Cardiac electrical instability in Erdheim-Chester disease: a case report.

Erdheim-Chester disease (ECD) is a rare multisystemic disorder of non-Langerhans histiocytic cells with a pleomorphic clinical presentation. It affects bones, skin, central nervous system, pituitary gland, ocular tissue, kidneys and perirenal tissue and lungs. Cardiac involvement presents usually with pericardial effusion and right atrial masses, but rarely with conduction system infiltration and subsequent arrhythmic events.

Predictors of Mortality and Long-Term Outcome in Patients with Anterior STEMI: Results from a Single Center Study.

Anterior ST segment elevation myocardial infarction (A-STEMI) has the worst prognosis among all infarct sites due to larger infarct size and the higher cardiac enzyme release. We retrospectively analyzed 584 A-STEMI undergoing urgent coronary angiography from October 2008 to April 2019. The median follow-up time was 1774 days with a minimum of a 1-year follow-up for 498 patients.

Predictors of procedural and clinical outcome in rotational atherectomy: analysis of a single center registry.

Background: Heavy calcified lesions can decrease effectiveness of drug eluted stents in preventing restenosis. Rotational atherectomy (RA) demonstrated to improve outcomes in patients with severely calcified lesions pretreated with debulking. However, its feasibility and its safety are continuously on stage.

Comparison of CRUSADE and ACUITY-HORIZONS Bleeding Risk Scores in Patients With Acute Coronary Syndromes.

Background: Compare the discriminative performance of two validated bleeding risk models for in-hospital bleeding events in a non-selected cohort of acute coronary syndrome (ACS) patients.

Methods: CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA Guidelines) and ACUITY-HORIZONS (Acute Catheterization and Urgent Intervention Triage strategY-Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction) scores were calculated in 501 consecutive patients (median age 68 years (IQR 57-77), 31% female) admitted for ACS to the coronary care unit (CCU) of San Paolo Hospital in Milan (Italy). In-hospital haemorrhagic events and mortality were recorded and calibration and discrimination of the two risk models were evaluated using the Hosmer-Lemeshow test and the C-statistic, respectively.

The paradox of clopidogrel use in patients with acute coronary syndromes and diabetes: insight from the Diabetes and Acute Coronary Syndrome Registry.

Background: Patients with diabetes mellitus (DM) and acute coronary syndromes have a greater level of platelet aggregation and a poor response to oral antiplatelet drugs. Clopidogrel is still widely used in clinical practice, despite the current evidence favoring ticagrelor and prasugrel.

Aim: The aim of this study was to investigate the determinants of clopidogrel use in the population of the multicenter prospective 'Acute Coronary Syndrome and Diabetes Registry' carried out during a 9-week period between March and May 2015 at 29 Hospitals.

Real-world clopidogrel utilization in acute coronary syndromes: patients selection and outcomes in a single-center experience.

Background: With this study, we sought to identify patient characteristics associated with clopidogrel prescription and its relationship with in-hospital adverse events in an unselected cohort of ACSs patients.

Materials And Methods: We studied all consecutive patients admitted at our institution for ACSs from 2012 to 2014. Patients were divided into two groups based on clopidogrel or novel P2Y12 inhibitors (prasugrel or ticagrelor) prescription and the relationship between clopidogrel use and patient clinical characteristics and in-hospital adverse events was evaluated using logistic regression analysis.

APpropriAteness of percutaneous Coronary interventions in patients with ischaemic HEart disease in Italy: the APACHE pilot study.

Objectives: To first explore in Italy appropriateness of indication, adherence to guideline recommendations and mode of selection for coronary revascularisation.

Design: Retrospective, pilot study.

Setting: 22 percutaneous coronary intervention (PCI)-performing hospitals (20 patients per site), 13 (59%) with on-site cardiac surgery.

Management of diabetic patients hospitalized for acute coronary syndromes: a prospective multicenter registry.

Background: Patients with diabetes mellitus and acute coronary syndrome (ACS) present an increased risk of adverse cardiovascular events. An Italian Consensus Document indicated 'three specific must' to obtain in this subgroup of patients: optimal oral antiplatelet therapy, early invasive approach and a tailored strategy of revascularization for unstable angina/non-ST-elevation-myocardial infarction (UA/NSTEMI); furthermore, glycemia at admission should be managed with dedicated protocols.

