0387 : Incidence and predictors of the late catch-up phenomenon after drug-eluting stent implantation

PurposeAlthough clinical restenosis within 1year after percutaneous coronary intervention has been remarkably reduced with the advent of drugeluting stents (DES), the late catch-up (LCU) phenomenon remains an issue despite medical advances. The aim of this study was to investigate the incidence and predictive factors of the LCU phenomenon in an unselected population treated with DES.Materials and MethodsA total of 936 lesions treated with DES between June 2002 and June 2010 were analyzed. The LCU phenomenon was defined as secondary revascularization 1 year after index stenting.ResultsIncidence of the LCU phenomenon was seen in 103 lesions (11,04%). In the multivariate analysis, severe calcifications [odds ratio (OR) 6.07, p=0.017], restenosis lesion (OR 1.58, p=0.003), and long lesions (OR 2.06, p=0.031) were identified as independent predictors of the LCU phenomenon.ConclusionThe LCU phenomenon is associated with serious consequences and adverse events and remains an important issue in modern practice, despite medical advances. Special consideration must be given to patients with restenosis lesion, long lesions and severe calcifications

0495: Clinical impact of second-generation everolimus eluting stent compared with first-generation sirolimus-eluting stent in diabetes mellitus patients

PurposeThis study sought to study the second-generation everolimuseluting stent (EES) as compared with first-generation sirolimus-eluting (SES) in diabetes mellitus (DM) patients.MethodsAll DM patients treated with EES or SES from January 2010, to December 2011 were included. The EES was compared with SES for the primary composite endpoint of clinically driven detected restenosis, definite stent thrombosis (ST), and all-cause mortality.ResultsIn 226 percutaneous coronary intervention-treated DM patients, 353 stents were implanted (EES 118, SES 235). The EES was associated with significantly lower restenosis rates compared with SES (SES vs. EES: 16.7% vs. 2.8%, p=0,001, OR: 2.96; 95% CI: 1.57 to 5.57). Lower incidence of ST (SES vs. EES: 2,1% vs 0,8%, p=0,38) and mortality (SES vs. EES: 1,7 % vs 0%, p=0,15) was noted but did not reach statistical significance.ConclusionsIn all-comer DM patients the use of EES was associated with improved outcomes compared with SES mainly driven by lower rates of clinically driven detected restenosis

0275: Diagnosis, complications and management of infective endocarditis: experience of Tunisian military hospital

BackgroundInfective endocarditis (IE) is lethal if not aggressively treated with antibiotics alone or in combination with surgery. The epidemiology of this condition has substantially changed over the past four decades, especially in industrialized countries. Once a disease that predominantly affected young adults with previously well-identified valve disease – mostly chronic rheumatic heart disease – IE nowadays tends to affect older patients and new at-risk groups, including intravenous-drug users, patients with intracardiac devices and degenerative valvular heart disease…ObjectivesWe aimed to evaluate demographic data, underlying cardiac abnormalities, clinical profile, microbiological features, treatments and complications of IE.MethodsA retrospective study of all cases with the diagnosis of definite endocarditis according to Duke Criteria admitted to The Tunisian Military Hospital between January 2001 and December 2007.ResultsThe study included 53 patients (32 males and 21 females; mean age 44.5±16.5 years). Infective endocarditis developed on a native valve in 48 patients (90%), a mechanical prosthetic valve in 5 patients (5%). Rheumatic heart disease in 26 cases (49%) was the most common preexisting valvular abnormality in native valve endocarditis. The mitral valve was the most commonly affected valve 23 (43.4%). Fever occurred in 50 (94%) of the cases. Trans-thoracic and/or trans-esophageal echocardiography showed vegetation and/or abcess in 33 patients (62.2%). Streptococci in 17 cases (32%) and Staphylococci in 13 cases (24%) were the most common causative agents. Twenty-six patients (49%) underwent surgical treatment. Cardiac complications occurred in 13% of cases, vascular complications in 18% of cases, cerebrovascular accidents in 15% of cases and septic metastatic complications in 15% of cases.ConclusionsIE usually occurred on rheumatic heart disease. Its diagnosis is based on hemocultures and echocardiography. There are deficiencies in applying prophylaxis, which is a justification for the improvement of patient management through education

