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Tessitore E, Branca M, Heg D, Nanchen D, Auer R, Räber L, Klingenberg R, Windecker S, Lüscher TF, Carballo S, Matter CM, Gmel G, Mukamal KJ, Rodondi N, Carballo D, Mach F, Gencer B. Drinking patterns of alcohol and risk of major adverse cardiovascular events after an acute coronary syndrome. Eur J Prev Cardiol 2023:zwad364. [PMID: 37995305 DOI: 10.1093/eurjpc/zwad364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 11/14/2023] [Accepted: 11/22/2023] [Indexed: 11/25/2023]
Abstract
AIM To evaluate the risk of alcohol consumption after acute coronary syndromes (ACS). METHODS A total of 6557 patients hospitalized for ACS at 4 Swiss centres were followed over 12 months. Weekly alcohol consumption was collected at baseline and 12 months. Binge drinking was defined as consumption of ≥6 units of alcohol on one occasion. Major adverse cardiovascular events (MACE) were defined as a composite of cardiac death, myocardial infarction, stroke or clinically indicated target vessel coronary revascularization. Cox regression analysis was performed to assess the risk of MACE in patients with heavy (>14 standard units/week), moderate (7-14 standard units per week), light consumption (<1 standard unit/week) or abstinence, and with binge drinking episodes, adjusted for baseline differences. RESULTS At baseline, 817 (13.4%) patients reported heavy weekly alcohol consumption. At one-year follow-up, 695/1667 (41.6%) patients reported having at least one or more episodes of binge drinking per month. The risk for MACE was not significantly higher in those with heavy weekly consumption compared to abstinence (8.6% vs. 10.2%, HR 0.97, 95%CI 0.69-1.36) or light consumption (8.6% vs. 8.5 %, HR 1.41, 95%CI 0.97-2.06). Compared to patients with no-binge drinking, the risk of MACE was dose-dependently higher in those with binge drinking with less than one episode per month (9.2% vs 7.8%, HR 1.61, 95%CI 1.23-2.11), or one or more episodes per month (13.6% vs 7.8%, HR 2.17, 95%CI 1.66-2.83). CONCLUSION Binge drinking during the year following an ACS, even less than once per month, is associated with worse clinical outcomes.
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Affiliation(s)
- Elena Tessitore
- Division of Cardiology, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Mattia Branca
- Clinical Trial Unit, University of Bern, Bern, Switzerland
| | - Dik Heg
- Clinical Trial Unit, University of Bern, Bern, Switzerland
| | - David Nanchen
- Department of Health promotion and preventions, Center for primary care and public health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Reto Auer
- Department of Health promotion and preventions, Center for primary care and public health (Unisanté), University of Lausanne, Lausanne, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roland Klingenberg
- Department of Cardiology University Hospital of Zurich, Zurich, Switzerland
- Department of Cardiology, Kerckhoff Heart and Thorax Center, and Campus of the Justus Liebig University of Giessen, Germany
- DZHK (German Center for Cardiovascular Research), partner site Rhine-Main, Bad Nauheim, Germany
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas F Lüscher
- Royal Brompton & Harefield Hospitals GSTT, Imperial College and Kings College, London, UK
- Center for Molecular Cardiology, Schlieren Campus, University Zurich, Zurich, Switzerland
| | - Sebastian Carballo
- Division of General Internal Medicine, Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Christian M Matter
- Department of Cardiology University Hospital of Zurich, Zurich, Switzerland
| | - Gerhard Gmel
- Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Kenneth J Mukamal
- Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - David Carballo
- Division of Cardiology, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - François Mach
- Division of Cardiology, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Baris Gencer
- Division of Cardiology, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
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Fessler L, Maltagliati S, Sieber S, Cullati S, Tessitore E, Craviari C, Luthy C, Hanna E, Meyer P, Orsholits D, Sarrazin P, Cheval B. Physical activity matters for everyone's health, but individuals with multimorbidity benefit more. Prev Med Rep 2023; 34:102265. [PMID: 37284656 PMCID: PMC10240419 DOI: 10.1016/j.pmedr.2023.102265] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/25/2023] [Accepted: 05/25/2023] [Indexed: 06/08/2023] Open
Abstract
Multimorbidity, defined as the presence of two or more chronic conditions, is increasingly prevalent and is a major contributor to ill health in old age. Physical activity (PA) is a key protective factor for health and individuals with multimorbidity could particularly benefit from engaging in PA. However, direct evidence that PA has greater health benefits in people with multimorbidity is lacking. The objective of the present study was to investigate whether the associations between PA and health were more pronounced in individuals with (vs. without) multimorbidity. We used data from 121,875 adults aged 50 to 96 years (mean age = 67 ± 10 years, 55% women) enrolled in the Survey of Health, Ageing and Retirement in Europe (SHARE). Multimorbidity and PA were self-reported. Health indicators were assessed using tests and validated scales. Variables were measured up to seven times over a 15-year period. Confounder-adjusted linear mixed-effects models were used to investigate the moderating role of multimorbidity on the associations of PA with the levels and trajectories of health indicators across aging. Results showed that multimorbidity was associated with declines in physical, cognitive, and mental health, as well as poorer general health. Conversely, PA was positively associated with these health indicators. We found a significant interaction between multimorbidity and PA, revealing that positive associations between PA and health indicators were strengthened in people with multimorbidity - although this stronger association became less pronounced in advanced age. These findings suggest that the protective role of PA for multiple health indicators is enhanced in individuals with multimorbidity.
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Affiliation(s)
- Layan Fessler
- Univ. Grenoble-Alpes, SENS, F-38000 Grenoble, France
| | | | - Stefan Sieber
- LIVES Centre, Swiss Centre of Expertise in Life Course Research, University of Lausanne, Switzerland
| | - Stéphane Cullati
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Switzerland
- Department of Readaptation and Geriatrics, University of Geneva, Switzerland
| | - Elena Tessitore
- Department of Cardiology and Department of Internal Medicine and Rehabilitation, University Hospital of Geneva, Switzerland
| | - Cecilia Craviari
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Rome, Italy
- Unit of Internal Medicine and Rehabilitation, Department of Rehabilitation and Geriatrics, Geneva University Hospital, Geneva, Switzerland
| | - Christophe Luthy
- Division of General Medical Rehabilitation, University Hospitals of Geneva, Switzerland
| | - Eliana Hanna
- Division of General Medical Rehabilitation, University Hospitals of Geneva, Switzerland
| | - Philippe Meyer
- Cardiology Service, Geneva University Hospitals, Geneva, Switzerland
| | - Dan Orsholits
- Swiss NCCR “LIVES – Overcoming Vulnerability: Life Course Perspectives”, University of Geneva, Geneva, Switzerland
| | | | - Boris Cheval
- Swiss Center for Affective Sciences, University of Geneva, Switzerland
- Laboratory for the Study of Emotion Elicitation and Expression (E3Lab), Department of Psychology, University of Geneva, Switzerland
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Tessitore E, Schmid JP, Hermann M, Schmied C, Wilhelm M, Meyer P. Cardiovascular Rehabilitation Delivery and Outcomes in Switzerland in More Than a Hundred Thousand Patients Over the Last Decade. J Cardiopulm Rehabil Prev 2023; 43:305-307. [PMID: 36857104 PMCID: PMC10287049 DOI: 10.1097/hcr.0000000000000776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Affiliation(s)
- Elena Tessitore
- Cardiology Service, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland (Drs Tessitore and Meyer); Clinic Gais, Gais, Switzerland (Dr Schmid); Division of Cardiology, University Hospital Zurich, Zurich, Switzerland (Drs Hermann and Schmied); and Department of Cardiology, Cardiovascular Center, University Hospital of Bern, Switzerland (Dr Wilhelm)
| | - Jean-Paul Schmid
- Cardiology Service, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland (Drs Tessitore and Meyer); Clinic Gais, Gais, Switzerland (Dr Schmid); Division of Cardiology, University Hospital Zurich, Zurich, Switzerland (Drs Hermann and Schmied); and Department of Cardiology, Cardiovascular Center, University Hospital of Bern, Switzerland (Dr Wilhelm)
| | - Matthias Hermann
- Cardiology Service, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland (Drs Tessitore and Meyer); Clinic Gais, Gais, Switzerland (Dr Schmid); Division of Cardiology, University Hospital Zurich, Zurich, Switzerland (Drs Hermann and Schmied); and Department of Cardiology, Cardiovascular Center, University Hospital of Bern, Switzerland (Dr Wilhelm)
| | - Christian Schmied
- Cardiology Service, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland (Drs Tessitore and Meyer); Clinic Gais, Gais, Switzerland (Dr Schmid); Division of Cardiology, University Hospital Zurich, Zurich, Switzerland (Drs Hermann and Schmied); and Department of Cardiology, Cardiovascular Center, University Hospital of Bern, Switzerland (Dr Wilhelm)
| | - Matthias Wilhelm
- Cardiology Service, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland (Drs Tessitore and Meyer); Clinic Gais, Gais, Switzerland (Dr Schmid); Division of Cardiology, University Hospital Zurich, Zurich, Switzerland (Drs Hermann and Schmied); and Department of Cardiology, Cardiovascular Center, University Hospital of Bern, Switzerland (Dr Wilhelm)
| | - Philippe Meyer
- Cardiology Service, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland (Drs Tessitore and Meyer); Clinic Gais, Gais, Switzerland (Dr Schmid); Division of Cardiology, University Hospital Zurich, Zurich, Switzerland (Drs Hermann and Schmied); and Department of Cardiology, Cardiovascular Center, University Hospital of Bern, Switzerland (Dr Wilhelm)
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Kehoe S, Malézieux-Picard A, Prendki V, Lübbeke A, Tessitore E. [Dilated cardiomyopathy: a toxic cause?]. Revue Médicale Suisse 2022; 18:2406-2409. [PMID: 36515479 DOI: 10.53738/revmed.2022.18.808.2406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Dilated cardiomyopathy is defined by the presence of left ventricular dilatation and contractile dysfunction in the absence of abnormal loading conditions and severe coronary artery disease. Once dilated cardiomyopathy is discovered, a careful and detailed history with laboratory tests may reveal a potential toxic cause. In this article, we present the case of a patient with suspected toxic dilated cardiomyopathy, and then discuss the common causes and treatment of toxic dilated cardiomyopathy.
