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Ntaios G, Baumgartner H, Doehner W, Donal E, Edvardsen T, Healey JS, Iung B, Kamel H, Kasner SE, Korompoki E, Navi BB, Pristipino C, Saba L, Schnabel RB, Svennberg E, Lip GYH. Embolic strokes of undetermined source: a clinical consensus statement of the ESC Council on Stroke, the European Association of Cardiovascular Imaging and the European Heart Rhythm Association of the ESC. Eur Heart J 2024:ehae150. [PMID: 38685132 DOI: 10.1093/eurheartj/ehae150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
One in six ischaemic stroke patients has an embolic stroke of undetermined source (ESUS), defined as a stroke with unclear aetiology despite recommended diagnostic evaluation. The overall cardiovascular risk of ESUS is high and it is important to optimize strategies to prevent recurrent stroke and other cardiovascular events. The aim of clinicians when confronted with a patient not only with ESUS but also with any other medical condition of unclear aetiology is to identify the actual cause amongst a list of potential differential diagnoses, in order to optimize secondary prevention. However, specifically in ESUS, this may be challenging as multiple potential thromboembolic sources frequently coexist. Also, it can be delusively reassuring because despite the implementation of specific treatments for the individual pathology presumed to be the actual thromboembolic source, patients can still be vulnerable to stroke and other cardiovascular events caused by other pathologies already identified during the index diagnostic evaluation but whose thromboembolic potential was underestimated. Therefore, rather than trying to presume which particular mechanism is the actual embolic source in an ESUS patient, it is important to assess the overall thromboembolic risk of the patient through synthesis of the individual risks linked to all pathologies present, regardless if presumed causally associated or not. In this paper, a multi-disciplinary panel of clinicians/researchers from various backgrounds of expertise and specialties (cardiology, internal medicine, neurology, radiology and vascular surgery) proposes a comprehensive multi-dimensional assessment of the overall thromboembolic risk in ESUS patients through the composition of individual risks associated with all prevalent pathologies.
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Affiliation(s)
- George Ntaios
- Department of Internal Medicine, School of Health Sciences, University of Thessaly, Larissa University Hospital, Larissa 41132, Greece
| | - Helmut Baumgartner
- Department of Cardiology III: Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany
| | - Wolfram Doehner
- Department of Cardiology (Campus Virchow), Center of Stroke Research Berlin, German Centre for Cardiovascular Research (DZHK) partner site Berlin, Berlin Institute of Health-Center for Regenerative Therapies, Deutsches Herzzentrum der Charité, Charité, Berlin, Germany
| | - Erwan Donal
- Service de Cardiologie et CIC-IT 1414, CHU Rennes, Rennes, France
| | - Thor Edvardsen
- Department of Cardiology, Faculty of Medicine, Oslo University Hospital, Rikshospitalet, University of Oslo, Oslo, Norway
| | - Jeff S Healey
- Cardiology Division, McMaster University, Hamilton, Canada
| | - Bernard Iung
- Bichat Hospital, APHP and Université Paris-Cité, INSERM LVTS U1148, Paris, France
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Scott E Kasner
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Eleni Korompoki
- Department of Clinical Therapeutics, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Babak B Navi
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Department of Neurology, Weill Cornell Medicine, New York, NY, USA
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christian Pristipino
- Interventional and Intensive Cardiology Unit, San Filippo Neri Hospital, ASL Roma 1, Rome, Italy
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari-Polo di Monserrato, Cagliari, Italy
| | - Renate B Schnabel
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Germany
| | - Emma Svennberg
- Department of Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University, Liverpool Heart & Chest Hospital, Liverpool, UK
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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2
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Pristipino C, Germonpré P, Toni D, Sievert H, Meier B, D'Ascenzo F, Berti S, Onorato E, Bedogni F, Mas JL, Scacciatella P, Hildick-Smith D, Gaita F, Kyrle P, Thomson J, Derumeaux G, Sibbing D, Chessa M, Hornung M, Zamorano J, Dudek D. European position paper on the management of patients with patent foramen ovale. Part II - Decompression sickness, migraine, arterial deoxygenation syndromes and select high-risk clinical conditions. EUROINTERVENTION 2021; 17:e367-e375. [PMID: 33506796 PMCID: PMC9724983 DOI: 10.4244/eij-d-20-00785] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Patent foramen ovale (PFO) is implicated in the pathogenesis of a number of medical conditions but to date only one official position paper related to left circulation thromboembolism has been published. This interdisciplinary paper, prepared with the involvement of eight European scientific societies, reviews the available evidence and proposes a rationale for decision making for other PFO-related clinical conditions. In order to guarantee a strict evidence-based process, we used a modified grading of recommendations, assessment, development, and evaluation (GRADE) methodology. A critical qualitative and quantitative evaluation of diagnostic and therapeutic procedures was performed, including assessment of the risk/benefit ratio. The level of evidence and the strength of the position statements were weighed and graded according to predefined scales. Despite being based on limited and observational or low-certainty randomised data, a number of position statements were made to frame PFO management in different clinical settings, along with suggestions for new research avenues. This interdisciplinary position paper, recognising the low or very low certainty of existing evidence, provides the first approach to several PFO-related clinical scenarios beyond left circulation thromboembolism and strongly stresses the need for fresh high-quality evidence on these topics.
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Affiliation(s)
- Christian Pristipino
- San Filippo Neri - ASL Roma 1 Hospital, Via Alessandro Poerio 140, 00152 Rome, Italy
| | | | - Danilo Toni
- Hospital Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Horst Sievert
- CardioVascular Center Frankfurt (CVC Frankfurt), Frankfurt, Germany,Anglia Ruskin University, Chelmsford, United Kingdom,University California San Francisco (UCSF), San Francisco, CA, USA
| | | | - Fabrizio D'Ascenzo
- Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | | | | | | | - Jean-Louis Mas
- Hôpital Sainte-Anne, Université Paris Descartes, Paris, France
| | | | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom
| | - Fiorenzo Gaita
- Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | | | | | | | - Dirk Sibbing
- Privatklinik Lauterbacher Mühle am Ostersee, Iffeldorf and Ludwig-Maximilians-Universität (LMU) München, Munich, Germany
| | - Massimo Chessa
- IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Marius Hornung
- CardioVascular Center Frankfurt (CVC Frankfurt), Frankfurt, Germany
| | | | - Dariusz Dudek
- Jagiellonian University Medical College, Krakow, Poland,Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy
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3
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Pristipino C, Germonpré P, Toni D, Sievert H, Meier B, D'Ascenzo F, Berti S, Onorato EM, Bedogni F, Mas JL, Scacciatella P, Hildick-Smith D, Gaita F, Kyrle PA, Thomson J, Derumeaux G, Sibbing D, Chessa M, Hornung M, Zamorano J, Dudek D, D'Ascenzo F, Omedè P, Ballocca F, Barbero U, Giordana F, Gili S, Iannaccone M, Akagi T, Anzola G, Carroll J, Dalvi B, Angelis CD, Junbo G, Kasner SE, Michel-Behnke I, Musumeci G, Søndergaard L, Tarantini G, Biondi-Zoccai GGL, Capodanno D, Valgimigli M, Byrne R, Kunadian V. European position paper on the management of patients with patent foramen ovale. Part II - Decompression sickness, migraine, arterial deoxygenation syndromes and select high-risk clinical conditions. Eur Heart J 2021; 42:1545-1553. [PMID: 33507260 DOI: 10.1093/eurheartj/ehaa1070] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 10/07/2020] [Accepted: 11/17/2020] [Indexed: 02/05/2023] Open
Abstract
Patent foramen ovale (PFO) is implicated in the pathogenesis of a number of medical conditions but to date only one official position paper related to left circulation thromboembolism has been published. This interdisciplinary paper, prepared with the involvement of eight European scientific societies, reviews the available evidence and proposes a rationale for decision making for other PFO-related clinical conditions. In order to guarantee a strict evidence-based process, we used a modified grading of recommendations, assessment, development, and evaluation (GRADE) methodology. A critical qualitative and quantitative evaluation of diagnostic and therapeutic procedures was performed, including assessment of the risk/benefit ratio. The level of evidence and the strength of the position statements were weighed and graded according to predefined scales. Despite being based on limited and observational or low-certainty randomised data, a number of position statements were made to frame PFO management in different clinical settings, along with suggestions for new research avenues. This interdisciplinary position paper, recognising the low or very low certainty of existing evidence, provides the first approach to several PFO-related clinical scenarios beyond left circulation thromboembolism and strongly stresses the need for fresh high-quality evidence on these topics.
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Affiliation(s)
| | | | - Danilo Toni
- Hospital Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Horst Sievert
- CardioVascular Center Frankfurt (CVC Frankfurt), Frankfurt, Germany.,Anglia Ruskin University, Chelmsford, United Kingdom.,University California San Francisco (UCSF), San Francisco, CA, USA
| | | | - Fabrizio D'Ascenzo
- Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | | | | | | | - Jean-Louis Mas
- Hôpital Sainte-Anne, Université Paris Descartes, Paris, France
| | | | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom
| | - Fiorenzo Gaita
- Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | | | | | | | - Dirk Sibbing
- Privatklinik Lauterbacher Mühle am Ostersee, Iffeldorf and Ludwig-Maximilians-Universität (LMU) München, Munich, Germany
| | - Massimo Chessa
- IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Marius Hornung
- CardioVascular Center Frankfurt (CVC Frankfurt), Frankfurt, Germany
| | | | - Dariusz Dudek
- Jagiellonian University Medical College, Krakow, Poland.,Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy
| | | | - Fabrizio D'Ascenzo
- Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Pierluigi Omedè
- Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | | | | | | | | | | | | | | | | | - John Carroll
- University of Colorado Hospital, Denver, CO, USA
| | | | | | - Ge Junbo
- Shanghai Institute of Cardiovascular Disease, Shanghai, China
| | | | - Ina Michel-Behnke
- University Hospital for Children and Adolescents, Medical University Vienna, Vienna, Austria
| | | | | | | | | | | | | | - Davide Capodanno
- Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | | | - Robert Byrne
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Vijay Kunadian
- Newcastle University and Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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4
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Pristipino C, Filice FB. Long-term benefits and risks in patients after persistent foramen ovale closure: a contemporary approach to guide clinical decision making. Kardiol Pol 2021; 79:248-254. [PMID: 33599457 DOI: 10.33963/kp.15817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Persistent foramen ovale (PFO) is a congenital heart disease which represents 80% of atrial septal defects. It is a remnant of fetal circulation that functions in postnatal conditions as a transient interatrial right‑to‑‑left shunt of variable magnitude. Persistent foramen ovale may be implicated in the pathogenesis of several medical conditions, such as cryptogenic stroke, cryptogenic left circulation thromboembolism, migraine syndromes, and decompression sickness. The most frequent indication for PFO closure remains PFO‑associated left circulation thromboembolism. In select patients, PFO closure reduces stroke recurrence in comparison with medical therapy after more than 3 years of follow‑up on average, especially in patients with a high risk of recurrence. While in PFO‑associated left circulation embolism, there is now conclusive evidence on the growing benefit of PFO closure in long‑term follow‑up, in many other clinical conditions, the degree of certainty of the results is deceiving. In this paper, we will review the benefits and risks that one can expect in the long term after percutaneous PFO closure in various clinical scenarios in order to facilitate therapeutic decision making.
