Abstract:
:The decision to offer patients with myocardial ischemia a coronary artery bypass graft (CABG) surgery has been largely determined by extent of coronary artery disease (CAD) and left ventricular function, since the early 1970's. Based upon subset analyses, and long-term follow-up, of three moderate-sized trials of stable patients and two small trials of unstable angina (excluding recent myocardial infarction, MI) patients, the notion has persisted that patients with left main narrowing >50% or three-vessel stenoses >70%, or even two-vessel stenoses >70%, where one of the vessels is the proximal left anterior descending, derive a "survival benefit" relative to medical therapy (MED), from CABG (anatomic paradigm). The MED of the original CABG versus MED trials consisted of little more than anti-anginal medications, used on an as-needed basis. In the ensuing 3 decades, multiple large, well done, randomized clinical trials have established a survival benefit for 4 different forms of MED among a broad spectrum of CAD patients. Aspirin; lipid lowering, especially with statins; b-blockers; and angiotensin-converting-enzyme inhibitors and/or angiotensin receptor blocking agents; have all been shown to enhance survival, as well as reduce other objective adverse outcomes of CAD. The advances in MED, coupled with the small but significant mortality and morbidities of both CABG and percutaneous coronary intervention (PCI), are among the reasons to skeptically consider potential "survival benefit" of revascularization. A more common and far more easily justified reason to consider revascularization is to relieve "medically refractory" myocardial ischemia, particularly when the ischemia is accompanied by symptoms. Accordingly, documentation of medically refractory myocardial ischemia provides the answer to the first question of myocardial revascularization, "Is this patient likely to derive clinical benefit from revascularization, at this time?" It is only after this question has been answered that one needs to consider the relative advantages and disadvantages of PCI versus CABG (physiologic paradigm). Two of the relative advantages of PCI, namely speed of reperfusion, and relatively low morbidity, are among the reasons that most randomized trial data, and most clinical application of revascularization to patients with MI (ST-elevation MI [STEMI], and non-STEMI) have been by PCI. In contrast, for stable patients with medically refractory ischemia, anatomic considerations continue to be relevant to the choice between CABG and PCI. Specific advantages of CABG include: its potential to revascularize chronically occluded vessels with collaterals supplying viable myocardium; the fact that conduits protect territories rather than simply treating lesions; and the greater durability of conduits compared to bare-metal stents (drug-eluting stents may change the picture). Based on these principles, physiologic, rather than anatomic, considerations are most useful in determining whether to revascularize, and how urgently to revascularize (STEMI is an emergent indication and high-risk non-STEMI an urgent indication). Coronary anatomy, including both number of vessels and lesion characteristics, continues to help decide between CABG and PCI, and in formulating patient specific strategies.
journal_name
Minerva Cardioangioljournal_title
Minerva cardioangiologicaauthors
Morrison Dsubject
Has Abstractpub_date
2006-10-01 00:00:00pages
643-72issue
5eissn
0026-4725issn
1827-1618journal_volume
54pub_type
杂志文章,评审abstract:BACKGROUND:Sutureless aortic valve prostheses have the potential to augment the adoption of alternative incision approaches for aortic valve replacement (AVR). Still, we lack the evidence on which surgical approach is best associated with sutureless AVR. METHODS:Data on 483 patients undergoing sutureless small incisio...
journal_title:Minerva cardioangiologica
pub_type: 杂志文章
doi:10.23736/S0026-4725.17.04568-6
更新日期:2018-04-01 00:00:00
abstract::The ability of interventional cardiologists to identify high-risk percutaneous coronary intervention (PCI) patients, requires the integration of different features belonging to medical history, organ damage, coronary anatomy and the nature of the acute event. The selection of a subgroup of patients that could benefit ...
journal_title:Minerva cardioangiologica
pub_type: 杂志文章,评审
doi:10.23736/S0026-4725.18.04678-9
更新日期:2018-10-01 00:00:00
abstract::Ultrasound contrast agents, used with contrast-specific imaging techniques, have an established role for diagnostic cardiovascular imaging in the echocardiography laboratory. The advent of tissue harmonic imaging, albeit a significant advancement in ultrasound technology, still fail to produce diagnostically useful im...
