ABSTRACT
BACKGROUND: In Tunisia, the number of cardiac implantable electronic devices (CIEDs) is increasing, owing to the increase in patient life expectancy and expanding indications. Despite their life-saving potential and a significant reduction in population morbidity and mortality, their increased numbers have been associated with the development of multiple early and late complications related to vascular access, pockets, leads, or patient characteristics. OBJECTIVE: The study aims to identify the rate, type, and predictors of complications occurring within the first year after CIED implantation. It also aims to describe the demographic and epidemiological characteristics of a nationwide sample of patients with CIED in Tunisia. Additionally, the study will evaluate the extent to which Tunisian electrophysiologists follow international guidelines for cardiac pacing and sudden cardiac death prevention. METHODS: The Tunisian National Study of Cardiac Implantable Electronic Devices (NATURE-CIED) is a national, multicenter, prospectively monitored study that includes consecutive patients who underwent primary CIED implantation, generator replacement, and upgrade procedure. Patients were enrolled between January 18, 2021, and February 18, 2022, at all Tunisian public and private CIED implantation centers that agreed to participate in the study. All enrolled patients entered a 1-year follow-up period, with 4 consecutive visits at 1, 3, 6, and 12 months after CIED implantation. The collected data are recorded electronically on the clinical suite platform (DACIMA Clinical Suite). RESULTS: The study started on January 18, 2021, and concluded on February 18, 2023. In total, 27 cardiologists actively participated in data collection. Over this period, 1500 patients were enrolled in the study consecutively. The mean age of the patients was 70.1 (SD 15.2) years, with a sex ratio of 1:15. Nine hundred (60%) patients were from the public sector, while 600 (40%) patients were from the private sector. A total of 1298 (86.3%) patients received a conventional pacemaker and 75 (5%) patients received a biventricular pacemaker (CRT-P). Implantable cardioverter defibrillators were implanted in 127 (8.5%) patients. Of these patients, 45 (3%) underwent CRT-D implantation. CONCLUSIONS: This study will establish the most extensive contemporary longitudinal cohort of patients undergoing CIED implantation in Tunisia, presenting a significant opportunity for real-world clinical epidemiology. It will address a crucial gap in the management of patients during the perioperative phase and follow-up, enabling the identification of individuals at particularly high risk of complications for optimal care. TRIAL REGISTRATION: ClinicalTrials.gov NCT05361759; https://classic.clinicaltrials.gov/ct2/show/NCT05361759. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/47525.
ABSTRACT
Complications following acute myocardial infarction (MI) such as ventricular septal rupture (VSR) and left ventricular (LV) aneurysm are rare and can be dreadful. Their simultaneous presence in the same patient is extremely rare. We aimed to present a rare case of concomitant association of ventricular aneurysm and VSR complicating an inferior myocardial infarction. We report the unusual case of Mr. A. D, a 63-year-old, active smoker, with a history of diabetes mellitus and hypertension, admitted for the management of inferior MI within 6 days. The MI was complicated by an LV aneurysm in the inferoposterior and the inferoseptal walls associated with a VSR in the inferoseptal wall. The patient had only signs of right heart failure on admission. This observation illustrates on the one hand the rarity of the association of VSR and LV aneurysm after an inferior myocardial infarction, and on the other hand the possibility of founding them at an early stage of MI without any signs of cardiogenic shock.
Subject(s)
Heart Aneurysm , Inferior Wall Myocardial Infarction , Myocardial Infarction , Ventricular Septal Rupture , Humans , Middle Aged , Inferior Wall Myocardial Infarction/complications , Inferior Wall Myocardial Infarction/diagnosis , Ventricular Septal Rupture/diagnosis , Ventricular Septal Rupture/etiology , Myocardial Infarction/complications , Myocardial Infarction/diagnosis , Shock, Cardiogenic , Heart Aneurysm/diagnostic imaging , Heart Aneurysm/etiologyABSTRACT
The NATURE-HF registry was aimed to describe clinical epidemiology and 1-year outcomes of outpatients and inpatients with heart failure (HF). This is a prospective, multicenter, observational survey conducted in Tunisian Cardiology centers. A total of 2040 patients were included in the study. Of these, 1632 (80%) were outpatients with chronic HF (CHF). The mean hospital stay was 8.7 ± 8.2 days. The mortality rate during the initial hospitalization event for AHF was 7.4%. The all-cause 1-year mortality rate was 22.8% among AHF patients and 10.6% among CHF patients. Among CHF patients, the older age, diabetes, anemia, reduced EF, ischemic etiology, residual congestion and the absence of ACEI/ ARBs treatment were independent predictors of 1-year cumulative rates of rehospitalization and mortality. The female sex and the functional status were independent predictors of 1-year all-cause mortality and rehospitalization in AHF patients. This study confirmed that acute HF is still associated with a poor prognosis, while the mid-term outcomes in patients with chronic HF seems to be improved. Some differences across countries may be due to different clinical characteristics and differences in healthcare systems.
