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Introduction: Atrial fibrillation (AF) is one of the most common causes of ischemic stroke. It is essential to target patients at highest risk of AF detected after stroke (AFDAS), who should benefit from a prolonged rhythm screening strategy. Cardiac-CT angiography (CCTA) was added to the stroke protocol used in our institution in 2018. We sought to assess, for AFDAS, the predictive value of atrial cardiopathy markers by a CCTA performed on admission for acute ischemic stroke. Patients and Methods: From November 2018 to October 2019, consecutive stroke patients with no history of AF were included. Let atrial volume (LAV), epicardial adipose tissue (EAT) attenuation and volume, and LAA characteristics were measured on CCTA. The primary endpoint was the presence of AFDAS at follow-up, diagnosed by continuous electrocardiographic monitoring, long-term external Holter monitoring during hospital stay, or implantable cardiac monitor (ICM). Results: Sixty of the 247 included patients developed AFDAS. Multivariable analysis shows independent predictors of AFDAS: age >80 years (HR 2.46; 95%CI (1.23–4.92), p = 0.011), indexed LAV >45 mL/m2 (HR 2.58; 95%CI (1.19–5.62), p = 0.017), EAT attenuation > −85HU (HR 2.16; 95%CI (1.13–4.15), p = 0.021) and LAA thrombus (HR 2.50; 95%CI (1.06–5.93), p = 0.037). Added consecutively to AFDAS prediction AS5F score (combining age and NIHSS >5), these markers had an incrementally better predictive value compared with the global Chi2 of the initial model ( p = 0.001, 0.035, and 0.015 respectively). Discussion and conclusion: Adding CCTA to the acute stroke protocol to assess markers of atrial cardiopathy associated with AFDAS may help to better stratify the AF screening strategy, including the use of an ICM.

Coronary artery embolism (CAE) is a rare, non-atherosclerotic cause of acute myocardial infarction (MI). Atrial fibrillation (AF) is the most frequent cause of CAE, and can be associated with multiple embolisms, particularly in the brain.To characterize CAE-related myocardial injury, assess the proportion of cardiocerebral infarction and characterize brain injuries associated with dual embolism.In this prospective study, patients with CAE-associated MI underwent (1) cardiac magnetic resonance imaging (MRI) to assess the extent of infarct transmurality and myocardial necrosis size and (2) brain MRI to assess the proportion of simultaneous cardiocerebral infarction. We screened 1401 consecutive patients with de novo acute MI from January 2019 to June 2021. CAE was diagnosed based on clinical, angiographic and diagnostic imaging criteria.Overall, 29/1401 patients presented with CAE (2.1%), of whom 21 underwent cardiac and cerebral MRI. Of these, nine (43%) had an ischaemic stroke, and AF was the leading cause of CAE in 14 patients (67%). Multiple CAE were common at coronary angiography (33%). Four patients (19%) had left atrial appendage thrombus - 4/9 patients (44%) with a stroke but 0/12 patients without a stroke. On cardiac MRI, the median (interquartile range) number of segments with acute infarction was 3 (0-11) in patients with stroke and 3 (1-6) in those without. Most acute ischaemic strokes (78%) were localized in the superficial sylvian territory and only 2/21 patients (10%) had stroke sequelae.MI-related to CAE was associated with infarctions of average size but multiple locations. Systematic brain MRI revealed that 33% of cases were associated with a stroke, which was generally asymptomatic. Further studies are required to better characterize the pathophysiology, clinical course and prognostic value of CAE. Moreover, optimal management strategies remain to be determined.

Performing a cardiac CT scan before ablation provides a better understanding of the anatomical variations of the left atrium and pulmonary veins, as well as an analysis of coronary anatomy and the calcium score. The aim of the present study was to determine whether the CT characteristics of patients with unknown CAD have an impact on recurrence of AF. This monocentric retrospective study included patients with AF who had undergone cardiac CT prior to a single ablation. Among the 229 patients included in the study, 70 (30.5%) presented AF recurrence between 3 and 12 months after a single ablation. The prevalence of CAD confirmed by CT coronary angiogram and the coronary calcium score were similar in the two groups. Patients with recurrent atrial fibrillation had a significantly higher LAVI evaluated by CT scan than patients without recurrence. The ROC curve determined an optimal LAVI threshold of 49 mL/m2. In multivariate analysis, the LAVI measured by CT scan was independently associated with the risk of AF recurrence. Our study confirms that CAD is not a predictor of AF recurrence after a single ablation, unlike the LAVI. Further studies are necessary to re-evaluate the long-term conclusions of this work.

