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Di Serafino L, Turturo M, Larosa C, Scalamogna M, Cirillo P, Vito Alessandro A, Lanzone S, Bartolomucci F, Granata R, Rea FS, Piccolo R, Franzone A, Gargiulo G, Spaccarotella CAM, Stabile E, Esposito G. A comparison between radial artery compression devices for patent hemostasis after transradial percutaneous interventions. J Invasive Cardiol 2024. [PMID: 38422529 DOI: 10.25270/jic/23.00302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
OBJECTIVES Patent hemostasis (PH) is essential for preventing radial artery occlusion (RAO) after trans-radial procedures; however, it remains unclear how it should be obtained. The aim of this multicenter randomized study was to evaluate whether the use of an adjustable device (AD), inflated with a pre-determined amount of air (AoA), was more effective than a non-adjustable device (non-AD) for achieving PH, thereby reducing the incidence of RAO. METHODS We enrolled a total of 480 patients undergoing transradial procedure at 3 Italian institutions. Before the procedure, a modified Reverse Barbeau Test (mRBT) was performed in all patients to evaluate the AoA to be eventually inflated in the AD. After the procedure, patients were randomized into 2 groups: (1) AD Group, using TR-Band (Terumo) inflated with the pre-determined AoA; and 2) non-AD Group, using RadiStop (Abbott). An RBT was performed during compression to demonstrate the achievement of PH, as well as 24 hours later to evaluate the occurrence of RAO. RESULTS PH was more often obtained in the AD Group compared with the non-AD Group (90% vs 64%, respectively, P less than .001), with no difference in terms of bleedings. RAO occurred more often in the non-AD Group compared with the AD Group (10% vs 3%, respectively, P less than .001). Of note, mRBT was effective at guiding AD inflation and identifying high-risk patients in whom PH was more difficult to obtain. CONCLUSIONS The use of AD, filled with a predetermined AoA, allowed PH significantly more often compared with non-AD, providing a significantly reduced incidence of RAO.
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Affiliation(s)
- Luigi Di Serafino
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
| | | | | | - Maria Scalamogna
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | | | | | - Riccardo Granata
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Francesco Saverio Rea
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Giuseppe Gargiulo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Eugenio Stabile
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy; Division of Cardiology, San Carlo Hospital, Potenza, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
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Gargiulo G, Cirillo P, Sperandeo L, Forzano I, Castiello DS, Florimonte D, Simonetti F, Paolillo R, Manzi L, Spinelli A, Spaccarotella CAM, Piccolo R, Di Serafino L, Franzone A, Capranzano P, Valgimigli M, Esposito G. Cangrelor in contemporary patients with ST-segment elevation myocardial infarction pretreated with Ticagrelor: Pharmacodynamic data from the POMPEII study. Int J Cardiol Heart Vasc 2024; 50:101344. [PMID: 38419600 PMCID: PMC10899723 DOI: 10.1016/j.ijcha.2024.101344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/12/2024] [Accepted: 01/14/2024] [Indexed: 03/02/2024]
Abstract
Background There are limited data to assess pharmacodynamic (PD) profiles of patients with STEMI undergoing primary percutaneous coronary intervention (PCI) and receiving cangrelor after pretreatment with ticagrelor. Methods The PharmacOdynaMic effects of cangrelor in PatiEnts wIth acute or chronIc coronary syndrome undergoing percutaneous coronary intervention (POMPEII) registry (NCT04790032) is a prospective study conducted at Federico II University of Naples enrolling all patients undergoing PCI receiving cangrelor at operator's discretion. PD assessments were performed with 3 assays: (1) the gold standard light transmittance aggregometry (LTA) (20- and 5-μM adenosine diphosphate [ADP] stimuli); (2) VerifyNow P2Y12-test; (3) Multiplate electrode aggregometry (MEA), ADP-test. Results We analyzed 13 STEMI patients pretreated with ticagrelor within 1 h at the time they underwent primary PCI receiving cangrelor. All patients showed low maximal platelet aggregation at 30-minute during cangrelor infusion, as well as at 3 h and 4-6 h (corresponding to 1 h and 2-4 h after stopping cangrelor infusion) with no cases of high residual platelet reactivity. These results were consistent with all assays. Conclusions PD data show that in contemporary real-world STEMI patients pretreated within 1 h with ticagrelor undergoing primary PCI, adding cangrelor resulted in fast and potent platelet inhibition, thus suggesting that cangrelor may bridge the gap until ticagrelor reaches its effect.
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Affiliation(s)
- Giuseppe Gargiulo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Luca Sperandeo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Imma Forzano
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | | | - Domenico Florimonte
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Fiorenzo Simonetti
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Roberta Paolillo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Lina Manzi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Alessandra Spinelli
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | | | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Luigi Di Serafino
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Piera Capranzano
- Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico-San Marco", University of Catania, Italy
| | - Marco Valgimigli
- Cardiocentro Institute, Ente Ospedaliero Cantonale, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
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Manzi L, Sperandeo L, Forzano I, Castiello DS, Florimonte D, Paolillo R, Santoro C, Mancusi C, Di Serafino L, Esposito G, Gargiulo G. Contemporary Evidence and Practice on Right Heart Catheterization in Patients with Acute or Chronic Heart Failure. Diagnostics (Basel) 2024; 14:136. [PMID: 38248013 PMCID: PMC10814482 DOI: 10.3390/diagnostics14020136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/21/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
Heart failure (HF) has a global prevalence of 1-2%, and the incidence around the world is growing. The prevalence increases with age, from around 1% for those aged <55 years to >10% for those aged 70 years or over. Based on studies in hospitalized patients, about 50% of patients have heart failure with reduced ejection fraction (HFrEF), and 50% have heart failure with preserved ejection fraction (HFpEF). HF is associated with high morbidity and mortality, and HF-related hospitalizations are common, costly, and impact both quality of life and prognosis. More than 5-10% of patients deteriorate into advanced HF (AdHF) with worse outcomes, up to cardiogenic shock (CS) condition. Right heart catheterization (RHC) is essential to assess hemodynamics in the diagnosis and care of patients with HF. The aim of this article is to review the evidence on RHC in various clinical scenarios of patients with HF.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Giuseppe Gargiulo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80131 Naples, Italy; (L.M.); (L.S.); (I.F.); (D.S.C.); (D.F.); (R.P.); (C.S.); (C.M.); (L.D.S.); (G.E.)
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Ciaramella L, Di Serafino L, Mitrano L, De Rosa ML, Carbone C, Rea FS, Monaco S, Scalamogna M, Cirillo P, Esposito G. Invasive Assessment of Coronary Microcirculation: A State-of-the-Art Review. Diagnostics (Basel) 2023; 14:86. [PMID: 38201395 PMCID: PMC10795746 DOI: 10.3390/diagnostics14010086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/28/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
A significant proportion of patients presenting with signs and symptoms of myocardial ischemia have no "significant" epicardial disease; thereby, the assessment of coronary microcirculation gained an important role in improving diagnosis and guiding therapy. In fact, coronary microvascular dysfunction (CMD) could be found in a large proportion of these patients, supporting both symptoms and signs of myocardial ischemia. However, CMD represents a diagnostic challenge for two main reasons: (1) the small dimension of the coronary microvasculature prevents direct angiographic visualization, and (2) despite the availability of specific diagnostic tools, they remain invasive and underused in the current clinical practice. For these reasons, CMD remains underdiagnosed, and most of the patients remain with no specific treatment and quality-of-life-limiting symptoms. Of note, recent evidence suggests that a "full physiology" approach for the assessment of the whole coronary vasculature may offer a significant benefit in terms of symptom improvement among patients presenting with ischemia and non-obstructive coronary artery disease. We analyze the pathophysiology of coronary microvascular dysfunction, providing the readers with a guide for the invasive assessment of coronary microcirculation, together with the available evidence supporting its use in clinical practice.
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Affiliation(s)
| | - Luigi Di Serafino
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy; (L.C.); (L.M.); (M.L.D.R.); (C.C.); (F.S.R.); (S.M.); (M.S.); (P.C.); (G.E.)
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Piccolo R, Leone A, Avvedimento M, Simonetti F, Ippolito D, Angellotti D, Verde N, Manzi L, Cirillo P, Serafino LD, Fortunato G, Franzone A, Esposito G. Impact of biomarker type on periprocedural myocardial infarction in patients undergoing elective PCI. Eur Heart J Qual Care Clin Outcomes 2023; 9:680-690. [PMID: 36385164 DOI: 10.1093/ehjqcco/qcac075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/30/2022] [Accepted: 11/15/2022] [Indexed: 11/08/2023]
Abstract
BACKGROUND Periprocedural myocardial infarction (MI) according to the Society for Cardiovascular Angiography and Interventions (SCAI) criteria has prognostic relevance among patients undergoing percutaneous coronary intervention (PCI). However, it is unclear whether the type of cardiac biomarker used for the diagnosis of periprocedural MI plays a role in terms of event frequency and outcomes. OBJECTIVES To compare the characteristics of SCAI periprocedural MI based on creatine kinase-myocardial band fraction (CK-MB) vs. high-sensitivity cardiac troponin (hs-cTn) in patients undergoing elective PCI. METHODS AND RESULTS Between 2017 and 2021, periprocedural MI was assessed in a prospective study. The primary clinical outcome of interest was all-cause death at 1-year follow-up. A total of 1010 patients undergoing elective PCI were included. SCAI periprocedural MI based on CK-MB vs. hs-cTnI occurred in 1.8 and 13.5% of patients, respectively. hs-cTnI periprocedural MI in the absence of concomitant CK-MB criteria was associated with lower rates of ancillary criteria, including angiographic, ECG, and cardiac imaging criteria. At 1-year follow-up, periprocedural MI defined by CK-MB (adjusted hazard ratio, HR, 4.27, 95% confidence intervals, CI, 1.23-14.8; P = 0.022) but not hs-cTnI (adjusted HR 2.04, 95% CI 0.94-4.45; P = 0.072) was associated with a higher risk of all-cause death. Hs-cTnI periprocedural MI was not predictive of death unless accompanied by CK-MB criteria (adjusted HR 4.64, 95% CI 1.32-16.31; P = 0.017). CONCLUSION In the setting of elective PCI, using hs-cTn instead of CK-MB resulted in a substantial increase in SCAI periprocedural MI events, which were not prognostically relevant in the absence of concurrent CK-MB elevations.
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Affiliation(s)
- Raffaele Piccolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Attilio Leone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Marisa Avvedimento
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Fiorenzo Simonetti
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Domenico Ippolito
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Domenico Angellotti
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Nicola Verde
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Lina Manzi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Luigi Di Serafino
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Giuliana Fortunato
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II and CEINGE S.C.a r.l. Advanced Biotechnology, 80131 Naples, Italy
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
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Ghizzoni G, Di Serafino L, Botti G, Galante D, D'Amario D, Benenati S, Gurgoglione FL, Laborante R, Pompei G, Porto I, Campo GC, Niccoli G, Esposito G, Leone AM, Chieffo A. [Ischemia with non-obstructive coronary artery disease: state-of-the-art review]. G Ital Cardiol (Rome) 2023; 24:5S-20S. [PMID: 37767843 DOI: 10.1714/4101.40990] [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: 09/29/2023]
Abstract
Chest pain affects more than 100 million people globally, however up to 70% of patients undergoing invasive angiography do not have obstructive coronary artery disease and ischemia with non-obstructive coronary artery disease (INOCA) is often a cause of the clinical picture. The symptoms reported by INOCA patients are very heterogeneous and often misdiagnosed as non-cardiac leading to under-diagnosis/investigation and under-treatment. The underlying pathophysiological mechanisms of INOCA are multiple and include coronary vasospasm and microvascular dysfunction. Most importantly, this condition must not be considered benign: compared to asymptomatic individuals, INOCA patients present an increased incidence of cardiovascular events, rehospitalizations, as well as impaired quality of life, with increasing costs for healthcare systems. The aims of this review are to describe the pathophysiological and clinical characteristics of INOCA and to provide guidance to the medical community on the diagnostic approaches and management of INOCA, also via a series of clinical case reports.
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Affiliation(s)
- Giulia Ghizzoni
- Università Vita-Salute San Raffaele, Milano - IRCCS Ospedale San Raffaele, Milano
| | - Luigi Di Serafino
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi "Federico II", Napoli
| | - Giulia Botti
- Università Vita-Salute San Raffaele, Milano - IRCCS Ospedale San Raffaele, Milano
| | - Domenico Galante
- Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Roma - Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma
| | - Domenico D'Amario
- Dipartimento di Cardiologia Traslazionale, Università del Piemonte Orientale, Novara
| | - Stefano Benenati
- Dipartimento di Medicina Interna, Università degli Studi, Genova - Oxford Heart Centre, Oxford University Hospitals, NHS Trust, Oxford, UK
| | | | - Renzo Laborante
- Dipartimento di Scienze Cardiovascolari e Polmonari, Università Cattolica del Sacro Cuore, Roma
| | - Graziella Pompei
- U.O. Cardiologia, Azienda Ospedaliero-Universitaria di Ferrara, Cona (FE)
| | - Italo Porto
- Dipartimento di Medicina Interna, Università degli Studi, Genova - U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare (DICATOV), Ospedale Policlinico San Martino IRCCS - IRCCS Cardiovascular Network, Genova
| | | | | | - Giovanni Esposito
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi "Federico II", Napoli
| | - Antonio Maria Leone
- Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Roma - Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma
| | - Alaide Chieffo
- Università Vita-Salute San Raffaele, Milano - IRCCS Ospedale San Raffaele, Milano
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Piccolo R, Avvedimento M, Canonico ME, Gargiulo P, Paolillo R, Conti V, Dal Piaz F, Filippelli A, Morisco C, Simonetti F, Leone A, Marenna A, Bruzzese D, Gargiulo G, Stabile E, Di Serafino L, Franzone A, Cirillo P, Esposito G. Platelet Inhibition with Ticagrelor 60 mg Versus 90 mg Twice Daily in Elderly Patients with Acute Coronary Syndrome: Rationale and Design of the PLINY THE ELDER Trial. Cardiovasc Drugs Ther 2023; 37:1031-1038. [PMID: 35048203 DOI: 10.1007/s10557-021-07302-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Elderly status is steadily increasing among patients with acute coronary syndrome (ACS). Dual antiplatelet therapy (DAPT) with aspirin and a potent P2Y12 receptor inhibitor is the cornerstone of treatment to prevent recurrent thrombotic complications in patients with ACS. However, DAPT in older patients is challenged by a concurrent heightened risk of ischemia and bleeding. The aim of this study is to evaluate the pharmacodynamic and pharmacokinetic profile of a lower dose of ticagrelor (60 mg twice daily) among elderly patients during the early phase of ACS. STUDY DESIGN PLINY THE ELDER (PLatelet INhibition with two different doses of potent P2y12 inhibitors in THE ELDERly population) (NCT04739384) is a prospective, randomized, open-label, crossover trial to evaluate the non-inferiority of a lower dose of ticagrelor (60 mg twice daily) compared with a standard dose (90 mg twice daily) among elderly patients with ACS undergoing percutaneous coronary intervention (PCI). A total of 50 patients, aged 75 years or more, with indication to potent P2Y12 receptor inhibitors will be randomized within 3 days from PCI for the index ACS. Patients with indication to oral anticoagulant therapy, treatment with glycoprotein IIb/IIIa inhibitors, or active bleeding will be excluded. The primary endpoint is platelet reactivity determined by P2Y12 reaction units (PRU) (VerifyNow, Accumetrics, San Diego, CA, USA) after treatment with ticagrelor 60 or 90 mg twice daily for 14 days. Secondary endpoints will include other pharmacodynamic tests of ADP-induced aggregation (light transmittance aggregometry and multiple electrode aggregometry) and determination of pharmacokinetic profile (plasma levels of ticagrelor and its metabolite AR-C124910XX) by high performance liquid chromatography-tandem mass spectrometry. CONCLUSIONS The PLINY THE ELDER trial will determine whether a lower dose of ticagrelor confers non-inferior platelet inhibition compared with the standard dose in the early phase of ACS among elderly patients undergoing PCI, informing future clinical investigation.
