Complex Lesions Research Articles

Congenital Cardiac Anesthesia: A Case-based Approach

Congenital Cardiac Anesthesia: A Case-based Approach

Diagnostic accuracy of wrist MRI in comparison to wrist arthroscopy regarding TFCC lesions in clinical practice.

The purpose of this study was to arthroscopically verify MRI diagnostic accuracy for triangular fibrocartilage complex (TFCC) lesions in a regular clinical environment. A total of 859 patients' data with both preoperative MRI of the wrist and additional wrist arthroscopy were retrospectively reviewed. Two board-certified hand surgeons and one orthopaedic surgeon executed wrist arthroscopy, whereas more than 100 radiologists examined the MRI of the wrist. The accordance of TFCC lesion classification using MRI in comparison to wrist arthroscopy and diagnostic precision of the former depending on technical details were evaluated. Diagnostic accuracy of MRI for TFCC lesions is poor in comparison to wrist arthroscopy as the reference standard. Technical specifications for MRI of the wrist are heterogeneous among the radiologists. These parameters have not improved accuracy of TFCC evaluation at large. The accuracy of MRI in a regular clinical environment still remains inferior to wrist arthroscopy for detection of TFCC lesions. Development of a standard MRI protocol may be implemented on a regular basis and application of the Palmer classification for TFCC lesion should be sought.

Short-term outcomes of endovascular therapy for chronic lower extremity arterial disease

Background: Chronic lower extremity arterial disease, mostly caused by atherosclerotic etiology, has been increasing in recent years. Currently, there has been a shift in the treatment chronic lower extremity arterial disease from open surgical treatment to endovascular intervention. According to the TASC classification, surgical treatment is preferred for patients with complex lesions of TASC C, D but recent studies have shown that endovascular intervention has had good results for high-grade lesions.
 Objective: To determine the efficacy, short-term results of endovascular intervention in patients with symptomatic lower extremity artery disease
 Methods: From January to December 2021, the cross sectional, descriptive study was carried out on 38 patients with lower limb artery disease, treated by endovascular intervetion in Interventional Department, Hanoi Heart hospital. All patients were evaluated by clinical symptoms, ankle- brachial index and lesion characteristic before and after the intervention to determine the initial success
 Results: Majority of lesions belong to TASC II C and D (78,9%). Injured arteries can be isolated in the aortoiliac (21,1%), femoropopliteal (21,1%), below-knee artery (21,1%) or combine aortoiliac and femoropopliteal (10,5%), femoropopliteal and BTK (15,8%). The ankle- brachial index before and after the intervention respectively 0,57 and 0.83 (p<0,001). The technical successful rate was 94,7%. Balloon angioplasty and stent placement were in 21 patients (55,3%) and balloon angioplasty in 17 patients (44,7%). Post-procedural complications included stent thrombosis (2.6%), amputation (2.6%), pseudoaneurysm at the puncture site (2.6%).
 Conclusion: Endovascular intervention is a safe, effective, minimally invasive method in the treatment of chronic lower extremity arterial disease

Hospital discharge codes and substantial underreporting of congenital heart disease

BackgroundHospital discharge codes are relied upon for research, accounting/invoicing and health systems planning. Congenital heart disease (CHD), however, is uniquely difficult for non-cardiologists to code due to the rarity, variety and complexity of lesions. It is therefore important that the accuracy of hospital discharge codes is regularly checked to ensure that the prevalence and burden of CHD is being correctly estimated and recorded. Methods and resultsWe identified all inpatient admissions of adults with CHD to Royal Prince Alfred Hospital in Sydney, Australia from January 2018 to March 2021 (257 admissions, 106 unique patients). The associated discharge coding summaries were extracted and compared to the codes in the separately collected and audited Adult CHD database. Only a quarter of discharge coding summaries contained any diagnosis of CHD, and just one-tenth accurately recorded all appropriate CHD diagnoses. Patients with simple lesions were most likely to have a coded diagnosis of CHD, while those with moderate and complex lesions were much less likely. Moreover, patients admitted under a cardiovascular specialty were twice as likely to have a coded diagnosis of CHD, compared with those admitted under non-cardiovascular specialties (p ​= ​0.006). Overall, less than half of patients had any hospital-coded diagnosis of CHD in any admission over the three-year study period. ConclusionsHospital discharge coding dramatically underreports CHD, especially for patients with moderate and severe CHD lesions and for admissions under non-cardiovascular specialties. This suggests that discharge coding-based estimates of the burden of CHD on hospitals and health systems may be substantially underestimated.

