Contemporary issues in the management of patient with coronary artery disease across the cardiology spectrum—part II

Abstract

In the current issue five topics are discussed: a) assessment and management of the cardiovascular risk in patients with chronic kidney disease; b) management of patients with coronary artery disease and chronic kidney disease; c) management of patients with atrial fibrillation and concomitant coronary artery disease; d) the importance of cardiovascular magnetic resonance imaging in patients with ischemic heart disease; and e) stent selection for percutaneous coronary intervention.

Patients with chronic kidney disease are at increased cardiovascular risk due to the coexistance of traditional and kidney disease-related risk factors. Currently, it is presented that the cardiovascular risk assessment and management of the whole spectrum of patients with chronic kidney disease including transplanted and dialysis patients.

Further to this the specific problems of the management of coronary artery disease in patients with established chronic kidney disease are presented. It is known that the mortality risk of the above patients when exhibit coronary artery disease is higher than the average. In addition, their management is a real challenge due to the complexity of anatomy, possibility of acute renal failure, and special considerations, needing to be taken into account when drugs are administered.

Coronary artery disease frequently coexists with atrial fibrillation. When these two conditions have to be managed together, ways of balancing the needs for antiothrombotic and antiplatelets regimes along with the bleeding risk of the patient have to be found. Also the ways of controlling heart rate in such patients or the heart rhythm restoration present a challenging situation.

Cardiovascular magnetic resonance imaging (CMR) offers a broad assessment of cardiac structure and function. In patients with known or suspected heart disease, CMR applications can provide assessment of left ventricular function, myocardial perfusion, and myocardial viability. Currently, the CMR techniques used to assess patients with known or suspected IHD along with situations in which it can be used are fully addressed.

Finally, clinically relevant information with regards to stenting, which is the backbone of the revascularization procedures, is discussed. Technology is advancing and stent characteristics along with patient and vessel factors should be taken into account for the selection of the proper vessel scaffold.

Finishing, I would like to thank again all the contributors of the current issue and especially Dr Jim Hall and Dr Robert Wright for all their effort.

I hope that all trainees and specialists find the current issue both educative and easy to read. I strongly encourage them to find the time and engage themselves to the CME activities accompanying each paper. I am sure it will help them to refresh their knowledge and hopefully improve their everyday clinical practice.

Dr. Michalis reports personal fees from Bayer, Menarini, Actelion, St Jude Medical, Sanofi, and grants from Medronic, Boehringer-Ingelheim, Elpen, St Jude Medical, Leo Pharmaceutical, Boston Scientific, Unipharma, outside the submitted work.