Comparison of Stroke and Bleeding Risk Profile in Patients With Atrial Fibrillation and Chronic Kidney Disease.

Clinical decision making on anticoagulation in patients with chronic kidney disease with atrial fibrillation (AF) is challenging. The current strategies are based on small observational studies with conflicting results. This study explores the impact of glomerular filtration rate (GFR) in the embolic-hemorrhagic balance among a large cohort of patients with AF.

Bleeding risk assessment in elderly patients with acute coronary syndrome.

Nowadays, elderly people represent a growing population segment with a well known increased risk of both ischemic and bleeding events. Current acute coronary syndrome guidelines, strongly recommend dual antiplatelet therapy (DAPT) with few specific references for aged patients due to lack of evidence. Patients aged ≥ 75 years are misrepresented in the classic derivation trials cohorts.

Effect of beta-blocker dose on mortality after acute coronary syndrome.

Introduction: Beta-blocker doses that have been shown to be effective in randomized clinical trials are not commonly used in daily clinical practice. The aim of this study was to analyze whether there is a prognostic benefit of high rather than low doses of beta-blockers after an acute coronary syndrome (ACS).

Methods: In this retrospective cohort study, 2092 ACS patients discharged from hospital between June 2013 and January 2016 were classified according to the beta-blocker dose prescribed: high dose (≥50% of the target dose tested in clinical trials) and low dose (<50%).

Prognostic usefulness of an age-adapted equation for renal function assessment in older patients with acute coronary syndrome.

Background:: Renal dysfunction negatively impacts survival in acute coronary syndrome patients. The Berlin Initiative Study creatinine-based (BIS) equation has recently been proposed for renal function assessment in older persons. However, up to now it is unknown if the superiority of the new BIS equation, with respect to the most recommended chronic kidney disease epidemiology collaboration creatinine-based (CKD-EPI) formula, would translate into better risk prediction of adverse events in older patients with acute coronary syndrome.

Anomalous hepatic vein drainage into a giant left atrium.

A 56-year-old man with a history of complex atrial-septal defect repair, atrial fibrillation, and severe mitral regurgitation presented with progressive shortness of breath. A cardiac CT examination was done as part of a preoperative protocol before mitral valve replacement and it showed a severely enlarged left atrium and an anomalous hepatic vein draining into the left atrium. These findings were totally unsuspected and changed the patient management, highlighting the benefit of cardiac CT beyond the coronary finding.