Subject(s)
Heart Failure , Registries , Adult , Aged , Aged, 80 and over , Disease-Free Survival , Female , Follow-Up Studies , Heart Failure/mortality , Heart Failure/therapy , Humans , Male , Middle Aged , Prospective Studies , Survival Rate , Tunisia/epidemiologyABSTRACT
BACKGROUND: Pseudoaneurysm of inferior wall of the left ventricle is an uncommon complication of myocardial infarction with high mortality. CASE PRESENTATION: We report the case of a 63-year-old Tunisian man, diagnosed with a thrombosed left ventricular pseudoaneurysm and a pericardial effusion after 1 week of angina. CONCLUSIONS: Left ventricular pseudoaneurysm is a serious complication of myocardial infarction that has atypical presentations. Diagnosis is generally established by transthoracic echocardiography but confirmed by magnetic resonance imaging. Urgent surgery is the treatment choice given the risk of embolization and rupture.
Subject(s)
Aneurysm, False , Myocardial Infarction , Aneurysm, False/diagnostic imaging , Aneurysm, False/etiology , Echocardiography , Heart Ventricles/diagnostic imaging , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Myocardial Infarction/complications , Myocardial Infarction/diagnostic imagingABSTRACT
BACKGROUND: Contemporary registries on atrial fibrillation (AF) are scare in North African countries. HYPOTHESIS: In the context of the epidemiological transition, prevalence of valvular AF in Tunisia has decreased and the quality of management is still suboptimal. METHODS: NATURE-AF is a prospective Tunisian registry, involving consecutive patients with AF from March 1, 2017 to May 31, 2017, with a one-year follow-up period. All the patients with an Electrocardiogram-documented AF, confirmed in the year prior to enrolment were eligible. The epidemiological characteristics and outcomes were described. RESULTS: A total of 915 patients were included in this study, with a mean age of 64.3 ± 22 years and a male/female sex ratio of 0.93. Valvular AF was identified in 22.4% of the patients. The mean CHA2 DS2 VASC score in nonvalvular AF was 2.4 ± 1.6. Monotherapy with antiplatelet agents was prescribed for 13.8% of the patients. However, 21.7% of the subjects did not receive any antithrombotic agent. Oral anticoagulants were prescribed for half of the patients with a low embolic risk score. In 341 patients, the mean time in therapeutic range was 48.87 ± 28.69%. Amiodarone was the most common antiarrhythmic agent used (52.6%). During a 12-month follow-up period, 15 patients (1.64%) had thromboembolism, 53 patients (5.8%) had major hemorrhage, and 52 patients (5.7%) died. CONCLUSIONS: NATURE-AF has provided systematic collection of contemporary data regarding the epidemiological and clinical characteristics as well as the management of AF by cardiologists in Tunisia. Valvular AF is still prevalent and the quality of anticoagulation was suboptimal.
Subject(s)
Atrial Fibrillation , Stroke , Anticoagulants/therapeutic use , Atrial Fibrillation/diagnosis , Atrial Fibrillation/drug therapy , Atrial Fibrillation/epidemiology , Female , Humans , Male , Prospective Studies , Registries , Risk Factors , Tunisia/epidemiologyABSTRACT
Klinefelter syndrome is the most common congenital abnormality causing primary hypogonadism and predisposing to a state of hypercoagulability. We report the case of a 37-year-old man, of Algerian nationality, diagnosed with Klinefelter syndrome admitted to the hospital via the emergency room for acute chest pain and dyspnea. The patient arrived in Tunisia 36 hours ago. On admission, body temperature was 38.2°C, blood pressure, pulse and respiratory rate were 130/70 mmHg, 120/minute and 26/minute, respectively. He had an oxygen saturation of 87% in room air. His electrocardiography revealed a complete right bundle-branch block, chest X-Ray was normal. In front of the clinical presentation and the origin of the patient coming from an endemic country, COVID-19 infection was suspected but ruled out by pharyngeal swabs testing negative by real-time reverse-transcription polymerase chain reaction test and massive pulmonary embolism was diagnosed from his chest computed tomography images. The symptoms improved with anticoagulation treatment.