Outcomes of the Novel Supreme Drug-Eluting Stent in Complex Coronary Lesions: A PIONEER III Substudy.

The Supreme healing-targeted drug-eluting stent (DES) is designed to promote endothelial healing to reduce stent-related adverse events. This may be particularly relevant among complex lesions that have a higher rate of adverse events. We sought to compare 1-year outcomes of percutaneous coronary intervention in complex lesions between the Supreme DES and contemporary durable-polymer, everolimus-eluting stents (DP-EES). PIONEER III was a multicenter, prospective, single-blind clinical trial, randomizing 1629 patients with either an acute or chronic coronary syndrome in a 2:1 ratio to the Supreme DES or DP-EES. Complex lesions (American College of Cardiology/American Heart Association type B2/C) were found in 1137 patients. Outcomes were also compared for specific parameters of lesion complexity: severe calcification, long length (>20​mm), and severe tortuosity. The primary end point was target lesion failure at 1​year. At 1​year, there was no difference in target lesion failure between the Supreme DES and DP-EES: (5.7% vs 5.6%; hazard ratio 1.00, 95% confidence interval 0.59-1.68, P = .99). Similarly, there were no differences in the secondary end points of lesion success (99.7% vs 99.4%, P = .41), device success (97.0% vs 98.5%, P = .14), target vessel failure (6.5% vs 7.4%, P = .50), major adverse cardiac events (7.8% vs 8.5%, P = .64), or stent thrombosis (0.7% vs 1.1%, P = .48). A trend was observed toward a higher rate of target lesion revascularization with the Supreme DES (2.5% vs 0.9%, P = .06). This study suggests that the Supreme DES is as effective and safe at 1​year compared with the standard DP-EES across a broad spectrum of lesion complexity.

A Warm Welcome to The First Issue of JSCAI

A Warm Welcome to The First Issue of JSCAI

Evaluating the frequency of successful guidewire crossing through a complex lesion in coronary artery disease patients having chronic total occlusion.

Objectives:To determine the frequency of successful guidewire crossing through chronic total occlusion (CTO) in patients having a J-CTO Score = 2 (difficult lesion).Methods:A prospective, cross-sectional study was conducted at the Armed Forces Institute of Cardiology (AFIC) in Rawalpindi. Patients with high calcium score on CT-angiogram were sent for elective coronary angiogram out of which patients diagnosed with chronic total occlusion (CTO) were selected and J-CTO Score was assessed. Those with a J-CTO score = 2 (difficult lesion) were enrolled for percutaneous coronary intervention (PCI). Guidewire that can cross the lesion within 30 minutes was considered successful.Results:A total of 158(95.8%) cases had successful guidewire crossing, while in 7(4.2%) patients, the procedure was unsuccessful. No significant association between the success rate of guidewire crossing and age (p = 0.21). Furthermore, there was no statistically significant relationship between guidewire crossing and LV function (p = 0.559) i.e. 32.2% and 42.9% of those with LV function between 25-35% had successful and unsuccessful guidewire crossing, respectively. While 67.7% and 57.1% patients having 36-65% LV function were observed having successful and failed PCI, respectively.Conclusions:The success rate of guidewire crossing through CTO in patients having a J-CTO Score =2 (difficult lesion) is acceptable so J-CTO score can be considered for difficulty grading of the lesion before intervention to prevent complications and success rate of PCI.