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Affiliation(s)
- Samuel Kehoe
- Service d'anesthésiologie, Département de médecine aiguë, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Astrid Malézieux-Picard
- Service de médecine interne de l'âgé, Département de réadaptation et gériatrie, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Virginie Prendki
- Service de gériatrie, Département de réadaptation et gériatrie, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Anne Lübbeke
- Service de chirurgie orthopédique et traumatologie de l'appareil moteur, Département de chirurgie, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Elena Tessitore
- Service de cardiologie, Département de médecine, Hôpitaux universitaires de Genève, 1211 Genève 14
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Follonier C, Tessitore E, Handgraaf S, Carballo D, Achard M, Pechère-Bertschi A, Mach F, Herrmann FR, Girardin FR. Cardiovascular therapy use, modification, and in-hospital death in patients with COVID-19: A cohort study. PLoS One 2022; 17:e0277653. [PMID: 36417470 PMCID: PMC9683559 DOI: 10.1371/journal.pone.0277653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 11/01/2022] [Indexed: 11/25/2022] Open
Abstract
AIMS To assess the associations of exposure and modifications in exposure (i.e., discontinuation on admission, initiation during hospitalization) to eight common cardiovascular therapies with the risk of in-hospital death among inpatients with coronavirus disease 2019 (COVID-19). METHODS In this observational study including 838 hospitalized unvaccinated adult patients with confirmed COVID-19, the use of cardiovascular therapies was assessed using logistic regression models adjusted for potential confounders. RESULTS No cardiovascular therapy used before hospitalization was associated with an increased risk of in-hospital death. During hospitalization, the use of diuretics (aOR 2.59 [1.68-3.98]) was associated with an increase, and the use of agents acting on the renin-angiotensin system (aOR 0.39 [0.23-0.64]) and lipid-lowering agents (aOR 0.41 [0.24-0.68]) was associated with a reduction in the odds of in-hospital death. Exposure modifications associated with decreased survival were the discontinuation of an agent acting on the renin-angiotensin system (aOR 4.42 [2.08-9.37]), a β-blocker (aOR 5.44 [1.16-25.46]), a lipid-modifying agent (aOR 3.26 [1.42-7.50]) or an anticoagulant (aOR 5.85 [1.25-27.27]), as well as the initiation of a diuretic (aOR 5.19 [2.98-9.03]) or an antiarrhythmic (aOR 6.62 [2.07-21.15]). Exposure modification associated with improved survival was the initiation of an agent acting on the renin-angiotensin system (aOR 0.17 [0.03-0.82]). CONCLUSION In hospitalized and unvaccinated patients with COVID-19, there was no detrimental association of the prehospital use of any regular cardiovascular medication with in-hospital death, and these therapies should be continued as recommended.
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Affiliation(s)
- Cédric Follonier
- Division of Cardiology, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Elena Tessitore
- Division of Cardiology, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Sandra Handgraaf
- Division of Cardiology, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - David Carballo
- Division of Cardiology, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Maëlle Achard
- Division of Cardiology, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Antoinette Pechère-Bertschi
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Nephrology and Hypertension, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - François Mach
- Division of Cardiology, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - François R. Herrmann
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Geriatrics, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - François R. Girardin
- Division of Clinical Pharmacology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital, Faculty of Medicine, University of Lausanne, Lausanne, Switzerland
- Division of Clinical Pharmacology and Toxicology, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
- * E-mail:
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Tessitore E, Schmid JP, Hermann M, Capoferri M, Kiencke S, Schmied C, Tschanz H, Wilhelm M, Meyer P. Cardiovascular rehabilitation delivery and outcomes in Switzerland: data from a national database over the last decade. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiac rehabilitation (CR) is a multidisciplinary, comprehensive, exercise-based intervention strongly recommended by current guidelines to improve symptoms and quality of life and to reduce cardiovascular adverse outcomes, mainly in patients with coronary artery disease and heart failure. CR activities have not been reported on a Swiss national base so far.
Purpose
To report CR outcome variables from a Swiss national base.
Methods
As part of the Swiss working group for cardiovascular prevention, rehabilitation, and sports cardiology (SCPRS) quality standards, all Swiss CR centres provide yearly a quality indicator report on an online questionnaire. Annual data from 2010 to 2019 were transferred as medians or means of all individual patients' data from each centre. We used the t-Student test to compare changes of outcome variables between entry and exit of the programme.
Results
A total of 133,060 CR patients were included (68,690 inpatients and 64,370 outpatients) with a progressive increase reaching its climax with 14'909 patients/year in 2018. Mean age ± standard deviation (SD) in outpatient and inpatient programmes was 60±1 and 68±1 years, and women percentage 21% and 32%, respectively. The most common CR indication was acute coronary syndrome (51%) in outpatient, whereas cardiovascular surgery of various types (60%) was the main indication in inpatient programmes. Mean improvement ± SD of functional capacity was 38% ±3.6 using the six-minute walk test in inpatient (p<0.001) and 21% ±2 using cycle-ergometer maximal exercise testing in outpatient programmes (p<0.001). Quality of life mainly assessed with the 12-item Short Form Survey (SF-12) in outpatient CR improved by 13% ±4.5. MacNew Heart questionnaire systematically performed in inpatient programmes showed significant improvement at emotional level by 12% ±0.4, at physical level by 30% ±0.9, and at social level by 18% ±0.6.
Conclusion
Even if still underutilised in certain groups of patients such as women or heart failure, CR has gained growing importance in Switzerland during the last decade. Functional capacity, as well as quality of life, was significantly improved. Individual CR patient data should be collected in the future to improve assessment of outcome parameters and benchmarking of centres.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- E Tessitore
- University Hospital of Geneva, Department of Cardiology , Geneva , Switzerland
| | - J P Schmid
- Clinic Gais, Department of Cardiology , Gais , Switzerland
| | - M Hermann
- University of Zurich, Department of Cardiology , Zurich , Switzerland
| | - M Capoferri
- Cardiocentro Ticino, Department of Cardiology , Lugano , Switzerland
| | - S Kiencke
- Kardiologische Gemeinschaftspraxis , Bern , Switzerland
| | - C Schmied
- University of Zurich, Department of Cardiology , Zurich , Switzerland
| | - H Tschanz
- Berner Reha Zentrum , Heiligenschwendi , Switzerland
| | - M Wilhelm
- University of Bern, Department of Cardiology , Bern , Switzerland
| | - P Meyer
- University Hospital of Geneva, Department of Cardiology , Geneva , Switzerland
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Tessitore E, Branca M, Heg D, Nanchen D, Auer R, Raber L, Klingenberg R, Windecker S, Luscher TF, Matter CM, Rodondi N, Carballo D, Mach F, Gencer B. Heavy weekly alcohol consumption versus binge drinking after an acute coronary syndrome and risk of major adverse cardiovascular events at one year follow up. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
The association between heavy weekly alcohol consumption or binge drinking and the risk of major adverse cardiovascular events (MACE) after acute coronary syndromes (ACS) is still unclear.
Purpose
To determine the risks of MACE at one year follow up according to baseline alcohol consumption, especially in patients with heavy weekly alcohol consumption or binge drinking.
Methods
We analyzed data of 6053 patients hospitalized in 4 Swiss centres for an ACS and followed over 12 months. Data on alcohol consumption were collected at baseline and at one year follow up after ACS. Binge drinking was defined as the consumption of ≥6 units of alcohol on one occasion, for the 12-months period preceding the one-year follow up. We defined MACE as a composite of cardiac death, myocardial infarction, stroke or clinically indicated target vessel coronary revascularization. We applied Cox regression to assess the risk of MACE associated with heavy alcohol weekly consumption (>14 standard units/week) compared to light consumption (<1 standard unit/week) or abstinence, as well as the risk with binge drinking, compared to no binge drinking, adjusting for baseline differences (age, sex, body-mass index, smoking, diabetes, peripheral artery disease, stroke, hypertension, use of aspirin, anticoagulation, statin, beta-blocker, ACE-inhibitor or ATII receptor blocker).