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Affiliation(s)
- Raffaele Piccolo
- Department of Advanced Biomedical Sciences, Division of Cardiology, University of Naples Federico II, Naples, Italy.
| | - Marisa Avvedimento
- Department of Advanced Biomedical Sciences, Division of Cardiology, University of Naples Federico II, Naples, Italy
| | - Mario Enrico Canonico
- Department of Advanced Biomedical Sciences, Division of Cardiology, University of Naples Federico II, Naples, Italy
| | - Paola Gargiulo
- Department of Advanced Biomedical Sciences, Division of Cardiology, University of Naples Federico II, Naples, Italy
| | - Roberta Paolillo
- Department of Advanced Biomedical Sciences, Division of Cardiology, University of Naples Federico II, Naples, Italy
| | - Valeria Conti
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Baronissi, SA, Italy
- Department of Clinical Pharmacology and Pharmacogenetics Unit, University Hospital "San Giovanni Di Dio E Ruggi d'Aragona", Salerno, Italy
| | - Fabrizio Dal Piaz
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Baronissi, SA, Italy
- Department of Clinical Pharmacology and Pharmacogenetics Unit, University Hospital "San Giovanni Di Dio E Ruggi d'Aragona", Salerno, Italy
| | - Amelia Filippelli
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Baronissi, SA, Italy
- Department of Clinical Pharmacology and Pharmacogenetics Unit, University Hospital "San Giovanni Di Dio E Ruggi d'Aragona", Salerno, Italy
| | - Carmine Morisco
- Department of Advanced Biomedical Sciences, Division of Cardiology, University of Naples Federico II, Naples, Italy
| | - Fiorenzo Simonetti
- Department of Advanced Biomedical Sciences, Division of Cardiology, University of Naples Federico II, Naples, Italy
| | - Attilio Leone
- Department of Advanced Biomedical Sciences, Division of Cardiology, University of Naples Federico II, Naples, Italy
| | - Alessandra Marenna
- Department of Advanced Biomedical Sciences, Division of Cardiology, University of Naples Federico II, Naples, Italy
| | - Dario Bruzzese
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Giuseppe Gargiulo
- Department of Advanced Biomedical Sciences, Division of Cardiology, University of Naples Federico II, Naples, Italy
| | - Eugenio Stabile
- Department of Advanced Biomedical Sciences, Division of Cardiology, University of Naples Federico II, Naples, Italy
| | - Luigi Di Serafino
- Department of Advanced Biomedical Sciences, Division of Cardiology, University of Naples Federico II, Naples, Italy
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, Division of Cardiology, University of Naples Federico II, Naples, Italy
| | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, Division of Cardiology, University of Naples Federico II, Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Division of Cardiology, University of Naples Federico II, Naples, Italy
- UNESCO Chair On Health Education and Sustainable Development, University of Naples Federico II, Naples, Italy
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Piccolo R, Leone A, Simonetti F, Avvedimento M, Angellotti D, Manzi L, Verde N, Spaccarotella CAM, Di Serafino L, Cirillo P, Gargiulo G, Fortunato G, Franzone A, Esposito G. Periprocedural myocardial infarction in patients undergoing complex versus noncomplex percutaneous coronary intervention. Catheter Cardiovasc Interv 2023. [PMID: 37337462 DOI: 10.1002/ccd.30749] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/18/2023] [Accepted: 06/07/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Limited data are available on the risk of periprocedural myocardial infarction (MI) in patients undergoing complex versus noncomplex percutaneous coronary intervention (PCI). METHODS We assessed the risk of periprocedural MI according to the fourth Universal definition of myocardial infarction (UDMI) and several other criteria among patients undergoing elective PCI in a prospective, single-center registry. Complex PCI included at least one of the following: 3 coronary vessels treated, ≥3 stents implanted, ≥3 lesions treated, bifurcation with 2 stents implanted, total stent length >60 mm, treatment of chronic total occlusion, and use of rotational atherectomy. RESULTS Between 2017 and 2021, we included 1010 patients with chronic coronary syndrome, of whom 226 underwent complex PCI (22.4%). The rate of periprocedural MI according to the fourth UDMI was significantly higher in complex compared to noncomplex PCI patients (26.5% vs. 14.5%, p < 0.001). Additionally, periprocedural MI was higher in the complex PCI group using SCAI (4% vs. 1.1%, p = 0.009), ARC-2 (13.7% vs. 8.0%, p = 0.013), ISCHEMIA (5.8% vs. 1.7%, p = 0.002), and EXCEL criteria (4.9% vs. 2.0%, p = 0.032). SYNTAX periprocedural MI occurred at low rates in both groups (0.9% vs. 0.6%, p = 0.657). Complex PCI was an independent predictor of the fourth UDMI periprocedural MI (odds ratio [OR] 1.54, 95% confidence interval [CI]: 1.04-2.27, p = 0.031). CONCLUSIONS In patients with chronic coronary syndrome undergoing elective PCI, complex PCI is associated with a significantly higher risk of periprocedural MI using multiple definitions. These findings highlight the importance of considering upfront this risk in the planning of complex PCI procedures.
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Affiliation(s)
- Raffaele Piccolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Attilio Leone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Fiorenzo Simonetti
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Marisa Avvedimento
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Domenico Angellotti
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Lina Manzi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Nicola Verde
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Luigi Di Serafino
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Giuseppe Gargiulo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Giuliana Fortunato
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II and CEINGE S.C.a r.l. Advanced Biotechnology, Naples, Italy
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
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Piccolo R, Manzi L, Simonetti F, Leone A, Angellotti D, Immobile Molaro M, Verde N, Cirillo P, Di Serafino L, Franzone A, Spaccarotella CAM, Esposito G. Management of Non-Culprit Lesions in STEMI Patients with Multivessel Disease. J Clin Med 2023; 12:jcm12072572. [PMID: 37048655 PMCID: PMC10095226 DOI: 10.3390/jcm12072572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/19/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
Multivessel disease is observed in approximately 50% of patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Data from randomized clinical trials has shown that complete revascularization in the STEMI setting improves clinical outcomes by reducing the risk of reinfarction and urgent revascularization. However, the timing and modality of revascularization of non-culprit lesions are still debated. PCI of non-culprit lesions can be performed during the index primary PCI or as a staged procedure and can be guided by angiography, functional assessment, or intracoronary imaging. In this review, we summarize the available evidence about the management of non-culprit lesions in STEMI patients with or without cardiogenic shock.
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Biscaglia S, Verardi FM, Tebaldi M, Guiducci V, Caglioni S, Campana R, Scala A, Marrone A, Pompei G, Marchini F, Scancarello D, Pignatelli G, D'Amore SM, Colaiori I, Demola P, Di Serafino L, Tumscitz C, Penzo C, Erriquez A, Manfrini M, Campo G. QFR-Based Virtual PCI or Conventional Angiography to Guide PCI: The AQVA Trial. JACC Cardiovasc Interv 2023; 16:783-794. [PMID: 36898939 DOI: 10.1016/j.jcin.2022.10.054] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [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: 04/21/2022] [Revised: 10/14/2022] [Accepted: 10/25/2022] [Indexed: 03/12/2023]
Abstract
BACKGROUND Post-percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) values ≥0.90 are associated with a low incidence of adverse events. OBJECTIVES The AQVA (Angio-based Quantitative Flow Ratio Virtual PCI Versus Conventional Angio-guided PCI in the Achievement of an Optimal Post-PCI QFR) trial aims to test whether a QFR-based virtual percutaneous coronary intervention (PCI) is superior to a conventional angiography-based PCI at obtaining optimal post-PCI QFR results. METHODS The AQVA trial is an investigator-initiated, randomized, controlled, parallel-group clinical trial. Three hundred patients (356 study vessels) undergoing PCI were randomized 1:1 to receive either QFR-based virtual PCI or angiography-based PCI (standard of care). The primary outcome was the rate of study vessels with a suboptimal post-PCI QFR value, which was defined as <0.90. Secondary outcomes were procedure duration, stent length/lesion, and stent number/patient. RESULTS Overall, 38 (10.7%) study vessels missed the prespecified optimal post-PCI QFR target. The primary outcome occurred significantly more frequently in the angiography-based group (n = 26, 15.1%) compared with the QFR-based virtual PCI group (n = 12 [6.6%]; absolute difference = 8.5%; relative difference = 57%; P = 0.009). The main cause of a suboptimal result in the angiography-based group is the underestimation of a diseased segment outside the stented one. There were no significant differences among secondary endpoints, although stent length/lesion and stent number/patient were numerically lower in the virtual PCI group (P = 0.06 and P = 0.08, respectively), whereas procedure length was higher in the virtual PCI group (P = 0.06). CONCLUSIONS The AQVA trial demonstrated the superiority of QFR-based virtual PCI over angiography-based PCI with regard to post-PCI optimal physiological results. Future larger randomized clinical trials that demonstrate the superiority of this approach in terms of clinical outcomes are warranted. (Angio-based Quantitative Flow Ratio Virtual PCI Versus Conventional Angio-guided PCI in the Achievement of an Optimal Post-PCI QFR [AQVA]; NCT04664140).
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Affiliation(s)
- Simone Biscaglia
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Ferrara, Italy.
| | | | - Matteo Tebaldi
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Ferrara, Italy
| | - Vincenzo Guiducci
- Cardiology Unit, Azienda Unità Sanitaria Locale, Istituti di Ricovero e Cura a Carattere Scientifico, Istituto in Tecnologie Avanzate e Modelli Assistenziali di Reggio Emilia, Reggio Emilia, Italy
| | - Serena Caglioni
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Ferrara, Italy
| | - Roberta Campana
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Ferrara, Italy
| | - Antonella Scala
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Ferrara, Italy
| | - Andrea Marrone
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Ferrara, Italy
| | - Graziella Pompei
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Ferrara, Italy
| | - Federico Marchini
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Ferrara, Italy
| | - Davide Scancarello
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Ferrara, Italy
| | - Gianluca Pignatelli
- Cardiology Unit, Azienda Unità Sanitaria Locale, Istituti di Ricovero e Cura a Carattere Scientifico, Istituto in Tecnologie Avanzate e Modelli Assistenziali di Reggio Emilia, Reggio Emilia, Italy
| | - Sergio Musto D'Amore
- Cardiology Unit, Azienda Unità Sanitaria Locale, Istituti di Ricovero e Cura a Carattere Scientifico, Istituto in Tecnologie Avanzate e Modelli Assistenziali di Reggio Emilia, Reggio Emilia, Italy
| | - Iginio Colaiori
- Cardiology Unit, Azienda Unità Sanitaria Locale, Istituti di Ricovero e Cura a Carattere Scientifico, Istituto in Tecnologie Avanzate e Modelli Assistenziali di Reggio Emilia, Reggio Emilia, Italy
| | - Pierluigi Demola
- Cardiology Unit, Azienda Unità Sanitaria Locale, Istituti di Ricovero e Cura a Carattere Scientifico, Istituto in Tecnologie Avanzate e Modelli Assistenziali di Reggio Emilia, Reggio Emilia, Italy
| | - Luigi Di Serafino
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Carlo Tumscitz
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Ferrara, Italy
| | - Carlo Penzo
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Ferrara, Italy
| | - Andrea Erriquez
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Ferrara, Italy
| | - Marco Manfrini
- Maria Cecilia Hospital, Gruppo Villa Maria Care and Research, Cotignola, Ravenna, Italy
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Ferrara, Italy
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11
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Di Serafino L, Barbato E, Serino F, Svanerud J, Scalamogna M, Cirillo P, Petitto M, Esposito M, Silvestri T, Franzone A, Piccolo R, Esposito G. Myocardial mass affects diagnostic performance of non-hyperemic pressure-derived indexes in the assessment of coronary stenosis. Int J Cardiol 2023; 370:84-89. [PMID: 36265648 DOI: 10.1016/j.ijcard.2022.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 09/09/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022]
Abstract
Background Several non-hyperemic pressure-derived Indexes (NHPI) have been introduced for the assessment of coronary stenosis, showing a good correlation with fractional flow reserve (FFR). Notably, either the assessment of NHPI during adenosine administration (NHPIADO) or the Hybrid Approach (NHPIHA), combining NHPI with FFR, have been showed to increase the accuracy of such indexes. It remains unclear whether diagnostic performance might be affected by the extent of the subtended myocardial mass. METHODS We enrolled consecutive patients with an intermediate coronary stenosis assessed with NHPI and FFR. NHPI were also measured during adenosine (ADO) administration (NHPIADO). The amount of jeopardized myocardium was assessed using the Duke Jeopardy Score (DJS). With FFR as reference, we assessed the accuracy of NHPI, NHPIADO and NHPIHA according to the extent of the subtended myocardium. RESULTS One-hundred-seventy stenoses from 151 patients were grouped according to the DJS as follows: A) Small Extent (SE, n = 82); B) Moderate Extent (ME, n = 53); C) Large Extent (LE, n = 35). As compared with FFR, NHPI showed a significantly different accuracy, as assessed by the Youden's index, according to the extent of the jeopardized myocardium (SE: 0.39 ± 0.05, ME: 0.68 ± 0.06, LE: 0.28 ± 0.06, p < 0.001). Conversely, both the NHPIADO (SE: 0.76 ± 0.02, ME: 0.88 ± 0.02, LE: 0.82 ± 0.02, p = 0.72) and NHPIHA (SE: 0.82 ± 0.07, ME: 0.84 ± 0.02, LE: 0.88 ± 0.02, p = 0.70) allowed for a better diagnostic accuracy regardless of the amount of myocardium subtended. CONCLUSIONS Diagnostic performance of NHPI might be affected by the extent of myocardial territory subtended by the coronary stenosis. A hybrid approach might be useful to overcome this limitation.
