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Attanasio A, Tondi L, Castelvecchio S, Pazzanese V, Palmisano A, Esposito A, Ameri P, Canale C, Cappelletti A, Alberti LP, Tavano D, Camporotondo R, Costantino I, Campodonico J, Pontone G, Villani A, Gallone GP, Montone RA, Niccoli G, Gargiulo P, Punzo B, Vicenzi M, Carugo S, Disabato G, Guida G, Camporeale A, Carrafiello G, Spagnolo P, Menicanti L, Ambrosio G, Piepoli M, Lombardi M, Camici PG. Left atrial dysfunction predicts left ventricular remodeling in patients with preserved ejection fraction after acute ST-elevation myocardial infarction. Eur J Prev Cardiol 2024:zwae072. [PMID: 38381565 DOI: 10.1093/eurjpc/zwae072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/06/2024] [Accepted: 02/19/2024] [Indexed: 02/23/2024]
Affiliation(s)
- Andrea Attanasio
- Clinical Cardiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Milan, Italy
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Lara Tondi
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
- Postgraduate School in Radiodiagnostics, Università Degli Studi di Milano, 20122 Milan, Italy
| | | | | | - Anna Palmisano
- Vita Salute University and IRCCS San Raffaele Hospital, Milano, Italy; Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Esposito
- Vita Salute University and IRCCS San Raffaele Hospital, Milano, Italy
| | - Pietro Ameri
- Cardio-Thoraco-Vascular Department, IRCCS Policlinico San Martino and Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Claudia Canale
- Cardio-Thoraco-Vascular Department, IRCCS Policlinico San Martino and Department of Internal Medicine, University of Genoa, Genoa, Italy
| | | | | | | | - Rita Camporotondo
- Coronary Care Unit Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ilaria Costantino
- Coronary Care Unit Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Jenness Campodonico
- Centro Cardiologico Monzino IRCCS and Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Gianluca Pontone
- Centro Cardiologico Monzino IRCCS and Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | | | - Rocco A Montone
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Paola Gargiulo
- Department of Advanced Biomedical Sciences, Federico II University, Napoli, Italy
| | | | - Marco Vicenzi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cardiovascular Disease Unit, Internal Medicine Department and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Stefano Carugo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cardiovascular Disease Unit, Internal Medicine Department and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Giandomenico Disabato
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Gianluigi Guida
- Clinical Cardiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Milan, Italy
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Antonia Camporeale
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
- Postgraduate School in Radiodiagnostics, Università Degli Studi di Milano, 20122 Milan, Italy
| | - Gianpaolo Carrafiello
- Department of Diagnostic and Interventional Radiology, Foundation IRCCS Cà Granda-Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Pietro Spagnolo
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Giuseppe Ambrosio
- Cardiology, University of Perugia School of Medicine, Perugia, Italy
| | - Massimo Piepoli
- Clinical Cardiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Milan, Italy
- Department of Preventive Cardiology, Wroclaw Medical University, Wroclaw, Poland
| | - Massimo Lombardi
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Paolo G Camici
- Vita Salute University and IRCCS San Raffaele Hospital, Milano, Italy
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Pica S, Crimi G, Castelvecchio S, Pazzanese V, Palmisano A, Lombardi M, Tondi L, Esposito A, Ameri P, Canale C, Cappelletti A, Alberti LP, Tavano D, Camporotondo R, Costantino I, Campodonico J, Pontone G, Villani A, Gallone GP, Montone RA, Niccoli G, Gargiulo P, Punzo B, Vicenzi M, Carugo S, Menicanti L, Ambrosio G, Camici PG. Corrigendum to "Cardiac magnetic resonance predictors of left ventricular remodelling following acute ST elevation myocardial infarction: The VavirimS study, Pica, Silvia et al." [International Journal of Cardiology, Volume 370, 8-17]. Int J Cardiol 2024:131824. [PMID: 38311510 DOI: 10.1016/j.ijcard.2024.131824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Affiliation(s)
- Silvia Pica
- IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Gabriele Crimi
- Cardio-Thoraco-Vascular Department, IRCCS Policlinico San Martino and Department of Internal Medicine, University of Genoa, Genoa, Italy
| | | | | | - Anna Palmisano
- Vita Salute University and IRCCS San Raffaele Hospital, Milano, Italy; Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Lara Tondi
- IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Antonio Esposito
- Vita Salute University and IRCCS San Raffaele Hospital, Milano, Italy; Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pietro Ameri
- Cardio-Thoraco-Vascular Department, IRCCS Policlinico San Martino and Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Claudia Canale
- Cardio-Thoraco-Vascular Department, IRCCS Policlinico San Martino and Department of Internal Medicine, University of Genoa, Genoa, Italy
| | | | | | | | - Rita Camporotondo
- Coronary Care Unit Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ilaria Costantino
- Coronary Care Unit Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Jenness Campodonico
- Centro Cardiologico Monzino IRCCS and Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Gianluca Pontone
- Centro Cardiologico Monzino IRCCS and Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | | | - Rocco A Montone
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giampaolo Niccoli
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Medicine, University of Parma, Parma, Italy
| | - Paola Gargiulo
- Department of Advanced Biomedical Sciences, Federico II University, Napoli, Italy
| | | | - Marco Vicenzi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cardiovascular Disease Unit, Internal Medicine Department and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Stefano Carugo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cardiovascular Disease Unit, Internal Medicine Department and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | | | - Giuseppe Ambrosio
- Cardiology, University of Perugia School of Medicine, Perugia, Italy
| | - Paolo G Camici
- Vita Salute University and IRCCS San Raffaele Hospital, Milano, Italy.
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Pica S, Crimi G, Castelvecchio S, Pazzanese V, Palmisano A, Lombardi M, Tondi L, Esposito A, Ameri P, Canale C, Cappelletti A, Alberti LP, Tavano D, Camporotondo R, Costantino I, Campodonico J, Pontone G, Villani A, Gallone GP, Montone RA, Niccoli G, Gargiulo P, Punzo B, Vicenzi M, Carugo S, Menicanti L, Ambrosio G, Camici PG. Cardiac magnetic resonance predictors of left ventricular remodelling following acute ST elevation myocardial infarction: The VavirimS study. Int J Cardiol 2023; 370:8-17. [PMID: 36351542 DOI: 10.1016/j.ijcard.2022.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 10/30/2022] [Accepted: 11/02/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Left ventricular (LV) remodelling (REM) ensuing after ST-elevation myocardial infarction (STEMI), has typically been studied by echocardiography, which has limitations, or cardiac magnetic resonance (CMR) in early phase that may overestimate infarct size (IS) due to tissue edema and stunning. This prospective, multicenter study investigated LV-REM performing CMR in the subacute phase, and 6 months after STEMI. METHODS AND RESULTS patients with first STEMI undergoing successful primary angioplasty were consecutively enrolled. CMR was done at 30-days and 6-months. Primary endpoint was prevalence at 6 months of LV-REM [≥12% increase in LV end-diastolic volume index (LV-REMEDV)]; LV-REM by end-systolic volume index increase ≥12% (LV-REMESV) was also calculated. Of 325 patients enrolled, 193 with a full set of research-quality CMR images were analyzed. LV-REMEDV and LV-REMESV were present in 36/193 (19%) and 34/193 (18%) patients, respectively. At follow up, LV ejection fraction (EF) improved in patients with or without LV-REMEDV, whilst it decreased in those with LV-REMESV (p < 0.001 for interaction). Considering predictors of LV-REM, IS in the highest tertile was clearly separated from the two lower tertiles. In LV-REMEDV, the highest tertile was associated with significantly higher LV-EDV, LV-ESV, and lower EF. CONCLUSIONS In a contemporary cohort of STEMI patients studied by CMR, prevalence of LV-REMEDV was lower than previously reported. Importantly, our data indicate that LV-REMEDV might not be "adverse" per se, but rather "compensatory", being associated with LV-EF improvement at follow-up. Conversely, LV-REMESV might be an "adverse" phenomenon associated with decreased LV-EF, driven by IS.
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Affiliation(s)
- Silvia Pica
- IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Gabriele Crimi
- Cardio-Thoraco-Vascular Department, IRCCS Policlinico San Martino and Department of Internal Medicine, University of Genoa, Genoa, Italy
| | | | | | - Anna Palmisano
- Vita Salute University and IRCCS San Raffaele Hospital, Milano, Italy; Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Lara Tondi
- IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Antonio Esposito
- Vita Salute University and IRCCS San Raffaele Hospital, Milano, Italy; Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pietro Ameri
- Cardio-Thoraco-Vascular Department, IRCCS Policlinico San Martino and Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Claudia Canale
- Cardio-Thoraco-Vascular Department, IRCCS Policlinico San Martino and Department of Internal Medicine, University of Genoa, Genoa, Italy
| | | | | | | | - Rita Camporotondo
- Coronary Care Unit Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ilaria Costantino
- Coronary Care Unit Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Jenness Campodonico
- Centro Cardiologico Monzino IRCCS and Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Gianluca Pontone
- Centro Cardiologico Monzino IRCCS and Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | | | - Rocco A Montone
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giampaolo Niccoli
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Medicine, University of Parma, Parma, Italy
| | - Paola Gargiulo
- Department of Advanced Biomedical Sciences, Federico II University, Napoli, Italy
| | | | - Marco Vicenzi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cardiovascular Disease Unit, Internal Medicine Department and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Stefano Carugo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cardiovascular Disease Unit, Internal Medicine Department and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | | | - Giuseppe Ambrosio
- Cardiology, University of Perugia School of Medicine, Perugia, Italy
| | - Paolo G Camici
- Vita Salute University and IRCCS San Raffaele Hospital, Milano, Italy.
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Boccellino A, Sacchi S, Pazzanese V, Calvo F, Gramegna M, Ingallina G, Cappelletti A, Baldetti L. 849 EFFECTS OF INTRA-AORTIC BALLOON PUMP DELAYED DEFLATION TIMING ON CAROTID BLOOD FLOW AND CARDIAC MECHANICS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Intra-Aortic Balloon Pump (IABP) efficacy is critically affected by the inflation/deflation timing. Balloon deflation may cause a sucking effect, and a steal phenomenon on carotid flow. Delaying IABP deflation reduces the degree of this flow reversal, but at the same time exposes patients to the risk of increased proto-systolic afterload with detrimental effects on the LV.
Hypothesis
To investigate the effects of a delayed IABP deflation timing on cerebral blood flow and LV hemodynamics.
Methods
We prospectively evaluated 20 consecutive patients who received transfemoral IABP for cardiogenic shock (CS). Central aortic pressures (augmented diastolic [ADP], end-diastolic [EDP], assisted systolic [ASP] and mean aortic [MAP] pressures) were recorded from the IABP console simultaneously with ultrasound data. First ultrasound and haemodynamic measurements were collected during conventional IABP deflation timing (balloon deflation completed before onset of LV systole by automated ECG gating). Then, IABP deflation was manually delayed to the beginning of the QRS (early LV systole). After adjustment, counterpulsation was performed for a minimum of 2 minutes to achieve steady hemodynamics, then the same ultrasound and haemodynamic measurements were recollected.
Results
Mean age was 67±13 years, LVEF was 25±11%. At the carotid ultrasound, the delayed deflation increased the net forward velocity time integral (VTI) in the common carotid artery (18±9 vs 15±8 cm; p=0.001), by reducing the end-diastolic backward VTI (1±1 vs 4±2 cm; p<0.001) while having no effect on the overall forward VTI (19±9 vs 19±9 cm; p=0.294). Specifically, the delayed deflation increased the diastolic forward VTI (12±5 vs 10±4 cm]; p<0.001) while decreasing the systolic forward VTI (7±4 vs 9±4 cm]; p<0.005). On central aortic hemodynamics, the delayed deflation decreased the ASP (91±21 vs 97±20 mmHg; p=0.001), increased the EDP (60±11 vs 48±9 mmHg; p<0.001), the ADP (123±19 vs 119±19 mmHg; p<0.001) and the MAP (89±14 vs 80±12 mmHg; p<0.001). On echocardiography, the delayed deflation increased the LVOT VTI (15±4 vs 13±4 cm; p<0.001), decreased LV ejection time (202±44 vs 211±43 ms; p=0.005) but did not affect the isovolumetric contraction time (119±56 vs 119±58 ms; p=0.989), eventually reducing the total duration of LV systole (321±54 vs 330±50 ms; p=0.009).
