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Giordano A, Corcione N, Barbanti M, Costa G, Dipietro E, Amat-Santos IJ, Gómez-Herrero J, Latib A, Scotti A, Testa L, Bedogni F, Schaefer A, Russo M, Musumeci F, Ferraro P, Morello A, Cimmino M, Albanese M, Pepe M, Giordano S, Biondi-Zoccai G. Features and outcomes of bailout repeat transcatheter aortic valve implantation (TAVI): the Bailout Acute TAVI-in-TAVI to Lessen Events (BATTLE) international registry. Clin Res Cardiol 2024; 113:68-74. [PMID: 37294310 PMCID: PMC10808138 DOI: 10.1007/s00392-023-02239-8] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/30/2023] [Indexed: 06/10/2023]
Abstract
AIM Transcatheter aortic valve implantation (TAVI) is a mainstay in the management of severe aortic stenosis in patients with intermediate to prohibitive surgical risk. When a single TAVI device fails and cannot be retrieved, TAVI-in-TAVI must be performed acutely, but outcomes of bailout TAVI-in-TAVI have been incompletely appraised. We aimed at analyzing patient, procedural and outcome features of patients undergoing bailout TAVI-in-TAVI in a multicenter registry. METHODS Details of patients undergoing bailout TAVI-in-TAVI, performed acutely or within 24 h of index TAVI, in 6 international high-volume institutions, were collected. For every case provided, 2 same-week consecutive controls (prior TAVI, and subsequent TAVI) were provided. Outcomes of interest were procedural and long-term events, including death, myocardial infarction, stroke, access site complication, major bleeding, and reintervention, and their composite (i.e. major adverse events [MAE]). RESULTS A total of 106 patients undergoing bailout TAVI-in-TAVI were included, as well as 212 controls, for a total of 318 individuals. Bailout TAVI-in-TAVI was less common in younger patients, those with higher body mass index, or treated with Portico/Navitor or Sapien devices (all p < 0.05). Bailout TAVI-in-TAVI was associated with higher in-hospital rates of death, emergency surgery, MAE, and permanent pacemaker implantation (all p < 0.05). Long-term follow-up showed that bailout TAVI-in-TAVI was associated with higher rates of death and MAE (both < 0.05). Similar findings were obtained at adjusted analyses (all p < 0.05). However, censoring early events, outlook was not significantly different when comparing the two groups (p = 0.897 for death, and p = 0.645 for MAE). CONCLUSIONS Bail-out TAVI-in-TAVI is associated with significant early and long-term mortality and morbidity. Thus, meticulous preprocedural planning and sophisticated intraprocedural techniques are of paramount importance to avoid these emergency procedures.
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Affiliation(s)
- Arturo Giordano
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
- Unità Operativa di Emodinamica, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Nicola Corcione
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
- Unità Operativa di Emodinamica, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Marco Barbanti
- Division of Cardiology, Università degli Studi di Enna "Kore", Enna, Italy
| | - Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico "Rodolico-San Marco", University of Catania, Catania, Italy
| | - Elena Dipietro
- Division of Cardiology, A.O.U. Policlinico "Rodolico-San Marco", University of Catania, Catania, Italy
| | - Ignacio J Amat-Santos
- Department of Cardiology, CIBERCV, University Clinical Hospital of Valladolid, Valladolid, Spain
| | - Javier Gómez-Herrero
- Department of Cardiology, CIBERCV, University Clinical Hospital of Valladolid, Valladolid, Spain
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, New York, NY, USA
| | - Andrea Scotti
- Department of Cardiology, Montefiore Medical Center, New York, NY, USA
| | - Luca Testa
- Cardiology Unit, IRCCS Policlinico San Donato, Milan, Italy
| | | | - Andreas Schaefer
- Department of Cardiovascular Surgery, University Heart and Vascular Center of Hamburg, Hamburg, Germany
| | - Marco Russo
- Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | - Francesco Musumeci
- Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | - Paolo Ferraro
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
- Unità Operativa di Emodinamica, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Alberto Morello
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
- Unità Operativa di Emodinamica, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Michele Cimmino
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
- Unità Operativa di Emodinamica, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Michele Albanese
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
- Unità Operativa di Emodinamica, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Martino Pepe
- Cardiovascular Diseases Section, Department of Interdisciplinary Medicine (DIM), University of Bari Aldo Moro, Bari, Italy
| | - Salvatore Giordano
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.
- Mediterranea Cardiocentro, Naples, Italy.
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Giordano A, Mas-Peiro S, Fichtlscherer S, Schaefer A, Beyer M, Maisano F, Ascione G, Buzzatti N, Teles R, Brito J, Albuquerque F, Sondergaard L, Vanhaverbeke M, Quagliana A, Costa G, Barbanti M, Ferraro P, Morello A, Cimmino M, Albanese M, Pepe M, Bardi L, Giordano S, Cittadini A, Corcione N, Biondi-Zoccai G. Long-term outcomes following transcatheter aortic valve implantation with the Portico self-expanding valve. Clin Res Cardiol 2024; 113:86-93. [PMID: 37391628 PMCID: PMC10808416 DOI: 10.1007/s00392-023-02252-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/20/2023] [Indexed: 07/02/2023]
Abstract
AIM Transcatheter aortic valve implantation (TAVI) is a mainstay in the management of severe aortic valve stenosis in elderly patients, but there is uncertainty on their long-term effectiveness. We aimed to assess the long-term outcome of patients undergoing TAVI with the Portico valve. METHODS We retrospectively collected the data on patients in whom TAVI with Portico was attempted from 7 high-volume centres. Only patients theoretically eligible for 3 or more years of follow-up were included. Clinical outcomes, including death, stroke, myocardial infarction, reintervention for valve degeneration and hemodynamic valve performance were systematically assessed. RESULTS A total of 803 patients were included, with 504 (62.8%) women, mean age of 82 years, median EuroSCORE II of 3.1%, and 386 (48.1%) subjects at low/moderate risk. The median follow-up was 3.0 years (3.0; 4.0). The composite of death, stroke, myocardial infarction, and reintervention for valve degeneration occurred in 37.5% (95% confidence interval: 34.1-40.9%), with all-cause death in 35.1% (31.8-38.4%), stroke in 3.4% (1.3-3.4%), myocardial infarction in 1.0% (0.3-1.5%), and reintervention for valve degeneration in 1.1% (0.6-2.1%). The mean aortic valve gradient at follow-up was 8.1 ± 4.6 mmHg, and at least moderate aortic regurgitation was present in 9.1% (6.7-12.3%). Independent predictors of major adverse events or death were: peripheral artery disease, chronic obstructive pulmonary disease, estimated glomerular filtration rate, atrial fibrillation, prior pacemaker implantation, EuroSCORE II, and reduced left ventricular ejection fraction (all p < 0.05). CONCLUSIONS Portico use is associated with favorable long-term clinical outcomes. Clinical outcomes were largely impacted by baseline risk factors and surgical risk.
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Affiliation(s)
- Arturo Giordano
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
- Unità Operativa di Emodinamica, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Silvia Mas-Peiro
- Department of Cardiology, Goethe University Hospital, Frankfurt, Germany
| | | | - Andreas Schaefer
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Martin Beyer
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Francesco Maisano
- Department of Cardiac Surgery IRCCS, San Raffaele Scientific Institute, Milan, Italy
| | - Guido Ascione
- Department of Cardiac Surgery IRCCS, San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Buzzatti
- Department of Cardiac Surgery IRCCS, San Raffaele Scientific Institute, Milan, Italy
| | - Rui Teles
- Division of Cardiology, Hospital de Santa Cruz, Carnaxide, Portugal
| | - João Brito
- Division of Cardiology, Hospital de Santa Cruz, Carnaxide, Portugal
| | | | | | | | | | - Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Paolo Ferraro
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
- Unità Operativa di Emodinamica, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Alberto Morello
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
- Unità Operativa di Emodinamica, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Michele Cimmino
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
- Unità Operativa di Emodinamica, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Michele Albanese
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
- Unità Operativa di Emodinamica, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Martino Pepe
- Division of Cardiology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Luca Bardi
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
- Unità Operativa di Emodinamica, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Salvatore Giordano
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Antonio Cittadini
- Department of Medical and Translational Sciences, Federico II University of Naples, Naples, Italy
| | - Nicola Corcione
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
- Unità Operativa di Emodinamica, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.
- Mediterranea Cardiocentro, Naples, Italy.
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3
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Spadafora L, Mohammadi T, Bernardi M, Testa A, Tun HN, D'Ascenzo F, DE Filippo O, Frati G, Peruzzi M, Pepe M, Pingitore A, DE Ferrari GM, Biondi-Zoccai G, Calcagno S. Appraising features and outlook of women and men discharged after an acute coronary syndrome: evidence from the 23,700-patient PRAISE International Registry. Panminerva Med 2023; 65:454-460. [PMID: 37335246 DOI: 10.23736/s0031-0808.23.04909-1] [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: 06/21/2023] [Imported: 06/27/2023]
Abstract
BACKGROUND Acute coronary syndromes (ACS) are a common cause of morbidity and mortality. Several studies have focused on ACS at admission, but limited evidence is available on sex-based comparison of patients discharged after ACS. We appraised the outlook of women and men discharged after ACS. METHODS Details on women enrolled in the PRAISE registry, an international cohort study spanning 23,700 patients included between 2003 and 2019, were systematically collected. We focused on patient and procedural features, medications at discharge, and 1-year outcomes. The primary endpoint was the composite of death, myocardial infarction, or major bleeding after discharge. RESULTS A total of 17,804 (76.5%) men and 5466 (23.5%) women were included. Several baseline differences were found, including risk factors and prior revascularization (all P<0.05). Men underwent more frequently radial access, and at discharge they received more commonly dual antiplatelet therapy and guideline-directed medical therapy (P<0.001). At 1-year follow-up, risks of death, reinfarction, major bleeding, and non-fatal major bleeding, jointly or individually, were all significantly higher in women (all P≤0.01). All such differences however did not hold true at multivariable analysis, with the exception of major bleeding, which appeared surprisingly less common in females at fully adjusted analysis (P=0.017). CONCLUSIONS Women, albeit only apparently, had worse outcomes 1 year after discharge for ACS, but adjusted analysis suggested instead that they faced a lower risk of major bleeding after discharge. These findings support the call for more aggressive management of women after ACS.
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Affiliation(s)
- Luigi Spadafora
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Tanya Mohammadi
- College of Science, School of Mathematics, Statistics, and Computer Science, University of Tehran, Tehran, Iran
| | - Marco Bernardi
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Alberto Testa
- Sapienza School for Advanced Studies, Sapienza University, Rome, Italy
| | - Han N Tun
- Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy
| | - Ovidio DE Filippo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy
| | - Giacomo Frati
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
- IRCCS NEUROMED, Pozzilli, Isernia, Italy
| | - Mariangela Peruzzi
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University, Rome, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Martino Pepe
- Division of Cardiology, Department of Interdisciplinary Medicine (DIM), University of Bari, Bari, Italy
| | - Annachiara Pingitore
- Department of General Surgery, Paride Stefanini Surgical Specialties and Organ Transplantation, Sapienza University, Rome, Italy
| | - Gaetano M DE Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy -
- Mediterranea Cardiocentro, Naples, Italy
| | - Simone Calcagno
- Division of Cardiology, Department of Emergency, San Paolo Hospital, Civitavecchia, Rome, Italy
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4
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Briguori C, Romagnoli E, Biondi-Zoccai G. Diuresis-matched hydration to prevent contrast-associated acute kidney injury in percutaneous cardiovascular procedures: the more the merrier? Rev Esp Cardiol (Engl Ed) 2023; 76:752-754. [PMID: 37001809 DOI: 10.1016/j.rec.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 05/28/2023]
Affiliation(s)
- Carlo Briguori
- Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli (IRCCS), Rome, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Mediterranea Cardiocentro, Naples, Italy.
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5
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Gaudino M, Hameed I, Di Franco A, Naik A, Demetres M, Biondi-Zoccai G, Bangalore S. Comparison of SYNTAX score strata effects of percutaneous and surgical revascularization trials: A meta-analysis. J Thorac Cardiovasc Surg 2023; 165:1405-1413.e13. [PMID: 34176619 PMCID: PMC8805094 DOI: 10.1016/j.jtcvs.2021.05.036] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/27/2021] [Accepted: 05/13/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The evidence supporting the use of the Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX) score for risk stratification is controversial. We performed a systematic review and meta-analysis of all the randomized controlled trials comparing percutaneous coronary intervention versus coronary artery bypass grafting that reported their outcomes stratified by SYNTAX score, focusing on between-strata comparisons. METHODS A systematic review of MEDLINE, EMBASE, Cochrane Library databases was performed. Incidence rate ratios were pooled with a random effect model. Between-group statistical heterogeneity according to accepted SYNTAX score tertiles was computed in the main analysis. Ratios of incidence rate ratios were computed to appraise between-strata effect, as sensitivity analysis. Primary and secondary outcomes were major adverse cardiac and cerebrovascular events and all-cause mortality, respectively. Separate sub-analyses were performed for left main and multivessel disease. RESULTS From 425 citations, 6 trials were eventually included (8269 patients [4134 percutaneous coronary interventions, 4135 coronary artery bypass graftings]; mean follow-up: 6.2 years [range: 3.8-10]). Overall, percutaneous coronary intervention was associated with a significant increase in major adverse cardiac and cerebrovascular events (incidence rate ratio, 1.39, 95% confidence interval, 1.27-1.51) and nonsignificant increase in all-cause mortality (incidence rate ratio, 1.17, 95% confidence interval, 0.98-1.40). There was no significant statistical heterogeneity of treatment effect by SYNTAX score for major adverse cardiac and cerebrovascular events or mortality (P = .40 and P = .34, respectively). Results were consistent also for patients with left main and multivessel disease (major adverse cardiac and cerebrovascular events: P = .85 in left main, P = .78 in multivessel disease 0.78; mortality: P = .12 in left main; P = .34 in multivessel disease). Results of analysis based on ratios of incidence rate ratios were consistent with the main analysis. CONCLUSIONS No significant association was found between SYNTAX score and the comparative effectiveness of percutaneous coronary intervention and coronary artery bypass grafting. These findings have implications for clinical practice, future guidelines, and the design of percutaneous coronary intervention versus coronary artery bypass grafting trials.
