Endothelin receptor antagonists.

Three pathways have been identified in the pathogenesis of pulmonary arterial hypertension (PAH): the endothelin (ET), nitric oxide (NO) and prostacyclin pathways. These pathways represent the targets of approved PAH therapies and their discovery has facilitated significant progress in the understanding and treatment of PAH. The ET system is well established as a key player in the pathophysiology of PAH, with deleterious effects mediated by both the ETA and ETB receptors.

Bosentan fosters microvascular de-remodelling in systemic sclerosis.

Bosentan, a dual endothelin receptor antagonist, may reduce blood pressure by blocking the vasoconstrictor effect of endothelin-1. In systemic sclerosis (SSc) nailfold videocapillaroscopy (NVC); allows diagnostic and follow-up of microvascular damage. Distinct NVC patterns have been identified for the evaluation of severity of SSc microvascular damage.

Long-term outcome after sirolimus-eluting stents versus bare metal stents in patients with diabetes mellitus: a patient-level meta-analysis of randomized trials.

Background: Although it is widely believed that patients with diabetes mellitus obtain the greatest benefit from drug-eluting stents, convincing evidence on long-term efficacy and safety of these stents is lacking.

Methods: We performed a meta-analysis of individual patient data from four randomized trials including 583 patients comparing sirolimus eluting with bare metal stents (median follow-up of 4.2 years).

Are drug-eluting stents superior to bare-metal stents in patients with unprotected non-bifurcational left main disease? Insights from a multicentre registry.

Aims: To compare long-term clinical outcome following drug-eluting stents (DES) or bare-metal stents (BMS) implantation on lesions located at the ostium or the shaft of the left main in a large real-world population. The advent of DES decreased the risk of unprotected left main coronary artery (ULMCA) restenosis when compared with BMS, but it is unclear if this advantage continues when non-bifurcational lesions are considered.

Methods And Results: The GISE-SICI registry is a retrospective, observational multicentre registry promoted by the Italian Society of Invasive Cardiology in which 19 high-volume participating centres enrolled 1453 consecutive patients who underwent percutaneous coronary intervention on ULMCA between January 2002 and December 2006.

Percutaneous coronary interventions in octogenarians: Acute and 12 month results in a large single-centre experience.

Objectives: To review the results of PCI in patients aged >or=80 years.

Background: Octogenarians represent a growing proportion of patients treated with PCI; in this subset of high-risk patients, the role of complete revascularization is still controversial.

Methods: We examined in-hospital, 30 days, and 12-month events in 356 patients aged >or=80 years submitted to PCI from 2004 to 2006 and 754 patients aged <80 years treated in 2006.

Long-term outcomes with drug-eluting stents versus bare metal stents in the treatment of saphenous vein graft disease (results from the REgistro Regionale AngiopLastiche Emilia-Romagna registry).

Percutaneous revascularization of saphenous vein grafts (SVGs) remains a challenging task. Drug-eluting stents (DESs) have been shown to decrease the incidence of restenosis in de novo native coronary artery lesions. However, their clinical value in SVGs remains to be established.

Two-year clinical outcomes with drug-eluting stents for diabetic patients with de novo coronary lesions: results from a real-world multicenter registry.

Background: The long-term effectiveness of drug-eluting stents (DES) in unselected diabetics in routine practice is currently unclear.

Methods And Results: To evaluate the long-term effectiveness of bare metal stents and DES in a real-world setting of diabetic patients, we analyzed 2-year follow-up data from all diabetic patients with de novo lesions enrolled in a prospective Web-based multicenter registry (Registro Regionale Angioplastiche dell'Emilia-Romagna; study period, 2002 to 2004) comprising all 13 hospitals performing percutaneous coronary interventions in the Emilia-Romagna region of Italy. Among the 1648 eligible patients treated with either bare metal stents alone (n=1089) or DES alone (n=559), 27% were insulin dependent and 83% had multivessel coronary disease.

Long-term safety and efficacy of drug-eluting stents: two-year results of the REAL (REgistro AngiopLastiche dell'Emilia Romagna) multicenter registry.

Background: The long-term safety and efficacy of drug-eluting stents (DES) have been questioned recently.

Methods And Results: Between July 2002 and June 2005, 10,629 patients undergoing elective percutaneous coronary intervention with either DES (n=3064) or bare-metal stents (BMS, n=7565) were enrolled in a prospective registry comprising 13 hospitals. We assessed the cumulative incidence of major adverse cardiac events (death, acute myocardial infarction, and target-vessel revascularization) and angiographic stent thrombosis during 2-year follow-up.

Direct coronary stenting versus stenting with balloon pre-dilation: incidence of enzyme release and follow-up results of a multicentre, prospective, randomized study. The CK and Troponin I Estimation in direct STenting (CK TEST) trial.

Aim: The aim of this study was to assess the safety of direct coronary stenting, its influence on costs, duration of the procedure, radiation exposure, clinical outcome and the incidence of periprocedural myocardial damage as assessed by enzyme release determination.

Methods: We randomized 103 patients (109 lesions) to direct stent implant or stent implant following balloon predilatation. Patients with heavily calcified lesions, bifurcations, total occlusions, left main lesions and very tortuous vessels were excluded.

