Place of Angioplasty for Coronary Artery Anomalies With Interarterial Course.

Few patients with an anomalous aortic origin of a coronary artery (AAOCA) require a correction of this congenital anomaly. Current recommendations offer surgical repair as a first line therapy to prevent a sudden cardiac death as a main objective. However, these guidelines are focused on children and not based on randomized controlled studies. Furthermore, decision-making should be different in an adult population less exposed to the risk of sudden cardiac death. Current practices showed reluctance to offer a surgical treatment for right AAOCA associated with ischemic symptoms or myocardial ischemia. Our aim in this review is to expose the rationale for percutaneous coronary intervention in right AAOCA with interarterial course and to present the published results.

Comparison of hospital mortality during ST-segment elevation myocardial infarction in the era of reperfusion therapy in women versus men and in older versus younger patients.

There is intense interest in examining hospital mortality in relation to gender in ST-segment elevation myocardial infarction. The aim of the present study was to determine whether gender influences outcomes in men and women treated with the same patency-oriented reperfusion strategy. The influence of gender on hospital mortality was tested using multivariate analysis and local regression. The influence of age was tested as a continuous and as a categorical variable. In the overall population of 2,600 consecutive patients, gender was not correlated with hospital mortality except in the subgroup of women aged ≥65 years. The risk for death increased linearly in logit scale for men. Up to the age of 65 years, the risk also increased linearly in women but thereafter increased faster than in men. Testing age as a categorical variable, hospital mortality was higher in women than in men aged ≥75 years but was similar between the genders in the younger age categories. In conclusion, despite following an equal patency-oriented management strategy in men and women with ST-segment elevation myocardial infarctions, the risk for hospital death increased linearly with age but with an interaction between age and gender such that older women had an independent increase in hospital mortality. Longer time to presentation and worse baseline characteristics probably contributed to determine a high-risk subset but reinforce the need to apply, as recommended in the international guidelines in the management of patients with ST-segment elevation myocardial infarctions, the same strategy of acute reperfusion in men and women.

Universal reperfusion therapy can be implemented: lessons from 20 years of management of patients admitted within 6 hours of symptom onset with ST-segment elevation acute myocardial infarction.

AIM: To describe longitudinal trends in patients' characteristics, management and hospital outcomes over 20 years of therapy for ST-segment elevation myocardial infarction (STEMI). METHODS: From 1988 to 2007, 2100 consecutive patients with STEMI were admitted within 6 hours of symptom onset to a centre with a systematic reperfusion policy. The population was divided into three periods 1988-1996, 1996-2001 and 2001-2007. RESULTS: The baseline risk of mortality increased over time (p=0.02). Use of primary PCI increased and the proportion not receiving reperfusion therapy decreased (from 11.4 to 4.2%, p=0.0001). Adjunctive use of stents and glycoprotein IIb/IIIa antagonists increased. The proportion of patients achieving acute TIMI-3 flow in the infarct artery increased (81 to 92%, p=0.001), while time from symptom onset to reperfusion decreased (240 to 205 min, p<0.0001). This was associated with a decrease in age- and sex-adjusted in-hospital mortality from 8.9 to 7.7% and eventually 5.4% (p<0.01). However, the mortality of patients with cardiogenic shock was unaffected (76, 62 and 61%, respectively, p=0.18). CONCLUSION: Reperfusion therapy can be implemented in up to 96% of STEMI patients admitted within 6 hours of symptom onset and this is associated with improvements in outcomes. Further improvements are needed in the management of patients with cardiogenic shock.