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Recent studies have suggested that oral administration of acetylcysteine could prevent the reduction in renal function induced by radiographic contrast agents in patients with chronic renal failure. Our prospective, controlled, open-label study included 100 consecutive patients with baseline serum creatinine > 1.5 mg/dl and intravenous hydratation who underwent coronary angiography. Baseline and peak post-procedure serum creatinine levels during the following 46 hours were compared in 50 patients with acetylcysteine (600 mg bid, before and after administration of the contrast agent) and 50 patients without acetylcysteine. The baseline clinical characteristics, creatinine levels (Z.l+/-1.2 YS 1 .a+/-0.4 mgldl) and constrast volume (171+/-72 vs 162+/-63 ml) of the 2 groups were similar. The mean changes in creatinine after 24 and 46 hours were -O.l+/-0.2 and O+/0.3 mgldl in the acetylcysteine group vs O+/-0.2 and 0~1-0.4 mgidl in the control group (NS). A contrast-agent-induced renal dysfunctioq, defined as 25% increase in creatinine levels, occurred in 2 patients of the acetylcysteine group and 2 patients of the control group. Conclusions : A contrast-agent-induced renal dysfunction is rare in patients with intravenous hydratation and low volumes of contrast-agent. Our study does not confirm the prophylactic effect of acetylcysteine in the prevention of contrast-agent-induced reduction in renal function after coronary angiography.

BACKGROUND The effect of mechanical reperfusion of the infarction-related artery on ventricular late potentials (VLP) continues to be debated. OBJECTIVE To assess the influence of successful late coronary angioplasty on the prevalence of VLP after acute myocardial infarction (AMI). METHODS We studied 113 consecutive patients (97 men, 16 women, mean age 57 +/- 10.8 years) in whom the infarction-related artery was occluded (thrombolysis in myocardial infarction score 0 or 1) at the time of the initial coronary arteriography 10.9 +/- 6.4 days after a first AMI. Successful late angioplasty of the infarcted artery was performed in 55 patients a mean of 11.5 +/- 7.2 days after AMI. The remaining 58 patients received a conservative treatment. Signal-averaged electrocardiograms (SAECGs) were recorded 25 +/- 10.2 days after AMI. Multivariate analysis was undertaken to assess the influence of late coronary angioplasty with respect to age, sex, infarction site, angiographic ejection fraction, extent of diseased coronary arteries, thrombolysis and time of recording the SAECG. RESULTS The overall prevalence of VLP was 27%. It was greater in patients without than in those with angioplasty (40% compared with 15%, P = 0.017). Multivariate analysis demonstrated that successful angioplasty (odds ratio 3.2; P = 0.019) and ejection fraction >0.4 (odds ratio 5.1; P = 0.0051) were the strongest independent predictors of an absence of VLP. 'Non-inferior' myocardial infarction was also correlated with the absence of VLP (odds ratio 2.6), but with borderline significance (P = 0.053). CONCLUSION When performed in an occluded, infarction-related artery, successful late coronary angioplasty contributes to a significant decrease in the prevalence of VLP.

Aim: We report the long-term outcome of aortic and mitral bioprostheses in patients over 65 years of age at the time of implantation. The aim was to determine actuarial patient survival, causes of death, and the rate of documented primary structural deterioration. Methods: One hundred ten patients 65 years of age (mean, 73.4; range, 65–82) underwent successful bioprosthetic valve replacement (aortic, n = 71; mitral, n = 32; both, n = 7) from 1979 to 1985. The valve was pericardial in 39 cases and porcine in 78. The mean follow-up was 8.5 years (101.9 months-total; 934 patient-years; range, 2 months to 15 years). Results: Actuarial patient survival was 79.6% (71–86) at 5 years and 62.4% (52–71) at 10 years. Forty-four patients died, 21 from valve-related causes and 23 from other causes. Thirteen patients (11.8%) had reoperation for valve-related complications: 10 structural deteriorations, 2 paravalvular leaks, and 1 case of endocarditis. One surgical death occurred (7.7%). Twenty-six percent of the patients were receiving anticoagulants because of atrial fibrillation, and 6.4% developed severe bleeding (2.9% patient-years). Conclusions: Long-term follow-up of these patients > 65 years of age, undergoing bioprosthetic value replacement surgery revealed a low rate of documented primary structural deterioration (0.95% per patient-year), a low mortality rate on reoperation (7.7%), and a high mortality rate due to non-value-related causes (52.3%). (J Card Surg 1999; 74:252–258)