Subject(s)
COVID-19/diagnosis , Klinefelter Syndrome/physiopathology , Pulmonary Embolism/diagnosis , Respiratory Distress Syndrome/diagnosis , Adult , Bundle-Branch Block/diagnosis , Chest Pain/etiology , Dyspnea/etiology , Electrocardiography , Emergency Service, Hospital , Humans , Male , Respiratory Distress Syndrome/etiology , Tomography, X-Ray ComputedABSTRACT
Thiamine-responsive megaloblastic anaemia (TRMA) is a syndrome associated with megaloblastic anaemia, diabetes mellitus and sensorineural deafness, due to mutations in the SLC19A2gene, which codes for a thiamine carrier protein. Oral thiamine supplementation is the main treatment. We report the case of a 19-year-old man known for TRMA, who presented in the emergency department with bicytopenia (haemoglobin 5,4 g/dL, thrombocytes 38×109/L) revealed by dyspnea and chest pain. Investigations excluded bleeding, hemolysis, coagulopathy and iron deficiencies. A recent infection and an acute coronary syndrome have also been eliminated. We later found out that thiamine treatment had been discontinued three months before, due to general confinement in Tunisia during the COVID-19 pandemic. Parenteral administration of 100 mg of thiamine daily resulted in the recovery of haematopoiesis within three weeks.
Subject(s)
Anemia, Megaloblastic/blood , Betacoronavirus , Coronavirus Infections/epidemiology , Diabetes Mellitus/blood , Hearing Loss, Sensorineural/blood , Pandemics , Pneumonia, Viral/epidemiology , Thiamine Deficiency/congenital , Thrombocytopenia/etiology , Acute Coronary Syndrome/diagnosis , Anemia, Megaloblastic/drug therapy , Anemia, Megaloblastic/physiopathology , COVID-19 , Chest Pain/etiology , Diabetes Mellitus/drug therapy , Diabetes Mellitus/physiopathology , Diagnosis, Differential , Glycated Hemoglobin/analysis , Health Services Accessibility , Hearing Loss, Sensorineural/drug therapy , Hearing Loss, Sensorineural/physiopathology , Hemoglobins/analysis , Humans , Male , Pericardial Effusion/diagnostic imaging , Pericardial Effusion/etiology , Recurrence , SARS-CoV-2 , Thiamine/supply & distribution , Thiamine/therapeutic use , Thiamine Deficiency/blood , Thiamine Deficiency/drug therapy , Thiamine Deficiency/physiopathology , Tunisia , Young AdultABSTRACT
Thiamine-responsive megaloblastic anaemia (TRMA) is a syndrome associated with megaloblastic anaemia, diabetes mellitus and sensorineural deafness, due to mutations in the SLC19A2 gene, which codes for a thiamine carrier protein. Oral thiamine supplementation is the main treatment. We report the case of a 19-year-old man known for TRMA, who presented in the emergency department with bicytopenia (haemoglobin 5,4 g/dL, thrombocytes 38×109/L) revealed by dyspnea and chest pain. Investigations excluded bleeding, hemolysis, coagulopathy and iron deficiencies. A recent infection and an acute coronary syndrome have also been eliminated. We later found out that thiamine treatment had been discontinued three months before, due to general confinement in Tunisia during the COVID-19 pandemic. Parenteral administration of 100 mg of thiamine daily resulted in the recovery of haematopoiesis within three weeks
Subject(s)
COVID-19 , Adult , Anemia, Megaloblastic , TunisiaABSTRACT
Complete atrioventricular block (AV block) associated with an accessory pathway is a rare phenomenon. We report the case of a third degree AV block paired with a Wolff Parkinson White (WPW) syndrome in a 91-year-old patient. The electrocardiogram (ECG) on admission showed a Mobitz type II AV block alternating with a third degree block on a wide-QRS ventricular rhythm beating at 35 cycles per minute. The patient urgently underwent the implantation of a single-lead pacemaker. The post-implantation ECG revealed a Kent accessory pathway on the left posteroseptal site. The existence of a complete AV block in the presence of an accessory pathway implies a more or less permanent blockage of atrial depolarization, both through the normal conduction tissue and the accessory pathway.
