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BackgroundPatients with renal insufficiency experience worse prognosis after STEMI.Aim of the study to compare primary PCI (PPCI) and thrombolysis results as well as in-hospital mortality after successful reperfusion between patients with or without renal dysfunction (RD).MethodsFrom January 1995 to October 2014, 1588 patients admitted for STEMI were enrolled in our registry. Two reperfusion groups were identified: PPCI (315 patients) and thrombolysis (379 patients). We compared the group of RD patients (RD+) and normal renal function patients (RD). Our main endpoints were: (1) The success of reperfusion and (2) the in-hospital mortality.ResultsNinety patients (13%) had RD, 50% of which underwent PPCI, and 50% received thrombolytics. In the PPCI group, although TIMI flow was similar before angioplasty (p=0.82), TIMI III flow restoration was significantly lower in the RD+group (78.6% vs 91.8%, p=0.013).Suboptimal result was also higher in the RD+group (13.6% vs 2.7%, p

Background Risk assessment after ACS is essential. Risk scores have been mainly used in Non-STEMI patients; nevertheless, patients with STEMI should also be screened according to their risk. Scores have been validated in European and American populations but have not been tested in African populations. Purpose to compare the short term prognosis according to the GRACE and TIMI scores for STEMI Methods GRACE and TIMI scores for STEMI were calculated for patients who were admitted for STEMI between January 2000 and June 2012. All variables included in each score were tested by univariate analysis then included in multivariate model. ROC curve was assessed for each score. Results 1162 patients were included in our analysis. 132 deaths occurred during the study period. All variables included in both scores were tested by univariate analysis and were significantly correlated to intra-hospital mortality except time delay to reperfusion >4hours (p=0.38). By multivariate analysis, the model provided 88.6% power to predict mortality and explained 35.1% of the outcome. Mean GRACE and TIMI scores were significantly higher in the mortality Group (respectively: 198 vs 149 and 7.46 vs 5.88; p Conclusion In the North African context, GRACE score seems to be more powerful in predicting intra-hospital mortality after STEMI and therefore it should be calculated in every patient.

IntroductionHigh glycaemia at admission in STEMI patients is common and associated with an increased risk of in-hospital and post-discharge death.AimTo evaluate the impact of admission glycaemia in the short prognosis of diabetic and non-diabetic patients admitted for STEMI and to identify independent predictors of post-ACS mortality.Population and methodsThis study included 567 patients admitted to a single coronary care unit for STEMI, between January 2004 and June 2012. Our population was divided in three groups according to the tertiles of glycaemia at admission (T111mmol/l). Rates of success after revascularisation, intrahospital mortality, and ventricular arrhythmias were collectedResultsHyperglycaemia at admission was associated to worse cardiovascular risk profile, more severe coronary disease (more 3 vessel disease), incomplete revascularization, higher creatinine levels and more life threatening ventricular arrhythmias (VT/VF). In the predefined tertiles, in-hospital mortality was 4%, 5.2% and 14% (p11mmol/l (224 patients), outcomes were similar between the diabetic and non diabetic patients with death rates respectively 13.8% and 13.9% (p:0.988) In a multivariate analysis, predictive factors of intrahospital mortality were ventricular arrhythmias (OR:70.74, CI [14.298–349.99]; p 130μmol/l (OR: 5.99; CI[1.37-26.18], p:0.017)ConclusionsThese data suggest that, in an STEMI population, glycemia at admission is a short prognostic marker, accurately predicting both death and survival post STEMI.

Background Percutaneous transvenous mitral balloon valvotomy (PTMV) optimal results are usually achieved when echocardiographic Wilkins score (WS) is ≤8. WS from 9 to 11 represent a gray zone in which only some patients have good results. Aim The aim of this study was to determine the early and long term results of this procedure in patients with WS 8 or less and at the gray WS zone. Methods Retrospective review of clinical records of patients with rheumatic MS submitted to PTMV from January 1990 to December 2010. Follow-up was obtained by clinical records when available. Procedure was considered unsuccessful when post-procedure MV area (MVA) was Results We analyzed data for 378 patients with a WS ≤11, 80.5% were women. Mean age at the time of repair was 33 years [10 to 76 years] and the mean follow up time was 74 months. Before the procedure, 33.9% had a WS in the gray zone. They were older (36 years vs. 31 years, p PTMV was safe in the two groups with same rates of success but a lower mitral surface gain in the gray zone group (0.88cm2 vs. 1.05cm2, p During follow up, patients in the gray zone had significantly lower event free survival (freedom from death, systemic embolism and restenosis) (58.6% vs. 69.2%, p Conclusion PTMV was a safe procedure in both WS groups. Optimal results patients with a WS≤8 zone. Patients with a WS 9-11 experienced worse outcomes during follow up.

