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Cornara S, Mandurino-Mirizzi A, Somaschini A, Mauri S, Crimi G, Munafò A, Camporotondo R, Gnecchi M, De Servi S, De Ferrari GM, Ferlini M. Derivation and validation of the incomplete ST-segment resolution score and its usefulness for treatment with glycoprotein IIb-IIIa inhibitors. J Cardiovasc Med (Hagerstown) 2024; 25:173-175. [PMID: 38149704 DOI: 10.2459/jcm.0000000000001583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Affiliation(s)
- Stefano Cornara
- Department of Molecular Medicine, Unit of Cardiology, University of Pavia, Pavia
- Cardiac Intensive Care Unit, Division of Cardiology, San Paolo Hospital, Savona
| | - Alessandro Mandurino-Mirizzi
- Department of Molecular Medicine, Unit of Cardiology, University of Pavia, Pavia
- Division of Cardiology, "V. Fazzi" Hospital, 73100 Lecce
| | - Alberto Somaschini
- Department of Molecular Medicine, Unit of Cardiology, University of Pavia, Pavia
- Cardiac Intensive Care Unit, Division of Cardiology, San Paolo Hospital, Savona
| | - Silvia Mauri
- Department of Molecular Medicine, Unit of Cardiology, University of Pavia, Pavia
- Cardiology and Coronary Unit, ASST Ovest Milanese, Milan
| | - Gabriele Crimi
- Interventional Cardiology Unit, CardioThoraco Vascular Department (DICATOV), IRCCS Ospedale Policlinico San Martino, Genova
| | - Andrea Munafò
- Department of Molecular Medicine, Unit of Cardiology, University of Pavia, Pavia
- Division of Cardiology
| | | | - Massimiliano Gnecchi
- Department of Molecular Medicine, Unit of Cardiology, University of Pavia, Pavia
- Cardiolgia Traslazionale, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Stefano De Servi
- Department of Molecular Medicine, Unit of Cardiology, University of Pavia, Pavia
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital, Turin, Italy
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Somaschini A, Cornara S, Leonardi S, Demarchi A, Mandurino-Mirizzi A, Fortuni F, Ferlini M, Crimi G, Camporotondo R, Gnecchi M, Oltrona Visconti L, De Servi S, De Ferrari GM. Beneficial Effects of IABP in Anterior Myocardial Infarction Complicated by Cardiogenic Shock. Medicina (Kaunas) 2023; 59:1806. [PMID: 37893524 PMCID: PMC10608192 DOI: 10.3390/medicina59101806] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 09/28/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives. Recent guidelines have downgraded the routine use of the intra-aortic balloon pump (IABP) in patients with cardiogenic shock (CS) due to ST-elevation myocardial infarction (STEMI). Despite this, its use in clinical practice remains high. The aim of this study was to evaluate the prognostic impact of the IABP in patients with STEMI complicated by CS undergoing primary PCI (pPCI), focusing on patients with anterior MI in whom a major benefit has been previously hypothesized. Materials and Methods. We enrolled 2958 consecutive patients undergoing pPCI for STEMI in our department from 2005 to 2018. Propensity score matching and mortality analysis were performed. Results. CS occurred in 246 patients (8.3%); among these patients, 145 (60%) had anterior AMI. In the propensity-matched analysis, the use of the IABP was associated with a lower 30-day mortality (39.3% vs. 60.9%, p = 0.032) in the subgroup of patients with anterior STEMI. Conversely, in the whole group of CS patients and in the subgroup of patients with non-anterior STEMI, IABP use did not have a significant impact on mortality. Conclusions. The use of the IABP in cases of STEMI complicated by CS was found to improve survival in patients with anterior infarction. Prospective studies are needed before abandoning or markedly limiting the use of the IABP in this clinical setting.
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Affiliation(s)
- Alberto Somaschini
- Cardiac Intensive Care Unit, Division of Cardiology, San Paolo Hospital, 17100 Savona, Italy;
- Department of Molecular Medicine, Unit of Cardiology, University of Pavia, 27100 Pavia, Italy (A.D.)
| | - Stefano Cornara
- Cardiac Intensive Care Unit, Division of Cardiology, San Paolo Hospital, 17100 Savona, Italy;
- Department of Molecular Medicine, Unit of Cardiology, University of Pavia, 27100 Pavia, Italy (A.D.)
| | - Sergio Leonardi
- Department of Molecular Medicine, Unit of Cardiology, University of Pavia, 27100 Pavia, Italy (A.D.)
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (M.F.); (R.C.); (L.O.V.)
| | - Andrea Demarchi
- Department of Molecular Medicine, Unit of Cardiology, University of Pavia, 27100 Pavia, Italy (A.D.)
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
| | - Alessandro Mandurino-Mirizzi
- Department of Molecular Medicine, Unit of Cardiology, University of Pavia, 27100 Pavia, Italy (A.D.)
- Division of Cardiology, “V. Fazzi” Hospital, 73100 Lecce, Italy
| | - Federico Fortuni
- Department of Molecular Medicine, Unit of Cardiology, University of Pavia, 27100 Pavia, Italy (A.D.)
| | - Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (M.F.); (R.C.); (L.O.V.)
| | - Gabriele Crimi
- Interventional Cardiology Unit, CardioThoraco Vascular Department (DICATOV), IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy;
| | - Rita Camporotondo
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (M.F.); (R.C.); (L.O.V.)
| | - Massimiliano Gnecchi
- Department of Molecular Medicine, Unit of Cardiology, University of Pavia, 27100 Pavia, Italy (A.D.)
- Cardiolgia Traslazionale, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Luigi Oltrona Visconti
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (M.F.); (R.C.); (L.O.V.)
| | - Stefano De Servi
- Department of Molecular Medicine, Unit of Cardiology, University of Pavia, 27100 Pavia, Italy (A.D.)
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital, 10126 Turin, Italy
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy
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3
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Cafaro A, Rizzo F, Fischetti D, Quarta L, Mussardo M, Mandurino-Mirizzi A, Tondo A, Ciccone MM, Iacovelli F, Colonna G. Intracoronary Pacing during "Chimney Technique" in Transcatheter Aortic Valve-in-Valve Implantation: An Alternative Temporary Rapid Ventricular Stimulation? J Cardiovasc Dev Dis 2023; 10:341. [PMID: 37623354 PMCID: PMC10455771 DOI: 10.3390/jcdd10080341] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/19/2023] [Accepted: 08/02/2023] [Indexed: 08/26/2023] Open
Abstract
Temporary rapid ventricular pacing (TRVP) is required during transcatheter aortic valve implantation (TAVI) in order to reduce cardiac output and to facilitate balloon aortic valvuloplasty, prosthesis deployment, and post-deployment balloon dilation. The two most frequently used TRVP techniques are right endocardial (RE)-TRVP and retrograde left endocardial temporary rapid ventricular pacing (RLE)-TRVP. The first one could be responsible for cardiac tamponade, one of the most serious procedural complications during TAVI, while the second one could often be unsuccessful. Intracoronary (IC)-TRVP through a coronary guidewire has been described as a safe and efficient procedure that could avoid such complications. We describe two clinical cases in which IC-TRVP has been effectively used during valve-in-valve TAVI with coronary protection via the "chimney technique", after unsuccessful RLE-TRVP.
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Affiliation(s)
- Alessandro Cafaro
- Division of Cardiology, “V. Fazzi” Hospital, 73100 Lecce, Italy; (A.C.); (D.F.); (L.Q.); (M.M.); (A.M.-M.); (A.T.); (G.C.)
| | - Francesco Rizzo
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 70124 Bari, Italy; (M.M.C.); (F.I.)
| | - Dionigi Fischetti
- Division of Cardiology, “V. Fazzi” Hospital, 73100 Lecce, Italy; (A.C.); (D.F.); (L.Q.); (M.M.); (A.M.-M.); (A.T.); (G.C.)
| | - Luca Quarta
- Division of Cardiology, “V. Fazzi” Hospital, 73100 Lecce, Italy; (A.C.); (D.F.); (L.Q.); (M.M.); (A.M.-M.); (A.T.); (G.C.)
| | - Marco Mussardo
- Division of Cardiology, “V. Fazzi” Hospital, 73100 Lecce, Italy; (A.C.); (D.F.); (L.Q.); (M.M.); (A.M.-M.); (A.T.); (G.C.)
| | - Alessandro Mandurino-Mirizzi
- Division of Cardiology, “V. Fazzi” Hospital, 73100 Lecce, Italy; (A.C.); (D.F.); (L.Q.); (M.M.); (A.M.-M.); (A.T.); (G.C.)
| | - Antonio Tondo
- Division of Cardiology, “V. Fazzi” Hospital, 73100 Lecce, Italy; (A.C.); (D.F.); (L.Q.); (M.M.); (A.M.-M.); (A.T.); (G.C.)
| | - Marco Matteo Ciccone
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 70124 Bari, Italy; (M.M.C.); (F.I.)
| | - Fortunato Iacovelli
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 70124 Bari, Italy; (M.M.C.); (F.I.)
- Division of Cardiology, “SS. Annunziata” Hospital, 74121 Taranto, Italy
| | - Giuseppe Colonna
- Division of Cardiology, “V. Fazzi” Hospital, 73100 Lecce, Italy; (A.C.); (D.F.); (L.Q.); (M.M.); (A.M.-M.); (A.T.); (G.C.)
