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Tuttolomondo D, Niccoli G, Martini C, D'Ascenzo F, De Filippo O, Nicolini F, Formica F, Carino D, Gurgoglione FL, Denegri A, Magnani G, Vignali L, De Filippo M, Sverzellati N, Ticinesi A, Bergamaschi L, Pizzi C, Gherbesi E, Suma S, Gaibazzi N. Cardiovascular Disease from Pathophysiology to Risk Estimation: Is Inflammation Estimated through Perivascular Attenuation on Computed Tomography the Key? Life (Basel) 2024; 14:457. [PMID: 38672728 PMCID: PMC11051374 DOI: 10.3390/life14040457] [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: 02/10/2024] [Revised: 03/19/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
(1) Background: Systemic inflammation stands as a well-established risk factor for ischemic cardiovascular disease, as well as a contributing factor in the development of cardiac arrhythmias, notably atrial fibrillation. Furthermore, scientific studies have brought to light the pivotal role of localized vascular inflammation in the initiation, progression, and destabilization of coronary atherosclerotic disease. (2) Methods: We comprehensively review recent, yet robust, scientific evidence elucidating the use of perivascular adipose tissue attenuation measurement on computed tomography applied to key anatomical sites. Specifically, the investigation extends to the internal carotid artery, aorta, left atrium, and coronary arteries. (3) Conclusions: The examination of perivascular adipose tissue attenuation emerges as a non-invasive and indirect means of estimating localized perivascular inflammation. This measure is quantified in Hounsfield units, indicative of the inflammatory response elicited by dense adipose tissue near the vessel or the atrium. Particularly noteworthy is its potential utility in assessing inflammatory processes within the coronary arteries, evaluating coronary microvascular dysfunction, appraising conditions within the aorta and carotid arteries, and discerning inflammatory states within the atria, especially in patients with atrial fibrillation. The widespread applicability of perivascular adipose tissue attenuation measurement underscores its significance as a diagnostic tool with considerable potential for enhancing our understanding and management of cardiovascular diseases.
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Affiliation(s)
- Domenico Tuttolomondo
- Department of Cardiology, Parma University Hospital, Via Gramsci 14, 43126 Parma, Italy
| | - Giampaolo Niccoli
- Department of Cardiology, Parma University Hospital, Via Gramsci 14, 43126 Parma, Italy
| | - Chiara Martini
- Department of Diagnostic, Parma University Hospital, 43126 Parma, Italy
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, 10126 Turin, Italy
| | - Ovidio De Filippo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, 10126 Turin, Italy
| | - Francesco Nicolini
- Department of Cardiac Surgery, Parma University Hospital, Via Gramsci 14, 43126 Parma, Italy
| | - Francesco Formica
- Department of Cardiac Surgery, Parma University Hospital, Via Gramsci 14, 43126 Parma, Italy
| | - Davide Carino
- Department of Cardiac Surgery, Parma University Hospital, Via Gramsci 14, 43126 Parma, Italy
| | | | - Andrea Denegri
- Department of Cardiology, Parma University Hospital, Via Gramsci 14, 43126 Parma, Italy
| | - Giulia Magnani
- Department of Cardiology, Parma University Hospital, Via Gramsci 14, 43126 Parma, Italy
| | - Luigi Vignali
- Department of Cardiology, Parma University Hospital, Via Gramsci 14, 43126 Parma, Italy
| | - Massimo De Filippo
- Department of Medicine and Surgery (DiMec), Section of Radiology, University of Parma, Maggiore Hospital, Via Gramsci 14, 43126 Parma, Italy
| | - Nicola Sverzellati
- Scienze Radiologiche, Dipartimento di Medicina e Chirurgia, University-Hospital of Parma, 43126 Parma, Italy
| | - Andrea Ticinesi
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, 43126 Parma, Italy
| | - Luca Bergamaschi
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Carmine Pizzi
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Elisa Gherbesi
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20154 Milan, Italy
| | - Sergio Suma
- Department of Cardiology, Parma University Hospital, Via Gramsci 14, 43126 Parma, Italy
| | - Nicola Gaibazzi
- Department of Cardiology, Parma University Hospital, Via Gramsci 14, 43126 Parma, Italy
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Gurgoglione FL, Benatti G, Vignali L, Tadonio I, Magnani G, Denegri A, Lazzeroni D, Tuttolomondo D, De Gregorio M, Indrigo E, Signoretta G, Abbati V, Nicolini F, Ardissino D, Solinas E, Niccoli G. Prognostic role of coronary artery ectasia in patients with nonobstructive coronary artery disease. J Cardiovasc Med (Hagerstown) 2024; 25:179-185. [PMID: 38305146 DOI: 10.2459/jcm.0000000000001592] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
AIMS Coronary artery ectasia (CAE) has been linked to the occurrence of adverse events in patients with ischemia/angina and no obstructive coronary arteries (INOCA/ANOCA), while the relationship between CAE and myocardial infarction with nonobstructive coronary arteries (MINOCA) has been poorly investigated. In our study we aimed at assessing differences in clinical, angiographic and prognostic features among patients with CAE and MINOCA vs. INOCA/ANOCA presentation. METHODS Patients with angiographic evidence of CAE were enrolled at the University Hospital of Parma and divided into MINOCA vs. INOCA/ANOCA presentation. Clinical and quantitative angiographic information was recorded and the incidence of major adverse cardiovascular events (MACE) was assessed at follow-up. RESULTS We enrolled a total of 97 patients: 49 (50.5%) with MINOCA and 48 (49.5%) with INOCA/ANOCA presentation. The presentation with MINOCA was associated with a higher frequency of inflammatory diseases ( P = 0.041), multivessel CAE ( P = 0.030) and thrombolysis in myocardial infarction (TIMI) flow < 3 ( P = 0.013). At a median follow-up of 38 months, patients with MINOCA had a significantly higher incidence of MACE compared with those with INOCA/ANOCA [8 (16.3%) vs. 2 (4.2%), P = 0.045], mainly driven by a higher rate of nonfatal MI [5 (10.2%) vs. 0 (0.0%), P = 0.023]. At multivariate Cox regression analysis, the presentation with MINOCA ( P = 0.039) and the presence of TIMI flow <3 ( P = 0.037) were independent predictors of MACE at follow-up. CONCLUSION Among a cohort of patients with CAE and nonobstructive coronary artery disease, the presentation with MINOCA predicted a worse outcome.
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Affiliation(s)
| | | | - Luigi Vignali
- Division of Cardiology, Parma University Hospital, Parma
| | - Iacopo Tadonio
- Division of Cardiology, Parma University Hospital, Parma
| | - Giulia Magnani
- Division of Cardiology, Parma University Hospital, Parma
| | - Andrea Denegri
- Division of Cardiology, Parma University Hospital, Parma
| | | | | | | | | | | | | | - Francesco Nicolini
- Division of Cardio surgery, University of Parma, Parma University Hospital, Parma, Italy
| | - Diego Ardissino
- Division of Cardiology, University of Parma
- Division of Cardiology, Parma University Hospital, Parma
| | - Emilia Solinas
- Division of Cardiology, Parma University Hospital, Parma
| | - Giampaolo Niccoli
- Division of Cardiology, University of Parma
- Division of Cardiology, Parma University Hospital, Parma
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Denegri A, Szarpak L, Pruc M, Jaguszewski MJ. Spontaneous coronary artery dissection and Takotsubo syndrome. Eur J Intern Med 2023; 117:137-139. [PMID: 37586984 DOI: 10.1016/j.ejim.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/03/2023] [Accepted: 08/05/2023] [Indexed: 08/18/2023]
Affiliation(s)
- Andrea Denegri
- Department of Cardiology, Parma University Hospital, Parma, Italy
| | - Lukasz Szarpak
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, One Baylor Plaza - BCM285, Houston, TX 77030, USA.
| | - Michal Pruc
- Department of Public Health, International Academy of Ecology and Medicine, Kyiv, Ukraine
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Bruno F, Adjibodou B, Obeid S, Kraler SC, Wenzl FA, Akhtar MM, Denegri A, Roffi M, Muller O, von Eckardstein A, Räber L, Templin C, Lüscher TF. Occlusion of the infarct-related coronary artery presenting as acute coronary syndrome with and without ST-elevation: impact of inflammation and outcomes in a real-world prospective cohort. Eur Heart J Qual Care Clin Outcomes 2023; 9:564-574. [PMID: 37197909 DOI: 10.1093/ehjqcco/qcad027] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 01/21/2023] [Revised: 04/18/2023] [Accepted: 05/16/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Patients with ST-segment elevation typically feature total coronary occlusion (TCO) of the infarct-related artery (IRA) on angiography, which may result in worse outcomes. Yet, relying solely on electrocardiogram (ECG) findings may be misleading and those presenting with non-ST-segment elevation acute coronary syndromes (NSTE-ACSs) may have TCO as well. Herein, we aimed to delineate clinical characteristics and outcomes of patients with ACS stratified by IRA location. METHODS A total of 4787 ACS patients were prospectively recruited between 2009 and 2017 in SPUM-ACS (ClinicalTrials.gov Identifier: NCT01000701). The primary endpoint was major adverse cardiovascular events (MACEs), a composite of all-cause death, non-fatal myocardial infarction and non-fatal stroke at 1 year. Multivariable-adjusted survival models were fitted using backward selection. RESULTS A total of 4412 ACS patients were included in this analysis, 56.0% (n = 2469) ST-elevation myocardial infarction (STEMI) and 44.0% (n = 1943) NSTE-ACS. The IRA was the right coronary artery (RCA) in 33.9% (n = 1494), the left-anterior descending coronary artery (LAD) in 45.6% (n = 2013), and the left circumflex (LCx) in 20.5% (n = 905) patients. In STEMI patients, TCO (defined as TIMI 0 flow at angiography) was observed in 55% of cases with LAD, in 63% with RCA, and in 55% with LCx. In those presenting with NSTE-ACS, TCO was more frequent in those with LCx and RCA as compared to the LAD (27 and 24%, respectively, vs. 9%, P < 0.001). Among patients with NSTE-ACS, occlusion of the LCx was associated with an increased risk of MACE during 1 year after the index ACS (fully adjusted hazard ratio 1.68, 95% confidence interval 1.10-2.59, P = 0.02; reference: RCA and LAD). Features of patients with NSTE-ACS associated with TCO of the IRA included elevated lymphocyte and neutrophil counts, higher levels of high-sensitivity C reactive protein (hs-CRP) and high-sensitivity cardiac troponin T, lower eGFR, and notably a negative history of MI. CONCLUSION In NSTE-ACS, both LCx and RCA involvement was associated with TCO at angiography despite the absence of ST-segment elevation. Involvement of the LCx, but not the LAD or RCA, as the IRA represented an independent predictor of MACE during 1-year follow-up. Hs-CRP, lymphocyte, and neutrophil counts were independent predictors of total IRA occlusion, suggesting a possible role of systemic inflammation in the detection of TCO irrespective of ECG presentation.
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Affiliation(s)
- Francesco Bruno
- Royal Brompton & Harefield Hospitals, Imperial College and King's College, Sydney Street, London SW3 6NP, UK
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Corso Bramante, 88, 10126, Turin, Italy; Cardiology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Boris Adjibodou
- Division of Cardiology, Department of Medicine, Aarau Cantonal Hospital, Tellstrasse 25, 5001 Aarau, Switzerland
| | - Slayman Obeid
- Division of Cardiology, Department of Medicine, Aarau Cantonal Hospital, Tellstrasse 25, 5001 Aarau, Switzerland
- Cardiology Liestal, Kantonsspital Baselland, Rheinstreet 26, CH-4410 Liestal, Switzerland
| | - Simon C Kraler
- Center for Molecular Cardiology, University of Zürich, Wagistrasse 12, 8952 Schlieren, Switzerland
| | - Florian A Wenzl
- Center for Molecular Cardiology, University of Zürich, Wagistrasse 12, 8952 Schlieren, Switzerland
| | - M Majid Akhtar
- Royal Brompton & Harefield Hospitals, Imperial College and King's College, Sydney Street, London SW3 6NP, UK
| | - Andrea Denegri
- Division of Cardiology, Parma University Hospital, via Antonio Gramsci 14, 43126, Parma, Italy
| | - Marco Roffi
- Division of Cardiology, Department of Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Olivier Muller
- Department of Cardiology, University Hospital of Lausanne, Rue du Bugnon46, 1011 Lausanne, Switzerland
| | | | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistreet 100, 8091 Zurich, Switzerland
| | - Thomas F Lüscher
- Royal Brompton & Harefield Hospitals, Imperial College and King's College, Sydney Street, London SW3 6NP, UK
- Center for Molecular Cardiology, University of Zürich, Wagistrasse 12, 8952 Schlieren, Switzerland
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Magnani G, Denegri A, Gurgoglione FL, Barocelli F, Indrigo E, Catellani D, Signoretta G, Bettella A, Tuttolomondo D, Solinas E, Nicolini F, Niccoli G, Ardissino D. Dual Antiplatelet Therapy or Antiplatelet Plus Anticoagulant Therapy in Patients with Peripheral and Chronic Coronary Artery Disease: An Updated Review. J Clin Med 2023; 12:5284. [PMID: 37629326 PMCID: PMC10455400 DOI: 10.3390/jcm12165284] [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: 06/15/2023] [Revised: 07/30/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
Despite evidence-based therapies, patients presenting with atherosclerosis involving more than one vascular bed, such as those with peripheral artery disease (PAD) and concomitant coronary artery disease (CAD), constitute a particularly vulnerable group characterized by enhanced residual long-term risk for major adverse cardiac events (MACE), as well as major adverse limb events (MALE). The latter are progressively emerging as a difficult outcome to target, being correlated with increased mortality. Antithrombotic therapy is the mainstay of secondary prevention in both patients with PAD or CAD; however, the optimal intensity of such therapy is still a topic of debate, particularly in the post-acute and long-term setting. Recent well-powered randomized clinical trials (RCTs) have provided data in favor of a more intense antithrombotic therapy, such as prolonged dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor or a therapy with aspirin combined with an anticoagulant drug. Both approaches increase bleeding and selection of patients is a key issue. The aim of this review is, therefore, to discuss and summarize the most up-to-date available evidence for different strategies of anti-thrombotic therapies in patients with chronic PAD and CAD, particularly focusing on studies enrolling patients with both types of atherosclerotic disease and comparing a higher- versus a lower-intensity antithrombotic strategy. The final objective is to identify the optimal tailored approach in this setting, to achieve the greatest cardiovascular benefit and improve precision medicine.
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Affiliation(s)
- Giulia Magnani
- Cardiology Division, Parma University Hospital, 43126 Parma, Italy
| | - Andrea Denegri
- Cardiology Division, Parma University Hospital, 43126 Parma, Italy
| | | | | | - Elia Indrigo
- Cardiology Division, Parma University Hospital, 43126 Parma, Italy
| | - Davide Catellani
- Cardiology Division, Parma University Hospital, 43126 Parma, Italy
| | | | - Alberto Bettella
- Cardiology Division, Parma University Hospital, 43126 Parma, Italy
| | | | - Emilia Solinas
- Cardiology Division, Parma University Hospital, 43126 Parma, Italy
| | | | | | - Diego Ardissino
- Cardiology Division, Parma University Hospital, 43126 Parma, Italy
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Denegri A, Magnani G, Kraler S, Bruno F, Klingenberg R, Mach F, Gencer B, Räber L, Rodondi N, Rossi VA, Matter CM, Nanchen D, Obeid S, Lüscher TF. History of peripheral artery disease and cardiovascular risk of real-world patients with acute coronary syndrome: Role of inflammation and comorbidities. Int J Cardiol 2023; 382:76-82. [PMID: 36958395 DOI: 10.1016/j.ijcard.2023.03.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 11/29/2022] [Revised: 02/23/2023] [Accepted: 03/20/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Patients with acute coronary syndromes (ACS) remain at risk of cardiovascular disease (CVD) recurrences. Peripheral artery disease (PAD) may identify a very high risk (VHR) group who may derive greater benefit from intensified secondary prevention. METHODS Among ACS-patients enrolled in the prospective multi-center Special Program University Medicine (SPUM), we assessed the impact of PAD on major cardiovascular events (MACE: composite of myocardial infarction, stroke and all-cause death) and major bleeding. Multivariate analysis tested the relation of each significant variable with MACE, as well as biomarkers of inflammation and novel markers of atherogenesis. RESULTS Out of 4787 ACS patients, 6.0% (n = 285) had PAD. PAD-patients were older (p < 0.001), with established CVD and signs of increased persistent inflammation (hs-CRP; 23.6 ± 46.5 vs 10.4 ± 27.2 mg/l, p < 0.001 and sFlt-1; 1399.5 ± 1501.3 vs 1047.2 ± 1378.6 ng/l, p = 0.018). In-hospital-death (3.2% vs 1.4%, p = 0.022) and -MACE (5.6% vs 3.0%, p = 0.017) were higher in PAD-patients. MACE at 1 year (18.6% vs 7.9%,p < 0.001) remained increased even after adjustment for confounders (Adj. HR 1.53, 95% CI: 1.14-2.08, p = 0.005). Major bleeding did not differ between groups (Adj. HR 1.18; 95% CI 0.71-1.97, p = 0.512). Although PAD predicted MACE, PAD-patients were prescribed less frequently for secondary prevention at discharge. CONCLUSIONS In this real-world ACS patient cohort, concomitant PAD is a marker of VHR and is associated with increased and persistent inflammation, higher risk for MACE without an increased risk of major bleeding. Therefore, a history of PAD may be useful to identify those ACS patients at VHR who require more aggressive secondary prevention.