Results
At baseline, 817 (13.4%) patients reported heavy weekly alcohol consumption and 717 (11.8%) reported to have at least one episode of binge drinking per month. The risk for MACE at one year follow up was not increased in those with heavy weekly consumption compared to light consumption (8.7% vs. 8.5%, HR 0.96, 95% CI 0.69–1.33, P=0.80) or no consumption (8.7% vs. 10.3%, HR 1.26, 95% CI 0.88–1.80, P=0.21). However, the risk of MACE was higher in those reporting binge drinking with less than one episode a month (9.4% vs. 7.7%, HR 1.67, 95% CI 1.32–2.12, P<0.001), as well as in those with at least one episode of binge drinking per month (13.4% vs. 7.7%, HR 2.07, 95% CI 1.62–2.65, P<0.001), when compared to no binge drinking.
Conclusion
In contrast to regular heavy alcohol consumption, binge drinking behavior is associated with significant increased risk of MACE 12 months after ACS.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- E Tessitore
- University Hospital of Geneva, Department of Cardiology , Geneva , Switzerland
| | - M Branca
- University of Bern, Department of Clinical Research , Bern , Switzerland
| | - D Heg
- University of Bern, Department of Clinical Research , Bern , Switzerland
| | - D Nanchen
- Centre for Primary Care and Public Health (Unisante) , Lausanne , Switzerland
| | - R Auer
- Centre for Primary Care and Public Health (Unisante) , Lausanne , Switzerland
| | - L Raber
- University of Zurich, Department of Cardiology , Zurich , Switzerland
| | - R Klingenberg
- University of Zurich, Department of Cardiology , Zurich , Switzerland
| | - S Windecker
- University of Bern, Department of Cardiology , Bern , Switzerland
| | - T F Luscher
- University of Zurich, Department of Cardiology , Zurich , Switzerland
| | - C M Matter
- University of Zurich, Department of Cardiology , Zurich , Switzerland
| | - N Rodondi
- University of Bern, Department of Cardiology , Bern , Switzerland
| | - D Carballo
- University Hospital of Geneva, Department of Cardiology , Geneva , Switzerland
| | - F Mach
- University Hospital of Geneva, Department of Cardiology , Geneva , Switzerland
| | - B Gencer
- University Hospital of Geneva, Department of Cardiology , Geneva , Switzerland
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Gencer B, Tessitore E. 2021 European guidelines on cardiovascular prevention: Challenges for an evidence-based patient care. Eur J Clin Invest 2022; 52:e13752. [PMID: 35118645 DOI: 10.1111/eci.13752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Baris Gencer
- Division of Cardiology, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Elena Tessitore
- Division of Cardiology, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
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Linschoten M, Uijl A, Schut A, Jakob CEM, Romão LR, Bell RM, McFarlane E, Stecher M, Zondag AGM, van Iperen EPA, Hermans-van Ast W, Lea NC, Schaap J, Jewbali LS, Smits PC, Patel RS, Aujayeb A, van der Harst P, Siebelink HJ, van Smeden M, Williams S, Pilgram L, van Gilst WH, Tieleman RG, Williams B, Asselbergs FW, Al-Ali AK, Al-Muhanna FA, Al-Rubaish AM, Al-Windy NYY, Alkhalil M, Almubarak YA, Alnafie AN, Alshahrani M, Alshehri AM, Anning C, Anthonio RL, Badings EA, Ball C, van Beek EA, ten Berg JM, von Bergwelt-Baildon M, Bianco M, Blagova OV, Bleijendaal H, Bor WL, Borgmann S, van Boxem AJM, van den Brink FS, Bucciarelli-Ducci C, van Bussel BCT, Byrom-Goulthorp R, Captur G, Caputo M, Charlotte N, vom Dahl J, Dark P, De Sutter J, Degenhardt C, Delsing CE, Dolff S, Dorman HGR, Drost JT, Eberwein L, Emans ME, Er AG, Ferreira JB, Forner MJ, Friedrichs A, Gabriel L, Groenemeijer BE, Groenendijk AL, Grüner B, Guggemos W, Haerkens-Arends HE, Hanses F, Hedayat B, Heigener D, van der Heijden DJ, Hellou E, Hellwig K, Henkens MTHM, Hermanides RS, Hermans WRM, van Hessen MWJ, Heymans SRB, Hilt AD, van der Horst ICC, Hower M, van Ierssel SH, Isberner N, Jensen B, Kearney MT, van Kesteren HAM, Kielstein JT, Kietselaer BLJH, Kochanek M, Kolk MZH, Koning AMH, Kopylov PY, Kuijper AFM, Kwakkel-van Erp JM, Lanznaster J, van der Linden MMJM, van der Lingen ACJ, Linssen GCM, Lomas D, Maarse M, Macías Ruiz R, Magdelijns FJH, Magro M, Markart P, Martens FMAC, Mazzilli SG, McCann GP, van der Meer P, Meijs MFL, Merle U, Messiaen P, Milovanovic M, Monraats PS, Montagna L, Moriarty A, Moss AJ, Mosterd A, Nadalin S, Nattermann J, Neufang M, Nierop PR, Offerhaus JA, van Ofwegen-Hanekamp CEE, Parker E, Persoon AM, Piepel C, Pinto YM, Poorhosseini H, Prasad S, Raafs AG, Raichle C, Rauschning D, Redón J, Reidinga AC, Ribeiro MIA, Riedel C, Rieg S, Ripley DP, Römmele C, Rothfuss K, Rüddel J, Rüthrich MM, Salah R, Saneei E, Saxena M, Schellings DAAM, Scholte NTB, Schubert J, Seelig J, Shafiee A, Shore AC, Spinner C, Stieglitz S, Strauss R, Sturkenboom NH, Tessitore E, Thomson RJ, Timmermans P, Tio RA, Tjong FVY, Tometten L, Trauth J, den Uil CA, Van Craenenbroeck EM, van Veen HPAA, Vehreschild MJGT, Veldhuis LI, Veneman T, Verschure DO, Voigt I, de Vries JK, van de Wal RMA, Walter L, van de Watering DJ, Westendorp ICD, Westendorp PHM, Westhoff T, Weytjens C, Wierda E, Wille K, de With K, Worm M, Woudstra P, Wu KW, Zaal R, Zaman AG, van der Zee PM, Zijlstra LE, Alling TE, Ahmed R, van Aken K, Bayraktar-Verver ECE, Bermúdez Jiménes FJ, Biolé CA, den Boer-Penning P, Bontje M, Bos M, Bosch L, Broekman M, Broeyer FJF, de Bruijn EAW, Bruinsma S, Cardoso NM, Cosyns B, van Dalen DH, Dekimpe E, Domange J, van Doorn JL, van Doorn P, Dormal F, Drost IMJ, Dunnink A, van Eck JWM, Elshinawy K, Gevers RMM, Gognieva DG, van der Graaf M, Grangeon S, Guclu A, Habib A, Haenen NA, Hamilton K, Handgraaf S, Heidbuchel H, Hendriks-van Woerden M, Hessels-Linnemeijer BM, Hosseini K, Huisman J, Jacobs TC, Jansen SE, Janssen A, Jourdan K, ten Kate GL, van Kempen MJ, Kievit CM, Kleikers P, Knufman N, van der Kooi SE, Koole BAS, Koole MAC, Kui KK, Kuipers-Elferink L, Lemoine I, Lensink E, van Marrewijk V, van Meerbeeck JP, Meijer EJ, Melein AJ, Mesitskaya DF, van Nes CPM, Paris FMA, Perrelli MG, Pieterse-Rots A, Pisters R, Pölkerman BC, van Poppel A, Reinders S, Reitsma MJ, Ruiter AH, Selder JL, van der Sluis A, Sousa AIC, Tajdini M, Tercedor Sánchez L, Van De Heyning CM, Vial H, Vlieghe E, Vonkeman HE, Vreugdenhil P, de Vries TAC, Willems AM, Wils AM, Zoet-Nugteren SK. Clinical presentation, disease course, and outcome of COVID-19 in hospitalized patients with and without pre-existing cardiac disease: a cohort study across 18 countries. Eur Heart J 2022; 43:1104-1120. [PMID: 34734634 DOI: 10.1093/eurheartj/ehab656] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/22/2021] [Accepted: 09/01/2021] [Indexed: 12/25/2022] Open
Abstract
AIMS Patients with cardiac disease are considered high risk for poor outcomes following hospitalization with COVID-19. The primary aim of this study was to evaluate heterogeneity in associations between various heart disease subtypes and in-hospital mortality. METHODS AND RESULTS We used data from the CAPACITY-COVID registry and LEOSS study. Multivariable Poisson regression models were fitted to assess the association between different types of pre-existing heart disease and in-hospital mortality. A total of 16 511 patients with COVID-19 were included (21.1% aged 66-75 years; 40.2% female) and 31.5% had a history of heart disease. Patients with heart disease were older, predominantly male, and often had other comorbid conditions when compared with those without. Mortality was higher in patients with cardiac disease (29.7%; n = 1545 vs. 15.9%; n = 1797). However, following multivariable adjustment, this difference was not significant [adjusted risk ratio (aRR) 1.08, 95% confidence interval (CI) 1.02-1.15; P = 0.12 (corrected for multiple testing)]. Associations with in-hospital mortality by heart disease subtypes differed considerably, with the strongest association for heart failure (aRR 1.19, 95% CI 1.10-1.30; P < 0.018) particularly for severe (New York Heart Association class III/IV) heart failure (aRR 1.41, 95% CI 1.20-1.64; P < 0.018). None of the other heart disease subtypes, including ischaemic heart disease, remained significant after multivariable adjustment. Serious cardiac complications were diagnosed in <1% of patients. CONCLUSION Considerable heterogeneity exists in the strength of association between heart disease subtypes and in-hospital mortality. Of all patients with heart disease, those with heart failure are at greatest risk of death when hospitalized with COVID-19. Serious cardiac complications are rare during hospitalization.
