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Migliaro S, Petrolini A, Mariani S, Tomai F. Impact of renal denervation on patients with coronary microvascular dysfunction: study rationale and design. J Cardiovasc Med (Hagerstown) 2024; 25:379-385. [PMID: 38477865 DOI: 10.2459/jcm.0000000000001609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
AIMS Long-standing hypertension may cause an impairment in microvascular coronary circulation, which is involved in many different cardiac conditions. Renal sympathetic denervation (RDN) has been successfully proven as a valuable therapeutic choice for patients with resistant hypertension; moreover, the procedure looks promising in other settings, such as heart failure and atrial fibrillation, given its ability to downregulate the sympathetic nervous system, which is a recognized driver in these conditions as well as in microvascular dysfunction progression. The aim of this study is to explore the effect of RDN on coronary physiology in patients with ascertained coronary microvascular dysfunction and resistant hypertension. METHODS This is a multicenter, prospective, nonrandomized, open-label, interventional study. Consecutive patients with resistant hypertension, nonobstructive coronary artery disease (NOCAD) and documented microvascular dysfunction will be enrolled. Patients will undergo RDN by Spyral Symplicity 3 (Medtronic Inc, Minneapolis, Minnesota, USA) and reassessment of coronary microvascular function 6 months after the procedure. Primary endpoint will be the difference in the index of microcirculatory resistance. CONCLUSION The IMPRESSION study seeks to evaluate if there is any pleiotropic effect of the RDN procedure that results in modulation of microvascular function; if observed, this would be the first evidence showing RDN as a valuable therapy to revert hypertension-related microvascular dysfunction.
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Affiliation(s)
| | - Alessandro Petrolini
- Department of Cardiovascular Sciences, Aurelia Hospital
- Department of Cardiovascular Sciences, European Hospital, Rome, Italy
| | | | - Fabrizio Tomai
- Department of Cardiovascular Sciences, Aurelia Hospital
- Department of Cardiovascular Sciences, European Hospital, Rome, Italy
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Pighi M, Tomai F, Fezzi S, Pesarini G, Petrolini A, Spedicato L, Tarantini G, Ferlini M, Calabrò P, Loi B, Ferrero V, Forero MNT, Daemen J, Ribichini F. Safety and efficacy of everolimus-eluting bioresorbable vascular scaffold for cardiac allograft vasculopathy (CART). Clin Res Cardiol 2024:10.1007/s00392-023-02351-9. [PMID: 38170246 DOI: 10.1007/s00392-023-02351-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/29/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Cardiac allograft vasculopathy (CAV) is still the main drawback of heart transplantation (HTx) and percutaneous coronary intervention (PCI) is a palliative measure because of the high incidence of failure. OBJECTIVE This study aimed to investigate the safety and efficacy of bioresorbable scaffolds (BRSs) as potential novel therapeutic tool for the treatment of coronary stenoses in CAV. METHODS This is a multicenter, single-arm, prospective, open-label study (CART, NCT02377648), that included patients affected by advanced CAV treated with PCI and second-generation ABSORB BRS (Abbott Vascular). The primary endpoint was the incidence of 12-month angiographic in-segment scaffold restenosis (ISSR). Secondary endpoints were the incidence of major adverse cardiac events (MACEs) at 12- and 36-month follow-up and the incidence of ISSR at 36 months. A paired intracoronary imaging analysis at baseline and follow-up was also performed. RESULTS Between 2015 and 2017 35 HTx patients were enrolled and treated for 44 coronary lesions with 51 BRSs. The primary endpoint occurred in 13.5% of the lesions (5/37), with a cumulative ISSR rate up to 3 years of 16.2% (6/37). Angiographic lumen loss was 0.40 ± 0.62 mm at 12 months and 0.53 ± 0.57 mm at 36 months. Overall survival rate was 91.4% and 74.3%, and MACEs incidence 14.2% and 31.4% at 12 and 36 months, respectively. At the paired intracoronary imaging analysis, a significant increase of the vessel external elastic membrane area in the treated segment and some progression of CAV proximally to the BRS were detected. CONCLUSIONS BRS-based PCI for the treatment of CAV is feasible and safe, with an ISSR incidence similar to what reported in retrospective studies with drug-eluting stents.
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Affiliation(s)
- Michele Pighi
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale Aristide Stefani, 1, 37126, Verona, Italy
| | - Fabrizio Tomai
- Department of Cardiovascular Sciences, European Hospital, Rome, Italy
| | - Simone Fezzi
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale Aristide Stefani, 1, 37126, Verona, Italy
| | - Gabriele Pesarini
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale Aristide Stefani, 1, 37126, Verona, Italy.
| | | | - Leonardo Spedicato
- Department of Cardiovascular Sciences, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
- Division of Clinical Cardiology, Sant'Anna e San Sebastiano Hospital, Caserta, Italy
| | - Bruno Loi
- Division of Cardiology, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Valeria Ferrero
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale Aristide Stefani, 1, 37126, Verona, Italy
| | | | - Joost Daemen
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Flavio Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale Aristide Stefani, 1, 37126, Verona, Italy
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3
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Laricchia A, Bossi I, Latini RA, Lee CY, Pérez IS, Tomai F, Nuruddin AA, Buccheri D, Seresini G, Ocaranza R, Sengottvelu G, Pesenti N, Mangieri A, Cortese B. Sirolimus-coated balloon in acute and chronic coronary syndromes: subanalysis of the EASTBOURNE registry. Rev Esp Cardiol (Engl Ed) 2023:S1885-5857(23)00336-5. [PMID: 38056772 DOI: 10.1016/j.rec.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/17/2023] [Indexed: 12/08/2023]
Abstract
INTRODUCTION AND OBJECTIVES The PEACE study (Performance of a sirolimus-eluting balloon strategy in acute and chronic coronary syndromes) investigated for the first time whether a sirolimus-coated balloon (SCB) (Magic Touch, Concept Medical, India) is associated with different outcomes depending on whether it is used in acute coronary syndromes (ACS) or chronic coronary syndromes (CCS). METHODS This was a post-hoc analysis from the all-comers EASTBOURNE Registry (NCT03085823). Out of 2083 patients enrolled, an SCB was used to treat 968 (46.5%) ACS and 1115 (53.5%) CCS patients. The primary endpoint was target lesion revascularization at 12 months, while secondary endpoints were angiographic success and major adverse cardiovascular events. RESULTS Baseline demographics, mean reference vessel diameter and mean lesion length were comparable between ACS and CCS. Predilatation was more commonly performed in ACS (P=.007). SCB was inflated at a standard pressure in both groups with a slight trend toward longer inflation time in ACS. Angiographic success was high in both groups (ACS 97.4% vs CCS 97.7%, P=.820) with limited bailout stenting. Similarly, at 12 months the cumulative incidence of target lesion revascularization (ACS 6.6% vs CCS 5.2%, P=.258) was comparable between ACS and CCS. Conversely, a higher rate of major adverse cardiovascular events in acute presenters was mainly driven by myocardial infarction recurrencies (ACS 10.4% vs CCS 8.3%, P=.009). In-stent restenosis showed a higher proportion of target lesion revascularization and major adverse cardiovascular events than de novo lesions, independently of the type of presentation at the index procedure. CONCLUSIONS This SCB shows good performance in terms of acute and 1-year outcomes independently of the clinical presentation.
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Affiliation(s)
- Alessandra Laricchia
- Cardiology Department, Ospedale San Carlo Borromeo, Milan, Italy; Cardiology Department, Ospedale Fatebenefratelli, Milan, Italy
| | - Irene Bossi
- Cardiology Department, Ospedale Niguarda, Milan, Italy
| | | | - Chuey Y Lee
- Cardiology Department, Sultanah Aminah Hospital Johor Bahru, Johor, Malaysia
| | - Ignacio S Pérez
- Cardiology Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | - Amin A Nuruddin
- Cardiology Department, Institute Jantung Negara, Kuala Lumpur, Malaysia
| | - Dario Buccheri
- Cardiology Department, Ospedale S. Antonio Abate, Trapani, Italy
| | | | | | | | - Nicola Pesenti
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology, and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Antonio Mangieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy, and Humanitas Clinical and Research Center IRCCS, Rozzano-Milan, Italy
| | - Bernardo Cortese
- Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy; DCB Academy, Milan, Italy.
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4
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Cortese B, Testa L, Heang TM, Ielasi A, Bossi I, Latini RA, Lee CY, Perez IS, Milazzo D, Caiazzo G, Tomai F, Benincasa S, Nuruddin AA, Stefanini G, Buccheri D, Seresini G, Singh R, Karavolias G, Cacucci M, Sciahbasi A, Ocaranza R, Menown IBA, Torres A, Sengottvelu G, Zanetti A, Pesenti N, Colombo A. Sirolimus-Coated Balloon in an All-Comer Population of Coronary Artery Disease Patients: The EASTBOURNE Prospective Registry. JACC Cardiovasc Interv 2023; 16:1794-1803. [PMID: 37495352 DOI: 10.1016/j.jcin.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/28/2023] [Accepted: 05/02/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Drug-coated balloons (DCB) represent 1 of the most promising innovations in interventional cardiology and may represent a valid alternative to drug-eluting stents. Currently, some sirolimus-coated balloons (SCB) are being investigated for several coronary artery disease applications. OBJECTIVES This study sought to understand the role of a novel SCB for the treatment of coronary artery disease. METHODS EASTBOURNE (All-Comers Sirolimus-Coated Balloon European Registry) is a prospective, multicenter, investigator-driven clinical study that enrolled real-world patients treated with SCB. Primary endpoint was target lesion revascularization (TLR) at 12 months. Secondary endpoints were procedural success, myocardial infarction (MI), all-cause death, and major adverse clinical events (a composite of death, MI, and TLR). All adverse events were censored and adjudicated by an independent clinical events committee. RESULTS A total population of 2,123 patients (2,440 lesions) was enrolled at 38 study centers in Europe and Asia. The average age was 66.6 ± 11.3 years, and diabetic patients were 41.5%. De novo lesions (small vessels) were 56%, in-stent restenosis (ISR) 44%, and bailout stenting occurred in 7.7% of the patients. After 12 months, TLR occurred in 5.9% of the lesions, major adverse clinical events in 9.9%, and spontaneous MI in 2.4% of the patients. The rates of cardiac/all-cause death were 1.5% and 2.5%, respectively. The primary outcome occurred more frequently in the ISR cohort (10.5% vs 2.0%; risk ratio: 1.90; 95% CI: 1.13-3.19). After multivariate Cox regression model, the main determinant for occurrence of the primary endpoint was ISR (OR: 5.5; 95% CI: 3.382-8.881). CONCLUSIONS EASTBOURNE, the largest DCB study in the coronary field, shows the safety and efficacy of a novel SCB in a broad population of coronary artery disease including small vessels and ISR patients at mid-term follow-up. (The All-Comers Sirolimus-Coated Balloon European Registry [EASTBOURNE]; NCT03085823).
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Affiliation(s)
| | - Luca Testa
- IRCCS Policlinico San Donato, Milan, Italy
| | - Tay M Heang
- Pantai Hospital Ayer Keroh, Melaka, Malaysia
| | - Alfonso Ielasi
- Cardiology Division, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | | | | | - Chuey Y Lee
- Sultanah Aminah Hospital Johor Bahru, Johor, Malaysia
| | - Ignacio S Perez
- Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | | | | | | | | | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | | | - Ramesh Singh
- University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | | | | | | | | | - Ian B A Menown
- Craigavon Cardiac Centre, Craigavon, Northern Ireland, United Kingdom
| | | | | | - Anna Zanetti
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology, and Public Health, University of Milano-Bicocca, Milan, Italy; We 4 Clinical Research, Milan, Italy
| | - Nicola Pesenti
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology, and Public Health, University of Milano-Bicocca, Milan, Italy; We 4 Clinical Research, Milan, Italy
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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5
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Sardella G, Stefanini G, Leone PP, Boccuzzi G, Fovero NT, Van Mieghem N, Giacchi G, Escaned J, Fineschi M, Testa L, Valenti R, Di Mario C, Briguori C, Cortese B, Ribichini F, Oreglia JA, Colombo A, Sangiorgi G, Barbato E, Sonck J, Ugo F, Trani C, Castriota F, Paggi A, Porto I, Tomai F, Mancone M. Coronary Lithotripsy as Elective or Bail-Out Strategy After Rotational Atherectomy in the Rota-Shock Registry. Am J Cardiol 2023; 198:1-8. [PMID: 37182254 DOI: 10.1016/j.amjcard.2023.04.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 04/04/2023] [Accepted: 04/15/2023] [Indexed: 05/16/2023]
Abstract
Debulking lesions with severe coronary artery calcification (CAC) is highly recommended to obtain good procedural and long-term success. Utilization and performance of coronary intravascular lithotripsy (IVL) after rotational atherectomy (RA) has not been thoroughly studied. This study aimed to evaluate the efficacy and safety of IVL with the Shockwave Coronary Rx Lithotripsy System in lesions with severe CAC as elective or bail-out strategy after RA. This observational, prospective, single-arm, multicenter, international, open-label Rota-Shock registry included patients with symptomatic coronary artery disease and lesions with severe CAC treated by percutaneous coronary intervention, including lesion preparation with RA and IVL, at 23 high-volume centers. Primary efficacy end point was procedural success, defined as final diameter stenosis <30% by quantitative coronary angiography. Primary safety end point was freedom from serious angiographic complications, which included >National Heart, Lung and Blood Institute type B dissection, perforation, abrupt closure, slow or no flow, final thrombolysis in myocardial infarction flow <3, and acute thrombosis. A total of 160 patients were enrolled between June 2020 and June 2022. The primary efficacy end point was observed in 155 patients (96.9%). The primary safety end point occurred in 145 cases (90.6%). Dissections >National Heart, Lung and Blood Institute type B occurred in 3 patients (1.9%), whereas slow or no flow occurred in 8 (5.0%), final thrombolysis in myocardial infarction flow <3 in 3 (1.9%), and perforation in 4 patients (2.5%). Free from inhospital major adverse cardiac and cerebrovascular events, including cardiac death, target vessel myocardial infarction, target lesion revascularization, cerebrovascular accident, definite/probable stent thrombosis, and major bleeding, occurred in 158 patients (98.7%). In conclusion, IVL after RA in lesions with severe CAC was effective and safe, with a very low incidence of complications as either elective or bail-out strategy.
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Affiliation(s)
- Gennaro Sardella
- Department of Clinical, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy.