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Affiliation(s)
- Andrea Denegri
- Department of Cardiology, Parma University Hospital, Parma, Italy
| | - Giulia Magnani
- Department of Cardiology, Parma University Hospital, Parma, Italy
| | - Simon Kraler
- Center for Molecular Cardiology, University of Zurich, Switzerland
| | - Francesco Bruno
- Royal Brompton and Harefield Hospitals, Imperial College and Kings College, London, United Kingdom; Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Turin 10126, Italy
| | - Roland Klingenberg
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Kerckhoff-Klinik, Campus of the Justus Liebig University of Giessen, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhine-Main, Bad Nauheim, Germany
| | - Francois Mach
- Department of Cardiology, University Hospital Geneva, Switzerland
| | - Baris Gencer
- Department of Cardiology, University Hospital Geneva, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, University Hospital, Bern, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Switzerland; Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | - David Nanchen
- Center for Primary Care and Public Health, University of Lausanne, Switzerland
| | - Slayman Obeid
- Division of Cardiology, Cantonal Hospital, Aarau, Switzerland
| | - Thomas F Lüscher
- Center for Molecular Cardiology, University of Zurich, Switzerland; Royal Brompton and Harefield Hospitals, Imperial College and Kings College, London, United Kingdom.
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Gurgoglione FL, Denegri A, Russo M, Calvieri C, Benatti G, Niccoli G. Intracoronary Imaging of Coronary Atherosclerotic Plaque: From Assessment of Pathophysiological Mechanisms to Therapeutic Implication. Int J Mol Sci 2023; 24:ijms24065155. [PMID: 36982230 PMCID: PMC10049285 DOI: 10.3390/ijms24065155] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/04/2023] [Accepted: 03/06/2023] [Indexed: 03/10/2023] Open
Abstract
Atherosclerotic cardiovascular disease is the leading cause of morbidity and mortality worldwide. Several cardiovascular risk factors are implicated in atherosclerotic plaque promotion and progression and are responsible for the clinical manifestations of coronary artery disease (CAD), ranging from chronic to acute coronary syndromes and sudden coronary death. The advent of intravascular imaging (IVI), including intravascular ultrasound, optical coherence tomography and near-infrared diffuse reflectance spectroscopy has significantly improved the comprehension of CAD pathophysiology and has strengthened the prognostic relevance of coronary plaque morphology assessment. Indeed, several atherosclerotic plaque phenotype and mechanisms of plaque destabilization have been recognized with different natural history and prognosis. Finally, IVI demonstrated benefits of secondary prevention therapies, such as lipid-lowering and anti-inflammatory agents. The purpose of this review is to shed light on the principles and properties of available IVI modalities along with their prognostic significance.
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Affiliation(s)
| | - Andrea Denegri
- Cardiology Department, Azienda Ospedaliero-Universitaria of Parma, 43126 Parma, Italy
| | - Michele Russo
- Department of Cardiology, S. Maria dei Battuti Hospital, AULSS 2 Veneto, 31015 Conegliano, Italy
| | - Camilla Calvieri
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, La Sapienza University, 00185 Rome, Italy
| | - Giorgio Benatti
- Cardiology Department, Azienda Ospedaliero-Universitaria of Parma, 43126 Parma, Italy
| | - Giampaolo Niccoli
- Cardiology Department, University of Parma, 43126 Parma, Italy
- Cardiology Department, Azienda Ospedaliero-Universitaria of Parma, 43126 Parma, Italy
- Correspondence: ; Tel.: +39-0521-702070; Fax: +39-0521-702189
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8
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Magnani G, Denegri A, Bottioni F, Gurgoglione FL, Tuttolomondo D, Noni M, Barocelli F, Vrenozaj R, Catellani D, Indrigo E, Donelli D, Maccari C, Andreoli R, Corradi M, Ossola P, Marchesi C, Ardissino D, Niccoli G. 706 ETIOLOGICAL ROLE OF STRESS IN ACUTE CORONARY SYNDROME: THE STRESS-ACS-ACTION STUDY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Acute coronary syndrome (ACS) is the main cause of mortality worldwide and despite the adherence to guidelines it is still burdened by an unacceptable risk for cardiovascular (CV) events recurrence, highlighting the need to identify other than traditional cardiovascular risk factors (CVrF) implicated in atherosclerotic plaque instability. In this regard, psychosocial stress appears to be a crucial player in the development of CV disease. Nevertheless, stress is not easy to standardize and the mechanisms by which it promotes coronary artery disease (CAD) are poorly understood.
Materials and Methods
We therefore prospectively enrolled patients with ACS, stable coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) and subjects presenting traditional CVrF but without established CV disease. Multimodality cortisol assessment, expression of acute and chronic stress, through blood, urine and hair samples collection was ascertained at baseline. A regression analysis was performed to assess the relationships between significant variables at univariate analysis.
Results
Fifty patients were enrolled in the present study. Cortisol levels in blood and urine were numerically higher in patients with ACS compared to CAD patients and subjects with traditional CVrF only. Hair cortisol levels did not differ between the three groups. The regression analysis showed an inverse correlation (R= -,532, p<0.001 and R=-,615, p<0.001 respectively) between urinary cortisol (UC) and UC/creatinine ratio and left ventricular ejection fraction (LVEF).
Conclusion
The preliminary results of our study showed that patients with ACS did not have significantly higher levels of hair cortisol compared to stable patients. The finding of an inverse relationship between higher UC, UC/C ratio levels and lower LVEF values support a link between a hyperactivity of the hypothalamic-pituitary-adrenal axis and a worse ACS presentation. These preliminary data will be implemented with serial multimodality assessment of cortisol that allow potential implications in diagnosis and outcome.
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Affiliation(s)
- Giuia Magnani
- Department Of Cardiology, Parma University Hospital , Parma , Italy
| | - Andrea Denegri
- Department Of Cardiology, Parma University Hospital , Parma , Italy
| | | | | | | | - Manjola Noni
- Department Of Cardiology, Parma University Hospital , Parma , Italy
| | | | - Rosi Vrenozaj
- Department Of Cardiology, Parma University Hospital , Parma , Italy
| | - Davide Catellani
- Department Of Cardiology, Parma University Hospital , Parma , Italy
| | - Elia Indrigo
- Department Of Cardiology, Parma University Hospital , Parma , Italy
| | - Davide Donelli
- Department Of Cardiology, Parma University Hospital , Parma , Italy
| | - Chiara Maccari
- Laboratory Of Industrial Toxicology, Department Of Medicine And Surgery, University Of Parma , Parma , Italy
| | - Roberta Andreoli
- Laboratory Of Industrial Toxicology, Department Of Medicine And Surgery, University Of Parma , Parma , Italy
| | - Massimo Corradi
- Laboratory Of Industrial Toxicology, Department Of Medicine And Surgery, University Of Parma , Parma , Italy
| | - Paolo Ossola
- Department Of Neuroscience, Psychiatric Unit, Parma University Hospital , Parma , Italy
| | - Carlo Marchesi
- Department Of Mental Health, Parma University Hospital , Parma , Italy
| | - Diego Ardissino
- Department Of Cardiology, Parma University Hospital , Parma , Italy
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Denegri A, Gurgoglione FL, Magnani G, Montagna R, Vignali L, Paoli G, Graziani T, Ruffini L, Ardissino D, Niccoli G. 702 PROGNOSTIC ROLE OF MYOCARDIAL VIABILITY ASSESSMENT BY 18F-FLUORODEOXYGLUCOSE POSITRON EMISSION TOMOGRAPHY IN STEMI PATIENTS WITH LATE PRESENTATION. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
ST-segment elevation myocardial infarction (STEMI) is one of the world's leading causes of disability and death. The incidence of late-onset STEMI (i.e. after at least 12 hours from symptom onset to medical observation) accounts up to 10% of overall STEMI events and optimal management in this setting is still debated due to the lack of randomized data. The aim of the present study is to explore the usefulness of FDG-PET to improve late-onset STEMI treatment.
Methods
We conducted a single-center retrospective observational study that included patients admitted for late-onset STEMI who underwent coronary angiography and FDG-PET to evaluate myocardial viability (MV). Follow-up by telephone interview and / or clinical follow-up at 6, 12, 24, 36, 48 and 60 months was performed in all patients. The prevalence of myocardial viability (MV) related to infarct-related artery (IRA) by FDG-PET study (using a semi-quantitative visual scoring method), the study of clinical and angiographic predictors of viability and the association of myocardial viability evaluated with FDG-PET with the improvement of the left ventricular ejection fraction (LVEF) were investigated.
Results
A total of 27 patients with mean age 64.7 ± 11.1 years, predominantly men (n=25, 92,6%), were enrolled in the study. Compared to patients without MV (n=12), MV-patients (n=15) presented more frequently dyslipidemia (100.0% vs 66.7%, p=0.015) and diabetes (53.3% vs 16.5%, p=0.050) but showed no difference in inflammatory biomarkers and echocardiographic parameters. Multivessel disease (MVD 86.7% vs 33.3%, p=0.004) and high-grade collateral-connection (hg-CC 80.0% vs 33.3%, p=0.027) were more frequent in MV-patients compared to patients without MV. The presence of angiographically visible hg-CC (OR=8.00, 95%CI 1.40-45.76, p=0.019) and MVD (OR=13.00, 95%CI 1.92-88.00, p<0.001) were positive predictors of FDG-PET MV related to IRA and remained independent positive predictors of FDG-PET MV related to IRA at multivariable logistic regression analysis (p<0.05). No significant differences were recorded between patients without MV and MV-patients in the incidence of MACEs (20.0% vs 50.0%, p=0.100). Of note, as compared to patients without MV, MV-patients displayed a significant improvement in LVEF (86.7% vs 50.0%, p = 0.036), with a higher mean value of LVEF at follow-up (39.4 ± 10.9 vs 29.6 ± 8.0, p = 0.013) and of LVEF change from baseline to follow-up (6.1 ± 7.2 vs -1.1 ± 9.1, p = 0.027).
Conclusions
This study could be of great help in clinical practice in order to provide a personalized approach in patients with late-STEMI, suggesting the potential benefit of a routine assessment IRA-related viability by FDG-PET in all asymptomatic late-STEMI subjects and providing further evidence in favor of a revascularization of occluded IRA in those with documented myocardial viability.
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Affiliation(s)
- Andrea Denegri
- Department Of Cardiology, Parma University Hospital , Parma , Italy
| | | | - Giulia Magnani
- Department Of Cardiology, Parma University Hospital , Parma , Italy
| | | | - Luigi Vignali
- Department Of Cardiology, Parma University Hospital , Parma , Italy
| | - Giorgia Paoli
- Department Of Cardiology, Parma University Hospital , Parma , Italy
| | - Tiziano Graziani
- Nuclear Medicine And Molecular Imaging Department, Parma University Hospital , Parma , Italy
| | - Livia Ruffini
- Nuclear Medicine And Molecular Imaging Department, Parma University Hospital , Parma , Italy
| | - Diego Ardissino
- Department Of Cardiology, Parma University Hospital , Parma , Italy
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10
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Matuszewski M, Szarpak L, Rafique Z, Peacock FW, Pruc M, Szwed P, Chirico F, Navolokina A, Ladny JR, Denegri A. Prediction Value of KREBS Von Den Lungen-6 (KL-6) Biomarker in COVID-19 Patients: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11216600. [PMID: 36362828 PMCID: PMC9658915 DOI: 10.3390/jcm11216600] [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: 09/21/2022] [Revised: 11/02/2022] [Accepted: 11/06/2022] [Indexed: 11/09/2022] Open
Abstract
The SARS-CoV-2 (COVID-19) pandemic is a major issue that necessitates the use of cutting-edge disease prediction models. The aim of the study was to assess the existing evidence regarding association between Krebs von den Lungen-6 levels and COVID-19 severity. A literature search was performed on Web of Science, PubMed, Scopus and Cochrane Central Register of Controlled Trials databases from 1 January 2020 up to 2 August 2022. The electronic database search was supplemented by searching Google Scholar. In addition, reference lists of relative articles were also reviewed. KL-6 levels among COVID-19 positive vs. negative patients varied and amounted to 443.37 ± 249.33 vs. 205.73 ± 86.8 U/mL (MD = 275.33; 95%CI: 144.57 to 406.09; p < 0.001). The KL-6 level was 402.82 ± 261.16 U/mL in the severe group and was statistically significantly higher than in the non-severe group (297.38 ± 90.46 U/mL; MD = 192.45; 95%CI: 118.19 to 266.72; p < 0.001). The KL-6 level in the mild group was 272.28 ± 95.42 U/mL, compared to 268.04 ± 55.04 U/mL in the moderate COVID-19 group (MD = −12.58; 95%CI: −21.59 to −3.57; p = 0.006). Our meta-analysis indicates a significant association between increased KL-6 levels and SARS-CoV-2 infection. Moreover, KL-6 levels are significantly higher in patients with a more severe course of COVID-19, indicating that KL-6 may be a useful predictor to identify patients at risk for severe COVID-19.
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Affiliation(s)
- Michal Matuszewski
- Department of Anaesthesiology and Intensive Therapy at the Central Clinical Hospital of the Ministry of Interior and Administration, 02-507 Warsaw, Poland
| | - Lukasz Szarpak
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, 00-136 Warsaw, Poland
- Correspondence:
| | - Zubaid Rafique
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Frank W. Peacock
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Michal Pruc
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warsaw, Poland
| | - Piotr Szwed
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Francesco Chirico
- Post-Graduate School of Occupational Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Health Service Department, Italian State Police, Ministry of the Interior, 20121 Milan, Italy
| | - Alla Navolokina
- Department of Public Health and Social Medicine, International European University, 03187 Kyiv, Ukraine
| | - Jerzy R. Ladny
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warsaw, Poland
- Department of Emergency Medicine, Medical University of Bialystok, 15-089 Bialystok, Poland
| | - Andrea Denegri
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41121 Modena, Italy
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11
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Nieborek A, Ladny JR, Jaguszewski MJ, Denegri A, Sikora A, Pucylo S, Gasecka A, Pruc M, Savytsky I, Szarpak L. Should targeted temperature management be used in cardiogenic shock patients? Systematic review and meta-analysis. Cardiol J 2022:VM/OJS/J/91254. [PMID: 36200546 DOI: 10.5603/cj.a2022.0093] [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: 08/03/2022] [Accepted: 08/30/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Therapeutic hypothermia, or targeted temperature management (TTM), is a strategy of reducing the core body temperature of survivors of sudden cardiac arrest, cardiogenic shock (CS) or stroke. Therefore, a systematic literature review and meta-analysis were performed to tackle the question about whether the implementation of TTM is actually beneficial for patients with CS. METHODS Study was designed as a systematic review and meta-analysis. PubMed, Cochrane Library, Web of Science and Scopus were searched from these databases inception to July 17, 2022. Eligible studies were those comparing TTM and non-TTM treatment in CS patients. Data were pooled with the Mantel-Haenszel method. RESULTS Thirty-day mortality was reported in 3 studies. Polled analysis of 30-day mortality was 44.2% for TTM group and 48.9% for non-TTM group (risk ratio: 0.90; 95% confidence interval: 0.75 to 1.08; p = 0.27). Other mortality follow-up periods showed also no statistically significant differences (p > 0.05). The occurrence of adverse events in the studied groups also did not show statistically significant differences between TTM and non-TTM groups (p > 0.05 for myocardial infarction, stent thrombosis, sepsis, pneumonia, stroke or bleeding events). CONCLUSIONS The present analysis shows no significant benefit of TTM in patients with CS. Moreover, no statistically significant increase of the incidence of adverse effects was found. However, further randomized studies with higher sample size and greater validity are needed to determine if TTM is worth implementing in CS patients.
