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Orzalkiewicz M, Foroni M, Chietera F, Bendandi F, Mazzapicchi A, Bruno AG, Ghetti G, Taglieri N, Marrozzini C, Galiè N, Palmerini T, Saia F. Off-Label Use of Balloon-Expandable Transcatheter Valves to Treat Pure Aortic Regurgitation. Am J Cardiol 2024:S0002-9149(24)00312-6. [PMID: 38663573 DOI: 10.1016/j.amjcard.2024.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 04/11/2024] [Accepted: 04/19/2024] [Indexed: 05/06/2024]
Abstract
Transcatheter aortic valve implantation (TAVI) in native pure aortic regurgitation (AR) with off-label use of balloon-expandable valves (BEV) has been reported. However, there are scant data regarding optimal oversizing and its safety, and our study assessed BEV oversizing and outcomes of TAVI. Thirteen consecutive tricuspid aortic valve patients who underwent transfemoral TAVIs for pure AR with Sapien BEV at our center between 2019 and 2023 (69.2% males, mean age 80.8 years, Society of Thoracic Surgeons 4.0%) were divided into small annulus (SA) group (≤618 mm2) where ≥20% oversizing is achievable based on published data on BEV overexpansion, and larger annulus (LA) group (>618 mm2). Overexpansion and actual oversizing were measured on postprocedural computed tomography scan. Technical success was 92.3% with 1 valve embolization in the LA group. The postprocedural computed tomography showed a mean 28.3% oversizing, significantly higher in SA (31.2%) than in LA group (19.4%), p = 0.0092. Oversizing ≥20% was achieved in 100% SA versus 33.3% LA patients (p = 0.046). In conclusion, TAVI in pure AR with oversized Sapien BEV showed good procedural and short-term outcomes when ≥20% oversizing was predictably achievable.
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Affiliation(s)
- Mateusz Orzalkiewicz
- Cardiology Unit, IRCCS University Hospital of Bologna, Policlinico S. Orsola, Bologna, Italy
| | - Marco Foroni
- Cardiology Unit, IRCCS University Hospital of Bologna, Policlinico S. Orsola, Bologna, Italy
| | - Francesco Chietera
- Cardiology Unit, IRCCS University Hospital of Bologna, Policlinico S. Orsola, Bologna, Italy
| | - Francesco Bendandi
- Cardiology Unit, IRCCS University Hospital of Bologna, Policlinico S. Orsola, Bologna, Italy
| | - Alessandro Mazzapicchi
- Cardiology Unit, IRCCS University Hospital of Bologna, Policlinico S. Orsola, Bologna, Italy
| | - Antonio Giulio Bruno
- Cardiology Unit, IRCCS University Hospital of Bologna, Policlinico S. Orsola, Bologna, Italy
| | - Gabriele Ghetti
- Cardiology Unit, IRCCS University Hospital of Bologna, Policlinico S. Orsola, Bologna, Italy
| | - Nevio Taglieri
- Cardiology Unit, IRCCS University Hospital of Bologna, Policlinico S. Orsola, Bologna, Italy
| | - Cinzia Marrozzini
- Cardiology Unit, IRCCS University Hospital of Bologna, Policlinico S. Orsola, Bologna, Italy
| | - Nazzareno Galiè
- Cardiology Unit, IRCCS University Hospital of Bologna, Policlinico S. Orsola, Bologna, Italy; Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Tullio Palmerini
- Cardiology Unit, IRCCS University Hospital of Bologna, Policlinico S. Orsola, Bologna, Italy; Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Francesco Saia
- Cardiology Unit, IRCCS University Hospital of Bologna, Policlinico S. Orsola, Bologna, Italy; Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy.
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2
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Gallitto E, Faggioli G, Saia F, Palmerini T, Pini R, Bruno AG, Feroldi FM, Alaidros M, Ghetti G, Taglieri N, Caputo S, Donati F, Marrozzini C, Gargiulo M. The role of the vascular surgeon in transcatheter aortic valve implantation. Vascular 2024:17085381241237844. [PMID: 38504140 DOI: 10.1177/17085381241237844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has become the standard treatment for severe aortic valve stenosis in patients at increased surgical risk. Percutaneous transfemoral (TF) is the access of choice due to its reduced invasiveness and perioperative morbidity/mortality compared with the trans-axillary, aortic, and apical routes. On the other hand, vascular access complications (VACs) of the TF access are associated with prolonged hospitalization, 30-day, and 1-year mortality. In addition, the concomitance of peripheral arterial disease may require associated endovascular management. A multidisciplinary team with Interventional Cardiologists and Vascular Surgeons may minimize the rate of VACs in patients with challenging femoral-iliac access or concomitant disease of other vascular districts, thus optimizing the outcome of TF-TAVI. The aim of this study was to evaluate the role of Vascular Surgeons in TF TAVI procedures. METHODS We conducted a retrospective single-center review of all TF-TAVI procedures assisted by Vascular Surgeons between January 2016 and December 2020 in a high-volume tertiary hospital. Pre, intra, and postoperative data were analyzed by a dedicated group of Interventional Cardiologists and Vascular Surgeons. VACs were defined according with the Valve Academic Research Consortium (VARC) three guidelines. The outcomes of TF-TAVI procedures with Vascular Surgeons involvement were assessed as study's endpoints. RESULTS Overall, 937 TAVI procedures were performed with a TF approach ranging between 78% (2016) and 98% (2020). Vascular Surgeons were involved in 67 (7%) procedures with the following indications: concomitant abdominal aortic aneurysm (EVAR + TAVI) - 3 (4%), carotid stenosis (TAVI + CAS) - 2 (3%), hostile femoral/iliac access, or VACs - 62 (93%). Balloon angioplasty of iliac artery pre-TAVI implantation was performed in 51 cases (conventional PTA: 38/51%-75%; conventional PTA + intravascular lithotripsy: 13/51%-25%; stenting: 5/51%-10%). TAVI procedure was successfully completed by percutaneous TF approach in all 62 cases with challenging femoral/iliac access. VACs necessitating interventions were 18/937 (2%) cases, localized to the common femoral or common/external iliac artery in 15/18 (83%) and 3/18 (17%) cases, respectively. They were managed by surgical or endovascular maneuvers in 3/18 (17%) and 15/18 (83%) cases, respectively. Fifteen/18 (83%) VACs were treated during the index procedure. There was no procedure-related mortality or 30-day readmission. CONCLUSION In our experience, Vascular Surgeon assistance in TAVI procedures was not infrequent and allowed safe and effective device introduction through challenging TF access. Similarly, the concomitant significant disease of other vascular districts could be safely addressed, potentially reducing postoperative related mortality and morbidity. The implementation of multidisciplinary team with interventional cardiologists and vascular surgeons should be encouraged whenever possible.
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Affiliation(s)
- Enrico Gallitto
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Gianluca Faggioli
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Francesco Saia
- Division of Interventional Cardiology, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Tullio Palmerini
- Division of Interventional Cardiology, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Rodolfo Pini
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Antonio Giulio Bruno
- Division of Interventional Cardiology, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Francesca Maria Feroldi
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Moad Alaidros
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Gabriele Ghetti
- Division of Interventional Cardiology, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Nevio Taglieri
- Division of Interventional Cardiology, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Stefania Caputo
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Francesco Donati
- Division of Interventional Cardiology, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Cinzia Marrozzini
- Division of Interventional Cardiology, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Mauro Gargiulo
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Dardi F, Rotunno M, Guarino D, Suarez SM, Niro F, Loforte A, Taglieri N, Ballerini A, Magnani I, Bertozzi R, Donato F, Martini G, Manes A, Saia F, Pacini D, Galiè N, Palazzini M. Comparison of different treatment strategies in patients with chronic thromboembolic pulmonary hypertension: a single centre real-world experience. Int J Cardiol 2023; 391:131333. [PMID: 37673403 DOI: 10.1016/j.ijcard.2023.131333] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 08/18/2023] [Accepted: 09/01/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Pulmonary endarterectomy (PEA) has been the most effective therapy for chronic thromboembolic pulmonary hypertension (CTEPH). However, there is a substantial proportion of patients deemed not operable in whom other treatment strategies are available: medical therapy and balloon pulmonary angioplasty (BPA). We aimed to compare different CTEPH treatment strategies effect in a real-world setting. METHODS All patients with CTEPH referred to our centre were included. We compare the short-term clinical, functional, exercise and haemodynamic effect of medical therapy (irrespective of subsequent treatment strategies), PEA and BPA (irrespective of previous/subsequent treatment strategies); we also describe the long-term outcome of the different patient groups. RESULTS We included 467 patients (39% were treated only with medical therapy, 43% underwent PEA, 13% underwent BPA and 5% were not treated with any therapy). Patients treated only with medical therapy were the oldest; compared to patients undergoing PEA, they had a lower exercise capacity, a higher risk profile and gained a lower haemodynamic, functional and survival benefit from the treatment. Patients undergoing BPA had a lower haemodynamic improvement but a comparable functional, exercise and risk improvement and a similar survival compared to patients undergoing PEA; their survival is anyway better than patients undergoing only medical treatment. Untreated historical control patients had the worst survival. CONCLUSIONS We confirm the superiority of PEA compared to any alternative treatment in CTEPH patients and we observe that BPA, in patients deemed not operable or with persistent/recurrent PH after PEA, leads to a better outcome than medical therapy alone.
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Affiliation(s)
- Fabio Dardi
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy.
| | - Mariangela Rotunno
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy
| | - Daniele Guarino
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy
| | - Sofia Martin Suarez
- Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy; Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Fabio Niro
- Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Antonio Loforte
- Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy; Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Nevio Taglieri
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy
| | - Alberto Ballerini
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy
| | - Ilenia Magnani
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy
| | - Riccardo Bertozzi
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy
| | - Federico Donato
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy
| | - Giulia Martini
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy
| | - Alessandra Manes
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy
| | - Francesco Saia
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy
| | - Davide Pacini
- Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy; Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Nazzareno Galiè
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy
| | - Massimiliano Palazzini
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy
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Ghetti G, Bendandi F, Donati F, Ciurlanti L, Nardi E, Bruno AG, Orzalkiewicz M, Palmerini T, Saia F, Marrozzini C, Galié N, Taglieri N. Predictors of bail-out stenting in patients with small vessel disease treated with drug-coated balloon percutaneous coronary intervention. Catheter Cardiovasc Interv 2023. [PMID: 37172212 DOI: 10.1002/ccd.30688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/16/2023] [Accepted: 04/30/2023] [Indexed: 05/14/2023]
Abstract
BACKGROUND Drug-coated balloons (DCBs) have shown comparable results with drug-eluting stents in small vessel disease (SVD) percutaneous coronary intervention (PCI) in terms of target vessel revascularization and a reduced incidence of myocardial infarction. However, the relatively high rate of bail-out stenting (BOS) still represents a major drawback of DCB PCI. AIMS The aim of the study was to investigate the clinical, anatomic, and procedural features predictive of BOS after DCB PCI in SVD. METHODS We included all consecutive patients undergoing PCI at our institution between January 2020 and May 2022 who were treated with DCB PCI of a de novo lesion in a coronary vessel with a reference vessel diameter (RVD) between 2.0 and 2.5 mm. Angiographic success was defined as a residual stenosis <30% without flow-limiting dissection. Patients who did not meet these criteria underwent BOS. RESULTS A total of 168 consecutive patients and 216 coronary stenoses were included. The rate of bail-out stent was 13.9%. On multivariate analysis, DCB/RVD ratio (odds ratio [OR]: 4.39, 95% confidence interval [CI]: 1.71-11.29, p < 0.01), vessel tortuosity (OR: 7.00, 95% CI: 1.66-29.62, p < 0.01), distal vessel disease (OR: 5.66, 95% CI: 2.02-15.83, p < 0.01), and high complexity (Grade C of ACC/AHA classification) coronary stenoses (OR: 6.31, 95% CI: 1.53-26.04, p = 0.01) were independent predictors of BOS. CONCLUSIONS BOS is not an infrequent occurrence in DCB PCI of small vessels and is correlated with vessel tortuosity, distal diffuse vessel disease, higher lesion complexity, and balloon diameter oversizing.
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Affiliation(s)
- Gabriele Ghetti
- Department of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Francesco Bendandi
- Department of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Francesco Donati
- Department of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Leonardo Ciurlanti
- Department of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Elena Nardi
- Department of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Antonio Giulio Bruno
- Department of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Mateusz Orzalkiewicz
- Department of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Tullio Palmerini
- Department of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Francesco Saia
- Department of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Cinzia Marrozzini
- Department of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Nazzareno Galié
- Department of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Nevio Taglieri
- Department of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Italy
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5
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Ghetti G, Chietera F, Donati F, Bendandi F, Minnucci M, Bruno AG, Orzalkiewicz M, Nardi E, Palmerini T, Saia F, Marrozzini C, Galié N, Taglieri N. Coronary ectasia in different scenarios, primarily in myocardial infarction with nonobstructive coronary artery disease. J Cardiovasc Med (Hagerstown) 2023; 24:167-171. [PMID: 36753724 DOI: 10.2459/jcm.0000000000001445] [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: 02/10/2023]
Abstract
AIMS Several causes have been reported for coronary artery ectasia (CAE), mostly atherosclerosis and tunica media abnormalities. The main aim of the present study was to investigate if CAE extension differs in distinct clinical settings. METHODS Three hundred and forty-one patients with diagnosis of CAE were identified among 9659 coronary angiographies and divided into four groups according to the patient's admission diagnosis: stable or unstable angina (S-UA), myocardial infarction (MI), aortic disease, aortic valvular disease (AVD). S-UA and MI were subgrouped according to the presence of obstructive coronary artery disease (OCAD). Multivariable logistic regression was used to investigate the relationship between clinical diagnosis and CAE extension as expressed by Markis classification and number of coronary vessels affected by CAE. RESULTS No significant differences in CAE extension were found among the four groups, in terms of vessels affected by CAE (P = 0.37) or Markis class (P = 0.33). CAE was not related to the extension of OCAD as assessed by the Gensini score, which was higher in MI and S-UA groups (P < 0.01). However, when ischemic patients were sub-divided on the basis of the presence of OCAD, MI without obstructive coronary artery disease (MINOCA) was associated with a higher extension of CAE in terms of Markis class 1 (OR 5.08, 95% CI 1.61-16.04; P < 0.01). CONCLUSION The extension of CAE is comparable in patients referred to coronary angiography for different clinical scenarios, including S-UA, MI, aortic disease, and AVD; however, patients with MINOCA were associated with a higher extension of CAE.Graphical abstract: Difference in coronary artery ectasia extension in terms of Markis class severity, respectively, stratified by clinical presentation and obstructive coronary artery disease presence, http://links.lww.com/JCM/A519.