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5
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Kurnat-Thoma E, Baranova A, Baird P, Brodsky E, Butte AJ, Cheema AK, Cheng F, Dutta S, Grant C, Giordano J, Maitland-van der Zee AH, Fridsma DB, Jarrin R, Kann MG, Keeney J, Loscalzo J, Madhavan G, Maron BA, McBride DK, McKean M, Mun SK, Palmer JC, Patel B, Parakh K, Pariser AR, Pristipino C, Radstake TRDJ, Rajasimha HK, Rouse WB, Rozman D, Saleh A, Schmidt HHHW, Schultz N, Sethi T, Silverman EK, Skopac J, Svab I, Trujillo S, Valentine JE, Verma D, West BJ, Vasudevan S. Recent Advances in Systems and Network Medicine: Meeting Report from the First International Conference in Systems and Network Medicine. Syst Med (New Rochelle) 2020; 3:22-35. [PMID: 32226924 PMCID: PMC7099876 DOI: 10.1089/sysm.2020.0001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The First International Conference in Systems and Network Medicine gathered together 200 global thought leaders, scientists, clinicians, academicians, industry and government experts, medical and graduate students, postdoctoral scholars and policymakers. Held at Georgetown University Conference Center in Washington D.C. on September 11-13, 2019, the event featured a day of pre-conference lectures and hands-on bioinformatic computational workshops followed by two days of deep and diverse scientific talks, panel discussions with eminent thought leaders, and scientific poster presentations. Topics ranged from: Systems and Network Medicine in Clinical Practice; the role of -omics technologies in Health Care; the role of Education and Ethics in Clinical Practice, Systems Thinking, and Rare Diseases; and the role of Artificial Intelligence in Medicine. The conference served as a unique nexus for interdisciplinary discovery and dialogue and fostered formation of new insights and possibilities for health care systems advances.
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Affiliation(s)
- Emma Kurnat-Thoma
- National Institutes of Health, National Institute of Nursing Research (NIH/NINR), Bethesda, Maryland.,Genetics and Genomics, Georgetown University School of Nursing and Health Studies, Washington, District of Columbia
| | - Ancha Baranova
- The Chronic Metabolic and Rare Diseases Systems Biology Initiative (ChroMe RaDSBIn), School of Systems Biology, George Mason University, Fairfax, Virginia
| | - Pat Baird
- Global Software Standards, Philips, Pleasant Prairie, Wisconsin
| | | | - Atul J Butte
- Bakar Computational Health Sciences Institute, University of California San Francisco (UCSF), San Fransisco, California
| | - Amrita K Cheema
- Department of Biochemistry, Molecular and Cellular Biology, Georgetown University Medical Center, Washington, District of Columbia
| | - Feixiong Cheng
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio
| | - Shuchismita Dutta
- Research Collaboratory for Structural Bioinformatics Protein Data Bank (RCSB PDB) and Institute for Quantitative Biomedicine, Rutgers University, The State University of New Jersey, Piscataway, New Jersey
| | - Christina Grant
- Rare Disease Institute, Division of Genetics and Metabolism, Children's National Medical Center, Washington, District of Columbia
| | - James Giordano
- Department of Neurology, Neuroethics Studies Program-Pellegrino Center for Clinical Bioethics, and O'Neill-Pellegrino Program in Brain Sciences and Global Law and Policy, Georgetown University Medical Center, Washington, District of Columbia.,Department of Biochemistry, Neuroethics Studies Program-Pellegrino Center for Clinical Bioethics, and O'Neill-Pellegrino Program in Brain Sciences and Global Law and Policy, Georgetown University Medical Center, Washington, District of Columbia
| | - Anke H Maitland-van der Zee
- Department of Respiratory Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Douglas B Fridsma
- American Medical Informatics Association, Washington, District of Columbia
| | - Robert Jarrin
- Department of Biochemistry, Molecular and Cellular Biology, Georgetown University Medical Center, Washington, District of Columbia
| | - Maricel G Kann
- Department of Biological Sciences, University of Maryland Baltimore County, Baltimore, Maryland
| | - Jonathon Keeney
- Department of Biochemistry and Molecular Medicine, George Washington University, Washington, District of Columbia
| | - Joseph Loscalzo
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Guru Madhavan
- National Academy of Engineering, The National Academies of Sciences, Engineering, and Medicine, Washington, District of Columbia
| | - Bradley A Maron
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Dennis K McBride
- Center for Advanced Healthcare Learning and Simulation (CAHLS), Washington, District of Columbia
| | - Maeve McKean
- Georgetown University Global Health Initiative, Georgetown University Medical Center, Washington, District of Columbia
| | - Seong K Mun
- Arlington Innovation Center, Health Research, Virginia Tech, Arlington, Virginia
| | | | - Bakul Patel
- Center for Devices and Radiological Health, Food and Drug Administration, White Oak, Maryland
| | | | - Anne R Pariser
- National Institutes of Health, National Center for Advancing Translational Sciences (NIH/NCATS), Bethesda, Maryland
| | - Christian Pristipino
- Interventional Cardiology Unit, San Filippo Neri ASL Roma 1 Hospital, Rome, Italy.,Italian Association for Systems Medicine and Healthcare (ASSIMSS), Rome, Italy
| | - Timothy R D J Radstake
- Department of Rheumatology, Clinical Immunology and Center of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Harsha K Rajasimha
- The Chronic Metabolic and Rare Diseases Systems Biology Initiative (ChroMe RaDSBIn), School of Systems Biology, George Mason University, Fairfax, Virginia.,Jeeva Informatics Solutions, Inc., Reston, Virginia
| | - William B Rouse
- McCourt School of Public Policy, Georgetown University, Washington, District of Columbia
| | - Damjana Rozman
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Harald H H W Schmidt
- Department of Pharmacology & Personalized Medicine, Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Nikolaus Schultz
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Tavpritesh Sethi
- Department of Computational Biology, Indraprastha Institute of Information Technology Delhi (IIIT), Delhi, India
| | - Edwin K Silverman
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Igor Svab
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Sylvia Trujillo
- Life Sciences/Digital Medicine, American Medical Association, Washington, District of Columbia
| | - James E Valentine
- Hyman, Phelps & McNamara PC, Washington, District of Columbia.,University of Maryland Carey School of Law, Baltimore Maryland
| | - Dinesh Verma
- Systems Engineering Research Center (SERC), Stevens Institute of Technology, New Jersey
| | - Bruce J West
- Army Research Laboratory, Army Research Office, Durham, North Carolina
| | - Sona Vasudevan
- Department of Biochemistry, Molecular and Cellular Biology, Georgetown University Medical Center, Washington, District of Columbia
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6
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Ahmed N, Audebert H, Turc G, Cordonnier C, Christensen H, Sacco S, Sandset EC, Ntaios G, Charidimou A, Toni D, Pristipino C, Köhrmann M, Kuramatsu JB, Thomalla G, Mikulik R, Ford GA, Martí-Fàbregas J, Fischer U, Thoren M, Lundström E, Rinkel GJ, van der Worp HB, Matusevicius M, Tsivgoulis G, Milionis H, Rubiera M, Hart R, Moreira T, Lantz M, Sjöstrand C, Andersen G, Schellinger P, Kostulas K, Sunnerhagen KS, Keselman B, Korompoki E, Purrucker J, Khatri P, Whiteley W, Berge E, Mazya M, Dippel DW, Mustanoja S, Rasmussen M, Söderqvist ÅK, Escudero-Martínez I, Steiner T. Consensus statements and recommendations from the ESO-Karolinska Stroke Update Conference, Stockholm 11-13 November 2018. Eur Stroke J 2019; 4:307-317. [PMID: 31903429 DOI: 10.1177/2396987319863606] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 06/22/2019] [Indexed: 11/16/2022] Open
Abstract
The purpose of the European Stroke Organisation-Karolinska Stroke Update Conference is to provide updates on recent stroke therapy research and to give an opportunity for the participants to discuss how these results may be implemented into clinical routine. The meeting started 22 years ago as Karolinska Stroke Update, but since 2014 it is a joint conference with European Stroke Organisation. Importantly, it provides a platform for discussion on the European Stroke Organisation guidelines process and on recommendations to the European Stroke Organisation guidelines committee on specific topics. By this, it adds a direct influence from stroke professionals otherwise not involved in committees and work groups on the guideline procedure. The discussions at the conference may also inspire new guidelines when motivated. The topics raised at the meeting are selected by the scientific programme committee mainly based on recent important scientific publications. This year's European Stroke Organisation-Karolinska Stroke Update Meeting was held in Stockholm on 11-13 November 2018. There were 11 scientific sessions discussed in the meeting including two short sessions. Each session except the short sessions produced a consensus statement (Full version with background, issues, conclusions and references are published as web-material and at www.eso-karolinska.org and http://eso-stroke.org) and recommendations which were prepared by a writing committee consisting of session chair(s), scientific secretary and speakers. These statements were presented to the 250 participants of the meeting. In the open meeting, general participants commented on the consensus statement and recommendations and the final document were adjusted based on the discussion from the general participants Recommendations (grade of evidence) were graded according to the 1998 Karolinska Stroke Update meeting with regard to the strength of evidence. Grade A Evidence: Strong support from randomised controlled trials and statistical reviews (at least one randomised controlled trial plus one statistical review). Grade B Evidence: Support from randomised controlled trials and statistical reviews (one randomised controlled trial or one statistical review). Grade C Evidence: No reasonable support from randomised controlled trials, recommendations based on small randomised and/or non-randomised controlled trials evidence.