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Pier Pasquale Leone
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy; Division of Cardiology, Montefiore Medical Center, Bronx, New York
| | - Giacomo Boccuzzi
- Division of Cardiology, Department of Medicine, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Natalia Tovar Fovero
- Department of Cardiology, Erasmus Medical University Center, Rotterdam, The Netherlands
| | - Nicolas Van Mieghem
- Department of Cardiology, Erasmus Medical University Center, Rotterdam, The Netherlands
| | | | - Javier Escaned
- Interventional Cardiology Unit, Hospital Clinico San Carlos IdISSC, Universidad Complutense de Madrid, C/ Profesor Martín Lagos, Madrid, Spain
| | - Massimo Fineschi
- Interventional Cardiology, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Siena, Italy
| | - Luca Testa
- IRCCS Policlinico S. Donato, Milan, Italy
| | - Renato Valenti
- Division of Interventional Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology Division, Department of Clinical & Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Carlo Briguori
- Division of Interventional Cardiology, Mediterranea Cardiocentro, Naples, Italy
| | - Bernardo Cortese
- Foundation for Cardiovascular Research and Innovation, Milan, Italy
| | - Flavio Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Jacopo Andrea Oreglia
- Department of Cardiology and de Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy; Interventional Cardiology Unit, EMO-GVM, Centro Cuore Columbus, Milan, Italy
| | | | - Emanuele Barbato
- Cardiology Department, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | | | - Carlo Trani
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Fausto Castriota
- Interventional Cardiology Unit, Maria Cecilia Hospital GVM Care and Research, Cotignola, Italy
| | - Anita Paggi
- Laboratory of Interventional Cardiology; Department of Cardiology, S. Anna Hospital, Catanzaro, Italy
| | - Italo Porto
- Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV) IRCCS, Ospedale Policlinico San Martino Genoa, Italy
| | - Fabrizio Tomai
- Department of Cardiovascular Sciences, European Hospital, Rome, Italy
| | - Massimo Mancone
- Department of Clinical, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
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Sticchi A, Costa F, Muscoli S, Zilio F, Buono A, Ruggiero R, Scoccia A, Caracciolo A, Licordari R, Cammalleri V, Iacovelli F, Loffi M, Scordino D, Ferro J, Rognoni A, Nava S, Albani S, Pavani M, Colaiori I, Benenati S, Pescetelli F, DE Marzo V, Borghesi M, Regazzoni V, Mannarini A, Spione F, Doronzo B, de Benedictis M, Bonmassari R, Danzi GB, Galli M, Ielasi A, Musumeci G, Tomai F, Micari A, Pasceri V, Patti G, Porto I, Campo G, Colombo A, Giannini F. Symptoms-to-emergency-call timing delay in acute coronary syndrome before and during COVID-19: independent predictors and their impact on mortality. Minerva Cardiol Angiol 2023; 71:12-19. [PMID: 36305773 DOI: 10.23736/s2724-5683.22.05985-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The COVID-19 pandemic severely impacted global health. The aim of this study was to compare predictors of symptoms-to-emergency-call timing delay in acute coronary syndrome (ACS) and their impact on mortality before and during the COVID-19 outbreak. METHODS We collected sociodemographic, clinical data, procedural features, preadmission and intra-hospital outcomes of consecutive patients admitted for ACS in seventeen Italian centers from March to April 2018, 2019, and 2020. RESULTS In 2020, a 32.92% reduction in ACS admissions was observed compared to 2018 and 2019. Unstable angina, typical and atypical symptoms, and intermittent angina were identified as significant predictors of symptoms-to-emergency-call timing delay before and during the COVID-19 pandemic (P<0.005 for all the items). Differently from 2018-2019, during the pandemic, hypertension and dyspnea (P=0.002 versus P=0.490 and P=0.001 vs. P=0.761 for 2018-2019 and 2020, respectively) did not result as predictors of delay in symptoms-to-emergency-call timing. Among these predictors, only the atypical symptoms (HR 3.36; 95% CI: 1.172-9.667, P=0.024) in 2020 and the dyspnea (HR 2.64; 95% CI: 1.345-5.190, P=0.005) in 2018-2019 resulted significantly associated with higher mortality. Finally, the family attendance at the onset of the symptoms resulted in a reduction in symptoms-to-emergency-call timing (in 2020 P<0.001; CI: -1710.73; -493.19) and in a trend of reduced mortality (HR 0.31; 95% CI: 0.089-1.079, P=0.066) in 2020. CONCLUSIONS During the COVID-19 outbreak, atypical symptoms and family attendance at ACS onset were identified, respectively, as adverse and favorable predictors of symptoms-to-emergency-call timing delay and mortality.
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Affiliation(s)
- Alessandro Sticchi
- Humanitas Research Hospital IRCCS, Milan, Italy - .,Centro per la Lotta Contro L'Infarto (CLI) Foundation, Rome, Italy - .,GVM Care & Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy -
| | - Francesco Costa
- Department of Clinical and Experimental Medicine, G. Martino Polyclinic, University of Messina, Messina, Italy
| | - Saverio Muscoli
- Department of Cardiovascular Disease, Tor Vergata University, Rome, Italy
| | - Filippo Zilio
- Unit of Cardiology, Santa Chiara Hospital, Trento, Italy
| | | | - Rossella Ruggiero
- GVM Care & Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | | | - Alessandro Caracciolo
- Department of Clinical and Experimental Medicine, G. Martino Polyclinic, University of Messina, Messina, Italy
| | - Roberto Licordari
- Department of Clinical and Experimental Medicine, G. Martino Polyclinic, University of Messina, Messina, Italy
| | - Valeria Cammalleri
- Department of Cardiovascular Disease, Tor Vergata University, Rome, Italy
| | - Fortunato Iacovelli
- Division of Cardiology, Cardiothoracic Department, Polyclinic University of Bari, Bari, Italy
| | - Marco Loffi
- Department of Cardiology, Hospital of Cremona, Cremona, Italy
| | | | - Jayme Ferro
- UOSD Cardiology, Department of Emergency, Intensive Care and Anesthesia, Hemodynamics Laboratory, ASST Lariana, S. Anna Hospital, Como, Italy
| | | | - Stefano Nava
- Division of Invasive Cardiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Marco Pavani
- SS Annunziata Civil Hospital, Savigliano, Cuneo, Italy
| | | | - Stefano Benenati
- CardioToracoVascular Department, IRCCS San Martino University Hospital, Genoa, Italy
| | - Fabio Pescetelli
- CardioToracoVascular Department, IRCCS San Martino University Hospital, Genoa, Italy
| | - Vincenzo DE Marzo
- CardioToracoVascular Department, IRCCS San Martino University Hospital, Genoa, Italy
| | - Marco Borghesi
- Unit of Cardiology, Santa Chiara Hospital, Trento, Italy
| | | | - Antonia Mannarini
- Division of Cardiology, Cardiothoracic Department, Polyclinic University of Bari, Bari, Italy
| | - Francesco Spione
- Division of Cardiology, Cardiothoracic Department, Polyclinic University of Bari, Bari, Italy
| | | | | | | | - Gian B Danzi
- Department of Cardiology, Hospital of Cremona, Cremona, Italy
| | - Mario Galli
- UOSD Cardiology, Department of Emergency, Intensive Care and Anesthesia, Hemodynamics Laboratory, ASST Lariana, S. Anna Hospital, Como, Italy
| | | | | | | | - Antonio Micari
- Department of Clinical and Experimental Medicine, G. Martino Polyclinic, University of Messina, Messina, Italy
| | | | | | - Italo Porto
- CardioToracoVascular Department, IRCCS San Martino University Hospital, Genoa, Italy
| | - Gianluca Campo
- Cardiovascular Institute, AOU Ferrara, Cona, Ferrara, Italy
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Scordino D, Venturi G, Nudi F, Tomai F. Multi-imaging evaluation and long-term outcome of a patient with chest pain and an anomalous right coronary artery arising from pulmonary artery: a case report. European Heart Journal - Case Reports 2022; 6:ytac430. [DOI: 10.1093/ehjcr/ytac430] [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] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/15/2022] [Accepted: 10/26/2022] [Indexed: 11/18/2022]
Abstract
Abstract
Background
Anomalous right coronary artery from pulmonary artery (ARCAPA) is a rare coronary anomaly. Adult patients usually present with few symptoms due to extensive collateral network from left coronary artery, with little/absent symptoms. Few data exist regarding surgical vs. conservative strategy for paucisymptomatic cases. Moreover, consensus is lacking.
Case summary
We describe the case of a 52-year-old male patient with undiagnosed ARCAPA, who acceded to our emergency department with suspected acute myocardial infarction and was discharged with medical therapy after demonstration of mild ischaemia at myocardial perfusion imaging with dipyridamole and bicycle exercise test.
Discussion
The patient completed 2-year event-free follow up. After complete imaging assessment and thorough clinical evaluation, medical management could be regarded as valid alternative to surgery for paucisymptomatic ARCAPA patients with evidence of limited ischaemia.
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Affiliation(s)
- Domenico Scordino
- Department of Cardiovascular Sciences, European Hospital and Aurelia Hospital , Via Portuense 700-00149 and Via Aurelia 860-00165, Rome , Italy
| | - Gabriele Venturi
- Department of Cardiovascular Sciences, European Hospital and Aurelia Hospital , Via Portuense 700-00149 and Via Aurelia 860-00165, Rome , Italy
- Division of Cardiology, Department of Medicine, University of Verona , Verona , Italy
| | - Francesco Nudi
- Service of Hybrid Cardio Imaging, Madonna Della Fiducia Clinic , Rome , Italy
| | - Fabrizio Tomai
- Department of Cardiovascular Sciences, European Hospital and Aurelia Hospital , Via Portuense 700-00149 and Via Aurelia 860-00165, Rome , Italy
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Pighi M, Tomai F, Fezzi S, Pesarini G, Petrolini A, Spedicato L, Tarantini G, Ferlini M, Calabro P, Loi B, Tovar Forero N, Daemen J, Ribichini FT. Everolimus-eluting bioresorabable scaffold system in the treatment of cardiac allograft vasculopathy: the cardiac allograft reparative therapy (CART) prospective multicentre pilot study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cardiac allograft vasculopathy (CAV) is still the main drawback of heart transplantation (HTx) and percutaneous coronary intervention (PCI) is a palliative measure because of the high incidence of PCI failure. The bioresorbable scaffolds (BRS) could represent a potential novel therapeutic tool for the treatment of coronary obstructions in CAV.
Purpose
To investigates the effects of BRS implantation in CAV patients in a Nationwide prospective study.
Methods
Multicentre, single-arm, prospective, open-label study that included patients affected by advanced CAV treated with PCI and second-generation ABSORB BRS. The primary endpoint was the incidence of 12-month angiographic in-segment scaffold restenosis (ISSR). Secondary endpoints were the composite of cardiac death, myocardial infarction, and target lesion revascularisation at 12-and 36-month follow-up and the incidence of ISSR at 36 months. A paired analysis of intravascular ultrasound (IVUS) and optical coherence tomography (OCT) at baseline and follow-up was also performed.
Results
Between 2015–2017 35 HTx patients were enrolled and treated on 44 coronary lesions with 51 BRS. The primary endpoint occurred in 13.5% of the lesions (5/37), with a cumulative ISSR rate up to 3 years of 16.2% (6/37).Angiographic lumen loss was 0.40±0.62mm at 12 months and 0.53±0.57mm at 36 months. Overall survival was 91.4% and 74.3%, and MACEs 14.2% and 31.4% at 12 and 36 months, respectively. At the paired intracoronary imaging analysis a significant increase of the vessel external elastic membrane area in the treated segment of the BRS was described at the OCT, while some progression of CAV was detected proximally at the IVUS assessment.
Conclusions
BRS in CAV was feasible and safe, with an ISSR incidence similar to drug-eluting stents. For the first time, a positive remodeling was observed in HTx patients after PCI. Vessel enlargement and the lack of metallic stents may allow repeated PCI avoiding the vessel shrinkage caused by the addition of multiple metal layers, being CAV a complex clinical scenario with a high incidence of MACEs, mainly driven by PCI failure.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Partial funding by Abbott Vascular Italy
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Affiliation(s)
- M Pighi
- University of Verona, Department of Biomedical and Surgical Sciences, Section of Cardiology , Verona , Italy
| | - F Tomai
- European Hospital , Rome , Italy
| | - S Fezzi
- University of Verona, Department of Biomedical and Surgical Sciences, Section of Cardiology , Verona , Italy
| | - G Pesarini
- University of Verona, Department of Biomedical and Surgical Sciences, Section of Cardiology , Verona , Italy
| | | | - L Spedicato
- Citta di Udine C.D.C Health Centre , Udine , Italy
| | | | - M Ferlini
- I.R.C.C.S. San Matteo Polyclinic , Pavia , Italy
| | - P Calabro
- Luigi Vanvitelli University Hospital , Naples , Italy
| | - B Loi
- AO Brotzu Hospital , Cagliari , Italy
| | - N Tovar Forero
- Erasmus University Medical Centre , Rotterdam , The Netherlands
| | - J Daemen
- Erasmus University Medical Centre , Rotterdam , The Netherlands
| | - F T Ribichini
- University of Verona, Department of Biomedical and Surgical Sciences, Section of Cardiology , Verona , Italy
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9
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Nudi F, Tomai F. Is Cardiac Shock Wave Therapy an Option for the Treatment of Myocardial Ischemia in Patients with Refractory Angina? J Nucl Cardiol 2022; 29:2420-2422. [PMID: 34755270 DOI: 10.1007/s12350-021-02821-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 09/21/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Francesco Nudi
- Service of Hybrid Cardio Imaging, Madonna Della Fiducia Clinic, Rome, Italy.
- Replycare, Rome, Italy.
| | - Fabrizio Tomai
- Replycare, Rome, Italy
- Department of Cardiovascular Sciences, European Hospital, Rome, Italy
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10
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Polimeni A, Spaccarotella C, Ielapi J, Esposito G, Ravera A, Martuscelli E, Ciconte V, Menichelli M, Varbella F, Imazio M, Navazio A, Sinagra G, Oberhollenzer R, Sibilio G, Cacciavillani L, Meloni L, Dominici M, Tomai F, Amico F, Corda M, Musumeci G, Lupi A, Zezza L, De Caterina R, Cernetti C, Metra M, Rossi L, Calabrò P, Murrone A, Volpe M, Caldarola P, Carugo S, Cortese B, Valenti R, Boriani G, Fedele F, Ventura G, Manes MT, Colavita AR, Feola M, Versaci F, Assennato P, Arena G, Ceravolo R, Amodeo V, Tortorici G, Nassiacos D, Antonicelli R, Esposito N, Favale S, Licciardello G, Tedesco L, Indolfi C. The impact of UEFA Euro 2020 football championship on Takotsubo Syndrome: Results of a multicenter national registry. Front Cardiovasc Med 2022; 9:951882. [PMID: 36247479 PMCID: PMC9554214 DOI: 10.3389/fcvm.2022.951882] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives The UEFA 2020 European Football Championship held in multiple cities across Europe from June 11 to July 11, 2021, was won by Italy, providing an opportunity to examine the relationship between emotional stress and the incidence of acute cardiovascular events (ACE). Methods and results Cardiovascular hospitalizations in the Cardiac Care Units of 49 hospital networks in Italy were assessed by emergency physicians during the UEFA Euro 2020 Football Championship. We compared the events that occurred during matches involving Italy with events that occurred during the remaining days of the championship as the control period. ACE was assessed in 1,235 patients. ACE during the UEFA Euro 2020 Football Championship semifinal and final, the most stressful matches ended with penalties and victory of the Italian team, were assessed. A significant increase in the incidence of Takotsubo Syndrome (TTS) by a factor of 11.41 (1.6-495.1, P < 0.003), as compared with the control period, was demonstrated during the semifinal and final, whereas no differences were found in the incidence of ACS [IRR 0.93(0.74-1.18), P = 0.57]. No differences in the incidence of ACS [IRR 0.98 (0.87-1.11; P = 0.80)] or TTS [IRR 1.66(0.80-3.4), P = 0.14] were found in the entire period including all matches of the UEFA Euro 2020 compared to the control period. Conclusions The data of this national registry demonstrated an association between the semifinal and final of UEFA Euro 2020 and TTS suggesting that it can be triggered by also positive emotions such as the victory in the European Football Championship finals.