Background Detection of left atrial appendage thrombus (LAAt) in acute stroke patients can be improved by cardiac computed tomography using prospective electrocardiogram-gated volume acquisition, which was added to the acute stroke computed tomography protocol in our institution in 2018. Aims To evaluate the factors and clinical management associated with LAAt in patients with acute ischemic stroke. Methods We retrospectively included 324 consecutive patients with ischemic stroke from November 2018 to October 2019. Clinical data and post-stroke management were compared in LAAt and no-LAAt patients. Results Thirty-five patients (10.8%; 95%CI 7.4–14.2) had LAAt and 289 had no-LAAt. LAAt patients were significantly older (82 ± 12 vs. 74 ± 14 yo for no-LAAt, p = 0.002), predominantly female (71% vs. 45%, p = 0.004), and were more likely to have previous atrial fibrillation (63% vs. 15%, p 86 ml (odds ratio 5.33; 95%CI 1.70–16.69, p = 0.004) were independently associated with LAAt. More than a third of LAAt patients (37%) received acute heparin therapy compared to 13% of no-LAAt patients (p Conclusions Cardiac computed tomography for left atrial appendage thrombus evaluation in routine acute stroke imaging protocol could be beneficial for decision-making with regard to the initiation of early anticoagulation.

The occurrence of coronary artery embolism (CE) has been associated with various clinical conditions, including aortic and mitral prosthetic heart valve implantation, atrial fibrillation (AF), dilated cardiomyopathy, neoplasia, infective endocarditis, atrial septal defect, cardiac tumors, and hypercoagulable states. CE is also a rare cause of myocardial infarction (MI), with a prevalence of about 5%, a figure probably underestimated. The purpose of this article was to determine the current state of knowledge on acute coronary syndrome (ACS) related to CE. We thus performed a comprehensive structured literature search of the MEDLINE database for articles published between 1 January 1990 and 31 December 2021. The diagnosis of CE remains difficult despite the currently used Shibata classification, which is based on major criteria, including angiographic characteristics: globular filling defects, saddle thrombi or multiple filling defects and absence of atherosclerosis in the coronary arteries. Suspected or confirmed CE requires the identification of an etiology. There are only two published series on CE, including about 50 cases each. The three main causes in these series were: 1) atrial fibrillation (73% vs 28.3%), 2) cardiomyopathy (9.4% vs 25%) and 3) malignancy (9.6% vs 15.1%). Finally, 26.3% of the MI patients with CE had no identifiable cause of CE. When anatomically possible, analyzing the thrombus after thrombectomy may help. MI due to CE requires systematic assessment of other locations, i.e. multiple coronary and extracardiac locations. Simultaneous systemic embolization to the brain (67%), limbs (25%), kidneys (25%) or spleen (4%) is frequent, occurring in approximately 25% of CE-related MI. In the setting of acute MI, CE is associated with significant morbidity and mortality. Coronary artery thromboembolism is a rare, non-atherosclerotic, cause of ACS, and prospective studies are needed to evaluate a systematic diagnostic approach and personalized therapeutic strategies.