0144: Depression and anxiety in coronary artery bypass grafting patients: comparisons with percutaneous intervention

BackgroundAnxiety and depression are two common psychic entities among coronary patients. They are often sub-diagnosed. Several studies demonstrated that they aggravated the morbi-mortality of the coronary patient. The objective of this study was to quantify the anxiety and the depression in coronary artery bypass grafting patients (CABG), to determine the effect of the revascularisation and to find a relation between depression and morbimortality.Method64 patients were admitted for a coronary event and divided in two groups. PTCA (N=34) and CABG (N=30). The anxiety and the depression were measured by two scales of psychological self-assessment (HAD, BDI) in three time; T1 (To the announcement of the disease), T2 (3 weeks after the revascularisation) and T3 (3 months later). A comparative study between 2 groups was realized.ResultsTwo groups were comparable on the sociodemographic plan and the risk factors. The cardiovascular histories of myocardial infarction and coronary angioplasty were frequent in the PTCA groups and CABG. The average of the day number of hospitalization was of 7.5±3.9 days for the PTCA group and 10.3±7.4 days for the CABG group. The psychological evaluation in the admission showed scores of anxiety raised in two groups and depression raised only in the group CABG. The myocardial revascularisation had a positive effect on the psychological state of the patients of the groups PTCA and CABG. The evolution of the psychological scores showed that the patients of the group surgery were more depressed and that the patients of the group angioplasty were more anxious. For the group PTCA, the average duration of survival without revascularisation was of 26 months in the absence of depression, against 21 months in its presence. For the group CABG, the average duration of survival without revascularisation was of 27 months in the absence of major depressive episode, against 16 months in its presence.ConclusionThe depression and the anxiety are two frequent symptoms in the ischemic heart disorder. The depression is a factor of bad forecast at CABG patients. The early screening is important for setting up appropriate therapeutic

Multimodality imaging assessment of a caseous calcification of the mitral valve annulus

Caseous calcification of the mitral annulus (CCMA) is a rare echocardiographic finding. It is commonly misdiagnosed as an abscess, tumor or infective vegetation on the mitral valve. Since it is a benign process, differentiating it from malignant intra-cardiac mass is primordial to avoid unnecessary surgery. Various imaging modalities can be complimentary for definitive diagnosis. We present a case of CCMA in a 71-year-old female patient. Her medical history revealed hypertension, diabetes mellitus, hyperlipidaemia and coronary artery disease. She was referred to our department for coronary catheterization because of angina symptoms upon minimal exertion. The lesion was detected during echocardiography and was defined as a mass of heterogeneous content with calcification points, located at the posterior side of the mitral valve annulus. Restricted motion of the posterior leaflet and the mass effect caused only minimal mitral regurgitation. To establish the correct diagnosis, we performed the full spectrum of noninvasive cardiac imaging modalities. Transesophageal echocardiography identified well-organized, composite lesion with regular edges, markedly calcified margins and more echolucent central portion. A computed tomography (CT) was performed, showing a hyperdense mass with hypodense center and a calcified peripheral rim located at the posterior mitral ring. Cardiac magnetic resonance imaging (MRI) showed that the mass was hypointense with respect to the myocardium in the T1 and T2-weighted sequences and only presented late-phase enhancement in the surrounding capsule. Based on the CT and MRI findings, the diagnosis of CCMA was established. The patient was managed conservatively

Cardiac tamponade: an uncommon presenting feature of systemic lupus erythematosus (a case-based review)

Although pericarditis is the most prevalent cardiac involvement in systemic lupus erythematosus (SLE), cardiac tamponade is extremely infrequent notably as the first manifestation of the disease. Here we report the case of a 22-year-old woman presenting with cardiac tamponade as the initial presentation of SLE