 (P<0.001; R: 0.76-0.86) and with LVEF (P<0.001; R: -0.42 to -0.50). Receiver-operator characteristic (ROC) curve analysis showed that admission concentrations of cTnI could not predict either a large infarct size (i.e., QHBDH72>10 g-eq l(-1)) or a low LVEF (i.e., LVEF<40%). However, 6 h and up until 72 h after PTCA, cTnI concentrations were predictive of large enzymatic infarct size (sensitivity: 91 and 95%, specificity: 90 and 87%, respectively) and of LVEF under 40% (sensitivity: 75 and 77%, specificity: 90 and 78%, respectively). Thus, our study suggests that in contrast with admission cTnI concentration, cTnI levels following primary PCI represent a reliable tool for predicting large enzymatic infarct size and may help in selecting patients with a high risk of low LVEF at 1 month.

A review of the results of randomised trials of the use of betablockers in acute myocardial infarction shows by techniques of meta-analysis that their prescription in the early hours of the acute event leads to a reduction in short-term mortality: the reduction of risk is 12% as compared with groups which are not given betablockers. In addition to its impact on mortality, early betablocker therapy is associated with a reduction in the risk of recurrence of myocardial infarction and a proven antalgic effect. However, in patients receiving thrombolysis, the beneficial effect on mortality and recurrence of infarction of intravenous betablockers seems less evident. In daily clinical practice, the prescription of betablockers in the first days of infarction has significantly increased over the last ten years. In the USIK trial carried out in France in November 1995, nearly two thirds of patients received betablocker therapy. In the same study, the prescription of betablockers is associated with a reduction in mortality independent of the classical risk factors and the prescription of angiotensin converting enzyme inhibitors. These results confirm the value of this therapeutic class in the acute phase of myocardial infarction.

Evaluation of heart rate variability is a common method of assessing autonomic nervous system function and its effects on heart rate in different conditions. The reproducibility of the technique is not known in the chronic phase of myocardial infarction. The aim of this study was therefore to assess the reproducibility of the measurement in 54 subjects who were clinically stable with no change in treatment at a distance from acute or semi-recent (> 2 years) myocardial infarction, after an interval of one month. The temporal and spectral analysis of heart rate variability included measurement of the standard deviation of the normal RR intervals (SDNN), on the mean heart rate, the percentage of RR intervals greater than 50 ms than the adjacent interval (pNN50), the coefficient of variability (CV), the square root of the differences between successive RR intervals (rMSSD), the power of low frequencies (LF) and high frequencies (HF) and of the fractional spectral power (LF/HF). No significant changes in these parameters were observed. Analysis of individual variations showed that the heart rate was the most stable parameter: for evaluation of vagal tone, the rMSSD showed less variability than the pNN50 and HF. The presence of cardiac disease did not influence these results. The authors conclude that parameters of evaluation of heart rate variability in temporal and spectral analysis are globally reproducible in stable subjects. However, individual values may change from one measurement to another. Nevertheless, abnormal variability is constantly observed at the second investigation and, similarly, normal variability also remains unchanged. These individual variations suggest that, for the demonstration of change in these parameters of variability with treatment, large population groups must be studied.

We compared the prognostic significance of prior angina pectoris in 151 patients > or = 75 years of age admitted for acute myocardial infarction. There was a similar in-hospital course, but the long-term outcome was poorer in patients with prior angina.

Programmed ventricular stimulation could be a useful technique to detect patients at high risk for ventricular arrhythmias and sudden death after acute myocardial infarction. However, prevention of arrhythmic events using this technique has never been demonstrated. To determine whether prophylactic antiarrhythmic therapy influences prognosis after acute myocardial infarction, 196 patients without spontaneous ventricular tachycardia (VT) but with inducible sustained monomorphic VT were followed for 3 +/- 1 years. Ninety-seven patients were not treated (control group). In 99 patients (study group), the antiarrhythmic therapy was guided by electrophysiologic study: One to four trials using class I, II, and III antiarrhythmic drugs were performed until the VT was not inducible or the induced VT was slower and was associated with hemodynamic stability. An effective antiarrhythmic drug prevented VT induction in 34 patients (34%; group I). Sixty-five patients (group II) still had inducible VT with the antiarrhythmic drug. Group II differed from group I in having a higher incidence of an inferior myocardial infarction location (57% vs. 47%; NS), a lower left ventricular ejection fraction (36.5% vs. 41%; NS), a slower rate of induced VT in the control state (227 vs. 255 beats/min; p < 0.05), and a higher number of drug trials (1.9 vs 1.3; p < 0.001). During the follow-up in the control group and in groups I and II, the incidence of total cardiac events was 25%, 15%, and 16% (NS), respectively, and the incidence of total arrhythmic events (VT, sudden death) was 18.5%, 9%, and 12% (NS). Only the risk of VT was reduced (14%, 0%, and 4%; p < 0.05). In conclusion, guided-antiarrhythmic therapy, including class III agents after acute myocardial infarction, was successful in only 34% of patients, and the incidence of arrhythmic events was not significantly decreased. Therefore, programmed ventricular stimulation does not help in managing patients at risk of ventricular arrhythmia after myocardial infarction but could help indicate the need for nonmedical treatment, such as device therapy.