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Affiliation(s)
- Luigi Di Serafino
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
| | - Emanuele Barbato
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Federica Serino
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Maria Scalamogna
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Marta Petitto
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Mafalda Esposito
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Tania Silvestri
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
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12
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Carbone C, De Rosa ML, Mitrano L, Di Serafino L, Piccolo R, Franzone A, Cirillo P, Esposito G. 893 FUNCTIONAL ASSESSMENT OF INTERMEDIATE CORONARY ARTERY STENOSIS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
FFR represents the gold standard to functionally assess the ischemic potential of intermediate coronary artery stenoses particularly in patients presenting with multivessel disease. However, it is still underused in the current practice. Less invasive techniques have been identified for the evaluation of intermediate stenosis. The Quantitative flow ratio (QFR), based on the angiography with 3D-reconstruction of the coronary artery and computational fluid dynamics, has been showed to well correlate with the FFR. The Angiography-DeriveD hEmoDynamic index (ADDED Index) has also been validated to assess the ischemic potential of intermediate coronary stenosis and was also found to well correlate with FFR. It considers the jeopardized subtended myocardium and the minimal lumen diameter calculated at the angiography. This study aimed to compare the ADDED Index with QFR in terms of diagnostic accuracy.
Methods
A retrospective observational study was conducted. We included all patients presenting with an intermediate stenosis assessed with QFR. Both QFR and ADDED Index were calculated. Correlation was studied using Pearson's r test and linear regression. Receiver operator characteristics curve analysis was also performed.
Results
A total of 54 patients presenting with either stable angina or acute coronary syndromes were enrolled and finally 62 intermediate stenoses were included. A significant correlation between the ADDED Index and QFR was found (r2=0,32, p <0.001) (Figure 1). At ROC analysis, and with the QFR as reference, the ADDED Index showed a significant and very high area under the curve (0.99 (0.99-1.00), p<0.001), Figure 2) suggesting the high accuracy for the assessment of the ischemic potential of intermediate coronary artery stenoses.
Conclusion
ADDED Index was found similar to the QFR in terms of accuracy for the functional assessment of intermediate coronary artery stenoses.
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Sperandeo L, Marenna A, Manzi L, Avvedimento M, Simonetti F, Canonico ME, Paolillo R, Spinelli A, Borgia F, Di Serafino L, Franzone A, Stabile E, Piccolo R, Cirillo P, Valgimigli M, Esposito G, Gargiulo G. 351 MULTIPLE PHARMACODYNAMIC ASSESSMENTS OF CANGRELOR EFFECTS IN ELECTIVE COMPLEX PCI: DATA FROM PHARMACODYNAMIC EFFECTS OF CANGRELOR IN PATIENTS WITH ACUTE OR CHRONIC CORONARY SYNDROME UNDERGOING PERCUTANEOUS CORONARY INTERVENTION REGISTRY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Aims
Complex percutaneous coronary intervention (PCI) patients have greater risk of peri-procedural complications, with potential to be associated with poor short-term and late prognosis. Cangrelor is an intravenous P2Y12 receptor inhibitor characterized by rapid onset and offset effect of platelet inhibition which reduced the risk of thrombotic complications. Cangrelor use is currently approved in patients naïve from oral P2Y12 inhibitors with chronic (CCS) or acute coronary syndrome (ACS) undergoing PCI with a IIb recommendation by European guidelines. Yet, the process of switching from cangrelor to oral P2Y12 inhibitor remains uncertain.
Methods and Results
POMPEII study (NCT04790032) is a prospective registry conducted at Federico II University of Naples enrolling all patients undergoing PCI and receiving cangrelor administration. Pharmacodynamic (PD) assessments were performed at baseline, at 30 minutes, 3 hours and 4-6 hours after cangrelor initiation with 3 assays: 1) the gold standard light transmittance aggregometry (LTA) (20- and 5-µM adenosine diphosphate [ADP] stimuli); 2) VerifyNow P2Y12-test; 3) Multiplate electrode aggregometry (MEA), ADP-test. We enrolled 41 patients undergoing elective complex PCI. All patients were P2Y12 inhibitor naïve and received aspirin, unfractionated heparin, and cangrelor (30-µg/kg bolus followed by 4-µg/kg/min infusion for 2 hours) prior to the start of PCI per standard of care. All patients showed low P2Y12 reactivity at 30 minutes during cangrelor infusion with a mean inhibition of platelet aggregation (IPA, %) of 55.7±18.0% at LTA 20-µM ADP test (34% with IPA ≤50%, 19.5% with IPA≥70%, 4.9% with IPA ≥80% and none IPA ≥90%). High residual platelet reactivity (HRPR) was observed in 1 case (2.4%) as shown by LTA (both 20- and 5-µM ADP stimuli) but not confirmed by VerifyNow and MEA. HRPR was observed in 55% at at 3h and 22.5% at 4-6h at LTA 20-µM and consistently with other assays. All patients with HRPR after cangrelor stop had received clopidogrel as switching drug, while no HRPR was observed in the 4 patients switching to ticagrelor.
Conclusions
Cangrelor showed to be effective and safe in patients undergoing complex PCI at high thrombotic risk. The switch from cangrelor to clopidogrel could expose patients to a variable period of on-treatment HRPR with inadequate platelet inhibition probably due to the fast offset of cangrelor effect and delay of oral drug effect, while the use of ticagrelor soon after cangrelor start might be ideal to cover the gap. This might be of relevance in such a delicate clinical setting.
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Affiliation(s)
- Luca Sperandeo
- Department Of Advance Biomedical Sciences, Federico Ii University Of Naples , Itlay
| | - Alessandra Marenna
- Department Of Advance Biomedical Sciences, Federico Ii University Of Naples , Itlay
| | - Lina Manzi
- Department Of Advance Biomedical Sciences, Federico Ii University Of Naples , Itlay
| | - Marisa Avvedimento
- Department Of Advance Biomedical Sciences, Federico Ii University Of Naples , Itlay
| | - Fiorenzo Simonetti
- Department Of Advance Biomedical Sciences, Federico Ii University Of Naples , Itlay
| | | | - Roberta Paolillo
- Department Of Advance Biomedical Sciences, Federico Ii University Of Naples , Itlay
| | - Alessandra Spinelli
- Department Of Advance Biomedical Sciences, Federico Ii University Of Naples , Itlay
| | - Francesco Borgia
- Department Of Advance Biomedical Sciences, Federico Ii University Of Naples , Itlay
| | - Luigi Di Serafino
- Department Of Advance Biomedical Sciences, Federico Ii University Of Naples , Itlay
| | - Anna Franzone
- Department Of Advance Biomedical Sciences, Federico Ii University Of Naples , Itlay
| | - Eugenio Stabile
- Cardiovascular Department , Azienda Ospedaliera Regionale ”San Carlo”, Potenza , Italy
| | - Raffaele Piccolo
- Department Of Advance Biomedical Sciences, Federico Ii University Of Naples , Itlay
| | - Plinio Cirillo
- Department Of Advance Biomedical Sciences, Federico Ii University Of Naples , Itlay
| | - Marco Valgimigli
- Cardiocentro Institute, Ente Ospedaliero Cantonale, Università Della Svizzera Italiana (Usi) , Lugano , Switzerland
| | - Giovanni Esposito
- Department Of Advance Biomedical Sciences, Federico Ii University Of Naples , Itlay
| | - Giuseppe Gargiulo
- Department Of Advance Biomedical Sciences, Federico Ii University Of Naples , Itlay
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14
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Angellotti D, Manzo R, Castiello DS, Piccolo R, Avvedimento M, Leone A, Ilardi F, Mariani A, Iapicca C, Di Serafino L, Cirillo P, Franzone A, Esposito G. Impact of COVID-19 pandemic on timing and early clinical outcomes of transcatheter aortic valve implantation. Acta Cardiol 2022; 77:937-942. [PMID: 36197014 DOI: 10.1080/00015385.2022.2119660] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 08/22/2022] [Accepted: 08/26/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND We sought to investigate the applicability and outcomes of a novel system to manage patients requiring transcatheter aortic valve implantation (TAVI) at a tertiary level hospital during the coronavirus disease-2019 (COVID-19) pandemic. METHODS To analyse the impact of hospitalisation pathways during the pandemic on clinical outcomes of TAVI patients, the study population was divided into two groups (pre-pandemic and pandemic groups) and all perioperative/follow-up data were compared. The primary endpoint was all-cause mortality at 30 days; secondary endpoints included procedural success and short-term complications. RESULTS A total of 315 patients received TAVI during the study period. Pandemic group (n = 77) showed a more complex baseline clinical profile (NYHA class III-IV, 70.1% vs. 56.3%; p = 0.03). The overall time to procedure was significantly longer during pandemic (56.9 ± 68.3 vs.37.7 ± 25.4; p = 0.004) while intensive care unit stay was shorter (2.2 ± 1.4 vs. 3.7 ± 3.9, p < 0.05). Hospitalisation length was similar in both groups as well as all-cause mortality rate and the incidence of major periprocedural complications. No case of infection by COVID-19 was reported among patients during the hospital stay. CONCLUSIONS Comparative analysis of early clinical outcomes showed that COVID-19 pandemic did not affect the safety and effectiveness of TAVI as similar rates of procedural complications and all-cause mortality were reported than before February 2020. Despite the increased time lag between diagnosis and procedure and a more complex clinical profile of patients at baseline, the revised pathway of hospitalisation allowed to resume inpatient procedures while not affecting patients' and healthcare workers' safety.
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Affiliation(s)
- Domenico Angellotti
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Rachele Manzo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Marisa Avvedimento
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Attilio Leone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Federica Ilardi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Andrea Mariani
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Cristina Iapicca
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Luigi Di Serafino
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
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15
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Di Serafino L, Esposito G. May FFR-guided PCI save lives?: Commentary on: "Clinical impact of FFR-guided PCI compared to angio-guided PCI from the France PCI registry". Catheter Cardiovasc Interv 2022; 100:49-50. [PMID: 35819145 DOI: 10.1002/ccd.30310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 06/11/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Luigi Di Serafino
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Giovanni Esposito
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
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16
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Leone A, Franzone A, Avvedimento M, Piccolo R, Angellotti D, Mariani A, Castiello DS, Ilardi F, Manzo R, Iapicca C, Serafino LD, Cirillo P, Esposito G. 143 Incidence, predictors, and clinical impact of transient left bundle branch block in patients undergoing transcatheter aortic valve implantation. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab134.025] [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
This study aims to evaluate the incidence and prognostic impact of transient left bundle branch block (LBBB) in patients undergoing transcatheter aortic valve implantation (TAVI) with balloon-expandable or self-expanding valves. Clinical, echocardiographic and electrocardiographic predictors of transient LBBB were also investigated.
Methods and results
197 patients treated with TAVI at Federico II University hospital, Naples, Italy were enrolled. Electrocardiograms (ECGs) were obtained before and after TAVI procedure, at discharge and at 30-day follow-up. ECGs were anonymously digitalized and analysed by five cardiologists. Transient LBBB was defined as LBBB regressed within 30 days after procedure. All ECGs for each patient were analysed by the same cardiologist. The primary endpoint of the study was all-cause mortality and permanent pacemaker implantation (PPI) at 1-month after TAVI. Secondary endpoints included cerebrovascular accidents, acute myocardial infarction, vascular complications, acute kidney injury, endocarditis, and re-hospitalization for all causes. Out of 197 patients enrolled, 54 (27.4%) developed transient LBBB. Among patients with transient LBBB, 70.4% were female. Mean age was higher in transient LBBB group compared with control group (81.0 ± 6.4 years, vs. 78. 6 ± 6.5 years; P = 0.022). From logistic analysis, peak transvalvular gradient (OR: 1.01, 95% CI: 0.93–1.00; P < 0.034) and left ventricular ejection fraction (LVEF) (OR: 0.96, 95% CI: 0.93–0.99, P < 0.012) were identified as predictive factors of transient LBBB. No differences between the two studied groups were observed in primary and secondary endpoints (all-cause mortality: 1.9% vs. 0.7%; P = 0.46; PPI: 9.6% vs. 12%; P = 0.80).
Conclusions
Peak transvalvular gradient and LVEF predict onset of transient LBBB, a common conduction disturbance after TAVI. Onset of transient LBBB does not correlate with worse clinical outcomes at 30 days.
