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Spontaneous coronary artery rupture is a rare disorder that may develop early into a sudden death due to the abrupt evolution of the associated cardiac tamponade. In some cases the rupture is contained and a false aneurysm develops with slower evolution of clinical signs. The correct diagnosis of spontaneous coronary artery rupture deserves a high level of suspicion; frequently it may be missed because the time window of its evolution seems to be very short or signs of acute coronary syndrome sometimes can prevail, leading to delays in diagnosis or to misdiagnosis. We report the case of a patient presenting a giant pseudoaneurysm of the right coronary artery due to spontaneous coronary artery rupture without any underlying disease. Moreover we present a review of the few cases in the literature, offering a pathophysiological hypothesis linking the site of rupture and clinical presentation.

To determine the association between baseline creatinine clearance (CrCl), coronary revascularization during index admission, and 1-year mortality in elderly patients with an acute coronary syndrome (ACS).We estimated CrCl using the Cockcroft-Gault (CG) formula in 313 patients aged ≥ 75 years enrolled in a prospective study of treatment strategies in non ST-elevation ACS (NSTEACS). Patients were stratified into four groups according to CrCl on admission (using a cutoff of 45 ml/min) and coronary revascularization versus medical management. The mean age of the study population was 81 years and the median serum creatinine level on admission was 1.0 mg/dl (interquartile range (IQR) 0.8-1.3). Patients with impaired renal function treated medically had higher in-hospital and 1-year mortality, especially if compared with patients with preserved renal function undergoing revascularization (1-year mortality 22.9% versus 4.9%). Across the spectrum of CrCl categories, coronary revascularization was independently associated with a lower risk of mortality (HR 0.405; 95% CI 0.174-0.940; p=0.035).In elderly patients with NSTEACS, coronary revascularization decreases the risk of 1-year death across each CrCl category, and is one of the most powerful predictors of 1-year outcome.

Purpose To test the accuracy of different mitral annular sites of the E / e ′ ratio in predicting invasive left ventricular filling pressure (LVFP) in patients hospitalized for coronary artery disease (CAD). Methods Forty-one patients with suspected or ascertained chronic CAD underwent non-invasive estimation of LVFP the same day as coronary angiography combined with right catheterization for pulmonary capillary wedge pressure (PCWP) assessment. The ratio between E velocity and early diastolic velocity of the mitral annulus (e′) was calculated as a surrogate of PWCP by (i) averaging septal and lateral e′ ( E / e ′A2); (ii) averaging septal, lateral, inferior, anterior ( E / e ′A4); (iii) using the sole septal ( E / e ′S); or (iv) lateral annulus ( E / e ′L). Patients were divided in two groups according to the PCWP: 25 with the PCWP

Background. an active lifestyle is associated with a reduced cardiovascular risk in middle-aged as well as in elderly patients. In the present study, we investigated the association between physical activity habits of elderly participants prior to coronary artery bypass grafting (CaBG) and survival free from both all-cause and cardiac death. Methods and Results. Study population consisted of 587 elderly patients ( ≥70 years) CaBG patients stratified, ac - cording to the Physical activity Scale for the Elderly (P aSE), into less active (low P aSE) and exercised (high P aSE) groups. at follow-up (mean: 44.3 ± 21.0 months), 33 (37.1%) of 89 total deaths occurred for cardiac causes. Sixty-month survival rate was 65% and 96% for low-P aSE and high-P aSE groups, respectively (log rank = 49.460, p < .0001). Cox survival analysis indicated a significant ( p < .0001) nonlinear association between P aSE score increments and improved survival with the most evident differences in the lowest score categories. a robust association was also found between low PaSE score and increased cardiac-related mortality ( p < .0001). Conclusions. our data indicate that a more active lifestyle is significantly associated with improved survival in elderly CaBG patients. The nonlinearity of the relation suggests that more sedentary patients could have the most benefit on survival by increasing their exercise lifestyle habits. The improved outcome is explained by both cardiac and overall mortality reduction.