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Affiliation(s)
- Niaz Ahmed
- Department of Neurology, Karolinska University Hospital, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (N Ahmed, Conference Chair)
| | - Heinrich Audebert
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Guillaume Turc
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences & Université de Paris & INSERM U1266, Paris, France
| | - Charlotte Cordonnier
- Department of Neurology, Stroke Unit, Roger Salengro Hospital, 59037 Lille, France
| | - Hanne Christensen
- Department of Neurology Neurology, Stroke Consultant at Bispebjerg & Frederiksberg Hospitals, Copenhagen, Denmark
| | - Simona Sacco
- Department of Applied Clinical sciences and Biotechnology, Section of Neurology, University of L'Alquila, L'Alquila, Italy
| | | | - George Ntaios
- Department of Internal Medicine, Larissa University Hospital, School of Medicine, University of Thessaly, Biopolis, Larissa, Greece
| | - Andreas Charidimou
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Danilo Toni
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Pristipino
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Köhrmann
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Joji B Kuramatsu
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Götz Thomalla
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Robert Mikulik
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Gary A Ford
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Joan Martí-Fàbregas
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Urs Fischer
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Magnus Thoren
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Erik Lundström
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Gabriel Je Rinkel
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - H Bart van der Worp
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Marius Matusevicius
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Georgios Tsivgoulis
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Haralampos Milionis
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Marta Rubiera
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Robert Hart
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Tiago Moreira
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Maria Lantz
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Christina Sjöstrand
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Grethe Andersen
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Schellinger
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Konstantinos Kostulas
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Stibrant Sunnerhagen
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Boris Keselman
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Eleni Korompoki
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Purrucker
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Pooja Khatri
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - William Whiteley
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Eivind Berge
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Mazya
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Diederik Wj Dippel
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Satu Mustanoja
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Mads Rasmussen
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Åsa Kuntze Söderqvist
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Irene Escudero-Martínez
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
| | - Thorsten Steiner
- Department of Neurology, Charité -- Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany. Center for Stroke Research, Charité -- Universitätsmedizin Berlin, Berlin, Germany
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7
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Kedra J, Radstake T, Pandit A, Baraliakos X, Berenbaum F, Finckh A, Fautrel B, Stamm TA, Gomez-Cabrero D, Pristipino C, Choquet R, Servy H, Stones S, Burmester G, Gossec L. Current status of use of big data and artificial intelligence in RMDs: a systematic literature review informing EULAR recommendations. RMD Open 2019; 5:e001004. [PMID: 31413871 PMCID: PMC6668041 DOI: 10.1136/rmdopen-2019-001004] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 05/09/2019] [Revised: 06/26/2019] [Accepted: 06/29/2019] [Indexed: 12/27/2022] Open
Abstract
Objective To assess the current use of big data and artificial intelligence (AI) in the field of rheumatic and musculoskeletal diseases (RMDs). Methods A systematic literature review was performed in PubMed MEDLINE in November 2018, with key words referring to big data, AI and RMDs. All original reports published in English were analysed. A mirror literature review was also performed outside of RMDs on the same number of articles. The number of data analysed, data sources and statistical methods used (traditional statistics, AI or both) were collected. The analysis compared findings within and beyond the field of RMDs. Results Of 567 articles relating to RMDs, 55 met the inclusion criteria and were analysed, as well as 55 articles in other medical fields. The mean number of data points was 746 million (range 2000–5 billion) in RMDs, and 9.1 billion (range 100 000–200 billion) outside of RMDs. Data sources were varied: in RMDs, 26 (47%) were clinical, 8 (15%) biological and 16 (29%) radiological. Both traditional and AI methods were used to analyse big data (respectively, 10 (18%) and 45 (82%) in RMDs and 8 (15%) and 47 (85%) out of RMDs). Machine learning represented 97% of AI methods in RMDs and among these methods, the most represented was artificial neural network (20/44 articles in RMDs). Conclusions Big data sources and types are varied within the field of RMDs, and methods used to analyse big data were heterogeneous. These findings will inform a European League Against Rheumatism taskforce on big data in RMDs.
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Affiliation(s)
- Joanna Kedra
- Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), UMR S 1136, Sorbonne Universite, Paris, France.,Rheumatology Department, Hôpital Universitaire Pitié Salpêtrière, APHP, Paris, France
| | - Timothy Radstake
- Department of Rheumatology, Clinical Immunology and Laboratory for Translational Immunology, University of Utrecht Faculty of Medicine, Utrecht, The Netherlands
| | - Aridaman Pandit
- Department of Rheumatology, Clinical Immunology and Laboratory for Translational Immunology, University of Utrecht Faculty of Medicine, Utrecht, The Netherlands
| | | | - Francis Berenbaum
- Rheumatology Department, Hospital Saint-Antoine, APHP, Paris, Île-de-France, France
| | - Axel Finckh
- Division of Rheumatology, University Hospital of Geneva, Geneva, Switzerland
| | - Bruno Fautrel
- Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), UMR S 1136, Sorbonne Universite, Paris, France.,Rheumatology Department, Hôpital Universitaire Pitié Salpêtrière, APHP, Paris, France
| | - Tanja A Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - David Gomez-Cabrero
- Departamento de Salud-Universidad Pública de Navarra, Translational Bioinformatics Unit, Navarra Biomed, Pamplona, Spain
| | | | | | | | - Simon Stones
- School of Healthcare, University of Leeds, Leeds, West Yorkshire, UK
| | - Gerd Burmester
- Department of Rheumatology and Clinical Immunology, Charité - University Medicine Berlin, Berlin, Germany
| | - Laure Gossec
- Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), UMR S 1136, Sorbonne Universite, Paris, France.,Rheumatology Department, Hôpital Universitaire Pitié Salpêtrière, APHP, Paris, France
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8
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Gossec L, Kedra J, Servy H, Pandit A, Stones S, Berenbaum F, Finckh A, Baraliakos X, Stamm TA, Gomez-Cabrero D, Pristipino C, Choquet R, Burmester GR, Radstake TRDJ. EULAR points to consider for the use of big data in rheumatic and musculoskeletal diseases. Ann Rheum Dis 2019; 79:69-76. [PMID: 31229952 DOI: 10.1136/annrheumdis-2019-215694] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [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: 05/10/2019] [Revised: 06/07/2019] [Accepted: 06/07/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Tremendous opportunities for health research have been unlocked by the recent expansion of big data and artificial intelligence. However, this is an emergent area where recommendations for optimal use and implementation are needed. The objective of these European League Against Rheumatism (EULAR) points to consider is to guide the collection, analysis and use of big data in rheumatic and musculoskeletal disorders (RMDs). METHODS A multidisciplinary task force of 14 international experts was assembled with expertise from a range of disciplines including computer science and artificial intelligence. Based on a literature review of the current status of big data in RMDs and in other fields of medicine, points to consider were formulated. Levels of evidence and strengths of recommendations were allocated and mean levels of agreement of the task force members were calculated. RESULTS Three overarching principles and 10 points to consider were formulated. The overarching principles address ethical and general principles for dealing with big data in RMDs. The points to consider cover aspects of data sources and data collection, privacy by design, data platforms, data sharing and data analyses, in particular through artificial intelligence and machine learning. Furthermore, the points to consider state that big data is a moving field in need of adequate reporting of methods and benchmarking, careful data interpretation and implementation in clinical practice. CONCLUSION These EULAR points to consider discuss essential issues and provide a framework for the use of big data in RMDs.
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Affiliation(s)
- Laure Gossec
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Universite, Paris, France .,APHP, Rheumatology Department, Pitie Salpetriere Hospital, Paris, France
| | - Joanna Kedra
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Universite, Paris, France.,APHP, Rheumatology Department, Pitie Salpetriere Hospital, Paris, France
| | | | - Aridaman Pandit
- Dept of Rheumatology, Clinical Immunology and Laboratory of Translational Immunology, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - Simon Stones
- School of Healthcare, University of Leeds, Leeds, UK
| | - Francis Berenbaum
- Rheumatology, St Antoine Hospital, Sorbonne Université, INSERM, Paris, France
| | - Axel Finckh
- Division of Rheumatology, University of Geneva, Geneva, Switzerland
| | - Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet Sankt Josefs-Krankenhaus, Herne, Germany.,Ruhr-Universitat Bochum, Bochum, Germany
| | - Tanja A Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - David Gomez-Cabrero
- Translational Bioinformatics Unit, Navarra Biomed, Departamento de Salud-Universidad Públicade Navarra, Pamplona, Navarra, Spain
| | | | | | - Gerd R Burmester
- Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany
| | - Timothy R D J Radstake
- Dept of Rheumatology, Clinical Immunology and Laboratory of Translational Immunology, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
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9
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Pristipino C, Roncella A, Pasceri V, Speciale G. Short-TErm Psychotherapy IN Acute Myocardial Infarction (STEP-IN-AMI) Trial: Final Results. Am J Med 2019; 132:639-646.e5. [PMID: 30659815 DOI: 10.1016/j.amjmed.2018.12.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 12/10/2018] [Accepted: 12/11/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this research was to assess whether short-term psychotherapy enhances long-term clinical outcomes in patients with a recent acute myocardial infarction (AMI). METHODS Patients ≤70 years old were randomized within 1 week of their AMI to short-term ontopsychological psychotherapy plus routine medical therapy vs routine medical therapy only. The primary composite outcome was defined as the combined incidence of new cardiovascular events (re-infarction, death, stroke, revascularization, life-threatening ventricular arrhythmias, and the recurrence of clinically significant angina) and clinically significant new comorbidities. Secondary outcome measures were: rates for individual components of the primary composite outcome; the rate of re-hospitalization for cardiovascular problems; and New York Heart Association functional class. RESULTS Ninety-four patients were analyzed, translating into 425 patient-years. The 2 treatment groups were similar across baseline characteristics. At 5-year follow-up, psychotherapy patients had a lower incidence of primary outcome, relative to controls (77/223 vs 98/202 patient-years, respectively; P = .035; absolute risk reduction = 19%, number needed to treat = 8); this benefit was attributable to the lower incidence of new comorbidities and clinically significant angina in the psychotherapy group. Gains in the primary outcome, relative to controls, among psychotherapy patients occurred in the first year and subsequently remained stable over the following 4 years. CONCLUSIONS Adding short-term ontopsychological psychotherapy to routine secondary prevention of myocardial infarction improves clinical outcomes overall up to 5 years post AMI. Studying time trends may aid in better targeting of psychological interventions during follow-up. Larger studies remain necessary to confirm these results. TRIAL REGISTRATION www.ClinicalTrial.gov NCT00769366.
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Affiliation(s)
| | - Adriana Roncella
- Interventional Cardiology Unit, San Filippo Neri Hospital, Rome, Italy
| | - Vincenzo Pasceri
- Interventional Cardiology Unit, San Filippo Neri Hospital, Rome, Italy
| | - Giulio Speciale
- Interventional Cardiology Unit, San Filippo Neri Hospital, Rome, Italy
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10
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Scacciatella P, Jorfida M, Biava LM, Meynet I, Zema D, D’Ascenzo F, Pristipino C, Cerrato P, Giustetto C, Gaita F. Insertable cardiac monitor detection of silent atrial fibrillation in candidates for percutaneous patent foramen ovale closure. J Cardiovasc Med (Hagerstown) 2019; 20:290-296. [DOI: 10.2459/jcm.0000000000000790] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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11
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Abstract
Patent foramen ovale (PFO) is associated with a number of clinical syndromes in which it plays variable roles that, often, cannot be accurately determined. This situation creates conflicting data and controversial studies. However, in 2017 and 2018, four randomized clinical trials have been published, allowing for the clarification of certain issues pertaining to cryptogenic stroke. Shortly after this, 8 European scientific societies collaborated to publish the first official international position paper on PFO and cryptogenic stroke, based upon best-available evidence. In the current report, the main positions are presented, relating to PFO diagnosis, general management, and therapeutic choices. Generally speaking, given the complexity of PFO roles, an interdisciplinary and personalized approach was chosen, especially taking into consideration patient involvement at all stages of management. This approach is not suitably addressed by standard guidelines, but can be accommodated in a position statement like this. For this reason, it was possible to offer an approach capable of aiding clinicians to make rational, patient-shared decisions, even when the available evidence is either weak or scarce.