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4
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Arzuffi L, Mandurino-Mirizzi A, Magrini G, Frassica R, Disabato G, Ferlini M, Gazzoli F, Scelsi L, Turco A, Munafò A, Ghio S, Ferrario M, Oltrona-Visconti L, Crimi G. Impact of mitral transcatheter edge-to-edge repair on pulmonary vein flow in patients with functional mitral regurgitation. J Cardiovasc Med (Hagerstown) 2023; 24:206-208. [PMID: 36729687 DOI: 10.2459/jcm.0000000000001417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Luca Arzuffi
- Division of Cardiology
- University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia
| | | | | | | | - Giandomenico Disabato
- Division of Cardiology
- University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia
| | | | | | | | | | - Andrea Munafò
- Division of Cardiology
- University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia
| | | | | | | | - Gabriele Crimi
- Division of Cardiology
- Interventional Cardiology Unit, Cardio-Thoraco Vascular Department (DICATOV), IRCCS Ospedale Policlinico San Martino, Genova, Italy - IRCCS Italian Cardiovascular Network & Department of Internal Medicine, University of Genova, Genova, Italy
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5
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Mandurino-Mirizzi A, Crimi G. Do We Need to Know and Monitor the Hemodynamics of Patients Treated With Mitral Transcatheter Edge-to-Edge Repair? Am J Cardiol 2023; 190:136. [PMID: 36621419 DOI: 10.1016/j.amjcard.2022.12.011] [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: 10/21/2022] [Revised: 11/16/2022] [Accepted: 12/10/2022] [Indexed: 01/09/2023]
Affiliation(s)
| | - Gabriele Crimi
- Interventional Cardiology Unit, Cardio-Thoraco Vascular Department (DICATOV), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy
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6
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Ghio S, Mandurino-Mirizzi A, La Rovere MT, Traversi E, Lombardi C, Scelsi L, Senni M, Iacovoni A. Sodium nitroprusside for advanced heart failure. A metanalysis of literature data. Vascul Pharmacol 2023; 148:107140. [PMID: 36563732 DOI: 10.1016/j.vph.2022.107140] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/03/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022]
Abstract
Advanced heart failure (HF) is associated with a very poor prognosis and places a big burden on health-care services. The gold standard treatment, i.e. long-term mechanical circulatory support or heart transplantation, is precluded in many patients but observational studies suggest that the use of SNP might be associated with favourable long-term clinical outcomes. We performed a metanalysis of published studies that compared sodium nitroprusside (SNP) with optimal medical therapy to examine the safety and efficacy of SNP as part of the treatment regimen of patients hospitalized for advanced heart failure (HF). We searched PUBMED, EMBASE and WEB OF SCIENCE for studies that compared SNP with optimal medical therapy in advanced HF on July 2022. After screening 700 full-text articles, data from two original articles were included in a combined analysis. The analysis demonstrated a 66% reduction in the odds of death in advanced HF patients treated with SNP. The results show the potential importance of the inclusion of SNP in the treatment regimen of patients hospitalized because of advanced HF and underlines that controlled, randomized studies are still required in this condition.
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Affiliation(s)
- S Ghio
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | | | - M T La Rovere
- Department of Cardiac Rehabilitation, IRCCS Istituti Clinici Scientifici Maugeri, Montescano, Pavia, Italy
| | - E Traversi
- Department of Cardiac Rehabilitation, IRCCS Istituti Clinici Scientifici Maugeri, Montescano, Pavia, Italy
| | - C Lombardi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy
| | - L Scelsi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - M Senni
- Division of Cardiology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - A Iacovoni
- Division of Cardiology, ASST Papa Giovanni XXIII, Bergamo, Italy
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7
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Tua L, Mandurino-Mirizzi A, Colombo C, Morici N, Magrini G, Nava S, Frassica R, Montalto C, Ferlini M, Sacco A, Musca F, Moreo A, Ghio S, Oreglia J, Oltrona-Visconti L, Oliva F, Crimi G. The impact of transcatheter edge-to-edge repair on right ventricle-pulmonary artery coupling in patients with functional mitral regurgitation. Eur J Clin Invest 2023; 53:e13869. [PMID: 36075584 PMCID: PMC10078416 DOI: 10.1111/eci.13869] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/08/2022] [Accepted: 09/07/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Lorenzo Tua
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Claudia Colombo
- Interventional Cardiology Division and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Nuccia Morici
- Interventional Cardiology Division and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giulia Magrini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Stefano Nava
- Interventional Cardiology Division and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Romina Frassica
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Claudio Montalto
- Interventional Cardiology Division and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alice Sacco
- Interventional Cardiology Division and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Francesco Musca
- Interventional Cardiology Division and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Antonella Moreo
- Interventional Cardiology Division and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Stefano Ghio
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Jacopo Oreglia
- Interventional Cardiology Division and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Fabrizio Oliva
- Interventional Cardiology Division and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Gabriele Crimi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Interventional Cardiology Unit, Cardio-Thoraco Vascular Department (DICATOV), IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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8
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Kajana V, Baldi E, Gentile FR, Compagnoni S, Quilico F, Vicini Scajola L, Repetto A, Mandurino-Mirizzi A, Ferlini M, Marinoni B, Ferrario Ormezzano M, Primi R, Bendotti S, Currao A, Savastano S. Complete Revascularization and One-Year Survival with Good Neurological Outcome in Patients Resuscitated from an Out-of-Hospital Cardiac Arrest. J Clin Med 2022; 11:jcm11175071. [PMID: 36079003 PMCID: PMC9456720 DOI: 10.3390/jcm11175071] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/22/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022] Open
Abstract
Background. The survival benefit of complete versus infarct-related artery (IRA)-only revascularization during the index hospitalization in patients resuscitated from an out-of-hospital cardiac arrest (OHCA) with multivessel disease is unknown. Methods. We considered all the OHCA patients prospectively enrolled in the Lombardia Cardiac Arrest Registry (Lombardia CARe) from 1 January 2015 to 1 May 2021 who underwent coronary angiography (CAG) at the Fondazione IRCCS Policlinico San Matteo (Pavia). Patients’ prehospital, angiographical and survival data were reviewed. Results. Out of 239 patients, 119 had a multivessel coronary disease: 69% received IRA-only revascularization, and 31% received a complete revascularization: 8 during the first procedure and 29 in a staged-procedure after a median time of 5 days [IQR 2.5−10.3]. The complete revascularization group showed significantly higher one-year survival with good neurological outcome than the IRA-only group (83.3% vs. 30.4%, p < 0.001). After correcting for cardiac arrest duration, shockable presenting rhythm, peak of Troponin-I, creatinine on admission and the need for circulatory support, complete revascularization was independently associated with the probability of death and poor neurological outcome [HR 0.3 (95%CI 0.1−0.8), p = 0.02]. Conclusions. This observation study shows that complete myocardial revascularization during the index hospitalization improves one-year survival with good neurological outcome in patients resuscitated from an OHCA with multivessel coronary disease.
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Affiliation(s)
- Vilma Kajana
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
- Humanitas Mater Domini, 21053 Castellanza, Italy
| | - Enrico Baldi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
- Correspondence: ; Tel.: +39-038-2501276
| | - Francesca Romana Gentile
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
- Department of Molecular Medicine, University of Pavia, 27100 Pavia, Italy
| | - Sara Compagnoni
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
- Department of Molecular Medicine, University of Pavia, 27100 Pavia, Italy
| | - Federico Quilico
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
- Department of Molecular Medicine, University of Pavia, 27100 Pavia, Italy
| | - Luca Vicini Scajola
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
- Department of Molecular Medicine, University of Pavia, 27100 Pavia, Italy
| | - Alessandra Repetto
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
| | | | - Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
| | - Barbara Marinoni
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
| | | | - Roberto Primi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
| | - Sara Bendotti
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
| | - Alessia Currao
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
| | - Simone Savastano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
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9
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Kajana V, Massaro G, Somaschini A, Cornara S, Demarchi A, Nardella E, Nicoletti A, Sangiorgi GM, Mandurino-Mirizzi A. Serum uric acid in patients with ST-segment elevation myocardial infarction: An innocent bystander or leading actor? Nutr Metab Cardiovasc Dis 2022; 32:1583-1589. [PMID: 35597708 DOI: 10.1016/j.numecd.2022.03.023] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/02/2022] [Accepted: 03/27/2022] [Indexed: 10/18/2022]
Abstract
Elevated serum uric acid (SUA) levels have been associated with several cardiovascular risk factors and the progression of coronary artery disease. In the setting of acute myocardial infarction, increasing evidence suggests that high SUA levels could be related to adverse outcomes. Interestingly elevated SUA levels have been linked to endothelial dysfunction, inflammation and oxidative stress. The aim of this review is to discuss the potential negative effects of SUA in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention, analyzing the possible underlying pathophysiological mechanisms.
