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Corallo F, Sessa E, Rifici C, De Cola MC, Di Cara M, Cardile D, Venuti G, Bonfiglio N, D’Aleo G, Quartarone A, Lo Buono V. Anxiety and Perception of Disease Control in Multiple Sclerosis Subjects Treated with Natalizumab. J Clin Med 2023; 13:13. [PMID: 38202019 PMCID: PMC10779828 DOI: 10.3390/jcm13010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/16/2023] [Accepted: 12/17/2023] [Indexed: 01/12/2024] Open
Abstract
Multiple sclerosis subjects treated with natalizumab face anxiety about developing progressive multifocal leukoencephalopathy (PML), besides the psychological distress caused by the disease. The aim of this study is to investigate whether increasing the frequency of neurological and nuclear magnetic resonance screening may affect anxiety and the perception of disease control in patients treated with natalizumab. A total of 62 relapsing-remitting multiple sclerosis patients were recruited from 2019 to 2020. All patients received conventional infusion treatments with natalizumab, along with a screening protocol for PML. Three clinical assessments were considered: at the beginning of the study (T0), after 3 months (T1) and after 6 months (T2). Patients were classified into three levels of risk, where level 1 represented a low risk of PML and level 3 a high risk. This classification determined treatment and screening protocol, i.e., the frequency of performing the Stratify test and the brain 3T NMR exam, as well as the frequency of infusion treatments. Anxiety and perception of disease control were assessed at T0, T1, and T2 by a skilled psychologist. The Friedman test and the Wilcoxon signed-rank test were used to compare outcomes at baseline with the two follow-ups. Statistical test results showed that the risk of PML (per 1000 patients) was significantly lower in women than in men (W = 198.5; p = 0.01). Moreover, significant differences between baseline and the two follow-ups were found, both for anxiety (F(2) = 122.6, p < 0.001) and for perception of disease control (F(2) = 123.5, p < 0.001). In both cases, there was significant improvement between baseline (T0) and the end of the study (T2) in any risk level (p < 0.001). An increase in the number of follow-ups, as well as an increase in instrumental investigations, might have a positive effect on both anxiety and the perception of disease control. However, there are many variables involved in the disease process that have an impact on patients' psychological well-being. Therefore, further and more extensive studies are necessary to evaluate how, and how much, each variable impacts the disease course.
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Affiliation(s)
| | | | | | - Maria Cristina De Cola
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C.da Casazza, 98124 Messina, Italy; (F.C.); (C.R.); (M.D.C.); (D.C.); (G.V.); (N.B.); (G.D.); (A.Q.); (V.L.B.)
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Gallone G, Burrello J, Burrello A, Iannaccone M, De Luca L, Patti G, Cerrato E, Venuti G, De Filippo O, Mattesini A, Muscoli S, Trabattoni D, Giammaria M, Truffa A, Cortese B, Conrotto F, Mulatero P, Monticone S, Escaned J, Usmiani T, D‘ascenzo F, De Ferrari G, Breviario S. C25 PREDICTION OF ALL–CAUSE MORTALITY FOLLOWING PERCUTANEOUS CORONARY INTERVENTION IN BIFURCATION LESIONS USING MACHINE LEARNING ALGORITHMS – THE RAIN–ML PREDICTION MODEL. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.024] [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: 11/14/2022]
Abstract
Abstract
Aims
Stratifying prognosis following coronary bifurcation percutaneous coronary intervention (PCI) is an unmet need. Machine learning (ML) may identify patterns from multidimensional, non–linear relationships to make outcome predictions. We sought to develop a ML–based risk stratification model built on clinical, anatomical and procedural features to predict all–cause mortality following contemporary bifurcation PCI.
Methods and Results
Multiple ML models to predict all–cause mortality were tested on a cohort of 2,393 patients (training, n = 1,795; internal validation, n = 598) undergoing bifurcation PCI with contemporary stents from the real–world RAIN (veRy thin stents for patients with left mAIn or bifurcatioN in real life) registry. Among 38 commonly available features, 25 (13 patient–related, 12 lesion–related) were selected to train ML models. The best performing model (the RAIN–ML prediction model) was validated in an external validation cohort of 1,701 patients undergoing bifurcation PCI from the DUTCH PEERS (DUrable polymer–based sTent CHallenge of Promus ElemEnt versus ReSolute integrity: TWENTE II) trial and the BIO–RESORT trial cohorts. The area under the receiver operating characteristic curves for the prediction of 2–year mortality was 0.786 (0.74–0.83) in the overall population, 0.736 (0.72–0.847) at internal validation and 0.706 (0.6919–0.794) at external validation. Performance at risk ranking analysis, k–center cross validation, and with continual learning confirmed the generalizability of the models, available also as an online interface.
Conclusions
The RAIN–ML prediction model represents the first tool combining clinical, anatomical and procedural features to predict all–cause mortality among patients undergoing contemporary bifurcation PCI with a good discriminative performance.
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Affiliation(s)
- G Gallone
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - J Burrello
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - A Burrello
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - M Iannaccone
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - L De Luca
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - G Patti
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - E Cerrato
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - G Venuti
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - O De Filippo
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - A Mattesini
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - S Muscoli
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - D Trabattoni
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - M Giammaria
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - A Truffa
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - B Cortese
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - F Conrotto
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - P Mulatero
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - S Monticone
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - J Escaned
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - T Usmiani
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - F D‘ascenzo
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - G De Ferrari
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - S Breviario
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
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Lo Buono V, D’Aleo G, Cammaroto S, De Cola MC, Palmese F, Smorto C, Marino S, Venuti G, Sessa E, Rifici C, Corallo F. Neuropsychological Disability in the Case of Natalizumab-Related Progressive Multifocal Leukoencephalopathy. Medicina (Kaunas) 2022; 58:medicina58040551. [PMID: 35454389 PMCID: PMC9025511 DOI: 10.3390/medicina58040551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/15/2022] [Accepted: 04/16/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Progressive multifocal leukoencephalopathy (PML) is a viral disease characterized by progressive damage or inflammation of the cerebral white matter that can be encountered in patients with multiple sclerosis (MS). There are cases of PML caused by pharmacological agents including natalizumab. Therefore, in patients treated with this drug, early identification of PML allows changes in the treatment plan, reducing the risks of morbidity and mortality. CASE PRESENTATION We reported the case of a 57-year-old female diagnosed with relapsing-remitting MS, who presented with PML related to natalizumab. The patient presented with change in behavioral, radiological abnormalities in the left parieto-temporal lobes. We described the longitudinal course of PML, from the diagnosis until the patient's death, documenting the progressive deterioration of her cognitive functioning, supported by changes on sequential brain scans and neurophysiological data. CONCLUSION The neuropsychological impairment documented in this case study expands the range of treatment-related complications associated with natalizumab, and provides evidence that occurrence of "atypical" cognitive deficits in MS may support the early diagnosis of PML.
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Affiliation(s)
- Viviana Lo Buono
- IRCCS Centro Neurolesi Bonino Pulejo, 98100 Messina, Italy; (V.L.B.); (G.D.); (S.C.); (C.S.); (S.M.); (G.V.); (E.S.); (C.R.); (F.C.)
| | - Giangaetano D’Aleo
- IRCCS Centro Neurolesi Bonino Pulejo, 98100 Messina, Italy; (V.L.B.); (G.D.); (S.C.); (C.S.); (S.M.); (G.V.); (E.S.); (C.R.); (F.C.)
| | - Simona Cammaroto
- IRCCS Centro Neurolesi Bonino Pulejo, 98100 Messina, Italy; (V.L.B.); (G.D.); (S.C.); (C.S.); (S.M.); (G.V.); (E.S.); (C.R.); (F.C.)
| | - Maria Cristina De Cola
- IRCCS Centro Neurolesi Bonino Pulejo, 98100 Messina, Italy; (V.L.B.); (G.D.); (S.C.); (C.S.); (S.M.); (G.V.); (E.S.); (C.R.); (F.C.)
- Correspondence:
| | - Francesca Palmese
- Azienda ULSS Marca Trevigiana, Ospedale Cà Foncello, 31100 Treviso, Italy;
| | - Chiara Smorto
- IRCCS Centro Neurolesi Bonino Pulejo, 98100 Messina, Italy; (V.L.B.); (G.D.); (S.C.); (C.S.); (S.M.); (G.V.); (E.S.); (C.R.); (F.C.)
| | - Silvia Marino
- IRCCS Centro Neurolesi Bonino Pulejo, 98100 Messina, Italy; (V.L.B.); (G.D.); (S.C.); (C.S.); (S.M.); (G.V.); (E.S.); (C.R.); (F.C.)
| | - Giuseppe Venuti
- IRCCS Centro Neurolesi Bonino Pulejo, 98100 Messina, Italy; (V.L.B.); (G.D.); (S.C.); (C.S.); (S.M.); (G.V.); (E.S.); (C.R.); (F.C.)
| | - Edoardo Sessa
- IRCCS Centro Neurolesi Bonino Pulejo, 98100 Messina, Italy; (V.L.B.); (G.D.); (S.C.); (C.S.); (S.M.); (G.V.); (E.S.); (C.R.); (F.C.)
| | - Carmela Rifici
- IRCCS Centro Neurolesi Bonino Pulejo, 98100 Messina, Italy; (V.L.B.); (G.D.); (S.C.); (C.S.); (S.M.); (G.V.); (E.S.); (C.R.); (F.C.)
| | - Francesco Corallo
- IRCCS Centro Neurolesi Bonino Pulejo, 98100 Messina, Italy; (V.L.B.); (G.D.); (S.C.); (C.S.); (S.M.); (G.V.); (E.S.); (C.R.); (F.C.)
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4
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Ferrarotto L, Venuti G, Castellana C, Piedimonte G, Mangione R, La Manna A, Tamburino C. [Devices for the prevention of contrast-induced acute kidney injury in interventional cardiology]. G Ital Cardiol (Rome) 2021; 22:1008-1016. [PMID: 34845403 DOI: 10.1714/3698.36880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Contrast-induced acute kidney injury (CI-AKI) consists in acute decline in renal function following iodinated contrast media exposure. It has a significant impact on long-term prognosis and mortality, development of chronic kidney disease and on the rate of hospitalization due to cardiovascular or renal events. Anamnestic and procedural aspects linked to higher risk of CI-AKI have been investigated and new devices have been designed in order to prevent it. This paper deals with CI-AKI in interventional cardiology, focusing on patients' risk stratification, contrast media agent selection and contrast media volume reduction strategies, in order to suggest a standardized algorithm.
