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Spontaneous coronary artery dissection is a rare cause of myocardial infarction but with potentially adverse outcome. It is more common in young women without conventional cardiovascular risk factors. Conservative medical strategy is the best therapeutic option with percutaneous coronary angioplasty reserved for high risk patients. We report a case of a young woman with spontaneous coronary artery dissection involving the left main coronary artery complicated by left ventricular thrombus. The patient was successfully managed with medical therapy resulting in favorable clinical course. [ABSTRACT FROM AUTHOR]

Les patients atteints de polyarthrite rhumatoïde et d'autres rhumatismes inflammatoires chroniques ont un risque de maladie cardiovasculaire (CV) plus élevé que dans la population générale. Les mécanismes sous-jacents à cette association sont complexes. L'inflammation chronique est un facteur majeur d'athérosclérose accélérée, en association aux facteurs de risque CV traditionnels, conduisant à des lésions de la paroi artérielle, à la formation rapide de plaques d'athérome et à la thrombose. Les différents traitements symptomatiques et de fond exercent également une influence notable sur le risque CV. La gestion des différents facteurs de risque chez les patients atteints de rhumatismes inflammatoires chroniques devient donc cruciale pour prévenir les complications CV. Cela implique une approche multidisciplinaire incluant un contrôle efficace de l'inflammation, une surveillance attentive des facteurs de risque CV traditionnels, ainsi que des changements de mode de vie tels que l'arrêt du tabac, l'exercice régulier et une alimentation saine. Patients with rheumatoid arthritis and other rheumatic diseases have a higher risk of cardiovascular (CV) disease than the general population. The underlying mechanisms of this association are complex. Chronic inflammation is a major factor in accelerated atherosclerosis, in conjunction with traditional CV risk factors, leading to arterial wall damage, rapid atheroma plaque formation, and thrombosis. Various symptomatic and background treatments also exert a significant influence on CV risk. Therefore, managing different risk factors in patients with chronic rheumatic diseases becomes crucial to prevent CV complications. This involves a multidisciplinary approach, including effective inflammation control, careful monitoring of traditional CV risk factors, as well as lifestyle changes such as smoking cessation, regular exercise, and a healthy diet. [ABSTRACT FROM AUTHOR]

Some beneficial effects of statins have been demonstrated in vitro and in vivo , both experimentally and clinically, independently on their hypolipidemic effects. These "pleiotropic" effects are multiple: improved endothelial function, improved atherosclerotic plaque stability, reduced oxidative stress and inflammation, inhibition of the thrombogenic response and modulation of the immune system. Logically, numerous clinical trials have evaluated the benefits of a loading dose of statin, administered before and usually a few days after coronary reperfusion surgery. Unfortunately, all these trials evidenced a "neutral effect", i.e. no detectable beneficial effect. In June 2023, Liakopoulos et al. -published a perfectly designed and conducted clinical trial in the European Heart Journal , confirming the absence of significant effect of an oral statin load during and following surgical coronary revascularization. Lina Badimon et al. , undisputed experts in the field, point out in an editorial in the same issue that the plasma statin doses required to obtain pleiotropic effects are much higher than those needed to induce a reduction in plasma LDL levels. The metabolic effects of higher doses are different, leading to inactivation of G proteins, which in turn are responsible for the pleiotropic effects of statins. Experimental studies in large animals confirm that intravenous administration of a statin significantly reduces the size and severity of a myocardial infarction following coronary ligation. The authors therefore recommend validating, in humans, the feasibility and safety of a loading dose of statin administered intravenously during coronary reperfusion procedure. [ABSTRACT FROM AUTHOR]

Cardiovascular magnetic resonance has emerged as a very helpful tool for the interventional cardiologists not only in the assessment and treatment of coronary artery disease, but also in the evaluation of various structural cardiac diseases. The main pulse sequences are standardised, acquired during short breath-holds, and include steady-state free precession cines, dynamic myocardial first-pass perfusion imaging during contrast injection, and late enhancement imaging for the identification of myocardial substrates. Less than 30-minute CMR studies are now available for the most common clinical indications. More recently, T1 and T2 parametric myocardial maps are promising for detailed myocardial tissue characterisation (edema, replacement fibrosis, diffuse interstitial fibrosis). Technical aspects will not be addressed with particular emphasis on clinical applications. [ABSTRACT FROM AUTHOR]

Acute Coronary Syndrome (ACS) are one of the main causes of mortality in France. Patients presenting with ACS are typically hospitalized in a specialized cardiology ward. The main objective of this study was to describe, characterize and evaluate the outcome of patients hospitalized for ACS in a generalist intensive care unit (rather than a cardiac care unit). This was a retrospective study. Our population consisted of ACS patients admitted to an intensive care unit in a hospital center (Centre Hospitalier de Troyes) between 2012 and 2021. All patients admitted for ACS to the intensive care unit and who underwent coronary angiography were included. In 10 years, 104 patients, or 3.8% of ACS patients who underwent coronary angiography were admitted to intensive care. The majority were admitted after recovered cardiac arrest (72%) and were in cardiogenic shock (68%), accounting for a high in-hospital mortality (45.2%). In-hospital mortality was 45.2%. In multivariate analysis, the GRACE score was associated with in-hospital mortality (OR for each additional point = 1.024, 95% confidence interval 1.006–1.045, p = 0.01). Among the survivors, 88% had good neurological function when leaving the hospital. Mortality of ACS patients in intensive care was close to 50%. However, the neurological prognosis of the surviving patients was good. This population is rarely mentioned in the literature, and deserves to be evaluated by multicenter, prospective registries, with a view to improving management and prognosis. [ABSTRACT FROM AUTHOR]