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Affiliation(s)
- Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY.
| | - Irbaz Hameed
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY; Section of Cardiac Surgery, Yale University School of Medicine, New Haven, Conn
| | - Antonino Di Franco
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Ajita Naik
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Michelle Demetres
- Samuel J. Wood Library and C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, NY
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy; Mediterranea Cardiocentro, Napoli, Italy
| | - Sripal Bangalore
- New York University Grossman School of Medicine, New York, New York, NY
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6
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Mohammadi T, D'Ascenzo F, Pepe M, Bonsignore Zanghì S, Bernardi M, Spadafora L, Frati G, Peruzzi M, De Ferrari GM, Biondi-Zoccai G. Unsupervised Machine Learning with Cluster Analysis in Patients Discharged after an Acute Coronary Syndrome: Insights from a 23,270-Patient Study. Am J Cardiol 2023; 193:44-51. [PMID: 36870114 DOI: 10.1016/j.amjcard.2023.01.048] [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: 09/11/2022] [Revised: 01/06/2023] [Accepted: 01/29/2023] [Indexed: 03/06/2023]
Abstract
Characterization and management of patients admitted for acute coronary syndromes (ACS) remain challenging, and it is unclear whether currently available clinical and procedural features can suffice to inform adequate decision making. We aimed to explore the presence of specific subsets among patients with ACS. The details on patients discharged after ACS were obtained by querying an extensive multicenter registry and detailing patient features, as well as management details. The clinical outcomes included fatal and nonfatal cardiovascular events at 1-year follow-up. After missing data imputation, 2 unsupervised machine learning approaches (k-means and Clustering Large Applications [CLARA]) were used to generate separate clusters with different features. Bivariate- and multivariable-adjusted analyses were performed to compare the different clusters for clinical outcomes. A total of 23,270 patients were included, with 12,930 cases (56%) of ST-elevation myocardial infarction (STEMI). K-means clustering identified 2 main clusters: a first 1 including 21,998 patients (95%) and a second 1 including 1,282 subjects (5%), with equal distribution for STEMI. CLARA generated 2 main clusters: a first 1 including 11,268 patients (48%) and a second 1 with 12,002 subjects (52%). Notably, the STEMI distribution was significantly different in the CLARA-generated clusters. The clinical outcomes were significantly different across clusters, irrespective of the originating algorithm, including death reinfarction and major bleeding, as well as their composite. In conclusion, unsupervised machine learning can be leveraged to explore the patterns in ACS, potentially highlighting specific patient subsets to improve risk stratification and management.
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Affiliation(s)
- Tanya Mohammadi
- School of Mathematics, Statistics, and Computer Science, College of Science, University of Tehran, Tehran, Iran
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy
| | - Martino Pepe
- Division of Cardiology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | | | - Marco Bernardi
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy
| | - Luigi Spadafora
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy
| | - Giacomo Frati
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; IRCCS NEUROMED, Pozzilli, Italy
| | - Mariangela Peruzzi
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Mediterranea Cardiocentro, Napoli, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Mediterranea Cardiocentro, Napoli, Italy.
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7
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Biondi-Zoccai G, Rodriguez-Granillo GA, Mercade JM, Dawidowski L, Seropian IM, Cohen F, Sturmer-Ramos C, Descalzo A, Rubilar B, Sztejfman M, Zaidel E, Pazos C, Leguizamon J, Cafaro G, Visconti M, Baglioni P, Noya A, Fontana L, Rodriguez-Granillo M, Pavlovsky H, Alvarez JA, Lylyk P, Versaci F, Abrutzky R. Interplay between climate, pollution and COVID-19 on ST-elevation myocardial infarction in a large metropolitan region. Minerva Med 2022; 113:950-958. [PMID: 34309338 DOI: 10.23736/s0026-4806.21.07748-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Collective risk factors such as climate and pollution impact on the risk of acute cardiovascular events, including ST-elevation myocardial infarction (STEMI). There is limited data however on the precise temporal and independent association between these factors and STEMI, and the potentially interacting role of government policies against Coronavirus disease 2019 (COVID-19), especially for Latin America. METHODS We retrospectively collected aggregate data on daily STEMI admissions at 10 tertiary care centers in the Buenos Aires metropolitan area, Argentina, from January 1, 2017 to November 30, 2020. Daily measurements for temperature, humidity, atmospheric pressure, wind direction, wind speed, and rainfall, as well as carbon monoxide (CO), nitrogen dioxide, and particulate matter <10 µm (PM10), were retrieved. Exploratory analyses focused on key COVID-19-related periods (e.g. first case, first lockdown), and Stringency Index quantifying the intensity of government policy response against COVID-19. RESULTS A total of 1498 STEMI occurred over 1430 days, for an average of 0.12 STEMI per center (decreasing from 0.130 in 2018 to 0.102 in 2020, P=0.016). Time series analysis showed that lower temperature and higher concentration of CO and PM10 were all significantly associated with an increased rate of STEMI (all P<0.05), whereas COVID-19 outbreak, lockdown, and stringency of government policies were all inversely associated with STEMI (all P<0.05). Notably, environmental features impacted as early as 28 days before the event (all P<0.05), even if same or prior day associations proved stronger (all P<0.05). Multivariable analysis suggested that maximum temperature (P=0.001) and PM10 (P=0.033) were the strongest predictor of STEMI, even after accounting for COVID-19-related countermeasures (P=0.043). CONCLUSIONS Lower temperature and higher concentrations of CO and PM10 are associated with significant increases in the rate of STEMI in a large Latin American metropolitan area. The reduction in STEMI cases seen during the COVID-19 pandemic is at least in part mediated by improvements in pollution, especially reductions in PM10.
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Affiliation(s)
- Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy - .,Mediterranea Cardiocentro, Naples, Italy -
| | - Gaston A Rodriguez-Granillo
- Department of Cardiovascular Imaging, ENERI Medical Institute, La Sagrada Familia Clinic, Buenos Aires, Argentina.,National Council of Scientific and Technical Investigations, Buenos Aires, Argentina
| | - Juan M Mercade
- Agencia de Proteccion Ambiental (APRA), Buenos Aires, Argentina
| | - Laura Dawidowski
- Comisión Nacional de Energía Atómica (CNEA), Buenos Aires, Argentina
| | - Ignacio M Seropian
- Department of Interventional Cardiology, Buenos Aires Italian Hospital, Buenos Aires, Argentina
| | - Fernando Cohen
- Department of Interventional Cardiology, Buenos Aires Italian Hospital, Buenos Aires, Argentina
| | | | - Amalia Descalzo
- Department of Interventional Cardiology ENERI Medical Institute, La Sagrada Familia Clinic, Buenos Aires, Argentina
| | - Bibiana Rubilar
- Department of Interventional Cardiology ENERI Medical Institute, La Sagrada Familia Clinic, Buenos Aires, Argentina
| | - Matias Sztejfman
- Department of Interventional Cardiology, Guemes Sanatorium, Buenos Aires, Argentina
| | - Ezequiel Zaidel
- Department of Interventional Cardiology, Guemes Sanatorium, Buenos Aires, Argentina
| | - Cristian Pazos
- Department of Interventional Cardiology, Santa Isabel Clinic, Buenos Aires, Argentina
| | - Jorge Leguizamon
- Department of Interventional Cardiology, Santa Isabel Clinic, Buenos Aires, Argentina
| | - German Cafaro
- Service of Interventional Cardiology, Diagnóstico Mediter-Sanatorio Dr Julio Méndez, Buenos Aires, Argentina
| | - Mariano Visconti
- Service of Interventional Cardiology, Diagnóstico Mediter-Sanatorio Dr Julio Méndez, Buenos Aires, Argentina
| | - Pablo Baglioni
- Department of Interventional Cardiology, San Juan de Dios Hospital, Buenos Aires, Argentina
| | - Agustin Noya
- Department of Interventional Cardiology, British Hospital, Buenos Aires, Argentina
| | - Lucia Fontana
- Department of Cardiovascular Imaging, ENERI Medical Institute, La Sagrada Familia Clinic, Buenos Aires, Argentina
| | | | - Hernan Pavlovsky
- Department of Interventional Cardiology, Otamendi Sanatorium, Buenos Aires, Argentina
| | - Jose A Alvarez
- Department of Interventional Cardiology, British Hospital, Buenos Aires, Argentina.,Department of Interventional Cardiology, German Hospital, Buenos Aires, Argentina
| | - Pedro Lylyk
- Department of Interventional Neuroradiology, ENERI Medical Institute, La Sagrada Familia Clinic, Buenos Aires, Argentina
| | - Francesco Versaci
- Unit of Hemodynamics and Cardiology, Santa Maria Goretti Hospital, Latina, Italy
| | - Rosana Abrutzky
- University of Buenos Aires, Faculty of Social Sciences, Gino Germani Investigation Institute, Buenos Aires, Argentina
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8
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Testa A, Biondi-Zoccai G, Anticoli S, Pezzella FR, Mangiardi M, DI Giosa A, Marchegiani G, Frati G, Sciarretta S, Perrotta A, Peruzzi M, Cavarretta E, Gaspardone A, Mariano E, Federici M, Montone RA, Dei Giudici A, Versaci B, Versaci F. Cluster analysis of weather and pollution features and its role in predicting acute cardiac or cerebrovascular events. Minerva Med 2022; 113:825-832. [PMID: 35156790 DOI: 10.23736/s0026-4806.22.08036-3] [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: 01/01/2023]
Abstract
BACKGROUND Despite mounting evidence, the impact of the interplay between weather and pollution features on the risk of acute cardiac and cerebrovascular events has not been entirely appraised. The aim of this study was to perform a comprehensive cluster analysis of weather and pollution features in a large metropolitan area, and their association with acute cardiac and cerebrovascular events. METHODS Anonymized data on acute myocardial infarction (AMI) and acute cerebrovascular events were obtained from 3 tertiary care centers from a single large metropolitan area. Weather and pollution data were obtained averaging measurements from several city measurement stations managed by the competent regional agency for enviromental protection, and from the Metereological Center of Italian Military Aviation. Unsupervised machine learning was performed with hierarchical clustering to identify specific days with distinct weather and pollution features. Clusters were then compared for rates of acute cardiac and cerebrovascular events with Poisson models. RESULTS As expected, significant pairwise correlations were found between weather and pollution features. Building upon these correlations, hierarchical clustering, from a total of 1169 days, generated 4 separate clusters: mostly winter days with low temperatures and high ozone concentrations (cluster 1, N.=60, 5.1%), days with moderately high temperatures and low pollutants concentrations (cluster 2, N.=419, 35.8%), mostly summer and spring days with high temperatures and high ozone concentrations (cluster 3, N.=673, 57.6%), and mostly winter days with low temperatures and low ozone concentrations (cluster 4, N.=17, 1.5%). Overall cluster-wise comparisons showed significant differences in adverse cardiac and cerebrovascular events (P<0.001), as well as in cerebrovascular events (P<0.001) and strokes (P=0.001). Between-cluster comparisons showed that cluster 1 was associated with an increased risk of any event, cerebrovascular events, and strokes in comparison to cluster 2, cluster 3 and cluster 4 (all P<0.05), as well as AMI in comparison to cluster 3 (P=0.047). In addition, cluster 2 was associated with a higher risk of strokes in comparison to cluster 4 (P=0.030). Analysis adjusting for season confirmed the increased risk of any event, cerebrovascular events and strokes for cluster 1 and cluster 2. CONCLUSIONS Unsupervised machine learning can be leveraged to identify specific days with a unique clustering of adverse weather and pollution features which are associated with an increased risk of acute cardiovascular events, especially cerebrovascular events. These findings may improve collective and individual risk prediction and prevention.