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Affiliation(s)
- Gabriele Ghetti
- Department of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Italy
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6
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Palmerini T, Saia F, Kim WK, Renker M, Iadanza A, Fineschi M, Bruno AG, Ghetti G, Vanhaverbeke M, Søndergaard L, De Backer O, Romagnoli E, Burzotta F, Trani C, Adrichem R, Van Mieghem NM, Nardi E, Chietera F, Orzalkiewicz M, Tomii D, Pilgrim T, Aranzulla TC, Musumeci G, Adam M, Meertens MM, Taglieri N, Marrozzini C, Alvarez Covarrubias HA, Joner M, Nardi G, Di Muro FM, Di Mario C, Loretz L, Toggweiler S, Gallitto E, Gargiulo M, Testa L, Bedogni F, Berti S, Ancona MB, Montorfano M, Leone A, Savini C, Pacini D, Gmeiner J, Braun D, Nerla R, Castriota F, De Carlo M, Petronio AS, Barbanti M, Costa G, Tamburino C, Leone PP, Reimers B, Stefanini G, Sudo M, Nickenig G, Piva T, Scotti A, Latib A, Vercellino M, Porto I, Codner P, Kornowski R, Bartorelli AL, Tarantini G, Fraccaro C, Abdel-Wahab M, Grube E, Galié N, Stone GW. Vascular Access in Patients With Peripheral Arterial Disease Undergoing TAVR: The Hostile Registry. JACC Cardiovasc Interv 2023; 16:396-411. [PMID: 36858659 DOI: 10.1016/j.jcin.2022.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND The optimal access route in patients with severe peripheral artery disease (PAD) undergoing transcatheter aortic valve replacement (TAVR) remains undetermined. OBJECTIVES This study sought to compare clinical outcomes with transfemoral access (TFA), transthoracic access (TTA), and nonthoracic transalternative access (TAA) in TAVR patients with severe PAD. METHODS Patients with PAD and hostile femoral access (TFA impossible, or possible only after percutaneous treatment) undergoing TAVR at 28 international centers were included in this registry. The primary endpoint was the propensity-adjusted risk of 30-day major adverse events (MAE) defined as the composite of all-cause mortality, stroke/transient ischemic attack (TIA), or main access site-related Valve Academic Research Consortium 3 major vascular complications. Outcomes were also stratified according to the severity of PAD using a novel risk score (Hostile score). RESULTS Among the 1,707 patients included in the registry, 518 (30.3%) underwent TAVR with TFA after percutaneous treatment, 642 (37.6%) with TTA, and 547 (32.0%) with TAA (mostly transaxillary). Compared with TTA, both TFA (adjusted HR: 0.58; 95% CI: 0.45-0.75) and TAA (adjusted HR: 0.60; 95% CI: 0.47-0.78) were associated with lower 30-day rates of MAE, driven by fewer access site-related complications. Composite risks at 1 year were also lower with TFA and TAA compared with TTA. TFA compared with TAA was associated with lower 1-year risk of stroke/TIA (adjusted HR: 0.49; 95% CI: 0.24-0.98), a finding confined to patients with low Hostile scores (Pinteraction = 0.049). CONCLUSIONS Among patients with PAD undergoing TAVR, both TFA and TAA were associated with lower 30-day and 1-year rates of MAE compared with TTA, but 1-year stroke/TIA rates were higher with TAA compared with TFA.
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Affiliation(s)
- Tullio Palmerini
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Cardiac, Thoracic and Vascular Department, Università di Bologna, Bologna, Italy.
| | - Francesco Saia
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Cardiac, Thoracic and Vascular Department, Università di Bologna, Bologna, Italy
| | | | | | - Alessandro Iadanza
- UOSA Cardiologia Interventistica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Massimo Fineschi
- UOSA Cardiologia Interventistica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Antonio Giulio Bruno
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Cardiac, Thoracic and Vascular Department, Università di Bologna, Bologna, Italy
| | - Gabriele Ghetti
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Cardiac, Thoracic and Vascular Department, Università di Bologna, Bologna, Italy
| | - Maarten Vanhaverbeke
- Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Søndergaard
- Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ole De Backer
- Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Enrico Romagnoli
- U.O.C. di Interventistica Cardiologica e Diagnostica Invasiva, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Burzotta
- U.O.C. di Interventistica Cardiologica e Diagnostica Invasiva, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo Trani
- U.O.C. di Interventistica Cardiologica e Diagnostica Invasiva, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rik Adrichem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Elena Nardi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Chietera
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Cardiac, Thoracic and Vascular Department, Università di Bologna, Bologna, Italy
| | - Mateusz Orzalkiewicz
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Cardiac, Thoracic and Vascular Department, Università di Bologna, Bologna, Italy
| | - Daijiro Tomii
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | - Matti Adam
- Klinik III für Innere Medizin - Kardiologie, Pneumologie und Internistische Intensivmedizin, University Hospital Cologne - Heart Center, Cologne, Germany
| | - Max M Meertens
- Klinik III für Innere Medizin - Kardiologie, Pneumologie und Internistische Intensivmedizin, University Hospital Cologne - Heart Center, Cologne, Germany
| | - Nevio Taglieri
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Cardiac, Thoracic and Vascular Department, Università di Bologna, Bologna, Italy
| | - Cinzia Marrozzini
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Cardiac, Thoracic and Vascular Department, Università di Bologna, Bologna, Italy
| | - Hector Alfonso Alvarez Covarrubias
- German Heart Centre Munich, Munich, Germany; Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Institutio Mexicano de Seguro Social, Mexico City, Mexico
| | | | | | | | | | - Lucca Loretz
- Cardiology, Heart Center Lucerne, Lucerne, Switzerland
| | | | - Enrico Gallitto
- Vascular Surgery, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Mauro Gargiulo
- Vascular Surgery, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luca Testa
- Coronary Revascularisation Unit, IRCCS Policlinico S. Donato, S. Donato Milanese, Italy
| | - Francesco Bedogni
- Coronary Revascularisation Unit, IRCCS Policlinico S. Donato, S. Donato Milanese, Italy
| | - Sergio Berti
- Unit of Diagnostic and Interventional Cardiology, C.N.R. Reg. Toscana G. Monasterio Foundation, Ospedale del Cuore, Massa, Italy
| | - Marco B Ancona
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Leone
- Cardiac Surgery Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Carlo Savini
- Cardiac Surgery Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Davide Pacini
- Cardiac Surgery Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Jonas Gmeiner
- Department of Medicine I, University Hospital Munich, Medical Faculty, Ludwig Maximilian University of Munich, Munich, Germany
| | - Daniel Braun
- Department of Medicine I, University Hospital Munich, Medical Faculty, Ludwig Maximilian University of Munich, Munich, Germany
| | | | | | - Marco De Carlo
- Cardiothoracic and Vascular Department, Pisa University Hospital, Pisa, Italy
| | - Anna Sonia Petronio
- Cardiothoracic and Vascular Department, Pisa University Hospital, Pisa, Italy
| | - Marco Barbanti
- Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, University of Catania, Catania, Italy
| | - Giuliano Costa
- Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, University of Catania, Catania, Italy
| | - Corrado Tamburino
- Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, University of Catania, Catania, Italy
| | | | - Bernhard Reimers
- Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Italy
| | - Giulio Stefanini
- Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Italy
| | - Mitsumasa Sudo
- Medizinische Klinik und Poliklinik II, Herzzentrum Bonn, Universitätsklinikum Bonn, Bonn, Germany
| | - Georg Nickenig
- Medizinische Klinik und Poliklinik II, Herzzentrum Bonn, Universitätsklinikum Bonn, Bonn, Germany
| | - Tommaso Piva
- Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I - GM Lancisi, Torette, Italy
| | - Andrea Scotti
- Montefiore Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Azeem Latib
- Montefiore Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Matteo Vercellino
- Cardiology Unit, Cardio-Thoraco Vascular Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Italo Porto
- Cardiology Unit, Cardio-Thoraco Vascular Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | | | - Antonio L Bartorelli
- Centro Cardiologico Monzino, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Chiara Fraccaro
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | | | - Eberhard Grube
- Medizinische Klinik und Poliklinik II, Herzzentrum Bonn, Universitätsklinikum Bonn, Bonn, Germany
| | - Nazzareno Galié
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Cardiac, Thoracic and Vascular Department, Università di Bologna, Bologna, Italy
| | - Gregg W Stone
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Orzalkiewicz M, Taglieri N, Palmerini T, Saia F. Overinflation of balloon-expandable valves for transcatheter treatment of pure noncalcified native aortic regurgitation: How much oversizing is needed and achievable? Catheter Cardiovasc Interv 2022; 101:481-484. [PMID: 36542666 DOI: 10.1002/ccd.30529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/12/2022] [Accepted: 12/10/2022] [Indexed: 02/17/2024]
Abstract
Transcatheter aortic valve implantation (TAVI) in noncalcified pure aortic valve regurgitation is challenging as dedicated valves are not widely available. We present a case series of four inoperable patients who underwent compassionate TAVI for this indication at our institution with a balloon-expandable valve. In this context, we analyzed the relevant technical aspects such as the need for larger oversizing of the transcatheter prosthesis and the safety and limits of valve overexpansion.
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Affiliation(s)
| | - Nevio Taglieri
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Tullio Palmerini
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Saia
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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8
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Sammartini E, Biccirè FG, Debelak C, La Porta Y, Budassi S, Varricchione G, Romagnoli E, Marco V, Boi A, Fineschi M, Fabbiocchi F, Taglieri N, Calligaris G, Ozaki Y, Arbustini E, Alfonso F, Prati F. 42 SEASON VARIABILITY IN ATHEROSCLEROSIS COMPOSITION: INSIGHTS FROM 1848 NON-CULPRIT CORONARY PLQUES. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.542] [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
Several environmental and seasonal factors are thought to be crucial in the risk of acute coronary syndromes (ACS), including temperature, latitude, longitude, atmospheric air pressure, wind velocity and circadian period. However differences in coronary plaque composition according to season variation is still poorly understood.
Purpose
Our study aims to analyse the characteristics of non-culprit coronary plaques in patients undergoing optical coherence tomography evaluation (OCT) evaluation of the left anterior descending artery.
Methods
We included 1848 non-culprit coronary plaques from 1003 patients of the CLIMA registry. The season of OCT pullback acquisition was collected for each patient.
Results
Overall, median age was 66 years (56-74), with 24.6% of women and 53.4% of ACS. At patient-level analysis, patients admitted in summer were less frequently affected by hypertension (59.8% vs 69.4% in autumn, 68.5% in winter and 72% in spring; p=0.027) and chronic kidney disease (14.8% vs 15.9% in autumn, 10.3% in winter and 19.4% in spring; p=0.037) in. At lesion-level analysis, similar values of fibrous cap thickness, maximum lipid arc, length of plaques and presence of macrophages were observed (Table 1). Summer plaques had a smaller minimum lumen area than spring plaques (5.7±3.1 vs 5.1±239; p=0.044) and also a less frequent superficial macrophage infiltration (23% vs 36.1% in autumn, 30.5% in winter and 30.6% in spring; p=0.030) and presence of cholesterol crystals (16.7% vs 23.8% in autumn, 28.4% in winter and 22.1% in spring; p=0.037 than three other season).
Table 1
Conclusions
Coronary plaques during summer had less local sign of inflammation such superficial macrophage infiltration and cholesterol crystals. Further studies are needed to confirm these results and investigate clinical implications.
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Affiliation(s)
| | | | - Caterina Debelak
- Centro Per La Lotta Contro L’infarto - Cli Foundation , Roma Italia
| | | | - Simone Budassi
- Centro Per La Lotta Contro L’infarto - Cli Foundation , Roma Italia
| | | | - Enrico Romagnoli
- Università Cattolica Del Sacro Cuore, Fondazione Policlinico A. Gemelli , Irccs, Roma Italia
| | - Valeria Marco
- Centro Per La Lotta Contro L’infarto - Cli Foundation , Roma Italia
| | - Alberto Boi
- Azienda Ospedaliera Brotzu , Cagliari Italia
| | | | | | | | | | - Yukio Ozaki
- Fujita Health University Hospital , Toyoake Japan
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9
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Celeski M, Compagnone M, Taglieri N, Ghetti G, Marrozzini C, Orzalkiewicz M, Bruno AG, Galiè N, Saia F, Palmerini T. 784 IMPACT OF ELECTIVE, UNCOMPLICATED TARGET LESION REVASCULARIZATION ON CARDIAC MORTALITY AFTER ELECTIVE PERCUTANEOUS CORONARY INTERVENTION OF UNPROTECTED LEFT MAIN CORONARY ARTERY DISEASE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.312] [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
Percutaneous coronary intervention (PCI) appears a reasonable alternative to coronary artery bypass graft in selected groups of patients with unprotected left main coronary artery (ULMCA) disease. Despite technological progression, improved operator skills and introduction of drug-eluting stents (DES), in-stent restenosis still remains a major limitation after PCI of ULMCA disease. The prognostic relevance of target lesion revascularization (TLR) after PCI of ULMCA disease is unknown.
Objectives
This study sought to evaluate the impact of elective, uncomplicated target lesion revascularization on long-term cardiac mortality after PCI of ULMCA disease.
Methods
Consecutive patients undergoing PCI for ULMCA disease between January 2003 and December 2015 in one interventional center in Italy were included. Patients presenting with cardiogenic shock, ST-segment elevation myocardial infarction (MI), as well as those undergoing urgent or complicated TLR were excluded. The primary endpoint of the study was cardiac mortality. The secondary endpoints of the study were all-cause death, MI, stroke as individual endpoints, or the composite of cardiac death, MI or stroke defined as major adverse cardiac events (MACE).
Results
Among the 418 patients fulfilling the study criteria, 79 (18.46%) underwent elective, uncomplicated TLR. After a median follow-up of 5.5 years, there were 23 cardiac deaths among patients undergoing elective, uncomplicated TLR versus 50 in patients not undergoing TLR. After adjusting for possible confounders, TLR was an independent predictor of cardiac mortality (Hazard ratio [HR] = 1.92, 95% confidence interval [CI]: 1.05 to 3.49; p = 0.03). Patients undergoing TLR had also significantly higher rates of the composite of cardiac death, MI and stroke compared with the no TLR group (adjusted HR = 1.76, 95% CI 1.14 to 2.72).
Conclusion
Elective, uncomplicated TLR after PCI of ULMCA disease is associated with increased risk of long-term cardiac mortality. Reducing the risk of TLR after PCI of ULMCA disease may potentially improve the survival of these patients.
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Affiliation(s)
- Mihail Celeski
- Unit Of Cardiovascular Sciences, Department Of Medicine, Campus Bio-Medico University Of Rome , Italy
- Cardiology Unit, Cardio-Thoraco-Vascular Department, University Hospital Of Bologna , Bologna , Italy
| | - Miriam Compagnone
- Cardiology Unit, Cardio-Thoraco-Vascular Department, University Hospital Of Bologna , Bologna , Italy
| | - Nevio Taglieri
- Cardiology Unit, Cardio-Thoraco-Vascular Department, University Hospital Of Bologna , Bologna , Italy
| | - Gabriele Ghetti
- Cardiology Unit, Cardio-Thoraco-Vascular Department, University Hospital Of Bologna , Bologna , Italy
| | - Cinzia Marrozzini
- Cardiology Unit, Cardio-Thoraco-Vascular Department, University Hospital Of Bologna , Bologna , Italy
| | - Mateusz Orzalkiewicz
- Cardiology Unit, Cardio-Thoraco-Vascular Department, University Hospital Of Bologna , Bologna , Italy
| | - Antonio Giulio Bruno
- Cardiology Unit, Cardio-Thoraco-Vascular Department, University Hospital Of Bologna , Bologna , Italy
| | - Nazzareno Galiè
- Cardiology Unit, Cardio-Thoraco-Vascular Department, University Hospital Of Bologna , Bologna , Italy
| | - Francesco Saia
- Cardiology Unit, Cardio-Thoraco-Vascular Department, University Hospital Of Bologna , Bologna , Italy
| | - Tullio Palmerini
- Cardiology Unit, Cardio-Thoraco-Vascular Department, University Hospital Of Bologna , Bologna , Italy
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10
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Palmerini T, Bruno AG, Gasparini M, Rizzello G, Kim HS, Kang J, Park KW, Hahn JY, Song YB, Gwon HC, Choo EH, Park MW, Kim CJ, Chang K, Cuisset T, Taglieri N, Kim BK, Jang Y, Nardi E, Saia F, Orzalkiewicz M, Chietera F, Ghetti G, Galiè N, Stone GW. Reduced Mortality With Antiplatelet Therapy Deescalation After Percutaneous Coronary Intervention in Acute Coronary Syndromes: A Meta-Analysis. Circ Cardiovasc Interv 2022; 15:906-914. [PMID: 36378738 DOI: 10.1161/circinterventions.122.012245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Antiplatelet therapy deescalation has been suggested as an alternative to standard treatment with potent dual antiplatelet therapy (DAPT) for 1 year in low bleeding risk patients with acute coronary syndromes undergoing percutaneous coronary intervention to mitigate the increased risk of bleeding. Whether this strategy preserves the ischemic and survival benefits of potent DAPT is uncertain. METHODS We performed a pairwise meta-analysis in patients with acute coronary syndrome undergoing percutaneous coronary intervention treated with either 1-year standard potent DAPT versus deescalation therapy (potent DAPT for 1-3 months followed by either reduced potency DAPT or ticagrelor monotherapy for up to 1 year). Randomized trials comparing standard DAPT versus deescalation therapy in patients with acute coronary syndrome undergoing percutaneous coronary intervention were searched through MEDLINE, EMBASE, Cochrane databases, and proceedings of international meetings. The primary end point was 1-year all-cause mortality. RESULTS The meta-analysis included 6 trials in which 20 837 patients were randomized to potent DAPT for 1 to 3 months followed by deescalation therapy for up to 1 year (n=10 392) or standard potent DAPT for 1 year (n=10 445). Deescalation therapy was associated with lower 1-year rates of all-cause mortality compared with standard therapy (odds ratio, 0.75 [95% CI, 0.59-0.95]; P=0.02). Deescalation therapy was also associated with lower rates of major bleeding (odds ratio, 0.59 [95% CI, 0.48-0.72]; P<0.0001), with no significant difference in major adverse cardiac events (major adverse cardiovascular events; odds ratio, 0.89 [95% CI, 0.77-1.04]; P=0.14). CONCLUSIONS In low bleeding risk patients with acute coronary syndrome undergoing percutaneous coronary intervention, compared with 1-year of potent DAPT, antiplatelet therapy deescalation therapy after 1 to 3 months was associated with decreased mortality and major bleeding with similar rates of major adverse cardiovascular events.