Conclusions
In our cohort, a delayed IABP deflation strategy, evaluated by a multi-parametric yet relatively simple approach, demonstrated to be safe and was associated with both an increase cerebral perfusion and an improvement in cardiac mechanics.
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Affiliation(s)
| | - Stefania Sacchi
- Terapia Intensiva Cardiologica - Irccs ”Ospedale S. Raffaele”
| | | | - Francesco Calvo
- Terapia Intensiva Cardiologica - Irccs ”Ospedale S. Raffaele”
| | - Mario Gramegna
- Terapia Intensiva Cardiologica - Irccs ”Ospedale S. Raffaele”
| | | | | | - Luca Baldetti
- Terapia Intensiva Cardiologica - Irccs ”Ospedale S. Raffaele”
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Baldetti L, Gagliardi MF, Boccellino A, Calvo F, Pazzanese V, Gramegna M, Sacchi S, Cappelletti A. 854 SODIUM NITROPRUSSIDE IN ACUTE HEART FAILURE: EFFECTS ON LV AFTERLOAD AND VENTRICULO-ARTERIAL COUPLING. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Acute heart failure (AHF) with left ventricle (LV) dysfunction is characterized by a condition of afterload mismatch without preload reserve. LV ejection fraction (LVEF) and stroke volume (SV) become thus dependent on the afterload. Owing to its arteriolar vasodilator properties, sodium nitroprusside (SNP) may reduce LV afterload and result particularly beneficial in this setting, improving LV ejection and ventriculo-arterial coupling (VAC).
Hypothesis
We aimed to assess the effect of SNP on LV afterload (arterial elastance, Ea), LV contractility (end-systolic elastance, Ees) and VAC (Ea/Ees ratio) in AHF patients.
Methods
Patients with AHF receiving SNP were prospectively enrolled and underwent Ea and Ees estimation with a single-beat echocardiographic method, before and after SNP infusion. The method was described by Chen et al (J Am Coll Cardiol, 2001) and Kelly et al (Circulation, 1992). Echocardiography was analyzed by a physician blinded to the images timing.
Results
A total of 36 AHF patients [69% male, age 70 (68, 76) years] received SNP infusion and were enrolled. Patients were admitted for acute coronary syndrome (47%) and for worsening heart failure (53%). SNP median dose was low: 0.30 (0.21-0.57) mcg/kg/min.
SNP led to a trend to SBP reduction [140 (131-150) vs 158 (140-168) mmHg; p=0.002]. Heart rate did not change: 84 (75, 92) vs 83 (72, 94) bpm; p=0.800. Afterload (Ea) was reduced following SNP infusion: 2.2 (1.9, 2.7) vs 2.8 (2.4, 3.4) mmHg/mL; p<0.001. LV contractility (Ees) was unchanged: 1.3 (0.8, 2.2) vs 1.5 (0.9, 3.4) mmHg/mL; p=0.13. End-diastolic volume did not change: 148 (110, 205) vs 146 (108, 213) mL; p=0.880. These effects led to an increased SV: 56 (47, 67) vs 50 (38, 56) mL; p<0.001; p<0.001 and, subsequently to an increased EF [40 (30, 50) vs 30 (20, 40)%; p<0.001]. The VAC did not significantly change after SNP infusion: 1.5 (0.9-2.8) vs 1.6 (0.9-2.7); p=0.64.
Conclusion
In this report on consecutive AHF, low-dose SNP did not significantly affect VAC but led to a significant reduction in LV afterload and to a significant increase in SV and LVEF.
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Affiliation(s)
- Luca Baldetti
- Terapia Intensiva Cardiologica - Irccs ”Ospedale S. Raffaele”
| | | | | | - Francesco Calvo
- Terapia Intensiva Cardiologica - Irccs ”Ospedale S. Raffaele”
| | | | - Mario Gramegna
- Terapia Intensiva Cardiologica - Irccs ”Ospedale S. Raffaele”
| | - Stefania Sacchi
- Terapia Intensiva Cardiologica - Irccs ”Ospedale S. Raffaele”
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Bodega F, Russi A, Melillo F, Blunda F, Rubino C, Leo G, Cappelletti A, Mazzone P, Mattiello P, Della Bella P, Castiglioni A, Alfieri O, De Bonis M, Montorfano M, Tresoldi M, Filippi M, Salerno A, Cera M, Zangrillo A, Alberto M, Godino C. Direct oral anticoagulants in patients with nonvalvular atrial fibrillation and extreme body weight. Eur J Clin Invest 2022; 52:e13658. [PMID: 34310688 DOI: 10.1111/eci.13658] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/19/2021] [Accepted: 07/22/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Limited clinical data exist describing the use of direct oral anticoagulants (DOACs) in patient with extreme body weight. Thus, the International Society of Thrombosis and Haemostasis (ISTH) recommends avoiding DOACs in patients with weight >120 Kg, and on the contrary, no restrictions exist for underweight patients. OBJECTIVE To evaluate the effects of extreme body weight on DOAC activity and to compare the clinical outcomes of patients with an extreme body weight versus patients with a normal weight (61-119 Kg) treated with DOACs. METHODS Single tertiary care Italian centre multidisciplinary registry including nonvalvular atrial fibrillation (NVAF) patients treated with DOACs. Based on weight, three subcohorts were defined: (i) underweight patients (≤60 Kg); (ii) patients with a normal weight (61-119 Kg, as control group); and (iii) overweight patients (≥120 Kg). Primary efficacy endpoint was 2-year rate of thromboembolic events. Primary safety endpoint was 2-year rate of major bleeding. Event-free survival curves among groups were compared using Cox-Mantel test. RESULTS 812 NVAF patients were included, 108 patients weighed ≤60 Kg (13%, underweight), 688 weighed between 61 and 119 Kg (85%, normal weight), and 16 weighed ≥120 Kg (2%, overweight). In particular, among underweight patients, dabigatran was prescribed in 26% patients, apixaban in 27%, rivaroxaban in 28% and edoxaban in 22% ones. Instead, among overweight patients, 44% were treated with dabigatran, 25% with apixaban, 25% with rivaroxaban and 4% with edoxaban. Underweight patients were older, more frequently women, with lower creatinine clearance and a history of previous strokes, resulting in higher CHA2DS2-VASc score than in both remaining groups. Up to 2 years, no statistically significant difference was observed between the three groups of weight for thromboembolic events (P = .765) and for overall bleeding (P = .125), but a trend towards decreased overall bleeding rates was noticed as weight increased (24.1% vs 16.7% vs 12.5%, respectively). CONCLUSION In this tertiary care centre registry, 15% of patients treated with DOACs presented an extreme weight. Compared to patients with a normal weight, no significant rates of thromboembolic events were observed for underweight or overweight patients. A trend towards decreased overall bleeding frequency as weight increased was highlighted up to 2 years. The present results should be considered as preliminary and hypothesis generating.
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Affiliation(s)
| | - Anita Russi
- Cardiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Fabiana Blunda
- Cardiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Claudia Rubino
- Cardiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Giulio Leo
- Cardiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Patrizio Mazzone
- Arrhythmia and Electrophysiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Paolo Mattiello
- Information Systems Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Paolo Della Bella
- Arrhythmia and Electrophysiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Ottavio Alfieri
- Cardiac Surgery Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Matteo Montorfano
- Interventional Cardiovascular Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Moreno Tresoldi
- General Medicine and Advanced Care Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Anna Salerno
- Cardiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Michela Cera
- Cardiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Alberto Zangrillo
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Cosmo Godino
- Cardiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
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Ghio S, Montalto C, Pagnesi M, Lupi L, Cappelletti A, Baldetti L, Baldi E, Lombardi C, Metra M, Perlini S, Oltrona Visconti L. High troponin levels in patients hospitalized for coronavirus disease 2019: a maker or a marker of prognosis? J Cardiovasc Med (Hagerstown) 2021; 22:828-831. [PMID: 34519287 DOI: 10.2459/jcm.0000000000001249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
AIMS Controversial data have been published regarding the prognostic role of cardiac troponins in patients who need hospitalization because of coronavirus disease 2019 (COVID-19). The aim of the study was to assess the role of high-sensitivity troponin plasma levels and of respiratory function at admission on all-cause deaths in unselected patients hospitalized because of COVID-19. METHODS We pooled individual patient data from observational studies that assessed all-cause mortality of unselected patients hospitalized for COVID-19. The individual data of 722 patients were included. The ratio of partial pressure arterial oxygen to fraction of inspired oxygen (PaO2/FiO2) and high-sensitivity troponins was reported at admission in all patients. This meta-analysis was registered on PROSPERO (CRD42020213209). RESULTS After a median follow-up of 14 days, 180 deaths were observed. At multivariable regression analysis, age [hazard ratio (HR) 1.083, 95% confidence interval (CI) 1.061-1.105, P < 0.0001], male sex (HR 2.049, 95% CI 1.319-3.184, P = 0.0014), moderate-severe renal dysfunction (estimated glomerular filtration rate < 30 mL/min/m2) (HR 2.108, 95% CI 1.237-3.594, P = 0.0061) and lower PaO2/FiO2 (HR 0.901, 95% CI 0.829-0.978, P = 0.0133) were the independent predictors of death. A linear increase in the HR was associated with decreasing values of PaO2/FiO2 below the normality threshold. On the contrary, the HR curve for troponin plasma levels was near-flat with large CI for values above the normality thresholds. CONCLUSION In unselected patients hospitalized for COVID-19, mortality is mainly driven by male gender, older age and respiratory failure. Elevated plasma levels of high-sensitivity troponins are not an independent predictor of worse survival when respiratory function is accounted for.
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Affiliation(s)
- Stefano Ghio
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Claudio Montalto
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Matteo Pagnesi
- Cardiac Intensive Care Unit, San Raffaele Scientific Institute, Milan
| | - Laura Lupi
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia
| | | | - Luca Baldetti
- Cardiac Intensive Care Unit, San Raffaele Scientific Institute, Milan
| | - Enrico Baldi
- Cardiac Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo
| | - Carlo Lombardi
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia
| | - Marco Metra
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia
| | - Stefano Perlini
- Emergency Department, Fondazione IRCCS Policlinico San Matteo, Pavia and Department of Internal Medicine, University of Pavia, Pavia, Italy
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8
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Montalto C, Ghio S, Pagnesi M, Cappelletti A, Baldetti L, Baldi E, Lombardi C, Lupi L, Metra M, Perlini S, Oltrona-Visconti L. Myocardial injury in patients hospitalized for SARS-CoV19: a maker or a marker of prognosis? Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, literature data are progressively accumulating, attesting to the possible prognostic role of cardiac troponins in patients who need hospitalization because of COVID-19 infection.
Purpose
To assess whether myocardial injury (measured by high sensitivity troponins) is an independent cause of disease severity and prognosis.
Methods
We performed a patient-level metanalysis (PROSPERO ID: CRD42020213209) in unselected patients hospitalized because of COVID-19 infection in whom the severity of respiratory failure was also evaluated at admission. To allow for comparison, troponin values were normalized to their threshold levels to obtain a normalized troponin (nTn) value which was used as a continuous variable in all analysis.
Results
A total of 722 patients were included in the analysis. Of note, patients who had elevated troponins at hospital admission had a significantly lower oxygenation status than those with normal nTn (PaO2/FiO2 232±215 vs. 276±124 mmHg/%; p<0.001). On the contrary, those with cardiovascular comorbidities had similar PaO2/FiO2 but higher nTn than those without (5.6817 vs. 2.1110 ng/mL; p=0.002).
After a median follow-up of 14 days, 180 deaths were observed. At multivariable regression analysis, age, male sex, moderate-severe renal dysfunction (eGFR <30 mL/min/m2) and lower PaO2/FiO2, were independent predictor of death (igure 1). The restricted cubic spline curves in Figure 2A and 2B show the hazard ratios (HRs) and 95% confidence interval for death according to nTn and PaO2/FiO2 levels as continuous variables. A linear increase in the HR is observed with lower PaO2/FiO2 values below the normal value of 300. On the contrary, the nTn spline curve is near-flat with large confidence interval for values above the normality thresholds.