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Affiliation(s)
- Attilio Leone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
| | - Marisa Avvedimento
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
| | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
| | - Domenico Angellotti
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
| | - Andrea Mariani
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
| | | | - Federica Ilardi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
| | - Rachele Manzo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
| | - Cristina Iapicca
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
| | - Luigi Di Serafino
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
| | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
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17
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Angellotti D, Manzo R, Franzone A, Esposito G, Avvedimento M, Ilardi F, Castiello D, Mariani A, Iapicca C, Faretra A, Leone A, Di Serafino L, Piccolo R, Cirillo PL, Esposito G. 134 Impact of COVID-19 pandemic on timing and early clinical outcomes of transcatheter aortic valve implantation. Eur Heart J Suppl 2021. [PMCID: PMC8689789 DOI: 10.1093/eurheartj/suab134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Aims COVID-19 pandemic deeply changed the management of patients with aortic stenosis. Many cardiac societies have drawn up guidelines for the optimal management of this population but applicability of such recommendations in the current clinical practice and their impact on clinical outcomes has not been adequately investigated. Methods and results A single-centre retrospective study included 315 patients undergoing transcatheter aortic valve implantation (TAVI) between April 2017 and June 2021. To analyse the impact of hospitalization pathways during the pandemic on clinical outcomes of TAVI patients, study population was divided into two groups (pre-pandemic and pandemic groups) and all perioperative/follow-up data were compared. The primary endpoint was all-cause mortality at 30 days; secondary endpoints included procedural success and short- term complications. Pandemic group patients showed a more complex baseline clinical profile (NYHA III–IV, 70.1% vs. 56.3%; P = 0.03). The overall time to procedure was significantly longer during pandemic (56.9 ± 68.3 vs.37.7 ± 25.4; P = 0.004) while intensive care unit stay was shorter (2.2 ± 1.4 vs. 3.3 ± 3.5). Hospitalization length was similar in both group as well as all-cause mortality rate and the incidence of major periprocedural complications. Conclusions COVID-19 pandemic did not affect the safety and effectiveness of TAVI as similar rates of procedural complications and all-cause mortality were reported than before February 2020. Despite the increased time lag between diagnosis and procedure and a more complex clinical profile of patients at baseline, the revised pathway of hospitalization allowed to resume inpatient procedures while not affecting patients’ and healthcare workers’ safety.
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Affiliation(s)
| | - Rachele Manzo
- Scienze Biomediche Avanzate, Federico II Napoli, Italy
| | - Anna Franzone
- Scienze Biomediche Avanzate, Federico II Napoli, Italy
| | | | | | | | | | | | | | | | - Attilio Leone
- Scienze Biomediche Avanzate, Federico II Napoli, Italy
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18
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Manzi L, Ilardi F, Simonetti F, Verde N, Franzone A, Angellotti D, Avvedimento M, Leone A, Castiello D, Manzo R, Mariani A, Piccolo R, Di Serafino L, Cirillo P, Esposito G. 676 Impact of transcatheter aortic valve implantation in patients with severe aortic stenosis and concomitant mitral regurgitation. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab147.013] [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: 11/12/2022]
Abstract
Abstract
Aims
Severe aortic stenosis (AS) and functional mitral regurgitation (MR) frequently coexist. There is no consensus about the optimal therapeutic strategy for patients with combined valve disease. Evidence has shown that double valve surgery is associated with high complication rates and mortality, whereas MR severity may improve after transcatheter aortic valve implantation (TAVI). To date, little is known on prognostic parameters associated with MR improvement after TAVI. Recently, a new echocardiographic parameter based on the ratio between peak E velocity and peak atrial longitudinal strain (E/PALS) has demonstrated to be accurate and sensitive in the prediction of elevated filling pressure. Its role in the setting of AS patients undergoing TAVI has never been investigated. Our study aims to evaluate haemodynamic conditions and left ventricular (LV) systolic and diastolic function in patients with severe AS and concomitant MR undergoing TAVI and to identify new echocardiographic parameters associated with MR improvement 1 month after the aortic valve replacement.
Methods
We prospectively enrolled 87 consecutive patients (mean age 80 ± 6 years) with severe symptomatic AS and concomitant MR undergoing TAVI between 2016 and 2021, for whom a complete echocardiographic assessment was available at baseline and 1 month after the procedure, selected from the EffecTAVI registry. Exclusion criteria were prior valve surgery, severe mitral stenosis, permanent atrial fibrillation, and poor ultrasound acoustic window. Echo-Doppler assessment, including global longitudinal strain (GLS) and peak atrial longitudinal strain (PALS), was performed before and after 1 month to TAVI procedure. Changes (Δ) of the main echo parameters before and after intervention were computed.
Results
A month after the procedure, 20 (23%) patients had a reduction of at least one degree of MR (P <0.001). Dividing study population in two groups, based on whether or not MR was reduced after TAVI, we found that patients with MR improvement had higher LV end-diastolic volume (P = 0.036) and left atrial volume (P = 0.015) at baseline compared with those without MR reduction. After TAVI no significant differences were found in heart chambers size between the two groups, but a significant increase in PALS (23.2 ± 7.3 vs. 22.3 ± 7, P=0.028), together with a reduction in E/A ratio (0.69 ± 0.14 vs. 0.90 ± 0.46, P = 0.046) were detected in patients with MR reduction. Furthermore, Δ E/PALS (−17.3±34.4% vs. 3.9±35.0% P=0.027), Δ E/A (−12.6±33.9% vs. 24.7±64.3%, P=0.018) and Δ systolic pulmonary artery pressure (sPAP) (−13.0±20.2% vs. −2.0±18.3, P=0.031) were significantly higher in patients with MR improvement to compared those without MR reduction. By the multivariate logistic regression analysis performed in the pooled population, Δ E/PALS (OR 0.968, 95% CI: 0.947–0.990, P=0.005), together with LV mass at baseline (OR 1.056, 95% CI: 1.007–1.107, P = 0.024) appeared to be independently associated with MR reduction post-TAVI.
Conclusions
Our study demonstrated that: after TAVI in a significant percentage of patients a relevant improvement in concomitant MR was detected; in the group of patients with improved MR a parallel improvement of sPAP, E/A and E/PALS ratio post TAVI was found; Δ E/PALS appears to be the main parameter independently associated with the reduction of MR severity.
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Affiliation(s)
- Lina Manzi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Federica Ilardi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Fiorenzo Simonetti
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Nicola Verde
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Domenico Angellotti
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Marisa Avvedimento
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Attilio Leone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Domenico Castiello
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Rachele Manzo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Andrea Mariani
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Luigi Di Serafino
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
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Di Serafino L, Magliulo F, Esposito G. Functionally Complete Coronary Revascularisation in Patients Presenting with ST-elevation MI and Multivessel Coronary Artery Disease. Interv Cardiol 2021; 16:e24. [PMID: 34400971 PMCID: PMC8353546 DOI: 10.15420/icr.2020.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 04/26/2021] [Indexed: 11/04/2022] Open
Abstract
Up to half of patients undergoing primary percutaneous coronary intervention of a culprit stenosis in the context of the ST-elevation MI may present with multivessel disease. The presence of non-culprit stenoses have been shown to affect the outcomes of these patients, and the results of the more recent randomised trials highlight the importance of complete coronary revascularisation. In this paper, the authors review the main trials published on the topic and discuss tools for the assessment of non-culprit stenoses, while considering the right time for carrying out a complete coronary revascularisation.
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Affiliation(s)
- Luigi Di Serafino
- Department of Advanced Biomedical Sciences, University of Naples Federico II Naples, Italy
| | - Fabio Magliulo
- Department of Advanced Biomedical Sciences, University of Naples Federico II Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University of Naples Federico II Naples, Italy
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20
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Stabile E, Franzese M, Chianese S, Alfani A, Gerardi D, Colaiori I, Annunziata M, Nappi P, Scalise M, Di Serafino L, Puzone B, Avvedimento M, Leone A, Ilardi F, Piccolo R, Franzone A, Cirillo P, Morisco C, Trimarco B, Esposito G. Predictors of adherence to composite therapy after acute coronary syndromes. J Cardiovasc Med (Hagerstown) 2021; 22:645-651. [PMID: 33966020 DOI: 10.2459/jcm.0000000000001201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Adherence to medical therapy following acute coronary syndrome (ACS) affects a patient's prognosis. In this cohort study, we sought to assess the factors that could affect a patient's adherence to therapy after ACS. METHODS We prospectively collected information from patients (N = 964) hospitalized at the coronary care unit of the Federico II University Hospital, from 1 January 2015 to 30 June 2017, for ACS. Adherence to three classes of drugs including statins, antiplatelets [dual or single antiplatelet agent (SAPT)] and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACE-I/ARB) and their composites were assessed at 1 month, 1 and 2 years after discharge. RESULTS At 30 days adherence to prescribed therapy was 94.4% for dual antiplatelet therapy (DAPT), 78.2% for statins, 92.7% for ACE-I/ARB and 70.7% for multitherapy. At 1 year, it was 91.1% for DAPT, 81.2% for ACE-I/ARB, 84.9% for statins and 71.4% for multitherapy. At 2 years, it was 97.1% for SAPT, 78.1% for ACE-I/ARB, 91.8% for statins, 72.8% for multitherapy. Multivariable logistic analysis demonstrated that at each time point, a telephone follow-up assessment predicts nonadherence to multitherapy and that a percutaneous coronary intervention at the index hospitalization is an independent predictor of adherence to composite therapy at 1 month and 1 year. CONCLUSION Up to 2 years after ACS, three out of four patients are adherent to multitherapy prescription; percutaneous coronary intervention during the index hospitalization improves a patient's adherence, whereas telephone follow-up is associated with reduced adherence to multitherapy.Campania Salute Network Registry (Clinical Trials.gov Identifier: NCT02211365).
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Affiliation(s)
- Eugenio Stabile
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Napoli 'Federico II', Napoli, Italy
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21
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Cirillo P, Taglialatela V, Pellegrino G, Morello A, Conte S, Di Serafino L, Cimmino G. Effects of colchicine on platelet aggregation in patients on dual antiplatelet therapy with aspirin and clopidogrel. J Thromb Thrombolysis 2021; 50:468-472. [PMID: 32335777 PMCID: PMC7183388 DOI: 10.1007/s11239-020-02121-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Platelets aggregation leading to thrombosis plays a pivotal role in the pathophysiology of acute coronary syndrome (ACS) and of stent thrombosis. Antiplatelet therapy with aspirin plus an ADP-receptor inhibitor (ticagrerol, prasugrel or clopidogrel) is recommended to reduce the risk of other platelet-mediated events. Clopidogrel is recommended in patients with Chronic Coronary Syndromes (CCS) or in ACS patients at high bleeding risk. Unfortunately, up to 30% of patients are non-responders to clopidogrel and show residual high platelet reactivity (HPR). Colchicine (COLC) is a drug with cardiovascular effects. We have demonstrated that COLC might exert protective cardiovascular effects by interfering with cytoskeleton rearrangement, a phenomenon involved in platelet aggregation. Here, we investigate in vitro the effects of colchicine on platelet aggregation of patients on DAPT with clopidogrel. Platelets obtained from 35 CCS patients on therapy with clopidogrel were pre-incubated with COLC 10 µM before being stimulated with ADP (20 µM), or TRAP (25 µM) at 0, 30, 60 and 90 min to measure max aggregation by LTA. Platelets not COLC-preincubated served as controls. Seven patients were pre-selected as clopidogrel non-responders. COLC significantly reduced TRAP-induced platelet aggregation in clopidogrel responders and non-responders. Interestingly, COLC inhibited ADP-induced platelet aggregation in clopidogrel non-responders in which ADP still caused activation despite DAPT. We demonstrate that COLC inhibits platelet aggregation in clopidogrel non-responders with HPR despite DAPT with this ADP receptor-inhibitor. Further in vivo studies should be designed to evaluate the opportunity to prescribe colchicine after ACS/CCS to overcome the clopidogrel limitations in the DAPT therapy.
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Affiliation(s)
- Plinio Cirillo
- Department of Advanced Biomedical Sciences, Division of Cardiology, University of Naples, "Federico II", Via Sergio Pansini 5, 80131, Naples, Italy.
| | - Vittorio Taglialatela
- Department of Advanced Biomedical Sciences, Division of Cardiology, University of Naples, "Federico II", Via Sergio Pansini 5, 80131, Naples, Italy
| | - Grazia Pellegrino
- Department of Advanced Biomedical Sciences, Division of Cardiology, University of Naples, "Federico II", Via Sergio Pansini 5, 80131, Naples, Italy
| | - Andrea Morello
- Department of Advanced Biomedical Sciences, Division of Cardiology, University of Naples, "Federico II", Via Sergio Pansini 5, 80131, Naples, Italy
| | - Stefano Conte
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luigi Di Serafino
- Department of Advanced Biomedical Sciences, Division of Cardiology, University of Naples, "Federico II", Via Sergio Pansini 5, 80131, Naples, Italy
| | - Giovanni Cimmino
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania "Luigi Vanvitelli", Naples, Italy
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22
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Di Serafino L, Mangiacapra F, Pyxaras S, Morisco C, Bartunek J, De Bruyne B, De Luise F, Wijns W, Barbato E. Relationship between peripheral arterial reactive hyperemia and the index of myocardial resistance in patients undergoing invasive coronary angiography. Int J Cardiol 2021; 333:8-13. [PMID: 33667574 DOI: 10.1016/j.ijcard.2021.02.085] [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] [Received: 10/31/2020] [Revised: 01/10/2021] [Accepted: 02/26/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Coronary microvascular dysfunction is a powerful prognostic factor in patients with coronary artery disease. We investigated the role of reactive digital hyperemia peripheral arterial tonometry (RH-PAT) as a non-invasive tool to identify patients with impaired coronary microvasculature. METHODS Patients undergoing elective coronary angiography were consecutively assessed for peripheral microvascular endothelial function before coronary angiography: both the Reactive Hyperemic Index (RHI) and the Framingham reactive hyperemic index (Endoscore) were measured. During coronary angiography, the Index of microvascular resistance (IMR) was measured in all patients, and an IMR value > 25 identified patients with coronary microvascular impairment. RESULTS A total of 47 patients with chronic coronary syndromes candidate to coronary angiography were included. Those with coronary microvascular impairment (n = 18 [38%]) presented with significantly lower RHI (1.68 ± 0.38 vs. 1.94 ± 0.93, p = 0.04) and Endoscore 0.50 ± 0.23 vs. 0.64 ± 0.23, p = 0.04) values as compared with patients with preserved coronary microvasculature. A significant relationship was observed between IMR with both RHI (r = 0.35, p = 0.02) and Endoscore (r = 0.34, p = 0.02). At the multivariable analysis, RHI and Endoscore were the only independent predictors of an IMR > 25. CONCLUSIONS Our study demonstrates that digital reactive hyperemia indexes are lower in patients with high IMR values, suggesting a role for RH-PAT as non-invasive tool for identifying patients with coronary microvascular impairment.
