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Forgiarini A, Deroma L, Buttussi F, Zangrando N, Licata S, Valent F, Chittaro L, Di Chiara A. Introducing Virtual Reality in a STEMI Coronary Syndrome Course: Qualitative Evaluation with Nurses and Doctors. Cyberpsychol Behav Soc Netw 2024. [PMID: 38527251 DOI: 10.1089/cyber.2023.0414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
In the increasing number of medical education topics taught with virtual reality (VR), the prehospital management of ST-segment elevation myocardial infarction (STEMI) had not been considered. This article proposes an implemented VR system for STEMI training and introduces it in an institutional course addressed to emergency nurses and case manager (CM) doctors. The system comprises three different applications to, respectively, allow (a) the course instructor to control the conditions of the virtual patient, (b) the CM to communicate with the nurse in the virtual field and receive from him/her the patient's parameters and electrocardiogram, and (c) the nurse to interact with the patient in the immersive VR scenario. We enrolled 17 course participants to collect their perceptions and opinions through a semistructured interview. The thematic analysis showed the system was appreciated (n = 17) and described as engaging (n = 4), challenging (n = 5), useful to improve self-confidence (n = 4), innovative (n = 5), and promising for training courses (n = 10). Realism was also appreciated (n = 13), although with some drawbacks (e.g., oversimplification; n = 5). Overall, participants described the course as an opportunity to share opinions (n = 8) and highlight issues (n = 4) and found it useful for novices (n = 5) and, as a refresh, for experienced personnel (n = 6). Some participants suggested improvements in the scenarios' type (n = 5) and variability (n = 5). Although most participants did not report usage difficulties with the VR system (n = 13), many described the need to get familiar with it (n = 13) and the specific gestures it requires (n = 10). Three suffered from cybersickness.
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Affiliation(s)
- Alessandro Forgiarini
- Human-Computer Interaction Laboratory, Department of Mathematics, Computer Science and Physics, University of Udine, Udine, Italy
- Hygiene and Clinical Epidemiology Unit, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Laura Deroma
- Hygiene and Public Health Unit, Department of Prevention, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Fabio Buttussi
- Human-Computer Interaction Laboratory, Department of Mathematics, Computer Science and Physics, University of Udine, Udine, Italy
| | - Nicola Zangrando
- Hygiene and Clinical Epidemiology Unit, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Sabrina Licata
- Hygiene and Clinical Epidemiology Unit, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Francesca Valent
- Hygiene and Clinical Epidemiology Unit, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Luca Chittaro
- Human-Computer Interaction Laboratory, Department of Mathematics, Computer Science and Physics, University of Udine, Udine, Italy
| | - Antonio Di Chiara
- Cardiology Tolmezzo, San Daniele-Tolmezzo Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
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Werren M, Valent F, Di Chiara A. Effectiveness of home-rehabilitation in patients after an acute coronary syndrome and myocardial revascularization. Int J Cardiol Cardiovasc Risk Prev 2022; 14:200131. [PMID: 35663539 PMCID: PMC9160771 DOI: 10.1016/j.ijcrp.2022.200131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/22/2022] [Accepted: 04/28/2022] [Indexed: 11/21/2022]
Abstract
Physical activity is a mainstay (class IA) of rehabilitation programme after an acute coronary syndrome, but less than 40% of patients is physically active at one year. Home-rehabilitation, initially designed to manage the increasing number of patients in rehabilitation programmes, could result in a better strategy to increase adherence and persistence to physical activity. Objectives To test such hypothesis, At Cardiac Rehabilitation Centre (Institute of Physical Medicine and Rehabilitation, Udine, Italy), physical activity adherence was compared between patients treated with a standard in-office rehabilitation programme and a cohort where home rehabilitation programme was added. Methods From February 2017 to February 2019, 372 patients after an acute coronary syndrome (72 were excluded according to study criteria) were included, 193 patients in standard rehabilitation and 179 in home rehabilitation. At the end of follow-up, patients of both groups were called on the telephone to collect physical activity items according to a standardized questionnaire. Results At a medium follow-up of 30.1 months, there are more physically active patients in home rehabilitation than in standard, respectively 139 vs 108 patients (77,1% vs. 56%, p < 0,0001).At multivariate analysis, including age, gender, and rehabilitation model, the probability to be fully physically active at the end of the rehabilitation programme, is 3 times higher (OR 3.0 CI 1,9-6,0 p < 0,0001) for home rehabilitation programme compared to standard one. Conclusions Home rehabilitation, when applied to selected populations, resulted in a feasible and effective strategy to promote long term physical activity in secondary prevention after an acute coronary syndrome.
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Affiliation(s)
- Marika Werren
- Cardiologia Riabilitativa, Istituto di Medicina Fisica e Riabilitazione, Azienda Sanitario-Universitaria Friuli Centrale, Udine, Italy
| | - Francesca Valent
- Servizio di Epidemiologia Clinica e Valutativa, Azienda Provinciale per i Servizi Sanitari della Provincia Autonoma di Trento, Trento, Italy
| | - Antonio Di Chiara
- Cardiologia Ospedale Tolmezzo-San Daniele, Azienda Sanitario-Universitaria Friuli Centrale, Udine, Italy
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Agostinis P, Vianello V, Dereani E, Caruso G, Montessoro B, Taurian M, Di Chiara A, Patruno V, Cavallin F, Fadini GP, Aldovini A, Baritussio A, Curcio F, Tascini C, Baritussio A. Response to a massive SARS-CoV-2 infection in a nursing home transformed into a caring center. Aging Clin Exp Res 2021; 33:443-450. [PMID: 33506312 PMCID: PMC7840424 DOI: 10.1007/s40520-020-01784-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/30/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND The best policy to follow when nursing homes are massively hit by SARS-CoV2 is unclear. AIM To describe COVID-19 containment in a nursing home transformed into a caring center. METHODS Physicians and nurses were recruited. The facility was reorganized and connected with the laboratory of the reference hospital. Ultrasound was used to diagnose pneumonia. Patients needing intensive care were transferred to the reference hospital. Hydroxychloroquine/azithromycin/enoxaparin were used initially, while amiodarone/enoxaparin were used at a later phase. Under both regimens, methylprednisolone was added for severe cases. Prophylaxis was done with hydroxychloroquine initially and then with amiodarone. PERIOD COVERED March 22-July 31, 2020. RESULTS The facility was reorganized in two days. Ninety-two guests of the 121 (76%) and 25 personnel of 118 (21.1%) became swab test positive. Seven swab test negative patients who developed symptoms were considered to have COVID-19. Twenty-seven patients died, 23 swab test positive, 5 of whom after full recovery. Four patients needing intensive care were transferred (3 died). Mortality, peaking in April 2020, was correlated with symptoms, comorbidities, dyspnea, fatigue, stupor/coma, high neutrophil to lymphocyte ratio, C-reactive protein, interleukin-6, pro-calcitonin, and high oxygen need (p ≤ 0.001 for all). Among swab-positive staff, 3 had pneumonia and recovered. Although no comparison could be made between different treatment and prophylaxis strategies, potentially useful suggestions emerged. Mortality compared well with that of nursing homes of the same area not transformed into care centers. CONCLUSION Nursing homes massively hit by SARS-CoV-2 can become caring centers for patients not needing intensive care.