journal_title:Minerva cardioangiologica
pub_type: 杂志文章,评审
doi:
更新日期:2009-08-01 00:00:00
abstract::Coronary artery disease and atherothrombosis are complex pathologic entities. The intricate interplay between anatomical, cellular and molecular factors characterizes their pathogenesis and determines their clinical manifestations. Coronary artery revascularization strategies, by restoring myocardial blood perfusion, ...
journal_title:Minerva cardioangiologica
pub_type: 杂志文章,评审
doi:
更新日期:2015-08-01 00:00:00
abstract:BACKGROUND:Aim of the present comparative clinical study was to demonstrate the efficacy of the topical application of mesoglycan, a profibrinolytic agent, for healing of leg ulcers in patients with chronic venous insufficiency. METHODS:Forty patients, observed in our outpatients department, with venous leg ulcers hav...
journal_title:Minerva cardioangiologica
pub_type: 临床试验,杂志文章
doi:
更新日期:1999-09-01 00:00:00
abstract::Despite some technical limits ambulatory blood pressure monitoring must be considered as a careful instrument for blood pressure measurement. After demonstration of its sensibility and specificity in experimental trials, the use of blood pressure monitoring has been extended to clinical evaluation. The recent Consensu...
journal_title:Minerva cardioangiologica
pub_type: 社论
doi:
更新日期:1996-10-01 00:00:00
abstract::Bacterial endocarditis in pregnancy is uncommon. We described two cases: the first case of endocarditis, caused by staphylococcus epidermidis (at the 35th week of pregnancy) was complicated by severe aortic valvular insufficiency; the second case, endocarditis caused by streptococcus alpha hemolytic (at the 32nd week ...
journal_title:Minerva cardioangiologica
pub_type: 杂志文章
doi:
更新日期:1990-03-01 00:00:00
abstract::The diagnosis of previous non-Q wave myocardial infarction by standard electrocardiographic investigation is uncertain, particularly in elderly patients because of concomitant disease. We have studied 31 elderly patients (aged 63-72 years) with a diagnosis of non-Q wave myocardial infarction between 1-6 months after t...
journal_title:Minerva cardioangiologica
pub_type: 杂志文章,评审
doi:
更新日期:1995-01-01 00:00:00
abstract:BACKGROUND:The deep femoral artery provides the primary blood supply to the thigh, and in addition serves as the major collateral channel for bypassing the obstructed superficial femoral artery. The purpose of isolated profundoplasty is to relieve a significant stenosis and improve perfusion of the ischaemic leg. METH...
journal_title:Minerva cardioangiologica
pub_type: 杂志文章
doi:
更新日期:2000-12-01 00:00:00
abstract::In a controlled study of 100 patients, mean age 65 years old, suffering from chronic peripheral obliterative arterial disease, Leriche's stage II, were randomised in two groups treated respectively with defibrotide (400 mg bid) or heparan-sulfate (40 mg bid) by the oral route for a period of 6 months. At basal and aft...
journal_title:Minerva cardioangiologica
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1996-01-01 00:00:00
abstract::With radioisotopes it is possible to study the heart obtaining complementary or substitutive informations to those provided by the most common noninvasive methods of myocardial assessment and by coronarography. This paper aim is to report experience with thallium 201 and 99mTc isonitrile in the diagnosis and followup ...
journal_title:Minerva cardioangiologica
pub_type: 杂志文章
doi:
更新日期:1994-01-01 00:00:00
abstract:AIM:The aim of this paper was to compare the in-hospital management and outcome of patients on oral anticoagulation (OAC) undergoing coronary artery stenting (PCI-S) for ST-elevation myocardial infarction (STEMI) vs. other indications. METHODS:One hundred and sixteen patients on OAC at the time of PCI-S who were prosp...