Conclusion
In patients hospitalized for COVID-19, mortality is mainly driven by gender, age and respiratory failure while myocardial damage is not an independent predictor of worse survival when respiratory function is accounted for.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Affiliation(s)
| | - S Ghio
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - M Pagnesi
- IRCCS San Raffaele Hospital, Milan, Italy
| | | | - L Baldetti
- IRCCS San Raffaele Hospital, Milan, Italy
| | - E Baldi
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - C Lombardi
- Civil Hospital of Brescia, Brescia, Italy
| | - L Lupi
- Civil Hospital of Brescia, Brescia, Italy
| | - M Metra
- Civil Hospital of Brescia, Brescia, Italy
| | | | - L Oltrona-Visconti
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
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9
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Rubino C, Blunda F, Bodega F, Melillo F, Russi A, Mattiello P, Salerno A, Cera M, Margonato D, Mazzone P, Della Bella P, Castiglioni A, Alfieri O, DE Bonis M, Montorfano M, Filippi M, Tresoldi M, Cappelletti A, Zangrillo A, Margonato A, Godino C. Safety and efficacy of Direct Oral Anticoagulants (DOACs) in very elderly patients (≥ 85 years old) with non-valvular atrial fibrillation. The Experience of an Italian tertiary care center. Minerva Med 2021; 114:137-147. [PMID: 34180639 DOI: 10.23736/s0026-4806.21.07432-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Limited real-world data are available regarding the comparison about safety and efficacy of DOACs prescription in very elderly patients (≥85 years) with non-valvular atrial fibrillation (NVAF). Concern about the risk of bleeding with anticoagulation in very older patients still represents an important challenge for clinicians. OBJECTIVE To evaluate the different prevalence of major bleeding and thromboembolic events between very elderly NVAF patients (≥85 years) compared to those non very elderly (<85 years). METHODS Single center multidisciplinary registry including NVAF patients treated with DOACs. Primary safety endpoint was 2-year rate of major bleeding. Primary efficacy endpoint was 2-year rate of thromboembolic events. Event-free survival curves among groups were compared using Cox-Mantel test. RESULTS 908 NVAF consecutive patients were included, of these, 805 patients were <85 years (89%) and 103 patients were very elderly patients with ≥85 years (11%). Compared to patients <85 years, those very elderly have higher CHA2DS2-VASc score (p=0.001), higher rate of hypertension (p=0.001), diabetes mellitus (p=0.030), previous bleeding events (p<0.001), previous stroke/TIA/SE (p=<0.001), heart failure (p=<0.001), and lower creatinine clearance (p<0.001). In terms of safety endpoints (overall ISTH-major bleeding) no significative difference between two groups (p=0.952) were observed up to 2-year follow-up. Systemic thromboembolic event (primary efficacy endpoint) was significantly higher in patients with ≥85 years (p=0.027). The incidence of all-cause death was significantly higher in very elderly patients (p<0.001). CONCLUSIONS This single center registry, showed that the use of DOACs in very elderly NVAF was safe and is a therapeutic option to be pursued for stroke prevention especially for those who are at high risk of ischemic events.
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Affiliation(s)
- Claudia Rubino
- Cardiology Unit, IRCCS San Raffaele Hospital, Milan, Italy -
| | - Fabiana Blunda
- Cardiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | | | | | - Anita Russi
- Cardiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Paolo Mattiello
- Information Systems Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Anna Salerno
- Cardiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Michela Cera
- Cardiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Patrizio Mazzone
- Arrhythmia and Electrophysiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Paolo Della Bella
- Arrhythmia and Electrophysiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Alessandro Castiglioni
- Cardiac Surgery Unit, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Ottavio Alfieri
- Cardiac Surgery Unit, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Michele DE Bonis
- Cardiac Surgery Unit, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiovascular Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Massimo Filippi
- Vita-Salute San Raffaele University, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Moreno Tresoldi
- Vita-Salute San Raffaele University, Milan, Italy.,General Medicine and Advanced Care Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Alberto Zangrillo
- Vita-Salute San Raffaele University, Milan, Italy.,Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Hospital, Milan, Italy
| | - Alberto Margonato
- Cardiology Unit, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Cosmo Godino
- Cardiology Unit, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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10
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Godino C, Bodega F, Melillo F, Rubino F, Parlati ALM, Cappelletti A, Mazzone P, Mattiello P, Della Bella P, Castiglioni A, Alfieri O, De Bonis M, Montorfano M, Tresoldi M, Filippi M, Zangrillo A, Salerno A, Cera M, Margonato A. Inappropriate dose of nonvitamin-K antagonist oral anticoagulants: prevalence and impact on clinical outcome in patients with nonvalvular atrial fibrillation. J Cardiovasc Med (Hagerstown) 2021; 21:751-758. [PMID: 32740435 DOI: 10.2459/jcm.0000000000001043] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Limited real-world data are available regarding the outcome of patients treated with inappropriate dose of nonvitamin-K antagonist oral anticoagulants (NOACs). OBJECTIVE To assess the prevalence and factors associated with inappropriate dose prescription of NOACs and to evaluate adverse events that come from this inappropriate prescription. METHODS Single-center multidisciplinary registry including nonvalvular atrial fibrillation patients treated with NOACs. Based on guidelines criteria for dose reduction, two subcohorts were defined as treated with appropriate or inappropriate NOACs dose. Primary efficacy endpoint was 2-year rate of thromboembolic events. Primary safety endpoint was 2-year rate of major bleeding. Event-free survival curves among groups were compared using Cox-Mantel test. RESULTS A total of 760 nonvalvular atrial fibrillation patients were included; 32% patients were treated with dabigatran, 34% with apixaban, 24% with rivaroxaban and 10% with edoxaban. An inappropriate dose was prescribed in 96 patients (12.6%), and in most cases (68%) it was too low. Rivaroxaban (15%) and apixaban (18.5%) were the most frequently prescribed with an inappropriate dose. Patients treated with an inappropriate dose were elderly people, with low-creatinine clearance value, who had experienced previous bleeding and with a high CHADS2 VASc score. In 2 years, a trend for higher numbers of thromboembolic events (5.2 vs. 3.3%, P = 0.348) and less major bleeding (2.1 vs. 4.2%, P = 0.316) has been observed in patients with inappropriate NOACs prescriptions. CONCLUSION Nearly 13% of patients were treated with an inappropriate dose of NOACs, in this single-center study. A trend for higher numbers of thromboembolic events was observed in these patients. The results should be considered as hypothesis generating.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Alberto Zangrillo
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Hospital, Milan, Italy
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11
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Moroni F, Gramegna M, Ajello S, Beneduce A, Baldetti L, Vilca LM, Cappelletti A, Scandroglio AM, Azzalini L. Collateral Damage: Medical Care Avoidance Behavior Among Patients With Myocardial Infarction During the COVID-19 Pandemic. JACC Case Rep 2020; 2:1620-1624. [PMID: 32835261 PMCID: PMC7252183 DOI: 10.1016/j.jaccas.2020.04.010] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 12/15/2022]
Abstract
The coronavirus disease-2019 (COVID-19) pandemic has caused an enormous strain on healthcare systems and society on a global scale. We report a new phenomenon of medical care avoidance among patients with acute coronary syndrome, which is due to concerns about contracting severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection during hospital stay, ultimately leading to dire clinical outcomes. (Level of Difficulty: Beginner.)
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Key Words
- COVID-19, coronavirus disease-2019
- ECG, electrocardiography
- EMS, emergency medical services
- ICU, intensive care unit
- LAD, left anterior descending artery
- LV, left ventricular
- MI, myocardial infarction
- PCI, percutaneous coronary intervention
- SARS-CoV-2, severe acute respiratory syndrome-coronavirus-2
- STEMI, ST-segment elevation myocardial infarction
- acute coronary syndrome
- complication
- myocardial infarction
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Affiliation(s)
| | - Mario Gramegna
- Coronary Intensive Care Unit, Cardio-Thoracic-Vascular Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Silvia Ajello
- Cardiac Intensive Care Unit, Cardio-Thoracic-Vascular Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Luca Baldetti
- Coronary Intensive Care Unit, Cardio-Thoracic-Vascular Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Luz Maria Vilca
- Unit of Obstetrics and Gynecology, Buzzi Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | - Alberto Cappelletti
- Coronary Intensive Care Unit, Cardio-Thoracic-Vascular Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Anna Mara Scandroglio
- Cardiac Intensive Care Unit, Cardio-Thoracic-Vascular Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Lorenzo Azzalini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
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12
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Demir OM, Poletti E, Lombardo F, Laricchia A, Beneduce A, Maccagni D, Cappelletti A, Colombo A, Bellini B, Ancona MB, Carlino M, Chieffo A, Montorfano M, Azzalini L. Rotational atherectomy-based percutaneous coronary intervention and the risk of contrast-induced nephropathy. Minerva Cardioangiol 2020; 68:137-145. [PMID: 32100984 DOI: 10.23736/s0026-4725.20.05099-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Rotational atherectomy (RA)-related complications (e.g., no-reflow and perforation) may be associated with increased risk of contrast-induced nephropathy (CIN), causing hypotension, acute heart failure, and periprocedural myocardial infarction. Our aim was to evaluate the incidence of CIN in patients undergoing RA-based vs. non-RA-based percutaneous coronary intervention (PCI). METHODS This single-center retrospective registry included all patients who underwent PCI between 2012 and 2016 for whom post-procedural creatinine was determined. Study endpoint was CIN, defined as an increase of serum creatinine ≥0.3 mg/dL or ≥50% from baseline within 72 h post-PCI. Propensity score matching (PSM) was performed to account for selection bias between RA and non-RA patients. RESULTS Study population included 2580 patients: 70 (3%) had RA PCI and 2510 (97%) had non-RA PCI. Following PSM, there were 70 patients in RA and 280 patients in non-RA group with good overall adjustment between groups, although RA patients received larger contrast volume (263±126 vs. 224±118 mL, P=0.01) and showed higher Mehran risk score at baseline (11.1±6.6 vs. 8.9±4.8, P=0.01). The incidence of CIN was similar between RA and non-RA patients (15.7% vs. 13.2%, P=0.59). New need for dialysis was required in 0% vs. 0.7% patients, respectively (P=0.48). On multivariate analysis, RA PCI was not independently associated with development of CIN. CONCLUSIONS Despite being performed in patients with a higher burden of comorbidities and with larger volumes of contrast, RA PCI is not associated with higher risk of CIN, compared with PCI in non-RA patients.
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Affiliation(s)
- Ozan M Demir
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.,Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Enrico Poletti
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Lombardo
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.,Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alessandra Laricchia
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Beneduce
- Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Davide Maccagni
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Cappelletti
- Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Barbara Bellini
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Marco B Ancona
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Mauro Carlino
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alaide Chieffo
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Azzalini
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy -
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13
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Beneduce A, Ferrante G, Ielasi A, Pivato CA, Chiarito M, Cappelletti A, Baldetti L, Magni V, Prati E, Falcone S, Pierri A, De Martini S, Montorfano M, Parisi R, Rutigliano D, Locuratolo N, Anzuini A, Tespili M, Margonato A, Benassi A, Briguori C, Reimers B, Fabbiocchi F, Bartorelli A, Colombo A, Godino C. One-year clinical outcome of biodegradable polymer sirolimus-eluting stent in diabetic patients: Insight from the ULISSE registry (ULtimaster Italian multicenter all comerS Stent rEgistry). Catheter Cardiovasc Interv 2020; 96:255-265. [PMID: 31905259 DOI: 10.1002/ccd.28694] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/03/2019] [Accepted: 12/20/2019] [Indexed: 11/05/2022]
Abstract
BACKGROUND The ULISSE registry evaluated the real-world performance of the Ultimaster® biodegradable polymer sirolimus-eluting stent (BP-SES) in a multicenter-independent cohort of patients undergoing percutaneous coronary intervention, including a large proportion of diabetes mellitus (DM) patients. METHODS In this subgroup analysis, 1,660 consecutive patients, 2,422 lesions, treated with BP-SES enrolled in the ULISSE registry were divided in two groups: DM (485 patients, 728 lesions) and non-DM (1,175 patients, 1,694 lesions). Primary endpoint was target lesion failure (TLF), a composite endpoint of cardiac-death, target-vessel myocardial infarction (TV-MI), and clinically driven target lesion revascularization (TLR) at 1-year. Secondary endpoint was TLR at 1-year. RESULTS At 1-year follow-up TLF occurred in 5% overall patients and was significantly higher in DM patients (8 vs. 3.7%; p = .001), due to more cardiac deaths (3.4 vs. 1.1%; p = .002). TLR occurred in 3.2% overall patients, and it was not significantly higher in DM compared to non-DM patients (4.4 vs. 2.8%; p = .114). The incidence of stent thrombosis was low and similar between groups (0.4 vs. 0.9%; p = .526). Insulin-treated DM (ITDM) patients showed higher rate of TLF as compared to non-ITDM patients (13 vs. 6.5%; p = .041), but similar rate of TLR (6 vs. 4%; p = .405). After adjustment for relevant comorbidities, DM was not significantly associated with TLF or cardiac death in patients undergoing BP-SES implantation. CONCLUSIONS This study is the first all-comers evaluation of BP-SES in DM patients. Our findings show that DM patients, mostly those with ITDM, still represent a vulnerable population and experience significantly higher rate of TLF. Overall BP-SES efficacy is considerable, although not statistically significant higher rate of TLR is still present in DM compared to non-DM patients.
