Italian heart journal : official journal of the Italian Federation of Cardiology
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Multicenter Study Comparative Study
Treatment modalities of non-ST-elevation acute coronary syndromes in the real world. Results of the prospective R.OS.A.I.-2 registry.
Despite advances in the treatment of non-ST-elevation acute coronary syndromes (ACS) based on randomized studies and published guidelines, the extent to which such treatments are applied in daily clinical practice remains elusive. The R.OS.A.I.-2 registry was undertaken to assess the modalities of the treatment of non-ST-elevation ACS, both in terms of the use of drugs, with particular attention to glycoprotein IIb/IIIa inhibitors and clopidogrel, as well as type of strategy, aggressive versus conservative, in a consecutive series of patients admitted to 76 coronary care units (CCU) in Italy. ⋯ The R.OS.A.I.-2 registry confirms that the population admitted to the CCU with non-ST-elevation ACS has a higher risk profile than that included in recent clinical trials. The aggressive approach is still more dependent on the cath lab availability than on a risk stratification process. Conservatively treated patients have worse clinical features and short-term prognosis. Applying an invasive approach to higher risk groups might further improve the global outcome of non-ST-elevation ACS.
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Transesophageal echocardiography (TEE) is the method of choice for the evaluation of the left atrium and of left atrial appendage (LAA) thrombosis. However, the anatomy of the left appendage is complex and reverberations from anatomical structures may create images and ghosting which mimic left atrial thrombosis. The purpose of this study was to investigate whether a systematic approach through TEE may facilitate the recognition of LAA anatomical variants and artifacts. ⋯ A systematic approach with multiplane TEE facilitates the evaluation of the LAA anatomy and the recognition of artifacts, thus reducing the likelihood of false positive or negative diagnoses of left appendage thrombi.