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Affiliation(s)
- Alberto Testa
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Giuseppe Biondi-Zoccai
- Mediterranea Cardiocentro, Naples, Italy - .,Scuola Superiore di Study Avanzati, Sapienza University, Rome, Italy
| | | | | | | | | | | | - Giacomo Frati
- Mediterranea Cardiocentro, Naples, Italy.,IRCCS Neuromed, Pozzilli, Isernia, Italy
| | | | | | - Mariangela Peruzzi
- IRCCS Neuromed, Pozzilli, Isernia, Italy.,Department of Clinical, Internal Anestesiology and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Elena Cavarretta
- Mediterranea Cardiocentro, Naples, Italy.,Scuola Superiore di Study Avanzati, Sapienza University, Rome, Italy
| | | | - Enrica Mariano
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Massimo Federici
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Rocco A Montone
- Department of Cardiovascular Medicine, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Angela Dei Giudici
- Cardiologic Intensive Care Unit, Hemodynamic and Cardiology, Santa Maria Goretti Hospital, Latina, Italy
| | | | - Francesco Versaci
- Cardiologic Intensive Care Unit, Hemodynamic and Cardiology, Santa Maria Goretti Hospital, Latina, Italy
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9
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Biondi-Zoccai G, Pirlamarla P, Sabouret P, Kozhukhov S, Marchenko O, Hill JA, Mamas MA. Cardiovascular scholarly challenges following the Russian invasion of Ukraine. Minerva Cardiol Angiol 2022; 70:525-528. [PMID: 35343175 DOI: 10.23736/s2724-5683.22.06102-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy - .,Mediterranea Cardiocentro, Naples, Italy -
| | - Preethi Pirlamarla
- Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pierre Sabouret
- Department of Cardiology, Heart Institute and Action Group, Campus Pitié-Salpétrière, Sorbonne University, Paris, France
| | - Sergey Kozhukhov
- Cardio-Oncology Center, Department of Clinical Pharmacology and Cardio-Oncology, The M.D. Strazhesko Institute of Cardiology National Scientific Center, Kyiv, Ukraine
| | | | - Joseph A Hill
- Harry S. Moss Heart Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
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10
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Testa A, Versaci F, Biondi-Zoccai G. Individualised prognosis in out-of-hospital cardiac arrest: The case for P-ROSC in Asian people. EClinicalMedicine 2022; 48:101446. [PMID: 35706493 PMCID: PMC9112103 DOI: 10.1016/j.eclinm.2022.101446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 04/22/2022] [Indexed: 02/08/2023] Open
Affiliation(s)
- Alberto Testa
- Sapienza School for Advanced Studies, Sapienza University of Rome, Rome, Italy
| | - Francesco Versaci
- Unit of UTIC, Hemodynamics and Cardiology, Santa Maria Goretti Hospital, Latina, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, Latina 04100, Italy
- Mediterranea Cardiocentro, Napoli, Italy
- Corresponding author at: Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, Latina 04100, Italy.
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11
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Bernardi M, Biondi-Zoccai G, Versaci F. Air pollution and cardiovascular risk: is it time to change guidelines? Open Heart 2022; 9:openhrt-2022-001961. [PMID: 35750421 PMCID: PMC9234796 DOI: 10.1136/openhrt-2022-001961] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/11/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Marco Bernardi
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, University of Rome La Sapienza, Rome, Lazio, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, University of Rome La Sapienza, Rome, Lazio, Italy .,Mediterranea Cardiocentro, Napoli, Campania, Italy
| | - Francesco Versaci
- UOC UTIC Emodinamica e Cardiologia, Ospedale Santa Maria Goretti, Latina, Lazio, Italy
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12
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Aktaa S, Gencer B, Arbelo E, Davos CH, Désormais I, Hollander M, Abreu A, Ambrosetti M, Bäck M, Carballo D, Crawford C, Deaton C, Dendale P, Eijsvogels TMH, Galbraith M, Piepoli MF, Salzwedel A, Smulders Y, Wilhelm M, Biondi-Zoccai G, Mach F, Visseren FLJ, Gale CP. European Society of Cardiology Quality Indicators for Cardiovascular Disease Prevention: developed by the Working Group for Cardiovascular Disease Prevention Quality Indicators in collaboration with the European Association for Preventive Cardiology of the European Society of Cardiology. Eur J Prev Cardiol 2022; 29:1060-1071. [PMID: 34687540 DOI: 10.1093/eurjpc/zwab160] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 08/01/2021] [Accepted: 09/07/2021] [Indexed: 02/05/2023]
Abstract
AIMS To develop a set of quality indicators (QIs) for the evaluation of the care and outcomes for atherosclerotic cardiovascular disease (ASCVD) prevention. METHODS AND RESULTS The Quality Indicator Committee of the European Society of Cardiology (ESC) formed the Working Group for Cardiovascular Disease Prevention Quality Indicators in collaboration with Task Force members of the 2021 ESC Guidelines on Cardiovascular Disease Prevention in Clinical Practice and the European Association of Preventive Cardiology (EAPC). We followed the ESC methodology for QI development, which involved (i) the identification of the key domains of care for ASCVD prevention by constructing a conceptual framework of care, (ii) the development of candidate QIs by conducting a systematic review of the literature, (iii) the selection of the final set of QIs using a modified Delphi method, and (iv) the evaluation of the feasibility of the developed QIs. In total, 17 main and 14 secondary QIs were selected across six domains of care for ASCVD prevention: (i) structural framework, (ii) risk assessment, (iii) care for people at risk for ASCVD, (iv) care for patients with established ASCVD, (v) patient education and experience, and (vi) outcomes. CONCLUSION We present the 2021 ESC QIs for Cardiovascular Disease Prevention, which have been co-constructed with EAPC using the ESC methodology for QI development. These indicators are supported by evidence from the literature, underpinned by expert consensus and aligned with the 2021 ESC Guidelines on Cardiovascular Disease Prevention in Clinical Practice to offer a mechanism for the evaluation of ASCVD prevention care and outcomes.
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Affiliation(s)
- Suleman Aktaa
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9LU, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds LS2 9LU, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Baris Gencer
- Division of Cardiology, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- IDIBAPS, Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Constantinos H Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Ileana Désormais
- Department of Thoracic and Cardiovascular Surgery and Angiology, Dupuytren University Hospital, Limoges, France
| | - Monika Hollander
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, Utrecht 3584 CG, The Netherlands
| | - Ana Abreu
- Cardiology Department, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, (CHULN) Lisboa, Lisbon, Portugal
| | - Marco Ambrosetti
- Cardiovascular Rehabilitation Unit, ASST Crema, Rivolta D'Adda Hospital, Rivolta D' Adda, Italy
| | - Maria Bäck
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - David Carballo
- Department of Cardiology, Cardiovascular Center, University Hospital Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva 1205, Switzerland
| | | | - Christi Deaton
- Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Forvie Site, Cambridge Biomedical Campus, Cambridge CB22 5DT, UK
| | - Paul Dendale
- Heart Centre Hasselt and Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Thijs M H Eijsvogels
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Massimo Francesco Piepoli
- Heart Failure Unit, Cardiology, Guglielmo da Saliceto Hospital, and University pof Parma, Piacenza, Italy
| | - Annett Salzwedel
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany
| | - Yvo Smulders
- Department of Internal Medicine and Geriatrics, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Napoli, Italy
| | - François Mach
- Division of Cardiology, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, Utrecht, The Netherlands
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9LU, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds LS2 9LU, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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13
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Bernardi M, Spadafora L, Biondi-Zoccai G, Giordano A. Juvenile myocardial infarction: Sex matters. Int J Cardiol 2022; 361:18-19. [PMID: 35618105 DOI: 10.1016/j.ijcard.2022.05.046] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/15/2022] [Accepted: 05/20/2022] [Indexed: 02/05/2023]
Affiliation(s)
- Marco Bernardi
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy
| | - Luigi Spadafora
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Mediterranea Cardiocentro, Napoli, Italy.
| | - Arturo Giordano
- Cardiovascular Interventional Operative Unit, Presidio Ospedaliero Pineta Grande, Castel Volturno, Caserta, Italy; Operative Unit of Hemodynamics, Casa di Salute Santa Lucia, San Giuseppe Vesuviano, Naples, Italy
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14
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Calcagno S, Corcione N, Biondi-Zoccai G, Giordano A. De-escalation of dual antiplatelet therapy: will we ever get to the right method? J Cardiovasc Pharmacol 2022. [PMID: 35580318 DOI: 10.1097/FJC.0000000000001304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 05/10/2022] [Indexed: 02/05/2023]
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15
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Corcione N, Berni A, Ferraro P, Morello A, Cimmino M, Albanese M, Nestola L, Bardi L, Pepe M, Giordano S, Biondi-Zoccai G, Rigattieri S, Giovannelli F, Giordano A. Transcatheter aortic valve implantation with the novel-generation Navitor device: Procedural and early outcomes. Catheter Cardiovasc Interv 2022; 100:114-119. [PMID: 35557027 PMCID: PMC9546195 DOI: 10.1002/ccd.30179] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/07/2022] [Accepted: 03/19/2022] [Indexed: 02/05/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) has proved beneficial in patients with severe aortic stenosis, especially when second‐generation devices are used. We aimed at reporting our experience with Navitor, a third‐generation device characterized by intrannular, large cell, and cuffed design, as well as high deliverability and minimization of paravalvular leak. Between June and December 2021, a total of 39 patients underwent TAVI with Navitor, representing 20% of all TAVI cases. Mean age was 80.0 ± 6.7 years, and 14 (36.8%) women were included. Severe aortic stenosis was the most common indication to TAVI (37 [97.4%] cases), whereas 2 (5.3%) individuals were at low surgical risk. Device and procedural success was obtained in all patients, with a total hospital stay of 6.6 ± 4.5 days. One (2.9%) patient required permanent pacemaker implantation, but no other hospital events occurred. At 1‐month follow‐up, a cardiac death was adjudicated in an 87‐year‐old man who had been at high surgical risk. Echocardiographic follow‐up showed no case of moderate or severe aortic regurgitation, with mild regurgitation in 18 (47%), and none or trace regurgitation in 20 (53%). The Navitor device, thanks to its unique features, is a very promising technology suitable to further expand indications and risk‐benefit profile of TAVI.
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Affiliation(s)
- Nicola Corcione
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
| | - Andrea Berni
- Interventional Cardiology Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Paolo Ferraro
- Unità Operativa di Emodinamica, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Alberto Morello
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
| | - Michele Cimmino
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
| | - Michele Albanese
- Unità Operativa di Emodinamica, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Luisa Nestola
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
| | - Luca Bardi
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
| | - Martino Pepe
- Department of Emergency and Organ Transplantation (DETO), Cardiovascular Diseases Section, University of Bari Aldo Moro, Bari, Italy
| | - Salvatore Giordano
- Department of Medical and Surgical Sciences, Division of Cardiology, "Magna Graecia" University, Catanzaro, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.,Mediterranea Cardiocentro, Napoli, Italy
| | - Stefano Rigattieri
- Interventional Cardiology Unit, Sant'Andrea University Hospital, Rome, Italy
| | | | - Arturo Giordano
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
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16
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Corcione N, Morello A, Ferraro P, Cimmino M, Albanese M, Pepe M, Nestola PL, Giordano S, Bardi L, Biondi-zoccai G, Giordano A. TAVI-CT score to evaluate the anatomic risk in patients undergoing transcatheter aortic valve implantation. Sci Rep 2022; 12. [PMID: 35534616 PMCID: PMC9085825 DOI: 10.1038/s41598-022-11788-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 04/07/2022] [Indexed: 02/08/2023] Open
Abstract
AbstractTranscatheter aortic valve implantation (TAVI) requires thorough preprocedural planning with non-invasive imaging, including computed tomography (CT). The plethora of details obtained with thoraco-abdominal CT represents a challenge for accurate and synthetic decision-making. We devised and tested a comprehensive score suitable to summarize CT exams when planning TAVI. An original comprehensive scoring system (TAVI-CT score) was devised, including details on cardiac, aortic, iliac and femoral artery features. The score was applied to a prospectively collected series of patients undergoing TAVI at our institution, driving decision making on access and prosthesis choice. Different TAVI-CT score groups were compared in terms of procedural success, acute complications, and early clinical outcomes. We included a total of 200 undergoing TAVI between February 2020 and May 2021, with 74 (37.0%) having a low (0–2) TAVI-CT score, 50 (25.0%) having a moderate (3) TAVI-CT score, and 76 (38.0%) having a high (≥ 4) TAVI-CT score. Male gender was the only non-CT variable significantly associated with the TAVI-CT score (p = 0.001). As expected, access choice differed significantly across TAVI-CT scores (p = 0.009), as was device choice, with Portico more favored and Allegra less favored in the highest TAVI-CT score group (p = 0.036). Acute outcomes were similar in the 3 groups, including device and procedural success rates (respectively p = 0.717 and p = 1). One-month follow-up showed similar rates of death, myocardial infarction, stroke, and bleeding, as well as of a composite safety endpoint (all p > 0.05). However, vascular complications were significantly more common in the highest TAVI-CT score group (p = 0.041). The TAVI-CT score is a simple scoring system that could be routinely applied to CT imaging for TAVI planning, if the present hypothesis-generating findings are confirmed in larger prospective studies.