Downregulation of hypoxia-inducible factor 1 (HIF-1) and vascular endothelial growth factor (VEGF) are shown to be involved in age-dependent impairment of angiogenesis. In this study, we explore whether prior exercise is able to affect these molecular patterns favorably and to enhance neoangiogenesis in old Wistar rats with hind-limb ischemia. At day 7 after surgery, HIF-1alpha and VEGF expression increased in the ischemic muscle of trained animals. Exercise increased capillary density and limb perfusion as revealed by histologic, angiographic, and dyed bead techniques. Furthermore, exercise capacity and limb trophism have significantly improved in trained aged rats. In these animals, the reduction of VEGF serum levels has reflected the comprehensive improvement in local ischemia evoked by exercise. In conclusion, prior exercise represents a valid tool to counteract age-related molecular alterations resulting in impaired angiogenesis in response to ischemia.

Aims Percutaneous transluminal coronary angioplasty (PTCA) has become the most widely used major intervention in western medicine. However, there is disparate use of this technique among different European countries and the U.S.A. In an attempt at quality assurance, the working group Coronary Circulation of the European Society of Cardiology has carried out a study on appropriateness, necessity, and performance of PTCA in Europe. The present paper reports on the procedural results of this survey. Methods In a multicentre case-control study in Europe, 750 patients (544 men, 206 women) with documented vascular disease of the From the countries participating in the European Registry of Coronary Intervention, the three countries with the highest absolute PTCA volume (Germany, France, and the United Kingdom) and two randomly selected countries (Belgium and Italy) were chosen for investigation. In these countries, five centres were selected at random according to the following criteria: one centre with >1000, three centres with 300–1000, and one centre with

The working group Coronary Circulation of the European Society of Cardiology conducts, with the support of the national societies of cardiology, an annual survey on cardiac interventions in Europe. This report is the fourth consecutive summary on cardiac interventions in Europe and gives an overview of interventional cardiology activities during 1995 in 30 member countries of the European Society of Cardiology, representing a population of 550 million people. Coronary angiography A total of 1065485 diagnostic coronary angiograms were reported, a 15% increase compared with 1994. The mean incidence of coronary angiograms increased to 1937 per 106inhabitants, ranging from 4667 per 106inhabitants in Germany to 67 per 106inhabitants in Romania. Coronary angioplasty A total of 278982 coronary angioplasty (PTCA) procedures were reported, an increase of 24% compared with 1994. The mean incidence of coronary angioplasty per capita was 507 per 106inhabitants, ranging from 1358 per 106inhabitants in Germany to 12 per 106inhabitants in Romania. The ratio of PTCAs per coronary angiogram was 0·26, ranging from 0·40 in the Netherlands to 0·08 in Cyprus. Ad hoc PTCA (combined diagnostic angiography and PTCA) accounted for 24% of all PTCA cases. The majority (85%) of PTCA procedures were restricted to a single vessel. Coronary stenting Coronary stents were used in 80383 coronary interventions, an increase of 272% compared with 1994, representing the fastest growth. The European mean ratio of coronary stenting per PTCA procedure was 0·29. Other new devices Other new interventional therapeutic devices were employed in 9798 cases, accounting for 3·5% of all coronary interventions. Coronary ultrasound wasused in 4787 (1·7%) and coronary angioscopy in 543 interventions (0·2%). Non-coronary interventions Balloon valvuloplasty remained the most frequent non-coronary intervention during 1995 with a total of 2715 mitral, 615 pulmonary, and 719 aortic valvuloplasties. Catheterization facilities There were a mean of 2·5 diagnostic cardiac catheterization institutions with a mean of 3·4 diagnostic laboratories per 106inhabitants in Europe. The number of PTCA institutions and laboratories were a mean of 0·7 and 0·9 per 106inhabitants, respectively. The mean numbers of trained operators were 11 for diagnostic cardiac catheterization and eight for PTCA per 106inhabitants. On average, 704 yearly coronary angiograms per diagnostic catheterization laboratory and 203 yearly PTCAs per PTCA laboratory were reported in Europe. The average operator performed 210 coronary angiograms and 78 PTCAs per year. Conclusions During 1995, coronary angiography increased at a mean annual rate of 10% and coronary angioplasty at a mean annual rate of nearly 20% in Europe. Coronary angioplasty was employed on a single vessel per procedure in the majority of cases. Coronary stenting remained the fastest growing procedure in interventional cardiology and the European mean ratio of coronary stenting per PTCA increased to 0·29. The ratio of PTCA to CABG further increased to 1·4:1. New devices were reserved for niche indications and balloon valvuloplasty was the most frequent non-coronary intervention.