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Tessitore E, Dobretz K, Dhayat NA, Kern I, Ponte B, Pruijm M, Ackermann D, Estoppey S, Burnier M, Martin PY, Vogt B, Vuilleumier N, Bochud M, Mach F, Ehret G. Changes of lipoprotein(a) levels with endogenous steroid hormones. Eur J Clin Invest 2022; 52:e13699. [PMID: 34695230 PMCID: PMC9286445 DOI: 10.1111/eci.13699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/24/2021] [Accepted: 10/04/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Lipoprotein(a) [Lp(a)] is an LDL-like molecule that is likely causal for cardiovascular events and Lp(a) variability has been shown to be mostly of genetic origin. Exogenous hormones (hormone replacement therapy) seem to influence Lp(a) levels, but the impact of endogenous hormone levels on Lp(a) is still unknown. The aim of the study was to assess the effect of endogenous steroid hormone metabolites on Lp(a). METHODS Lipoprotein(a) levels were measured in 1,021 participants from the Swiss Kidney Project on Genes in Hypertension, a family-based, multicentre, population-based prospective cohort study. Endogenous levels of 28 steroid hormone precursors were measured in 24-h urine collections from 883 individuals. Of the participants with Lp(a) data, 1,011 participants had also genotypes available. RESULTS The participants had an average age of 51 years and 53% were female. Median Lp(a) levels were 62 mg/L, and the 90th percentile was 616 mg/L. The prevalence of a Lp(a) elevation ≥700 mg/L was 3.2%. Forty-three per cent of Lp(a) variability was explained respectively by: age (2%, p < .001), LDL-C (1%, p = .001), and two SNPs (39%, p value<2⋅10-16 ). Of the 28 endogenous steroid hormones assessed, androstenetriol, androsterone, 16α-OH-DHEA and estriol were nominatively associated with serum Lp(a) levels in univariable analyses and explained 0.4%-1% of Lp(a) variability, but none of them reached significance in multivariable models. CONCLUSIONS In this contemporary population-based study, the prevalence of a Lp(a) elevation ≥700 mg/L was 3.2%. The effect of endogenous steroid hormone levels of Lp(a) variability was small at best, suggesting a negligible impact on the wide range of Lp(a) variability.
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Affiliation(s)
- Elena Tessitore
- Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Kevin Dobretz
- Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Nasser Abdalla Dhayat
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ilse Kern
- Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Belen Ponte
- Nephrology and Hypertension, Geneva University Hospitals, Geneva, Switzerland
| | - Menno Pruijm
- Nephrology, University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - Daniel Ackermann
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sandrine Estoppey
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Michel Burnier
- Nephrology, University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - Pierre-Yves Martin
- Nephrology and Hypertension, Geneva University Hospitals, Geneva, Switzerland
| | - Bruno Vogt
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Murielle Bochud
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - François Mach
- Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Georg Ehret
- Cardiology, Geneva University Hospitals, Geneva, Switzerland
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11
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Najjar I, Socquet J, Gayet-Ageron A, Ricou B, Le Breton J, Rossel A, Abdulcadir J, Soroken C, Tessitore E, Gerstel C, Halimi J, Frasca Polara G, Coen M, Niyibizi E. Prevalence and forms of gender discrimination and sexual harassment among medical students and physicians in French-speaking Switzerland: a survey. BMJ Open 2022; 12:e049520. [PMID: 35039283 PMCID: PMC8765015 DOI: 10.1136/bmjopen-2021-049520] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES The aim of this study was to determine the prevalence and forms of gender discrimination and sexual harassment experienced by medical students and physicians in French-speaking part of Switzerland. DESIGN AND SETTING We conducted an online survey using a questionnaire of 9 multiple-choice and 2 open questions between 24 January 2019 and 24 February 2019. Our target population was medical students and physicians working at hospitals and general practitioners from the French-speaking part of Switzerland. The online survey was sent via social media platforms and direct emails. We compared answers between male-determined and female-determined respondents using either χ2 or Fisher's exact tests. RESULTS Among 1071 responders, a total of 893 were included (625 females, 264 males, 4 non-binary and 1 non-binary and male). 178 were excluded because they did not mention their working place or were working only outside Switzerland. Because of the small number of non-binary participants, they were not contemplated in further statistical analysis. Of 889 participants left, 199 (31.8%) women and 18 (6.8%) men reported having personally experienced gender discrimination, in terms of sexism, difficulties in career development and psychological pressure. Among women, senior attendings were the most affected (55.2%), followed by residents (44.1%) and junior attendings (41.1%). Sexual harassment was equally observed among women (19.0%) and men (16.7%). Compared with men (47.0%), women (61.4%) expressed the need to promote equality and inclusivity in medicine more frequently (p<0.001), as well as the need for support in their professional development (38.7% women and 23.9% men; p<0.001). CONCLUSIONS Gender discrimination in medicine in French-speaking Switzerland affects one-third of women, in particular, those working in hospital settings and senior positions.
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Affiliation(s)
- Iris Najjar
- Department of Medicine, HUG, Geneva, Switzerland
| | | | | | - Bara Ricou
- Department of APSI, HUG, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Julien Le Breton
- Department of Rehabilitation and Geriatrics, HUG, Geneva, Switzerland
| | - Anne Rossel
- Department of Medicine, HUG, Geneva, Switzerland
| | | | - Cindy Soroken
- Department of Maternity, Adolescent and Child Health, HUG, Geneva, Switzerland
| | | | - Caroline Gerstel
- Department of General Internal Medicine, Delta Practice Network, Geneva, Switzerland
| | - Julie Halimi
- Department of Child Psychiatry, HUG, Geneva, Switzerland
| | | | - Matteo Coen
- Department of Medicine, HUG, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Eva Niyibizi
- Deprtment of Emergency Care, Hirslanden Clinique La Colline, Geneva, Switzerland
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12
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Triolo J, Buchs N, Tessitore E, Hannouche D, Dominguez D, Kalbermatten D, Oranges C. VP3: Pelvic Reconstruction After Large Sacral Chordoma Resection Using Acellular Dermal Matrix and Double Pedicled Gracilis Muscle Flap Combined with Gluteal Fasciocutaneous Rotation Flap. Plast Reconstr Surg Glob Open 2022. [PMCID: PMC8729200 DOI: 10.1097/01.gox.0000817688.18343.a0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Tessitore E, Handgraaf S, Poncet A, Achard M, Höfer S, Carballo S, Marti C, Follonier C, Girardin F, Mach F, Carballo D. Symptoms and quality of life at 1-year follow up of patients discharged after an acute COVID-19 episode. Swiss Med Wkly 2021; 151:w30093. [PMID: 34909433 DOI: 10.4414/smw.2021.w30093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
AIM OF THE STUDY Patients surviving COVID-19 have been described as being at risk of developing sequelae. We aimed to investigate and elicit persistent symptoms, emotional status and quality-of-life in patients discharged after an acute COVID-19 episode. METHODS Patient-reported outcome measures were collected during a telephone interview 30 days and 1 year after discharge. Patients' general health status was evaluated using questions based on their symptoms, emotional status was assessed using the items 9 to 12 of the HeartQoL questionnaire and quality of life was assessed at 1 year through the EQ-5D-5L. In patients with a history of cardiovascular disease, all 14 items of the HeartQoL questionnaire were completed to derive the HeartQoL global score. RESULTS Among 687 patients who survived after being hospitalised for COVID-19 at the University Hospitals of Geneva between 26 February and 26 April 2020, 184 (27%) and 165 (24%), respectively, participated in the follow-up at 30 days and 1 year. Of these 184 participants, 62% were male, median age was 58 years and 21% had a past medical history of cardiovascular disease. At one month after discharge, 61% (113/184) of patients presented fatigue and 28% (52/184) dyspnoea. One year after discharge, the main complaints were persistent fatigue in 27% (45/165) of patients, neurological problems in 17% (28/165) and dyspnoea in 14% (23/165). Eight percent (14/184) of patients declared being significantly worried 1 month after discharge and 5% (9/184) feeling depressed. The number of patients reporting being significantly worried or depressed at 1 year was lower. Regarding the quality of life at 1 year, the median EQ-5D-5L visual analogue scale score was 80 (interquartile range 70-90). CONCLUSIONS Approximately half of patients reported some symptoms 1 year after discharge following an acute episode of COVID-19. The predominant symptom was persistent fatigue both at 1-month and at 1-year follow-up. Emotional status and quality of life appeared satisfactory.