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Affiliation(s)
- Vilma Kajana
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gianluca Massaro
- Division of Cardiology, University Hospital "Tor Vergata", Rome, Italy
| | - Alberto Somaschini
- Division of Cardiology and Cardiac Intensive Care Unit, San Paolo Hospital, Savona, Italy
| | - Stefano Cornara
- Division of Cardiology and Cardiac Intensive Care Unit, San Paolo Hospital, Savona, Italy
| | | | - Elisabetta Nardella
- Internal Medicine, Gastroenterology and Hepatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alberto Nicoletti
- Internal Medicine, Gastroenterology and Hepatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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10
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Mandurino-Mirizzi A, Munafò A, Raineri C, Magrini G, Frassica R, Arzuffi L, Scelsi L, Turco A, Ferlini M, Gazzoli F, Ferrario M, Ghio S, Oltrona-Visconti L, Crimi G. Response to acute vasodilator challenge and haemodynamic modifications after MitraClip in patients with functional mitral regurgitation and pulmonary hypertension. European Heart Journal. Acute Cardiovascular Care 2022; 11:464-469. [PMID: 35524735 PMCID: PMC9459870 DOI: 10.1093/ehjacc/zuac053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/17/2022]
Abstract
The effectiveness of transcatheter edge-to-edge repair (TEER) in patients with functional mitral regurgitation (FMR) and pulmonary hypertension (PH) is still debated and pre-procedural predictors of haemodynamic improvement after TEER in this setting are currently unknown. We investigated whether normalization of pulmonary artery wedge pressure (PAWP) in response to sodium nitroprusside (SNP) during baseline right heart catheterization might be predictive of a favourable haemodynamic response to MitraClip in patients with FMR and PH. Among 22 patients enrolled, 13 had a positive response to SNP (responders), nine were non-responders. At 6-months follow-up, responders showed a 33% reduction in PAWP and a 25% reduction in mean pulmonary artery pressure (PAP) (P = 0.002 and 0.004, respectively); no significant change occurred in non-responders. In patients with FMR and PH, pre-procedural vasodilator challenge with SNP may help define patients who may have haemodynamic improvement after TEER.
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Affiliation(s)
| | - Andrea Munafò
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 1, 27100 Pavia, Italy
- University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Claudia Raineri
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 1, 27100 Pavia, Italy
| | - Giulia Magrini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 1, 27100 Pavia, Italy
| | - Romina Frassica
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 1, 27100 Pavia, Italy
| | - Luca Arzuffi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 1, 27100 Pavia, Italy
- University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Laura Scelsi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 1, 27100 Pavia, Italy
| | - Annalisa Turco
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 1, 27100 Pavia, Italy
| | - Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 1, 27100 Pavia, Italy
| | - Fabrizio Gazzoli
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 1, 27100 Pavia, Italy
| | - Maurizio Ferrario
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 1, 27100 Pavia, Italy
| | - Stefano Ghio
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 1, 27100 Pavia, Italy
| | - Luigi Oltrona-Visconti
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 1, 27100 Pavia, Italy
| | - Gabriele Crimi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 1, 27100 Pavia, Italy
- Interventional Cardiology Unit, Cardio-Thoraco Vascular Department (DICATOV), IRCCS Ospedale Policlinico San Martino, Genova, Italy
- IRCCS Italian Cardiovascular Network & Department of Internal Medicine, University of Genova, Genova, Italy
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11
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Montalto C, Munafò AR, Arzuffi L, Casula M, Mandurino-Mirizzi A, Costa F, Leonardi S, Visconti LO, Ferlini M. Validation of the ARC-HBR criteria in 68,874 patients undergoing PCI: A systematic review and meta-analysis. Hellenic J Cardiol 2022; 66:59-66. [PMID: 35550178 DOI: 10.1016/j.hjc.2022.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 02/26/2022] [Accepted: 04/27/2022] [Indexed: 11/25/2022] Open
Abstract
The Academic Research Consortium High Bleeding Risk (ARC-HBR) criteria aims to stratify patients undergoing percutaneous coronary intervention (PCI) and are now recommended by international guidelines to stratify bleeding risk in clinical practice. We searched electronic databases from 2019 (ARC-HBR proposal) up to February 2021 for studies that reported the occurrence of major bleedings according to ARC-HBR status in patients undergoing PCI and pooled them as relative risk (RR) in a random-effect analysis. Only studies that reported events according to the number of times the ARC-HBR definition was met were included in a sensitivity analysis and RR for each stratum was calculated. Nine studies and 68,874 subjects were included in our analysis; 39.2% of them were at HBR and they had a significantly higher risk of major bleedings (RR: 2.70; 95% CI: 2.35-3.10; p<0.0001). The ARC-HBR definition also had a moderate discriminative power (pooled c-stat: 0.69; 95% CI: 0.61-0.75) while calibration was suboptimal with a tendency toward underpredicting bleeding events (pooled observed:expected ratio: 1.47; 95% CI: 0.82-2.60). Our sensitivity analysis included 5 studies and 46,712 patients and confirmed the incremental, additive power of the ARC-HBR when it is met multiple times. Finally, among baseline characteristics explored, only presenting with an acute coronary syndrome had a significant impact on the ARC-HBR predictive ability. The ARC-HBR definition is a useful clinical tool, but with a tendency towards underpredicting major bleedings and its predictive ability might be optimized by including the number of times the definition is met.
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Affiliation(s)
- Claudio Montalto
- Department of Molecular Medicine, University of Pavia, Pavia, Italy; De Gasperis Cardio Center, Interventional Cardiology Unit, Niguarda Hospital, Milan, Italy. https://twitter.com/MdMontalto
| | | | - Luca Arzuffi
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Matteo Casula
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | | | - Francesco Costa
- Department of Clinical and Experimental Medicine, Policlinic "G. Martino", University of Messina, Messina, Italy. https://twitter.com/Costa_F_8
| | - Sergio Leonardi
- Department of Molecular Medicine, University of Pavia, Pavia, Italy; Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
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12
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Mandurino-Mirizzi A, Munafò A, Crimi G. Contrast-Associated Acute Kidney Injury. J Clin Med 2022; 11:jcm11082167. [PMID: 35456260 PMCID: PMC9027950 DOI: 10.3390/jcm11082167] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 02/27/2022] [Revised: 03/28/2022] [Accepted: 04/06/2022] [Indexed: 01/25/2023] Open
Abstract
Contrast-associated acute kidney injury (CA-AKI) is an impairment of renal function, which occurs within days of intravascular administration of iodinated contrast media. Taking into account that minimally invasive cardiac interventions are becoming increasingly popular, compared to traditional surgery, given their impact on prognosis and costs, CA-AKI remains a subject of increasing interest for patients and physicians. This review summarizes the epidemiology and risk stratification, diagnostic criteria, pathophysiology and clinical implications of CA-AKI, providing evidence for the most studied preventive strategies.
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Affiliation(s)
| | - Andrea Munafò
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (A.M.-M.); (A.M.)
| | - Gabriele Crimi
- Interventional Cardiology Unit, Cardio-Thoraco Vascular Department (DICATOV), IRCCS Ospedale Policlinico San Martino, 16100 Genova, Italy
- IRCCS Italian Cardiovascular Network & Department of Internal Medicine, University of Genova, 16100 Genova, Italy
- Correspondence: ; Tel.: +39-3479345112
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13
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Somaschini A, Casirati A, Cornara S, Demarchi A, Mandurino-Mirizzi A, Androulakis E, Lioudaki E. Extracorporeal veno-venous ultrafiltration in patients with acute heart failure. Rev Cardiovasc Med 2021; 22:1311-1322. [PMID: 34957772 DOI: 10.31083/j.rcm2204137] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/28/2021] [Accepted: 10/13/2021] [Indexed: 11/06/2022] Open
Abstract
Hospitalization for congestive heart failure represents a growing burden for health care systems. Heart failure is characterized by extracellular fluid overload and loop diuretics have been for decades the cornerstone of therapy in these patients. However, extensive use of intra-venous diuretics is characterised by several limitations: risk of worsening renal function and electrolyte imbalance, symptomatic hypotension and development of diuretic resistance. Extracorporealveno-venous ultrafiltration (UF) represents an interesting adjunctive therapy to target congestion in patients with heart failure and fluid overload. UF consists of the mechanical removal of iso-tonic plasma water from the blood through a semipermeable membrane using a pressure gradient generated by a pump. Fluid removal through UF presents several advantages such as removal of higher amount of sodium, predictable effect, limited neuro-hormonal activation, and enhanced spontaneous diuresis and diuretic response. After twenty years of "early" studies, since 2000 some pilot studies and randomized clinical trials with modern devices have been carried out with somehow conflicting results, as discussed in this review. In addition, some practical aspects of UF are addressed.