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Affiliation(s)
- Luigi Ferrarotto
- U.O.C. Cardiologia, Centro Alte Specialità e Trapianti (C.A.S.T.), A.O.U. "Policlinico G. Rodolico-S. Marco", Università degli Studi, Catania
| | | | - Carmelo Castellana
- U.O.C. Cardiologia, Centro Alte Specialità e Trapianti (C.A.S.T.), A.O.U. "Policlinico G. Rodolico-S. Marco", Università degli Studi, Catania
| | - Giulio Piedimonte
- U.O.C. Cardiologia, Centro Alte Specialità e Trapianti (C.A.S.T.), A.O.U. "Policlinico G. Rodolico-S. Marco", Università degli Studi, Catania
| | - Riccardo Mangione
- U.O.C. Cardiologia, Centro Alte Specialità e Trapianti (C.A.S.T.), A.O.U. "Policlinico G. Rodolico-S. Marco", Università degli Studi, Catania
| | - Alessio La Manna
- U.O.C. Cardiologia, Centro Alte Specialità e Trapianti (C.A.S.T.), A.O.U. "Policlinico G. Rodolico-S. Marco", Università degli Studi, Catania
| | - Corrado Tamburino
- U.O.C. Cardiologia, Centro Alte Specialità e Trapianti (C.A.S.T.), A.O.U. "Policlinico G. Rodolico-S. Marco", Università degli Studi, Catania
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De Filippo O, D'Ascenzo F, Angelini F, Franchin L, Cerrato E, Pennacchi M, Nuñez-Gil I, Wojakowski W, Imori Y, Trabattoni D, Huczek Z, Venuti G, Muscoli S, Iannaccone M, Montabone A, Marengo G, Rognoni A, Parma R, Figini F, Mitomo S, Boccuzzi G, Mattesini A, Quadri G, Wańha W, Smolka G, Rolfo C, Cortese B, Ryan N, Capodanno D, Chieffo A, di Mario C, Varbella F, Romeo F, Sheiban I, Escaned J, Helft G, De Ferrari GM. Performance of Thin-Strut Stents in Non-Left Main Bifurcation Coronary Lesions: A RAIN Subanalysis. J Invasive Cardiol 2021; 33:E890-E899. [PMID: 34735352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVES This study assesses the safety and efficacy of thin-strut stents in non-left main (non-LM) bifurcation coronary lesions. BACKGROUND Thinner struts of recent drug-eluting stent (DES) devices are associated with improved outcomes, but data about their performance in challenging scenarios are scant. METHODS RAIN was a retrospective multicenter registry enrolling patients with coronary bifurcation lesions or left main (LM) disease treated with thin-strut DESs. Target-lesion revascularization (TLR) was the primary endpoint, while major adverse clinical event (MACE) rate, a composite of all-cause death, myocardial infarction (MI), target-vessel revascularization (TVR), TLR, and stent thrombosis (ST), and its single components were the secondary endpoints. Multivariable analysis was performed to identify predictors of TLR. Outcome incidences according to stenting strategy (provisional vs 2-stent technique), use of final kissing balloon (FKB), and intravascular ultrasound/optical coherence tomography optimization were further investigated in prespecified subanalyses. RESULTS A total of 1803 patients (59% acute coronary syndrome, 41% stable coronary artery disease) with non-LM bifurcations were enrolled. After a median follow-up of 12 months, TLR incidence was 2.5% (2.2% for provisional stenting and 3.5% for 2-stent technique). MACE rate was 9.4% (all-cause death, 4.1%; MI, 3.2%; TVR, 3.7%; definite ST, 1.1%). After multivariable adjustment, postdilation (hazard ratio [HR], 0.32; 95% confidence interval [CI], 0.15-0.71; P<.01) and provisional stenting (HR, 0.62; 95% CI, 0.55-0.89; P=.03) were associated with lower TLR rates. FKB was associated with a lower incidence of TLR in the 2-stent subgroup (P=.03). Intracoronary imaging had no significant impact on the primary endpoint. CONCLUSIONS Thin-strut DES options represent an effective choice in bifurcation lesions. Postdilation and provisional stenting are associated with a reduced risk of TLR. FKB should be recommended in 2-stent techniques.
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Affiliation(s)
- Ovidio De Filippo
- Department of Medical Sciences, Division of Cardiology, AOU Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, 10126, Turin, Italy.
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6
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Iannaccone M, Venuti G, di Simone E, De Filippo O, Bertaina M, Colangelo S, Boccuzzi G, de Piero ME, Attisani M, Barbero U, Zanini P, Livigni S, Noussan P, D'Ascenzo F, de Ferrari GM, Porto I, Truesdell AG. Comparison of ECMO vs ECpella in patients with non post-pericardiotomy cardiogenic shock: An updated meta-analysis. Cardiovasc Revasc Med 2021; 40:134-141. [PMID: 34654655 DOI: 10.1016/j.carrev.2021.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 09/12/2021] [Accepted: 10/01/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The impact of Impella and ECMO (ECPELLA) in cardiogenic shock (CS) remains to be defined. The aim of this meta-analysis is to evaluate the benefit of ECPELLA compared to VA-ECMO in patients with non post-pericardiotomy CS. METHODS All studies reporting short term outcomes of ECpella or VA ECMO in non post-pericardiotomy CS were included. The primary endpoint was 30-day mortality. Vascular and bleeding complications and LVAD implantation/heart transplant within 30-days were assessed as secondary outcomes. RESULTS Of 407 studies identified, 13 observational studies (13,682 patients, 13,270 with ECMO and 412 with ECpella) were included in this analysis. 30-day mortality was 55.8% (51.6-59.9) in the VA-ECMO group and 58.3% (53.5-63.0) in the ECpella group. At meta-regression analysis the implantation of IABP did not affect mortality in the ECMO group. The rate of major bleeding in patients on VA-ECMO and ECpella support were 21.3% (16.9-26.5) and 33.1% (25.9-41.2) respectively, while the rates of the composite outcome of LVAD implantation and heart transplantation within 30-days in patients on VA-ECMO and ECpella support were 14.4% (9.0-22.2) and 10.8%. When directly compared in 3 studies, ECpella showed a positive effect on 30-day mortality compared to ECMO (OR: 1.81: 1.039-3.159). CONCLUSION Our data suggest that ECpella may reduce 30-day mortality and increase left ventricle recovery, despite increased of bleeding rates.
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Affiliation(s)
- Mario Iannaccone
- Division of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy.
| | | | - Emanuela di Simone
- Division of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Ovidio De Filippo
- Division of Cardiology, Città della Scienza e della Salute, University of Turin, Turin, Italy
| | - Maurizio Bertaina
- Division of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Salvatore Colangelo
- Division of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Giacomo Boccuzzi
- Division of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Maria Elena de Piero
- Department of Anesthesiology and Intensive Care, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Matteo Attisani
- Division of Cardiology, Città della Scienza e della Salute, University of Turin, Turin, Italy
| | | | - Paola Zanini
- Division of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Sergio Livigni
- Department of Anesthesiology and Intensive Care, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Patrizia Noussan
- Division of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Città della Scienza e della Salute, University of Turin, Turin, Italy
| | | | - Italo Porto
- Cardiovascular Disease Unit, IRCCS Policlinic Hospital San Martino, Genova, Italy
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7
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Piedimonte G, Bertagnin E, Castellana C, Ferrarotto L, Mangione R, Venuti G, Valvo R, Scalia M, Capodanno D, Tamburino C, La Manna A. Ultrasound versus fluoroscopy-guided femoral access for percutaneous coronary intervention of chronic total occlusions: Insights from FOUND BLOOD CTO Registry. Cardiovasc Revasc Med 2021; 38:61-67. [PMID: 34556431 DOI: 10.1016/j.carrev.2021.08.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/29/2021] [Accepted: 08/25/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare vascular complications in patients undergoing percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) using ultrasound guidance (USG) versus fluoroscopy guidance (FSG) for femoral access. BACKGROUND In patients undergoing PCI, using the arterial femoral access increases the risk of vascular complications compared using the radial access. USG reduces time to access, number of attempts, and vascular complications compared with FSG, but the efficacy of USG has never been tested in the setting of CTO-PCI. METHODS A total of 197 patients undergoing CTO-PCI using at least a femoral vascular access from November 2015 to September 2020 were screened. The primary outcome was a composite of local hematoma, pseudoaneurysm, retroperitoneal hemorrhage, arteriovenous fistula or hemoglobin drop ≥3 g/dL during hospitalization. The independent association between USG and the primary outcome of interest was explored. RESULTS The primary outcome occurred in 17.3% of patients. Patients in the USG group had a significantly lower incidence of vascular complications compared with patients in the FSG group (8.5% vs. 21.0%, p = 0.039), driven by a reduction of localized hematomas (3.4% vs 13.0%, p = 0.042). After adjustment for type of CTO approach and heparin dose, USG was significantly associated with a reduced relative risk of the composite primary outcome (adjusted odds ratio 0.16, 95% confidence interval 0.05 to 0.51; p = 0.002). CONCLUSION USG in CTO-PCI is associated with a decreased risk of vascular complications, primarily driven by a reduction in local hematomas, especially in complex CTO-PCI where the larger use of heparin increases the risk of vascular complications.
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Affiliation(s)
- Giulio Piedimonte
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria "Policlinico G.Rodolico - San Marco", University of Catania, Catania, Italy
| | - Enrico Bertagnin
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria "Policlinico G.Rodolico - San Marco", University of Catania, Catania, Italy
| | - Carmelo Castellana
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria "Policlinico G.Rodolico - San Marco", University of Catania, Catania, Italy
| | - Luigi Ferrarotto
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria "Policlinico G.Rodolico - San Marco", University of Catania, Catania, Italy
| | - Riccardo Mangione
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria "Policlinico G.Rodolico - San Marco", University of Catania, Catania, Italy
| | - Giuseppe Venuti
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria "Policlinico G.Rodolico - San Marco", University of Catania, Catania, Italy
| | - Roberto Valvo
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria "Policlinico G.Rodolico - San Marco", University of Catania, Catania, Italy
| | - Matteo Scalia
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria "Policlinico G.Rodolico - San Marco", University of Catania, Catania, Italy
| | - Davide Capodanno
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria "Policlinico G.Rodolico - San Marco", University of Catania, Catania, Italy
| | - Corrado Tamburino
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria "Policlinico G.Rodolico - San Marco", University of Catania, Catania, Italy
| | - Alessio La Manna
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria "Policlinico G.Rodolico - San Marco", University of Catania, Catania, Italy.
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8
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Franchin L, Piroli F, D'Ascenzo F, Nuñez-Gil I, Wojakowski W, Imori Y, Trabattoni D, Huczek Z, Venuti G, Muscoli S, Montabone A, Rognoni A, Parma R, Figini F, Mitomo S, Quadri G, Wańha W, Cortese B, De Filippo O, Ryan N, Varbella F, Sheiban I, Helft G, De Ferrari GM. Impact of stent thickness on clinical outcomes in small vessel and bifurcation lesions: a RAIN-CARDIOGROUP VII sub-study. J Cardiovasc Med (Hagerstown) 2021; 22:20-25. [PMID: 32740419 DOI: 10.2459/jcm.0000000000001037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The clinical impact of stent strut thickness in coronary bifurcation lesions in small vessels has not been assessed in a real-world population. METHODS All 506 patients enrolled in the RAIN study, undergoing PCI in a vessel with a diameter 2.5 mm or less were retrospectively evaluated and divided into two groups according to stent strut thickness: 74 μm (n = 206) versus 81 μm (n = 300); 87.1% of the lesions involved bifurcations. TLF [defined as a composite of myocardial infarction (MI) and target lesion revascularization (TLR)] was the primary endpoint, with MACE (a composite of death, MI and TLR), its components and stent thrombosis the secondary endpoint. RESULTS After 16 (14-18) months, a lower incidence of TLF (4.3 vs. 9.8%, P = 0.026) and ST (1.0 vs. 3.0%, P = 0.042) was seen in the 74 μm group, whereas MACE occurred in 60 of 506 patients, with no statistical difference between the two groups (9.7 vs. 13.3%, P = 0.070). At multivariate analysis, chronic renal failure increased the risk of TLF while thinner strut was an independent protective factor (hazard ratio 0.51, CI 0.17-0.85, P = 0.005). CONCLUSION In this real-world population, patients being treated for small vessels lesions with thinner strut stents had lower rates of TLF, MI and ST.