Evaluation of the Safety and Efficacy of Resection of Endometrial Polyps and Submucosal Fibroids in an Outpatient Setting in a Large District General Hospital in the UK.

Background:Conventionally, endometrial pathologies of varying complexity have been surgically treated as inpatients under a general or regional anesthetic.Aim:In this paper, we evaluate the safety and efficacy of hysteroscopic morcellation of endometrial pathology in the form of endometrial polyps (EPs) and submucosal fibroids in an outpatient setting for both simple and complex lesions using the Myosure™ device.Methods:Two hundred and forty-nine hysteroscopic resections were performed in an outpatient setting at the < BLINDED FOR REVIEW > from May 2014 to March 2021. The median age of the patients was 54 years. More than half of the patients presented with postmenopausal bleeding; 64% were diagnosed with EPs and 24% with submucous fibroids (SMFs). The size, topography, extension, penetration, and wall classification system scoring system were used to grade them as simple (≤4) or complex (≥5) pathologies.Results:90% of pathologies were simple (≤4), of which complete resection was carried out in 95% of patients; 10% of the pathologies were complex (≥5), of which 63% had complete resection. Two patients with complex pathologies returned for completion surgery as a two-step procedure. No procedure was abandoned due to the patient intolerance. The median intraprocedure pain score visual analog scale was 5/10 and immediate postprocedure pain score was 1/10. Notably, there was no intra- or post-procedure complications.Conclusion:Outpatient resection of endometrial pathology, both simple and complex, can be safely and effectively performed using hysteroscopic morcellator (Myosure™) and is accepted and well tolerated by patients.

Six-years experience in major scalp defect reconstruction with free flap: analysis of the results.

Introduction:The purposes of this study were to report 10-years experiences in microsurgical reconstruction of major scalp defects, comparing outcomes, evaluating complications.Materials and methods:From November to July 2015, 10 consecutive patients underwent microsurgical procedures for severe scalp defects.Results:The average age was 55,1 years ranging from 6 to 87 years. The mean follow-up was 16.7 months ranging from 12 to 24 months. The size of the lesions ranged from 9x10 to 16x20cm. The average hospital stay was 20 days ranging from 8 to 43 days. Mean operative times was 5.3 h ranging from 5 to 6.45 h. Free flaps included 8 Latissimus Dorsi flaps (LD) and 2 anterolateral thigh flaps (ALT). The superficial temporal vessels were used as recipient vessels in 9 cases while the superior Thyroid artery was used in remaining case.Discussion:For large or complex lesions, the use of free flaps is mandatory. Nowadays LD and ALT flaps are among the most common reconstructive choices for scalp defects reconstructions. Older age does not contraindicate the operation procedure nevertheless in younger patients the size of vessels is proportionately larger and pristine.Conclusion:Microvascular free tissue transfer is the mainstay of scalp defects coverage. In our series early complications are less common and concerning than late complications and in fact reoperations are mainly required to manage these latter. Advanced age should be not consider a contraindication for free flap surgery and the procedure can be considered safe and reliable in both old and young population. (www.actabiomedica.it)

Emotions, Perceptions and Health Behaviors of Adult Congenital Heart Disease Patients during COVID-19 in New York City