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Affiliation(s)
- Alberto Polimeni
- Division of Cardiology and Center for Cardiovascular Research, University Magna Graecia, Catanzaro, Italy
| | - Carmen Spaccarotella
- Division of Cardiology, Department of Advanced Biomedical Science, Federico II University, Naples, Italy
| | - Jessica Ielapi
- Division of Cardiology and Center for Cardiovascular Research, University Magna Graecia, Catanzaro, Italy
| | - Giovanni Esposito
- Division of Cardiology, Department of Advanced Biomedical Science, Federico II University, Naples, Italy
| | - Amelia Ravera
- San Giovanni di Dio e Ruggi d'Aragona Hospital, Salerno, Italy
| | - Eugenio Martuscelli
- Dipartimento di Medicina Interna, Divisione Cardiologia, Università degli Studi di Roma Tor Vergata, Rome, Italy
| | | | | | | | - Massimo Imazio
- Cardiology, Cardiothoracic Department, University Hospital “Santa Maria della Misericordia”, ASUFC, Udine, Italy
| | - Alessandro Navazio
- IRCCS Azienda Unità Sanitaria Locale di Reggio Emilia, Reggio Emilia, Italy
| | - Gianfranco Sinagra
- Dipartimento Cardiotoracovascolare, Università degli Studi di Trieste, Trieste, Italy
| | | | | | - Luisa Cacciavillani
- Dipartimento Cardiotoracovascolare, Università degli Studi di Padova, Padua, Italy
| | - Luigi Meloni
- Dipartimento di Cardiologia, Università degli Studi di Cagliari, Cagliari, Italy
| | | | | | | | - Marco Corda
- SC Cardiologia UTIC, ARNAS “G. Brotzu”, Cagliari, Italy
| | | | - Alessandro Lupi
- Dipartimento di Cardiologia, Università degli Studi dell'Insubria, Varese, Italy
| | | | | | | | - Marco Metra
- Divisione di Cardiologia, Università degli Studi di Brescia, Brescia, Italy
| | - Lidia Rossi
- Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Paolo Calabrò
- Università degli Studi della Campania Luigi Vanvitelli, AORN Sant'Anna e San Sebastiano Caserta, Caserta, Italy
| | - Adriano Murrone
- Ospedali di Città di Castello e Gubbio - Gualdo Tadino Azienda USL Umbria 1, Perugia, Italy
| | - Massimo Volpe
- University of Rome Sapienza and Sant'Andrea Hospital, Rome, Italy
| | | | - Stefano Carugo
- Cardiology Unit, Internal Medicine Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Bernardo Cortese
- Cardiac Department Clinica Polispecialistica San Carlo, Milan, Italy,Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy
| | | | - Giuseppe Boriani
- Divisione di Cardiologia, Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Università degli Studi di Modena e Reggio Emilia, Policlinico di Modena, Modena, Italy
| | | | - Giorgio Ventura
- Istituto Ninetta Rosano - Casa di Cura Polispecialistica Tricarico, Belvedere Marittimo, Italy
| | | | | | - Mauro Feola
- Regina Montis Regalis Hospital, Mondovi, Italy
| | - Francesco Versaci
- Department of Cardiology, Santa Maria Goretti Hospital, Latina, Italy,Dipartimento di Medicina, University of Rome Tor Vergata, Rome, Italy
| | - Pasquale Assennato
- Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone, Palermo, Italy
| | | | | | | | | | | | | | - Nicolino Esposito
- Divisione di Cardiologia, Ospedale Evangelico Betania, Naples, Italy
| | | | | | - Luigi Tedesco
- Presidio Ospedaliero S. Maria della Speranza, Battipaglia, Italy
| | - Ciro Indolfi
- Division of Cardiology and Center for Cardiovascular Research, University Magna Graecia, Catanzaro, Italy,Mediterranea Cardiocentro, Naples, Italy,*Correspondence: Ciro Indolfi
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11
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De Luca L, Calabrò P, Chirillo F, Rolfo C, Menozzi A, Capranzano P, Menichelli M, Nicolini E, Mauro C, Trani C, Versaci F, Tomai F, Musumeci G, Di Mario C, Pepe M, Berti S, Cernetti C, Cirillo P, Maffeo D, Talanas G, Ferlini M, Contarini M, Lanzilotti V, Scherillo M, Tarantini G, Muraglia S, Rossini R, Bolognese L. Use of cangrelor in patients with acute coronary syndromes undergoing percutaneous coronary intervention: Study design and interim analysis of the ARCANGELO study. Clin Cardiol 2022; 45:913-920. [PMID: 35733352 PMCID: PMC9451664 DOI: 10.1002/clc.23878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/31/2022] [Accepted: 06/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The itAlian pRospective Study on CANGrELOr (ARCANGELO) was aimed to assess the safety of using cangrelor during percutaneous coronary intervention (PCI) in patients with acute coronary syndromes (ACS) in the daily practice. HYPOTHESIS The safety of cangrelor after the transition to oral P2Y12 inhibitors was evaluated as the incidence of bleeding outcomes in the 30 days following PCI according to postauthorization safety study guidelines. METHODS Adults with ACS who were treated with cangrelor in one of the 28 centers involved in the study. Patients who consented to participate were followed in the 30 days following their PCI. Bleedings (Bleeding Academic Research Consortium [BARC] classification), major adverse cardiac events (MACEs), and adverse events were recorded. The interim results at two-thirds of the enrollment period are presented. RESULTS A total of 17 bleedings were observed in the 320 patients who completed the study at this stage. All bleedings were classified as BARC Type 1-2, except for one case of Type 3a (vessel puncture site hematoma). Four patients experienced MACEs (2 acute myocardial infarctions, 1 sudden cardiac death, 1 noncardiovascular death due to respiratory distress, and multiorgan failure). None of the bleedings was rated as related to cangrelor. CONCLUSIONS The interim results of the ARCANGELO study provide a preliminary confirmation that the use of cangrelor on patients with ACS undergoing PCI is not associated with severe bleedings.
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Affiliation(s)
- Leonardo De Luca
- Department of Cardiosciences, Division of Cardiology, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
| | - Paolo Calabrò
- U.O.C. Cardiologia Clinica con UTIC. A.O.R.N. Sant'Anna e San Sebastiano, Caserta, Italy
| | - Fabio Chirillo
- U.O.C. Cardiologia Ospedale San Bassiano, Bassano del Grappa (VI), Italy
| | - Cristina Rolfo
- S.C. Cardiologia Ospedale degli Infermi di Rivoli ASLTO3, Rivoli, Italy
| | - Alberto Menozzi
- S.C. Cardiologia, Ospedale S. Andrea, ASL5 Liguria, La Spezia, Italy
| | | | | | - Elisa Nicolini
- U.O. Cardiologia Interventistica, strutturale e pediatrica, Ospedali Riuniti, Ancona, Italy
| | - Ciro Mauro
- Cardiologia UTIC con emodinamica AORN Cardarelli Napolii, Napoli, Italy
| | - Carlo Trani
- U.O.C. Interventistica Cardiologica e diagnostica invasiva Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Francesco Versaci
- Department of Cardiology, Santa Maria Goretti Hospital, Latina, Italy
| | | | | | - Carlo Di Mario
- Interventistica Cardiologica Strutturale A.O.U. Careggi, Firenze, Italy
| | - Martino Pepe
- Cardiologia Universitaria A.O.U. Consorziale Policlinico, Bari, Italy
| | - Sergio Berti
- Fondazione C.N.R. Reg. Toscana G. Monasterio, Pisa, Italy
| | | | - Plinio Cirillo
- Dipartimento di Scienze Biomediche Avanzate, Cardiologia, A.O.U.P. "Federico II", Napoli, Italy
| | - Diego Maffeo
- Cardiologia Emodinamica Fondazione Poliambulanza, Brescia, Italy
| | - Giuseppe Talanas
- U.O.C. Cardiologia Clinica ed Interventistica, Azienda Ospedaliero-Universitaria di Sassari, Sassari, Italy
| | - Marco Ferlini
- U.O.C. Cardiologia Fondazione IRCCS Policlinico San Matteo, San Matteo, Italy
| | - Marco Contarini
- U.O.C. di Cardiologia con UTIC ed Emodinamica Ospedale Umberto I di Siracusa Azienda Sanitaria Provinciale di, Siracusa, Italy
| | | | - Marino Scherillo
- U.O.C. Cardiologia interventistica e UTIC Azienda Ospedaliera San Pio, Benevento, Italy
| | - Giuseppe Tarantini
- U.O.S.D. Emodinamica e Cardiologia Interventistica Azienda Ospedale Università, Padova, Italy
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12
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Licordari R, Sticchi A, Mancuso F, Caracciolo A, Muscoli S, Iacovelli F, Ruggiero R, Scoccia A, Cammalleri V, Pavani M, Loffi M, Scordino D, Ferro J, Rognoni A, Buono A, Nava S, Albani S, Colaiori I, Zilio F, Borghesi M, Regazzoni V, Benenati S, Pescetelli F, De Marzo V, Mannarini A, Spione F, Baldassarre D, De Benedictis M, Bonmassari R, Danzi GB, Galli M, Ielasi A, Musumeci G, Tomai F, Pasceri V, Porto I, Patti G, Campo G, Colombo A, Micari A, Giannini F, Costa F. The Incidence and Impact of In-Hospital Bleeding in Patients with Acute Coronary Syndrome during the COVID-19 Pandemic. J Clin Med 2022; 11:jcm11102926. [PMID: 35629052 PMCID: PMC9146584 DOI: 10.3390/jcm11102926] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/12/2022] [Accepted: 05/18/2022] [Indexed: 12/28/2022] Open
Abstract
Background: The COVID-19 pandemic increased the complexity of the clinical management and pharmacological treatment of patients presenting with an Acute Coronary Syndrome (ACS). Aim: to explore the incidence and prognostic impact of in-hospital bleeding in patients presenting with ACS before and during the COVID-19 pandemic. Methods: We evaluated in-hospital Thrombolysis In Myocardial Infarction (TIMI) major and minor bleeding among 2851 patients with ACS from 17 Italian centers during the first wave of the COVID-19 pandemic (i.e., March–April 2020) and in the same period in the previous two years. Results: The incidence of in-hospital TIMI major and minor bleeding was similar before and during the COVID-19 pandemic. TIMI major or minor bleeding was associated with a significant threefold increase in all-cause mortality, with a similar prognostic impact before and during the COVID-19 pandemic. Conclusions: the incidence and clinical impact of in-hospital bleeding in ACS patients was similar before and during the COVID-19 pandemic. We confirmed a significant and sizable negative prognostic impact of in-hospital bleeding in ACS patients.
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Affiliation(s)
- Roberto Licordari
- Department of Clinical and Experimental Medicine, Policlinic “G Martino”, University of Messina, 98124 Messina, Italy; (R.L.); (F.M.); (A.C.); (A.M.)
| | - Alessandro Sticchi
- GVM Care & Research, Maria Cecilia Hospital, 48033 Cotignola, Italy; (A.S.); (R.R.); (A.S.); (A.C.); (F.G.)
- Centro per la Lotta Contro L’Infarto (CLI) Foundation, 00182 Rome, Italy
- Department of Cardiology, Saint Camillus International University of Health Sciences, 00131 Rome, Italy
| | - Filippo Mancuso
- Department of Clinical and Experimental Medicine, Policlinic “G Martino”, University of Messina, 98124 Messina, Italy; (R.L.); (F.M.); (A.C.); (A.M.)
| | - Alessandro Caracciolo
- Department of Clinical and Experimental Medicine, Policlinic “G Martino”, University of Messina, 98124 Messina, Italy; (R.L.); (F.M.); (A.C.); (A.M.)
| | - Saverio Muscoli
- Department of Cardiovascular Disease, Tor Vergata University, 00133 Rome, Italy; (S.M.); (V.C.)
| | - Fortunato Iacovelli
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 072006 Bari, Italy; (F.I.); (A.M.); (F.S.)
| | - Rossella Ruggiero
- GVM Care & Research, Maria Cecilia Hospital, 48033 Cotignola, Italy; (A.S.); (R.R.); (A.S.); (A.C.); (F.G.)
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 30010 Cona, Italy;
| | - Alessandra Scoccia
- GVM Care & Research, Maria Cecilia Hospital, 48033 Cotignola, Italy; (A.S.); (R.R.); (A.S.); (A.C.); (F.G.)
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 30010 Cona, Italy;
| | - Valeria Cammalleri
- Department of Cardiovascular Disease, Tor Vergata University, 00133 Rome, Italy; (S.M.); (V.C.)
| | - Marco Pavani
- Department of Cardiology, Ospedale Civile SS Annunziata, 12038 Savigliano, Italy; (M.P.); (D.B.); (M.D.B.)
| | - Marco Loffi
- Department of Cardiology, Ospedale di Cremona, 26100 Cremona, Italy; (M.L.); (V.R.); (G.B.D.)
| | - Domenico Scordino
- Division of Cardiology, Aurelia Hospital, 00165 Rome, Italy; (D.S.); (F.T.)
| | - Jayme Ferro
- U.O.S.D. Cardiologia-Laboratorio di Emodinamica, Dipartimento di Emergenza, Rianimazione e Anestesia, ASST Lariana, Ospedale S. Anna, 22100 Como, Italy; (J.F.); (M.G.)
| | - Andrea Rognoni
- Department of Cardiology, Azienda Ospedaliero–Universitaria Maggiore della Carità, 28100 Novara, Italy; (A.R.); (G.P.)
| | - Andrea Buono
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant’Ambrogio, 20149 Milan, Italy; (A.B.); (A.I.)
| | - Stefano Nava
- Division of Invasive Cardiology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy;
| | - Stefano Albani
- Department of Cardiology, Mauriziano Hospital, 10128 Turin, Italy; (S.A.); (G.M.)
| | - Iginio Colaiori
- Azienda Unità Sanitaria Locale, IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Filippo Zilio
- U.O.C. Cardiologia, Ospedale Santa Chiara, 38121 Trento, Italy; (F.Z.); (M.B.); (R.B.)
| | - Marco Borghesi
- U.O.C. Cardiologia, Ospedale Santa Chiara, 38121 Trento, Italy; (F.Z.); (M.B.); (R.B.)
| | - Valentina Regazzoni
- Department of Cardiology, Ospedale di Cremona, 26100 Cremona, Italy; (M.L.); (V.R.); (G.B.D.)
| | - Stefano Benenati
- Dipartimento CardioToracoVascolare, Ospedale Policlinico San Martino IRCCS, 16132 Genoa, Italy; (S.B.); (F.P.); (V.D.M.); (I.P.)
| | - Fabio Pescetelli
- Dipartimento CardioToracoVascolare, Ospedale Policlinico San Martino IRCCS, 16132 Genoa, Italy; (S.B.); (F.P.); (V.D.M.); (I.P.)
| | - Vincenzo De Marzo
- Dipartimento CardioToracoVascolare, Ospedale Policlinico San Martino IRCCS, 16132 Genoa, Italy; (S.B.); (F.P.); (V.D.M.); (I.P.)
| | - Antonia Mannarini
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 072006 Bari, Italy; (F.I.); (A.M.); (F.S.)
| | - Francesco Spione
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 072006 Bari, Italy; (F.I.); (A.M.); (F.S.)
| | - Doronzo Baldassarre
- Department of Cardiology, Ospedale Civile SS Annunziata, 12038 Savigliano, Italy; (M.P.); (D.B.); (M.D.B.)
| | - Michele De Benedictis
- Department of Cardiology, Ospedale Civile SS Annunziata, 12038 Savigliano, Italy; (M.P.); (D.B.); (M.D.B.)
| | - Roberto Bonmassari
- U.O.C. Cardiologia, Ospedale Santa Chiara, 38121 Trento, Italy; (F.Z.); (M.B.); (R.B.)
| | - Gian Battista Danzi
- Department of Cardiology, Ospedale di Cremona, 26100 Cremona, Italy; (M.L.); (V.R.); (G.B.D.)
| | - Mario Galli
- U.O.S.D. Cardiologia-Laboratorio di Emodinamica, Dipartimento di Emergenza, Rianimazione e Anestesia, ASST Lariana, Ospedale S. Anna, 22100 Como, Italy; (J.F.); (M.G.)
| | - Alfonso Ielasi
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant’Ambrogio, 20149 Milan, Italy; (A.B.); (A.I.)
| | - Giuseppe Musumeci
- Department of Cardiology, Mauriziano Hospital, 10128 Turin, Italy; (S.A.); (G.M.)
| | - Fabrizio Tomai
- Division of Cardiology, Aurelia Hospital, 00165 Rome, Italy; (D.S.); (F.T.)
| | - Vincenzo Pasceri
- Department of Cardiology, San Filippo Neri Roma, 00135 Rome, Italy;
| | - Italo Porto
- Dipartimento CardioToracoVascolare, Ospedale Policlinico San Martino IRCCS, 16132 Genoa, Italy; (S.B.); (F.P.); (V.D.M.); (I.P.)
| | - Giuseppe Patti
- Department of Cardiology, Azienda Ospedaliero–Universitaria Maggiore della Carità, 28100 Novara, Italy; (A.R.); (G.P.)