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Affiliation(s)
- Luca Franchin
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, Hospital, University of Turin, Turin, Italy
| | - Francesco Piroli
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, Hospital, University of Turin, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, Hospital, University of Turin, Turin, Italy
| | - Ivan Nuñez-Gil
- Interventional Cardiology Department, Clinico San Carlos University Hospital, IdISSC, Madrid, Spain
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Yoichi Imori
- Department of Cardiovascular Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Daniela Trabattoni
- Department of Cardiovascular Sciences, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | - Giuseppe Venuti
- Cardio-thoracic-vascular Department, A.O.U. 'Vittorio Emanuele' Hospital, University of Catania, Catania
| | - Saverio Muscoli
- Department of Cardiovascular Disease, Tor Vergata University of Rome, Rome
| | | | - Andrea Rognoni
- Division of Cardiology, Maggiore della Carità Hospital, Novara
| | - Radoslaw Parma
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | - Satoru Mitomo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Hospital, Milan
| | - Giorgio Quadri
- Department of Cardiology, Infermi Hospital, Rivoli.,Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin
| | - Wojciech Wańha
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | - Ovidio De Filippo
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, Hospital, University of Turin, Turin, Italy
| | - Nicola Ryan
- Interventional Cardiology Department, Clinico San Carlos University Hospital, IdISSC, Madrid, Spain
| | - Ferdinando Varbella
- Department of Cardiology, Infermi Hospital, Rivoli.,Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin
| | | | - Gerard Helft
- Sorbonne Université, Institut de Cardiologie, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| | - Gaetano M De Ferrari
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, Hospital, University of Turin, Turin, Italy
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Corallo F, Rifici C, Bonanno L, Di Cara M, Lo Buono V, Venuti G, Marino S, Ciurleo R, Torre V, D'Aleo G, Bramanti P, Sessa E. The role of teriflunamide in multiple sclerosis patient: an observational study. PSYCHOL HEALTH MED 2021; 27:2204-2211. [PMID: 34044680 DOI: 10.1080/13548506.2021.1931371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Teriflunomide is a drug with immunosuppressive and selective immunomodulatory action, characterized by anti-inflammatory and antiproliferative properties. Several clinical studies have demonstrated the efficacy and safety of this drug in Multiple Sclerosis, estimating a significant improvement in cognitive performance.The aim of our study is to evaluate the effects of teriflunomide by analysing the correlation between brain atrophy and the general cognitive profile and evaluating long-term changes. The effect of teriflunomide was studied in 30 patients with multiple sclerosis and 30 control subjects. Patients underwent a full cognitive profile assessment using the Brief Repeatable Battery of Neuropsychological Tests and a neuroimaging examination with a 3.0 T working scanner.Our results suggested that treatment with teriflunomide could potentially not only slow down the accumulation of microstructural tissue damage in Grey Matter and With Matter, but also better preserve the cognitive profile, particularly by highlighting the benefits in the memory domain. Thanks to drug therapy, brain volume in our patients has remained constant, leading to improvements in memory, indicating teriflunomide as a neuroprotective potential and further strengthening the evidence of a link between loss of brain volume and cognitive impairment.
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Affiliation(s)
- Francesco Corallo
- Neuroimaging Laboratory - IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | - Carmela Rifici
- Neuroimaging Laboratory - IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | - Lilla Bonanno
- Neuroimaging Laboratory - IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | - Marcella Di Cara
- Neuroimaging Laboratory - IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | - Viviana Lo Buono
- Neuroimaging Laboratory - IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | - Giuseppe Venuti
- Neuroimaging Laboratory - IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | - Silvia Marino
- Neuroimaging Laboratory - IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | - Rosella Ciurleo
- Neuroimaging Laboratory - IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | - Viviana Torre
- Neuroimaging Laboratory - IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | - Giangaetano D'Aleo
- Neuroimaging Laboratory - IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | - Placido Bramanti
- Neuroimaging Laboratory - IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | - Edoardo Sessa
- Neuroimaging Laboratory - IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
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10
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Gallone G, D'Ascenzo F, Conrotto F, Costa F, Capodanno D, Muscoli S, Chieffo A, Yoichi I, Pennacchi M, Quadri G, Nuñez-Gil I, Bocchino PP, Piroli F, De Filippo O, Rolfo C, Wojakowski W, Trabattoni D, Huczek Z, Venuti G, Montabone A, Rognoni A, Parma R, Figini F, Mitomo S, Boccuzzi G, Mattesini A, Cerrato E, Wańha W, Smolka G, Cortese B, Ryan N, Bo M, di Mario C, Varbella F, Burzotta F, Sheiban I, Escaned J, Helft G, De Ferrari GM. Accuracy of the PARIS score and PCI complexity to predict ischemic events in patients treated with very thin stents in unprotected left main or coronary bifurcations. Catheter Cardiovasc Interv 2021; 97:E227-E236. [PMID: 32438488 DOI: 10.1002/ccd.28972] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 04/07/2020] [Accepted: 05/04/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND The PARIS risk score (PARIS-rs) and percutaneous coronary intervention complexity (PCI-c) predict clinical and procedural residual ischemic risk following PCI. Their accuracy in patients undergoing unprotected left main (ULM) or bifurcation PCI has not been assessed. METHODS The predictive performances of the PARIS-rs (categorized as low, intermediate, and high) and PCI-c (according to guideline-endorsed criteria) were evaluated in 3,002 patients undergoing ULM/bifurcation PCI with very thin strut stents. RESULTS After 16 (12-22) months, increasing PARIS-rs (8.8% vs. 14.1% vs. 27.4%, p < .001) and PCI-c (15.2% vs. 11%, p = .025) were associated with higher rates of major adverse cardiac events ([MACE], a composite of death, myocardial infarction [MI], and target vessel revascularization), driven by MI/death for PARIS-rs and target lesion revascularization/stent thrombosis for PCI-c (area under the curves for MACE: PARIS-rs 0.60 vs. PCI-c 0.52, p-for-difference < .001). PCI-c accuracy for MACE was higher in low-clinical-risk patients; while PARIS-rs was more accurate in low-procedural-risk patients. ≥12-month dual antiplatelet therapy (DAPT) was associated with a lower MACE rate in high PARIS-rs patients, (adjusted-hazard ratio 0.42 [95% CI: 0.22-0.83], p = .012), with no benefit in low to intermediate PARIS-rs patients. No incremental benefit with longer DAPT was observed in complex PCI. CONCLUSIONS In the setting of ULM/bifurcation PCI, the residual ischemic risk is better predicted by a clinical risk estimator than by PCI complexity, which rather appears to reflect stent/procedure-related events. Careful procedural risk estimation is warranted in patients at low clinical risk, where PCI complexity may substantially contribute to the overall residual ischemic risk.
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Affiliation(s)
- Guglielmo Gallone
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Federico Conrotto
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Francesco Costa
- Department of Clinical and Experimental Medicine, Policlinic "G. Martino", University of Messina, Messina, Italy
| | - Davide Capodanno
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Saverio Muscoli
- Department of Cardiovascular Disease, Tor Vergata University of Rome, Rome, Italy
| | - Alaide Chieffo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Hospital, Milan, Italy
| | - Imori Yoichi
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Mauro Pennacchi
- Department of Cardiovascular, Respiratory and Morphologic Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Giorgio Quadri
- Department of Cardiology, Infermi Hospital, Rivoli, Italy
| | - Ivan Nuñez-Gil
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Pier Paolo Bocchino
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Francesco Piroli
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Ovidio De Filippo
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Cristina Rolfo
- Department of Cardiology, Infermi Hospital, Rivoli, Italy
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Daniela Trabattoni
- Department of Cardiovascular Sciences, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | - Giuseppe Venuti
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | | | - Andrea Rognoni
- Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Novara, Italy
| | - Radoslaw Parma
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | - Satoru Mitomo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Alessio Mattesini
- Division of Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Enrico Cerrato
- Department of Cardiology, Infermi Hospital, Rivoli, Italy
| | - Wojciech Wańha
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Grzegorz Smolka
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Bernardo Cortese
- Interventional Cardiology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Nicola Ryan
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Mario Bo
- Section of Geriatrics, Department of Medical Sciences, Università degli Studi di Torino, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Carlo di Mario
- Division of Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | | | - Francesco Burzotta
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Javier Escaned
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Gerard Helft
- Pierre and Marie Curie University, Paris, France
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
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Hagnäs MJ, Venuti G, Castellana C, Piedimonte G, Ferrarotto L, Mäkikallio T, Capodanno D, Tamburino C, La Manna A. Does the left circumflex coronary artery location impact on the success of chronic total occlusion recanalization? A single-center cohort study. SCAND CARDIOVASC J 2020; 55:106-108. [PMID: 33331181 DOI: 10.1080/14017431.2020.1852307] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We sought to determine whether the chronic total occlusions (CTO) recanalization results differ between circumflex artery (CX) and other coronary arteries in our center. The study dataset encompassed 428 consecutive procedures. J-CTO score was highest in the right coronary artery (RCA) and lowest in CX lesions. After adjusting for the J-CTO score, age, body mass index, baseline creatinine, diabetes, dyslipidemia and hypertension the odds ratio for procedural success in CX compared to the other arteries was not statistically significant. We found no difference in success rates of recanalizing CTO in CX compared to other coronary arteries.
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Affiliation(s)
- Magnus J Hagnäs
- Division of Cardiology, CAST, P.O. "Rodolico", Azienda Ospedaliero-Universitaria, "Policlinico-Vittorio Emanuele," University of Catania, Catania, Italy.,Department of Internal Medicine, Heart smithy, Lapland Central Hospital, Rovaniemi, Finland
| | - Giuseppe Venuti
- Division of Cardiology, CAST, P.O. "Rodolico", Azienda Ospedaliero-Universitaria, "Policlinico-Vittorio Emanuele," University of Catania, Catania, Italy
| | - Carmelo Castellana
- Division of Cardiology, CAST, P.O. "Rodolico", Azienda Ospedaliero-Universitaria, "Policlinico-Vittorio Emanuele," University of Catania, Catania, Italy
| | - Giulio Piedimonte
- Division of Cardiology, CAST, P.O. "Rodolico", Azienda Ospedaliero-Universitaria, "Policlinico-Vittorio Emanuele," University of Catania, Catania, Italy
| | - Luigi Ferrarotto
- Division of Cardiology, CAST, P.O. "Rodolico", Azienda Ospedaliero-Universitaria, "Policlinico-Vittorio Emanuele," University of Catania, Catania, Italy
| | - Timo Mäkikallio
- Division of Cardiology, Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
| | - Davide Capodanno
- Division of Cardiology, CAST, P.O. "Rodolico", Azienda Ospedaliero-Universitaria, "Policlinico-Vittorio Emanuele," University of Catania, Catania, Italy
| | - Corrado Tamburino
- Division of Cardiology, CAST, P.O. "Rodolico", Azienda Ospedaliero-Universitaria, "Policlinico-Vittorio Emanuele," University of Catania, Catania, Italy
| | - Alessio La Manna
- Division of Cardiology, CAST, P.O. "Rodolico", Azienda Ospedaliero-Universitaria, "Policlinico-Vittorio Emanuele," University of Catania, Catania, Italy
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Venuti G, D'Agosta G, Tamburino C, La Manna A. When antegrade microcatheter does not follow: The "facilitated tip-in technique". Catheter Cardiovasc Interv 2020; 96:E458-E461. [PMID: 32091661 DOI: 10.1002/ccd.28803] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/11/2020] [Accepted: 02/10/2020] [Indexed: 11/11/2022]
Abstract
The introduction of retrograde techniques in percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) has significantly improved the success rates. After crossing the CTO lesion in the retrograde approach, wire externalization is a pivotal step to complete the PCI. Many techniques have been described to accomplish externalization in different scenarios of increasing difficulty. We describe the novel "facilitated tip-in technique" which involves the insertion of the back end of an extra-guidewire into and through the antegrade microcatheter (MC) in order to increase antegrade support and overcome demanding CTO cases where, even after successful tip-in technique, the antegrade MC does not cross the CTO segment.