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Affiliation(s)
- Paolo Agostinis
- Department of Medicine, Ospedale Sant'Antonio Abate, Azienda Sanitaria Universitaria Friuli Centrale, Tolmezzo, Italy
| | - Valentina Vianello
- Department of General Surgery, Ospedale Santa Maria della Misericordia, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | | | - Giuseppe Caruso
- Special Continuity Care Units, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Beatrice Montessoro
- Special Continuity Care Units, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Marco Taurian
- Special Continuity Care Units, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Antonio Di Chiara
- Department of Medicine, Ospedale Sant'Antonio Abate, Azienda Sanitaria Universitaria Friuli Centrale, Tolmezzo, Italy
| | - Vincenzo Patruno
- Department of Pulmonology and Respiratory Medicine, Ospedale Santa Maria della Misericordia, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | | | - Gian Paolo Fadini
- Department of Medicine, Section of Diabetes and Metabolic Diseases, University of Padua, Padua, Italy
| | - Anna Aldovini
- Department of Medicine and Harvard Medical School, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Anna Baritussio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Francesco Curcio
- Department of Medicine and Clinical Pathology Institute, University of Udine and Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Carlo Tascini
- Clinical Infectious Diseases, Ospedale Santa Maria Della Misericordia, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
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Valent F, Di Chiara A. Detection of severe acute respiratory syndrome coronavirus 2 in nasopharynx according to clinical phenotype of affected patients. Clin Microbiol Infect 2020; 26:1686.e1-1686.e4. [PMID: 32905833 PMCID: PMC7474912 DOI: 10.1016/j.cmi.2020.08.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/26/2020] [Accepted: 08/31/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Duration of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the upper respiratory tract is extremely variable, but its relation to disease severity is unknown. We investigated this relation in the 530 000 inhabitants of the northeastern Italian province of Udine. METHODS We analysed real-time RT-PCR tests for SARS-CoV-2 in upper respiratory specimens conducted at the Virology Laboratory of the University Hospital of Udine, Italy (which serves the whole province) from 1 March to 30 April 2020 Specimens were from positive individuals in four groups characterized by different disease severity (critically ill patients admitted to intensive care units, patients admitted to infectious disease units, symptomatic patients visiting the emergency department and not hospitalized, and asymptomatic individuals tested during contact tracing or screening activities). Duration of viral positivity was assessed from the first positive test to the day of the first of two consecutive negative tests. Univariate and multivariate analyses were conducted to investigate differences in the four groups. RESULTS From 1 March to 30 April, 39 483 RT-PCR tests for SARS-CoV-2 were conducted on 23 778 individuals, and 974 individuals had a positive test result. Among those with multiple tests (n = 878), mean time to negativity was 23.7 days (standard error 0.3639; median 23, interquartile range 16-30 days). Mean time to negativity was longer in the group admitted to the intensive care unit than in the others, whereas no difference was observed between asymptomatic patients and those with mild disease. CONCLUSIONS Disease control measures should not be adjusted to account for differences in viral shedding according to symptomatic status.
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Affiliation(s)
- Francesca Valent
- SOC Istituto di Igiene ed Epidemiologia Clinica, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.
| | - Antonio Di Chiara
- SOC Cardiologia e riabilitazione cardiologica, Azienda Sanitaria Universitaria Friuli Centrale, San Daniele del Friuli, Italy
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Valent F, Di Chiara A, Di Bartolomeo S. Emergency Key Performance Indicators in the Italian region Friuli Venezia Giulia. Emerg Care J 2020. [DOI: 10.4081/ecj.2020.8910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Key Performance Indicators (KPI) regard key areas of a particular service which needs to be evaluated. Within the health system, they represent specific and measurable elements and are based on standards generally set by the scientific literature. KPI can be used to assess performances in different areas and achievement of goals. To develop and calculate a set of KPI in the Italian Region Friuli Venezia Giulia (1 million inhabitants) as an audit tool for the regional Emergency healthcare system, with a focus on three timedependent conditions: trauma, acute myocardial infarction, and stroke. To develop the set, a modified Delphi process was applied among Emergency care experts in Friuli Venezia Giulia. Then, the indicators were calculated from anonymous administrative health databases (Emergency Medical System, Emergency Department, hospital discharge, cardiac catheterization laboratory). Databases could be linked with each other at the individual level through a univocal stochastic key. Sensitivity analyses were conducted where different results were expected using different databases. Sixty-one indicators were calculated for the year 2018. Five indicators were summary descriptive measures, 10 were outcome measures, the others were process indicators; 20 were specific on acute myocardial infarction, 12 on trauma, 4 on stroke. Values for some indicators varied depending on the data source. These KPI provided new and interesting information and are used for periodic audit purposes in Friuli Venezia Giulia. Higher quality, completeness and richness of the administrative databases should be promoted to further increase the value of the indicators.
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Werren M, Di Chiara A, Pavan D, Di Lenarda A. [Should we just pursue LDL-cholesterol levels of <55 mg/dl for all patients in secondary prevention? How the concept of "residual risk" may become a clinical opportunity in very-high cardiovascular risk patients]. G Ital Cardiol (Rome) 2020; 21:599-601. [PMID: 32686786 DOI: 10.1714/3405.33893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Marika Werren
- Cardiologia Riabilitativa, Istituto Medicina Fisica e Riabilitativa Gervasutta, ASUFC, Udine
| | - Antonio Di Chiara
- Cardiologia e Riabilitazione Cardiovascolare, Ospedale di San Daniele-Tolmezzo, ASUFC, Tolmezzo (UD)
| | - Daniela Pavan
- Cardiologia, Ospedale S. Maria degli Angeli, Pordenone
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Di Chiara A, Clagnan E, Valent F. Epidemiology and mortality in an Italian region after the adoption of the universal definition of myocardial infarction. J Cardiovasc Med (Hagerstown) 2020; 21:34-39. [PMID: 31834103 DOI: 10.2459/jcm.0000000000000893] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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 The aim of the study is to validate at the biochemical level (presence of myocardial damage) the discharge diagnosis code ICD-9-CM 410.x1, and to compare the acute myocardial infarction (AMI) epidemiology based on pure administrative data with the epidemiology based on troponin and clinical data. METHODS The health-related administrative databases of the Italian Region Friuli Venezia Giulia were used as the source of information. All the databases are anonymous and can be linked with each other at the individual patient level through a univocal stochastic key. Two methods were used to assess incidence in 2017: the first used the main hospital discharge diagnosis, validated by biochemical myocardial necrosis; the second identified from the cohort of all patients with any myocardial injury those with ischemic origin. RESULTS The positive-predictive value of the clinical diagnosis of AMI (410.x1), validated at the biochemical level, was 96.2%.About 40% of patients with a not trivial biochemical myocardial injury and an ischemic heart disease diagnosis (e.g. 411) were discharged without either ST-elevation myocardial infarction (STEMI) or non-ST elevation myocardial infarction (NSTEMI) diagnosis, leading to a sensitivity of clinical discharge diagnosis of 47.6%.Thirty-day and 90-day mortality at multivariate analysis resulted respectively, 1.8 and 4.0% in NSTEMI, 6.6 and 9.8% in STEMI, 8.8 and 12.2% in patients with biochemical AMI and discharge diagnosis other than 410.x1. CONCLUSION Pure administrative data (clinical discharge diagnosis) are today insufficient to catch the whole hospital epidemiology of myocardial infarction missing an important proportion of AMI with an adverse prognosis comparable with STEMI.