Introduction: Acute Coronary Syndrome (ACS) are one of the main causes of mortality in France. Patients presenting with ACS are typically hospitalized in a specialized cardiology ward. The main objective of this study was to describe, characterize and evaluate the outcome of patients hospitalized for ACS in a generalist intensive care unit (rather than a cardiac care unit)., Methods: This was a retrospective study. Our population consisted of ACS patients admitted to an intensive care unit in a hospital center (Centre Hospitalier de Troyes) between 2012 and 2021. All patients admitted for ACS to the intensive care unit and who underwent coronary angiography were included., Results: In 10 years, 104 patients, or 3.8% of ACS patients who underwent coronary angiography were admitted to intensive care. The majority were admitted after recovered cardiac arrest (72%) and were in cardiogenic shock (68%), accounting for a high in-hospital mortality (45.2%). In-hospital mortality was 45.2%. In multivariate analysis, the GRACE score was associated with in-hospital mortality (OR for each additional point = 1.024, 95% confidence interval 1.006-1.045, p = 0.01). Among the survivors, 88% had good neurological function when leaving the hospital., Discussion: Mortality of ACS patients in intensive care was close to 50%. However, the neurological prognosis of the surviving patients was good. This population is rarely mentioned in the literature, and deserves to be evaluated by multicenter, prospective registries, with a view to improving management and prognosis., Competing Interests: Déclaration de liens d'intérêts Les auteurs déclarent n'avoir aucun lien d'intérêt en relation avec cet article., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Objective: Cardiovascular risk is increased in patients with diabetes. Little is known about glycemic and lipid control in patients with diabetes. We aimed to assess glycemic and lipid controls in patients with diabetes at time of their myocardial infarction., Method: All known patients with type 2 diabetes consecutively admitted for a myocardial infarction in our coronary care unit between March 1 st and December 31 st , 2021 were included in this retrospective study. Glycemic and lipid control was assessed through individualized target of glycated haemoglobin (HbA 1c ) and low-density lipoprotein cholesterol (LDL-c), respectively. At admission, the comprehensive list of chronic medications was obtained through medication reconciliation., Results: This study included 112 patients with a median age of 72 years. Most of patients had an individualized target of HbA 1c and LDL-c of 7.0% (67%) and 0.55g/L (96%), respectively. The rate of uncontrolled patients for HbA 1c and LDL-c and both was 46%, 90%, and 42% respectively. The rate of patients with non-optimal glucose- and lipid-lowering medications in uncontrolled patients was 63% and 87%, respectively. The rate of inappropriate glucose- and lipid-lowering medications was 73% and 91%, respectively., Conclusion: We highlighted the poor glycemic and lipid control in high-risk CV patients. There is an urgent need to develop multidisciplinary approaches to optimize CV risk factors control to reduce myocardial infarction and strokes., (Copyright © 2024. Published by Elsevier Masson SAS.)

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

We report a case of fatal myocardial infarction (MI) after electrocution in a 26-year-old male patient without cardiovascular risk factors. The patient was admitted to the Emergency Department of the University Clinics of Lubumbashi for management of accidental electrocution on a high-voltage power line. The admission ECG showed lesions consistent with myocardial infarction. Despite treatment, the patient died 30 minutes after admission. [ABSTRACT FROM AUTHOR]

From hypoglycemia to myocardial infarction: another particularity of diabetes Diabetic myocardial infarction can be completely silent. Hypoglycemia is rarely a circumstance of discovery unlike hyperglycemia and ketoacidosis which can mask myocardial infarction. We report the case of a 43-year-old patient with type 1 diabetes who had lipothymia at home that has shown hypoglycemia corrected after sugar intake, in whom a complicated acute myocardial infarction of the atrioventricular block was diagnosed. He benefited from the placement of a temporary pacemaker in emergency and revascularization of the right coronary seat of a thrombotic occlusion. [ABSTRACT FROM AUTHOR]

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Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Résumé: Le cannabis est la drogue illicite la plus consommée dans le monde, en Europe et en France. Son principal composé psychoactif est le delta-9 tétrahydrocannabinol (Δ-9-THC), classé comme stupéfiant. Si les effets psychiatriques et neuropsychiques du cannabis sont depuis longtemps largement décrits, les effets somatiques du cannabis fumé, notamment cardiovasculaires, ne sont rapportés que depuis peu avec des publications sur des infarctus du myocarde (IDM) du sujet jeune qui se sont multipliées depuis les années 2000. Les mécanismes impliqués dans la survenue des IDM restent hypothétiques, associant dysfonctionnement du système nerveux autonome, altération de la fonction plaquettaire, induction d'un vasospasme et effets toxiques directs des constituants de la fumée et des produits adultérins. La relation causale entre la consommation de cannabis et la survenue d'IDM reste sujette à débat. Cependant, parce qu'il s'agit de complications graves, touchant très majoritairement des hommes jeunes, pouvant entraîner le décès, et que l'existence d'une relation temporelle entre leur survenue et la prise de cannabis suggère fortement un lien de causalité, il serait prudent, malgré les limites des études mentionnées, d'informer les professionnels et les usagers sur l'existence possible de ce type de complication, notamment lors d'un usage chronique et en quantité importante, ce d'autant que l'on fait face à l'augmentation du nombre de consommateurs et aussi de la teneur en THC des produits consommés. Today, cannabis is the most frequently used psychoactive substance after alcohol and tobacco, particularly among young people, the main psychoactive constituent being 9-tetrahydrocannabinol (Δ-9-THC), responsible for the euphoric effects of cannabis. In parallel with increasing cannabis consumption and rising THC concentrations, a growing number of published case reports have described cannabis-induced adverse cardiovascular events such as myocardial infarction (MI). The literature suggests that cannabis use plays a role in inducing MI, particularly in young, otherwise healthy adults who present shortly after use. Increased autonomic stimulation, altered platelet aggregation, vasospasm, and toxic smoke constituents have all been proposed as explanations of this effect. However, it is likely that the true pathogenesis is multifactorial. As most studies are observational in nature, causality link, although not proven, is suggested by the existence of a temporal relation between occurrence of these complications and cannabis use. It would be desirable in cases of myocardial infarction of the young person, to systematically seek cannabis use. [ABSTRACT FROM AUTHOR]