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Affiliation(s)
- Giuseppe Venuti
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - Guido D'Agosta
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - Corrado Tamburino
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - Alessio La Manna
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
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13
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Trabattoni D, Gili S, Teruzzi G, Omedè P, Cerrato E, Templin C, Capodanno D, Lüscher T, Ryan N, Venuti G, Montabone A, Wojakowski W, Rognoni A, Helft G, Gallo D, Biolè CA, Parma R, De Luca L, Figini F, Mitomo S, Mattesini A, Boccuzzi G, Quadri G, Wańha W, Smolka G, Huczek Z, Chieffo A, Nuñez-Gil I, Morbiducci U, Iannaccone M, di Mario C, Moretti C, D'Amico M, Sheiban I, Escaned J, D'Ascenzo F. A Sex-Based Analysis From the RAIN-CARDIOGROUP VII Study (VeRy Thin Stents for Patients With Left MAIn or BifurcatioN in Real Life) on Left Main Stenting. J Invasive Cardiol 2020; 32:342-346. [PMID: 32568097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION There is a lack of data on clinical outcomes of percutaneous coronary intervention (PCI) with ultrathin stents on unprotected left main (ULM) coronary artery comparing women and men. METHODS All patients treated with ULM-PCI with ultrathin stents (struts ≤81 μm) enrolled in the RAIN-CARDIOGROUP VII study were analyzed according to a sex-assessment evaluation. Major adverse cardiovascular event (MACE, a composite of all-cause death, myocardial infarction, target-lesion revascularization [TLR], and stent thrombosis) was the primary endpoint, whereas single components of MACE were the secondary endpoints. RESULTS Out of a cohort of 793 patients, a total of 172 women (21.7%) and 621 men (78.3%) were included. Compared with men, women were older and less frequently smokers, had more frequently a history of previous PCI, and presented more frequently with an acute coronary syndrome. Among women, ostial lesions were more prevalent and mean stent diameter was lower compared with men. After 13.4 months (range, 8.4-21.6 months), 32 women (18.6%) and 106 men (17.1%) experienced MACE (P=.64). Censoring follow-up data at 3 years, no differences were observed in MACE (16.9 vs 14.7 per 100•patient-years; log-rank P=.61) and their single components between women and men. At multivariate analysis, chronic kidney disease (hazard ratio [HR], 1.91: 95% confidence interval [CI], 1.23 to -2.95; P<.01) and acute coronary syndrome presentation (HR, 1.84; 95% CI, 1.22-2.77; P=.01) were independent predictors of MACE overall. Larger stent size (HR, 0.65; 95% CI, 0.48-0.89; P<.01) and longer dual-antiplatelet therapy duration (HR, 0.95; 95% CI, 0.90-0.99; P=.03) were associated with a reduced risk of MACE during the subsequent follow-up. CONCLUSION Ultrathin stents offer low rates of MACE and TLR in the overall population without significant differences between sexes.
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Affiliation(s)
- Daniela Trabattoni
- Invasive Cardiology Unit 3, Centro Cardiologico Monzino, IRCCS, Via Parea, 4 - 20138 Milan, Italy.
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14
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Di Cara M, Bonanno L, Rifici C, Sessa E, D'Aleo G, Corallo F, Lo Buono V, Venuti G, Bramanti P, Marino S. Quality of life in patients with multiple sclerosis and caregivers. Predictive factors: An observational study. J Clin Neurosci 2020; 78:242-245. [DOI: 10.1016/j.jocn.2020.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/04/2020] [Indexed: 01/22/2023]
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15
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Venuti G, Piedimonte G, Castellana C, Ferrarotto L, Guarracini S, Azzalini L, Manna AL. Using the coronary lithotripsy system for coronary artery disease. Future Cardiol 2020; 17:59-71. [PMID: 32530304 DOI: 10.2217/fca-2020-0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Severe coronary artery calcification increases percutaneous treatment complexity and the risk of intraprocedural complications, affecting acute and long-term outcomes. Current use of specialty balloons and atherectomy technologies is limited due to the higher risk of complications, degree of technical difficulty and operator experience. Intravascular lithotripsy (IVL) is a novel technology for severe calcified coronary artery disease that facilitates vessel preparation, enhancing vessel compliance. IVL system emits sonic waves that penetrate through vascular layers and disrupt both superficial and deep calcium, leaving the soft tissue unharmed. The purpose of the present review is to provide a summary of the evidence currently available on this therapy, including a practical description of the components and function of the shockwave coronary IVL system.
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Affiliation(s)
- Giuseppe Venuti
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania 95123, Italy
| | - Giulio Piedimonte
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania 95123, Italy
| | - Carmelo Castellana
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania 95123, Italy
| | - Luigi Ferrarotto
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania 95123, Italy
| | | | - Lorenzo Azzalini
- The Zena & Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Alessio La Manna
- Division of Cardiology, C.A.S.T., Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania 95123, Italy
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16
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Piedimonte G, D'Agosta G, Gravina G, Venuti G, Castellana C, Tamburino C, La Manna A. [Management of coronary perforations during angioplasty]. G Ital Cardiol (Rome) 2020; 21:27S-34S. [PMID: 32469342 DOI: 10.1714/3373.33490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Coronary perforation represents a terrible complication of percutaneous coronary intervention (PCI) which, if not promptly recognized and treated, can lead to catastrophic consequences for the patient. Hence, acquisition of the basic techniques for the treatment of coronary perforations is critical for the interventional cardiologist in order to safely perform PCIs. Although the incidence of coronary perforations remains low during PCI, it is possible to recognize some subgroups of patients and some types of coronary lesions, such as chronic coronary total occlusions, that are associated with increased risk. The treatments currently available depend on the type and site of coronary perforation, therefore timely recognition is of paramount importance in order to be able to quickly establish the most appropriate treatment.
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Affiliation(s)
- Giulio Piedimonte
- U.O. Cardiologia - Laboratorio di Emodinamica, Dipartimento Cardio-Toraco-Vascolare e Trapianto d'Organi, CAST, P.O. G. Rodolico, A.O.U. Policlinico-Vittorio Emanuele, Catania
| | - Guido D'Agosta
- U.O. Cardiologia - Laboratorio di Emodinamica, Dipartimento Cardio-Toraco-Vascolare e Trapianto d'Organi, CAST, P.O. G. Rodolico, A.O.U. Policlinico-Vittorio Emanuele, Catania
| | - Giacomo Gravina
- U.O. Cardiologia - Laboratorio di Emodinamica, Dipartimento Cardio-Toraco-Vascolare e Trapianto d'Organi, CAST, P.O. G. Rodolico, A.O.U. Policlinico-Vittorio Emanuele, Catania
| | - Giuseppe Venuti
- U.O. Cardiologia - Laboratorio di Emodinamica, Dipartimento Cardio-Toraco-Vascolare e Trapianto d'Organi, CAST, P.O. G. Rodolico, A.O.U. Policlinico-Vittorio Emanuele, Catania
| | - Carmelo Castellana
- U.O. Cardiologia - Laboratorio di Emodinamica, Dipartimento Cardio-Toraco-Vascolare e Trapianto d'Organi, CAST, P.O. G. Rodolico, A.O.U. Policlinico-Vittorio Emanuele, Catania
| | - Corrado Tamburino
- U.O. Cardiologia - Laboratorio di Emodinamica, Dipartimento Cardio-Toraco-Vascolare e Trapianto d'Organi, CAST, P.O. G. Rodolico, A.O.U. Policlinico-Vittorio Emanuele, Catania
| | - Alessio La Manna
- U.O. Cardiologia - Laboratorio di Emodinamica, Dipartimento Cardio-Toraco-Vascolare e Trapianto d'Organi, CAST, P.O. G. Rodolico, A.O.U. Policlinico-Vittorio Emanuele, Catania
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17
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Iannaccone M, Barbero U, De Benedictis M, Imori Y, Quadri G, Trabattoni D, Ryan N, Venuti G, Montabone A, Wojakowski W, Rognoni A, Helft G, Parma R, De Luca L, Autelli M, Boccuzzi G, Mattesini A, Templin C, Cerrato E, Wańha W, Smolka G, Huczek Z, Tomassini F, Cortese B, Capodanno D, Chieffo A, Nuñez-Gil I, Gili S, Bassignana A, di Mario C, Doronzo B, Omedè P, D'Amico M, Tedeschi D, Varbella F, Luscher T, Sheiban I, Escaned J, Rinaldi M, D'Ascenzo F. Comparison of bioresorbable vs durable polymer drug-eluting stents in unprotected left main (from the RAIN-CARDIOGROUP VII Study). BMC Cardiovasc Disord 2020; 20:225. [PMID: 32414330 PMCID: PMC7227223 DOI: 10.1186/s12872-020-01420-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 03/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are limited data regarding the impact of bioresorbable polymer drug eluting stent (BP-DES) compared to durable polymer drug eluting stent (DP-DES) in patients treated with percutaneous coronary intervention using ultrathin stents in left main or bifurcations. METHODS In the RAIN registry (ClinicalTrials NCT03544294, june 2018 retrospectively registered) patients with a ULM or bifurcation stenosis treated with PCI using ultrathin stents (struts thinner than 81 μm) were enrolled. The primary endpoint was the rate of target lesion revascularization (TLR); major adverse cardiovascular events (MACE, a composite of all-cause death, myocardial infarction, TLR and stent thrombosis) and its components, along with target vessel revascularization (TVR) were the secondary ones. A propensity score with matching analysis to compare patients treated with BP-DES versus DP-DES was also assessed. RESULTS From 3001 enrolled patients, after propensity score analysis 1400 patients (700 for each group) were selected. Among them, 352 had ULM disease and 1048 had non-LM bifurcations. At 16 months (12-22), rates of TLR (3.7% vs 2.9%, p = 0.22) and MACE were similar (12.3% vs. 11.6%, p = 0.74) as well as for the other endpoints. Sensitivity analysis of outcomes after a two-stents strategy, showed better outcome in term of MACE (20.4% vs 10%, p = 0.03) and TVR (12% vs 4.6%, p = 0.05) and a trend towards lower TLR in patients treated with BP-DES. CONCLUSION In patients with bifurcations or ULM treated with ultrathin stents BP-DES seems to perform similarly to DP-DES: the trends toward improved clinical outcomes in patients treated with the BP-DES might potentially be of value for speculating the stent choice in selected high-risk subgroups of patients at increased risk of ischemic events. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03544294. Retrospectively registered June 1, 2018.