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Affiliation(s)
- Antonio Di Chiara
- Cardiology Department, Azienda per l'Assistenza Sanitaria n°3, Gemona del Friuli, Italy
| | - Elena Clagnan
- Servizio Epidemiologico e Flussi Informativi, Azienda regionale di coordinamento per la salute (ARCS), Udine, Friuli Venezia Giulia Italy
| | - Francesca Valent
- Istituto di Igiene ed Epidemiologia, Clinica Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
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Dauriz M, Morici N, Gonzini L, Lucci D, Di Chiara A, Boccanelli A, Olivari Z, Casella G, De Luca L, Temporelli P, De Servi S, Bonora E, Savonitto S. Fifteen-Year Trends of Cardiogenic Shock and Mortality in Patients with Diabetes and Acute Coronary Syndromes. Am J Med 2020; 133:331-339.e2. [PMID: 31445812 DOI: 10.1016/j.amjmed.2019.07.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 07/15/2019] [Accepted: 07/15/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Our study was intended to examine time trends of management and mortality of acute coronary syndrome patients with associated diabetes mellitus. METHODS We analyzed data from 5 nationwide registries established between 2001 and 2014, including consecutive acute coronary syndrome patients admitted to the Italian Intensive Cardiac Care Units. RESULTS Of 28,225 participants, 8521 (30.2%) had diabetes: as compared with patients without diabetes, they were older and had significantly higher rates of prior myocardial infarction and comorbidities (all P < .0001). Prevalence of diabetes and comorbidities increased over time (P for trend < .0001). Cardiogenic shock rates were higher in patients with diabetes, as compared with those without diabetes (7.8% vs 2.8%, P < .0001), and decreased significantly over time only in patients without diabetes (P = .007). Revascularization rates increased over time in patients both with and without diabetes (both P for trend < .0001), although with persistingly lower rates in patients with diabetes. All-cause in-hospital mortality was higher in patients with diabetes (5.4 vs 2.5%, respectively, P < .0001) and decreased more consistently in patients without diabetes (P for trend = .007 and < .0001, respectively). At multivariable analysis, diabetes remains an independent predictor of both cardiogenic shock (odds ratio 2.03; 95% confidence interval, 1.77-2.32; P < .0001) and mortality (odds ratio 1.95; 95% confidence interval, 1.69-2.26; P < .0001). CONCLUSIONS Despite significant mortality reductions observed over 15 years in acute coronary syndromes, patients with diabetes continue to show threefold higher rates of cardiogenic shock and lower revascularization rates as compared with patients without diabetes. These findings may explain the persistingly higher mortality of patients with diabetes and acute coronary syndromes.
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Affiliation(s)
- Marco Dauriz
- Department of Internal Medicine, Section of Endocrinology and Diabetes, Bolzano General Hospital, Bolzano, Italy
| | - Nuccia Morici
- Intensive Cardiac Care Unit and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Clinical Sciences and Community Health Università degli Studi di Milano, Milan, Italy
| | - Lucio Gonzini
- ANMCO Research Center of the Heart Care Foundation, Florence, Italy
| | - Donata Lucci
- ANMCO Research Center of the Heart Care Foundation, Florence, Italy
| | - Antonio Di Chiara
- Division of Cardiology, Ospedale Sant'Antonio Abate, Tolmezzo, Italy
| | | | - Zoran Olivari
- Department of Cardiology, Ca' Foncello Hospital, Treviso, Italy
| | - Gianni Casella
- Department of Cardiology, Maggiore Hospital, Bologna, Italy
| | - Leonardo De Luca
- Division of Cardiology, San Giovanni Evangelista Hospital, Tivoli, (Rome), Italy
| | - Pierluigi Temporelli
- Cardiac Rehabilitation Istituti Clinici Scientifici Maugeri, IRCCS, Veruno, Italy
| | - Stefano De Servi
- Department of Cardiology, Multimedica IRCCS, Sesto San Giovanni, Italy
| | - Enzo Bonora
- Section of Endocrinology, Diabetes and Metabolism Department of Medicine, University of Verona, Verona, Italy
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De Luca L, Di Pasquale G, Gonzini L, Chiarella F, Di Chiara A, Boccanelli A, Casella G, Olivari Z, De Servi S, Gulizia MM, Di Lenarda A, Savonitto S, Bolognese L. Trends in management and outcome of patients with non-ST elevation acute coronary syndromes and peripheral arterial disease. Eur J Intern Med 2019; 59:70-76. [PMID: 30154039 DOI: 10.1016/j.ejim.2018.08.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 07/09/2018] [Accepted: 08/15/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Patients with non ST-segment elevation acute coronary syndromes (NSTE-ACS) and peripheral arterial disease (PAD) present a worse prognosis compared to those without PAD. We sought to describe contemporary trends of in-hospital management and outcome of patients admitted for NSTE-ACS with associated PAD. METHODS We analyzed data from 6 Italian nationwide registries, conducted between 2001 and 2014, including consecutive NSTE-ACS patients. RESULTS Out of 15,867 patients with NSTE-ACS enrolled in the 6 registries, 2226 (14.0%) had a history of PAD. As compared to non-PAD patients, those with PAD had significantly more risk factors and comorbidities (all p < 0.0001) that increased over time. Patients with PAD underwent less frequently coronary angiography (72.0% vs 79.2%, p < 0.0001) and percutaneous coronary intervention (PCI, 42.9% vs 51.8%, p < 0.0001), compared to patients without PAD. Over the years, a progressive and similar increase occurred in the rates of invasive procedures both in patients with and without PAD (both p for trend <0.0001). The crude in-hospital mortality rate did not significantly change over time (p for trend = 0.83). However, as compared to 2001, the risk of death was significantly lower in all other studies performed at different times, after adjustment for multiple comorbidities.. At multivariable analysis, PAD on admission was an independent predictor of in-hospital mortality [odds ratio (OR): 1.75; 95% confidence intervals (CI): 1.35-2.27; p < 0.0001]. CONCLUSIONS Over the 14 years of observation, patients with PAD and NSTE-ACS exhibited worsening baseline characteristics and a progressive increase in invasive procedures. Whereas crude in-hospital mortality did not change over time, we observed a significant reduction in comorbidity-adjusted mortality, as compared to 2001.