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Affiliation(s)
- Tullio Palmerini
- Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy (T.P., A.G.B., N.T., E.N., F.S., M.O., F.C., G.G., N.G.)
| | - Antonio Giulio Bruno
- Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy (T.P., A.G.B., N.T., E.N., F.S., M.O., F.C., G.G., N.G.)
| | - Mauro Gasparini
- Dipartimento di Scienze Matematiche, Politecnico di Torino, Italy (M.G., G.R.)
| | - Giulia Rizzello
- Dipartimento di Scienze Matematiche, Politecnico di Torino, Italy (M.G., G.R.)
| | - Hyo-Soo Kim
- Severance Cardiovascular Hospital and Science Institute, Yonsei University College of Medicine, Seoul, South Korea (H.-S.K., J.K., K.-W.P.)
| | - Jeehoon Kang
- Severance Cardiovascular Hospital and Science Institute, Yonsei University College of Medicine, Seoul, South Korea (H.-S.K., J.K., K.-W.P.)
| | - Kyung-Woo Park
- Severance Cardiovascular Hospital and Science Institute, Yonsei University College of Medicine, Seoul, South Korea (H.-S.K., J.K., K.-W.P.)
| | - Joo-Yong Hahn
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (J.-Y.H., Y.B.S., H.-C.G.)
| | - Young Bin Song
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (J.-Y.H., Y.B.S., H.-C.G.)
| | - Hyeon-Cheol Gwon
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (J.-Y.H., Y.B.S., H.-C.G.)
| | - Eun Ho Choo
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of South Korea (E.H.C., K.C.)
| | - Mahn-Won Park
- Division of Cardiology, Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of South Korea (M.-W.P.)
| | - Chan Joon Kim
- Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of South Korea (C.J.K.)
| | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of South Korea (E.H.C., K.C.)
| | - Thomas Cuisset
- Department of Cardiology, CHU Timone, Marseille, France (T.C.)
| | - Nevio Taglieri
- Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy (T.P., A.G.B., N.T., E.N., F.S., M.O., F.C., G.G., N.G.)
| | - Byeong-Keuk Kim
- Division of Cardiology, Yonsei University Severance Cardiovascular Hospital, Seoul, South Korea (B.-K.K.)
| | - Yangsoo Jang
- Department of Cardiology, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, South Korea (Y.J.)
| | - Elena Nardi
- Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy (T.P., A.G.B., N.T., E.N., F.S., M.O., F.C., G.G., N.G.)
| | - Francesco Saia
- Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy (T.P., A.G.B., N.T., E.N., F.S., M.O., F.C., G.G., N.G.)
| | - Matheusz Orzalkiewicz
- Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy (T.P., A.G.B., N.T., E.N., F.S., M.O., F.C., G.G., N.G.)
| | - Francesco Chietera
- Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy (T.P., A.G.B., N.T., E.N., F.S., M.O., F.C., G.G., N.G.)
| | - Gabriele Ghetti
- Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy (T.P., A.G.B., N.T., E.N., F.S., M.O., F.C., G.G., N.G.)
| | - Nazzareno Galiè
- Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy (T.P., A.G.B., N.T., E.N., F.S., M.O., F.C., G.G., N.G.)
| | - Gregg W Stone
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (G.W.S.)
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11
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Taglieri N, Bonfiglioli R, Bon I, Malosso P, Corovic A, Bruno M, Le E, Granozzi B, Palmerini T, Ghetti G, Tamburello M, Bruno AG, Saia F, Tarkin JM, Rudd JHF, Calza L, Fanti S, Re MC, Galié N. Pattern of arterial inflammation and inflammatory markers in people living with HIV compared with uninfected people. J Nucl Cardiol 2022; 29:1566-1575. [PMID: 33569752 PMCID: PMC9345795 DOI: 10.1007/s12350-020-02522-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/25/2020] [Indexed: 11/03/2022]
Abstract
STUDY DESIGN To compare arterial inflammation (AI) between people living with HIV (PLWH) and uninfected people as assessed by 18F-Fluorodeoxyglucose (18F-FDG)-positron emission tomography (PET). METHODS We prospectively enrolled 20 PLWH and 20 uninfected people with no known cardiovascular disease and at least 3 traditional cardiovascular risk factors. All patients underwent 18F-FDG-PET/computed tomography (CT) of the thorax and neck. Biomarkers linked to inflammation and atherosclerosis were also determined. The primary outcome was AI in ascending aorta (AA) measured as mean maximum target-to-background ratio (TBRmax). The independent relationships between HIV status and both TBRmax and biomarkers were evaluated by multivariable linear regression adjusted for body mass index, creatinine, statin therapy, and atherosclerotic cardiovascular 10-year estimated risk (ASCVD). RESULTS Unadjusted mean TBRmax in AA was slightly higher but not statistically different (P = .18) in PLWH (2.07; IQR 1.97, 2.32]) than uninfected people (2.01; IQR 1.85, 2.16]). On multivariable analysis, PLWH had an independent risk of increased mean log-TBRmax in AA (coef = 0.12; 95%CI 0.01,0.22; P = .032). HIV infection was independently associated with higher values of interleukin-10 (coef = 0.83; 95%CI 0.34, 1.32; P = .001), interferon-γ (coef. = 0.90; 95%CI 0.32, 1.47; P = .003), and vascular cell adhesion molecule-1 (VCAM-1) (coef. = 0.75; 95%CI: 0.42, 1.08, P < .001). CONCLUSIONS In patients with high cardiovascular risk, HIV status was an independent predictor of increased TBRmax in AA. PLWH also had an increased independent risk of IFN-γ, IL-10, and VCAM-1 levels.
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Affiliation(s)
- Nevio Taglieri
- Division of Cardiology, Department of Experimental Diagnostic and Specialty Medicine, IRCCS Policlinico di St.Orsola, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.
| | - Rachele Bonfiglioli
- Division of Nuclear Medicine, Department of Experimental Diagnostic and Specialty Medicine, IRCCS Policlinico di St. Orsola, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Isabella Bon
- Division of Microbiology, Department of Experimental Diagnostic and Specialty Medicine, IRCCS Policlinico di St. Orsola, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Pietro Malosso
- Department of Medical and Surgical Sciences, Clinics of Infectious Diseases, IRCCS Policlinico di St. Orsola, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Andrej Corovic
- Division of Cardiovascular Medicine, Addenbrookes Hospital, University of Cambridge, Cambridge, UK
| | - Matteo Bruno
- Division of Cardiology, Department of Experimental Diagnostic and Specialty Medicine, IRCCS Policlinico di St.Orsola, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Elizabeth Le
- Division of Cardiovascular Medicine, Addenbrookes Hospital, University of Cambridge, Cambridge, UK
| | - Bianca Granozzi
- Department of Medical and Surgical Sciences, Clinics of Infectious Diseases, IRCCS Policlinico di St. Orsola, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Tullio Palmerini
- Division of Cardiology, Department of Experimental Diagnostic and Specialty Medicine, IRCCS Policlinico di St.Orsola, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Gabriele Ghetti
- Division of Cardiology, Department of Experimental Diagnostic and Specialty Medicine, IRCCS Policlinico di St.Orsola, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Martina Tamburello
- Division of Microbiology, Department of Experimental Diagnostic and Specialty Medicine, IRCCS Policlinico di St. Orsola, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Antonio Giulio Bruno
- Division of Cardiology, Department of Experimental Diagnostic and Specialty Medicine, IRCCS Policlinico di St.Orsola, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Francesco Saia
- Division of Cardiology, Department of Experimental Diagnostic and Specialty Medicine, IRCCS Policlinico di St.Orsola, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Jason M Tarkin
- Division of Cardiovascular Medicine, Addenbrookes Hospital, University of Cambridge, Cambridge, UK
| | - James H F Rudd
- Division of Cardiovascular Medicine, Addenbrookes Hospital, University of Cambridge, Cambridge, UK
| | - Leonardo Calza
- Department of Medical and Surgical Sciences, Clinics of Infectious Diseases, IRCCS Policlinico di St. Orsola, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Stefano Fanti
- Division of Nuclear Medicine, Department of Experimental Diagnostic and Specialty Medicine, IRCCS Policlinico di St. Orsola, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Maria Carla Re
- Division of Microbiology, Department of Experimental Diagnostic and Specialty Medicine, IRCCS Policlinico di St. Orsola, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Nazzareno Galié
- Division of Cardiology, Department of Experimental Diagnostic and Specialty Medicine, IRCCS Policlinico di St.Orsola, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
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12
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Bendandi F, Bruno AG, Donati F, Ciurlanti L, Orzalkiewicz M, Palmerini T, Marrozzini C, Saia F, Galiè N, Martin Suarez S, Taglieri N, Ghetti G. Coronary Stent Infection and Subsequent Abscessualization Causing Dislocation in Extravascular Position. JACC Cardiovasc Interv 2022; 15:e189-e191. [DOI: 10.1016/j.jcin.2022.05.048] [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] [Received: 05/24/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022]
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13
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Gallitto E, Faggioli G, Saia F, Palmerini T, Pini R, Bruno A, Alaidroos M, Ghetti G, Mirandola V, Taglieri N, Marrozzini C, Gargiulo M. The Role of the Vascular Surgeon in Transcatheter Aortic Valve Implantation. J Vasc Surg 2022. [DOI: 10.1016/j.jvs.2022.03.173] [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: 11/25/2022]
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Paradossi U, Taglieri N, Massarelli G, Palmieri C, De Caterina AR, Bruno AG, Taddei A, Nardi E, Ghetti G, Palmerini T, Trianni G, Mazzone A, Pizzi C, Donati F, Bendandi F, Marrozzini C, Ravani M, Galiè N, Saia F, Berti S. Female gender and mortality in ST-segment-elevation myocardial infarction treated with primary PCI. J Cardiovasc Med (Hagerstown) 2022; 23:234-241. [PMID: 35081074 DOI: 10.2459/jcm.0000000000001300] [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 To investigate gender difference in mortality among patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous angioplasty (PPCI). METHODS We analyzed data from the prospective registries of two hub PPCI centres over a 10-year period to assess the role of female gender as an independent predictor of both all-cause and cardiac death at 30 days and 1 year. To account for all confounding variables, a propensity score (PS)-adjusted multivariable Cox regression model and a PS-matched comparison between the male and female were used. RESULTS Among 4370 consecutive STEMI patients treated with PPCI at participating centres, 1188 (27.2%) were women. The survival rate at 30 days and 1 year were significantly lower in women (Log-rank P-value < 0.001). At PS-adjusted multivariable Cox regression analysis, female gender was independently associated with an increased risk of 30-day all-cause death [hazard ratio (HR) = 2.09; 95% confidence interval (CI): 1.45-3.01, P < 0.001], 30-day cardiac death (HR = 2.03;95% CI:1.41-2.93, P < 0.001), 1-year all-cause death (HR = 1.45; 95% CI:1.16-1.82, P < 0.001) and 1-year cardiac death (HR = 1.51; 95% CI:1.15-1.97, P < 0.001). For the study outcome, we found a significant interaction of gender with the multivessel disease in females who were at increased risk of mortality in comparison with men in absence of multivessel disease. After the PS matching procedure, a subset of 2074 patients were identified. Women still had a lower survival rate and survival free from cardiac death rate both at 30-day and at 1-year follow-up. CONCLUSION As compared with men, women with STEMI treated with PPCI have higher risk of both all-cause death and cardiac mortality at 30-day and 1-year follow-up.
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Affiliation(s)
| | - Nevio Taglieri
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Giulia Massarelli
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | | | - Antonio Giulio Bruno
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | - Elena Nardi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Gabriele Ghetti
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Tullio Palmerini
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | | | - Carmine Pizzi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Francesco Donati
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Francesco Bendandi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Cinzia Marrozzini
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | - Nazzareno Galiè
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Francesco Saia
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS-Policlinico di St. Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Sergio Berti
- Fondazione Toscana G. Monasterio, Ospedale del Cuore, Massa
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Palazzini M, Saia F, Taglieri N, Guarino D, Rotunno M, Galiѐ N, Dardi F. Balloon pulmonary angioplasty after pulmonary thromboendarterectomy. Ann Cardiothorac Surg 2022; 11:192-194. [PMID: 35433357 PMCID: PMC9012207 DOI: 10.21037/acs-2021-pte-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/10/2022] [Indexed: 07/21/2023]
Affiliation(s)
- Massimiliano Palazzini
- Alma Mater Studiorum, University of Bologna and IRCCS Sant'Orsola University Hospital, Bologna, Italy
| | - Francesco Saia
- Alma Mater Studiorum, University of Bologna and IRCCS Sant'Orsola University Hospital, Bologna, Italy
| | - Nevio Taglieri
- Alma Mater Studiorum, University of Bologna and IRCCS Sant'Orsola University Hospital, Bologna, Italy
| | - Daniele Guarino
- Alma Mater Studiorum, University of Bologna and IRCCS Sant'Orsola University Hospital, Bologna, Italy
| | - Mariangela Rotunno
- Alma Mater Studiorum, University of Bologna and IRCCS Sant'Orsola University Hospital, Bologna, Italy
| | - Nazzareno Galiѐ
- Alma Mater Studiorum, University of Bologna and IRCCS Sant'Orsola University Hospital, Bologna, Italy
| | - Fabio Dardi
- Alma Mater Studiorum, University of Bologna and IRCCS Sant'Orsola University Hospital, Bologna, Italy
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Gatto L, Alfonso F, Paoletti G, Burzotta F, La Manna A, Budassi S, Biccirè FG, Fineschi M, Marco V, Fabbiocchi F, Vergallo R, Boi A, Ruscica G, Versaci F, Taglieri N, Calligaris G, Albertucci M, Romagnoli E, Ramazzotti V, Tamburino C, Crea F, Ozaki Y, Arbustini E, Prati F. Relationship betweeen the amount and location of macrophages and clinical outcome: subanalysis of the CLIMA-study. Int J Cardiol 2022; 346:8-12. [PMID: 34798205 DOI: 10.1016/j.ijcard.2021.11.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 06/02/2021] [Revised: 10/30/2021] [Accepted: 11/15/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND The ability of optical coherence tomography (OCT) to recognize intraplaque macrophage infiltration is now well acknowledged. This post-hoc analysis of the CLIMA study aimed to address the clinical impact of the circumferential extension of OCT-defined macrophages and their location at one year follow-up. METHODS The multicentre CLIMA study enrolled 1003 patients undergoing OCT evaluation of the untreated proximal left anterior descending (LAD) coronary artery. Measurements of circumferential extension of macrophages and measurements of the distance from intima-lumen contour to macrophages string were performed at the plaque cross-section judged as containing the greatest amount of macrophages. The main study endpoint was a composite of cardiac death, myocardial infarction (MI) and/or target vessel revascularization (TVR). RESULTS Patients with large macrophage arc (p = 0.001) and superficial macrophage arc (p < 0.001) showed a higher one-year incidence of the main one-year composite endpoint. Consistently hypertension (p = 0.018), family history of CAD (p = 0.046), diabetes mellitus (p = 0.036), lower ejection fraction (p = 0.009) and chronic kidney disease (p = 0.019) were more frequently found in patients experiencing the main composite endpoint. At multivariate Cox regression analysis, fibrous cap thickness < 75 μm (HR 2.51, 95% 1.46-4.32), presence of large (HR 1.97, 95%CI 1.16-3.35, p = 0.012) and superficial (HR 1.72, 95%CI 1.02-2.90; p = 0.040) macrophage arc remained independent predictors of the main composite endpoint. Large macrophage arc was associated with target LAD related MI. CONCLUSION The present post-hoc analysis of the CLIMA showed that the circumferential extension of macrophages and their location are related to a composite endpoint of cardiac death, MI and/or TVR.