Percutaneous treatment of multivessel coronary disease in the drug eluting stent era: comparison of bare-metal stents, drug-eluting stents and a mixed approach in a large multicentre registry.

Background: Restenosis and a high incidence of new revascularisations reduce the long-term efficacy of percutaneous coronary intervention (PCI) in patients with multivessel coronary artery disease.

Aims: To determine the modality of utilisation and the clinical efficacy of drug eluting stents (DES) in a real world multivessel PCI scenario.

Methods: From July 2002 to December 2004, 1726 consecutive patients enrolled in the REAL Registry (Registro REgionale AngiopLastiche Emilia-Romagna) underwent elective multivessel PCI with multiple stents in at least two different vessels; among them, 939 (54%) received only bare-metal stents (BMS group), 288 (17%) only DES (DES group) and 499 (29%) were treated with BMS and DES in different vessels (MIX group).

Effective intracoronary thrombectomy with the X-sizer catheter of the right coronary artery and left anterior descending artery in a patient with acute inferior and right ventricular infarction complicated by hypotension and diffuse intracoronary thrombosis.

Intracoronary thrombosis of non infarct-related arteries during an episode of acute myocardial infarction can be correlated with a general thrombogenic state and precipitated by prolonged hypotension. We report the case of a patient with acute inferior and right ventricular infarction with acute thrombotic obstruction of the proximal right coronary artery and associated sessile thrombus in the proximal left anterior descending artery, both successfully treated by thromboaspiration with the X-Sizer catheter (ev3, Inc., Plymouth, Minnesota, USA).

[Impact of a regional project on patterns of care for acute myocardial infarction].

Background: On May 2003 the Emilia-Romagna Regional Commission for Cardiology and Cardiac Surgery launched a project aimed at improving health service ability to adopt interventions of well-known effectiveness for the treatment of patients with acute myocardial infarction. One of the main goals was to stimulate the clinical and organizational responsibilities operating at the local level, in order to improve the frequency of use of primary percutaneous coronary intervention.

Methods: In assessing the overall impact of this regional project, an interrupted time series regression analysis was conducted, relying on information drawn from the regional hospital discharge database.

Subcutaneous enoxaparin following thrombolysis and intravenous unfractionated heparin in ST-elevation acute myocardial infarction: safety and efficacy of low vs full dose.

Aim: In ST-segment elevation myocardial infarction (STEMI) treated with fibrin-specific thrombolytic agents, early intravenous unfractionated heparin (UFH) is warranted. Low molecular weight heparin Enoxaparin currently represents an alternative to UFH, to be used until hospital discharge. Since optimal dosing of subcutaneous Enoxaparin is not standardized, we conducted an observational study to compare safety and efficacy of low (4,000 U once daily) vs full dose (100 U/kg twice daily) regimens.

Occurrence of non-Q wave myocardial infarction following percutaneous coronary intervention in the stent era: systematic monitoring of the three markers of myocardial necrosis.

Objectives: To compare the elevation of the three markers total creatine kinase (CK), CK-MB mass, and troponin I (TnI) and their relationship with clinical and procedural characteristics following percutaneous coronary intervention (PCI).

Methods: We prospectively evaluated 385 patients consecutively undergoing successful PCI. The three markers were systematically measured before and at 6, 12, and 24 hours after PCI.

Comparison of effectiveness of sirolimus-eluting stents versus bare metal stents for percutaneous coronary intervention in patients at high risk for coronary restenosis or clinical adverse events.

We evaluated the clinical effect of selective use of sirolimus-eluting stents (SESs) in real-world, high-risk patients. A total of 4,237 consecutive patients who underwent percutaneous coronary intervention (SES, n = 872, bare metal stents [BMSs], n = 3,365) was enrolled in a prospective regional survey. A prespecified high-risk subset of patients was selected on the basis of clinical and angiographic characteristics.

Cost of single-vessel and multivessel coronary drug-eluting stenting: comparison to the DRG funding level.

Background: Large-scale utilization of drug-eluting stents (DES) presents significant economic limitations, related to the current high cost of the device and the absence of adequate reimbursement from the health care system. The aim of the study was to evaluate the cost of single-vessel and multivessel drug-eluting stenting and to compare it with the DRG funding level.

Methods: Between November 2003 and May 2004, we studied 100 consecutive patients who underwent a percutaneous coronary intervention (PCI) with DES, 50 single-vessel and 50 multivessel procedures, in order to evaluate the real procedure costs of DES.

Starc II, a multicenter randomized placebo-controlled double-blind clinical trial of trapidil for 1-year clinical events and angiographic restenosis reduction after coronary angioplasty and stenting.

The objective of this study was to investigate the effect of trapidil 200 mg t.i.d.

Cerebral vasoconstriction in neurally mediated syncope: relationship with type of head-up tilt test response.

Background: The pathophysiology of neurally mediated syncope (NMS) is unclear. Cerebral vasoconstriction has been observed in NMS patients during tilt testing. To shed light on the pathophysiology of NMS, we attempted to establish whether the degree of cerebral vasoconstriction changes with the tilt test positivity type, scored in accordance with Sutton's classification.