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Affiliation(s)
- Leonardo De Luca
- Division of Cardiology, San Giovanni Evangelista Hospital, Tivoli, Rome, Italy.
| | | | | | - Francesco Chiarella
- Division of Cardiology, Azienda Ospedaliera-Universitaria S. Martino, Genova, Italy
| | - Antonio Di Chiara
- Division of Cardiology, Ospedale Sant'Antonio Abate, Tolmezzo, Italy
| | | | - Gianni Casella
- Department of Cardiology, Maggiore Hospital, Bologna, Italy
| | - Zoran Olivari
- Department of Cardiology, Ca' Foncello Hospital, Treviso, Italy
| | - Stefano De Servi
- Division of Cardiology, IRCCS Multimedica, Sesto San Giovanni, Milano, Italy
| | | | - Andrea Di Lenarda
- Division of Cardiology, Azienda Sanitaria Universitaria Integrata di Trieste, Italy
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De Luca L, Casella G, Rubboli A, Gonzini L, Lucci D, Boccanelli A, Chiarella F, Di Chiara A, De Servi S, Di Lenarda A, Di Pasquale G, Savonitto S. Recent trends in management and outcome of patients with acute coronary syndromes and atrial fibrillation. Int J Cardiol 2017; 248:369-375. [DOI: 10.1016/j.ijcard.2017.08.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 07/15/2017] [Accepted: 08/08/2017] [Indexed: 11/16/2022]
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De Luca L, Marini M, Gonzini L, Boccanelli A, Casella G, Chiarella F, De Servi S, Di Chiara A, Di Pasquale G, Olivari Z, Caretta G, Lenatti L, Gulizia MM, Savonitto S. Contemporary Trends and Age-Specific Sex Differences in Management and Outcome for Patients With ST-Segment Elevation Myocardial Infarction. J Am Heart Assoc 2016; 5:e004202. [PMID: 27881426 PMCID: PMC5210417 DOI: 10.1161/jaha.116.004202] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 10/07/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND Age- and sex-specific differences exist in the treatment and outcome of ST-elevation myocardial infarction (STEMI). We sought to describe age- and sex-matched contemporary trends of in-hospital management and outcome of patients with STEMI. METHODS AND RESULTS We analyzed data from 5 Italian nationwide prospective registries, conducted between 2001 and 2014, including consecutive patients with STEMI. All the analyses were age- and sex-matched, considering 4 age classes: <55, 55 to 64, 65 to 74, and ≥75 years. A total of 13 235 patients were classified as having STEMI (72.1% men and 27.9% women). A progressive shift from thrombolysis to primary percutaneous coronary intervention occurred over time, with a concomitant increase in overall reperfusion rates (P for trend <0.0001), which was consistent across sex and age classes. The crude rates of in-hospital death were 3.2% in men and 8.4% in women (P<0.0001), with a significant increase over age classes for both sexes and a significant decrease over time for both sexes (all P for trend <0.01). On multivariable analysis, age (odds ratio 1.09, 95% CI 1.07-1.10, P<0.0001) and female sex (odds ratio 1.44, 95% CI 1.07-1.93, P=0.009) were found to be significantly associated with in-hospital mortality after adjustment for other risk factors, but no significant interaction between these 2 variables was observed (P for interaction=0.61). CONCLUSIONS Despite a nationwide shift from thrombolytic therapy to primary percutaneous coronary intervention for STEMI affecting both sexes and all ages, women continue to experience higher in-hospital mortality than men, irrespective of age.
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Affiliation(s)
- Leonardo De Luca
- Division of Cardiology, San Giovanni Evangelista Hospital, Tivoli (Rome), Italy
| | - Marco Marini
- Department of Cardiovascular Sciences, Ospedali Riuniti, Ancona, Italy
| | | | | | - Gianni Casella
- Department of Cardiology, Maggiore Hospital, Bologna, Italy
| | - Francesco Chiarella
- Division of Cardiology, Azienda Ospedaliera-Universitaria S. Martino, Genova, Italy
| | - Stefano De Servi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonio Di Chiara
- Division of Cardiology, Ospedale Sant'Antonio Abate, Tolmezzo, Italy
| | | | - Zoran Olivari
- Department of Cardiology, Ca' Foncello Hospital, Treviso, Italy
| | - Giorgio Caretta
- Division of Cardiology, Sant'Andrea Hospital, ASL 5 Liguria, La Spezia, Italy
| | - Laura Lenatti
- Division of Cardiology, Ospedale A. Manzoni, Lecco, Italy
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De Luca L, Olivari Z, Farina A, Gonzini L, Lucci D, Di Chiara A, Casella G, Chiarella F, Boccanelli A, Di Pasquale G, De Servi S, Bovenzi FM, Gulizia MM, Savonitto S. Temporal trends in the epidemiology, management, and outcome of patients with cardiogenic shock complicating acute coronary syndromes. Eur J Heart Fail 2015; 17:1124-32. [DOI: 10.1002/ejhf.339] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 07/06/2015] [Accepted: 07/18/2015] [Indexed: 11/10/2022] Open
Affiliation(s)
- Leonardo De Luca
- Department of Cardiovascular Sciences; European Hospital; Rome Italy
| | - Zoran Olivari
- Department of Cardiology; Ca' Foncello Hospital; Treviso Italy
| | - Andrea Farina
- Division of Cardiology; Ospedale A. Manzoni; Lecco Italy
| | | | | | | | - Gianni Casella
- Department of Cardiology; Maggiore Hospital; Bologna Italy
| | - Francesco Chiarella
- Division of Cardiology; Azienda Ospedaliera-Universitaria; S. Martino Genova Italy
| | | | | | - Stefano De Servi
- Division of Cardiology; Fondazione IRCCS Policlinico San Matteo; Pavia Italy
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De Luca L, Olivari Z, Bolognese L, Lucci D, Gonzini L, Di Chiara A, Casella G, Chiarella F, Boccanelli A, Di Pasquale G, Bovenzi FM, Savonitto S. A decade of changes in clinical characteristics and management of elderly patients with non-ST elevation myocardial infarction admitted in Italian cardiac care units. Open Heart 2014; 1:e000148. [PMID: 25525506 PMCID: PMC4267110 DOI: 10.1136/openhrt-2014-000148] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 07/24/2014] [Accepted: 11/04/2014] [Indexed: 11/24/2022] Open
Abstract
Objective To describe the evolution of clinical characteristics, in-hospital management and early outcome of elderly patients with non-ST elevation myocardial infarction (NSTEMI). Methods We analysed data from five consecutive Italian nationwide registries, conducted between 2001 and 2010, including patients with acute coronary syndromes admitted to cardiac care units (CCUs). Results Of 10 983 patients with NSTEMI enrolled in the 5 surveys, 4350 (39.6%) were ≥75 years old (mean age 81±5 years). Some clinical characteristics such as diabetes mellitus, hypertension, renal dysfunction and previous percutaneous coronary intervention increased significantly, whereas a history of stroke, myocardial infarction and heart failure decreased over time. An invasive approach increased from 26.6% in 2001 to 68.4% in 2010 (p<0.0001) and revascularisation rates increased from 9.9% to 51.7% (p<0.0001). Early use and prescription at discharge of β-blockers, statins and dual antiplatelet treatment increased significantly (p<0.0001). Thirty-day observed mortality decreased from 14.6% (95% CI 9.9 to 20.4) to 9.5% (95% CI 7.7 to 11.6). At the multivariate logistic regression analyses adjusted for baseline characteristics, compared with 2001, the risk of death was significantly lower in all the other studies performed at different times with reductions in adjusted mortality between 66% and 45%. Conclusions Over the past decade, substantial changes have occurred in the clinical characteristics and management of elderly patients admitted with NSTEMI in Italian CCUs, with a greater use of revascularisation therapy and recommended medications. These variations have been associated with a reduction in 30-day adjusted mortality rate.