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14
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Godino C, Melillo F, Rubino F, Arrigoni L, Cappelletti A, Mazzone P, Mattiello P, Della Bella P, Colombo A, Salerno A, Cera M, Margonato A. Real-world 2-year outcome of atrial fibrillation treatment with dabigatran, apixaban, and rivaroxaban in patients with and without chronic kidney disease. Intern Emerg Med 2019; 14:1259-1270. [PMID: 31073827 DOI: 10.1007/s11739-019-02100-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 04/29/2019] [Indexed: 01/05/2023]
Abstract
Patients with non-valvular atrial fibrillation (NVAF) and chronic kidney disease (CKD) are at increased risk of stroke and bleeding. Although direct oral anticoagulant (DOAC) trials excluded patients with severe CKD, a growing portion of CKD patients have been starting DOACs and limited data from real-world outcome in this high-risk setting are available. The INSigHT registry included 632 consecutive NVAF patients that started apixaban (256 patients, 41%), dabigatran (245, 39%) and rivaroxaban (131, 20%) between 2012 and 2015. Based on creatinine clearance, two sub-cohorts were defined: (1) non-CKD group (CrCl 60-89 mL/min, 413 patients) and (2) CKD group (15-59 ml/min, 219). Compared to non-CKD patients, those with CKD, were at higher ischemic (CHA2DS2-VASc 4.5 vs 2.9, p < 0.001) and hemorrhagic risk (HAS-BLED 2.4 vs 1.8, p < 0.001). At 2-year follow-up, the overall ISTH-major bleeding and thromboembolic event rates were 5.2% and 2.3% and no significant difference between non-CKD and CKD patients for both efficacy and safety endpoints were observed. In non-CKD patients, the 2-year ISTH-major bleeding rates were higher in rivaroxaban group (HR 2.9, 95% CI 1.1-7.3; p = 0.047) while dabigatran showed non-significant excess in thromboembolic events (HR 4.3, 95% CI 0.9-20.8; p = 0.068). In CKD patients, a significantly higher rate of thromboembolic events was observed in rivaroxaban (HR 6.3, 95% CI 1.1-38.1; p = 0.044). This real-world, non-insurance database registry shows remarkable 2-year safety and efficacy profile of DOACs even in patients with moderate to severe CKD. Head to head differences between DOACs are exploratory, hypothesis generating and warrant further investigation in larger studies.
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Affiliation(s)
- Cosmo Godino
- Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
| | - Francesco Melillo
- Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Francesca Rubino
- Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Luca Arrigoni
- Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Alberto Cappelletti
- Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Patrizio Mazzone
- Arrhythmia and Electrophysiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Mattiello
- Information Systems Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Della Bella
- Arrhythmia and Electrophysiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Interventional Cardiovascular Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Anna Salerno
- Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Michela Cera
- Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Alberto Margonato
- Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
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15
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Pisoni E, Guerreiro C, Lopez-Aparicio S, Guevara M, Tarrason L, Janssen S, Thunis P, Pfäfflin F, Piersanti A, Briganti G, Cappelletti A, D'Elia I, Mircea M, Villani MG, Vitali L, Matavž L, Rus M, Žabkar R, Kauhaniemi M, Karppinen A, Kousa A, Väkevä O, Eneroth K, Stortini M, Delaney K, Struzewska J, Durka P, Kaminski JW, Krmpotic S, Vidic S, Belavic M, Brzoja D, Milic V, Assimakopoulos VD, Fameli KM, Polimerova T, Stoyneva E, Hristova Y, Sokolovski E, Cuvelier C. Supporting the improvement of air quality management practices: The "FAIRMODE pilot" activity. J Environ Manage 2019; 245:122-130. [PMID: 31150903 PMCID: PMC6584326 DOI: 10.1016/j.jenvman.2019.04.118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/18/2019] [Accepted: 04/29/2019] [Indexed: 06/09/2023]
Abstract
This paper presents the first outcomes of the "FAIRMODE pilot" activity, aiming at improving the way in which air quality models are used in the frame of the European "Air Quality Directive". Member States may use modelling, combined with measurements, to "assess" current levels of air quality and estimate future air quality under different scenarios. In case of current and potential exceedances of the Directive limit values, it is also requested that they "plan" and implement emission reductions measures to avoid future exceedances. In both "assessment" and "planning", air quality models can and should be used; but to do so, the used modelling chain has to be fit-for-purpose and properly checked and verified. FAIRMODE has developed in the recent years a suite of methodologies and tools to check if emission inventories, model performance, source apportionment techniques and planning activities are fit-for-purpose. Within the "FAIRMODE pilot", these tools are used and tested by regional/local authorities, with the two-fold objective of improving management practices at regional/local scale, and providing valuable feedback to the FAIRMODE community. Results and lessons learnt from this activity are presented in this paper, as a showcase that can potentially benefit other authorities in charge of air quality assessment and planning.
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Affiliation(s)
- E Pisoni
- European Commission, Joint Research Centre (JRC), Directorate for Energy, Transport and Climate, Air and Climate Unit, Via E. Fermi 2749, I-21027, Ispra, VA, Italy.
| | - C Guerreiro
- NILU Norwegian Institute for Air Research, Instituttveien 18, 2027 Kjeller, Norway
| | - S Lopez-Aparicio
- NILU Norwegian Institute for Air Research, Instituttveien 18, 2027 Kjeller, Norway
| | - M Guevara
- Earth Sciences Department, Barcelona Supercomputing Center, Barcelona, 08034, Spain
| | - L Tarrason
- NILU Norwegian Institute for Air Research, Instituttveien 18, 2027 Kjeller, Norway
| | - S Janssen
- VITO, Flemish Institute for Technological Research, Boeretang 200, 2400 Mol, Belgium
| | - P Thunis
- European Commission, Joint Research Centre (JRC), Directorate for Energy, Transport and Climate, Air and Climate Unit, Via E. Fermi 2749, I-21027, Ispra, VA, Italy
| | - F Pfäfflin
- IVU Umwelt GmbH, 79110 Freiburg, Germany
| | - A Piersanti
- ENEA, National Agency for New Technologies, Energy and Sustainable Economic Development, Laboratory of Atmospheric Pollution, Bologna-Ispra-Pisa-Roma, Italy
| | - G Briganti
- ENEA, National Agency for New Technologies, Energy and Sustainable Economic Development, Laboratory of Atmospheric Pollution, Bologna-Ispra-Pisa-Roma, Italy
| | - A Cappelletti
- ENEA, National Agency for New Technologies, Energy and Sustainable Economic Development, Laboratory of Atmospheric Pollution, Bologna-Ispra-Pisa-Roma, Italy
| | - I D'Elia
- ENEA, National Agency for New Technologies, Energy and Sustainable Economic Development, Laboratory of Atmospheric Pollution, Bologna-Ispra-Pisa-Roma, Italy
| | - M Mircea
- ENEA, National Agency for New Technologies, Energy and Sustainable Economic Development, Laboratory of Atmospheric Pollution, Bologna-Ispra-Pisa-Roma, Italy
| | - M G Villani
- ENEA, National Agency for New Technologies, Energy and Sustainable Economic Development, Laboratory of Atmospheric Pollution, Bologna-Ispra-Pisa-Roma, Italy
| | - L Vitali
- ENEA, National Agency for New Technologies, Energy and Sustainable Economic Development, Laboratory of Atmospheric Pollution, Bologna-Ispra-Pisa-Roma, Italy
| | - L Matavž
- Slovenian Environment Agency, Ljubljana, Slovenia
| | - M Rus
- Slovenian Environment Agency, Ljubljana, Slovenia
| | - R Žabkar
- Slovenian Environment Agency, Ljubljana, Slovenia
| | - M Kauhaniemi
- FMI, Finnish Meteorological Institute, Helsinki, Finland
| | - A Karppinen
- FMI, Finnish Meteorological Institute, Helsinki, Finland
| | - A Kousa
- HSY, Helsinki Region Environmental Services, Helsinki, Finland
| | - O Väkevä
- HSY, Helsinki Region Environmental Services, Helsinki, Finland
| | - K Eneroth
- Environment and Health Administration, City of Stockholm, Sweden
| | | | - K Delaney
- Irish Environmental Protection Agency, Ireland
| | - J Struzewska
- Institute of Environmental Protection - National Research Institute, Poland; Warsaw University of Technology, Poland
| | - P Durka
- Institute of Environmental Protection - National Research Institute, Poland
| | - J W Kaminski
- Institute of Environmental Protection - National Research Institute, Poland; Institute of Geophysics, Polish Academy of Sciences, Poland
| | | | - S Vidic
- Meteorological and Hydrological Service, Croatia
| | - M Belavic
- Meteorological and Hydrological Service, Croatia
| | - D Brzoja
- Meteorological and Hydrological Service, Croatia
| | - V Milic
- Meteorological and Hydrological Service, Croatia
| | - V D Assimakopoulos
- Institute for Environmental Research and Sustainable Development, National Observatory of Athens, Lofos Koufou, 152 36 Penteli, Greece
| | - K M Fameli
- Institute for Environmental Research and Sustainable Development, National Observatory of Athens, Lofos Koufou, 152 36 Penteli, Greece
| | - T Polimerova
- "Climate, Energy and Air" Directorate, Sofia Municipality, USA
| | - E Stoyneva
- "Climate, Energy and Air" Directorate, Sofia Municipality, USA
| | - Y Hristova
- "Climate, Energy and Air" Directorate, Sofia Municipality, USA
| | - E Sokolovski
- Universität für Chemische Technologie und Metallurgie, Sofia, USA
| | - C Cuvelier
- Ex European Commission, Joint Research Centre, Ispra, Italy
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Moscarella E, Ielasi A, Beneduce A, Ferrante G, Pivato AC, Chiarito M, Cappelletti A, Perfetti G, Magni V, Prati E, Falcone S, Pierri A, De Martini S, Montorfano M, Parisi R, Rutigliano D, Locuratolo N, Anzuini A, Calabrò P, Tespili M, Margonato A, Benassi A, Briguori C, Fabbiocchi F, Reimers B, Bartorelli A, Colombo A, Godino C. One‐year clinical outcome of biodegradable polymer sirolimus‐eluting stent in patients presenting with acute myocardial infarction: Insight from the ULISSE registry. Catheter Cardiovasc Interv 2019; 94:972-979. [DOI: 10.1002/ccd.28305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/19/2019] [Accepted: 04/10/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Elisabetta Moscarella
- Department of Translational Medical SciencesUniversity of Campania Caserta Italy
- Cardiology Unit, Ospedale “Sant'Anna e San Sebastiano” Caserta Italy
| | - Alfonso Ielasi
- Cardiology Unit, Ospedale Bolognini, ASST Bergamo Est Seriate Italy
- Clinical and Interventional Cardiology UnitSant'Ambrogio Cardio‐Thoracic Center Milan Italy
| | | | | | | | - Mauro Chiarito
- Interventional Cardiology Unit, Ospedale Humanitas Rozzano Italy
| | | | | | | | | | - Stefania Falcone
- Cardiology Unit, Ospedale Humanitas Mater Domini Castellanza Italy
| | - Adele Pierri
- Cardiology Unit, Clinica Mediterranea Naples Italy
| | | | | | - Rosario Parisi
- Cardiology Unit, Ospedali Riuniti Marche Nord Pesaro Italy
| | | | | | - Angelo Anzuini
- Cardiology Unit, Ospedale Humanitas Mater Domini Castellanza Italy
| | - Paolo Calabrò
- Department of Translational Medical SciencesUniversity of Campania Caserta Italy
- Cardiology Unit, Ospedale “Sant'Anna e San Sebastiano” Caserta Italy
| | - Maurizio Tespili
- Cardiology Unit, Ospedale Bolognini, ASST Bergamo Est Seriate Italy
- Clinical and Interventional Cardiology UnitSant'Ambrogio Cardio‐Thoracic Center Milan Italy
| | | | | | | | | | - Bernhard Reimers
- Interventional Cardiology Unit, Ospedale Humanitas Rozzano Italy
| | | | | | - Cosmo Godino
- Cardiology Unit, Ospedale San Raffaele Milan Italy
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Spoladore R, Boccellino A, Fragasso G, Slavich M, Cappelletti A, Margonato A. An unusual trigger of Tako-Tsubo cardiomyopathy. J Cardiovasc Med (Hagerstown) 2019; 20:619-620. [PMID: 30889079 DOI: 10.2459/jcm.0000000000000788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | - Massimo Slavich
- Clinical Cardiology Unit, IRCCS San Raffaele University Hospital
| | | | - Alberto Margonato
- Clinical Cardiology Unit, IRCCS San Raffaele University Hospital.,Vita-Salute University, Milan, Italy
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18
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Godino C, Giannattasio A, Scotti A, Baldetti L, Pivato CA, Munafò A, Cappelletti A, Beneduce A, Melillo F, Chiarito M, Biondi Zoccai G, Frati G, Fragasso G, Azzalini L, Carlino M, Montorfano M, Margonato A, Colombo A. Risk of cardiac and sudden death with and without revascularisation of a coronary chronic total occlusion. Heart 2019; 105:1096-1102. [PMID: 30792237 DOI: 10.1136/heartjnl-2018-314076] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 12/28/2018] [Accepted: 01/14/2019] [Indexed: 02/05/2023] Open
Abstract
ObjectiveThe aim of this study is to evaluate the long-term risk of cardiac death and sudden cardiac death (SCD) and/or sustained ventricular arrhythmias (SVAs) in patients with coronary chronic total occlusions (CTO) revascularised versus those with CTO not revascularised by percutaneous coronary intervention (PCI).MethodsFrom a cohort of 1357 CTO-PCI patients, 1162 patients who underwent CTO PCI attempt were included in this long-term analysis: 837 patients were revascularised by PCI (CTO-R group) and 325 were not revascularised (CTO-NR group). Primary adverse endpoint was the incidence of cardiac death; secondary endpoint was the cumulative incidence of SCD/SVAs.ResultsUp to 12-year follow-up (median 6 year), compared with CTO-R patients, those with CTO-NR had significantly higher rate of cardiac death (13%[43/325]vs6%[48/837]; p<0.001) and SCD/SVAs (7.5%[24/325]vs2.5%[20/837]; p<0.001). The risk of cardiac death and SCD/SVAs was mainly driven by the subgroup of infarct-related artery (IRA) CTO patients and was significantly higher only in IRA CTO-NR patients (18%vs7%, p<0.001, 14%vs5%, p=0.001; IRA CTO-NR vs IRA CTO-R, respectively). At multivariable Cox hazards regression analysis, CTO-NR remains one of the strongest independent predictors of higher risk of cardiac death and of SCD/SVAs in the overall population and in IRA CTO patients.ConclusionsAt long-term follow-up, patients with CTO not revascularised by PCI had worse outcomes compared with those with CTO revascularised, with >2-fold risk of cardiac death and threefold risk of SCD/SVAs. The presence of an infarct-related artery (IRA CTO) not revascularised identified the category of patients with the highest rate of adverse events .
