Pub Date : 2025-09-01Epub Date: 2025-08-20DOI: 10.1016/j.ancard.2025.101928
Pierre Bourbon , Matthieu Périer , Benamer Hakim
Refractory angina is characterized by angina-type pain, which remains uncontrolled despite pharmacological optimization, and patients are not eligible or unsuitable for further interventional or surgical revascularisation. This condition may concern 5 to 10 % of coronary artery disease patients. This review gives an overview of the conventional pharmacological and interventional approaches in the field of refractory angina. It considers the variety of emerging non-pharmacological therapeutics and technologies addressing neural pain processing or myocardial perfusion, and offers a special focus on the coronary sinus reducer implantation technique, its physiopathological rationale and its clinical evidence.
{"title":"Angor réfractaire et place du réducteur de sinus coronaire","authors":"Pierre Bourbon , Matthieu Périer , Benamer Hakim","doi":"10.1016/j.ancard.2025.101928","DOIUrl":"10.1016/j.ancard.2025.101928","url":null,"abstract":"<div><div>Refractory angina is characterized by angina-type pain, which remains uncontrolled despite pharmacological optimization, and patients are not eligible or unsuitable for further interventional or surgical revascularisation. This condition may concern 5 to 10 % of coronary artery disease patients. This review gives an overview of the conventional pharmacological and interventional approaches in the field of refractory angina. It considers the variety of emerging non-pharmacological therapeutics and technologies addressing neural pain processing or myocardial perfusion, and offers a special focus on the coronary sinus reducer implantation technique, its physiopathological rationale and its clinical evidence.</div></div>","PeriodicalId":7899,"journal":{"name":"Annales de cardiologie et d'angeiologie","volume":"74 4","pages":"Article 101928"},"PeriodicalIF":0.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144864197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01Epub Date: 2025-08-11DOI: 10.1016/j.ancard.2025.101920
Mohamed Ghannem , Inès Cazaubiel
The coronary disease is the leading cause of mortality in women, with 4 to 6 times more deaths than breast cancer. Classically, cardiovascular risk factors show some particularities. Acute coronary syndromes with non-obstructive forms, known as MINOCA (Myocardial Infarction with Non-Obstructive Coronary Arteries), occur more frequently in women than in men, particularly including coronary spasm, microcirculatory ischemia, spontaneous coronary artery dissections (SCAD), and stress cardiomyopathy (takotsubo). The proven benefits of cardiac rehabilitation on hard endpoints, such as morbidity and mortality, do not prevent it from being underutilized, especially in women. The cardiovascular rehabilitation program must be personalized and adapted.
{"title":"La réadaptation cardiaque de la femme coronarienne","authors":"Mohamed Ghannem , Inès Cazaubiel","doi":"10.1016/j.ancard.2025.101920","DOIUrl":"10.1016/j.ancard.2025.101920","url":null,"abstract":"<div><div>The coronary disease is the leading cause of mortality in women, with 4 to 6 times more deaths than breast cancer. Classically, cardiovascular risk factors show some particularities. Acute coronary syndromes with non-obstructive forms, known as MINOCA (Myocardial Infarction with Non-Obstructive Coronary Arteries), occur more frequently in women than in men, particularly including coronary spasm, microcirculatory ischemia, spontaneous coronary artery dissections (SCAD), and stress cardiomyopathy (takotsubo). The proven benefits of cardiac rehabilitation on hard endpoints, such as morbidity and mortality, do not prevent it from being underutilized, especially in women. The cardiovascular rehabilitation program must be personalized and adapted.</div></div>","PeriodicalId":7899,"journal":{"name":"Annales de cardiologie et d'angeiologie","volume":"74 4","pages":"Article 101920"},"PeriodicalIF":0.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144827035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01Epub Date: 2025-08-20DOI: 10.1016/j.ancard.2025.101922
Sara Jourani , Zakariae Laraichi , Hakim Benamer
Myocardial ischemia occurring in patients with history of coronary artery bypass grafting (CABG) presents a significant therapeutic challenge. Vein graft degeneration, particularly of saphenous vein grafts, is a common complication with a time-dependent increase in incidence. Although arterial grafts offer greater long-term durability, they are not exempt from complications and may also require percutaneous interventions, which are often technically complex. Through this literature review, we examine the various revascularization strategies and reassess current guidelines, with the aim of optimizing therapeutic management in this high-risk patient population.