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17
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Saade W, Miraldi F, Biondi-Zoccai G, Frati G. Challenges of redo cardiac surgery: forewarned is forearmed? J Cardiovasc Med (Hagerstown) 2022; 23:335-337. [PMID: 35486683 DOI: 10.2459/jcm.0000000000001315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Wael Saade
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome
- IRCCS NEUROMED, Pozzilli
| | - Fabio Miraldi
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome
- IRCCS NEUROMED, Pozzilli
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina
- Mediterranea Cardiocentro, Napoli, Italy
| | - Giacomo Frati
- IRCCS NEUROMED, Pozzilli
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina
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18
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Qayyum H, Narlawar R, Biondi-Zoccai G, Cavarretta E, Versaci F, Antoniou GA. Severe infrarenal aortic neck angulation alone may not be a predictor of adverse outcomes in the medium term following endovascular aortic aneurysm repair. J Cardiovasc Surg (Torino) 2022; 63:237-239. [PMID: 35445806 DOI: 10.23736/s0021-9509.21.11997-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Haisum Qayyum
- Department of Radiology, The Royal Oldham Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, UK
| | - Ranjeet Narlawar
- Department of Radiology, The Royal Oldham Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, UK
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | - Elena Cavarretta
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | | | - George A Antoniou
- Department of Vascular and Endovascular Surgery, Manchester University NHS Foundation Trust, Manchester, UK - .,School of Medical Sciences, Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
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19
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Vescovo GM, Chiabrando JG, Zivelonghi C, Romeo FJ, Lombardi M, Del Buono MG, Galli M, Biondi-Zoccai G, Wilgenhof A, Willemen Y, Scott B, Convens C, Verheye S, Vermeersch P, Agostoni P. Comparison of Different Stenting Techniques in Left Main Bifurcation Disease: Evidence From a Network Meta-Analysis. J Invasive Cardiol 2022; 34:E334-E342. [PMID: 35366228 DOI: pmid/35366228] [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] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES We aimed to assess which bifurcation technique performs best in unprotected left-main (LM) percutaneous coronary intervention (PCI). BACKGROUND Provisional stenting was considered the preferred technique for LM bifurcation PCI due to the supposed lower risks of thrombosis and restenosis. However, recent studies showed potential advantages of double kissing (DK)-crush technique over the other strategies. METHODS We performed a frequentist network meta-analysis comparing different stenting techniques in the setting of LM bifurcation. PubMed, Embase, the Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov were searched. Both randomized clinical trials and non-randomized clinical trials were considered eligible for inclusion. Incidence rate ratios (IRRs) were computed using a random-effects model for death, cardiac death, myocardial infarction, target-vessel revascularization, target-lesion revascularization, and stent thrombosis, including 95% confidence intervals (CIs). RESULTS A total of 10 studies (2364 patients) were included. Compared with provisional stenting, DK-crush was associated with fewer cardiac deaths (IRR, 0.34; 95% CI, 0.17-0.70; P<.01), myocardial infarctions (IRR, 0.19; 95% CI, 0.08-0.44; P<.001), stent thromboses (IRR, 0.31; 95% CI, 0.14-0.69; P<.01), target-vessel revascularizations (IRR, 0.25; 95% CI, 0.14-0.46; P<.001), and target-lesion revascularizations (IRR, 0.25; 95% CI, 0.14-0.46; P<.001). DK-crush was also associated with a lower risk of myocardial infarction (IRR, 0.19; 95% CI, 0.05-0.76; P=.02) when compared with standard crush and lower risk of target-lesion revascularization when compared with culotte (IRR, 0.32; 95% CI, 0.12-0.83; P=.02) and crush (IRR, 0.07; 95% CI, 0.02-0.28; P<.001). CONCLUSIONS DK-crush is the best technique for unprotected LM bifurcation PCI.
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Affiliation(s)
- Giovanni Maria Vescovo
- Department of Cardiology, Hartcentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium.
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20
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Correction: Novel tech throws knock-out punch to ECG improving GP referral decisions to cardiology. Open Heart 2022; 9:e001852corr1. [PMID: 35332051 DOI: 10.1136/openhrt-2021-001852corr1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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21
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Versaci F, Anticoli S, Pezzella FR, Mangiardi M, DI Giosa A, Marchegiani G, Calcagno S, DI Pietro R, Frati G, Sciarretta S, Perrotta A, Peruzzi M, Cavarretta E, Roever L, Antonazzo B, Ronzoni S, Versaci B, Biondi-Zoccai G. Impact of weather and pollution on the rate of cerebrovascular events in a large metropolitan area. Panminerva Med 2022; 64:17-23. [PMID: 35330556 DOI: 10.23736/s0031-0808.21.04525-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Despite mounting evidence, there is uncertainty on the impact of the interplay between weather and pollution features on the risk of acute cerebrovascular events (CVE). We aimed at appraising role of weather and pollution on the daily risk of CVE. METHODS Anonymized data from a hub CVE center in a large metropolitan area were collected and analyzed according to weather (temperature, pressure, humidity, and rainfall) and pollution (carbon monoxide [CO], nitrogen dioxide [NO2], nitrogen oxides [NOX], ozone [O3], and particulate matter [PM]) on the same and the preceding days. Poisson regression and time series analyses were used to appraise the association between environmental features and daily CVE, distinguishing also several subtypes of events. RESULTS We included a total of 2534 days, with 1363 days having ≥1 CVE, from 2012 to 2017. Average daily rate was 1.56 (95% confidence interval: 1.49; 1.63) for CVE, with other event rates ranging between 1.42 for stroke and 0.01 for ruptured intracranial aneurysm. Significant associations were found between CVE and temperature, pressure, CO, NO2, NOX, O3, and PM <10 µm (all P<0.05), whereas less stringent associations were found for humidity, rainfall, and PM <2.5 µm. Time series analysis exploring lag suggested that associations were stronger at same-day analysis (lag 0), but even environmental features predating several days or weeks were significantly associated with events. Multivariable analysis suggested that CO (point estimate 1.362 [1.011; 1.836], P=0.042) and NO2 (1.011 [1.005; 1.016], P<0.001) were the strongest independent predictors of CVE. CONCLUSIONS Environmental features are significantly associated with CVE, even several days before the actual event. Levels of CO and NO2 can be potentially leveraged for population-level interventions to reduce the burden of CVE.
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Affiliation(s)
- Francesco Versaci
- Unit of UTIC, Hemodynamics and Cardiology, Santa Maria Goretti Hospital, Latina, Italy
| | | | | | | | | | | | - Simone Calcagno
- Division of Cardiology, San Paolo Hospital, Civitavecchia, Rome, Italy
| | - Riccardo DI Pietro
- Unit of UTIC, Hemodynamics and Cardiology, Santa Maria Goretti Hospital, Latina, Italy
| | - Giacomo Frati
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy.,IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Sebastiano Sciarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy.,IRCCS Neuromed, Pozzilli, Isernia, Italy
| | | | - Mariangela Peruzzi
- Mediterranea Cardiocentro, Naples, Italy.,Department of Clinical, Internal Anestesiology and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | - Leonardo Roever
- Department of Clinical Research, Federal University of Uberlândia, Uberlândia, Brazil
| | | | | | | | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy - .,Mediterranea Cardiocentro, Naples, Italy
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Kirov H, Caldonazo T, Rahouma M, Robinson NB, Demetres M, Serruys PW, Biondi-Zoccai G, Gaudino M, Doenst T. A systematic review and meta-analysis of percutaneous coronary intervention compared to coronary artery bypass grafting in non-ST-elevation acute coronary syndrome. Sci Rep 2022; 12:5138. [PMID: 35332253 DOI: 10.1038/s41598-022-09158-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 03/17/2022] [Indexed: 02/05/2023] Open
Abstract
Non-ST-elevation acute coronary syndrome (NSTE-ACS) affects millions of patients. Although an invasive strategy can improve survival, the optimal treatment [i.e., percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)] is not clear. We performed a meta-analysis of studies reporting outcomes between PCI and CABG in patients with NSTE-ACS. MEDLINE, EMBASE and Cochrane Library were assessed. The primary outcome was long-term mortality. Inverse variance method and random model were performed. We identified 13 observational studies (48,891 patients). No significant difference was found in the primary endpoint [CABG vs. PCI, incidence rate ratio (IRR) 0.93, 95% confidence interval (CI) 0.70; 1.23]. CABG was associated with lower long-term major adverse cardiovascular events (MACE) (IRR 0.64, 95% CI 0.54; 0.76) and lower long-term re-revascularization (IRR 0.37, 95% CI 0.30; 0.47). There was no significant difference in long-term myocardial infarction (CABG vs. PCI, IRR 0.96, 95% CI 0.50; 1.84) and peri-operative mortality (CABG vs. PCI, odds ratio 1.36, 95% CI 0.94; 1.95). For the treatment of NSTE-ACS, CABG and PCI are associated with similar rates of long-term mortality and myocardial infarction. CABG is associated with lower rates of long-term MACE and re-revascularization. Randomized comparisons in this setting are necessary.
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Bachini JP, Torrado J, Vignolo G, Durán A, Biondi-Zoccai G. Postinfarction Ventricular Septal Rupture: Identification of the Failure Mechanism of a Percutaneous Closure Procedure. JACC Case Rep 2022; 4:255-61. [PMID: 35257098 DOI: 10.1016/j.jaccas.2021.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 09/10/2021] [Accepted: 09/20/2021] [Indexed: 02/08/2023]
Abstract
Ventricular septal rupture (VSR) is a rare but highly lethal (∼60%) mechanical complication of myocardial infarction (MI). Although surgical repair has been the gold standard to correct the structural anomaly, percutaneous closure of the defect may represent a valuable therapeutic alternative, with the advantage of immediate shunt reduction to prevent further hemodynamic deterioration in patients with prohibitive surgical risk. Nonetheless, catheter-based VSR closure has faced certain drawbacks that have hampered its application. We describe a clinical case of postinfarction VSR treated with a percutaneous closure device and discuss the procedure's failure mechanism. (Level of Difficulty: Intermediate.).
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Key Words
- ASD, atrial septal defect
- CMR, cardiac magnetic resonance
- CT, computed tomography
- IABP, intra-aortic balloon pump
- LAD, left anterior descending
- MI, myocardial infarction
- PCI, percutaneous coronary intervention
- STEMI, ST-segment myocardial infarction
- TEE, transesophageal echocardiography
- TTE, transthoracic echocardiography
- VSD, ventricular septal defect
- VSR, ventricular septal rupture
- acute myocardial infarction
- mechanical complication
- percutaneous closure device
- percutaneous septal defect closure
- ventricular septal defect
- ventricular septal rupture
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24
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Cavarretta E, Sciarra L, Biondi-Zoccai G, Maffessanti F, Nigro A, Sperandii F, Guerra E, Quaranta F, Fossati C, Peruzzi M, Pingitore A, Stasinopoulos DM, Rigby RA, Adorisio R, Saglietto A, Calò L, Frati G, Pigozzi F. Age-Related Electrocardiographic Characteristics of Male Junior Soccer Athletes. Front Cardiovasc Med 2022; 8:784170. [PMID: 35187105 PMCID: PMC8850359 DOI: 10.3389/fcvm.2021.784170] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/22/2021] [Indexed: 02/05/2023] Open
Abstract
Introduction Very limited data exist on normal age-related ECG variations in adolescents and no data have been published regarding the ECG anomalies induced by intensive training, which are relevant in pre-participation screening for sudden cardiac death prevention in the adolescent athletic population. The purpose of this study was to establish normal age-related electrocardiographic measurements (P wave duration, PR interval, QRS duration, QT, and QTc interval) grouped according to 2-year age intervals. Methods A total of 2,151 consecutive healthy adolescent Soccer athletes (trained for a mean of 7.2 ± 1.1 h per week, 100% male Caucasians, mean age 12.4 ± 1.4 years, range 7–18) underwent pre-participation screening, which included ECG and transthoracic echocardiography in a single referral center. Results Their heart rate progressively slowed as age increased (p < 0.001, ranging from 80.8 ± 13.2 to 59.5 ± 10.2 bpm), as expected. The P wave, PR interval, and QRS duration significantly increased in older age classes (p = 0.019, p = 0.001, and p < 0.001, respectively), and after Bonferroni's correction, the difference remained significant in all age classes for QRS duration. The QTc interval diminished progressively with increasing age (p = 0.003) while the QT interval increased progressively (p < 0.001). Conclusions Significant variations in the normal ECG characteristics of young athletes exist between different age groups related to increasing age and training burden, thus, age-specific reference values could be adopted, as already done for echocardiographic measurements, and may help to further discriminate potentially pathologic conditions.
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Affiliation(s)
- Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
- *Correspondence: Elena Cavarretta
| | - Luigi Sciarra
- Department of Clinical Medicine, Public Health, Life and Environment Sciences, L'Aquila University, L'Aquila, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | | | - Antonia Nigro
- Villa Stuart Sport Clinic, FIFA Medical Centre of Excellence, Rome, Italy
| | - Fabio Sperandii
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Rome, Italy
| | - Emanuele Guerra
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Rome, Italy
| | - Federico Quaranta
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Rome, Italy
| | - Chiara Fossati
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Rome, Italy
| | - Mariangela Peruzzi
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Annachiara Pingitore
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | | | | | - Rachele Adorisio
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrea Saglietto
- Division of Cardiology, Department of Medical Sciences, “Città della Salute e della Scienza di Torino” Hospital, University of Turin, Turin, Italy
| | - Leonardo Calò
- Division of Cardiology, Policlinico Casilino, Rome, Italy
| | - Giacomo Frati
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | - Fabio Pigozzi
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Rome, Italy
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25
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Nudi A, Biondi-Zoccai G, Versaci F, Nudi F. Promises and pitfalls of relying on angiography-derived indexes to identify myocardial ischemia: A tale of Romulus and Remus. J Nucl Cardiol 2022; 29:359-362. [PMID: 32910417 DOI: 10.1007/s12350-020-02313-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/16/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Alessandro Nudi
- Service of Hybrid Cardiac Imaging, Madonna Della Fiducia Clinic, Rome, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Francesco Versaci
- Unità Operativa Complessa di UTIC Emodinamica e Cardiologia, Ospedale Santa Maria Goretti, Latina, Italy
| | - Francesco Nudi
- Service of Hybrid Cardiac Imaging, Madonna Della Fiducia Clinic, Rome, Italy.
- Ostia Radiologica, Rome, Italy.
- Replycare, Rome, Italy.