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Affiliation(s)
- Adam Nieborek
- Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland
| | - Jerzy R Ladny
- Clinic of Emergency Medicine, Medical University Bialystok, Poland
| | | | - Andrea Denegri
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Italy
| | - Aleksandra Sikora
- First Chair and Department of Cardiology, Medical University of Warsaw, Poland
| | - Szymon Pucylo
- First Chair and Department of Cardiology, Medical University of Warsaw, Poland
| | - Aleksandra Gasecka
- First Chair and Department of Cardiology, Medical University of Warsaw, Poland
| | - Michal Pruc
- Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland
| | - Ivan Savytsky
- European School of Medicine, International European University, Kyiv, Ukraine
| | - Lukasz Szarpak
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland.
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, United States.
- Reseach Unit, Maria Sklodowska-Curie Bialysok Oncology Center, Bialystok, Poland.
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12
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Obeid S, Adjibodou B, Denegri A, Kraler S, Katsarov K, Roffi M, Raeber L, Muller O, Staehli B, Luescher TF. Collaterals and extent of myocardial injury in patients with acute coronary syndromes – an analysis of the prospective SPUM-ACS cohort. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1310] [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: 11/12/2022] Open
Abstract
Abstract
Introduction
The impact of collateral circulation in the presence of severe coronary artery disease such as chronic total occlusion (CTO) has been extensively studied, with results despite few discrepancies, supporting an overall benefit on preservation of myocardial tissue and left ventricular ejection fraction (LVEF). However, less is known about the protective effects of collaterals in the context of acute coronary syndromes (ACS). In the current study we sought to analyze the incidence, grade and impact of collateral circulation in a large prospectively recruited cohort of patients presenting with ACS with independent events adjudication.
Methods and results
4'546 ACS patients presenting with ACS, enrolled in the prospective Special Program University Medicine ACS (SPUM-ACS) cohort were included. The current analysis showed the presence of a collateralized culprit lesion in 12.9% (n=586) of patients, 84% (n=492) originating from the contralateral side and 16% (n=94) from the ipsilateral side. Of those 64.6% (n=378) were being graded as Rentrop 2 or more. There were no differences in baseline characteristics between the two groups including incidence of diabetes, coronary artery disease, age and gender. However, despite the presence of collaterals graded Rentrop 2 or more, those patients had a significantly lower LVEF mean 48,44% vs 51.6%, p=0.025 and higher creatinine Kinase levels, mean (CK) 981 U/I vs 957 UI, p<0.001 as compared to patients with absent collateral-circulation on admission. Interestingly a sub analysis of the STEMI population showed no significant differences in both LVEF and CK at presentation, while troponin (TNT) plasma levels were significantly lower in patients with collaterals (mean TNT 0.0031 ug/l vs 0.035 ug/l p=0.001). Additionally no differences in cardiovascular mortality, stent thrombosis or MI was seen at one year follow-up.
Conclusion
The current analysis highlights a possible protective impact of a pre-existing collateral circulation against myocardial injury in the setting of ACS and ST elevation myocardial infarction. However this was not translated into improvement in hard outcomes acutely and up to one year of follow up, but may be important in the long run.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Swiss National Research Foundation - ZurichHeart House
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Affiliation(s)
- S Obeid
- Cantonal Hospital Aarau , Aarau , Switzerland
| | - B Adjibodou
- Cantonal Hospital Aarau , Aarau , Switzerland
| | - A Denegri
- University of Modena & Reggio Emilia, Cardiology , Modena , Italy
| | - S Kraler
- University of Zurich, Center for molecular cardiology , Schlieren , Switzerland
| | - K Katsarov
- Cantonal Hospital Aarau , Aarau , Switzerland
| | - M Roffi
- Hopitaux Universitaires De Geneve, Cardiology , Geneva , Switzerland
| | - L Raeber
- Inselspital - University of Bern, Cardiology , Bern , Switzerland
| | - O Muller
- University Hospital Centre Vaudois (CHUV), Cardiology , Lausanne , Switzerland
| | - B Staehli
- University Hospital Zurich, Cardiology , Zurich , Switzerland
| | - T F Luescher
- Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust , London , United Kingdom
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13
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Denegri A, Magnani G, Kraler S, Wenzl F, Raeber L, Gencer B, Mach F, Nanchen D, Matter CM, Luescher TF. Prevalence and outcomes of peripheral artery disease in a real-world cohort of patients with acute coronary syndrome: insights from the prospective SPUM registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1321] [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: 11/15/2022] Open
Abstract
Abstract
Background
Despite substantial improvement in secondary preventive therapy, the burden of recurrent cardiovascular (CV) events remains high. Peripheral artery disease (PAD), is a potential marker of increased residual ischemic risk in acute coronary syndrome (ACS) patients suggesting greater net clinical benefit from intensified individualized therapy.
Purpose
We aimed to assess the prevalence and cardiovascular (CV) outcomes of peripheral arterial disease (PAD) in 4'787 patients with acute coronary syndromes (ACS) in the Swiss prospective multicenter SPUM study.
Methods
PAD was defined according to international guidelines. The composite primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), i.e., stroke, myocardial infarction (MI) and death at 1 year. Adjusted Cox proportional hazards regression models were used to estimate the risk associated with PAD and outcomes.
Results
Out of 4'787 ACS patients, 285 patients (6.0%) had PAD. These patients were older (70.1±10.6 vs 63.3±12.4, p<0.001), presented all traditional CV risk factors (all p<0.001) and were more likely to have a complex history of CV disease, such as previous MI (24.3% vs 11.4%, p<0.001), prior percutaneous (32.3% vs 13.8%, p<0.001) or surgical (12.6% vs 3.5%, p<0.001) coronary revascularization. PAD-patients presented also higher levels of inflammatory biomarkers, such as hs-CRP, and GRACE 2.0 score (all p<0.001). At 1 year, patients with PAD had a higher rate of MACCE compared to those presenting without PAD. Rates of the individual components of the primary endpoint and CV-death were all significantly higher in patients with PAD (all p<0.001), except for a numerical increase in MI (5.3% vs 3.3%, p=0.060). This enhanced risk persisted after adjustment for differences in baseline characteristics, with a 53% (Adj. HR 1.53, CI95% 1.14–2.08, p=0.005) increase in MACCE. In spite of high-intensity anti-thrombotic therapy, PAD patients presented the same rate (Adj. HR 1.03, CI95% 0.68–1.54, p=0.901) of major bleeding events at 1 year.
Conclusions
Among a real-world cohort of ACS patients, the coexistence of PAD, a very-high CV risk phenotype, is associated with significantly increased rates of MACCE, but no difference in major bleeding events. These observations might help clinicians to further stratify this very-high risk population and to identify patients who may derive the greatest benefit from more intense secondary prevention therapies.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | | | - S Kraler
- Center for Molecular Cardiology, University of Zurich , Zurich , Switzerland
| | - F Wenzl
- Center for Molecular Cardiology, University of Zurich , Zurich , Switzerland
| | - L Raeber
- Bern University Hospital, Cardiology , Bern , Switzerland
| | - B Gencer
- University Hospital of Geneva, Cardiology , Geneva , Switzerland
| | - F Mach
- University Hospital of Geneva, Cardiology , Geneva , Switzerland
| | - D Nanchen
- Centre for Primary Care and Public Health (Unisante) , Lausanne , Switzerland
| | - C M Matter
- University Hospital Zurich, Cardiology , Zurich , Switzerland
| | - T F Luescher
- Royal Brompton and Harefield Hospital , London , United Kingdom
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14
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Cardillo G, Nosotti M, Scarci M, Torre M, Alloisio M, Benvenuti MR, Bertani A, Cagini L, Casablanca G, Cavallesco G, Cherchi R, Crucitti P, Curcio C, Denegri A, Droghetti A, Guggino G, Imperatori A, Infante MV, Lucchi M, Macrì P, Marulli G, Melloni G, Paci M, Paladini P, Pariscenti GL, Potenza E, Rea F, Refai M, Rena O, Ricciardi S, Rusca M, Sollitto F, Taurchini M, Terzi A, Voltolini L, Crisci R. Air leak and intraoperative bleeding in thoracic surgery: a Delphi consensus among the members of Italian society of thoracic surgery. J Thorac Dis 2022; 14:3842-3853. [PMID: 36389328 PMCID: PMC9641338 DOI: 10.21037/jtd-22-619] [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: 05/18/2022] [Accepted: 09/09/2022] [Indexed: 01/25/2023]
Abstract
Background Persistent air leak and the management of intraoperative blood loss are common threats in thoracic surgical practice. The availability of new procedures, technology and materials is constantly evolving topical hemostats and surgical sealants must be added to this toolkit. Topical hemostats and surgical sealants differ according to their chemical nature and physical characteristics, to their origin and mechanism of action, regulatory/registration and vigilance paths. A Delphi consensus was set to highlight the different points of view on the use of topical haemostatic products and sealants among the members of Italian Society of thoracic surgery. Methods The board was formed by a group of five Italian experts; in the first phase after a careful review of the scientific literature and two rounds, the board finally generated 16 consensus statements for testing across a wider audience. During the second phase, the statements were collated into a questionnaire, which was electronically sent to a panel of 46 Italian surgeons, experts in the field. Results Out of 46 Italian surgeons, 33 (72%) panel members responded to the Delphi questionnaire. All the items reached a positive consensus, with elevated levels of agreement, as demonstrated by the presence of a 100% consensus for nine items. For the remaining 7 statements the minimum level of consent was 88% (29 participants approved the statement and 4 disagreed) and the maximum was 97% (32 participants approved the statement and 1 was in disagreement). Conclusions The present Delphi analysis shows that air leak and intraoperative bleeding are clinical problems well known among thoracic surgeons. Nevertheless, the aim of the scientific societies and of the group of experts is to execute the education activities in the surgery community. This Delphi survey suggest the need of wider and updated scientific information about technical and registration characteristics of most recent technologic solutions, such as the of topical hemostats and surgical sealants to provide healthcare and administrative staff with the opportunity to work and interact through a common and shared language and eventually to guarantee minimal requirements of assistance.
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Affiliation(s)
- Giuseppe Cardillo
- Department of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
- Unicamillus - Saint Camillus International University of Health Sciences, Rome, Italy
| | - Mario Nosotti
- University of Milan, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Scarci
- Imperial College Healthcare NHS Trust, London, UK
| | - Massimo Torre
- Department of Thoracic Surgery, ASST GOM Niguarda, Milan, Italy
| | - Marco Alloisio
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | - Alessandro Bertani
- Thoracic Surgery and Lung Transplant Division, IRCCS ISMETT – UPMC, Palermo, Italy
| | - Lucio Cagini
- Department of Thoracic Surgery, University of Perugia, Perugia, Italy
- Thoracic Surgery Department, Ospedale del Mare, Naples, Italy
| | | | - Giorgio Cavallesco
- Department of Surgery 1 Thoracic, Hospital Unit University of Ferrara, Ferrara, Italy
| | - Roberto Cherchi
- Department of Thoracic Surgery, U.O.C A.R.N.A.S. -Brotzu, Cagliari, Italy
| | - Pierfilippo Crucitti
- Department of Thoracic Surgery, Fondazione Policlinico Campus Bio-Medico of Rome, Rome, Italy
| | - Carlo Curcio
- UOC Thoracic Surgery, AORN dei Colli. Monaldi Hospital, Naples, Italy
| | - Andrea Denegri
- Department of Thoracic Surgery, UOC Azienda Ospedaliera SS Annunziata Cosenza, Cosenza, Italy
| | | | - Gianluca Guggino
- Department of Thoracic Surgery, UOC Azienda Ospedaliera Rilievo Nazionale “A. Cardarelli”, Naples, Italy
| | - Andrea Imperatori
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | - Marco Lucchi
- Division of Thoracic Surgery, University of Pisa, Pisa, Italy
| | - Paolo Macrì
- Department of Thoracic Surgery, Humanitas Istituto Clinico Catanese, Misterbianco, Italy
| | - Giuseppe Marulli
- Thoracic Surgery Unit, Department of Emergency and Organ Transplantation, University Hospital of Bari, Bari, Italy
| | - Giulio Melloni
- Department of Thoracic Surgery, S.Croce e Carle General Hospital, Cuneo, Italy
| | - Massimiliano Paci
- Department of Thoracic Surgery, Azienda Unità Sanitaria Locale–IRCCS, Reggio Emilia, Italy
| | - Piero Paladini
- Department of Thoracic Surgery, University of Siena, Siena, Italy
| | - Gian Luca Pariscenti
- Department of Thoracic Surgery, IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Enrico Potenza
- Department of Thoracic Surgery, U.O.C. A.O.R.N.A.S. Garibaldi Nesima, Catania, Italy
| | - Federico Rea
- Unit of Thoracic Surgery and Lung Transplantation, Department of Cardio-Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Majed Refai
- Department of Thoracic Surgery, AOU Ospedali Riuniti, Ancona, Italy
| | - Ottavio Rena
- Thoracic Surgery Unit, University Hospital “Maggiore della Carità”, Novara, Italy
| | - Sara Ricciardi
- Unit of Thoracic Surgery, San Camillo Forlanini Hospital, Rome, Italy
- PhD Program, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | | | | | - Marco Taurchini
- Department of Thoracic Surgery, UOC Policlinico SS Annunziata Asl Taranto, Taranto, Italy
| | - Alberto Terzi
- IRCCS Sacro Cuore-Don Calabria, Hospital Negrar di Valpolicella, Valpolicella, Italy
| | - Luca Voltolini
- Thoracic Surgery Unit, University Hospital Careggi, Florence, Italy
| | - Roberto Crisci
- Department of Thoracic Surgery, MeSVA Department University of L’Aquila, L’Aquila, Italy
- Division of Thoracic Surgery, “Mazzini” Hospital, Teramo, Italy
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15
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Zimodro JM, Gasecka A, Jaguszewski M, Amanowicz S, Szkiela M, Denegri A, Pruc M, Duchnowski P, Peacock FW, Rafique Z, Szarpak L. Role of copeptin in diagnosis and outcome prediction in patients with heart failure: a systematic review and meta-analysis. Biomarkers 2022; 27:720-726. [PMID: 36083024 DOI: 10.1080/1354750x.2022.2123042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Introduction: This systematic review and meta-analysis of 19 studies, was conducted to evaluate the role of copeptin in diagnosis and outcome prediction in HF patients. Materials and Methods: A systematic literature search for clinical trials reporting copeptin levels in HF patients was performed using EMBASE, PubMed, Cochrane Register of Controlled Trials, and Google Scholar. Articles from databases published by January 2nd, 2022, that met the selection criteria were retrieved and reviewed. The random effects model was used for analyses. Results: Pooled analysis found higher mean copeptin levels in HF vs. non-HF populations (43.6 ± 46.4 vs. 21.4 ± 21.4; MD= 20.48; 95%CI: 9.22 to 31.74; p < 0.001). Pooled analysis of copeptin concentrations stratified by ejection fraction showed higher concentrations in HFrEF vs. HFpEF (17.4 ± 7.1 vs. 10.1 ± 5.5; MD= -4.69; 95%CI: -7.58 to -1.81; p = 0.001). Copeptin level was higher in patients with mortality/acute HF-related hospitalization vs. stable patients (31.3 ± 23.7 vs. 20.4 ± 12.8; MD= -13.06; 95%CI: -25.28 to -0.84; p = 0.04). Higher copeptin concentrations were associated with mortality and observed in all follow-up periods (p <0.05). Discussion and Conclusions: Present meta-analysis showed that elevated copeptin plasma concentrations observed in HF patients are associated with increased risk of all-cause mortality, thus copeptin may serve as predictor of outcome in HF.