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Affiliation(s)
- Elena Tessitore
- Department of Internal Medicine, Division of Cardiology, University Hospitals of Geneva, Switzerland
| | - Sandra Handgraaf
- Department of Internal Medicine, Division of Cardiology, University Hospitals of Geneva, Switzerland
| | - Antoine Poncet
- Department of Health and Community Medicine, University Hospitals of Geneva, Switzerland
| | - Maëlle Achard
- Department of Internal Medicine, Division of Cardiology, University Hospitals of Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Switzerland
| | - Stefan Höfer
- Department of Medical Psychology, Innsbruck Medical University, Innsbruck, Austria
| | - Sebastian Carballo
- Department of Internal Medicine, Division of Internal Medicine, University Hospitals of Geneva, Switzerland
| | - Christophe Marti
- Department of Internal Medicine, Division of Internal Medicine, University Hospitals of Geneva, Switzerland
| | - Cédric Follonier
- Department of Internal Medicine, Division of Cardiology, University Hospitals of Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Switzerland
| | - François Girardin
- Service of Clinical Pharmacology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital (CHUV) and University of Lausanne, Switzerland.,Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Division of Clinical Pharmacology and Toxicology, University Hospitals of Geneva, Switzerland
| | - François Mach
- Department of Internal Medicine, Division of Cardiology, University Hospitals of Geneva, Switzerland
| | - David Carballo
- Department of Internal Medicine, Division of Cardiology, University Hospitals of Geneva, Switzerland
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14
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Tessitore E, Dobretz K, Dhayat NA, Estoppey S, Kern I, Ponte B, Pruijm M, Vogt B, Vuilleumier N, Bochud M, Mach F, Ehret G. Lipoprotein(a) levels are not independently associated with endogenous steroid hormone levels, in contrast to other non-genetic and genetic factors: the population-based SKIPOGH study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Lipoprotein(a) [Lp(a)] is an LDL-like molecule that is likely causally related to cardiovascular events. Lp(a) levels are highly variable, by more two orders of magnitude, and most of this variability appears to be of genetic origin. Exogenous hormones (hormone replacement therapy) seem to influence Lp(a) levels, but the impact of the variation of endogenous hormone levels on Lp(a) is unknown.
Purpose
To investigate the association between Lp(a) levels and non-genetic factors, as endogenous steroid hormone levels, in contrast to genetic factors.
Methods
We investigated the association of 28 endogenous steroids with Lp(a) levels and compared the association to other non-genetic and genetic variables in a prospective, population-based sample (N=1,021).
Results
The average age of the participants was 51 years and 53% were female. Median Lp(a) levels were 62 (±204) mg/l and the 90th and 99th percentile of Lp(a) was 616mg/l and 1035 mg/l respectively. The prevalence of a Lp(a) elevation ≥700mg/l was 3.2% and Lp(a) varied greatly from undetectable to 1,690mg/l. Age explained 2.0% of Lp(a) variability (p<0.001), 1% was explained by LDL levels (p=0.001), and 40% by two single nucleotide polymorphisms near the Lp(a) gene that have been previously described. Lp(a) levels were on average almost two times more elevated in secondary prevention and in individuals with very elevated LDL levels (≥4.9 mmol/l). Of the 28 endogenous steroid hormones assessed, 5-androstene-3b,16α,17β-triol, androsterone, 16α-hydroxy DHEA, and estriol were nominatively associated with serum Lp(a) levels and explained 0.4–1% of Lp(a) variability in univariate analyses, but they did not reach significance in multi-variate models.
Conclusion
Our results confirm previous findings demonstrating that the majority of the Lp(a) variation in the general population is of genetic origin. Age and LDL-levels explain a further small part of Lp(a) variability. Endogenous hormone levels do not contribute significantly to the wide range of variability.
Funding Acknowledgement
Type of funding sources: None. Coefficient plot Lp(a) and variables
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Affiliation(s)
- E Tessitore
- University Hospital of Geneva, Department of Cardiology, Geneva, Switzerland
| | - K Dobretz
- University Hospital of Geneva, Department of Cardiology, Geneva, Switzerland
| | - N A Dhayat
- Inselspital - University of Bern, Department of Nephrology and Hypertension, Bern, Switzerland
| | - S Estoppey
- Centre for Primary Care and Public Health (Unisante), Lausanne, Switzerland
| | - I Kern
- Geneva University Hospitals, Geneva, Switzerland
| | - B Ponte
- Geneva University Hospitals, Department of Nephrology and Hypertension, Geneva, Switzerland
| | - M Pruijm
- University Hospital Centre Vaudois (CHUV), Department of Nephrology, Lausanne, Switzerland
| | - B Vogt
- Inselspital - University of Bern, Department of Nephrology and Hypertension, Bern, Switzerland
| | | | - M Bochud
- Centre for Primary Care and Public Health (Unisante), Lausanne, Switzerland
| | - F Mach
- University Hospital of Geneva, Department of Cardiology, Geneva, Switzerland
| | - G Ehret
- University Hospital of Geneva, Department of Cardiology, Geneva, Switzerland
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15
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Tessitore E, Sittarame F, Sigaud P, Dousse N, Mach F, Meyer P. [Cardiac rehabilitation : a multidisciplinary program of cardiovascular prevention of essential importance]. Rev Med Suisse 2021; 17:1010-1014. [PMID: 34042335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Cardiovascular diseases and especially coronary artery disease remain the first cause of mortality in Switzerland. Comprehensive cardiac rehabilitation is a validated multidisciplinary intervention, which represents the most appropriate strategy of implementing an effective secondary cardiovascular prevention to reduce the impact of cardiovascular diseases. However, less than half of patients after a myocardial infarction and a tiny proportion of patients with heart failure participate in a rehabilitation program in our country. This article summarizes the current state of cardiac rehabilitation in Switzerland, as well as future developments of cardiac tele-rehabilitation that have accelerated due to the COVID-19 pandemic.
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Affiliation(s)
- Elena Tessitore
- Service de cardiologie, Département de médecine, HUG, 1211 Genève 14
| | | | - Philippe Sigaud
- Service de cardiologie, Département de médecine, HUG, 1211 Genève 14
| | - Nicolas Dousse
- Service de cardiologie, Département de médecine, HUG, 1211 Genève 14
| | - François Mach
- Service de cardiologie, Département de médecine, HUG, 1211 Genève 14
| | - Philippe Meyer
- Service de cardiologie, Département de médecine, HUG, 1211 Genève 14
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16
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Tessitore E, Carballo D, Poncet A, Perrin N, Follonier C, Assouline B, Carballo S, Girardin F, Mach F. Mortality and high risk of major adverse events in patients with COVID-19 and history of cardiovascular disease. Open Heart 2021; 8:openhrt-2020-001526. [PMID: 33833064 PMCID: PMC8039226 DOI: 10.1136/openhrt-2020-001526] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/01/2021] [Accepted: 03/19/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE History of cardiovascular diseases (CVDs) may influence the prognosis of patients hospitalised for COVID-19. We investigated whether patients with previous CVD have increased risk of death and major adverse cardiovascular event (MACE) when hospitalised for COVID-19. METHODS We included 839 patients with COVID-19 hospitalised at the University Hospitals of Geneva. Demographic characteristics, medical history, laboratory values, ECG at admission and medications at admission were collected based on electronic medical records. The primary outcome was a composite of in-hospital mortality or MACE. RESULTS Median age was 67 years, 453 (54%) were males and 277 (33%) had history of CVD. In total, 152 (18%) died and 687 (82%) were discharged, including 72 (9%) who survived a MACE. Patients with previous CVD were more at risk of composite outcomes 141/277 (51%) compared with those without CVD 83/562 (15%) (OR=6.0 (95% CI 4.3 to 8.4), p<0.001). Multivariate analyses showed that history of CVD remained an independent risk factor of in-hospital death or MACE (OR=2.4; (95% CI 1.6 to 3.5)), as did age (OR for a 10-year increase=2.2 (95% CI 1.9 to 2.6)), male gender (OR=1.6 (95% CI 1.1 to 2.3)), chronic obstructive pulmonary disease (OR=2.1 (95% CI 1.0 to 4.2)) and lung infiltration associated with COVID-19 at CT scan (OR=1.9 (95% CI 1.2 to 3.0)). History of CVD (OR=2.9 (95% CI 1.7 to 5)), age (OR=2.5 (95% CI 2.0 to 3.2)), male gender (OR=1.6 (95% CI 0.98 to 2.6)) and elevated C reactive protein (CRP) levels on admission (OR for a 10 mg/L increase=1.1 (95% CI 1.1 to 1.2)) were independent risk factors for mortality. CONCLUSION History of CVD is associated with higher in-hospital mortality and MACE in hospitalised patients with COVID-19. Other factors associated with higher in-hospital mortality are older age, male sex and elevated CRP on admission.