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Affiliation(s)
- Laura Gatto
- Cardiovascular Sciences Department, San Giovanni Addolorata Hospital, Rome, Italy; Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Giulia Paoletti
- Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy; Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain; UniCamillus - Saint Camillus International University of Health Sciences, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Alessio La Manna
- Cardio-Thoracic Vascular Department, Azienda ospedaliero-Universitaria "Policlinico Vittorio-Emanuele", University of Catania, Catania, Italy
| | - Simone Budassi
- Cardiovascular Sciences Department, San Giovanni Addolorata Hospital, Rome, Italy; Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy
| | - Flavio Giuseppe Biccirè
- Cardiovascular Sciences Department, San Giovanni Addolorata Hospital, Rome, Italy; Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy; Sapienza University of Rome, Rome, Italy
| | - Massimo Fineschi
- Department of Cardiovascular Diseases, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Valeria Marco
- Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy
| | | | - Rocco Vergallo
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Alberto Boi
- Interventional Cardiology Unit, Ospedale Brotzu, Cagliari, Italy
| | - Giovanni Ruscica
- Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy
| | | | - Nevio Taglieri
- Cardio-Thoracic Vascular Department, University Hospital of Bologna, Bologna, Italy
| | | | - Mario Albertucci
- Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Vito Ramazzotti
- Cardiovascular Sciences Department, San Giovanni Addolorata Hospital, Rome, Italy
| | - Corrado Tamburino
- Cardio-Thoracic Vascular Department, Azienda ospedaliero-Universitaria "Policlinico Vittorio-Emanuele", University of Catania, Catania, Italy
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University Hospital, Toyoake, Japan
| | - Eloisa Arbustini
- Centre for Inherited Cardiovascular Diseases, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Francesco Prati
- Cardiovascular Sciences Department, San Giovanni Addolorata Hospital, Rome, Italy; Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy; Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain; UniCamillus - Saint Camillus International University of Health Sciences, Rome, Italy.
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Loforte A, Comentale G, Coppola G, Amodio C, Botta L, Saia F, Taglieri N, Marrozzini C, Savini C, Pacini D. A rescue transcatheter solution for early sutureless basal ring infolding. J Card Surg 2021; 37:697-699. [PMID: 34970780 DOI: 10.1111/jocs.16196] [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: 10/15/2021] [Revised: 11/13/2021] [Accepted: 12/08/2021] [Indexed: 12/01/2022]
Abstract
We report the case of an 83-year-old woman treated with a "rescue" valve-in-valve transcatheter aortic valve implantation because of an early basal ring partial collapse of a sutureless valve, probably due to septal hypertrophy.
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Affiliation(s)
- Antonio Loforte
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
| | - Giuseppe Comentale
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy.,Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Giuditta Coppola
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
| | - Ciro Amodio
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
| | - Luca Botta
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
| | - Francesco Saia
- Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
| | - Nevio Taglieri
- Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
| | - Cinzia Marrozzini
- Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
| | - Carlo Savini
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
| | - Davide Pacini
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
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Abstract
Abstract
Aims
Coronary artery ectasia (CAE) is not a rare finding in coronary angiography with a prevalence ranging from 1% to 20% according to clinical setting. The aim of this study was to analyse the angiographic differences of coronary ectasia based on admitting diagnosis.
Methods and results
A cohort study was conducted including patients with angiographic evidence of CAE between January 2016 and December 2020. The study population was divided into two groups according to the clinical presentation: stable coronary artery disease (SCAD) and acute coronary syndrome (ACS). Markis classification, basal thrombolysis in myocardial infarction (TIMI) flow of each coronary artery, associated coronary artery obstruction (CAO), and respective Gensini score were reported. A total of 144 patients were included in this study. No difference were found concerning age or the traditional cardiovascular risk factors. Compared to general population, higher rates of myocardial infarction with non-obstructive coronary arteries (MINOCA) and ischaemia with non-obstructive coronary arteries (INOCA) (31% of the entire ACS cohort and 42% the SCAD group, respectively) were observed. Furthermore, irrespective of lower Gensini score values, MINOCA patients showed significantly more widespread CAE and a more severe impairment of coronary flow compared to SCAD and obstructive ACS patients.
Conclusions
CAE patients show a surprisingly high rate of acute coronary syndromes with non-obstructive coronary arteries. The extent of the ectatic involvement and its consequences on coronary blood flow could be the base of the higher rate of ACS events observed in this population, recognizing mechanisms other than plaque rupture.
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Guarino D, Palazzini M, Saia F, Dardi F, Taglieri N, De Lorenzis A, Ballerini A, Rotunno M, Magnani I, Donato F, Bertozzi R, Marrozzini C, Manes A, Galiè N. 45 Experience of 5 years of balloon pulmonary angioplasty in a single centre: safety and short-term results. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab133.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
Balloon pulmonary angioplasty (BPA) has recently been developed as a treatment strategy for chronic thromboembolic pulmonary hypertension (CTEPH) but efficacy and technical safety have to be established. We examine the effects of BPA on patients with inoperable disease or residual pulmonary hypertension (PH) after pulmonary endarterectomy (PEA).
Methods and results
From 2015 to 2020 we enrolled symptomatic inoperable CTEPH patients and patients with residual PH after PEA. At baseline and 3 months after last BPA session patients underwent clinical evaluation, 6-min walking distance (6MWD), and right heart catheterization. Friedman test with Bonferroni post-hoc pairwise analysis was used. Fifty patients [male 42%, median age 68 (51–74) years, 42 inoperable, and 8 with residual PH after PEA] were treated for a total of 156 sessions (median 2 sessions/patient); during each session we treated 2.3 (2.2–2.7) vessels. Results are shown in the Table. Forty-nine patients were treated with medical therapy before BPA (19 with combination therapy). Five pulmonary artery dissection and two haemoptysis with clinical impairment were documented during the procedures; 37 patients had lung injury (radiographic opacity with/without haemoptysis and/or hypoxaemia), none had renal dysfunction, 7 patients had access site complications. Seven patients died during follow-up (none within 30 days from the procedure) because of sepsis (1), heart failure (1), cancer (2), arrhythmic storm (2), and sudden death in patients with severe coronary atherosclerosis (1).
Conclusions
BPA is a safe and effective treatment able to improve symptoms and haemodynamic profile. 45 Table 16MWD, six minute walking distanceCI, cardiac index; mPAP, mean pulmonary arterial pressure; PAC, pulmonary arterial compliance; PVR, pulmonary vascular resistance; RAP, right atrial pressure; SvO2, mixed venous oxygen saturation; WHO-FC, World Health Organization functional class.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Alessandra Manes
- Department of Experimental, Diagnostic and Specialty Medicine—DIMES (Alma Mater Studiorum Di Bologna), Italy
| | - Nazzareno Galiè
- Department of Experimental, Diagnostic and Specialty Medicine—DIMES (Alma Mater Studiorum Di Bologna), Italy
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Ghetti G, Minnucci M, Chietera F, Donati F, Gagliardi C, Bruno AG, Orzalkiewicz M, Nardi E, Palmerini T, Saia F, Marrozzini C, Galié N, Taglieri N. Sino-tubular junction to sinuses of Valsalva ratio: An echocardiographic parameter to predict coronary artery ectasia in patients with aortic enlargement. Int J Cardiol 2021; 344:226-229. [PMID: 34655674 DOI: 10.1016/j.ijcard.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 10/05/2021] [Accepted: 10/09/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Coronary artery ectasia (CAE) is associated with ascending aortic (AA) ectasia. The purpose of this study is to evaluate the diagnostic performance of different echocardiographic parameters (EP) in predicting the presence of CAE. METHODS Four hundred-eighteen patients with AA ectasia candidate to coronary angiography were identified and divided in two groups in respect of the presence of CAE. Receiver-operating characteristic curves areas (AUC) were used to assess the discrimination power of the following EP: aortic annulus diameter, sinuses of Valsalva (SV) diameter, sino-tubular junction (STJ) diameter, AA diameter, STJ to SV ratio (STJ-to-SV) and STJ to AA ratio (STJ-to-AA). All these parameters were indexed by body surface area. The relationship between the best EP and the presence of CAE was investigated by means of multivariable logistic regression. RESULTS The rate of CAE in the study population was 32%. On univariable logistic regression, aortic annulus, STJ, STJ-to-SV and STJ-to-AA were associated with the presence of CAE after Bonferroni correction. STJ-to-SV emerged as the parameter with the best discrimination power (AUC = 0.81) compared to STJ (AUC = 0.69), STJ-to-AA (AUC = 0.68), aortic annulus (AUC = 0.59), AA (AUC = 0.56) and SV (AUC = 0.55); (p for comparison <0.01). An 89.6% value for STJ-to-SV ratio emerged as the best cut-off to diagnose CAE with a sensitivity = 75%, specificity = 82%, positive predictive value = 66% and negative predictive value = 88%. On multivariable analysis, STJ-to-SV was still associated with the presence of CAE (OR = 1.15;95%CI:1.11-1.19;p < 0.01). CONCLUSION In patients with dilated aorta, STJ-to-SV sampled by transthoracic echocardiography shows a good diagnostic performance in predicting the presence of CAE.
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Affiliation(s)
- Gabriele Ghetti
- Istituto di Cardiologia, Università di Bologna, IRCCS Policlinicodi S. Orsola, Via G. Massarenti 9, 40138 Bologna, Italy.
| | - Matteo Minnucci
- Istituto di Cardiologia, Università di Bologna, IRCCS Policlinicodi S. Orsola, Via G. Massarenti 9, 40138 Bologna, Italy
| | - Francesco Chietera
- Istituto di Cardiologia, Università di Bologna, IRCCS Policlinicodi S. Orsola, Via G. Massarenti 9, 40138 Bologna, Italy
| | - Francesco Donati
- Istituto di Cardiologia, Università di Bologna, IRCCS Policlinicodi S. Orsola, Via G. Massarenti 9, 40138 Bologna, Italy
| | - Christian Gagliardi
- Istituto di Cardiologia, Università di Bologna, IRCCS Policlinicodi S. Orsola, Via G. Massarenti 9, 40138 Bologna, Italy
| | - Antonio Giulio Bruno
- Istituto di Cardiologia, Università di Bologna, IRCCS Policlinicodi S. Orsola, Via G. Massarenti 9, 40138 Bologna, Italy
| | - Mateusz Orzalkiewicz
- Istituto di Cardiologia, Università di Bologna, IRCCS Policlinicodi S. Orsola, Via G. Massarenti 9, 40138 Bologna, Italy
| | - Elena Nardi
- Istituto di Cardiologia, Università di Bologna, IRCCS Policlinicodi S. Orsola, Via G. Massarenti 9, 40138 Bologna, Italy
| | - Tullio Palmerini
- Istituto di Cardiologia, Università di Bologna, IRCCS Policlinicodi S. Orsola, Via G. Massarenti 9, 40138 Bologna, Italy
| | - Francesco Saia
- Istituto di Cardiologia, Università di Bologna, IRCCS Policlinicodi S. Orsola, Via G. Massarenti 9, 40138 Bologna, Italy
| | - Cinzia Marrozzini
- Istituto di Cardiologia, Università di Bologna, IRCCS Policlinicodi S. Orsola, Via G. Massarenti 9, 40138 Bologna, Italy
| | - Nazzareno Galié
- Istituto di Cardiologia, Università di Bologna, IRCCS Policlinicodi S. Orsola, Via G. Massarenti 9, 40138 Bologna, Italy
| | - Nevio Taglieri
- Istituto di Cardiologia, Università di Bologna, IRCCS Policlinicodi S. Orsola, Via G. Massarenti 9, 40138 Bologna, Italy
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Bendandi F, Ghetti G, Taglieri N. [Optical coherence tomography and coronary artery ectasia: the critical role of intracoronary imaging for optimal results of percutaneous coronary intervention]. G Ital Cardiol (Rome) 2021; 22:42-44. [PMID: 35343491 DOI: 10.1714/3723.37140] [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: 06/14/2023]
Abstract
Percutaneous coronary intervention (PCI) in coronary artery ectasia is technically challenging, particularly regarding appropriate stent sizing, and it is associated with a higher incidence of adverse events. In this case report, a 63-year-old male patient, heart transplant recipient, underwent elective follow-up coronary angiography in the absence of clinical symptoms. Five years previously the patient was treated with coronary angioplasty and drug-eluting stent implantation for critical lesions of the left anterior descending coronary artery. Angiographic images showed a focal in-stent haziness at the level of an ectatic segment. To elucidate this finding, optical coherence tomography (OCT) was performed. Intracoronary imaging showed severe malapposition of the proximal end of the stent, with an intraluminal signal-rich structure, suggestive of organized stent thrombosis. Stent dilation was performed to maximal recommended diameter, with significant reduction of the malapposed area, as shown by repeated OCT pullbacks. Intracoronary imaging is particularly valuable in PCI of ectatic vessels to guide appropriate stent sizing and avoid stent malapposition. OCT, thanks to its superior spatial resolution in comparison with other intravascular imaging techniques, provides advantages for stent optimization and evaluation of stent failure causes. However, its limited imaging area and possible incomplete blood clearance may limit its usefulness in severely ectatic vessels.