journal_title:Minerva cardioangiologica
pub_type: 杂志文章,多中心研究
doi:
更新日期:2011-10-01 00:00:00
abstract::A carotid stenosis is responsible for about 30% of strokes occurring. Carotid endarterectomy (CEA) is considered to be the gold standard treatment of a carotid stenosis. Carotid angioplasty and stenting (CAS) is emerging as a new alternative treatment for a carotid artery stenosis, but the risk of neurological complic...
journal_title:Minerva cardioangiologica
pub_type: 杂志文章,评审
doi:
更新日期:2007-02-01 00:00:00
abstract::Over the last years, endovascular intervention have become an important part of treatment in patients with congenital heart disease particularly for residual defects after surgery done in infancy. These transcatheter procedures can be described as dilatation of stenotic sites (angioplasty, endovascular stenting and va...
journal_title:Minerva cardioangiologica
pub_type: 杂志文章,评审
doi:
更新日期:2007-10-01 00:00:00
abstract::Report of a case of a 54-year-old man who, during acute anterior myocardial infarction developed an apical thrombus and an embolism of the right leg. The serial echocardiographic study demonstrates how the original shape of the thrombus acutely changed at the same time of the embolic episode and how the new morphology...
journal_title:Minerva cardioangiologica
pub_type: 杂志文章
doi:
更新日期:1993-12-01 00:00:00
abstract::We report the clinical, echocardiographic and therapeutic aspect of one case of right cardiac migrant thromboembolus in pulmonary embolism. Medical therapy consisted of tissue plasminogen activator (rt-PA, 100 mg/3h). Progressive reduction of thromboembolus until its disappearance was observed by echo 2D after this th...
journal_title:Minerva cardioangiologica
pub_type: 杂志文章
doi:
更新日期:1993-01-01 00:00:00
abstract:BACKGROUND:Precise calcium evaluation in the aortic complex may be complicated. We aimed to assess the usefulness of a novel semi-automatic algorithm for multi slice computed tomography-derived (MSCT) quantitative estimation of aortic valve calcifications (AVC) in patients with severe aortic stenosis (AS) undergoing tr...
journal_title:Minerva cardioangiologica
pub_type: 杂志文章
doi:10.23736/S0026-4725.18.04793-X
更新日期:2019-02-01 00:00:00
abstract::The clinical significance of coronary myocardial bridging has been debated and different interventional strategies proposed. We discuss the case of a patient who presented with the recent onset of symptoms of exertional chest pain, diaphoresis, and electrocardiographic signs of acute anterior myocardial wall ischemia....
journal_title:Minerva cardioangiologica
pub_type: 杂志文章
doi:
更新日期:1998-04-01 00:00:00
abstract::Cardiac hydatid disease represents 0.02-2% of the possible locations of the parasite. The case of an asymptomatic 60-year-old male patient, hospitalised for mnesic and cognitive disease, and with history of hepatic and pulmonary echinococcosis is reported. The patient showed a cardiac cyst localised in the mediobasal ...
journal_title:Minerva cardioangiologica
pub_type: 杂志文章
doi:
更新日期:1998-01-01 00:00:00
abstract::The Post-CABG trial was designed to assess the effects of 2 different lipid lowering strategies and low dose warfarin vs placebo (2 x 2 factorial) design on the progression of atherosclerosis in saphenous vein grafts. Atherosclerotic progression was determined by comparing baseline and follow-up angiograms (mean inter...
journal_title:Minerva cardioangiologica
pub_type: 临床试验,杂志文章,评审
doi:
更新日期:2002-08-01 00:00:00
abstract::The development of drug-eluting stents is one of the major revolutions in the field of Interventional Cardiology. Restenosis rate has been significantly reduced, in comparison to bare metal stents. The ideal drug to prevent restenosis must have an anti-proliferative and anti-migratory effect on smooth muscle cells but...