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Affiliation(s)
- Luigi Di Serafino
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Fabio Mangiacapra
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Stylianos Pyxaras
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Cardiology Department, Coburg-Clinic, Coburg, Germany
| | - Carmine Morisco
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Jozef Bartunek
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | | | - Federica De Luise
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway and Saolta University Healthcare Group, Galway, Ireland
| | - Emanuele Barbato
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium.
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23
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Di Serafino L, Magliulo F, Barbato E, Cirillo P, Esposito M, Serino F, Ziviello F, Stabile E, Franzone A, Piccolo R, Borgia F, Morisco C, Rapacciuolo A, Esposito G. ADDED Index or percentage diameter of residual coronary stenosis to risk-stratify patients presenting with STEMI. Cardiovasc Revasc Med 2021; 34:92-98. [PMID: 33547023 DOI: 10.1016/j.carrev.2021.01.030] [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] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND We compared the prognostic value of the ADDED Index with visually estimated diameter (DS) of residual coronary stenosis (RS) in STEMI patients after successful PCI of the culprit lesion. Even though associated with a positive outcome, the functional assessment of non-culprit stenosis remains largely underused, especially in STEMI patients. The Angiography-DeriveD hEmoDynamic index (ADDED index) showed high accuracy to predict FFR and it might be used to better guide the diagnostic and therapeutic work-up of such patients. METHODS We retrospectively included 596 patients grouped on the basis of either the ADDED Index (ADDED Negative (<2.23, n = 153) vs ADDED Positive (≥2.23, n = 129)) or the DS of the RS (RS Negative (<50%, n = 177) vs RS Positive (≥50%, n = 105)). Patients without any RS served as control (n = 314). Primary endpoints were: 1) major adverse cardiac events (MACE), composite of all-cause death, myocardial infarction (MI), clinically driven revascularizations (CDR); 2) non-culprit vessel oriented clinical events (VOCE), composite of all-cause death, non-culprit vessel related MI and CDR. RESULTS At 24 months the rate of both MACE and VOCE was significantly higher in both the ADDED Positive and RS Positive groups. However, differently from patients in whom complete revascularization was deferred on the basis of the angiography (RS Negative), no additional risk was found for patients in the ADDED Negative group. CONCLUSIONS In STEMI patients with MVD deferring treatment of RS on the basis of the ADDED index, rather than the visually estimated DS, is associated with a favorable clinical outcome.
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Affiliation(s)
- Luigi Di Serafino
- Department of Advanced Biomedical Sciences - University of Naples Federico II, Naples, Italy.
| | - Fabio Magliulo
- Department of Advanced Biomedical Sciences - University of Naples Federico II, Naples, Italy
| | - Emanuele Barbato
- Department of Advanced Biomedical Sciences - University of Naples Federico II, Naples, Italy
| | - Plinio Cirillo
- Department of Advanced Biomedical Sciences - University of Naples Federico II, Naples, Italy
| | - Mafalda Esposito
- Department of Advanced Biomedical Sciences - University of Naples Federico II, Naples, Italy
| | - Federica Serino
- Department of Advanced Biomedical Sciences - University of Naples Federico II, Naples, Italy
| | - Francesca Ziviello
- Department of Advanced Biomedical Sciences - University of Naples Federico II, Naples, Italy
| | - Eugenio Stabile
- Department of Advanced Biomedical Sciences - University of Naples Federico II, Naples, Italy
| | - Anna Franzone
- Department of Advanced Biomedical Sciences - University of Naples Federico II, Naples, Italy
| | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences - University of Naples Federico II, Naples, Italy
| | - Francesco Borgia
- Department of Advanced Biomedical Sciences - University of Naples Federico II, Naples, Italy
| | - Carmine Morisco
- Department of Advanced Biomedical Sciences - University of Naples Federico II, Naples, Italy
| | - Antonio Rapacciuolo
- Department of Advanced Biomedical Sciences - University of Naples Federico II, Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences - University of Naples Federico II, Naples, Italy
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Cimmino G, Gallinoro E, Di Serafino L, De Luca N, Cirillo P. Antiplatelet Therapy in Acute Coronary Syndromes. Lights and Shadows of Platelet Function Tests to Guide the Best Therapeutic Approach. Curr Vasc Pharmacol 2020; 18:262-272. [PMID: 31092181 DOI: 10.2174/1570161117666190513105859] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/30/2019] [Accepted: 04/30/2019] [Indexed: 11/22/2022]
Abstract
The key role of platelets in pathophysiology of Acute Coronary Syndromes (ACS) has been well recognized. Platelet activation and aggregation, together with tissue factor-pathway activation, lead to acute thrombus formation in the coronary vessels at sites of plaque rupture. Thus, antiplatelet therapy with drugs able to interfere with platelet activation/aggregation represents a cornerstone of ACS treatment in intensive care units and catheterisation labs. Several observational studies have described that residual high platelet reactivity, despite antiplatelet therapy, is associated with increased risk of nonfatal Myocardial Infarction (MI), definite/probable stent thrombosis and cardiovascular mortality. Thus, assessment of platelet function with reliable and reproducible platelet function tests might be crucial to identify patients at high risk of thrombosis or not responding to ongoing antiplatelet strategies. However, despite this promising background, some randomized clinical trials have failed to demonstrate improvement in outcomes when using platelet function tests for clinical decision-making. This review, after describing platelet biology and pathophysiology of ACS, briefly considers the drugs currently approved for use in patients with ACS or treated by the percutaneous coronary intervention (PCI). Finally, we provide an updated overview of the current methods to evaluate platelet reactivity in the clinical setting of ACS illustrating their potential advantages/limitations in current clinical practice.
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Affiliation(s)
- Giovanni Cimmino
- Department of Translational Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Emanuele Gallinoro
- Department of Translational Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Luigi Di Serafino
- Department of Advanced Biomedical Sciences, Division of Cardiology, University of Naples Federico II, Naples, Italy
| | - Nicola De Luca
- Department of Advanced Biomedical Sciences, Division of Cardiology, University of Naples Federico II, Naples, Italy
| | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, Division of Cardiology, University of Naples Federico II, Naples, Italy
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25
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Toth GG, Sasi V, Franco D, Prassl AJ, Di Serafino L, Ng JCK, Szanto G, Schneller L, Ang HY, Plank G, Wijns W, Barbato E. Double-kissing culotte technique for coronary bifurcation stenting. EUROINTERVENTION 2020; 16:e724-e733. [PMID: 32338608 DOI: 10.4244/eij-d-20-00130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
AIMS The aim of this study was to assess whether the culotte technique could be improved by an additional kissing dilation prior to main branch (MB) stenting. METHODS AND RESULTS Double-kissing (DK) culotte was compared to the culotte and DK-crush techniques in a bench model (n=24). Results were evaluated for stent apposition, luminal opening and flow dynamics. The total procedure duration of DK-culotte was 18.3±3.4 minutes, significantly lower than for DK-crush (24.3±5.7 min; p=0.015), but similar to culotte (21.6±5.9 min, p=0.104). In DK-culotte the overall rate of moderate (200-500 µm) and significant (>500 µm) malapposition was 2.1±1.9% and 0.4±0.2%, similar as compared to culotte (3.7±3.8%, p=0.459 and 1.0±1.0%, p=0.517, respectively), and lower as compared to DK-crush (8.1±2.5%, p<0.001 and 3.7±5.3%, p=0.002, respectively). The lower malapposition rate of DK-culotte as compared to DK-crush was due to less moderate and significant malapposition in the proximal MB (0.0±0.0% vs 14.0±7.6%, p<0.001 and 0.0±0.0% vs 4.2±9.1%, p=0.026, respectively). Micro-computed tomography did not show a difference in luminal opening at the proximal MB, distal MB or SB. There was no difference either in the maximum shear rate or in areas of high shear or recirculation. CONCLUSIONS Bench test data suggest that the DK approach facilitates the culotte technique. The clinical validity and relevance remain to be confirmed in a larger in vivo population.
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Affiliation(s)
- Gabor G Toth
- University Heart Center Graz, Department of Cardiology, Medical University of Graz, Graz, Austria
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26
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Toth G, Sasi V, Franco D, Di Serafino L, Prassl A, Ng J, Szanto G, Plank G, Ang HY, Wijns W, Barbato E. TCT CONNECT-153 Double-Kissing Culotte Technique for Coronary Bifurcation Stenting: Technical Evaluation and Comparison With Conventional Double-Stenting Techniques. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.163] [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: 11/16/2022]
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27
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Bressi E, Mangiacapra F, Di Gioia G, Pellicano M, Di Serafino L, Peace AJ, Bartunek J, Morisco C, Wijns W, De Bruyne B, Barbato E. Coronary microcirculation and peri-procedural myocardial injury during elective percutaneous coronary intervention. Vascul Pharmacol 2020. [DOI: 10.1016/j.vph.2020.106704] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mangiacapra F, Bressi E, Di Gioia G, Pellicano M, Di Serafino L, Peace AJ, Bartunek J, Morisco C, Wijns W, De Bruyne B, Barbato E. Coronary microcirculation and peri-procedural myocardial injury during elective percutaneous coronary intervention. Int J Cardiol 2020; 306:42-46. [DOI: 10.1016/j.ijcard.2019.12.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/02/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022]
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Di Serafino L, Barbato E. [Invasive functional assessment of coronary artery stenosis using fractional flow reserve]. G Ital Cardiol (Rome) 2020; 21:16-24. [PMID: 31960831 DOI: 10.1714/3285.32586] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The presence of myocardial ischemia significantly affects prognosis of patients with coronary artery disease. The fractional flow reserve (FFR) allows interventional cardiologists to evaluate whether an equivocal coronary artery stenosis is associated or not with myocardial ischemia, and therefore deserve to be properly treated. The present article has the purpose to provide the readers with an overview about the role of FFR in the diagnosis and management of coronary artery disease, as well as the potential related controversies. The coronary physiology on the basis of this tool is also provided together with all the procedural aspects useful in the catheterization laboratory. In addition, the landmark trials on the basis of the FFR application in different clinical settings and coronary anatomies will be described, together with the main improvements aiming at favoring a more extensive use of this invasive tool.
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Affiliation(s)
- Luigi Di Serafino
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi "Federico II", Napoli
| | - Emanuele Barbato
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi "Federico II", Napoli
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Cirillo P, Di Serafino L, Taglialatela V, Calabrò P, Antonucci E, Gresele P, Palareti G, Patti G, Pengo V, Pignatelli P, Marcucci R. Optimal Medical Therapy on Top of Dual-Antiplatelet Therapy: 1-Year Clinical Outcome in Patients With Acute Coronary Syndrome: The START Antiplatelet Registry. Angiology 2019; 71:235-241. [DOI: 10.1177/0003319719895171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Optimal medical therapy (OMT) at discharge is recommended after acute coronary syndrome (ACS). Few studies report the impact of OMT on long-term clinical outcome in a real-world scenario. We evaluated the impact of discharge OMT on top of dual-antiplatelet therapy (DAPT) on clinical outcome in the real-world ACS population of the Survey on anTicoagulated pAtients RegisTer ANTIPLATELET registry. The primary end point was major adverse cardiac and cerebrovascular event (MACCE), a composite of death, myocardial infarction, stroke, or target vessel revascularization. The co-primary end point was net adverse cardiac and cerebrovascular event (NACE), based on MACCE plus major bleeding. Consecutive patients with ACS with 1-year follow-up were enrolled. They were evaluated at discharge for the use of a β-blocker, angiotensin-converting enzyme inhibitor/angiotensin II receptor blockers and statins. Optimal medical therapy was defined as the use of ≥2 of 3 medications. At multivariate analysis, both MACCE and NACE were significantly higher in non-OMT patients than in OMT patients (MACCE 18 [19] vs 59 [9], hazard ratio [HR] = 0.44 [0.26-0.75], P = .002, NACE 19 [20] vs 67 [10], HR = 0.47 [0.28-0.79], P = .004). In this real-world scenario, OMT at discharge on top of DAPT seems associated with a better clinical outcome compared with patients discharged on non-OMT.
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Affiliation(s)
- Plinio Cirillo
- Division of Cardiology, Department of Advanced Biomedical Sciences, School of Medicine, “Federico II” University, Naples, Italy
| | - Luigi Di Serafino
- Division of Cardiology, Department of Advanced Biomedical Sciences, School of Medicine, “Federico II” University, Naples, Italy
| | - Vittorio Taglialatela
- Division of Cardiology, Department of Advanced Biomedical Sciences, School of Medicine, “Federico II” University, Naples, Italy
| | - Paolo Calabrò
- Department of Cardio-Thoracic and Respiratory Sciences, Università degli Studi della Campania “Luigi Vanvitelli,” Italy
| | | | - Paolo Gresele
- Department of Medicine, Section of Internal and Cardiovascular Medicine, University of Perugia, Italy
| | | | - Giuseppe Patti
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Italy
| | - Vittorio Pengo
- Department of Cardiac, Thoracic, and Vascular Sciences, Padua University Hospital, Italy
| | - Pasquale Pignatelli
- Department of Internal Medicine and Medical Specialities, University of Rome “La Sapienza,” Italy
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, Center for Atherothrombotic Disease, University of Florence, Florence, Italy
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Mangiacapra F, Pellicano M, Di Serafino L, Bressi E, Peace AJ, Di Gioia G, Morisco C, Bartunek J, Wijns W, Bruyne BD, Barbato E. Platelet reactivity and coronary microvascular impairment after percutaneous revascularization in stable patients receiving clopidogrel or prasugrel. Atherosclerosis 2018; 278:23-28. [PMID: 30236867 DOI: 10.1016/j.atherosclerosis.2018.08.044] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 07/15/2018] [Accepted: 08/29/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Increased platelet reactivity (PR) associated with variable degree of coronary microvascular impairment has been reported in patients on clopidogrel after elective percutaneous coronary intervention (PCI). Prasugrel provides more potent platelet inhibition than clopidogrel, though it is unknown whether it might also prevent PCI-related platelet activation. In stable patients undergoing elective PCI, we compared: (1) the effects of prasugrel vs. clopidogrel on peri-procedural variations of PR and (2) the correlation of platelet inhibition potency with PCI-induced coronary microvascular impairment. METHODS Forty thienopyridine-naive patients were randomly assigned to a loading dose of either prasugrel 60 mg (n = 20) or clopidogrel 600 mg (n = 20) at least 12 h before PCI. At the time of PCI, we assessed adenosine diphosphate (ADP)-induced PR with the Multiplate Analyzer, and the pressure-derived index of microvascular resistance (IMR) in the treated coronary, both at baseline and post-procedure. RESULTS ADP-induced PR was significantly lower in the prasugrel compared with clopidogrel group both at baseline (16.0 ± 8.7 vs. 33.9 ± 18.0 aggregation units [AU], p < 0.001) and post-procedure (16.2 ± 9.0 vs. 39.0 ± 18.6 AU, p < 0.001). A significant peri-procedural increase in PR was observed in the clopidogrel group (p = 0.008), but not in the prasugrel group (p = 0.822). A significant correlation was found between IMR and PR both at baseline (r = 0.458, p = 0.003) and post-PCI (r = 0.487, p = 0.001). CONCLUSIONS A loading dose of prasugrel compared with clopidogrel is able to attenuate PCI-related increase in PR in patients with stable CAD undergoing PCI, which might contribute to the beneficial effect of this drug on peri-procedural coronary microvascular function.