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12
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Pristipino C, Sievert H, D'Ascenzo F, Mas JL, Meier B, Scacciatella P, Hildick-Smith D, Gaita F, Toni D, Kyrle P, Thomson J, Derumeaux G, Onorato E, Sibbing D, Germonpré P, Berti S, Chessa M, Bedogni F, Dudek D, Hornung M, Zamorano J. European position paper on the management of patients with patent foramen ovale. General approach and left circulation thromboembolism. EUROINTERVENTION 2019; 14:1389-1402. [PMID: 30141306 DOI: 10.4244/eij-d-18-00622] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [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: 09/03/2023]
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13
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Pristipino C, Sievert H, D’Ascenzo F, Louis Mas J, Meier B, Scacciatella P, Hildick-Smith D, Gaita F, Toni D, Kyrle P, Thomson J, Derumeaux G, Onorato E, Sibbing D, Germonpré P, Berti S, Chessa M, Bedogni F, Dudek D, Hornung M, Zamorano J, D’Ascenzo F, Omedè P, Ballocca F, Barbero U, Giordana F, Gili S, Iannaccone M, Capodanno D, Valgimigli M, Byrne R, Akagi T, Carroll J, Dalvi B, Ge J, Kasner S, Michel-Behnke I, Pedra C, Rhodes J, Søndergaard L, Thomassen L, Biondi-Zoccai GGL. European position paper on the management of patients with patent foramen ovale. General approach and left circulation thromboembolism. Eur Heart J 2018; 40:3182-3195. [PMID: 30358849 DOI: 10.1093/eurheartj/ehy649] [Citation(s) in RCA: 165] [Impact Index Per Article: 27.5] [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: 09/24/2018] [Accepted: 09/28/2018] [Indexed: 02/05/2023] Open
Abstract
Abstract
The presence of a patent foramen ovale (PFO) is implicated in the pathogenesis of a number of medical conditions; however, the subject remains controversial and no official statements have been published. This interdisciplinary paper, prepared with involvement of eight European scientific societies, aims to review the available trial evidence and to define the principles needed to guide decision making in patients with PFO. In order to guarantee a strict process, position statements were developed with the use of a modified grading of recommendations assessment, development, and evaluation (GRADE) methodology. A critical qualitative and quantitative evaluation of diagnostic and therapeutic procedures was performed, including assessment of the risk/benefit ratio. The level of evidence and the strength of the position statements of particular management options were weighed and graded according to predefined scales. Despite being based often on limited and non-randomised data, while waiting for more conclusive evidence, it was possible to conclude on a number of position statements regarding a rational general approach to PFO management and to specific considerations regarding left circulation thromboembolism. For some therapeutic aspects, it was possible to express stricter position statements based on randomised trials. This position paper provides the first largely shared, interdisciplinary approach for a rational PFO management based on the best available evidence.
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Affiliation(s)
| | - Horst Sievert
- CardioVascular Center (CVC) Frankfurt, Frankfurt, Germany
- Anglia Ruskin University, Chelmsford, United Kingdom, and University of California San Francisco (UCSF), San Francisco, USA
| | - Fabrizio D’Ascenzo
- Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Jean Louis Mas
- Hôpital Sainte-Anne, Université Paris Descartes, Paris, France
| | | | - Paolo Scacciatella
- Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom
| | - Fiorenzo Gaita
- Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Danilo Toni
- Hospital Policlinico Umberto I, Sapienza University, Rome, Italy
| | | | | | | | | | - Dirk Sibbing
- Campus Großhadern, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | | | | | - Massimo Chessa
- Policlinico, San Donato, University Hospital, San Donato Milanese, Milan, Italy
| | - Francesco Bedogni
- Policlinico, San Donato, University Hospital, San Donato Milanese, Milan, Italy
| | | | - Marius Hornung
- CardioVascular Center (CVC) Frankfurt, Frankfurt, Germany
| | | | - Fabrizio D’Ascenzo
- Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Pierluigi Omedè
- Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Flavia Ballocca
- Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Umberto Barbero
- Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Francesca Giordana
- Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Sebastiano Gili
- Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Mario Iannaccone
- Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Davide Capodanno
- Azienda Ospedaliero-Universitaria “Policlinico-Vittorio Emanuele”, University of Catania, Catania, Italy
| | | | - Robert Byrne
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | | | - John Carroll
- University of Colorado Hospital, Denver, CO, USA
| | | | - Junbo Ge
- Shanghai Institute of Cardiovascular Disease, Shanghai, China
| | - Scott Kasner
- University of Pennsylvania, Philadelphia, PA, USA
| | | | - Carlos Pedra
- Dante Pazzanese Instituto de Cardiologia, Sao Paulo, Brazil
| | - John Rhodes
- Nicklaus Children’s Hospital, Miami, USA, FL
| | | | | | - Giuseppe G L Biondi-Zoccai
- Sapienza University of Rome, Latina, Italy
- Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy
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14
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Morello E, Malagola M, Bernardi S, Pristipino C, Russo D. The role of allogeneic hematopoietic stem cell transplantation in the four P medicine era. Blood Res 2018; 53:3-6. [PMID: 29662853 PMCID: PMC5898991 DOI: 10.5045/br.2018.53.1.3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 02/28/2018] [Accepted: 03/09/2018] [Indexed: 12/11/2022] Open
Affiliation(s)
- Enrico Morello
- Clinical and Experimental Sciences Department, University of Brescia, Bone Marrow Transplant Unit, ASST Spedali Civili, Brescia, Italy
| | - Michele Malagola
- Clinical and Experimental Sciences Department, University of Brescia, Bone Marrow Transplant Unit, ASST Spedali Civili, Brescia, Italy
| | - Simona Bernardi
- Clinical and Experimental Sciences Department, University of Brescia, Bone Marrow Transplant Unit, ASST Spedali Civili, Brescia, Italy
| | | | - Domenico Russo
- Clinical and Experimental Sciences Department, University of Brescia, Bone Marrow Transplant Unit, ASST Spedali Civili, Brescia, Italy
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15
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Melina G, Angeloni E, Refice S, Benegiamo C, Lechiancole A, Matteucci M, Roscitano A, Bianchini R, Capuano F, Comito C, Spitaleri P, Tonelli E, Speciale G, Pristipino C, Monti F, Serdoz R, Paneni F, Sinatra R. Residual SYNTAX score following coronary artery bypass grafting. Eur J Cardiothorac Surg 2017; 51:547-553. [PMID: 28007880 DOI: 10.1093/ejcts/ezw356] [Citation(s) in RCA: 5] [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: 09/07/2015] [Accepted: 08/29/2016] [Indexed: 12/14/2022] Open
Abstract
Objectives To quantify residual coronary artery disease measured using the SYNTAX score (SS) and its relation to outcomes after coronary artery bypass grafting (CABG). Methods We conducted a retrospective analysis on a consecutive series of 1608 patients [mean age 68 years, standard deviation (SD): 7, F:M, 242:1366] undergoing first-time isolated CABG from 2004 to 2015. The baseline SS was retrospectively determined from preoperative angiograms, and the residual SS (rSS) was measured during assessment of the actual operative report for each patient after CABG. Patients were then stratified according to tercile cut points of low (rSS low 0-11, N = 537), intermediate (rSS mid >11-18.5, N = 539) and high residual SS (rSS high >18.5, N = 532). The Cox regression model was used to investigate the impact of rSS on major adverse cardiac and cerebrovascular events (MACCE) at 1 year. Results The mean preoperative SS was 26.6 (SD: 9.4) (range 10.1-53), and the residual SS after CABG was 15.3 (SD: 8.4) (range 0-34) ( P < 0.001 versus preoperative). At 1 year, cumulative incidence of MACCE in the low rSS was 1.5% ( N = 8/537), 4.5% ( N = 24/539) in the intermediate and 8.8% ( N = 47/532) in the high rSS group. Kaplan-Meier analysis showed a statistically significant difference of MACCE-free survival between the three groups (log-rank test, P < 0.001). The estimated MACCE-free survival rate at 1 year was 98.1% [standard error (SE): 1.6] for the rSS low , 95.5% (SE: 1.9) for the rSS mid , and 90.5% (SE: 1.3) for the rSS high group, respectively. After multivariable adjustment, the rSS high group was independently associated with a higher incidence of MACCE at 1 year (hazard ratio 1.92, 95% confidence interval 1.21-3.23) compared to the rSS low group. Conclusions These unanticipated findings suggest that a residual SS may be a useful tool for risk stratification of patients undergoing isolated first-time CABG. Our study may set the stage for further investigations addressing this important clinical question.
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Affiliation(s)
- Giovanni Melina
- Department of Cardiac Surgery, Ospedale Sant'Andrea, Rome, Italy
| | | | - Simone Refice
- Department of Cardiac Surgery, Ospedale Sant'Andrea, Rome, Italy
| | | | | | - Maria Matteucci
- Department of Cardiac Surgery, Ospedale Sant'Andrea, Rome, Italy
| | | | | | - Fabio Capuano
- Department of Cardiac Surgery, Ospedale Sant'Andrea, Rome, Italy
| | - Cosimo Comito
- Department of Cardiac Surgery, Ospedale Sant'Andrea, Rome, Italy
| | - Pietro Spitaleri
- Department of Cardiac Surgery, Ospedale Sant'Andrea, Rome, Italy
| | - Euclide Tonelli
- Department of Cardiac Surgery, Ospedale Sant'Andrea, Rome, Italy
| | - Giulio Speciale
- Catheterization Laboratory, Ospedale San Filippo Neri, Rome, Italy
| | | | - Francesco Monti
- Department of Cardiology, Ospedale San Pietro Fatebenefratelli, Rome, Italy
| | - Roberto Serdoz
- Department of Cardiology, Ospedale San Pietro Fatebenefratelli, Rome, Italy
| | - Francesco Paneni
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Riccardo Sinatra
- Department of Cardiac Surgery, Ospedale Sant'Andrea, Rome, Italy
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16
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Casu G, Gulizia MM, Molon G, Mazzone P, Audo A, Casolo G, Di Lorenzo E, Portoghese M, Pristipino C, Ricci RP, Themistoclakis S, Padeletti L, Tondo C, Berti S, Oreglia JA, Gerosa G, Zanobini M, Ussia GP, Musumeci G, Romeo F, Di Bartolomeo R. ANMCO/AIAC/SICI-GISE/SIC/SICCH Consensus Document: percutaneous occlusion of the left atrial appendage in non-valvular atrial fibrillation patients: indications, patient selection, staff skills, organisation, and training. Eur Heart J Suppl 2017; 19:D333-D353. [PMID: 28751849 PMCID: PMC5520759 DOI: 10.1093/eurheartj/sux008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia and its prevalence is increasing due to the progressive aging of the population. About 20% of strokes are attributable to AF and AF patients are at five-fold increased risk of stroke. The mainstay of treatment of AF is the prevention of thromboembolic complications with oral anticoagulation therapy. Drug treatment for many years has been based on the use of vitamin K antagonists, but recently newer and safer molecules have been introduced (dabigatran etexilate, rivaroxaban, apixaban, and edoxaban). Despite these advances, many patients still do not receive adequate anticoagulation therapy because of contraindications (relative and absolute) to this treatment. Over the last decade, percutaneous closure of left atrial appendage, main site of thrombus formation during AF, proved effective in reducing thromboembolic complications, thus offering a valid medical treatment especially in patients at increased bleeding risk. The aim of this consensus document is to review the main aspects of left atrial appendage occlusion (selection and multidisciplinary assessment of patients, currently available methods and devices, requirements for centres and operators, associated therapies and follow-up modalities) having as a ground the significant evolution of techniques and the available relevant clinical data.