Subject(s)
Atrioventricular Block/complications , Wolff-Parkinson-White Syndrome/complications , Aged, 80 and over , Electrocardiography , Humans , Male , Pacemaker, Artificial , Wolff-Parkinson-White Syndrome/surgeryABSTRACT
BACKGROUND: Congenital coronary arteries anomalies are a rare entity. Although their identification started in the 60th, there is a lack of data concerning their frequency and clinical significance in Tunisia. AIM: To characterize clinical and imaging features and mid-term follow up data of congenital coronary artery anomalies in a population of Tunisian adults. METHODS: We reviewed the records of 6358 adult patients who underwent coronary angiography between 2009-2015 years in Mongi Slim hospital La Marsa, Tunisia. Multidetector computed tomography was performed on all patients diagnosed having these anomalies and Angelini classification was used for their arrangement. Patients, having intramural coronary artery, were excluded from this study. RESULTS: Thirteen patients had congenital coronary arteries anomalies (seven females and six males). Ten had anomalies of origination and course while the others had anomalies of coronary termination. The right coronary artery was the vessel involved most frequently. It originated from an anomalous coronary ostium in four patients and a unique right coronary artery was reported in one case. An anomalous left main coronary artery was seen in four cases. One patient had the left anterior descending artery originating from the right Valsalva sinus. Four patients underwent coronary revascularization, one died before the intervention and the remainder received medical management. The mean follow up was 54.1±20 months. CONCLUSION: Congenital coronary arteries anomalies have a low incidence in adults. Coronary revascularization is actually indicated in anomalous aortic origin with inter aorto-pulmonary course.
Subject(s)
Coronary Artery Disease/epidemiology , Coronary Artery Disease/therapy , Coronary Vessel Anomalies/epidemiology , Coronary Vessel Anomalies/therapy , Adult , Aged , Aged, 80 and over , Angioplasty/statistics & numerical data , Coronary Angiography , Coronary Artery Bypass/statistics & numerical data , Coronary Artery Disease/diagnosis , Coronary Vessel Anomalies/diagnosis , Female , Humans , Incidence , Male , Middle Aged , Multidetector Computed Tomography , Tunisia/epidemiology , Young AdultABSTRACT
The use of doping substances and methods is prevalent not only among elite athletes, but also among amateur athletes and other athletes. However, the abuse of substances and methods of doping has been associated with the occurrence of numerous adverse health effects. Cardiovascular effects are the most deleterious. The objective of this manuscript is to study through a review the literature, adverse cardiovascular effects after the abuse of substances and doping methods in athletes. Three major classes of products have more cardiovascular side effects; they are anabolic, stimulants and narcotics. It is possible to predict their use according to the desired objectives. Anabolic doping is used by sportsmen who practice strength sports, stimulants are used by those who practice speed sports, while endurance sportsmen prefer products that improve the transport of oxygen. Cases of myocardial infarction, hyperlipidemia, hypertension, venous thrombosis, arrhythmogenesis, heart failure and sudden cardiac death have been observed. The doping substances of varied nature seem to have adverse cardiovascular effects whose physiopathology remains a research and investigation track. Further randomized trials are needed to better understand the interaction of these doping substances taken in a combined way in athletes.