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Affiliation(s)
- Leonardo De Luca
- Department of Cardiovascular Sciences , European Hospital , Rome , Italy
| | - Zoran Olivari
- Department of Cardiology , Ca' Foncello Hospital , Treviso , Italy
| | - Leonardo Bolognese
- Cardiovascular and Neurologic Department , San Donato Hospital , Arezzo , Italy
| | | | | | - Antonio Di Chiara
- Division of Cardiology , Ospedale San Antonio Abate , Tolmezzo , Italy
| | - Gianni Casella
- Department of Cardiology , Maggiore Hospital , Bologna , Italy
| | | | - Alessandro Boccanelli
- Department of Cardiovascular Diseases , S. Giovanni-Addolorata Hospital , Rome , Italy
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Pereira de Sousa L, Burba I, Ruperto C, Lattuada L, Barbone F, Di Chiara A. Vitamin K antagonists in patients with nonvalvular atrial fibrillation. J Cardiovasc Med (Hagerstown) 2013; 14:534-40. [DOI: 10.2459/jcm.0b013e32835dbd58] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Fabris E, Brun F, Porto AG, Losurdo P, Vitali Serdoz L, Zecchin M, Severini GM, Mestroni L, Di Chiara A, Sinagra G. Cardiac hypertrophy, accessory pathway, and conduction system disease in an adolescent: the PRKAG2 cardiac syndrome. J Am Coll Cardiol 2013; 62:e17. [PMID: 23810891 DOI: 10.1016/j.jacc.2013.02.099] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 02/07/2013] [Accepted: 02/12/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Enrico Fabris
- Cardiovascular Department, Ospedali Riuniti, and University of Trieste, Trieste, Italy
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Sciahbasi A, Rizzello V, Gonzini L, Giampaoli S, Greco C, Di Pasquale G, Mureddu GF, Di Chiara A, Lioy E, Boccanelli A. Chronic aspirin and statin therapy in patients with impaired renal function and acute coronary syndromes: results from the IN-ACS Outcome Registry. Eur J Prev Cardiol 2012; 21:214-21. [PMID: 22952286 DOI: 10.1177/2047487312460021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The cardioprotective role that statin and aspirin has appears to be reduced in patients with chronic kidney disease (CKD). This analysis aims to evaluate the impact of statin and aspirin on the outcome of patients with CKD and acute coronary syndrome (ACS). METHODS All patients who were enrolled in the IN-ACS Outcome registry, diagnosed with CKD, were included in our analysis. We divided patients into four groups, according to previous chronic therapy: neither aspirin nor statin therapy (Group 1), aspirin only therapy (Group 2), statin only therapy (Group 3) and aspirin plus statin therapy (Group 4). RESULTS Of the 5483 patients enrolled that had data on glomerular filtration rate available, 1484 had CKD: These segregated into 589 patients in Group 1, 477 in Group 2, 89 in Group 3 and 329 in Group 4. Despite having a higher baseline risk profile, groups 3 and 4, as compared to the other two groups, exhibited a significantly lower in-hospital mortality (1% in Group 3, 2% in Group 4; but 8% in Group 1 and 7% in Group 2, p = 0.0007); while at 30 days it remained so, as it was 1% in Group 3, 4% in Group 4 (and 10% in Group 1 and 10% in Group 2 p = 0.0002); and at 1 year it was 11% in Group 3 and 13% in Group 4 (compared to 20% in Group 1 and 23% in Group 2, p = 0.0012). CONCLUSIONS In a large cohort of patients with CKD and ACS, chronic treatment with statin or the combination of aspirin and statin is associated with short-term and long-term better outcomes for in-hospital mortality, as compared to those receiving no therapy or aspirin therapy alone.
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Affiliation(s)
- Alessandro Sciahbasi
- Unità Operativa Complessa di Cardiologia, Policlinico Casilino - ASL RMB, Rome, Italy
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Rizzello V, Lucci D, Maggioni AP, Giampaoli S, Greco C, Pasquale GD, Pallotti MG, Mureddu GF, Chiara AD, Boccanelli A. Clinical epidemiology, management and outcome of acute coronary syndromes in the Italian network on acute coronary syndromes (IN-ACS Outcome study). ACTA ACUST UNITED AC 2012; 14:71-80. [DOI: 10.3109/17482941.2012.655296] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Di Chiara A. [What to ask and what not to ask a registry]. G Ital Cardiol (Rome) 2011; 12:47-49. [PMID: 21428028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Di Chiara A, Dall'Armellina E, Badano LP, Meduri S, Pezzutto N, Fioretti PM. Predictive value of cardiac troponin-I compared to creatine kinase-myocardial band for the assessment of infarct size as measured by cardiac magnetic resonance. J Cardiovasc Med (Hagerstown) 2010; 11:587-92. [PMID: 20588136 DOI: 10.2459/jcm.0b013e3283383153] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The estimation of infarct size by biochemical myocardial necrosis markers is used in current clinical practice, rather than the more expensive and not always available imaging techniques. However, for this purpose, the peak value of serum biomarkers can overestimate the necrotic area, especially after reperfusion. OBJECTIVE We investigated whether late release cardiac troponin I (cTnI) values could predict more precisely infarct volume measured by delayed-enhancement cardiac magnetic resonance (DE-CMR) in patients with acute myocardial infarction [ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI)] independently of reperfusion (spontaneous and provoked). METHODS Sixty patients with a first acute myocardial infarction (55 STEMI and five NSTEMI) and normal function were enrolled. Among STEMI patients, 52 underwent reperfusion. cTnI and creatine kinase-myocardial band were assessed at admission and at 6, 12, 24, 48, 72 and 96 h (+/-1 h) from symptom onset. DE-CMR (Siemens Avanto 1.5T) was performed before discharge (4 +/- 2 days). Infarct size was determined by manual delineation of the areas of delayed enhancement. Infarct volume was calculated as the sum of each slice of infarct size area multiplied by thickness. RESULTS Peak cTnI was 55 +/- 59 ng/ml (range 0.3-347). The area under the curve of cTnI was 1916 +/- 2224 ng/ml. The volume of infarcted myocardium assessed by DE-CMR was 27 +/- 25 ml (range 0-134). The single value of cTnI at 72 h after symptom onset provided the most accurate estimation of predischarge infarct volume (r = 0.84, 95% confidence interval 0.75-0.91) and was significantly more accurate than creatine kinase-myocardial band value assessed at any time during the same period (r = 0.42, 95% confidence interval 0.19-0.62; P < 0.002). CONCLUSION In patients with a first acute myocardial infarction, cTnI value assessed at 72 h from symptom onset shows the best correlation with predischarge infarct volume as assessed by DE-CMR and is superior to cTnI and creatine kinase-myocardial band peak and total values.
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Affiliation(s)
- Antonio Di Chiara
- Cardiology Unit, Cardiopulmonary Science Department, Azienda Ospedaliero-Universitaria, Udine, Italy.
