[Immediate, medium- and long-term outcomes of percutaneous coronary intervention with very long drug eluting stent : An observational multicentric study]. / Les résultats immédiats, à moyen et à long terme de l'angioplastie coronaire par stent actif très long : à propos d'une étude multicentrique observationnelle.

INTRODUCTION: Very long coronary lesions account for 20% of coronary stenoses in the real world. There are few data on the effectiveness of angioplasty of these lesions with very long active stents (DES) in the literature. We conducted this study to assess the long-term outcomes of angioplasty with DES length ≥ 40 mm in a population with multiple cardiovascular risk factors. PATIENTS AND METHODS: This is a retrospective, multicenter, descriptive, and prognostic study, conducted between January 2015 and January 2020, in four Tunisian centers, including all patients who underwent angioplasty with a DES of length ≥ 40 mm with a follow-up of at least one year. The primary outcome was a combined criteria (major cardiovascular and Cerebral events: MACCE) (stroke, acute coronary syndrome, revascularization of the target lesion: TLR, cardiovascular death: CVD). RESULTS: We included 480 procedures. More than half of the patients had at least three risk factors. The prevalence of high blood pressure, diabetes and smoking were 61.1%, 56.6% and 60.4%, respectively. The treated lesions were complex: 23.54% calcified lesions, 8.75% chronic occlusions, 25% bifurcation lesions and 12.08% ostial lesions. The average length of the stents was 47.72 mm. We noted 17 cases of per-procedural complications (3.55%). The median follow-up was 35 months (extremes 1-60 months). The rate of stent thrombosis was 0.83%. The incidence of MACCE, TLR and CVD were respectively 16.25%, 8.12% and 5.2%. In multivariate analysis, diabetes (HR = 1.7, 95% CI [1.01-2.9]), dyslipidemia (HR = 2.08, 95% CI [1.3-3.3]), familial coronary artery disease (HR = 1.9, 95% CI [1.01-3.6]), left ventricle dysfunction (HR = 2.07, 95% CI [1.1-3.6]) and bifurcation lesions (HR = 1.9, 95% CI [1.2-3.14]) were the independent predictors of MACCE, while statin intake (HR = 0.38, 95% CI [0.19-0.78]) was a protective factor. CONCLUSION: Angioplasty with very long DES is associated with low levels of MACCE, TLR, stent thrombosis and CVD in our population. Therefore, it could be an interesting alternative to cardiac surgery. Randomized comparative studies of the two treatment options are needed.

[Advantages of simulation-based training in improving skills of beginners in interventional cardiology procedures: a Tunisian cross-sectional study]. / Apport de la simulation dans l'apprentissage de la cardiologie interventionnelle chez les débutants: étude tunisienne transversale.

Introduction: simulator training in interventional cardiology (ST) is an educational tool that is rapidly spreading worldwide. The purpose of this study was to evaluate the advantages of ST in improving skills of beginners in interventional cardiology procedures, through a short training cycle. Methods: we conducted a before-and-after quasi-experimental evaluative study in the simulation center of the Faculty of Medicine in Sfax. We involved cardiology residents at the beginning of their training in interventional cardiology. All the participants attended a 4-hour training course on a Cathi®, high-fidelity simulator, after giving their consent. The primary endpoint was a significant improvement in performance and competence scores before and after the course. The secondary endpoint was the reduction in irradiation time and the time of the procedure. Results: thirteen learners participated in our study. The performance score improved by a median of 216.12% (ISQ = 285%). This improvement was significantly greater for learners who had never had access to the catheterisation room. The performance score ranged from a median of 31 (ISQ=40.5) to a median of 120 (ISQ=19.7), (p=0.001). The competence score for coronary angiography improved significantly, from a median of 16 (ISQ=18) to a median of 70 (ISQ=6), (p=0.001). The competence score for angioplasty improved significantly from a median of 10 (ISQ=17) to a median of 50 (ISQ=13.7), p=0.001. Procedure time of coronary angiography and angioplasty were significantly shortened from 12 min (ISQ=2) to 7 min (ISQ=1) after the simulation cycle (p=0.001), and from a median of 19 min to a median of 17 min after simulation, p=0.002. Conclusion: despite a short-time simulation training, our pilot study demonstrates a significant improvement in the learners´ skills and performance, as well as a reduction in the time taken to carry out procedures and irradiation. This could eventually increase the number of procedures carried out daily in our cathlab and limit radiation exposure of staff and patients, while ensuring that the learners receive adequate training.