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Ferlini M, Munafò A, Varbella F, Delnevo F, Solli M, Trabattoni D, Piccaluga E, Cardile A, Canova P, Rossini R, Celentani D, Ugo F, Taglialatela V, Airoldi F, Rognoni A, Oliva F, Porto I, Carugo S, Castiglioni B, Lettieri C, Chinaglia A, Currao A, Patti G, Oltrona Visconti L, Musumeci G. Achievement of target LDL-cholesterol level in patients with acute coronary syndrome undergoing percutaneous coronary intervention: The JET-LDL registry. Int J Cardiol 2024; 397:131659. [PMID: 38101704 DOI: 10.1016/j.ijcard.2023.131659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 11/28/2023] [Accepted: 12/10/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND In patients with acute coronary syndromes (ACS), current guidelines recommend a low-density lipoprotein cholesterol (LDL-C) level < 1.4 mmol/L (<55 mg/dL). METHODS The JET-LDL is a multicenter, observational, prospective registry created to investigate levels of LDL-C in consecutive patients with ACS undergoing PCI at 35 Italian hospitals, and to report their lipid lowering therapies (LLT). Follow-up was planned at 1 and 3 months. LDL-C reduction >50% from baseline or level < 55 mg/dL at 1-month was the primary endpoint. RESULTS A total of 1095 patients were included: median age was 67 (58-75); 33.7% were already on LLT. Baseline LDL-C levels was 105 (76.5-137) mg/dL. At hospital discharge all patients were on LLT: 98.1% received statins (as mono or combination therapy), ezetimibe and PCSK9i were used in 60.1% and 8.5% of cases, respectively. Primary endpoint was achieved in 62% (95% CI 58-65) of cases. At 1-month LDL-C levels dropped to 53 (38-70) mg/dL (p < 0.001 vs baseline) and it was <55 mg/dL in 53% (95% CI 49-57) of patients; however, PCSK9i were added to 7 further cases. At 3-months 58% (95% CI 55-62) of patients achieved the target level, but PCSK9i was added to only 11 new patients. CONCLUSIONS In this real-world registry of ACS patients undergoing PCI, recommend LDL-C levels were obtained in 62% of patients, but PCSK9i prescription was limited to 10% of cases. As LLT pattern appeared mainly improved at hospital discharge, an early and strong treatment should be considered.
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Affiliation(s)
- Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Andrea Munafò
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | | | - Fabrizio Delnevo
- Cardiologia, Azienda Ospedaliera Ordine Mauriziano, Torino, Italy
| | - Martina Solli
- Università del Piemonte Orientale, Cardiologia, AOU Maggiore della Carità di Novara, Italy
| | - Daniela Trabattoni
- Interventional Cardiology Dept., Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - Emanuela Piccaluga
- Cardiologia 1, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Antonino Cardile
- SC Cardiologia, ASST Bergamo Ovest - Ospedale Treviglio, Treviglio (BG), Italy
| | - Paolo Canova
- SC Cardiologia, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | | | - Fabrizio Ugo
- SC Cardiologia, Ospedale Sant'Andrea di Vercelli, Italy
| | | | - Falvio Airoldi
- SC Cardiologia, I.R.C.C.S. MultiMedica di Sesto San Giovanni, Italy
| | | | - Fabrizio Oliva
- Cardiologia 1, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Italo Porto
- SC Cardiologia, Ospedale San Martino Genova, Università degli studi di Genova, Italy
| | - Stefano Carugo
- Department of Clinical Sciences and Community Health, University of Milano, Italy, Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy
| | | | - Corrado Lettieri
- SC Cardiologia, ASST Mantova, Ospedale Carlo Poma di Mantova, Italy
| | | | - Alessia Currao
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giuseppe Patti
- Università del Piemonte Orientale, Cardiologia, AOU Maggiore della Carità di Novara, Italy
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2
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Genovesi S, Porcu L, Rebora P, Slaviero G, Casu G, Bertoli S, Airoldi F, Buskermolen M, Gallieni M, Pieruzzi F, Rovaris G, Montoli A, Piccaluga E, Molon G, Alberici F, Adamo M, Gaspardone A, D'Angelo G, Merella P, Vezzoli G, Trezzi B, Mazzone P. Long-term safety and efficacy of left atrial appendage occlusion in dialysis patients with atrial fibrillation: a multi-center, prospective, open label, observational study. Clin Kidney J 2023; 16:2683-2692. [PMID: 38046009 PMCID: PMC10689152 DOI: 10.1093/ckj/sfad221] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Indexed: 12/05/2023] Open
Abstract
Background The prevalence of atrial fibrillation (AF) in end stage kidney disease (ESKD) patients undergoing dialysis is high, however, the high risk of bleeding often hampers with a correct anticoagulation in ESKD patients with AF, despite high thromboembolic risk. Left atrial appendage (LAA) occlusion is a anticoagulation (OAT) for thromboembolism prevention in AF populations with high hemorrhagic risk. Methods and Results The purpose of the study was to evaluate the efficacy and safety of LAA occlusion in a cohort of dialysis patients undergoing the procedure (LAA occlusion cohort, n = 106), in comparison with two other ESKD cohorts, one taking warfarin (Warfarin cohort, n = 114) and the other without anticoagulation therapy (No-OAT cohort, n = 148). After a median follow-up of 4 years, a Cox regression model, adjusted for possible confounding factors, showed that the hazard ratios (HRs) of thromboembolic events in the LAA occlusion cohort were 0.19 (95%CI 0.04-0.96; p = 0.045) and 0.16 (95%CI 0.04-0.66; p = 0.011) as compared with Warfarin and No-OAT cohorts, respectively. The HR of bleeding in the LAA occlusion cohort was 0.37 (95%CI 0.16-0.83; p = 0.017) compared to Warfarin cohort, while there were no significant differences between the LAA occlusion and the No-OAT cohort (HR 0.51; 95%CI 0.23-1.12; p = 0.094). Adjusted Cox regression models showed lower mortality in patients undergoing LAA occlusion as compared with both the Warfarin cohort (HR 0.60; 95%CI 0.38-0.94; p = 0.027) and no-OAT cohort (HR 0.52; 95%CI 0.34-0.78; p = 0.002). Thromboembolic events in the LAA occlusion cohort were lower than expected according to the CHA2DS2VASc score (1.7 [95%CI 0.3-3.0] vs 6.7 events per 100 person/years, p < 0.001). Conclusion In ESKD patients with AF, LAA occlusion is safe and effective and is associated with reduced mortality compared with OAT or no therapy.
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Affiliation(s)
- Simonetta Genovesi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Luca Porcu
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Paola Rebora
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | | | - Gavino Casu
- Cardiology Unit, Azienda Ospedaliera Universitaria di Sassari, Sassari, Italy
| | - Silvio Bertoli
- Dialysis and Nephrology Unit-IRCCS-Multimedica, Sesto S.Giovanni, Italy
| | - Flavio Airoldi
- Electrophysiology Unit-IRCCS-Multimedica, Sesto S.Giovanni, Italy
| | | | - Maurizio Gallieni
- Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, Milano, Italy
- Department of Biomedical and Clinical Sciences, University of Milano, Milano, Italy
| | - Federico Pieruzzi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Giovanni Rovaris
- Interventional Electrophysiology Unit, San Gerardo Hospital, Monza, Italy
| | | | | | - Giulio Molon
- Cardiology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Federico Alberici
- Nephrology Unit, ASST degli Spedali Civili di Brescia, Brescia, Italy
| | - Marianna Adamo
- Cardiology Unit, ASST degli Spedali Civili di Brescia, Brescia, Italy
| | | | | | - Pierluigi Merella
- Cardiology Unit, Azienda Ospedaliera Universitaria di Sassari, Sassari, Italy
| | | | - Barbara Trezzi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Patrizio Mazzone
- Cardiology 3, “A. De Gasperis” Cardio Center, ASST GOM Niguarda Ca' Granda, Milan, Italy
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3
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Morelli M, Galasso M, Esposito G, Soriano FS, Nava S, Da Pozzo C, Bossi I, Piccaluga E, Bruschi G, Maloberti A, Oliva F, Oreglia JA, Giannattasio C, Montalto C. Natural history and clinical burden of moderate aortic stenosis: a systematic review and explorative meta-analysis. J Cardiovasc Med (Hagerstown) 2023; 24:659-665. [PMID: 37409667 PMCID: PMC10754483 DOI: 10.2459/jcm.0000000000001490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/11/2023] [Accepted: 04/16/2023] [Indexed: 07/07/2023]
Abstract
AIMS The mortality risk of patients with moderate aortic stenosis is not well known, but recent studies suggested that it might negatively affect prognosis. We aimed to assess the natural history and clinical burden of moderate aortic stenosis and to investigate the interaction of patients' baseline characteristics with prognosis. METHODS Systematic research was conducted on PubMed. The inclusion criteria were inclusion of patients with moderate aortic stenosis; and report of the survival at 1-year follow-up (minimum). Incidence ratios related to all-cause mortality in patients and controls of each study were estimated and then pooled using a fixed effects model. All patients with mild aortic stenosis or without aortic stenosis were considered controls. Meta-regression analysis was performed to assess the impact of left ventricular ejection fraction and age on the prognosis of patients with moderate aortic stenosis. RESULTS Fifteen studies and 11 596 patients with moderate aortic stenosis were included. All-cause mortality was significantly higher among patients with moderate aortic stenosis than in controls in all timeframes analysed (all P < 0.0001). Left ventricular ejection fraction and sex did not significantly impact on the prognosis of patients with moderate aortic stenosis ( P = 0.4584 and P = 0.5792), while increasing age showed a significant interaction with mortality (estimate = 0.0067; 95% confidence interval: 0.0007-0.0127; P = 0.0323). CONCLUSION Moderate aortic stenosis is associated with reduced survival. Further studies are necessary to confirm the prognostic impact of this valvulopathy and the possible benefit of aortic valve replacement.
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Affiliation(s)
- Martina Morelli
- School of Medicine and Surgery, University of Milano-Bicocca
| | - Michele Galasso
- School of Medicine and Surgery, University of Milano-Bicocca
| | - Giuseppe Esposito
- Interventional Cardiology, 1 Division of Cardiology, De Gasperis Cardio Center, Niguarda Hospital
| | | | - Stefano Nava
- Interventional Cardiology, 1 Division of Cardiology, De Gasperis Cardio Center, Niguarda Hospital
| | | | - Irene Bossi
- Interventional Cardiology, 1 Division of Cardiology, De Gasperis Cardio Center, Niguarda Hospital
| | - Emanuela Piccaluga
- Interventional Cardiology, 1 Division of Cardiology, De Gasperis Cardio Center, Niguarda Hospital
| | | | - Alessandro Maloberti
- School of Medicine and Surgery, University of Milano-Bicocca
- 4 Division of Cardiology, De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | - Fabrizio Oliva
- Interventional Cardiology, 1 Division of Cardiology, De Gasperis Cardio Center, Niguarda Hospital
| | - Jacopo Andrea Oreglia
- Interventional Cardiology, 1 Division of Cardiology, De Gasperis Cardio Center, Niguarda Hospital
| | - Cristina Giannattasio
- School of Medicine and Surgery, University of Milano-Bicocca
- 4 Division of Cardiology, De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | - Claudio Montalto
- Interventional Cardiology, 1 Division of Cardiology, De Gasperis Cardio Center, Niguarda Hospital
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Manzo-Silberman S, Velázquez M, Burgess S, Sahni S, Best P, Mehran R, Piccaluga E, Vitali-Serdoz L, Sarma A, Barbash IM, Mauri J, Szymański P, Hinterbuchner L, Stefanini G, Gimelli A, Maurovich-Horvat P, Boersma L, Buchanan GL, Pontone G, Holmvang L, Karam N, Neylon A, Morice MC, Leclercq C, Tarantini G, Dudek D, Chieffo A. Radiation protection for healthcare professionals working in catheterisation laboratories during pregnancy: a statement of the European Association of Percutaneous Cardiovascular Interventions (EAPCI) in collaboration with the European Heart Rhythm Association (EHRA), the European Association of Cardiovascular Imaging (EACVI), the ESC Regulatory Affairs Committee and Women as One. EUROINTERVENTION 2023; 19:53-62. [PMID: 36411964 PMCID: PMC10173757 DOI: 10.4244/eij-d-22-00407] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 09/19/2022] [Indexed: 05/13/2023]
Abstract
The European Association of Percutaneous Cardiovascular Interventions (EAPCI), the European Heart Rhythm Association (EHRA), the European Association of Cardiovascular Imaging (EACVI), the European Society of Cardiology (ESC) Regulatory Affairs Committee and Women as One support continuous review and improvement, not only in the practice of assuring patients a high quality of care but also in providing health professionals with support documents to help them in their career and enhance gender equity. Recent surveys have revealed that radiation exposure is commonly reported as the primary barrier for women pursuing a career in interventional cardiology or cardiac electrophysiology (EP). The fear of foetal exposure to radiation during pregnancy may lead to a prolonged interruption in their career. Accordingly, this joint statement aims to provide a clear statement on radiation risk and the existing data on the experience of radiation-exposed cardiologists who continue to work in catheterisation laboratories (cath labs) throughout their pregnancies. In order to reduce the barrier preventing women from accessing these careers, increased knowledge in the community is warranted. Finally, by going beyond simple observations and review of the literature, our document suggests proposals for improving workplace safety and for encouraging equity.