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Secchiero P, Corallini F, Beltrami AP, Ceconi C, Bonasia V, Di Chiara A, Ferrari R, Zauli G. An imbalanced OPG/TRAIL ratio is associated to severe acute myocardial infarction. Atherosclerosis 2009; 210:274-7. [PMID: 20015493 DOI: 10.1016/j.atherosclerosis.2009.11.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [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] [Received: 09/26/2009] [Revised: 11/02/2009] [Accepted: 11/03/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND This study was designed to evaluate the biological significance of simultaneous changes in the circulating levels of osteoprotegerin (OPG) and TNF-related apoptosis inducing ligand (TRAIL) in patients with coronary artery disease (CAD), and, in particular, with acute myocardial infarction (AMI). METHODS Total levels of OPG and TRAIL were measured by ELISA in patients with AMI (n=113), unstable angina (UA, n=21) and healthy controls (n=120). RESULTS Since OPG was elevated during the acute phase (first 12-24-48h) after AMI and in patients with UA with respect to healthy controls, while TRAIL was decreased in acute AMI patients, CAD patients were characterized by an increased OPG/TRAIL ratio. Moreover, the OPG/TRAIL ratio was significantly (p<0.05) higher in the acute AMI patients who developed heart failure (HF) than in those who did not develop HF in the follow-up. CONCLUSIONS An impaired OPG/TRAIL ratio after AMI is related to a higher risk of HF.
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Affiliation(s)
- Paola Secchiero
- Department of Morphology and Embryology, University of Ferrara, Via Fossato di Mortara 66, 44100 Ferrara, Italy
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Bernardi G, Di Chiara A, Armellini I. The Acute Myocardial Infarction with ST Segment Elevation Udine Registry (Come-to-Udine): predictors of 3 years mortality. J Cardiovasc Med (Hagerstown) 2009; 10:474-84. [DOI: 10.2459/jcm.0b013e32832a56c9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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De Luca L, Bolognese L, Casella G, Savonitto S, Gonzini L, Di Chiara A, De Servi S, Notaristefano S, Valagussa L, Maggioni AP, Chiarella F. Modalities of treatment and 30-day outcomes of unselected patients older than 75 years with acute ST-elevation myocardial infarction: data from the BLITZ study. J Cardiovasc Med (Hagerstown) 2008; 9:1045-51. [DOI: 10.2459/jcm.0b013e32830eb6eb] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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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Giansante C, Fiotti N, Di Chiara A, Altamura N, Wasserman S, Fioretti P, Guarnieri G. In-hospital outcome of patients with acute coronary syndrome: relationship with inflammation and remodeling markers. J Cardiovasc Med (Hagerstown) 2007; 8:602-7. [PMID: 17667031 DOI: 10.2459/jcm.0b013e32802e6c28] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [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
OBJECTIVES AND METHODS The present study was designed to evaluate the role of some inflammation [interleukin (IL)-1beta, soluble IL-1 receptor, IL-1 receptor antagonist (IL-1RA), high-sensitivity C-reactive protein (hsCRP) and fibrinogen], and remodeling markers [matrix metalloproteinase (MMP)-9, tissue inhibitor of metalloproteinase (TIMP)-1 and TIMP-2] in patients with acute coronary syndrome (ACS; 40 patients), or chronic stable angina (CSA; 40 patients) compared to age- and sex-matched healthy controls (20 subjects). RESULTS IL-1RA, hsCRP, fibrinogen, MMP-9, and TIMP-1 plasma levels were significantly higher in patients than in controls, whereas soluble IL-1 receptor had an opposite pattern. Among patients with ACS, hsCRP plasma levels were higher in patients with non-ST segment elevation myocardial infarction (NSTEMI) than in those with unstable angina (UA). TIMP-1 plasma levels were higher in those patients with ACS who did not respond to medical therapy (non-responsive unstable angina; NR-UA). A CRP plasma level higher than 0.86 mg/dl had a 91% positive predictive value (PPV) and 63% negative predictive value for NSTEMI (odds ratio = 6.4, 95% confidence interval = 1.5-27.4). TIMP-1 plasma level higher than 21.5 ng/ml had a 100% PPV for patients with NR-UA or NSTEMI. Binary logistic analysis confirmed TIMP-1 levels as being able to predict responsiveness to therapy. CONCLUSIONS In conclusion, a different biochemical pattern characterizes ACS patients: those with NR-UA show only an increase of remodeling markers, whereas ACS patients with NSTEMI have an increase of both remodeling and inflammation markers.
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Affiliation(s)
- Carlo Giansante
- U.C.O. Clinica Medica Generale e Terapia Medica Dipartimento di Scienze Cliniche, Morfologiche e Tecnologiche, Università degli Studi di Trieste, Strada di Fiume 447, 34149 Trieste, Italy.
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Di Chiara A. [Technical equipment of modern coronary care units: ventricular assist devices]. G Ital Cardiol (Rome) 2007; 8:25S-31S. [PMID: 17649870] [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: 05/16/2023]
Abstract
Intra-aortic balloon counterpulsation (IABP) is sometimes used in critically ill patients with cardiac disease. By increasing diastolic arterial pressure and decreasing systolic pressure, it reduces left ventricular afterload. IABP may be beneficial in subjects with cardiogenic shock, mechanical complications of myocardial infarction, intractable ventricular arrhythmias, or advanced heart failure or those who undergo high-risk surgical or percutaneous revascularization, but the evidence to support its use in these patient subsets is largely observational. Contraindications to IABP include severe peripheral vascular disease as well as aortic regurgitation, dissection, or aneurysm. The potential benefits of IABP must be weighed against its possible complications (bleeding, systemic thromboembolism, limb ischemia, and, rarely, death). Besides the mandatory specific knowledge, its use in coronary care units should be supported by adequate clinical competence.
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Di Chiara A, Plewka M, Werren M, Badano LP, Fresco C, Fioretti PM. Estimation of infarct size by single measurements of creatine kinase levels in patients with a first myocardial infarction. J Cardiovasc Med (Hagerstown) 2007; 7:340-6. [PMID: 16645412 DOI: 10.2459/01.jcm.0000223256.01439.1b] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [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
OBJECTIVE Enzymatic estimation of infarct size is desirable in the reperfusion era, because a possible discrepancy with the observed asynergic area of the left ventricle may suggest the presence of stunned myocardium. Unfortunately, timely myocardial reperfusion produces a rapid washout of creatine kinase (CK) in blood flow, which overestimates infarct size. In this perspective, we investigated whether the mid-terminal portion of the CK time-activity curve could predict infarct size more reliably. METHODS Enzymatic infarct size was calculated by peak CK levels, the CK area under the curve and by single CK values, in 103 patients with a first ST-elevation myocardial infarction, and compared to the left ventricular akinetic area. The wall motion asynergy score at follow-up was considered as the actual infarct size. RESULTS In patients with peak CK within 10 h of symptom onset, CK levels at 30 h showed a high independent correlation (r = 0.83; P < 0.001) with infarct size. In patients with late peak CK (> 10 h), CK levels at 12 h turned out to be the best predictor of infarct size (r = 0.55; P < 0.01). At multivariate regression analysis, peak CK was the best predictor of infarct size in the whole population (r = 0.61; P < 0.001). CONCLUSIONS In patients with ST-elevation myocardial infarction and early peak CK, infarct size at follow-up could be better estimated with single values of the mid-terminal portion of the CK time-activity curve.