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Affiliation(s)
- Alberto Somaschini
- Division of Cardiology and Cardiac Intensive Care Unit, San Paolo Hospital, 17100 Savona, Italy
| | - Amanda Casirati
- Advanced Pediatrics and Child Health Program, University of Florence, 50121 Florence, Italy
| | - Stefano Cornara
- Division of Cardiology and Cardiac Intensive Care Unit, San Paolo Hospital, 17100 Savona, Italy
| | - Andrea Demarchi
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
| | | | - Emmanuel Androulakis
- Royal Brompton and Harefield Hospitals, Heart Imaging Centre, SW3 6NP, London, UK
| | - Eirini Lioudaki
- Renal Unit, King's College Hospital NHS Foundation Trust, SE5 9RS, London, UK
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14
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Mandurino-Mirizzi A, Crimi G, Raineri C, Magrini G, Gazzoli F, Frassica R, Gritti V, Montalto C, Scelsi L, Turco A, Ameri P, Ghio S, Ferrario M, Oltrona-Visconti L. Haemodynamic impact of MitraClip in patients with functional mitral regurgitation and pulmonary hypertension. Eur J Clin Invest 2021; 51:e13676. [PMID: 34487548 DOI: 10.1111/eci.13676] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 12/14/2022]
Affiliation(s)
- Alessandro Mandurino-Mirizzi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gabriele Crimi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Interventional Cardiology Unit, Cardio-Thoraco Vascular Department (DICATOV), IRCCS Ospedale Policlinico San Martino, Genova, Italy.,IRCCS Italian Cardiovascular Network & Department of Internal Medicine, University of Genova, Genova, Italy
| | - Claudia Raineri
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giulia Magrini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Fabrizio Gazzoli
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Romina Frassica
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valeria Gritti
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Claudio Montalto
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Laura Scelsi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Annalisa Turco
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Pietro Ameri
- Interventional Cardiology Unit, Cardio-Thoraco Vascular Department (DICATOV), IRCCS Ospedale Policlinico San Martino, Genova, Italy.,IRCCS Italian Cardiovascular Network & Department of Internal Medicine, University of Genova, Genova, Italy
| | - Stefano Ghio
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Maurizio Ferrario
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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15
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Montalto C, Russo FA, Uccello A, Carli S, Gazmawi R, Galazzi M, Tua L, Acquaro M, Ferlini M, Mandurino-Mirizzi A, Marinoni B, Gnecchi M, Costantino I, Oltrona-Visconti L, Leonardi S. Clinical utility of the academic research consortium new proposed criteria for high bleeding risk definition in patients with acute coronary syndromes. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1415] [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: 11/13/2022] Open
Abstract
Abstract
Background
The Academic Research Consortium High Bleeding Risk (ARC-HBR) criteria have been proposed to stratify the bleeding risk of patients undergoing percutaneous coronary intervention (PCI). While most criteria were established, 4 criteria have been proposed on a de novo basis.
Purpose
We assessed the prevalence and prognosis of new ARC-HBR criteria in a contemporary, prospective, multicenter, quality-improvement registry of all-comers patients with acute coronary syndromes.
Methods
Between 2016 and 2020, consecutive subjects were enrolled; baseline characteristics and medications were prospectively collected, and patients were followed-up at 1 year. All clinical events (including bleeding) were adjudicated by an independent committee. All 17 ARC-HBR criteria were individually evaluated by reviewing patients' charts.
Results
Of the 2804 patients enrolled, 782 (28.0%) met the ARC-HBR definition and 47 (6%) of them experienced a major BARC 3 or 5) bleeding at 1-year. HBR patients had a significantly higher risk of BARC 3–5 bleedings (HR for: 3.07; 95% CI: 2.02–4.67; p<0.0001; Fig. 1A), BARC 2–5 (HR: 1.845; 95% CI: 1.4–2.42; p<0.0001). Fig. 1B indicates the proportion of patients meeting each criterion. Age, (moderate or severe) chronic kidney disease, (moderate or severe) anemia and oral anticoagulant therapy included 88% of HBR patients.
The 4 new ARC-HBR criteria, all together, were present in only 1.7% of our population: 1.0% was planned for major surgery while on dual antiplatelet therapy, 0.5% had a recent intracranial hemorrhage/ictus or brain arteriovenous malformations, 0.1% had hepatic cirrhosis with portal hypertension and 0.1% had a recent surgery or trauma. In a multivariable Cox regression analysis including individual ARC-HBR criteria, only CKD (major and minor criteria), anemia (major and minor criteria) and cancer were the independent predictors of BARC 3–5 events with a concordance-index for this model of 0.698 (p<0.001). In a second model including only CKD (major criterion), anemia (major criterion), age and oral anticoagulation therapy, all these criteria were independent predictors of BARC 3–5 events with a concordance index of 0.674 (pmodel<0.001 for the model) (Fig. 2).
Conclusion
Almost one third of contemporary ACS patients was at HBR according to the ARC-HBR definition and these patients presented a significantly higher risk of bleedings at 1-year. The most common 4 criteria (age, CKD, anemia, and oral anticoagulant therapy) allowed the identification of 88% of HBR patients. The newly proposed HBR criteria were extremely rare and therefore challenging to validate and of uncertain clinical utility. These data may inform and simplify clinical decision making and provide priority for future directions of HBR definitions.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Affiliation(s)
| | | | | | - S Carli
- University of Pavia, Pavia, Italy
| | | | | | - L Tua
- University of Pavia, Pavia, Italy
| | | | - M Ferlini
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - A Mandurino-Mirizzi
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - B Marinoni
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | | | - I Costantino
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - L Oltrona-Visconti
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
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16
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Wang X, Montero-Cabezas JM, Mandurino-Mirizzi A, Hirasawa K, Ajmone Marsan N, Knuuti J, Bax JJ, Delgado V. Prevalence and Long-term Outcomes of Patients with Coronary Artery Ectasia Presenting with Acute Myocardial Infarction. Am J Cardiol 2021; 156:9-15. [PMID: 34344511 DOI: 10.1016/j.amjcard.2021.06.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 04/09/2021] [Revised: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 12/11/2022]
Abstract
Coronary artery ectasia (CAE) is described in 5% of patients undergoing coronary angiography. Previous studies have shown controversial results regarding the prognostic impact of CAE. The prevalence and prognostic value of CAE in patients with acute myocardial infarction (AMI) remain unknown. In 4788 patients presenting with AMI referred for coronary angiography the presence of CAE (defined as dilation of a coronary segment with a diameter ≥1.5 times of the adjacent normal segment) was confirmed in 174 (3.6%) patients (age 62 ± 12 years; 81% male), and was present in the culprit vessel in 79.9%. Multivessel CAE was frequent (67%). CAE patients were more frequently male, had high thrombus burden and were treated more often with thrombectomy and less often was stent implantation. Markis I was the most frequent angiographic phenotype (43%). During a median follow-up of 4 years (1-7), 1243 patients (26%) experienced a major adverse cardiovascular event (MACE): 282 (6%) died from a cardiac cause, 358 (8%) had a myocardial infarction, 945 (20%) underwent coronary revascularization and 58 (1%) presented with a stroke. Patients with CAE showed higher rates of MACE as compared to those without CAE (36.8% versus 25.6%; p <0.001). On multivariable analysis, CAE was associated with MACE (HR 1.597; 95% CI 1.238-2.060; p <0.001) after adjusting for risk factors, type of AMI and number of narrowed coronary arteries. In conclusion, the prevalence of CAE in patients presenting with AMI is relatively low but was independently associated with an increased risk of MACE at follow-up.
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Affiliation(s)
- Xu Wang
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | | | - Alessandro Mandurino-Mirizzi
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Division of Cardiology, Foundation IRCCS Policlinico San Matteo, Pavia, Italy
| | - Kensuke Hirasawa
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Juhani Knuuti
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
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17
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Mandurino-Mirizzi A, Kajana V, Cornara S, Somaschini A, Demarchi A, Galazzi M, Crimi G, Ferlini M, Camporotondo R, Gnecchi M, Ferrario M, Oltrona-Visconti L, De Ferrari GM. Elevated serum uric acid is a predictor of contrast associated acute kidney injury in patient with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Nutr Metab Cardiovasc Dis 2021; 31:2140-2143. [PMID: 34039505 DOI: 10.1016/j.numecd.2021.04.002] [Citation(s) in RCA: 3] [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: 02/03/2021] [Revised: 04/02/2021] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Contrast associated-acute kidney injury (CA-AKI) has been associated with adverse outcomes after ST-segment elevation myocardial infarction (STEMI). However, early markers of CA-AKI are still needed to improve risk stratification. We investigated the association between elevated serum uric acid (eSUA) and CA-AKI in patients with STEMI treated with primary percutaneous coronary intervention (pPCI). METHODS AND RESULTS Serum creatinine (Scr) was measured at admission and 24, 48 and 72 h after pPCI. CA-AKI was defined as an increase of 25% (CA-AKI 25%) or 0.5 mg/dl (CA-AKI 0.5) of Scr level above the baseline after 48 h following contrast administration. Multivariable analyses to investigate CA-AKI predictors were performed by binary logistic regression and multivariable backward logistic regression model. In the 3023 patients considered, CA-AKI was more frequent among patients with eSUA as compared with patients with normal SUA levels, considering both CA-AKI definitions (CA-AKI25%: 20.8% vs 16.2%, p < 0.012; CA-AKI 0.5: 10.1% vs 5.8%, p < 0.001). The association between eSUA and CA-AKI was confirmed at multivariable analyses (CA-AKI 25%: odd ratio 1.32, 95% CI 1.03-1.69, p = 0.027; CA-AKI 0.5: odd ratio 1.76, 95% CI 1.11-2.79, p = 0.016). CONCLUSION Elevated serum uric acid is associated with CA-AKI after reperfusion in patients with STEMI treated with pPCI.