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Affiliation(s)
- Stéphane Manzo-Silberman
- ACTION Study Group, Sorbonne University, Institute of Cardiology, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France and Women as One
| | - Maite Velázquez
- Department of Cardiology, University Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre, Madrid, Spain and CIBERCV, Madrid, Spain
| | - Sonya Burgess
- Department of Cardiology, Nepean Hospital, the University of Sydney, NSW, Australia and Women as One
| | - Sheila Sahni
- Hackensack Meridian Health Medical Group, Clark, NJ, USA
| | - Patricia Best
- Department of Cardiology, Mayo Clinic, Rochester, MN, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Laura Vitali-Serdoz
- Department of Cardiology, Klinikum Fuerth, Teaching Hospital of Erlangen-Nuernberg University, Fuerth, Germany
| | - Amy Sarma
- Department of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Israel Moshe Barbash
- Interventional Cardiology Unit, Leviev Heart Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Josepa Mauri
- Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Piotr Szymański
- Centre for Postgraduate Medical Education, Warsaw and Centre for Clinical Cardiology, CSK MSWiA Hospital, Warsaw, Poland
| | - Lynne Hinterbuchner
- Department of Cardiology, Landeskrankenhaus Salzburg - Universitätsklinikum der Paracelsus Medizinischen Privatuniversität, Salzburg, Austria
| | - Giulio Stefanini
- Humanitas Clinical and Research Center IRCCS, Rozzano-Milan, Italy
| | - Alessia Gimelli
- Fondazione Toscana Gabriele Monasterio, Imaging Department, Pisa, Italy
| | | | - Lucas Boersma
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Gill Louise Buchanan
- Department of Cardiology, North Cumbria Integrated Care NHS Foundation Trust, Carlisle, UK
| | | | - Lene Holmvang
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nicole Karam
- Université de Paris, PARCC, INSERM, European Georges Pompidou Hospital, Paris, France
| | | | | | - Christophe Leclercq
- Department of Cardiology and Vascular Diseases, C.H.U. Pontchaillou, Rennes, France
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Science, University of Padova, Padova, Italy
| | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland and Maria Cecilia Hospital GVM, Cotignola RA, Italy
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Morelli M, Galasso M, Soriano FS, Nava S, Da Pozzo C, Esposito G, Piccaluga E, Bossi I, Montalto C, Oreglia JA, Giannattasio C. 456 NATURAL HISTORY AND CLINICAL BURDEN OF MODERATE AORTIC STENOSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.739] [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
Objectives
The aim of this study was to assess the natural history and clinical burden of moderate aortic stenosis and to investigate the interaction of left ventricular ejection fraction and of age with prognosis.
Background
The mortality risk of patients with moderate aortic stenosis is not well known but recent studies suggested that it might negatively affect prognosis.
Methods
A systematic research was conducted on PubMed. The inclusion criteria were: 1) inclusion of patients with moderate aortic stenosis; 2) report of the survival at 1-year follow-up (minimum). Incidence ratios related to all-cause mortality in patients and controls of each study were estimated and then pooled using a fixed effects model. Meta-regression analysis was performed to assess the impact of left ventricular ejection fraction and age on the prognosis of patients with moderate aortic stenosis.
Results
Fifteen studies and 11,596 patients with moderate aortic stenosis were included. All-cause mortality was significantly higher among patients with moderate aortic stenosis than among controls: 10.7% (95% CI: 0.1010-0.1136) vs 4.5% (95% CI: 0.0438-0.0454) at 1-year, 17.7% (95% CI: 0.1692-0.1854) vs 7.6% (95% CI: 0.0754-0.0775) at 2-year, 23.0% (95% CI: 0.2204-0.2387) vs 9.9% (95% CI: 0.0973-0.0997) at 3-year, 27.9% (95% CI: 0.2685-0.2899) vs 11.9% (95% CI: 0.1177-0.1203) at 4-year, and 32.4% (95% CI: 0.3125-0.3360) vs 14.2% (95% CI: 0.1402-0.1430) at 5-year follow-up. Left ventricular ejection fraction did not significantly impact on the prognosis of patients with moderate aortic stenosis (estimate = -0.0020; 95% CI: -0.0078-0.0038; p = 0.4584), unlike of age (estimate = 0.0067; 95% CI: 0.0007-0.0127; p = 0.0323).
Conclusions
Moderate aortic stenosis is not a benign disease. Further studies are necessary to confirm the prognostic impact of this valvulopathy and the possible benefit of the aortic valve replacement.
All-cause mortality of patients (red) vs controls (black) at 1-, 2-, 3-, 4- and 5-year follow-up.
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Affiliation(s)
- Martina Morelli
- School Of Medicine And Surgery, University Of Milano-Bicocca , Milan , Italy
| | - Michele Galasso
- School Of Medicine And Surgery, University Of Milano-Bicocca , Milan , Italy
| | | | - Stefano Nava
- Emodinamica , Cardiologia I, Asst Grande Ospedale Metropolitano Niguarda, Milan , Italy
| | | | - Giuseppe Esposito
- Emodinamica , Cardiologia I, Asst Grande Ospedale Metropolitano Niguarda, Milan , Italy
| | - Emanuela Piccaluga
- Emodinamica , Cardiologia I, Asst Grande Ospedale Metropolitano Niguarda, Milan , Italy
| | - Irene Bossi
- Emodinamica , Cardiologia I, Asst Grande Ospedale Metropolitano Niguarda, Milan , Italy
| | - Claudio Montalto
- Emodinamica , Cardiologia I, Asst Grande Ospedale Metropolitano Niguarda, Milan , Italy
| | - Jacopo Andrea Oreglia
- Emodinamica , Cardiologia I, Asst Grande Ospedale Metropolitano Niguarda, Milan , Italy
| | - Cristina Giannattasio
- School Of Medicine And Surgery, University Of Milano-Bicocca , Milan , Italy
- Cardiologia Iv, Dipartimento A. De Gasperis , Asst Grande Ospedale Metropolitano Niguarda, Milan , Italy
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6
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Veas N, Winter J, Soriano F, Valdebenito M, Piccaluga E, Nava S, Muñoz R, Cruz-González I, Puentes A, Lindefjeld D. [Use of anticoagulants in patients with atrial fibrillation undergoing transcatheter aortic valve implantation]. Rev Med Chil 2022; 150:618-624. [PMID: 37906762 DOI: 10.4067/s0034-98872022000500618] [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: 06/11/2021] [Accepted: 11/04/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Transcatheter Aortic Valve Implantation (TAVI) is beneficial in patients with symptomatic severe Aortic Stenosis (AS). There is no consensus about the best anticoagulation strategy for patients with a recent TAVI and with atrial fibrillation (AF). Direct oral anticoagulants (DOACs) are effective to prevent embolic events with a significant lower incidence of bleeding. There is scarce evidence about the use of these drugs in patients undergoing TAVI. AIM To assess the management of anticoagulation at the moment of discharge of patients with AF and TAVI. MATERIAL AND METHODS A four question survey was sent to cardiologists involved in TAVI programs in different international centers. RESULTS The survey was answered by 72 interventional cardiologists. Even with the lack of randomized evidence, in most of the scenarios DOACs are prescribed at discharge in patients with indication for anticoagulation. Also, in patients with high bleeding risk, most cardiologists would perform a left atrial appendage closure. In patients with concomitant coronary artery disease, if a stent was recently implanted, prescription of the combination of a DOAC and one antiplatelet drug was the most common answer. In patients with a former coronary angioplasty, DOAC or Warfarin was the therapy of choice. CONCLUSIONS In the absence of randomized data, interventional cardiologists prescribe DOACs at discharge to patients with AF and TAVI, without following current guidelines in most cases.
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Affiliation(s)
| | | | | | | | | | - Stefano Nava
- Gran Ospedale Metropolitano Niguarda, Milán, Italia
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7
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Maloberti A, Bossi I, Tassistro E, Rebora P, Racioppi A, Nava S, Soriano F, Piccaluga E, Piccalò G, Oreglia J, Vallerio P, Pirola R, De Chiara B, Oliva F, Moreo A, Valsecchi MG, Giannattasio C. Uric acid in chronic coronary syndromes: Relationship with coronary artery disease severity and left ventricular diastolic parameter. Nutr Metab Cardiovasc Dis 2021; 31:1501-1508. [PMID: 33810962 DOI: 10.1016/j.numecd.2021.01.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 11/25/2020] [Revised: 01/19/2021] [Accepted: 01/24/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Uric Acid (UA) has been related to the development of Cardio-Vascular (CV) events in patients affected by Chronic Coronary Syndromes (CCS). Among various hypothesis, two arise: UA may negatively act on coronary artery determining a higher degree of atherosclerotic disease, and/or on heart determining a higher prevalence of diastolic dysfunction. Both the above hypothesized effects are object of our investigation. METHODS AND RESULTS 231 patients who were admitted to the cardiological department of the Niguarda Hospital (Milan, Italy) for CCS from January 2017 to June 2018 were enrolled. Coronary atherosclerotic burden was evaluated from coronary angiography as the number and type of involved vessels, as well as with both Gensini and Syntax scores. All subjects underwent a complete echocardiogram. At unadjusted and adjusted/multivariable analysis, UA levels were not significantly associated with variables analysed from the coronary angiography (number and type of vessels involved, neither the Gensini and Syntax scores) as well as with echocardiographic parameters regarding systolic and diastolic function. CONCLUSIONS In conclusion, the main finding of our work is the absence of a role for UA in determining coronary arteries disease as well as LV diastolic dysfunction in CCS subjects. Taking together the results of previous studies with ours, we hypothesize that UA could act on heart (both on coronary arteries and on LV function) in an early phase of the disease, whereas while in the advanced stages other factors (previous myocardial infarction, previous myocardial revascularization and so on) may overshadow its effects.