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Affiliation(s)
- Cosmo Godino
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alessia Giannattasio
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Andrea Scotti
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Luca Baldetti
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | | | - Andrea Munafò
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Cappelletti
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Beneduce
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Melillo
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Mauro Chiarito
- Interventional Cardiology Unit, Istituto Clinico Humanitas, Milan, Italy
| | - Giuseppe Biondi Zoccai
- Division of Cardiology, IRCCS Neuromed, Pozzilli, Italy
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Giacomo Frati
- Division of Cardiology, IRCCS Neuromed, Pozzilli, Italy
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Gabriele Fragasso
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Azzalini
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Mauro Carlino
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Margonato
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
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19
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Azzalini L, Vilca LM, Lombardo F, Poletti E, Laricchia A, Beneduce A, Maccagni D, Demir OM, Slavich M, Giannini F, Carlino M, Margonato A, Cappelletti A, Colombo A. Incidence of contrast-induced acute kidney injury in a large cohort of all-comers undergoing percutaneous coronary intervention: Comparison of five contrast media. Int J Cardiol 2018; 273:69-73. [DOI: 10.1016/j.ijcard.2018.08.097] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 08/29/2018] [Accepted: 08/31/2018] [Indexed: 12/01/2022]
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20
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Demir OM, Lombardo F, Poletti E, Laricchia A, Beneduce A, Maccagni D, Slavich M, Giannini F, Carlino M, Margonato A, Cappelletti A, Colombo A, Azzalini L. Contrast-Induced Nephropathy After Percutaneous Coronary Intervention for Chronic Total Occlusion Versus Non-Occlusive Coronary Artery Disease. Am J Cardiol 2018; 122:1837-1842. [PMID: 30292337 DOI: 10.1016/j.amjcard.2018.08.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/14/2018] [Accepted: 08/16/2018] [Indexed: 11/18/2022]
Abstract
Contrast volume is associated with the incidence of contrast-induced nephropathy (CIN), and CIN risk could be particularly high in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Our aim was to evaluate the incidence of CIN in patients who underwent CTO versus non-CTO PCI. All PCIs performed at our institution from January 2012 to December 2016 were included in this study. CIN was defined as an increase of ≥0.3 mg/dl or ≥50% from baseline within 72 hours. Multivariable logistic regression analysis was performed to identify independent predictors of CIN. A total of 2,580 patients were included (n = 309 CTO PCI and n = 2271 non-CTO PCI). Estimated glomerular filtration rate was lower in the non-CTO group (73.9 ± 27.3 vs 77.1 ± 24.7 ml/min/1.73/m2, p = 0.05). Patients in the non-CTO PCI group presented more often with acute coronary syndrome (47% vs 15%, p < 0.001). Contrast volume (347 ± 159 vs 215 ± 107 ml, p < 0.001) and contrast-volume-to-creatinine-clearance ratio (4.7 ± 2.1 vs 3.2 ± 1.8, p < 0.001) were higher in the CTO group. There was no difference in CIN rates between CTO and non-CTO groups (9.4% vs 12.1%, p = 0.17). This was confirmed in a sensitivity analysis including only patients who underwent PCI in a stable clinical setting (7.7% vs 8.5%, p = 0.66). On multivariate analysis hypotension during/before PCI (odds ratio [OR] 2.86), acute coronary syndrome (OR 1.86), age (OR 1.54), female sex (OR 1.51), left ventricular ejection fraction (OR 0.64), diabetes mellitus (OR 1.49), and contrast volume (OR 1.17) were independent predictors of CIN, while CTO PCI was not. In conclusion, CTO PCI is associated with similar rates of CIN, compared with non-CTO PCI. These findings persisted on sensitivity and multivariable analyses.
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Affiliation(s)
- Ozan M Demir
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy; Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Francesca Lombardo
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy; Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Enrico Poletti
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alessandra Laricchia
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Beneduce
- Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Davide Maccagni
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Slavich
- Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Giannini
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Mauro Carlino
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Margonato
- Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Cappelletti
- Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Azzalini
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.
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Cappelletti A, Astore D, Godino C, Bellini B, Magni V, Mazzavillani M, Pagnesi M, Agricola E, Chiesa R, Colombo A, Margonato A. Relationship between Syntax Score and prognostic localization of coronary artery lesions with conventional risk factors, plasma profile markers, and carotid atherosclerosis (CAPP Study 2). Int J Cardiol 2018; 257:306-311. [PMID: 29506713 DOI: 10.1016/j.ijcard.2017.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 12/05/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Data concerning the relationship between cardiovascular risk factors, plasmatic markers, carotid disease and extent of coronary lesions are lacking. OBJECTIVES To evaluate the role of cardiovascular risk factors, plasmatic levels of high sensitivity C-reactive protein (hs-CRP), fibrinogen, lipoprotein(a), and carotid plaque extension in predicting the severity of coronary artery disease (CAD). METHODS We analyzed 574 subjects undergoing first coronary angiography. For angiographic analysis, we used the Syntax Score and we defined the prognostic localization of CAD as a critical stenosis of the left main and/or proximal segment of left anterior descending artery. Levels of hs-CRP >3mg/L, lipoprotein(a) plasma levels >30mg/dL and plasma fibrinogen >300mg/dL were considered critical. Significant carotid disease (SCD) was defined by the presence of lesions producing a 50% diameter stenosis with a peak systolic velocity >125cm/s. A mean carotid intima media thickness (IMT) >0.9mm was considered abnormal. RESULTS In the adjusted analysis the presence of SCD was found to be an independent predictor of high Syntax Score (p<0.001), while high fibrinogen levels were independently associated with the presence of CAD in prognostic localization (p=0.04). In the sub-group of patients without SCD, IMT >0.9mm was found to be an independent predictor of the presence of CAD (p<0.001). CONCLUSIONS SCD strongly predicts high Syntax Score, while IMT shows excellent positive predictive value for the presence of CAD. In addition, high plasma fibrinogen levels are associated with coronary stenoses in prognostic localization.
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Affiliation(s)
- Alberto Cappelletti
- Department of Cardiology, San Raffaele University Hospital, IRCCS, Milan, Italy.