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Affiliation(s)
- Alessandro Mandurino-Mirizzi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Vilma Kajana
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Stefano Cornara
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alberto Somaschini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Demarchi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marco Galazzi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gabriele Crimi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Cardio-Thoraco-Vascular Department, Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Rita Camporotondo
- Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Massimiliano Gnecchi
- University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Maurizio Ferrario
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Gaetano M De Ferrari
- University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Cardio-Thoraco-Vascular Department, Ospedale Policlinico San Martino IRCCS, Genova, Italy
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18
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Demarchi A, Cornara S, Somaschini A, Fortuni F, Mandurino-Mirizzi A, Crimi G, Ferlini M, Gnecchi M, De Servi S, Visconti LO, De Ferrari GM. Has hyperglycemia a different prognostic role in STEMI patients with or without diabetes? Nutr Metab Cardiovasc Dis 2021; 31:528-531. [PMID: 33223396 DOI: 10.1016/j.numecd.2020.09.005] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 08/07/2020] [Accepted: 09/01/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS Hyperglycemia at hospital admission is a common finding in patients with STEMI. However, whether elevated acute glycemia in these patients may have a direct impact on worsening prognosis or is just a marker of a greater neurohormonal activation in response to the infarction is still unsettled. We sought to investigate the prognostic impact of hyperglycemia at hospital admission in patients undergoing primary PCI (pPCI) for STEMI, and the influence of the presence of diabetes mellitus (DM) on its prognostic impact. METHODS and Results, We enrolled 2958 consecutive STEMI patients treated by pPCI. Hyperglycemia was defined as plasma glucose >198 mg/dL (or >11 mmol/L). Patients with hyperglycemia showed a greater risk-profile; they also experienced a higher mortality both at univariable (17.6% vs 5.2%, p < 0.001) and multivariable (HR 1.9, 95%IC 1.5-2.9, p = 0.001) analysis. However, after stratification for DM presence, hyperglycemia resulted as an independent predictor of mortality only in patients without DM (HR 2, 95%IC 1.2-3.4, p = 0.01). CONCLUSION Hyperglycemia in the setting of myocardial infarction treated with primary PCI in an independent predictor of all-cause mortality in patients without diabetes; in patients with diabetes, its prognostic impact seems attenuated.
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Affiliation(s)
- Andrea Demarchi
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, Unit of Cardiology, Università degli studi di Pavia, Pavia, Italy; Cardiocentro Ticino, Lugano, Switzerland.
| | - Stefano Cornara
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, Unit of Cardiology, Università degli studi di Pavia, Pavia, Italy
| | - Alberto Somaschini
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, Unit of Cardiology, Università degli studi di Pavia, Pavia, Italy
| | - Federico Fortuni
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, Unit of Cardiology, Università degli studi di Pavia, Pavia, Italy
| | - Alessandro Mandurino-Mirizzi
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, Unit of Cardiology, Università degli studi di Pavia, Pavia, Italy
| | - Gabriele Crimi
- Interventional Cardiology Unit, Cardio Thoraco Vascular Department (DICATOV), Genova, Italy
| | - Marco Ferlini
- Fondazione IRCCS Policlinico San Matteo, Division of cardiology, Pavia, Italy
| | - Massimiliano Gnecchi
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, Unit of Cardiology, Università degli studi di Pavia, Pavia, Italy; Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | | | - Gaetano Maria De Ferrari
- Ospedale "Città della Salute e della Scienza di Torino", Division of Cardiology and Department of Medical Sciences, University of Torino, Italy
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Mandurino-Mirizzi A, Cornara S, Somaschini A, Demarchi A, Galazzi M, Puccio S, Montalto C, Crimi G, Ferlini M, Camporotondo R, Gnecchi M, Ferrario M, Oltrona-Visconti L, De Ferrari GM. Elevated serum uric acid is associated with a greater inflammatory response and with short- and long-term mortality in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Nutr Metab Cardiovasc Dis 2021; 31:608-614. [PMID: 33358717 DOI: 10.1016/j.numecd.2020.10.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 04/22/2020] [Revised: 09/18/2020] [Accepted: 10/23/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND AIMS Despite elevated serum uric acid (eSUA) has been identified as independent risk factor for cardiovascular diseases, its prognostic value in the setting of ST-segment elevation myocardial infarction (STEMI) is still controversial. Although the mechanisms of this possible relationship are unsettled it has been suggested that eSUA could trigger the inflammatory response. This study sought to investigate the association between eSUA with short- and long-term mortality and with inflammatory response in patients with STEMI treated with primary percutaneous coronary intervention (pPCI). METHODS AND RESULTS Blood samples were collected on admission and at 24 and 48 h after pPCI: the inflammatory biomarkers C-reactive protein (CRP), neutrophil count and neutrophil to lymphocytes ratio (NLR) were considered. Baseline eSUA was defined as ≥6.8 mg/dl. Cumulative 30-days and 1-year mortalities were estimated using the Kaplan-Meyer analysis. Multivariable analyses were performed by Cox proportional hazard models. In the 2369 patients with STEMI considered, 30-day mortality was 5.8% among patients with eSUA and 2% among patient with normal SUA level (p < 0.001); 1-year mortality was 8.5% vs 4%, respectively (p < 0.001). At multivariable analyses eSUA was an independent predictor of 30-day mortality (HR 1.196, 95%CI 1.006-1.321, p = 0.042) and 1-year mortality (HR 1.178, 95%CI 1.052-1.320, p = 0.005). eSUA patients presented higher values in on admission CRP (p < 0.001) and in neutrophil count and NLR at 24 h (respectively, p = 0.020 and p < 0.001) and at 48 h (p = 0.018 and p < 0.001) compared to patients with normal SUA levels. CONCLUSIONS Elevated serum uric acid is associated with higher short- and long-term mortality and with a greater inflammatory response after reperfusion in patients with STEMI treated with primary PCI.
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Affiliation(s)
- Alessandro Mandurino-Mirizzi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Stefano Cornara
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alberto Somaschini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Demarchi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marco Galazzi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sebastiano Puccio
- University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Claudio Montalto
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gabriele Crimi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Rita Camporotondo
- Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Massimiliano Gnecchi
- University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Maurizio Ferrario
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Gaetano M De Ferrari
- University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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20
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Mandurino-Mirizzi A, Tua L, Arzuffi L, Demarchi A, Somaschini A, Tournas G, Crimi G, Androulakis E, Briasoulis A, Cornara S. Transcatheter mitral valve repair with MitraClip in patients with pulmonary hypertension: hemodynamic and prognostic perspectives. Rev Cardiovasc Med 2021; 22:33-38. [PMID: 33792246 DOI: 10.31083/j.rcm.2021.01.214] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 11/06/2022] Open
Abstract
Transcatheter mitral valve repair with MitraClip has emerged as a possible therapeutic option for patients with severe mitral regurgitation (MR) with high risk for surgical valve repair. MitraClip intervention has demonstrated to improve haemodynamics and clinical outcomes in selected patients in observational and randomized studies. Preoperative pulmonary hypertension (PH) is known to affect prognosis in patients undergoing surgical mitral valve intervention. The aim of the present review is to discuss the available literature focused on the haemodynamic and clinical effects of MitraClip in patients with severe MR and PH.
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Affiliation(s)
| | - Lorenzo Tua
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo and University of Pavia, 27100 Pavia, Italy
| | - Luca Arzuffi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo and University of Pavia, 27100 Pavia, Italy
| | - Andrea Demarchi
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
| | - Alberto Somaschini
- Division of Cardiology and Cardiac Intensive Care Unit, San Paolo Hospital, 17100 Savona, Italy
| | | | - Gabriele Crimi
- Interventional Cardiology Unit, Cardio-Thoraco Vascular Department (DICATOV), IRCCS Ospedale Policlinico San Martino, Genova, Italy; IRCCS Italian Cardiovascular Network & Department of Internal Medicine, University of Genova, 16122 Genova, Italy
| | - Emmanuel Androulakis
- National Kapodistrian University of Athens, Medical School, 106 71 Athens, Greece
| | - Alexandros Briasoulis
- University of Iowa, Section of Advanced Heart Failure and Transplantation, Iowa City, IA 52242, USA
| | - Stefano Cornara
- Division of Cardiology and Cardiac Intensive Care Unit, San Paolo Hospital, 17100 Savona, Italy
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21
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Montalto C, Ferlini M, Casula M, Mandurino-Mirizzi A, Costa F, Leonardi S, Oltrona Visconti L. DAPT Score to Stratify Ischemic and Bleeding Risk after Percutaneous Coronary Intervention: An Updated Systematic Review, Meta-Analysis, and Meta-Regression of 100,211 Patients. Thromb Haemost 2020; 121:687-689. [PMID: 33212543 DOI: 10.1055/s-0040-1721145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Claudio Montalto
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Clinical and Experimental Medicine, Policlinic "G. Martino," University of Messina, Messina, Italy
| | - Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Matteo Casula
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Francesco Costa
- Department of Clinical and Experimental Medicine, Policlinic "G. Martino," University of Messina, Messina, Italy
| | - Sergio Leonardi
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
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22
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Mandurino-Mirizzi A, Demarchi A, Ruffinazzi M, Cornara S, Somaschini A, Crimi G, Ferlini M, Camporotondo R, Gnecchi M, Ferrario M, Oltrona Visconti L, De Ferrari GM. Serum uric acid may modulate the inflammatory response after primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction. J Cardiovasc Med (Hagerstown) 2020; 21:337-339. [PMID: 31977536 DOI: 10.2459/jcm.0000000000000926] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
| | - Andrea Demarchi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo.,University of Pavia
| | - Marta Ruffinazzi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo.,University of Pavia
| | - Stefano Cornara
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo.,University of Pavia
| | - Alberto Somaschini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo.,University of Pavia
| | - Gabriele Crimi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo
| | - Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo
| | - Rita Camporotondo
- Coronary care unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Massimiliano Gnecchi
- University of Pavia.,Coronary care unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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23
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Montalto C, Morici N, Munafò AR, Mangieri A, Mandurino-Mirizzi A, D’Ascenzo F, Oreglia J, Latib A, Porto I, Colombo A, Savonitto S, De Servi S, Crimi G. Optimal P2Y12 inhibition in older adults with acute coronary syndromes: a network meta-analysis of randomized controlled trials. European Heart Journal - Cardiovascular Pharmacotherapy 2020; 8:20-27. [DOI: 10.1093/ehjcvp/pvaa101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/22/2020] [Accepted: 08/18/2020] [Indexed: 12/26/2022]
Abstract
Abstract
Aims
Dual antiplatelet therapy (DAPT) with a P2Y12 inhibitor on top of aspirin is the cornerstone of therapy after acute coronary syndromes (ACS). Nonetheless, the safest and most efficacious P2Y12 for older patients who are both at high ischaemic and bleeding risk remains uncertain. We aimed to examine the effect of available P2Y12 inhibitors on ischaemic and bleeding endpoints in older adults with ACS.