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 30010 Cona, Italy;
| | - Antonio Colombo
- GVM Care & Research, Maria Cecilia Hospital, 48033 Cotignola, Italy; (A.S.); (R.R.); (A.S.); (A.C.); (F.G.)
| | - Antonio Micari
- Department of Clinical and Experimental Medicine, Policlinic “G Martino”, University of Messina, 98124 Messina, Italy; (R.L.); (F.M.); (A.C.); (A.M.)
| | - Francesco Giannini
- GVM Care & Research, Maria Cecilia Hospital, 48033 Cotignola, Italy; (A.S.); (R.R.); (A.S.); (A.C.); (F.G.)
| | - Francesco Costa
- Department of Clinical and Experimental Medicine, Policlinic “G Martino”, University of Messina, 98124 Messina, Italy; (R.L.); (F.M.); (A.C.); (A.M.)
- Correspondence:
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13
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Lunardi M, Pighi M, Banning A, Reimers B, Castriota F, Tomai F, Venturi G, Pesarini G, Scarsini R, Kotronias R, Regazzoli D, Maurina M, Nerla R, De Persio G, Ribichini FL. Vascular complications after transcatheter aortic valve implantation: treatment modalities and long-term clinical impact. Eur J Cardiothorac Surg 2022; 61:934-941. [DOI: 10.1093/ejcts/ezab499] [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] [Received: 03/14/2021] [Revised: 06/30/2021] [Accepted: 10/03/2021] [Indexed: 11/14/2022] Open
Abstract
Abstract
OBJECTIVES
Vascular complications (VC) are the most frequent drawback of transcatheter aortic valve implantation (TAVI), affecting up to 20% of overall procedures. Data on the treatment and their long-term impact are scarce. The goal of this study was to report on the incidence, management and impact on the long-term outcomes of VC following TAVI.
METHODS
This was a multicentric retrospective analysis of consecutive patients undergoing TAVI. The primary endpoint was freedom from major adverse cardiac and cerebrovascular events at long-term follow-up. Adverse events were evaluated according to Valve Academic Research Consortium-2 criteria.
RESULTS
A total of 2145 patients were included: VC occurred in 188 (8.8%); of which 180 were limited to the access site. Two-thirds of the VC were minor; 8% required surgical treatment; the remaining were repaired percutaneously. The major adverse cardiac and cerebrovascular events-free survival at 2 years was 83.0% for patients with VC and 86.7% for those without (P = 0.143), but 71.9% for patients with major compared to 89.0% in those with minor VC (P = 0.022). Major VC and diabetes mellitus independently predicted worse outcomes at 2 years. The major adverse cardiac and cerebrovascular events-free survival rate and the occurrence of vascular adverse events in the long term among patients with VC at the access site treated by endovascular techniques (covered stent implantation or angioplasty) were similar to those without VC (84.2% vs 86.7%; P = 0.635).
CONCLUSIONS
Major but not minor VC impact long-term survival after TAVI. Covered stents implanted to manage VC at the access site have no impact on the long-term clinical outcome of TAVI.
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Affiliation(s)
- Mattia Lunardi
- Cardiology Division, Department of Medicine, University of Verona, Verona, Italy
| | - Michele Pighi
- Cardiology Division, Department of Medicine, University of Verona, Verona, Italy
| | - Adrian Banning
- Cardiology Department, John Radcliffe Oxford University Hospital, NHS Trust, Oxford, UK
| | - Bernhard Reimers
- Cardiovascular Department, Humanitas Clinical and Research Center, Rozzano-Milan, Italy
| | | | - Fabrizio Tomai
- Department of Cardiovascular Sciences, European Hospital, Rome, Italy
| | - Gabriele Venturi
- Cardiology Division, Department of Medicine, University of Verona, Verona, Italy
| | - Gabriele Pesarini
- Cardiology Division, Department of Medicine, University of Verona, Verona, Italy
| | - Roberto Scarsini
- Cardiology Division, Department of Medicine, University of Verona, Verona, Italy
- Cardiology Department, John Radcliffe Oxford University Hospital, NHS Trust, Oxford, UK
| | - Rafail Kotronias
- Cardiology Department, John Radcliffe Oxford University Hospital, NHS Trust, Oxford, UK
| | - Damiano Regazzoli
- Cardiovascular Department, Humanitas Clinical and Research Center, Rozzano-Milan, Italy
| | - Matteo Maurina
- Cardiovascular Department, Humanitas Clinical and Research Center, Rozzano-Milan, Italy
| | - Roberto Nerla
- Cardiovascular Department, Humanitas-Gavazzeni, Bergamo, Italy
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14
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Chiarito M, Sturla M, Briguori C, Mancone M, Tamburino C, Fabbiocchi F, Trabattoni D, Tomai F, Paggi A, Gioffrè G, Sclafani R, Giordano A, Stefanini GG, Sardella G. Polymer-free biolimus-A9-eluting stent performance according to renal impairment: insights from the RUDI-FREE registry. J Cardiovasc Med (Hagerstown) 2022; 23:127-134. [PMID: 34632982 DOI: 10.2459/jcm.0000000000001269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Patients with chronic kidney disease (CKD) are at increased risk of cardiovascular disease and have a worse prognosis after percutaneous coronary interventions (PCI). The BioFreedom polymer-free biolimus-A9-eluting stent (PF-BES) has shown promising results in patients at high bleeding risk; however, its performance in CKD patients has yet to be analyzed. METHODS The all-comers RUDI-FREE registry documented patients undergoing PCI with PF-BES in routine clinical practice. Patients were stratified into three groups according to their estimated glomerular filtration rate (eGFR): preserved renal function, mild renal insufficiency (RI), and with moderate to severe RI (eGFR ≥ 90, between 90 and 45, and <45 ml/min/1.73 m2, respectively). The primary safety end point was a patient-oriented composite end point of cardiovascular death, myocardial infarction (MI), and definite or probable stent thrombosis (ST). The primary efficacy end point was target lesion revascularization (TLR). RESULTS The registry documented 1,104 consecutive patients treated with PF-BES: 258 (23.4%) with preserved renal function, whereas 712 (64.7%) and 131 (11.9%) had mild and moderate to severe RI, respectively. At 1 year, the primary safety end point was significantly higher in patients with moderate to severe RI (3.5% vs. 2.8% vs. 11.5%; P < 0.001). Conversely, TLR proved similar among groups (0.4% vs. 1.8% vs. 0.8%; P = 0.235). CONCLUSIONS Patients with worse renal function had increased risk of the composite of cardiovascular deaths, MI, and definite or probable ST. However, the PF-BES showed similar efficacy despite differences in renal function. These findings need to be confirmed in large-scale randomized trials.
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Affiliation(s)
- Mauro Chiarito
- Humanitas Clinical and Research Hospital IRCCS
- Department of Biomedical Sciences, Humanitas University, Milan
| | - Matteo Sturla
- Humanitas Clinical and Research Hospital IRCCS
- Department of Biomedical Sciences, Humanitas University, Milan
| | - Carlo Briguori
- Clinica Mediterranea, Laboratory of Interventional Cardiology and Department of Cardiology, Naples, Italy
| | - Massimo Mancone
- Policlinico Umberto I, Department of Cardiovascular Sciences, Rome
| | | | | | | | - Fabrizio Tomai
- European Hospital, Laboratory of Interventional Cardiology and Department of Cardiology, Rome
| | - Anita Paggi
- S. Anna Hospital, Laboratory of Interventional Cardiology and Department of Cardiology, Como
| | - Gaetano Gioffrè
- S. Eugenio Hospital, Laboratory of Interventional Cardiology and Department of Cardiology, Rome
| | | | - Arturo Giordano
- Clinica Pineta Grande, Laboratory of Interventional Cardiology and Department of Cardiology, Castel Volturno, Italy
| | - Giulio G Stefanini
- Humanitas Clinical and Research Hospital IRCCS
- Department of Biomedical Sciences, Humanitas University, Milan
| | - Gennaro Sardella
- Policlinico Umberto I, Department of Cardiovascular Sciences, Rome
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15
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Pontone G, Marano R, Agricola E, Alushi B, Bartorelli A, Cameli M, Carrabba N, Esposito A, Faletti R, Francone M, Galea N, Golino P, Guglielmo M, Palmisano A, Petronio S, Petullà M, Pradella S, Ribichini F, Romeo F, Russo V, Scandura S, Schicchi N, Spaccarotella C, Tomai F, Centonze M, indolfi C. Recommendations in pre-procedural imaging assessment for transcatheter aortic valve implantation intervention. J Cardiovasc Med (Hagerstown) 2022; 23:216-227. [DOI: 10.2459/jcm.0000000000001293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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16
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Zecchino S, De Marzo V, Licordari R, Costa F, Caracciolo A, Pescetelli F, Muscoli S, Iacovelli F, Ruggiero R, Scoccia A, Cammalleri V, Pavani M, Loffi M, Scordino D, Ferro J, Rognoni A, Buono A, Nava S, Albani S, Zilio F, Colaiori I, Borghesi M, Regazzoni V, Mannarini A, Spione F, Doronzo B, De Benedictis M, Bonmassari R, Danzi GB, Galli M, Ielasi A, Musumeci G, Tomai F, Micari A, Pasceri V, Patti G, Campo G, Colombo A, Porto I, Sticchi A, Giannini F. 692 Impact of COVID-19 pandemic on in-hospital outcomes for patients with acute coronary syndrome: a propensity-weighted, multicentre study. Eur Heart J Suppl 2021. [PMCID: PMC8689766 DOI: 10.1093/eurheartj/suab135.014] [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: 11/14/2022]
Abstract
Aims Coronavirus disease 19 (COVID-19) pandemic has dramatically changed the management and the prognosis of patients experiencing acute coronary syndrome (ACS). Several scientific societies have highlighted the need for dedicated paths to deliver better and faster care to improve outcomes. Nevertheless, data depicting the impact of COVID-19 pandemic on ACS in Italy are still poor. To perform a propensity weighted analysis on a multicentre Italian registry involving patients with ACS managed before vs. during COVID-19 pandemic, taking into account baseline patients characteristics, clinical presentation, procedural aspects, and in-hospital outcomes (death, bleeding, stent thrombosis, myocardial infarction, stroke/transient ischaemic attack, mechanical complication, and arrhythmic complication). Methods and results We included all consecutive patients who have suffered from ACS during two periods before (March/April 2018, March/April 2019) vs. the period of COVID-19 pandemic (March/April 2020). A generalized boosted non-parsimonious regression was used to estimate the propensity scores of having an ACS in 2020 (year of COVID-19) vs. 2018/2019 using an average treatment effect and balancing for all baseline confounders. We included 2851 patients admitted to hospital with ACS in 17 Italian centres: 1079 (37.8%) during 2018, 1056 (37.0%) in 2019, and 716 (25.1%) during the first COVID-19 wave of 2020. Seventy (2.5%) patients had a positive swab for SARS-CoV-2 at admission. During 2020 there were higher time-to-emergency-call (P = 0.028) and less diagnosis of unstable angina (P = 0.029) and MINOCA (P = 0.004); none of the admission symptoms differ significantly across the years (P > 0.05) except for fever that was more prevalent in 2020 (P < 0.001). Patients suffering from ACS had lower admission EF (P = 0.006). After PS weighting, multivariate Cox regression analysis showed age (P < 0.001), night admission (P = 0.017), cardiocirculatory arrest before cath-lab (P = 0.041), worst Killip class (P = 0.039), admission EF (P = 0.026), and need for left-ventricle mechanical support (P = 0.011) as independent predictors of in-hospital death. After propensity weighted analysis none of the in-hospital outcomes differed significantly across the years of investigation (all P > 0.05). Conclusions During COVID-19 pandemic in Italy the characteristics and management of ACS was slightly different than the past. However, the rates of ‘hard’, in-hospital outcomes (e.g. deaths) are almost similar to the past, suggesting appropriate care and well-organized emergency-paths for ACS.
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Affiliation(s)
- Simone Zecchino
- Dipartimento Cardiotoracovascolare, IRCCS, Ospedale Policlinico San Martino, Genova, Italy
| | - Vincenzo De Marzo
- Dipartimento Cardiotoracovascolare, IRCCS, Ospedale Policlinico San Martino, Genova, Italy
| | - Roberto Licordari
- Department of Clinical and Experimental Medicine, Policlinico G. Martino, University of Messina, Italy
| | - Francesco Costa
- Department of Clinical and Experimental Medicine, Policlinico G. Martino, University of Messina, Italy
| | - Alessandro Caracciolo
- Department of Clinical and Experimental Medicine, Policlinico G. Martino, University of Messina, Italy
| | - Fabio Pescetelli
- Dipartimento Cardiotoracovascolare, IRCCS, Ospedale Policlinico San Martino, Genova, Italy
| | - Saverio Muscoli
- Department of Cardiovascular Disease, Tor Vergata University, Italy
| | | | | | | | | | - Marco Pavani
- Ospedale Civile SS Annunziata, Savigliano, Italy
| | - Marco Loffi
- Department of Cardiology, Ospedale di Cremona, Italy
| | | | | | - Andrea Rognoni
- Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | | | - Stefano Nava
- Invasive Cardiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Filippo Zilio
- UOC Cardiologia, Ospedale Santa Chiara, Trento, Italy
| | | | | | | | - Antonia Mannarini
- Cardiotohoracic Department, Policlinico University Hospital, Bari, Italy
| | - Francesco Spione
- Cardiotohoracic Department, Policlinico University Hospital, Bari, Italy
| | | | | | | | | | | | | | | | | | - Antonio Micari
- Department of Clinical and Experimental Medicine, Policlinico G. Martino, University of Messina, Italy
| | | | - Giuseppe Patti
- Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
| | - Antonio Colombo
- Humanitas Clinical and Research Center IRCCS, Humanitas University, Pieve Emanuele (MI), Rozzano, Italy
| | - Italo Porto
- Dipartimento Cardiotoracovascolare, IRCCS, Ospedale Policlinico San Martino, Genova, Italy
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17
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Berti S, Bartorelli AL, Koni E, Giordano A, Petronio AS, Iadanza A, Bedogni F, Reimers B, Spaccarotella C, Trani C, Attisano T, Sardella G, Bonmassari R, Medda M, Sherwood MW, Tomai F, Navarese EP. Impact of High Body Mass Index on Vascular and Bleeding Complications After Transcatheter Aortic Valve Implantation. Am J Cardiol 2021; 155:86-95. [PMID: 34284861 DOI: 10.1016/j.amjcard.2021.06.015] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/09/2021] [Accepted: 06/14/2021] [Indexed: 12/20/2022]
Abstract
Increased body mass index (BMI) is an established cardiovascular risk factor. The impact of high BMI on vascular and bleeding complications in patients undergoing transcatheter aortic valve implantation (TAVI) is not clarified. RISPEVA, a multicenter prospective database of patients undergoing TAVI stratified by BMI was used for this analysis. Patients were classified as normal or high BMI (obese and overweight) according to the World Health Organization criteria. A comparison of 30-day vascular and bleeding outcomes between groups was performed using propensity scores methods. A total of 3776 matched subjects for their baseline characteristics were included. Compared with normal BMI, high BMI patients had significantly 30-day greater risk of the composite of vascular or bleeding complications (11.1% vs 8.8%, OR: 1.28, 95% CI [1.02 to 1.61]; p = 0.03). Complications rates were higher in both obese (11.3%) and overweight (10.5%), as compared with normal weight patients (8.8%). By a landmark event analysis, the effect of high versus normal BMI on these complications appeared more pronounced within 7 days after the TAVI procedure. A significant linear association between increased BMI and vascular complications was observed at this time frame (p = 0.03). In conclusion, compared with normal BMI, both obese and overweight patients undergoing TAVI, experience increased rates of 30-day vascular and bleeding complications. These findings indicate that high BMI is an independent risk predictor of vascular and bleeding complications after TAVI.
