P84 RENAL DENERVATION IN RESISTANT ARTERIAL HYPERTENSION: OUR CENTER‘S EXPERIENCE

Introduction

The renal denervation procedure (RDN) represents an innovative alternative in patients with resistant arterial hypertension, in addition to medical therapy and lifestyle changes. This document presents our experience at the Cardiology department of the “Fatebenefratelli di Benevento” hospital where 19 effective RDN procedures were performed.

Methods

19 RDNs were performed at the “Fatebenefratelli di Benevento” Hospital in patients with resistant arterial hypertension (defined as failure to control blood pressure values using three or more drugs, including a diuretic). The long–term efficacy of the technique was evaluated by comparing blood pressure measurements using ECG–holter before and after the RDN (follow–up visit – 12 months). In addition, patients underwent a clinical–instrumental evaluation before the procedure and at the follow–up visit.

Results

The analysis of the collected data revealed a significant reduction in systolic, mean (p–value <0.001) and diastolic (p–value = 0.001) blood pressure. The mean variation was –13 ± 8 for systolic blood pressure, –7 ± 7 for diastolic blood pressure, and –11 ± 9 for mean pressure. The procedure was completed in all patients without peri–procedural and post–procedural complications. During the 12 months of observation, no fatal or non–fatal cardiovascular events, hospitalization or death from any cause were reported.

Conclusions

In our experience, renal denervation has been a safe and efficacy procedure in reducing blood pressure and the amount of drugs taken in high–risk cardiovascular patients with resistant arterial hypertension. It will be necessary to confirm the results benefits through a longer follow up.

Early myocardial surgical revascularization after ST-segment elevation myocardial infarction in multivessel coronary disease: bridge therapy is the solution?

BACKGROUND

Many ST-segment elevation myocardial infarction (STEMI) patients have a multivessel disease that initially require percutaneous coronary intervention (PCI) of the culprit vessel but subsequently may require coronary artery bypass graft (CABG) of nonculprit vessels. Evidence supports staged revascularization, but the identification of optimal strategies (percutaneous or surgical), the timing and the management of antiplatelet therapy after recent PCI with stenting are matters of great controversies.

METHODS

In our retrospective registry, we have enrolled 21 patients presenting with STEMI and multivessel disease, who underwent PCI of the culprit vessel only and then CABG of nonculprit vessels. Demographic, clinical, echocardiographic, angiographic findings, preoperative score, surgical data and postoperative complications were collected. At 21.6 ± 15.6 months follow-up death, reinfarction and/or cardiovascular and noncardiovascular events were recorded.

RESULTS

Patients were 62 ± 9 years old and had in the most cases a good ejection fraction. At angiography, the culprit lesion was right coronary artery in 16 patients (76%). Angiographic characteristics excluded a staged PCI (SYNTAX score = 31.6 ± 7.4) and European System for Cardiac Operative Risk Evaluation II resulted low (1.46 ± 1.01). Following the indication to cardiac surgery after Heart Team discussion, the withdrawal of oral P2Y12 inhibitor was planned and tirofiban intravenous was started. Off-pump CABG was performed after 7.2 ± 3.2 days. No death, reinfarction and/or cardiovascular and noncardiovascular events occurred at follow-up.

CONCLUSION

We can conclude that a careful preoperative selection is mandatory for a good postoperative course and long-term survival and that early-staged CABG can, however, be performed using bridge therapy, also after STEMI.