Fatma Ben Amor

0409: Selection and timing for invasive therapy in non ST segment elevation acute coronary syndrome: Impact in the real world

Introduction The optimal timing of coronary intervention in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACSs) is a matter of debate. Purpose We 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 methods It 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. Results A 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 Conclusion Despite the fact that our work has showed that invasive strategy is associated with a better prognosis in ACS ST (-) patients, the use of this strategy remains insufficient.

146: Native valve infective endocarditis in a tertiary care center in a Tunisian context: Clinical aspects and predictors events

Background Despite significant progress made in diagnostic and therapeutic modalities, infective endocarditis (IE) remains a serious affection associated with considerable mortality and morbidity. Aim To describe the epidemiological and clinical aspects of native valve infective endocarditis (IE) in a Tunisian high-volume tertiary care center and to identify the predictors of outcome. Methods and results Demographic, clinical, laboratory, and echocardiographic characteristics were examined in 176 patients who fulfilled the modified Duke criteria for native valve IE between January 1993 and December 2008. Logistic regression analysis was used to identify prognostic factors for death. Mean age was 36.1±7.5 years. Diagnosis was definite in 85% of cases. Median time to diagnosis was 19 days. Rheumatic heart disease (RHD) was the predominant (47%) underlying heart condition. Mitral valve location was the most frequent seat of IE (37.7%). One or more vegetations were detected in more than 86.8% of cases. The median size of vegetation was >15 mm in 26% of cases. In 84 cases (48.5%), cultures remained negative. Serology was positive in 16 cases, and in 4 cases leaflet culture identified the agent. Causative microorganisms were mainly Staphylococci (n=42 (24.2%), including 8 coagulase-negative Staphylococcus), and Streptococci (n=32). Overall mortality was 18.6%. On multivariate analysis, congestive heart failure (hazard ratio = 5.62, 95% CI 1.32 to 12.54, p=0.008) and large vegetations (>15 mm; hazard ratio = 4.28, 95% CI 1.91 to 11.69, p=0.004) and neurological complications (hazard ratio = 3.27, 95% CI 1.84 to 9.11, p=0.002) were predictive of in-hospital mortality. Conclusion IE remains a serious disease affecting a young population in Tunisia, with RHD as still the most common underlying heart disease, and it is associated with a high mortality.

079: Heart failure in native valve infective endocarditis: characteristics, prognosis, and results of surgical treatment

Background Although congestive heart failure (CHF) represents the most common cause of death in native valve infective endocarditis (IE), recent data on the outcome of IE complicated by CHF are lacking. Objective We aimed to analyse the characteristics and prognosis of patients with left-sided native valve IE complicated by CHF and to evaluate the impact of early surgery on 1 year outcome. Methods and results Two hundred and twenty consecutive patients with definite left-sided native valve IE according to the Duke criteria were included in this analysis. When compared with patients without CHF (n=144), new heart murmur, high comorbidity index, aortic valve IE, and severe valve regurgitation were more frequently observed in CHF patients (n=76, 34.5%). Aortic valve IE, elderly patients were more frequent in CHF patients. Congestive heart failure was independently predictive of in-hospital [OR 3.8 (1.7-9.0); P=0.0013] and 1 year mortality [HR 1.8 (1.1-3.0); P=0.007]. Early surgery was performed in 63% of CHF patients with a peri-operative mortality of 15%. In the CHF group, comorbidity index, anemia, uncontrolled infection, and major neurological events were multivariate predictors of 1 year mortality. Early surgery was independently associated with improved 1 year survival [HR 0.45 (0.22-0.93); P=0.03]. Conclusion Native valve IE complicated by CHF is more frequent in aortic IE and is associated with severe regurgitation. Congestive heart failure is an independent predictor of in-hospital and 1 year mortality. In CHF patients, early surgery is independently associated with reduced mortality and should be widely considered to improve outcome.

047 What are the predictors of not receiving a reperfusion therapy in STEMI patients

The proportion of pts receiving a reperfusion therapy was fluctuating but relatively stable during the last 16 years ranging from 45.2% in 1995 to 58.2% in 2010 with a peak of 74.2% in 2001. From 1995 to 2000, reperfusion was almost exclusively performed by thrombolysis whereas a dramatic increase of the use of PAMI was observed between 2000 and 2005 followed by a decrease in favor of the use of thrombolysis during the following 5 years probably due to an increase of the use of prehospital thrombolysis that ranged from14.3% in 2001 to 84% in 2009 among the thrombolysed pts.