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Affiliation(s)
- Jakub Michal Zimodro
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Aleksandra Gasecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Milosz Jaguszewski
- 1st Department of Cardiology, Medical University of Gdansk, 80-211 Gdansk, Poland
| | - Sandra Amanowicz
- Students Research Club, Maria Sklodowska-Curie Medical Academy, 03-411 Warsaw, Poland
| | - Marta Szkiela
- Students Research Club, Maria Sklodowska-Curie Medical Academy, 03-411 Warsaw, Poland
| | - Andrea Denegri
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41121 Modena, Italy
| | - Michal Pruc
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warsaw, Poland
| | - Piotr Duchnowski
- Cardinal Wyszynski National Institute of Cardiology, 04-628 Warsaw, Poland
| | - Frank W Peacock
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Zubaid Rafique
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Lukasz Szarpak
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA.,Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, 03-411 Warsaw, Poland
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Fialek B, Pruc M, Smereka J, Jas R, Rahnama-Hezavah M, Denegri A, Szarpak A, Jaguszewski MJ, Peacock FW, Szarpak L. Diagnostic value of lactate dehydrogenase in COVID-19: A systematic review and meta-analysis. Cardiol J 2022; 29:751-758. [PMID: 35762075 PMCID: PMC9550334 DOI: 10.5603/cj.a2022.0056] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/06/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND This meta-analysis outlines the role of elevated lactate dehydrogenase (LDH) levels in assessing the severity of coronavirus disease 2019 (COVID-19). METHODS The current study was designed as a systematic review and meta-analysis. Embase, Pub- Med, Web of Science, Scopus and Cochrane Central Register of Controlled Trials were searched to identify the usefulness of LDH as a marker of COVID-19 severity. All extracted data were analyzed using RevMan V.5.4 or STATA V.14 software. RESULTS A total of 264 records were selected for this meta-analysis. Pooled analysis showed that LDH levels were statistically significantly lower in the group of survivors compared to patients who died in hospital (standardized mean differences [SMD] = -3.10; 95% confidence interval [CI]: -3.40 to -2.79; I2 = 99%; p < 0.001). Lower LDH levels were observed in non-severe groups compared to severe course of COVID-19 (SMD = -2.38; 95% CI: -2.61 to -2.14; I2 = 99%; p < 0.001). The level of LDH was statistically significantly lower in the severe group compared to the critical group (SMD = -1.48; 95% CI: -2.04 to -0.92; I2 = 98%; p < 0.001). Patients who did not require treatment in the intensive care unit (ICU) showed significantly lower levels of LDH compared to patients who required treatment in the ICU (SMD = -3.78; 95% CI: -4.48 to -3.08; I2 = 100%; p < 0.001). CONCLUSIONS This meta-analysis showed that elevated LDH was associated with a poor outcome in COVID-19.
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Affiliation(s)
- Bartosz Fialek
- Rheumatology Department, Marshal Jozef Pilsudski Memorial Hospital, Plonsk, Poland
| | - Michal Pruc
- Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland
| | - Jacek Smereka
- Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
| | - Rafal Jas
- Students Research Club, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland
| | | | | | - Agnieszka Szarpak
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland
| | | | - Frank W Peacock
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine Houston, Houston, TX, United States
| | - Lukasz Szarpak
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine Houston, Houston, TX, United States.
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17
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Klingenberg R, Stähli BE, Heg D, Denegri A, Manka R, Kapos I, von Eckardstein A, Carballo D, Hamm CW, Vietheer J, Rolf A, Landmesser U, Mach F, Moccetti T, Jung C, Kelm M, Münzel T, Pedrazzini G, Räber L, Windecker S, Matter CM, Ruschitzka F, Lüscher TF. Controlled-Level EVERolimus in Acute Coronary Syndrome (CLEVER-ACS) - A phase II, randomized, double-blind, multi-center, placebo-controlled trial. Am Heart J 2022; 247:33-41. [PMID: 35092722 DOI: 10.1016/j.ahj.2022.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Activation of inflammatory pathways during acute myocardial infarction contributes to infarct size and left ventricular (LV) remodeling. The present prospective randomized clinical trial was designed to test the efficacy and safety of broad-spectrum anti-inflammatory therapy with a mammalian target of rapamycin (mTOR) inhibitor to reduce infarct size. DESIGN Controlled-Level EVERolimus in Acute Coronary Syndrome (CLEVER-ACS, clinicaltrials.gov NCT01529554) is a phase II randomized, double-blind, multi-center, placebo-controlled trial on the effects of a 5-day course of oral everolimus on infarct size, LV remodeling, and inflammation in patients with acute ST-elevation myocardial infarction (STEMI). Within 5 days of successful primary percutaneous coronary intervention (pPCI), patients are randomly assigned to everolimus (first 3 days: 7.5 mg every day; days 4 and 5: 5.0 mg every day) or placebo, respectively. The primary efficacy outcome is the change from baseline (defined as 12 hours to 5 days after pPCI) to 30-day follow-up in myocardial infarct size as measured by cardiac magnetic resonance imaging (CMRI). Secondary endpoints comprise corresponding changes in cardiac and inflammatory biomarkers as well as microvascular obstruction and LV volumes assessed by CMRI. Clinical events, laboratory parameters, and blood cell counts are reported as safety endpoints at 30 days. CONCLUSION The CLEVER-ACS trial tests the hypothesis whether mTOR inhibition using everolimus at the time of an acute STEMI affects LV infarct size following successful pPCI.
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Affiliation(s)
- Roland Klingenberg
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland; Department of Cardiology, Kerckhoff Heart and Thorax Center, and Campus of the Justus Liebig University of Giessen, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhine-Main, Bad Nauheim, Germany
| | - Barbara E Stähli
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Dik Heg
- Clinical Trial Unit, Social and Preventive Medicine, University of Bern, Switzerland
| | - Andrea Denegri
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Robert Manka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Ioannis Kapos
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | | | - David Carballo
- Department of Cardiology, Hopitaux Universitaires de Geneve, Geneva, Switzerland
| | - Christian W Hamm
- Department of Cardiology, Kerckhoff Heart and Thorax Center, and Campus of the Justus Liebig University of Giessen, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhine-Main, Bad Nauheim, Germany
| | - Julia Vietheer
- Department of Cardiology, Kerckhoff Heart and Thorax Center, and Campus of the Justus Liebig University of Giessen, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhine-Main, Bad Nauheim, Germany
| | - Andreas Rolf
- Department of Cardiology, Kerckhoff Heart and Thorax Center, and Campus of the Justus Liebig University of Giessen, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhine-Main, Bad Nauheim, Germany
| | - Ulf Landmesser
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland; Department of Cardiology, Charité - University Medicine, , Berlin, Germany
| | - François Mach
- Department of Cardiology, Hopitaux Universitaires de Geneve, Geneva, Switzerland
| | - Tiziano Moccetti
- Department of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Christian Jung
- Division of Cardiology, Pulmonary Diseases and Vascular Medicine, University Hospital of Duesseldorf, Duesseldorf, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonary Diseases and Vascular Medicine, University Hospital of Duesseldorf, Duesseldorf, Germany
| | - Thomas Münzel
- Department of Cardiology, University Hospital Mainz, Mainz, Germany
| | | | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, Inselspital, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Inselspital, Bern, Switzerland
| | - Christian M Matter
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland; Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Thomas F Lüscher
- Department of Cardiology, Bern University Hospital, Inselspital, Bern, Switzerland; Imperial College, National Heart and Lung Institute and Royal Brompton and Harefield Hospitals, Heart Division London, U.K..
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18
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Szarpak L, Lapinski M, Gasecka A, Pruc M, Drela WL, Koda M, Denegri A, Peacock FW, Jaguszewski MJ, Filipiak KJ. Performance of Copeptin for Early Diagnosis of Acute Coronary Syndromes: A Systematic Review and Meta-Analysis of 14,139 Patients. J Cardiovasc Dev Dis 2021; 9:jcdd9010006. [PMID: 35050216 PMCID: PMC8780262 DOI: 10.3390/jcdd9010006] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/18/2021] [Accepted: 12/23/2021] [Indexed: 12/28/2022] Open
Abstract
Diagnosis of acute coronary syndrome (ACS) based on copeptin level may enable one to confirm or rule-out acute myocardial infarction (AMI) with higher sensitivity and specificity, which may in turn further reduce mortality rate and decrease the economic costs of ACS treatment. We conducted a systematic review and meta-analysis to investigate the relationship between copeptin levels and type of ACS. We searched Scopus, PubMed, Web of Science, Embase, and Cochrane to locate all articles published up to 10 October 2021. We evaluated a meta-analysis with random-effects models to evaluate differences in copeptin levels. A total of 14,139 patients (4565 with ACS) were included from twenty-seven studies. Copeptin levels in AMI and non-AMI groups varied and amounted to 68.7 ± 74.7 versus 14.8 ± 19.9 pmol/L (SMD = 2.63; 95% CI: 2.02 to 3.24; p < 0.001). Copeptin levels in the AMI group was higher than in the unstable angina (UAP) group, at 51.9 ± 52.5 versus 12.8 ± 19.7 pmol/L (SMD = 1.53; 95% CI: 0.86 to 2.20; p < 0.001). Copeptin levels in ST-elevation myocardial infarction (STEMI) versus non-ST elevation myocardial infarction (NSTEMI) patient groups were 54.8 ± 53.0 versus 28.7 ± 46.8 pmol/L, respectively (SMD = 1.69; 95% CI: = 0.70 to 4.09; p = 0.17). In summary, elevated copeptin levels were observed in patients with ACS compared with patients without ACS. Given its clinical value, copeptin levels may be included in the assessment of patients with ACS as well as for the initial differentiation of ACS.
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Affiliation(s)
- Lukasz Szarpak
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, 03-411 Warsaw, Poland
- Research Unit, Maria Sklodowska-Curie Bialystok Oncology Center, 15-027 Bialystok, Poland;
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warsaw, Poland;
- Correspondence: or ; Tel.: +48-500-186-225
| | - Marcin Lapinski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (M.L.), (A.G.)
| | - Aleksandra Gasecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (M.L.), (A.G.)
- Laboratory of Experimental Clinical Chemistry, Amsterdam University Medical Center, 1105 Amsterdam, The Netherlands
| | - Michal Pruc
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warsaw, Poland;
| | - Wiktoria L. Drela
- Students Research Club, Maria Sklodowska-Curie Medical Academy, 04-311 Warsaw, Poland;
| | - Mariusz Koda
- Research Unit, Maria Sklodowska-Curie Bialystok Oncology Center, 15-027 Bialystok, Poland;
| | - Andrea Denegri
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41121 Modena, Italy;
| | - Frank W. Peacock
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA;
| | | | - Krzysztof J. Filipiak
- Institute of Clinical Medicine, Maria Sklodowska-Curie Medical Academy, 00-001 Warsaw, Poland;
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19
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Bielski K, Makowska K, Makowski A, Kopiec T, Gasecka A, Malecka M, Pruc M, Rafique Z, Peacock FW, Denegri A, Szarpak L. Impact of COVID-19 on in-hospital cardiac arrest outcomes: An updated meta-analysis. Cardiol J 2021; 28:816-824. [PMID: 34985120 PMCID: PMC8747824 DOI: 10.5603/cj.a2021.0168] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/03/2021] [Accepted: 12/03/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The main purposes of this meta-analysis are to update the information about the impact of coronavirus disease 2019 (COVID-19) pandemic on outcomes of in-hospital cardiac arrest (IHCA) and to investigate the impact of being infected by by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) on IHCA outcomes. METHODS The current meta-analysis is an update and follows the recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). RESULTS In analyses, pre- and intra-COVID-19 periods were observed for: shockable rhythms in 17.6% vs. 16.2% (odds ratio [OR]: 1.11; 95% confidence interval [CI]: 0.71-1.72; p = 0.65), return of spontaneous circulation (ROSC) in 47.4% vs. 44.0% (OR: 1.36; 95% CI: 0.90-2.07; p = 0.15), 30-day mortality in 59.8% vs. 60.9% (OR: 0.95; 95% CI: 0.75-1.22; p = 0.69) and overall mortality 75.8% vs. 74.7% (OR: 0.80; 95% CI: 0.49-1.28; p = 0.35), respectively. In analyses, SARS-CoV-2 positive and negative patients were observed for: shockable rhythms in 9.6% vs. 19.8% (OR: 0.51; 95% CI: 0.35-0.73; p < 0.001), ROSC in 33.9% vs. 52.1% (OR: 0.47; 95% CI: 0.30-0.73; p < 0.001), 30-day mortality in 77.2% vs. 59.7% (OR: 2.08; 95% CI: 1.28-3.38; p = 0.003) and overall mortality in 94.9% vs. 76.7% (OR: 3.20; 95% CI: 0.98-10.49; p = 0.05), respectively. CONCLUSIONS Despite ROSC, 30-day and overall mortality rate were not statistically different in pre- vs. intra-COVID-19 periods, a lower incidence of ROSC and higher 20-day mortality rate were observed in SARS-CoV-2 (+) compared to SARS-CoV-2 (-) patients.
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Affiliation(s)
- Karol Bielski
- Research Unit, Polonia University, Czestochowa, Poland,Provincial Emergency Medical Service Dispatcher, Warsaw, Poland
| | - Katarzyna Makowska
- First Chair and Department of Cardiology, Medical University of Warsaw, Poland
| | - Adam Makowski
- First Chair and Department of Cardiology, Medical University of Warsaw, Poland
| | - Tomasz Kopiec
- First Chair and Department of Cardiology, Medical University of Warsaw, Poland
| | - Aleksandra Gasecka
- First Chair and Department of Cardiology, Medical University of Warsaw, Poland
| | - Mariola Malecka
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland
| | - Michal Pruc
- Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland
| | - Zubaid Rafique
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Frank W. Peacock
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Andrea Denegri
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Lukasz Szarpak
- Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland. .,Research Unit, Maria Sklodowska-Curie Bialystok Oncology Center, Bialystok, Poland.
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20
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Szarpak L, Filipiak KJ, Skwarek A, Pruc M, Rahnama M, Denegri A, Jachowicz M, Dawidowska M, Gasecka A, Jaguszewski MJ, Iskrzycki L, Rafique Z. Outcomes and mortality associated with atrial arrhythmias among patients hospitalized with COVID-19: A systematic review and meta-analysis. Cardiol J 2021; 29:33-43. [PMID: 34897631 PMCID: PMC8890412 DOI: 10.5603/cj.a2021.0167] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 11/09/2021] [Revised: 11/27/2021] [Accepted: 11/27/2021] [Indexed: 11/25/2022] Open
Abstract
Background Atrial fibrillation (AF) is the most common cardiac arrhythmia in the adult population. Herein, is a systematic review with meta-analysis to determine the impact of AF/atrial flutter (AFL) on mortality, as well as individual complications in patients hospitalized with the coronavirus disease 2019 (COVID-19). Methods A systematic search of the SCOPUS, Medline, Web of Science, CINAHL and Cochrane databases was performed. The a priori primary outcome of interest was in-hospital mortality. A random-effects model was used to pool study results. Results Nineteen studies which included 33,296 patients were involved in this meta-analysis. In-hospital mortality for AF/AFL vs. no-AF/AFL groups varied and amounted to 32.8% vs. 14.2%, respectively (risk ratio [RR]: 2.18; 95% confidence interval [CI]: 1.79–2.65; p < 0.001). In-hospital mortality in new onset AF/AFL compared to no-AFAFL was 22.0% vs. 18.8% (RR: 1.86; 95% CI: 1.54–2.24; p < 0.001). Intensive care unit (ICU) admission was required for 17.7% of patients with AF/AFL compared to 10.8% for patients without AF/AFL (RR: 1.94; 95% CI: 1.04–3.62; p = 0.04). Conclusions The present study reveals that AF/AFL is associated with increased in-hospital mortality and worse outcomes in patients with COVID-19 and may be used as a negative prognostic factor in these patients. Patients with AF/AFL are at higher risk of hospitalization in ICU. The presence of AF/AFL in individuals with COVID-19 is associated with higher risk of complications, such as bleeding, acute kidney injury and heart failure. AF/AFL may be associated with unfavorable outcomes due to the hemodynamic compromise of cardiac function itself or hyperinflammatory state typical of these conditions.