IntroductionThe optimal timing of coronary intervention in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACSs) is a matter of debate.PurposeWe proposed through this work to study the optimal time to coronary angiography in patients admitted for acute coronary syndrome without ST-segment elevation in the Tunisian context and its prognostic impact on inhospital mortality.Materials and methodsIt is about an observational study from MIRACOS registry that included 407 patients admitted for NSTE-ACS. We were interested to find general characteristics, the time to coronary angiography, mortality and in-hospital complications.ResultsA total of 407 patients were included in our study. Nearly half of our patients (49.5%) were considered at high cardiovascular risk. The average to coronary angiography was 5.09 days. Patients who underwent early coronary angiography were significantly younger (p=0.01), had a lower incidence of diabetes (p=0.01), left heart failure (p=0.0001) and electrical changes suggestive of ischemia (p=0.009). Patients who have undergone an invasive strategy had significantly lower levels of creatinine (p

Background: Mitral stenosis is the most common valvular heart lesion found in pregnancy. When severe, it leads to significant risk of mortality for both mother and fetus, since the hemodynamic adaptations to pregnancy are badly tolerated. Many pregnant women with mitral stenosis present in a critically ill condition. The role of Balloon Mitral Valvotomy (BMV) in such patients is ill-defined. Purpose: We sought to evaluate the feasibility, efficacy and safety of emergent BMV in pregnant patients with refractory pulmonary edema and to determine maternal and fetal outcome. Methods: Of 88 patients undergoing BMV during pregnancy from January 1990 to December 2011 in Cardiology A Department of Monastir Hospital, 28 women were in New York Heart Association functional class IV and underwent emergent BMV. During the procedure, radiation exposure was minimized by means of total abdominal and pelvic shielding. Results: The mothers's mean age at the time of BMV was 28.86±5.7 (range 19–43) years, and the gestation period was 30±5.1 (range 20 –39) weeks. Ten patients were primiparas. Mitral valve (MV) was assessed using the Wilkins score which averaged 7.4±1.8 (range 4 to 14). Fluoroscopy time was 7.8±1.9 minutes. The BMV procedure was successful in 25 (89.3%) patients with a dramatic improvement in patient symptoms. The mitral valve area increased from 0.8±0.2 cm2 to 2.2±0.42 cm2 (p < 0.0001). The mitral valve pressure gradient decreased from 22.2±9.3 to 5.7±4 mm Hg (p < 0.0001). The left atrial pressure decreased from 29.4±9.3 to 15.4±7.3 mm Hg (p < 0.0001). The pulmonary artery pressure decreased from 58.8±21.1 to 37.2±14.3 mm Hg (p < 0.0001). One patient developed severe mitral regurgitation and required urgent mitral valve replacement. There was no maternal mortality or significant foetal morbidity. Pregnancy was uneventful in all patients, all babies were born at full term by spontaneous vaginal delivery in 24 cases (85.7%) and by cesarian section for obstetrical reasons in 4 (14.3%), with no obvious malformations (4 of them were twin babies). None of the babies needed intensive care monitoring. The average Apgar scores at 1 min were 8.6±1. The mean birth weight was 3.1 Kilograms ranged from 1.9 to 3.8 kg. Conclusion: During pregnancy, emergent BMV is safe and feasible in patients with symptomatic mitral stenosis and severe pulmonary edema. There is marked symptomatic relief, along with excellent maternal and fetal outcomes.

BackgroundAtrial fibrillation (AF) is a common finding in patients with severe mitral stenosis requiring Balloon Mitral Valvotomy (BMV). Its immediate and long term prognosis remains controversial.ObjectivesWe sought to evaluate the effect of AF on the immediate and long-term (23 years) outcome of patients undergoing BMV.MethodsThe immediate procedural and the long-term clinical outcome after BMV of 139 patients with AF were collected and compared with those of 381 patients in normal sinus rhythm (NSR).ResultsPatients with AF were older (43.3 vs. 29.7 years; p < 0.001), had frequently a history of systemic embolism (9.4% vs. 1.6%, p> 0.001) and of mitral commissurotomy (28.1% vs. 19.4%, p=0.035). Patients with AF had more frequently a Wilkins score > 8 (51.4% vs. 30.9%, p

IntroductionRight ventricular (RV) infarction is a serious and life threatening condition which mainly complicates an inferior wall myocardial infarction (MI). In the literature, data for predictive factors of mortality in this setting remains scarce.Aim to study predictive factors of intrahospital mortality in patients with RV infarction.Methods and resultsData was collected from a monocenter registry including all patients with AMI admitted in our department between January 1995 and March 2013. 1483 patients were enrolled in our registry. RV infarction was diagnosed in 160 (10.7%) patients, always complicating an inferior wall MI. 37 (23.1%) patients presented with right sided heart failure while the remaining patients presented with isolated features of RV involvement on the ECG with ST elevation in the right leads. Intrahospital death occurred in 20 patients (12.5%) and was significantly higher in patients with RV heart failure (p=0.02). Among all deaths included in our registry, RV infarction was responsible for 14.5%. The reperfusion strategy was Thrombolysis in 48 patients (30%), angioplasty in 62 patients (38.8%), a combined approach in 10 cases (6.3%) and conservative treatment in 40 cases (25%). There was no difference in mortality among all strategies (p: 0.556). In patients who had angioplasty, post procedural TIMI flow 0 or 1 was associated with a higher mortality (p130umol/l (OR: 8.22; 95% CI [1.33-50.9]; p: 0.023), triple vessel disease (OR: 7.09; 95% CI [1.738-28.93]; p: 0.006) and left ventricular failure with KILLIP>1 (p: 0.004).ConclusionOur data support the fact that several factors may predict intra-hospital mortality after RV myocardial infarction among which renal impairment, the extent of coronary artery disease and left ventricular heart failure are most the powerful predictors.