Methods and results
Randomized clinical trials that reported separately the results of adults older >70 years for at least the primary endpoint [composite of death, myocardial infarction (MI), and stroke]. Seven studies (14 485 patients-years) were included. Network meta-analysis showed that prasugrel was associated with similar occurrence of the primary endpoint and of a secondary ischaemic endpoint (composite of MI and stroke) and was most likely the best treatment [Surface Under the Cumulative Ranking curve Analysis (SUCRA) 54.5 and 59.8, respectively]. With regards to major bleedings, clopidogrel showed the highest likelihood of event reduction (SUCRA 70.1%), while ticagrelor of stent thrombosis (SUCRA 55.6%). Our meta-regression with a fixed proportion of patients managed invasively of 100% confirmed these trends with increasing SUCRA.
Conclusion
Among older subjects with ACS, DAPT should be balanced upon ischaemic and bleeding risks as prasugrel is associated with the highest probability of reduction of ischaemic events and clopidogrel of bleedings. Ticagrelor had highest SUCRA for stent thrombosis reduction but seems suboptimal in older adults.
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Affiliation(s)
- Claudio Montalto
- Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, Pavia, Italy
- Department of Molecular Medicine, University of Pavia, C. Strada Nuova 65, Pavia, Italy
| | - Nuccia Morici
- Dipartimento Cardio-toracovascolare, SS UTIC/ SC Cardiologia 1-Emodinamica, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, Milan, Italy
| | - Andrea Raffaele Munafò
- Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, Pavia, Italy
- Department of Molecular Medicine, University of Pavia, C. Strada Nuova 65, Pavia, Italy
| | - Antonio Mangieri
- GVM Care and Research, Maria Cecilia Hospital, Via Corriera 1, Cotignola, Ravenna, Italy
| | | | - Fabrizio D’Ascenzo
- Division of Cardiology, Department of Medical Sciences, University of Turin, Corso Dogliotti, Turin, Italy
| | - Jacopo Oreglia
- Dipartimento Cardio-toracovascolare, SS UTIC/ SC Cardiologia 1-Emodinamica, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, Milan, Italy
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, 111 E 210th St, The Bronx, NY, USA
| | - Italo Porto
- Interventional Cardiology Unit, Cardio Thoraco Vascular Department (DICATOV), IRCCS Policlinico San Martino, Genova, Italy
- IRCCS Italian Cardiovascular Network, Italy
| | - Antonio Colombo
- GVM Care and Research, Maria Cecilia Hospital, Via Corriera 1, Cotignola, Ravenna, Italy
| | - Stefano Savonitto
- Department of Cardiology, A. Manzoni Hospital, Via dell'Eremo, 9/11, Lecco, Italy
| | - Stefano De Servi
- Department of Molecular Medicine, University of Pavia, C. Strada Nuova 65, Pavia, Italy
| | - Gabriele Crimi
- Interventional Cardiology Unit, Cardio Thoraco Vascular Department (DICATOV), IRCCS Policlinico San Martino, Genova, Italy
- IRCCS Italian Cardiovascular Network, Italy
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24
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Crimi G, Montalto C, Ferri LA, Piatti L, Bossi I, Morici N, Mandurino-Mirizzi A, Grosseto D, Tortorella G, Savonitto S, De Servi S. Clinical Impact of Valvular Heart Disease in Elderly Patients Admitted for Acute Coronary Syndrome: Insights From the Elderly-ACS 2 Study. Can J Cardiol 2020; 36:1104-1111. [DOI: 10.1016/j.cjca.2019.11.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/05/2019] [Accepted: 11/15/2019] [Indexed: 11/16/2022] Open
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25
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Crimi G, De Rosa R, Mandurino-Mirizzi A, Morici N, Alberti LP, Savonitto S, De Servi S. De-escalating dual antiplatelet therapy in patients with acute coronary syndromes: the right strategy to harmonize time-dependent ischemic and bleeding risk in elderly patients? J Cardiovasc Med (Hagerstown) 2020; 21:281-285. [PMID: 32108125 DOI: 10.2459/jcm.0000000000000929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
: The European Society of Cardiology guidelines for myocardial revascularization state that de-escalation of P2Y12 inhibitor treatment guided by platelet function testing may be considered for acute coronary syndrome (ACS) patients deemed unsuitable for 12-month potent platelet inhibition. De-escalation strategy aim is to harmonize the time-dependency of thrombotic risk, which is high in the first month after ACS, then decreases exponentially, with bleeding risk, which tends to remain more stable after the procedure-related peak. Harmonizing time-dependency of clinical events may be particularly relevant in those at high risk, such as the elderly patients with ACS in whom an individualized antiplatelet therapy may be more appropriate than a 'one-size-fits all' approach. In this review, we outline the current medical evidence on the topic of dual antiplatelet therapy de-escalation. In addition, we include insights from the Elderly ACS 2 study and recently published post-hoc analyses conducted by the authors' consortium, which further expands current knowledge.
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Affiliation(s)
- Gabriele Crimi
- SC. Cardiologia, Fondazione Policlinico San Matteo, Pavia.,Cardiologia Interventistica, Dipartimento CardioToracoVascolare, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Roberta De Rosa
- Department of Medicine, Surgery and Dentistry, Schola Medica Salernitana, University of Salerno
| | | | - Nuccia Morici
- Intensive Cardiac Care Unit and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan
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26
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Somaschini A, Cornara S, Demarchi A, Mandurino-Mirizzi A, Baldi E, Ferlini M, Crimi G, Camporotondo R, Gnecchi M, Oltrona Visconti L, De Ferrari GM. The unfavourable inflammatory response in elderly patients after myocardial infarction: should we talk of 'dysflammaging'? J Cardiovasc Med (Hagerstown) 2020; 21:340-342. [PMID: 31972747 DOI: 10.2459/jcm.0000000000000925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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)
- Alberto Somaschini
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology - Fondazione IRCCS Policlinico San Matteo.,Department of Molecular Medicine, Unit of Cardiology, Università degli studi di Pavia, Pavia, Italy
| | - Stefano Cornara
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology - Fondazione IRCCS Policlinico San Matteo.,Department of Molecular Medicine, Unit of Cardiology, Università degli studi di Pavia, Pavia, Italy
| | - Andrea Demarchi
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology - Fondazione IRCCS Policlinico San Matteo.,Department of Molecular Medicine, Unit of Cardiology, Università degli studi di Pavia, Pavia, Italy
| | - Alessandro Mandurino-Mirizzi
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology - Fondazione IRCCS Policlinico San Matteo.,Department of Molecular Medicine, Unit of Cardiology, Università degli studi di Pavia, Pavia, Italy
| | - Enrico Baldi
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology - Fondazione IRCCS Policlinico San Matteo.,Department of Molecular Medicine, Unit of Cardiology, Università degli studi di Pavia, Pavia, Italy
| | - Marco Ferlini
- Division of Cardiology - Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Gabriele Crimi
- Division of Cardiology - Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Rita Camporotondo
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology - Fondazione IRCCS Policlinico San Matteo
| | - Massimiliano Gnecchi
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology - Fondazione IRCCS Policlinico San Matteo.,Department of Molecular Medicine, Unit of Cardiology, Università degli studi di Pavia, Pavia, Italy
| | | | - Gaetano M De Ferrari
- Division of Cardiology, Città della Salute e della Scienza Hospital, Department of Medical Sciences, University of Torino, Torino, Italy
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27
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Somaschini A, Cornara S, Demarchi A, Mandurino-Mirizzi A, Fortuni F, Crimi G, Ferlini M, Camporotondo R, Gnecchi M, Visconti LO, De Ferrari GM. Neutrophil to platelet ratio: A novel prognostic biomarker in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. Eur J Prev Cardiol 2019; 27:2338-2340. [PMID: 31841054 DOI: 10.1177/2047487319894103] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 01/25/2023]
Affiliation(s)
- Alberto Somaschini
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology - Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Molecular Medicine, Unit of Cardiology, University of Pavia, Pavia, Italy
| | - Stefano Cornara
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology - Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Molecular Medicine, Unit of Cardiology, University of Pavia, Pavia, Italy
| | - Andrea Demarchi
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology - Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Molecular Medicine, Unit of Cardiology, University of Pavia, Pavia, Italy
| | - Alessandro Mandurino-Mirizzi
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology - Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Molecular Medicine, Unit of Cardiology, University of Pavia, Pavia, Italy
| | - Federico Fortuni
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology - Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Molecular Medicine, Unit of Cardiology, University of Pavia, Pavia, Italy
| | - Gabriele Crimi
- Division of Cardiology - Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marco Ferlini
- Division of Cardiology - Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Rita Camporotondo
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology - Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Massimiliano Gnecchi
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology - Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Molecular Medicine, Unit of Cardiology, University of Pavia, Pavia, Italy
| | | | - Gaetano M De Ferrari
- Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Italy
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Montalto C, Crimi G, Mandurino-Mirizzi A, Frassica R, Gazzoli F, Covi R, Moschella M, Ghio S, Magrini G, Raineri C, Pelenghi S, Ferrario M, De Ferrari GM, Oltrona-Visconti L. P1856Percutaneous mitral edge-to-edge valvuloplasty in end-stage heart failure as a bridge to heart transplant: a case series from a single tertiary referral center. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0607] [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: 11/13/2022] Open
Abstract
Abstract
Background
Improved outcomes after percutaneous edge-to-edge mitral valvuloplasthy with MitraClip implantation were recently observed in patients with heart failure (HF) and functional severe mitral regurgitation (MR). Nonetheless, its efficacy in end-stage heart failure (HF) are lacking.