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Affiliation(s)
- Elena Tessitore
- Department of Cardiology, University Hospitals of Geneva Department of Medical Specializations, Geneva, Switzerland
| | - David Carballo
- Department of Cardiology, University Hospitals of Geneva Department of Medical Specializations, Geneva, Switzerland
| | - Antoine Poncet
- Department of Health and Community Medicine, University of Geneva, Geneva, Switzerland
| | - Nils Perrin
- Department of Cardiology, University Hospitals of Geneva Department of Medical Specializations, Geneva, Switzerland
| | - Cedric Follonier
- Department of Cardiology, University Hospitals of Geneva Department of Medical Specializations, Geneva, Switzerland
| | - Benjamin Assouline
- Intensive Care Division, Department of Acute Medicine, University Hospitals of Geneva, Oakland, California, USA
| | - Sebastian Carballo
- Department of Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - François Girardin
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland.,Department of Laboratory Medicine and Pathology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Francois Mach
- Department of Cardiology, University Hospitals of Geneva Department of Medical Specializations, Geneva, Switzerland
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Laurencet ME, Iglesias JF, Noble S, Tessitore E, Degrauwe S. Walking on a thin line between potent platelet inhibition for myocardial infarction and risk of hemorrhagic complications. Tirofiban induced subconjunctival hemorrhage. Cardiol J 2021; 28:351-352. [PMID: 33881772 DOI: 10.5603/cj.2021.0032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 01/15/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Marie-Eva Laurencet
- Department of Cardiology, Geneva University Hospital, Geneva, Switzerland, Gabrielle- Perret-Gentil 4, 1205 Genève, Switzerland
| | - Juan F Iglesias
- Department of Cardiology, Geneva University Hospital, Geneva, Switzerland, Gabrielle- Perret-Gentil 4, 1205 Genève, Switzerland
| | - Stéphane Noble
- Department of Cardiology, Geneva University Hospital, Geneva, Switzerland, Gabrielle- Perret-Gentil 4, 1205 Genève, Switzerland
| | - Elena Tessitore
- Department of Cardiology, Geneva University Hospital, Geneva, Switzerland, Gabrielle- Perret-Gentil 4, 1205 Genève, Switzerland
| | - Sophie Degrauwe
- Department of Cardiology, Geneva University Hospital, Geneva, Switzerland, Gabrielle- Perret-Gentil 4, 1205 Genève, Switzerland.
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Perrin N, Iglesias JF, Rey F, Benzakour L, Cimci M, Noble S, Degrauwe S, Tessitore E, Mach F, Roffi M. Impact of the COVID-19 pandemic on acute coronary syndromes. Swiss Med Wkly 2020; 150:w20448. [PMID: 33382905 DOI: 10.4414/smw.2020.20448] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
AIM To assess the impact of the first wave of the COVID-19 pandemic on acute coronary syndromes and on the delay from symptom onset to first medical contact among patients presenting with ST-segment elevation myocardial infarction (STEMI), as well as to investigate whether there were patient-related reasons related to COVID-19 for delaying first medical contact. METHODS AND RESULTS All patients undergoing percutaneous coronary intervention (PCI) at the Geneva University Hospitals for acute coronary syndromes (ACS) during the first COVID-19 wave were compared with a control group consisting of all ACS patients who underwent PCI during the same period in 2019 and those treated in the period immediately preceding the pandemic. The primary outcome measure was the difference in the delay from symptom onset to first medical contact in the setting of STEMI between the COVID-19 period and the control period. Secondary outcome measures were the difference in ACS incidence and the impact of the COVID-19 pandemic on patients’ decisions to call the emergency services, assessed using a questionnaire. Delay from symptom onset to first medical contact was longer among patients suffering from STEMI in the COVID-19 period compared with the control period (112 min vs 60 min, p = 0.049). The incidence rate of ACS was lower during the COVID-19 period (incidence rate ratio 0.6, 95% confidence interval [CI] 0.449–0.905). ACS patients delayed their call to the emergency services mainly because of fear of contracting or spreading COVID-19 following hospital admission, as well as of adding burden to the healthcare system. CONCLUSION We observed prolonged delays from symptom onset to first medical contact and a decline in overall ACS incidence during the first wave of the COVID-19 pandemic, with a higher threshold to call for help among ACS patients.
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Affiliation(s)
- Nils Perrin
- Cardiology division, Geneva University Hospitals, Geneva, Switzerland
| | - Juan F Iglesias
- Cardiology division, Geneva University Hospitals, Geneva, Switzerland
| | - Florian Rey
- Cardiology division, Geneva University Hospitals, Geneva, Switzerland
| | - Lamyae Benzakour
- Psychiatric department, Geneva University Hospitals, Geneva, Switzerland
| | - Murat Cimci
- Cardiology division, Geneva University Hospitals, Geneva, Switzerland
| | - Stephane Noble
- Cardiology division, Geneva University Hospitals, Geneva, Switzerland
| | - Sophie Degrauwe
- Cardiology division, Geneva University Hospitals, Geneva, Switzerland
| | - Elena Tessitore
- Cardiology division, Geneva University Hospitals, Geneva, Switzerland
| | - François Mach
- Cardiology division, Geneva University Hospitals, Geneva, Switzerland
| | - Marco Roffi
- Cardiology division, Geneva University Hospitals, Geneva, Switzerland
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Fazzolari B, Jannelli G, Conti E, Delitala A, Tessitore E, Brunori A. Clinical and radiological outcome after minimally invasive surgical approach for type II unstable odontoid fractures. Neurochirurgie 2020; 67:350-357. [PMID: 33338497 DOI: 10.1016/j.neuchi.2020.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 11/25/2020] [Accepted: 11/29/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Anterior odontoid screw fixation is a valid surgical option for unstable odontoid fractures, as type II Anderson D'Alonzo fractures. Grauer further divided type II fractures in subtypes according to the fracture line, providing recommendations for implementation of screw fixation techniques. OBJECTIVE Primary endpoint of our study is to evaluate the postoperative results of minimally invasive odontoid screw insertion in terms of outcome, fusion rate and stability of cranio-cervical junction. Secondary endpoint was to investigate the influence of age or fractures' features on outcome and fusion rate. MATERIALS AND METHODS We report the clinical and radiological features of 32 patients harbouring unstable type II fractures operated by a minimally invasive odontoid screw insertion technique. All patients underwent a high resolution multiplanar CT in order to assess fracture features according to Grauer's classification; the integrity of ligaments was investigated by MRI. In addition, a preoperative neurological performance (modified Rankin Scale, mRS) was evaluated for patients either directly or interviewing their families. Follow-up at one, three and six months and 1 year have been performed (averaging 13.5 months) by cervical CT (fusion rate and stability) and mRS update. In order to investigate the influence of age on postoperative neurological performance, two groups (≤50 yrs, 9 pts/>50 yrs, 23 pts) were separately considered and analysed. Overall, we observed no surgery related complications. We also analysed the fusion rate and its correlation with patient age and Grauer's subtype of fracture. RESULTS At last available clinical follow-up, the preoperative performance was preserved (mRS 0/1: 24, 75%; mRS 2-4: 9, 15%) although with slight reduction of intact patients (mRS 0: 22 vs. 19; 71.8 vs. 59.3%). Younger patients (≤50 yrs) fared significantly better than older ones, achieving a good clinical outcome (mRS 0/1) in 100% vs. 69.5% (9/9 vs. 16/23 pts). Statistical analysis showed a fair correlation between age and outcome. Other factors such as sex and Grauer's type did not influence significantly the clinical outcome. Nine patients did not complete a full radiological follow-up and were therefore excluded from analysis of radiological outcome. Among the remaining 23 patients, only 25% of those who were followed three months or less showed fusion; conversely, all patients who have been examined from 6 to 48 months fused. Among the non-union patients, two underwent a second surgery by posterior approach. CONCLUSIONS In our recent experience, the minimally invasive AOSF proved safe and effective in treating odontoid peg fractures. Selection based on Grauer's type is mandatory to achieve best results. While in the elderly, an anterior approach is well accepted as the first choice treatment, we recommend that this option should be offered as a suitable alternative to Halo or orthosis also in younger patients since it provides prompt, excellent clinical outcome and high fusion rate especially in this age group.
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Affiliation(s)
- B Fazzolari
- Neurosurgical Unit, San Camillo Hospital, Rome, Italy.
| | - G Jannelli
- Division of Neurosurgery, Geneva University Hospitals and University of Geneva Faculty of Medicine, Geneva, Switzerland.
| | - E Conti
- United Nations High Commissioner for Refugees, Rome, Italy.
| | - A Delitala
- Neurosurgical Unit, San Camillo Hospital, Rome, Italy.
| | - E Tessitore
- Division of Neurosurgery, Geneva University Hospitals and University of Geneva Faculty of Medicine, Geneva, Switzerland.
| | - A Brunori
- Neurosurgical Unit, San Camillo Hospital, Rome, Italy.
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20
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Tessitore E, Meyer P. COVID-19 and cardiovascular disease: what have we learned? Swiss Med Wkly 2020; 150:w20452. [PMID: 33382902 DOI: 10.4414/smw.2020.20452] [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: 11/18/2022] Open
Affiliation(s)
- Elena Tessitore
- Cardiology Service, Geneva University Hospitals, Geneva, Switzerland
| | - Philippe Meyer
- Cardiology Service, Geneva University Hospitals, Geneva, Switzerland
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21
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Grandjean T, Degrauwe S, Tessitore E, Iglesias JF. The 'de Winter' electrocardiogram pattern as a ST-elevation myocardial infarction equivalent: a case report. Eur Heart J Case Rep 2020; 3:1-5. [PMID: 31911997 PMCID: PMC6939815 DOI: 10.1093/ehjcr/ytz210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/10/2019] [Accepted: 11/03/2019] [Indexed: 12/30/2022]
Abstract
Background A ‘STEMI equivalent’ electrocardiogram (ECG) pattern reflects an acute thrombotic occlusion of a large epicardial coronary artery without ST-segment elevation. These ECG patterns are less known by caregivers. Case summary We describe the case of a 56-year-old patient suffering from acute chest pain, presenting in our emergency department with a ‘de Winter’ ECG pattern: an upsloping ST-segment depression with tall symmetrical T waves associated with left anterior descending artery occlusion. Discussion The ‘de Winter’ ECG pattern, as other ‘STEMI equivalent’, must be recognized promptly and treated as soon as possible with emergent reperfusion by percutaneous coronary intervention.