• Dans une vaste cohorte nord-américaine de patients atteints de GPA et de GEPA, nous avons observé une incidence élevée d'infarctus du myocarde et d'AVC. • Les événements cardiovasculaires dans le contexte de la GPA et de la GEPA peuvent s'expliquer par une combinaison de facteurs de risque traditionnels et liés à la maladie. • L'âge relativement jeune de notre cohorte souligne l'importance du risque CV et de sa prise en charge dans toutes les classes d'âge dans la GPA et la GEPA. Les personnes atteintes de vascularite à ANCA présentent un risque accru d'événements cardiovasculaires. L'objectif de cette étude était d'évaluer les facteurs prédictifs d'événements cardiovasculaires chez des patients atteints de granulomatose avec polyangéite ou de granulomatose éosinophilique avec polyangéite. Il s'agit d'une étude longitudinale rétrospective menée sur des patients de la cohorte du réseau de recherche Canadian Vasculitis de Toronto. Les caractéristiques au moment du diagnostic ont été collectées. Pendant la période de suivi, les événements cardiovasculaires non mortels ont été déterminés à partir de l'indice VDI (séquelles liées à la vascularite) et la mortalité a été enregistrée avec les causes de décès. Des modèles de régression de Cox ont été élaborés pour identifier les facteurs prédictifs d'événements cardiovasculaires, définis comme un AVC ou un infarctus du myocarde. Au total, 336 patients ont été inclus : 231 (69 %) atteints de granulomatose avec polyangéite et 105 (31 %) de granulomatose éosinophilique avec polyangéite. L'âge moyen au moment du diagnostic était de 44 ans (± 18) et 44 % des patients étaient des hommes. Le taux d'incidence du critère combiné de l'ensemble des événements mortels et non mortels était de 7,2 événements pour 1000 années–patient. Dans un modèle multivarié, les antécédents familiaux d'événements cardiovasculaires et un score BVAS (Birmingham Vasculitis Activity Score) plus élevé au moment du diagnostic étaient prédictifs d'événements cardiovasculaires (odds ratio et intervalle de confiance à 95 % : 3,46 [1,06–11,28] et 1,09 [1,02–1,16], respectivement). Une analyse de sous-groupe n'a pas montré d'association entre les caractéristiques cardiovasculaires ou spécifiques à la maladie et la survenue d'événements cardiovasculaires dans la granulomatose éosinophilique avec polyangéite. Dans cette cohorte de patients atteints de granulomatose avec polyangéite et de granulomatose éosinophilique avec polyangéite, des facteurs de risque traditionnels et spécifiques à la maladie étaient prédictifs d'événements cardiovasculaires. Des études prospectives complémentaires devraient permettre de préciser leurs effets, ainsi que ceux d'autres facteurs de risque modifiables, sur le risque cardiovasculaire dans la vascularite à ANCA. [ABSTRACT FROM AUTHOR]

Post-infarction ventricular septal defect (PIVSD) is one of the most serious mechanical complications of acute myocardial infarction (AMI). Over the last decade, percutaneous closure is increasingly undertaken, with results similar to cardiac surgery. We present a case of ST-elevated anterior AMI, complicated by apical PIVSD successfully treated with transcatheter closure. An 83-year-old man was hospitalized for chest pain occurred 18 hours before, during the night time. He was an active smoker. Clinical examination revealed normal heart sounds and pulmonary bibasilar crackles. ST-segment elevation with deep T waves inversion in anterior leads were detected on the electrocardiogram. A mildly-reduced ejection fraction (40%) was found by transthoracic echocardiogram. The patient underwent emergency coronary angiography, which revealed a subocclusive stenosis of the mid left anterior descending artery with a TIMI 2 flow, treated by balloon angioplasty and drug-eluting stent. Four days after revascularization, the patient developed an acute deterioration with signs of decompensated heart failure and a new holosystolic murmur with large irradiation. Inotropic agents' administration was required to maintain a precarious hemodynamic condition. A bedside Echo revealed an apical VSD, measuring 15 × 10 mm, with left-to-right shunting, and pulmonary hypertension. The patient was scheduled for transcatheter PIVSD closure. The procedure was performed under fluoroscopic guide. Two vascular access sites were placed, femoral arterial and right internal jugular vein. Through the right internal jugular vein, a 24-mm Amplatzer atrial septal occluder on a 9 French Amplatzer TREVISIO™ intravascular delivery system was advanced via right ventricle into the PIVSD. Contrast fluoroscopy was used to assess apposition and the degree of shunt reduction before release. Echocardiographic evaluation performed 48 hours later confirmed a correct apposition of the device with insignificant residual shunt. At 6 months follow-up, he was asymptomatic, with unchanged prosthetic findings. Percutaneous closure has been emerged as a valid cost-effective alternative to surgery and should be advised. However, debate remains on the optimal preprocedural optimization, timing of repair and modality of treatment. [ABSTRACT FROM AUTHOR]

