Coronary artery anomalies: a diagnostic challenge

Coronary artery anomalies [CAAs] are found in approximately 1% of all patients undergoing coronary angiography and in 0.3% of patients undergoing autopsy [Roberts, 1986]. CAAs may be classified into those of origin and course, intrinsic coronary arterial anatomy, and coronary termination [Angelini et al. 2002]. The most common malformation is abnormal origin and course, origin of a coronary artery from a wrong aortic sinus of Valsalva; either the right from the left coronary sinus or the left from the right coronary sinus; these anomalies must be excluded in young adults with typically ischemic- sounding chest pain or syncope. Anomalies coronary artery termination typically presented as coronary artery fistula, commonly the right coronary artery is affected, although, left sided coronary artery fistulae are well documented [Gandy et al. 2004]. The anomalies of intrinsic coronary arterial anatomy, such as ostial stenosis, Artesia, and single, absent, or hypoplastic coronary arteries are rare but may have clinical importance

Drug-eluting stents: Insights into safety and indications

Currently, more than 4 million patients receive drug-eluting stents worldwide. Despite recent studies and editorials that have stirred controversy and generated tremendous publicity in the lay press related to the safety of drug-eluting stents for the treatment of coronary artery disease, enthusiasm for drug-eluting stents remains high. Drug-eluting stents decrease the need for repeat revascularization, but exhibit delayed endothelialization compared with bare metal stents. Adverse late vessel wall remodeling and inflammation have also been attributed to the drug/polymer coating. Recent registry analysis data suggesting an increased risk of late or very late thrombosis with drug-eluting stents in routine clinical practice compared with previous clinical trial experience has led to concerns regarding the long-term safety of these devices. Clearly, there are many benefits to drug-eluting stents, which are an excellent and appropriate revascularization treatment for many patients with substantial reduction of restenosis compared with bare-metal stents. There is a need for understanding the benefits and risks of these devices in order to use them optimally and reduce likelihood of thrombosis. This review sheds some light on the risks and benefits of drug-eluting stents, and puts this treatment in perspective compared with alternative revascularization treatment options for obstructive coronary artery disease. The important take-home message is that the risks of drug-eluting stent thrombosis versus bare-metal stent thrombosis may have been overstated by some studies

Update in hypertension: the seventh joint national committee report and beyond

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation on and Treatment of High Blood Pressure [JNCVII] had new key messages that need to be highlighted for practicing physicians. More than two years has elapsed since its publication and several important trials and meta-analyses were published during this period. Most of these publications supported and reinforced the JNC-VII recommendations, but others did not fully agree. Thus, some questions have arisen that need to be addressed in future research. This review will discuss what is new in JNC-VII and post-JNC-VII evidence that supports or disputes the recommendations. In addition, the results of other significant trials will be addressed. Finally, we outline the clinical "bottom line" and emphasize the practical application of this evidence