Background: Few data are available about brain natriuretic peptide (BNP) variation and left atrial remodeling after the left atrial appendage occlusion (LAAO) technique. Methods: Prospective study included all consecutive patients successfully implanted with an LAAO device. Contrast-enhanced cardiac computed tomography (CT) was performed before and 6 weeks after the procedure with reverse left atrial remodeling defined by an increase in LA volume &gt, 10%, together with blood sampling obtained before, 48 h after device implantation and at the first visit after discharge (30–45 days) for BNP measurement. Results: Among the 43 patients implanted with a complete dataset, mean end-diastolic LA volume was 139 ± 64 mL and 141 ± 62 mL at baseline and during follow-up (45 ± 15 days), respectively, showing no statistical difference (p = 0.45). No thrombus was seen on the atrial side of the device. Peridevice leaks (defined as presence of dye in the LAA beyond the device) were observed in 17 patients (40%) but were trivial or mild. Reverse atrial remodeling (RAR) at 6 weeks was observed in six patients (14%). Despite no difference in BNP levels on admission, median BNP levels at 48 h were slightly increased in RAR patients when compared with controls. During FU, BNP levels were strictly identical in both groups. These results were not modified even when each RAR case was matched with two controls on age, LVEF, creatinine levels and ACE inhibitors treatment to avoid potential confounders. Conclusion: Our study showed that despite the fact that the LAAO technique can induce left atrial remodeling measured by a CT scan, it does not seem to impact BNP levels on the follow-up. The results need to be transposed to clinical outcomes of this expanding population in future studies.

Background Atrial Fibrillation (AF) is a common cause of ischemic stroke but also the most common cause of Coronary Artery Embolism (CE). Many previous case of coexistence of coronary and cerebral embolism have been reported in the literature but in specific situations were clinical signs of stroke but also indisputable clinical and/or electrocardiographic (ECG) signs leaded to the realization of coronarography in emergency. Objectives The aim of the study was to determine the existence of simultaneous cardio-cerebral embolization associated in patients with ischemic embolic stroke on de novo AF, in the absence of clinical and/or ECG signs evocative of myocardial infarction (MI). Methods We prospectively included patients hospitalized in our institution for ischemic embolic stroke on de novo AF. Patients with history of ischemic disease were excluded. All patients had: 1/ troponin assay; 2/ Cardiac Magnetic Resonance (CMR) imaging with Late-Gadolinium Enhancement (LGE) in order to detect myocardial infarction; 3/ coronary exploration by cardiac CT scan or coronarography to exclude patients with significant coronary lesion. Results Between January and December 2019, 32 patients were included. Of them, 15 had subendocardial or transmural LGE on CMR, evocative of MI. Among these 15 MIs we classified acute MIs according to the level of troponin at the admission in stroke unit, the coronarography and T2 hypersignal on cardiac MRI. Median delay of cardiac MRI was 6 days for acute MIs. CE was clearly identified by coronarography for 4 patients with acute simultaneous cardio-cerebral infarction (56%). The MRI abnormalities showed that lesions of all MIs were transmural, relatively small (average 1.3±0.44 segments) and in most cases in the inferior cardiac wall (47%) and these abnormalities were comparable in sequelae and acute MI. Moreover, the left appendage morphology was a “cactus” in 62.7% of simultaneous acute cardio-cerebral infarction and only 33% in patients without MI or sequelae MI. Strokes were mainly localized in the superficial territory of the middle cerebral artery, and were similar in patients with or without MI. In addition, the rate of sequelae strokes was higher in isolated stroke group than “cardiocerebral infarction” (29.5% versus 13.3%). Conclusion Simultaneous acute cardio-cerebral infarction is not uncommon, diagnosed in 22% of our prospective cohort of embolic stroke. Cardiac MRI may help us to diagnose a concomitant cardiac embolization and evaluate the prognosis. Unfortunately optimal therapeutic strategy of these patients is still unknown. Flow Chart Funding Acknowledgement Type of funding source: None

Background Cardioembolic factors are responsible for 20–30% of ischemic strokes, especially atrial fibrillation (AF) through left atrial appendage (LAA) thrombus formation. The aim of the present study was to evaluate the prevalence and associated factors of LAA thrombus (LAAt) in patients with acute ischemic stroke by adding a cardiac CT during the initial imaging, and their early management and outcome accordingly. Methods From November 2018 to October 2019, 875 consecutive patients admitted with stroke like symptoms in the emergency department of our institution were included. All patients underwent a stroke CT protocol including a non-enhanced brain CT, a brain perfusion if necessary, a carotid CT angiography, a cardiac CT and a post-contrast brain CT. The cardiac CT was performed with a prospectively ECG gated volume acquisition. Results Among 324 strokes confirmed, 35 LAAt patients (11%) and 289 no LAAt patients were analysed. Compared to no LAAt patients, LAAt patients were significantly older (82 ± 12 vs. 74 ± 14 years old, P = 0.002), predominantly female (71% vs. 45%, P = 0.004) and more often had previous AF history (63% vs. 15%, P Conclusion This study highlights the contribution of cardiac CT, in addition to the usual brain CT in acute stroke imaging protocol in routine practice, for LAA thrombus evaluation. Such a strategy could be helpful for making decision with regard to early anticoagulation initiation. Further studies are needed to assess the impact on patients’ outcome.