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Affiliation(s)
- Mario Iannaccone
- Division of Cardiology, SS. Annunziata Hospital, ASL CN1, Savigliano, Italy
| | - Umberto Barbero
- Division of Cardiology, SS. Annunziata Hospital, ASL CN1, Savigliano, Italy.
| | | | - Yoichi Imori
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, Japan
| | - Giorgio Quadri
- Department of Cardiology, Infermi Hospital, Rivoli, Italy.,Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Daniela Trabattoni
- Department of Cardiovascular Sciences, IRCCS Centro Cardiologico Monzino, Milan, Italy.,University of Milan, Milan, Italy
| | - Nicola Ryan
- Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | - Giuseppe Venuti
- Division of Cardiology, Cardio-Thoracic-Vascular Department, Azienda Ospedaliero Universitaria "Policlinico-Vittorio Emanuele,", Catania, Italy
| | - Andrea Montabone
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | | | - Andrea Rognoni
- Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Novara, Italy
| | - Gerard Helft
- Division of Cardiology, Pierre and Marie Curie University, Paris, France
| | | | | | - Michele Autelli
- Cardiology Department, Ospedale San Giovanni Bosco, Turin, Italy
| | - Giacomo Boccuzzi
- Cardiology Department, Ospedale San Giovanni Bosco, Turin, Italy
| | - Alessio Mattesini
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Christian Templin
- Division of Cardiology, Universityspirtal of Zurich, Zürich, Switzerland
| | - Enrico Cerrato
- Department of Cardiology, Infermi Hospital, Rivoli, Italy.,Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Wojciech Wańha
- Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Grzegorz Smolka
- Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | | | - Francesco Tomassini
- Department of Cardiology, Infermi Hospital, Rivoli, Italy.,Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Bernardo Cortese
- Interventional Cardiology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Davide Capodanno
- Division of Cardiology, Cardio-Thoracic-Vascular Department, Azienda Ospedaliero Universitaria "Policlinico-Vittorio Emanuele,", Catania, Italy
| | | | - Ivan Nuñez-Gil
- Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | - Sebastiano Gili
- Department of Cardiovascular Sciences, IRCCS Centro Cardiologico Monzino, Milan, Italy.,University of Milan, Milan, Italy
| | - Antonia Bassignana
- Division of Cardiology, SS. Annunziata Hospital, ASL CN1, Savigliano, Italy
| | - Carlo di Mario
- Division of Cardiology, Cardio-Thoracic-Vascular Department, Azienda Ospedaliero Universitaria "Policlinico-Vittorio Emanuele,", Catania, Italy
| | | | - Pierluigi Omedè
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Maurizio D'Amico
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Delio Tedeschi
- Interventional Cardiology, Istituto clinico Sant'anna, Brescia, Italy
| | - Ferdinando Varbella
- Department of Cardiology, Infermi Hospital, Rivoli, Italy.,Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Thomas Luscher
- Division of Cardiology, Universityspirtal of Zurich, Zürich, Switzerland
| | - Imad Sheiban
- Interventional Cardiology, Pederzoli Hospital Peschiera del Garda, Verona, Italy
| | - Javier Escaned
- Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | - Mauro Rinaldi
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
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Ojeda S, Luque A, Pan M, Bellini B, Xenogiannis I, Lostalo A, Montorfano M, Hidalgo F, Venuti G, La Manna A, Carlino M, Brilakis ES, Azzalini L. Percutaneous coronary intervention in aorto-ostial coronary chronic total occlusion: outcomes and technical considerations in a multicenter registry. ACTA ACUST UNITED AC 2020; 73:1011-1017. [PMID: 32146121 DOI: 10.1016/j.rec.2020.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 01/15/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES Percutaneous coronary intervention (PCI) for aorto-ostial chronic total coronary occlusion (CTO) can be a particularly challenging lesion subset. The aim of this study was to analyze the technical aspects and outcomes of aorto-ostial CTO PCI in a multicenter registry. METHODS Patients undergoing aorto-ostial CTO PCI at 4 centers between February 2013 and December 2018 were included. Success rates, as well as procedural aspects and outcomes, were analyzed. RESULTS A total of 103 patients were included. Mean age was 64±10 years and the mean J-CTO score was 3.1±1.1. Thirty-one lesions (30.4%) were flush ostial CTOs. Technical and procedural success were achieved in 79 (76.7%) and 78 (75.7%) of the patients, respectively. The retrograde approach was the most frequent successful crossing technique (n=49; 62.0%), especially in flush vs nonflush aorto-ostial CTOs (82.6% vs 53.5%; P=.02). The only variable independently associated with technical failure was the absence of interventional collaterals (OR, 12.38; 95%CI, 4.02-38.15; P <.001). Coronary perforation occurred in 4 patients (3.9%) requiring covered stent implantation (without subsequent cardiac tamponade) and 2 patients (1.9%) had a stroke (one of which was a transient ischemic attack). During a median follow-up of 31 months, 3 (2.9%) patients died from cardiovascular causes and 13 (12.6%) required repeat target vessel revascularization. CONCLUSIONS Aorto-ostial occlusions represent a challenging subset for PCI. However, an acceptable success rate with favorable outcomes during follow-up can be achieved by experienced operators. The presence of interventional collaterals allowing the use of the retrograde approach is key for achieving procedural success.
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Affiliation(s)
- Soledad Ojeda
- Departamento de Cardiología, Hospital Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.
| | - Aurora Luque
- Departamento de Cardiología, Hospital Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Manuel Pan
- Departamento de Cardiología, Hospital Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Barbara Bellini
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Iosif Xenogiannis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, United States
| | - Adrián Lostalo
- Departamento de Cardiología, Hospital Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Matteo Montorfano
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Francisco Hidalgo
- Departamento de Cardiología, Hospital Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Giuseppe Venuti
- Division of Cardiology, A.O.U. "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - Alessio La Manna
- Division of Cardiology, A.O.U. "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - Mauro Carlino
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, United States
| | - Lorenzo Azzalini
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy; Cardiac Catheterization Laboratory, The Mount Sinai Hospital, New York, NY, United States
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D'Ascenzo F, Barbero U, Abdirashid M, Trabattoni D, Boccuzzi G, Ryan N, Quadri G, Capodanno D, Venuti G, Muscoli S, Tomassini F, Autelli M, Montabone A, Wojakowski W, Rognoni A, Gallo D, Parma R, De Luca L, Figini F, Mitomo S, Montefusco A, Mattesini A, Wańha W, Protasiewicz M, Smolka G, Huczek Z, Rolfo C, Cortese B, Chieffo A, Kuliczowki W, Nuñez-Gil I, Morbiducci U, Ugo F, Marengo G, Iannaccone M, Cerrato E, Mario CD, Moretti C, D'Amico M, Varbella F, Lüscher TF, Sheiban I, Escaned J, Romeo F, Rinaldi M, De Ferrari GM, Helft G. Incidence of Adverse Events at 3 Months Versus at 12 Months After Dual Antiplatelet Therapy Cessation in Patients Treated With Thin Stents With Unprotected Left Main or Coronary Bifurcations. Am J Cardiol 2020; 125:491-499. [PMID: 31889527 DOI: 10.1016/j.amjcard.2019.10.058] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 11/29/2022]
Abstract
Incidence and predictors of adverse events after dual antiplatelet therapy (DAPT) cessation in patients treated with thin stents (<100 microns) in unprotected left main (ULM) or coronary bifurcation remain undefined. All consecutive patients presenting with a critical lesion of an ULM or involving a main coronary bifurcation who were treated with very thin strut stents were included. MACE (a composite end point of cardiovascular death, myocardial infarction [MI], target lesion revascularization [TLR], and stent thrombosis [ST]) was the primary endpoint, whereas target vessel revascularization (TVR) was the secondary endpoint, with particular attention to type and occurrence of ST and occurrence of ST, CV death, and MI during DAPT or after DAPT discontinuation. All analyses were performed according to length of DAPT dividing the patients in 3 groups: Short DAPT (3-months), intermediate DAPT (3 to 12 months), and long DAPT (12-months). A total of 117 patients were discharged with an indication for DAPT ≤3 months (median 1: 1 to 2.5), 200 for DAPT between 3 and 12 months (median 8: 7 to 10), and 1,958 with 12 months DAPT. After 12.8 months (8 to 20), MACE was significantly higher in the 3-month group compared with 3 to 12 and 12-month groups (9.4% vs 4.0% vs 7.2%, p ≤0.001), mainly driven by MI (4.4% vs 1.5% vs 3%, p ≤0.001) and overall ST (4.3% vs 1.5% vs 1.8%, p ≤0.001). Independent predictors of MACE were low GFR and a 2 stent strategy. Independent predictors of ST were DAPT duration <3 months and the use of a 2-stent strategy. In conclusion, even stents with very thin strut when implanted in real-life ULM or coronary bifurcation patients discharged with short DAPT have a relevant risk of ST, which remains high although not significant after DAPT cessation.
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Affiliation(s)
- Fabrizio D'Ascenzo
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy; Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan; Division of Cardioloy, Universityspirtal of Zürich, Zürich, Switzerland
| | - Umberto Barbero
- Ospedale Civile SS. Annunziata, Savigliano, Italiy, Via Ospedali, 9, 12038
| | - Mohamed Abdirashid
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy.
| | - Daniela Trabattoni
- Department of Cardiovascular Sciences, IRCCS Centro Cardiologico Monzino, Milan, Italy; University of Milan, Milan, Italy
| | | | - Nicola Ryan
- Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | - Giorgio Quadri
- Department of Cardiology, Infermi Hospital, Rivoli, Italy; Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Davide Capodanno
- Division of Cardiology, Cardio-Thoracic-Vascular Department, Azienda Ospedaliero Universitaria "Policlinico-Vittorio Emanuele," Catania, Italy
| | - Giuseppe Venuti
- Division of Cardiology, Cardio-Thoracic-Vascular Department, Azienda Ospedaliero Universitaria "Policlinico-Vittorio Emanuele," Catania, Italy
| | - Saverio Muscoli
- San Raffaele Scientific Institute, Milan, Italy; Department of Medicine, Università degli Studi di Roma 'Tor Vergata', Rome, Italy
| | - Francesco Tomassini
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Michele Autelli
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Andrea Montabone
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | | | - Andrea Rognoni
- Coronary Care Unit and Catheterization laboratory, A.O.U. Maggiore della Carità, Novara, Italy
| | - Diego Gallo
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, and Royal Brompton and Harefield Hospital Trust and Imperial College, London, United Kingdom
| | | | - Leonardo De Luca
- Division of Cardiology, S. Giovanni Evangelista Hospital, Tivoli, Italy
| | | | - Satoru Mitomo
- San Raffaele Scientific Institute, Milan, Italy; Department of Medicine, Università degli Studi di Roma 'Tor Vergata', Rome, Italy
| | - Antonio Montefusco
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Alessio Mattesini
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Wojciech Wańha
- Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Marcin Protasiewicz
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Grzegorz Smolka
- Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | | | - Cristina Rolfo
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Bernardo Cortese
- Interventional Cardiology, ASST Fatebenefratelli-Sacco, Milano, Italy
| | | | - Wiktor Kuliczowki
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Ivan Nuñez-Gil
- Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | - Umberto Morbiducci
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, and Royal Brompton and Harefield Hospital Trust and Imperial College, London, United Kingdom
| | - Fabrizio Ugo
- Dipartimento di Cardiologia, Ospedale San Giovanni Bosco, Italy
| | - Giorgio Marengo
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Mario Iannaccone
- Ospedale Civile SS. Annunziata, Savigliano, Italiy, Via Ospedali, 9, 12038
| | - Enrico Cerrato
- Department of Cardiology, Infermi Hospital, Rivoli, Italy; Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Carlo di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Claudio Moretti
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Maurizio D'Amico
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Ferdinando Varbella
- Department of Cardiology, Infermi Hospital, Rivoli, Italy; Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Thomas F Lüscher
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | | | - Javier Escaned
- Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | - Francesco Romeo
- Department of Medicine, Università degli Studi di Roma 'Tor Vergata', Rome, Italy
| | - Mauro Rinaldi
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Gerard Helft
- Pierre and Marie Curie University, Paris, France
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20
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La Manna A, D'Agosta G, Venuti G, Tamburino C. Cracking the Plaque With Coronary Lithotripsy: Mechanistic Insights From Optical Coherence Tomography. J Invasive Cardiol 2020; 32:E14. [PMID: 31893507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Coronary lithoplasty is a promising technique that can overcome issues regarding the treatment of undilatable, heavily calcified, de novo, and in-stent restenotic lesions, allowing plaque modification and successful stent deployment, as demonstrated by intravascular imaging.
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Affiliation(s)
- Alessio La Manna
- Division of Cardiology - CAST, Policlinico Hospital, via S. Sofia 78, 95123 Catania, Italy.