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We report the observation of an acute coronary syndrome in an 84-year-old woman evolving to an anterior myocardial infarction with persistent elevation of the ST segment (STEMI), without significant stenosis of the left descending coronary artery after manual aspiration of a distal thrombus. The diagnostic workflow secondary to this clinical condition of MINOCA (Myocardial Infarction with Non Obstructive Coronary Arteries), integrated, according to the very latest definition of myocardial infarction, in the infarcts subgroup type 2 (not linked to an athero-thrombotic event) led to the very high probability of the diagnosis of coronary embolism related to a chronic and untreated atrial fibrillation. The purpose of this article is to provide a formal and updated definition for the broadly labelled term MINOCA (incorporating the definition of AMI from the newly released "Fourth Universal Definition of Myocardial Infarction") and to provide a clinically useful framework and algorithms pertaining to the diagnostic evaluation and management of these patients. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Post-infarction ventricular septal defect (PIVSD) is one of the most serious mechanical complications of acute myocardial infarction (AMI). Over the last decade, percutaneous closure is increasingly undertaken, with results similar to cardiac surgery. We present a case of ST-elevated anterior AMI, complicated by apical PIVSD successfully treated with transcatheter closure., Case Report: An 83-year-old man was hospitalized for chest pain occurred 18 hours before, during the night time. He was an active smoker. Clinical examination revealed normal heart sounds and pulmonary bibasilar crackles. ST-segment elevation with deep T waves inversion in anterior leads were detected on the electrocardiogram. A mildly-reduced ejection fraction (40%) was found by transthoracic echocardiogram. The patient underwent emergency coronary angiography, which revealed a subocclusive stenosis of the mid left anterior descending artery with a TIMI 2 flow, treated by balloon angioplasty and drug-eluting stent. Four days after revascularization, the patient developed an acute deterioration with signs of decompensated heart failure and a new holosystolic murmur with large irradiation. Inotropic agents' administration was required to maintain a precarious hemodynamic condition. A bedside Echo revealed an apical VSD, measuring 15 × 10 mm, with left-to-right shunting, and pulmonary hypertension. The patient was scheduled for transcatheter PIVSD closure. The procedure was performed under fluoroscopic guide. Two vascular access sites were placed, femoral arterial and right internal jugular vein. Through the right internal jugular vein, a 24-mm Amplatzer atrial septal occluder on a 9 French Amplatzer TREVISIO™ intravascular delivery system was advanced via right ventricle into the PIVSD. Contrast fluoroscopy was used to assess apposition and the degree of shunt reduction before release. Echocardiographic evaluation performed 48 hours later confirmed a correct apposition of the device with insignificant residual shunt. At 6 months follow-up, he was asymptomatic, with unchanged prosthetic findings., Conclusion: Percutaneous closure has been emerged as a valid cost-effective alternative to surgery and should be advised. However, debate remains on the optimal preprocedural optimization, timing of repair and modality of treatment., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

La pandémie du COVID-19 a eu un impact inattendu sur les urgences cardiovasculaires, en particulier le SCA ST+. Le registre France PCI et d'autres études à travers le monde ont mis en exergue une baisse notable des infarctus arrivant dans les structures hospitalières. Cette baisse est principalement liée à la peur des patients de venir à l'hôpital et d'y être contaminés. Si les objectifs de délais de revascularisation du SCA ST+ (< 120 min) sont souvent difficiles à tenir en temps normal, ils ont été quasi impossibles à atteindre en période de confinement, tant les obstacles étaient nombreux. L'allongement des délais et du temps total d'ischémie a conduit à une surmortalité, notamment dans les régions les plus affectées par l'épidémie. Des recommandations de prise en charge des SCA ST+ en période de COVID-19 ont ainsi été édictées par les sociétés savantes. Les SCA ST+ chez les patients porteurs du COVID-19 ont souvent une présentation clinique particulière et l'absence d'obstruction coronaire à l'angiographie est fréquente. Leur pronostic est très sombre. Seules des campagnes d'information du public et une organisation adaptée à la prise en charge des urgences coronaires en période épidémique pourront tenter d'en limiter les effets et éviter d'aggraver à l'avenir une situation sanitaire déjà fragilisée. The COVID-19 pandemic had an unexpected impact on cardiovascular emergencies, particularly STEMI. The France PCI registry and other studies around the world have highlighted a significant decrease in myocardial infarctions arriving at hospital. This decrease is mainly related to patients' fear of coming to the hospital and being contaminated. Although the STEMI revascularisation time targets (< 120 min) are often difficult to achieve in normal times, they were almost impossible to achieve in periods of lockdown because of the many obstacles. Longer delays and longer total ischemic time have led to excess mortality, especially in the regions most affected by the epidemic. Recommendations for the management of STEMI during the COVID-19 period have thus been issued by the scientific societies. STEMI in patients with COVID-19 often have an uncommon clinical presentation, and the absence of coronary obstruction on angiography is frequent. Their prognosis is very poor. Only public information campaigns and an organisation adapted to the management of coronary emergencies during epidemics can try to limit their effects and avoid aggravating an already fragile health situation in the future. [ABSTRACT FROM AUTHOR]