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Affiliation(s)
- Antonio Di Chiara
- Division of Cardiology, Department of Cardiopulmonary Sciences, S Maria della Misericordia Hospital, Udine, Italy.
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Di Chiara A, Marinigh R. [Bundle-branch block in the course of myocardial infarction. Recent advances]. Recenti Prog Med 2006; 97:401-4. [PMID: 16913177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
In case of acute myocardial infarction and a bundle-branch block (BBB) major diagnostic and prognostic issues should be addressed with different considerations, depending on the presence of a left BBB (LBBB) or a right BBB (RBBB), distinguishing new or presumably new BBB, considering the possibility that the BBB masks electrocardiographic features of MI with ST-segment elevation. In this paper we briefly discuss the results of published trials that assessed the prognostic difference between different types of BBB during the early phase of acute myocardial infarction. The Wong et al. analysis of HERO-2 trial demonstrates that in the setting of an anterior STEMI, the presence of an RBBB, whatever its onset, is associated with a higher risk of death. The same analysis shows as RBBB associated with an inferior infarction does not portend a worse prognosis independently of its onset. Patients with LBBB already present at randomization were found to have worse pre-infarction characteristics, responsible, by itself, for the worst prognosis. However, the occurrence of an LBBB after randomization indicates a 'true' ischaemic conduction damage, thus carrying an independent negative prognostic value due to the large percentage of myocardium involved. HERO-2 trial, showing prognostic differences between different clinical presentations, underlines the importance to be familiar with the mechanisms related to BBBs and with the prognostic implications of BBBs in the setting of an acute myocardial infarction.
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Di Chiara A, Fresco C, Savonitto S, Greco C, Lucci D, Gonzini L, Mafrici A, Ottani F, Bolognese L, De Servi S, Boccanelli A, Maggioni AP, Chiarella F. Epidemiology of non-ST elevation acute coronary syndromes in the Italian cardiology network: the BLITZ-2 study. Eur Heart J 2005; 27:393-405. [PMID: 16219657 DOI: 10.1093/eurheartj/ehi557] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Acute coronary syndromes without ST-segment elevation (NSTEACS) represent an increasingly frequent cause of hospital admission. The BLITZ-2 study was planned to survey the epidemiology and management strategies of NSTEACS in the Italian cardiological network. METHODS AND RESULTS The study included 1888 patients with NSTEACS in 275 hospitals in 3 weeks. At admission, almost 20% of patients showed clinical signs of heart failure, half showed ST-segment depression, and half showed any positive biochemical myocardial necrosis marker. Patients admitted to hospitals without CathLab (n=973) were older (P=0.0005) and with higher Killip class on admission (P<0.0001) when compared with those admitted to hospitals with CathLab (n=915). During index hospitalization, 76% of the patients initially admitted to hospitals with invasive capability underwent coronary angiography and 39% percutaneous coronary intervention when compared with 39 and 17.2% of those admitted to hospitals without CathLab (P<0.001). Overall, 30-day mortality was 2.4% (2.0% in patients with invasive capability vs. 2.9% in hospitals without CathLab, P=0.2). Cardiac ischaemic events at 30 days (recurrent MI, recurrent angina, and re-hospitalization for ACS) were significantly higher in the group of patients admitted to hospitals without CathLab (OR 1.71, 95% CI 1.24-2.35). However, after multivariable adjustment, only advanced age (OR 1.043, 95% CI 1.021-1.065, P<0.0001) and Killip class >1 (OR 1.633, 95% CI 1.020-2.614, P=0.04) resulted in independent predictors of death, in-hospital MI, and re-admission for ACS, whereas the absence of an on-site CathLab did not predict an adverse outcome (OR 1.104, 95% CI 0.734-1.660). CONCLUSION According to this, the nationwide registry outcome is only marginally influenced by invasive procedures. Contemporary management of patients with NSTEACS in Italy is primarily driven by resource availability.
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Di Chiara A, Bernardi G. Percutaneous left atrial appendage transcatheter occlusion as an alternative to oral anticoagulation in patients with atrial fibrillation. Is it the time? Ital Heart J 2005; 6:418-9. [PMID: 15934417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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Casella G, Savonitto S, Chiarella F, Gonzini L, Di Chiara A, Bolognese L, De Servi S, Greco C, Zonzin P, Coccolini S, Maggioni AP, Boccanelli A. Clinical characteristics and outcome of diabetic patients with acute myocardial infarction. Data from the BLITZ-1 study. Ital Heart J 2005; 6:374-83. [PMID: 15934409] [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: 05/02/2023]
Abstract
BACKGROUND The determinants of a worse outcome in diabetic patients after an acute myocardial infarction (AMI) are controversial. They include delayed hospital admission, worse clinical presentation and lesser efficacy of accepted therapeutic interventions. Therefore, to improve our knowledge, we aimed to describe the clinical characteristics, treatment options and short-term outcomes of diabetic patients in a survey of consecutive AMI subjects admitted to the Italian coronary care unit (CCU) network in the current era of reperfusion. METHODS The BLITZ study prospectively enrolled patients with AMI, within 48 hours of symptom onset, admitted to 296 out of the 341 existing Italian CCUs from October 15 to 29, 2001. Diabetic status was recorded by collecting clinical history. In-hospital and post-discharge management and outcomes were collected up to 30 days from admission. RESULTS Overall, 434 of 1959 enrolled patients (22%) had a clinical diagnosis of diabetes. Diabetic patients were older, more frequently women, had a worse coronary risk profile, and an unfavorable clinical presentation compared to non-diabetics. Among 1275 patients with ST-elevation AMI, diabetics (20%) received a similar proportion of any reperfusion therapy (61 vs 66%, p = 0.10), but significantly less primary percutaneous coronary angioplasty (9 vs 16%, p = 0.003). Diabetic patients were treated less often with oral beta-blockers than non-diabetics both during hospitalization (56 vs 64%, p = 0.003) and at discharge (54 vs 61%, p = 0.01). In contrast, in-hospital use of angiotensin-converting enzyme inhibitors (76 vs 67%, p = 0.0003), digitalis (10 vs 5%, p = 0.0005), and diuretics (54 vs 36%, p < 0.0001) was more frequent among diabetics. During their index admission, subjects with diabetes had higher in-hospital mortality (11 vs 6%, p = 0.0004), as well as higher rates of reinfarction (6 vs 2%, p = 0.0003), new congestive heart failure (28 vs 14%, p < 0.0001), cardiogenic shock (10 vs 5%, p = 0.0005) or recurrent angina (22 vs 16%, p = 0.0034). A similar pattern was observed at 30-day follow-up. At multivariate analysis, diabetic status was not confirmed to be an independent predictor of 30-day mortality. CONCLUSIONS Although diabetic patients with AMI admitted to the Italian CCU network have a higher in-hospital and 30-day morbidity and mortality rates compared to non-diabetics, a clinical diagnosis of diabetes has no independent predictive value on short-term outcome.
