Annales de cardiologie et d'angeiologie最新文献

Myocardial infarction (MI) is the leading cause of death worldwide, particularly affecting the elderly, a growing population. Yet, their management remains under-researched, especially in cases of multivessel coronary artery disease. These patients are at higher risk for post-procedural complications, but evidence - especially from the FIRE study (2023 - suggests that complete revascularization guided by coronary physiology (FFR or QFR) significantly reduces cardiovascular events in patients over 75, without a significant increase in complications. However, other studies like FLOWER-MI and SENIOR-RITA offer more nuanced perspectives. FLOWER-MI did not show a benefit of FFR guidance in younger patients, while SENIOR-RITA (2024) found that an invasive strategy after a non ST elevation acute coronary syndrome did not improve survival over medical therapy in very comorbid elderly patients, though it did reduce the rate of recurrent MIs. In conclusion, complete physiology-guided revascularization appears beneficial and safe for robust or mildly comorbid elderly patients, whereas a conservative approach may be preferable for more frail individuals. Treatment decisions should be individualized, considering overall health, comorbidities, life expectancy, patient preferences, and ideally discussed within a cardiogeriatric team. There's a growing need for practical tools to assess patient frailty and support clinical decision-making.

Women remain underrepresented in major TAVI studies, despite notable anatomical, pathophysiological, and clinical characteristics. These differences impact diagnosis, technical decisions, outcomes, and post-TAVI complications. Women typically present with a smaller aortic annulus, lower calcific burden but increased fibrosis, and a specific hemodynamic profile: paradoxical low-flow, low-gradient aortic stenosis. In the short term, they are at higher risk of annular rupture, coronary obstruction, and vascular complications, but experience less paravalvular regurgitation. In the long term, women benefit from better survival and a quality of life comparable to that of men. In light of these findings and the RHEIA study, a sex-specific, personalized approach is essential in the management of aortic stenosis.

Severe tricuspid regurgitation, considered a benign condition for decades, is now recognized for its significant impact on morbidity, mortality and quality of life. Despite this awareness, management often remains limited to symptomatic treatment with diuretics while surgery is rarely proposed due to a high operative risk approaching 10%. In this context transcatheter therapies have gained considerable momentum and represent a credible therapeutic alternative for high-risk patients. Among the emerging strategies, two techniques are predominant: edge-to-edge repair, the most extensively studied to date and now well established and transcatheter tricuspid valve replacement whose clinical data and visibility are steadily increasing owing to promising results. Therapeutic decision-making relies on a multidisciplinary evaluation incorporating clinical parameters, multimodality imaging and detailed valvular morphology. Two clinical cases are presented to illustrate the key factors guiding indication and procedural strategy for each approach.

Introduction: Data on coronary artery disease in women in the Maghreb remain scarce, particularly regarding the angiographic profile and procedural success of percutaneous coronary interventions (PCI). This study aimed to characterize the clinical and angiographic features of female patients undergoing PCI in a Moroccan center and to identify factors associated with incomplete revascularization.

Methods: This was a prospective observational study conducted between January and April 2025 in a cardiology center in Nador, Morocco. All female patients who underwent PCI during the study period were included. Clinical, angiographic, and procedural data were collected prospectively. Logistic regression analyses were performed to assess factors associated with incomplete revascularization.

Results: A total of 50 female patients were included (mean age: 69.9 ± 8.7 years). The prevalence of cardiovascular risk factors was high: 72% had diabetes, 74% had hypertension, and all were physically inactive. The most frequent indication for PCI was acute coronary syndrome (36%), followed by stable angina (32%). The median SYNTAX score was 7 [IQR: 4-16.25]. Complete revascularization was achieved in 72% of cases. In univariate analysis, incomplete revascularization was significantly associated with age >75 years (p = 0.03), higher SYNTAX score (median 12 vs. 6; p < 0.001), multivessel intervention (p = 0.001), severe coronary calcification (p < 0.001), and longer total stent length (p = 0.002). In multivariate analysis, only SYNTAX score (OR = 1.27; p < 0.05) and severe calcification (OR = 32.2; p < 0.05) remained independent predictors of incomplete revascularization.

Conclusion: This study highlights the distinctive clinical and angiographic profile of Moroccan women undergoing PCI, characterized by advanced age, a high burden of diabetes, and frequent calcified lesions. SYNTAX score and severe calcification emerged as the main predictors of incomplete revascularization in this cohort.

Diabetes constitutes a major risk factor for coronary artery disease, with often diffuse, calcified, and complex lesions, making the revascularization strategy particularly challenging. We report two clinical cases illustrating contrasting approaches in diabetic patients presenting with multivessel coronary disease. The first case involves a complex coronary angioplasty in the setting of acute coronary syndrome, guided by intracoronary imaging, highlighting the value of this modality in ostial left main lesions. The second case describes surgical revascularization in a stable patient with extensive coronary artery disease and left ventricular dysfunction, demonstrating the superiority of coronary artery bypass grafting in this context. These observations illustrate the importance of a personalized and multidisciplinary approach, based on current guidelines and the patient's anatomical and clinical characteristics. The advent of modern revascularization techniques and the anticipated results of the ANDAMAN study could soon redefine the standards of care for these high-risk patients.