ObjectivesWe sought to assess the mechanism and significance of different 201Tl redistribution patterns after successful primary stenting following acute myocardial infarction (AMI).BackgroundThe mechanism of 201Tl reverse redistribution and the impact of different redistribution patterns on the recovery of contractility after successful reperfusion therapy for AMI remain unclear.MethodsWe studied 41 consecutive patients with successful primary stenting for a first AMI. Patients underwent predischarge and six-month follow-up dipyridamole stress-reinjection single photon emission tomography (SPECT), coronary and left ventricular angiography. Intracoronary Doppler assessment of coronary flow reserve (CFR) was performed before discharge.ResultsFour patient groups were identified according to predischarge SPECT: patients with I: nonreversible defects (n = 8), II: redistribution (n = 7), III: reverse redistribution (n = 21), IV: no defect (n = 5). At follow-up contractility recovery increased in a stepwise fashion from groups I to IV (19 ± 41%, 40 ± 53%, 70 ± 28%, 78 ± 33%, p = 0.01). Compared with patients with redistribution, those with reverse redistribution had lower infarct-related artery (IRA) CFR (2.2 ± 0.5 vs. 2.8 ± 0.9, p = 0.03) but higher contractility recovery.ConclusionsVariable 201Tl redistribution patterns, early after successful stenting for AMI, may predict different degrees of late contractility recovery. The lower IRA CFR and the higher contractility recovery in areas with reverse redistribution suggest more severe microvascular dysfunction and less severe myocardial injury in such areas compared with those with redistribution.

Summary Background Coronary angiography (CA), an invasive and expensive procedure, is still recommended in most patients referred for elective valve surgery. Multislice computed tomography (MSCT) is a promising alternative technique to rule out significant coronary artery lesions. Aim To evaluate MSCT in detecting significant coronary artery lesions in patients referred for elective valve surgery. Methods Between August 2007 and December 2010, patients referred for elective valve surgery were identified prospectively and underwent 64-slice MSCT and CA. We compared significant coronary stenoses, defined as a reduction of luminal diameter ≥ 50%, to establish the diagnostic accuracy of MSCT. All coronary segments were analysed and uninterpretable lesions were scored positive. Results Forty-eight patients were included (62.5% male; mean age 65 ± 12 years), the majority had aortic insufficiency (37.7%) or aortic stenosis (32.0%). The prevalence of significant coronary artery stenoses was 27.1%. The sensitivity, specificity, positive and negative predictive values of MSCT were 77%, 89%, 71% and 91%, respectively, in a patient-based analysis; 82%, 86%, 64% and 94% in a revascularization-based analysis; 67%, 94%, 52% and 97% in a vessel-based analysis; and 65%, 98%, 52% and 99% in a segment-based analysis. Overall, CA could have been avoided in 65% of patients. Conclusion In patients referred for elective valve surgery, MSCT had a high diagnostic accuracy to rule out significant coronary stenoses. However, larger multicenter studies in an unselected population of patients are needed to determine its place within the range of diagnostic tool in the preoperative assessment of valvular heart disease.

AimCompare the effectiveness and safety of drug-eluting stent (DES) vs bare metal stent (BMS) for percutaneous coronary intervention (PCI) in patients with chronic renal failure (CRF).Methods1126 patients treated by PCI over one year were divided in 4 patients groups, according to the type of stent used (DES vs BMS) and the creatinin clearance (CrCl). Clinical and angiographic data were prospectively entered into the web-based “Middle-Care” database. Chronic renal failure (CRF) was defined by a CrCl < 60 ml/min. The occurrence of cardiovascular (CV) death, MACCE (Death, myocardial infarction and stroke) and TLR was recorded at one year follow-up. We report the preliminary (6 months) results of patients treated between August 2007 and January 2008.Results497 patients underwent PCI: 250 (50.3%), 120 (24.1%), 81 (16.3%) and 46 (9.3%) patients were allocated in the BMS, DES, BMS CRF and DES CRF groups respectively. Mean age was 64 +/- 13 years, 82.5% were male, 24.4% had diabetes, 62.1% had an acute coronary syndrom (ACS) and 47% multivessel disease. One year follow-up was completed for 485 (97.6%) patients: 36 (7.1%) patients died, 54 (10.7%) had MACCE and 35 (6.9%) underwent TLR. The use of DES was associated with significantly less CV death and MACCE, a trend for less TLR and the same stent thrombosis (ST) rate compared with BMS use in patients with and without CRF (figure).ConclusionsThe use of DES appears to be more effective and at least as safe as BMS at one year follow up in patients with CRF. Final results will be available for the meeting.