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Affiliation(s)
- Alessandro Maloberti
- Cardiology IV, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy; School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy.
| | - Irene Bossi
- Cardiology I, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Elena Tassistro
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging (B4 center), School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Paola Rebora
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging (B4 center), School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Angelo Racioppi
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Stefano Nava
- Cardiology I, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Francesco Soriano
- Cardiology I, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Emanuela Piccaluga
- Cardiology I, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Giacomo Piccalò
- Cardiology I, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Jacopo Oreglia
- Cardiology I, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Paola Vallerio
- Cardiology IV, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Roberto Pirola
- Cardiology IV, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Benedetta De Chiara
- Cardiology IV, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Fabrizio Oliva
- Cardiology I, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Antonella Moreo
- Cardiology IV, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Maria Grazia Valsecchi
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging (B4 center), School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Cristina Giannattasio
- Cardiology IV, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy; School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
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8
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Bernelli C, Cerrato E, Ortega R, Piccaluga E, Ricottini E, Chieffo A, Masiero G, Mattesini A, La Manna A, Musumeci G, Tarantini G, Mehran R. Gender Issues in Italian Catheterization Laboratories: The Gender-CATH Study. J Am Heart Assoc 2021; 10:e017537. [PMID: 33618540 PMCID: PMC8174252 DOI: 10.1161/jaha.120.017537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/24/2020] [Indexed: 11/16/2022]
Abstract
Background Women represent an increasing percentage of interventional cardiologists in Italy compared with other countries. However, gaps exist in understanding and adapting to the impact of these changing demographics. Methods and Results We performed a national survey to analyze demographics, gender-based professional difference, needs in terms of catheterization laboratory (Cath-Lab) abstention, and radiation safety issues in Italian Cath-Lab settings. A survey supported by the Italian Society of Interventional Cardiology (Società Italiana di Cardiologia Interventistica-Gruppo Italiano di Studi Emodinamici SICI-GISE) was mailed to all SICI-GISE members. Categorical data were compared using the χ2 test. P<0.05 was considered significant. There were 326 respondents: 20.2% were <35 years old, and 64.4% had >10 years of Cath-Lab experience. Notably, 26.4% were women. Workload was not gender-influenced (women performed "on-call" duty 69.8% versus men 68.3%; P=0.97). Women were more frequently unmarried (22.1% women versus 8.7% men; P=0.002) and childless (43.9% versus 56.1%; P<0.001). Interestingly, 69.8% of women versus 44.6% of men (P<0.001) argued that pregnancy/breastfeeding negatively impacts professional skill development and career advancement. For Cath-Lab abstention, 38.9% and 69.6% of respondents considered it useful to perform percutaneous coronary intervention robotic simulations and "refresh-skill" sessions while they were absent or on return to work, respectively, without gender differences. Overall, 80% of respondents described current radioprotection counseling efforts as inadequate and not gender specific. Finally, 26.7% faced some type of job discrimination, a significantly higher proportion of whom were women. Conclusions Several gender-based differences exist or are perceived to exist among interventional cardiologists in Italian Cath-Labs. Joint strategies addressing Cath-Lab abstention and radiation exposure education should be developed to promote gender equity in interventional cardiologists.
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Affiliation(s)
- Chiara Bernelli
- Cardiology DepartmentInterventional Cardiology Unit Santa Corona HospitalPietra LigureItaly
| | - Enrico Cerrato
- Interventional Cardiology Unit San Luigi Gonzaga University HospitalOrbassano and Infermi HospitalRivoli TurinItaly
| | | | - Emanuela Piccaluga
- Interventional Cardiology Unit ASST Grande Ospedale Metropolitano NiguardaMilanItaly
| | | | - Alaide Chieffo
- Interventional Cardiology Unit San Raffaele Hospital of Milan (IRCCS)MilanItaly
| | - Giulia Masiero
- Interventional Cardiology UnitUniversity Hospital of PadovaPaduaItaly
| | - Alessio Mattesini
- Interventional Cardiology Unit Careggi University Hospital (AOUC)FlorenceItaly
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9
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Manzo-Silberman S, Piccaluga E, Radu MD, James SK, Schüpke S, Vaquerizo B, Kunadian V, Capranzano P, Mehilli J, Buchanan GL, Chieffo A, Mauri J. Radiation protection measures and sex distribution in European interventional catheterisation laboratories. EUROINTERVENTION 2020; 16:80-82. [PMID: 30888957 DOI: 10.4244/eij-d-18-01044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 11/23/2022]
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10
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Genovesi S, Porcu L, Slaviero G, Casu G, Bertoli S, Sagone A, Buskermolen M, Pieruzzi F, Rovaris G, Montoli A, Oreglia J, Piccaluga E, Molon G, Gaggiotti M, Ettori F, Gaspardone A, Palumbo R, Viazzi F, Breschi M, Gallieni M, Contaldo G, D'Angelo G, Merella P, Galli F, Rebora P, Valsecchi M, Mazzone P. Correction to: Outcomes on safety and efficacy of left atrial appendage occlusion in end stage renal disease patients undergoing dialysis. J Nephrol 2020; 34:75-76. [PMID: 32661734 PMCID: PMC7881957 DOI: 10.1007/s40620-020-00800-6] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The original article can be found online.
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Affiliation(s)
- Simonetta Genovesi
- Dipartimento di Medicina e Chirurgia-School of Medicine and Surgery, Università di Milano-Bicocca-University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy. .,Nephrology Unit, San Gerardo Hospital, Monza, Italy.
| | - Luca Porcu
- Laboratory of Methodology for Clinical Research, Oncology Department, Istituto di Ricerche Farmacologiche IRCCS Mario Negri, Milan, Italy
| | | | - Gavino Casu
- San Francesco Hospital, Nuoro. ATS Sardegna Nuoro, Nuoro, Italy
| | - Silvio Bertoli
- Dialysis and Nephrology Unit-IRCCS-Multimedica, Sesto S.Giovanni, Italy
| | - Antonio Sagone
- Electrophysiology Unit-IRCCS-Multimedica, Sesto S.Giovanni, Italy
| | | | - Federico Pieruzzi
- Dipartimento di Medicina e Chirurgia-School of Medicine and Surgery, Università di Milano-Bicocca-University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy.,Nephrology Unit, San Gerardo Hospital, Monza, Italy
| | - Giovanni Rovaris
- Interventional Electrophysiology Unit, San Gerardo Hospital, Monza, Italy
| | | | - Jacopo Oreglia
- Interventional Cardiology Unit, Niguarda Hospital, Milan, Italy
| | | | - Giulio Molon
- Cardiology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Mario Gaggiotti
- Nephrology Unit, ASST degli Spedali Civili di Brescia, Brescia, Italy
| | - Federica Ettori
- Cardiology Unit, ASST degli Spedali Civili di Brescia, Brescia, Italy
| | | | | | | | - Marco Breschi
- Cardiology Unit, USL Toscana Sud-Est, Grosseto, Italy
| | - Maurizio Gallieni
- Department of Nephrology and Dialysis, Luigi Sacco Hospital, Milan, Italy
| | - Gina Contaldo
- Dipartimento di Medicina e Chirurgia-School of Medicine and Surgery, Università di Milano-Bicocca-University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
| | | | | | - Fabio Galli
- Laboratory of Methodology for Clinical Research, Oncology Department, Istituto di Ricerche Farmacologiche IRCCS Mario Negri, Milan, Italy
| | - Paola Rebora
- Dipartimento di Medicina e Chirurgia-School of Medicine and Surgery, Università di Milano-Bicocca-University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
| | - Mariagrazia Valsecchi
- Dipartimento di Medicina e Chirurgia-School of Medicine and Surgery, Università di Milano-Bicocca-University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
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11
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Genovesi S, Porcu L, Slaviero G, Casu G, Bertoli S, Sagone A, Buskermolen M, Pieruzzi F, Rovaris G, Montoli A, Oreglia J, Piccaluga E, Molon G, Gaggiotti M, Ettori F, Gaspardone A, Palumbo R, Viazzi F, Breschi M, Gallieni M, Contaldo G, D'Angelo G, Merella P, Galli F, Rebora P, Valsecchi M, Mazzone P. Outcomes on safety and efficacy of left atrial appendage occlusion in end stage renal disease patients undergoing dialysis. J Nephrol 2020; 34:63-73. [PMID: 32535831 PMCID: PMC7881969 DOI: 10.1007/s40620-020-00774-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 03/19/2020] [Accepted: 06/06/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND In patients with end stage renal disease and atrial fibrillation (AF), undergoing chronic dialysis, direct oral agents are contraindicated and warfarin does not fully prevent embolic events while increasing the bleeding risk. The high hemorrhagic risk represents the main problem in this population. Aim of the study was to estimate the safety and efficacy for thromboembolic prevention of left atrial appendage (LAA) occlusion in a cohort of dialysis patients with AF and high hemorrhagic risk. METHODS Ninety-two dialysis patients with AF who underwent LAA occlusion were recruited. For comparative purposes, two cohorts of dialysis patients with AF, one taking warfarin (oral anticoagulant therapy, OAT cohort, n = 114) and the other not taking any OAT (no-therapy cohort, n = 148) were included in the study. Primary endpoints were (1) incidence of peri-procedural complications, (2) incidence of 2-year thromboembolic and hemorrhagic events, (3) mortality at 2 years. In order to evaluate the effect of the LAA occlusion on the endpoints with respect to the OAT and No-therapy cohorts, a multivariable Cox regression model was applied adjusted for possible confounding factors. RESULTS The device was successfully implanted in 100% of cases. Two major peri-procedural complications were reported. No thromboembolic events occurred at 2-year follow-up. The adjusted multivariable Cox regression model showed no difference in bleeding risk in the OAT compared to the LAA occlusion cohort in the first 3 months of follow-up [HR 1.65 (95% CI 0.43-6.33)], when most of patients were taking two antiplatelet drugs. In the following 21 months the bleeding incidence became higher in OAT patients [HR 6.48 (95% CI 1.32-31.72)]. Overall mortality was greater in both the OAT [HR 2.76 (95% CI 1.31-5.86)] and No-Therapy [HR 3.09 (95% CI 1.59-5.98)] cohorts compared to LAA occlusion patients. CONCLUSIONS The study could open the way to a non-pharmacological option for thromboembolic protection in dialysis patients with AF and high bleeding risk.
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Affiliation(s)
- Simonetta Genovesi
- Dipartimento di Medicina e Chirurgia-School of Medicine and Surgery, Università di Milano-Bicocca-University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy. .,Nephrology Unit, San Gerardo Hospital, Monza, Italy.
| | - Luca Porcu
- Laboratory of Methodology for Clinical Research, Oncology Department, Istituto di Ricerche Farmacologiche IRCCS Mario Negri, Milan, Italy
| | | | - Gavino Casu
- San Francesco Hospital, Nuoro. ATS Sardegna Nuoro, Nuoro, Italy
| | - Silvio Bertoli
- Dialysis and Nephrology Unit-IRCCS-Multimedica, Sesto S.Giovanni, Italy
| | - Antonio Sagone
- Electrophysiology Unit-IRCCS-Multimedica, Sesto S.Giovanni, Italy
| | | | - Federico Pieruzzi
- Dipartimento di Medicina e Chirurgia-School of Medicine and Surgery, Università di Milano-Bicocca-University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy.,Nephrology Unit, San Gerardo Hospital, Monza, Italy
| | - Giovanni Rovaris
- Interventional Electrophysiology Unit, San Gerardo Hospital, Monza, Italy
| | | | - Jacopo Oreglia
- Interventional Cardiology Unit, Niguarda Hospital, Milan, Italy
| | | | - Giulio Molon
- Cardiology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Mario Gaggiotti
- Nephrology Unit, ASST degli Spedali Civili di Brescia, Brescia, Italy
| | - Federica Ettori
- Cardiology Unit, ASST degli Spedali Civili di Brescia, Brescia, Italy
| | | | | | | | - Marco Breschi
- Cardiology Unit, USL Toscana Sud-Est, Grosseto, Italy
| | - Maurizio Gallieni
- Department of Nephrology and Dialysis, Luigi Sacco Hospital, Milan, Italy
| | - Gina Contaldo
- Dipartimento di Medicina e Chirurgia-School of Medicine and Surgery, Università di Milano-Bicocca-University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
| | | | | | - Fabio Galli
- Laboratory of Methodology for Clinical Research, Oncology Department, Istituto di Ricerche Farmacologiche IRCCS Mario Negri, Milan, Italy
| | - Paola Rebora
- Dipartimento di Medicina e Chirurgia-School of Medicine and Surgery, Università di Milano-Bicocca-University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
| | - Mariagrazia Valsecchi
- Dipartimento di Medicina e Chirurgia-School of Medicine and Surgery, Università di Milano-Bicocca-University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
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12
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Andreassi MG, Borghini A, Vecoli C, Piccaluga E, Guagliumi G, Del Greco M, Gaita F, Picano E. Reproductive outcomes and Y chromosome instability in radiation-exposed male workers in cardiac catheterization laboratory. Environ Mol Mutagen 2020; 61:361-368. [PMID: 31605552 DOI: 10.1002/em.22341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 09/10/2019] [Accepted: 09/18/2019] [Indexed: 06/10/2023]
Abstract
Occupational radiation exposure may impact the reproductive outcome of male workers in the cardiac catheterization laboratory (cath Lab) who receive a dose of ~1-10 mSv/year. An increased copy number variation (CNV) in azoospermia factor region c (AZFc) of the Y chromosome is a marker of spermatogenic failure, previously associated with radiation exposure. This study sought to investigate the association between paternal exposure in the Cath Lab and adverse reproductive outcomes as well as to assess the induction of CNV in the AZFc region. In a case-control study, we enrolled 193 catheterization lab workers (Group I) and 164 age-matched unexposed controls (Group II). Reproductive outcomes were assessed through a structured questionnaire. Two sequence-tagged sites (SY1197 and SY579) in AZFc region were evaluated by qRT-PCR in 83 exposed and 47 unexposed subjects. Exposed workers had a higher prevalence of low birth weight in offspring (Group I = 13% vs. II = 5.3%, P = 0.02; ORadjusted = 2.7; 95% CI: 1.1-6.3; P = 0.02). The mean of CNV (microdeletion and microduplication) for SY1197 was significantly higher in the exposed workers (Group I = 1.53 ± 0.85 vs. Group II = 1.02 ± 0.41; P = 0.0005). Despite the study design limitations, our findings show that chronic occupational radiation exposure of male workers is correlated with higher prevalence of low birth weight in offspring and instability in the Y chromosome AZFc region. Environ. Mol. Mutagen. 61:361-368, 2020. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
| | | | | | | | - Giulio Guagliumi
- Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Fiorenzo Gaita
- Division of Cardiology, Department of Medical Science, University of Turin, Turin, Italy
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13
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Bernelli C, Ricottini E, Cerrato E, Chieffo A, Piccaluga E, Masiero G, Mattesini A, La Manna A, Musumeci G, Tarantini G. P5638The gender issues and radiation risk in Italian cath lab: insights from a national survey. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0581] [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
Females are continuously growing in interventional communities, but some unmet needs exist on the issue of gender's differences.