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21
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Iannaccone M, D'Ascenzo F, Gallone G, Mitomo S, Parma R, Trabattoni D, Ryan N, Muscoli S, Venuti G, Montabone A, De Lio F, Zaccaro L, Quadri G, De Filippo O, Wojakowski W, Rognoni A, Helft G, Gallo D, De Luca L, Figini F, Imori Y, Conrotto F, Boccuzzi G, Mattesini A, Wańha W, Smolka G, Huczek Z, Rolfo C, Pennone M, Cortese B, Capodanno D, Chieffo A, Nuñez-Gil I, Morbiducci U, D'Amico M, Varbella F, Romeo F, Sheiban I, Escaned J, Garbo R, Moretti C, di Mario C, De Ferrari GM. Impact of structural features of very thin stents implanted in unprotected left main or coronary bifurcations on clinical outcomes. Catheter Cardiovasc Interv 2019; 96:1-9. [PMID: 31860158 DOI: 10.1002/ccd.28667] [Citation(s) in RCA: 10] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 10/24/2019] [Accepted: 12/08/2019] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To evaluate the independent clinical impact of stent structural features in a large cohort of patients undergoing unprotected left main (ULM) or coronary bifurcation percutaneous coronary intervention (PCI) with a range of very thin strut stents. BACKGROUND Clinical impact of structural features of contemporary stents remains to be defined. METHODS All consecutive patients enrolled in the veRy thin stents for patients with left mAIn or bifurcatioN in real life (RAIN) registry were included. The following stent structural features were studied: antiproliferative drugs (everolimus vs. sirolimus vs. zotarolimus), strut material (platinum-chromium vs. cobalt-chromium), polymer (bioresorbable vs. durable), number of crowns (<8 vs. ≥8) and number of connectors (<3 vs. ≥3). For small diameter stents (≤2.5 mm), struct thickness (74 vs. 80/81 μm) was also tested. Target lesion failure (TLF), a composite of target lesion revascularization and stent thrombosis, was the primary endpoint. Multivariate analysis was performed with Cox regression models. RESULTS Out of 2,707 patients, 110 (4.1%) experienced a TLF event after 16 months (12-18). After adjustment for confounders, an increased number of connectors (adjusted hazard ratio [adj-HR] 0.62, 95% confidence interval (CI) 0.39-0.99, p = .04) reduced risk of TLF, driven by stents with ≥2.5 mm diameter (HR 0.54, 95% CI 0.32-0.93, p = .02). This independent relationship was lost for stents with diameter <2.5 mm, where only strut thickness appeared to impact. Conversely, no independent relationship of polymer type, number of crowns, and the specific limus-family eluted drug with outcomes was observed. CONCLUSIONS Among a range of contemporary very thin stent models, an increased number of connectors improved device-related outcomes in this investigated high-risk procedural setting.
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Affiliation(s)
- Mario Iannaccone
- Division of Cardiology, SS. Annunziata Hospital, Savigliano, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Guglielmo Gallone
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Satoru Mitomo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Hospital, Milan, Italy
| | - Radosław Parma
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Daniela Trabattoni
- Department of Cardiovascular Sciences, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Nicola Ryan
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Saverio Muscoli
- Department of Cardiovascular Disease, Tor Vergata University of Rome, Rome, Italy
| | - Giuseppe Venuti
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | | | - Francesca De Lio
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Lorenzo Zaccaro
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Giorgio Quadri
- Department of Cardiology, Infermi Hospital, Rivoli, Italy
| | - Ovidio De Filippo
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Andrea Rognoni
- Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Novara, Italy
| | - Gerard Helft
- Pierre and Marie Curie University, Paris, France
| | - Diego Gallo
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Leonardo De Luca
- Division of Cardiology, S. Giovanni Evangelista Hospital, Tivoli, Italy
| | | | - Yoichi Imori
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Federico Conrotto
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | | | - Alessio Mattesini
- Division of Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Wojciech Wańha
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Grzegorz Smolka
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | - Cristina Rolfo
- Department of Cardiology, Infermi Hospital, Rivoli, Italy
| | - Mauro Pennone
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Bernardo Cortese
- Interventional Cardiology Unit, ASST Fatebenefratelli-Sacco, 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
| | - Ivan Nuñez-Gil
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Umberto Morbiducci
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Maurizio D'Amico
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | | | - Francesco Romeo
- Department of Medicine, Università degli Studi di Roma 'Tor Vergata', Rome, Italy
| | | | - Javier Escaned
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Roberto Garbo
- Department of Cardiology, S.G. Bosco Hospital, Torino, Italy
| | - Claudio Moretti
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Carlo di Mario
- Division of Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Gaetano M De Ferrari
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
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Poletti E, Azzalini L, Ayoub M, Ojeda S, Zivelonghi C, La Manna A, Bellini B, Lostalo A, Luque A, Venuti G, Montorfano M, Agostoni P, Pan M, Carlino M, Mashayekhi K. Conventional vascular access site approach versus fully trans-wrist approach for chronic total occlusion percutaneous coronary intervention: a multicenter registry. Catheter Cardiovasc Interv 2019; 96:E45-E52. [PMID: 31596537 DOI: 10.1002/ccd.28513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 04/02/2019] [Revised: 08/01/2019] [Accepted: 09/17/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To evaluate the incidence of vascular complication and major bleeding in patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI) with a fully trans-wrist access (TWA) approach versus a conventional approach based on trans-femoral access (TFA). BACKGROUND TFA is the preferred vascular access in CTO PCI, but it has been associated with a non-negligible risk of complications. METHODS This retrospective registry included all patients undergoing CTO PCI at five institutions between July 2011 and October 2018. Patients were divided into two groups: Conventional (patients treated with at least one TFA) and Fully TWA (subjects exclusively treated with one or two TWA). The primary safety endpoint was a composite of vascular complications and major bleeding. The primary efficacy endpoint was procedural success. RESULTS We included 1,900 patients (Conventional n = 1,496 and Fully TWA n = 404). Conventional patients showed higher occlusion complexity (J-CTO score 2.1 ± 1.2 vs. 1.5 ± 1.1, p < .001). Procedural success showed no significant difference between both groups (85.7 vs. 83.0%, p = .17). The primary safety endpoint occurred more frequently in the Conventional group (10.3 vs. 4.5%, p < .001), driven by vascular complications (9.4 vs. 3.7%, p < .001). On multivariate analysis, not using a Fully TWA approach was an independent predictor of the study endpoint, after adjusting for age, sex, diabetes, body mass index, chronic kidney disease, prior coronary artery bypass graft, and J-CTO score. CONCLUSIONS Embracing a Fully TWA approach for CTO PCI might be associated with lower incidence of a composite endpoint of vascular complications and major bleeding, compared with a Conventional approach.
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Affiliation(s)
- Enrico Poletti
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Azzalini
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Mohamed Ayoub
- Department of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Germany
| | - Soledad Ojeda
- Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
| | - Carlo Zivelonghi
- Hartcentrum, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Alessio La Manna
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Barbara Bellini
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Adrián Lostalo
- Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
| | - Aurora Luque
- Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
| | - Giuseppe Venuti
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Matteo Montorfano
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | | | - Manuel Pan
- Division of Interventional Cardiology, Reina Sofia Hospital, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
| | - Mauro Carlino
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Kambis Mashayekhi
- Department of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Germany
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23
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Azzalini L, Poletti E, Ayoub M, Ojeda S, Zivelonghi C, La Manna A, Bellini B, Lostalo A, Luque A, Venuti G, Montorfano M, Agostoni P, Pan M, Carlino M, Mashayekhi K. Coronary artery perforation during chronic total occlusion percutaneous coronary intervention: epidemiology, mechanisms, management, and outcomes. EUROINTERVENTION 2019; 15:e804-e811. [DOI: 10.4244/eij-d-19-00282] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [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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24
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Azzalini L, Ayoub M, Ojeda S, Zivelonghi C, La Manna A, Bellini B, Lostalo A, Luque A, Venuti G, Montorfano M, Agostoni P, Pan M, Carlino M, Mashayekhi K. TCT-248 Coronary Artery Perforation During Chronic Total Occlusion Percutaneous Coronary Intervention: Epidemiology, Mechanisms, Management, and Outcomes. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25
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Corallo F, Bonanno L, Di Cara M, Rifici C, Sessa E, D’Aleo G, Lo Buono V, Venuti G, Bramanti P, Marino S. Therapeutic adherence and coping strategies in patients with multiple sclerosis: An observational study. Medicine (Baltimore) 2019; 98:e16532. [PMID: 31335734 PMCID: PMC6709257 DOI: 10.1097/md.0000000000016532] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic demyelinating autoimmune disorder affecting the central nervous system and targets the myelin sheaths around nerves. Local problem: Medical advances have enabled patients to lead a better quality of life (QoL) than before. However, because of its chronicity and unpredictability, it remains a very challenging disease for both patients and their families, as it involves the continued use of medication to slow down progression. The aim of this study is to assess drug adherence in patients with MS. In particular, we will examine how the way drugs are administered (oral or injective) affects compliance with therapy, including the correlation with coping strategies and the QoL of each patient.We enrolled 88 patients with MS, divided into 2 groups according to therapy (injective or oral). The Morisky Medication Adherence scale was administered to evaluate adherence to treatment, the MS QoL 54 to estimate mental and physical health, and Brief coping orientation to problems experienced Inventory for coping strategies.The results showed that in both groups the patients showed a good therapeutic alliance and trust in treatment. In particular, a correlation has been found between therapeutic adherence, adaptive coping strategies, and mental health when drug therapy is administered by injection. In conclusion, this result suggests that for patients receiving injection treatment to have greater adherence to therapy, appropriate coping strategies and good mental health must be developed in order for patients receiving injection therapy to have greater adherence to therapy; they need to develop appropriate coping strategies and good mental health to address this mode of administration successfully.
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Pereira GTR, La Manna A, Ichibori Y, Vergara-Martel A, Ramos Nascimento B, Samdani AJ, Capodanno D, D'Agosta G, Gravina G, Venuti G, Tamburino C, F Attizzani G. Optical coherence tomography evaluation of the absorb bioresorbable scaffold performance for overlap versus non-overlap segments in patients with coronary chronic total occlusion: insight from the GHOST-CTO registry. Int J Cardiovasc Imaging 2019; 35:1767-1776. [PMID: 31175527 DOI: 10.1007/s10554-019-01636-3] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 05/27/2019] [Indexed: 01/18/2023]
Abstract
The Absorb bioresorbable vascular scaffold (BVS) promised to avoid some of the disadvantages of its metal predecessors. Even though it has been taken off the market, limited data is available about its use in coronary chronic total occlusion (CTO) and its performance in overlap segments, which would be of special research interest due to its large thickness. This data is still pertinent since the platform of bioresorbable devices has not been abandoned, with several companies working on it. We aimed to compare healing and performance between overlap (OL) and non-overlap regions (NOL) of CTO lesions treated with BVS, using optical coherence tomography (OCT). Fourteen patients with overlapping BVS were included from the GHOST-CTO registry, resulting in 25 OL and 38 NOL regions. OCT based parameters were compared between OL and NOL groups at baseline (post-implantation) and 12-month follow-up. The mean age was 61.7 ± 7.2 years and 12 (86%) were males. Twelve (86%) patients underwent PCI for stable coronary artery disease and 2 (14%) had unstable angina. At 12-month follow-up, mean lumen area decreased in both NOL and OL regions, but the decrease was significantly larger in the OL region (NOL - 0.7 ± 1.33 vs. OL - 2.4 ± 1.54 mm2; p = 0.002). Mean scaffold area increased in both regions, but increased significantly more in NOL ( + 1.1 ± 1.54 vs. + 0.4 ± 1.16 mm2; p = 0.016). The percent of uncovered struts was lower in the OL group (5.0 ± 6.6% vs. 3.75 ± 8.7%, p = 0.043), whereas the percentage of malapposed struts was similar (0.3 ± 0.5% vs. 0.7 ± 2.3%, p = 0.441). Neointimal hyperplasia (NIH) was more pronounced in the OL region (0.13 ± 0.04 vs. 0.24 ± 0.10 mm2, p = 0.001). The OL and NOL segments showed comparable healing in terms of coverage and malapposition. However, NIH was more prominent in OL region. The long-term clinical implications of these findings needs further evaluation. The present study provides important insights for future development of BVS technology.