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26
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Matteucci A, Sangiorgi G, Giordano C, Biondi-zoccai G. Computed tomography angiography in blunt cerebrovascular injury: navigating through perspectives and diagnostics. Eur Radiol. [PMID: 35092475 DOI: 10.1007/s00330-021-08534-0] [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] [Received: 10/28/2021] [Revised: 10/28/2021] [Accepted: 11/18/2021] [Indexed: 02/05/2023]
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Del Buono MG, Damonte JI, Trankle CR, Kadariya D, Carbone S, Thomas G, Turlington J, Markley R, Canada JM, Biondi-Zoccai GG, Kontos MC, Van Tassell BW, Abbate A. Effect of interleukin-1 blockade with anakinra on leukocyte count in patients with ST-segment elevation acute myocardial infarction. Sci Rep 2022; 12:1254. [PMID: 35075216 PMCID: PMC8786840 DOI: 10.1038/s41598-022-05374-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/11/2022] [Indexed: 02/08/2023] Open
Abstract
Leukocytosis is a common finding in patients with ST elevation myocardial infarction (STEMI) and portends a poor prognosis. Interleukin 1-β regulates leukopoiesis and pre-clinical studies suggest that anakinra (recombinant human interleukin-1 [IL-1] receptor antagonist) suppresses leukocytosis in myocardial infarction. However, the effect of IL-1 blockade with anakinra on leukocyte count in patients with STEMI is unknown. We reviewed the white blood cell (WBC) and differential count of 99 patients enrolled in a clinical trial of anakinra (n = 64) versus placebo (n = 35) for 14 days after STEMI. A complete blood cell count with differential count were obtained at admission, and after 72 h, 14 days and 3 months. After 72 h from treatment, anakinra compared to placebo led to a statistically significant greater percent reduction in total WBC count (− 35% [− 48 to − 24] vs. − 21% [− 34 to − 10], P = 0.008), absolute neutrophil count (− 48% [− 60 to − 22] vs. − 27% [− 46 to − 5], P = 0.004) and to an increase in absolute eosinophil count (+ 50% [0 to + 100] vs. 0% [− 50 to + 62], P = 0.022). These changes persisted while on treatment at 14 days and were no longer apparent at 3 months after treatment discontinuation. We found that in patients with STEMI IL-1 blockade with anakinra accelerates resolution of leukocytosis and neutrophilia. This modulation may represent one of the mechanisms by which IL-1 blockade improves clinical outcomes.
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Affiliation(s)
- Marco Giuseppe Del Buono
- Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, West Hospital, West Wing 5-020, 1200 E Broad Street, P.O. Box 980204, Richmond, VA, 23298, USA.,Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Juan Ignacio Damonte
- Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, West Hospital, West Wing 5-020, 1200 E Broad Street, P.O. Box 980204, Richmond, VA, 23298, USA.,Interventional Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Cory R Trankle
- Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, West Hospital, West Wing 5-020, 1200 E Broad Street, P.O. Box 980204, Richmond, VA, 23298, USA
| | - Dinesh Kadariya
- Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, West Hospital, West Wing 5-020, 1200 E Broad Street, P.O. Box 980204, Richmond, VA, 23298, USA
| | - Salvatore Carbone
- Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, West Hospital, West Wing 5-020, 1200 E Broad Street, P.O. Box 980204, Richmond, VA, 23298, USA.,Department of Kinesiology and Health Sciences, College of Humanities and Sciences, Virginia Commonwealth University, Richmond, VA, USA
| | - Georgia Thomas
- Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, West Hospital, West Wing 5-020, 1200 E Broad Street, P.O. Box 980204, Richmond, VA, 23298, USA
| | - Jeremy Turlington
- Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, West Hospital, West Wing 5-020, 1200 E Broad Street, P.O. Box 980204, Richmond, VA, 23298, USA
| | - Roshanak Markley
- Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, West Hospital, West Wing 5-020, 1200 E Broad Street, P.O. Box 980204, Richmond, VA, 23298, USA
| | - Justin M Canada
- Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, West Hospital, West Wing 5-020, 1200 E Broad Street, P.O. Box 980204, Richmond, VA, 23298, USA
| | - Giuseppe G Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | - Michael C Kontos
- Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, West Hospital, West Wing 5-020, 1200 E Broad Street, P.O. Box 980204, Richmond, VA, 23298, USA
| | - Benjamin W Van Tassell
- Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, West Hospital, West Wing 5-020, 1200 E Broad Street, P.O. Box 980204, Richmond, VA, 23298, USA.,Department of Pharmacotherapy and Outcome Sciences, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA
| | - Antonio Abbate
- Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, West Hospital, West Wing 5-020, 1200 E Broad Street, P.O. Box 980204, Richmond, VA, 23298, USA.
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Affiliation(s)
- Simone Calcagno
- Department of Cardiology, Santa Maria Goretti Hospital, Latina, Italy
| | | | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.,Mediterranea Cardiocentro, Napoli, Italy
| | - Francesco Versaci
- Department of Cardiology, Santa Maria Goretti Hospital, Latina, Italy.,Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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Affiliation(s)
- Luigi Spadafora
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy
| | - Alberto Testa
- Sapienza School for Advanced Studies, Sapienza University of Rome, Italy
| | - Giacomo Frati
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Italy; IRCCS NEUROMED, Pozzilli, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Italy; Mediterranea Cardiocentro, Napoli, Italy.
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30
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Gragnano F, Jolly S, Mehta S, Branca M, van Klaveren D, Frigoli E, Gargiulo G, Leonardi S, Vranckx P, Di Maio D, Monda E, Fimiani L, Fioretti V, Chianese S, Andò G, Esposito G, Sangiorgi G, Biondi-Zoccai G, Heg D, Calabrò P, Windecker S, Romagnoli E, Valgimigli M. Prediction of radial crossover in acute coronary syndromes: derivation and validation of the MATRIX score. EUROINTERVENTION 2021; 17:e971-e980. [PMID: 34374343 PMCID: PMC9724886 DOI: 10.4244/eij-d-21-00441] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The radial artery is recommended by international guidelines as the default vascular access in patients with acute coronary syndromes (ACS) managed invasively. However, crossover from radial to femoral access is required in 4-10% of cases and has been associated with worse outcomes. No standardised algorithm exists to predict the risk of radial crossover. AIMS We sought to derive and externally validate a risk score to predict radial crossover in patients with ACS managed invasively. METHODS The derivation cohort consisted of 4,197 patients with ACS undergoing invasive management via the randomly allocated radial access from the MATRIX trial. Using logistic regression, we selected predictors of radial crossover and developed a numerical risk score. External validation was accomplished among 3,451 and 491 ACS patients managed invasively and randomised to radial access from the RIVAL and RIFLE-STEACS trials, respectively. RESULTS The MATRIX score (age, height, smoking, renal failure, prior coronary artery bypass grafting, ST-segment elevation myocardial infarction, Killip class, radial expertise) showed a c-index for radial crossover of 0.71 (95% CI: 0.67-0.75) in the derivation cohort. Discrimination ability was modest in the RIVAL (c-index: 0.64; 95% CI: 0.59-0.67) and RIFLE-STEACS (c-index: 0.66; 95% CI: 0.57-0.75) cohorts. A cut-off of ≥41 points was selected to identify patients at high risk of radial crossover. CONCLUSIONS The MATRIX score is a simple eight-item risk score which provides a standardised tool for the prediction of radial crossover among patients with ACS managed invasively. This tool can assist operators in anticipating and better addressing difficulties related to transradial procedures, potentially improving outcomes.
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Affiliation(s)
- Felice Gragnano
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland,Division of Cardiology, Department of Translational Medicine, University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - Sanjit Jolly
- Department of Medicine, McMaster University, and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Shamir Mehta
- Department of Medicine, McMaster University, and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Mattia Branca
- Clinical Trials Unit, University of Bern, Bern, Switzerland
| | | | - Enrico Frigoli
- Clinical Trials Unit, University of Bern, Bern, Switzerland
| | - Giuseppe Gargiulo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Sergio Leonardi
- University of Pavia and Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, Belgium,Faculty of Medicine and Life Sciences, University of Hasselt, Hasselt, Belgium
| | - Dario Di Maio
- Division of Cardiology, Department of Translational Medicine, University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - Emanuele Monda
- Division of Cardiology, Department of Translational Medicine, University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - Luigi Fimiani
- Unit of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Vincenzo Fioretti
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Salvatore Chianese
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Giuseppe Andò
- Unit of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Giuseppe Sangiorgi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy,Mediterranea Cardiocentro, Naples, Italy
| | - Dik Heg
- Clinical Trials Unit, University of Bern, Bern, Switzerland
| | - Paolo Calabrò
- Division of Cardiology, Department of Translational Medicine, University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Enrico Romagnoli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marco Valgimigli
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, CH-6900 Lugano, Switzerland. E-mail:
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Chiariello GA, Romagnoli E, Biondi-Zoccai G, Frati G. Transcatheter versus surgical aortic valve replacement for severe aortic stenosis: Pat Garrett versus Billy the Kid? Eur J Cardiothorac Surg 2021; 61:988-989. [PMID: 34918064 DOI: 10.1093/ejcts/ezab528] [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: 11/02/2021] [Accepted: 11/09/2021] [Indexed: 02/05/2023] Open
Affiliation(s)
- Giovanni A Chiariello
- Cardiovascular Sciences Department, Agostino Gemelli Foundation Polyclinic IRCSS, Rome, Italy.,Catholic University of the Sacred Heart, Rome, Italy
| | - Enrico Romagnoli
- Cardiovascular Sciences Department, Agostino Gemelli Foundation Polyclinic IRCSS, Rome, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.,Mediterranea Cardiocentro, Napoli, Italy
| | - Giacomo Frati
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.,IRCCS NEUROMED, Pozzilli, Italy
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32
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Galli M, Benenati S, Franchi F, Rollini F, Capodanno D, Biondi-Zoccai G, Vescovo GM, Cavallari LH, Bikdeli B, Ten Berg J, Mehran R, Gibson CM, Crea F, Pereira NL, Sibbing D, Angiolillo DJ. Comparative effects of guided vs. potent P2Y12 inhibitor therapy in acute coronary syndrome: a network meta-analysis of 61 898 patients from 15 randomized trials. Eur Heart J 2021; 43:959-967. [PMID: 34918066 DOI: 10.1093/eurheartj/ehab836] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [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: 09/06/2021] [Revised: 09/30/2021] [Accepted: 11/22/2021] [Indexed: 02/05/2023] Open
Abstract
AIMS Guidelines recommend the use of potent P2Y12 inhibitors over clopidogrel for the reduction of ischaemic events in patients with acute coronary syndrome (ACS). However, this comes at the expense of increased bleeding. A guided selection of P2Y12 inhibiting therapy has the potential to overcome this limitation. We aimed at evaluating the comparative safety and efficacy of guided vs. routine selection of potent P2Y12 inhibiting therapy in patients with ACS. METHODS AND RESULTS We performed a network meta-analysis of randomized controlled trials (RCTs) comparing different oral P2Y12 inhibitors currently recommended for the treatment of patients with ACS (clopidogrel, prasugrel, and ticagrelor). RCTs including a guided approach (i.e. platelet function or genetic testing) vs. standard selection of P2Y12 inhibitors among patients with ACS were also included. Incidence rate ratios (IRR) and associated 95% confidence intervals (CIs) were estimated. P-scores were used to estimate hierarchies of efficacy and safety. The primary efficacy endpoint was major adverse cardiovascular events (MACE) and the primary safety endpoint was all bleeding. A total of 61 898 patients from 15 RCTs were included. Clopidogrel was used as reference treatment. A guided approach was the only strategy associated with reduced MACE (IRR: 0.80, 95% CI: 0.65-0.98) without any significant trade-off in all bleeding (IRR: 1.22, 95% CI: 0.96-1.55). A guided approach and prasugrel were associated with reduced myocardial infarction. A guided approach, prasugrel, and ticagrelor were associated with reduced stent thrombosis. Ticagrelor was also associated with reduced total and cardiovascular mortality. Prasugrel was associated with increased major bleeding. Prasugrel and ticagrelor were associated with increased minor bleeding. The incidence of stroke did not differ between treatments. CONCLUSION In patients with an ACS, compared with routine selection of potent P2Y12 inhibiting therapy (prasugrel or ticagrelor), a guided selection of P2Y12 inhibiting therapy is associated with the most favourable balance between safety and efficacy. These findings support a broader adoption of guided approach for the selection of P2Y12 inhibiting therapy in patients with ACS. STUDY REGISTRATION NUMBER This study is registered in PROSPERO (CRD42021258603). KEY QUESTION A guided selection of P2Y12 inhibiting therapy using platelet function or genetic testing improves outcomes among patients undergoing percutaneous coronary intervention. Nevertheless, the comparative safety and efficacy of a guided versus routine selection of potent P2Y12-inhibiting therapy in acute coronary syndrome has not been explored. KEY FINDING In a comprehensive network meta-analysis including the totality of available evidence and using clopidogrel as treatment reference, a guided approach was the only strategy associated with reduced major adverse cardiovascular events without any significant trade-off in bleeding. Prasugrel and ticagrelor increased bleeding and only ticagrelor reduced mortality. TAKE HOME MESSAGE A guided selection of P2Y12-inhibiting therapy represents the strategy associated with the most favourable balance between safety and efficacy. These findings support a broader adoption of guided P2Y12 inhibiting therapy in patients with acute coronary syndrome.