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Affiliation(s)
- Lukasz Szarpak
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy in Warsaw, Poland. .,Research Unit, Maria Sklodowska-Curie Bialystok Oncology Center, Bialystok, Poland. .,Outcomes Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland.
| | - Krzysztof J Filipiak
- Institute of Clinical Medicine, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland
| | - Aleksandra Skwarek
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Michal Pruc
- Outcomes Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland
| | - Mansur Rahnama
- Chair and Department of Oral Surgery, Medical University of Lublin, Lublin, Poland
| | - Andrea Denegri
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena Italy
| | - Marta Jachowicz
- Students Research Club, Maria Sklodowska-Curie Medical Academy in Warsaw, Poland
| | - Malgorzata Dawidowska
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy in Warsaw, Poland
| | - Aleksandra Gasecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | - Lukasz Iskrzycki
- Department of Emergency Medical Service, Medical University of Wroclaw, Wroclaw, Poland
| | - Zubaid Rafique
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
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21
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Mahmoud SED, Shahin M, Yousif N, Denegri A, Abo Dahab LH, Lüscher TF. Cardiovascular Risk Profile, Presentation and Management Outcomes of Patients with Acute Coronary Syndromes after Coronary Artery Bypass Grafting. Curr Probl Cardiol 2021; 47:101078. [PMID: 34902394 DOI: 10.1016/j.cpcardiol.2021.101078] [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: 11/21/2021] [Accepted: 12/05/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Coronary artery bypass (CABG) is an important revascularization procedure with excellent long-term results. However, bypass grafts, particularly venous grafts, develop structural changes and atherosclerotic plaques that may cause angina or even acute coronary syndromes (ACS). Here we aimed to study patients with previous CABG presenting with an ACS and evaluated their cardiovascular (CV) risk profile, clinical presentations, angiographic findings, management strategies and short and long term outcomes. PATIENTS AND METHODS This represents an observational retrospective cross sectional single center study including all consecutive patients with previous CABG presenting with ACS at the University Heart Center of the University Hospital Zurich, Switzerland between January 1, 2000 and December 31, 2016. Mean age was 76.4 years and 83.1% were males. Major adverse cardiovascular and cerebrovascular events (MACCE) at 1-year follow up and long-term follow up were analyzed using Kaplan Meyer survival analysis. RESULTS We included 510 patients with ACS and prior CABG. Most patients were elderly at the time of presentation. 60.2% were diabetics and 58.6% obese, 43.5% hypertensives and 37.8% had hyperlipidemia. 73% (n=372) presented as unstable angina (UA), 22.5% as NSTEMI (n=115) and only 4.5% as STEMI (n=23). The acute events occurred in 4.9% (n=25) before discharge, in 4.9% (n=25) within the first year and in 90.2% (n=460) thereafter. Most of the patients (92.2%; n=470) had stenosed or occluded venous bypass grafts at presentation, while a minority (7.8%; n=40) had significantly narrowed or occluded arterial grafts. CV risk profiles were similar in both groups. However, arterial graft disease occurred earlier after CABG and more likely presented as NSTEMI rather than UA compared to the SVG group. In 54.7% (n=279) primary PCI of the saphenous graft, and in 13.5% (n=69) of the native coronary arteries was performed, while 6.5% (n=33) underwent redo CABG and 25.3% (n=129) received medical treatment only. MACE at 1 year occurred in 12.2% (n=62) with repeated revascularization as the most common event (7.2%; n=37) followed by cardiac death (2.4%; n=12), MI (1.2%; n=6), cerebrovascular infarction (1.2%; n=6) and major bleeding (0.2%; n=1). Hypertensive and obese patients, those with myocardial infarction or an ACS before discharge or during the first year after CABG had higher MACCE. In patients undergoing pPCI the rate of cardiac death and MI at 1 year was lower with an intervention in the native coronary arteries and with redo CABG compared to pPCI of bypass grafts. CONCLUSION Thus, patients with ACS and prior CABG typically present as UA and much less frequently as NSTEMI-ACS and particularly STEMI. Most events occur after one year, particularly with SVG. The 1 year MACCE rate is comparable to those with native coronary artery ACS. Hypertensive and obese patients, those with MI or with an ACS before discharge had higher MACCE rates.
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Affiliation(s)
- Sharaf E D Mahmoud
- Department of Internal Medicine and Cardiology unit, Sohag University, Egypt.
| | - Mohammady Shahin
- University Heart Center, Department of Cardiology, University Hospital Zurich, Switzerland; Department of Internal Medicine and Cardiology unit, Sohag University, Egypt
| | - Nooraldaem Yousif
- University Heart Center, Department of Cardiology, University Hospital Zurich, Switzerland; Mohamed Bin Khalifa Cardiac Centre, Bahrain
| | - Andrea Denegri
- University Heart Center, Department of Cardiology, University Hospital Zurich, Switzerland; Division of Cardiology, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Lotfy H Abo Dahab
- Department of Internal Medicine and Cardiology unit, Sohag University, Egypt
| | - Thomas F Lüscher
- Royal Brompton and Harefield Hospital Trust and Imperial College, National Heart and Lung Institute, London, United Kingdom; Centre for Molecular Cardiology, Zurich University, Switzerland
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22
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Denegri A, Obeid S, Raeber L, Windecker S, Gencer B, Mach F, Rodondi N, Heg D, Nanchen D, Matter CM, Klingenberg R, Luescher TF. Systemic immune-inflammation index predicts major adverse cardiovascular events in patients with ST-elevation myocardial infarction. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1353] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
ST-elevation myocardial infarction (STEMI) represents the life-threatening manifestation of atherosclerosis, a chronic inflammatory disease of arterial wall, and is associated with high rate of morbidity and mortality. Thus, inflammatory biomarkers may be useful in identifying high inflammatory burden patients who may benefit from tailored high-intensity secondary prevention therapy.
Purpose
We therefore assessed the relationship between the systemic immune-inflammation index (SII) and CV outcomesamong 1144 all-comers patients admitted to four Swiss University Hospital for STEMI and enrolled in the prospective multicenter SPUM registry cohort I (NCT 01000701).
Methods
SII was calculated as platelet counts x neutrophil counts / lymphocyte counts. Patients were subdivided into three groups according to SII tertiles. The composite primary endpoint was major adverse cardiac and cerebrovascular events (MACCE: stroke, myocardial infarction, CV death). Adjusted Cox proportional hazards regression models were implemented to determine the risk associated with SII and outcomes.
Results
Out of 1144 STEMI patients, 912 patients (79,7%) had available for SII. Patients within the highest tertile were slightly more frequently male (23.0 vs 22.0%, p=0.05), with higher plasma values of neutrophils (11.4±2.4 vs 6.5±3.7 G/l, p<0.001), platelets (275.3±97.5 vs 202.5±51.6 G/l, p<0.001) and lower levels of lymphocytes (1.0±0.6 vs 2.1±1.1 G/l, p<0.001) and LVEF (46.4±11.5% vs 50.4±10.3%, p<0.001) (Fig. 1A). At 1 year, these patients presented the highest rate of all-cause mortality (7.2% vs 2.6%, p=0.02) and MACCE (8.2% vs 3.3, p=0.03). This enhanced risk persisted for all-cause mortality and MACCE, after adjustment for age, sex, ace-inhibitors and statin therapy (Adj. HR 2.85, 95% CI 1.30–6.70, p=0.03 and Adj. HR 2.63, 95% CI 1.25–5.55, p=0.03, respectively, Fig. 1B).
Conclusions
Among a real-world cohort of STEMI-patients, SII highlights the highest inflammatory risk phenotype, being associated with significant increased rates of MACCE and all-cause of death. These observations might help clinicians to furtherly identify patients who may derive the greatest benefit from tailored more intense secondary prevention therapies including inflammatory modulation.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- A Denegri
- Azienda Ospedaliero Universitaria, Modena, Italy
| | - S Obeid
- Cantonal Hospital Aarau, Division of Cardiology, Aarau, Switzerland
| | - L Raeber
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - S Windecker
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - B Gencer
- Geneva University Hospitals, Cardiology, Geneva, Switzerland
| | - F Mach
- Geneva University Hospitals, Cardiology, Geneva, Switzerland
| | - N Rodondi
- University Hospital, Department of Family Medicine, Bern, Switzerland
| | - D Heg
- Institute of Social and Preventive Medicine. University of Bern, Bern, Switzerland
| | - D Nanchen
- Centre for Primary Care and Public Health (Unisante), Lausanne, Switzerland
| | - C M Matter
- University Hospital Zurich, Cardiology, Zurich, Switzerland
| | - R Klingenberg
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - T F Luescher
- Royal Brompton and Harefield Hospital, London, United Kingdom
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Adjibodou B, Obeid S, Kraler S, Denegri A, Mach F, Matter CM, Nanchen D, Roffi M, Muller O, Raeber L, Luescher T. Location and impact of the infarct-related artery in acute coronary syndrome: insight from the Swiss SPUM- ACS cohort. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Identifying the infarct-related artery (IRA) in patients with acute coronary syndromes (ACS) has prognostic and therapeutic implications.
Purpose
We aimed to evaluate the distribution, clinical presentation and impact of the culprit lesion location on long-term outcomes in ACS patients treated with primary percutaneous coronary intervention, medication and secondary prevention according to Guidelines.
Methods
Patients referred for ACS to one of the participating centres of the observational SPUM-ACS study between 2009 and 2017 with one year outcomes and independent events adjudication were included. The distribution of IRA, clinical presentation (STEMI/NSTEMI) and impact of IRA location on major adverse cardiac events (cardiac death, myocardial infarction, stent thrombosis, target vessel revascularisation) at one year were investigated.
Results
4'546 patients were included with 55% presenting as STEMI (mean age 62-years; 20% women), 42% as NSTEMI and 3% as unstable angina. The left anterior descending (LAD) artery was involved in 44.3%, the right coronary artery (RCA) and left circumflex artery (LCX) in 32.9% and 20%, respectively. Proximal and middle segments of the 3 main vessels were more often the culprit location compared to distal segments and side branches (78% versus. 22%). Left main (LM) and bypass graft were rarely involved (1.6% and 1.2% respectively), but most often responsible to overall cardiac dysfunction (higher NT-proBNP and hs troponin levels). Patients with an occluded IRA at angiography usually presented as STEMI on ECG (100% for LM, 90.5% for LAD territory, 83.8% for RCA territory, 56.6% for LCX territory). However 43.1% of patients with occluded LCX presented as NSTEMI. These patients were prone to extensive cardiac damage and significantly higher hs troponin levels as compared to those with patent LCX or STEMI presentation (626 ng/l vs 310 ng/l and 626 ng/l vs 580 ng/l respectively, p<0.001). Overall, 1-year MACE occurred in 11.8%. In native coronaries, the location of IRA had no impact on outcomes (20% LM, 10.9% LAD, 11.8% RCA, 11.8% LCX, p=0.112). However, in NSTEMI-ACS there were twice as many events when the LM was the IRA (MACE 20%, p=0.023) and 3-times higher when a bypass-graft was the IRA (33.9%, p=0.0001).
Conclusions
ST elevations are highly suggestive of an occluded IRA. However more than 40% of patients presenting with ACS involving an occluded LCX did not demonstrate ST-elevation and were prone to extensive cardiac damage, urging the necessity for early invasive measures in these patients. In native coronaries the IRA location did not affect outcomes except in NSTEMI with LM involvement or ACS with bypass grafts as IRA that had much worse outcomes.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): - Swiss National Research Foundation - Zurich Heart House
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Affiliation(s)
| | - S Obeid
- Cantonal Hospital Aarau, Aarau, Switzerland
| | - S Kraler
- University of Zurich, Center for molecular cardiology, Schlieren, Switzerland
| | - A Denegri
- University of Modena & Reggio Emilia, Cardiology, Modena, Italy
| | - F Mach
- Hopitaux Universitaires De Geneve, Cardiology, Geneva, Switzerland
| | - C M Matter
- University Hospital Zurich, Cardiology, Zurich, Switzerland
| | - D Nanchen
- University Hospital Centre Vaudois (CHUV), Ambulatory care and community medicine, Lausanne, Switzerland
| | - M Roffi
- Hopitaux Universitaires De Geneve, Cardiology, Geneva, Switzerland
| | - O Muller
- University Hospital Centre Vaudois (CHUV), Cardiology, Lausanne, Switzerland
| | - L Raeber
- Bern University Hospital, Inselspital, Cardiology, Bern, Switzerland
| | - T Luescher
- University of Zurich, Center for molecular cardiology, Schlieren, Switzerland
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Denegri A, Morelli M, Pezzuto G, Malavasi VL, Boriani G. Atrial fibrillation is related to higher mortality in COVID-19/SARS-CoV-2 pneumonia infection. Cardiol J 2021; 28:973-975. [PMID: 34523114 PMCID: PMC8747817 DOI: 10.5603/cj.a2021.0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Andrea Denegri
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy, Largo del Pozzo 71, 41125 Modena, Italy.
| | - Marianna Morelli
- Emergency Department, Azienda Ospedaliero-Universitaria di Modena,, Largo del Pozzo 71, 41125 Modena, Italy
| | - Giuseppe Pezzuto
- Emergency Department, Azienda Ospedaliero-Universitaria di Modena,, Largo del Pozzo 71, 41125 Modena, Italy
| | - Vincenzo Livio Malavasi
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy, Largo del Pozzo 71, 41125 Modena, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy, Largo del Pozzo 71, 41125 Modena, Italy
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25
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Denegri A, Pezzuto G, D'Arienzo M, Morelli M, Savorani F, Cappello CG, Luciani A, Boriani G. Clinical and electrocardiographic characteristics at admission of COVID-19/SARS-CoV2 pneumonia infection. Intern Emerg Med 2021; 16:1451-1456. [PMID: 33398608 PMCID: PMC7781180 DOI: 10.1007/s11739-020-02578-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 11/17/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND The aim of the present study was to compare clinical and electrocardiographic characteristics of patients with COVID-19 pneumonia in Modena, Emilia Romagna, Italy. METHODS Patients admitted to the emergency department for suspected COVID-19 pneumonia from March the 16th to April the 15th were enrolled in the study. COVID-19 pneumonia was confirmed by positive nasopharyngeal swab. Primary endpoint was 30-day mortality. RESULTS 201 patients were diagnosed with COVID-19 pneumonia. Compared to survivors, patients who died were older (79.7 ± 10.8 vs 65.6 ± 14.1, p < 0.001), with a more complex cardiovascular history, including coronary artery disease (CAD, 33.3% vs 13.3%, p = 0.004), atrial fibrillation (23.8 vs 8.8, p = 0.011) and chronic kidney disease (CKD 35.7% vs 7.0%, p < 0.001). 30-day mortality was 20,9% in these patients; atrial fibrillation (OR 12.74, 95% CI 3.65-44.48, p < 0.001), ST-segment depression (OR 5.30, 95% CI 1.50-18.81, p = 0.010) and QTc-interval prolongation (OR 3.17, 95% CI 1.24-8.10, p = 0.016) at ECG admission were associated to an increased mortality risk. On the contrary, sinus rhythm (OR 0.08, 95% CI 0.02-0.27, p < 0.001) and low-molecular weight heparin (LMWH) administration (OR 0.08, 95% CI 0.02-0.29, p < 0.001) were related to reduced mortality. At multivariate analysis, after adjustment for age, sex, diabetes, CAD, and MCA admission, sinus rhythm (HR 2.7, CI 95% 1.1-7.0, p = 0.038) and LMWH (HR 8.5, 95% CI 2.0-36.6, p = 0.004) were confirmed to be independent predictors of increased survival. CONCLUSION Sinus rhythm at ECG admission in COVID-19 pneumonia patients was associated with greater survival as well as LMWH administration, which conferred an overall better outcome.