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• We studied the association between Halloween and risk of myocardial infarction. • We included 54,699 adults with myocardial infarction. • The likelihood of myocardial infarction was higher the day after Halloween. • Excessive junk food at Halloween may lead to myocardial infarction in adults. [ABSTRACT FROM AUTHOR]

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L'intérêt pronostique à long terme du stress hyperglycémique et de l'HbA1c à la phase aiguë d'un infarctus du myocarde (IDM) chez les patients non diabétiques reste controversé. Issus de la base de données de l'obseRvatoire des Infarctus de Côte-d'Or (RICO), tous les patients non diabétiques admis consécutivement aux soins intensifs cardiologiques de Côte-d'Or pour IDM, de 2001 à 2016, ont été inclus (n = 6617). Le critère de jugement principal était la mortalité toutes causes à un an, chez les survivants à la phase hospitalière. Les seuils étaient déterminés par analyse des AUC des courbes ROC pour la prédiction de la mortalité toutes causes (HbA1c ≥ 5,9 % et Gp ≥ 131 mg/dL). Quatre groupes ont été définis : groupe 1 : HbA1c basse/Gp basse (n = 3158), groupe 2 : HbA1c basse/Gp haute (n = 1264), groupe 3 : HbA1c haute/Gp basse (n = 1378) et groupe 4 : HbA1c haute/Gp haute (n = 817). Les patients avec une Gp ≥ 131 mg/dL présentaient plus souvent une FEVG < 40 % (p < 0,001), un STEMI (p < 0,001), un IDM antérieur (p < 0,001), une altération du DFG < 60 mL/min/1,73m2 (p < 0,001) et un pic de troponine plus élevé (p < 0,001). Ceux avec une HbA1c et une Gp élevées avaient un taux plus élevé de décès (p < 0,001) et de MACE (p < 0,001) à un an. En analyse multivariée, une Gp et une HbA1c élevées à l'admission étaient indépendamment associées à la mortalité toutes causes à un an (OR [IC à 95 %] = 1,641 [1,311–2,053], p < 0,001 et OR [IC à 95 %] = 1,431 [1,153–1,776], p = 0,001 respectivement). Dans notre travail, la Gp et l'HbA1c à l'admission sont de puissants marqueurs prédictifs indépendants de la mortalité à un an chez les patients non diabétiques ayant présenté un IDM. Ces deux biomarqueurs pourraient permettre d'affiner la stratification du risque résiduel pour une optimisation de la prévention secondaire et une amélioration de la survie dans cette population. The usefulness of the combined assessment of HbA1c and plasma glucose (PG) in acute myocardial infarction (AMI) in non-diabetic patients remains unclear. In a large observational study, we aimed to identify the prognostic values of these biomarkers regarding one-year all-cause mortality in non-diabetic patients after AMI. From the "obseRvatoire des Infarctus de Côte d'Or" (RICO) survey database, we included all consecutive non-diabetic patients with AMI (n = 6617) from May 2001 to December 2016. Exclusion criteria were: admission known or unknown diabetes, in-hospital death. The primary endpoint was all-cause one-year mortality. The secondary endpoints were: MACE, infarct size, LVEF < 40% and GRACE risk score. Cut-off levels (high/low) were determined by ROC curve analysis for the prediction of one-year death (HbA1c 5.9% and PG 131 mg/dL) to set up 4 groups: low HbA1c/low glucose (n = 3158), low HbA1c/high glucose (n = 1264), high HbA1c/low glucose (n = 1378) and high HbA1c/high glucose (n = 817). Elevation of PG was associated with elevated rate of LVEF < 40%, STEMI, anterior wall location, DFG < 60 mL/min/m2 and higher troponin Ic pic (all P < 0.001); HbA1c > 5.9% was associated with elevated rate of CRP > 3 mg/L (P < 0.001); high HbA1c and high PG together were associated with higher rate of MACE (P < 0.001). By multivariate logistic regression analysis, elevated admission PG remained a strong predictor of one-year all-cause [OR (95%CI): 1.64 (1.31–2.05)] mortality and cardiovascular mortality [OR (95%CI): 1.75 (1.33–2.31)], beyond GRACE score [OR (95%CI): 1.03 (1.03–1.04)], as well as elevated HbA1c [OR (95%CI): 1.43 (1.15–1.78) and OR (95%CI): 1.83 (1.39–2.41) respectively]. Admission PG and HbA1c had strong independent predictive value regarding one-year all-cause mortality in our non-diabetic patients with AMI. These biomarkers could be useful to identify the most-at-risk patients after AMI in order to reduce residual risk in this target population. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Ces trente dernières années, les résultats de nombreuses recherches tendent à démontrer que la survenue d'un événement cardiovasculaire aigu, tel que l'infarctus du myocarde, peut être à l'origine du développement de symptômes de stress post-traumatique (SSPT) ou d'un trouble de stress post-traumatique (TSPT) qui, à leur tour, participent à une altération de la qualité de vie, de la santé psychique et contribuent à accroître le risque d'événements cardiovasculaires indésirables et de mortalité. Aussi utile et intéressant soit-il, le TSPT doit-il être considéré comme une entité nosographique suffisamment adaptée pour rendre compte, à elle seule, des troubles d'origine traumatique liés aux événements coronariens aigus ? Pour tenter de répondre à cette question, nous expliquerons, tout d'abord, pourquoi une cardiopathie coronaire s'étant manifestée sous la forme d'un événement aigu, à un moment donné, ne peut pas être considérée comme un événement potentiellement traumatique « comme les autres » : nous en préciserons les spécificités. Dans un second temps, nous montrerons que les personnes ayant survécu à un événement cardiaque aigu présentent des difficultés d'ordre traumatique dont la symptomatologie de stress post-traumatique, telle que définie par le DSM-5, ne témoigne pas totalement. Enfin, et compte tenu des limites du concept de TSPT à rendre compte de la complexité des traumatismes psychiques dans le champ de la psycho-cardiologie, et plus précisément dans celui des formes aiguës de cardiopathies ischémiques, nous proposerons quelques pistes de réflexion visant à enrichir la conceptualisation du traumatisme psychique dans ce domaine. Over the past thirty years, the results of a large number of studies have shown that the occurrence of an acute cardiovascular event, such as myocardial infarction, can lead to the development of symptoms of post-traumatic stress disorder (PTSD) or post-traumatic stress disorder (PTSD), which in turn contribute to an impairment in quality of life, psychological health and increase the risk of cardiovascular adverse events and death. However useful and interesting it may be, PTSD should be considered as a nosographic entity sufficiently adapted to account, on its own, for traumatic disorders related to acute coronary events? To answer to this question, we will first explain why an acute cardiovascular event, such as a myocardial infarction, cannot be considered a potentially traumatic event "like any other": we will describe its specific features. In a second step, we will show that people who have survived to myocardial infarction present traumatic difficulties for which the symptomatology of post-traumatic stress, as defined by the DSM-5, does not fully reflect. Finally, and given the limitations of the concept of PTSD in addressing the complexity of psychological trauma in the field of psycho-cardiology, and more specifically in the context of acute forms of ischemic heart disease, we will propose some avenues for reflection aimed at enriching the conceptualization of psychological trauma in this field. [ABSTRACT FROM AUTHOR]