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Affiliation(s)
| | | | - Nevio Taglieri
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna
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22
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Palmerini T, Bruno AG, Redfors B, Valgimigli M, Taglieri N, Feres F, Abizaid A, Costa R, Gilard M, Morice MC, Hong MK, Kim BK, Jang Y, Kim HS, Park KW, Colombo A, Chieffo A, Nakamura M, Kotinkaduwa LN, Nardi E, Saia F, Gasparini M, Rizzello G, Weisz G, Kirtane AJ, Mehran R, Witzenbichler B, Galiè N, Stone GW. Risk-Benefit of 1-Year DAPT After DES Implantation in Patients Stratified by Bleeding and Ischemic Risk. J Am Coll Cardiol 2021; 78:1968-1986. [PMID: 34763774 DOI: 10.1016/j.jacc.2021.08.070] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/19/2021] [Accepted: 08/25/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although a 1-year duration of dual antiplatelet therapy (DAPT) is used in many patients after drug-eluting stent (DES) implantation, the evidence supporting this duration is uncertain. OBJECTIVES The authors investigated the risk-benefit profile of 1-year vs ≤6-month DAPT after DES using 2 novel scores to risk stratify bleeding and ischemic events. METHODS Ischemic and bleeding risk scores were generated from ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents), a multicenter, international, "all-comers" registry that enrolled 8,665 patients treated with DES. The risk-benefit profile of 1-year vs ≤6-month DAPT was then investigated across risk strata from an individual patient data pooled dataset of 7 randomized trials that enrolled 15,083 patients treated with DES. RESULTS In the derivation cohort, the ischemic score and the bleeding score had c-indexes of 0.76 and 0.66, respectively, and both were well calibrated. In the pooled dataset, no significant difference was apparent in any ischemic endpoint between 1-year and ≤6-month DAPT, regardless of the risk strata. In the overall dataset, there was no significant difference in the risk of clinically relevant bleeding between 1-year and ≤6-month DAPT; however, among 2,508 patients at increased risk of bleeding, 1-year compared with ≤6-month DAPT was associated with greater bleeding (HR: 2.80; 95% CI: 1.12-7.13) without a reduced risk of ischemic events in any risk strata, including those with acute coronary syndromes. These results were consistent in a network meta-analysis. CONCLUSIONS In the present large-scale study, compared with ≤6-month DAPT, a 1-year duration of DAPT was not associated with reduced adverse ischemic events in any risk strata (including acute coronary syndromes) but was associated with greater bleeding in patients at increased risk of bleeding.
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Affiliation(s)
- Tullio Palmerini
- Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Antonio Giulio Bruno
- Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Björn Redfors
- Cardiovascular Research Foundation, New York, New York, USA; NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marco Valgimigli
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Nevio Taglieri
- Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Fausto Feres
- Istituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
| | | | - Ricardo Costa
- Istituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
| | - Martine Gilard
- Department of Cardiology, Brest University, Brest, France
| | | | - Myeong-Ki Hong
- Severance Cardiovascular Hospital and Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Byeong-Keuk Kim
- Severance Cardiovascular Hospital and Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yangsoo Jang
- Severance Cardiovascular Hospital and Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kyung Woo Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | | | | | - Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | | | - Elena Nardi
- Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Francesco Saia
- Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Mauro Gasparini
- Dipartimento di Scienze Matematiche, Politecnico di Torino, Torino, Italy
| | - Giulia Rizzello
- Dipartimento di Scienze Matematiche, Politecnico di Torino, Torino, Italy
| | - Giora Weisz
- Cardiovascular Research Foundation, New York, New York, USA; NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Ajay J Kirtane
- Cardiovascular Research Foundation, New York, New York, USA; NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Roxana Mehran
- Cardiovascular Research Foundation, New York, New York, USA; Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Nazzareno Galiè
- Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Gregg W Stone
- Cardiovascular Research Foundation, New York, New York, USA; Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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23
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Budassi S, Biccirè F, Gatto L, Alfonso F, Paoletti G, Burzotta F, La Manna A, Fineschi M, Marco V, Fabbiocchi F, Vergallo R, Boi A, Ruscica G, Versaci F, Taglieri N, Calligaris G, Albertucci M, Romagnoli E, Ramazzptto V, Tamburino C, Crea F, Ozaki Y, Arbustini E, Prati F. TCT-88 Relationship Between the Amount and Location of Macrophages and Clinical Outcome: Subanalysis of the CLIMA Study. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.938] [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: 10/20/2022]
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24
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Biccirè F, Budassi S, Isidori F, Lella E, Marco V, Albertucci M, Ozaki Y, La Manna A, Romagnoli E, Bourantas C, Paoletti G, Fabbiocchi F, Gatto L, Sticchi A, Burzotta F, Taglieri N, Calligaris G, Arbustini E, Alfonso F, Prati F. TCT-80 Feasibility and Prognostic Meaning of the Automated Detection of Lipid Core Burden Index at Optical Coherence Tomography: Post Hoc Analysis of the CLIMA Study. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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25
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Orzalkiewicz M, Donati F, Santona L, Marcelli C, Chietera F, Bendandi F, Bruno AG, Ghetti G, Taglieri N, Palmerini T, Marrozzini C, Galie N, Saia F. Management strategies for acutely decompensated aortic stenosis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Uncertainty exists over the optimal treatment strategy for patients presenting with acutely decompensated severe aortic stenosis (AS). The available options include a bridging balloon aortic valvuloplasty (BAV) or a direct transcatheter aortic valve implantation (TAVI).
Purpose
Our study compares TAVI outcomes in patients treated with two different strategies in acutely decompensated severe AS: bridged TAVI vs direct TAVI.
Methods
In this observational study all patients admitted with decompensated severe AS who underwent balloon aortic balloon valvuloplasty (BAV) and/or TAVI on the index admission were included. Comparison was made between bridged TAVI group (defined as initial BAV followed by TAVI) and direct TAVI group (TAVI on the index admission without bridging BAV). For this analysis we excluded patients in cardiogenic shock. Baseline characteristics, echocardiographic and periprocedural data were recorded in hospital database. Major adverse cardiovascular events (MACE) were defined as death, major bleeding, rehospitalisation for heart failure, or stroke). The follow-up data was obtained by outpatient visits and/or telephone calls.
Results
178 patients with acutely decompensated AS were analysed: 58 bridged TAVI, 23 direct TAVI, 9 bridged SAVR and 88 destination BAV (defined as BAV non followed by a definite treatment). There was no statistically significant difference between bridged TAVI and direct TAVI group in mean age (83.6±6.6 vs 80.4±8.3 years), the prevalence major comorbidities (coronary, respiratory, neurological or peripheral vascular disease), renal function (eGFR 43.4±18.9 vs 45.2±20.9 ml/min/m2), the mean LV ejection fraction (53.4±13.8 vs 48.6±14.6%) or aortic valve gradient (39.4±13.0 vs 34.1±12.3mmHg), respectively. Direct TAVI patients had a higher mean surgical risk scores (STS 6.1±3.7 vs 9.1±7.0%, logES 18.8±11.5 vs 30.8±20.9%, p=0.01) and higher prevalence of significant aortic regurgitation (5% vs 43%, p=0.0001). The femoral TAVI access was used in 98% of bridged and 78% of direct TAVI patients (p=0.006). The estimated 1-year survival and 1-year MACE-free survival did not differ significantly between the bridged TAVI and direct TAVI groups (86.8% vs 78.3%, p=0.20 and 79.7% vs 64.2%, p=0.11, respectively).
Conclusions
A large proportion of patients admitted with acutely decompensated AS were not eligible for definite treatment. There is no difference in procedural success, 1-year all-cause mortality and 1-year major adverse cardiovascular events between the bridged TAVI or direct TAVI strategies in acute decompensated aortic stenosis allowing to personalize treatment strategy for individual patient.
Funding Acknowledgement
Type of funding sources: None. Table 1. Clinical and procedural data
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Affiliation(s)
| | - F Donati
- St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - L Santona
- St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - C Marcelli
- St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - F Chietera
- St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - F Bendandi
- St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - A G Bruno
- St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - G Ghetti
- St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - N Taglieri
- St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - T Palmerini
- St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - C Marrozzini
- St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - N Galie
- St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - F Saia
- St. Orsola-Malpighi University Hospital, Bologna, Italy
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26
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Orzalkiewicz M, Bruno AG, Taglieri N, Ghetti G, Marrozzini C, Galiè N, Palmerini T, Saia F. Transcatheter Aortic Valve Replacement for Pure Aortic Regurgitation in a Large and Noncalcified Annulus. JACC Cardiovasc Interv 2021; 14:e271-e273. [PMID: 34538599 DOI: 10.1016/j.jcin.2021.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/23/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
Affiliation(s)
| | | | - Nevio Taglieri
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Gabriele Ghetti
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Nazzareno Galiè
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Tullio Palmerini
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Saia
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
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27
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Stolcova M, Meucci F, Moretti C, Chiriatti N, Marcelli C, Mattesini A, Taglieri N, Ristalli F, Galiè N, Palmerini T, Di Mario C, Saia F. Long-term echocardiographic findings after TAVR: 5-year follow-up in 400 consecutive patients. Intern Emerg Med 2021; 16:1873-1882. [PMID: 33770370 DOI: 10.1007/s11739-021-02689-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 06/15/2020] [Indexed: 02/01/2023]
Abstract
A little is known about long-term hemodynamic performance of the transcatheter heart valves (THVs). The aim of the present study was to assess hemodynamic outcome, structural valve deterioration (SVD) and bioprosthetic valve failure (BVF) in patients treated with transcatheter aortic valve replacement (TAVR) five or more years ago. All consecutive patients treated at Bologna and Florence University Hospitals with TAVR between January 2008 and December 2013 were analyzed in a retrospective registry with regards to demographic, procedural and outcome data as well as follow-up data on mortality and echocardiographic characteristics. Standardized definitions were used to define outcomes and durability of the THVs. 400 patients were included in the study, mostly treated with transfemoral TAVR (71.8%), using first generation balloon-expandable (37%) or self-expanding (63%) devices. The 1-year mortality was 21.8% (87 patients) and 5-year mortality was 53.8% (215 patients). Median follow-up was 45.5 months (14.0-68.9) totaling 1516.7 patient/years, with the longest follow-up being 10.25 years. At least one follow-up echocardiogram was available for 320 patients (80%), SVD occurred in 19 of these patients (5.94%): moderate in 17 patients (5.31%) and severe in two patients (0.63%). The hemodynamic presentation was stenosis in most of the cases (12 patients). Late BVF was registered in 10 patients (3.13%) and this was mainly driven by transcatheter paravalvular leak closure (six patients) with subsequent good long-term outcome. Our results confirm that TAVR appears to be a long-lasting treatment strategy with low rates of structural valve degeneration and valve failure.
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Affiliation(s)
- Miroslava Stolcova
- Structural Interventional Cardiology Division, Careggi University Hospital, Largo Brambilla 3, 50134, Firenze, Italy.
| | - Francesco Meucci
- Structural Interventional Cardiology Division, Careggi University Hospital, Largo Brambilla 3, 50134, Firenze, Italy
| | - Carolina Moretti
- Cardiology Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Niccolò Chiriatti
- Structural Interventional Cardiology Division, Careggi University Hospital, Largo Brambilla 3, 50134, Firenze, Italy
| | - Chiara Marcelli
- Cardiology Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Alessio Mattesini
- Structural Interventional Cardiology Division, Careggi University Hospital, Largo Brambilla 3, 50134, Firenze, Italy
| | - Nevio Taglieri
- Cardiology Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Francesca Ristalli
- Structural Interventional Cardiology Division, Careggi University Hospital, Largo Brambilla 3, 50134, Firenze, Italy
| | - Nazzareno Galiè
- Cardiology Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Tullio Palmerini
- Cardiology Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology Division, Careggi University Hospital, Largo Brambilla 3, 50134, Firenze, Italy
| | - Francesco Saia
- Cardiology Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy
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Taglieri N, Bruno AG, Ghetti G, Marrozzini C, Saia F, Galié N, Palmerini T. Target Lesion Failure With Current Drug-Eluting Stents: Evidence From a Comprehensive Network Meta-Analysis. JACC Cardiovasc Interv 2021; 13:2868-2878. [PMID: 33357524 DOI: 10.1016/j.jcin.2020.09.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/24/2020] [Accepted: 09/08/2020] [Indexed: 01/30/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the efficacy and safety of currently used drug-eluting stents (DES). BACKGROUND Head-to-head comparisons among newer DES have shown conflicting results. METHODS For this network meta-analysis, randomized controlled trials comparing different types of currently used DES were searched in PubMed, Scopus, and proceedings of international meetings. The primary endpoint was target lesion failure (TLF) at 1 year and at long-term follow-up. RESULTS Seventy-seven trials with 99,039 patients were selected for this network meta-analysis. Among the 10 DES included in the meta-analysis, 4 received the most extensive investigation: Orsiro, XIENCE, Nobori/BioMatrix, and Resolute. At 1 year, the Orsiro stent was associated with lower rates of TLF compared with XIENCE (odds ratio [OR]: 0.84; 95% confidence interval [CI]: 0.71 to 0.98; p = 0.03), Resolute (OR: 0.81; 95% CI: 0.68 to 0.95; p = 0.01), and Nobori/BioMatrix (OR: 0.81; 95% CI: 0.67 to 0.98; p = 0.03). Orsiro had the highest probability to be the best (70.8%), with a surface under the cumulative ranking curve value of 95.9%. However, after a median follow-up period of 50 months (range: 24 to 60 months), no significant difference was apparent in the rates of TLF between any DES, although Orsiro still ranked as the best stent (58.6% probability to be the best). In addition, Orsiro had a lower rate of long-term definite stent thrombosis compared with Nobori/BioMatrix (OR: 0.60; 95% CI: 0.36 to 0.98; p = 0.04) and lower rates of definite and probable stent thrombosis compared with Resolute (OR: 0.66; 95% CI: 0.45 to 0.99; p = 0.04). No differences in cardiac mortality between any DES were observed. CONCLUSIONS Orsiro is associated with a lower 1-year rate of TLF compared with XIENCE, Resolute, and Nobori/BioMatrix but with an attenuation of the efficacy signal at long-term follow-up.
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Affiliation(s)
- Nevio Taglieri
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, IRCCS Policlinico di St. Orsola, Alma Mater Studiorum Università di Bologna, Bologna, Italy.
| | - Antonio G Bruno
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, IRCCS Policlinico di St. Orsola, Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - Gabriele Ghetti
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, IRCCS Policlinico di St. Orsola, Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - Cinzia Marrozzini
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, IRCCS Policlinico di St. Orsola, Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - Francesco Saia
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, IRCCS Policlinico di St. Orsola, Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - Nazzareno Galié
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, IRCCS Policlinico di St. Orsola, Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - Tullio Palmerini
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, IRCCS Policlinico di St. Orsola, Alma Mater Studiorum Università di Bologna, Bologna, Italy
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Bruno AG, Taglieri N, Saia F, Pini R, Gallitto E, Ghetti G, Orzalkiewicz M, Marrozzini C, Faggioli G, Gargiulo M, Leone A, Savini C, Pacini D, Galié N, Palmerini T. Recapture of the Sapien-3 Delivery System After Transversal Balloon Rupture Using a Whole Percutaneous Femoral Approach. JACC Cardiovasc Interv 2021; 14:e183-e187. [PMID: 34274296 DOI: 10.1016/j.jcin.2021.04.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/12/2021] [Accepted: 04/20/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Antonio Giulio Bruno
- Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Nevio Taglieri
- Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Saia
- Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Rodolfo Pini
- Division of Vascular Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Enrico Gallitto
- Division of Vascular Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Gabriele Ghetti
- Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Mateusz Orzalkiewicz
- Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Cinzia Marrozzini
- Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Gianluca Faggioli
- Division of Vascular Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Mauro Gargiulo
- Division of Vascular Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessandro Leone
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Carlo Savini
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Davide Pacini
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Nazzareno Galié
- Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Tullio Palmerini
- Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
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30
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Taglieri N, Ghetti G, Bruno AG, Marco V, Reggiani MLB, Bonfiglioli R, Massarelli G, Gatto L, Bruno M, Paoletti G, Fanti S, Saia F, Prati F, Galiè N. Optical coherence tomography assessment of macrophages accumulation in non-ST-segment elevation acute coronary syndromes. J Cardiovasc Med (Hagerstown) 2021; 21:860-865. [PMID: 33017123 DOI: 10.2459/jcm.0000000000001015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To investigate in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) the prevalence and the features of optical coherence tomography (OCT)-detected macrophages accumulation in culprit plaques as compared with nonculprit plaques (NCP). METHODS The study is a post-hoc analysis of a prospective study aimed at evaluating the relationship between aortic inflammation as assessed by F-fluorodeoxyglucose-PET and features of coronary plaque vulnerability as assessed by OCT. We enrolled 32 patients with first NSTE-ACS who successfully underwent three-vessel OCT. RESULTS The median age was 65 (54-72) years and 27 patients (84%) were men. Culprit plaques were clinically defined. Overall, the rate of lipid plaques and lipid plaques containing macrophages were 6.4 and 4.2 per patient, respectively. Culprit plaques had a smaller minimal luminal area, a higher extension of lipid component and a thinner fibrous cap than NCPs. Macrophages accumulations were more likely found in culprit plaque (84 vs. 61%, P = 0.015) in which they had also a higher circumferential extension. On univariable analysis, macrophages accumulation extension had a higher association with culprit plaques (odds ratio = 4.42; 95% confidence interval; 2.54-9.15, P < 0.001) than the mere presence of macrophages accumulation (odds ratio = 3.36; 95% confidence interval; 1.30-8.66, P = 0.012). Culprit plaques with thrombus had a lower distance between macrophages accumulation and the luminal surface than culprit plaque with no thrombus (0.06 vs. 0.1 mm; P = 0.04). CONCLUSION In patients with NSTE-ACS, macrophages accumulations are more likely present in culprit plaque in which they disclose also a greater extension compared with those observed in NCP. The distance between macrophages accumulation and the luminal surface is lower in thrombotic culprit plaque than that in nonthrombotic culprit plaque.