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Affiliation(s)
- Andrea Denegri
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Di Modena, Largo del Pozzo, 71, 41125, Modena, Italy.
| | - Giuseppe Pezzuto
- Emergency Department, Azienda Ospedaliero-Universitaria Di Modena, Largo del Pozzo, 71, 41125, Modena, Italy
| | - Matteo D'Arienzo
- Emergency Department, Azienda Ospedaliero-Universitaria Di Modena, Largo del Pozzo, 71, 41125, Modena, Italy
| | - Marianna Morelli
- Emergency Department, Azienda Ospedaliero-Universitaria Di Modena, Largo del Pozzo, 71, 41125, Modena, Italy
| | - Fulvio Savorani
- Emergency Department, Azienda Ospedaliero-Universitaria Di Modena, Largo del Pozzo, 71, 41125, Modena, Italy
| | - Carlo G Cappello
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Di Modena, Largo del Pozzo, 71, 41125, Modena, Italy
| | - Antonio Luciani
- Emergency Department, Azienda Ospedaliero-Universitaria Di Modena, Largo del Pozzo, 71, 41125, Modena, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Di Modena, Largo del Pozzo, 71, 41125, Modena, Italy
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26
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Denegri A, Boriani G. High Sensitivity C-reactive Protein (hsCRP) and its Implications in Cardiovascular Outcomes. Curr Pharm Des 2021; 27:263-275. [PMID: 32679014 DOI: 10.2174/1381612826666200717090334] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 04/09/2020] [Accepted: 05/20/2020] [Indexed: 11/22/2022]
Abstract
Atherosclerosis and its fearsome complications represent the first cause of morbidity and mortality worldwide. Over the last two decades, several pieces of evidence have been accumulated, suggesting a central role of inflammation in atheroma development. High sensitivity C-reactive protein (hsCRP) is a well-established marker of cardiovascular (CV) disease; high levels of hsCRP have been associated with adverse CV outcome after acute coronary syndrome (ACS) and, despite some controversy, an active role for hsCRP in initiation and development of the atherosclerotic plaque has been also proposed. Randomized clinical trials focusing on hsCRP have been crucial in elucidating the anti-inflammatory effects of statin therapy. Thus, hsCRP has been progressively considered a real CV risk factor likewise to low-density lipoprotein cholesterol (LDL-C), expanding the concept of residual CV inflammatory risk. Subsequent research has been designed to investigate potential new targets of atherothrombotic protection. Despite the fact that the clinical usefulness of hsCRP is widely recognized, hsCRP may not represent the ideal target of specific anti-inflammatory therapies. Clinical investigations, therefore, have also focused on other inflammatory mediators, restricting hsCRP to an indicator rather than a therapeutic target. The aim of the present review is to provide an illustrative overview of the current knowledge of atherosclerosis and inflammation, highlighting the most representative clinical studies of lipid-lowering and antiinflammatory therapies focused on hsCRP in CV diseases.
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Affiliation(s)
- Andrea Denegri
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Largo del Pozzo, 71, 41125, Modena, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Largo del Pozzo, 71, 41125, Modena, Italy
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27
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Rossi VA, Denegri A, Candreva A, Klingenberg R, Obeid S, Räber L, Gencer B, Mach F, Nanchen D, Rodondi N, Heg D, Windecker S, Buhmann J, Ruschitzka F, Lüscher TF, Matter CM. Prognostic value of inflammatory biomarkers and GRACE score for cardiac death and acute kidney injury after acute coronary syndromes. Eur Heart J Acute Cardiovasc Care 2021; 10:445-452. [PMID: 33624028 DOI: 10.1093/ehjacc/zuab003] [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] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/29/2019] [Accepted: 01/12/2021] [Indexed: 11/13/2022]
Abstract
AIMS The aim of this study was to analyse the role of inflammation and established clinical scores in predicting acute kidney injury (AKI) after acute coronary syndromes (ACS). METHODS AND RESULTS In a prospective multicentre cohort including 2034 patients with ACS undergoing percutaneous coronary intervention, high-sensitivity C-reactive protein (hsCRP), neutrophil count, neutrophil-to-lymphocyte ratio (NL-ratio), and creatinine were measured at the index procedure. AKI (n = 39, defined according to RIFLE criteria) and major cardiovascular and cerebrovascular events were adjudicated after 1 year. Associations between inflammation, AKI, and cardiac death (CD) were assessed by C-statistics and Cox proportional hazard models with log-rank test to compare survival. Patients with ACS with elevated neutrophil count >7.8 × 109/L, NL-ratio >5, combined neutrophil-count/creatinine, or NL-ratio/creatinine at baseline showed a higher incidence of AKI (all P < 0.05) and CD (all P < 0.001). The risk of AKI, CD, and their combination was increased in patients with higher neutrophil count/creatinine (heart rate (HR) = 3.7, 95% cardiac index (CI) 1.9-7.1; HR = 2.7, 95% CI 1.6-4.6; HR = 3.2, 95% CI 2.1-4.9); NL-ratio/creatinine (HR = 2.1, 95% CI 1.6-4.1; HR = 2.2, 95% CI 1.3-3.8; HR = 2.3, 95% CI 1.5-3.5); and hsCRP (HR = 1.8, 95% CI 0.9-3.5; HR = 2.2, 95% CI 1.3-3.6; HR = 1.9, 95% CI 1.2-2.8) after adjustment for age, diabetes, hypertension, previous heart failure, kidney function, haemodynamic instability at admission, statin, and renin-angiotensin-aldosterone antagonists use. Subjects with higher GRACE score 1.0/NL-ratio had higher rate of AKI, CD, and both (HR = 1.4, 95% CI 0.5-4.2; HR = 2.7, 95% CI 1.3-5.9; HR = 2.1, 95% CI 1-4.3). CONCLUSIONS Inflammation markers may predict AKI after correction for renal function at the index procedure. hsCRP performed better than the NL-ratio. However, the integration of inflammation markers to traditional risk factors or scores does not add prognostic information. TRIAL REGISTRATION ClinicalTrials.gov, NCT01000701.
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Affiliation(s)
- Valentina A Rossi
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Andrea Denegri
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland.,Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via Università 4, 41125 Modena, Italy
| | - Alessandro Candreva
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Roland Klingenberg
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland.,Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany
| | - Slayman Obeid
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Cardiovascular Center, University Hospital Bern, Freiburgstrasse 4, 3010 Bern, Switzerland
| | - Baris Gencer
- Department of Cardiology, Cardiovascular Center, University Hospital Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - François Mach
- Department of Cardiology, Cardiovascular Center, University Hospital Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - David Nanchen
- Department of Ambulatory Care and Community Medicine, University Hospital of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, University Hospital Bern, Freiburgstrasse 4, 3010 Bern, Switzerland.,Bern Institute of Primary Health Care (BIHAM), University of Bern, Hochschulstrasse 6, 3012 Bern, Switzerland
| | - Dik Heg
- Department of Cardiology, Cardiovascular Center, University Hospital Bern, Freiburgstrasse 4, 3010 Bern, Switzerland.,Institute of Social and Preventive Medicine, (ISPM) University of Bern, Hochschulstrasse 6, 3012 Bern, Switzerland
| | - Stephan Windecker
- Department of Clinical Research, Clinical Trials Unit, ISPM, University of Bern, Hochschulstrasse 6, 3012 Bern, Switzerland
| | - Joachim Buhmann
- Institute of Neuroinformatics, University of Zurich and ETH Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Thomas F Lüscher
- Department of Cardiology, Royal Brompton and Harefield Hospitals and Imperial College, Sydney St, Chelsea, London SW3 6NP, UK.,Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
| | - Christian M Matter
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
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28
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Dal Fabbro J, Candreva A, Rossi VA, Shahin M, Yousif N, Lüscher TF, Duru F, Denegri A. Clinical and electrocardiographic features of patients with myocardial infarction with non-obstructive coronary artery disease (MINOCA). J Cardiovasc Med (Hagerstown) 2021; 22:104-109. [PMID: 32706560 DOI: 10.2459/jcm.0000000000001027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Myocardial infarction with non-obstructive coronary artery disease (MINOCA) is often an underdiagnosed and undertreated condition. This study aimed to evaluate clinical and ECG characteristics of MINOCA in a large cohort of patients admitted for acute coronary syndrome. METHODS All coronary angiograms performed at the University Heart Center in Zurich (Switzerland) between 2012 and 2016 were investigated. MINOCA was defined according to European Society of Cardiology guidelines and patients were divided into two groups, based on the presence or absence of coronary sclerosis at angiogram[nonobstructive coronary artery disease (noCAD) and normal coronary arteries (NCA)]), after exclusion of myocarditis and Takotsubo syndrome. RESULTS Out of 13 669 angiographic studies, 3695 were diagnosed with acute coronary syndrome; of these, 244 patients presented MINOCA (6.6%). Patients with noCAD were more likely to be older (67.9 vs. 59.2 years, P < 0.001) with higher prevalence of traditional cardiovascular risk factors (hypertension 64.1 vs. 41.2%, P = 0.002; diabetes 19.7 vs. 10.8%, P = 0.036; hypercholesterolemia 36.6 vs. 23.5%, P = 0.037). On surface ECG, anterior ST- segment elevation was more frequent in NCA patients (13.7 vs. 5.0%, P = 0.016). Secondary prevention therapy was significantly more prescribed in noCAD compared with NCA patients (acetylsalicylic acid 68.3 vs. 21.6%, P less than 0.001; statins 76.1 vs. 22.5%, P less than 0.001; angiotensin-converting enzyme inhibitor-AT1 blockers 51.4 vs. 31.3%, P = 0.006). One-year mortality was very low (0.4% for noCAD patients). CONCLUSION noCAD patients were older, with higher prevalence of cardiovascular risk factors and more frequently discharged with secondary prevention therapy. NCA patients presented more frequently anterior ST- segment elevation. Further diagnostic tests should be highly recommended to determine the underlying mechanism of MINOCA.
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Affiliation(s)
- Jan Dal Fabbro
- Department of Cardiology, University Heart Center, University Hospital Zurich
| | - Alessandro Candreva
- Department of Cardiology, University Heart Center, University Hospital Zurich
| | - Valentina A Rossi
- Department of Cardiology, University Heart Center, University Hospital Zurich
| | - Mohammady Shahin
- Department of Cardiology, University Heart Center, University Hospital Zurich
| | - Nooraldaem Yousif
- Department of Cardiology, University Heart Center, University Hospital Zurich
| | - Thomas F Lüscher
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Zurich, Switzerland.,Royal Brompton and Harefield Hospitals Trust and Imperial College, London, UK
| | - Firat Duru
- Department of Cardiology, University Heart Center, University Hospital Zurich.,Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Andrea Denegri
- Department of Cardiology, University Heart Center, University Hospital Zurich.,Division of Cardiology, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
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29
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Denegri A, Venturelli A, Boriani G. Infective endocarditis with perivalvular abscess complicated by septic embolization with acute ST-segment elevation myocardial infarction and peripheral ischemia. Int J Cardiol Heart Vasc 2021; 32:100711. [PMID: 33490364 PMCID: PMC7811112 DOI: 10.1016/j.ijcha.2020.100711] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/20/2020] [Accepted: 12/29/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Andrea Denegri
- Cardiology Division, Policlinico di Modena, Azienda Ospedaliero-Universitaria di Modena, Largo del Pozzo, 71, 41125 Modena, Italy
| | - Andrea Venturelli
- Cardiology Division, Policlinico di Modena, Azienda Ospedaliero-Universitaria di Modena, Largo del Pozzo, 71, 41125 Modena, Italy
| | - Giuseppe Boriani
- Cardiology Division, Policlinico di Modena, Azienda Ospedaliero-Universitaria di Modena, Largo del Pozzo, 71, 41125 Modena, Italy
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30
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Sgura FA, Arrotti S, Magnavacchi P, Monopoli D, Gabbieri D, Banchelli F, Tondi S, Denegri A, D'Amico R, Guiducci V, Vignali L, Boriani G. Kidney dysfunction and short term all-cause mortality after transcatheter aortic valve implantation. Eur J Intern Med 2020; 81:32-37. [PMID: 32487372 DOI: 10.1016/j.ejim.2020.05.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 12/14/2019] [Revised: 04/29/2020] [Accepted: 05/16/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) after transcatheter aortic valve implantation (TAVI) has been associated with worse outcomes. However, the impact on outcome of AKI in TAVI-patients is not well established. METHODS Inoperable patients with severe aortic stenosis (AS) undergoing TAVI in 2010-2018 were enrolled in this study. AKI and chronic kidney disease (CKD) were defined according to KDIGO guidelines. Patients were divided in two groups according to post-procedural AKI development. The primary endpoint was 30-day all-cause mortality across the two groups. RESULTS A total of 373 patients (mean age 82.3 ± 6) were analyzed. Compared to non-AKI patients, those who developed AKI, were treated more frequently with trans-apical TAVI (66% vs 35%, p<0.01), with greater amount of contrast medium (200.6 vs 170.4 ml, p=0.02) and in presence of clinically significant peripheral artery disease (PAD, 33% vs 21%, p=0.04). Trans-apical access (OR 3.24, 95% CI 1.76-5.60, p<0.01) was associated with a 3-fold risk of AKI. After adjustment for age, Society of Thoracic Surgery risk score (STS), PAD, access type, EF and contrast medium amount, patients with AKI presented an increased risk of 30-day all-cause mortality (HR=1.25, 95%CI 1.09-1.69, p=0.008). Patients with CKD IV and V, who developed AKI, presented a 9-fold 30-day mortality risk (HR=9.71, 95% CI 2.40-39.2, p=0.001). CONCLUSION In our analysis, AKI was a strong predictor of 30-day all-cause mortality. Particularly, patients with severe CKD with AKI showed the highest 30-day mortality risk. Thus, this group of patients might benefit from closer monitoring and specific kidney protection therapies.
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Affiliation(s)
- Fabio Alfredo Sgura
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena
| | - Salvatore Arrotti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena
| | | | - Daniel Monopoli
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena
| | | | - Federico Banchelli
- Statistic Unit, Department of Medical and Surgical Sciences, University of Modena, 41124 Modena, Italy
| | - Stefano Tondi
- Cardiology Division, Baggiovara Hospital, Modena, Italy
| | - Andrea Denegri
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena
| | - Roberto D'Amico
- Statistic Unit, Department of Medical and Surgical Sciences, University of Modena, 41124 Modena, Italy
| | - Vincenzo Guiducci
- Interventional Cardiology Unit, S. Maria Nuova Hospital, Reggio Emilia, Italy
| | - Luigi Vignali
- Cardiology Division, Parma University Hospital, Parma, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena.
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31
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Denegri A, Raeber L, Windecker S, Gencer B, Mach F, Rodondi N, Heg D, Nanchen D, Klingenberg R, Matter C, Luescher T. Uncontrolled hypertension and elevated NT-proBNP predict acute kidney injury and cardiac death in all-comer patients 1 year after acute coronary syndromes. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1655] [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
Hypertension is a recognized cardiovascular (CV) risk factor and, although many highly effective antihypertensive drugs have been developed, most patients fail to achieve recommended blood pressure target levels. This may increase major adverse CV events after acute coronary syndromes (ACS) such as acute kidney injury (AKI) and cardiac death (CD).
Purpose
We assessed the prognostic value of uncontrolled hypertension (UH) and elevated NT-proBNP among 2,168 all-comer patients admitted to 4 Swiss University Hospitals for acute coronary syndromes (ACS) enrolled in the prospective multicenter SPUM registry.
Methods
Patients with UH defined as a systolic blood pressure≥140 mmHg, and a NT-proBNP>900 ng/l were considered for the analysis. The composite primary endpoint was AKI and CD. Adjusted Cox proportional hazards regression models were implemented to determine risk prediction for UH and elevated NT-proBNP levels.