International audience; BackgroundThe most common cause of myocarditis is viral infection, especially from cardiotropic viruses (Parvovirus B19, Human Herpesvirus 6 and Coxsackie) resulting in a destruction of the myocardium. Moreover, a serological analysis is not systematic and their value remains unclear. The objectives of this study were to assess the viral serology of the patients with acute myocarditis and the relation with clinical and CMR parameters at the acute phase and at distance.MethodsAll cases of infarct-like acute myocarditis confirmed by CMR from April 2012 to January 2018 were included in a prospective study at Dijon University Hospital. A blood sampling including viral serology is obtained at the moment of the diagnostic. One-year follow-up included a complete clinical and rhythmic evaluation, and a CMR control.ResultsAmong the patients with “infarct like” acute myocarditis, serological analyses were performed in 62 patients and cardiotropic viruses are found in 29 patients. No statistical difference was observed regarding demographic and clinical parameters. However, concerning CMR parameters, the extent of myocarditis is more important in the “cardiotropic viruses” group at the acute phase (10.4 vs. 7.3 – P=0.05) and at three months (6.3 vs. 2.7 – P=0.007) compared to the “no cardiotropic viruses” group. At one year, there was no significant difference between the two groups regarding CMR parameters.ConclusionCardiotropic viruses (HHV6, Parvovirus B19 and Coxsackie virus) were found in almost 50% of cases in “infarct like” acute myocarditis. According the presence or absence of cardiotropic viruses, CMR parameters were different. Furthermore, use of quantitative PCR (detection of viral genomes) or detection of viral DNA and RNA via in situ hybridization would be a challenge for the future identification of viruses in myocarditis.

Background Familial hypercholesterolaemia is a well-known disorder, but clinical diagnoses tend to be delayed. Acute coronary syndrome may occur in childhood. Case summary Our patient, a young boy with homozygous familial hypercholesterolaemia, complained of persistent chest pain at rest and suffered a non-ST-elevation myocardial infarction (NSTEMI). The diagnosis of NSTEMI was made on the basis of his clinical features, dynamic electrocardiogram changes, troponin elevation, and cardiac computed tomography findings. The patient was managed surgically by intrathoracic artery (ITA) bypass graft. During post-operative follow-up, the young patient suffered from angina pectoris from unexpected and exceptional atheroma stenosis on the ITA. Discussion Familial hypercholesterolaemia needs to be identified quickly in young patients and lipid lowering therapies should be started without delay.

Introduction Cardiac Magnetic Resonance (CMR) has emerged as a reference tool for the non-invasive diagnosis of myocarditis but its role in follow-up (FU) after the acute event is unknown. Objectives To assess the evolution of CMR parameters between the acute phase of infarct-like myocarditis and 12 months thereafter, and to identify the predictive factors of persistent myocarditis at one year and the long-term prognosis of this infarct-like form. Methods All patients with infarct-like acute myocarditis confirmed by CMR (with typical non-ischemic late gadolinium enhancement (LGE)) were included from April 2012 to January 2017 in this prospective single-center study at Dijon University Hospital. CMR was performed within 7 days following symptom onset, at 3 months and one year after the acute event. One-year FU included ECG, a cardiac stress test, Holter recording, biological assessments, medical history and a quality of life questionnaire. Patients were classified according to the presence or absence of complete healing at one-year, based on the CMR evaluation. Results In total, 85 patients were included. At one year, 44 patients (52%) exhibited persistent myocarditis on CMR. Multivariate analysis showed that high peak troponin at the acute phase (OR 8.2–95%CI 1.63–41.20–P = 0.011) and the initial extent of LGE (OR 1.1–95%CI 1.02–1.23–P = 0.019) were independent predictors of persistent myocarditis at one year. No patients experienced major adverse cardiac events (cardiac death or serious rhythm disorders). Moreover, patients with persistent myocarditis were more likely than patients with complete recovery to have premature ventricular contractions during the cardiac stress test (31% versus 6%, P = 0.006). Conclusion Less than 50% of patients with infarct-like acute myocarditis showed complete healing at one year. Although no MACE were found, these results thus highlight the importance of maintaining long-term FU in patients with infarct-like myocarditis.