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Affiliation(s)
- Thierry Grandjean
- Department of Cardiology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Sophie Degrauwe
- Department of Cardiology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Elena Tessitore
- Department of Cardiology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Juan F Iglesias
- Department of Cardiology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
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22
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Tessitore E, Ramlawi M, Tobler O, Sunthorn H. Brugada Pattern Caused by a Flecainide Overdose. J Emerg Med 2017; 52:e95-e97. [PMID: 27884575 DOI: 10.1016/j.jemermed.2016.10.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 10/12/2016] [Accepted: 10/21/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Brugada pattern can be found on the electrocardiogram (ECG) of patients with altered mental status, usually with fever or drug intoxication. Diagnosis remains challenging, because the ECG changes are dynamic and variable. In addition, triggers are not always clearly identified. In patients with atrial fibrillation (AF), the use of class IC antidysrhythmic drugs can unmask a Brugada pattern on the ECG, especially if combined with other medications acting on sodium channels. CASE REPORT A 62-year-old man with a medical history of AF was admitted to our emergency department for altered mental status. The ECG at the time of admission showed a Brugada pattern, triggered by a flecainide overdose (about 1 g), in association with an unknown dose of lamotrigine and quetiapine. After discontinuation of all medications, the Brugada pattern disappeared and his ECG showed no abnormalities. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In patients with AF, the use of class IC antidysrhythmic drugs, if overdosed, can trigger a Brugada ECG pattern, and therefore it can increase the risk for malignant dysrhythmias. It is important to provide, to all patients with a Brugada ECG pattern, a list of drugs to avoid, and to underline the synergistic interplay between drugs, taking into consideration all patients' comorbidities.
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Affiliation(s)
- Elena Tessitore
- Department of Cardiology, University Hospital of Geneva, Geneva, Switzerland
| | - Majd Ramlawi
- Department of Emergency Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Olivier Tobler
- Department of Emergency Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Henri Sunthorn
- Department of Cardiology, University Hospital of Geneva, Geneva, Switzerland
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23
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Rigamonti F, Gencer B, Rey F, Chaara J, Tessitore E, Bunwaree S, Meier P, Noble S, Grosgurin O, Larribau R, Windecker S, Carbone F, Montecucco F, Rodondi N, Matter CM, Luscher TF, Mach F, Roffi M. Pre-hospital alarm activation for STEMI patients undergoing primary percutaneous coronary intervention in the era of transradial procedures. Eur J Intern Med 2016; 35:83-88. [PMID: 27436141 DOI: 10.1016/j.ejim.2016.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/30/2016] [Accepted: 07/02/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Transradial access (TRA) improves outcome compared with trans-femoral access for the management of patients with acute coronary syndromes. In this setting, it is unknown whether the activation of a pre-hospital alarm system (PHAS) confers additional benefit for the prognosis of patients with ST-segment elevation myocardial infarction (STEMI). MATERIALS AND METHODS We retrospectively analyzed a cohort of patients with a first STEMI who underwent a primary percutaneous coronary intervention (PPCI) at a single center within a prospective cohort of acute coronary syndrome patients (SPUM-ACS). TRA was used in 85% of patients. We assessed how PHAS (n=165) vs. no-PHAS (n=166) activation was associated with the composite outcome of all-cause mortality and recurrence of myocardial infarction (MI) at 1-year follow-up. As secondary outcomes, the individual clinical endpoints were separately assessed for association. RESULTS Compared with no-PHAS patients, patients in the PHAS group were predominantly women, and presented more frequently with dyslipidemia and cardiac arrest. A significant reduction in the composite outcome of all-cause mortality and recurrent MI at 1-year was observed in the PHAS group, compared with no-PHAS (3.6% vs. 8.5%, p=0.027). When adjusted for age, sex and resuscitation status, PHAS activation remained associated with decreased all-cause mortality and recurrent MI (HR: 0.36 [95% CI: 0.13-0.95]; p=0.040). CONCLUSIONS This study suggests that the benefit of PHAS activation in STEMI patients undergoing PPCI persists also in the era of TRA.
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Affiliation(s)
- Fabio Rigamonti
- Division of Cardiology, Department of Medical Specialties, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland.
| | - Baris Gencer
- Division of Cardiology, Department of Medical Specialties, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland.
| | - Florian Rey
- Division of Cardiology, Department of Medical Specialties, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland.
| | - Jawad Chaara
- Division of Cardiology, Department of Medical Specialties, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland.
| | - Elena Tessitore
- Division of Cardiology, Department of Medical Specialties, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland.
| | - Sholan Bunwaree
- Division of Cardiology, Department of Medical Specialties, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland.
| | - Pascal Meier
- Division of Cardiology, Department of Medical Specialties, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland.
| | - Stéphane Noble
- Division of Cardiology, Department of Medical Specialties, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland.
| | - Olivier Grosgurin
- Division of General Internal Medicine, Department of Medical Specialties, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland; Division of Emergency Medicine, Department of Medical Specialties, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland.
| | - Robert Larribau
- Division of Emergency Medicine, Department of Medical Specialties, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland.
| | - Stephan Windecker
- Division of Cardiology, Bern University Hospital, 3010 Bern, Switzerland.
| | - Federico Carbone
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy.
| | - Fabrizio Montecucco
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy; IRCCS AOU San Martino - IST, 10 largo Benzi, 16132 Genoa, Italy.
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, 3010 Bern, Switzerland; Institute of Primary Health Care (BIHAM) University of Bern, 3010 Bern, Switzerland.
| | - Christian M Matter
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland; Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland.
| | - Thomas F Luscher
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland; Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland.
| | - François Mach
- Division of Cardiology, Department of Medical Specialties, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland.
| | - Marco Roffi
- Division of Cardiology, Department of Medical Specialties, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland.
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Brscic M, Gottardo F, Prevedello P, Tessitore E, Cozzi G. Veal calves’ clinical/health status in large groups fed with automatic feeding devices. Italian Journal of Animal Science 2016. [DOI: 10.4081/ijas.2009.s3.187] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Marta Brscic
- Dipartimento di Scienze AnimaliUniversità di Padova, Italy
| | | | | | | | - Giulio Cozzi
- Dipartimento di Scienze AnimaliUniversità di Padova, Italy
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25
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Tessitore E, Boukha A, Guzzo L, Cozzi G. Effects of pen floor on clinical and behavioural parameters of newly received beef cattle fattened under intensive rearing systems. Italian Journal of Animal Science 2016. [DOI: 10.4081/ijas.2009.s3.190] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
| | - Aziza Boukha
- Dipartimento di Scienze AnimaliUniversità di Padova, Italy
| | - Luca Guzzo
- Dipartimento di Scienze AnimaliUniversità di Padova, Italy
| | - Giulio Cozzi
- Dipartimento di Scienze AnimaliUniversità di Padova, Italy
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26
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Brscic M, Wemelsfelder F, Tessitore E, Gottardo F, Cozzi G, Van Reenen C. Welfare assessment: correlations and integration between a Qualitative Behavioural Assessment and a clinical/ health protocol applied in veal calves farms. Italian Journal of Animal Science 2016. [DOI: 10.4081/ijas.2009.s2.601] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Marta Brscic
- >Dipartimento di Scienze Animali, Università di Padova, Italy
| | | | - Elena Tessitore
- >Dipartimento di Scienze Animali, Università di Padova, Italy
| | | | - Giulio Cozzi
- >Dipartimento di Scienze Animali, Università di Padova, Italy
| | - Cornelis Van Reenen
- Animal Sciences Group, Wageningen University and Research Centre, Lelystad, Netherlands
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Tessitore E, Brscic M, Boukha A, Prevedello P, Cozzi G. Effects of pen floor and class of live weight on behavioural and clinical parameters of beef cattle. Italian Journal of Animal Science 2016. [DOI: 10.4081/ijas.2009.s2.658] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Elena Tessitore
- Dipartimento di Scienze Animali, Università di Padova, Cremona, Italy
| | - Marta Brscic
- Dipartimento di Scienze Animali, Università di Padova, Cremona, Italy
| | - Aziza Boukha
- Dipartimento di Scienze Animali, Università di Padova, Cremona, Italy
| | - Paola Prevedello
- Dipartimento di Scienze Animali, Università di Padova, Cremona, Italy
| | - Giulio Cozzi
- Dipartimento di Scienze Animali, Università di Padova, Cremona, Italy
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28
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Corniola MV, Tessitore E, Schaller K, Gautschi OP. [Response]. Rev Med Suisse 2015; 11:2349. [PMID: 26790245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Corniola MV, Stienen MN, Tessitore E, Schaller K, Gautschi OP. [Minimally invasive spine surgery: past and present]. Rev Med Suisse 2015; 11:2186-2189. [PMID: 26742240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In the early twentieth century, the understanding of spine biomechanics and the advent of surgical techniques of the lumbar spine, led to the currently emerging concept of minimal invasive spine surgery, By reducing surgical access, blood loss, infection rate and general morbidity, functional prognosis of patients is improved. This is a real challenge for the spine surgeon, who has to maintain a good operative result by significantly reducing surgical collateral damages due to the relatively traumatic conventional access.