Purposes
To investigate gender's differences on job-habits and private-life in Italian Cath-Labs. Further, the topic of temporary abstention from the interventional activity for any cause (pregnancy, illness, injury) and radioprotection issues were also assessed.
Methods
A national survey supported by Italian Interventional Cardiology Society (GISE) was submitted by mail to overall 1,230 GISE-members. Questions were formulated in multiple-choice and some required an open answer or a scale definition. Categorical data are presented as numbers and percentages and compared using chi-square test. P-values <0.05 were considered significant.
Results
Responders were 326 (26.5%). Sixty-six (20.2%) were young (<35-years), and 29.6% were aged between 41–50 years. Among these, 211 (65.9%) were expert operators with more than 10-years of Cath-Lab experience. Notably 86 (26.4%) of responders were females. There were more females aged <40-years as compared with males (50 vs. 34%, p=0.010). No differences were observed according to the job-position (consultants-females 72.1% vs males 78.3%, p=0.15), as well as workload (females performing “on call” 69.8% vs. males 68.3%, p=0.12). However, as compared with males, females were more frequently single (22.1% vs. 8.7%, p=0.02), childless (58.1% vs 26.7%, p<0.001). In addition, males had more frequently a partner working in the hospital-staff as compared to females (56% vs 44.8%, p<0.001). In case of abstention from Cath-Lab, 39.7% and 70.9% of the population believe that, it is useful to perform PCI-robotics simulations, and to participate in “Refresh-skill”-sessions, respectively. Indeed, 53.3% of responders argue that pregnancy/breastfeeding negatively affect professional skill and job-career. Even it allowed, 71.9% suggest abstention from Cath-Lab during pregnancy. Notably, only 50% declare to be aware of the laws that regulate access to the Cath-Lab during pregnancy and only 23% of females report to have received detailed information regarding the radio-exposition during the first trimester of pregnancy and breastfeeding. The 80% of responders retains the current radioprotection counseling programs not enough specific for age and gender and more than 80% agree there are not campaigns designed and promoted to prevent infertility. Finally, more than 60% of responders reported to have had any type of job-discriminations.
Conclusions
The number of Young-females' Italian interventional cardiologists is increasing. According to this National survey there are not gender disparities in the working. Conversely several important differences exist in the private-life. There is the need of developing strategies for education, professional advancement in cases of Cath-Lab abstention as well as of sex-specific radio-exposure programs in the field of interventional cardiology.
Acknowledgement/Funding
None
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Affiliation(s)
- C Bernelli
- Ospedale Santa Corona, Pietra Ligure, Italy
| | - E Ricottini
- University Campus Bio-Medico of Rome, Rome, Italy
| | - E Cerrato
- San Luigi Gonzaga University Hospital, Orbassano (Turin), Italy Infermi Hospital, Rivoli (Turin), It, turin, Italy
| | | | | | - G Masiero
- Santa Croce E Carle Hospital, Cuneo, Italy
| | - A Mattesini
- Careggi University Hospital (AOUC), Florence, Italy
| | | | - G Musumeci
- Santa Croce E Carle Hospital, Cuneo, Italy
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Sciahbasi A, Piccaluga E, Andreassi MG, Trianni A, Rosi A, Sarandrea A, Longoni M, Germinal F, Santucci S, Bernardi G, Rigattieri S, La Manna A, Castiglioni B, Limbruno U, Mauro C, Tarantino F, Esposito G, Musumeci G, Tarantini G. [SICI-GISE Position paper: Enhancing radiation safety in the catheterization laboratory]. G Ital Cardiol (Rome) 2019; 20:14S-28S. [PMID: 31593188 DOI: 10.1714/3219.31965] [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: 06/10/2023]
Abstract
The radiation dose received by interventional cardiologists during their activity in the catheterization laboratory is a matter of concern in terms of possible deterministic and stochastic risk. At the same time, very often, the knowledge of the effect and consequences of radiation exposure in the interventional cardiology community is limited. This document endorsed by the Italian Society of Interventional Cardiology (SICI-GISE) provides recommendations for cardiologists' radiation protection. Radiation safety considerations dedicated to women and other staff personnel working in the catheterization laboratory are also discussed.
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Affiliation(s)
| | - Emanuela Piccaluga
- Cardiologia-Emodinamica, ASST Grande Ospedale Metropolitano Niguarda, Milano
| | | | | | - Antonella Rosi
- Centro Nazionale delle Tecnologie Innovative per la Sanità Pubblica, Istituto Superiore di Sanità, Roma
| | | | - Matteo Longoni
- Emodinamica e Cardiologia Interventistica, Ospedale San Raffaele, Milano
| | - Francesco Germinal
- U.O.C. Cardiologia Interventistica ed Emodinamica, Ospedale "Vito Fazzi", Lecce
| | - Stefano Santucci
- U.O.S. Cardiologia Interventistica, Emodinamica ed Elettrostimolazione, AOU Sant'Andrea, Roma
| | | | - Stefano Rigattieri
- U.O.S. Cardiologia Interventistica, Emodinamica ed Elettrostimolazione, AOU Sant'Andrea, Roma
| | - Alessio La Manna
- Dipartimento Cardio-Toraco-Vascolare, AOU Policlinico "Vittorio Emanuele", Catania
| | | | - Ugo Limbruno
- U.O.C. Cardiologia, Ospedale Misericordia, Grosseto
| | - Ciro Mauro
- U.O.C. Cardiologia, Ospedale Cardarelli, Napoli
| | | | | | | | - Giuseppe Tarantini
- Dipartimento di Scienze Cardiache, Toraciche e Vascolari, Policlinico Universitario di Padova
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Borghini A, Vecoli C, Piccaluga E, Guagliumi G, Picano E, Andreassi MG. Increased mitochondrial DNA4977-bp deletion in catheterization laboratory workers with long-term low-dose exposure to ionizing radiation. Eur J Prev Cardiol 2019; 26:976-984. [PMID: 30782005 DOI: 10.1177/2047487319831495] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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] [Indexed: 11/15/2022]
Abstract
AIMS Ionizing radiation may lead to mitochondrial DNA (mtDNA) mutations and changes in mtDNA content in cells, major driving mechanisms for carcinogenesis, vascular aging and neurodegeneration. The aim of this study was to investigate the possible induction of common mitochondrial deletion (mtDNA4977) and mtDNA copy number (mtDNA-CN) changes in peripheral blood of personnel working in high-volume cardiac catheterization laboratories (Cath Labs). METHODS A group of 147 Cath Lab workers (median individual effective dose = 16.8 mSv, for the 41 with lifetime dosimetric record) and 74 unexposed individuals were evaluated. The occupational radiological risk score was computed for each subject on the basis of the length of employment, individual caseload and proximity to the radiation source. mtDNA4977 deletion and mtDNA-CN were assessed by using quantitative real-time polymerase chain reaction. RESULTS Increased levels of mtDNA4977 deletion were observed in high-exposure Cath Lab workers compared with unexposed individuals ( p < 0.0001). Conversely, mtDNA-CN was significantly greater in the low-exposure workers ( p = 0.003). Occupational radiological risk score was positively correlated with mtDNA4977 deletion (Spearman's r = 0.172, p = 0.03) and inversely correlated with mtDNA-CN (Spearman's r = -0.202, p = 0.01). In multiple regression model, occupational radiological risk score emerged as significant predictor of high levels of mtDNA4977 deletion (ß coefficient = 0.236, p = 0.04). CONCLUSION mtDNA4977 deletion is significantly high in Cath Lab personnel. Beyond the well-recognized nuclear DNA, mtDNA damage might deserve attention as a pathogenetic molecular pathway and a potential therapeutic target of ionizing radiation damage.
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Affiliation(s)
| | | | | | - Giulio Guagliumi
- 3 Ospedale Papa Giovanni XXIII, Cardiovascular Department, Bergamo, Italy
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Buono A, Maloberti A, Bossi IM, Piccaluga E, Piccalò G, Oreglia JA, Moreo A, Russo CF, Oliva F, Giannattasio C. Mycotic coronary aneurysms. J Cardiovasc Med (Hagerstown) 2019; 20:10-15. [DOI: 10.2459/jcm.0000000000000734] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Trabattoni D, Collaku E, Savonitto S, Musumeci G, Calchera I, Lettino M, Molfese M, Piatti L, Tarantini G, Piccaluga E, Visconti LO, Ferlini M, Caporale R, Rossini R. TCT-403 The Surgery after Stent (SAS) Registry: a gender-based analysis on clinical outcomes in women undergoing cardiac and non-cardiac surgery. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Tarantini G, Esposito G, Musumeci G, Fraccaro C, Franzone A, Castiglioni B, La Manna A, Limbruno U, Marchese A, Mauro C, Rigattieri S, Tarantino F, Gandolfo C, Santoro G, Violini R, Airoldi F, Albiero R, Balbi M, Baralis G, Bartorelli AL, Bedogni F, Benassi A, Berni A, Bonzani G, Bortone AS, Braito G, Briguori C, Brscic E, Calabrò P, Calchera I, Cappelli Bigazzi M, Caprioglio F, Castriota F, Cernetti C, Cicala C, Cioffi P, Colombo A, Colombo V, Contegiacomo G, Cremonesi A, D'Amico M, De Benedictis M, De Leo A, Di Biasi M, Di Girolamo D, Di Lorenzo E, Di Mario C, Dominici M, Ettori F, Ferrario M, Fioranelli M, Fischetti D, Gabrielli G, Giordano A, Giudice P, Greco C, Indolfi C, Leonzi O, Lettieri C, Loi B, Maddestra N, Marchionni N, Marrozzini C, Medda M, Missiroli B, My L, Oreglia JA, Palmieri C, Pantaleo P, Paparoni SR, Parodi G, Petronio AS, Piatti L, Piccaluga E, Pierli C, Perkan A, Pitì A, Poli A, Ramondo AB, Reale MA, Reimers B, Ribichini FL, Rosso R, Saccà S, Sacra C, Santarelli A, Sardella G, Satullo G, Scalise F, Siviglia M, Spedicato L, Stabile A, Tamburino C, Tesorio TNM, Tolaro S, Tomai F, Trani C, Valenti R, Valsecchi O, Valva G, Varbella F, Vigna C, Vignali L, Berti S. [Updated SICI-GISE position paper on institutional and operator requirements for transcatheter aortic valve implantation]. G Ital Cardiol (Rome) 2018; 19:519-529. [PMID: 30087514 DOI: 10.1714/2951.29672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) has revolutionized the management of patients with symptomatic severe aortic stenosis and has become the standard of care for inoperable patients and the preferred therapy for those at increased surgical risk with peculiar clinical and anatomic features. Technology advances, growing experience and accumulating data prompted the update of the 2011 Italian Society of Interventional Cardiology (SICI-GISE) position paper on institutional and operator requirements to perform TAVI. The main objective of this document is to provide a guidance to assess the potential of institutions and operators to initiate and maintain an efficient TAVI program.