| | - Domenico Astore
- Department of Vascular Surgery, San Raffaele University Hospital, IRCCS, Milan, Italy
| | - Cosmo Godino
- Department of Cardiology, San Raffaele University Hospital, IRCCS, Milan, Italy
| | - Barbara Bellini
- Department of Cardiology, San Raffaele University Hospital, IRCCS, Milan, Italy
| | - Valeria Magni
- Department of Cardiology, San Raffaele University Hospital, IRCCS, Milan, Italy
| | - Monica Mazzavillani
- Department of Cardiology, San Raffaele University Hospital, IRCCS, Milan, Italy
| | - Matteo Pagnesi
- Department of Cardiology, San Raffaele University Hospital, IRCCS, Milan, Italy
| | - Eustachio Agricola
- Department of Cardiology, San Raffaele University Hospital, IRCCS, Milan, Italy
| | - Roberto Chiesa
- Department of Vascular Surgery, San Raffaele University Hospital, IRCCS, Milan, Italy
| | - Antonio Colombo
- Department of Interventional Cardiology, San Raffaele University Hospital, IRCCS, Milan, Italy
| | - Alberto Margonato
- Department of Cardiology, San Raffaele University Hospital, IRCCS, Milan, Italy
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Azzalini L, Vilca LM, Lombardo F, Poletti E, Laricchia A, Maccagni D, Demir O, Slavich M, Giannini F, Carlino M, Margonato A, Cappelletti A, Colombo A. TCT-128 Contrast-Induced Acute Kidney Injury after Percutaneous Coronary Intervention: Comparison of Five Contrast Media. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Demir O, Lombardo F, Poletti E, Laricchia A, Beneduce A, Maccagni D, Slavich M, Giannini F, Carlino M, Margonato A, Cappelletti A, Colombo A, Azzalini L. TCT-594 Rotational atherectomy and the risk for contrast-induced nephropathy. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Moscarella E, Ielasi A, Godino C, Ferrante G, Pivato CA, Chiarito M, Cappelletti A, Perfetti G, Magni V, Prati E, Falcone S, Pierri A, De Martini S, Montorfano M, rosario parisi, Locuratolo N, Anzuini A, Margonato A, Benassi A, Calabro' P, Briguori C, Fabbiocchi F, Reimers B, Bartorelli A, Colombo A. TCT-469 One-year clinical outcome of biodegradable polymer sirolimus-eluting stent in patients with acute coronary syndrome. Insight from the ULISSE registry. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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25
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Demir O, Lombardo F, Poletti E, Laricchia A, Beneduce A, Maccagni D, Slavich M, Giannini F, Carlino M, Margonato A, Cappelletti A, Colombo A, Azzalini L. TCT-126 Percutaneous coronary intervention of chronic total occlusions is not associated with a higher risk for contrast-induced nephropathy compared to revascularization of non-occlusive stenoses. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Godino C, Scotti A, Munafò A, Taramasso M, Adamo M, Russo M, Toscano E, Salerno A, Cappelletti A, Stella S, Fragasso G, Montorfano M, Agricola E, Ettori F, Margonato A, Maisano F, Colombo A. Observed versus predicted mortality after MitraClip treatment in patients with symptomatic heart failure and significant functional mitral regurgitation. Eur J Heart Fail 2018; 20:1495-1496. [DOI: 10.1002/ejhf.1291] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/01/2018] [Accepted: 07/03/2018] [Indexed: 11/06/2022] Open
Affiliation(s)
- Cosmo Godino
- Cardiothoracic Vascular Department; San Raffaele Scientific Institute; Milan Italy
| | - Andrea Scotti
- Department of Cardiac, Thoracic and Vascular Sciences; University Hospital of Padova; Padova Italy
| | - Andrea Munafò
- Cardiothoracic Vascular Department; San Raffaele Scientific Institute; Milan Italy
| | | | - Marianna Adamo
- Cardiac Catheterization Laboratory, Cardiothoracic Department; Spedali Civili, Brescia Italy
| | - Marco Russo
- Division of Cardiac Surgery; University Hospital Zurich; Switzerland
| | - Evelina Toscano
- Cardiothoracic Vascular Department; San Raffaele Scientific Institute; Milan Italy
| | - Anna Salerno
- Cardiothoracic Vascular Department; San Raffaele Scientific Institute; Milan Italy
| | - Alberto Cappelletti
- Cardiothoracic Vascular Department; San Raffaele Scientific Institute; Milan Italy
| | - Stefano Stella
- Cardiothoracic Vascular Department; San Raffaele Scientific Institute; Milan Italy
| | - Gabriele Fragasso
- Cardiothoracic Vascular Department; San Raffaele Scientific Institute; Milan Italy
| | - Matteo Montorfano
- Cardiothoracic Vascular Department; San Raffaele Scientific Institute; Milan Italy
| | - Eustachio Agricola
- Cardiothoracic Vascular Department; San Raffaele Scientific Institute; Milan Italy
| | - Federica Ettori
- Cardiac Catheterization Laboratory, Cardiothoracic Department; Spedali Civili, Brescia Italy
| | - Alberto Margonato
- Cardiothoracic Vascular Department; San Raffaele Scientific Institute; Milan Italy
| | - Francesco Maisano
- Division of Cardiac Surgery; University Hospital Zurich; Switzerland
| | - Antonio Colombo
- Cardiothoracic Vascular Department; San Raffaele Scientific Institute; Milan Italy
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Galati G, Leone O, Cappelletti A, Molfetta R, Volpe M, Ancona F, Magni V, Capogrosso C, Stella S, Castelvecchio S, Rapezzi C, Margonato A. P2585Coronary microvascular pathology as the major determinant of severe fibrosis in end-stage hypertrophic cardiomyopathy (HCM). Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- G Galati
- San Raffaele Hospital and Scientific Institute (IRCCS), Heart Failure Unit and Division of Cardiology, Cardiothoracic and vascular Department, Milan, Italy
| | - O Leone
- S.Orsola-Malpighi University Hospital, Pathology Unit, Department of Experimental, Diagnostic and Specialty Medicine, Bologna, Italy
| | - A Cappelletti
- San Raffaele Hospital and Scientific Institute (IRCCS), Heart Failure Unit and Division of Cardiology, Cardiothoracic and vascular Department, Milan, Italy
| | - R Molfetta
- IRCCS, Policlinico San Donato, Cardiac Surgery Division, Cardiovascular Department, San Donato Milanese, Italy
| | - M Volpe
- IRCCS, Policlinico San Donato, Cardiac Surgery Division, Cardiovascular Department, San Donato Milanese, Italy
| | - F Ancona
- San Raffaele Hospital and Scientific Institute (IRCCS), Heart Failure Unit and Division of Cardiology, Cardiothoracic and vascular Department, Milan, Italy
| | - V Magni
- San Raffaele Hospital and Scientific Institute (IRCCS), Heart Failure Unit and Division of Cardiology, Cardiothoracic and vascular Department, Milan, Italy
| | - C Capogrosso
- San Raffaele Hospital and Scientific Institute (IRCCS), Heart Failure Unit and Division of Cardiology, Cardiothoracic and vascular Department, Milan, Italy
| | - S Stella
- San Raffaele Hospital and Scientific Institute (IRCCS), Heart Failure Unit and Division of Cardiology, Cardiothoracic and vascular Department, Milan, Italy
| | - S Castelvecchio
- IRCCS, Policlinico San Donato, Cardiac Surgery Division, Cardiovascular Department, San Donato Milanese, Italy
| | - C Rapezzi
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - A Margonato
- San Raffaele Hospital and Scientific Institute (IRCCS), Heart Failure Unit and Division of Cardiology, Cardiothoracic and vascular Department, Milan, Italy
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Galati G, Di Lenarda A, Cappelletti A, Volpe M, Ancona F, Mazzavillani M, Magni V, Capogrosso C, Stella S, Castelvecchio S, Margonato A. P2597Clinicopathological profiles responsible for advanced heart failure, heart transplantation, left ventricular assist device implantation and death for heart failure in Hypertrophic cardiomyopathy. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- G Galati
- San Raffaele Hospital and Scientific Institute (IRCCS), Heart Failure Unit and Division of Cardiology, Cardiothoracic and vascular Department, Milan, Italy
| | - A Di Lenarda
- Cardiovascular Center A.S.S. 1 of Trieste, Cardiovascular Department, Trieste, Italy
| | - A Cappelletti
- San Raffaele Hospital and Scientific Institute (IRCCS), Heart Failure Unit and Division of Cardiology, Cardiothoracic and vascular Department, Milan, Italy
| | - M Volpe
- IRCCS, Policlinico San Donato, Cardiac Surgery Division, Cardiovascular Department, San Donato Milanese, Italy
| | - F Ancona
- San Raffaele Hospital and Scientific Institute (IRCCS), Heart Failure Unit and Division of Cardiology, Cardiothoracic and vascular Department, Milan, Italy
| | - M Mazzavillani
- San Raffaele Hospital and Scientific Institute (IRCCS), Heart Failure Unit and Division of Cardiology, Cardiothoracic and vascular Department, Milan, Italy
| | - V Magni
- San Raffaele Hospital and Scientific Institute (IRCCS), Heart Failure Unit and Division of Cardiology, Cardiothoracic and vascular Department, Milan, Italy
| | - C Capogrosso
- San Raffaele Hospital and Scientific Institute (IRCCS), Heart Failure Unit and Division of Cardiology, Cardiothoracic and vascular Department, Milan, Italy
| | - S Stella
- San Raffaele Hospital and Scientific Institute (IRCCS), Heart Failure Unit and Division of Cardiology, Cardiothoracic and vascular Department, Milan, Italy
| | - S Castelvecchio
- IRCCS, Policlinico San Donato, Cardiac Surgery Division, Cardiovascular Department, San Donato Milanese, Italy
| | - A Margonato
- San Raffaele Hospital and Scientific Institute (IRCCS), Heart Failure Unit and Division of Cardiology, Cardiothoracic and vascular Department, Milan, Italy
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Godino C, Beneduce A, Ferrante G, Ielasi A, Pivato CA, Chiarito M, Cappelletti A, Perfetti G, Magni V, Prati E, Falcone S, Pierri A, De Martini S, Montorfano M, Parisi R, Rutigliano D, Locuratolo N, Anzuini A, Tespilli M, Margonato A, Benassi A, Briguori C, Fabbiocchi F, Reimers B, Bartorelli A, Colombo A. One-year clinical outcome of biodegradable polymer sirolimus-eluting stent in all-comers population. Insight from the ULISSE registry (ULtimaster Italian multicenter all comerS Stent rEgistry). Int J Cardiol 2018; 260:36-41. [DOI: 10.1016/j.ijcard.2018.02.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 02/02/2018] [Indexed: 10/17/2022]
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Peri AM, Bisi L, Cappelletti A, Colella E, Verga L, Borella C, Foresti S, Migliorino GM, Gori A, Bandera A. Invasive aspergillosis with pulmonary and central nervous system involvement during ibrutinib therapy for relapsed chronic lymphocytic leukaemia: case report. Clin Microbiol Infect 2018; 24:785-786. [PMID: 29427802 DOI: 10.1016/j.cmi.2018.01.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/21/2018] [Accepted: 01/24/2018] [Indexed: 10/18/2022]
Affiliation(s)
- A M Peri
- Division of Infectious Diseases, San Gerardo Hospital, ASST Monza (MB), Italy.
| | - L Bisi
- Division of Infectious Diseases, San Gerardo Hospital, ASST Monza (MB), Italy
| | - A Cappelletti
- Division of Infectious Diseases, San Gerardo Hospital, ASST Monza (MB), Italy
| | - E Colella
- Division of Infectious Diseases, San Gerardo Hospital, ASST Monza (MB), Italy
| | - L Verga
- Hematology Department, San Gerardo Hospital, ASST Monza (MB), Italy
| | - C Borella
- Hematology Department, San Gerardo Hospital, ASST Monza (MB), Italy
| | - S Foresti
- Division of Infectious Diseases, San Gerardo Hospital, ASST Monza (MB), Italy
| | - G M Migliorino
- Division of Infectious Diseases, San Gerardo Hospital, ASST Monza (MB), Italy
| | - A Gori
- Division of Infectious Diseases, San Gerardo Hospital, ASST Monza (MB), Italy
| | - A Bandera
- Division of Infectious Diseases, San Gerardo Hospital, ASST Monza (MB), Italy
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Godino C, Pivato CA, Chiarito M, Donahue M, Testa L, Colantonio R, Cappelletti A, Milazzo D, Parisi R, Nicolino A, Moshiri S, Aprigliano G, Palloshi A, Zavalloni Parenti D, Rutigliano D, Locuratolo N, Melillo F, Scotti A, Arrigoni L, Montorfano M, Fattori R, Presbitero P, Sardella G, Bedogni F, Margonato A, Briguori C, Colombo A. Polymer-free amphilimus-eluting stent versus biodegradable polymer biolimus-eluting stent in patients with and without diabetes mellitus. Int J Cardiol 2017; 245:69-76. [DOI: 10.1016/j.ijcard.2017.06.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/22/2017] [Accepted: 06/07/2017] [Indexed: 11/28/2022]
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Godino C, Pivato CA, Beneduce A, Cappelletti A, Ferrante G, Fabbiocchi F, Falcone S, Ielasi A, Pierri A, Chiarito M, Magni V, Perfetti G, Scotti A, Montorfano M, De Martini S, Parisi R, Rutigliano D, Locuratolo N, Margonato A, Benassi A, Anzuini A, Reimers B, Tespilli M, Briguori C, Bartorelli A, Colombo A. TCT-249 Clinical Outcomes of Biodegradable Polymer Sirolimus Eluting Stent in Diabetes Mellitus Patients. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Scotti A, Taramasso M, Adamo M, Russo M, Chiarito M, Melillo F, Beneduce A, Baldetti L, Pivato CA, Salerno A, Cappelletti A, Magni V, Stella S, Fragasso G, Montorfano M, Agricola E, Ettori F, Margonato A, Maisano F, Colombo A, Godino C. TCT-541 Multi-center experience of MitraClip therapy in patients with Ischaemic and Non-ischaemic Functional Mitral Regurgitation: 2-year outcomes. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Godino C, Scotti A, Taramasso M, Adamo M, Russo M, Pivato CA, Arrigoni L, Baldetti L, Bellini B, Cappelletti A, Stella S, Fragasso G, Montorfano M, Agricola E, Margonato A, Maisano F, Ettori F, Colombo A. TCT-542 Incidence and Predictors of Left Ventricular Negative Remodeling after MitraClip treatment in patients with Functional Mitral Regurgitation. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Godino C, Baldetti L, Giannattasio A, Munafò A, Pivato CA, Scotti A, Beneduce A, Perfetti G, Cappelletti A, Magni V, Carlino M, Margonato A, Colombo A. TCT-109 Ten-year clinical outcome in patients with Coronary Chronic Total Occlusions not revascularized by Percutaneous Coronary Intervention. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Monello A, Godino C, Chiarito M, Pivato C, Munafo A, Pazzanese V, Arrigoni L, Scotti A, Melillo F, Magni V, Cappelletti A, Montorfano M, Colombo A, Margonato A. P6491One-year clinical outcome and predictors of adverse events after percutaneous coronary intervention in elderly patients. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Scotti A, Adamo M, Beneduce A, Pivato C, Arrigoni L, Salerno A, Cappelletti A, Stella S, Fragasso G, Montorfano M, Agricola E, Ettori F, Margonato A, Colombo A, Godino C. 3863Two-year outcomes after mitraclip treatment of functional mitral regurgitation in ischemic and non-ischemic dilated cardiomyopathy. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.3863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Arrigoni L, Cera M, Melillo F, Lombardo F, Perfetti G, Rubino F, Slavich M, Spoladore R, Salerno A, Cappelletti A, Godino C, Margonato A. P3606Clinical outcome of low-dose regimen of dabigatran, apixaban, rivaroxaban compared with warfarin in patients with non-valvular atrial fibrillation: a single tertiary care multidisciplinary experience. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Arrigoni L, Cera M, Melillo F, Lombardo F, Perfetti G, Rubino F, Slavich M, Spoladore R, Salerno A, Cappelletti A, Godino C, Margonato A. P3585Real-world single tertiary-care multidisciplinary experience with dabigatran, apixaban, rivaroxaban and warfarin in patients with renal failure and concomitant NVAF. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Godino C, Pavon AG, Mangieri A, Salerno A, Cera M, Monello A, Chieffo A, Magni V, Cappelletti A, Margonato A, Colombo A. Platelet reactivity in response to loading dose of atorvastatin or rosuvastatin in patients with stable coronary disease before percutaneous coronary intervention: The STATIPLAT randomized study. Clin Cardiol 2017; 40:605-611. [PMID: 28422300 DOI: 10.1002/clc.22709] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 02/24/2017] [Accepted: 02/28/2017] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The acute effects of statin loading dose (LD) on platelet reactivity in patients with chronic stable angina (CSA) are not completely clear. HYPOTHESIS We hypothesized that LDs of atorvastatin and rosuvastatin have different pharmacodynamic acute effects on platelet aggregability in CSA patients with baseline normal platelet reactivity while on dual antiplatelet therapy (DAPT). METHODS From September 2011 to February 2014, all consecutive CSA patients on chronic DAPT (aspirin and clopidogrel) were evaluated before elective percutaneous coronary intervention (PCI). An initial assessment of platelet reactivity in response to thrombin receptor agonist, ADP, and ASP (respectively, indicative of the response to clopidogrel and aspirin) was performed with impedance aggregometry. Patients with high platelet reactivity to ADP test (area under the curve >47) were excluded. The remaining patients were randomized into 3 treatment groups: Group A, atorvastatin LD 80 mg; Group B, rosuvastatin LD 40 mg; and Group C, no statin LD (control group). A second assessment of platelet reactivity was performed ≥12 hours after statin LD. RESULTS 682 patients were screened and 145 were randomized into the 3 groups. At baseline and after statin LD, no significant difference was found in platelet reactivity in response to 3 different agonists between the 3 groups. Subgroup analysis showed that platelet reactivity to ADP test was significantly lower in patients chronically treated with low-dose statins (n = 94) compared with statin-naïve patients (n = 51; 15.32 ± 1.50 vs 18.59 ± 1.30; P = 0.007). CONCLUSIONS Loading dose of atorvastatin (80 mg) or rosuvastatin (40 mg) did not induce significant variation in platelet reactivity in CSA patients with baseline reduced platelet reactivity as in chronic DAPT. Our data confirm that chronic concomitant treatment with low-dose statins and clopidogrel resulted in significantly lower platelet reactivity compared with clopidogrel alone.