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Affiliation(s)
- Mattia Galli
- Division of Cardiology, University of Florida College of Medicine-Jacksonville, 655 West 8th Street, Jacksonville, FL 32209, USA.,Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Largo Francesco Vito, 1, Rome 00168, Italy
| | - Stefano Benenati
- Dipartimento di Medicina Interna e Specialità Mediche (DIMI), Policlinico San Martino IRCCS, University of Genoa, Largo Rosanna Benzi, 10, Genoa 16132, Italy
| | - Francesco Franchi
- Division of Cardiology, University of Florida College of Medicine-Jacksonville, 655 West 8th Street, Jacksonville, FL 32209, USA
| | - Fabiana Rollini
- Division of Cardiology, University of Florida College of Medicine-Jacksonville, 655 West 8th Street, Jacksonville, FL 32209, USA
| | - Davide Capodanno
- Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco", University of Catania, Via Santa Sofia, 78, Catania 95123, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Piazzale Aldo Moro, 5, Rome 00185, Italy.,Mediterranea Cardiocentro, Via Orazio, 2, Napoli 80122, Italy
| | - Giovanni Maria Vescovo
- Interventional Cardiology, Department of Cardiothoracic and Vascular Science, Ospedale dell'Angelo, Via Paccagnella, 11, Venice 30174, Italy
| | - Larisa H Cavallari
- Department of Pharmacotherapy & Translational Research, Center for Pharmacogenomics & Precision Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Behnood Bikdeli
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.,Center for Outcomes Research and Evaluation (CORE), Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510, USA.,Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway, New York, NY 10019, USA
| | - Jurrien Ten Berg
- Department of Cardiology and Center for Platelet Function Research, St Antonius Hospital, The Cardiovascular Research Institute Maastricht (CARIM), Universiteitssingel 50, Maastricht 6229, the Netherlands
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, Cardiovascular Institute, 1 Gustave L. Levy Pl, New York, NY 10029, USA
| | - Charles Michael Gibson
- Department of Medicine, Beth Israel Deaconess Medical Center, 169 Pilgrim Rd, Boston, MA 02215, USA
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Largo Francesco Vito, 1, Rome 00168, Italy
| | - Naveen L Pereira
- Department of Cardiovascular Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Dirk Sibbing
- Privatklinik Lauterbacher Mühle am Ostersee, Unterlauterbach 1, Seeshaupt 82402, Germany.,Department of Cardiology, Ludwig-Maximilians-Universität München (LMU Munich), Geschwister-Scholl-Platz 1, Munich 80539, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Greifswald 17475, Germany
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine-Jacksonville, 655 West 8th Street, Jacksonville, FL 32209, USA
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Toldo S, Mezzaroma E, Buckley LF, Potere N, Di Nisio M, Biondi-Zoccai G, Van Tassell BW, Abbate A. Targeting the NLRP3 inflammasome in cardiovascular diseases. Pharmacol Ther 2021; 236:108053. [PMID: 34906598 PMCID: PMC9187780 DOI: 10.1016/j.pharmthera.2021.108053] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [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: 08/31/2021] [Revised: 11/21/2021] [Accepted: 12/06/2021] [Indexed: 02/05/2023]
Abstract
The NACHT, leucine-rich repeat (LRR), and pyrin domain (PYD)-containing protein 3 (NLRP3) inflammasome is an intracellular sensing protein complex that plays a major role in innate immunity. Following tissue injury, activation of the NLRP3 inflammasome results in cytokine production, primarily interleukin(IL)-1β and IL-18, and, eventually, inflammatory cell death - pyroptosis. While a balanced inflammatory response favors damage resolution and tissue healing, excessive NLRP3 activation causes detrimental effects. A key involvement of the NLRP3 inflammasome has been reported across a wide range of cardiovascular diseases (CVDs). Several pharmacological agents selectively targeting the NLRP3 inflammasome system have been developed and tested in animals and early phase human studies with overall promising results. While the NLRP3 inhibitors are in clinical development, multiple randomized trials have demonstrated the safety and efficacy of IL-1 blockade in atherothrombosis, heart failure and recurrent pericarditis. Furthermore, the non-selective NLRP3 inhibitor colchicine has been recently shown to significantly reduce cardiovascular events in patients with chronic coronary disease. In this review, we will outline the mechanisms driving NLRP3 assembly and activation, and discuss the pathogenetic role of the NLRP3 inflammasome in CVDs, providing an overview of the current and future therapeutic approaches targeting the NLRP3 inflammasome.
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Affiliation(s)
- Stefano Toldo
- VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Eleonora Mezzaroma
- VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA; Department of Pharmacotherapy and Outcome Studies, Virginia Commonwealth University, Richmond, VA, USA
| | - Leo F Buckley
- Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA
| | - Nicola Potere
- Department of Innovative Technologies in Medicine and Dentistry, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Marcello Di Nisio
- Department of Medicine and Ageing Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Mediterranea Cardiocentro, Napoli, Italy
| | - Benjamin W Van Tassell
- VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA; Department of Pharmacotherapy and Outcome Studies, Virginia Commonwealth University, Richmond, VA, USA
| | - Antonio Abbate
- VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA; Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, VA, USA.
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34
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Camilli M, Lombardi M, Chiabrando JG, Zito A, Del Buono MG, Vergallo R, Aspromonte N, Lombardo A, Montone RA, Niccoli G, Biondi-zoccai G, Crea F, Minotti G. Sodium–Glucose Cotransporter Inhibitors Reduce Mortality and Morbidity in Patients With Heart Failure: Evidence From a Meta-Analysis of Randomized Trials. Am J Ther 2021; Publish Ahead of Print. [PMID: 35389572 DOI: 10.1097/mjt.0000000000001452] [Citation(s) in RCA: 6] [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: 02/05/2023]
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35
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Kobo O, Moledina SM, Slawnych M, Sinnarajah A, Simon J, Van Spall HGC, Sun LY, Zoccai GB, Roguin A, Mohamed MO, Mamas MA. Predictors, Treatments, and Outcomes of Do-Not-Resuscitate Status in Acute Myocardial Infarction Patients (from a Nationwide Inpatient Cohort Study). Am J Cardiol 2021; 159:8-18. [PMID: 34656317 DOI: 10.1016/j.amjcard.2021.07.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/27/2021] [Accepted: 07/30/2021] [Indexed: 02/05/2023]
Abstract
Little is known about how frequently do-not-resuscitate (DNR) orders are placed in patients with acute myocardial infarction (AMI), the types of patients in which they are placed, treatment strategies or clinical outcomes of such patients. Using the United States (US) National Inpatient Sample (NIS) database from 2015 to 2018, we identified 2,767,549 admissions that were admitted to US hospitals and during the hospitalization received a principle diagnosis of AMI, of which 339,270 (12.3%) patients had a DNR order (instigated both preadmission and during in-hospital stay). Patients with a DNR status were older (median age 83 vs 65, p < 0.001), more likely to be female (53.4% vs 39.3%, p < 0.001) and White (81.0% vs 73.3%, p < 0.001). Predictors of DNR status included comorbidities such as heart failure (OR: 1.47, 95% CI: 1.45 to 1.48), dementia (OR: 2.53, 95% CI: 2.50 to 2.55), and cancer. Patients with a DNR order were less likely to undergo invasive management or be discharged home (13.5% vs 52.8%), with only 1/3 receiving palliative consultation. In hospital mortality (32.7% vs 4.6%, p < 0.001) and MACCE (37.1% vs 8.8%, p < 0.001) were higher in the DNR group. Factors independently associated with in-hospital mortality among patients with a DNR order included a STEMI presentation (OR: 2.90, 95% CI: 2.84 to 2.96) and being of Black (OR: 1.29, 95% CI: 1.26 to 1.33), Hispanic (OR: 1.36, 95% CI: 1.32 to 1.41) or Asian/Pacific Islander (OR: 1.56, 95% CI:1.49-race. In conclusion, AMI patients with a DNR status were older, multimorbid, less likely to receive invasive management, with only one third of patients with DNR status referred for palliative care.
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Affiliation(s)
- Ofer Kobo
- Department of Cardiology, Hillel Yaffe Medical Centre, Hadera, Israel; Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, United Kingdom
| | - Saadiq M Moledina
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, United Kingdom
| | - Michael Slawnych
- Libin Cardiovascular Institute and Division of Palliative care, Department of Oncology, University of Calgary, Alberta, Canada
| | | | - Jessica Simon
- Department of Oncology, University of Calgary, Alberta, Canada
| | - Harriette G C Van Spall
- Department of Medicine and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, and Population Health Research Institute, Canada
| | - Louise Y Sun
- Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Giuseppe Biondi Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Mediterranea Cardiocentro, Napoli, Italy
| | - Ariel Roguin
- Department of Cardiology, Hillel Yaffe Medical Centre, Hadera, Israel
| | - Mohamed O Mohamed
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, United Kingdom
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, United Kingdom; Department of Cardiology, Jefferson University, Philadelphia, Pennsylvania.
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Irace FG, Cammisotto V, Valenti V, Forte M, Schirone L, Bartimoccia S, Iaccarino A, Peruzzi M, Schiavon S, Morelli A, Marullo AGM, Miraldi F, Nocella C, De Paulis R, Benedetto U, Greco E, Biondi-Zoccai G, Sciarretta S, Carnevale R, Frati G. Role of Oxidative Stress and Autophagy in Thoracic Aortic Aneurysms. JACC Basic Transl Sci 2021; 6:719-730. [PMID: 34754985 PMCID: PMC8559314 DOI: 10.1016/j.jacbts.2021.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 08/05/2021] [Accepted: 08/09/2021] [Indexed: 02/08/2023]
Abstract
Because autophagy and Nox2 activation were identified as possible mechanisms for preservation of vessel integrity, they could be useful biomarkers to predict risk of aneurysm rupture by detecting the presence of a subclinical aneurysm or monitoring their growth. Biomarkers such as molecules involved in autophagic machinery or Nox2 activation may help to explain pathological processes involved in TAA development and expansion, thereby opening up novel potential therapeutic strategies, such as the use of natural activators of autophagy or molecules that inhibit Nox2 activation, in the setting of aneurysmatic pathology. Formation of aortic aneurysmal disease is multifactorial. Among the mechanisms involved, there is endothelial damage, oxidative stress, as well as an autophagy process, that seem to play a key role in TAA. Therefore, to identify the molecular mechanisms of these processes in TAA patients could lay the groundwork for defining strategies for preventing and slowing the progression of TAA.
Thoracic aortic aneurysms (TAA) pathogenesis and progression include many mechanisms. The authors investigated the role of autophagy, oxidative stress, and endothelial dysfunction in 36 TAA patients and 23 control patients. Univariable and multivariable analyses were performed. TAA patients displayed higher oxidative stress and endothelial dysfunction then control patients. Autophagy in the TAA group was reduced. The association of oxidative stress and autophagy with aortic disease supports the role of these processes in TAA. The authors demonstrate a putative role of Nox2 and autophagy dysregulation in human TAA. These findings could pinpoint novel treatment targets to prevent or limit TAA progression.
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Key Words
- ATG5, autophagy protein 5
- HBA, hydrogen peroxide break-down activity
- HRP, horseradish peroxidase
- NADPH, nicotinamide adenine dinucleotide phosphate
- NO, nitric oxide
- PAGE, polyacrylamide gel electrophoresis
- ROS, reactive oxygen species
- SDS, sodium dodecyl sulfate
- TAA, thoracic aortic aneurysms
- VSMC, vascular smooth muscle cell
- autophagy
- endothelial dysfunction
- oxidative stress
- sNox2-dp, soluble Nox2-derived peptide
- thoracic aortic aneurysm
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Affiliation(s)
- Francesco G Irace
- Department of Cardiac Surgery, European Hospital, Rome, Italy.,Department of General and Specialized Surgery "Paride Stefanini," Sapienza University of Rome, Rome, Italy
| | - Vittoria Cammisotto
- Department of General and Specialized Surgery "Paride Stefanini," Sapienza University of Rome, Rome, Italy.,Department of Clinical Internal, Anesthesiological, and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Valentina Valenti
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | | | - Leonardo Schirone
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Simona Bartimoccia
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Alessandra Iaccarino
- Department of Cardiothoracic Surgery, Humanitas Clinical and Research Centre, IRCCS, Milan, Italy
| | - Mariangela Peruzzi
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | - Sonia Schiavon
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Andrea Morelli
- Department of Clinical Internal, Anesthesiological, and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Antonino G M Marullo
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Fabio Miraldi
- Department of Clinical Internal, Anesthesiological, and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Cristina Nocella
- Department of Clinical Internal, Anesthesiological, and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Umberto Benedetto
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Ernesto Greco
- Department of Clinical Internal, Anesthesiological, and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | - Sebastiano Sciarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.,IRCCS Neuromed, Pozzilli (IS), Italy
| | - Roberto Carnevale
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | - Giacomo Frati
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.,IRCCS Neuromed, Pozzilli (IS), Italy
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Perrotta A, Biondi-Zoccai G, Saade W, Miraldi F, Morelli A, Marullo AG, Cavarretta E, Carnevale R, DE Falco E, Chimenti I, Sciarretta S, Frati P, Mamas MA, Ciardi S, Frati L, Frati G, Peruzzi M. A snapshot global survey on side effects of COVID-19 vaccines among healthcare professionals and armed forces with a focus on headache. Panminerva Med 2021; 63:324-331. [PMID: 34738774 DOI: 10.23736/s0031-0808.21.04435-9] [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: 02/05/2023]
Abstract
BACKGROUND New messenger RNA (mRNA) and adenovirus-based vaccines (AdV) against Coronavirus disease 2019 (COVID-19) have entered large scale clinical trials. Since healthcare professionals (HCPs) and armed forces personnel (AFP) represent a high-risk category, they act as a suitable target population to investigate vaccine-related side effects, including headache, which has emerged as a common complaint. METHODS We investigated the side-effects of COVID-19 vaccines among HCPs and AFP through a 38 closed-question international survey. The electronic link was distributed via e-mail or via Whatsapp to more than 500 contacts. Responses to the survey questions were analyzed with bivariate tests. RESULTS A total of 375 complete surveys have been analyzed. More than 88% received an mRNA vaccine and 11% received AdV first dose. A second dose of mRNA vaccine was administered in 76% of individuals. No severe adverse effects were reported, whereas moderate reactions and those lasting more than 1 day were more common with AdV (P=0.002 and P=0.024 respectively). Headache was commonly reported regardless of the vaccine type, but less frequently, with shorter duration and lower severity that usually experienced by participants, without significant difference irrespective of vaccine type. CONCLUSIONS Both mRNA and AdV COVID-19 vaccines were safe and well tolerated in a real-life subset of HCPs and AFP subjects.
