Acute coronary syndrome in very elderly patients-a real-world experience.

Very elderly population constitutes an increasingly larger proportion of patients admitted for acute coronary syndromes (ACS). Notably, age represents both a proxy of frailty and an exclusion criterion in clinical randomized trials, which probably contributes to lack of data and undertreatment of real-world elderly patients. The aim of the study is to describe patterns of treatment and outcome of very elderly patients with ACS.

Antiplatelet Therapy with Cangrelor in Patients Undergoing Surgery after Coronary Stent Implantation: A Real-World Bridging Protocol Experience.

 The aim of the study is to describe the real-world use of the P2Y inhibitor cangrelor as a bridging strategy in patients at high thrombotic risk after percutaneous coronary intervention (PCI) and referred to surgery requiring perioperative withdrawal of dual antiplatelet therapy (DAPT).  We collected data from nine Italian centers on patients with previous PCI who were still on DAPT and undergoing nondeferrable surgery requiring DAPT discontinuation. A perioperative standardized bridging protocol with cangrelor was used.

Catheterization laboratory activity before and during COVID-19 spread: A comparative analysis in Piedmont, Italy, by the Italian Society of Interventional Cardiology (GISE).

Background: COronaVIrus Disease 19 (COVID-19) led to the reorganization of Cardiology Units in terms of working spaces and healthcare personnel. In this scenario, both outpatient visits and elective interventional cardiology procedures were suspended and/or postponed. We aimed to report the impact of COVID-19 on interventional coronary and structural procedures in Piedmont, Italy.

Bioresorbable scaffold: Never say never.

Bioresorbable vascular scaffolds (BVSs) were designed to overcome the limitations of metallic stents. Absorb BVS has provided information about strut thickness, scaffold degradation, vessel wall coverage, and their influence on thrombosis. Clinical trials have shown higher rates of target vessel myocardial infarction and stent thrombosis with the absorb BVS than with second-generation drug-eluting stents.

Antiplatelet therapy in STEMI undergoing primary PCI: when, which one and how long.

Reperfusion therapy for patients presenting with an acute ST-segment elevation myocardial infarction (STEMI) involves primary percutaneous coronary intervention (PPCI) and concomitant dual antiplatelet therapy (DAPT) with combination of a P2Y12 inhibitor and acetylsalicylic acid (ASA). Decision regarding DAPT can be challenging clinically in the modern era with the evolution of newer stents, more potent antiplatelet agents and novel anticoagulant drugs in addition to an older patient population with multiple comorbidities. This review outlines the currently available antiplatelet treatments, and their place within the therapeutic timeline of a patient presenting with STEMI.

Management strategies in patients affected by chronic total occlusions: results from the Italian Registry of Chronic Total Occlusions.

Background: Through contemporary literature, the optimal strategy to manage coronary chronic total occlusions (CTOs) remains under debate.

Objectives: The aim of the Italian Registry of Chronic Total Occlusions (IRCTO) was to provide data on prevalence, characteristics, and outcome of CTO patients according to the management strategy.

Methods: The IRCTO is a prospective real world multicentre registry enrolling patients showing at least one CTO.

[Transcatheter aortic valve implantation in bicuspid aortic valve: never say never].

Transcatheter aortic valve implantation (TAVI) is an emerging alternative technique that has shown promise in the treatment of severe aortic stenosis in patient populations at high risk with conventional surgery. The presence of a bicuspid aortic valve (BAV) has been considered an exclusion criterion for TAVI, because of the presumed risk for poor seating or paravalvular regurgitation due to severe distortion of the native valve leaflets. For this reason, BAV disease has generally been an exclusion criterion in major trials of TAVI and there is little clinical experience available.

Clinical characteristics and outcome of left ventricular ballooning syndrome in a European population.

We assessed the clinical characteristics and determinants of the prognosis of patients with left ventricular ballooning syndrome (LVBS) in an European population. A total of 128 patients with LVBS (98% women, age 67 ± 11 years) were prospectively followed up for a median of 13 months. A trigger event was identifiable in 58% of the patients.

Implementation of radial arterial access for cardiac interventions: a strong case for quality assurance protocols by the nursing staff.

Background: Radial arterial access is becoming increasingly popular for coronary angiography and angioplasty. The technique is, however, more demanding than femoral arterial access, and hemostasis is not care-free. A quality assurance program was run by our nursing staff, with patient follow-up, to monitor radial arterial access implementation in our laboratory.

Vascular access complications after cardiac catheterisation: a nurse-led quality assurance program.

Background: Vascular access complications may be a cause of discomfort, prolonged hospital stay, and impaired outcomes in patients undergoing cardiac catheterisation.

Aims: To assess vascular access complication in our patients with/without the use of closure devices as a first local benchmark for subsequent quality improvement.