La mort subite à un âge jeune est vécue comme un phénomène dramatique nécessitant la connaissance de son incidence. Notre étude a pour objectifs de décrire les particularités épidémiologiques de la mort subite cardiaque d'origine ischémique chez le sujet jeune dans la population d'étude et de discuter son implication dans la survenue du décès. Dans ce travail, le sujet jeune a été défini comme toute personne âgée de 1 an à 35 ans pour les sujets de sexe masculin, et jusqu'à 45 ans pour les sujets de sexe féminin. Il s'agit d'une étude descriptive, rétrospective, exhaustive, concernant 312 cas de mort subite chez le sujet jeune colligés au service de médecine légale de l'hôpital universitaire Fattouma Bourguiba de Monastir-Tunisie, durant une période de 23 ans. Les données recueillies ont été saisies et traitées à l'aide du logiciel SPSS 20. Le taux de significativité a été fixé à 0,05. Trente-deux cas de mort subite cardiaque d'origine ischémique ont été recensés. L'infarctus du myocarde (IDM) représentait la deuxième cause de mort subite du sujet jeune après la cardiomyopathie hypertrophique. La prédominance masculine était nette. La tranche d'âge la plus touchée était celle entre 25–45 ans. La mortalité par IDM est survenue plus fréquemment au repos. Une coronaropathie a été objectivée dans vingt-quatre cas (75 %). L'IDM est survenu sur des artères coronaires saines dans huit cas. Une anomalie du trajet, en particulier le pont myocardique, a été trouvée dans huit cas (25 %). Le « screening » toxicologique était négatif dans tous les cas. La prévention doit intéresser toute la population avec une éducation sur les moyens des mesures générales d'hygiène de vie et de prévention des facteurs de risques cardiovasculaires à long terme, ainsi que le dépistage clinique orienté au moindre signe d'appel. Sudden cardiac death in young is seen as a dramatic phenomenon requiring knowledge of its impact. We aim to study the epidemiological characteristics of sudden cardiac ischemic death in young, and to discuss his involvement in the occurrence of death. We performed a retrospective cohort study using autopsy data from the department of forensic medicine of the University Hospital of Fattouma Bourguiba, Monastir-Tunisia. A review of all autopsies performed during 23 years was done. In each case, clinical information and circumstances of death were obtained. We have included all sudden death in persons aged between 1 year and 35 years for the male and from one year to 45 years for female. We collected 312 cases of sudden death during the studied period. The collected data were processed using SPSS 20. The significance level was set at 0.05. Thirty-two cases of cardiac ischemic sudden death have been collected. Myocardial infarction was the second cause of sudden death in young patients. There was a male predominance. The most affected subjects were aged between 25–45 years. The death occurred more frequently at rest. Coronary artery disease has been discovered in twenty-four cases (75%). The myocardial infarction occurred on healthy coronary arteries in eight cases. An anomalous course of coronary arteries, in particular myocardial bridging, was found in eight cases (25%). Toxicological screening was negative in all cases. Identifying epidemiological characteristics of sudden cardiac ischemic death in this population is important for guiding approaches to prevention that must be based on dietary hygienic measures and the control of cardiovascular risk factors. [ABSTRACT FROM AUTHOR]