Subject(s)
Athletes , Cardiovascular Diseases/chemically induced , Doping in Sports , Substance-Related Disorders/complications , Athletes/statistics & numerical data , Cardiovascular Diseases/epidemiology , Doping in Sports/statistics & numerical data , Drug-Related Side Effects and Adverse Reactions/epidemiology , Humans , Iatrogenic Disease/epidemiology , Sports/statistics & numerical data , Substance-Related Disorders/epidemiologyABSTRACT
BACKGROUND: Smoking cessation should be a priority for smokers, especially coronary patients. AIM: To study the place and effectiveness of acupuncture in smoking cessation in coronary patients. METHODS: We conducted a prospective open-label study of 25 coronary smokers treated by acupuncture over a 10-month period, from June 2017 to March 2018. A 2-session protocol acupuncture weekly for three to five weeks, with a positive response. In order to evaluate the effectiveness of acupuncture, a questionnaire was completed by the doctor during the treatment, at three and six months after the end of the sessions. Positive response was defined by total cessation of smoking. RESULTS: The average age of our patients was 55.5 years (33 to 77 years). The sex ratio of our population was 1.5 with a male predominance. All our patients had a coronary history. The average cigarette consumption was 22.7 pack-years on average. The results of our study showed that acupuncture allows the withdrawal of 5 smokers (20%) from the first session. After the fifth session, 60% of our patients stopped smoking. At the end of the treatment, 17 smokers (70%) stopped smoking completely. At 3 and 6 months of treatment, we observed a stabilization of smoking cessation and decrease rates. CONCLUSION: Smoking cessation is difficult to obtain whatever the therapeutic method used, which encourages us to strengthen preventive measures.
Subject(s)
Acupuncture Therapy , Smoking Cessation/methods , Smoking/therapy , Tobacco Use Disorder/therapy , Adult , Aged , Female , Humans , Male , Middle Aged , Prognosis , Prospective Studies , Smoking/epidemiology , Smoking Cessation/statistics & numerical data , Time Factors , Tobacco Use Disorder/diagnosis , Tobacco Use Disorder/epidemiology , Treatment OutcomeABSTRACT
INTRODUCTION: Right ventricular (RV) dysfunction is one of the leading predictors of mortality and heart failure in chronic hemodialysis (HD) patients. AIM: To describe the different echocardiographic abnormalities of the RV in subjects with HD. METHODS: We performed a descriptive cross-sectional study covering the period from July to October 2018; involving 42 patients treated with chronic HD. Patients underwent a conventional transthoracic echocardiographic (TTE) study supplemented with tissue Doppler between two hemodialysis sessions. RESULTS: We included 42 patients. The sex ratio of our population was 1.6 with a male predominance, the average age of patients was 62.7 ± 12.4 years. The most important cardiovascular risk factor was arterial hypertension (78.6%). The most important causative nephropathy was nephroangisclerosis (31% of cases). The average age of dialysis was 34.5±30 months. Forty-two percent of our patients had RV dilation, 38% had right atrium dilatation, 7% had Right ventricular outflow tract dilatation, and 59.5% had RV hypertrophy. We noted RV systolic dysfunction in 66.7% of cases, a predominant normalized tricuspid profile with an average E / A ratio of 1.11 ± 0.5. CONCLUSION: Our study is consistent with the various echocardiographic data already raised in the literature, showing a high prevalence of RV dilatation and systolic dysfunction. It is one of the leading predictors of mortality and heart failure in chronic hemodialysis patients.
Subject(s)
Heart Ventricles/diagnostic imaging , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/therapy , Renal Dialysis , Ventricular Dysfunction, Right/complications , Ventricular Dysfunction, Right/diagnosis , Aged , Cross-Sectional Studies , Echocardiography , Female , Heart Ventricles/physiopathology , Humans , Kidney Failure, Chronic/diagnosis , Kidney Failure, Chronic/epidemiology , Male , Middle Aged , Prevalence , Ventricular Dysfunction, Right/epidemiology , Ventricular Dysfunction, Right/physiopathologyABSTRACT
Atrial fibrillation and hypertension are often coexistent. Their incidence increases with advancing age and they are responsible for considerable morbidity and mortality. The relation between theses 2 diseases has long been discussed and determined by clinical studies. Left ventricular hypertrophy and left atrial remodeling during hypertension favor the development of atrial fibrillation. AF during hypertension increases the risk of thromboembolic complications and heart failure. In patients with hypertension, pharmacological treatment may control the cardiac structural changes and retard or prevent the occurrence of atrial fibrillation. In case of atrial fibrillation, treatment should be focused on the control of heart rate and rhythm and the prevention of thromboembolic accidents. A strict control of blood pressure is highly required in this situation.