Elevated troponin levels are found in a significant number of patients who are diagnosed with acute embolic stroke (AES) after first diagnosed atrial fibrillation (AF). These myocardial injuries, which are known as cardiocerebral infarction (CCI), are potentially caused by coronary embolism and correspond to simultaneous cardiac and cerebral embolisms. However, this severe condition remains poorly understood. In this prospective study, we aimed to investigate the prevalence and the cardiac magnetic resonance (CMR) characteristics of CCI.Consecutive patients with first diagnosed AF hospitalized for AES in a neurovascular intensive care unit from 2019 to 2020 were included. Troponin Ic kinetic were measured72 h, MRI and coronary angiography or CT scan were performed7 days after admission. Patients with significant coronary lesions were excluded.During the study period, 1150 patients with strokes were hospitalized in the neurovascular intensive care unit (ICU). Of these patients, 955 had an ischemic stroke and 97 had a transient ischemic attack. Among the 44 patients with AES and with first diagnosed AF, 34 patients underwent CMR and CMR analysis identified 12 MI. A significant rise in troponin (0.10 µg/L) was observed in 35% of the total population (12/34 patients). More specifically, a rise was seen in 23% of the AES without MI group, 58% of the AES with MI. In addition, coronary embolism was identified in 3 patients who underwent coronary angiography (3/12) and MI was often (30%) localized in infero-latero-medial and infero-apical segments. Most AES were localized in the superficial sylvian territory.We found a high prevalence of CMR-confirmed double embolization sites in the acute phase of an embolic stroke. Further studies are required to better characterize the pathophysiology, clinical course and prognostic value of CCI. Moreover, optimal management strategies, including antiplatelet therapy, remain to be determined.

Background The persistence of symptoms after infarct-like acute myocarditis remains unclear. The objectives of this study were to identify the predictive factors of persistent symptomatic patients at one year in “infarct like” myocarditis. Methods All patients with infarct-like acute myocarditis confirmed by CMR (with typical non-ischemic late gadolinium enhancement (LGE)) were included from 2012 to 2018 at Dijon University Hospital. CMR was performed in the acute phase, at 3 months and 1 year after the acute event. One-year FU included ECG, cardiac stress test, Holter recording, biological assessments, medical history and a QoL questionnaire. Patients were classified according to symptoms (chest pain or dyspnea) at one year. Results 111 patients were included. At one year, 31% of the patients report symptoms while 53% of them had persistent myocarditis on CMR. Among symptomatic patients, 23% reported intermittent chest pain and 20% reported dyspnea. One patient experienced cardiac death before the one-year CMR control and had persistent myocarditis at 3 months. The predictive factors of persistent symptoms at 1 year were left ventricular dysfunction (P = 0,005) and wall abnormalities (P = 0,005) on one year CMR, and hospitalization in the year (P = 0,002). Nevertheless, symptomatic patients more often had beta blocker treatment than asymptomatic patients (17% vs. 48%, P = 0,001). The initial extent of LGE and persistent myocarditis on CMR at one year didn’t seem to be predictors of the persistence of symptoms. Conclusion On third of patients with “infarct like” acute myocarditis reported persistent symptoms at 1 year while less than 50% of patients showed complete healing at one year. Persistent symptoms appear to be more related to left ventricular dysfunction than persistent myocarditis, and are associated with greater cardio-protective therapy. These results thus highlight the importance of maintaining long-term FU in patients with infarct-like myocarditis.