{"title":"Revascularisation du patient ponté : revue de la littérature des stratégies thérapeutiques","authors":"Sara Jourani , Zakariae Laraichi , Hakim Benamer","doi":"10.1016/j.ancard.2025.101922","DOIUrl":"10.1016/j.ancard.2025.101922","url":null,"abstract":"<div><div>Myocardial ischemia occurring in patients with history of coronary artery bypass grafting (CABG) presents a significant therapeutic challenge. Vein graft degeneration, particularly of saphenous vein grafts, is a common complication with a time-dependent increase in incidence. Although arterial grafts offer greater long-term durability, they are not exempt from complications and may also require percutaneous interventions, which are often technically complex. Through this literature review, we examine the various revascularization strategies and reassess current guidelines, with the aim of optimizing therapeutic management in this high-risk patient population.</div></div>","PeriodicalId":7899,"journal":{"name":"Annales de cardiologie et d'angeiologie","volume":"74 4","pages":"Article 101922"},"PeriodicalIF":0.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144864199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01Epub Date: 2025-08-23DOI: 10.1016/j.ancard.2025.101916
Serigne C.T. Ndao, Nicolas Amabile
Background
Coronary artery disease remains the leading cause of mortality among women, despite a persistent underestimation of its clinical impact. Intracoronary imaging techniques (ICI), such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT), have emerged as valuable tools to complement angiography, especially in women, whose pathophysiological mechanisms are often atypical.
Aims
To analyse current data on the use of ICI in women and highlight its benefits, limitations, and sex-specific considerations.
Methods
Narrative review of recent literature, including observational studies, post-hoc analyses of randomized trials, and registries focusing on IVUS and OCT use in women.
Results
Women tend to have smaller coronary arteries, less extensive atherosclerotic disease, and distinct plaque composition, with a predominance of erosions over ruptures. These characteristics are poorly assessed by angiography alone, reinforcing the value of ICI, particularly in cases of MINOCA and spontaneous coronary artery dissection (SCAD). Despite demonstrated clinical benefits, ICI remains underused in women, with lower penetration into routine practice and underrepresentation in clinical trials. Complications related to intracoronary imaging are rare and comparable between genders, if precautions specific to female anatomy are observed.
Conclusion
ICI represents a significant yet underutilized opportunity to improve cardiovascular outcomes in women. Better integration of this technology into diagnostic and therapeutic strategies, combined with more gender-specific research, is essential to reduce persistent disparities in care.
{"title":"Imagerie intracoronaire : quelle place dans la pathologie cardiovasculaire de la femme ?","authors":"Serigne C.T. Ndao, Nicolas Amabile","doi":"10.1016/j.ancard.2025.101916","DOIUrl":"10.1016/j.ancard.2025.101916","url":null,"abstract":"<div><h3>Background</h3><div>Coronary artery disease remains the leading cause of mortality among women, despite a persistent underestimation of its clinical impact. Intracoronary imaging techniques (ICI), such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT), have emerged as valuable tools to complement angiography, especially in women, whose pathophysiological mechanisms are often atypical.</div></div><div><h3>Aims</h3><div>To analyse current data on the use of ICI in women and highlight its benefits, limitations, and sex-specific considerations.</div></div><div><h3>Methods</h3><div>Narrative review of recent literature, including observational studies, post-hoc analyses of randomized trials, and registries focusing on IVUS and OCT use in women.</div></div><div><h3>Results</h3><div>Women tend to have smaller coronary arteries, less extensive atherosclerotic disease, and distinct plaque composition, with a predominance of erosions over ruptures. These characteristics are poorly assessed by angiography alone, reinforcing the value of ICI, particularly in cases of MINOCA and spontaneous coronary artery dissection (SCAD). Despite demonstrated clinical benefits, ICI remains underused in women, with lower penetration into routine practice and underrepresentation in clinical trials. Complications related to intracoronary imaging are rare and comparable between genders, if precautions specific to female anatomy are observed.</div></div><div><h3>Conclusion</h3><div>ICI represents a significant yet underutilized opportunity to improve cardiovascular outcomes in women. Better integration of this technology into diagnostic and therapeutic strategies, combined with more gender-specific research, is essential to reduce persistent disparities in care.</div></div>","PeriodicalId":7899,"journal":{"name":"Annales de cardiologie et d'angeiologie","volume":"74 4","pages":"Article 101916"},"PeriodicalIF":0.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144889088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01Epub Date: 2025-08-08DOI: 10.1016/j.ancard.2025.101917
Andrei Georgian Florescu, Enrique Alonso, Emilie Fougères, Morad Djebbar, Imane Bagdadi, Antoinette Neylon, Mariama Akodad
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.
