Delay of fibrinolysis in St- elevation myocardial infarction: Results of an investigation conducted in a single center in Sousse Tunisia

Background: The aim of our study was to assess the delay of fibrinolysis in ST elevation myocardial infarction (STEMI) in our region and to identify characteristics associated with prolonged delay. Patients and Methods: We analyzed clinical characteristics of a prospective cohort of unselected patients admitted for (STEMI). The study was conducted over three years 2007-2009 and 250 patients were included in a single center without capability of percutaneous coronary intervention. Results: The mean age of our patients was 58±13, 7 years. Ninety percent of our patients consult directly the emergency department and 61, (5%) of them were admitted within first 6 hours of onset of symptoms. Median time to reperfusion was 46 min. Predictor of this long delay to initiate fibrinolysis were inter-department decision OR 6; 95% CI 3,48-10,34, diabetes OR 2,25; 95% CI 1,28-3,96 age >58,4 years OR 1,97; 95% CI 1,19-3,25 and transfer from regional hospital to our center OR 1,78; 95% 1,03-3.07. Conclusion: These results suggest that improvement in organization health care system can shorten delay to fibrinolysis in a center without percutaneous coronary intervention capability

264: Myeloperoxidase, hs CRP and endothelial dysfunction in cardiovascular risk assessment in diabetic and hypertensive patients

IntroductionSeveral inflammatory markers have been associated with a greater likelihood of cardiovascular diseases. Of those C-reactive protein (CRP) and myeloperoxidase (MPO) are the most well known.The development of sensitive rapid tests for MPO and hs-CRP, together with a simple hand-held reader promises to open up the possibility of identifying high-risk patients early enough for the introduction of prophylactic therapies or the adoption of beneficial life-style changes.ObjectivesWe propose to evaluate the cardiovascular risk for 50 hypertensive and diabetic patients by rapid tests for MPO and hs-CRP and to compare with endothelial function and Framingham score.ResultsWe evaluate prospectively 50 patients without cardiovascular events, the mean age is 53 years, 78% have mean or high CV risk according to the Framingham score and 38% presenting endothelial dysfunction.The statistical analysis showed a significant association between the rate of hs-CRP, the Framingham score (p=0,02, r=0,424), with the metabolic syndrome (p=0,0001), and endothelial dysfunction (p=0,001).MPO level is correlated with the sex (p=0,002), age (p=0,05), as well with the Framingham score (r=0,345), the metabolic syndrome (p=0,001), the endothelial dysfunction (p=0,001), and also with the LDL cholesterol. (p=0,04; r=0,3).In the same way, a significant Correlation was shown between hs-CRP and MPO (p=0,016; r=0,34).The hs-CRP test showed a good specificity (85%), and VPP (96%), a weak VPN (27%).However MPO test showed a low specificity (25%) low sensitivity (25%), VPP of (73%) and a low VPN (5%).ConclusionThe hs-CRP represents the inflammatory marker most relevant in the prediction of risk CV, better than the MPO.These markers reflect the clinical potential of atherothrombotic disease may allow more precise risk stratification and prognostication in high-risk populations, and perhaps earlier diagnosis and intervention in patients at risk for or with occult cardiovascular disease

A retrospective study from a single center to compare outcomes in 79 patients with in-stent restenosis treated with paclitaxel-coated balloon angioplasty or drug-eluting stent implantation

Abstract Background Despite the recent progress made in drug-eluting stents (DESs), in-stent restenosis (ISR) is still a common complication of percutaneous coronary interventions. This retrospective study from a single center aimed to compare outcomes in 79 patients with ISR treated with paclitaxel-coated balloon (PCB) angioplasty or DES implantation. Results From January 2017 to December 2021, 83 ISR lesions from 79 patients were included. Thirty-two were treated with PCB and 51 treated with available DES in the catheterization laboratory. Baseline characteristics were similar in both groups. Mean time between index angioplasty and restenosis was 27 months with a minimum of 4 months and a maximum of 70 months. Concerning Mehran ISR angiographic classification, classes II and III were more likely treated with DES. Stenosis diameter and minimal lumen diameter (MLD) were similar in both groups. PCB used was significantly shorter than DES: Mean length was 19.75 ± 5.7 versus 22.1 ± 16.5 (p < 0.001), respectively. Angiographic results immediately after intervention were similar in both groups: In-segment MLD after the procedure was 2.5 ± 0.4 in the DES group and 2.26 ± 0.55 in the PCB group. A median follow-up of 20 months was achieved for 68 patients, and 11 were lost to follow-up. There was also no difference in both groups regarding free from events survival. Conclusions The findings from this study support recent international studies that have shown no significant differences between DES and PCB and in-stent restenosis. This suggests that PCB use is an option to consider in our local daily practice