Minerva cardioangiologica
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Minerva cardioangiologica · Feb 2009
ReviewUpdate on the management of atherosclerotic renal artery disease.
Typically involving the renal artery ostium or proximal segment of the renal artery, atherosclerosis is the major cause of renal artery stenosis. While commonly without direct clinical consequences, the presence of renal artery atherosclerosis is associated with atherosclerotic disease in other vascular beds and in some subjects may give rise to systemic hypertension, progressive renal dysfunction and/or heart failure. ⋯ The role for concomitant renal artery revascularization remains unclear and the decision should be individualized depending on patient preferences, co-morbidities, institutional expertise, and carefully weighed risks and benefits. Ongoing trials including CORAL and ASTRAL will hopefully provide critical evidence for or against this additive invasive strategy.
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Minerva cardioangiologica · Feb 2009
Comparative StudyLong term results of unprotected left main percutaneous coronary intervention with DES versus BMS.
Stenosis in the unprotected left main coronary artery (ULMCA) is considered a standard indication for surgical revascularization. Some studies have demonstrated that stenting of the ULMCA is safe and feasible in selected patients. Drug eluting stents (DES) have been shown to be superior to bare metal stents (BMS) in reducing restenosis and major adverse cardiac events (MACE) both in-hospital and at follow-up after treatment of ULMCA disease. Several studies showed that the mid-term prognosis of patients with left main stenting is good, but most of them are limited by small populations and the availability of mid-term results. Thus, we sought to evaluate the very long term impact of DES vs BMS in a large cohort of patients undergoing stent implantation for ULMCA disease in our center. ⋯ Patients presenting with ULMCA disease, who are treated with DES have a significant reduction in the rate of target lesion revascularization with no increased risk of death or myocardial infarction.
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Minerva cardioangiologica · Dec 2008
ReviewPrevention of thromboembolic complications in patients with atrial fibrillation.
Atrial fibrillation (AF) is a major arrhythmia in clinical practice, and its frequency rises rapidly from the sixth decade onward. Its most serious clinical consequence is ischemic stroke. Patients with AF have a five-fold increased risk of stroke compared to those in sinus rhythm. ⋯ Inconvenience of monitoring and frequent dose adjustments, together with fear of major hemorrhage associated with oral anticoagulants, contribute to this underuse. In particular, conventional intensity of anticoagulation increases the risk of intracranial hemorrhage, and patients with advanced age are more prone to cerebral bleeding than younger patients. Up to date, the efficacy of aspirin, an antiplatelet agent, for stroke prevention in AF patients is less clear and remains controversial and alternative pharmacological treatment options have failed to demonstrate their superiority over vitamin K antagonists.
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Minerva cardioangiologica · Dec 2008
Plasma NT-proBNP levels and the risk of atrial fibrillation after major lung resection.
Supraventricular tachyarrhythmias, most frequently atrial fibrillation (AF), occur in 8-30% of patients undergoing major pulmonary resection. The aim of this study was to characterize a biochemical marker in order to identify subjects at higher risk of postoperative AF. The authors tested the hypothesis that elevated preoperative plasma levels of N-terminal brain-type natriuretic peptide (NT-pro-BNP) may predict the occurrence of postoperative AF. ⋯ A preoperative elevated plasma NT-pro-BNP level was associated with the occurrence of AF in patient undergoing major thoracic surgery. Baseline NT-pro-BNP levels may be proposed as a biochemical marker to detect patients at higher risk of postoperative AF who could benefit from prophylactic therapeutic medication.