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Affiliation(s)
- Nevio Taglieri
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Alma Mater Studiorum Università di Bologna, Bologna
| | - Gabriele Ghetti
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Alma Mater Studiorum Università di Bologna, Bologna
| | - Antonio G Bruno
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Alma Mater Studiorum Università di Bologna, Bologna
| | | | - Maria L Bacchi Reggiani
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Alma Mater Studiorum Università di Bologna, Bologna
| | - Rachele Bonfiglioli
- Dipartimento di Medicina Specialistica, Istituto di Medicina Nucleare, Diagnostica e Sperimentale, Alma Mater Studiorum Università di Bologna, Bologna
| | - Giulia Massarelli
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Alma Mater Studiorum Università di Bologna, Bologna
| | - Laura Gatto
- CLI Foundation, Rome.,Dipartimento di Scienze Cardiovascolari, Ospedale San Giovanni Addolorata Roma, Roma
| | - Matteo Bruno
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Alma Mater Studiorum Università di Bologna, Bologna
| | | | - Stefano Fanti
- Dipartimento di Medicina Specialistica, Istituto di Medicina Nucleare, Diagnostica e Sperimentale, Alma Mater Studiorum Università di Bologna, Bologna
| | - Francesco Saia
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Alma Mater Studiorum Università di Bologna, Bologna
| | - Francesco Prati
- CLI Foundation, Rome.,UniCamillus-International Medical University, Rome Italy
| | - Nazzareno Galiè
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Alma Mater Studiorum Università di Bologna, Bologna
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31
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Prati F, Romagnoli E, Gatto L, La Manna A, Burzotta F, Ozaki Y, Marco V, Boi A, Fineschi M, Fabbiocchi F, Taglieri N, Niccoli G, Trani C, Versaci F, Calligaris G, Ruscica G, Di Giorgio A, Vergallo R, Albertucci M, Biondi-Zoccai G, Tamburino C, Crea F, Alfonso F, Arbustini E. Relationship between coronary plaque morphology of the left anterior descending artery and 12 months clinical outcome: the CLIMA study. Eur Heart J 2021; 41:383-391. [PMID: 31504405 DOI: 10.1093/eurheartj/ehz520] [Citation(s) in RCA: 157] [Impact Index Per Article: 52.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 01/11/2019] [Accepted: 07/30/2019] [Indexed: 02/05/2023] Open
Abstract
AIMS The CLIMA study, on the relationship between coronary plaque morphology of the left anterior descending artery and twelve months clinical outcome, was designed to explore the predictive value of multiple high-risk plaque features in the same coronary lesion [minimum lumen area (MLA), fibrous cap thickness (FCT), lipid arc circumferential extension, and presence of optical coherence tomography (OCT)-defined macrophages] as detected by OCT. Composite of cardiac death and target segment myocardial infarction was the primary clinical endpoint. METHODS AND RESULTS From January 2013 to December 2016, 1003 patients undergoing OCT evaluation of the untreated proximal left anterior descending coronary artery in the context of clinically indicated coronary angiogram were prospectively enrolled at 11 independent centres (clinicaltrial.gov identifier NCT02883088). At 1-year, the primary clinical endpoint was observed in 37 patients (3.7%). In a total of 1776 lipid plaques, presence of MLA <3.5 mm2 [hazard ratio (HR) 2.1, 95% confidence interval (CI) 1.1-4.0], FCT <75 µm (HR 4.7, 95% CI 2.4-9.0), lipid arc circumferential extension >180° (HR 2.4, 95% CI 1.2-4.8), and OCT-defined macrophages (HR 2.7, 95% CI 1.2-6.1) were all associated with increased risk of the primary endpoint. The pre-specified combination of plaque features (simultaneous presence of the four OCT criteria in the same plaque) was observed in 18.9% of patients experiencing the primary endpoint and was an independent predictor of events (HR 7.54, 95% CI 3.1-18.6). CONCLUSION The simultaneous presence of four high-risk OCT plaque features was found to be associated with a higher risk of major coronary events.
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Affiliation(s)
- Francesco Prati
- Cardiovascular Sciences Department, San Giovanni Addolorata Hospital, Rome, Italy.,Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy
| | - Enrico Romagnoli
- Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy.,Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Laura Gatto
- Cardiovascular Sciences Department, San Giovanni Addolorata Hospital, Rome, Italy.,Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy
| | - Alessio La Manna
- Cardio-Thoracic-Vascular Department, Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - Francesco Burzotta
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University Hospital, Toyoake, Japan
| | - Valeria Marco
- Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy
| | - Alberto Boi
- Interventional Cardiology Unit, Ospedale Brotzu, Cagliari, Italy
| | - Massimo Fineschi
- Department of Cardiovascular Diseases, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | | | - Nevio Taglieri
- Cardio-Thoracic-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - Giampaolo Niccoli
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | | | | | - Gianni Ruscica
- Cardio-Thoracic-Vascular Department, Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | | | - Rocco Vergallo
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Mario Albertucci
- Cardiovascular Sciences Department, San Giovanni Addolorata Hospital, Rome, Italy.,Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.,Mediterranea Cardiocentro, Napoli, Italy
| | - Corrado Tamburino
- Cardio-Thoracic-Vascular Department, Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Eloisa Arbustini
- Centre for Inherited Cardiovascular Diseases, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
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32
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Vitale G, Ditaranto R, Graziani F, Tanini I, Camporeale A, Lillo R, Rubino M, Panaioli E, Di Nicola F, Ferrara V, Zanoni R, Caponetti AG, Pasquale F, Graziosi M, Berardini A, Ziacchi M, Biffi M, Santostefano M, Liguori R, Taglieri N, Nardi E, Linhart A, Olivotto I, Rapezzi C, Biagini E. Standard ECG for differential diagnosis between Anderson-Fabry disease and hypertrophic cardiomyopathy. Heart 2021; 108:54-60. [PMID: 33563631 DOI: 10.1136/heartjnl-2020-318271] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 09/20/2020] [Revised: 01/19/2021] [Accepted: 01/22/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To evaluate the role of the ECG in the differential diagnosis between Anderson-Fabry disease (AFD) and hypertrophic cardiomyopathy (HCM). METHODS In this multicentre retrospective study, 111 AFD patients with left ventricular hypertrophy were compared with 111 patients with HCM, matched for sex, age and maximal wall thickness by propensity score. Independent ECG predictors of AFD were identified by multivariate analysis, and a multiparametric ECG score-based algorithm for differential diagnosis was developed. RESULTS Short PR interval, prolonged QRS duration, right bundle branch block (RBBB), R in augmented vector left (aVL) ≥1.1 mV and inferior ST depression independently predicted AFD diagnosis. A point-by-point ECG score was then derived with the following diagnostic performances: c-statistic 0.80 (95% CI 0.74 to 0.86) for discrimination, the Hosmel-Lemeshow χ2 6.14 (p=0.189) for calibration, sensitivity 69%, specificity 84%, positive predictive value 82% and negative predictive value 72%. After bootstrap resampling, the mean optimism was 0.025, and the internal validated c-statistic for the score was 0.78. CONCLUSIONS Standard ECG can help to differentiate AFD from HCM while investigating unexplained left ventricular hypertrophy. Short PR interval, prolonged QRS duration, RBBB, R in aVL ≥1.1 mV and inferior ST depression independently predicted AFD. Their systematic evaluation and the integration in a multiparametric ECG score can support AFD diagnosis.
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Affiliation(s)
- Giovanni Vitale
- Cardiology Unit, IRCCS, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Raffaello Ditaranto
- Cardiology Unit, IRCCS, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Francesca Graziani
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCSS, Roma, Lazio, Italy
| | - Ilaria Tanini
- Cardiomyopathy Unit, Careggi University Hospital, Firenze, Toscana, Italy
| | - Antonia Camporeale
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Lombardia, Italy
| | - Rosa Lillo
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCSS, Roma, Lazio, Italy
| | - Marta Rubino
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Napoli, Campania, Italy
| | - Elena Panaioli
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCSS, Roma, Lazio, Italy
| | - Federico Di Nicola
- Cardiology Unit, IRCCS, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Valentina Ferrara
- Cardiology Unit, IRCCS, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Rossana Zanoni
- Cardiology Unit, IRCCS, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Angelo Giuseppe Caponetti
- Cardiology Unit, IRCCS, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Ferdinando Pasquale
- Cardiology Unit, IRCCS, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Maddalena Graziosi
- Cardiology Unit, IRCCS, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Alessandra Berardini
- Cardiology Unit, IRCCS, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Matteo Ziacchi
- Cardiology Unit, IRCCS, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Mauro Biffi
- Cardiology Unit, IRCCS, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Marisa Santostefano
- Division of Nephrology, Azienda Ospedaliero Universitaria - Policlinico di St. Orsola, Bologna, Emilia-Romagna, Italy
| | - Rocco Liguori
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Emilia-Romagna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Emilia-Romagna, Italy
| | - Nevio Taglieri
- Cardiology Unit, IRCCS, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Elena Nardi
- Cardiology Unit, IRCCS, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Ales Linhart
- 2nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital, Praha, Czech Republic
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Firenze, Toscana, Italy
| | - Claudio Rapezzi
- Cardiovascular Center, University of Ferrara, Azienda Ospedaliero Universitaria di Ferrara Ospedale Sant'Anna, Cona, Emilia-Romagna, Italy.,Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Emilia-Romagna, Italy
| | - Elena Biagini
- Cardiology Unit, IRCCS, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Emilia-Romagna, Italy
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33
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Zuffa E, Dardi F, Saia F, Niro F, Palazzini M, Russo V, Taglieri N, Lovato L, De Lorenzis A, Pasca F, Guarino D, Magnani I, Marrozzini C, Manes A, Galie N. Prognostic value of pulmonary artery diameter in patients with pulmonary arterial hypertension. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Pulmonary artery (PA) dilation is common in pulmonary arterial hypertension (PAH) and may cause left main coronary artery (LMCA) compression. This complication have been sistematically evaluated in patients with angina but no evidence is available for patients asymptomatic for angina.
Purpose
To evaluate the prognostic value of PA diameter and the prevalence of LMCA compression in PAH patients with and without angina.
Methods
All patients with PAH and a baseline angio-CT scan were included. The last angio-CT scan performed was considered for PA diameter increase velocity calculation. Patients with angina or radiological signs of suspected LMCA compression underwent a coronary (cor)-CT scan. Patients with a not negative cor-CT underwent invasive coronary angiography. If clinically indicated invasive coronary angiography was performed without a preliminary cor-CT. To evaluate the predictivity for compression at coronary angiography the PA diameter at cor-CT or at the nearest angio-CT scan was considered.
Results
958 patients were included. PA diameter at baseline is higher in patients with congenital heart disease (CHD) and is not predictive of death. The velocity of PA diameter increase is lower in patients with connective tissue disease and is a risk factor for death in both overall population and different etiological subgroups except CHD and pulmonary veno-occlusive disease. 180 patients had angina and 50 had LMCA compression. 120 patients without angina underwent cor-CT and/or coronary angiography and 15 patients had LMCA compression. The best PA diameter cut-offs predicting LMCA compression in symptomatic/asymptomatic patients were, respectively, 40/42 mm (sensitivity and specificity, respectively, 80 and 72%/87 and 77%).
Conclusion
28% of patients with angina and 13% of patients without angina had LMCA compression. We found a similar PA diameter predicting LMCA compression in patients with or without angina. PA diameter, instead, was not predictive of prognosis (maybe because most deaths were related to heart failure and also because patients with LMCA compression were treated with stenting, possibly preventing sudden cardiac death). Eventually, PA diameter velocity increase is associated with prognosis but this may only reflect a severe disease refractory to medical therapy.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- E Zuffa
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - F Dardi
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - F Saia
- Universitary Hospital Sant'orsola Malpighi, Cardio-thoracic-vascular Department, Cardiology, Bologna, Italy
| | - F Niro
- Universitary Hospital Sant'orsola Malpighi, Cardio-thoracic-vascular Department, Radiology, Bologna, Italy
| | - M Palazzini
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - V Russo
- Universitary Hospital Sant'orsola Malpighi, Cardio-thoracic-vascular Department, Radiology, Bologna, Italy
| | - N Taglieri
- Universitary Hospital Sant'orsola Malpighi, Cardio-thoracic-vascular Department, Cardiology, Bologna, Italy
| | - L Lovato
- Universitary Hospital Sant'orsola Malpighi, Cardio-thoracic-vascular Department, Radiology, Bologna, Italy
| | - A De Lorenzis
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - F Pasca
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - D Guarino
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - I Magnani
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - C Marrozzini
- Universitary Hospital Sant'orsola Malpighi, Cardio-thoracic-vascular Department, Cardiology, Bologna, Italy
| | - A Manes
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - N Galie
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
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34
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Paolisso P, Donati F, Bergamaschi L, Toniolo S, D'Angelo E, Magnani I, Angeli F, Bartoli L, Stefanizzi A, Foa' A, Rinaldi A, Casella G, Taglieri N, Pizzi C, Galie' N. Impact of type 2 diabetes mellitus and blood glucose admission levels in patients with myocardial infarction with non obstructive coronary artery disease (MINOCA). Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous clinically entity and represents 5% to 10% of all patients with myocardial infarction (MI). Besides type 2 diabetes mellitus (DM), which is a common comorbidity in patients hospitalized for an acute coronary syndrome, high glucose levels (HGL) at admission are frequently observed in this context. The risk of major adverse cardiovascular events following acute coronary syndrome is increased in people with DM and HGL. However, evidence regarding diabetes and high glucose level among MINOCA patients is lacking.
Purpose
To examine the incidence of major adverse cardiovascular events (MACEs) in diabetic and non-diabetic MINOCA patients as well as according to HGL at presentation.
Methods
Among 1995 patients with acute MI admitted to our coronary care unit from 2016 to 2018, we enrolled 186 consecutive MINOCA patients according to the current ESC diagnostic criteria. HGL at admission was defined as serum glucose level above 180 mg/dl. All-cause mortality and a composite end-point of all-cause mortality and myocardial re-infarction were compared. The median follow-up time was 19.6±12.9 months.
Results
Diabetic MINOCA patients were older (mean age 75.5±9.6 vs 66.5±14.7; p=0.002) and with higher prevalence of hypertension (p=0.016). Conversely, there were no significant differences in gender, BMI, dyslipidemia and atrial fibrillation. Similarly, no significant differences were observed regarding clinical and ECG presentation, echocardiographic features and laboratory tests. The rates of death (30.8% vs 8.3%; p=0.013) and MACEs (22.2% vs 6.8%; p=0.025) were significantly higher in MINOCA-DM patients; conversely, no significant differences were observed for re-MI (p=0.58). At multivariate regression model adjusted for age and sex, type 2 DM was not an independent predictor of all cause deaths (p=0.36) and MACE (p=0.24).