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Affiliation(s)
- Gabriel T R Pereira
- Case Western Reserve University and Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center, Cleveland, USA. .,Cardiovascular Imaging Core Laboratory, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside building, Room 3113, Mailstop Lakeside 5038, Cleveland, OH, 44106, USA.
| | - Alessio La Manna
- Cardio-Thoracic-Vascular Department, Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - Yasuhiro Ichibori
- Case Western Reserve University and Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center, Cleveland, USA
| | - Armando Vergara-Martel
- Case Western Reserve University and Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center, Cleveland, USA
| | | | - Abdul Jawwad Samdani
- Case Western Reserve University and Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center, Cleveland, USA
| | - Davide Capodanno
- Cardio-Thoracic-Vascular Department, Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - Guido D'Agosta
- Cardio-Thoracic-Vascular Department, Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - Giacomo Gravina
- Cardio-Thoracic-Vascular Department, Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - Giuseppe Venuti
- Cardio-Thoracic-Vascular Department, Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - Corrado Tamburino
- Cardio-Thoracic-Vascular Department, Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - Guilherme F Attizzani
- Case Western Reserve University and Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center, Cleveland, USA. .,Cardiovascular Imaging Core Laboratory, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside building, Room 3113, Mailstop Lakeside 5038, Cleveland, OH, 44106, USA.
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D'Ascenzo F, Omedè P, De Filippo O, Cerrato E, Autelli M, Trabattoni D, Ryan N, Venuti G, Muscoli S, Montabone A, Wojakowski W, Rognoni A, Helft G, Gallo D, Parma R, De Luca L, Figini F, Mitomo S, Boccuzzi G, Mattesini A, Wańha W, Smolka G, Huczek Z, Cortese B, Sheiban I, Escaned J, Biolè C, Conrotto F, Templin C, Quadri G, Rolfo C, Capodanno D, Chieffo A, Nuñez-Gil I, Morbiducci U, Iannaccone M, Gili S, Mario CD, Moretti C, D'Amico M, Varbella F, Romeo F, Lüscher TF. Impact of Final Kissing Balloon and of Imaging on Patients Treated on Unprotected Left Main Coronary Artery With Thin-Strut Stents (From the RAIN-CARDIOGROUP VII Study). Am J Cardiol 2019; 123:1610-1619. [PMID: 30846212 DOI: 10.1016/j.amjcard.2019.02.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/06/2019] [Accepted: 02/13/2019] [Indexed: 11/25/2022]
Abstract
Few data are available about the impact on outcomes of procedural strategies for percutaneous coronary intervention with thin-struts stents on unprotected left main (ULM): 792 patients with an ULM stenosis treated with percutaneous coronary intervention with thin-strut stents were enrolled in the present multicenter registry. Target lesion revascularization (TLR) was the primary end point. MACE (a composite of all-cause death, myocardial infarction, TLR, and stent thrombosis) and its single components, along with target vessel revascularization were the secondary end points. Subgroup analyses were performed according to complex versus noncomplex bifurcation lesions. After 16 months, 5.5% of patients experienced a TLR. At multivariate analysis, provisional stenting (odds ratio [OR] 0.46: 0.85 to 0.23, p = 0.006), use of imaging (OR 0.45: 0.23 to 0.98, p = 0.003) and final kissing balloon (FKB) (OR 0.41: 0.83 to 0.21, p = 0.001) reduced risk of TLR. FKB reduced risk of overall TLR only for 2 stents-strategy (6.2% vs 32.4%, p <0.05), but not for provisional strategy (3.8% vs 3.7%, p = 0.67). Intracoronary imaging reduced risk of overall TLR both for provisional (2.2% vs 5.4%) and for 2-stents strategy (7.3% vs 14.1% p <0.05 for both, all confidence interval 95%). In conclusion, TLR for ULM patients treated with thin-strut stents is infrequent. Provisional stenting was noninferior compared with 2-stents apart from complex lesions. Benefit from intracoronary imaging is consistent for different strategies, whereas that from FKB persists only for 2-stents.
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Venuti G, D'Agosta G, Tamburino C, La Manna A. Coronary lithotripsy for failed rotational atherectomy, cutting balloon, scoring balloon, and ultra‐high‐pressure non‐compliant balloon. Catheter Cardiovasc Interv 2019; 94:E111-E115. [DOI: 10.1002/ccd.28287] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/20/2019] [Accepted: 04/05/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Giuseppe Venuti
- Division of CardiologyC.A.S.T., Azienda Ospedaliero‐Universitaria “Policlinico‐ Vittorio Emanuele,” University of Catania Catania Italy
| | - Guido D'Agosta
- Division of CardiologyC.A.S.T., Azienda Ospedaliero‐Universitaria “Policlinico‐ Vittorio Emanuele,” University of Catania Catania Italy
| | - Corrado Tamburino
- Division of CardiologyC.A.S.T., Azienda Ospedaliero‐Universitaria “Policlinico‐ Vittorio Emanuele,” University of Catania Catania Italy
| | - Alessio La Manna
- Division of CardiologyC.A.S.T., Azienda Ospedaliero‐Universitaria “Policlinico‐ Vittorio Emanuele,” University of Catania Catania Italy
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Biolè C, Huczek Z, Nuñez-Gil I, Boccuzzi G, Autelli M, Montefusco A, Trabattoni D, Ryan N, Venuti G, Imori Y, Takano H, Matsuda J, Shimizu W, Muscoli S, Montabone A, Wojakowski W, Rognoni A, Helft G, Gallo D, Parma R, De Luca L, Figini F, Mitomo S, Pennone M, Mattesini A, Templin C, Quadri G, Wańha W, Cerrato E, Smolka G, Protasiewicz M, Kuliczkowski W, Rolfo C, Cortese B, Capodanno D, Chieffo A, Morbiducci U, Iannaccone M, Gili S, di Mario C, D'Amico M, Romeo F, Lüscher TF, Sheiban I, Escaned J, Varbella F, D'Ascenzo F. Daily risk of adverse outcomes in patients undergoing complex lesions revascularization: A subgroup analysis from the RAIN-CARDIOGROUP VII study (veRy thin stents for patients with left mAIn or bifurcatioN in real life). Int J Cardiol 2019; 290:64-69. [PMID: 30971372 DOI: 10.1016/j.ijcard.2019.03.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 09/27/2018] [Revised: 02/13/2019] [Accepted: 03/18/2019] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Percutaneous coronary intervention (PCI) for complex lesions, including unprotected left main (ULM) and bifurcations, is gaining a relevant role in treating coronary artery disease with good outcomes, also thanks to new generation stents. The daily risk of adverse cardiovascular events and their temporal distribution after these procedures is not known. METHODS All consecutive patients presenting with a critical lesion of ULM or bifurcation treated with very thin struts stents, enrolled in the RAIN-Cardiogroup VII study, were analyzed. The daily risk of major acute cardiovascular events (MACE), target lesion revascularization (TLR) and stent thrombosis (ST) and their temporal distribution in the first year of follow-up was the primary endpoint. Differences among subgroups (ULM, patient presentation, kind of stent polymer) were the secondary endpoint. RESULTS 2745 patients were included, mean age 68 ± 11 years, 33.3% diabetics, 54.5% had an acute coronary syndrome (ACS); 88.5% of treated lesions were bifurcations, 27.2% ULM. Average daily risk was 0.022% for MACE, 0.005% for TLR and 0.004% for ST, in the first year. Bimodal distribution of adverse events, especially TLR, with an early peak in the first 50 days and a late one after 150 days, was observed. Patients with ULM presented a significantly higher daily risk of events, and ACS patients presented higher MACE risk. No difference emerged according to the type of stent polymer. CONCLUSIONS The daily risk of adverse events in the first year after complex PCI in our study is acceptably low. PCI on ULM carries a higher risk of complications.
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Affiliation(s)
- Carloalberto Biolè
- Division of Cardiology, Departement of Internal Medicine, Città della Salute e della Scienza, Turin, Italy.
| | | | - Ivan Nuñez-Gil
- Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | | | - Michele Autelli
- Division of Cardiology, Departement of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Antonio Montefusco
- Division of Cardiology, Departement of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Daniela Trabattoni
- Department of Cardiovascular Sciences, IRCCS Centro Cardiologico Monzino, Milan, Italy; University of Milan, Milan, Italy
| | - Nicola Ryan
- Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | - Giuseppe Venuti
- Division of Cardiology, Cardio-Thoracic-Vascular Department, Azienda Ospedaliero Universitaria "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Yoichi Imori
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, Japan
| | - Hitoshi Takano
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, Japan
| | - Junya Matsuda
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, Japan
| | - Saverio Muscoli
- San Raffaele Scientific Institute, Milan, Italy; Department of Medicine, Università degli Studi di Roma 'Tor Vergata', Rome, Italy
| | - Andrea Montabone
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | | | - Andrea Rognoni
- Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Novara, Italy
| | - Gerard Helft
- Pierre and Marie Curie University, Paris, France
| | - Diego Gallo
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Italy
| | | | - Leonardo De Luca
- Division of Cardiology, S. Giovanni Evangelista Hospital, Tivoli, Rome, Italy
| | | | | | - Mauro Pennone
- Division of Cardiology, Departement of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Alessio Mattesini
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | | | - Giorgio Quadri
- Department of Cardiology, Infermi Hospital, Rivoli, Italy; Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Wojciech Wańha
- Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Enrico Cerrato
- Department of Cardiology, Infermi Hospital, Rivoli, Italy; Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Grzegorz Smolka
- Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | | | | | - Cristina Rolfo
- Department of Cardiology, Infermi Hospital, Rivoli, Italy; Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Bernardo Cortese
- Interventional Cardiology, ASST Fatebenefratelli-Sacco, Milano, Italy
| | - Davide Capodanno
- Division of Cardiology, Cardio-Thoracic-Vascular Department, Azienda Ospedaliero Universitaria "Policlinico-Vittorio Emanuele", Catania, Italy
| | | | - Umberto Morbiducci
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Italy
| | - Mario Iannaccone
- Division of Cardiology, Departement of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Sebastiano Gili
- Division of Cardiology, Universityszpital of Zurich, Switzerland
| | - Carlo di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Maurizio D'Amico
- Division of Cardiology, Departement of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Francesco Romeo
- Department of Medicine, Università degli Studi di Roma 'Tor Vergata', Rome, Italy
| | - Thomas F Lüscher
- Division of Cardiology, Universityszpital of Zurich, Switzerland
| | | | - Javier Escaned
- Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | - Ferdinando Varbella
- Department of Cardiology, Infermi Hospital, Rivoli, Italy; Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Departement of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
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Azzalini L, Ojeda S, Demir OM, Dens J, Tanabe M, La Manna A, Benincasa S, Bellini B, Poletti E, Maccagni D, Hidalgo F, Chavarría J, Maeremans J, Gravina G, Miccichè E, D’Agosta G, Venuti G, Tamburino C, Pan M, Carlino M, Colombo A. Recanalization of Chronic Total Occlusions in Patients With vs Without Chronic Kidney Disease: The Impact of Contrast-Induced Acute Kidney Injury. Can J Cardiol 2018; 34:1275-1282. [DOI: 10.1016/j.cjca.2018.07.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 07/14/2018] [Accepted: 07/15/2018] [Indexed: 12/31/2022] Open
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Azzalini L, Candilio L, Ojeda S, Dens J, La Manna A, Benincasa S, Bellini B, Hidalgo F, Chavarría J, Maeremans J, Gravina G, Miccichè E, D'Agosta G, Venuti G, Tamburino C, Pan M, Carlino M, Colombo A. Impact of Incomplete Revascularization on Long-Term Outcomes Following Chronic Total Occlusion Percutaneous Coronary Intervention. Am J Cardiol 2018; 121:1138-1148. [PMID: 29563016 DOI: 10.1016/j.amjcard.2018.01.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 01/20/2018] [Accepted: 01/30/2018] [Indexed: 11/25/2022]
Abstract
We aimed to evaluate the impact of incomplete revascularization (ICR) on long-term outcomes of patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Consecutive patients undergoing CTO PCI at 4 centers were included. Baseline SYNTAX score (bSS: low [≤ 22], intermediate [>22 and <33], high [≥33]), residual SYNTAX score (rSS: 0, >0 and ≤8, >8), and SYNTAX revascularization index (SRI: 100 × (bSS-rSS)/bSS: 100%, 50% to 99%, <50%) were calculated. The primary end point was major adverse cardiac events (MACEs; cardiac death, any myocardial infarction, any revascularization) on follow-up. Multivariable Cox regression analysis was conducted to identify predictors of MACEs. Overall, 686 patients were included (low bSS: n = 437; intermediate bSS: n = 187; high bSS: n = 62). Occlusion complexity, crossing strategies, and procedural success rates were similar across groups. The degree of ICR increased with higher bSS categories (rSS was 2.5 ± 4.7 in low vs 6.2 ± 9.3 in intermediate vs 9.1 ± 12.2 in high bSS, p <0.001). The SRI followed a similar pattern. Median follow-up was 781 (369 to 1,217) days. Three-year MACE rates increased with higher bSS and rSS, and decreasing SRI categories (bSS: low 19.4% vs intermediate 25.9% vs high 33.3%, p = 0.02), which was driven by a higher incidence of repeat revascularization. Compared with an rSS = 0, both an rSS >0 and ≤8 (hazard ratio 2.06, p = 0.004) and an rSS >8 (hazard ratio 3.19, p <0.001) were independent predictors of MACEs. Similar findings were observed when the SRI was entered in a separate model. In conclusion, even a mild degree of ICR is associated with a higher incidence of MACEs on long-term follow-up after CTO PCI.