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Affiliation(s)
- Cosmo Godino
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Anna Giulia Pavon
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Mangieri
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Anna Salerno
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Michela Cera
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Monello
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alaide Chieffo
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Valeria Magni
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Cappelletti
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Margonato
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.,EMO-GVM Centro Cuore Columbus, Milan, Italy
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Spartera M, Godino C, Baldissera E, Campochiaro C, La Spina K, Aiello P, Salerno A, Cera M, Magni V, Jabbour RJ, Dagna L, Tresoldi M, Cappelletti A, Alfieri O, Colombo A, Sabbadini MG, Margonato A. Long-term clinical outcomes of patients with rheumatoid arthritis and concomitant coronary artery disease. Am J Cardiovasc Dis 2017; 7:9-18. [PMID: 28337386 PMCID: PMC5344967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 01/22/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND Rheumatoid arthritis (RA) is associated with high morbidity and mortality predominately due to increased cardiovascular risk. Few reports are available regarding the management of coronary artery disease (CAD) in RA patients and the long-term clinical outcomes after coronary revascularization. METHODS AND RESULTS All consecutive patients with RA were identified by retrospective review at a rheumatology tertiary center in Milan, Italy between 2001 and 2013. RA patients affected by significant CAD (RA-CAD+) were prospectively followed for major adverse cardiovascular and cerebrovascular events (MACCE) after percutaneous coronary revascularization (RA-PCI), coronary artery bypass grafting (RA-CABG) or medical therapy (RA-MT). Among 936 patients with RA, the presence of clinically significant CAD was found in 5.6% (53 patients, RA-CAD+). Of these, 32 patients (60%) underwent PCI (RA-PCI), 10 patients (19%) underwent CABG (RA-CABG) and 11 patients (21%) treated with MT (RA-MT). After a mean follow-up of 9±7 years, the rate of MACCE was 56% in RA-PCI patients, 50% in RA-CABG and 27% in RA-MT patients (P=0.184). The high MACCE rate was mainly driven by repeat coronary revascularization (47%) in the RA-PCI group and high rate of strokes (30%) in RA-CABG patients. CONCLUSION In patients with rheumatoid arthritis and concomitant coronary artery disease (RA-CAD+), we observed at long-term follow-up a high MACCE rate, predominantly in those who underwent coronary revascularization.
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Affiliation(s)
- Marco Spartera
- Department of Cardiovascular, San Raffaele Scientific InstituteMilan, Italy
| | - Cosmo Godino
- Department of Cardiovascular, San Raffaele Scientific InstituteMilan, Italy
| | - Elena Baldissera
- Unit of Internal Medicine and Clinical Immunology, San Raffaele Scientific InstituteMilan, Italy
| | - Corrado Campochiaro
- Unit of Internal Medicine and Clinical Immunology, San Raffaele Scientific InstituteMilan, Italy
| | - Ketty La Spina
- Department of Cardiovascular, San Raffaele Scientific InstituteMilan, Italy
| | - Patrizia Aiello
- Unit of Internal Medicine and Clinical Immunology, San Raffaele Scientific InstituteMilan, Italy
| | - Anna Salerno
- Department of Cardiovascular, San Raffaele Scientific InstituteMilan, Italy
| | - Michela Cera
- Department of Cardiovascular, San Raffaele Scientific InstituteMilan, Italy
| | - Valeria Magni
- Department of Cardiovascular, San Raffaele Scientific InstituteMilan, Italy
| | | | - Lorenzo Dagna
- Unit of Internal Medicine and Clinical Immunology, San Raffaele Scientific InstituteMilan, Italy
| | - Moreno Tresoldi
- Unit of Internal Medicine and Clinical Immunology, San Raffaele Scientific InstituteMilan, Italy
| | | | - Ottavio Alfieri
- Department of Cardiovascular, San Raffaele Scientific InstituteMilan, Italy
| | - Antonio Colombo
- Department of Cardiovascular, San Raffaele Scientific InstituteMilan, Italy
- EMO-GVM Centro Cuore ColumbusMilan, Italy
| | - Maria Grazia Sabbadini
- Unit of Internal Medicine and Clinical Immunology, San Raffaele Scientific InstituteMilan, Italy
| | - Alberto Margonato
- Department of Cardiovascular, San Raffaele Scientific InstituteMilan, Italy
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Agricola E, Marini C, Stella S, Monello A, Fisicaro A, Tufaro V, Slavich M, Oppizzi M, Castiglioni A, Cappelletti A, Margonato A. Effects of functional tricuspid regurgitation on renal function and long-term prognosis in patients with heart failure. J Cardiovasc Med (Hagerstown) 2017; 18:60-68. [DOI: 10.2459/jcm.0000000000000312] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Godino C, Chiarito M, Donahue M, Testa L, Colantonio R, Cappelletti A, Monello A, Magni V, Milazzo D, Parisi R, Nicolino A, Moshiri S, Fattori R, Aprigliano G, Palloshi A, Caramanno G, Montorfano M, Bedogni F, Briguori C, Margonato A, Colombo A. Midterm and one-year outcome of amphilimus polymer free drug eluting stent in patients needing short dual antiplatelet therapy. Insight from the ASTUTE registry (AmphilimuS iTalian mUlticenTer rEgistry). Int J Cardiol 2017; 231:54-60. [PMID: 28104306 DOI: 10.1016/j.ijcard.2017.01.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 12/08/2016] [Accepted: 01/02/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND To assess clinical outcomes of patients needing short dual antiplatelet therapy (S-DAPT) after PCI with Cre8 polymer-free amphilimus eluting-stent (AES). The Cre8-AES with pure i-Carbofilm coating was supposed to induce faster stent endothelialization and reduce device thrombogenicity. METHODS We performed a sub-analysis of unrestricted consecutive patients treated with Cre8-AES between August 2011 and January 2015. Two groups were formed: 1) patients discharged with S-DAPT (≤3-month), because of high bleeding risk or attending urgent non-cardiac surgery; and 2) patients discharged with Recommended DAPT duration (R-DAPT; ≥6-month). The primary ischemic- and bleeding-safety endpoints were Target Vessel Failure (TVF, composite endpoint of cardiac-death, target vessel-myocardial infarction and target vessel-revascularization), and major-bleeding (BARC ≥type-3a) at 6-month and 1-year. RESULTS 106 patients (8.7%) were discharged with ≤3-month DAPT (83±19days; S-DAPT group) and 1102 patients (90.6%) with ≥6-month DAPT (342±62days; R-DAPT group). Between S-DAPT and R-DAPT groups no significant differences were observed in TVF at 1-year (5.7% vs 5.1%); 1-year BARC major bleeding rate was higher in S-DAPT group (3.4% vs 0.2%, p=0.007) with all bleeding events occurred within 3months. The landmark analysis (started at 90days, ended at 1year) showed no differences in BARC major bleedings between groups (0% vs. 0.3%). CONCLUSIONS The results of this multicenter registry show that the use of Cre8 AES in patients needing short DAPT (≤3-month) was safe regarding ischemic events and could favor a reduction of bleeding events related to the recommended DAPT. A large randomized trial is necessary to support these preliminary findings.
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Affiliation(s)
- Cosmo Godino
- San Raffaele Scientific Institute, Milan, Italy.
| | | | | | - Luca Testa
- IRCCS Policlinico San Donato, San Donato M.ne, Milan, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Antonio Colombo
- San Raffaele Scientific Institute, Milan, Italy; EMO-GVM Centro Cuore Columbus, Milan, Italy
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Colombo A, Godino C, Donahue M, Testa L, Chiarito M, Pavon AG, Colantonio R, Cappelletti A, Monello A, Magni V, Milazzo D, Parisi R, Nicolino A, Moshiri S, Fattori R, Aprigliano G, Palloshi A, Caramanno G, Montorfano M, Bedogni F, Margonato A, Briguori C. One-year clinical outcome of amphilimus polymer-free drug-eluting stent in diabetes mellitus patients. Int J Cardiol 2016; 214:113-20. [DOI: 10.1016/j.ijcard.2016.03.088] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 03/17/2016] [Accepted: 03/19/2016] [Indexed: 01/04/2023]
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Godino C, Salerno A, Cera M, Agricola E, Fragasso G, Rosa I, Oppizzi M, Monello A, Scotti A, Magni V, Montorfano M, Cappelletti A, Margonato A, Colombo A. Impact and evolution of right ventricular dysfunction after successful MitraClip implantation in patients with functional mitral regurgitation. Int J Cardiol Heart Vasc 2016; 11:90-98. [PMID: 28616532 PMCID: PMC5441334 DOI: 10.1016/j.ijcha.2016.05.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 05/02/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Right ventricular dysfunction (RVdysf) is a predictor of poor outcome in patients with heart failure and valvular disease. The aim of this study was to evaluate the evolution and the impact of RVdysf in patients with moderate-severe functional mitral regurgitation (FMR) successfully treated with MitraClip. METHODS AND RESULTS From October 2008 to July 2014, 60 consecutive high surgical risk FMR patients were evaluated and stratified into two groups: RVdysf group (TAPSE < 16 mm and/or S'TDI < 10 cm/s, 21 patients) and No-RVdysf group (38 patients). The overall mean age of patients was 73 ± 8 (83% male). Ischemic FMR etiology was present in 67%. Mean LVEF was 30 ± 10%. Overall mean time follow-up was 565 ± 310 days. The only significant difference between the two groups was a greater prevalence of stroke, ICD and use of aldosterone antagonist in RVdysf group. Acute procedural success was achieved in 90% of patients. At 6-month echo-matched analysis significant RV function improvement was observed in patients with baseline RVdysf (TAPSE 15 ± 3.0 vs. 19 ± 4.5, p = 0.007; S'TDI 7 ± 1.2 vs. 11 ± 2.8, p < 0.0001; baseline vs. 6-month, respectively). The mean improvement in the 6-min walking test was significant in both groups (120 and 143 m, RVdysf and No-RVdysf groups, respectively). At Kaplan-Meier analysis, the presence of RVdysf did not affect the outcome in terms of freedom from composite efficacy endpoint. CONCLUSIONS This study shows that successful MitraClip implantation in patients with FMR and concomitant right ventricular dysfunction yields significant improvement of RV function at mid-term follow-up. Further data on larger population will be required to confirm our observations.