Results
Out of 2,168 ACS patients, 235 patients (10.8%) showed UH and NT-proBNP>900 ng/l (Fig. 1A). Compared to the general ACS population, those with UH and elevated NT-proBNP were more likely to be older (41.7% vs 20.0%, p<0.001), of female sex (36.2% vs 19.7%, p<0.001) and with a more complex history of CV disease, such as hypertension (77.0% vs 56.2%, p<0.001), diabetes (24.7% vs 17.5%, p=0.006), peripheral artery disease (9.4% vs 5.2%, p=0.011), cerebrovascular disease (6.8% vs 3.4%, p=0.013), chronic heart failure (3.4% vs 1.3%, p=0.025), dialysis (2.1% vs 0.3%, p=0.004) as well as prior CABG (9.4% vs 5.2%, p=0.010) and more often admitted as NSTEMIs (59.6% vs 40.9%, p<0.001). Although these patients were on a more aggressive antihypertensive therapy at admission (all p<0.05 for ACEi, ARB, Beta-blockers, calcium antagonists, nitrates and diuretics), there was a higher rate of death (OR 1.83, 95% CI 1.07–3.14, p=0.027), CD (OR 2.13, 95% CI 1.19–3.81, p=0.009), AKI (OR 2.83, 95% CI 1.41–5.67, p=0.002) and composite endpoint AKI+CD (OR 2.46, 95% CI 1.56–3.90, p<0.001) at one year. This combined risk persisted after adjustment for baseline differences, with a 71% (Adj. HR 1.71, 95% CI 1.44–1.84, p=0.003) increase for the composite endpoint (Fig. 1B).
Conclusions
Among a real-world cohort of ACS patients, coexistence of UH with elevated levels of NT-proBNP confers increased risk for AKI and CD up to one year after ACS. These observations might help clinicians to identify ACS patients at risk using simple clinical parameters and biomarkers and to target them for more intense preventive therapies.
Figure 1. A: GRADE1 = 140–159 mmHg and/or 90–99 mmHg; GRADE2 = 160–179 mmHg and/or 100–109 mmHg; GRADE3 = ≥180 mmHg and/or ≥110 mmHg; ISH (isolate systolic hypertension) = ≥140 mmHg and <90 mmHg; NT-proBNP = N-terminal-pro B-type natriuretic peptide. B: UH = uncontrolled hypertension; AKI = acute kidney injury; CD = cardiac death.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Denegri
- Azienda Ospedaliero Universitaria, Modena, Italy
| | - L Raeber
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - S Windecker
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - B Gencer
- Geneva University Hospitals, Cardiology, Geneva, Switzerland
| | - F Mach
- Geneva University Hospitals, Cardiology, Geneva, Switzerland
| | - N Rodondi
- Bern University Hospital, Inselspital, Department of Family Medicine, Bern, Switzerland
| | - D Heg
- University of Bern, Institute of Social and Preventive Medicine, Bern, Switzerland
| | - D Nanchen
- University of Lausanne, Center for Primary Care and Public Health, Lausanne, Switzerland
| | - R Klingenberg
- University Hospital Zurich, Cardiology, Zurich, Switzerland
| | - C.M Matter
- University Hospital Zurich, Cardiology, Zurich, Switzerland
| | - T.F Luescher
- Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
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Denegri A, Albini A, Barbieri A, Boriani G. A giant right coronary artero-venous fistula revealed by an integrated multimodality imaging approach. Intern Emerg Med 2020; 15:1331-1332. [PMID: 32274648 DOI: 10.1007/s11739-020-02324-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/24/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Andrea Denegri
- Cardiology Division, Policlinico di Modena, Azienda Ospedaliero-Universitaria di Modena, Largo del Pozzo, 71, 41125, Modena, Italy.
| | - Alessandro Albini
- Cardiology Division, Policlinico di Modena, Azienda Ospedaliero-Universitaria di Modena, Largo del Pozzo, 71, 41125, Modena, Italy
| | - Andrea Barbieri
- Cardiology Division, Policlinico di Modena, Azienda Ospedaliero-Universitaria di Modena, Largo del Pozzo, 71, 41125, Modena, Italy
| | - Giuseppe Boriani
- Cardiology Division, Policlinico di Modena, Azienda Ospedaliero-Universitaria di Modena, Largo del Pozzo, 71, 41125, Modena, Italy
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Naduvathumuriyil T, Held U, Steigmiller K, Denegri A, Cantatore S, Obeid S, Flammer AJ, Ruschitzka F, Lüscher TF, Sudano I. Clinical benefits and safety of renal denervation in severe arterial hypertension: A long‐term follow‐up study. J Clin Hypertens (Greenwich) 2020; 22:1854-1864. [DOI: 10.1111/jch.14005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 05/01/2020] [Accepted: 05/17/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Tino Naduvathumuriyil
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Ulrike Held
- Epidemiology, Biostatistics and Prevention Institute University of Zurich Zurich Switzerland
| | - Klaus Steigmiller
- Epidemiology, Biostatistics and Prevention Institute University of Zurich Zurich Switzerland
| | - Andrea Denegri
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
- Cardiology Division Department of Biomedical, Metabolic and Neural Sciences University of Modena and Reggio EmiliaPoliclinico di Modena Modena Italy
| | - Silviya Cantatore
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Slayman Obeid
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Andreas J. Flammer
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Frank Ruschitzka
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Thomas F. Lüscher
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
- Royal Brompton & Harefield HospitalImperial College London UK
- Center for Molecular Cardiology University of Zurich Zurich Switzerland
| | - Isabella Sudano
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
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Denegri A, Raeber L, Windecker S, Gencer B, Mach F, Rodondi N, Heg D, Nanchen D, Matter C, Luescher TF. Best Poster Award - Third Prize: The Perilousness of Antidepressant Drugs in a Real-world Cohort of Patients with Acute Coronary Syndrome. Eur Cardiol 2020; 15:e26. [PMID: 32612686 PMCID: PMC7312711 DOI: 10.15420/ecr.2020.15.1.po3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Denegri A, Rossi VA, Vaghi F, Di Muro P, Regazzi M, Moccetti T, Pasotti E, Pedrazzini GB, Capoferri M, Moccetti M. A patient-centered multidisciplinary cardiac rehabilitation program improves glycemic control and functional outcome in coronary artery disease after percutaneous and surgical revascularization. Cardiol J 2020; 29:72-79. [PMID: 32037504 PMCID: PMC8890425 DOI: 10.5603/cj.a2020.0006] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 07/23/2019] [Accepted: 08/19/2019] [Indexed: 11/25/2022] Open
Abstract
Background Cardiac rehabilitation (CR) is strongly associated with all-cause mortality reduction in patients with coronary artery disease (CAD). The impact of CR on pathological risk factors, such as impaired glucose tolerance (IGT) and functional recovery remains under debate. The aim of the present study is to determine whether CR had a positive effect beside physical exercise improvement on pathological risk factors in IGT and diabetic patients with CAD. Methods One hundred and seventy-one consecutive patients participating in a 3-month CR from January 2014 to June 2015 were enrolled. The primary endpoint was defined as an improvement of peak workload and VO2-peak; glycated hemoglobin (HbA1c) reduction was considered as secondary endpoint. Results Euglycemic patients presented a significant improvement in peak workload compared to diabetic patients (from 5.75 ± 1.45 to 6.65 ± 1.84 METs vs. 4.8 ± 0.8 to 4.9 ± 1.4 METs, p = 0.018). VO2-peak improved in euglycemic patients (VO2-peak from 19.3 ± 5.3 to 22.5 ± 5.9 mL/min/kg, p = 0.003), while diabetic patients presented only a statistically significant trend (VO2-peak from 16.9 ± 4.4 to 18.0 ± 3.8 mL/min/kg, p < 0.056). Diabetic patients have benefited more in terms of blood glucose control compared to IGT patients (HbA1c from 7.7 ± 1.0 to 7.4 ± 1.1 compared to 5.6 ± 0.4 to 5.9 ± 0.5, p = 0.02, respectively). Conclusions A multidisciplinary CR program improves physical functional capacity in CAD setting, particularly in euglycemic patients. IGT patients as well as diabetic patients may benefit from a CR program, but long-term outcome needs to be clarified in larger studies.
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Affiliation(s)
- Andrea Denegri
- Department of Cardiology, ASST Mantova, Strada Lago Paiolo 10, 46100 Mantova, Italy.
| | - Valentina A Rossi
- Department of Cardiology, University Hospital, Zurich CH-8091, Switzerland
| | - Fabrizio Vaghi
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Paolo Di Muro
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Martino Regazzi
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Tiziano Moccetti
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Elena Pasotti
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | | | - Mauro Capoferri
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Marco Moccetti
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
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Langfritz M, Shahin M, Nietlispach F, Taramasso M, Denegri A, Moccetti M, Pedrazzini G, Moccetti T, Keller LS, Ruschitzka F, Maisano F, Obeid S. Baseline Predictors of Renal Failure in Transcatheter Aortic Valve Implantation. J Invasive Cardiol 2019; 31:E289-E297. [PMID: 31567117] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) post transcatheter aortic valve implantation (TAVI) is associated with worsened short- and long-term outcomes. We sought to identify significant baseline predictors of AKI and establish a high-risk group within patients enrolled in the multicenter SWISS-TAVI cohort. METHODS AND RESULTS A total of 526 patients who underwent TAVI were included in our analysis. Patients on hemodialysis were excluded. Within the first week after valve implantation, fifty patients (9.5%) developed AKI. There was a significantly higher prevalence of diabetes mellitus in the AKI group (45% vs 28%; P=.02). The odds ratio (OR) for patients suffering from diabetes mellitus who developed AKI was 1.9 after multivariable binary regression analysis (95% confidence interval, 1.018-3.553; P=.04). Chronic kidney disease (CKD) stage ≥4 was more prevalent in the AKI group (26% vs 14%; P=.04). Every 1 mg/dL creatinine above normal level at baseline increased AKI risk by a factor of 1.6 (OR, 1.605; 95% CI, 1.111-2.319; P=.01). Age, gender, body mass index, history of dyslipidemia, and history of hypertension were similar between the groups. In the diabetic population of 155 patients (29.5%), AKI developed in 22 patients (14.2%), compared with the non-diabetic population of 370 patients (70.5%), where AKI developed in 27 patients (7.3%). In the diabetic population, an elevation by 1 mg/dL in baseline creatinine was an independent predictor of developing kidney injury (OR, 2.061; 95% CI, 1.154-3.683; P=.02, while in non-diabetic patients, neither baseline glomerular filtration rate, CKD grade, STS score, EuroScore II, ACEF score, nor procedural contrast usage were predictors of AKI. CONCLUSION Diabetics with CKD stage ≥4 (as defined by the Kidney Disease: Improving Global Outcomes criteria) constitute a high-risk group for developing AKI after TAVI. In this high-risk subgroup, baseline creatinine in combination with amount of contrast agent used were strong risk factors for developing AKI. AKI in non-diabetics was less predictable by baseline characteristics.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Slayman Obeid
- University Heart Center, University Hospital, Zurich, Rämistrasse 100, 8091 Zürich, Switzerland.
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Denegri A, Magnani G, Rossi VA, Raeber L, Windecker S, Gencer B, Mach F, Rodondi N, Heg D, Nanchen D, Matter CM, Luescher TF. P6440The perils of polyvascular disease with concomitant type 2 diabetes in a real-world cohort of patients with acute coronary syndrome. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1034] [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
Despite substantial improvement in type 2 diabetes (DM2) care, the burden of recurrent cardiovascular (CV) events remains high. Polyvascular disease (PVD), has recently emerged as a potential marker of heightened residual ischemic risk in DM2 patients, that are likely to derive a greater absolute risk reduction from more intense, individualized therapy.
Purpose
We sought to assess the relationship between DM2, PVD and CV outcomes among 2,168 all-comers patients admitted to four Swiss University Hospital for acute coronary syndrome (ACS) and enrolled in the prospective multicenter SPUM registry (NCT 01000701).
Methods
PVD was defined as concomitant peripheral artery disease, stroke or transient ischemic attack, or both. The composite primary endpoint was major adverse cardiac and cerebrovascular events (MACCE: Stroke, myocardial infarction, CV death). Adjusted Cox proportional hazards regression models were implemented to determine the risk associated with PVD disease in DM2 and outcomes, and intention-to-treat analysis was performed.
Results
Out of 2,168 ACS patients, 396 patients (18.3%) had DM2; of these 62 (15%) had PVD. Despite compared with the general ACS population, those with PVD + DM2 were more likely to have a complex history of CV disease, such as previous MI (27.4% vs 14.7%, p=0.021), prior percutaneous (37.1% vs 17%, p<0.001) or surgical (24.2% vs 5.1%, p<0.001) coronary revascularization, one third was not on statin therapy. At 1 year, patients with PVD + DM2 had a higher rate of MACCE compared to those presenting with PVD or DM2 alone. Rates of the single components of the primary endpoint and all-cause of death were all significantly higher in patients with PVD + DM2 vs. PVD or DM2 alone (Fig. 1A, all p<0.001). This enhanced risk persisted after adjustment for significant baseline differences, with a 34% (Adj. HR 1.34, 95% CI 1.15–1.49, p=0.02) increase in MACCE and a 44% increment of all cause of death (Adj. HR 1.44, 95% CI 1.06–1.54, p=0.02, Fig. 1B).
Outcomes by PVD and DM2 status.
Conclusions
Among a real-world cohort of ACS-patients, the coexistence of PVD and DM2 highlights the highest CV risk phenotype, being associated with significant increased rates of MACCE and all-cause of death. These observations might help clinicians to furtherly stratify the very high risk population and to identify patients who may derive the greatest benefit from more intense secondary prevention therapies.
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Affiliation(s)
| | - G Magnani
- University Hospital of Parma, Cardiology, Parma, Italy
| | - V A Rossi
- University Hospital Zurich, Cardiology, Zurich, Switzerland
| | - L Raeber
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - S Windecker
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - B Gencer
- Geneva University Hospitals, Cardiology, Geneva, Switzerland
| | - F Mach
- Geneva University Hospitals, Cardiology, Geneva, Switzerland
| | - N Rodondi
- Bern University Hospital, Department of Family Medicine, Bern, Switzerland
| | - D Heg
- Bern University Hospital, Institute of Social and Preventive Medicine, Bern, Switzerland
| | - D Nanchen
- University of Lausanne, Center for Primary Care and Public Health, Lausanne, Switzerland
| | - C M Matter
- University Hospital Zurich, Cardiology, Zurich, Switzerland
| | - T F Luescher
- Royal Brompton Hospital, Cardiology, London, United Kingdom
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Weidmann L, Obeid S, Mach F, Shahin M, Yousif N, Denegri A, Muller O, Räber L, Matter CM, Lüscher TF. Pre-existing treatment with aspirin or statins influences clinical presentation, infarct size and inflammation in patients with de novo acute coronary syndromes. Int J Cardiol 2018; 275:171-178. [PMID: 30344063 DOI: 10.1016/j.ijcard.2018.10.050] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 10/10/2018] [Accepted: 10/15/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Influence of pre-existing treatment with aspirin and/or statins prior to a first acute coronary syndrome (ACS) on clinical presentation, infarct size and inflammation markers. We analyzed patients from the Swiss Program University Medicine ACS-cohort (SPUM-ACS; ClinicalTrials.govnumber:NCT01075867). METHODS 1639 patients were categorized into 4 groups: (1) patients without either drug (n = 1181); (2) patients only on aspirin (n = 157); (3) patients only on statins (n = 133) and (4) patients on both drugs (n = 168). Clinical features, electrocardiogram (ECG), creatinine kinase (CK, U/l), high-sensitivity troponin T (hsTNT, μg/l), N-terminal brain natriuretic peptide (NT-proBNP, ng/l), leucocytes (Lc, G/l), neutrophils (Nc, G/l), C-reactive protein (CRP, mg/l) and angiographic features were documented at baseline. RESULTS Incidences of ST-elevation myocardial infarction (STEMI) were 64% in group 1, 45% in group 2, 52% in group 3 and 40% in group 4 (p < 0.0001). Those with both drugs had significantly lower CK (median 145 U/l, interquartile range (IQR) 89-297), hsTNT (median 0.13 μg/l, IQR 0.03-0.52) and higher left ventricular ejection fraction values (LVEF) (mean 55 ± 12%) compared to untreated patients (median CK 273 U/l, IQR 128-638; median hsTNT 0.26 μg/l, IQR 0.08-0.85; mean LVEF 51 ± 11%) (p < 0.0001, p = 0.001, p = 0.028, respectively). Co-medicated groups matched for high risk factors presented less frequently as STEMIs (p < 0.0001), had significantly smaller infarcts determined by CK and hsTNT (both p < 0.0001) and lower CRP levels (p = 0.01) compared to patients without pre-existing treatment with either drug. CONCLUSION Pre-existing treatment with aspirin and/or statins and particularly with their combination changes the clinical presentation, infarct size, inflammation markers and LVEF in patients suffering their first ACS.