{"title":"[Percutaneous treatment of severe tricuspid regurgitation: indications and therapeutic options through two clinical cases].","authors":"Andrei Georgian Florescu, Enrique Alonso, Emilie Fougères, Morad Djebbar, Imane Bagdadi, Antoinette Neylon, Mariama Akodad","doi":"10.1016/j.ancard.2025.101917","DOIUrl":"10.1016/j.ancard.2025.101917","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":7899,"journal":{"name":"Annales de cardiologie et d'angeiologie","volume":"74 4","pages":"101917"},"PeriodicalIF":0.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144811528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01Epub Date: 2025-08-20DOI: 10.1016/j.ancard.2025.101925
Frédéric Lapostolle , Hakim Benamer , Aurélie Loyeau , Hugo Michalak , Tomislav Petrovic , Sophie Bataille , Yves Lambert
The issue of gender in acute myocardial infarction (AMI) emerged in the literature over 25 years ago. It became evident that, all other factors being equal, women with AMI had higher mortality rates than men. The e-MUST registry, which includes patients with ST-segment elevation myocardial infarction (STEMI) of less than 24 hours’ duration managed by one of the 39 Mobile Emergency and Resuscitation Services (SMUR) in the Île-de-France region, has allowed for numerous gender-focused analyses. Key findings include: [1] higher mortality in women: women experiencing AMI have a higher mortality risk (OR = 1.4; 95% CI: 1.1–1.8) compared to men [2]. Younger age of onset in women: while the average age at AMI onset increased by 2.9 years in men between 2002 and 2021 (from 57.6 to 60.5 years; p < 0.05), it decreased by 3.1 years in women (from 73.7 to 70.6 years; p < 0.0001) [3]. Advanced age in a subset of women: women represented 22% of the total registry population but accounted for over 60% of nonagenarian patients. In this very elderly subgroup, the rate of myocardial reperfusion decisions rose from 50% in the early 2000s to over 90% by the early 2020s. This intervention was associated with a 58% reduction in mortality [4]. Nontraditional risk profiles: women with AMI often presented without traditional cardiovascular risk factors, or with risk factors not routinely screened for [5]. Circadian patterns and delayed calls: AMI in women frequently occurred in the early morning, peaking at 08:00. Call delays to emergency services increased with age and nighttime onset, reaching up to 300 minutes in women over 65 experiencing chest pain at 1 a.m [6]. Prehospital management: except for a slightly lower rate of myocardial reperfusion in women (93% vs. 96% in men; p < 0.0001), prehospital management, including anticoagulant and antiplatelet therapy, was comparable between genders [7]. Gender bias in medical regulation: analysis of SAMU call regulation revealed that both the patient’s and the physician’s gender influenced the decision to dispatch a SMUR unit—ranging from 49% when both regulator and patient were men to just 18% when both were women [8]. Need for targeted approaches: these findings underscore the necessity for increased awareness, dedicated training, and gender-specific emergency care protocols to improve outcomes in women with AMI.
{"title":"Ce que le registre e-MUST dit de l’infarctus de la femme","authors":"Frédéric Lapostolle , Hakim Benamer , Aurélie Loyeau , Hugo Michalak , Tomislav Petrovic , Sophie Bataille , Yves Lambert","doi":"10.1016/j.ancard.2025.101925","DOIUrl":"10.1016/j.ancard.2025.101925","url":null,"abstract":"<div><div>The issue of gender in acute myocardial infarction (AMI) emerged in the literature over 25 years ago. It became evident that, all other factors being equal, women with AMI had higher mortality rates than men. The e-MUST registry, which includes patients with ST-segment elevation myocardial infarction (STEMI) of less than 24 hours’ duration managed by one of the 39 Mobile Emergency and Resuscitation Services (SMUR) in the Île-de-France region, has allowed for numerous gender-focused analyses. Key findings include: [1] higher mortality in women: women experiencing AMI have a higher mortality risk (OR = 1.4; 95% CI: 1.1–1.8) compared to men [2]. Younger age of onset in women: while the average age at AMI onset increased by 2.9 years in men between 2002 and 2021 (from 57.6 to 60.5 years; <em>p</em> < 0.05), it decreased by 3.1 years in women (from 73.7 to 70.6 years; <em>p</em> < 0.0001) [3]. Advanced age in a subset of women: women represented 22% of the total registry population but accounted for over 60% of nonagenarian patients. In this very elderly subgroup, the rate of myocardial reperfusion decisions rose from 50% in the early 2000s to over 90% by the early 2020s. This intervention was associated with a 58% reduction in mortality [4]. Nontraditional risk profiles: women with AMI often presented without traditional cardiovascular risk factors, or with risk factors not routinely screened for [5]. Circadian patterns and delayed calls: AMI in women frequently occurred in the early morning, peaking at 08:00. Call delays to emergency services increased with age and nighttime onset, reaching up to 300 minutes in women over 65 experiencing chest pain at 1 a.m [6]. Prehospital management: except for a slightly lower rate of myocardial reperfusion in women (93% vs. 96% in men; <em>p</em> < 0.0001), prehospital management, including anticoagulant and antiplatelet therapy, was comparable between genders [7]. Gender bias in medical regulation: analysis of SAMU call regulation revealed that both the patient’s and the physician’s gender influenced the decision to dispatch a SMUR unit—ranging from 49% when both regulator and patient were men to just 18% when both were women [8]. Need for targeted approaches: these findings underscore the necessity for increased awareness, dedicated training, and gender-specific emergency care protocols to improve outcomes in women with AMI.</div></div>","PeriodicalId":7899,"journal":{"name":"Annales de cardiologie et d'angeiologie","volume":"74 4","pages":"Article 101925"},"PeriodicalIF":0.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144864198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01Epub Date: 2025-08-08DOI: 10.1016/j.ancard.2025.101921
El Mostafa Aziouaz, Sara Jourani, Zakariae Laraichi, Hakim Benamer
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.