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Affiliation(s)
| | | | | | - Chiara Fraccaro
- A.O. Policlinico Universitario di Padova, Centro Gallucci, Padova
| | | | | | - Alessio La Manna
- Cardiologia Centro Alte Specialità e Trapianti, Ospedale Gaspare Rodolico, Catania
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ciro Indolfi
- Policlinico Universitario Mater Domini, Catanzaro
| | | | | | | | | | | | - Cinzia Marrozzini
- A.O. Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna
| | | | | | - Luigi My
- Casa di Cura Villa Verde, Taranto
| | | | | | | | | | | | | | | | | | | | - Andrea Perkan
- Azienda Sanitaria Universitaria Integrata di Trieste, Ospedale di Cattinara, Trieste
| | | | | | | | | | | | | | | | | | - Cosimo Sacra
- Università Cattolica del Sacro Cuore, Campobasso
| | | | | | | | | | | | | | | | - Corrado Tamburino
- Cardiologia Centro Alte Specialità e Trapianti, Ospedale Gaspare Rodolico, Catania
| | | | | | | | - Carlo Trani
- Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Roma
| | | | | | | | | | - Carlo Vigna
- Ospedale Casa Sollievo della Sofferenza, IRCCS, San Giovanni Rotondo (FG)
| | | | - Sergio Berti
- Ospedale del Cuore, Fondazione CNR Toscana G. Monasterio, Pisa
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Andreassi MG, Borghini A, Vecoli C, Piccaluga E, Guagliumi G, Del Greco M, Picano E. P4570Reproductive health risks and y chromosome genomic instability in male staff working in cardiac catheterization laboratory with chronic low-dose x-ray exposure. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4570] [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)
- M G Andreassi
- Institute of Clinical Physiology (IFC), Massa, Italy
| | - A Borghini
- Institute of Clinical Physiology (IFC), Massa, Italy
| | - C Vecoli
- Institute of Clinical Physiology (IFC), Massa, Italy
| | | | - G Guagliumi
- Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - M Del Greco
- Santa Chiara Hospital in Trento, Trento, Italy
| | - E Picano
- Institute of Clinical Physiology (IFC), Massa, Italy
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Rossini R, Iorio A, Musumeci G, Savonitto S, Trabattoni D, Lettino M, Molfese M, Lettieri C, Ferlini M, Oltrona Visconti L, Piccaluga E, Masiero G, Caporale R, Calchera I, Tarantini G. P2686Role of optimal medical therapy on perioperative outcome in patients with heart failure and coronary artery disease undergoing surgery: insights from the SAS registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2686] [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)
- R Rossini
- Santa Croce E Carle Hospital, Cuneo, Italy
| | - A Iorio
- Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - G Musumeci
- Santa Croce E Carle Hospital, Cuneo, Italy
| | | | - D Trabattoni
- Centro Cardiologico Monzino, IRCCS, Milano, Milano, Italy
| | - M Lettino
- Istituto Clinico Humanitas, Milano, Italy
| | | | | | - M Ferlini
- Policlinic Foundation San Matteo IRCCS, Pavia, Italy
| | | | | | - G Masiero
- University Hospital of Padova, Padua, Italy
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Collaku E, Trabattoni D, Savonitto S, Musumeci G, Calchera I, Lettino M, Molfese M, Piatti L, Tarantini G, Piccaluga E, Oltrona Visconti L, Ferlini M, Caporale R, Masiero G, Rossini R. P2644The Surgery after Stent (SAS) Registry: a gender-based analysis on clinical outcomes in women undergoing cardiac and non-cardiac surgery. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2644] [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)
- E Collaku
- Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - D Trabattoni
- Centro Cardiologico Monzino, IRCCS, Milano, Milano, Italy
| | | | - G Musumeci
- Santa Croce E Carle Hospital, Cuneo, Italy
| | | | - M Lettino
- Istituto Clinico Humanitas, Milan, Italy
| | | | - L Piatti
- Alessandro Manzoni Hospital, Lecco, Italy
| | | | | | | | - M Ferlini
- Policlinic Foundation San Matteo IRCCS, Pavia, Italy
| | | | - G Masiero
- University Hospital of Padova, Padua, Italy
| | - R Rossini
- Santa Croce E Carle Hospital, Cuneo, Italy
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Andreassi MG, Piccaluga E, Sacca SC, Del Greco M, Guagliumi G, Gaita F, Padovani R, Picano E. P574High prevalence of vision impairing cataract and subclinical lens opacities in cardiac catheterization laboratory staff with low-dose x-ray exposure: results from the italian healthy cath lab study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p574] [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: 11/15/2022] Open
Affiliation(s)
| | | | | | - M Del Greco
- Santa Chiara Hospital in Trento, Trento, Italy
| | - G Guagliumi
- Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - F Gaita
- Division of Cardiology, Department of Medical Science, University of Turin, turin, Italy
| | - R Padovani
- International Centre for Theoretical Physics, trento, Italy
| | - E Picano
- Institute of Clinical Physiology, CNR, Pisa, Italy
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Borghini A, Vecoli C, Mercuri A, Turchi S, Piccaluga E, Guagliumi G, Picano E, Andreassi MG. P6200Increased mitochondrial 4977-bp deletion and copy number in cath lab personnel with long-term occupational exposure to ionizing radiation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6200] [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)
- A Borghini
- Institute of Clinical Physiology (IFC), Massa, Italy
| | - C Vecoli
- Institute of Clinical Physiology (IFC), Massa, Italy
| | - A Mercuri
- Institute of Clinical Physiology (IFC), Massa, Italy
| | - S Turchi
- Institute of Clinical Physiology (IFC), Massa, Italy
| | | | - G Guagliumi
- Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - E Picano
- Institute of Clinical Physiology (IFC), Massa, Italy
| | - M G Andreassi
- Institute of Clinical Physiology (IFC), Massa, Italy
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Bossi I, D'Anna M, Vaccaro V, Caria MP, Colombo P, De Marco F, Oreglia J, Piccalò G, Piccaluga E, Soriano F, Oliva F, Klugmann S. [Paclitaxel-coated balloons for in-stent restenosis treatment: long-term clinical results and predictors of recurrent target lesion revascularization]. G Ital Cardiol (Rome) 2018; 19:232-238. [PMID: 29912237 DOI: 10.1714/2898.29217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The aim of this study was to report clinical outcomes in patients treated with paclitaxel-coated balloons (PCB) for in-stent restenosis (ISR) in both bare metal (BMS) and drug-eluting stent (DES). METHODS Between May 2009 and December 2015, we treated 155 ISR in 140 patients. At recruitment, 35% of patients had diabetes. Among the lesions, 125 were first occurrence (55 within BMS and 70 within DES) and 30 recurrent; 24 ISR were multi-metal layered. Mean reference diameter was 2.79 ± 0.52 mm and mean lesion length 13.2 ± 7.1 mm. PCB use included 32 Dior I, 97 InPact Falcon, 18 Panthera Lux, and 8 Restore DEB. RESULTS At a median follow-up of 442 days, we observed 18 target lesion revascularizations (TLR), one myocardial infarction, 3 cardiac deaths, and 5 non-cardiac deaths. TLR occurrence differed according to type of ISR (4% within BMS, 14% within DES, 28% within recurrent ISR; p<0.05). TLR was associated with PCB type (35% Dior I, 9% InPact Falcon, 0% Panthera Lux and Restore DEB; p<0.05). Multivariable analysis revealed that first-generation PCB without a carrier (hazard ratio [HR] 2.50, 95% confidence interval [CI] 0.96-6.50; p=0.06) and recurrent ISR (HR 7.76, 95% CI 1.56-38.66; p=0.01) correlated with subsequent TLR. CONCLUSIONS Our results confirm the safety and efficacy of PCB for ISR treatment both within BMS and DES. PCB type and recurrent ISR correlate with subsequent TLR.
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Affiliation(s)
- Irene Bossi
- Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | | | - Valentina Vaccaro
- U.O. Cardiologia, Istituto Scientifico Ospedale San Luca, Istituto Auxologico Italiano, Milano
| | - Maria Paola Caria
- Dipartimento di Scienze Chirurgiche e Morfologiche, Università degli Studi dell'Insubria, Varese
| | - Paola Colombo
- Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Federico De Marco
- Cardiologia Ospedaliera, UTIC e Cardiologia Interventistica, IRCCS Policlinico San Donato, San Donato Milanese (MI)
| | - Jacopo Oreglia
- Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Giacomo Piccalò
- Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Emanuela Piccaluga
- Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Francesco Soriano
- Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Fabrizio Oliva
- Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
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Sciahbasi A, Piccaluga E, Sarandrea A, Nucci G, Caretto N, Rigattieri S, Fedele S, Romano S, Penco M. Operator Pelvic Radiation Exposure During Percutaneous Coronary Procedures. J Invasive Cardiol 2018; 30:71-74. [PMID: 29245152] [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
OBJECTIVES To evaluate operator pelvic radiation exposure during percutaneous coronary procedures. BACKGROUND During percutaneous coronary procedures, the operator's pelvic region is close to the x-ray source and is probably exposed to more radiation than the operator's thorax. However, no data are available on the pelvic radiation exposure of interventional cardiologists. METHODS The RADIANT study (NCT01974453) is a prospective, single-center, observational study evaluating operator radiation exposure during percutaneous coronary procedures using electronic dosimeters placed at thorax level. In the last period of the study enrollment, a single operator was also equipped with an adjunctive electronic dedicated dosimeter to evaluate pelvic radiation exposure. RESULTS From a total of 2028 procedures included in the RADIANT study, operator pelvic doses were available for 138 procedures (68 right radial, 55 left radial, and 15 transfemoral). Median fluoroscopy time was 226 sec (interquartile range [IQR], 117-407 sec) and the dose-area product (DAP) was 15.3 Gy•cm² (IQR, 9.3-27.8 Gy•cm²). Radiation dose at pelvic region was significantly higher (40.1 μSv; IQR, 22.7-76.3 μSv) compared to thorax dose (5.6 μSv; IQR, 1.5-12 μSv; P<.001) even after normalization by DAP (2.98 μSv/Gy•cm² [IQR, 1.6-4.6 μSv/Gy•cm²] at pelvic vs 0.33 μSv/Gy•cm² [IQR, 0.11-0.81 μSv/Gy•cm²] at thorax level; P<.001). No significant differences were observed comparing pelvic dose in right radial (42 μSv), left radial (39 μSv), or femoral access (40 μSv; P=.43). CONCLUSIONS Operator radiation exposure to the pelvic region during percutaneous coronary procedures is significantly higher compared to thorax radiation dose independently of the vascular access site employed.