Patients with admission HGL had similar baseline characteristics, cardiovascular risk factors, clinical presentations, echocardiographic features and troponin values as compared to patients with no-HGL. HGL at admission was associated with higher incidence of all-cause-death (p<0.001) and MACE (p=0.003) during follow-up compared to patients with no HGL; conversely, no significant differences were observed in the incidence of re-MI (p=0.7). Multivariate analysis adjusted for age and sex demonstrated that HGL was an independent predictor of death (HR 6.25; CI 1.64–23.85; p=0.007) and MACEs (HR 6.17; CI 1.79–21.23, p=0.004).
Conclusion
In MINOCA patients, HGL was an independent risk factor for both MACEs and death while type 2 DM was not correlated with these hard endpoints. As a consequence, HGL could have a still unexplored pathophysiological role in MINOCA. Properly powered randomized trials are warranted.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- P Paolisso
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - F Donati
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - L Bergamaschi
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - S Toniolo
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - E.C D'Angelo
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - I Magnani
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - F Angeli
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - L Bartoli
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - A Stefanizzi
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - A Foa'
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - A Rinaldi
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - G Casella
- Maggiore Hospital, Cardiology Department, Bologna, Italy
| | - N Taglieri
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - C Pizzi
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - N Galie'
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
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35
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Corsini A, Massarelli G, Bruno M, Bruno A, Compagnone M, Ghetti G, Saia F, Galie' N, Taglieri N. Derivation and validation of a scoring system to predict after discharge risk of cardiac events in patients with acute myocardial infarction undergoing percutaneous coronary revascularization. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In the acute coronary syndromes (ACS) setting, despite the extensive use of coronary revascularization and P2Y12 inhibitors such as prasugrel and ticagrelor, with a more pronounced inhibitory effect on platelets than clopidogrel, the rate of death and recurrent myocardial infarction (MI) at 1 year is still high. In this clinical setting the development of a risk score which takes into account patient's and procedural characteristics could represent a useful tool to identify patients at high risk for ischaemic events at 1 year who could take advantage from more aggressive secondary prevention strategies.
Purpose
The aim of our study was to develop a risk score to predict 1-year probability of after discharge cardiac events (recurrent MI and cardiac death) in patients with acute MI treated with percutaneous coronary intervention (PCI).
Methods
We prospectively enrolled all consecutive patients hospitalized for acute MI between 2003 and 2017 treated with PCI with/without stent placement at our center. We excluded patients who died in-hospital or who experienced in-hospital recurrent MI and patients undergoing surgical revascularization by coronary artery bypass graft (CABG). The patients of the final study cohort were therefore randomly assigned to either a derivation sample (60%) or a validation sample (40%). Based on the multivariate analysis we developed a point system according to the “Framingham Risk Score” method.
Results
The final study cohort, represented by 4922 patients, was split in a derivation sample of 2972 patients and in a validation sample of 1950 patients: in both groups the median age was around 70 years; the male prevalence was 73%; 65% of patients were dagnosed with ST-segment elevation MI.
The clinical prediction score underlined as risk factors for recurrent cardiac events older age, diabetes mellitus, peripheral arterial disease, prior MI, Killip class >2 at presentation, higher platelet count and creatinine values, lower left ventricular ejection fraction; radial access and the use of second generation drug eluting stents resulted to be protective. This model showed a good discrimination power in both the derivation and the validation samples with an area under the curve (AUC) of 0.75 and 0.71, respectively. The calibration showed a good concordance between predicted and observed events in both the derivation and the validation samples. Same results were observed in patients with/without ST-segment elevation MI and in gender subgroups.
Conclusions
The present study, conducted retrospectively on a large population of patients with acute MI treated with PCI enrolled prospectively, enabled us to derivate and validate a risk score of cardiac death and recurrent MI at 1 year which took into account both clinical and procedural characteristics and which demonstrated a good predictive performance.
After-discharge events by risk subgroups
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Corsini
- University Hospital Policlinic S. Orsola-Malpighi, Cardio-Thoraco-Vascular, Bologna, Italy
| | - G Massarelli
- University Hospital Policlinic S. Orsola-Malpighi, Cardio-Thoraco-Vascular, Bologna, Italy
| | - M Bruno
- University Hospital Policlinic S. Orsola-Malpighi, Cardio-Thoraco-Vascular, Bologna, Italy
| | - A.G Bruno
- University Hospital Policlinic S. Orsola-Malpighi, Cardio-Thoraco-Vascular, Bologna, Italy
| | - M Compagnone
- University Hospital Policlinic S. Orsola-Malpighi, Cardio-Thoraco-Vascular, Bologna, Italy
| | - G Ghetti
- University Hospital Policlinic S. Orsola-Malpighi, Cardio-Thoraco-Vascular, Bologna, Italy
| | - F Saia
- University Hospital Policlinic S. Orsola-Malpighi, Cardio-Thoraco-Vascular, Bologna, Italy
| | - N Galie'
- University Hospital Policlinic S. Orsola-Malpighi, Cardio-Thoraco-Vascular, Bologna, Italy
| | - N Taglieri
- University Hospital Policlinic S. Orsola-Malpighi, Cardio-Thoraco-Vascular, Bologna, Italy
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Gatto L, Paoletti G, Marco V, La Manna A, Fabbiocchi F, Cortese B, Vergallo R, Boi A, Fineschi M, Di Giorgio A, Taglieri N, Calligaris G, Budassi S, Burzotta F, Isidori F, Lella E, Ruscica G, Albertucci M, Tamburino C, Ozaki Y, Alfonso F, Arbustini E, Prati F. Prevalence and quantitative assessment of macrophages in coronary plaques. Int J Cardiovasc Imaging 2020; 37:37-45. [PMID: 32779079 DOI: 10.1007/s10554-020-01957-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 07/24/2020] [Indexed: 11/30/2022]
Abstract
Although optical coherence tomography (OCT) proved to be able to identify macrophage clusters, there are no available data on the possibility to obtain reproducible measurements of their circumferential extension and location. The purpose of the present post-hoc analysis of the CLIMA study was to revise the clinical and demographic variables of patients having coronary plaques with macrophages and to investigate the reproducibility of their quantitative assessment. A total of 577 patients out of 1003 undergoing OCT showed macrophage accumulation. Three groups were identified; group 1 (426 patients) without macrophages, group 2 (296) patients with low macrophage content (less than median value [67°] of circumferential arc) and group 3 (281) with high macrophage content arc [> 67°]. Patients with macrophages (groups 2 and 3) showed a higher prevalence of family history for coronary artery disease and hypercholesterolemia and had a significantly larger body mass index. Furthermore, group 3 had more commonly triple vessel disease and higher value of LDL cholesterol levels compared to the two other groups. The inter-observer agreement for macrophage interpretation was good: R values were 0.97 for the circumferential arc extension, 0.95 for the minimum distance and 0.98 for the mean distance. A non-significant correlation between circumferential extension of macrophages and hsCRP values was found (R = 0.013). Quantitative assessment of macrophage accumulations can be obtained with high reproducibility by OCT. The presence and amount of macrophages are poorly correlated with hsCRP and identify patients with more advanced atherosclerosis and higher LDL cholesterol levels.
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Affiliation(s)
- Laura Gatto
- Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy.,Cardiovascular Sciences Department, San Giovanni Addolorata Hospital, Rome, Italy
| | - Giulia Paoletti
- Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy.,UniCamillus - Saint Camillus International University of Health Sciences, Rome, Italy
| | - Valeria Marco
- Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy
| | - Alessio La Manna
- Cardio-Thoracic Vascular Department, Azienda Ospedaliero-Universitaria "Policlinico Vittorio-Emanuele", University of Catania, Catania, Italy
| | | | | | - Rocco Vergallo
- Department of Cardiovascular and Thoracic Sciences, University Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Alberto Boi
- Interventional Cardiology Unit, Ospedale Brotzu, Cagliari, Italy
| | - Massimo Fineschi
- Department of Cardiovascular Diseases, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | | | - Nevio Taglieri
- Cardio-Thoracic Vascular Department, University Hospital of Bologna, Bologna, Italy
| | | | - Simone Budassi
- Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy.,Cardiovascular Sciences Department, San Giovanni Addolorata Hospital, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular and Thoracic Sciences, University Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | | | - Eugenio Lella
- Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy
| | - Giovanni Ruscica
- Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy
| | - Mario Albertucci
- Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy.,Cardiovascular Sciences Department, San Giovanni Addolorata Hospital, Rome, Italy
| | - Corrado Tamburino
- Cardio-Thoracic Vascular Department, Azienda Ospedaliero-Universitaria "Policlinico Vittorio-Emanuele", University of Catania, Catania, Italy
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University Hospital, Toyoake, Japan
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Eloisa Arbustini
- Centre for Inherited Cardiovascular Diseases, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Francesco Prati
- Centro per la Lotta Contro L'Infarto - CLI Foundation, Rome, Italy. .,Cardiovascular Sciences Department, San Giovanni Addolorata Hospital, Rome, Italy. .,UniCamillus - Saint Camillus International University of Health Sciences, Rome, Italy. .,Cardiology Unit, San Giovanni-Addolorata Hospital, Via Amba Aradam 9, 00184, Rome, Italy.
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Compagnone M, Taglieri N, Celeski M, Ghetti G, Marrozzini C, Reggiani MLB, Nardi E, Orzalkiewicz M, Bruno AG, Galiè N, Saia F, Palmerini T. Impact of Elective, Uncomplicated Target Lesion Revascularization on Cardiac Mortality After Elective Percutaneous Coronary Intervention of Unprotected Left Main Coronary Artery Disease. Am J Cardiol 2020; 128:94-100. [PMID: 32650931 DOI: 10.1016/j.amjcard.2020.04.053] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/21/2020] [Accepted: 04/27/2020] [Indexed: 11/28/2022]
Abstract
This study sought to investigate the impact of elective, uncomplicated target lesion revascularization (TLR) on long-term cardiac mortality after percutaneous coronary intervention (PCI) of unprotected left main coronary artery (ULMCA) disease. Consecutive patients undergoing PCI for ULMCA disease between January 2003 and December 2015 in 1 interventional center in Northern Italy were included. Patients presenting with cardiogenic shock, ST-segment elevation myocardial infarction (MI), as well as those undergoing urgent or complicated TLR were excluded. The primary endpoint of the study was cardiac mortality. Among the 418 patients fulfilling the study criteria, 79 (18.46%) underwent elective, uncomplicated TLR. After a median follow-up of 5.5 years, there were 23 cardiac deaths among patients undergoing elective, uncomplicated TLR versus 50 in patients not undergoing TLR. After adjusting for possible confounders, TLR was an independent predictor of cardiac mortality (Hazard ratio [HZ] = 1.92, 95% confidence interval [CI]: 1.05 to 3.49; p = 0.03). Patients undergoing TLR had also significantly higher rates of the composite of cardiac death, MI and stroke compared with the no TLR group (adjusted HR = 1.76, 95% CI 1.14 to 2.72). In conclusion, elective, uncomplicated TLR after PCI of ULMCA disease is associated with increased risk of long-term cardiac mortality. Reducing the risk of TLR after PCI of ULMCA disease may potentially improve the survival of these patients.
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Affiliation(s)
- Miriam Compagnone
- Cardiology Unit, Cardio-Thoraco-Vascular Department, University Hospital of Bologna, Bologna, Italy.
| | - Nevio Taglieri
- Cardiology Unit, Cardio-Thoraco-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - Mihail Celeski
- Cardiology Unit, Cardio-Thoraco-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - Gabriele Ghetti
- Cardiology Unit, Cardio-Thoraco-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - Cinzia Marrozzini
- Cardiology Unit, Cardio-Thoraco-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | | | - Elena Nardi
- Cardiology Unit, Cardio-Thoraco-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - Mateusz Orzalkiewicz
- Cardiology Unit, Cardio-Thoraco-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - Antonio G Bruno
- Cardiology Unit, Cardio-Thoraco-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - Nazzareno Galiè
- Cardiology Unit, Cardio-Thoraco-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - Francesco Saia
- Cardiology Unit, Cardio-Thoraco-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - Tullio Palmerini
- Cardiology Unit, Cardio-Thoraco-Vascular Department, University Hospital of Bologna, Bologna, Italy
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Saia F, Palmerini T, Marcelli C, Chiarabelli M, Taglieri N, Ghetti G, Negrello F, Moretti C, Bruno AG, Compagnone M, Corsini A, Castelli A, Marrozzini C, Galiè N. Routine minimalist transcatheter aortic valve implantation with local anesthesia only. J Cardiovasc Med (Hagerstown) 2020; 21:805-811. [DOI: 10.2459/jcm.0000000000001030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Bruno AG, Santona L, Palmerini T, Taglieri N, Marrozzini C, Ghetti G, Orzalkiewicz M, Galiè N, Saia F. Predicting and improving outcomes of transcatheter aortic valve replacement in older adults and the elderly. Expert Rev Cardiovasc Ther 2020; 18:663-680. [DOI: 10.1080/14779072.2020.1778465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 12/13/2022]
Affiliation(s)
- Antonio Giulio Bruno
- Cardiology Unit, Cardio-Thorax-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - Laura Santona
- Cardiology Unit, Cardio-Thorax-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - Tullio Palmerini
- Cardiology Unit, Cardio-Thorax-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - Nevio Taglieri
- Cardiology Unit, Cardio-Thorax-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - Cinzia Marrozzini
- Cardiology Unit, Cardio-Thorax-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - Gabriele Ghetti
- Cardiology Unit, Cardio-Thorax-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - Mateusz Orzalkiewicz
- Cardiology Unit, Cardio-Thorax-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - Nazzareno Galiè
- Cardiology Unit, Cardio-Thorax-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - Francesco Saia
- Cardiology Unit, Cardio-Thorax-Vascular Department, University Hospital of Bologna, Bologna, Italy
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Taglieri N, Bruno AG, Bacchi Reggiani ML, D'Angelo EC, Ghetti G, Bruno M, Palmerini T, Rapezzi C, Galiè N, Saia F. Impact of coronary bypass or stenting on mortality and myocardial infarction in stable coronary artery disease. Int J Cardiol 2020; 309:63-69. [DOI: 10.1016/j.ijcard.2020.01.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/31/2019] [Accepted: 01/22/2020] [Indexed: 11/29/2022]
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Saia F, Dall'Ara G, Marzocchi A, Dardi F, Palazzini M, Manes A, Taglieri N, Marrozzini C, Rinaldi A, Galiè N. Left Main Coronary Artery Extrinsic Compression in Patients With Pulmonary Arterial Hypertension: Technical Insights and Long-Term Clinical Outcomes After Stenting. JACC Cardiovasc Interv 2020; 12:319-321. [PMID: 30732740 DOI: 10.1016/j.jcin.2018.08.002] [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: 07/12/2018] [Accepted: 08/01/2018] [Indexed: 10/27/2022]
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Palmerini T, Chakravarty T, Saia F, Bruno AG, Bacchi-Reggiani ML, Marrozzini C, Patel C, Patel V, Testa L, Bedogni F, Ancona M, Montorfano M, Chieffo A, Olivares P, Bartorelli AL, Buscaglia A, Porto I, Nickenig G, Grube E, Sinning JM, De Carlo M, Petronio AS, Barbanti M, Tamburino C, Iadanza A, Burzotta F, Trani C, Fraccaro C, Tarantini G, Aranzulla TC, De Benedictis M, Pagnotta P, Stefanini GG, Miura M, Taramasso M, Kang JH, Kim HS, Codner P, Kornowski R, Pelliccia F, Vignali L, Taglieri N, Ghetti G, Leone A, Galiè N, Makkar R. Coronary Protection to Prevent Coronary Obstruction During TAVR: A Multicenter International Registry. JACC Cardiovasc Interv 2020; 13:739-747. [PMID: 32061608 DOI: 10.1016/j.jcin.2019.11.024] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/12/2019] [Accepted: 11/19/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the safety and efficacy of coronary protection by preventive coronary wiring and stenting across the coronary ostia in patients at high risk for coronary obstruction after transcatheter aortic valve replacement (TAVR). BACKGROUND Coronary obstruction following TAVR is a life-threatening complication with high procedural and short-term mortality. METHODS Data were collected retrospectively from a multicenter international registry between April 2011 and February 2019. RESULTS Among 236 patients undergoing coronary protection with preventive coronary wiring, 143 had eventually stents implanted across the coronary ostia after valve deployment. At 3-year follow-up, rates of cardiac death were 7.8% in patients receiving stents and 15.7% in those not receiving stents (adjusted hazard ratio: 0.42; 95% confidence interval: 0.14 to 1.28; p = 0.13). There were 2 definite stent thromboses (0.9%) in patients receiving stents, both occurring after TAVR in "valve-in-valve" procedures. In patients not receiving stents, there were 4 delayed coronary occlusions (DCOs) (4.3%), occurring from 5 min to 6 h after wire removal. Three cases occurred in valve-in-valve procedures and 1 in a native aortic valve procedure. Distance between the virtual transcatheter valve and the protected coronary ostia <4 mm was present in 75.0% of patients with DCO compared with 30.4% of patients without DCO (p = 0.19). CONCLUSIONS In patients undergoing TAVR at high risk for coronary obstruction, preventive stent implantation across the coronary ostia is associated with good mid-term survival rates and low rates of stent thrombosis. Patients undergoing coronary protection with wire only have a considerable risk for DCO.