Background: Adults with congenital heart disease (ACHD) have increased prevalence of mood and anxiety disorders. There are limited data regarding the influence of the COVID-19 pandemic on the mental health and health behaviors of these patients. Objective: The purpose is to evaluate the perceptions, emotions, and health behaviors of ACHD patients during the COVID-19 pandemic. Methods: In this cross-sectional study of ACHD patients, we administered surveys evaluating self-reported emotions, perceptions and health behaviors. Logistic regressions were performed to determine the adjusted odds of displaying each perception, emotion and health behavior based on predictor variables. Results: Ninety-seven patients (mean age 38.3 years, 46.4% female, 85.6% moderate or complex lesion) completed the survey. The majority of patients reported feeling moderately or very sad (63.1%), and 48.4% of patients identified themselves as feeling moderately or very anxious. The majority of patients perceived their risk of COVID-19 as moderate or high. Females were more likely to report feeling sad and anxious (95% CI 1.06–10.96, p-value 0.039, and 95% CI 1.44–15.30, p-value = 0.012, respectively), and were associated with higher odds of having a perceived increased risk of COVID-19 (95% CI 1.33–10.59, p-value 0.012). There was no association between ACHD anatomic or physiologic classification and perceptions, emotions and health behaviors. Conclusions: Females were more likely to report feeling sad, anxious and an increased risk of COVID-19 in comparison to males. These findings indicate the need for mental health support and promotion of health behaviors during the pandemic amongst all ACHD patients, regardless of underlying condition.

TRANS-OLECRANIAL DISLOCATION FRACTURE IN CHILDREN

Trans-olecranial fracture-dislocations are a rare entity of elbow fracture-luxations in children and the literature is poor in recommendations for their management. It is a complex lesion that can compromise the functional prognosis of the elbow[7]. It is characterized by a dislocation of the humero-ulnar joint associated with a fracture of the olecranon without dissociation of the two bones of the forearm. We report an observation with a lesion that is rarely described in the literature.

COMPARATIVE RADIOLOGICAL DIAGNOSTICS OF ACUTE TRIANGULAR FIBROCARTILAGE COMPLEX INJURIES.

The aim was to analyze patients with clinical diagnosis of triangular fibrocartilage complex (TFCC) lesion using standard x-ray, ultrasound, conventional magnetic resonance imaging (MRI) and MR arthrography (MRA); to evaluate the accuracy of MRA compared with MRI in the diagnosis of this lesion; and to evaluate ultrasound as a method of diagnosing TFCC lesion. We analyzed 72 patients (46 female and 26 male; age range, 22-61 years; mean age 37 years; 50 right and 22 left wrists) with suspected TFCC lesion with clinical examination, standard x-rays, and ultrasound. We confirmed patients with traumatic TFCC injury on MRI and MRA. Ultrasound found 13 lesions in 72 patients with suspected TFCC lesions. Conventional MRI found 66 and MRA 68 TFCC lesions. Ultrasound is useful for visualizing intra-articular effusion, soft tissue, bone surface, and for early detection of occult fractures. MRI is a better diagnostic modality, fully able to visualize the TFCC cartilage and ligaments. MRA is consistently and accurately able to visualize structural abnormalities of TFCC.

PROGNOSTIC VALUE OF RESIDUAL SYNTAX SCORE COMBINED WITH ACEF SCORE IN ACUTE CORONARY SYNDROME PATIENT AFTER PERCUTANEUS CORONARY INTERVENTION IN SAIFUL ANWAR HOSPITAL, MALANG