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Affiliation(s)
- Fabio Mangiacapra
- Cardiovascular Research Center Aalst, OLV Clinic, Aalst, Belgium; Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | | | | | - Edoardo Bressi
- Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Aaron J Peace
- Cardiovascular Research Center Aalst, OLV Clinic, Aalst, Belgium; Altnagelvin Hospital, WHSCT, Londonderry, Northern Ireland, United Kingdom
| | | | - Carmine Morisco
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Jozef Bartunek
- Cardiovascular Research Center Aalst, OLV Clinic, Aalst, Belgium
| | - William Wijns
- Cardiovascular Research Center Aalst, OLV Clinic, Aalst, Belgium; The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway, Ireland; Saolta University Healthcare Group, Galway, Ireland
| | | | - Emanuele Barbato
- Cardiovascular Research Center Aalst, OLV Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
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Westra J, Andersen BK, Campo G, Matsuo H, Koltowski L, Eftekhari A, Liu T, Di Serafino L, Di Girolamo D, Escaned J, Nef H, Naber C, Barbierato M, Tu S, Neghabat O, Madsen M, Tebaldi M, Tanigaki T, Kochman J, Somi S, Esposito G, Mercone G, Mejia-Renteria H, Ronco F, Bøtker HE, Wijns W, Christiansen EH, Holm NR. Diagnostic Performance of In-Procedure Angiography-Derived Quantitative Flow Reserve Compared to Pressure-Derived Fractional Flow Reserve: The FAVOR II Europe-Japan Study. J Am Heart Assoc 2018; 7:JAHA.118.009603. [PMID: 29980523 PMCID: PMC6064860 DOI: 10.1161/jaha.118.009603] [Citation(s) in RCA: 215] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background Quantitative flow ratio (QFR) is a novel modality for physiological lesion assessment based on 3‐dimensional vessel reconstructions and contrast flow velocity estimates. We evaluated the value of online QFR during routine invasive coronary angiography for procedural feasibility, diagnostic performance, and agreement with pressure‐wire–derived fractional flow reserve (FFR) as a gold standard in an international multicenter study. Methods and Results FAVOR II E‐J (Functional Assessment by Various Flow Reconstructions II Europe‐Japan) was a prospective, observational, investigator‐initiated study. Patients with stable angina pectoris were enrolled in 11 international centers. FFR and online QFR computation were performed in all eligible lesions. An independent core lab performed 2‐dimensional quantitative coronary angiography (2D‐QCA) analysis of all lesions assessed with QFR and FFR. The primary comparison was sensitivity and specificity of QFR compared with 2D‐QCA using FFR as a reference standard. A total of 329 patients were enrolled. Paired assessment of FFR, QFR, and 2D‐QCA was available for 317 lesions. Mean FFR, QFR, and percent diameter stenosis were 0.83±0.09, 0.82±10, and 45±10%, respectively. FFR was ≤0.80 in 104 (33%) lesions. Sensitivity and specificity by QFR was significantly higher than by 2D‐QCA (sensitivity, 86.5% (78.4–92.4) versus 44.2% (34.5–54.3); P<0.001; specificity, 86.9% (81.6–91.1) versus 76.5% (70.3–82.0); P=0.002). Area under the receiver curve was significantly higher for QFR compared with 2D‐QCA (area under the receiver curve, 0.92 [0.89–0.96] versus 0.64 [0.57–0.70]; P<0.001). Median time to QFR was significantly lower than median time to FFR (time to QFR, 5.0 minutes [interquartile range, –6.1] versus time to FFR, 7.0 minutes [interquartile range, 5.0–10.0]; P<0.001). Conclusions Online computation of QFR in the catheterization laboratory is clinically feasible and is superior to angiographic assessment for evaluation of intermediary coronary artery stenosis using FFR as a reference standard. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT02959814.
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Affiliation(s)
- Jelmer Westra
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | | | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy.,Maria Cecilia Hospital, GVM Care and Research, Cotignola (RA), Italy
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu City, Japan
| | - Lukasz Koltowski
- Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Ashkan Eftekhari
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - Tommy Liu
- Department of Cardiology, Hagaziekenhuis, The Hague, The Netherlands
| | - Luigi Di Serafino
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Javier Escaned
- Hospital Clinico San Carlos IDISSC, Complutense University, Madrid, Spain
| | - Holger Nef
- Department of Cardiology and Angiology, University of Giessen, Giessen, Germany
| | | | - Marco Barbierato
- Emodinamica Aziendale AULSS 3 Serenissima, Ospedale Dell'Angelo, Mestre, Italy
| | - Shengxian Tu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Omeed Neghabat
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - Morten Madsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Skejby, Denmark
| | - Matteo Tebaldi
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
| | - Toru Tanigaki
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu City, Japan
| | - Janusz Kochman
- Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Samer Somi
- Department of Cardiology, Hagaziekenhuis, The Hague, The Netherlands
| | - Giovanni Esposito
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | | | - Federico Ronco
- Emodinamica Aziendale AULSS 3 Serenissima, Ospedale Dell'Angelo, Mestre, Italy
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway, Galway, Ireland
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Borgia F, Niglio T, De Luca N, Di Serafino L, Esposito G, Trimarco B, Cirillo P. True double bifurcation lesions: new application of the self-expandable Axxess stent and review of literature with dedicated bifurcation devices. Cardiovasc Revasc Med 2018; 20:254-260. [PMID: 29735349 DOI: 10.1016/j.carrev.2018.04.011] [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] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 04/03/2018] [Accepted: 04/09/2018] [Indexed: 11/17/2022]
Abstract
Complex coronary artery bifurcation lesions occurred in hard clinical scenarios, such as acute coronary syndromes, may represent a challenge for interventional cardiologists, with not-defined general consensus on treatment. Even if provisional stenting is the most common option used to restore rapidly the coronary branches flow, improvements in industrial technologies and design of new dedicated bifurcation devices might open new modalities of treatment in these complex cases. The Axxess stent (Biosensors Europe SA, Morges, Switzerland) is a self-expanding biolimus-eluting conical V-shape stent, specifically designed to treat "easily" coronary artery bifurcation lesions, with reported favorable long-term clinical results in stable patients compared to a provisional technique. We report for the first time the feasibility to use this device in a case of "true double coronary bifurcation lesion" occurred in the context of acute coronary syndrome. Moreover, we reviewed studies with bifurcation dedicated devices and available cases of "true double bifurcation lesions", underlying advantages/disadvantages of using one device over the others during acute coronary syndrome.
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Affiliation(s)
- Francesco Borgia
- Department of Advanced Biomedical Sciences, Divisions of Cardiology and Cardiothoracic Surgery, Federico II University, Naples, Italy.
| | - Tullio Niglio
- Department of Advanced Biomedical Sciences, Divisions of Cardiology and Cardiothoracic Surgery, Federico II University, Naples, Italy
| | - Nicola De Luca
- Department of Advanced Biomedical Sciences, Divisions of Cardiology and Cardiothoracic Surgery, Federico II University, Naples, Italy
| | - Luigi Di Serafino
- Department of Advanced Biomedical Sciences, Divisions of Cardiology and Cardiothoracic Surgery, Federico II University, Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Divisions of Cardiology and Cardiothoracic Surgery, Federico II University, Naples, Italy
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, Divisions of Cardiology and Cardiothoracic Surgery, Federico II University, Naples, Italy
| | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, Divisions of Cardiology and Cardiothoracic Surgery, Federico II University, Naples, Italy
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Di Serafino L, Turturo M, Lanzone S, Marano M, Scognamiglio G, Trimarco B, Cirillo P, Esposito G, D'Agostino C. Comparison of the Effect of Dual-Axis Rotational Coronary Angiography Versus Conventional Coronary Angiography on Frequency of Acute Kidney Injury, X-Ray Exposure Time, and Quantity of Contrast Medium Injected. Am J Cardiol 2018. [PMID: 29519544 DOI: 10.1016/j.amjcard.2018.01.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Dual-axis rotational coronary angiography (DARCA) has already been shown to reduce both the amount of contrast medium and radiation exposure compared with conventional coronary angiography (CCA). However, a clinical benefit of such imaging modality has never been demonstrated. The aim of this study was to evaluate the efficacy of DARCA to prevent acute kidney injury (AKI) compared with CCA. Consecutive patients who underwent coronary angiography were enrolled to DARCA (n = 80) or CCA (n = 80). Patients presenting with ST-segment elevation myocardial infarction or previously underwent coronary artery bypass graft were excluded. The 2 groups were homogeneous in terms of both clinical and procedural characteristics. Total x-ray time and total amount of contrast medium were significantly lower in the DARCA group compared with the CCA group (x-ray time 3.2 minutes [1.8 to 7.0] vs 5.1 minutes [2.6 to 9.9], p = 0.002; contrast medium amount 40 ml [31 to 116] vs 80 ml [50 to 150], p <0.001). AKI more often occurred in the CCA group compared with the DARCA group (16 [20%] vs 4 [5%], p = 0.007). Moreover, in patients presenting with acute coronary syndrome (ACS) or who underwent percutaneous coronary intervention (PCI), AKI more often occurred in the CCA group compared with the DARCA group (ACS patients, 6 [29%] vs 2 [6%], p = 0.04, and PCI patients, 11 [33%] vs 0 [0%], p <0.001). In addition, in patients with high pretest probability of coronary artery disease, AKI more often occurred in the CCA group compared with the DARCA group (11 [55%] vs 2 [6%], p <0.001). In conclusion, DARCA significantly reduces both x-ray exposure and amount of contrast medium usage, thereby reducing the occurrence of AKI compared with CCA.
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Di Serafino L, Cirillo P, Niglio T, Borgia F, Trimarco B, Esposito G, Stabile E. Very late bioresorbable scaffold thrombosis and reoccurrence of dissection two years later chronic total occlusion recanalization of the left anterior descending artery. World J Cardiol 2017; 9:710-714. [PMID: 28932360 PMCID: PMC5583544 DOI: 10.4330/wjc.v9.i8.710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 05/22/2017] [Accepted: 06/20/2017] [Indexed: 02/06/2023] Open
Abstract
We describe the case of a patient presenting with ST-segment elevation myocardial infarction due to very late scaffold thrombosis. The patient was already admitted for an elective percutaneous recanalization of a chronically occluded left anterior descending artery (LAD). The procedure was performed according the sub-intimal tracking and re-entry (STAR) technique with 4 bioresorbable vascular scaffolds implantation. However, even though the coronary flow was preserved at the end of the procedure, the dissected segment was only partially sealed at the distal segment of the LAD. After 18 mo of regular assumption, dual antiplatelet therapy was discontinued for 10 mo before his presentation at the emergency room. This is the first reported case of a very late scaffold thrombosis after coronary chronic total occlusion (CTO) recanalization performed according to the STAR technique. This case raises concerns about the risk of very late scaffold thrombosis after complex CTO revascularization.
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Affiliation(s)
- Luigi Di Serafino
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy
| | - Plinio Cirillo
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy
| | - Tullio Niglio
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy
| | - Francesco Borgia
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy
| | - Bruno Trimarco
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy
| | - Giovanni Esposito
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy
| | - Eugenio Stabile
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy
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Ciccarelli G, Barbato E, Golino M, Cimmino G, Bartunek J, Di Serafino L, Di Girolamo D, De Bruyne B, Wijns W, Golino P. Prognostic Factors in Patients With Stemi Undergoing Primary PCI in the Clopidogrel Era: Role of Dual Antiplatelet Therapy at Admission and the Smoking Paradox on Long-Term Outcome. J Interv Cardiol 2016; 30:5-15. [PMID: 27925310 DOI: 10.1111/joic.12360] [Citation(s) in RCA: 8] [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: 11/30/2022] Open
Abstract
BACKGROUND Several clinical and laboratory variables have an impact on the prognosis of STEMI patients undergoing PPCI; however, little is known about the role of ongoing DAPT at the time of the event and the smoking status as prognostic factors affecting the outcome of these patients. METHODS AND RESULTS Seven-hundred and thirteen consecutive STEMI patients undergoing PPCI, admitted to the S. Anna and S. Sebastiano Hospital (Caserta, Italy) and to the OLV Clinic (Aalst, Belgium), between March 2009 and December 2011, were retrospectively enrolled. Rescue PCI was the only exclusion criterion. Primary end-point was the combination of death for all causes, re-infarction, stroke, and target lesion revascularization (TLR). Patients already on DAPT at admission (26.4%) showed a significant increase in the event rate at univariate analysis (HR 2.34, CI 1.62-3.75, P < 0.05), while current smokers (56.5%) had a lower event rate, as compared to non-smokers (HR 0.67, CI 0.46-0.96, P < 0.05). In smoking patients already on DAPT at admission, a lower event rate was observed than in non-smoking patients on DAPT. Although, patients already on DAPT had a higher-risk profile (renal impairment, ongoing statin treatment, ST resolution <50%, and Killip class >1 were more frequently present than in patients not on DAPT), Cox regression analysis confirmed that both DAPT (HR 1.74, 95%CI 1.20-2.53, P < 0.01) and smoking status (HR 0.69, 95%CI 0.48-1.00, P < 0.05) retained their statistical significance, as they and were significantly associated with a worse and a better outcome, respectively, underlying their role as independent prognostic factors. CONCLUSIONS Not being a current smoker and ongoing DAPT at admission, in patients with STEMI undergoing PPCI, represent independent negative prognostic value.