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Affiliation(s)
- Gavino Casu
- CCU-Cardiology Department, Ospedale San Francesco Nuoro, Via Mannironi, 1 Nuoro, Italy
- Corresponding author. Tel: +393356623601, Fax: +390784240376,
| | - Michele Massimo Gulizia
- Cardiology Department, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione “Garibaldi, Catania”, Italy
| | - Giulio Molon
- Cardiology Unit Ospedale Sacro Cuore, Negrar (Verona), Italy
| | - Patrizio Mazzone
- Arrhythmology and Electrophysiology Unit, Ospedale San Raffaele, Milan, Italy
| | - Andrea Audo
- Cardiac Surgery Unit, Ospedale Civile SS. Antonio e Biagio, Alessandria, Italy
| | - Giancarlo Casolo
- Cardiology Department, Nuovo Ospedale Versilia, Lido di Camaiore (Lucca), Italy
| | | | | | | | - Renato Pietro Ricci
- CCU-Cardiology Department Presidio Ospedaliero San Filippo Neri, Rome, Italy
| | - Sakis Themistoclakis
- Electrophysiology and Electrostimulation Department, Ospedale dell’Angelo, Venice Mestre, Italy
| | - Luigi Padeletti
- Experimental and Clinical Medicine Department, Università degli Studi, Florence, Italy
| | - Claudio Tondo
- Arrhythmology Unit, Centro Cardiologico Monzino, Milan, Italy
| | - Sergio Berti
- Diagnostic and Interventional Cardiology Department, Fondazione Toscana “G. Monasterio”, Ospedale del Cuore, Massa, Italy
| | | | - Gino Gerosa
- Cardiac Surgery Unit—Centro V. Gallucci, Azienda Ospedaliera di Padova, Padua, Italy
| | - Marco Zanobini
- Cardiac Surgery Unit, Centro Cardiologico Monzino, Milan, Italy
| | - Gian Paolo Ussia
- Systems Medicine Department, Università degli Studi di Roma “Tor Vergata”, Rome, Italy
| | | | - Francesco Romeo
- Cardiology and Interventional Cardiology, Policlinico “Tor Vergata”, Rome, Italy
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17
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Casu G, Gulizia MM, Molon G, Mazzone P, Audo A, Casolo G, Di Lorenzo E, Portoghese M, Pristipino C, Ricci RP, Themistoclakis S, Padeletti L, Tondo C, Berti S, Oreglia JA, Gerosa G, Zanobini M, Ussia GP, Musumeci G, Romeo F, Di Bartolomeo R. [ANMCO/AIAC/SICI-GISE/SIC/SICCH Consensus document: Percutaneous left atrial appendage occlusion in patients with nonvalvular atrial fibrillation: indications, patient selection, competences, organization, and operator training]. G Ital Cardiol (Rome) 2016; 17:594-613. [PMID: 27571335 DOI: 10.1714/2330.25054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia and its prevalence is increasing due to the progressive aging of the population. About 20% of strokes are attributable to AF and AF patients are at 5-fold increased risk of stroke. The mainstay of treatment of AF is the prevention of thromboembolic complications with oral anticoagulation therapy. Drug treatment for many years has been based on the use of vitamin K antagonists, but recently newer and safer molecules have been introduced (dabigatran etexilate, rivaroxaban, apixaban and edoxaban). Despite these advances, many patients still do not receive adequate anticoagulation therapy because of contraindications (relative and absolute) to this treatment. Over the last decade, percutaneous closure of left atrial appendage, main site of thrombus formation during AF, proved effective in reducing thromboembolic complications, thus offering a valid medical treatment especially in patients at increased bleeding risk. The aim of this consensus document is to review the main aspects of left atrial appendage occlusion (selection and multidisciplinary assessment of patients, currently available methods and devices, requirements for centers and operators, associated therapies and follow-up modalities) having as a ground the significant evolution of techniques and the available relevant clinical data.
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Affiliation(s)
- Gavino Casu
- Cardiologia-UTIC, Ospedale San Francesco, Nuoro
| | - Michele Massimo Gulizia
- U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania
| | - Giulio Molon
- U.O. Cardiologia, Ospedale Sacro Cuore, Negrar (VR)
| | - Patrizio Mazzone
- Unità Aritmologia ed Elettrofisiologia, Ospedale San Raffaele, Milano
| | - Andrea Audo
- Divisione di Cardiochirurgia, Ospedale Civile SS. Antonio e Biagio, Alessandria
| | - Giancarlo Casolo
- S.C. Cardiologia, Nuovo Ospedale Versilia, Lido di Camaiore (LU)
| | | | | | | | | | - Sakis Themistoclakis
- U.O.S.D. Elettrofisiologia Elettrostimolazione, Ospedale dell'Angelo, Venezia Mestre
| | - Luigi Padeletti
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi, Firenze
| | | | - Sergio Berti
- U.O.C. Cardiologia Diagnostica e Interventistica, Fondazione Toscana "G. Monasterio", Ospedale del Cuore, Massa
| | | | - Gino Gerosa
- Cardiochirurgia - Centro V. Gallucci, Azienda Ospedaliera di Padova, Padova
| | | | - Gian Paolo Ussia
- Dipartimento Medicina dei Sistemi, Università degli Studi di Roma "Tor Vergata", Roma
| | | | - Francesco Romeo
- U.O.C. Cardiologia e Cardiologia Interventistica, Policlinico "Tor Vergata", Roma
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Pristipino C. Systems medicine as a scientific method for individualizing therapies in cardiology. Monaldi Arch Chest Dis 2015; 78:3-5. [DOI: 10.4081/monaldi.2012.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Cesario A, Auffray C, Agusti A, Apolone G, Balling R, Barbanti P, Bellia A, Boccia S, Bousquet J, Cardaci V, Cazzola M, Dall'Armi V, Daraselia N, Ros LD, Bufalo AD, Ducci G, Ferri L, Fini M, Fossati C, Gensini G, Granone PM, Kinross J, Lauro D, Cascio GL, Lococo F, Lococo A, Maier D, Marcus F, Margaritora S, Marra C, Minati G, Neri M, Pasqua F, Pison C, Pristipino C, Roca J, Rosano G, Rossini PM, Russo P, Salinaro G, Shenhar S, Soreq H, Sterk PJ, Stocchi F, Torti M, Volterrani M, Wouters EFM, Frustaci A, Bonassi S. A systems medicine clinical platform for understanding and managing non- communicable diseases. Curr Pharm Des 2015; 20:5945-56. [PMID: 24641232 DOI: 10.2174/1381612820666140314130449] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 03/12/2014] [Indexed: 11/22/2022]
Abstract
Non-Communicable Diseases (NCDs) are among the most pressing global health problems of the twenty-first century. Their rising incidence and prevalence is linked to severe morbidity and mortality, and they are putting economic and managerial pressure on healthcare systems around the world. Moreover, NCDs are impeding healthy aging by negatively affecting the quality of life of a growing number of the global population. NCDs result from the interaction of various genetic, environmental and habitual factors, and cluster in complex ways, making the complex identification of resulting phenotypes not only difficult, but also a top research priority. The degree of complexity required to interpret large patient datasets generated by advanced high-throughput functional genomics assays has now increased to the point that novel computational biology approaches are essential to extract information that is relevant to the clinical decision-making process. Consequently, system-level models that interpret the interactions between extensive tissues, cellular and molecular measurements and clinical features are also being created to identify new disease phenotypes, so that disease definition and treatment are optimized, and novel therapeutic targets discovered. Likewise, Systems Medicine (SM) platforms applied to extensively-characterized patients provide a basis for more targeted clinical trials, and represent a promising tool to achieve better prevention and patient care, thereby promoting healthy aging globally. The present paper: (1) reviews the novel systems approaches to NCDs; (2) discusses how to move efficiently from Systems Biology to Systems Medicine; and (3) presents the scientific and clinical background of the San Raffaele Systems Medicine Platform.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Stefano Bonassi
- Deputy Scientific Director and Systems Medicine Coordinator, IRCCS San Raffaele Pisana, Via di Val Cannuta, 247, 00166 Rome, Italy.
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Pristipino C. Think left and think right and think low and think high. Oh, the thinks you can think up if only you try! (Theodore Seuss Geisel, a.k.a. Dr. Seuss). Int J Cardiol 2014; 173:347-8. [PMID: 24703802 DOI: 10.1016/j.ijcard.2014.03.094] [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: 01/20/2014] [Accepted: 03/14/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Christian Pristipino
- Interventional Cardiology Unit, San Filippo Neri Hospital, Via A. Poerio, 140-00152 Roma, Italy.
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21
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Pristipino C, Anzola GP, Ballerini L, Bartorelli A, Cecconi M, Chessa M, Donti A, Gaspardone A, Neri G, Onorato E, Palareti G, Rakar S, Rigatelli G, Santoro G, Toni D, Ussia GP, Violini R, Guagliumi G, Bedogni F, Cremonesi A. [Multidisciplinary position paper on the management of patent foramen ovale in the presence of cryptogenic cerebral ischemia - Italian version 2013]. G Ital Cardiol (Rome) 2014; 14:699-712. [PMID: 24121896 DOI: 10.1714/1335.14838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
There is no generally accepted consensus on the management of patent foramen ovale (PFO) in the presence of cryptogenic cerebral ischemia, because of the lack of conclusive evidence. The aim of this position paper was to develop and promote a joint approach based on available data that may be shared by different specialists, while waiting for definite results from randomized controlled trials. A position statement was produced involving the major national scientific societies. The task force members were nominated by the presidents and/or executive boards of each society or working group, as appropriate, based on their previous work in relevant topic areas. Specific task force working groups prepared the drafts. In order to achieve maximum agreement, these drafts were merged and distributed to the scientific societies for local evaluation. The ensuing final draft, merging all the revisions, was reviewed by the task force and finally approved by all scientific societies. The following issues were addressed: definitions of transient ischemic attack (TIA) and both symptomatic and asymptomatic cryptogenic stroke; formulation of a diagnostic workup for patients with clinical event(s) and PFO; recommendations regarding medical and interventional treatment options considering individual risk factors based on the three available randomized trials and other observational studies; recommendations regarding requirements for operators and centers in Italy; definition of a follow-up evaluation protocol. In conclusion, available data provided the basis for the first multi-society position paper on the management of cryptogenic stroke/TIA and PFO.
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22
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Pristipino C, Anzola GP, Ballerini L, Bartorelli A, Cecconi M, Chessa M, Donti A, Gaspardone A, Neri G, Onorato E, Palareti G, Rakar S, Rigatelli G, Santoro G, Toni D, Ussia GP, Violini R. Management of patients with patent foramen ovale and cryptogenic stroke: a collaborative, multidisciplinary, position paper: executive summary. Catheter Cardiovasc Interv 2014; 82:122-9. [PMID: 23788390 DOI: 10.1002/ccd.24693] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [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: 04/24/2012] [Accepted: 08/28/2012] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To organize a common approach on the management of patent foramen ovale (PFO) and cryptogenic stroke that may be shared by different specialists. BACKGROUND The management of PFO related to cryptogenic stroke is controversial, despite an increase in interventional closure procedures. METHODS A consensus statement was developed by approaching Italian national cardiological, neurological, and hematological scientific societies. Task force members were identified by the president and/or the boards of each relevant scientific society or working group, as appropriate. Drafts were outlined by specific task force working groups. To obtain a widespread consensus, these drafts were merged and distributed to the scientific societies for local evaluation and revision by as many experts as possible. The ensuing final draft, merging all the revisions, was reviewed by the task force and finally approved by scientific societies. RESULTS Definitions of transient ischemic attack and both symptomatic and asymptomatic cryptogenic strokes were specified. A diagnostic workout was identified for patients with candidate event(s) and patient foramen ovale to define the probable pathogenesis of clinical events and to describe individual PFO characteristics. Further recommendations were provided regarding medical and interventional therapy considering individual risk factors of recurrence. Finally, follow-up evaluation was appraised. CONCLUSIONS Available data provided the basis for a shared approach to management of cryptogenic ischemic cerebral events and PFO among different Italian scientific societies. Wider international initiatives on the topic are awaited.