Résumé: Les bêtabloquants font partie de l'ordonnance classique du patient coronarien, comme les antiagrégants plaquettaires ou les statines. Pourtant, s'il existe des preuves nombreuses et formelles du bénéfice pronostique en prévention secondaire des antiagrégants et des statines, ce n'est pas le cas pour les bêtabloquants. L'objectif ici est de resituer l'action des bêtabloquants dans la physiopathologie de l'athérome coronaire et de ses complications, et de refaire un point sur les données factuelles de la littérature et des dernières recommandations de la Société Européenne de Cardiologie, afin de remettre à jour et adapter la place des bêtabloquants dans la prise en charge quotidienne de nos patients coronariens. Betablockers are part of the classic prescription of the coronary patient, like antiplatelet agents or statins. However, if there is numerous and formal evidence of the prognostic benefit in secondary prevention of antiaggregants and statins, this is not the case for beta-blockers. The objective here is to re-situate the action of beta-blockers in the pathophysiology of coronary atheroma and its complications, and to review the factual data in the literature and the latest recommendations of the European Cardiology Society, in order to update and adapt the place of beta-blockers in the daily care of our coronary patients. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The WAMIF study was conducted from 2017 to 2019 to include 314 patients in 30 French investigative centers in France. We have systematically collected the clinical, morphological and biological characteristics of cases of myocardial infarction affecting women under 50 years of age and evaluated their short-term (intra-hospital) and mid-term (at 12 months) prognosis.. The main results were: a particularly high incidence of modifiable risk factors affecting 86% of patients with smoking in the first place in 75% of them. The clinical presentation revealed chest pain in more than 90% of cases. The pathophysiological forms of acute coronary syndrome identified the culprit artery in 90% of cases, MI without obstruction (MINOCA) was found in 17.8% of the ST elevation MI (STEMI), spontaneous dissection in 14.6% of STEMI and 16.3% of NSTEMI. Hospital events included 3 strokes, 3 cases of bleeding and no deaths. At 12 months, follow-up showed no cardiovascular deaths. The results of this study allow us to better understand the particularities of cardiovascular diseases in women and thus to develop targeted strategies for prevention and improvement of their management. [ABSTRACT FROM AUTHOR]

The French PCI Registry collects up to 150 clinical, procedural, and one-year follow-up data on all coronary angiographies and angioplasties performed in the 61 participating centers in September 2023. Thanks to the support of the GACI, the DGOS, the ARS, and numerous hospitals, the registry is continuing to expand its coverage across the entire territory, with 90 centers expected to participate in 2024, accounting for nearly half of the French centers. The high quality of this data has already led to the publication of 18 studies in international journals, and around twenty others are currently being written. The online publication of comprehensive and comparative annual reports, along with the implementation of quality indicators to assess practices, would enhance the performance of all participating centers and ultimately benefit our coronary patients. [ABSTRACT FROM AUTHOR]

The French PCI Registry collects up to 150 clinical, procedural, and one-year follow-up data on all coronary angiographies and angioplasties performed in the 61 participating centers in September 2023. Thanks to the support of the GACI, the DGOS, the ARS, and numerous hospitals, the registry is continuing to expand its coverage across the entire territory, with 90 centers expected to participate in 2024, accounting for nearly half of the French centers. The high quality of this data has already led to the publication of 18 studies in international journals, and around twenty others are currently being written. The online publication of comprehensive and comparative annual reports, along with the implementation of quality indicators to assess practices, would enhance the performance of all participating centers and ultimately benefit our coronary patients., Competing Interests: Déclaration de liens d'intérêts None, (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