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Affiliation(s)
- Sergio Berti
- Department of Diagnostic and Interventional Cardiology, Gabriele Monasterio Tuscany Foundation, G. Pasquinucci Heart Hospital, Massa, Italy
| | - Antonio L Bartorelli
- Centro Monzino, IRCCS and Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Endrin Koni
- Department of Diagnostic and Interventional Cardiology, Gabriele Monasterio Tuscany Foundation, G. Pasquinucci Heart Hospital, Massa, Italy; Department of Interventional Cardiology, Santa Corona Hospital, Pietra Ligure, Italy
| | - Arturo Giordano
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
| | - Anna S Petronio
- Department of Cardiology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Alessandro Iadanza
- Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Siena, Italy
| | - Francesco Bedogni
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Bernard Reimers
- Cardio Center, Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy
| | - Carmen Spaccarotella
- Division of Cardiology, CCU and Interventional, Cardiology, Cardiovascular Research Center, University Magna Graecia, Catanzaro, Italy
| | - Carlo Trani
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Tiziana Attisano
- Department of Cardiology, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Gennaro Sardella
- Department of Cardiology, Policlinico "Umberto I," Sapienza University of Rome, Rome, Italy
| | | | - Massimo Medda
- Istituto Clinico Sant'Ambrogio, Gruppo San Donato, Milano, Italy
| | | | | | - Eliano P Navarese
- Interventional Cardiology and Cardiovascular Medicine Research, Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland; Faculty of Medicine, University of Alberta, Edmonton, Canada.
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18
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Navarese EP, Zhang Z, Kubica J, Andreotti F, Farinaccio A, Bartorelli AL, Bedogni F, Rupji M, Tomai F, Giordano A, Reimers B, Spaccarotella C, Wilczek K, Stepinska J, Witkowski A, Grygier M, Kukulski T, Wanha W, Wojakowski W, Lesiak M, Dudek D, Zembala MO, Berti S. Development and Validation of a Practical Model to Identify Patients at Risk of Bleeding After TAVR. JACC Cardiovasc Interv 2021; 14:1196-1206. [PMID: 34112454 DOI: 10.1016/j.jcin.2021.03.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/05/2021] [Accepted: 03/09/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES No standardized algorithm exists to identify patients at risk of bleeding after transcatheter aortic valve replacement (TAVR). The aim of this study was to generate and validate a useful predictive model. BACKGROUND Bleeding events after TAVR influence prognosis and quality of life and may be preventable. METHODS Using machine learning and multivariate regression, more than 100 clinical variables from 5,185 consecutive patients undergoing TAVR in the prospective multicenter RISPEVA (Registro Italiano GISE sull'Impianto di Valvola Aortica Percutanea; NCT02713932) registry were analyzed in relation to Valve Academic Research Consortium-2 bleeding episodes at 1 month. The model's performance was externally validated in 5,043 TAVR patients from the prospective multicenter POL-TAVI (Polish Registry of Transcatheter Aortic Valve Implantation) database. RESULTS Derivation analyses generated a 6-item score (PREDICT-TAVR) comprising blood hemoglobin and serum iron concentrations, oral anticoagulation and dual antiplatelet therapy, common femoral artery diameter, and creatinine clearance. The 30-day area under the receiver-operating characteristic curve (AUC) was 0.80 (95% confidence interval [CI]: 0.75-0.83). Internal validation by optimism bootstrap-corrected AUC was 0.79 (95% CI: 0.75-0.83). Score quartiles were in graded relation to 30-day events (0.8%, 1.1%, 2.5%, and 8.5%; overall p <0.001). External validation produced a 30-day AUC of 0.78 (95% CI: 0.72-0.82). A simple nomogram and a web-based calculator were developed to predict individual patient probabilities. Landmark cumulative event analysis showed greatest bleeding risk differences for top versus lower score quartiles in the first 30 days, when most events occurred. Predictivity was maintained when omitting serum iron values. CONCLUSIONS PREDICT-TAVR is a practical, validated, 6-item tool to identify patients at risk of bleeding post-TAVR that can assist in decision making and event prevention.
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Affiliation(s)
- Eliano Pio Navarese
- Interventional Cardiology and Cardiovascular Medicine Research, Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland; Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada; SIRIO MEDICINE Research Network, Bydgoszcz, Poland.
| | - Zhongheng Zhang
- Department of Emergency Medicine, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jacek Kubica
- Interventional Cardiology and Cardiovascular Medicine Research, Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland; SIRIO MEDICINE Research Network, Bydgoszcz, Poland
| | - Felicita Andreotti
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonella Farinaccio
- Department of Biotechnology and Biosciences, University of Milano-Bicocca, Italy
| | - Antonio L Bartorelli
- Centro Monzino, IRCCS and Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Milan, Italy
| | - Francesco Bedogni
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Manali Rupji
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | | | - Arturo Giordano
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
| | - Bernard Reimers
- Division of Cardiology, CCU and Interventional, Cardiology, Cardio Center, Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy
| | | | - Krzysztof Wilczek
- Cardiac and Lung Transplantation Mechanical Circulatory Support, Silesian Center for Heart Diseases, Pomeranian Medical University, Szczecin, Poland
| | | | | | | | - Tomasz Kukulski
- Cardiac and Lung Transplantation Mechanical Circulatory Support, Silesian Center for Heart Diseases, Pomeranian Medical University, Szczecin, Poland
| | - Wojciech Wanha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Maciej Lesiak
- Department of Cardiology, Poznań University of Medical Sciences, Poznań, Poland
| | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Michal O Zembala
- Cardiac and Lung Transplantation Mechanical Circulatory Support, Silesian Center for Heart Diseases, Pomeranian Medical University, Szczecin, Poland
| | - Sergio Berti
- Department of Diagnostic and Interventional Cardiology, Gabriele Monasterio Tuscany Foundation, G. Pasquinucci Heart Hospital, Massa, Italy
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19
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Abstract
We present the case of a 73-year-old male patient undergoing a modified Bentall-DeBono procedure in 2015 due to aortic stenosis and aortic aneurism involving the root. A bioprosthetic stented conduit made with a stented Edwards Perimount 21-mm bioprosthesis and a Vascutek Valsalva 28-mm Dacron graft was implanted along with a mitral annuloplasty. Five years later, due to early degeneration of the bioprosthesis and a progression of the mitral disease, he underwent a second surgical procedure where a Medtronic Mosaic 27-mm valve prosthesis was implanted in mitral position and a sutureless Livanova Perceval 23-mm valve in aortic position. Because of the difficulty in removing the previously implanted aortic prosthesis, the Perceval valve was inserted inside the frame of the PeriMount as an open "valve-in-valve" procedure. In October 2020, the patient underwent a ViV TAVI with a 23-mm Edwards Sapien 3 (Edwards Lifescience). After induction of general anesthesia and heparin administration, the procedure was performed via right femoral artery approach with preimplantation of two Proglides. After transfemoral insertion of a 14-French sheath, the aortic valve was crossed with a 0.035-in. straight guide-wire, taking care to avoid crossing the crowns of Perceval frame. After exchange of the standard wire with an extra-stiff 0.035-in. Safari wire, the Sapien-3 valve was advanced across the two previously implanted surgical valves and deployed at the level of the Perceval ring. After bioprosthesis deployment, peak-to-peak left ventricular aortic gradient was reduced from 51 to 16 mmHg.
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Affiliation(s)
- Fabrizio Tomai
- Department of Cardiovascular Sciences, European Hospital, Rome, Italy
| | - Luca Weltert
- Department of Cardiovascular Sciences, European Hospital, Rome, Italy
| | | | - Tiziana Salatino
- Department of Cardiovascular Sciences, European Hospital, Rome, Italy
| | - Ruggero de Paulis
- Department of Cardiovascular Sciences, European Hospital, Rome, Italy
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20
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Tomai F, Petrolini A, Corvo P, Gagliardi GM. A Five-Year Follow-up of Left Main Coronary Artery Stenting 8 Years After Arterial Switch Operation. CJC Open 2021; 3:552-554. [PMID: 34027360 PMCID: PMC8129448 DOI: 10.1016/j.cjco.2020.12.001] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/01/2020] [Indexed: 11/25/2022] Open
Abstract
The fate of coronary artery stenting in children several years after implantation is unknown. We previously reported the case of an 8-year-old child undergoing stent implantation for a total left main coronary artery occlusion after arterial switch operation. Six months later, she needed another stent implantation for in-stent restenosis. Here we report the angiographic, intravascular ultrasound and optical coherence tomography findings at 5-year follow-up. Despite nongrowth of the left main coronary artery inherent to the stents, luminal patency, adequate struts apposition, and the absence of in situ complications were confirmed.
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Affiliation(s)
- Fabrizio Tomai
- Department of Cardiovascular Sciences, European Hospital, Rome, Italy
| | | | - Pierfrancesco Corvo
- Cardiovascular Department, Sheik Khalifa Specialty Hospital, Ras AlKhaimah, UAE
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21
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Gallone G, D'Ascenzo F, Ielasi A, Landra F, Stefanini GG, Di Biasi M, Mancone M, Tomai F, Infantino V, Rognoni A, Briguori C, Boccuzzi G, Smolka G, Chiarito M, Capodanno D, Chieffo A, Fabbiocchi F, Poli A, Tespili M, D'Urbano M, Giordano A, Escaned J, De Ferrari GM, Sardella G. Polymer-free biolimus-eluting stents or polymer-based zotarolimus-eluting stents for coronary bifurcation lesions. Cardiovasc Revasc Med 2021; 35:66-73. [PMID: 33903036 DOI: 10.1016/j.carrev.2021.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/22/2021] [Accepted: 04/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND A polymer-free biolimus-eluting stent (PF-BES) and a zotarolimus-eluting stent (ZES) recently showed similar clinical profiles and appear to be competing options in specific clinical settings of patients undergoing percutaneous coronary intervention (PCI). Whether they perform similarly also in complex procedural settings as coronary bifurcation lesions remains unaddressed. METHODS All consecutive patients undergoing coronary bifurcation PCI with PF-BES or the new iteration of the ZES from three large multicenter real-world registries were included. The primary outcome was major adverse cardiovascular events (MACE), a composite of all-cause death, myocardial infarction (MI), target lesion revascularization (TLR) and stent thrombosis (ST). Multiple analyses to adjust for baseline differences were carried out including propensity-score matching, propensity-score stratification and inverse-probability-weighting. Outcomes are reported according to Cox proportional hazard models censored at 400-day follow-up. RESULTS 1169 patients treated with PF-BES (n = 440) or ZES (n = 729) on the main branch of a coronary bifurcation lesion were included (mean age 69 ± 11 years, 75.4% male, 53.8% acute coronary syndrome at presentation, 26.6% left main bifurcation, median dual antiplatelet therapy duration 12 [range 12-12] months). MACE, all-cause death, TLR and ST tended towards non-statistically higher rates with the PF-BES as compared to the ZES. Higher MI and target vessel revascularization occurrence was observed with PF-BES. CONCLUSIONS In this large contemporary cohort of patients undergoing coronary bifurcation PCI, the occurrence of MACE was non-statistically different with the use of PF-BES and ZES devices. However, differences favoring the ZES device that may entail clinical relevance were observed. Further studies are needed to confirm these findings and explore whether they remain valid when a short dual antiplatelet therapy is adopted.
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Affiliation(s)
- Guglielmo Gallone
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy.
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy
| | - Alfonso Ielasi
- Interventional Cardiology Unit, Istituto Clinico S. Ambrogio, Milan, Italy
| | - Federico Landra
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy
| | | | - Maurizio Di Biasi
- Interventional Cardiology Unit, Ospedale Sacco, ASST Fatebenefratelli/Sacco, Milano, Italy
| | - Massimo Mancone
- Department of Cardiovascular Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Fabrizio Tomai
- Department of Cardiovascular Sciences, European Hospital, Rome, Italy
| | | | - Andrea Rognoni
- Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Novara, Italy
| | | | | | - Grzegorz Smolka
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Mauro Chiarito
- Humanitas Clinical and Research Center IRCCS, Rozzano-Milan, Italy
| | - Davide Capodanno
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Alaide Chieffo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Hospital, Milan, Italy
| | - Franco Fabbiocchi
- Interventional Cardiology Unit, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, Milan, Italy
| | - Arnaldo Poli
- Division of Cardiology, Ospedale di Legnano, ASST Milanese Ovest, Italy
| | - Maurizio Tespili
- Interventional Cardiology Unit, Istituto Clinico S. Ambrogio, Milan, Italy
| | - Maurizio D'Urbano
- Division of Cardiology, Ospedale di Magenta, ASST Milanese Ovest, Italy
| | | | - Javier Escaned
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Gaetano M De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy
| | - Gennaro Sardella
- Department of Cardiovascular Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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22
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Gaspardone A, Versaci F, Tomai F, Biondi-Zoccai G, Sgueglia GA, Gioffré G, Romagnoli E, Mancone M, Calcagno S, Proietti I, Sciahbasi A, DI Pietro R, Tanzilli G, Mariano E, Romeo F. Reduction in emergency access for acute myocardial infarction during the COVID-19 pandemic: a survey from the greater area of Rome, Italy. Minerva Cardiol Angiol 2021; 70:421-427. [PMID: 33823575 DOI: 10.23736/s2724-5683.21.05516-2] [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: 11/08/2022]
Abstract
BACKGROUND On March 9, 2020, the Italian government imposed a national lockdown to tackle the COronaVIrus Disease 19 (COVID-19) pandemic, including stay at home recommendations. The precise impact of COVID-19 scare and lockdown on emergency access for acute myocardial infarction (MI) is still subject to debate. METHODS Data on all patients undergoing invasive coronary angiography at 9 hospitals in the greater area of Rome, Italy, between February 19, 2020 and March 29, 2020, 9, 2020, were retrospectively collected. Incidence of ST-elevation MI (STEMI), and non-ST-elevation MI (NSTEMI), as well as corresponding percutaneous coronary intervention (PCI), was compared distinguishing two different 20-day time periods (before vs on or after March 10, 2020). RESULTS During the study period, 1,068 patients underwent coronary angiography, 142 (13%) with STEMI and 169 (16%) with NSTEMI. The average daily number of STEMI decreased from 4.3 before the lockdown to 2.9 after the lockdown (p=0.021). Similarly, the average daily number of NSTEMI changed from 5.0 to 3.5 (p=0.028). The average daily number of primary PCI changed from 4.2 to 2.9 (p=0.030), while the average daily number of PCI for NSTEMI changed from 3.5 to 2.5 (p=0.087). For STEMI patients, the time from symptom onset to hospital arrival (onset-to-door time less than three hours) showed a significant increase after the lockdown (p=0.018), whereas door-to-balloon time did not change significantly from before to after the lockdown (p=0.609). CONCLUSIONS The present study, originally reporting on the trends in STEMI and NSTEMI in the Rome area, highlights that significant decreases in the incidence of both acute coronary syndromes occurred between February 19, 2020 and March 29, 2020, together with increases in time from symptom onset to hospital arrival, luckily without changes in door-to-balloon time.