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Affiliation(s)
- Giovanni Ciccarelli
- Department of Cardio-Thoracic Sciences, Section of Cardiology, Second University of Naples, Naples, Italy.,Cardiovascular Center, OLV Clinic, Aalst, Belgium
| | - Emanuele Barbato
- Cardiovascular Center, OLV Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
| | - Marco Golino
- Department of Cardio-Thoracic Sciences, Section of Cardiology, Second University of Naples, Naples, Italy
| | - Giovanni Cimmino
- Department of Cardio-Thoracic Sciences, Section of Cardiology, Second University of Naples, Naples, Italy
| | | | - Luigi Di Serafino
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
| | | | | | | | - Paolo Golino
- Department of Cardio-Thoracic Sciences, Section of Cardiology, Second University of Naples, Naples, Italy
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Di Serafino L, Scognamiglio G, Turturo M, Esposito G, Savastano R, Lanzone S, Trimarco B, D'Agostino C. FFR prediction model based on conventional quantitative coronary angiography and the amount of myocardium subtended by an intermediate coronary artery stenosis. Int J Cardiol 2016; 223:340-344. [DOI: 10.1016/j.ijcard.2016.08.205] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 08/09/2016] [Accepted: 08/10/2016] [Indexed: 01/10/2023]
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Di Serafino L, Borgia F, Maeremans J, Pyxaras SA, De Bruyne B, Wijns W, Heyndrickx GR, Dens J, Di Mario C, Barbato E. Periprocedural Myocardial Injury and Long-Term Clinical Outcome in Patients Undergoing Percutaneous Coronary Interventions of Coronary Chronic Total Occlusion. J Invasive Cardiol 2016; 28:410-414. [PMID: 26984930] [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: 06/05/2023]
Abstract
BACKGROUND Periprocedural myocardial injury (PMI) after percutaneous coronary intervention (PCI) might occur more frequently during challenging procedures such as PCI of chronic coronary total occlusion (CTO). The prognostic implication of PMI in CTO-PCI remains unclear. METHODS From January 2006 to September 2012, a total of 715 consecutive patients undergoing CTO-PCI were screened at three centers. Only patients with available pre-PCI and post-PCI troponin (cTn) were included (n = 442). PMI was defined as an elevation of cTn >5x the upper reference limit (URL), or a rise of cTn >20% if baseline values were elevated. RESULTS Patients were grouped into: (1) successful CTO-PCI and no-PMI (Group A; n = 195); (2) successful CTO-PCI with PMI (Group B; n = 133); failed CTO-PCI (Group C; n = 114). Occurrence of major adverse cardiovascular event (MACE) was assessed in 431 patients (97%), at a median follow-up of 25 months, and were significantly lower in patients successfully treated without PMI occurrence, while increased in cases of PMI or failed CTO-PCI (Group A, 9%; Group B, 15%; Group C, 28%; hazard ratio, 1.57 (95% confidence interval, 1.12-2.18); P<.01). At Kaplan-Meier analysis, MACE-free survival was significantly higher in Group A (log-rank, 21.46; P<.001). CONCLUSION Successful CTO revascularization is still associated with a better long-term clinical outcome vs patients in whom it failed, regardless of the occurrence of PMI.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Emanuele Barbato
- Cardiovascular Research Center, Aalst OLV Hospital, Moorselbaan, n. 164, B-9300 Aalst, Belgium.
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Esposito G, Di Serafino L, Gargiulo G, Sannino A, Schiattarella GG, Franzone A, Perrino C, Chiariello M. Rotational atherectomy for the treatment of isolated femoral artery traumatic lesion: a case report. Monaldi Arch Chest Dis 2016. [DOI: 10.4081/monaldi.2009.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We describe the case of a 50-year-old man with an isolated plaque of the left distal superficial femoral artery (SFA), probably not related to atherosclerosis, but rather to a traumatic event. He was admitted to our hospital because of intermittent claudication. The critical distal SFA stenosis was documented by angiography and the lesion was treated by rotational atherectomy without stent implantation. At 1-year follow up, Doppler Ultrasound scan demonstrated a normal flow pattern of the left SFA and downstream districts in the absence of any complication. Therefore, rotational atherectomy is a safe and effective technique particularly in cases of peripheral arterial disease wherein stent implantation is dangerous.
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Toth GG, Toth B, De Vroey F, Di Serafino L, Pyxaras S, Rusinaru D, Di Gioia G, Pellicano M, Barbato E, Van Mieghem C, Heyndrickx GR, De Bruyne B, Wijns W, Johnson NP. Response to letter regarding article, "revascularization decisions in patients with stable angina and intermediate lesions: results of the international survey on interventional strategy". Circ Cardiovasc Interv 2015; 8:e002296. [PMID: 25663323 DOI: 10.1161/circinterventions.115.002296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Gabor G Toth
- University Heart Center Graz, Medical University Graz, Graz, Austria
| | - Balint Toth
- Cardiovascular Research Centre Aalst, OLV-Ziekenhuis, Aalst, Belgium
| | - Frederic De Vroey
- Cardiovascular Research Centre Aalst, OLV-Ziekenhuis, Aalst, Belgium
| | - Luigi Di Serafino
- Cardiovascular Research Centre Aalst, OLV-Ziekenhuis, Aalst, Belgium
| | - Stylianos Pyxaras
- Cardiovascular Research Centre Aalst, OLV-Ziekenhuis, Aalst, Belgium
| | - Dan Rusinaru
- Cardiovascular Research Centre Aalst, OLV-Ziekenhuis, Aalst, Belgium
| | - Giuseppe Di Gioia
- Cardiovascular Research Centre Aalst, OLV-Ziekenhuis, Aalst, Belgium
| | - Mariano Pellicano
- Cardiovascular Research Centre Aalst, OLV-Ziekenhuis, Aalst, Belgium
| | - Emanuele Barbato
- Cardiovascular Research Centre Aalst, OLV-Ziekenhuis, Aalst, Belgium
| | | | - Guy R Heyndrickx
- Cardiovascular Research Centre Aalst, OLV-Ziekenhuis, Aalst, Belgium
| | - Bernard De Bruyne
- Cardiovascular Research Centre Aalst, OLV-Ziekenhuis, Aalst, Belgium
| | - William Wijns
- Cardiovascular Research Centre Aalst, OLV-Ziekenhuis, Aalst, Belgium
| | - Nils P Johnson
- Weatherhead PET Center, University of Texas Medical School, Houston, TX
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Toth GG, Toth B, Johnson NP, De Vroey F, Di Serafino L, Pyxaras S, Rusinaru D, Di Gioia G, Pellicano M, Barbato E, Van Mieghem C, Heyndrickx GR, De Bruyne B, Wijns W. Revascularization Decisions in Patients With Stable Angina and Intermediate Lesions. Circ Cardiovasc Interv 2014; 7:751-9. [DOI: 10.1161/circinterventions.114.001608] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background—
Fractional flow reserve (FFR) measurement of intermediate coronary stenoses is recommended by guidelines when demonstration of ischemia by noninvasive testing is unavailable. The study aims to evaluate the penetration of this recommendation into current thinking about revascularization strategies for stable coronary artery disease.
Methods and Results—
International Survey on Interventional Strategy was conducted via a web-based platform. First, participants’ experiences in interventional cardiology were queried. Second, 5 complete angiograms were provided, presenting only focal intermediate stenoses. FFR and quantitative coronary angiography values were known; however, remained undisclosed. Determination of stenosis significance was asked for each lesion. In cases of uncertainty, the most appropriate adjunctive invasive diagnostic method among quantitative coronary angiography, intravascular ultrasound, optical coherence tomography, or FFR needed to be selected. International Survey on Interventional Strategy was taken by 495 participants who provided 4421 lesion evaluations. In 3158 (71%) decisions, participants relied solely on angiographic appearance that was discordant in 47% with the known FFR, using 0.80 as cutoff value. The use of FFR and imaging modalities was requested in 21% and 8%, respectively. Comparing 4 groups of participants according to the experience in FFR, angiogram-based decisions were less frequent with increasing experience (77% versus 72% versus 69% versus 67%, respectively;
P
<0.001). As a result, requests for FFR were more frequent (14% versus 19% versus 24% versus 28%, respectively;
P
<0.001) and rates of discordant decisions decreased (51% versus 49% versus 47% versus 43%, respectively;
P
<0.022).
Conclusions—
The findings confirm that, even when all potential external constraints are virtually eliminated, visual estimation continues to dominate the treatment decisions for intermediate stenoses, indicative of a worrisome disconnect between recommendations and current practice.
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Affiliation(s)
- Gabor G. Toth
- From the Cardiovascular Research Center Aalst, OLV-Ziekenhuis, Aalst, Belgium (G.G.T., B.T., F.D.V., L.D.S., S.P., D.R., G.D.G., M.P., E.B., C.V.M., G.R.H., B.D.B., W.W.); University Heart Center Graz, Medical University of Graz, Graz, Austria (G.G.T.); and Weatherhead PET Center, University of Texas Medical School, Houston (N.P.J.)
| | - Balint Toth
- From the Cardiovascular Research Center Aalst, OLV-Ziekenhuis, Aalst, Belgium (G.G.T., B.T., F.D.V., L.D.S., S.P., D.R., G.D.G., M.P., E.B., C.V.M., G.R.H., B.D.B., W.W.); University Heart Center Graz, Medical University of Graz, Graz, Austria (G.G.T.); and Weatherhead PET Center, University of Texas Medical School, Houston (N.P.J.)
| | - Nils P. Johnson
- From the Cardiovascular Research Center Aalst, OLV-Ziekenhuis, Aalst, Belgium (G.G.T., B.T., F.D.V., L.D.S., S.P., D.R., G.D.G., M.P., E.B., C.V.M., G.R.H., B.D.B., W.W.); University Heart Center Graz, Medical University of Graz, Graz, Austria (G.G.T.); and Weatherhead PET Center, University of Texas Medical School, Houston (N.P.J.)
| | - Frederic De Vroey
- From the Cardiovascular Research Center Aalst, OLV-Ziekenhuis, Aalst, Belgium (G.G.T., B.T., F.D.V., L.D.S., S.P., D.R., G.D.G., M.P., E.B., C.V.M., G.R.H., B.D.B., W.W.); University Heart Center Graz, Medical University of Graz, Graz, Austria (G.G.T.); and Weatherhead PET Center, University of Texas Medical School, Houston (N.P.J.)
| | - Luigi Di Serafino
- From the Cardiovascular Research Center Aalst, OLV-Ziekenhuis, Aalst, Belgium (G.G.T., B.T., F.D.V., L.D.S., S.P., D.R., G.D.G., M.P., E.B., C.V.M., G.R.H., B.D.B., W.W.); University Heart Center Graz, Medical University of Graz, Graz, Austria (G.G.T.); and Weatherhead PET Center, University of Texas Medical School, Houston (N.P.J.)
| | - Stylianos Pyxaras
- From the Cardiovascular Research Center Aalst, OLV-Ziekenhuis, Aalst, Belgium (G.G.T., B.T., F.D.V., L.D.S., S.P., D.R., G.D.G., M.P., E.B., C.V.M., G.R.H., B.D.B., W.W.); University Heart Center Graz, Medical University of Graz, Graz, Austria (G.G.T.); and Weatherhead PET Center, University of Texas Medical School, Houston (N.P.J.)
| | - Dan Rusinaru
- From the Cardiovascular Research Center Aalst, OLV-Ziekenhuis, Aalst, Belgium (G.G.T., B.T., F.D.V., L.D.S., S.P., D.R., G.D.G., M.P., E.B., C.V.M., G.R.H., B.D.B., W.W.); University Heart Center Graz, Medical University of Graz, Graz, Austria (G.G.T.); and Weatherhead PET Center, University of Texas Medical School, Houston (N.P.J.)
| | - Giuseppe Di Gioia
- From the Cardiovascular Research Center Aalst, OLV-Ziekenhuis, Aalst, Belgium (G.G.T., B.T., F.D.V., L.D.S., S.P., D.R., G.D.G., M.P., E.B., C.V.M., G.R.H., B.D.B., W.W.); University Heart Center Graz, Medical University of Graz, Graz, Austria (G.G.T.); and Weatherhead PET Center, University of Texas Medical School, Houston (N.P.J.)
| | - Mariano Pellicano
- From the Cardiovascular Research Center Aalst, OLV-Ziekenhuis, Aalst, Belgium (G.G.T., B.T., F.D.V., L.D.S., S.P., D.R., G.D.G., M.P., E.B., C.V.M., G.R.H., B.D.B., W.W.); University Heart Center Graz, Medical University of Graz, Graz, Austria (G.G.T.); and Weatherhead PET Center, University of Texas Medical School, Houston (N.P.J.)
| | - Emanuele Barbato
- From the Cardiovascular Research Center Aalst, OLV-Ziekenhuis, Aalst, Belgium (G.G.T., B.T., F.D.V., L.D.S., S.P., D.R., G.D.G., M.P., E.B., C.V.M., G.R.H., B.D.B., W.W.); University Heart Center Graz, Medical University of Graz, Graz, Austria (G.G.T.); and Weatherhead PET Center, University of Texas Medical School, Houston (N.P.J.)
| | - Carlos Van Mieghem
- From the Cardiovascular Research Center Aalst, OLV-Ziekenhuis, Aalst, Belgium (G.G.T., B.T., F.D.V., L.D.S., S.P., D.R., G.D.G., M.P., E.B., C.V.M., G.R.H., B.D.B., W.W.); University Heart Center Graz, Medical University of Graz, Graz, Austria (G.G.T.); and Weatherhead PET Center, University of Texas Medical School, Houston (N.P.J.)
| | - Guy R. Heyndrickx
- From the Cardiovascular Research Center Aalst, OLV-Ziekenhuis, Aalst, Belgium (G.G.T., B.T., F.D.V., L.D.S., S.P., D.R., G.D.G., M.P., E.B., C.V.M., G.R.H., B.D.B., W.W.); University Heart Center Graz, Medical University of Graz, Graz, Austria (G.G.T.); and Weatherhead PET Center, University of Texas Medical School, Houston (N.P.J.)
| | - Bernard De Bruyne
- From the Cardiovascular Research Center Aalst, OLV-Ziekenhuis, Aalst, Belgium (G.G.T., B.T., F.D.V., L.D.S., S.P., D.R., G.D.G., M.P., E.B., C.V.M., G.R.H., B.D.B., W.W.); University Heart Center Graz, Medical University of Graz, Graz, Austria (G.G.T.); and Weatherhead PET Center, University of Texas Medical School, Houston (N.P.J.)
| | - William Wijns
- From the Cardiovascular Research Center Aalst, OLV-Ziekenhuis, Aalst, Belgium (G.G.T., B.T., F.D.V., L.D.S., S.P., D.R., G.D.G., M.P., E.B., C.V.M., G.R.H., B.D.B., W.W.); University Heart Center Graz, Medical University of Graz, Graz, Austria (G.G.T.); and Weatherhead PET Center, University of Texas Medical School, Houston (N.P.J.)
