Temporal trends in referral patterns for invasive coronary angiography - a multicenter 10-year analysis.

Aim: To assess the temporal trends in the usage pattern of non-invasive testing before invasive coronary angiography (ICA) and its diagnostic yield in patients with suspected coronary artery disease (CAD).

Methods: Cross-sectional observational multicenter study of 4805 consecutive patients (60% male, mean age 66 ± 10 years) with suspected CAD undergoing elective ICA due to angina pectoris in two centers, from 2008 to 2017. The use of noninvasive testing and the proportion of patients with obstructive CAD (defined as the presence of at least one ≥50% stenosis on ICA) were assessed.

Utility of Pacemaker With Sleep Apnea Monitor to Predict Left Ventricular Overload and Acute Decompensated Heart Failure.

Pacemakers with sleep apnea monitor (SAM) provide an easy tool to assess obstructive sleep apnea over long periods of time. The link between respiratory disturbances at night and the incidence of acute decompensated heart failure (ADHF) is not well established. We aimed at (1) determining the ability of SAM pacemakers to evaluate the extent of left ventricular overload and (2) assess the impact of respiratory disturbances at night on the occurrence of ADHF over 1-year of follow-up.

Mild troponin elevation in patients admitted to the emergency department with atrial fibrillation: 30-day post-discharge prognostic significance.

Patients with atrial fibrillation (AF) often undergo troponin (Tn) testing in the emergency department (ED), but the clinical significance of mildly elevated values remains unclear. We evaluated short-term 30-day post-discharge outcomes in AF patients according to troponin levels. Out of 2181 AF patients evaluated in the ED (June 2014 to June 2015), we included consecutive admitted patients.

Pre-test probability of obstructive coronary stenosis in patients undergoing coronary CT angiography: Comparative performance of the modified diamond-Forrester algorithm versus methods incorporating cardiovascular risk factors.

Background: Current guidelines recommend the use of the Modified Diamond-Forrester (MDF) method to assess the pre-test likelihood of obstructive coronary artery disease (CAD). We aimed to compare the performance of the MDF method with two contemporary algorithms derived from multicenter trials that additionally incorporate cardiovascular risk factors: the calculator-based 'CAD Consortium 2' method, and the integer-based CONFIRM score.

Methods: We assessed 1069 consecutive patients without known CAD undergoing coronary CT angiography (CCTA) for stable chest pain.

ECG evaluation in patients with pacemaker and suspected acute coronary syndrome: Which score should we apply?

Background/purpose: In patients with right ventricular pacing, the ECG shows a left bundle branch block (LBBB) pattern. There are several criteria to diagnose ST-elevation myocardial infarction (STEMI) in patients with LBBB. The aim of this study was to validate and compare Sgarbossa's with two new scores - Selvester's and Smith's - in this context.

Impact of complete revascularization in patients with ST-elevation myocardial infarction: analysis of a 10-year all-comers prospective registry.

Background: The benefit of complete revascularization (CR) during a primary percutaneous coronary intervention (PCI) in patients with multivessel disease (MVD) is still not clear. The aim of the present study was to evaluate the impact of CR in a nonselected population from an all-comers prospective registry of patients with ST-elevation myocardial infarction (STEMI) over a long period of time.

Methods And Results: Between 2004 and 2014, 671 noncardiogenic shock STEMI patients with MVD were included in the present study, of whom 522 were subjected to incomplete revascularization and 149 were subjected to CR.

Applicability of the Zwolle risk score for safe early discharge after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction.

Introduction And Aim: The optimal length of stay for patients with uncomplicated ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI) is still undetermined. The Zwolle risk score (ZRS) is a simple tool designed to identify patients who can be safely discharged within 72 hours. The purpose of this study was to assess the applicability and performance of the ZRS in our population.

Aortic valve replacement for severe aortic stenosis in octogenarians: patient outcomes and comparison of operative risk scores.

Introduction And Aim: Isolated aortic valve replacement (AVR) in octogenarians is associated with increased operative risk, due to higher prevalence of associated risk factors and other comorbidities, making outcome prediction essential. We sought to analyze operative mortality and morbidity and to compare the predictive accuracy of the logistic European System for Cardiac Operative Risk Evaluation score (EuroSCORE) I, EuroSCORE II and Society of Thoracic Surgeons (STS) score in this population.

Methods: We retrospectively enrolled 106 consecutive octogenarians with symptomatic severe aortic stenosis undergoing isolated AVR in a large-volume single center between January 2003 and December 2010 and calculated surgical risk scores.

A rare case of persistent troponin elevation in a patient with chronic heart failure.

We present the case of a woman diagnosed with hypertrophic cardiomyopathy who suffered a myocardial infarction when she was 28 years old, without coronary artery disease on coronary angiography. Two years later, she presented signs of heart failure and left ventricular systolic dysfunction with persistent troponin I elevation, followed by progressive worsening of ventricular dysfunction.

Diagnostic yield of current referral strategies for elective coronary angiography in suspected coronary artery disease-an analysis of the ACROSS registry.

Introduction And Objectives: The purpose of this study was to assess the diagnostic yield of current referral strategies for elective invasive coronary angiography (ICA).

Methods: We performed a cross-sectional observational study of consecutive patients without known coronary artery disease (CAD) undergoing elective ICA due to chest pain symptoms. The proportion of patients with obstructive CAD (defined as the presence of at least one ≥50% stenosis on ICA) was determined according to the use of noninvasive testing.

Ultrasound-guided thrombin-gelatin injection is effective for the treatment of iatrogenic femoral artery pseudoaneurysms: initial results.

Objectives: To describe the technique of ultrasound (US)-guided percutaneous thrombin-gelatin injection for the treatment of femoral artery pseudoaneurysms (FAPs).

Background: FAPs are a possible complication from percutaneous angiographic procedures. US-guided thrombin injection is currently the preferential therapeutic option, limited by a low risk of potentially catastrophic femoral thrombosis; transluminal injection of collagen is another effective and safe option, although a more invasive one; surgical repair is associated with significant comorbidity.