The working group Coronary Circulation of the European Society of Cardiology conducts an annual survey of cardiac interventions in Europe with the support of the national societies of cardiology. A detailed questionnaire about cardiac interventions performed during 1994 was mailed to all members of the European Society of Cardiology. Incomplete or absent data from eight national members precluded their inclusion in the final analysis. Thus, this report summarizes the cardiac interventions performed during 1994 in 29 of 37 members of the European Society of Cardiology, representing a total population of approximately 490 million inhabitants. Coronary angiography A total of 922687 coronary angiograms were reported during 1994, representing an increase of 22% compared with 1993 and of 35% compared with 1992. The mean incidence of coronary angiograms was 1881/106inhabitants, ranging from 4417/106inhabitants in Germany to 35/106inhabitants in Romania. Germany, France, Great Britain, and Italy with 50% of the European population performed 73% of all cardiac interventions. Coronary angioplasty During 1994, a total of 224722 coronary angioplasty (PTCA) procedures were reported in Europe, an increase of 22% compared with 1993 and of 52% compared with 1992. Adjusted per capita, the mean incidence of coronary angioplasty was 458/106inhabitants, ranging from 1091/106inhabitants in Germany to 6/106inhabitants in Romania. On average, the ratio PTCA per coronary angiogram was 0·24, ranging from 0·37 in the Netherlands to 0·06 in Cyprus. Ad hoc PTCA accounted for 22% of all PTCA cases. The majority (81%) of PTCAs were restricted to a single vessel. Major com-plications were reported in 2% of patients undergoing PTCA, including death (0·3%), myocardial infarction (1·0%) and need for emergency coronary artery bypass grafting (0·7%). Coronary stenting Coronary stents were utilized in 21599 coronary interventions during 1994, an increase of 235% compared with 1993 and thus representing the fastest growth in interventional cardiology. The number of European countries employing stents during coronary angioplasty grew from 14 during 1993 to 24 during 1994. Elective use (38%) became the most frequent indication for coronary stenting during 1994, replacing bail-out stenting as the primary indication during 1993. Other new devices Other new interventional therapeutic devices were employed in 8827 cases. Only the Rotablator was used more frequently during 1994 as compared with 1993. All other new therapeutic devices showed a decline. Coronary ultrasound was utilized in 3032 interventions and coronary angioscopy in 304 cases during 1994. Non-coronary interventions Valvuloplasty remained the most frequent non-coronary intervention in Europe during 1994 with a total of 2622 mitral, 609 pulmonary and 506 aortic valvuloplasties. Catheterization facilities The number of facilities per 106inhabitants performing invasive cardiac procedures in Europe during 1994 ranged from 7·7 in Iceland to 0·2 in Romania (European mean 2·9). The number of trained operators per 106inhabitants ranged from 24 in Germany to 0·4 in Romania (European mean 10). During 1994, a mean of 701 coronary angiograms and 170PTCAs were performed per catheterization facility in Europe (range: 1052 coronary angiograms and 293PTCAs per facility in Norway to 218 coronary angiograms and 37PTCAs per facility in Romania). Conclusions The number of both coronary angiograms and coronary angioplasties continues to grow at an annual rate of approximately 20% in Europe. There is a wide range in the amount of revascularization procedures performed between western and eastern European countries. However,countries with the lowest numbers of coronary angiogramsand coronary angioplasties, e.g. Romania, also show the fastest annual growth. About one quarter of all patients undergoing coronary angiography are subsequently revascularized by coronary angioplasty. Coronary angioplasty is employed for the treatment of a single vessel in the majorityof cases. Coronary stenting is the fastest growing procedure in interventional cardiology and its primary indication has changed from bail-out stenting in previous years to its elective use during 1994.