AimTo compare cardiovascular (CV) outcomes after contemporary PCI in patients with vs. without renal failure (RF) according to clinical presentation (ST-elevated myocardial infarction (STEMI), acute coronary syndrome (ACS), and stable coronary artery disease (sCAD)).MethodsConsecutive patients undergoing PCI with stent implantation were prospectively included from 2007 to 2012. RF was defined by a CrCl 0.05 for both). After multivariable analyses, RF was independently associated with an excess of death with a more than doubled relative risk in STEMI compared to ACS and sCAD patients (OR 5.3: CI 3.627-7.821 in STEMI vs. 2.1: CI 1.465-3.140 and 2.3: CI: 1.507-3.469 in ACS and sCAD, respectively, p

Background: there are many differents risk factors of cardiac allograft vasculopathy after heart transplantation. Preformed donor-specific-antibodies (DSA) could be one of them. Objective: to assess the impact of pre-transplant DSA on cardiac allograft vasculopathy development. Methods: we performed an observational, retrospective and single center study. All patients with heart transplantation between 2008 and 2013 with at least one coronary angiography were included. We compared the occurence of moderate or severe cardiac allograft vasculopathy (CAV 2-3) and its evolution (at least +1 point of CAV) in patients with (MFI >1000) and without (MFI < 1000) pretransplant DSA, identified by Luminex single antigen. Results: 287 patients were included. 98 patients had DSA with MFI > 1000, 189 had DSA with MFI < 1000. The median follow-up was 5,17 years. In univariate analysis, DSA were not a significant risk factor of CAV 2-3 (sHR=0,74 ; p=0,37) or evolution of CAV (sHR=0,7 ; p=0,36) neither. Patients with high antibodies level (MFI > 3000) didn’t have more CAV 2-3 (sHR=0,58 ; p=0,47) or evolution of CAV (sHR=0,53 ; p=0,60) neither. Positive risk factors in multivariate analysis were donor’s ones (age, gender, smoking). Conclusion: heart transplantation of patients with pre-transplant DSA does not seem to cause more cardiac allograft vasculopathy.; Introduction : les facteurs de risque de maladie coronaire du greffon après transplantation cardiaque sont multiples. La présence d’anticorps anti-HLA dirigés contre le greffon (DSA) au moment de la greffe en est un très discuté. Objectif : évaluer l’impact de la présence d’anticorps préformés sur le développement d’une forme précoce de coronaropathie du greffon. Méthode : nous avons mené une étude observationnelle rétrospective monocentrique. Nous avons inclus les patients transplantés cardiaques entre 2008 et 2013 ayant eu au moins une coronarographie. Nous avons comparé la survenue d’une maladie coronaire du greffon modérée à sévère (CAV 2-3) et son évolution (+1 point au moins de CAV), chez les patients avec DSA (MFI>1000) et sans DSA (MFI 1000, et 189 n’en possédaient pas. Le suivi médian a été de 5,17 ans. En analyse univariée, les anticorps préformés n’étaient pas un facteur de risque significatif de survenue d’une CAV 2-3 (sHR=0,74 ; p=0,37) ni d’évolution de CAV (sHR=0,7 ; p=0,36). Un taux d’anticorps élevé (MFI > 3000) n’avait pas non plus d’influence sur la survenue d’une CAV 2-3 (sHR=0,58 ; p=0,47) ni sur son évolution (sHR=0,53 ; p=0,60). Les facteurs de risque positifs en analyse multivariée étaient ceux liés au donneur (âge, sexe, tabagisme). Conclusion : la transplantation cardiaque des patients présentant préalablement des anticorps anti- HLA ne semble pas provoquer de maladie coronaire du greffon supplémentaire.