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Affiliation(s)
- Christian Pristipino
- Clinical Research Centre and Cardiovascular Department, San Filippo Neri Hospital, Roma, Italy.
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23
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Pasceri V, Pelliccia F, Pristipino C, Roncella A, Irini D, Varveri A, Bisciglia A, Speciale G. Clinical effects of routine postdilatation of drug-eluting stents. Catheter Cardiovasc Interv 2013; 83:898-904. [DOI: 10.1002/ccd.24999] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Revised: 05/12/2013] [Accepted: 05/12/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Vincenzo Pasceri
- Interventional Cardiology; San Filippo Neri Hospital; Rome Italy
| | | | | | - Adriana Roncella
- Interventional Cardiology; San Filippo Neri Hospital; Rome Italy
| | - Diego Irini
- Interventional Cardiology; San Filippo Neri Hospital; Rome Italy
| | - Antonio Varveri
- Interventional Cardiology; San Filippo Neri Hospital; Rome Italy
| | - Andrea Bisciglia
- Interventional Cardiology; San Filippo Neri Hospital; Rome Italy
| | - Giulio Speciale
- Interventional Cardiology; San Filippo Neri Hospital; Rome Italy
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24
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Pristipino C, Toni D, Bedogni F. Letter by Pristipino et al Regarding Article, “Potentially Large yet Uncertain Benefits: A Meta-analysis of Patent Foramen Ovale Closure Trials”. Stroke 2013; 44:e233. [DOI: 10.1161/strokeaha.113.003604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Christian Pristipino
- Interventional Cardiology Unit and Personalized Care Unit, San Filippo Neri Hospital, Roma, Italy
| | - Danilo Toni
- Intensive Care Stroke Unit, Università La Sapienza, Roma, Italy
| | - Francesco Bedogni
- Interventional Cardiology Unit, Istituto Clinico Sant’Ambrogio Hospital, IRCCS San Donato, Milan, Italy
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25
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Auriti A, Antonini L, Pristipino C, Di Lella E, Campanella C. Communication between coronary aneurysmal malformations and the left atrium. Eur Heart J Cardiovasc Imaging 2013; 15:470. [PMID: 24168905 PMCID: PMC3959994 DOI: 10.1093/ehjci/jet187] [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] [Indexed: 11/14/2022] Open
Affiliation(s)
- Antonio Auriti
- Department of Cardiovascular Diseases, Clinical Advanced Echocardiography Lab, S. Filippo Neri Hospital, Via Martinotti 20, Rome 00135, Italy
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26
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Hamon M, Pristipino C, Di Mario C, Nolan J, Ludwig J, Tubaro M, Sabate M, Mauri-Ferré J, Huber K, Niemelä K, Haude M, Wijns W, Dudek D, Fajadet J, Kiemeneij F. Consensus document on the radial approach in percutaneous cardiovascular interventions: position paper by the European Association of Percutaneous Cardiovascular Interventions and Working Groups on Acute Cardiac Care** and Thrombosis of the European Society of Cardiology. EUROINTERVENTION 2013; 8:1242-51. [PMID: 23354100 DOI: 10.4244/eijv8i11a192] [Citation(s) in RCA: 273] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Radial access use has been growing steadily but, despite encouraging results, still varies greatly among operators, hospitals, countries and continents. Twenty years from its introduction, it was felt that the time had come to develop a common evidence-based view on the technical, clinical and organisational implications of using the radial approach for coronary angiography and interventions. The European Association of Percutaneous Cardiovascular Interventions (EAPCI) has, therefore, appointed a core group of European and non-European experts, including pioneers of radial angioplasty and operators with different practices in vascular access supported by experts nominated by the Working Groups on Acute Cardiac Care and Thrombosis of the European Society of Cardiology (ESC). Their goal was to define the role of the radial approach in modern interventional practice and give advice on technique, training needs, and optimal clinical indications.
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Affiliation(s)
- Martial Hamon
- Recherche Clinique, Bureau 364, Centre Hospitalier Universitaire de Caen, Avenue Côte de Nacre, 14033 Caen, Normandie, France.
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27
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Pristipino C, Anzola GP, Ballerini L, Bartorelli A, Cecconi M, Chessa M, Donti A, Gaspardone A, Neri G, Onorato E, Palareti G, Rakar S, Rigatelli G, Santoro G, Toni D, Ussia GP, Violini R. Management of patients with patent foramen ovale and cryptogenic stroke: A collaborative, multidisciplinary, position paper. Catheter Cardiovasc Interv 2013; 82:E38-51. [DOI: 10.1002/ccd.24637] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 08/28/2012] [Indexed: 11/09/2022]
Affiliation(s)
- Christian Pristipino
- Clinical Research Centre and Cardiovascular Department; San Filippo Neri Hospital; Roma; Italy
| | | | - Luigi Ballerini
- Women and Children Department; S. Carlo Hospital; Potenza; Italy
| | - Antonio Bartorelli
- Interventional Cardiology Area; Monzino Cardiology Centre; Milano; Italy
| | - Moreno Cecconi
- Cardiological; Medical and Surgical Sciences Department; University United Hospitals; Ancona; Italy
| | - Massimo Chessa
- Pediatric Cardiology and Adult with Congenital Heart Disease Department; IRCCS Policlinico San Donato; San Donato Milanese; Italy
| | - Andrea Donti
- Pediatric and Developmental Age Cardiology-Bologna University-S. Orsola Malpighi Hospital; Bologna; Italy
| | | | | | | | - Gualtiero Palareti
- Angiology and Coagulation Disorders Unit-S.Orsola Malpighi Hospital; Bologna; Italy
| | - Serena Rakar
- Cardiology Department; Cattinara Hospital; Trieste; Italy
| | - Gianluca Rigatelli
- Cardiovascular Diagnosis and Endoluminal Interventions Department; Rovigo General Hospital; Rovigo; Italy
| | - Gennaro Santoro
- Cardiology and Vessel Department; Careggi Hospital; Firenze; Italy
| | - Danilo Toni
- Neurology and Psychiatry Department; Sapienza University; Roma; Italy
| | - Gian Paolo Ussia
- Invasive Cardiology Unit, Ferrarotto Hospital; Catania University; Catania; Italy
| | - Roberto Violini
- Interventional Cardiology Unit; San Camillo Hospital; Roma; Italy
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28
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Pelliccia F, Pasceri V, Rosano G, Pristipino C, Roncella A, Speciale G, Pannarale G, Schiariti M, Greco C, Gaudio C. Endothelial Progenitor Cells Predict Long-Term Prognosis in Patients With Stable Angina Treated With Percutaneous Coronary Intervention. Circ J 2013; 77:1728-1735. [DOI: 10.1253/circj.cj-12-1608] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
| | - Vincenzo Pasceri
- Department of Cardiovascular Diseases, San Filippo Neri Hospital
| | - Giuseppe Rosano
- Department of Cardiovascular Research, IRCCS San Raffaele Pisana
| | | | - Adriana Roncella
- Department of Cardiovascular Diseases, San Filippo Neri Hospital
| | - Giulio Speciale
- Department of Cardiovascular Diseases, San Filippo Neri Hospital
| | | | | | | | - Carlo Gaudio
- Department of Cardiology, Sapienza University
- Eleonora Lorillard Spencer Cenci Foundation
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Pelliccia F, Trani C, Biondi-Zoccai GG, Nazzaro M, Berni A, Patti G, Patrizi R, Pironi B, Mazzarotto P, Gioffrè G, Speciale G, Pristipino C. Comparison of the feasibility and effectiveness of transradial coronary angiography via right versus left radial artery approaches (from the PREVAIL Study). Am J Cardiol 2012; 110:771-5. [PMID: 22651876 DOI: 10.1016/j.amjcard.2012.05.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 05/01/2012] [Accepted: 05/01/2012] [Indexed: 02/08/2023]
Abstract
It remains undefined if transradial coronary angiography from a right or left radial arterial approach differs in real-world practice. To address this issue, we performed a subanalysis of the PREVAIL study. The PREVAIL study was a prospective, multicenter, observational survey of unselected consecutive patients undergoing invasive cardiovascular procedures over a 1-month observation period, specifically aimed at assessing the outcomes of radial approach in the contemporary real world. The choice of arterial approach was left to the discretion of the operator. Prespecified end points of this subanalysis were procedural characteristics. Of 1,052 patients consecutively enrolled, 509 patients underwent transradial catheterization, 304 with a right radial and 205 with a left radial approach. Procedural success rates were similar between the 2 groups. Compared to the left radial group, the right radial group had longer procedure duration (46 ± 29 vs 33 ± 24 minutes, p <0.0001) and fluoroscopy time (765 ± 787 vs 533 ± 502, p <0.0001). At multivariate analysis, including a parsimonious propensity score for the choice of left radial approach, duration of procedure (beta coefficient 11.38, p <0.001) and total dose-area product (beta coefficient 11.38, p <0.001) were independently associated with the choice of the left radial artery approach. The operator's proficiency in right/left radial approach did not influence study results. In conclusion, right and left radial approaches are feasible and effective to perform percutaneous procedures. In the contemporary real world, however, the left radial route is associated with shorter procedures and lower radiologic exposure than the right radial approach, independently of an operator's proficiency.
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Antonini L, Auriti A, Pasceri V, Meo A, Pristipino C, Varveri A, Greco S, Santini M. Optimization of the atrioventricular delay in sequential and biventricular pacing: physiological bases, critical review, and new purposes. Europace 2012; 14:929-38. [DOI: 10.1093/europace/eur425] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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32
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Pristipino C, Hamon M. Letter by Pristipino and Hamon regarding article, "cerebral microembolism during coronary angiography: a randomized comparison between femoral and radial arterial access". Stroke 2011; 42:e418; author reply e419. [PMID: 21737810 DOI: 10.1161/strokeaha.111.623249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Pasceri V, Irini D, Pelliccia F, Pristipino C, Roncella A, Varveri A, Speciale G. CLINICAL EFFECTS OF ROUTINE HIGH-PRESSURE POSTDILATATION OF DRUG-ELUTING STENTS. J Am Coll Cardiol 2011. [DOI: 10.1016/s0735-1097(11)61766-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Pandozi C, Ficili S, Galeazzi M, Lavalle C, Russo M, Pandozi A, Venditti F, Pristipino C, Verbo B, Santini M. Propagation of the Sinus Impulse Into the Koch Triangle and Localization, Timing, and Origin of the Multicomponent Potentials Recorded in This Area. Circ Arrhythm Electrophysiol 2011; 4:225-34. [DOI: 10.1161/circep.110.957381] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
The presence of a conduction block at the level of the Koch triangle (KT) and the origin of the multicomponent potentials inside this area are controversial issues. We investigated the propagation of the sinus impulse into the KT and the characteristics of multicomponent potentials recorded in that area in patients with and without atrioventricular nodal reentrant tachycardia (AVNRT).