journal_title:Minerva cardioangiologica
pub_type: 杂志文章,评审
doi:
更新日期:2005-10-01 00:00:00
abstract:AIM:It is not known whether therapy assisted by determinations of serum B-type natriuretic peptide (BNP) may improve the outcome for outpatients with chronic heart failure (CHF). METHODS:A retrospective case-control study was carried out, enrolling patients with acutely decompensated heart failure (ADHF) who were foll...
journal_title:Minerva cardioangiologica
pub_type: 杂志文章
doi:
更新日期:2013-08-01 00:00:00
abstract::Assays for cardiac troponin have become a standard for the diagnosis of myocardial damage. Due to their high sensitivity, minor myocardial injury can be frequently detected following percutaneous coronary interventions (PCI). Minor elevations in cardiac enzymes after apparently successful PCI are rather common and eve...
journal_title:Minerva cardioangiologica
pub_type: 杂志文章,评审
doi:
更新日期:2003-10-01 00:00:00
abstract:OBJECTIVE:To analyze the usefulness of autologous blood salvage and intraoperative isovolemic hemodilution in conjunction with autologous blood salvage in cardiac surgery, and also to compare two different autologous blood salvage methods. EXPERIMENTAL DESIGN:Retrospective analysis of transfusion practice in cardiac s...
journal_title:Minerva cardioangiologica
pub_type: 杂志文章
doi:
更新日期:1997-09-01 00:00:00
abstract:BACKGROUD:This study aimed to analyze the correlations between anterior wall motion velocity of ascending aorta measured by quantitative tissue velocity image (QTVI) technique and left ventricular geometry as well as left heart function to evaluate its value of clinical application. METHODS:One hundred ten hypertensio...
journal_title:Minerva cardioangiologica
pub_type: 杂志文章
doi:10.23736/S0026-4725.17.04535-2
更新日期:2018-04-01 00:00:00
abstract::Pulmonary hypertension (PH) is the common hemodynamic consequence of various pathophysiologic mechanisms. Since the publication of the most current American and European guidelines (2009) new agents were introduced into the clinical arena while data regarding former drugs has been substantiated. The therapeutic endeav...
journal_title:Minerva cardioangiologica
pub_type: 杂志文章,评审
doi:
更新日期:2015-04-01 00:00:00
abstract:BACKGROUND:The aim of this prospective supplement summer registry study was to evaluate the efficacy of Pycnogenol® in controlling symptoms of chronic venous insufficiency (CVI) and microcirculatory parameters: venous hypertension and microangiopathy. Pycnogenol® (Horphag Research) is the standardized extract of the ba...
journal_title:Minerva cardioangiologica
pub_type: 杂志文章
doi:10.23736/S0026-4725.19.04948-X
更新日期:2019-08-01 00:00:00
abstract:AIM:The aim of this study was to analyze restenosis after percutaneous coronary intervention, factors related to restenosis after coronary artery stenting and the degree of the risk of restenosis were evaluated. METHODS:The study enrolled 181 patients (249 lesions) who underwent the first coronary artery stenting. Mul...
journal_title:Minerva cardioangiologica
pub_type: 杂志文章
doi:
更新日期:2008-06-01 00:00:00
abstract:UNLABELLED:Currently, there are not reliable data on the incidence and prevalence of post-phlebitic syndrome (PTS) after an episode of asymptomatic postoperative deep vein thrombosis (DVT). In order to evaluate the epidemiology and the clinical course of PTS in patients who were submitted to hip and knee replacement, w...
journal_title:Minerva cardioangiologica
pub_type: 杂志文章
doi:
更新日期:1997-03-01 00:00:00
abstract::The number of women who become ill and die from acute myocardial infarction (AMI) increases steadily with age. It is not yet clearly defined whether and why women suffer from a higher in-hospital mortality rate after AMI. In this study we evaluated the importance of the female sex as a risk factor for in-hospital mort...
journal_title:Minerva cardioangiologica
pub_type: 杂志文章,评审
doi:
更新日期:1997-06-01 00:00:00