Methods: A nurse-led single-centre prospective survey of all vascular access complications in consecutive patients submitted to cardiac catheterisation during 4 months.

[Angioplasty in the elderly].

Due to increasing age in the general population, patients > 75 years are more and more often submitted to cardiac catheterization. These patients have, in general, more severe and diffuse coronary disease, more severe comorbidities, and a higher risk for periprocedural complications. Elderly patients have traditionally been excluded from most clinical trials of coronary interventions, and most often receive medical undertreatment in clinical practice.

Management and outcomes of patients transferred for rescue coronary angioplasty in acute myocardial infarction.

Background: Rescue coronary angioplasty (PTCA), though recommended by the guidelines, is not regularly performed after failed lysis in patients with ST-elevation acute myocardial infarction (AMI), and data from large contemporary studies are not available. The outcomes of a recent series of consecutive patients in our Center are presented.

Methods: Between August 2000 and November 2003, 270 patients with AMI < 12 hours were referred to our cath lab for emergency PTCA: 117 (43%) for rescue PTCA after failed lysis, and 153 for primary or facilitated PTCA.

Half-dose thrombolysis to begin with, when immediate coronary angioplasty in acute myocardial infarction is not possible.

Background: Low-dose lytic drugs are sometimes administered to patients with ST-elevation acute myocardial infarction (AMI) as a bridge to coronary angioplasty (facilitated PTCA). Reports are scarce. The characteristics and outcomes of a recent series of consecutive patients treated in our Center are presented.

[Selection of contrast media for hemodynamic studies and limitation of the associated risk].

Both the choice of contrast media for use in the cardiac catheterization laboratory, and the practice for limiting patient damage, are relevant to the quality of health care. As part of our quality assurance program, and as a preliminary step to a critical reappraisal of our current protocols, an updated review has been made of existing evidence about contrast media for this use, and about measures to prevent adverse events. Consideration was also given to evidence-based measures or drug treatment in patients at risk for anaphylactoid reactions or with renal failure, as well as to the recommended course of action in diabetic patients receiving oral biguanide agents.

[Should we use clopidogrel instead of ticlopidine in elective coronary angioplasty?].

The use of ticlopidine in association with aspirin has reduced the incidence of subacute stent thrombosis to currently < 1% after coronary stent implantation. Clopidogrel, a more recently marketed thienopyridine derivative, has a lower incidence of side effects than ticlopidine. The use of clopidogrel in association with aspirin as compared to aspirin alone from the second through the sixth month after coronary angioplasty has been shown to reduce the 6-month incidence of major adverse cardiac events by 20-30%.

Clinical value of left atrial appendage flow velocity for predicting of cardioversion success in patients with non-valvular atrial fibrillation.

Background: Echocardiographic parameters for predicting cardioversion outcome in patients with non-valvular atrial fibrillation are not accurately defined.

Objective: To evaluate the role of left atrial appendage flow velocity detected by transoesophageal echocardiography for prediction of cardioversion outcome in patients with non-valvular atrial fibrillation enrolled in a prospective. multicentre, international study.

Transesophageal echocardiographic evidence of more pronounced left atrial stunning after chemical (propafenone) rather than electrical attempts at cardioversion from atrial fibrillation.

We studied left atrial function in 55 patients undergoing electrical (n = 23) or chemical (intravenous administration of propafenone, n = 32) attempts at cardioversion from atrial fibrillation. Chemical attempts at cardioversion revealed a significant increase in spontaneous echo contrast and a significant decrease in left atrial appendage Doppler flow, even in patients who did not have successful conversion to sinus rhythm.

Role of lipid, apolipoprotein levels and apolipoprotein E genotype in young Italian patients with myocardial infarction.

Background And Aim: Studies of young patients with acute myocardial infarction (AMI) have demonstrated that conventional risk factors are usually responsible for their premature atherosclerosis. No account has yet been published of the risk profile of young Italians surviving an AMI. In this study, the conventional risk factors, lipids and apolipoproteins, and apolipoprotein E (APOE) allele distribution were evaluated in 98 consecutive AMI survivors (94 males, 4 females) aged 40.

[Natriuretic peptides and the heart. Critical review and application].

This paper deals with a literature survey on natriuretic peptides (NP) and their clinical use in prognostic stratification and therapy of arterial hypertension and cardiac failure. After a brief historical introduction, the phylogenesis of NP is analyzed and the reasons of their preservation in the evolution are emphasized. The biochemistry of the NP is then treated, and the structure, synthesis, mechanism of cellular action and systems of regulation are analyzed.

[Evaluation of a registration card for logging electrocardiographic records into standard personal computers].

Background: The MS200 Cardioscope, from MRT Micro as., Norway, is a 12 channel ECG card to be directly inserted into a standard personal computer (PC). The standard ISA Bus compatible half length card comes with a set of 10 cables with electrodes and the software for recording, displaying and saving ECG signals.