Methods and Results—
Thirty-two patients (16 with AVNRT, 16 without AVNRT) underwent a sinus rhythm electroanatomic mapping of the right atrium (RA). Conduction velocities in the RA and in the KT were evaluated quantitatively on activation maps and qualitatively on isochronal and propagation maps. The presence, location, and timing of different types of multicomponent potentials were evaluated. A mean of 149±44 points were sampled in the RA, whereas a mean of 79±21 points were collected inside the KT. Propagation block at the level of crista terminalis was not found in any patient, whereas slow conduction inside the KT was found in all (median conduction velocity, 122 cm/s [110 to 135 cm/s] outside KT versus 60 cm/s [48 to 75 cm/s] inside KT;
P
<0.0001). Jackman potentials were identified inside KT in almost all the patients and were invariably found on the line of collision between the wavefronts activating the KT in opposite directions.
Conclusions—
No conduction block was detected inside the KT in patients with and without AVNRT. Conduction slowing was demonstrated during propagation of the sinus impulse inside the KT. The genesis of the Jackman potential may be related to the collision of the wavefronts activating KT in opposite directions.
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Affiliation(s)
- Claudio Pandozi
- From the Department of Cardiology (C. Pandozi, S.F., M.G., C.L., M.R., A.P., F.V., B.V., M.S.) and Clinical Research Centre and Department of Cardiology (C. Pristipino), San Filippo Neri Hospital, Rome, Italy
| | - Sabina Ficili
- From the Department of Cardiology (C. Pandozi, S.F., M.G., C.L., M.R., A.P., F.V., B.V., M.S.) and Clinical Research Centre and Department of Cardiology (C. Pristipino), San Filippo Neri Hospital, Rome, Italy
| | - Marco Galeazzi
- From the Department of Cardiology (C. Pandozi, S.F., M.G., C.L., M.R., A.P., F.V., B.V., M.S.) and Clinical Research Centre and Department of Cardiology (C. Pristipino), San Filippo Neri Hospital, Rome, Italy
| | - Carlo Lavalle
- From the Department of Cardiology (C. Pandozi, S.F., M.G., C.L., M.R., A.P., F.V., B.V., M.S.) and Clinical Research Centre and Department of Cardiology (C. Pristipino), San Filippo Neri Hospital, Rome, Italy
| | - Maurizio Russo
- From the Department of Cardiology (C. Pandozi, S.F., M.G., C.L., M.R., A.P., F.V., B.V., M.S.) and Clinical Research Centre and Department of Cardiology (C. Pristipino), San Filippo Neri Hospital, Rome, Italy
| | - Angela Pandozi
- From the Department of Cardiology (C. Pandozi, S.F., M.G., C.L., M.R., A.P., F.V., B.V., M.S.) and Clinical Research Centre and Department of Cardiology (C. Pristipino), San Filippo Neri Hospital, Rome, Italy
| | - Franco Venditti
- From the Department of Cardiology (C. Pandozi, S.F., M.G., C.L., M.R., A.P., F.V., B.V., M.S.) and Clinical Research Centre and Department of Cardiology (C. Pristipino), San Filippo Neri Hospital, Rome, Italy
| | - Christian Pristipino
- From the Department of Cardiology (C. Pandozi, S.F., M.G., C.L., M.R., A.P., F.V., B.V., M.S.) and Clinical Research Centre and Department of Cardiology (C. Pristipino), San Filippo Neri Hospital, Rome, Italy
| | - Brunella Verbo
- From the Department of Cardiology (C. Pandozi, S.F., M.G., C.L., M.R., A.P., F.V., B.V., M.S.) and Clinical Research Centre and Department of Cardiology (C. Pristipino), San Filippo Neri Hospital, Rome, Italy
| | - Massimo Santini
- From the Department of Cardiology (C. Pandozi, S.F., M.G., C.L., M.R., A.P., F.V., B.V., M.S.) and Clinical Research Centre and Department of Cardiology (C. Pristipino), San Filippo Neri Hospital, Rome, Italy
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Auriti A, Loiaconi V, Pristipino C, Leonardi Cattolica FS, Cini R, Guido V, Cianfrocca C, Greco S, Agostini F, Staibano M, Santini M. Recovery of distal coronary flow reserve in LAD and LCx after Y-Graft intervention assessed by transthoracic echocardiography. Cardiovasc Ultrasound 2010; 8:34. [PMID: 20716357 PMCID: PMC2933599 DOI: 10.1186/1476-7120-8-34] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Accepted: 08/17/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Y- graft (Y-G) is a graft formed by the Left Internal Mammary Artery (LIMA) connected to the Left Anterior Descending Artery (LAD) and by a free Right Internal Mammary Artery (RIMA) connected to LIMA and to a Marginal artery of Left Circumflex Artery (LCx). Aim of the work was to study the flow of this graft during a six months follow-up to assess whether the graft was able to meet the request of all the left coronary circulation, and to assess whether it could be done by evaluation of coronary flow reserve (CFR). METHODS In 13 consecutive patients submitted to Y-G (13 men), CFR was measured in distal LAD and in distal LCx from 1 week after , every two months, up to six months after operation (a total of 8 tests for each patient) by means of transthoracic echocardiography (TTE) and Adenosine infusion (140 mcg/kg/min for 3-6 min). A Sequoia 256, Acuson-Siemens, was used. Contrast was used when necessary (Levovist 300 mg/ml solution at a rate of 0,5-1 ml/min). Max coronary flow diastolic velocity post-/pre-test > or =2 was considered normal CFR. RESULTS Coronary arteriography revealed patency of both branches of Y-G after six months. Accuracy of TTE was 100% for LAD and 85% for LCx. Feasibility was 100% for LAD and 85% for LCx. CFR improved from baseline in LAD (2.21 +/- 0.5 to 2.6 +/- 0.5, p = 0.03) and in LCx (1.7 +/- 1 to 2.12 +/- 1, p = 0.05). CFR was under normal at baseline in 30% of patients vs 8% after six months in LAD (p = 0.027), and in 69% of patients vs 30% after six months in LCx (p = 0.066). CONCLUSION CFR in Y-G is sometimes reduced in both left territories postoperatively but it improves at six months follow-up. A follow-up can be done non-invasively by TTE and CFR evaluation.
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Affiliation(s)
- Antonio Auriti
- Department of Cardiovascular Disease, Echocardiography Lab, S,Filippo Neri Hospital, Rome, Italy.
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Pasceri V, Patti G, Pristipino C, Pelliccia F, Irini D, Varveri A, Roncella A, Di Sciascio G, Speciale G. Safety of drug eluting stents in patients on chronic anticoagulation using long-term single antiplatelet treatment with clopidogrel. Catheter Cardiovasc Interv 2010; 75:936-42. [PMID: 20146326 DOI: 10.1002/ccd.22380] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Use of triple therapy with aspirin, clopidogrel, and anticoagulants significantly increases bleeding, thus drug eluting stents (DES) are usually avoided in patients requiring anticoagulation. We tested use of DES vs. BMS using a long-term therapy with clopidogrel only and anticoagulants in this group of patients. METHODS We enrolled 165 consecutive patients, 79 receiving DES (age 67 +/- 9 years, 84% with atrial fibrillation) and 86 receiving bare metal stents (BMS) (age 70 +/- 11 years, 71% with atrial fibrillation). All patients received aspirin + clopidogrel + oral anticoagulants for 4 weeks, then aspirin was stopped and clopidogrel was continued during the 12-month follow-up. Primary end point was the combined incidence of major adverse coronary events and major bleedings. RESULTS Incidence of the primary endpoint was 10.1% in patients with DES and 26.7% in patients with BMS (P = 0.01). There was a large difference in incidence of target vessel revascularization (8.1% for DES, 23.3% for BMS, P = 0.01), whereas incidence of myocardial infarction (3.8% in DES vs. 8.1% in BMS) and major bleeding (1.3% vs. 2.3%, respectively) were not significantly different. There were no cases of stent thrombosis. On multivariate Cox regression analysis, the only factor associated with a reduced risk of the primary endpoint was use of DES (hazard ratio 0.35 with 95% confidence interval 0.14-0.85, P = 0.02). CONCLUSIONS Results of our cohort study suggest that use of DES associated with a treatment with clopidogrel only may be safe and significantly reduce the need for new revascularization in patients requiring chronic anticoagulation.
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Affiliation(s)
- Vincenzo Pasceri
- Interventional Cardiology Unit, San Filippo Neri Hospital, Rome, Italy.
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Pristipino C, Roncella A, Trani C, Nazzaro M, Berni A, Di Sciascio G, Sciahbasi A, Musarò S, Mazzarotto P, Gioffrè G, Speciale G. Identifying factors that predict the choice and success rate of radial artery catheterisation in contemporary real world cardiology practice: a sub-analysis of the PREVAIL study data. EUROINTERVENTION 2010. [DOI: 10.4244/eijv6i2a38] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Pristipino C, Roncella A, Trani C, Nazzaro MS, Berni A, Di Sciascio G, Sciahbasi A, Musarò SD, Mazzarotto P, Gioffrè G, Speciale G. Identifying factors that predict the choice and success rate of radial artery catheterisation in contemporary real world cardiology practice: a sub-analysis of the PREVAIL study data. EUROINTERVENTION 2010; 6:240-246. [PMID: 20562075] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
AIMS To assess: the reasons behind an operator choosing to perform radial artery catheterisation (RAC) as against femoral arterial catheterisation, and to explore why RAC may fail in the real world. METHODS AND RESULTS A pre-determined analysis of PREVAIL study database was performed. Relevant data were collected in a prospective, observational survey of 1,052 consecutive patients undergoing invasive cardiovascular procedures at nine Italian hospitals over a one month observation period. By multivariate analysis, the independent predictors of RAC choice were having the procedure performed: (1) at a high procedural volume centre; and (2) by an operator who performs a high volume of radial procedures; clinical variables played no statistically significant role. RAC failure was predicted independently by (1) a lower operator propensity to use RAC; and (2) the presence of obstructive peripheral artery disease. A 10-fold lower rate of RAC failure was observed among operators who perform RAC for > 85% of their personal caseload than among those who use RAC < 25% of the time (3.8% vs. 33.0%, respectively); by receiver operator characteristic (ROC) analysis, no threshold value for operator RAC volume predicted RAC failure. CONCLUSIONS A routine RAC in all-comers is superior to a selective strategy in terms of feasibility and success rate.
