The anatomy of the radial artery has yet to be systematically studied from the perspective of using it as a route for catheter access. We prospectively performed angiography of the arteries of the upper limb to delineate the anatomic features of the radial artery as a way to determine the feasibility of using it as a route for coronary intervention. We studied 2,211 consecutive patients submitted to transradial cardiac catheterization. In all patients, an angiography of the upper limb arteries was performed before and after procedure. Radial puncture was successful in 98.9% of patients. At angiography, anatomic variations of upper limb arteries were noted in 505 patients (22.8%) and included tortuous configurations (3.8%), stenosis (1.7%), hypoplasias (7.7%), radioulnar loop (0.8%), abnormal origin of the radial artery (8.3%), and lusoria subclavian artery (0.45%). Overall procedural success by transradial approach was 97.5%. Patients with anatomic variations of radial artery had a significantly lower puncture (96.2% vs 99.7%, P < 0.0001) and procedural (93.1% vs 98.8%, P < 0.0001) success. The procedure was successfully performed by radial approach in 98.8% of patients with tortuous configurations, 91.9% of radial stenosis, 93.9% of hypoplastic radial artery, 83.3% of radioulnar loop, 96.7% of radial axillary origin, and 60% of lusoria subclavian artery setting. Anatomic variations of the radial artery are not rare. However, they do not represent an important limitation in transradial approach if they are well documented previously.

The exact relationship between primary percutaneous coronary intervention (PCI) volume and mortality remains unclear. No data are available on how this relationship could be affected by time-to-presentation. The primary aim of this study was to evaluate the impact of hospital primary PCI volume on in-hospital mortality in ST-elevation myocardial infarction (STEMI) patients depending on time-to-presentation. The impact of primary PCI volume on in-hospital mortality was investigated in a prospective registry of the Lombardy region in Northern Italy, deriving data on mortality rates and number of primary PCIs from a cohort of 2,558 patients. We also explored this relationship at different times-to-presentation (≤90 min, >90 min-180 min, >180 min) and risk profiles assessed with the TIMI Risk Index. A strong inverse relationship was found between primary PCI hospital volume and risk-adjusted mortality (r = -0.9; P < 0.001). High primary PCI volumes best predicted the improvement of survival when the time-to-presentation was ≤90 min (area under the curve = 0.73, P < 0.0001). At this time, the best primary PCI threshold to provide benefit was >66 primary PCIs/year (OR = 0.21 [95% CI 0.10-0.47], P < 0.001) and those with high TIMI Risk Index achieved the greatest benefit (P < 0.001). At >90 min-180 min, the model was less significant (P = 0.02) with a higher threshold of procedures (>145 primary PCIs/year) required to provide benefits. The model was not predictive of survival for time-to-presentation >180 min (P = 0.30). The reduction of mortality of STEMI patients treated at high-volume primary PCI centers is time-dependent and affected by risk profile. The greatest benefit was observed in high-risk patients presenting within 90 min from symptoms onset.

Atherosclerotic cardiovascular disease still represents the leading cause of death in Western countries. A wealth of scientific evidence demonstrates that increased blood cholesterol levels have a major impact on the outbreak and progression of atherosclerotic plaques. Moreover, several cholesterol-lowering pharmacological agents, including statins and ezetimibe, have proved effective in improving clinical outcomes. This document focuses on the clinical management of hypercholesterolaemia and has been conceived by 16 Italian medical associations with the support of the Italian National Institute of Health. The authors discuss in detail the role of hypercholesterolaemia in the genesis of atherosclerotic cardiovascular disease. In addition, the implications for high cholesterol levels in the definition of the individual cardiovascular risk profile have been carefully analysed, while all available therapeutic options for blood cholesterol reduction and cardiovascular risk mitigation have been explored. Finally, this document outlines the diagnostic and therapeutic pathways for the clinical management of patients with hypercholesterolaemia.

Purpose Ventricular tachycardia (VT) ablation is a complex procedure that requires remarkable catheter manipulation skill, great mapping accuracy and catheter stability, and can expose patients to serious complications. Magnetic navigation system (RMN)‐guided ablation and contact force‐sensing (CFS) catheters have the potential to overcome these obstacles. We performed a systematic review and updated meta‐analysis of all available studies evaluating the outcomes of VT ablation by using RMN‐guided compared to manual navigation (MAN)‐guided, with and without CFS catheters. Methods MEDLINE/PubMed, Cochrane, and Google Scholar were searched for randomized controlled trials (RCT) or observational studies with multivariate adjustment comparing RMN‐guided versus MAN‐guided VT ablation. Results Thirteen studies enrolling 1348 patients (656 RMN‐guided vs. 692 MAN‐guided) were included. CFS catheter were used in 14% of MAN‐guided patients. In comparison to MAN‐guided and CFS‐guided, RMN‐guided VT ablation was associated with a significant higher acute ablation success (OR 2.32, 1.66–3.23 and OR 2.91, 1.29–6.53, respectively) but similar results in term of long‐term VT recurrence (OR 0.75, 0.56–1.01 and OR 0.79, 0.27–2.36, respectively). RMN‐guided showed a better safety profile (for all complications, OR 0.52, 0.34–0.81) and allowed a significant x‐ray reduction compared to MAN‐guided (OR 0.21, 0.14–0.32) and CFS‐guided VT ablation (OR 0.23, 0.11–0.52, all 95% CI). Conclusions RMN‐guided was superior to MAN‐guided and CFS‐guided VT ablation in term of acute ablation success, all complications endpoint, and reduction of fluoroscopy exposure, but did not reduce long‐term VT recurrence. Large prospective multicenter randomized trials are needed to confirm these findings.

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