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Affiliation(s)
| | - Francesco Versaci
- Division of Cardiology, Ospedale Santa Maria Goretti, Latina, Italy -
| | | | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | | | | | - Enrico Romagnoli
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Massimo Mancone
- Department of Cardiovascular, Respiratory, Nephrological, Anaesthetic and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
| | - Simone Calcagno
- Division of Cardiology, Ospedale Santa Maria Goretti, Latina, Italy
| | - Igino Proietti
- Division of Cardiology, Ospedale M.G. Vannini, Rome, Italy
| | | | | | - Gaetano Tanzilli
- Department of Cardiovascular, Respiratory, Nephrological, Anaesthetic and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
| | - Enrica Mariano
- Division of Cardiology, Department of Medical Sciences, Università Tor Vergata, Rome, Italy
| | - Francesco Romeo
- Division of Cardiology, Department of Medical Sciences, Università Tor Vergata, Rome, Italy
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23
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Versaci F, Gaspardone A, Danesi A, Ferranti F, Mancone M, Mariano E, Rotolo FL, Musto C, Proietti I, Berni A, Trani C, Sergi SC, Speciale G, Tanzilli G, Tomai F, Di Giosa A, Marchegiani G, Romagnoli E, Cavarretta E, Carnevale R, Frati G, Biondi-Zoccai G. Interplay between COVID-19, pollution, and weather features on changes in the incidence of acute coronary syndromes in early 2020. Int J Cardiol 2020; 329:251-259. [PMID: 33387558 PMCID: PMC7833791 DOI: 10.1016/j.ijcard.2020.12.059] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/15/2020] [Accepted: 12/18/2020] [Indexed: 02/05/2023]
Abstract
Background Coronavirus disease 2019 (COVID-19) has caused an unprecedented change in the apparent epidemiology of acute coronary syndromes (ACS). However, the interplay between this disease, changes in pollution, climate, and aversion to activation of emergency medical services represents a challenging conundrum. We aimed at appraising the impact of COVID-19, weather, and environment features on the occurrence of ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) in a large Italian region and metropolitan area. Methods and results Italy was hit early on by COVID-19, such that state of emergency was declared on January 31, 2020, and national lockdown implemented on March 9, 2020, mainly because the accrual of cases in Northern Italy. In order to appraise the independent contribution on changes in STEMI and NSTEMI daily rates of COVID-19, climate and pollution, we collected data on these clinical events from tertiary care cardiovascular centers in the Lazio region and Rome metropolitan area. Multilevel Poisson modeling was used to appraise unadjusted and adjusted effect estimates for the daily incidence of STEMI and NSTEMI cases. The sample included 1448 STEMI and 2040 NSTEMI, with a total of 2882 PCI spanning 6 months. Significant reductions in STEMI and NSTEMI were evident already in early February 2020 (all p<0.05), concomitantly with COVID-19 spread and institution of national countermeasures. Changes in STEMI and NSTEMI were inversely associated with daily COVID-19 tests, cases, and/or death (p<0.05). In addition, STEMI and NSTEMI incidences were associated with daily NO2, PM10, and O3 concentrations, as well as temperature (p<0.05). Multi-stage and multiply adjusted models highlighted that reductions in STEMI were significantly associated with COVID-19 data (p<0.001), whereas changes in NSTEMI were significantly associated with both NO2 and COVID-19 data (both p<0.001). Conclusions Reductions in STEMI and NSTEMI in the COVID-19 pandemic may depend on different concomitant epidemiologic and pathophysiologic mechanisms. In particular, recent changes in STEMI may depend on COVID-19 scare, leading to excess all-cause mortality, or effective reduced incidence, whereas reductions in NSTEMI may also be due to beneficial reductions in NO2 emissions in the lockdown phase.
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Affiliation(s)
- Francesco Versaci
- UOC UTIC, Emodinamica e Cardiologia, Ospedale S. Maria Goretti, Latina, Italy
| | | | | | - Fabio Ferranti
- Division of Cardiology, G. B. Grassi Hospital, Lido di Ostia, Rome, Italy
| | - Massimo Mancone
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Francesco L Rotolo
- Interventional Cardiology Unit, San Pietro Fatebenefratelli Hospital, Rome, Italy
| | - Carmine Musto
- Interventional Cardiology Unit, San Camillo Hospital, Rome, Italy
| | - Igino Proietti
- Division of Cardiology, M. G. Vannini Hospital, Rome, Italy
| | - Andrea Berni
- Department of Cardiovascular Diseases, Sant'Andrea Hospital, Rome, Italy
| | - Carlo Trani
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | | | | | - Gaetano Tanzilli
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | | | | | | | - Enrico Romagnoli
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Mediterranea Cardiocentro, Napoli, Italy
| | - Roberto Carnevale
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Mediterranea Cardiocentro, Napoli, Italy
| | - Giacomo Frati
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; IRCCS NEUROMED, Pozzilli, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Mediterranea Cardiocentro, Napoli, Italy.
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24
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De Luca L, Uguccioni M, Meessen J, Temporelli PL, Tomai F, De Rosa FM, Passamonti E, Formigli D, Riccio C, Gabrielli D, Colivicchi F, Gulizia MM, Perna GP. External applicability of the ISCHEMIA trial: an analysis of a prospective, nationwide registry of patients with stable coronary artery disease. EUROINTERVENTION 2020; 16:e966-e973. [PMID: 32830646 DOI: 10.4244/eij-d-20-00610] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIMS We sought to assess the proportion of patients eligible for the ISCHEMIA trial and to compare the characteristics and outcomes of these patients with those without ISCHEMIA inclusion or with ISCHEMIA exclusion criteria in a contemporary, nationwide cohort of patients with stable coronary artery disease (CAD). METHODS AND RESULTS Among the 5,070 consecutive patients enrolled in the START registry, 4,295 (84.7%) did not fulfil the inclusion criteria (ISCHEMIA-Not Included or ISCHEMIA-Unclassifiable), 582 (11.5%) had exclusion criteria (ISCHEMIA-Excluded), and the remaining 193 (3.8%) were classified as ISCHEMIA-Like. At one year, the incidence of the primary outcome, a composite of death from cardiovascular (CV) causes, myocardial infarction (MI), or hospitalisation for unstable angina and heart failure, was 0.5% in the ISCHEMIA-Like versus 3.3% in other patients (p=0.03). The composite secondary outcome of CV mortality and MI occurred in 0.5% of the ISCHEMIA-Like patients and in 1.4% of the remaining patients (p=0.1). CONCLUSIONS In a contemporary real-world cohort of stable CAD patients, only 4% resulted in being eligible for the ISCHEMIA trial. These patients presented an extremely low annual risk of adverse events, especially when compared with other groups of stable CAD patients.
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Affiliation(s)
- Leonardo De Luca
- Division of Cardiology, A. O. San Camillo-Forlanini, Roma, Italy
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25
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De Luca A, Proietti I, Trani C, Berni A, Sergi SC, Speciale G, Tanzilli G, Tomai F, Di Giosa A, Marchegiani G, Zoccai GB, Versaci F. 342 Impact of temporary traffic bans on the risk of acute coronary syndromes in a large metropolitan area. Eur Heart J Suppl 2020; 22:N81-N82. [PMID: 38626246 PMCID: PMC7799104 DOI: 10.1093/eurheartj/suaa200] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims Strong epidemiologic evidence has highlighted the role of pollution, on top of adverse climate features, as a novel cardiovascular risk factor. However, mechanistic proof that reducing pollution may be beneficial to prevent atherothrombotic events is limited. We aimed at appraising the impact of temporary traffic bans in a large metropolitan area on the risk of acute coronary syndromes. Methods and results Aggregate and anonymized data from 15 tertiary cardiac care centers were obtained detailing pre-coronarivus disease 2019 (COVID-19) daily cases of ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI), including those treated with percutaneous coronary intervention (PCI). Data on pollutants and climate were sought for the same days. Mixed level regression was used to compare the week before vs. after the traffic ban (Fortnight analysis), the 3 days before vs. after (Weekly analysis) and the Sunday before vs. after (Sunday analysis). A total of 8 days of temporary traffic bans were included, occurring between 2017 and 2020, totaling 802 STEMI and 1196 NSTEMI in the Fortnight analysis, 382 STEMI and 585 in the Weekly analysis, and 148 STEMI and 210 NSTEMI in the Sunday analysis. Fortnight and Sunday analysis did not disclose a significant impact of traffic ban on STEMI or NSTEMI (all P > 0.05). Conversely, Weekly analysis showed non-significant changes for STEMI but a significant decrease in daily NSTEMI when comparing the 3 days before the traffic ban with the ban day (P = 0.043), as well as the 3 days before vs. the 3 days after the ban (P = 0.025). No statistically significant effect of traffic ban was found at Fortnight, Weekly or Sunday analyses for daily mean concentrations of benzene, carbon monoxide, nitric oxide, nitrogen dioxide, ozone, sulfur dioxide, particulate matter (PM) <2.5 µm or PM < 10 µm (all P > 0.05). However, minimum daily concentrations showed a significant reduction of ozone during the ban in comparison to the week preceding it (P = 0.034), nitric oxide during the ban in comparison to the 3 days preceding it (P = 0.046), and an increase in benzene during the ban in comparison to the Sunday before (P = 0.039). Conclusion Temporary traffic bans may favorably reduce coronary atherothrombotic events, and in particular NSTEMI, even if not globally and immediately impacting on environmental pollution. Further controlled studies are required to confirm and expand this hypothesis-generating results.
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Affiliation(s)
| | | | - Carlo Trani
- Fondazione Policlinico, Universitario Agostino Gemelli
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26
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Ielasi A, Moscarella E, Testa L, Gioffrè G, Morabito G, Cortese B, Colangelo S, Tomai F, Arioli F, Maioli M, Leoncini M, Tumminello G, Benedetto S, Lucchina PG, Pennesi M, Ugo F, Viganò E, Bollati M, Missiroli B, Gaspardone A, Calabrò P, Bedogni F, Tespili M. IntravaScular Lithotripsy for the Management of UndILatable Coronary StEnt: The SMILE Registry. Cardiovascular Revascularization Medicine 2020; 21:1555-1559. [DOI: 10.1016/j.carrev.2020.05.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/13/2020] [Accepted: 05/18/2020] [Indexed: 01/20/2023]
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27
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Berti S, Bedogni F, Giordano A, Petronio AS, Iadanza A, Bartorelli AL, Reimers B, Spaccarotella C, Trani C, Attisano T, Marella Cenname A, Sardella G, Bonmassari R, Medda M, Tomai F, Tarantini G, Navarese EP. Efficacy and Safety of ProGlide Versus Prostar XL Vascular Closure Devices in Transcatheter Aortic Valve Replacement: The RISPEVA Registry. J Am Heart Assoc 2020; 9:e018042. [PMID: 33103545 PMCID: PMC7763424 DOI: 10.1161/jaha.120.018042] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Transcatheter aortic valve replacement (TAVR) requires large‐bore access, which is associated with bleeding and vascular complications. ProGlide and Prostar XL are vascular closure devices widely used in clinical practice, but their comparative efficacy and safety in TAVR is a subject of debate, owing to conflicting results among published studies. We aimed to compare outcomes with Proglide versus Prostar XL vascular closure devices after TAVR. Methods and Results This large‐scale analysis was conducted using RISPEVA, a multicenter national prospective database of patients undergoing transfemoral TAVR treated with ProGlide versus Prostar XL vascular closure devices. Both multivariate and propensity score adjustments were performed. A total of 2583 patients were selected. Among them, 1361 received ProGlide and 1222 Prostar XL. The predefined primary end point was a composite of cardiovascular mortality, bleeding, and vascular complications assessed at 30 days and 1‐year follow‐up. At 30 days, there was a significantly greater reduction of the primary end point with ProGlide versus Prostar XL (13.8% versus 20.5%, respectively; multivariate adjusted odds ratio, 0.80 [95% CI, 0.65–0.99]; P=0.043), driven by a reduction of bleeding complications (9.1% versus 11.7%, respectively; multivariate adjusted odds ratio, 0.76 [95% CI, 0.58–0.98]; P=0.046). Propensity score analysis confirmed the significant reduction of major adverse cardiovascular events and bleeding risk with ProGlide. No significant differences in the primary end point were found between the 2 vascular closure devices at 1 year of follow‐up (multivariate adjusted hazard ratio, 0.88 [95% CI, 0.72–1.10]; P=0.902). Comparable results were obtained by propensity score analysis. During the procedure, compared with Prostar XL, ProGlide yielded significant higher device success (99.2% versus 97.5%, respectively; P=0.001). Conclusions ProGlide has superior efficacy as compared with Prostar XL in TAVR procedures and is associated with a greater reduction of composite adverse events at short‐term, driven by lower bleeding complications. Registration Information URL: clinicaltrials.gov; Unique identifier: NCT02713932.