Background : Percutaneous coronary intervention (PCI) is one of the revascularization options in patients with clinical acute coronary syndrome (ACS) who often have multiple and complex vascular lesions. So, the decision to complete revascularization is still a topic that is widely explored to reduce the rate of rehospitalization and reinfarction. This study aims to determine the predictor value of rehospitalization and reinfarction events that can be used in ACS patients undergoing IKP using coronary angiography parameters with residual SYNTAX scores and clinical parameters using ACEF scores. Method : The study was cohort prospective with the inclusion criteria being all ACS patients who underwent PCI in RSUD Dr. Saiful Anwar Malang from January 2017 to July 2021. All patients underwent IKP and underwent coronary angiography evaluation after IKP with a residual SYNTAX score (rSS) and divided into categories into rSS≤8 and rSS&gt;8. All patients underwent laboratory examination of serum creatinine and post-PCI echocardiography, and an ACEF score was obtained (ACEF score = age/left ventricular ejection fraction + 1 [if serum creatinine &gt;2 mg/dl]). Research subjects will be followed up for at least 1 year related to the incidence of post-PCI rehospitalization and reinfarction. Results : From a total sample of 209 patients, it was found that the residual SYNTAX score data had the most significant predictive factor for the occurrence of rehospitalization at 1 year after PCI (OR 6.14 [95% CI, 1.92-1967]). At the value of rSS &gt; 8, (AUC 0.750 [95% CI, 0.682-0.818], p 0.001) has a good predictive value for the occurrence of rehospitalization. However, combining with clinical parameters using the ACEF score provides a better predictive value. This study shows that the combination of rSS&gt;8 and ACEF score&gt;1.2 provides a better predictive value (AUC 0.884 [95%CI, 0.832-0.936) for the incidence of rehospitalization in post-PCI ACS patients. Conclusion : Acute coronary syndrome patients with residual SYNTAX scores &gt; 8 and ACEF scores &gt; 1.2 had a strong predictive value for rehospitalization events 1 year after PCI. The use of the combination of these two scores is expected to be a clinical guide to obtain the degree of completeness of revascularization in ACS patients.

Prevalence of metabolic syndrome and its clinical and angiographic profile in patients with naive acute coronary syndrome

Objective: The objective of the study is to evaluate the prevalence of metabolic syndrome (MS) and its clinical and angiographic profile in patients with naive acute coronary syndrome (ACS). Furthermore, this study tried to evaluate the severity of coronary artery disease in patients with and without MS. Methods: This was a single-center, cross-sectional study which prospectively enrolled 500 patients with naive ACS during the period from January 2017 to December 2018 at a tertiary care center in India. They were divided into two groups according to the presence and absence of MS based on revised NCEP ATP III guidelines. The ACS was defined based on the Joint Committee of the American College of Cardiology. After clinical evaluation and investigations, the prevalence of MS in ACS patients was calculated. Results: Prevalence of MS in this study was 46.2% and was more frequent in males (81%) compared to females (19%). Maximum number of patients with MS were between the age group of 40–59 years (55%). Prevalence of diabetes (56.7%), hypertension (58.0%), and smoking (45.88%) were significantly higher in patients with MS (P < 0.001). Most prevalent components of MS were low high-density lipoprotein (HDL) levels, increased blood pressure, fasting blood sugar, and triglyceride levels (P < 0.001). Conclusion: Prevalence of MS was high in patients with ACS and was more often after the age of 40 years and most commonly seen in males. Low HDL levels, increased blood pressure, and blood sugar were most prevalent components in the criteria for MS. Patients with MS tend to have more complex coronary lesions.

Coronary Intravascular Lithotripsy Versus Rotational Atherectomy in an Asian Population: Clinical Outcomes in Real-World Patients.

We compared real-world clinical outcomes of patients receiving intravascular lithotripsy (IVL) versus rotational atherectomy (RA) for heavily calcified coronary lesions. Fifty-three patients who received IVL from January 2017 to July 2020 were retrospectively compared to 271 patients who received RA from January 2017 to December 2018. Primary endpoints were in-hospital and 30-day major adverse cardiovascular events (MACE). IVL patients had a higher prevalence of acute coronary syndrome (56.6% vs 24.4, p<0.001), multivessel disease (96.2% vs 73.3%, p<0.001) and emergency procedures (17.0% vs 2.2%, p<0.001) compared to RA. In-hospital MACE (11.3% vs 5.9%, p=0.152), MI (7.5% vs 3.3%, p=0.152), and mortality (5.7% vs 3.0%, p=0.319) were not statistically significant. 30-day MACE was higher in the IVL cohort vs RA (17.0% vs 7.4%, p=0.035). Propensity score adjusted regression using IVL was also performed on in-hospital MACE (odds ratio [OR], 1.677; 95% confidence interval [CI], 0.588-4.779) and 30-day MACE (OR, 1.910; 95% CI, 0.774-4.718). These findings represent our initial IVL experience in a high-risk, real-world cohort. Although the event rate in the IVL arm was numerically higher compared to RA, the small numbers and retrospective nature of this study preclude definitive conclusions. These clinical outcomes are likely to improve with greater experience and better case selection, allowing IVL to effectively treat complex calcified coronary lesions.