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Affiliation(s)
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | - Wael Saade
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Fabio Miraldi
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Andrea Morelli
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Antonino G Marullo
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | - Roberto Carnevale
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | - Elena DE Falco
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | - Isotta Chimenti
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | - Sebastiano Sciarretta
- IRCCS NEUROMED, Pozzilli, Isernia, Italy.,Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
| | - Paola Frati
- IRCCS NEUROMED, Pozzilli, Isernia, Italy.,Department of Anatomical Histological, Forensis and Orthopedic Sciences, Sapienza University, Rome, Italy
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Institutes of Applied Clinical Science and Primary Care and Health Sciences, University Hospital of North Midlands, Keele University, Stoke-on-Trent, UK.,Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK
| | - Sara Ciardi
- Carabinieri Corps Health Service, Rome, Italy
| | - Luigi Frati
- IRCCS NEUROMED, Pozzilli, Isernia, Italy.,Pasteur Institute, Rome, Italy
| | - Giacomo Frati
- IRCCS NEUROMED, Pozzilli, Isernia, Italy.,Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
| | - Mariangela Peruzzi
- Mediterranea Cardiocentro, Naples, Italy - .,Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University, Rome, Italy
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Avondo S, Andreis A, Casula M, Biondi-Zoccai G, Imazio M. Pharmacologic treatment of acute and recurrent pericarditis: a systematic review and meta-analysis of controlled clinical trials. Panminerva Med 2021; 63:314-323. [PMID: 34738773 DOI: 10.23736/s0031-0808.21.04263-4] [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] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Recurrence is the most frequent complication following acute pericarditis and may occur in 30% patients, rising to 50% in case of multiple recurrences, lack of colchicine treatment or use of glucocorticoids. Available treatments include aspirin or non-steroidal anti-inflammatory drugs (NSAIDs), colchicine, glucocorticoids, immunosuppressive agents, immunoglobulins, anti-interleukin-1 (IL-1) agents. EVIDENCE ACQUISITION This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to assess the efficacy of pharmacological treatments for acute and recurrent pericarditis. Bibliographic databases were searched (PubMed, MEDLINE, Embase, Scopus, and the Cochrane Library) using the terms "acute pericarditis" or "recurrent pericarditis" and "colchicine" or "NSAIDs" or "glucocorticoids" or "immunosuppressive agents" or "immunoglobulins" or "anti-IL1 agents." Random-effects meta-analysis was used to assess the risk of recurrent pericarditis. Publication bias was assessed using the Egger test, and meta-regression was performed to assess sources of heterogeneity. EVIDENCE SYNTHESIS Eleven RCTs assessed the efficacy of pharmacological treatments for acute and recurrent pericarditis (colchicine and anti-interleukin-1 agents). Colchicine, assessed in nine RCTs, was effective in the reduction of recurrent pericarditis, compared with standard treatment (17% vs .34%, RR=0.50; 95% CI 0.42-0.60, P<0.001), without any differences according to clinical setting (i.e. acute pericarditis, recurrent pericarditis, post-pericardiotomy syndrome; P=0.58). Anti-interleukin-1 agents (anakinra, rilonacept), assessed in two RCT, were effective in the reduction of recurrences, compared with placebo (10% vs.78%, RR=0.14; 95% CI 0.05-0.35, P<0.001). CONCLUSIONS A correct pharmacological management of pericarditis is key to prevent recurrences. Colchicine is the mainstay of treatment in acute and recurrent pericarditis, while anti-IL1 agents are a valuable option in case of recurrent pericarditis refractory to conventional drugs.
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Affiliation(s)
- Stefano Avondo
- Department of Cardiology, Città della Salute e della Scienza, Turin, Italy
| | - Alessandro Andreis
- Department of Cardiology, Città della Salute e della Scienza, Turin, Italy
| | - Matteo Casula
- Department of Cardiology, Città della Salute e della Scienza, Turin, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | - Massimo Imazio
- Department of Cardiology, Città della Salute e della Scienza, Turin, Italy - .,Unit of Cardiology, Cardiothoracic Department, University Hospital "Santa Maria della Misericordia", Udine, Italy
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39
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Matteucci A, Bonanni M, Versaci F, Frati G, Peruzzi M, Sangiorgi G, Biondi-Zoccai G, Massaro G. Cardiovascular medicine: a year in review. Minerva Cardiol Angiol 2021; 70:40-55. [PMID: 34713681 DOI: 10.23736/s2724-5683.21.05816-6] [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: 02/05/2023]
Abstract
Cardiovascular medicine is facing several challenges in the current era, dominated by the rapid spread of a previously unknown virus around the world. Indeed, the 2020 COVID-19 pandemic set the course of cardiovascular science and education in an extraordinary way, hogging the attention of the medical community. Notably, while COVID-19 impacted research progress, there has been considerable effort in exploring topics of great interest, from the management of acute coronary syndromes to new horizons in the treatment of heart failure, from novelties in the surgical treatment of cardiovascular disease to new data on implantable cardiac devices, and from new diagnostic applications of multimodal imaging techniques to relevant basic science findings. Minerva Cardiology and Angiology, formerly Minerva Cardioangiologica, has strived to inform its readers on these topics and novelties, aiming for a succinct yet poignant melding of timeliness and accuracy. Accordingly, the purpose of this narrative review is to highlight and summarize the major research and review articles published during 2020. In particular, we provide a broad overview of the novelties identifying six major areas of interest in the field of cardiovascular sciences in which new evidences have contributed to improving prevention, diagnosis and treatment of heart and vessels diseases.
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Affiliation(s)
- Andrea Matteucci
- Department of Experimental Medicine, Tor Vergata University of Rome, Rome, Italy -
| | - Michela Bonanni
- Department of Experimental Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Francesco Versaci
- UOC UTIC Emodinamica e Cardiologia, S. Maria Goretti Hospital, Latina, Italy
| | - Giacomo Frati
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy.,IRCCS NEUROMED, Pozzilli, Isernia, Italy
| | - Mariangela Peruzzi
- Mediterranea Cardiocentro, Napoli, Italy.,Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Sangiorgi
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy
| | - Giuseppe Biondi-Zoccai
- IRCCS NEUROMED, Pozzilli, Isernia, Italy.,Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Gianluca Massaro
- Division of Cardiology, Tor Vergata University of Rome, Rome, Italy
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Tumminello G, Cereda A, Barbieri L, Biondi-Zoccai G, Lucreziotti S, Mafrici A, Carugo S. Meta-Analysis of Placebo-Controlled Trials of Levosimendan in Acute Myocardial Infarction. J Cardiovasc Dev Dis 2021; 8:jcdd8100129. [PMID: 34677198 PMCID: PMC8539734 DOI: 10.3390/jcdd8100129] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/03/2021] [Accepted: 10/05/2021] [Indexed: 02/05/2023] Open
Abstract
The treatment of acute myocardial infarction is early revascularization. Heart failure and cardiogenic shock may complicate acute myocardial infarction despite applying the best available strategy. Levosimendan is a relatively new drug to treat heart failure with a peculiar mechanism of action: calcium sensitization of myocardial fibres. Levosimendan has a direct inotropic effect but also pleiotropic effects; through the K+ATP channel's opening, it also has a vasodilator effect which may participate concretely in the global effects of the drug. The focus of the literature is on the anti-heart failure and anti-cardiogenic shock properties of Levosimendan, but it may have effects also preventing the development of myocardial insufficiency in acute myocardial infarction. The aim of the meta-analysis is to evaluate the effect of Levosimendan on acute myocardial infarction in placebo-controlled trials. Based on the eight studies selected, we found a beneficial effect of Levosimendan on acute and long-term mortality of patients affected by acute myocardial infarction. With caution in interpreting the results of this meta-analysis, our data support the idea that Levosimendan may already have a role in the treatment of acute ischemic heart disease. Further studies specifically designed to investigate the early role in the treatment of ischemic heart failure are needed.
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Affiliation(s)
- Gabriele Tumminello
- Cardiology Division, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (A.C.); (S.L.); (A.M.)
- Correspondence: ; Tel.: +39-024-022-2792 or +39-334-925-6132
| | - Alberto Cereda
- Cardiology Division, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (A.C.); (S.L.); (A.M.)
| | - Lucia Barbieri
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Division of Cardiology, Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (L.B.); (S.C.)
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, Italy;
- Mediterranea Cardiocentro, 80138 Napoli, Italy
| | - Stefano Lucreziotti
- Cardiology Division, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (A.C.); (S.L.); (A.M.)
| | - Antonio Mafrici
- Cardiology Division, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (A.C.); (S.L.); (A.M.)
| | - Stefano Carugo
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Division of Cardiology, Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (L.B.); (S.C.)
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Affiliation(s)
- Leonardo Roever
- Department of Clinical Research, Federal University of Uberlândia, Uberlândia, Brazil
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
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D'Ascenzo F, Elia E, Marengo G, Wańha W, González Ferreiro R, Truffa A, Trabattoni D, Figini F, Verardi R, Di Palma G, Infusino F, Pivato C, Ochała A, Omedè P, Milewski M, Estevez R, Raporeiras Roubin S, De Filippo O, Conrotto F, Montefusco A, Gili S, Cortese B, Dusi V, Gallone G, Manfredi R, Mancone M, Biondi Zoccai G, Casella G, Templin C, Stefanini G, Wojakowski W, Sheiban I, De Ferrari GM. Long-term (≥15 years) Follow-up of Percutaneous Coronary Intervention of Unprotected Left Main (From the GRAVITY Registry). Am J Cardiol 2021; 156:72-78. [PMID: 34325877 DOI: 10.1016/j.amjcard.2021.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/04/2021] [Accepted: 06/14/2021] [Indexed: 02/05/2023]
Abstract
Long term survival and its determinants after Percutaneous Coronary Intervention (PCI) on Unprotected Left Main Coronary Artery (ULMCA) remain to be appraised. In 9 European Centers 470 consecutive patients performing PCI on ULMCA between 2002 and 2005 were retrospectively enrolled. Survival from all cause and cardiovascular (CV) death were the primary end points, while their predictors at multivariate analysis the secondary ones. Among the overall cohort 81.5% of patients were male and mean age was 66 ± 12 years. After 15 years (IQR 13 to 16), 223 patients (47%) died, 81 (17.2%) due to CV etiology. At multivariable analysis, older age (HR 1.06, 95%CI 1.02 to 1.11), LVEF < 35% (HR 2.97, 95%CI 1.24 to 7.15) and number of vessels treated during the index PCI (HR 1.75, 95%CI 1.12 to 2.72) were related to all-cause mortality, while only LVEF <35% (HR 4.71, 95%CI 1.90 to 11.66) to CV death. Repeated PCI on ULMCA occurred in 91 (28%) patients during the course of follow up and did not significantly impact on freedom from all-cause or CV mortality. In conclusion, in a large, unselected population treated with PCI on ULMCA, 47% died after 15 years, 17% due to CV causes. Age, number of vessels treated during index PCI and depressed LVEF increased risk of all cause death, while re-PCI on ULMCA did not impact survival.
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Affiliation(s)
- Fabrizio D'Ascenzo
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy.
| | - Edoardo Elia
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy
| | - Giorgio Marengo
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy
| | - Wojciech Wańha
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | | | | | - Filippo Figini
- Division of Cardiology, Pederzoli Hospital-Peschiera del Garda, Verona, Italy
| | - Roberto Verardi
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy; U.O.C. Cardiologia, Ospedale Maggiore, Bologna, Italy
| | - G Di Palma
- Cardiovascular Research Team, San Carlo Clinic, Milan, Italy
| | - Fabio Infusino
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Carlo Pivato
- Cardio Center, Humanitas Clinical and Research Center IRCCS, Rozzano-Milan, Italy
| | - Andrzej Ochała
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Pierluigi Omedè
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy
| | - Marek Milewski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Roi Estevez
- Department of Cardiology, University Hospital Alvaro Cunqueiro, Vigo, Spain
| | | | - O De Filippo
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy
| | - Federico Conrotto
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy
| | - Antonio Montefusco
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy
| | | | | | - Veronica Dusi
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy
| | - Guglielmo Gallone
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy
| | - Roberto Manfredi
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy
| | - Massimo Mancone
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - G Biondi Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy; Mediterranea Cardiocentro, Naples, Italy
| | | | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Giulio Stefanini
- Cardio Center, Humanitas Clinical and Research Center IRCCS, Rozzano-Milan, Italy
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Imad Sheiban
- Division of Cardiology, Pederzoli Hospital-Peschiera del Garda, Verona, Italy
| | - G M De Ferrari
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy
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43
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Del Prete A, Conway F, Della Rocca DG, Biondi-Zoccai G, De Felice F, Musto C, Picichè M, Martuscelli E, Natale A, Versaci F. COVID-19, Acute Myocardial Injury, and Infarction. Card Electrophysiol Clin 2021; 14:29-39. [PMID: 35221083 PMCID: PMC8556597 DOI: 10.1016/j.ccep.2021.10.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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44
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Zanetti HR, Lopes LTP, Gonçalves A, Soares VL, Soares WF, Hernandez AV, Tse G, Liu T, Biondi-Zoccai G, Roever L, Mendes EL. Effects of resistance training on muscle strength, body composition and immune-inflammatory markers in people living with HIV: a systematic review and Meta-analysis of randomized controlled trials. HIV Res Clin Pract 2021. [PMID: 34569442 DOI: 10.1080/25787489.2021.1975448] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Purpose: The purpose of this review is to evaluate the effect of resistance training (RT) as a unique intervention on muscle strength, body composition, and immune-inflammatory markers in people living with HIV (PLHIV).Methods: The searches were conducted in seven databases and included published randomized clinical trials that assessed the effect of RT vs. no exercise on muscle strength, body composition, and immune-inflammatory markers in PLHIV until June 2021. Random effects meta-analyses of mean differences (MD) and their 95% confidence intervals (CI) were performed, and the effect size was estimated by Hedges' g test.Results: Seven RCTs were included (n= 258 PLHIV) and the study duration lasted between six and 24 weeks. In comparison to no exercise, RT improved muscle strength in bench press (MD 10.69 kg, 95%IC 3.44 to 17.93, p= 0.004, g =2.42) and squat (MD 22.66 kg, 95%IC 7.82 to 37.50, p= 0.003, g = 3.8) exercises, lean body mass (MD 2.96 kg, 95%CI 0.98 to 4.94, p= 0.003, g = 1.99), fat body mass(MD -2.67 kg; 95%CI -4.95 to -0.39, p= 0.02, g=-0.99), body fat percentage (MD -3.66%, 95%CI -6.04 to -1.29, p= 0.003, g=-1.99) and CD4+ cells count(MD 100.15 cells/mm3, 95%CI 12.21 to 188.08, p = 0.03, g = 2.91) in PLHIV. There was no effect of RT on IL-6 (MD -1.18 pg/mL, 95%CI -3.71 to 1.35, p = 0.36, g = 0.001) and TNF-α (MD -4.76 pg/mL, 95%CI -10.81 to 1.29, p = 0.12, g=-1.3) concentrations in PLHIV. Conclusions: RT as a unique intervention improves muscle strength, body composition and CD4+ count cells in PLHIV.
