Clinical Appropriateness of Coronary Angiography

Background: The study evaluates the appropriateness of coronary angiography and the agreement between the used method and the presence of coronary artery disease by the indications proposed from American College of Cardiology/American Heart Association (1999). Method: The guidelines allow us to associate to Class I and IIa the judgment of appropriateness, to the Class IIb of uncertainty; to Class III of inappropriateness. Result: On 761 coronary angiography 76.74% were appropriate, 23.13% unsuitable, 0.13% uncertain. The group with the greater value of appropriateness is that one with unstable angina (97.9% appropriate); that one with the lower value is the group with non-specific symptomatology (26.7% appropriate). Conclusion: Considering the false positives, it is important the rate of the greater sensibility and the lower specificity of the not invasive tests carried before coronary angiography, as well as, the probable presence of microcircle disease. Among the false negatives, we must considered the number of patients with effective coronary artery disease which has “jumped” the intermediate stage of the not invasive diagnostic process, before the coronary angiography, but have obtained the same final benefit

One year in review 2019: pathogenesis of rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease influenced by both genetic and environmental factors. Over the last few years, particular attention has been given to novel genes and to the close interaction between genetic factors and epigenetic mechanisms. Research has also focused on the influence of environmental factors on disease development, and on new mechanisms of the innate and adaptive immune system that can influence the different stages of RA. However, there are still several aspects of the disease that need further investigation. Shedding some light on the different aspects of RA pathogenesis will help to improve the current diagnostic tools and to identify new targets for the development of disease-modifying therapies. Thus, in this review we summarise the new insights in RA pathogenesis, resulting from literature research data published in the last year

Peripheral atherosclerosis is associated with the occurrence of restenosis after percutaneous coronary intervention

INTRODUCTION: The aim of our study was to evaluate, in patients with proven coronary artery disease (CAD) and treated with elective percutaneous coronary intervention (PCI), whether the coexistence of asymptomatic carotid and femoral atherosclerotic lesions would provide prognostic information in terms of occurrence of restenosis. METHODS: We studied 104 patients with CAD (M/F=77/27), mean age 60.5+/-9 years. All patients were treated with elective PCI. After PCI the suspicion of restenosis was confirmed by coronary angiography. All patients underwent ultrasound duplex scan of carotid and femoral-popliteal-tibial axis to detect atherosclerotic lesions. According to ultrasound results, patients were classified as normal, with increased intima-media thickness (IMT) or with asymptomatic plaque (AP). If carotid and femoral lesions coexisted (together with coronary ones) patients were considered to have multifocal atherosclerosis. RESULTS: About 90% of the patients had carotid lesions: 40% had carotid IMT and 50% AP. Femoral lesions were found in 72% of the population and in 41% there was an increased IMT and in 21% an increased AP. Prevalence of restenosis after PCI was 12.5%. Patients with restenosis had a significantly higher prevalence of asymptomatic carotid and/or femoral lesions than those without restenosis. The occurrence of restenosis was independently associated with the detection of carotid, femoral and multifocal atherosclerosis. CONCLUSION: The detection of carotid and/or peripheral atherosclerotic lesions in patients with CAD who underwent PCI may be a marker of increased risk. We believe that investigating these areas, by echo-Doppler duplex scanning, may be a cost-effective strategy in the work-up before elective PCI. It may allow identification of high-risk subgroups of patients, and enable the planning of patient-tailored therapeutic strategies and follow-up