Cell-to-Cell Crosstalk: A New Insight into Pulmonary Hypertension.

Pulmonary hypertension (PH) is a disease with high pulmonary arterial pressure, pulmonary vasoconstriction, pulmonary vascular remodeling, and microthrombosis in complex plexiform lesions, but it has been unclear of the exact mechanism of PH. A new understanding of the pathogenesis of PH is occurred and focused on the role of crosstalk between the cells on pulmonary vessels and pulmonary alveoli. It was found that the crosstalks among the endothelial cells, smooth muscle cells, fibroblasts, pericytes, alveolar epithelial cells, and macrophages play important roles in cell proliferation, migration, inflammation, and so on. Therefore, the heterogeneity of multiple pulmonary blood vessels and alveolar cells and tracking the transmitters of cell communication could be conducive to the further insights into the pathogenesis of PH to discover the potential therapeutic targets for PH.

The role of diffusion-weighted imaging in the evaluation of adnexal lesions.

PurposeMagnetic resonance imaging (MRI) has been used as a problem-solving tool in the diagnosis of adnexal lesions. Both benign and malignant ovarian masses can present as complex adnexal lesions. Preoperative diagnosis of malignancy is essential for planning the surgical approach and appropriate treatment regimen. The aim of our study was to determine the role of diffusion-weighted MRI (DWI) in differentiating benign from malignant adnexal lesions.Material and methodsFifty-five patients (constituting 67 lesions) referred to MRI for evaluation of adnexal lesions were studied using 1.5 T MRI. The signal on DWI (qualitative) and ADC values (quantitative DWI) of the solid and cystic components of the lesions were analysed separately. Chi-square test, cross tabulation, and ROC curves were used to determine features on DWI that could distinguish benign from malignant lesions.ResultsOf the 67 lesions, 50 were benign and 17 were malignant. There was a significant association of hyperintense signal of solid components on T2W and DWI with malignancy, with a p-value of 0.003 and 0.001, respectively. Benign lesions showed hypointense signal on T2W and DWI. ADC values of the solid components could not distinguish benign from malignant lesions; p = 0.290. The signal intensity and ADC values of the cystic fluid in benign and malignant lesions showed a significant overlap.ConclusionsQualitative DWI acts as an adjunct to conventional MRI in differentiating benign from malignant adnexal lesions showing solid/mixed morphology. It plays no role in distinguishing lesions based on their cystic components. ADC values play no role in differentiating benign from malignant adnexal lesions irrespective of lesion morphology.

Research Progress of Percutaneous Interventional Therapy For Bifurcation Lesions of Coronary Heart Disease

Compared with non-bifurcation lesions, even if the new generation of percutaneous coronary intervention (PCI) technology is used to treat coronary bifurcation lesions, the incidence of adverse cardiovascular events is still higher. The evaluation of related clinical data and computer virtual modeling before surgery can guide the implementation of bifurcation PCI in a more precise manner. The new understanding of bifurcation PCI may further improve the clinical prognosis and outcome of patients with bifurcation disease. This review aims to summarize the assessment methods of PCI for coronary heart disease non-left main bifurcation disease and the treatment plan supported by clinical evidence. The treatment plan depends on three parameters: the diameter of the three parts of the bifurcation lesion; the length of the lesion and plaque distribution; and the angle of the bifurcation. To this day, the best technique for PCI for bifurcation lesions is still controversial, and a personalized approach using temporary collateral stent implantation schemes seems to be suitable for 75% to 95% of patients. For more complex bifurcation lesions, it may be necessary to use two stents at the same time. More and more evidence supports the practicability of the DK-crush technique.

