[Percutaneous coronary intervention for chronic total occlusion: clinical perspectives in 2015]. / Traitement percutané de l'occlusion coronaire totale chronique: perspectives cliniques en 2015.

Chronic total occlusions (CTOs) are considered as the last frontier of percutaneous coronary intervention (PCI). Despite an incidence of 15-30%, CTOs are largely undertreated (< 10%) by percutaneous techniques, as the majority of patients are managed conservatively or surgically. Although data from randomized trials are lacking, current evidence suggests that successful CTO-PCI improves symptoms, quality of life and long-term survival. CTO-PCI represents the most technically challenging procedure in contemporary interventional cardiology. Recent interventional developments and increasing experience of dedicated operators have significantly improved procedural success rates up to 90%. This review aims to provide a contemporary overview on the current body of evidence regarding CTO-PCI, with an emphasis on the clinical benefits and patient selection criteria.

[Pre-operative cardiac assessment in non-cardiac surgery: a frequent dilemma simplified by a decision tree]. / Evaluation cardiologique préopératoire avant chirurgie non cardiaque: du choix cornélien a l'arbre décisionnel.

In patients undergoing non-cardiac surgery, cardiac events are the most common cause of perioperative morbidity and mortality. It is often difficult to choose adequate cardiologic examinations before surgery. This paper, inspired by the guidelines of the European and American societies of cardiology (ESC, AHA, ACC), discusses the place of standard ECG, echocardiography, treadmill or bicycle ergometer and pharmacological stress testing in preoperative evaluations. The role of coronary angiography and prophylactic revascularization will also be discussed. Finally, we provide a decision tree which will be helpful to both general practitioners and specialists.

[Preoperative cardiac assessment before non-cardiac surgery: cardiac risk stratification]. / Evaluation cardiologique préopératoire avant chirurgie non cardiaque: stratification du risque cardiovasculaire.

Perioperative cardiac events occurring in patients undergoing non-cardiac surgery are a common cause of morbidity and mortality. Current guidelines recommend an individualized approach to preoperative cardiac risk stratification prior to non-cardiac surgery, integrating risk factors both for the patient (active cardiac conditions, clinical risk factors, functional capacity) and for the planned surgery. Preoperative cardiac investigations are currently limited to high-risk patients in whom they may contribute to modify the perioperative management. A multidisciplinary approach to such patients, integrating the general practitioner, is recommended in order to define an individualized peri-operative strategy.

[Indications for urgent coronary angiography. Part I: ST-segment elevation acute coronary syndromes]. / Indications à la coronarographie en urgence. Partie I: syndromes coronariens aigus avec élévation du segment ST.

The indications for urgent coronary angiography are stated in the guidelines for treatment of acute coronary syndromes. An invasive approach is considered the treatment of choice for patients presenting with ST elevation myocardial infarction within 12 hours of the beginning of symptoms. In the absence of contraindication, intravenous thrombolysis continues to be a valuable alternative to primary angioplasty within 3 hours of the beginning of clinical symptoms. Urgent coronary angiography continues to be recommended following the failure of thrombolysis, persistent myocardial ischemia after 12 hours of symptoms, recurrent myocardial ischemia following myocardial infarction or in the case of cardiogenic shock.

[Indications for urgent coronary angiography. Part II: Acute coronary syndromes without ST-segment elevation]. / Indications à la coronarographie en urgence. Partie II: syndromes coronariens aigus sans élévation du segment ST.

The optimal treatment strategy for patients presenting with an acute coronary syndrome without ST elevation is controversial and different therapeutic approaches are recognized. Currently, given the literature available, it is not possible to recommend a universal systematic invasive approach. It is essential to individually risk stratify patients in order to identify those high risk patients that have been shown to benefit from an invasive strategy. Compared to conservative medical treatment, patients at low risk have not been shown to benefit from an invasive strategy. Urgent coronary angiography remains recommended for those patients with persistent or recurrent ischemic symptoms under optimal medical treatment.