057 A simple prediction score for significant renal artery stenosis in patients with coronary artery disease

BackgroundRenal artery stenosis (RAS) is a strong independent predictor of mortality in patients (pts) with coronary artery disease (CAD).Aim of studyTo develop and validate a score predicting RAS in patients with CAD.MethodsThree hundred consecutive pts (50 females) with significant CAD underwent abdominal aortography following coronary angiography to screen for significant RAS defined as luminal narrowing of > 50%. Univariate and multivariate analyses were performed comparing pts with and without RAS. Significant factors associated with RAS were included in constructing a score that predicts RAS.The score was internally validated in pts randomly selected from the entire study group (validation group; n=103), using ROC curves and the Hosmer-Lemeshow goodness-of-fit test.ResultsTwenty-seven pts (9%) had a significant RAS. Univariate predictors of significant RAS were: age > 65 years (OR=4.5, p < 0.0001), hypertension (OR=3.6, p=0.001), and female gender (OR=3.6, p=0.015). We found a tendency of more prevalent renal insufficiency (37.1% vs. 21.5%; p=0.05) and the presence of 2 or more significant CAD lesions (70.4% vs. 50.9%; p=0.05) in pts with RAS.Multivariate analysis showed that age > 65 years (OR=4.1%, 95% CI=1.6-10.3, p=0.003) and hypertension (OR=3.1, 95% CI=1.2-7.7, p=0.015) were independent predictors of RAS. The ranged from 0 to 7: 2 points for age > 65 years and hypertension 1 point for female gender, renal insufficiency, and > 3-vessel disease). Internal validation showed a good performance (ROC curve = 0.79 and Chi2 Lemeshow = 3.45). For a score < 2, the negative predictive value is 98%. Applying this criteria, 48.3% of our population would not require systematic abdominal angiography.ConclusionThe performance of our predictive score was good, and significant reduction in the need to perform systematic abdominal aortography could be expected with the use of this score

211: Left atrial flutter occurring after atrial fibrillation ablation: ablation using remote magnetic navigation versus manual technique

IntroductionLimited data exist on the efficacy and safety of remote magnetic navigation (RMN) ablation of iatrogenic left atrial flutter (LAF) occurring after atrial fibrillation (AF) ablation.MethodsLAF ablation procedures (proc) were reviewed. Patients (pts) were divided into 2 groups (gr): RMN gr if proc were performed remotely using the Niobe system (Sterotaxis) and conventional gr (CON) if proc were performed with manually driven catheters. Open-irrigated 3.5mm-tip catheters were used in all pts. Activation LA maps were realized in all pts using Carto or EnSite). Acute (defined as sinus rhythm- SR- resumption during ablation) and long-term (defined as SR maintenance) proc success, proc duration, fluoroscopy and radiofrequency (RF) times, and the mechanism of arrhythmias were studied.ResultsIn 46 pts (38 males, 60.8±10.19 y) 57 LAF ablation proc were performed. Age and LA size were similar. Activation maps showed: a unique macro-reentrant circuit 46%, multiples successive macro-reentrant circuits 26%, focal pulmonary vein tachycardia 9%, micro-reentrant circuit 19%. Results are showed in the table. Complications occurred in 3 proc: 1 in the RMN gr (groin hematoma) and 2 in the CON gr (1 transient ischemic attack and 1 cardiac perforation with tamponade). Perimitral flutter that occurred at any stage of the proc was associated with significantly higher rate of acute failure (persistent perimitral flutter at the end of the proc, both gr): 44% vs 12% for other types of flutter, p=0.02.RMN (n=25)CON (n=32)pAcute success80%78%0.86Proc/pt1.2±0.51.2±0.80.74Long-term success (follow-up 12.5±11.3 months)81%66%0.44Fluoroscopy748±377 s1086±772 s0.05Proc time236±68 min201±72 min0.06RF time1291±880 s1181±897 s0.70ConclusionAs compared to manual proc, RMN guided ablation for LAF after AF ablation provides comparable acute and long-term success rate but is potentially safer

Colocolic Intussusception in an Adult Patient Secondary to Caecal Adenocarcinoma

Acute intestinal invagination is the pathology of infants and small children. Its occurrence in adults is rare, and it represents 1 to 5% of intestinal occlusions often leading to the discovery of an organic cause that may be tumor. We report the case of a 72-year-old patient admitted to the emergency room of Ibn Sina Rabat, Morocco, for intestinal occlusion. The abdominal CT scan showed a voluminous intestinal invagination on a very probable heterogeneous digestive mass. The treatment was an open right hemicolectomy. The histopathological examination of the surgical specimen concluded a colonic well-differentiated adenocarcinoma with a 30% mucinous component. By review of literature, we discuss diagnostic and therapeutic procedures in emergency