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Barbato E, Sarno G, Berza CT, Di Gioia G, Bartunek J, Vanderheyden M, Di Serafino L, Wijns W, Trimarco B, De Bruyne B. Impact of Alpha- and Beta-Adrenergic Receptor Blockers on Fractional Flow Reserve and Index of Microvascular Resistance. J Cardiovasc Transl Res 2014; 7:803-9. [DOI: 10.1007/s12265-014-9599-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 10/22/2014] [Indexed: 12/21/2022]
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Di Serafino L, Turturo M, D'Agostino C. TCT-325 Influence of the amount of myocardium subtended by an intermediate coronary artery stenosis on FFR and iFR. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.07.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Toth G, Hamilos M, Pyxaras S, Mangiacapra F, Nelis O, De Vroey F, Di Serafino L, Muller O, Van Mieghem C, Wyffels E, Heyndrickx GR, Bartunek J, Vanderheyden M, Barbato E, Wijns W, De Bruyne B. Evolving concepts of angiogram: fractional flow reserve discordances in 4000 coronary stenoses. Eur Heart J 2014; 35:2831-8. [DOI: 10.1093/eurheartj/ehu094] [Citation(s) in RCA: 211] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pyxaras SA, Mangiacapra F, Wijns W, Di Serafino L, De Vroey F, Toth G, Sinagra G, De Bruyne B, Heyndrickx GR, Barbato E. ACEF and clinical SYNTAX score in the risk stratification of patients with heavily calcified coronary stenosis undergoing rotational atherectomy with stent implantation. Catheter Cardiovasc Interv 2014; 83:1067-73. [DOI: 10.1002/ccd.25360] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [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: 08/03/2013] [Revised: 11/11/2013] [Accepted: 12/21/2013] [Indexed: 11/07/2022]
Affiliation(s)
| | | | - William Wijns
- Cardiovascular Center Aalst; OLV Clinic Aalst Belgium
| | | | | | - Gabor Toth
- Cardiovascular Center Aalst; OLV Clinic Aalst Belgium
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Pyxaras SA, Mangiacapra F, Verhamme K, Di Serafino L, De Vroey F, Toth G, Perkan A, Salvi A, Bartunek J, De Bruyne B, Wijns W, Sinagra G, Barbato E. Synergistic effect of thrombus aspiration and abciximab in primary percutaneous coronary intervention. Catheter Cardiovasc Interv 2013; 82:604-11. [PMID: 23359568 DOI: 10.1002/ccd.24837] [Citation(s) in RCA: 3] [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: 10/05/2012] [Revised: 12/31/2012] [Accepted: 01/21/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND Previous studies failed to assess the individual prognostic role of thrombus aspiration (TA) or abciximab in primary percutaneous coronary intervention (pPCI), due their prevalent combined use. METHODS AND RESULTS A total of 644 consecutive ST-segment elevation myocardial infarction patients treated with pPCI were included in this retrospective registry from January 2006 to December 2008. Patients were divided in: (a) Group 1, with conventional pPCI; (b) Group 2, with pPCI and abciximab; (c) Group 3, with pPCI and TA; (d) Group 4, with pPCI and abciximab plus TA. Primary end point was the composite of major adverse cardiovascular events (MACEs, defined as overall mortality, myocardial infarction, target vessel revascularization, and major bleedings) at 1 year. Baseline clinical and angiographic characteristics were not different among the groups, with the exception of a younger age in group 4. The two groups of patients treated with TA (group 3 and 4) received more frequently direct stenting (P < 0.001 vs. group 1 for both), presented higher rate of end-procedural TIMI flow grade 3 (P < 0.001 vs. group 1 for both), and lower rate of no-reflow (P = 0.016 and P < 0.001 vs. group 1, respectively). Patients of group 2 presented a borderline nonsignificant trend toward higher rate of end-procedural TIMI flow grade 3 (P = 0.083 vs. group 1). MACEs at 1 year were 43 (29%) in group 1 versus 25 (22%) in group 2 versus 24 (19%) in group 3 versus 32 (13%) in group 4 (log-rank P = 0.001). At the multivariate Cox regression analysis, combined TA plus abciximab in group 4 [hazard ratio (HR): 0.48, confidence interval (CI) 95% 0.28-0.84, P = 0.01] and a higher left ventricular ejection fraction (HR: 0.97, CI 95% 0.95-0.98, P < 0.001) were significantly associated with lower MACE rate. CONCLUSIONS The combination of pharmacologic and mechanic antithrombotic treatment during pPCI was associated with better 1-year clinical outcome.
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Affiliation(s)
- Stylianos A Pyxaras
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Cardiovascular Department, University Hospital of Trieste, Trieste, Italy
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Maeremans J, Selleslagh P, Di Serafino L, Barbato E, Dens J. Impact of negative lesion characteristics of chronic total occlusions on procedural outcome and strategy. Acta Cardiol 2013; 68:455-61. [PMID: 24283105 DOI: 10.1080/ac.68.5.2994467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE In the past, certain lesion characteristics of chronic total occlusions (CTOs) have been shown to have an influence on guidewire crossing and thus percutaneous coronary interventional outcome. However, a clear description of the individual impact of these characteristics on procedural outcome, procedural characteristics and treatment strategy is lacking. The purpose of this study was to give a "weight"to these individual characteristics and evaluate their influence on interventional strategy. METHODS Between November 2011 and May 2013, a non-randomized, prospective study was conducted in the hospitals of Genk and Aalst, leading to the inclusion of 132 consecutive patients. Lesions were classified according to the J-CTO (Multicenter CTO Registry of Japan) score (Morino et al., 2011). Both antegrade and retrograde procedures were performed. For antegrade procedures, a step-up strategy was applied. Univariate and multivariate analyses were performed and compared with the results of Morino et al.The study end point was general procedural success, defined as successful stenting with thrombosis in myocardial infarction 3 flow. RESULTS Overall procedural success was achieved in 74% and according to J-CTO criteria, in 92% (easy), 82% (intermediate), 77% (difficult) and 40% (very difficult), respectively. Independent predictors included bending, blunt stump, multivessel PCI and a retrograde approach with corresponding odds ratios for failure of 5.3, 2.7, 2.8 and 4.0, respectively. CONCLUSION Lesion characteristics of CTOs remain important in the prediction of success. In this study, bending and a blunt stump at the entry site came forth as the most important independent predictors of failure.
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Affiliation(s)
- Joren Maeremans
- Faculty of Medicine and Life Sciences – Hasselt University, Diepenbeek, Belgium
| | | | | | | | - Joseph Dens
- Dept. of Cardiology – Ziekenhuis Oost-Limburg, Genk, Belgium
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Toth G, De Bruyne B, Casselman F, De Vroey F, Pyxaras S, Di Serafino L, Van Praet F, Van Mieghem C, Stockman B, Wijns W, Degrieck I, Barbato E. Fractional flow reserve-guided versus angiography-guided coronary artery bypass graft surgery. Circulation 2013; 128:1405-11. [PMID: 23985788 DOI: 10.1161/circulationaha.113.002740] [Citation(s) in RCA: 142] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Fractional flow reserve (FFR) is well established for patients undergoing percutaneous coronary intervention, yet little is known about candidates for coronary artery bypass graft surgery. METHODS AND RESULTS From 2006 to 2010, we retrospectively included in this registry 627 consecutive patients treated by coronary artery bypass graft surgery having at least 1 angiographically intermediate stenosis. In 429 patients, coronary artery bypass graft surgery was based solely on angiography (angiography-guided group). In 198 patients, at least 1 intermediate stenosis was grafted with an FFR ≤0.80 or deferred with an FFR >0.80 (FFR-guided group). The end point was major adverse cardiovascular events at 3 years, defined as the composite of overall death, myocardial infarction, and target vessel revascularization. The rate of angiographic multivessel disease was similar in the angiography-guided and FFR-guided groups (404 [94.2%] versus 186 [93.9%]; P=0.722). In the FFR-guided group, this was significantly downgraded after FFR measurements to 86.4% (P<0.001 versus before FFR) and was associated with a smaller number of anastomoses (3 [2-3] versus 3 [2-4]; P<0.001) and rate of on-pump surgery (49% versus 69%; P<0.001). At 3 years, major adverse cardiovascular events were not different between the angiography-guided and FFR-guided groups (12% versus 11%; hazard ratio, 1.030; 95% confidence interval, 0.627-1.692; P=0.908). However, the FFR-guided group compared with the angiography-guided group presented a significantly lower rate of angina (Canadian Cardiovascular Society class II-IV, 31% versus 47%; P<0.001). CONCLUSIONS FFR-guided coronary artery bypass graft surgery was associated with a lower number of graft anastomoses and a lower rate of on-pump surgery compared with angiography-guided coronary artery bypass graft surgery. This did not result in a higher event rate during up to 36 months of follow-up and was associated with a lower rate of angina.
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Affiliation(s)
- Gabor Toth
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
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Di Serafino L, De Bruyne B, Mangiacapra F, Bartunek J, Agostoni P, Vanderheyden M, Scognamiglio G, Heyndrickx GR, Wijns W, Barbato E. Long-term clinical outcome after fractional flow reserve- versus angio-guided percutaneous coronary intervention in patients with intermediate stenosis of coronary artery bypass grafts. Am Heart J 2013; 166:110-8. [PMID: 23816029 DOI: 10.1016/j.ahj.2013.04.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 04/17/2013] [Indexed: 01/17/2023]
Abstract
BACKGROUND Fractional flow reserve (FFR)-guided percutaneous revascularization (percutaneous coronary intervention [PCI]) of intermediate stenosis in native coronary artery is safe and associated with better clinical outcomes as compared with an angiography-guided PCI. It is unknown whether this applies to coronary artery bypass grafts (CABGs). METHODS We included 223 patients with CABG and with stable or unstable angina and an intermediate stenosis involving an arterial or a venous graft. Patients were divided into 2 groups: FFR guided (n = 65, PCI performed in case of FFR ≤0.80) and angio guided (n = 158, PCI performed based on angiographic evaluation). Primary end point was major adverse cardiac and cerebrovascular event, defined as death, myocardial infarction, target vessel failure, and cerebrovascular accident (CVA). RESULTS The 2 groups were similar in terms of demographic and clinical characteristics. Percutaneous coronary intervention was performed in 23 patients (35%) of the FFR-guided group and 90 patients (57%) of the angio-guided group (P < .01). In the FFR-guided group, PCI was more often performed in arterial grafts as compared with the angio-guided group (16 [70%] vs 12 [13%], respectively; P < .01). Follow-up was obtained in 96% of patients at a median of 3.8 years (1.6-4.0 years). At multivariate analysis, major adverse cardiac and cerebrovascular event rate was significantly lower in the FFR-guided group as compared with the angio-guided group (18 [28%] vs 77 [51%], hazard ratio 0.33 [0.11-0.96], P = .043]. Procedure costs were overall reduced in the FFR-guided group (€2240 ± €652 vs €2416 ± €522, P = .03). CONCLUSIONS An FFR-guided PCI of intermediate stenosis in bypass grafts is safe and results in better clinical outcomes as compared with an angio-guided PCI. This clinical benefit is achieved with a significant overall reduction in procedural costs.
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Pyxaras SA, Sinagra G, Mangiacapra F, Perkan A, Di Serafino L, Vitrella G, Rakar S, De Vroey F, Santangelo S, Salvi A, Toth G, Bartunek J, De Bruyne B, Wijns W, Barbato E. Contrast-induced nephropathy in patients undergoing primary percutaneous coronary intervention without acute left ventricular ejection fraction impairment. Am J Cardiol 2013; 111:684-8. [PMID: 23261003 DOI: 10.1016/j.amjcard.2012.11.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Revised: 11/09/2012] [Accepted: 11/09/2012] [Indexed: 12/30/2022]
Abstract
The prognostic relevance of direct contrast toxicity in patients treated with primary percutaneous coronary intervention remains unclear, owing to the confounding hemodynamic effect of acute left ventricular ejection fraction (LVEF) impairment on kidney function estimation. In the present study, 644 consecutive patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention were prospectively enrolled. Contrast-induced nephropathy (CIN) was defined as an increase in serum creatinine >25% or a decrease in the estimated glomerular filtration rate (eGFR) <25% from baseline in the first 72 hours. The primary end point of the study was major adverse cardiovascular events at 1 year (composite of death, myocardial infarction, target lesion revascularization, and bleeding). Among the global population, the interaction between the LVEF and eGFR at admission to define CIN was statistically significant (p <0.001). When only the 385 patients without acute LVEF impairment (i.e., those with LVEF ≥40%) were considered, 27 (7%) developed postprocedural CIN that was associated with increased major adverse cardiovascular events rate at 1 year of clinical follow-up (38% vs 9%; p <0.001). On adjusted Cox multivariate analysis, CIN was an independent predictor of worse outcomes, both when defined according to creatinine (hazard ratio 3.81, 95% confidence interval 1.71 to 8.48, p = 0.001) or eGFR (hazard ratio 3.77, 95% confidence interval 1.53 to 9.28, p = 0.004) variations. In conclusion, in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention, LVEF has a significant interaction with eGFR. When only patients without acute LVEF impairment were considered, CIN confirmed its negative prognostic effect on the 1-year clinical outcomes.
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