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Bossi I, D'Anna M, Valentina V, Caria M, Canova P, Colombo P, Piccaluga E, Piccalo' G, Soriano F, Nava S, Oliva F. P519Predictors of target lesion revascularization after paclitaxel-coated balloon treatment of in-stent restenosis: a real-world single center registry. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bossi I, Vaccaro V, D'Anna M, Canova P, Colombo P, Nava S, Piccaluga E, Piccalo G, Soriano F, Oliva F, Frigerio M. P6072The role of paclitaxel-coated balloons for the management of in-stent or in-scaffold restenosis in patients with allograft vasculopathy: results from a case series of consecutive patients. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Danzi GB, Olivotti L, Valenti R, Bedogni F, Ciarma L, Cremonesi A, Marchese A, Piccaluga E, Salvi A, Sardella G, Varbella F, Berti S. Trends of percutaneous coronary intervention in Italy in the last 10 years. J Cardiovasc Med (Hagerstown) 2017; 18:170-177. [DOI: 10.2459/jcm.0000000000000393] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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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Andreassi MG, Piccaluga E, Guagliumi G, Del Greco M, Gaita F, Picano E. Occupational Health Risks in Cardiac Catheterization Laboratory Workers. Circ Cardiovasc Interv 2016; 9:e003273. [PMID: 27072525 DOI: 10.1161/circinterventions.115.003273] [Citation(s) in RCA: 146] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 02/24/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Orthopedic strain and radiation exposure are recognized risk factors in personnel staff performing fluoroscopically guided cardiovascular procedures. However, the potential occupational health effects are still unclear. The purpose of this study was to examine the prevalence of health problems among personnel staff working in interventional cardiology/cardiac electrophysiology and correlate them with the length of occupational radiation exposure. METHODS AND RESULTS We used a self-administered questionnaire to collect demographic information, work-related information, lifestyle-confounding factors, all current medications, and health status. A total number of 746 questionnaires were properly filled comprising 466 exposed staff (281 males; 44±9 years) and 280 unexposed subjects (179 males; 43±7years). Exposed personnel included 218 interventional cardiologists and electrophysiologists (168 males; 46±9 years); 191 nurses (76 males; 42±7 years), and 57 technicians (37 males; 40±12 years) working for a median of 10 years (quartiles: 5-24 years). Skin lesions (P=0.002), orthopedic illness (P<0.001), cataract (P=0.003), hypertension (P=0.02), and hypercholesterolemia (P<0.001) were all significantly higher in exposed versus nonexposed group, with a clear gradient unfavorable for physicians over technicians and nurses and for longer history of work (>16 years). In highly exposed physicians, adjusted odds ratio ranged from 1.7 for hypertension (95% confidence interval: 1-3; P=0.05), 2.9 for hypercholesterolemia (95% confidence interval: 1-5; P=0.004), 4.5 for cancer (95% confidence interval: 0.9-25; P=0.06), to 9 for cataract (95% confidence interval: 2-41; P=0.004). CONCLUSIONS Health problems are more frequently observed in workers performing fluoroscopically guided cardiovascular procedures than in unexposed controls, raising the need to spread the culture of safety in the cath laboratory.
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Affiliation(s)
- Maria Grazia Andreassi
- From the CNR Institute of Clinical Physiology, Pisa, Italy (M.G.A., E. Picano); Cardiovascular Department, Niguarda Ca' Granda Hospital Milan, Milano Italy (E. Piccaluga); Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy (G.G.); Department of Cardiology, S. Chiara Hospital, Trento, Italy (M.D.G.); and Division of Cardiology, Department of Medical Science, University of Turin, Torino, Italy (F.G.).
| | - Emanuela Piccaluga
- From the CNR Institute of Clinical Physiology, Pisa, Italy (M.G.A., E. Picano); Cardiovascular Department, Niguarda Ca' Granda Hospital Milan, Milano Italy (E. Piccaluga); Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy (G.G.); Department of Cardiology, S. Chiara Hospital, Trento, Italy (M.D.G.); and Division of Cardiology, Department of Medical Science, University of Turin, Torino, Italy (F.G.)
| | - Giulio Guagliumi
- From the CNR Institute of Clinical Physiology, Pisa, Italy (M.G.A., E. Picano); Cardiovascular Department, Niguarda Ca' Granda Hospital Milan, Milano Italy (E. Piccaluga); Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy (G.G.); Department of Cardiology, S. Chiara Hospital, Trento, Italy (M.D.G.); and Division of Cardiology, Department of Medical Science, University of Turin, Torino, Italy (F.G.)
| | - Maurizio Del Greco
- From the CNR Institute of Clinical Physiology, Pisa, Italy (M.G.A., E. Picano); Cardiovascular Department, Niguarda Ca' Granda Hospital Milan, Milano Italy (E. Piccaluga); Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy (G.G.); Department of Cardiology, S. Chiara Hospital, Trento, Italy (M.D.G.); and Division of Cardiology, Department of Medical Science, University of Turin, Torino, Italy (F.G.)
| | - Fiorenzo Gaita
- From the CNR Institute of Clinical Physiology, Pisa, Italy (M.G.A., E. Picano); Cardiovascular Department, Niguarda Ca' Granda Hospital Milan, Milano Italy (E. Piccaluga); Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy (G.G.); Department of Cardiology, S. Chiara Hospital, Trento, Italy (M.D.G.); and Division of Cardiology, Department of Medical Science, University of Turin, Torino, Italy (F.G.)
| | - Eugenio Picano
- From the CNR Institute of Clinical Physiology, Pisa, Italy (M.G.A., E. Picano); Cardiovascular Department, Niguarda Ca' Granda Hospital Milan, Milano Italy (E. Piccaluga); Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy (G.G.); Department of Cardiology, S. Chiara Hospital, Trento, Italy (M.D.G.); and Division of Cardiology, Department of Medical Science, University of Turin, Torino, Italy (F.G.)
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Andreassi MG, Piccaluga E, Gargani L, Sabatino L, Borghini A, Faita F, Bruno RM, Padovani R, Guagliumi G, Picano E. Subclinical carotid atherosclerosis and early vascular aging from long-term low-dose ionizing radiation exposure: a genetic, telomere, and vascular ultrasound study in cardiac catheterization laboratory staff. JACC Cardiovasc Interv 2016; 8:616-27. [PMID: 25907089 DOI: 10.1016/j.jcin.2014.12.233] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 12/02/2014] [Accepted: 12/18/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study sought to assess the association between long-term radiation exposure in the catheterization laboratory (cath lab) and early signs of subclinical atherosclerosis. BACKGROUND There is growing evidence of an excess risk of cardiovascular disease at low-dose levels of ionizing radiation exposure. METHODS Left and right carotid intima-media thickness (CIMT) was measured in 223 cath lab personnel (141 male; age, 45 ± 8 years) and 222 unexposed subjects (113 male; age, 44±10 years). Leukocyte telomere length (LTL) was evaluated by quantitative reverse transcriptase polymerase chain reaction. The DNA repair gene XRCC3 Thr241Met polymorphism was also analyzed to explore the possible interaction with radiation exposure. The occupational radiological risk score (ORRS) was computed for each subject on the basis of the length of employment, individual caseload, and proximity to the radiation source. A complete lifetime effective dose (mSv) was recorded for 57 workers. RESULTS Left, right, and averaged CIMTs were significantly increased in high-exposure workers compared with both control subjects and low-exposure workers (all p values<0.04). On the left side, but not on the right, there was a significant correlation between CIMT and ORRS (p=0.001) as well as lifetime dose (p=0.006). LTL was significantly reduced in exposed workers compared with control subjects (p=0.008). There was a significant correlation between LTL and both ORRS (p=0.002) and lifetime dose (p=0.03). The XRCC3 Met241 allele presented a significant interaction with high exposure for right side (pinteraction=0.002), left side (pinteraction<0.0001), and averaged (pinteraction<0.0001) CIMTs. CONCLUSIONS Long-term radiation exposure in a cath lab may be associated with increased subclinical CIMT and telomere length shortening, suggesting evidence of accelerated vascular aging and early atherosclerosis.
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Affiliation(s)
| | | | - Luna Gargani
- CNR Institute of Clinical Physiology, Pisa, Italy
| | | | | | | | | | - Renato Padovani
- International Centre for Theoretical Physics, Trieste, Italy
| | - Giulio Guagliumi
- Ospedale Papa Giovanni XXIII, Cardiovascular Department, Bergamo, Italy; on behalf of the Healthy Cath Lab (HCL) Study Group of the Italian Society of Invasive Cardiology (GISE)
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Marchese A, Rossini R, Basile M, Bedogni F, Danzi GB, Musumeci G, Paradies V, Piccaluga E, Sardella G, Varbella F, Giordano A, Berti S. [Position paper of the Italian Society of Invasive Cardiology (SICI-GISE) on indications for coronary angiography in patients with stable angina]. G Ital Cardiol (Rome) 2015; 16:582-9. [PMID: 26444218 DOI: 10.1714/2028.22048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Available data suggest a steep increase in stable coronary artery disease with age. Its prevalence reaches a peak of almost 12-14% in men aged 65-84 years with an annual mortality ranging from 1.2% to 2.4%. The diagnosis of stable angina is primarily based on history and therefore relies on clinical judgment. In addition, its diagnosis can be extremely challenging because of the frequent transition from unstable to stable angina. Current European guidelines on the management of stable coronary artery disease give increased importance to the pre-test probability, which strongly affects the diagnostic algorithms. Imaging techniques play a greater role in the diagnosis of stable angina than in the past. Conversely, despite recent advances in technology and in the physiological assessment of coronary stenosis, an ever decreasing relevance is conferred to coronary angiography. Another difficult and controversial issue relates to the prognostic benefit of myocardial revascularization. The aim of this position paper is to review the most relevant clinical aspects of the European guidelines on the management of stable coronary artery disease.
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Affiliation(s)
- Alfredo Marchese
- U.O.C. Cardiologia Interventistica, Anthea Hospital, GVM Care & Research, Bari
| | - Roberta Rossini
- Dipartimento Cardiovascolare, A.O. Papa Giovanni XXIII, Bergamo
| | - Marco Basile
- U.O.C. Cardiologia Interventistica, Anthea Hospital, GVM Care & Research, Bari
| | - Francesco Bedogni
- Dipartimento di Cardiologia, IRCCS Policlinico San Donato, San Donato Milanese (MI)
| | | | | | - Valeria Paradies
- U.O.C. Cardiologia Interventistica, Anthea Hospital, GVM Care & Research, Bari
| | | | - Gennaro Sardella
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Sapienza Università di Roma, Roma
| | | | - Arturo Giordano
- U.O.C. Cardiologia Interventistica, Clinica Pineta Grande, Castel Volturno (CE)
| | - Sergio Berti
- U.O. Cardiologia Diagnostica ed Interventistica, Fondazione Toscana "Gabriele Monasterio", Ospedale del Cuore, Massa
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Piccaluga E, Marchese A, Varbella F, Sardella G, Danzi GB, Salvi A, Cremonesi A, Merelli A, Ciarma L, Magro B, Bedogni F. [SICI-GISE position paper on standards and guidelines for diagnostic and catheterization laboratories]. G Ital Cardiol (Rome) 2015; 16:590-600. [PMID: 26444219 DOI: 10.1714/2028.22050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In the last few years, the activity of cath labs has undergone some notable changes, at present largely focusing on diagnosis and invasive therapy of a broad spectrum of cardiovascular diseases. Technological and pharmacological advances have allowed for procedures to be performed in patients who are increasingly complex, and cath labs have become the preferred venue for endovascular treatment of coronary artery disease, in particular acute coronary syndrome, as well as the treatment of structural heart disease and peripheral vascular disease. This position paper is an update of the 1996 and 2008 versions, given the present level of experience and the situation in Italy. It aims to provide the quality standards required to maintain adequate conditions of know-how and safety, as well as the structural and organizational requirements that are fundamental to obtain the best possible use of human and technological resources. Position papers should be a stimulus and guide for operators in the field as well as for those who govern health policies. This should allow for an improved and more rational allocation of cath labs in Italy, based on the real need for procedures and an optimal distribution and organization of the cardiovascular emergency networks while respecting the minimum standards of care.