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Affiliation(s)
- Tullio Palmerini
- Polo Cardio-Toraco Vascolare, Policlinico S. Orsola, Bologna, Italy.
| | | | - Francesco Saia
- Polo Cardio-Toraco Vascolare, Policlinico S. Orsola, Bologna, Italy
| | - Antonio G Bruno
- Polo Cardio-Toraco Vascolare, Policlinico S. Orsola, Bologna, Italy
| | | | | | - Chinar Patel
- Cedars-Sinai Medical Center, Los Angeles, California
| | - Vivek Patel
- Cedars-Sinai Medical Center, Los Angeles, California
| | - Luca Testa
- Coronary Revascularisation Unit, IRCCS Policlinico S. Donato, S. Donato Milanese, Italy
| | - Francesco Bedogni
- Coronary Revascularisation Unit, IRCCS Policlinico S. Donato, S. Donato Milanese, Italy
| | - Marco Ancona
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Olivares
- Centro Cardiologico Monzino, University of Milan, Milan, Italy
| | | | - Angelo Buscaglia
- University of Genova, Cardiovascular Unit, Department of Internal Medicine and Specialties and IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Italo Porto
- University of Genova, Cardiovascular Unit, Department of Internal Medicine and Specialties and IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Georg Nickenig
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Eberhard Grube
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Jan-Malte Sinning
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | | | | | - Marco Barbanti
- Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, University of Catania, Catania, Italy
| | - Corrado Tamburino
- Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, University of Catania, Catania, Italy
| | - Alessandro Iadanza
- Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Siena, Italy
| | - Francesco Burzotta
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo Trani
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Chiara Fraccaro
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | | | | | - Paolo Pagnotta
- Cardio Center, Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy
| | | | - Mizuki Miura
- Heart Valve Clinic, University Hospital of Zürich, Zürich, Switzerland
| | | | - Jee-Hoon Kang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | | | | | | | - Luigi Vignali
- UO Cardiologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Nevio Taglieri
- Polo Cardio-Toraco Vascolare, Policlinico S. Orsola, Bologna, Italy
| | - Gabriele Ghetti
- Polo Cardio-Toraco Vascolare, Policlinico S. Orsola, Bologna, Italy
| | - Alessandro Leone
- Polo Cardio-Toraco Vascolare, Policlinico S. Orsola, Bologna, Italy
| | - Nazzareno Galiè
- Polo Cardio-Toraco Vascolare, Policlinico S. Orsola, Bologna, Italy
| | - Raj Makkar
- Cedars-Sinai Medical Center, Los Angeles, California
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Paolisso P, Bergamaschi L, Saturi G, D'Angelo EC, Magnani I, Toniolo S, Stefanizzi A, Rinaldi A, Bartoli L, Angeli F, Donati F, Rucci P, Mattioli AV, Taglieri N, Pizzi C, Galiè N. Secondary Prevention Medical Therapy and Outcomes in Patients With Myocardial Infarction With Non-Obstructive Coronary Artery Disease. Front Pharmacol 2020; 10:1606. [PMID: 32082147 PMCID: PMC7005107 DOI: 10.3389/fphar.2019.01606] [Citation(s) in RCA: 48] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 12/10/2019] [Indexed: 01/01/2023] Open
Abstract
Background Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous entity with relevant long-term major cardiovascular events. Several trials have demonstrated that dual antiplatelet therapy (DAPT), β-blocker, renin-angiotensin-aldosterone system (RAAS) inhibitor and statin therapy improve the prognosis in patients with obstructive myocardial infarction (ob-MI). However, evidence on the best medical therapy for secondary prevention in MINOCA patients is lacking. Purpose To investigate the effects of secondary prevention treatments at discharge on mid-term outcomes in MINOCA. Methods Patients with acute myocardial infarction (MI) undergoing early coronary angiography between 2016 and 2018 were extracted from a clinical database. The diagnosis of MINOCA was made according to 2016 ESC MINOCA Position Paper criteria. Second-level diagnostic work-up including cardiac magnetic resonance was performed to exclude non-ischemic troponin elevation cause. The relationship between treatments and outcomes was evaluated by using Kaplan-Meier survival analysis and Cox regression models. All confirmed MINOCA were followed in our outpatient clinics. The primary end-points were all-cause mortality, re-hospitalization for MI and a composite outcome including all-cause mortality, hospitalization for MI and ischemic stroke (MACE). Results Out of 1,141 AMI who underwent coronary angiography, 134 were initially diagnosed as MINOCA. Patients with MINOCA were less likely to receive secondary prevention treatments than patients with obstructive coronary artery disease (CAD) MI (respectively, 42.1% vs 81.8% for DAPT; 75.5% vs 89.6% for β-blockers; 64.7% vs 80.3% for RAAS inhibitor and 63.9% vs 83% for statins). Based on the diagnostic work-up completed during the first month after discharge, a final sample of 88 patients had confirmed MINOCA. During an average follow-up of 19.35 ± 10.65 months, all-cause mortality occurred in 11 (12.5%) patients, recurrence of MI in 4 (4.5%), and MACE in 15 (17.0%) patients. Patients treated with RAAS inhibitors and statins had a significantly longer survival. On the contrary, no increase in survival was found in patients treated with β-blockers or DAPT. Cox multivariable analysis, including all secondary prevention drugs, showed that only RAAS inhibitors were associated with reduced all cause-mortality and MACE. Conclusion This prospective study suggests that RAAS inhibitor therapy provides mid-term beneficial effects on outcomes in MINOCA patients; in contrast, dual antiplatelet, β-blocker and statin therapy had no effects on mortality and MACE. These results should be considered preliminary and warrant confirmation from larger studies.
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Affiliation(s)
- Pasquale Paolisso
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Luca Bergamaschi
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Giulia Saturi
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Emanuela Concetta D'Angelo
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Ilenia Magnani
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Sebastiano Toniolo
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Andrea Stefanizzi
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Andrea Rinaldi
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Lorenzo Bartoli
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Francesco Angeli
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Francesco Donati
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Paola Rucci
- Division of Hygiene and Biostatistics, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Anna Vittoria Mattioli
- Department of Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Nevio Taglieri
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Carmine Pizzi
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Nazzareno Galiè
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
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Della Riva D, Bruno M, Taglieri N. Successful manual thrombus aspiration in anterior ST-segment elevation myocardial infarction due to cardioembolic obstruction of the left main coronary artery. J Cardiol Cases 2019; 21:46-49. [PMID: 32042353 DOI: 10.1016/j.jccase.2019.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 04/28/2019] [Accepted: 06/30/2019] [Indexed: 10/25/2022] Open
Abstract
Large clinical trials and meta-analyses have shown that thrombus aspiration (TA) in the setting of ST-T segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) does not improve clinical outcome, whilst it may be associated with an increased risk of stroke. Accordingly, in the most recent European Society of Cardiology guidelines the role of routine TA during PPCI has been downgraded to a class III recommendation with level A of evidence. On the other hand, it has been suggested that in case of high thrombus burden a selective use of TA may still play a role. STEMI due to cardioembolism (CE) definitely represents one of these situations. In the present case of an 81-year-old woman presenting with STEMI due to a cardioembolic obstruction of left main coronary artery, we show that TA succeeded, whereas classical angioplasty failed, in promoting a prompt coronary flow restoration in a life-threatening condition. Further, it allowed us not to upgrade the procedure with stent implantation that would have required a triple antithrombotic therapy, significantly increasing the bleeding risk. Visual examination of thrombi retrieved suggested the diagnosis of CE. Finally, we clearly show which is the mechanism linking TA with the risk of stroke. <Learning objective: Recent European Society of Cardiology guidelines have downgraded thrombus aspiration (TA) in the setting of ST-T segment elevation myocardial infarction (STEMI) to a class III recommendation with level A of evidence. Nevertheless, we show a case where TA can still be useful as bail out therapy to treat a critical condition, to diagnose a rare mechanism of STEMI, and to understand the mechanism linking its use to the increased risk of stroke.>.
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Affiliation(s)
- Diego Della Riva
- Polo Cardio-Toraco-Vascolare, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - Matteo Bruno
- Polo Cardio-Toraco-Vascolare, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - Nevio Taglieri
- Polo Cardio-Toraco-Vascolare, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Alma Mater Studiorum Università di Bologna, Bologna, Italy
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Compagnone M, Moretti C, Marcelli C, Taglieri N, Ghetti G, Corsini A, Bruno M, Bruno AG, Orzalkiewicz M, Marrozzini C, Bacchi Reggiani ML, Palmerini T, Saia F. Surgical Risk Scores Applied to Transcatheter Aortic Valve Implantation: Friends or Foes? Short-Term and Long-Term Outcomes From a Single-Center Registry. J Invasive Cardiol 2019; 31:E282-E288. [PMID: 31567116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is a valid alternative to surgical aortic valve replacement for the treatment of symptomatic aortic stenosis. The EuroScore (ES) II, logistic EuroScore (log ES), and the Society of Thoracic Surgeons (STS) score are the most applied scores for surgical risk stratification. However, their predictive value for patients undergoing TAVI is still unclear. AIM To evaluate the performance of STS, log ES and ES II as predictors of short-term and long-term mortality in patients undergoing TAVI. METHODS Between February 2008 and October 2017, a total of 384 patients underwent transfemoral TAVI at our institution and constituted the study population. Patients were divided into three groups based on the class of risk (low, intermediate, and high) calculated by each score. In-hospital complications, 30-day outcomes, and 5-year outcomes were assessed. RESULTS In-hospital mortality rate was 2.6% (n = 10). All scores over-estimated the risk of 30-day mortality, especially for the highest risk classes. At the end of follow-up (5 years), STS risk stratification was able to stratify all-cause and cardiovascular (CV) mortality (P<.01 and P=.02, respectively). Patients with intermediate ES II risk showed a lower survival rate (P=.04) while CV deaths did not differ between classes of risk. All-cause mortality and CV mortality curves did not diverge according to the patients' risk profiles derived from log ES. CONCLUSION Conventional surgical risk scores are not appropriate to predict 30-day mortality in patients undergoing transfemoral TAVI. STS assessment was the only risk score able to stratify long-term all-cause and CV mortality.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Francesco Saia
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, Policlinico S.Orsola-Malpighi (Pavilion 23), Via Massarenti 9, 40138 Bologna, Italy.
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Ruscica G, Gatto L, Romagnoli E, Di Vito L, Fabbiocchi F, Marco V, Versaci F, Di Giorgio A, Taglieri N, La Manna A, Fineschi M, Boi A, Niccoli G, Albertucci M, Crea F, Arbustini E, Alfonso F, Prati F. Assessment of Mechanisms of Acute Coronary Syndromes and Composition of Culprit Plaques in Patients With and Without Diabetes. JACC Cardiovasc Imaging 2019; 12:1111-1112. [PMID: 30772213 DOI: 10.1016/j.jcmg.2018.12.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 12/10/2018] [Accepted: 12/20/2018] [Indexed: 11/29/2022]
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47
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Loforte A, Coppola G, Amodio C, Folesani G, Saia F, Taglieri N, Marozzini C, Savini C, Pacini D, Di Bartolomeo R. VD19 TRANS-FEMORAL IMPLANT OF A BALLOON EXPANDABLE AORTIC VALVE IN A LEAKING SUTURELESS SELF-EXPANDABLE VALVE. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549937.84819.e2] [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: 11/05/2022]
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48
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Romagnoli E, Gatto L, La Manna A, Burzotta F, Marco V, Boi A, Fineschi M, Fabbiocchi F, Taglieri N, Niccoli G, Ruscica G, Versaci F, Albertucci M, Crea F, Alfonso F, Arbustini E, Prati F. TCT-53 Role of Single OCT Morphological Variable in the CLIMA Trial (Relationship between Coronary pLaque morphology of the left anterIor descending artery and long terM clinicAl outcome). J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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49
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Ghetti G, Bacchi Reggiani ML, Rosetti C, Battistini P, Lanati G, Di Dio MT, Corsini A, Bruno M, Della Riva D, Bruno AG, Compagnone M, Narducci R, Saia F, Rapezzi C, Taglieri N. Prodromal angina and risk of 2-year cardiac mortality in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous intervention. Medicine (Baltimore) 2018; 97:e12332. [PMID: 30212983 PMCID: PMC6156056 DOI: 10.1097/md.0000000000012332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
We sought to investigate the prognostic significance of prodromal angina (PA) in unselected patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) and its additive predictive value to the GRACE score.We prospectively enrolled 3015 consecutive STEMI patients undergoing PPCI. Patients were divided in 2 groups according to the presence or absence of PA. Multivariable Cox regression was used to establish the relation to 2-year cardiac mortality of PA.The mean age of the study population was 68 (±14) years; 2178 patients (72%) were male. During follow-up, 395 (13%) patients died with 278 of these (9.2%) suffering from cardiac mortality. Kaplan-Meier estimates showed a survival rate of 95% and 87% for patients with PA and no PA, respectively (log rank test < 0.001). After multivariable analysis, patients with PA had still a lower risk of 2 years' cardiac mortality compared with patients without PA (adjusted hazard ratio = 0.50; 95% confidence interval [CI] 1.06-1.81, P = .001). Evaluation of net reclassification improvement showed that reclassification improved by 0.16% in case patients, whereas classification worsened in control patients by 1.08% leading to a net reclassification improvement of -0.93% (95% CI: -0.98, -0.88).In patients with STEMI undergoing PPCI the presence of PA is independently associated with a lower risk of 2-year cardiac mortality. However, the incorporation of this variable to the GRACE score slightly worsened the classification of risk. Accordingly, it seems unlikely that the evaluation of PA may be useful in clinical practice.
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Romagnoli E, Gatto L, La Manna A, Burzotta F, Taglieri N, Saia F, Amico F, Marco V, Ramazzotti V, Di Giorgio A, Ruscica G, Di Vito L, Boi A, Contarini M, Mintz G, Prati F. TCT-427 Role of Residual Stent Under-expansion ersus In-stent Minimum Lumen Area in Percutaneous Coronary Intervention Outcome: a CLI-OPCI Project Substudy. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1591] [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: 11/30/2022]
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