Objectives: Analyze management of myocardial infarction in elderly subjects and assess long-term outcome., Methods: We studied retrospectively a series of 151 consecutive cases of acute myocardial infarction in patients over 75 years of age and compared then with a group of young subjects under 65 years of age admitted for the same pathology during the same period (1989-1993)., Results: In the elderly population, female sex, past history of angina or infarction, atypical presentation and hemodynamic complications were more frequent in the elderly population (left ventricle failure 44 vs 13%, cardiogenic shock 17.2 vs 0.7% without any difference in localization. Mortality was higher in the elderly group (23.2 vs 2.6%) with 68.6% of the deaths due to primary cardiogenic shock. Beta-blockers were used less frequently in the elderly population (31.8 vs 83.0%) as was thrombolysis (26.5 vs 64.5%); coronography was performed less often (21.8 vs 92.7%) as was percutaneous revascularization (9.9 vs 36.4%) or surgery (1.3 vs 6.6%). Survival at 1, 2 and 5 years was 88, 76 and 57% in the elderly group (Kaplan-Meier plot). A past history of unstable angina and a critical episode of left ventricle failure were factors predicting overmortality., Conclusion: Acute myocardial infarction remains a severe condition in patients over 75 years of age with overmortality during hospitalization and poor long-term prognosis. Clinical signs of poor prognosis could help guide selection for more aggressive therapeutic management during the post-infarction period, notably in terms of coronary revascularization.

The aim of this study was to determine the influence of the chronicity of myocardial infarction on QRS duration. The signal-averaged electrocardiogram (SA ECG) was recorded with a 40 Hz filter in 239 patients with a history of myocardial infarction. The infarction was recent (up to 6 weeks) in 105 patients (group A) and chronic (> 1 year) in the other 134 cases (group B). In group A, 35 patients had inductible sustained ventricular tachycardia (VT) at less than 270/mn; 40 had negative electrophysiological investigations and 30 had inducible ventricular flutter or fibrillation (VF). In group B, 58 had inducible VT, 54 had negative investigations and 22 had inducible VF. The three SA ECG parameters (QRS duration, amplitude of RMS 40 and duration of LAS) differed significantly in subjects with VT with respect to those with negative investigations and inducible VF, irrespective of the chronicity of infarction. On the other hand, only QRS duration differentiated patients with recent infarction from those with chronic infarction, irrespective of the results of programmed pacing, QRS duration being longer in group B. The best diagnostic value of QRS duration for identifying subjects with VT < 270/mn and negative investigations was 110 ms in group A and 120 ms in group B (sensitivity 46% and 77.5% respectively). In chronic infarction, the increase in QRS duration was significantly correlated to the decrease in left ventricular ejection fraction. The authors conclude that the criteria of abnormality of QRS duration are dependent on the chronicity of myocardial infarction. Although a duration of 110 ms is abnormal in the early post-infarction period, after a period of one year, a value of 120 ms should be considered to be pathological, especially when the sequellae of infarction are important.

Abstract: Aims of the study: The study evaluated in-hospital and long-term outcome of patients less than 50 years old with myocardial infarction within 12hours after symptom onset treated by coronary angioplasty. Patients and method: This is a retrospective study with survival analysis by Kaplan-Meier method in patients included from December2003 to February2008. Results: We included 93 patients aged 42,8±5,2 years old with smoking estimated at 27,7±12,7 pack-years. Thirty-one patients (33,3%) were dyslipidemic and 36 patients had family history of coronary artery disease. Thirty patients (32,3%) had an anterior myocardial infarction and four patients (4.4%) had Killip greater than 2. Coronary angioplasty was performed within 4.5±3.0hours after symptom onset with TIMI 3 final flow in the culprit vessel in 96.8%. One patient died from cardiogenic shock. With a follow-up of 85 patients during 20.0±15.6 months, the survival without death was 98.2% and survival without major cardiac complication was 87.9% at 24months. Seventy-two patients (85.7%) were taking a betablocker, 81 patients (96.4%) aspirin, 75 patients (89.3%) a statin and 64 patients (76.2%) an angiotensin-converting inhibitor. Only 50 patients (58.8%) were nonsmokers. Conclusion: Thus, young smokers with acute MI treated by coronary angioplasty have a good prognosis during in-hospital stay and long-term outcome. Secondary medical treatment prevention is well followed but there is a low rate of smoking cessation. [Copyright &y& Elsevier]