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Affiliation(s)
| | - Alfredo Marchese
- U.O. Cardiologia Interventistica, Anthea Hospital, GVM Care & Research, Bari
| | | | - Gennaro Sardella
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Sapienza Università di Roma, Roma
| | | | - Alessandro Salvi
- Emodinamica Diagnostica e Interventistica, Azienda Ospedaliero-Universitaria "Ospedali Riuniti", Trieste
| | - Alberto Cremonesi
- Laboratorio di Cardio-Angiologia Diagnostica ed Interventistica, Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA)
| | | | - Lorenzo Ciarma
- U.O. Emodinamica, Policlinico S. Orsola-Malpighi, Bologna
| | - Beatrice Magro
- UOSD Diagnostica ed Interventistica Cardiovascolare Endoluminale, Ospedale Civile "S. Maria della Misericordia", ULSS 18, Rovigo
| | - Francesco Bedogni
- Dipartimento di Cardiologia, IRCCS Policlinico San Donato, San Donato Milanese (MI)
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Lettieri C, Zavalloni D, Rossini R, Morici N, Ettori F, Leonzi O, Latib A, Ferlini M, Trabattoni D, Colombo P, Galli M, Tarantini G, Napodano M, Piccaluga E, Passamonti E, Sganzerla P, Ielasi A, Coccato M, Martinoni A, Musumeci G, Zanini R, Castiglioni B. Management and Long-Term Prognosis of Spontaneous Coronary Artery Dissection. Am J Cardiol 2015; 116:66-73. [PMID: 25937347 DOI: 10.1016/j.amjcard.2015.03.039] [Citation(s) in RCA: 201] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 03/17/2015] [Accepted: 03/17/2015] [Indexed: 12/15/2022]
Abstract
The optimal management and short- and long-term prognoses of spontaneous coronary artery dissection (SCAD) remain not well defined. The aim of this observational multicenter study was to assess long-term clinical outcomes in patients with SCAD. In-hospital and long-term outcomes were assessed in 134 patients with documented SCAD, as well as the clinical impact and predictors of a conservative rather than a revascularization strategy of treatment. The mean age was 52 ± 11, years and 81% of patients were female. SCAD presented as an acute coronary syndromes in 93% of patients. A conservative strategy was performed in 58% of patients and revascularization in 42%. On multivariate analysis, distal versus proximal or mid location of dissection (odds ratio 9.27) and basal Thrombolysis In Myocardial Infarction (TIMI) flow grade 2 or 3 versus 0 or 1 (odds ratio 0.20) were independent predictors of conservative versus revascularization strategy. A conservative strategy was associated with better in-hospital outcomes compared with revascularization (rates of major adverse cardiac events 3.8% and 16.1%, respectively, p = 0.028); however, no significant differences were observed in the long-term outcomes. In conclusion, in this large observational study of patients with SCAD, angiographic features significantly influenced the treatment strategy, providing an excellent short- and long-term prognosis.
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Affiliation(s)
| | - Dennis Zavalloni
- Department of Cardiology, Istituto Clinico Humanitas, Rozzano, Italy
| | - Roberta Rossini
- Department of Cardiology, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Nuccia Morici
- Department of Cardiology, Ospedale Niguarda, Milano, Italy
| | | | - Ornella Leonzi
- Department of Cardiology, Ospedale Poliambulanza, Brescia, Italy
| | - Azeem Latib
- Department of Cardiology, Istituto Scientifico San Raffaele, Milano, Italy
| | - Marco Ferlini
- Department of Cardiology, Policlinico S. Matteo, Pavia, Italy
| | | | - Paola Colombo
- Department of Cardiology, Ospedale Niguarda, Milano, Italy
| | - Mario Galli
- Department of Cardiology, Ospedale S. Anna, Como, Italy
| | | | | | | | | | - Paolo Sganzerla
- Department of Cardiology, Ospedale di Treviglio Caravaggio, Treviglio, Italy
| | - Alfonso Ielasi
- Department of Cardiology, Ospedale Mater Domini, Castellanza Italy
| | - Micol Coccato
- Department of Cardiology, Università di Padova, Padova, Italy
| | | | - Giuseppe Musumeci
- Department of Cardiology, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Roberto Zanini
- Department of Cardiology, Ospedale Carlo Poma, Mantova, Italy
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Borghini A, Mercuri A, Turchi S, Chiesa MR, Piccaluga E, Andreassi MG. Increased circulating cell-free DNA levels and mtDNA fragments in interventional cardiologists occupationally exposed to low levels of ionizing radiation. Environ Mol Mutagen 2015; 56:293-300. [PMID: 25327629 DOI: 10.1002/em.21917] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 04/23/2014] [Accepted: 09/30/2014] [Indexed: 06/04/2023]
Abstract
Circulating cell-free DNA (ccf-DNA) and mtDNA (ccf-mtDNA) have often been used as indicators of cell death and tissue damage in acute and chronic disorders, but little is known about changes in ccf-DNA and ccf-mtDNA concentrations following radiation exposure. The aim of the study was to investigate the impact of chronic low-dose radiation exposure on serum ccf-DNA levels and ccf-mtDNA fragments (mtDNA-79 and mtDNA-230) of interventional cardiologists working in high-volume cardiac catheterization laboratory to assess their possible role as useful radiation biomarkers. We enrolled 50 interventional cardiologists (26 males; age = 48.4 ± 10 years) and 50 age- and gender-matched unexposed controls (27 males; age = 47.6 ± 8.3 years). Quant-iT™ dsDNA High-Sensitivity assay was used to measure circulating ccf-DNA isolated from serum samples. Quantitative analysis of mtDNA fragments was performed by real-time PCR. No significant relationships were found between ccf-DNA and ccf-mtDNA, and age, gender, smoking, or other clinical parameters. Ccf-DNA levels (44.2 ± 31.1 vs. 30.6 ± 19.2 ng/ml, P = 0.013), ccf-mtDNA-79 (2.6 ± 2.1 vs. 1.1 ± 0.8, P < 0.01), and ccf-mtDNA-230 copies (2.0 ± 1.8 vs. 1.04 ± 0.9, P = 0.02) were significantly higher in interventional cardiologists compared with the non-exposed group. In a subset (n = 15) of interventional cardiologists with a reliable reconstruction of cumulative professional exposure (59.7 ± 48.4 mSv; range: 1.4-182 mS), ccf-DNA (53.2 ± 41.3 vs. 36.4 ± 22.9 and 32.2 ± 20.5, P = 0.08), mtDNA-79 (2.4 ± 2.1 vs. 2.03 ± 1.7 and 1.09 ± 0.82, P = 0.05), and mtDNA-230 (2.0 ± 2.2 vs. 1.5 ± 1.4 and 1.04 ± 0.9, P = 0.09) tended to be significantly increased in high-exposure subjects compared with both low-exposure interventional cardiologists and controls. Our results provide evidence for a possible role of circulating DNA as a relevant biomarker of cellular damage induced by exposure to chronic low-dose radiation.
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Affiliation(s)
- Andrea Borghini
- Genetics Research Unit, CNR Institute of Clinical Physiology, Pisa, Italy
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Mojoli M, Musumeci G, Tarantini G, Limbruno U, Tarantino F, Lettieri C, Napodano M, Fineschi M, Menozzi A, Pavei A, Parodi G, Santarelli A, Trabattoni D, Marchese A, Piccaluga E, Danzi GB, Varbella F, Bedogni F, Sardella G, Berti S. [New Technologies in coronary interventional cardiology: results from the first inter-regional survey promoted by SICI-GISE in four regions of northern Italy ("the GISE TOLOVE" area: Tuscany, Lombardy, Veneto, Emilia-Romagna)]. G Ital Cardiol (Rome) 2015; 16:100-7. [PMID: 25805094 DOI: 10.1714/1798.19584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The implementation of the latest medical innovations can vary widely within the same geographic area. This study aimed to describe the current status of recent innovations in the field of coronary interventional cardiology in 4 regions of Northern Italy. METHODS From April to May 2014, 4 regional delegations of the Italian Society of Invasive Cardiology (SICI-GISE) have promoted a multicenter survey. By means of a web-based methodology, a focused questionnaire was administered to head physicians of 97 cath-labs in 4 Italian regions within the "GISE TOLOVE" area (Lombardy, Veneto, Tuscany, Emilia-Romagna). RESULTS Pharmacological and technological innovations in coronary interventional cardiology appear to be widely used in the area covered by this survey, with uniformity in application and availability of therapeutic devices and drugs within the 4 regions involved. The main limiting factors to the adoption of new technologies and drugs were economic factors or lack of scientific evidence for some specific devices or drugs. CONCLUSIONS This survey showed widespread and consistent application of the main latest innovations in coronary interventional cardiology across 4 Italian regions of Northern Italy.
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De Luca L, Bolognese L, Valgimigli M, Ceravolo R, Danzi GB, Piccaluga E, Rakar S, Cremonesi A, Bovenzi FM, Abbate R, Andreotti F, Bolognese L, Biondi-Zoccai G, Bovenzi FM, Capodanno D, Caporale R, Capranzano P, Carrabba N, Casella G, Cavallini C, Ceravolo R, Colombo P, Conte MR, Cordone S, Cremonesi A, Danzi GB, Del Pinto M, De Luca G, De Luca L, De Servi S, Di Lorenzo E, Di Pasquale G, Esposito G, Farina R, Fiscella A, Formigli D, Galli S, Giudice P, Gonzi G, Greco C, Grieco NB, La Vecchia L, Lazzari M, Lettieri C, Lettino M, Limbruno U, Lupi A, Macchi A, Marini M, Marzilli M, Montinaro A, Musumeci G, Navazio A, Olivari Z, Oltrona Visconti L, Oreglia JA, Ottani F, Parodi G, Pasquetto G, Patti G, Perkan A, Perna GP, Piccaluga E, Piscione F, Prati F, Rakar S, Ravasio R, Ronco F, Rossini R, Rubboli A, Saia F, Sardella G, Satullo G, Savonitto S, Sbarzaglia P, Scorcu G, Signore N, Tarantini G, Terrosu P, Testa L, Tubaro M, Valente S, Valgimigli M, Varbella F, Vatrano M. ANMCO/SICI-GISE paper on antiplatelet therapy in acute coronary syndrome. Eur Heart J Suppl 2014. [DOI: 10.1093/eurheartj/suu030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Rossini R, Oltrona Visconti L, Musumeci G, Filippi A, Pedretti R, Lettieri C, Buffoli F, Campana M, Capodanno D, Castiglioni B, Cattaneo MG, Colombo P, De Luca L, De Servi S, Ferlini M, Limbruno U, Nassiacos D, Piccaluga E, Raisaro A, Ravizza P, Senni M, Tabaglio E, Tarantini G, Trabattoni D, Zadra A, Riccio C, Bedogni F, Febo O, Brignoli O, Ceravolo R, Sardella G, Bongo S, Faggiano P, Cricelli C, Greco C, Gulizia MM, Berti S, Bovenzi F. A multidisciplinary consensus document on follow-up strategies for patients treated with percutaneous coronary intervention. Catheter Cardiovasc Interv 2014; 85:E129-39. [DOI: 10.1002/ccd.25724] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 11/03/2014] [Indexed: 12/31/2022]
Affiliation(s)
- Roberta Rossini
- Dipartimento Cardiovascolare; AO Papa Giovanni XXIII; Bergamo Italia
| | | | - Giuseppe Musumeci
- Dipartimento Cardiovascolare; AO Papa Giovanni XXIII; Bergamo Italia
| | | | - Roberto Pedretti
- UO di Cardiologia Riabilitativa, IRCCS Fondazione Salvatore Maugeri; Istituto Scientifico di Tradate; Tradate Italia
| | - Corrado Lettieri
- UO di Cardiologia; Azienda Ospedaliera Carlo Poma; Mantova Italia
| | | | - Marco Campana
- UO Cardiologia, Fondazione Poliambulanza; Brescia Italia
| | - Davide Capodanno
- Dipartimento di Cardiologia; Ospedale Ferrarotto, Università di Catania; Catania Italia
| | | | | | - Paola Colombo
- Dipartimento Cardiotoracovascolare; Ospedale Niguarda; Milano Italia
| | - Leonardo De Luca
- Department of Cardiovascular Sciences; European Hospital; Roma Italia
| | - Stefano De Servi
- Unita' Coronarica; IRCCS Fondazione Policlinico San Matteo; Pavia Italia
| | - Marco Ferlini
- Divisione di Cardiologia; IRCCS Fondazione Policlinico S. Matteo; Pavia Italia
| | - Ugo Limbruno
- Divisione di Cardiologia; Ospedale della Misericordia; Grosseto Italia
| | | | | | - Arturo Raisaro
- Divisione di Cardiologia; IRCCS Fondazione Policlinico S. Matteo; Pavia Italia
| | | | - Michele Senni
- Dipartimento Cardiovascolare; AO Papa Giovanni XXIII; Bergamo Italia
| | | | - Giuseppe Tarantini
- Dipartimento di Scienze Cardiache; Toraciche e Vascolari, Università di Padova; Padova Italia
| | - Daniela Trabattoni
- Dipartimento di Scienze Cardiovascolari; Centro Cardiologico Monzino, IRCCS; Milano Italia
| | | | - Carmine Riccio
- UOC Cardiologia e Riabilitazione Cardiologica, Azienda Ospedaliera Sant'Anna e San Sebastiano; Caserta Italia
| | - Francesco Bedogni
- Department of Cardiology; Istituto Clinico S. Ambrogio; Milano Italia
| | - Oreste Febo
- UO Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS Istituto Scientifico di Montescano (PV); Pavia Italia
| | | | - Roberto Ceravolo
- Dipartimento di Cardiologia, Ospedale Civile Pugliese; Catanzaro Italia
| | - Gennaro Sardella
- Department of Cardiovascular; Respiratory and Morphologic Sciences, Policlinico Umberto I, “Sapienza” University of Rome; Italia
| | - Sante Bongo
- Divisione di Cardiologia; Azienda Ospedaliero Universitaria Maggiore della Carità; Novara Italia
| | | | | | - Cesare Greco
- UOC Cardiologia - Azienda ospedaliera San Giovanni Addolorata Roma; Italia
| | - Michele Massimo Gulizia
- UOC Cardiologia; Azienda Rilievo Nazionale e Alta Specializzazione, Ospedale Garibaldi-Nesima; Catania Italia
| | - Sergio Berti
- Operative Unit of Cardiology, G. Pasquinucci Heart Hospital, Fondazione Toscana G. Monasterio; Massa Italia
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Picano E, Piccaluga E, Padovani R, Antonio Traino C, Grazia Andreassi M, Guagliumi G. Risks Related To Fluoroscopy Radiation Associated With Electrophysiology Procedures. J Atr Fibrillation 2014; 7:1044. [PMID: 27957094 DOI: 10.4022/jafib.1044] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 07/03/2014] [Accepted: 07/04/2014] [Indexed: 11/10/2022]
Abstract
The benefits of cardiac imaging are immense, and modern cardiac electrophysiology (EP) requires the extensive and versatile use of a variety of cardiac imaging and radiology-based techniques. In the cardiac electrophysiology lab, doses can range around a reference effective dose (ED) of 15 milliSievert corresponding to 750 chest x-rays for a cardiac radiofrequency ablation, ranging from less than 2 to > 60 mSv. The reference dose for a regular pacemaker or ICD implant is 4 mSv (range 1.4-17) and for a CRT implant is 22 mSv (range 2.2-95). Doses on the order of magnitude of 10-100 milliSievert (mSv) correspond to a low (albeit definite, not negligible) additional lifetime risk of fatal and non-fatal cancer from between 1 in 1000 (10 mSv) to 1 in 100 (100 mSv). The increasing use and complexity of cardiac electrophysiology techniques have not been matched by increasing awareness and knowledge by prescribers and practitioners. The protection of doctors is just as important as protection of patients. Most experienced (and most exposed) interventional cardiologists and electrophysiologists have an exposure per annum of around 5 mSv, two to three times higher than diagnostic radiologists, with a typical cumulative lifetime attributable risk on the order of magnitude of 1 cancer (fatal and non-fatal) per 100 exposed subjects. Operator dose per procedure correlates somewhat with the patient dose, but may be typically 1000 times lower depending upon the shielding employed (one unit of incidence scatter dose for the operator when 1000 units of incident dose are given to the patient). However, adequate radiation protection training and diligent protection can reduce this radiation exposure by 90%. The priority given to radioprotection in every cardiology department is an effective strategy for primary prevention of cancer, a strong indicator of the quality of the cardiology division, and the most effective shielding for enhancing the safety of patients, doctors, and staff.