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Colivicchi F, Di Roma A, Uguccioni M, Scotti E, Ammirati F, Arcas M, Avallone A, Bonaccorso O, Germanò G, Letizia C, Manfellotto D, Minardi G, Pristipino C, D'Amore F, Di Veroli C, Fierro A, Pastorellio R, Tozzi Q, Tubaro M, Santini M, Angelico F, Azzolini P, Bellasi A, Brocco P, Calò L, Cerquetani E, De Biase L, Di Napoli M, Galati A, Gallieni M, Jesi AP, Lombardo A, Loricchio V, Menghini F, Mezzanotte R, Minutolos R, Mocini D, Patti G, Patrizi R, Pajes G, Pulignano G, Ricci RP, Ricci R, Sardella G, Strano S, Terracina D, Testa M, Tomai F, Volpes R, Volterrani M. [Secondary cardiovascular prevention after acute coronary syndrome in clinical practice]. G Ital Cardiol (Rome) 2010; 11:3S-29S. [PMID: 20873094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Secondary prevention after acute coronary syndromes should be aimed at reducing the risk of further adverse cardiovascular events, thereby improving quality of life, and lengthening survival. Despite compelling evidence from large randomized controlled trials, secondary prevention is not fully implemented in most cases after hospitalization for acute coronary syndrome. The Lazio Region (Italy) has about 5.3 million inhabitants (9% of the entire Italian population). Every year about 11 000 patients are admitted for acute coronary syndrome in hospitals of the Lazio Region. Most of these patients receive state-of-the art acute medical and interventional care during hospitalization. However, observational data suggest that after discharge acute coronary syndrome patients are neither properly followed nor receive all evidence-based treatments. This consensus document has been developed by 11 Scientific Societies of Cardiovascular and Internal Medicine in order develop a sustainable and effective clinical approach for secondary cardiovascular prevention after acute coronary syndrome in the local scenario of the Lazio Region. An evidence-based simplified decalogue for secondary cardiovascular prevention is proposed as the cornerstone of clinical intervention, taking into account regional laws and relative shortage of resources. The following appropriate interventions should be consistently applied: smoking cessation, blood pressure control (blood pressure < 130/80 mmHg), optimal lipid management (LDL cholesterol < 80 mmHg), weight and diabetes management, promotion of physical activity and rehabilitation, correct use of antiplatelet agents, beta-blockers, renin-angiotensin-aldosterone system blockers.
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Affiliation(s)
- Furio Colivicchi
- ANMCO (Associazione Nazionale Medici Cardiologi Ospedalieri) Sezione Lazio.
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Pasceri V, Irini D, Pelliccia F, Pristipino C, Roncella A, Varveri A, Speciale G. Treatment of left main disease with a new dedicated side-branch protection stent. J Cardiovasc Med (Hagerstown) 2010; 12:896-900. [PMID: 20093943 DOI: 10.2459/jcm.0b013e32833522f7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Roncella A, Giornetti A, Cianfrocca C, Pasceri V, Pelliccia F, Denollet J, Pedersen SS, Speciale G, Richichi G, Pristipino C. Rationale and trial design of a randomized, controlled study on short-term psychotherapy after acute myocardial infarction: the STEP-IN-AMI trial (Short Term Psychotherapy in Acute Myocardial Infarction). J Cardiovasc Med (Hagerstown) 2009; 10:947-452. [DOI: 10.2459/jcm.0b013e32832fb477] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Pelliccia F, Pasceri V, Cianfrocca C, Vitale C, Meoni G, Pristipino C, Speciale G, Mercuro G, Rosano G. Circulating endothelial progenitor cells in postmenopausal women with and without coronary artery disease. Climacteric 2009; 12:259-65. [DOI: 10.1080/13697130802696191] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Pelliccia F, Pasceri V, Meoni G, Pristipino C, Cianfrocca C, Li X, La Rocca S, Rosano G, Mercuro G, Richichi G. Numbers of endothelial progenitor cells in peripheral blood are similar in younger and older patients with coronary artery disease. Int J Cardiol 2009; 133:277-9. [DOI: 10.1016/j.ijcard.2007.11.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2007] [Revised: 11/14/2007] [Accepted: 11/14/2007] [Indexed: 11/25/2022]
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Pelliccia F, Cianfrocca C, Pasceri V, Granatelli A, Speciale G, Roncella A, Turturo M, Richichi G, Pristipino C. Transcathether occlusion of interatrial communications: postprocedural transoesophageal echocardiography allows timely detection and treatment of intracardiac thrombus formation. European Journal of Echocardiography 2009; 10:439-41. [DOI: 10.1093/ejechocard/jen306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Pristipino C, Danchin N, Lablanche JM, Komajda M, Tubaro M, Maseri A, Cianflone D. The development of an international, common, prospective, cardiology database. Report of the joint G8 Cardio-Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO)--Societé Française de Cardiologie (SFC) database committee. Acute Card Care 2009; 11:113-120. [PMID: 19526386 DOI: 10.1080/17482940802699213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Sharing and comparing health data at the international level is made difficult by heterogeneity in real world databases. AIM Our primary objective was to field-test the implementation of the first common database developed conjointly by different national cardiological societies. METHODS Based upon G8-Cardio feasibility projects, the Italian Society of Hospital Cardiologists and the French Society of Cardiology joined together to standardize a cardiological, patient-oriented database, created by means of consensus agreement for sharing data in a common server. Quantification of standardization was obtained by analysing each dataset according to the possibility of merging corresponding fields. Data merging from national centres was completed in the common server and after proper data integration in the common database; a comparison was performed between French and Italian populations. RESULTS Standardization of contents allowed for 89% overall interoperability (merged fields) to be achieved with only 11% divergent fields. All (100%) merged homogeneous data on the first 2717 patients from peripheral centres were selected consecutively from the common database and analysed successfully. Relevant differences between the two populations were outlined. CONCLUSIONS The international standardization and sharing/merging of databases is feasible. This model opens the way to important applications in internationally shared health care policies.
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Pristipino C, Trani C, Nazzaro MS, Berni A, Patti G, Patrizi R, Pironi B, Mazzarotto P, Gioffrè G, Biondi-Zoccai GGL, Richichi G. Major improvement of percutaneous cardiovascular procedure outcomes with radial artery catheterisation: results from the PREVAIL study. Heart 2008; 95:476-82. [PMID: 19036757 DOI: 10.1136/hrt.2008.150714] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [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] Open
Abstract
OBJECTIVE To obtain a "snapshot" view of access-specific percutaneous cardiovascular procedures outcomes in the real world. DESIGN Multicentre, prospective study performed over a 30-day period. SETTING Nine hospitals with invasive cardiology facilities, reflecting the contemporary state of healthcare. PATIENTS Unselected consecutive sample of patients undergoing any percutaneous cardiovascular procedure requiring an arterial access. INTERVENTIONS Percutaneous cardiovascular procedures by radial or femoral access MAIN OUTCOME MEASURES The primary outcome was the combined incidence of in-hospital (a) major and minor haemorrhages; (b) peri-procedural stroke; and (c) entry-site vascular complications. The secondary outcome was the combined incidence of in-hospital death and myocardial infarction/reinfarction. For analysis purposes, outcomes were allocated to arterial access-determined study arms on an intention-to treat basis. Multivariable analysis adjusted using propensity score was performed to correct for selection bias related to arterial site. RESULTS A total of 1052 patients were enrolled: 509 underwent radial access and 543 femoral access. In both groups, 40% underwent a coronary angioplasty. Relative to femoral access, radial access was associated with a lower incidence both of primary (4.2% vs 1.96%, p = 0.03, respectively) and secondary endpoints (3.1% vs 0.6%, p = 0.005, respectively). Multivariate analysis, adjusted for procedural and clinical confounders, confirmed that intention-to-access via the radial route was significantly and independently associated with a decreased risk both of primary (OR 0.37, 95% CI 0.16 to 0.84) and secondary endpoints (OR 0.14, 95% CI 0.03 to 0.62). CONCLUSIONS Our study indicates strikingly better outcomes of percutaneous cardiovascular procedures with radial access versus femoral access in contemporary, real-world clinical settings.
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Burzotta F, Parma A, Pristipino C, Manzoli A, Belloni F, Sardella G, Rigattieri S, Danesi A, Mazzarotto P, Summaria F, Romagnoli E, Prati F, Trani C, Crea F. Angiographic and clinical outcome of invasively managed patients with thrombosed coronary bare metal or drug-eluting stents: the OPTIMIST study. Eur Heart J 2008; 29:3011-21. [PMID: 18987096 DOI: 10.1093/eurheartj/ehn479] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
AIMS Stent thrombosis (ST) is a major complication of percutaneous coronary interventions (PCIs). An invasive management by re-PCI is the commonly adopted treatment for ST, but data on outcome are limited. METHODS AND RESULTS We performed a 2-year multicentre registry enrolling consecutive patients with angiographically confirmed ST undergoing PCI. The primary angiographic endpoint was optimal angiographic reperfusion (TIMI 3 + blush grade 2 or 3). The primary clinical endpoints were death and major adverse coronary and cerebrovascular events (MACCEs) at 6 months. A total of 110 patients underwent 117 urgent PCI during the study. Patients with drug-eluting stent (DES) thrombosis, compared with those with bare metal stent (BMS) thrombosis, exhibited a higher rate of late or very late presentation and of anti-platelet therapy withdrawal. Optimal angiographic reperfusion was obtained in 64% of the patients. Death and MACCE rates at 6 months were 17 and 30%, respectively. Clinical outcome was similar for BMS and DES thrombosis. Very late ST, implantation of stent during PCI for ST, and failure to achieve optimal angiographic reperfusion were the independent predictors of 6-month mortality. CONCLUSION DES and BMS thromboses have different clinical features, but a similar poor outcome. Indeed, PCI for ST is associated with a low rate of reperfusion and to a high rate of death and MACCE, calling for action in order to prevent its occurrence and to improve its management.
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Affiliation(s)
- Francesco Burzotta
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
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De Luca A, Gabriele S, Lauria L, Francia C, Caminiti A, Tubaro M, Pillon S, Pristipino C, Ammirati F, Guasticchi G. [Implementation of an emergency clinical pathway for ST-elevation myocardial infarction in the Lazio Region: results of a pilot study]. G Ital Cardiol (Rome) 2008; 9:118-125. [PMID: 18383774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Timely reperfusion therapies (primary angioplasty and pre-hospital thrombolysis) remain a key component in improving the survival of patients with ST-segment elevation myocardial infarction (STEMI). The Lazio Region emergency organization has a complex mixed logistic (the large city of Rome, presence of complex orography), therefore the use of telemedicine technologies by the emergency medical system (EMS) is mandatory. Emergency clinical pathways (ECP) for the management of STEMI patients were designed, focusing on early pre-hospital diagnosis and best appropriate treatment through the ECG transmission and teleconsultation among EMS and cardiologists in coronary care units (CCU). METHODS To evaluate the effectiveness of ECP-STEMI in the current practice, a prospective observational cohort study of ambulance-transported patients with cardiovascular symptoms was conducted in a selected area of the Lazio Region during a 6-month period. The implementation of the ECP was carried out by educational activities for the EMS personnel based on the "experiential learning" methods. RESULTS From October 2005 to March 2006, 287 patients were enrolled in the study and a pre-hospital ECG was performed in 66% of them. One hundred and fifty-two patients were referred to hospital and only 34 had discharged diagnosis of acute myocardial infarction, of whom 23 were STEMI. In the 34 acute myocardial infarction patients the medium time from "call to the EMS" to "arrival to the hospital" was 41 min (range 29-63 min) and 3 had their ECG telematically transmitted from the ambulance to the CCU. All of these cases were STEMI. Twenty-eight acute myocardial infarctions were discharged alive, 2 were transferred in other hospitals, 4 died. No patients received pre-hospital thrombolysis. Prior to the ECP implementation the ECG for STEMI patients has never been transmitted by EMS to the CCU in the Lazio Region. CONCLUSIONS Our study suggests that adherence to ECP improved the appropriateness of STEMI patient referral and treatment in the CCU in the Lazio Region. The EMS personnel, during the study, showed a high interest in the protocol trying to change their current practice. The Regional Administration plans to expand the utilization of ECP to all regional emergency network (EMS and Emergency Departments) and to improve its use.
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Affiliation(s)
- Assunta De Luca
- Area Governo dell'Offerta Lazio Sanità, Agenzia di Sanità Pubblica della Regione Lazio, Roma.
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