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Azzalini L, Ojeda S, Karatasakis A, Maeremans J, Tanabe M, La Manna A, Dautov R, Ybarra LF, Benincasa S, Bellini B, Candilio L, Demir OM, Hidalgo F, Karacsonyi J, Gravina G, Miccichè E, D'Agosta G, Venuti G, Tamburino C, Pan M, Carlino M, Dens J, Brilakis ES, Colombo A, Rinfret S. Long-Term Outcomes of Percutaneous Coronary Intervention for Chronic Total Occlusion in Patients Who Have Undergone Coronary Artery Bypass Grafting vs Those Who Have Not. Can J Cardiol 2018; 34:310-318. [DOI: 10.1016/j.cjca.2017.12.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 12/19/2017] [Accepted: 12/19/2017] [Indexed: 10/18/2022] Open
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Di Bella G, Pizzino F, Aquaro GD, Piaggi P, Venuti G, Carerj S, Pingitore A. High-risk patients with mild-moderate left ventricular dysfunction after a previous myocardial infarction. A long-term prognostic data by cardiac magnetic resonance. Int J Cardiol 2017; 245:13-19. [PMID: 28757089 DOI: 10.1016/j.ijcard.2017.07.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 07/15/2017] [Accepted: 07/18/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Few studies have explored prognosis in patients with previous myocardial infarction (MI) with mild-moderate (MM) left ventricular (LV) dysfunction (D). The aim of our study was to investigate whether combining LV parameters obtained by cardiac magnetic resonance (CMR) improves risk stratification of patients with previous MI and MM-LV-D. METHODS In 418 consecutive patients (63.3±11.3years old, female 12.9%) with previous MI, we quantified LVEF, volumes and wall motion score index (WMSI) and measured the infarct extent by late gadolinium enhancement (LGE). According to LVEF, patients were considered with normal LVEF (>55%), MM-LV-D (LVEF>30 and ≤55%) and severe (S) LV-D (LVEF ≤30). RESULTS During follow-up (median, 39.7months) cardiac events (cardiac death or appropriate intra-cardiac defibrillator shocks) occurred in 17/99 of patients with S-LV-D, in 15/201 with MM-LV-D, and in only 1/118 of those with normal LV-EF. After adjustment for age, an extent of LGE >11.3%, a dilated LV (male >112ml/m2; female >92ml/m2) and a WMSI>1.59 were associated with adverse cardiac events in patients with MM-LV-D. In patients with MM-LV-D, when each of these 3 factors was observed, the prognosis was worse respect to those with 1-2 factors and no factor (p=0.035 and p=0.004, respectively). Prognosis was similar (p=0.61) between MM-LV-D patients with all 3 factors and those with S-LV-dysfunction. CONCLUSIONS A multiparametric CMR approach, which includes LGE, dilated LV and WMSI, permits to identify post MI patients with MM-LV-D with a risk of cardiac events similar to those with S-LV-D. Further multicenter studies are needed to confirm our data.
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Affiliation(s)
- Gianluca Di Bella
- CNR Institute of Clinical Physiology, Pisa, Italy; Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Messina, Italy.
| | - Fausto Pizzino
- Fondazione Toscana G. Monasterio, CNR, Regione Toscana, Pisa, Italy; Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Messina, Italy
| | - Giovanni Donato Aquaro
- Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Messina, Italy
| | - Paolo Piaggi
- Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Pisa, Pisa, Italy
| | - Giuseppe Venuti
- Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Messina, Italy
| | - Scipione Carerj
- Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Messina, Italy
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Dastidar AG, Singhal P, Venuti G, Amadu AM, Baritussio A, Scatteia A, Garate ED, Lawton CB, Rodrigues JC, Bucciarelli-Ducci C. Cardiac magnetic resonance imaging (CMR) characteristics in apical versus non-apical hypertrophic cardiomyopathy (HCM). J Cardiovasc Magn Reson 2016. [PMCID: PMC5032699 DOI: 10.1186/1532-429x-18-s1-p269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Garate ED, Dastidar AG, Baritussio A, Scatteia A, Amadu A, Venuti G, Rodrigues JC, Bucciarelli-Ducci C. 129 Impact of Cardiovascular Magnetic Resonance on Management and Clinical Decision-Making in Acute Hospitalised Patients. Heart 2016. [DOI: 10.1136/heartjnl-2016-309890.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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De Garate E, Dastidar AG, Baritussio A, Scatteia A, Amadu A, Venuti G, Erdei T, Rodrigues J, Bucciarelli-Ducci C. 7 Clinical impact of cardiovascular magnetic resonance on the management of acutely hospitalised patients. Heart 2016. [DOI: 10.1136/heartjnl-2016-309668.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Angela S, Camaioni C, Bohnen S, Khanji MY, Hilbert S, Goetschalckx K, Calvieri C, Reinstadler SJ, Maestrini V, James S, Bastiaenen R, Reid AB, Amadu A, Pontone G, Alberto C, Manuel DL, Federico M, Francesca P, Bendetta G, Giorgio DC, Giuseppe T, Luisa C, Emanuele B, Domenico C, Sabino I, Martina PM, Morlon L, Vergé MP, Jais P, Roudaut R, Laurent F, Lafitte S, Cochet H, Réant P, Radunski UK, Lund GK, Senel M, Avanesov M, Tahir E, Stehning C, Adam G, Blankenberg S, Muellerleile K, Balawon A, Boubertakh R, Petersen SE, Spampinato R, Oebel S, Hindricks G, Bollmann A, Jahnke C, Paetsch I, Bogaert J, Desmet W, Toth A, Merkely B, Janssens S, Claus P, Preda MB, Perfetti A, Valaperta R, Secchi F, Fedele F, Martelli F, Lombardi M, Eitel C, Fuernau G, de Waha S, Desch S, Mende M, Metzler B, Schuler G, Thiele H, Eitel I, Mun HC, Kotwinski P, Rosmini S, Sanders J, Lloyd G, Dudley JP, Kellman P, Hugh EM, Manisty C, James CM, Waterhouse D, Murphy T, Kenny C, O'Hanlon R, Cox AT, Wijeyeratne Y, Colbeck N, Pakroo N, Ahmed H, Bunce N, Anderson L, Prasad S, Sharma S, Behr ER, Miller C, Jovanovic A, Woolfson P, Abidin N, Schmitt M, Rodrigues J, Dastidar AG, Baritussio A, Lawton C, Venuti G, Meloni G, Conti M, Bucciarelli-Ducci C, Andreini D, SoLbiati A, Guglielmo M, Mushtaq S, Baggiano A, Beltrama V, Rota C, Guaricci AI, Pepi M. ORAL AB QUICK FIRE I1496Myocardial substrates underlyng early ventricular arrhythmias in st-elevation acute myocardial infarction: the role of cardiac magnetic resonance1416Cardiac magnetic resonance predicts atrial fibrillation occurrence in patients with hypertrophic cardiomyopathy1469T1 and T2 mapping cardiovascular magnetic resonance to monitor inflammatory activity in patients with myocarditis1480Impact of electronic coaching on cardiovascular risk reduction in a high-risk primary prevention population – A cardiovascular magnetic resonance sub-study1598Anatomical and functional evaluation of postinterventional pulmonary vein stenosis by magnetic resonance imaging1364Reduced infarct-adjacent wall thickening and impaired restperfusion in the area at risk of successfully reperfused acute myocardial infarction1580Correlation between circulating microRNA 29 and diffuse myocardial fibrosis, assessed by T1 mapping, in patients affected by non ischemic dilative cardiomyopathy1435Association of Smoking with Myocardial Injury and Clinical Outcome in Patients Undergoing Mechanical Reperfusion for ST-Elevation Myocardial Infarction1640Assessing the risk of late cardiotoxicity in low risk breast cancer survivors receiving contemporary anthracycline treatment: a 6 year 100 patient study1511Risk stratification in sarcoidosis: Incidence of cardiac sarcoidosis in individuals diagnosed with extra-cardiac disease by cardiovascular magnetic resonance1334Patterns of late gadolinium enhancement in Brugada syndrome1591Detailed Left Atrial Assessment in Anderson Fabry Disease1634Role of cardiac magnetic resonance in the diagnosis of ARVC/D mimics1321Comparison of transtlioracic ecliocardiography versus cardiac magnetic for implantable cardioverter defibrillator therapy in primary prevention strategy dilated cardiomyopathy patients: Table 1. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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De Garate E, Dastidar AG, Singhal P, Venuti G, Amadu A, Baritussio A, Scatteia A, Lawton C, Rodrigues J, Bucciarelli-Ducci C. 6 Prevalence and CMR characteristics of apical HCM: Abstract 6 Table 1. Heart 2016. [DOI: 10.1136/heartjnl-2016-309668.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gioffrè M, Micali B, Micali A, Venuti G, Giorgianni G. [Effects of surgery and anesthesia on serum immunoglobulins]. Boll Soc Ital Biol Sper 1979; 55:1747-52. [PMID: 550874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Serum immunoglobulins levels after surgery with and without anaesthesia are reported. No significant change was found after surgery without anaesthesia; significant changes of serum Ig (A,G,M) were observed in surgery with anaesthesia (60-180 m') group on day 1 following operation. This Ig decrease is probably due to a reduced immunologic response by long anaesthesia.
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