The WAMIF study was conducted from 2017 to 2019 to include 314 patients in 30 French investigative centers in France. We have systematically collected the clinical, morphological and biological characteristics of cases of myocardial infarction affecting women under 50 years of age and evaluated their short-term (intra-hospital) and mid-term (at 12 months) prognosis. . The main results were: a particularly high incidence of modifiable risk factors affecting 86% of patients with smoking in the first place in 75% of them. The clinical presentation revealed chest pain in more than 90% of cases. The pathophysiological forms of acute coronary syndrome identified the culprit artery in 90% of cases, MI without obstruction (MINOCA) was found in 17.8% of the ST elevation MI (STEMI), spontaneous dissection in 14.6% of STEMI and 16.3% of NSTEMI. Hospital events included 3 strokes, 3 cases of bleeding and no deaths. At 12 months, follow-up showed no cardiovascular deaths. The results of this study allow us to better understand the particularities of cardiovascular diseases in women and thus to develop targeted strategies for prevention and improvement of their management., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Résumé Contexte Le nombre de sujets âgés traités pour syndrome coronaire aigu avec sus-décalage du segment ST (SCA ST +) est en augmentation. Néanmoins, il est possible que leur prise en charge ne soit pas optimale par rapport aux sujets jeunes. L'objectif de cette étude est de décrire la démographie, les caractéristiques cliniques et le pronostic intrahospitalier des patients de plus de 75 ans traités par angioplastie primaire pour SCA ST+. Méthodes Revue rétrospective des dossiers de tous les patients admis pour SCA ST+ entre janvier 2012 et décembre 2017. Les données cliniques, biologiques, échocardiographiques, et angiographiques recueillies pendant l'hospitalisation ont été collectées et comparées entre les groupes ≥ 75 ans et < 75 ans. Résultats Cinq cent soixante-huit patients dont 99 (17,4 %) âgés de 75 ans ou plus ont été admis pour un SCA ST+. Les sujets âgés de plus de 75 ans avaient un délai de prise en charge entre l'heure du début des symptômes et l'heure de la revascularisation myocardique plus élevé (7,30 ± 1,16 vs 4,77 ± 0,36 heures, p = 0,0391), avaient comme deuxième antiagrégant plaquettaire plus fréquemment du clopidogrel (55,6 % vs 24,8 %, p < 0,0001) et ont reçu significativement moins de traitements par anti-GP2B3A (44,8 % vs 23,2 %, p < 0,0001). Il existe une tendance à une mortalité intrahospitalière accrue, bien que non statistiquement significative (4,04 % chez > 75 ans vs 1,5 % < 75 ans, p = 0,0847). Les sujets âgés avaient un tableau clinique plus sévère avec une fraction d'éjection du ventricule gauche postinfarctus plus basse (44,42 ± 1,38 vs 49,07 ± 0,49, p = 0,0019). Ils ont également été moins traités par stent actif (51,5 % vs 73,9 %, p < 0,0001). Conclusion Les sujets âgés de plus 75 ans représentent une proportion non négligeable des patients admis pour SCA ST+. Ces patients ont une présentation clinique plus sévère avec un pronostic moins favorable que les sujets jeunes. Leur délai de prise en charge reste plus important et leur traitement sous-optimal, notamment en termes d'utilisation de nouveaux inhibiteurs des P2Y12 et d'angioplastie par stent actif. Abstract Background The number of older adults treated for ST-segment elevation myocardial infarction (STEMI) is increasing. Nevertheless, their treatment might not be as optimal as younger adults. This study sought to evaluate demographic evolution, clinical characteristics and in-hospital outcomes of patients of patients aged 75 years-old or older treated by primary angioplasty for STEMI. Methods Retrospective study of all consecutive patients for STEMI between January 2012 and December 2017. Their clinical, biologic, echocardiographic and angiographic data, as well as in-hospital outcomes were collected and compared between two groups: younger and older than 75 year-olds. Results Five hundred and sixty-eight patients including 99 (17.4%) 75 year-old or older were included in the present study. Patients aged 75 or older had an increased delay of treatment between the time of the chest pain onset and revascularization (7.30 ± 1,16 vs 4.77 ± 0,36 hours, P = 0.0391), they were more frequently treated with clopidogrel rather than more potent anti P2Y12 antiplatelet therapies (55.6% vs 24.8%, P < 0.0001) and received less frequently anti-GP2B3A therapy (44.8% vs 23.2%, P < 0.0001). There was a trend for increased in-hospital mortality in the older group, despite non statistically significant (4.04% vs 1.5%, P = 0.0847). Older adults had a worse clinical status with decreased post-STEMI left ventricular ejection fraction (44.42 ± 1,38 vs 49.07 ± 0,49, P = 0,0019). They were also less treated with drug-eluting stents (51.5% vs 73.9%, P < 0.0001). Conclusion Adults aged 75 years-old or older represent a subsequent proportion of patients admitted for STEMI. They had a worse initial clinical presentation associated with worse prognostic, as compared to younger adults. They experience delayed reperfusion therapy and suboptimal treatment as compared to younger adults. [ABSTRACT FROM AUTHOR]

Résumé: L'anémie est une condition fréquemment retrouvée chez les patients admis pour un infarctus du myocarde (IDM), en particulier chez les personnes âgées. S'il apparaît bien établi que le taux d'hémoglobine est un prédicteur indépendant d'événements cardiovasculaires chez ces patients, l'intérêt de la transfusion de culots globulaires dans ce contexte n'est pas encore tranché. Certains mécanismes pourraient expliquer que la transfusion soit délétère, en particulier par une augmentation de la thrombogénicité, de la réponse inflammatoire, de l'activation plaquettaire et de la dysfonction endothéliale. Seuls deux essais de petite taille ont évalué une stratégie de transfusion « restrictive » ou « libérale » chez des patients admis pour IDM et leurs résultats se sont révélés contradictoires. De même, les données observationnelles sont également discordantes, probablement en rapport avec de nombreux facteurs confondants. Deux larges essais randomisés sont en cours : l'essai REALITY (étude française pilotée par le groupe académique FACT) et l'essai MINT (étude nord-américaine). Les résultats de ces essais permettront d'établir l'intérêt de la transfusion chez les patients anémiques admis pour un IDM et ainsi d'adapter notre pratique clinique dans ce groupe de patients à haut risque. Anaemia is a frequent condition in patients presenting with acute myocardial infarction (MI), in particular among elderly patients. If the haemoglobin level appears as an independent predictor of adverse cardiac events, the impact of transfusion in this context remains however unclear. Several reasons could explain that transfusion could be pejorative in patients with MI: increase in thrombogenicity, inflammatory response, platelet activation and endothelial dysfunction. Only two small randomized trials have compared a "restrictive" vs a "liberal" transfusion strategy, yielding contradictory results. Observational data are also discordant, probably due to multiple confounding factors. Two randomized controlled trial are currently assessing this critical issue: the REALITY trial (a French trial conducted by the FACT academic group) and the MINT trial (a North American trial). Results of these two trials will allow to establish the interest of transfusion in anaemic patients presenting with MI and therefore to improve management of this high risk subset of patients. [ABSTRACT FROM AUTHOR]

Widely spread, and continuously increasing, recreational drug use in general population has been associated with cardiovascular events, as illustrated by clinical studies and supported by a pathophysiological rationale. Understanding the cardiovascular effects of drugs, screening, and secondary prevention are crucial components in the management of those patients in cardiology. [ABSTRACT FROM AUTHOR]