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Affiliation(s)
- Cosmo Godino
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
- Corresponding author at: Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy.Cardio-Thoracic-Vascular DepartmentSan Raffaele Scientific InstituteVia Olgettina 60Milan20132Italy
| | - Anna Salerno
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Michela Cera
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Eustachio Agricola
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Gabriele Fragasso
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Isabella Rosa
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Michele Oppizzi
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Monello
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Scotti
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Valeria Magni
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Cappelletti
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Margonato
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
- EMO-GVM Centro Cuore Columbus, Milan, Italy
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Godino C, Salerno A, Cera M, Agricola E, Oppizzi M, Monello A, Pavon AG, Scotti A, Chiarito M, Magni V, Chieffo A, Montorfano M, Cappelletti A, Margonato A, Colombo A. TCT-713 Impact And Evolution Of Right Ventricular Dysfunction After MitraClip In High Risk Patients With Functional Mitral Regurgitation. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.08.733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Agricola E, Slavich M, Rinaldi E, Bertoglio L, Civilini E, Melissano G, Marone E, Fisicaro A, Marini C, Tufaro V, Cappelletti A, Margonato A, Chiesa R. Usefulness of contrast-enhanced transoesophageal echocardiography to guide thoracic endovascular aortic repair procedure. Eur Heart J Cardiovasc Imaging 2015; 17:67-75. [PMID: 26034095 DOI: 10.1093/ehjci/jev118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 04/15/2015] [Indexed: 11/13/2022] Open
Abstract
AIMS Thoracic endovascular aortic repair (TEVAR) is commonly considered as a valid alternative to surgery. Endoleaks occurrence is one of the principal limitations of TEVAR. Transoesophageal echocardiography (TEE) is often adopted in adjunct to fluoroscopy and angiography (ANGIO) during stent-graft implantation. In the present study, we compare intraprocedural ANGIO, TEE, and contrast-enhanced TEE (cTEE), and we also evaluate their accuracy in early endoleaks detection and characterization. METHODS AND RESULTS Fifty-four patients with thoracic aortic disease suitable for TEVAR were prospectively enrolled in the study. After stent placement, the result of the procedure was assessed by ANGIO, TEE, and cTEE. The use of contrast (Sonovue, Bracco) significantly improved TEE quality (P = 0.0001). cTEE was superior in entry tears, false and true lumen and aneurysm thrombosis identification, and microtears and ulcer-like projections detection before stent deployment. After stent deployment, cTEE was more accurate than TEE and ANGIO in the detection of slow flow in the false lumen and in the aneurismal sac (P = 0.0001), and in the remaining flow identification (P = 0.0001). Notably, cTEE is more accurate in the endoleaks detection (P = 0.0001) and in the incomplete stent expansion diagnosis and need for a further balloon inflation (P 0.002), or a further stent implantation (P 0.006), compared with TEE and ANGIO. CONCLUSION TEVAR procedures are improved by the complimentary use of contrast fluoroscopy, multiplane TEE with Doppler flow interrogation, and cTEE. This triple imaging approach provides additional information in all phases of the procedure improving safety of stent-grafting and the procedural outcomes.
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Affiliation(s)
- Eustachio Agricola
- Division of Non-Invasive Cardiology, San Raffaele Hospital, Via Olgettina 58, Milan 20100, Italy
| | - Massimo Slavich
- Division of Non-Invasive Cardiology, San Raffaele Hospital, Via Olgettina 58, Milan 20100, Italy
| | - Enrico Rinaldi
- Division of Vascular Surgery, San Raffaele Hospital, Milan 20100, Italy
| | - Luca Bertoglio
- Division of Vascular Surgery, San Raffaele Hospital, Milan 20100, Italy
| | - Efrem Civilini
- Division of Vascular Surgery, San Raffaele Hospital, Milan 20100, Italy
| | - Germano Melissano
- Division of Vascular Surgery, San Raffaele Hospital, Milan 20100, Italy
| | - Enrico Marone
- Division of Vascular Surgery, San Raffaele Hospital, Milan 20100, Italy
| | - Andrea Fisicaro
- Division of Non-Invasive Cardiology, San Raffaele Hospital, Via Olgettina 58, Milan 20100, Italy
| | - Claudia Marini
- Division of Non-Invasive Cardiology, San Raffaele Hospital, Via Olgettina 58, Milan 20100, Italy
| | - Vincenzo Tufaro
- Division of Non-Invasive Cardiology, San Raffaele Hospital, Via Olgettina 58, Milan 20100, Italy
| | - Alberto Cappelletti
- Division of Non-Invasive Cardiology, San Raffaele Hospital, Via Olgettina 58, Milan 20100, Italy
| | - Alberto Margonato
- Division of Non-Invasive Cardiology, San Raffaele Hospital, Via Olgettina 58, Milan 20100, Italy
| | - Roberto Chiesa
- Division of Vascular Surgery, San Raffaele Hospital, Milan 20100, Italy
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Mangieri A, Godino C, Montorfano M, Arioli F, Rosa I, Ajello S, Piraino D, Monello A, Pavon AG, Viani G, Magni V, Cappelletti A, Margonato A, Colombo A. PFO closure with only fluoroscopic guidance: 7 years real-world single centre experience. Catheter Cardiovasc Interv 2015; 86:105-12. [DOI: 10.1002/ccd.25735] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 11/02/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Antonio Mangieri
- Cardio-Thoracic-Vascular Department; San Raffaele Institute; Milan Italy
| | - Cosmo Godino
- Cardio-Thoracic-Vascular Department; San Raffaele Institute; Milan Italy
| | - Matteo Montorfano
- Cardio-Thoracic-Vascular Department; San Raffaele Institute; Milan Italy
| | - Francesco Arioli
- Cardio-Thoracic-Vascular Department; San Raffaele Institute; Milan Italy
| | - Isabella Rosa
- Cardio-Thoracic-Vascular Department; San Raffaele Institute; Milan Italy
| | - Silvia Ajello
- Cardio-Thoracic-Vascular Department; San Raffaele Institute; Milan Italy
| | - Daniela Piraino
- Cardio-Thoracic-Vascular Department; San Raffaele Institute; Milan Italy
| | - Alberto Monello
- Cardio-Thoracic-Vascular Department; San Raffaele Institute; Milan Italy
| | - Anna Giulia Pavon
- Cardio-Thoracic-Vascular Department; San Raffaele Institute; Milan Italy
| | - Giacomo Viani
- Cardio-Thoracic-Vascular Department; San Raffaele Institute; Milan Italy
| | - Valeria Magni
- Cardio-Thoracic-Vascular Department; San Raffaele Institute; Milan Italy
| | | | - Alberto Margonato
- Cardio-Thoracic-Vascular Department; San Raffaele Institute; Milan Italy
| | - Antonio Colombo
- Cardio-Thoracic-Vascular Department; San Raffaele Institute; Milan Italy
- EMO-GVM Centro Cuore Columbus; Milan Italy
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Cappelletti A, Zanussi M, Mazzavillani M, Magni V, Calori G, Godino C, Ferrari M, Margonato A. Association of LOXIN, a new functional splicing isoform of the OLR1 gene, with severity and prognostic localization of critical coronary artery stenoses. J Cardiovasc Med (Hagerstown) 2014; 15:391-6. [PMID: 24743687 DOI: 10.2459/jcm.0b013e3283624251] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
AIMS To evaluate the association between LOXIN, a new functional protective splicing isoform of the oxidized LDL receptor 1 (OLR1) gene, and the severity of coronary artery stenoses. METHODS We analyzed 100 consecutive patients with coronary artery disease (CAD) and 100 controls, all evaluated by a new molecular biology test using highly specific allele primers able to identify the single nucleotide variation (IVS4-14 A>G) in the OLR1 gene (Loxin Test - Technogenetics). All the patients and the controls underwent coronary angiography and, for quantitative evaluation, we used both vessel and stenosis score, and SYNTAX score to evaluate the severity of CAD. Moreover, we defined the prognostic localization of CAD as a critical stenosis (>50%) of the left main and/or proximal segment of left anterior descending artery (LAD). Finally, we evaluated a correlation with the presence of diabetes mellitus, dyslipidemia, hypertension, smoking and family history of CAD. RESULTS In this selected population, even though the 'AA nonrisk haplotype' is more frequent in the controls, we did not find any statistically significant correlation between the severity of CAD or the prognostic localization of critical stenosis and the difference of IVS4-14 A>G OLR1 genotype (P > 0.05). CAD patients showed significantly higher frequencies of dyslipidemia and smoking (P < 0.05) than controls, but no significant association was found between overall risk factors and the OLR1 polymorphism. CONCLUSION In this selected population, we did not find any correlation of LOXIN with the severity or prognostic localization of CAD on left main and/or proximal LAD.
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Affiliation(s)
- Alberto Cappelletti
- aDepartment of Cardiology, San Raffaele Scientific Institute bUnit of Genomics for Diagnosis of Human Pathologies, San Raffaele Scientific Institute, Milan, Italy
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Piatti P, Setola E, Galluccio E, Costa S, Fontana B, Stuccillo M, Crippa V, Cappelletti A, Margonato A, Bosi E, Monti LD. Smoking is associated with impaired glucose regulation and a decrease in insulin sensitivity and the disposition index in first-degree relatives of type 2 diabetes subjects independently of the presence of metabolic syndrome. Acta Diabetol 2014; 51:793-9. [PMID: 24934227 DOI: 10.1007/s00592-014-0599-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 05/17/2014] [Indexed: 01/18/2023]
Abstract
The aim of this study was to investigate glucose tolerance, insulin secretion and insulin resistance according to smoking habits in first-degree relatives of type 2 diabetes patients, a population at high risk for developing diabetes. One thousand three hundred (646 females and 654 males) subjects underwent an oral glucose tolerance test (OGTT) to investigate their glucose metabolism and answered questionnaires about their lifestyle habits. Smoker subjects showed significant impairment compared with non-smoker subjects in 2-h post-oral glucose tolerance test (2hOGTT, 129.3 ± 40.2 vs. 117.7 ± 37.6 mg/dl, p < 0.001), the OGTT insulin sensitivity (386.3 ± 54.9 vs. 400.5 ± 53.4 ml min(-1) m(2), p < 0.01) method and the insulin sensitivity and secretion index-2 (ISSI-2, 1.7 ± 0.8 vs. 2.0 ± 1.0, p < 0.005). Metabolic syndrome (MS) was higher in the smoker than in the non-smoker group (46.5 vs. 29.7 %, p < 0001), and smokers were more sedentary than non-smokers (3.94 ± 3.77 vs. 4.86 ± 4.41 h/week, p < 0.001). Smokers showed an increased risk of impaired glucose regulation (IGR: impaired glucose tolerance or diabetes mellitus) with a hazard ratio (HR) adjusted by gender, metabolic syndrome and physical activity of 1.78, 95 % CI 1.27-2.47 (p < 0.001). The association between smoking and MS conferred a risk of IGR that was five times higher (HR 5.495, 95 % CI 4.07-7.41, p < 0.001). Smoking habit was a significant explanatory variable in a multiple forward stepwise regression analysis performed using 2hOGTT and ISSI-2 as dependent variables (p < 0.0001, R = 0.313 and p < 0.0001, R = 0.347, respectively). In conclusions, our results show that tobacco smoking is tightly associated with impairments in glucose metabolism and insulin sensitivity and insulin secretion.
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Affiliation(s)
- PierMarco Piatti
- Cardio-Metabolism and Clinical Trials Unit, Diabetes Research Institute, Division of Immunology, Transplantation and Infective Diseases, Department of Internal Medicine, IRCCS San Raffaele, Milan, Italy,
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