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Affiliation(s)
- Lukas Weidmann
- Department of Cardiology, University Heart Center Zurich, Switzerland
| | - Slayman Obeid
- Department of Cardiology, University Heart Center Zurich, Switzerland
| | - François Mach
- Department of Cardiology, University Hospital Geneva, Switzerland
| | - Mohammady Shahin
- Department of Cardiology, University Heart Center Zurich, Switzerland
| | - Nooraldaem Yousif
- Department of Cardiology, University Heart Center Zurich, Switzerland
| | - Andrea Denegri
- Department of Cardiology, University Heart Center Zurich, Switzerland
| | - Olivier Muller
- Department of Cardiology, Cardiovascular Center, University Hospital Lausanne, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Cardiovascular Center, University Hospital Bern, Switzerland
| | | | - Thomas F Lüscher
- Department of Cardiology, University Heart Center Zurich, Switzerland; Royal Brompton and Harefield Hospital Trust and Imperial College, London, United Kingdom.
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Denegri A, Mehran R, Holy E, Taramasso M, Pasotti E, Pedrazzini G, Moccetti T, Maisano F, Nietlispach F, Obeid S. Post procedural risk assessment in patients undergoing trans aortic valve implantation according to the age, creatinine, and ejection fraction-7 score: Advantages of age, creatinine, and ejection fraction-7 in stratification of post-procedural outcome. Catheter Cardiovasc Interv 2018; 93:141-148. [PMID: 30269398 DOI: 10.1002/ccd.27806] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 06/30/2018] [Accepted: 07/12/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND Post-procedural risk stratification based on renal function after trans aortic valve implantation (TAVI) was assessed by means of a modified age, creatinine, and ejection fraction (ACEF) score using the lowest glomerular filtration rate (GFR), obtained within 1 week after valve implantation. We refer to the score as ACEF-7 score. METHODS The Zurich- and Cardiocentro Ticino TAVI-Cohorts comprised of 424, and 137 patients, who were not on hemodialysis and had already survived the first post-procedural week. Zurich patients were stratified into tertiles of ACEF-7 score (ACEF-7Low ≤ 2.45 (n = 138), ACEF-7Mid 2.46-4.38 (n = 142), and ACEF-7High ≥ 4.39 (n = 144) and compared for survival using KM curves. Euroscore II, Society of Thoracic Surgeons (STS), and ACEF were also calculated at baseline in all patients and assessed for prognostic significance in predicting the primary outcome of 1-year all-cause mortality using univariate and multivariate Cox regression models. Results were then confirmed in the Cardiocentro cohort. RESULTS Six months (18.1% vs. 6.3% vs. 2.9% P < 0.001) and 1-year all-cause mortality (24.3% vs. 12.7% % vs. 5.8%, P < 0.001), as well as the composite of death or rehospitalization (35% vs. 20% vs. 11% P < 0.001) occurred significantly more frequently in the ACEF-7High compared to the other groups. Both Euroscore II and STS score were not predictors of mortality in our cohort. In a multivariate Cox regression model corrected for gender, Acute Kidney Injury, and baseline ACEF score, the ACEF-7 score was an independent predictor of 1-year all-cause mortality as a per point increment HR 1.512 [95% CI 1.227-1.862, P < 0.001] and as ACEF-7High (≥4.39); HR 5.541 [1.694-18.120]). In addition, the ACEF-7 tertiles showed a significant (P = 0.02) net reclassification improvement of 16% when compared to baseline tertiles of ACEF score, when assessing 1-year all-cause mortality. CONCLUSION Post-procedural risk stratification using the simple ACEF-7 score significantly better predicted long-term outcome than commonly used risk-scores. Practical implications could include contrast sparing and renal protection in high-risk patients, emphasizing the importance of preventative measures.
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Affiliation(s)
- Andrea Denegri
- University Heart Center, University Hospital, Zurich, Switzerland.,Cardiocentro Lugano, University of Zurich, Lugano, Switzerland.,Cardiology Unit and Laboratory of Cardiovascular Biology, IRCCS-AOU San Martino-IST University of Genova, Genoa, Italy
| | | | - Erik Holy
- University Heart Center, University Hospital, Zurich, Switzerland
| | | | - Elena Pasotti
- Cardiocentro Lugano, University of Zurich, Lugano, Switzerland
| | | | | | | | | | - Slayman Obeid
- University Heart Center, University Hospital, Zurich, Switzerland
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40
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Denegri A, Rossi VA, Niederseer D, Obeid S, Klingenberg R, Raeber L, Gencer B, Mach F, Rodondi N, Heg D, Windecker S, Ruschitzka F, Luescher TF, Matter C. P2480Baseline inflammatory markers, NT-proBNP and LVEF predict heart failure and cardiac death one year after acute coronary syndromes. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Denegri
- University Hospital Zurich, Cardiology, Zurich, Switzerland
| | - V A Rossi
- University Hospital Zurich, Cardiology, Zurich, Switzerland
| | - D Niederseer
- University Hospital Zurich, Cardiology, Zurich, Switzerland
| | - S Obeid
- University Hospital Zurich, Cardiology, Zurich, Switzerland
| | - R Klingenberg
- University Hospital Zurich, Cardiology, Zurich, Switzerland
| | - L Raeber
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - B Gencer
- Geneva University Hospitals, Cardiology, Geneva, Switzerland
| | - F Mach
- Geneva University Hospitals, Cardiology, Geneva, Switzerland
| | - N Rodondi
- Bern University Hospital, Internal Medicine, Bern, Switzerland
| | - D Heg
- University of Bern, Institute of Social and Preventive Medicine, Bern, Switzerland
| | - S Windecker
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - F Ruschitzka
- University Hospital Zurich, Cardiology, Zurich, Switzerland
| | - T F Luescher
- Royal Brompton Hospital, Cardiology, London, United Kingdom
| | - C Matter
- University Hospital Zurich, Cardiology, Zurich, Switzerland
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Gulan U, Saguner AM, Akdis D, Denegri A, Miranda MX, Manka R, Brunckhorst C, Holzner M, Duru F. P2834An in vitro study on the influence of increased heart rate on the right ventricular kinetic energy and shear stresses. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- U Gulan
- Swiss Federal Institute of Technology Zurich (ETH Zurich), Zurich, Switzerland
| | - A M Saguner
- University Heart Center, Zurich, Switzerland
| | - D Akdis
- University Heart Center, Zurich, Switzerland
| | - A Denegri
- University Heart Center, Zurich, Switzerland
| | - M X Miranda
- University Heart Center, Zurich, Switzerland
| | - R Manka
- University Heart Center, Zurich, Switzerland
| | | | - M Holzner
- Swiss Federal Institute of Technology Zurich (ETH Zurich), Zurich, Switzerland
| | - F Duru
- University Heart Center, Zurich, Switzerland
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Rossi VA, Denegri A, Obeid S, Klingenberg R, Raeber L, Gencer B, Mach F, Rodondi N, Heg D, Windecker S, Buhmann JM, Luescher TF, Ruschitzka F, Matter C. 3400Neutrophil count and neutrophil/lymphocyte ratio predict cardiac death and acute kidney injury after acute coronary syndromes independently from smoking status. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.3400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- V A Rossi
- University Heart Center, Zurich, Switzerland
| | - A Denegri
- University Heart Center, Zurich, Switzerland
| | - S Obeid
- University Heart Center, Zurich, Switzerland
| | - R Klingenberg
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - L Raeber
- Bern University Hospital, Department of Cardiology, Bern, Switzerland
| | - B Gencer
- Geneva University Hospitals, Division of Cardiology, Geneva, Switzerland
| | - F Mach
- Geneva University Hospitals, Division of Cardiology, Geneva, Switzerland
| | - N Rodondi
- Bern University Hospital, Departement of Internal Medicine, Bern, Switzerland
| | - D Heg
- University of Bern, Institute of Social and Preventive Medicine (ISPM), Bern, Switzerland
| | - S Windecker
- Bern University Hospital, Department of Cardiology, Bern, Switzerland
| | - J M Buhmann
- Swiss Federal Institute of Technology Zurich (ETH Zurich), Department of Computer Science, Zurich, Switzerland
| | - T F Luescher
- Royal Brompton Hospital, Departement of Cardiology, London, United Kingdom
| | | | - C Matter
- University Heart Center, Zurich, Switzerland
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Denegri A, Naduvathumuriyil T, Lüscher TF, Sudano I. Renal nerve ablation reduces blood pressure in resistant hypertension: Long-term clinical outcomes in a single-center experience. J Clin Hypertens (Greenwich) 2018; 20:627-633. [DOI: 10.1111/jch.13252] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 01/26/2018] [Accepted: 01/29/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Andrea Denegri
- Department of Cardiology; University Hospital Zurich; University Heart Center; Zurich Switzerland
| | - Tino Naduvathumuriyil
- Department of Cardiology; University Hospital Zurich; University Heart Center; Zurich Switzerland
| | - Thomas Felix Lüscher
- Department of Cardiology; University Hospital Zurich; University Heart Center; Zurich Switzerland
- Royal Brompton & Harefield Hospital; Imperial College; London UK
| | - Isabella Sudano
- Department of Cardiology; University Hospital Zurich; University Heart Center; Zurich Switzerland
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Obeid SN, von Eckardstein A, Loretz R, Denegri A, Koestler F, Klingenberg R, Gencer B, Mach F, Räber LR, Windecker S, Nanchen D, Ruschitzka F, Tanner F, Matter C, Luscher TF. ROLE OF GALECTIN 3, NGAL AND CYSTATIN C IN RISK ASSESSMENT IN THE SETTING OF ACUTE CORONARY SYNDROME. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31928-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Taramasso M, Denegri A, Kuwata S, Rickli H, Haager PK, Sütsch G, Rodriguez Cetina Biefer H, Kottwitz J, Nietlispach F, Maisano F. Feasibility and safety of transfemoral sheathless portico aortic valve implantation: Preliminary results in a single center experience. Catheter Cardiovasc Interv 2018; 91:533-539. [PMID: 28500739 DOI: 10.1002/ccd.27100] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 12/05/2016] [Revised: 02/25/2017] [Accepted: 03/25/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Feasibility of transfemoral (TF) transcathteter aortic valve replacement (TAVR) is limited by the smallest diameter, the calcification and tortuosity of the iliofemoral access vessels. The use of the Portico system without delivery sheath results in significantly lower profile delivery system compared to standard technique. We herein report our single center experience, feasibility and safety of such an approach. METHODS The Portico valve was implanted sheathless in 81 high-risk patients with severe aortic stenosis utilizing percutaneous femoral access. Mean minimal diameter of the ileo-femoral arterial access was 7.06 ± 1.89 mm. In most cases a multidetector computed tomography was performed before the intervention to assess the feasibility of vascular access and for aortic annulus measurements. The vascular access site was preclosed using two ProGlide suture systems. RESULTS Device implantation was successful 98.7% of patients. Valve recapturing and repositioning as well as valve-in-valve deployment was performed in only one case (1.2%). There were no infarctions, 2 strokes (2.4%) and 2 acute kidney failure (2.4%), 1 major vascular complication1 (1.2%) 4 major bleedings (4.9%), 11 conductions disturbances and relative pace-maker implantations (14.2%). The mean gradient decreased from 42.3 ± 17 to 6.3 ± 2.78 mm Hg. Paravalvular regurgitation as assessed by TTE at discharge was absent or trivial in 19 patients, mild in 60 and moderate 1. Thirty-day mortality was 2.4%. CONCLUSIONS Sheathless use of the Portico valve is feasible and appears to be safe, with excellent rates of complications and mortality in the short-term. Such an approach has the potential to further expand feasibility of TF TAVR to patients with severe peripheral arterial disease. Feasibility in patients with smaller femoral access and more challenging anatomy has to be proven in further studies. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Maurizio Taramasso
- Heart Valve Clinic, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Andrea Denegri
- Heart Valve Clinic, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Shingo Kuwata
- Heart Valve Clinic, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Hans Rickli
- Heart Valve Clinic, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Philipp K Haager
- Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Gabor Sütsch
- Heart Valve Clinic, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Jan Kottwitz
- Heart Valve Clinic, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Fabian Nietlispach
- Heart Valve Clinic, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Francesco Maisano
- Heart Valve Clinic, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Denegri A, Nietlispach F, Kottwitz J, Suetsch G, Haager P, Rodriguez H, Taramasso M, Obeid S, Maisano F. Real-world procedural and 30-day outcome using the Portico transcatheter aortic valve prosthesis: A large single center cohort. Int J Cardiol 2018; 253:40-44. [DOI: 10.1016/j.ijcard.2017.10.101] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 10/13/2017] [Accepted: 10/26/2017] [Indexed: 02/06/2023]
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Denegri A, Yousif N, Manka R, Alkadhi H, Maier W. Rare coronary anomaly with hemodynamic consequence: squeezing of the right coronary artery. Eur Heart J 2017; 38:3539. [DOI: 10.1093/eurheartj/ehx651] [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: 11/15/2022] Open
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Denegri A, Frangieh AH, D'Ascenzo F, Ghadri JR, Nietlispach F, Templin C. "Full Plastic-Jacket": Reconstruction of 18 cm of coronary arteries with bioresorbable vascular scaffolds in a young patient with ST-elevation myocardial infarction and multivessel disease. Cardiol J 2017; 24:221-223. [PMID: 28421591 DOI: 10.5603/cj.2017.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/03/2017] [Accepted: 01/03/2017] [Indexed: 11/25/2022] Open
Affiliation(s)
| | | | | | | | | | - Christian Templin
- University Hospital Zurich, University Heart Center, Department of Cardiology, Raemistrasse 100, 8091 Zurich, Switzerland.
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Petrova-Slater I, Denegri A, Pasotti E, Rossi MG, Spirk D, Riesen WF, Moccetti T, Moccetti M. [Inhibitors of PCSK9]. Rev Med Suisse 2017; 13:821-825. [PMID: 28727332] [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] [Indexed: 06/07/2023]
Abstract
Observational data show a consistent association between elevated low density lipoproteins (LDL-C) and cardiovascular disease (CVD). Reduction of LDL-C reduces the risk of CVD as has been shown by many trials. Statins are currently the most effective drugs for lowering LDL-C, but can present side effects which might limit the prescribed dosage and prevent patients from reaching the recommended LDL levels. Although treated with statins important residual cardiovascular event risk remains in patients in primary and secondary prevention for CVD. The discovery of protein convertase subtilisin kexin 9 antibodies is a very promising new hypolipidemic treatment and the aim of this review is to explain their mechanism of action and to discuss safety and efficacy results of some phase III studies.
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Affiliation(s)
- Iveta Petrova-Slater
- Cardiocentro Ticino, Servizio ricerca cardiovascolare, Via Tesserete 48, 6900 Lugano
| | | | | | - Maria Grazia Rossi
- Cardiocentro Ticino, Servizio ricerca cardiovascolare, Via Tesserete 48, 6900 Lugano
| | - David Spirk
- Sanofi-Aventis (Suisse) SA, 3, route de Montfleury, 1214 Vernier
| | - Walter F Riesen
- Center of Laboratory Medicine, Hôpital cantonal, 9007 Saint-Gall
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Denegri A, Ameri P, Paparo F, Murialdo G. Lower limb ischemia due to long-term abuse of cocaine. J Cardiovasc Med (Hagerstown) 2016; 17 Suppl 2:e176-e177. [DOI: 10.2459/jcm.0000000000000083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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