Subject(s)
Atrial Fibrillation/complications , Hypertension/complications , Atrial Fibrillation/drug therapy , Humans , Hypertension/drug therapyABSTRACT
Hisian extrasystoles originate from the His bundle. They are rare and usually misdiagnosed. In fact, they manifest on the EKG, with a p' wave located before, in or after the QRS complex. More rarely, the extrasystole blocks the propagation of the influx to the ventricles simulating a Mobitz II atrioventricular (AV) block. We report the case of a 36-Year-old woman with no medical History, suffering from presyncope and palpitations at rest. Her physical examination and EKG were normal. The 24-hour Holter monitoring showed some long periods with unexpected blocked p waves but with no significant pause. Considering her young age and the absence of causes of AV block, we performed an intracardiac electrophysiological study which showed hisian extrasystoles with normal conduction tissue properties at baseline and under flecainide. The diagnosis of hisian extrasystoles simulating Mobitz II AV block was made. A simple monitoring with beta-blockers therapy was recommended. Hisian extrasystoles may simulate first or second degree AV block with different therapeutic and prognostic implications. Nevertheless, these hisian extrasystoles may be the marker of a vulnerable AV conduction, long-term follow up should be considered.
Subject(s)
Atrioventricular Block/diagnosis , Bundle of His/abnormalities , Cardiac Complexes, Premature/diagnosis , Adult , Bundle of His/diagnostic imaging , Bundle of His/pathology , Bundle-Branch Block/diagnosis , Bundle-Branch Block/etiology , Cardiac Complexes, Premature/etiology , Cardiac Complexes, Premature/pathology , Cardiac Complexes, Premature/physiopathology , Diagnosis, Differential , Electrocardiography , Female , HumansABSTRACT
Class Ic antiarrythmic overdose is associated with a relatively high mortality. We presenta case report regarding a suicidal intoxication of an 18-year old female with a medical history of Wolff-Parkinson-White syndrome. The preliminary examination highlighted a profound cardiovascular collapse. The electrocardiogram showed a PR interval extended to 360 ms. The QRS complexes were enlarged to 360 ms with a right bundle brunch block appearance associated with left posterior hemibloc. There were repolarization abnormalities such as elevation of the J-point, convex ST segment and biphasic T wave in the right precordial leads ("Brugada-Like ECG pattern"). Sodium bicarbonate was administered. A rapid decrease in the duration of the QRS complexes was noted as well as a slowing of the heart rate. The electrocardiogram aspect on the 4th day showed the reappearance of the ventricular pre-excitation. The severity and lethal potential of Flecainide poisoning are linked to the cardiotoxic effects of these molecules. The prognosis remains poor despite progress in intensive care procedures.
Subject(s)
Drug Overdose/etiology , Flecainide/poisoning , Suicide, Attempted , Adolescent , Drug Overdose/physiopathology , Electrocardiography , Female , HumansABSTRACT
BACKGROUND: Myocardial reperfusion is the « corner stone ¼ in the treatment of myocardial infarction. Primary percutaneous coronary intervention has proved its superiority upon intravenous thrombolysis. aim: To evaluate in hospital mortality of acute myocardial infarction treated with primary angioplasty and to determine its predictive factors. METHODS: We performed a retrospective study including 250 patients admitted to Mongi Slim university Hospital at la Marsa between January the 1st, 2006 and June the 30th, 2011. All these patients had an ST segment elevation myocardial infarction and underwent primary percutaneous coronary intervention within 24 hours after symptom onset. RESULTS: In our study, males were predominant with a sex-ratio of 4.55. Our patients were aged 59.8± 11.19 years old. Diabetes mellitus was present in 42% of our population. In 60.4% of the cases, myocardial infarction was located in the anterior wall. Cardiogenic shock was present in 13.6% of patients. The culprit coronary artery was the left anterior descending artery in 57.6% of the cases. The coronary flow in the culprit artery was TIMI 0 in 64% of the patients and TIMI 1 in 13.2% of the patients. Angiographic success (TIMI 3 flow and residual stenosis <20%) was achieved in 84% of cases. Our in-hospital mortality rate (cardiogenic shock excluded) was 6.9%. Predictive factors of in-hospital mortality were: female gender, diabetes mellitus, hypertension, renal failure, multi-vessel lesion,TIMI flow before percutaneous coronary intervention, proximal left anterior descending artery lesion, initial cardiogenic shock and acute stent thrombosis. CONCLUSION: In our local context, primary percutaneous coronary intervention is an efficient and safe treatment of myocardial infarction with persistent ST-segment elevation.