Background Antinuclear antibodies (ANA) are often positive in patients with “infarct like” acute myocarditis. The objectives of this study were to compare the course of “infarct like” acute myocarditis depending on the presence or absence of ANA at diagnosis. Methods All cases of infarct-like acute myocarditis, revealed as an acute coronary syndrome with chest pain, elevated troponin levels and ECG changes, from 2012 to 2018, were included at Dijon University Hospital. The diagnosis of myocarditis was based on clinical symptoms and was confirmed by cardiac magnetic resonance (CMR). CMR was performed in the acute phase, at 3 months and one year after the acute event. A blood sampling including ANA test is obtained at the moment of the diagnostic. Results Among the patients with “infarct like” acute myocarditis, the ANA assay was performed in 83 patients. In 45 patients (54%), ANA were detected, with a median peak of 160 (n Conclusion Antinuclear antibodies (ANA) are present in patients with “infarct like” acute myocarditis in more than 50% of cases. According to the presence or absence of ANA, the CMR profile is different, both on initial extent and on recovery at distance of the acute phase. These results demonstrate that the presence of ANA, even without other manifestations of an autoimmune disease, influence or affect the course of “infarct like” acute myocarditis.

Introduction The role of cardiac magnetic resonance (CMR in the follow-up after the acute myocarditis is unknown. The objectives of our study were to assess the evolution of CMR parameters between the acute phase of infarct-like myocarditis and 3 months thereafter. Methods All patients with chest pain associated with acute myocarditis confirmed by CMR [with typical delayed myocardial enhancement after gadolinium injection (LGE)] were included from April 2012 to October 2016. CMR was performed within 7 days following symptom onset and 3 months thereafter. Results Eighty-five patients were included. The predominant location of LGE was anteroseptoapical in nine patients, infero-lateral in 63 patients and diffuse in 13 patients. Twenty-one patients (25%) had no significant ( 10% of the LV was significantly associated with absence of significant LGE regression at 3-month follow-up (OR: 3.52, 95%CI: 1.06–11.72, P = 0.041). Moreover, when compared with patients experiencing significant LGE regression, those without significant LGE regression 3 months after the first CMR more often had adverse remodeling of the left ventricle as assessed by a delta end-systolic volume > 10% (43% vs 16%, P = 0.012). Conclusion Three months after acute “infarct-like” myocarditis, a high proportion of patient had no significant reduction in LGE extent. The relationship between 3-month CMR findings and the onset of clinical and functional outcomes at one-year follow-up will be evaluated soon.

IF 2.558; International audience; Stroke is a serious complication after acute myocardial infarction (AMI) and is associated with an increased risk of death. Though the pathophysiological mechanisms are not exactly known, increased inflammation and platelet reactivity could play an important role in the occurrence of stroke during AMI. We aimed to investigate the relationship between both mean platelet volume (MPV), a parameter of platelet function, and C-reactive protein (CRP) and the occurrence of in-hospital ischemic stroke (IHS) after AMI. Data were obtained from a French regional survey for AMI that included 5976 patients admitted to an intensive care unit (ICU) between 2001 and 2010. Patients were divided into two groups according to the occurrence of IHS. MPV, platelet count (PC), and CRP were routinely measured at admission to the ICU; 99 (1.6%) IHSs were recorded during hospitalization after admission for AMI. In multivariate analysis, IHS was independently associated with a history of stroke (OR: 1.99%, CI: 1.1-3.49, p = 0.01), impaired left ventricular ejection fraction 10 mg/l (OR: 2.19, 95% CI: 1.44-3.33, p < 0.001), and MPV/PC ratio (OR: 1.04, 95% CI: 1.01-1.08, p = 0.023). Compared with the first to fourth quintiles, the last quintile of the MPV/PC ratio was associated with higher rates of IHS on survival curve analysis (p = 0.014). At hospital admission, a high MPV/PC ratio and a high level of CRP might help to identify patients at increased risk of IHS. Moreover, these results provide new insights into the potential role played by increased inflammation and platelet reactivity in the occurrence of stroke after AMI.