Purpose
Our aim was to investigate feasibility, preliminary efficacy on hemodynamics and follow-up of MitraClip implantation in a cohort of patients with very advanced HF.
Methods
Patients were retrospectively included in the present analysis if already in HT list, unsuitable for HT despite optimal medical and device therapy, or if implantation was a “bridge-to-candidacy”.
Results
Baseline and procedural characteristics are listed in Table 1; MR etiology was predominantly functional (n=7). No major complications were observed in the peri-operative period. At 6-month follow-up, invasive hemodynamics was available for 8 patients. A significant increase in cardiac index was observed (Least Square Mean Difference, LSMD = +0.47 L/min/m2; p=0.03; Figure 1), in conjunction with a numerical reduction in pulmonary vascular resistance (LSMD = −1.02 WU; p=0.3), a trend towards lower mean pulmonary arterial pressure (LSMD = −6.5 mmHg; p=0.053) and lower ejection fraction (LSMD = −6.5%; p=0.053). At a median follow-up of 772 days (IQR 156–1,578), all three patients unsuitable for HT at baseline could be eligible to HT list and one of them received LVAD. Moreover, two patients were transplanted, four experienced unplanned rehospitalization for HF, and one died of non-cardiac cause.
Table 1. Baseline clinical evaluation (n=10) Age (y) 53.67±8.43 HF Etiology – post ischemic 4 (40) Male sex 6 (60) HF Etiology – no CAD 4 (40) Body Surface Area (m2) 1.76±0.22 HF Etiology – other 2 (20) Chronic Resynchronization Therapy 5 (50) Euroscore II 6.00±2.74 Baseline MR grade (+) 4 (40) STS mortality 1.71±2.65 Residual MR grade (+) 1.71±0.49 Clips implanted (number) 1.78±0.67 Data are expressed as mean ± SD or count (valid %). MR scored on a scale from 0+ to 4+. STS, Society of Thoracic Surgeons.
Figure 1
Conclusions
Percutaneous edge-to-edge mitral valvuloplasty with MitraClip appears safe and effective in end-stage patients, impacts on clinical decision-making and therefore might be considered as a “bridge” towards a more definite strategy.
Acknowledgement/Funding
None
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Affiliation(s)
- C Montalto
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - G Crimi
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - A Mandurino-Mirizzi
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - R Frassica
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - F Gazzoli
- Policlinic Foundation San Matteo IRCCS, Division of Cardiac Surgery, Pavia, Italy
| | - R Covi
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - M Moschella
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - S Ghio
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - G Magrini
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - C Raineri
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - S Pelenghi
- Policlinic Foundation San Matteo IRCCS, Division of Cardiac Surgery, Pavia, Italy
| | - M Ferrario
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - G M De Ferrari
- Policlinic Foundation San Matteo IRCCS, Coronary Care Unit, Pavia, Italy
| | - L Oltrona-Visconti
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
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Crimi G, Mandurino-Mirizzi A, Gritti V, Scotti V, Strozzi C, de Silvestri A, Montalto C, di Giacomo C, d'Ascenzo F, Repetto A, Ferlini M, Marinoni B, Ferrario M, de Servi S, Visconti LO, Klersy C. Percutaneous Coronary Intervention Techniques for Bifurcation Disease: Network Meta-analysis Reveals Superiority of Double-Kissing Crush. Can J Cardiol 2019; 36:906-914. [PMID: 31924454 DOI: 10.1016/j.cjca.2019.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 09/05/2019] [Accepted: 09/05/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Provisional T-stenting (PS) is generally recommended to treat patients with coronary bifurcation disease (CBD) percutaneously, but PS may not fit all complex bifurcation anatomies. Therefore, several types of up-front 2-stent techniques have been described. We aimed to identify the best percutaneous coronary intervention (PCI) technique to manage patients with CBD. METHODS We systematically reviewed randomized controlled trials (RCTs) including patients undergoing CBD PCI which included several types of PCI techniques-PS, double-kissing (DK) crush, T-stenting and protrusion, culotte, dedicated bifurcation stents, crushing, and T-stenting-and we compared device-oriented clinical events (DOCEs), a composite of cardiac death, target-vessel myocardial infarction, stent thrombosis, and target-lesion or target-vessel revascularization, in a network meta-analysis. We included 26 RCTs, leading to a pooled population of 10,339 patient-years and a total of 1229 DOCEs. RESULTS The DK-crush technique was associated with the lowest DOCE rate, with a relative risk of 0.62 (95% CI 0.42-0.92) compared with the PS technique. DK-crush had the highest probability (model likelihood 90.2%, area under the cumulative ranking curve 98.0%) of being the best technique among those explored to reduce DOCEs in patients receiving CBD PCI. CONCLUSIONS When a 2-stent strategy is considered in a patient with CBD, the DK-crush technique reduces DOCEs compared with other bifurcation techniques based on all available RCTs.
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Affiliation(s)
- Gabriele Crimi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Alessandro Mandurino-Mirizzi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; University of Pavia, Pavia, Italy
| | - Valeria Gritti
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valeria Scotti
- Centre for Scientific Documentation, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Annalisa de Silvestri
- Service of Clinical Epidemiology and Biostatistic, Fondazione IRCCS Policlinico san Matteo, Pavia, Italy
| | - Claudio Montalto
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; University of Pavia, Pavia, Italy
| | - Ciro di Giacomo
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; University of Pavia, Pavia, Italy
| | - Fabrizio d'Ascenzo
- Division of Cardiology, Città Della Salute e Della Scienza, Turin, Italy
| | - Alessandra Repetto
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Barbara Marinoni
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Maurizio Ferrario
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | | | - Catherine Klersy
- Service of Clinical Epidemiology and Biostatistic, Fondazione IRCCS Policlinico san Matteo, Pavia, Italy
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Calogiuri G, Nettis E, Mandurino-Mirizzi A, Di Leo E, Macchia L, Foti C, Vacca A, Kounis NG. Omalizumab for the Treatment of Persistent Drug Induced Urticaria Elicited by Thienopyridines: A Case Report. Antiinflamm Antiallergy Agents Med Chem 2019; 19:335-339. [PMID: 31113348 DOI: 10.2174/1871523018666190522105055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/30/2019] [Accepted: 04/30/2019] [Indexed: 11/22/2022]
Abstract
The anti-IgE Omalizumab may be helpful to treat clopidogrel hypersensitivity without stopping thienopyridine administration in patients requirining continuous antiplatellet therapy after coronary stent placement.