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Bernardi G, Di Chiara A. Fluoroscopic guidance is mandatory to insert intra-aortic balloon pump!(?). Ital Heart J 2005; 6:363-4. [PMID: 15902940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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Di Chiara A, Chiarella F, Savonitto S, Lucci D, Bolognese L, De Servi S, Greco C, Boccanelli A, Zonzin P, Coccolini S, Maggioni AP. Epidemiology of acute myocardial infarction in the Italian CCU network The BLITZ Study. Eur Heart J 2003; 24:1616-29. [PMID: 14499224 DOI: 10.1016/s0195-668x(03)00278-1] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.5] [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] [Indexed: 11/22/2022] Open
Abstract
AIMS A large number of descriptive data on patients with acute myocardial infarction are based on clinical trials and registries on non consecutive patients: these data may give only a partial picture on treatment delay, patient characteristics, treatment and outcome of acute myocardial infarction in the real world. METHODS AND RESULTS The BLITZ survey prospectively enrolled all of the patients with acute myocardial infarction admitted in 296 (87%) Italian Coronary Care Units from 15-29 October 2001. Data on treatment delay, therapeutic strategies, duration of hospitalization and 30-day outcome were collected. One thousand nine hundred and fifty-nine consecutive patients (mean age 67+/-12 years, 70% males) were enrolled, 65% with ST-segment elevation (STEMI), 30% with no ST-segment elevation (NSTEMI) and 5% with undetermined ECG. The median delay between symptom onset and hospital arrival was 2h and 9 min with 76% of patients hospitalized within the sixth hour (26% within the first hour, 48% within the second). The median delay from hospital arrival to reperfusion therapy in STEMI was 45 min (IQR 26-85) for thrombolysis (50% of the patients) and 85 min (IQR 60-135) for primary angioplasty (15% of the patients). Coronary angiography was performed during hospital stay in 46% of the patients (STEMI 48%, NSTEMI 43%, undetermined AMI 35%), coronary angioplasty in 25% (STEMI 26%, NSTEMI 15%, undetermined AMI 13%) and coronary bypass in 1.4% (1%, 2.2% and 1% respectively). Twenty-two percent of the patients admitted to hospitals without cath-lab were transferred to a tertiary care hospital for invasive procedures. The overall median hospital stay was 10 days (IQR 7-12, STEMI 10, NSTEMI 9, undetermined AMI 11) and was not significantly different between hospitals with or without cath-lab (respectively, 9 and 10 days, P=0.38). After discharge and up to 30 days, coronary angiography was performed in 11% (STEMI 11%, NSTEMI 11%, undetermined MI 9%), angioplasty in 10% (STEMI 10%, NSTEMI 11%, undetermined MI 7%), bypass surgery in 7% (STEMI 5%, NSTEMI 11%, undetermined AMI 7%). The in-hospital and 30-day case fatality rates were 7.4% and 9.4%, respectively (7.5% and 9.5% for STEMI, 5.2% and 7.1% for NSTEMI, 18.2% and 21.2% for undetermined MI). CONCLUSIONS Patients with acute myocardial infarction admitted to the Italian CCUs, are older than those represented in clinical trials. A high proportion of these cases has the chance to receive early reperfusion therapy. Short-term mortality is lower than expected for patients with STEMI, but higher than reported for NSTEMI.
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Di Chiara A, Zonzin P, Pavoni D, Fioretti PM. [The RUTA project (Registro UTIC Triveneto ANMCO). An e-network for the coronary care units for acute myocardial infarction]. Ital Heart J Suppl 2003; 4:481-494. [PMID: 19400054] [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: 05/27/2023]
Abstract
In the era of evidence-based medicine, the monitoring of the adherence to the guidelines is fundamental, in order to verify the diagnostic and therapeutic processes. Informatic paperless databases allow a higher data quality, lower costs and timely analysis with overall advantages over the traditional surveys. The RUTA project (acronym of Triveneto Registry of ANMCO CCUs) was designed in 1999, aiming at creating an informatic network among the coronary care units of a large Italian region, for a permanent survey of patients admitted for acute myocardial infarction. Information ranges from the pre-hospital phase to discharge, including all relevant clinical and management variables. The database uses DBMS Personal Oracle and Power-Builder as user interface, on Windows platform. Anonymous data are sent to a central server.
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Badano LP, Werren M, Di Chiara A, Fioretti PM. Contrast echocardiographic evaluation of early changes in myocardial perfusion after recanalization therapy in anterior wall acute myocardial infarction and their relation with early contractile recovery. Am J Cardiol 2003; 91:532-7. [PMID: 12615255 DOI: 10.1016/s0002-9149(02)03300-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [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] [Indexed: 10/27/2022]
Abstract
Temporal changes in myocardial perfusion after recanalization and their relation with functional recovery in patients with acute myocardial infarction (AMI) using intravenous myocardial contrast echocardiography (MCE) have not yet been clarified. To address this issue, 19 patients with first, uncomplicated anterior wall AMI were studied using intravenous MCE within 24 hours of recanalization and before discharge. MCE was performed using harmonic power Doppler. Each asynergic left ventricular (LV) myocardial segment was scored for myocardial perfusion (1 = complete, 0.7 = patchy but >50%, 0.3 = patchy <50%, and 0 = absent) and a regional perfusion index was calculated within the dysfunctioning myocardium. During the day-1 study (11 +/- 2 hours from recanalization), the regional perfusion index was 0.4 +/- 0.3 and the LV wall motion score index was 1.9 +/- 0.2. During the study before discharge (7 +/- 4 days from admission), all but 2 patients showed an improvement of either perfusion index (0.6 +/- 0.3, p <0.0001) or wall motion score index (1.7 +/- 0.4, p <0.0001). Changes in perfusion score from 24-hours to before discharge showed a significant correlation with LV segment contractile recovery at 2-month of follow-up (R(2) = 0.42, 95% confidence interval 0.33 to 0.50, p <0.0001). Thus, our data show that after recanalized AMI, there is a significant amount of microvascular obstruction that recovers in the days after, and the extent of this perfusion improvement appears to be related with early myocardial contractile recovery. Our data provide clinical evidence for a transient microvascular dysfunction after successfully recanalized AMI.
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Affiliation(s)
- Luigi Paolo Badano
- Cardiovascular Science Department, Cardiology Unit, A.O. S Maria della Misericordia, Udine, Italy.
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Di Chiara A, Greco C, Savonitto S, De Servi S, Bolognese L, Chiarella F. [Myocardial infarction redefined based on the consensus document of the ESC/ACC]. Ital Heart J Suppl 2002; 3:208-14. [PMID: 11926027] [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: 02/24/2023]
Abstract
An expert committee of the European Society of Cardiology and the American College of Cardiology has recently proposed new and more precise criteria for the diagnosis of myocardial infarction, entailing both relevant implications in clinical practice and scientific, epidemiological and organizational aspects. The Board of the Emergency Area of the National Association of Hospital Cardiologists (ANMCO) will review the document and analyze the issues of major concern.
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Affiliation(s)
- Antonio Di Chiara
- U.O. di Cardiologia A.O.S. Maria della Misericordia Piazzale S. Maria della Misericorda, 15 33100 Udine.
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