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Affiliation(s)
| | | | - Renato Padovani
- Medical Physics Department, University Hospital, Udine, Italy
| | | | | | - Giulio Guagliumi
- Interventional Cardiology Unit, Ospedale Papa Giovanni XXIII, Bergamo, Italy
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Rossini R, Musumeci G, Visconti LO, Bramucci E, Castiglioni B, De Servi S, Lettieri C, Lettino M, Piccaluga E, Savonitto S, Trabattoni D, Capodanno D, Buffoli F, Parolari A, Dionigi G, Boni L, Biglioli F, Valdatta L, Droghetti A, Bozzani A, Setacci C, Ravelli P, Crescini C, Staurenghi G, Scarone P, Francetti L, D’Angelo F, Gadda F, Comel A, Salvi L, Lorini L, Antonelli M, Bovenzi F, Cremonesi A, Angiolillo DJ, Guagliumi G. Perioperative management of antiplatelet therapy in patients with coronary stents undergoing cardiac and non-cardiac surgery: a consensus document from Italian cardiological, surgical and anaesthesiological societies. EUROINTERVENTION 2014; 10:38-46. [DOI: 10.4244/eijv10i1a8] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Piccaluga E. [To know how to be protected: the risks of low-dose ionizing radiation exposure]. G Ital Cardiol (Rome) 2014; 15:286-288. [PMID: 25002167 DOI: 10.1714/1563.17023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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De Luca L, Bolognese L, Valgimigli M, Ceravolo R, Danzi GB, Piccaluga E, Rakar S, Cremonesi A, Bovenzi FM. [ANMCO/SICI-GISE document on antiplatelet therapy in patients with acute coronary syndrome]. G Ital Cardiol (Rome) 2014; 14:839-66. [PMID: 24336601 DOI: 10.1714/1371.15242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Antiplatelet therapy is the cornerstone of the pharmacologic management of patients with acute coronary syndrome (ACS). Over the last years, several studies have evaluated old and new oral or intravenous antiplatelet agents in ACS patients. In particular, research was focused on assessing superiority of two novel platelet ADP P2Y12 receptor antagonists (i.e., prasugrel and ticagrelor) over clopidogrel. Several large randomized controlled trials have been undertaken in this setting and a wide variety of prespecified and post-hoc analyses are available that evaluated the potential benefits of novel antiplatelet therapies in different subsets of patients with ACS. The aim of this document is to review recent data on the use of current antiplatelet agents for in-hospital treatment of ACS patients. For each drug or class of drugs, strong evidence and/or areas of uncertainty that warrant further research are highlighted by examining 10 subgroups of patients with ACS.
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Ferlini M, Mafrici A, Marzegalli M, Piccaluga E, Sponzilli C, Bramucci E, Visconti LO. [Upstream administration of oral antiplatelet agents in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention]. G Ital Cardiol (Rome) 2014; 15:90-8. [PMID: 24625848 DOI: 10.1714/1424.15778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Current guidelines for the management of patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) recommend the administration of dual antiplatelet therapy with aspirin and an ADP receptor blocker "as early as possible" before angiography (upstream), though this suggestion is not based on the results of randomized clinical trials designed to investigate pre-hospital rather than in-hospital drug administration. The present review analyzed randomized clinical trials, registries and observational studies that assessed clopidogrel, prasugrel and ticagrelor administration in STEMI patients undergoing primary PCI to evaluate if their upstream use may be justified in clinical practice. A significant difference favoring early clopidogrel administration has been demonstrated in observational studies. No evidence is available for prasugrel and ticagrelor; however, the initial delay of their antiplatelet effect in STEMI patients could support an upstream strategy to obtain complete platelet inhibition in the first hours after PCI and prevent major adverse events (e.g., stent thrombosis) despite an increased risk of major bleeding, particularly in case of urgent bypass surgery. Data from specifically designed randomized clinical trials are warranted to establish whether early administration of prasugrel and ticagrelor may favor reperfusion and improve clinical outcome with an acceptable risk-benefit ratio.
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Tonacci A, Baldus G, Corda D, Piccaluga E, Andreassi M, Cremonesi A, Guagliumi G, Picano E. Olfactory non-cancer effects of exposure to ionizing radiation in staff working in the cardiac catheterization laboratory. Int J Cardiol 2014; 171:461-3. [DOI: 10.1016/j.ijcard.2013.12.223] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 12/21/2013] [Indexed: 11/26/2022]
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Piccaluga E, Andreassi MG, Chiesa MR, Fortunato L, Trivellini G, Molinaro S, Cremonesi G, Guagliumi G, Picano E. Occupational risks in cardiac catheterization laboratory workers. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sabatino L, Borghini A, Turchi S, Mercuri A, Lazzerini G, Piccaluga E, Magro B, Guagliumi G, Picano E, Andreassi MG. Leukocyte telomere shortening in staff working in cardiac catheterization laboratory. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Piccaluga E, Simonetti I, Chiesa MR, Andreassi MG, Padovani R, Bernardi G, Cremonesi A, Guagliumi G, Picano E. Radiation awareness and safety practices in the cardiac catheterization laboratory: results of a survey among Italian cardiac cath lab workers. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Tonacci A, Baldus G, Corda D, Tartarisco G, Piccaluga E, Guagliumi G, Cremonesi A, Pioggia G, Andreassi MG, Picano E. Olfactory testing in staff working in the cardiac catheterization laboratory. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Borghini A, Gargani L, Mercuri A, Faita F, Turchi S, Magro B, Piccaluga E, Guagliumi G, Picano E, Andreassi MG. Increased carotid media thickness in cath lab workers exposed to chronic ionizing radiation and its interaction with DNA repair XRCC3 gene. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Rossini R, Bramucci E, Castiglioni B, De Servi S, Lettieri C, Lettino M, Musumeci G, Visconti LO, Piccaluga E, Savonitto S, Trabattoni D, Buffoli F, Angiolillo DJ, Bovenzi F, Cremonesi A, Scherillo M, Guagliumi G. [Coronary stenting and surgery: perioperative management of antiplatelet therapy in patients undergoing surgery after coronary stent implantation]. G Ital Cardiol (Rome) 2012; 13:528-51. [PMID: 22781382 DOI: 10.1714/1114.12251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The management of antiplatelet therapy in patients with coronary stents undergoing surgery is a growing clinical problem and often represents a matter of debate between cardiologists and surgeons. It has been estimated that about 4-8% of patients undergoing coronary stenting need to undergo surgery within the next year. Surgery represents one of the most common reasons for premature antiplatelet therapy discontinuation, which is associated with a significant increase in mortality and major adverse cardiac events, in particular stent thrombosis. In addition, surgery confers an additional risk of perioperative cardiac ischemic events, being high in these patients because of the pro-inflammatory and pro-thrombotic effects of surgery. Current international guidelines recommend to postpone non-urgent surgery for at least 6 weeks after bare metal stent implantation and for 6-12 months after drug-eluting stent implantation. However, these recommendations provide little support with regard to managing antiplatelet therapy in the perioperative phase in case of urgent operations and/or high hemorrhagic risk. Furthermore, ischemic and hemorrhagic risk is not defined in detail on the basis of clinical and procedural characteristics. Finally, guidelines shared with cardiologists and surgeons are lacking. The present consensus document provides practical recommendations on the management of antiplatelet therapy in the perioperative period in patients with coronary stents undergoing surgery. Cardiologists and surgeons contributed equally to its creation. An ischemic risk stratification has been provided on the basis of clinical and procedural data. All surgical interventions have been defined on the basis of the hemorrhagic risk. A consensus on the most appropriate antiplatelet regimen in the perioperative phase has been reached on the basis of the ischemic and hemorrhagic risk. Dual antiplatelet therapy should not be withdrawn for surgery at low bleeding risk, whereas aspirin should be continued perioperatively in the majority of surgical operations. In the event of interventions at high risk for both bleeding and ischemic events, when oral antiplatelet therapy withdrawal is required, perioperative treatment with short-acting intravenous glycoprotein IIb/IIIa inhibitors (tirofiban or eptifibatide) should be considered.
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Martinoni A, De Servi S, Politi A, Palmerini T, Musumeci G, Ettori F, Zanini R, Piccaluga E, Sangiorgi D, Repetto A, D'Urbano M, Castiglioni B, Fabbiocchi F, Onofri M, Lauria G, De Cesare N, Sangiorgi G, Lettieri C, Belli G, Poletti F, Pirelli S, Klugman S. Defining high-risk patients with ST-segment elevation acute myocardial infarction undergoing primary percutaneous coronary intervention: A comparison among different scoring systems and clinical definitions. Int J Cardiol 2012; 157:207-11. [DOI: 10.1016/j.ijcard.2010.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Revised: 07/03/2010] [Accepted: 12/04/2010] [Indexed: 12/22/2022]
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