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Affiliation(s)
- Gianfranco Calogiuri
- Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immunology, University of Bari Aldo Moro, Bari, Italy
| | - Eustachio Nettis
- Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immunology, University of Bari Aldo Moro, Bari, Italy
| | | | - Elisabetta Di Leo
- Section of Allergy and Clinical Immunology, Unit of Internal Medicine-"F. Miulli" Hospital, Acquaviva Delle Fonti, Bari, Italy
| | - Luigi Macchia
- Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immunology, University of Bari Aldo Moro, Bari, Italy
| | - Caterina Foti
- Department of Biomedical Science and Human Oncology, Dermatological Clinic, University of Bari, 70124 Bari, Italy
| | - Angelo Vacca
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine, University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Nicholas G Kounis
- Department of Cardiology, University of Patras Medical School, Patras, Greece
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Mandurino-Mirizzi A, Crimi G, Raineri C, Pica S, Ruffinazzi M, Gianni U, Repetto A, Ferlini M, Marinoni B, Leonardi S, De Servi S, Oltrona Visconti L, De Ferrari GM, Ferrario M. Elevated serum uric acid affects myocardial reperfusion and infarct size in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. J Cardiovasc Med (Hagerstown) 2018; 19:240-246. [PMID: 29470249 DOI: 10.2459/jcm.0000000000000634] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
AIMS Elevated serum uric acid (eSUA) was associated with unfavorable outcome in patients with ST-segment elevation myocardial infarction (STEMI). However, the effect of eSUA on myocardial reperfusion injury and infarct size has been poorly investigated. Our aim was to correlate eSUA with infarct size, infarct size shrinkage, myocardial reperfusion grade and long-term mortality in STEMI patients undergoing primary percutaneous coronary intervention. METHODS We performed a post-hoc patients-level analysis of two randomized controlled trials, testing strategies for myocardial ischemia/reperfusion injury protection. Each patient underwent acute (3-5 days) and follow-up (4-6 months) cardiac magnetic resonance. Infarct size and infarct size shrinkage were outcomes of interest. We assessed T2-weighted edema, myocardial blush grade (MBG), corrected Thrombolysis in myocardial infarction Frame Count, ST-segment resolution and long-term all-cause mortality. RESULTS A total of 101 (86.1% anterior) STEMI patients were included; eSUA was found in 16 (15.8%) patients. Infarct size was larger in eSUA compared with non-eSUA patients (42.3 ± 22 vs. 29.1 ± 15 ml, P = 0.008). After adjusting for covariates, infarct size was 10.3 ml (95% confidence interval 1.2-19.3 ml, P = 0.001) larger in eSUA. Among patients with anterior myocardial infarction the difference in delayed enhancement between groups was maintained (respectively, 42.3 ± 22.4 vs. 29.9 ± 15.4 ml, P = 0.015). Infarct size shrinkage was similar between the groups. Compared with non-eSUA, eSUA patients had larger T2-weighted edema (53.8 vs. 41.2 ml, P = 0.031) and less favorable MBG (MBG < 2: 44.4 vs. 13.6%, P = 0.045). Corrected Thrombolysis in myocardial infarction Frame Count and ST-segment resolution did not significantly differ between the groups. At a median follow-up of 7.3 years, all-cause mortality was higher in the eSUA group (18.8 vs. 2.4%, P = 0.028). CONCLUSION eSUA may affect myocardial reperfusion in patients with STEMI undergoing percutaneous coronary intervention and is associated with larger infarct size and higher long-term mortality.
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Affiliation(s)
- Alessandro Mandurino-Mirizzi
- Division of Cardiology.,School of Cardiovascular Disease, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia
| | | | | | - Silvia Pica
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, Milan
| | - Marta Ruffinazzi
- School of Cardiovascular Disease, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Umberto Gianni
- Division of Cardiology.,School of Cardiovascular Disease, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia
| | | | | | | | - Sergio Leonardi
- Cardiac Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia
| | | | | | - Gaetano M De Ferrari
- School of Cardiovascular Disease, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia.,Cardiac Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia
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Calogiuri G, Mandurino-Mirizzi A, Parlangeli C, Macchia L, Foti C, Savage MP. Comparing Allergist and Cardiologist Considerations for the Optimal Management of Thienopyridines Hypersensitivity. Endocr Metab Immune Disord Drug Targets 2018; 19:2-12. [PMID: 30215337 DOI: 10.2174/1871530318666180914121758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/26/2017] [Revised: 04/30/2018] [Accepted: 06/21/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVE The thienopyridine family includes ticlopidine, clopidogrel and prasugrel which are antiplatelet drugs largely used, mainly associated to aspirin, for treatment of acute coronary syndromes and after percutaneous coronary interventions, to avoid thrombosis. In some patients, thienpyridines may cause hypersensitivity reactions which jeopardize the optimal therapeutic and preventive approach to vascular diseases. The management of thienopyridine hypersensitivity seems to be best done as an interdisciplinary collaboration between the allergist and cardiologist. METHOD The present study investigates the management of thienopyridines hypersensitivity on the basis of published case reports and studies, comparing the pro and contro of pharmacological treatments, different desensitization protocols to thienopyridines and substitution of antiplatelet agents eaches others, according to the point of view of cardiologist and allergist. For the cardiologist, the important issues are the necessity of continuing therapy, the desired duration of therapy based on the clinical indication of the individual patient and appropriateness of using one of the alternative P2Y12 inhibitors. For the allergist, the important issues are weighing the risk and benefits of the various therapeutic options: treating "through" desensitization, or switching to an alternative agent. RESULTS AND CONCLUSION All the data seem to suggest that only working together, a cardio-allergy team of specialists may evaluate and offer the best approach to clinical decision-making for the individual patient.
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Affiliation(s)
- Gianfanco Calogiuri
- Pneumology and Allergy Department - Civil Hospital "Sacro Cuore" Gallipoli, Lecce, Italy.,Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immunology, University of Bari Aldo Moro, Bari, Italy
| | | | - Claudio Parlangeli
- Cardiology Intensive Care Unit - Civil Hospital San Giuseppe da Copertino - Copertino Lecce, Italy
| | - Luigi Macchia
- Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immunology, University of Bari Aldo Moro, Bari, Italy
| | - Caterina Foti
- Department of Biomedical Science and Human Oncology, Dermatological Clinic, University of Bari, 70124 Bari, Italy
| | - Michael P Savage
- Department of Medicine, Jefferson Angioplasty Center, Thomas Jefferson University Hospital, Philadelphia, United States
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Demarchi A, Mandurino-Mirizzi A, Ruffinazzi M, Crimi G, Ravera A, Ferlini M, Camporotondo R, De Ferrari G. P1796Inflammatory response and myocardial reperfusion in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1796] [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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Leonardi S, Saturi G, Arpellini M, Repetto A, Camporotondo R, Ferlini M, Mandurino-Mirizzi A, Mauri S, Ottani F, Castelli C, Barengo A, Raisaro A, Ferrario M, Oltrona-Visconti L, De Ferrari G. P3019Blood transfusions and high haemoglobin thresholds for transfusion are associated with increased mortality in patients with acute coronary syndrome. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3019] [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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Somaschini A, Demarchi A, Cornara S, Ferlini M, Crimi G, Ravera A, Mandurino-Mirizzi A, Camporotondo R, Oltrona Visconti L, De Ferrari G, De Servi S. P1756Vagal activity reduces inflammatory response in patients with STEMI treated with primary PCI and GPIIbIIIa inhibitors. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1756] [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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Demarchi A, Somaschini A, Cornara S, Ferlini M, Ravera A, Mandurino-Mirizzi A, Camporotondo R, Ferrario Ormezzano M, Oltrona Visconti L, De Ferrari G. P3440Inflammation and microvascular dysfunction in elderly patients with ST elevation acute myocardial infarction treated with primary PCI. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3440] [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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Mandurino-Mirizzi A, Leonardi S, Melloni C. Concomitant use of proton pump inhibitors and dual antiplatelet therapy for cardiovascular outcomes. MINERVA ENDOCRINOL 2016; 42:228-237. [PMID: 27808485 DOI: 10.23736/s0391-1977.16.02571-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
INTRODUCTION The aim of this review is to discuss the consequences of potential pharmacokinetic interactions between proton pump inhibitors (PPIs) and antiplatelet therapy on cardiovascular (CV) outcomes and provide guidance on the management of concomitant use of PPIs in patients on dual antiplatelet therapy (DAPT). EVIDENCE ACQUISITION DAPT combining aspirin and oral P2Y12 receptor inhibitors increases the risk of gastrointestinal (GI) bleeding, with higher rates of morbidity and mortality in patients undergoing percutaneous coronary intervention (PCI). PPIs are recommended in patients at risk of bleeding to reduce the risk of GI hemorrhage. PPIs can reduce the metabolism of clopidogrel by competing with CYP450 enzymes, mostly CYP2C19 isoform. The clinical significance of this pharmacological interaction is not uniform in observational studies. The only randomized clinical trial assessing the clinical relevance of clopidogrel-omeprazole interaction showed that the use of omeprazole was associated with a reduction in GI bleeding, without any differences in CV outcomes. EVIDENCE SYNTHESIS Several systematic reviews and meta-analyses suggest an increased risk of major adverse cardiovascular events (MACE), but not of mortality in patients with concomitant use of PPIs and clopidogrel. Two meta-analysis studying the interactions between individual PPIs and clopidogrel failed to demonstrate any strong relationships with adverse CV outcomes. CONCLUSIONS PPIs should be administered in patients on DAPT at risk for GI bleeding. However the uncertain benefit of PPIs in patients who are not at risk of GI bleeding and the unclear risk in MACE suggest that caution should be used when prescribing PPIs in these patients.
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Affiliation(s)
| | | | - Chiara Melloni
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA -
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Melpignano A, Mandurino-Mirizzi A, Besagni F, Leri A. Dermatologic manifestations and neuropathic symptoms in women with Fabry disease. Acta Biomed 2014; 85:81-84. [PMID: 24897976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 02/19/2014] [Indexed: 06/03/2023]
Abstract
Fabry disease (angiokeratoma corporis diffusum universale) is a rare, progressive, X-linked lysosomal storage disease. Deficiency of the α-galactosidase A (α-gal A) enzyme leads to accumulation of neutral glycosphingolipids within vascular endothelial lysosomes of various organs, including skin, kidneys, heart, and brain (1). We herein describe the case of a 30-year-old female presenting two classic signs of Fabry disease, angiokeratomas and episodic acroparesthesias, in the absence of other clinical manifestations. An haplotype corresponding to the combination of three different nucleotide polymorphic variants (g. 7192-7198del5+ g. 10115A>G + g. 10956 C>T) at the heterozygous state, was identified (2).
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