047 Coronary angioplasty of the chronic total occlusion. Outcome and study of the Balance Risc and Benefit. A study of 62 cases

Percutaneous coronary intervention (PCI) of the coronary chronic total occlusion (CTO) is widely discussed because of the difficulty and the risks of the procedure and the controversial but very interesting clinical benefit in case of procedure success.ObjectiveTo evaluate the in-hospital and long-term clinical outcome of PCI in the case of CTO and measure the adverse effects and complications.Methods62 cases of PCI for a CTO were consecutively registered from January 2005 to February 2009. In addition to an assessment of the technical characteristics and procedural outcomes, patients were followed for occurrence of major adverse cardiac events (MACE). These patients are distributed in two groups: (A) for the occlusion between 1 and 3 months age and (B) for the occlusion of more than 3 months age.Results68 lesions were treated in these 62 patients (47 male and 15 female) with mean age of 59 years (40-80). 42% of theses patients were diabetics, 48% smoker and 26% with hypertension. 27 patients had an ST elevation acute coronary syndrome (ACS) and 24 a non ST elevation ACS, where 2 had stable angina. Balloon angioplasty was performed in only 4 cases and the stenting in 58 cases with use of 64 stents (average of 1.1 stent / artery and of 1.2 stent / patient), we used drug eluting stent in only 10 case (15.6%). Total procedure success rate, defined by a patent artery (less then 30% residual stenosis) with TIMI 3 flow (grade 3) at the end of the PCI was 83% (57/68). The success was better in the group A 90% (29/32) then the group B 77% (28/36) (P<0.05). The most frequent cause of procedure failures was unsuccessful crossing with the wire in 6 cases and no severe acute complications were done. Theses CTO required long procedures with an average time of fluoroscopy of 30 ‘13’, an average calculated dose radiation DAP of 20611 cGy / cm2 and a high mean amount of contrast media 289.46 ml. At the preliminary clinical results, patients with successful PCI of a CTO had a significantly better clinical outcome than those whose PCI was unsuccessful

Management of patients with acute ST-elevation myocardial infarction: Results of the FAST-MI Tunisia Registry.

BackgroundThe FAST-MI Tunisia registry was set up by the Tunisian Society of Cardiology and Cardiovascular Surgery to assess the demographic and clinical characteristics, management and hospital outcome of patients with ST-elevation myocardial infarction (STEMI).MethodsData for 459 consecutive patients (mean age 60.8 years; 88.5% male) with STEMI, treated in 16 public hospitals (representing 72.2% of public hospitals in Tunisia treating STEMI patients), were collected prospectively.The most common risk factors were smoking (63.6%), hypertension (39.7%), diabetes (32%) and dyslipidaemia (18.2%).ResultsAmong the 459 patients, 61.8% received reperfusion therapy: 30% with primary percutaneous coronary intervention (PPCI) and 31.8% with intravenous fibrinolysis (IF) (28.6% with pre-hospital thrombolysis). The median time from symptom onset to thrombolysis was 185 min and to PPCI was 358 min. In-hospital mortality was 5.3%. Compared with those managed at regional hospitals, patients managed at interventional university hospitals (n = 357) were more likely to receive reperfusion therapy (52.9% vs. 34.1%; pConclusionsData from the FAST-MI Tunisia registry show that a pharmaco-invasive strategy of management for STEMI should be promoted in non-interventional regional hospitals