BACKGROUND Bleedings are an independent risk factor for subsequent mortality in patients with acute coronary syndromes(ACS)and in those undergoing percutaneous coronary intervention.This represents a hazard equivalent...BACKGROUND Bleedings are an independent risk factor for subsequent mortality in patients with acute coronary syndromes(ACS)and in those undergoing percutaneous coronary intervention.This represents a hazard equivalent to or greater than that for recurrent ACS.Dual antiplatelet therapy(DAPT)represents the cornerstone in the secondary prevention of thrombotic events,but the benefit of such therapy is counteracted by the increased hemorrhagic complications.Therefore,an early and individualized patient risk stratification can help to identify high-risk patients who could benefit the most from intensive medical therapies while minimizing unnecessary treatment complications in low-risk patients.AIM To review existing literature and gain better understanding of the role of ischemic and hemorrhagic risk scores in patients with ischemic heart disease(IHD).METHODS We used a combination of terms potentially used in literature describing the most common ischemic and hemorrhagic risk scores to search in PubMed as well as references of full-length articles.RESULTS In this review we briefly describe the most important ischemic and bleeding scores that can be adopted in patients with IHD,focusing on GRACE,CHA2DS2-Vasc,PARIS CTE,DAPT,CRUSADE,ACUITY,HAS-BLED,PARIS MB and PRECISE-DAPT score.In the second part of this review,we try to define a possible approach to the IHD patient,using the most suitable scores to stratify patient risk and decide the most appropriate patient treatment.CONCLUSION It becomes evident that risk scores by themselves can’t be the solution to balance the ischemic/bleeding risk of an IHD patient.Instead,some risk factors that are commonly associated with an elevated risk profile and that are already included in risk scores should be the focus of the clinician while he/she is taking care of a patient affected by IHD.展开更多
Giant cell myocarditis (GCM) is a rare, rapidly progressive and highly lethal disease in young and middle-aged adults. It is attributed to an inflammation of the heart muscle, and mediated by T lymphocytes and anti-my...Giant cell myocarditis (GCM) is a rare, rapidly progressive and highly lethal disease in young and middle-aged adults. It is attributed to an inflammation of the heart muscle, and mediated by T lymphocytes and anti-myosin autoantibodies. Making diagnosis of GCM with multiple noninvasive imaging modalities is possible in a small percentage of patients, so myocardial tissue diagnosis is often required. An early diagnosis is very important, because immunosuppressive treatment may significantly improve clinical course and survival of these patients. GCM often escapes diagnosis until autopsy or transplantation and has defied proper treatment trials for its rarity and deadly behavior. This review will focus on the diagnostic approach to patients with suspected GCM and currently evidence-based treatment strategy for this disease.展开更多
文摘BACKGROUND Bleedings are an independent risk factor for subsequent mortality in patients with acute coronary syndromes(ACS)and in those undergoing percutaneous coronary intervention.This represents a hazard equivalent to or greater than that for recurrent ACS.Dual antiplatelet therapy(DAPT)represents the cornerstone in the secondary prevention of thrombotic events,but the benefit of such therapy is counteracted by the increased hemorrhagic complications.Therefore,an early and individualized patient risk stratification can help to identify high-risk patients who could benefit the most from intensive medical therapies while minimizing unnecessary treatment complications in low-risk patients.AIM To review existing literature and gain better understanding of the role of ischemic and hemorrhagic risk scores in patients with ischemic heart disease(IHD).METHODS We used a combination of terms potentially used in literature describing the most common ischemic and hemorrhagic risk scores to search in PubMed as well as references of full-length articles.RESULTS In this review we briefly describe the most important ischemic and bleeding scores that can be adopted in patients with IHD,focusing on GRACE,CHA2DS2-Vasc,PARIS CTE,DAPT,CRUSADE,ACUITY,HAS-BLED,PARIS MB and PRECISE-DAPT score.In the second part of this review,we try to define a possible approach to the IHD patient,using the most suitable scores to stratify patient risk and decide the most appropriate patient treatment.CONCLUSION It becomes evident that risk scores by themselves can’t be the solution to balance the ischemic/bleeding risk of an IHD patient.Instead,some risk factors that are commonly associated with an elevated risk profile and that are already included in risk scores should be the focus of the clinician while he/she is taking care of a patient affected by IHD.
文摘Giant cell myocarditis (GCM) is a rare, rapidly progressive and highly lethal disease in young and middle-aged adults. It is attributed to an inflammation of the heart muscle, and mediated by T lymphocytes and anti-myosin autoantibodies. Making diagnosis of GCM with multiple noninvasive imaging modalities is possible in a small percentage of patients, so myocardial tissue diagnosis is often required. An early diagnosis is very important, because immunosuppressive treatment may significantly improve clinical course and survival of these patients. GCM often escapes diagnosis until autopsy or transplantation and has defied proper treatment trials for its rarity and deadly behavior. This review will focus on the diagnostic approach to patients with suspected GCM and currently evidence-based treatment strategy for this disease.