Clinicopathological Spectrum of Salivary Gland Lesions - A Retrospective Study from Tertiary Care Research Institute, Andhra Pradesh

Introduction: The salivary glands are subjected to various pathological conditions ranging from simple inflammation to most complex malignant lesions. Majority of these lesions can be diagnosed by simple histopathological examination. But, as these salivary gland lesions are not common, the incidence of these varies in different geographic locations. Aim: To study the spectrum of different salivary gland lesions and demographic data in a tertiary care hospital serving North East coastal area of Andhra Pradesh. Materials and Methods: This was a retrospective study conducted in Great Eastern Medical School and Hospital,Srikakulam, Andhra Pradesh, India. Total of 85 salivary gland lesions were analyzed for a period of 4 years (December 2015 to November 2019). From the records of Histopathology, Department of Pathology, data was retrieved. Typing of the salivary gland tumours were done using sections stained with Hematoxylin and Eosin (H&amp;E). All the cases were analysed and divided according to the demographics and histological type. Descriptive statistics were used and data was tabulated in frequency and percentages. Results: A total of 85 salivary gland lesions were studied, of which 14 (16%) were non-neoplastic and 71 (84%) were neoplastic in nature. Among the neoplastic lesions, 56 (66%) were benign and 15 (18%) were malignant. There was slight male preponderance with a ratio of M:F=1.3:1. Majority of the tumours occurred in parotid gland (73), followed by submandibular gland (7) and minor salivary glands (5). All the tumours were classified and graded according to World Health Organization (WHO), while Brandwein Grading System was followed for mucoepidermoid carcinoma. Pleomorphic adenoma was the most frequent benign tumour and mucoepidermoid carcinoma was the most common malignant tumour. Conclusion: Though benign salivary gland tumours are more frequently encountered in the present study, malignant salivary gland tumours are not uncommon.

Factors associated with major adverse cardiac events in very elderly patients with acute coronary syndrome

Prognosis of acute coronary syndrome (ACS) in very elderly patients is bleak. Also older people tend to receive less invasive treatment than younger patients. The aim of our study was to analyze the factors associated with major adverse cardiac events (MACE) on the mid-term outcome of elderly patients admitted with ACS. We retrospectively studied 158 patients 75 years or older admitted for ACS between January 2019 to December 2019. This population was more likely to be male (62% versus (vs.) 38%) with mean age 79,72 ± 4,46 years. The majority of patients had NSTEMI (67% NSTEMI, 33% STEMI). Thirty patients (19%) were managed medically and 128 patients (81%) underwent coronary angiography. Coronary angiograms showed complex coronary lesions with a high incidence of multivessel disease. Percutaneous angioplasty was performed in 88 patients (55.7%). Only 42% of patients had received complete revascularization. Four patients (2.5%) underwent surgical revascularization. At 12-month clinical follow-up, MACE were observed in 17.5%, with no differences between medically treated patients and revascularized patients (14,5% vs. 20%, P = 0,371). The factors associated with MACE were: STEMI compared to NSTEMI (26% vs. 13.5%, P-value 0.055), age ≥ 80 years (23.4% vs. 11.7%, P-value 0.05), obesity (50% vs. 15.3%, P-value 0.005), tachycardia on admission (39.1% vs. 13.7%, P-value 0.003), heart failure (29% vs. 14.6% P-value 0.06), a GRACE score ≥ 140 (35.7% vs. 23.7% vs. 0%, P-value 0.054), stents diameter < 3 mm (61.5% vs. 12.5%, P-value < 0.001) and no reflow (75% vs. 17.3%, P-value 0.005) The prognosis of ACS in the elderly is grim and medical and interventional therapeutic means remain underutilized in this population. A case-by-case assessment integrating the patient's wishes, his comorbidity and his degree of autonomy is necessary in order to assess the benefit/risk ratio of the therapeutic strategy.