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Affiliation(s)
- Hugo R Zanetti
- Department of Physical Education, University Centre IMEPAC, Araguari, Minas Gerais, Brazil.,Department of Medicine, University Centre IMEPAC, Araguari, Minas Gerais, Brazil.,Postgraduate Program in Physical Education, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Leandro T P Lopes
- Department of Medicine, Brazil University, Fernandópolis, São Paulo, Brazil
| | - Alexandre Gonçalves
- Department of Physical Education, University Centre IMEPAC, Araguari, Minas Gerais, Brazil.,Department of Medicine, University Centre IMEPAC, Araguari, Minas Gerais, Brazil
| | - Vitor L Soares
- Postgraduate Program in Physical Education, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Weverton F Soares
- Postgraduate Program in Physical Education, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Adrian V Hernandez
- Health Outcomes, Policy, and Evidence Synthesis (HOPES) Group, University of Connecticut School of Pharmacy, Storrs, Connecticut, USA.,Vicerrectorado de Investigación, Universidad San Ignacio de Loyola (USIL), Lima, Peru
| | - Gary Tse
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Tong Liu
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.,IRCCS Neuromed, Pozzilli, Italy
| | - Leonardo Roever
- Department of Clinical Research, Federal University of Uberlândia, Minas Gerais, Brazil
| | - Edmar L Mendes
- Postgraduate Program in Physical Education, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
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Mazza M, Marano G, Gonsalez del Castillo A, Chieffo D, Albano G, Biondi-Zoccai G, Galiuto L, Sani G, Romagnoli E. Interpersonal violence: Serious sequelae for heart disease in women. World J Cardiol 2021; 13:438-445. [PMID: 34621488 PMCID: PMC8462046 DOI: 10.4330/wjc.v13.i9.438] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 04/10/2021] [Accepted: 07/19/2021] [Indexed: 02/06/2023] Open
Abstract
Experiencing various forms of violence in either childhood or adulthood has been associated with cardiovascular disease, both shortly after the event and during follow-up, particularly in women. The coronavirus disease 2019 pandemic has heightened the risk of domestic violence with serious sequelae for mental and cardiovascular health in women, possibly due to several contributing factors, ranging from lockdown, stay at home regulations, job losses, anxiety, and stress. Accordingly, it remains paramount to enforce proactive preventive strategies, at both the family and individual level, maintain a high level of attention to recognize all forms of violence or abuse, and guarantee a multidisciplinary team approach for victims of interpersonal or domestic violence in order to address physical, sexual, and emotional domains and offer a personalized care.
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Affiliation(s)
- Marianna Mazza
- Department of Neurosciences, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Giuseppe Marano
- Department of Neurosciences, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Angela Gonsalez del Castillo
- Unit of Clinical Psychology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Daniela Chieffo
- Unit of Clinical Psychology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Gabriella Albano
- Department of Neurosciences, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina 04100, Italy
- Mediterranea Cardiocentro, Napoli 80122, Italy
| | - Leonarda Galiuto
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Gabriele Sani
- Department of Neurosciences, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
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Pepe M, Peruzzi M, Biondi-Zoccai G, Giordano A. Antithrombotic Therapy for Vascular Disease and Intervention: The Best Is Yet to Come? J Cardiovasc Pharmacol 2021; 78:334-335. [PMID: 34173809 DOI: 10.1097/fjc.0000000000001092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Martino Pepe
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
| | - Mariangela Peruzzi
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
- Mediterranea Cardiocentro, Napoli, Italy ; and
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
- Mediterranea Cardiocentro, Napoli, Italy ; and
| | - Arturo Giordano
- Interventional Cardiology Unit, Pineta Grande Hospital, Castel Volturno, Italy
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47
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Pepe M, Napoli G, Carulli E, Moscarelli M, Forleo C, Nestola PL, Biondi-Zoccai G, Giordano A, Favale S. Autoimmune diseases in patients undergoing percutaneous coronary intervention: A risk factor for in-stent restenosis? Atherosclerosis 2021; 333:24-31. [PMID: 34418682 DOI: 10.1016/j.atherosclerosis.2021.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/25/2021] [Accepted: 08/04/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Despite the relation between autoimmune diseases and increased atherosclerotic risk is established, the influence of autoimmune disorders on in-stent restenosis (ISR) after percutaneous coronary intervention (PCI) is only partly known. ISR is an aberrant reparative process mainly characterized by an increased number of vascular smooth muscle cells and excessive deposition of extracellular proteoglycans and type III collagen. Chronic inflammation, always present in autoimmune diseases, modulates the endothelial response to PCI. Aim of this review is to resume the current evidence on the association between ISR and autoimmune diseases, focusing on pathogenic mechanisms and therapeutic targets. METHODS We conducted a comprehensive review of the literature on the relationship between ISR and insulin-dependent diabetes mellitus (IDDM), rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), antiphospholipid-antibodies syndrome (APS), inflammatory bowel diseases (IBD), and Hashimoto's thyroiditis (HT). RESULTS Patients affected with IDDM, RA, SLE, APS, IBD and HT proved to face higher rates of ISR compared to the general population. The endothelial dysfunction seems the principal common pathogenic pathway for ISR and is attributed to both the immune system disorder and the systemic inflammation. Some evidence suggested that methotrexate and anti-tumor necrosis factor treatments can be effective in reducing ISR, while antibodies against vascular cell adhesion molecule-1 and intercellular adhesion molecule-1 showed to reduce neointimal hyperplasia in animal models. CONCLUSIONS Autoimmune diseases are a risk factor for ISR. The study of the potential cardiovascular benefits of the current therapies, mainly anti-inflammatory drugs, and the pursuit of innovative treatments appear of paramount interest.
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Affiliation(s)
- Martino Pepe
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Piazza G. Cesare 11, Bari (BA), 70120, Italy.
| | - Gianluigi Napoli
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Piazza G. Cesare 11, Bari (BA), 70120, Italy
| | - Eugenio Carulli
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Piazza G. Cesare 11, Bari (BA), 70120, Italy
| | - Marco Moscarelli
- Cardiothoracic and Vascular Department, Maria Cecilia Hospital GVM Care & Research, Via Via Corriera 1,Cotignola, 48033, Ravenna, Italy
| | - Cinzia Forleo
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Piazza G. Cesare 11, Bari (BA), 70120, Italy
| | - Palma Luisa Nestola
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Piazza G. Cesare 11, Bari (BA), 70120, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Republica 79, Latina, 04100,Latina, Italy; Mediterranea Cardiocentro, Via Orazio 2, Napoli, 80122, Napoli, Italy
| | - Arturo Giordano
- Invasive Cardiology Unit, "Pineta Grande" Hospital, Via Domitiana km 30, Castel Volturno, 81030, Caserta, Italy
| | - Stefano Favale
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Piazza G. Cesare 11, Bari (BA), 70120, Italy
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Matetic A, Doolub G, Bharadwaj A, Osman M, Biondi-Zoccai G, Ullah W, Bagur R, Velagapudi P, Alraies MC, Mohamed MO, Mamas MA. Differential impact of type 1 and type 2 diabetes mellitus on outcomes among 1.4 million US patients undergoing percutaneous coronary intervention. Cardiovasc Revasc Med 2021:S1553-8389(21)00616-3. [PMID: 34446373 DOI: 10.1016/j.carrev.2021.08.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/16/2021] [Accepted: 08/16/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND The aim was to determine the impact of diabetes mellitus (DM) on outcomes after percutaneous coronary intervention (PCI). There is limited data on the impact of DM and its subtypes among patients who underwent PCI during hospitalization. METHODS All PCI hospitalizations from the National Inpatient Sample (October 2015-December 2018) were stratified by the presence and subtype of DM. Multivariable logistic regression was performed to determine the adjusted odds ratios (aOR) of in-hospital adverse outcomes in type 1 DM (T1DM) and type 2 DM (T2DM) compared to no-DM. RESULTS Out of 1,363,800 individuals undergoing PCI, 12,640 (0.9%) had T1DM and 539,690 (39.6%) had T2DM. T1DM patients had increased aOR of major adverse cardiovascular and cerebrovascular events (MACCE) (1.26, 95%CI 1.17-1.35), mortality (1.56, 95%CI 1.41-1.72), major bleeding (1.63, 95%CI 1.45-1.84), and stroke (1.75, 95%CI 1.51-2.02), while T2DM patients had only increased aOR of MACCE (1.02, 95%CI 1.01-1.04), mortality (1.10, 95%CI 1.08-1.13) and stroke (1.22, 95%CI 1.18-1.27), compared to no-DM patients. However, both T1DM and T2DM had lower aOR of cardiac complications (0.87, 95%CI 0.77-0.97 and 0.87, 95%CI 0.85-0.89, respectively), in comparison to no-DM patients. When accounting for the indication, both DM subgroups had higher aOR of MACCE, mortality, and stroke compared to no-DM patients in the acute coronary syndrome setting (p < 0.001, for all), while only increased aOR of stroke (1.59, 95%CI 1.17-2.15 for T1DM and 1.12, 95%CI 1.05-1.20 for T2DM) persisted in the elective setting. CONCLUSIONS Patients with DM who have undergone PCI during hospitalization are more likely to experience adverse in-hospital outcomes, and T1DM patients are a particularly high-risk cohort.
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Affiliation(s)
- Riccardo Di Pietro
- UOC UTIC Emodinamica e Cardiologia, Santa Maria Goretti Hospital, Via Antonio Canova, 04100 Latina, Italy
| | - Simone Calcagno
- UOC UTIC Emodinamica e Cardiologia, Santa Maria Goretti Hospital, Via Antonio Canova, 04100 Latina, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100 Latina, Italy.,Mediterranea Cardiocentro, Via Orazio 2, 80122 Napoli, Italy
| | - Francesco Versaci
- UOC UTIC Emodinamica e Cardiologia, Santa Maria Goretti Hospital, Via Antonio Canova, 04100 Latina, Italy
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Giordano A, Biondi-Zoccai G, Finizio F, Ferraro P, Denti P, Rubbio AP, Petronio AS, Bartorelli AL, Mongiardo A, De Felice F, Adamo M, Montorfano M, Baldi C, Tarantini G, Giannini F, Ronco F, Monteforte I, Villa E, Ferrario M, Fiocca L, Castriota F, Tamburino C. Characteristics and outcomes of MitraClip in octogenarians: Evidence from 1853 patients in the GIOTTO registry. Int J Cardiol 2021:S0167-5273(21)01220-1. [PMID: 34375704 DOI: 10.1016/j.ijcard.2021.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/22/2021] [Accepted: 08/04/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND We aimed at appraising features and outcomes of patients undergoing MitraClip treatment according to their age. METHODS We queried the prospective GIse registry Of Transcatheter treatment of mitral valve regurgitaTiOn (GIOTTO) multicenter registry dataset including 19 Italian centers performing MitraClip implantation, distinguishing patients <80 vs ≥80 years of age. RESULTS In total, 1853 patients were included, 751 (40.5%) octogenarians and 1102 (59.5%) non-octogenarians. Several baseline and procedural features were significantly different, including gender, regurgitation etiology, and functional class (all p < 0.05). In-hospital outcomes were similarly satisfactory, with death occurring in 18 (2.4%) and 32 (2.9%, p = 0.561), respectively, and improvement in mitral regurgitation in 732 (97.4%) and 1078 (97.8%, p = 0.746), respectively. After a mean follow-up of 15 months, death occurred in 152 (20.2%) and 264 (24.0%), and cardiac death in 85 (11.3%) and 138 (12.5%), respectively (both p > 0.05). Rehospitalization for heart failure and the composite of cardiac death or rehospitalization for heart failure were significantly less common in octogenarians: 63 (8.4%) vs 156 (14.2%, p < 0.001), and 125 (16.6%) vs 242 (22.0%, p = 0.005), respectively. Multivariable analysis showed that these differences were largely due to confounding features, as after adjustment for baseline, clinical and imaging characteristics no significant difference was found for the above clinical endpoints. CONCLUSIONS Transcatheter mitral valve repair with the MitraClip in carefully selected octogenarians appears feasible and safe, and is associated with favorable clinical outcomes at mid-term follow-up.
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