Aim: To investigate if previous recommendations are followed, the present multicenter prospective observational registry was carried out in Lombardia during a 9-week period between March and May 2015.

A rare case of large intracoronary thrombosis in advanced breast cancer patient treated with epirubicin and cisplatin.

: Cancer is associated with a prothrombotic or hypercoagulable state. Intracoronary thrombosis is a rare and potentially life-threatening complication in cancer patients. We describe a rare case of large nonocclusive intracoronary thrombosis successfully treated by means of medical therapy.

A comparison between two different definitions of contrast-induced acute kidney injury in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

Background: Contrast-induced acute kidney injury (CI-AKI) is associated with significantly increased mortality after primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI). The prognostic value of CI-AKI depends on the definitions used to define it. We compare the predictive accuracy of long-term mortality of two definitions of CI-AKI on consecutive patients undergoing pPCI for STEMI.

[Multidisciplinary management of patients with acute coronary syndrome and diabetes mellitus: from antithrombotic therapy to treatment of hyperglycemia].

Patients with diabetes mellitus (DM) and acute coronary syndromes (ACS) present a significantly higher risk of developing ischemic complications as compared to nondiabetic patients. Multiple mechanisms contribute to DM patients' enhanced prothrombotic status, including impaired fibrinolysis and coagulation, as well as endothelial and platelet dysfunction. Therefore, antithrombotic agents generally, and antiplatelet agents in particular, represent a logical secondary preventive strategy to reduce the risk of recurrent ischemic events in DM patients with ACS.

Acute myocardial infarction as first manifestation of left atrial myxoma in a young woman: role of echocardiography.

We report the case of a young woman with an acute myocardial infarction secondary to coronary embolization from a left atrial myxoma, as unusual presentation of a cardiac tumor.We also describe the role of transthoracic echocardiograpy in the multidisciplinary approach to diagnosis and treatment of this life-threatening condition.

Female gender and contrast-induced nephropathy in primary percutaneous intervention for ST-segment elevation myocardial infarction.

Background: Patients undergoing primary percutaneous coronary intervention (PCI) are at high risk for contrast-induced nephropathy (CIN), a complication that has been demonstrated to negatively affect outcomes. It has been suggested that, when compared to males, female patients present higher incidence of CIN and higher mortality after primary PCI. However, the specific role of gender in this setting remains ill-defined given its complex interplay with several co-morbidities and clinical characteristics.

[Upstream administration of oral antiplatelet agents in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention].

Current guidelines for the management of patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) recommend the administration of dual antiplatelet therapy with aspirin and an ADP receptor blocker "as early as possible" before angiography (upstream), though this suggestion is not based on the results of randomized clinical trials designed to investigate pre-hospital rather than in-hospital drug administration. The present review analyzed randomized clinical trials, registries and observational studies that assessed clopidogrel, prasugrel and ticagrelor administration in STEMI patients undergoing primary PCI to evaluate if their upstream use may be justified in clinical practice. A significant difference favoring early clopidogrel administration has been demonstrated in observational studies.

Prevention of contrast-induced nephropathy: a single center randomized study.

Background: Contrast-induced nephropathy (CIN) is the third cause of acute deterioration of renal function in hospitalized patients.

Hypothesis: The purpose of the study was to compare the efficacy of saline infusion, saline infusion plus N-acetylcysteine (NAC), and sodium bicarbonate (SB) infusion to prevent CIN in patients undergoing coronary angiography and/or percutaneous coronary intervention.

Methods: We prospectively studied 156 patients with a baseline creatinine level > or = 1.

Stress echocardiography for risk stratification of patients with chest pain and normal or slightly narrowed coronary arteries.

One hundred twenty-five patients (60 +/- 10 years old, 60 women) with known (35, previous myocardial infarction) or suspected (90) coronary artery disease (CAD) and no more than 50% coronary stenoses underwent pharmacologic (48 dipyridamole and 77 dobutamine) stress echocardiography (SE) and prospective follow-up (36 +/- 22 months) for cardiac death, nonfatal infarction, and unstable angina. The ability of clinical and SE variables to predict the outcome was assessed by the Cox model. A significant increase in the global chi-square of the model indicated an incremental prognostic value.