{"title":"[Coronary Angioplasty among Women in Morocco].","authors":"El Mostafa Aziouaz, Sara Jourani, Zakariae Laraichi, Hakim Benamer","doi":"10.1016/j.ancard.2025.101921","DOIUrl":"10.1016/j.ancard.2025.101921","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":7899,"journal":{"name":"Annales de cardiologie et d'angeiologie","volume":"74 4","pages":"101921"},"PeriodicalIF":0.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144811525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01Epub Date: 2025-09-04DOI: 10.1016/S0003-3928(25)00085-X
{"title":"Sommaire","authors":"","doi":"10.1016/S0003-3928(25)00085-X","DOIUrl":"10.1016/S0003-3928(25)00085-X","url":null,"abstract":"","PeriodicalId":7899,"journal":{"name":"Annales de cardiologie et d'angeiologie","volume":"74 4","pages":"Article 101946"},"PeriodicalIF":0.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144988107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01Epub Date: 2025-08-08DOI: 10.1016/j.ancard.2025.101918
Mehdi Benamer, Patrick Henry, Jean Guillaume Dillinger, Antoine Lequipar, Théo Pezel, Alexandre Lafont, Emmanuel Gall
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.
{"title":"[Coronary revascularization in diabetic patient: which approach to choose?]","authors":"Mehdi Benamer, Patrick Henry, Jean Guillaume Dillinger, Antoine Lequipar, Théo Pezel, Alexandre Lafont, Emmanuel Gall","doi":"10.1016/j.ancard.2025.101918","DOIUrl":"10.1016/j.ancard.2025.101918","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":7899,"journal":{"name":"Annales de cardiologie et d'angeiologie","volume":"74 4","pages":"101918"},"PeriodicalIF":0.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144811526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01Epub Date: 2025-08-20DOI: 10.1016/j.ancard.2025.101926
Ikram El marzouki , Jacques Monsegu
Coronary artery calcification is highly prevalent in elderly patients and poses significant challenges during percutaneous coronary intervention (PCI).
We report the case of an 86-year-old man admitted for ST-elevation myocardial infarction. Coronary angiography revealed triple-vessel disease with an acute coronary artery occlusion, a long, heavily calcified proximal-to-mid left anterior descending artery stenosis, and a severely calcified proximal circumflex lesion. PCI revascularization was performed in 3 steps: primary PCI of the right coronary artery initially, then 3 days after, PCI of the circumflex artery using rotational atherectomy, scoring balloon dilation, and intravascular lithotripsy. Then, at Day 15, PCI of the left anterior descending artery with orbital atherectomy finished complete revascularization.
This case underscores the importance of a comprehensive geriatric assessment—particularly frailty and physiological age—before selecting a revascularization strategy requiring the use of specific tools as advanced plaque-modification techniques and intravascular imaging, without any restriction according to age.
{"title":"Séniors et lésions coronaires calcifiées","authors":"Ikram El marzouki , Jacques Monsegu","doi":"10.1016/j.ancard.2025.101926","DOIUrl":"10.1016/j.ancard.2025.101926","url":null,"abstract":"<div><div>Coronary artery calcification is highly prevalent in elderly patients and poses significant challenges during percutaneous coronary intervention (PCI).</div><div>We report the case of an 86-year-old man admitted for ST-elevation myocardial infarction. Coronary angiography revealed triple-vessel disease with an acute coronary artery occlusion, a long, heavily calcified proximal-to-mid left anterior descending artery stenosis, and a severely calcified proximal circumflex lesion. PCI revascularization was performed in 3 steps: primary PCI of the right coronary artery initially, then 3 days after, PCI of the circumflex artery using rotational atherectomy, scoring balloon dilation, and intravascular lithotripsy. Then, at Day 15, PCI of the left anterior descending artery with orbital atherectomy finished complete revascularization.</div><div>This case underscores the importance of a comprehensive geriatric assessment—particularly frailty and physiological age—before selecting a revascularization strategy requiring the use of specific tools as advanced plaque-modification techniques and intravascular imaging, without any restriction according to age.</div></div>","PeriodicalId":7899,"journal":{"name":"Annales de cardiologie et d'angeiologie","volume":"74 4","pages":"Article 101926"},"PeriodicalIF":0.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144864200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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