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Affiliation(s)
- Sergio Berti
- Department of Diagnostic and Interventional Cardiology Gabriele Monasterio Tuscany Foundation, G. Pasquinucci Heart Hospital Massa Italy
| | - Francesco Bedogni
- Department of Clinical and Interventional Cardiology IRCCS Policlinico San Donato Milan Italy
| | - Arturo Giordano
- Unità Operativa di Interventistica Cardiovascolare Pineta Grande Hospital Castel Volturno Italy
| | - Anna S Petronio
- Department of Cardiology Azienda Ospedaliero-Universitaria Pisana Pisa Italy
| | - Alessandro Iadanza
- Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte Siena Italy
| | - Antonio L Bartorelli
- Centro Monzino IRCCS and Department of Biomedical and Clinical Sciences "Luigi Sacco" University of Milan Italy
| | - Bernard Reimers
- Cardio Center Humanitas Research Hospital IRCCS Rozzano-Milan Italy
| | - Carmen Spaccarotella
- Division of Cardiology CCU and Interventional Cardiology Cardiovascular Research Center University Magna Graecia Catanzaro Italy
| | - Carlo Trani
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy
| | - Tiziana Attisano
- Cardiologia Interventistica Dipartimento Cardio Toraco Vascolare AOU S. Giovanni di Dio e Ruggi D'Aragona Salerno Italt
| | - Angela Marella Cenname
- Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy
| | - Gennaro Sardella
- Department of Cardiology Policlinico "Umberto I" Sapienza University of Rome Italy
| | | | - Massimo Medda
- Istituto Clinico Sant'Ambrogio, Gruppo San Donato Milano Italy
| | | | | | - Eliano P Navarese
- Department of Cardiology and Internal Medicine Interventional Cardiology and Cardiovascular Medicine Research Nicolaus Copernicus University Bydgoszcz Poland.,Faculty of Medicine University of Alberta Edmonton Canada.,SIRIO MEDICINE Research Network Bydgoszcz Poland
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28
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Versaci F, Gaspardone A, Danesi A, Ferranti F, Mancone M, Mariano E, Rotolo FL, Musto C, Proietti I, Berni A, Trani C, Sergi SC, Speciale G, Tanzilli G, Tomai F, DI Giosa AD, Marchegiani G, Calcagno S, Romagnoli E, Frati G, Biondi Zoccai G. Impact of temporary traffic bans on the risk of acute coronary syndromes in a large metropolitan area. Panminerva Med 2020; 62:252-259. [PMID: 33021366 DOI: 10.23736/s0031-0808.20.04161-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Strong epidemiologic evidence has highlighted the role of pollution, on top of adverse climate features, as a novel cardiovascular risk factor. However, mechanistic proof that reducing pollution may be beneficial to prevent atherothrombotic events is limited. We aimed at appraising the impact of temporary traffic bans in a large metropolitan area on the risk of acute coronary syndromes. METHODS Aggregate and anonymized data from 15 tertiary cardiac care centers were obtained detailing precoronavirus disease 2019 (COVID-19) daily cases of ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI), including those treated with percutaneous coronary intervention (PCI). Data on pollutants and climate were sought for the same days. Mixed level regression was used to compare the week before vs after the traffic ban (Fortnight analysis), the 3 days before vs. after (Weekly analysis) and the Sunday before vs. after (Sunday analysis). RESULTS A total of 8 days of temporary traffic bans were included, occurring between 2017 and 2020, totaling 802 STEMI and 1196 NSTEMI in the Fortnight analysis, 382 STEMI and 585 in the Weekly analysis, and 148 STEMI and 210 NSTEMI in the Sunday analysis.Fortnight and Sunday analyses did not disclose a significant impact of traffic ban on STEMI or NSTEMI (all P>0.05). Conversely, Weekly analysis showed non-significant changes for STEMI, but a significant decrease in daily NSTEMI when comparing the 3 days before the traffic ban with the ban day (P=0.043), as well as the 3 days before vs. the 3 days after the ban (P=0.025). No statistically significant effect of traffic ban was found at Fortnight, Weekly or Sunday analyses for daily mean concentrations of benzene, carbon monoxide, nitric oxide, nitrogen dioxide, ozone, sulfur dioxide, particulate matter (PM) <2.5 µm or PM <10 µm (all P>0.05). However, minimum daily concentrations showed a significant reduction of ozone during the ban in comparison to the week preceding it (P=0.034), nitric oxide during the ban in comparison to the 3 days preceding it (P=0.046), and an increase in benzene during the ban in comparison to the Sunday before (P=0.039). CONCLUSIONS Temporary traffic ban may favorably reduce coronary atherothrombotic events, and in particular NSTEMI, even if not globally and immediately impacting on environmental pollution. Further controlled studies are required to confirm and expand this hypothesis-generating results.
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Affiliation(s)
- Francesco Versaci
- UOC UTIC Emodinamica e Cardiologia, S. Maria Goretti Hospital, Latina, Italy
| | | | | | - Fabio Ferranti
- Division of Cardiology, G. B. Grassi Hospital, Rome, Italy
| | - Massimo Mancone
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Enrica Mariano
- Department of Cardiology, Tor Vergata University, Rome, Italy
| | - Francesco L Rotolo
- Interventional Cardiology Unit, San Pietro Fatebenefratelli Hospital, Rome, Italy
| | - Carmine Musto
- Interventional Cardiology Unit, San Camillo Hospital, Rome, Italy
| | - Igino Proietti
- Division of Cardiology, M. G. Vannini Hospital, Rome, Italy
| | - Andrea Berni
- Department of Cardiovascular Diseases, Sant'Andrea Hospital, Rome, Italy
| | - Carlo Trani
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Sonia C Sergi
- Division of Cardiology, Casilino Hospital, Rome, Italy
| | | | - Gaetano Tanzilli
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | | | | | - Giada Marchegiani
- Agenzia Regionale per la Protezione Ambientale (ARPA) Lazio, Rome, Italy
| | - Simone Calcagno
- UOC UTIC Emodinamica e Cardiologia, S. Maria Goretti Hospital, Latina, Italy
| | | | - Giacomo Frati
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy.,IRCCS Istituto Neurologico Mediterraneo (NEUROMED), Pozzilli, Isernia, Italy
| | - Giuseppe Biondi Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy - .,Mediterranea Cardiocentro Clinic, Naples, Italy
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29
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Pepe M, Corcione N, Biondi-Zoccai G, Morello A, Berti S, Bedogni F, Iadanza A, Tomai F, Sardella G, Romagnoli E, Ferraro P, Conte S, Nestola PL, Giosa MD, Cimmino M, Frati G, Giordano A. Comparison of Outcomes of Transcatheter Aortic Valve Implantation in Patients ≥85 Years Versus Those <85 Years. Am J Cardiol 2020; 129:60-70. [PMID: 32565091 DOI: 10.1016/j.amjcard.2020.05.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/16/2020] [Accepted: 05/19/2020] [Indexed: 02/08/2023]
Abstract
The differential outcomes across the age spectrum of transcatheter aortic valve implantation (TAVI) recipients are still debated. Aim of the study was to evaluate the clinical outcomes of oldest-old patients undergoing TAVI in the large "Registro Italiano GISE sull'impianto di Valvola Aortica Percutanea (RISPEVA)" registry. A total of 3,507 patients were stratified according to age: 1,381 were ≥85 years, 2,126 were <85 years. Primary endpoints were death at 30-days and complete follow-up (FU) (medium 368 days). Cerebrovascular events, myocardial infarction, bleedings, vascular complications at 30-days and complete FU were considered. In the unadjusted analysis, 30-days mortality in the oldest-old group was higher than in younger patients (4.2% vs 2.4%; p = 0.007); this difference kept true also at complete FU (19.6% vs 15.9%; p = 0.014). After propensity score (PS) matching, the oldest-old population showed a higher mortality solely at 30-days (4.7% vs 2.4%; p = 0.016), while the survival at complete FU was similar to that of younger patients (20.1% vs 18.0%; p = 0.286). The incidence of non-fatal outcomes resulted comparable between the 2 groups, also after propensity score matching. At the multivariate logistic regression analysis procedural major or disabling bleedings, cerebrovascular events, cardiogenic shock resulted predictors of 30-days death in the oldest-old cohort. In conclusion, patients ≥85 years can safely undergo TAVI being not more exposed to procedural complications than those <85 years; nevertheless they showed worse 30-days mortality, probably driven by reduced tolerance to complications. Passed the critical periprocedural phase, patients ≥85 years had a similar survival to those <85 years with comparable risk profile.
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Cortese B, Testa L, Di Palma G, Heang TM, Bossi I, Nuruddin AA, Ielasi A, Tespili M, Perez IS, Milazzo D, Benincasa S, Latib A, Cacucci M, Caiazzo G, Seresini G, Tomai F, Ocaranza R, Torres A, Perotto A, Bedogni F, Colombo A. Clinical performance of a novel sirolimus-coated balloon in coronary artery disease: EASTBOURNE registry. J Cardiovasc Med (Hagerstown) 2020; 22:94-100. [DOI: 10.2459/jcm.0000000000001070] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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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Giordano A, Corcione N, Ferraro P, Morello A, Conte S, Bedogni F, Testa L, Iadanza A, Sardella G, Mancone M, Tomai F, De Persio G, Attisano T, Pepe M, Frati G, Biondi-Zoccai G. Impact of Predilation Before Transcatheter Aortic Valve Implantation with New-Generation Devices. Cardiovascular Revascularization Medicine 2019; 20:1096-1099. [PMID: 30711476 DOI: 10.1016/j.carrev.2019.01.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/04/2019] [Accepted: 01/11/2019] [Indexed: 02/08/2023]
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Ielasi A, Gioffrè G, Cortese B, Colangelo S, Arioli F, Tomai F, Maioli M, Greco Lucchina GP, Leoncini M, Tumminello G, Pennesi M, Bedogni F, Tespili M. TCT-652 Intravascular Lithotripsy for the Management of Undilatable Coronary Stent: The Multicenter SMILE Registry. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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De Carlo M, Testa L, Leoncini M, Nicolini E, Varbella F, Cortese B, Ribichini F, Bartorelli AL, Calabria P, Indolfi C, Tomai F, Loi B, Fischietti D, Tarantini G, Bedogni F, Petronio AS. Two-year clinical outcomes of the “Italian diffuse/multivessel disease absorb prospective registry” (IT-DISAPPEARS). Int J Cardiol 2019; 290:21-26. [DOI: 10.1016/j.ijcard.2019.04.095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 04/27/2019] [Accepted: 04/29/2019] [Indexed: 10/26/2022]
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Giordano A, Corcione N, Ferraro P, Pieri P, Avellino R, Frati G, De Persio G, Altamura L, Tomai F, Biondi-Zoccai G. Propensity-score-adjusted comparison of Evolut vs. Portico devices for transcatheter aortic valve implantation. J Cardiovasc Med (Hagerstown) 2019; 20:351-357. [PMID: 30676494 DOI: 10.2459/jcm.0000000000000764] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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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Bartorelli AL, Versaci F, Briguori C, Tomai F, Aprigliano G, Poli A, Vigna C, Marinucci L, My L, Masi F, Turturo M. The BIOFLOW-III Italian Satellite Registry: 18-month results of the Orsiro stent in an all-comer high-risk population. J Cardiovasc Med (Hagerstown) 2019; 20:464-470. [PMID: 30994511 DOI: 10.2459/jcm.0000000000000795] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS We aimed to corroborate clinical evidence on the safety and efficacy of the ultrathin-strut biodegradable-polymer sirolimus-eluting Orsiro stent in an all-comer population including high-risk subgroups. METHODS The nationwide, prospective, all-comer BIOFLOW-III Satellite Registry was conducted at 18 Italian sites. High-risk subgroups [diabetes, small vessels (≤2.75 mm), acute myocardial infarction (AMI), and chronic total occlusions (CTOs)] were prespecified. The primary endpoint was target lesion failure (TLF) at 12 months, a composite of cardiac death, target vessel myocardial infarction (MI), emergent coronary artery bypass graft, and clinically driven target lesion revascularization (TLR). RESULTS In all, 601 patients were enrolled (31.9% diabetes, 34.6% AMIs) with 736 lesions (37.2% small vessels, 5.7% CTOs, and 15.5% bifurcation lesions). Cumulative TLF rate at 12 months was 4.6% [95% confidence interval (CI) 3.2-6.6]: 6.9% (95% CI 4.1-11.6) in the diabetic patients, 5.0% (95% CI 2.7-9.1) in acute MI subgroup, 4.2% (95% CI 2.3-7.7) in small vessels, and 5.3% (95% CI 1.4-19.7) in CTOs. At 18-month follow-up, TLF, target vessel revascularization, and clinically driven TLR rates in the overall population were 5.2% (95% CI 3.7-7.4), 1.8% (95% CI 1.0-3.3), and 1.6% (95% CI 0.8-3.1), respectively. Probable stent thrombosis rate was 0.5% (95% CI 0.1-1.4), whereas no definite stent thrombosis was observed. CONCLUSIONS The study results confirmed the excellent clinical performance of the Orsiro drug-eluting stents at 18 months in the whole all-comer population and in the prespecified high-risk subgroups.
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Affiliation(s)
- Antonio Luca Bartorelli
- Centro Cardiologico Monzino, IRCCS, Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan, Milan
| | | | - Carlo Briguori
- Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples
| | - Fabrizio Tomai
- Department of Cardiovascular Sciences, European Hospital, Rome
| | | | - Arnaldo Poli
- Department of Cardiology, ASST Ovest Milanese, Legnano
| | - Carlo Vigna
- Department of Cardiology, Casa Sollievo della Sofferenza Hospital IRCCS, San Giovanni Rotondo (FG)
| | | | - Luigi My
- Cardiology Unit, Casa di Cura Villa Verde, Taranto
| | | | - Maurizio Turturo
- Division of Cardiology, Presidio Ospedaliero Di Venere, Bari Carbonara, Italy
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Parisi C, De Giusti M, Castello L, Dito E, Proietti F, Tomai F. Sacubitril/valsartan: preliminary experience in post-acute stabilized patients with reduced ejection fraction heart failure. Curr Med Res Opin 2019; 35:17-20. [PMID: 30864896 DOI: 10.1080/03007995.2019.1576485] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION We investigated the effectiveness of sacubitril/valsartan by performing laboratory tests and a 6-minute walking test (6-MWT) at 1 and 6 months after treatment initiation. METHODS We evaluated patients admitted to our Cardiology Department, stabilized after an episode of acute decompensated heart failure (HF), who were considered eligible for sacubitril/valsartan therapy. Therapy was initiated after interrupting angiotensin-converting enzyme (ACE) inhibitors for at least 36 h or after the last dose of an angiotensin receptor blocker (ARB). In naïve patients, we initiated a low dose of sacubitril/valsartan combination following patient stabilization. Before discharge, a 6-MWT was performed to evaluate patient's functional capacity, measuring total walked distance (in meters), oxygen saturation and heart rate at the beginning and at the end of the test; Borg Scale was applied to evaluate the intensity of dyspnoea. After discharge, follow-up visits at 1 and 6 months, 2D-echocardiography, blood tests and 6-MWT were performed to re-evaluate the efficacy of the treatment. RESULTS A total of 14 patients (85.7% males) were included. Mean age was 66.0 ± 10.3 years. Body mass index (BMI) was 29.9 ± 4.7 kg/m2. There were no differences in creatinine at admission compared with values at 1 and 6 months. Mean left ventricular ejection fraction (LVEF) was 28.7 ± 4.7% at baseline and increased to 33.5 ± 6.6% and 38.0 ± 2.9% at 1 and 6 months, respectively (p = .028). Total distance covered at 6-MWT increased over the study period (baseline: 227.4 ± 62.8 m; 6 months: 257.3 ± 65.2 m, p = .317) although the increase was not statistically significant. CONCLUSIONS The present experience showed that angiotensin receptor-neprilysin inhibitor (ARNi) might represent a new valuable therapeutic strategy, even at the earlier stages of stabilized acute HF. Therefore, we suggest a clinical practice algorithm, to consider before discharge, which should be validated by further analyses.
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Weltert L, De Paulis R, Salatino T, Tomai F. Latest Advances in Transcatheter Cardiac Valvular Treatment. Surg Technol Int 2018; 33:219-237. [PMID: 30204929] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
When the original monograph on valvular prostheses was published in Surgical Technology International, back in 1993, transcatheter technology had not yet been invented. These techniques have been gradually revealed in subsequent issues. When we first considered writing a paper that described both surgical and transcatheter prosthesis, we realized that such a combined paper would be impractically large. Therefore, we decided to split our survey into more than one paper. This paper seeks to address the paucity of information available regarding transcatheter aortic valve implantation (TAVI) and similar devices. This publication may serve as a reference point for critically organizing information on an evolving topic. The following article deals with the large number of transcatheter devices related to valvular and ventricular pathologies: TAVI for the aortic and mitral valves, with a focus on indications, techniques and complications, as well as specific aortic devices, and devices to treat mitral regurgitation with non-conventional access. Every effort has been made to make the content relevant and up-to-date, which proved to be particularly challenging due to the continuous technological evolution which characterizes this field.