PurposeStroke is a serious complication after acute myocardial infarction (AMI) and is closely associated with poor prognosis. This study aimed to investigate the frequency, the characteristics and factors associated with in-hospital and postdischarge stroke in patients with AMI.Methods8485 consecutive patients admitted in intensive care unit (ICU) between January 2001 and June 2010 were included. Among other major adverse cardiac events (MACE), both stroke and transient ischemic attack (TIA) were collected during one-year follow-up.Results168 (1.98%) strokes were recorded during the first year of follow-up after AMI. In-hospital strokes (IHS) occurred in 123 patients (1.4%), and 87% of them in the first five days after admission in ICU. After multivariate logistic regression analysis, IHS was independently associated with female sex (OR: 1.73, 95% CI: 1.19-2.51, p=0.004), previous stroke/TIA (OR: 2.21, 95% CI: 1.28-3.83, p=0.004), LVEF (OR: 0.96, 95% CI: 0.95-0.98, p

Background The SYNTAX score was developed to characterize the degree and the complexity of coronary anatomy. Since then, many studies have demonstrated the prognostic value of the SYNTAX score and the « residual » SYNTAX score (SYNTAX score after PCI) in patients who suffered an acute coronary syndrome. Aims The relationship between the « residual » SYNTAX score and myocardial ischemia assessed by gSPECT at 6 months after acute coronary syndrome has not yet been established. Methods 245 consecutive patients admitted for acute myocardial infarction between January 2009 and December 2010 who underwent percutaneous coronary intervention were prospectively included. The SYNTAX score and « residual » SYNTAX score were assessed before and after PCI, respectively. Six months after discharge, a post-stress/rest 99 mTc-sestamibi gated-SPECT was performed. Results Patients were divided into two groups according to « residual » SYNTAX score tertiles: 81 patients >4 (highest tertile) vs. 164 patients ≤4 (lowest and mean tertiles). On perfusion data there were significant differences for significant ischemia (SDS>1) (48% vs. 35%, p = 0.043) and post-stress LVEF 4 (OR: 3.49, 95% CI: 1.06-11.51; p=0.04) and post-stress LVEF Conclusions Six months after acute myocardial infarction, a « residual » SYNTAX score >4 was associated with myocardial ischemia and post-stress LVEF

PurposeStroke is a serious complication after acute myocardial infarction (AMI) and is associated with an increased risk of death. However, the increased use of evidence-based therapies (ASA, P2Y12 and statins) has reduced the risk of stroke during the last decade. Whereas the pathophysiological mechanisms are not exactly known, increased inflammation and platelet reactivity could play an important role in the occurrence of stroke during the acute phase of MI. We aimed to investigate the relationship between the mean platelet volume (MPV), a parameter of platelet function, the C-reactive protein (CRP), and the occurrence of in-hospital ischemic stroke (IHS) after AMI.MethodsData were obtained from a French regional survey for AMI, including 5976 patients admitted in intensive care unit (ICU) between 2001 and 2010. Patients were divided in 2 groups according to the occurrence of IHS. MPV, platelet count and CRP were routinely measured from blood samples drawn at admission in ICU.Results87 (1.4%) IHS were recorded during the hospitalization period after admission for AMI. After Cox multivariate regression, IHS was independently associated with history of stroke (OR: 2.26, 95% CI: 1.26-4.06, p=0.006), LVEF10mg/l (OR: 2.56, 95% CI: 1,64-4.01, p

ObjectivesWe assessed the interest of systematically using the GRACE scoring system (in addition to clinical assessment) for in-hospital outcomes and bleeding complications in the management of NSTEMI compared with clinical assessments alone.MethodsMulticentre, randomized study that included 572 consecutive NSTEMI patients, randomized 1:1, into group A: clinical stratification alone and group B: clinical+ GRACE score stratification.Main Outcome MeasuresIn-hospital outcomes and bleeding complications.ResultsThere was no significant difference between the two groups for baseline data or for in-hospital MACE. In multivariate analysis, only a GRACE >140 (OR: 3.5, 95% CI: 1.8-6.6, p140, and these patients were significantly older, and were more likely to have a history of diabetes, stroke and renal failure, together with symptoms of heart failure. After multivariate analysis, the independent predictors of a lack of compliance with guideline delays were a GRACE score >140 (OR: 9.2; CI: 4.2-20.3, p