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Affiliation(s)
- Luca Weltert
- Heart Surgery Division, European Hospital, Rome, Italy
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Borioni R, Tomai F, De Persio G, Fratticci L, Tesori MC, Paciotti C, Garofalo M. Safety of carotid endarterectomy early after percutaneous coronary interventions. Ital J Vasc Endovasc Surg 2018. [DOI: 10.23736/s1824-4777.18.01371-2] [Citation(s) in RCA: 1] [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: 12/22/2022]
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Sardella G, Stefanini GG, Briguori C, Tamburino C, Fabbiocchi F, Rotolo F, Tomai F, Paggi A, Lombardi M, Gioffrè G, Sclafani R, Rolandi A, Sciahbasi A, Scardaci F, Signore N, Calcagno S, Mancone M, Chiarito M, Giordano A. Safety and efficacy of polymer-free biolimus-eluting stents in all-comer patients: the RUDI-FREE study. EUROINTERVENTION 2018; 14:772-779. [DOI: 10.4244/eij-d-18-00148] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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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Giordano A, Biondi-Zoccai G, Corcione N, Ferraro P, Bedogni F, Testa L, Sardella G, Mancone M, Tomai F, De Persio G, Iadanza A, Pierli C, Frati G. TCT-44 Comparative effectiveness and safety of five leading new-generation TAVI devices: 12-month results from the RISPEVA Study. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1128] [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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41
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Galli S, Versaci F, Briguori C, Tomai F, Poli A, Vigna C, My L, Masi F, Turturo M, Bartorelli A. TCT-509 Eighteen-month results of high-risk patients treated with ultrathin-strut biodegradable-polymer Orsiro DES. The Bioflow-III Satellite Italy Subgroups analysis. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1687] [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: 11/28/2022]
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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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Nudi F, Schilllaci O, Biondi-Zoccai G, Pinto A, Neri G, Procaccini E, Versaci F, Nudi A, Tomai F, Frati G, Iskandrian AE. Impact of specific coronary lesions on regional ischemia at single photon emission computed tomography. J Cardiovasc Med (Hagerstown) 2018; 19:329-336. [PMID: 29846303 DOI: 10.2459/jcm.0000000000000675] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AIMS Prior studies using stress myocardial perfusion imaging (MPI), which examined the association between obstructive epicardial coronary disease and presence of myocardial ischemia did not provide a detailed assessment on a regional level. We examined this relationship in a large population of patients in whom the coronary anatomy was defined by invasive coronary angiography. METHODS We retrospectively extracted details on individuals undergoing MPI with single photon emission computed tomography (SPECT) who had coronary angiography within 12 months. A 17-segment model for native coronary anatomy and a 7-region model for myocardial perfusion were used with a dedicated matching algorithm. RESULTS A total of 2564 patients were included, yielding a total of 6279 stenoses matched with 17 948 myocardial regions. From such a cohort, 151 (5.9%) patients had normal perfusion, 1878 (73.2%) had myocardial ischemia (reversible defects), 260 (10.1%) had myocardial necrosis (scar or fixed defects), and 275 (10.7%) had ischemia and necrosis. At per-patient analysis, significant angiographic disease was more common in the ischemic group (prevalence between 69.6 and 80.0%) than other groups. At per-region analysis, abnormal perfusion in the coronary-specific regions varied depending on location of stenosis; it was 96% for left main disease, 81% for proximal left anterior descending disease, 85% for proximal left circumflex disease, and 82% for proximal right coronary artery disease and <60% for posterior descending artery disease. CONCLUSION The correlation between significant coronary stenosis and presence of corresponding regional perfusion abnormality depends on the location of the lesion and the corresponding myocardial region.
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Affiliation(s)
- Francesco Nudi
- Service of Nuclear Cardiology, Madonna della Fiducia Clinic.,ETISAN
| | | | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina.,Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli
| | - Annamaria Pinto
- Service of Nuclear Cardiology, Madonna della Fiducia Clinic.,Ostia Radiologica, Rome
| | | | | | | | | | | | - Giacomo Frati
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina.,Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli
| | - Ami E Iskandrian
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Alabama, USA
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Nudi F, Di Belardino N, Pinto A, Procaccini E, Neri G, Schillaci O, Tomai F, Frati G, Biondi-Zoccai G. Assessment of the fate of myocardial necrosis by serial myocardial perfusion imaging. J Nucl Cardiol 2018; 25:496-505. [PMID: 28078574 DOI: 10.1007/s12350-016-0751-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 09/30/2016] [Accepted: 11/28/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Myocardial necrosis after myocardial infarction (MI) is common; extent and severity are however variable. The pattern is recognized by myocardial perfusion imaging (MPI) as fixed perfusion defects (FPD). The fate of such FPD is not well appraised. This study addressed this important issue in a large number of patients undergoing serial MPI in relation to type of intervening therapy. METHODS Patients with prior MI or MPI-evidence of myocardial necrosis undergoing serial MPI without intervening acute coronary syndromes were included. The fate of necrosis by MPI on per-patient and per-region analysis was analyzed, factoring also the impact of intervening coronary revascularization (CR). RESULTS A total of 3691 patients with 25,837 regions were identified, including 1413 (38.3%) subjects with 3358 (13.0%) regions exhibiting necrosis. Serial MPI after 29±21 months confirmed the persistent presence of myocardial necrosis FPD in the vast majority of patients and regions (86%); the consistency was even higher in the presence of moderate or severe necrosis (99%). Neither type nor site of CR significantly impacted on the presence and extent of myocardial necrosis at multivariable analysis. CONCLUSIONS The finding of myocardial necrosis by MPI remains highly consistent over time, and is not significantly altered by CR.
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Affiliation(s)
- Francesco Nudi
- Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Via Giuseppe Mantellini 3, 00179, Rome, Italy.
- ETISAN, Rome, Italy.
| | | | - Annamaria Pinto
- Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Via Giuseppe Mantellini 3, 00179, Rome, Italy
- Service of Anatomo Functional Cardio Imaging, Ostia Radiologica, Rome, Italy
| | - Enrica Procaccini
- Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Via Giuseppe Mantellini 3, 00179, Rome, Italy
- Service of Anatomo Functional Cardio Imaging, Ostia Radiologica, Rome, Italy
| | - Giandomenico Neri
- Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Via Giuseppe Mantellini 3, 00179, Rome, Italy
- Service of Anatomo Functional Cardio Imaging, Ostia Radiologica, Rome, Italy
| | - Orazio Schillaci
- Department of Nuclear Medicine, Tor Vergata University of Rome, Rome, Italy
| | | | - Giacomo Frati
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy
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Nudi F, Schillaci O, Di Belardino N, Versaci F, Tomai F, Pinto A, Neri G, Procaccini E, Nudi A, Frati G, Biondi-Zoccai G. Temporal Trends in the Prevalence, Severity, and Localization of Myocardial Ischemia and Necrosis at Myocardial Perfusion Imaging After Myocardial Infarction. Am J Cardiol 2017; 120:1238-1244. [PMID: 28888406 DOI: 10.1016/j.amjcard.2017.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/19/2017] [Accepted: 07/06/2017] [Indexed: 02/08/2023]
Abstract
The definition, presentation, and management of myocardial infarction (MI) have changed substantially in the last decade. Whether these changes have impacted on the presence, severity, and localization of necrosis at myocardial perfusion imaging (MPI) has not been appraised to date. Subjects undergoing MPI and reporting a history of clinical MI were shortlisted. We focused on the presence, severity, and localization of necrosis at MPI with a retrospective single-center analysis. A total of 10,476 patients were included, distinguishing 5 groups according to the period in which myocardial perfusion scintigraphy had been performed (2004 to 2005, 2006 to 2007, 2008 to 2009, 2010 to 2011, 2012 to 2013). Trend analysis showed over time a significant worsening in baseline features (e.g., age, diabetes mellitus, and Q waves at electrocardiogram), whereas medical therapy and revascularization were offered with increasing frequency. Over the years, there was also a lower prevalence of normal MPI (from 16.8% to 13.6%) and ischemic MPI (from 35.6% to 32.8%), and a higher prevalence of ischemic and necrotic MPI (from 12.0% to 12.7%) or solely necrotic MPI (from 35.7% to 40.9%, p <0.001). Yet the prevalence of severe ischemia decreased over time from 11.4% to 2.0%, with a similar trend for moderate ischemia (from 15.9% to 11.8%, p <0.001). Similarly sobering results were wound for the prevalence of severe necrosis (from 19.8% to 8.2%) and moderate necrosis (from 8.5% to 7.8%, p = 0.028). These trends were largely confirmed at regional level and after propensity score matching. In conclusion, the outlook of stable patients with previous MI has substantially improved in the last decade, with a decrease in the severity of residual myocardial ischemia and necrosis, despite an apparent worsening in baseline features.
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Nudi F, Di Belardino N, Versaci F, Pinto A, Procaccini E, Neri G, Vetere M, Frati G, Peruzzi M, Schillaci O, Gaspardone A, Tomai F, Biondi-Zoccai G. Impact of coronary revascularization vs medical therapy on ischemia among stable patients with or suspected coronary artery disease undergoing serial myocardial perfusion scintigraphy. J Nucl Cardiol 2017; 24:1690-1698. [PMID: 27229341 DOI: 10.1007/s12350-016-0504-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 04/03/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Randomized trials have challenged the role of revascularization in stable coronary artery disease. We aimed to appraise the impact of revascularization on ischemia in patients undergoing serial myocardial perfusion scintigraphy (MPS). METHODS We queried our institutional database for stable subjects undergoing serial MPS and appraised the impact of revascularization on changes in ischemia. RESULTS A total of 3631 patients were included: 967 (27%) undergoing revascularization and 2664 (73%) receiving medical therapy only. Patients treated with revascularization had a significantly lower burden of myocardial ischemia at follow-up (odds ratio = 0.577 [95% confidence interval 0.483-0.689] vs medical therapy, P < .001). Among all those having moderate or severe ischemia at baseline, revascularization was associated with a follow-up prevalence of 80% for no, minimal, or mild ischemia and 20% for moderate or severe ischemia, vs 43% and 57% for medical therapy (P < .001). Even at multivariable analysis and propensity-adjusted, and propensity-matched analyses, revascularization was associated with a significantly lower prevalence of moderate or severe ischemia at follow-up (respectively P < .001, P = .001, and P = .042). CONCLUSIONS Revascularization appears superior to medical therapy in reducing ischemic burden and normalizing myocardial perfusion among subjects with moderate or severe ischemia at baseline.
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Affiliation(s)
- Francesco Nudi
- Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Rome, Italy
- Ostia Radiologica, Rome, Italy
- Etisan, Rome, Italy
| | | | - Francesco Versaci
- Department of Cardiovascular Disease, Ospedale A. Cardarelli, Campobasso, Italy
- Department of Cardiovascular Disease, Ospedale F. Veneziale, Isernia, Italy
| | - Annamaria Pinto
- Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Rome, Italy
| | - Enrica Procaccini
- Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Rome, Italy
| | - Giandomenico Neri
- Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Rome, Italy
| | - Maurizio Vetere
- Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Rome, Italy
| | - Giacomo Frati
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100, Latina, Italy
- Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy
| | - Mariangela Peruzzi
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100, Latina, Italy
| | - Orazio Schillaci
- Department of Nuclear Medicine, Tor Vergata University of Rome, Rome, Italy
| | | | | | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100, Latina, Italy.
- Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy.
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Testa L, De Carlo M, Petrolini A, Rapetto C, Varbella F, Cortese B, Gabrielli G, Geraci S, Loi B, Boccuzzi G, Tarantini G, Fischetti D, Calabria P, Tomai F, Ribichini F, Tamburino C, Indolfi C, Bartorelli A, Petronio AS, Bedogni F. One-year clinical results of the Italian diffuse/multivessel disease ABSORB prospective registry (IT-DISAPPEARS). EUROINTERVENTION 2017; 13:424-431. [DOI: 10.4244/eij-d-17-00246] [Citation(s) in RCA: 12] [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] [Indexed: 11/23/2022]
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Nudi F, Schillaci O, Neri G, Pinto A, Procaccini E, Vetere M, Frati G, Tomai F, Biondi-Zoccai G. Erratum to: Prognostic impact of location and extent of vessel-related ischemia at myocardial perfusion scintigraphy in patients with or at risk for coronary artery disease. J Nucl Cardiol 2017; 24:1102. [PMID: 28332178 DOI: 10.1007/s12350-017-0849-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Francesco Nudi
- Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Rome, Italy.
- ETISAN, Rome, Italy.
| | - Orazio Schillaci
- Institute of Nuclear Medicine, Tor Vergata University, Rome, Italy
| | - Giandomenico Neri
- Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Rome, Italy
| | - Annamaria Pinto
- Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Rome, Italy
- Ostia Radiologica, Rome, Italy
| | - Enrica Procaccini
- Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Rome, Italy
- Ostia Radiologica, Rome, Italy
| | - Maurizio Vetere
- Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Rome, Italy
| | - Giacomo Frati
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy
| | | | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy
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Nudi F, Procaccini E, Versaci F, Giordano A, Pinto A, Neri G, Frati G, Schillaci O, Nudi A, Tomai F, Biondi-Zoccai G. Impact of coronary revascularization on the clinical and scintigraphic outlook of patients with myocardial ischemia. J Cardiovasc Med (Hagerstown) 2017; 18:404-409. [PMID: 28118184 DOI: 10.2459/jcm.0000000000000506] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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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Nudi F, Schillaci O, Neri G, Pinto A, Procaccini E, Vetere M, Frati G, Tomai F, Biondi-Zoccai G. Prognostic impact of location and extent of vessel-related ischemia at myocardial perfusion scintigraphy in patients with or at risk for coronary artery disease. J Nucl Cardiol 2016; 23:274-84. [PMID: 25827620 DOI: 10.1007/s12350-015-0077-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 10/07/2014] [Accepted: 01/19/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND Myocardial perfusion scintigraphy (MPS) has an established diagnostic and prognostic role in patients with or at risk for coronary artery disease, with ischemia severity and extent having already been identified as key predictors. Whether this is affected by the location of myocardial ischemia is uncertain. We aimed at comparing the prognostic outlook of patients undergoing MPS according to the site of ischemia. METHODS Our institutional database was queried for subjects undergoing MPS, without myocardial necrosis or recent revascularization. We focused on the prognostic impact of location of vessel-related ischemia (VRI) at MPS, distinguishing four mutually exclusive groups: single-VRI involving left anterior descending (LAD), single-VRI not involving LAD, multi-VRI involving LAD, and multi-VRI not involving LAD. The primary outcome was the long-term (>1 year) rate of death or myocardial infarction (D/MI). RESULTS A total of 13,254 patients were included. Moderate or severe VRI occurred in 2,627 (20%) patients. Clinical outcomes were significantly different among the groups of patients with moderate or severe VRI, including death, cardiac death, non-fatal myocardial infarction or their composites (overall P < .001). Specifically, and excluding subjects undergoing revascularization as first follow-up event, D/MI occurred in 8.4% of patients with single-VRI involving LAD, 5.5% of subjects with single-VRI not involving LAD, 16.5% of those with multi-VRI involving LAD, and 7.3% of patients with multi-VRI not involving LAD (overall P < .001). Even at incremental multivariable Cox proportional analysis, hierarchical VRI was independently associated with an increased risk of D/MI [hazard ratio = 1.17 (1.04-1.08) for each class increment, P = .010]. CONCLUSIONS Location and extent of myocardial ischemia at MPS according to the VRI concept have a hierarchical predictive impact, with multi-VRI involving LAD being significantly and independently more prognostically ominous than other types of VRI.
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Affiliation(s)
- Francesco Nudi
- Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Via Cesare Correnti 6, 00179, Rome, Italy.
- ETISAN, Rome, Italy.
| | - Orazio Schillaci
- Institute of Nuclear Medicine, Tor Vergata University, Rome, Italy
| | - Giandomenico Neri
- Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Via Cesare Correnti 6, 00179, Rome, Italy
| | - Annamaria Pinto
- Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Via Cesare Correnti 6, 00179, Rome, Italy
- Ostia Radiologica, Rome, Italy
| | - Enrica Procaccini
- Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Via Cesare Correnti 6, 00179, Rome, Italy
- Ostia Radiologica, Rome, Italy
| | - Maurizio Vetere
- Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Via Cesare Correnti 6, 00179, Rome, Italy
| | - Giacomo Frati
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | | | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
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