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30
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Corniola MV, Tessitore E, Schaller K, Gautschi OP. [Cervical disc herniation--diagnosis and treatment]. Rev Med Suisse 2015; 11:2023-2029. [PMID: 26672182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A cervical disc herniation (CDH) is a frequently encountered pathology in primary care medicine. It may give rise to a compression of a nerve root (a radiculopathy, with or without sensory-motor deficit) or of the spinal cord (myelopathy). The majority of CDHs can be supported by means of a conservative treatment. When a radiculopathy is found and a clinico-radiological correlation is present, a moderate neurological deficit appears suddenly, or if it is progressive under conservative treatment or if pain is poorly controlled by well-conducted conservative treatment performed during 6 to 8 months, surgery is then recommended. A symptomatic cervical myelopathy is, by itself, an indication for a surgical treatment.
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Stienen M, Smoll N, Tessitore E, Schaller K, Hildebrandt G, Gautschi O. Does Smoking Influence the Postoperative Outcome? 4.5-Year Results of a Prospective Observational Study. J Neurol Surg A Cent Eur Neurosurg 2015. [DOI: 10.1055/s-0035-1564501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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32
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Stienen M, Smoll N, Tessitore E, Schaller K, Hildebrandt G, Gautschi O. Surgical Resident Education Is Safe for Noninstrumented Lumbar Spine Surgery: 4.5-Year Outcomes of a Prospective Observational Study. J Neurol Surg A Cent Eur Neurosurg 2015. [DOI: 10.1055/s-0035-1564527] [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: 10/23/2022]
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33
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Agostinho A, Olearo F, Delannoy D, Fouchard-Chavatte F, Goascoz MC, Ares M, Cabrilo I, Gautschi O, Tessitore E, Bijlenga P, Czarnetzki C, Lysakowski C, Schaller K, Harbarth S. Compliance with antibiotic prophylaxis guidelines in a university hospital’s neurosurgical unit: a 7-year follow-up. Antimicrob Resist Infect Control 2015. [PMCID: PMC4474617 DOI: 10.1186/2047-2994-4-s1-p80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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34
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Tessitore E, Tran VN, Sunthorn H, Burri H, Namdar M, Shah D. [Very long term follow-up after radiofrequency ablation for atrial fibrillation: the Geneva experience]. Rev Med Suisse 2015; 11:1180-1184. [PMID: 26182636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Catheter ablation (CA) has emerged as an increasingly popular treatment option for selected patients with atrial fibrillation (AF) because drugs are frequently limited by side effects and poor effectiveness. However, very little data is available regarding outcomes of CA of AF beyond 5 years. Guidelines' recommendations are not clear regarding long-term oral anticoagulation (OAC) after 2 years. We assessed thromboembolic events (TE) and AF ablation outcomes at very long-term follow-up (> 5 years) after CA. During a mean follow-up of 9 years after CA, 68% patients were in stable sinus rhythm without anti-arrhythmic drugs and the TE event rate was 0.41 per 100 patients/year. Our data suggests that patients post ablation with a high risk for stroke (CHA2DS2-VASc ≥ 2) should however continue OAC treatment.
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35
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Pestalozza G, Romagnoli M, Tessitore E. Incidence and risk factors of acute otitis media and otitis media with effusion in children of different age groups. Adv Otorhinolaryngol 2015; 40:47-56. [PMID: 3291570 DOI: 10.1159/000415672] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- G Pestalozza
- Divisione di Otorinolaringoiatria, Ospedale dei Bambini V. Buzzi, Milano, Italia
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Pestalozza G, Tessitore E, Bellotto R, Zucconi M. Tonsil surgery in heavy snoring young children. Adv Otorhinolaryngol 2015; 47:251-9. [PMID: 1456143 DOI: 10.1159/000421753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- G Pestalozza
- ENT Division, Children's Hospital V. Buzzi, Milan, Italy
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Corniola MV, Tessitore E, Schaller K, Gautschi OP. [Lumbar disc herniation--diagnosis and treatment]. Rev Med Suisse 2014; 10:2376-2382. [PMID: 25632633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A lumbar disc herniation (LDH) is a condition frequently encountered in primary care medicine. It may give rise to a compression of one or more nerve roots, which can lead to a nerve root irritation, a so-called radiculopathy, with or without a sensorimotor deficit. The majority of LDHs can be supported by means of a conservative treatment consisting of physical therapy, ergotherapy, analgetics, anti-inflammatory therapy or corticosteroids, which may be eventually administered by infiltrations. If a clinico-radiological correlation is present and moderate neurological deficit appears suddenly, if it is progressive under conservative treatment or if pain is poorly controlled by well-conducted conservative treatment performed during four to six months, surgery is then recommended.
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Tessitore E, Müller H, Nganou-Gnindjio CN, Grisel P, Šekoranja L. An interesting case of tricuspid aortic valve with a quadricuspid function. Echocardiography 2014; 32:595-7. [PMID: 25287612 DOI: 10.1111/echo.12793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Quadricuspid aortic valve (QAV) is a rare congenital heart defect, often related to severe aortic regurgitation, and usually detected by echocardiography or at the time of aortic valve surgery. We report a case of an interesting and extremely rare variant of "false" QAV, detected preoperatively by transthoracic and transesophageal echocardiography, in a severely symptomatic patient, admitted to our hospital for dyspnea. Three leaflets of aortic valve appeared quadricuspid, because the left coronary cusp was divided into 2 parts, as confirmed by MRI and pathology. Most frequently, QAV presents with all 4 leaflets equal in size.
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Affiliation(s)
- Elena Tessitore
- Division of Cardiology, University Hospital of Geneva, Geneva, Switzerland
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Beauverd Y, Boehlen F, Tessitore E, Gerstel E, Fontana P, Nendaz M, Perrier A, Reny JL. Suspicion of heparin-induced thrombocytopenia in internal medicine: How appropriate is the ordering of anti-PF4/heparin antibody testing? Platelets 2014; 26:632-7. [DOI: 10.3109/09537104.2014.965134] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Stienen M, Smoll N, Schaller K, Tessitore E, Gautschi O. Gastrointestinal Morbidity after Lumbar Spondylodesis Surgery. J Neurol Surg A Cent Eur Neurosurg 2014. [DOI: 10.1055/s-0034-1383801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Gautschi OP, Payer M, Corniola MV, Smoll NR, Schaller K, Tessitore E. Clinically relevant complications related to posterior atlanto-axial fixation in atlanto-axial instability and their management. Clin Neurol Neurosurg 2014; 123:131-5. [PMID: 25012025 DOI: 10.1016/j.clineuro.2014.05.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [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: 04/26/2014] [Revised: 05/22/2014] [Accepted: 05/26/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND The Magerl transarticular technique and the Harms-Goel C1 lateral mass-C2 isthmic screw technique are the two most commonly used surgical procedures to achieve fusion at C1-C2 level for atlanto-axial instability. Despite recent technological advances with an increased safety, several complications may still occur, including vascular lesions, neurological injuries, pain at the harvested bone graft site, infections, and metallic device failure. METHODS We retrospectively analyzed all patients (n=42 cases) undergoing a Harms-Goel C1-C2 fixation surgery with polyaxial C1 lateral mass screws and C2 isthmic screws at two different institutions between 2003 and 2012 and report clinical and radiological complications. One patient was lost to follow-up. The mean follow-up of the remaining 41 patients was 18.7 months (range 12-90). A clinically relevant complication was defined as a complication determining the onset of a new neurological deficit or requiring the need for a revision surgery. RESULTS A total of 14 complications occurred in 10 patients (24.4% of 41 patients). Greater occipital nerve neuralgia was evident in 4 patients (9.8%). All but one completely resolved at the end of the follow-up. Persistent neck pain was reported by 3 patients (7.3%), hypoesthesia by 1 patient (2.4%), and anesthesia in the C2 area on both sides in 1 patient (2.4%). Furthermore, a superficial, a deep, and a combined superficial and deep wound infection occurred in 1 patient each (2.4%). One patient (2.4%) had pain at the iliac bone graft donor site for several weeks with spontaneous resolution. A posterior progressive intestinal herniation through the iliac scar was seen in 1 case (2.4%), which required surgical repair. No vascular damages occurred. Altogether, 5/41 patients (12.2%) had a clinically relevant complication including 4 patients necessitating a revision surgery at the C1-C2 level (9.8%). CONCLUSIONS Atlanto-axial fixation surgery remains a challenging procedure because of the proximity of important neurovascular structures. Nevertheless, on the basis of our current experience, the C1 lateral mass-C2 isthmic screw technique appears to be safe with a low incidence of clinically relevant complications. Postoperative C2 neuralgia, as the most frequent problem, is due to surgical manipulation during preparation of the C1 screw entry point.
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Affiliation(s)
- O P Gautschi
- Department of Neurosurgery, Geneva University Medical Center, Faculty of Medicine, University of Geneva, Switzerland.
| | - M Payer
- Department of Neurosurgery, Geneva University Medical Center, Faculty of Medicine, University of Geneva, Switzerland; Neurosurgical Spine Unit, Hirslanden Klinik, Zurich, Switzerland
| | - M V Corniola
- Department of Neurosurgery, Geneva University Medical Center, Faculty of Medicine, University of Geneva, Switzerland
| | - N R Smoll
- Department of Neurosurgery, Geneva University Medical Center, Faculty of Medicine, University of Geneva, Switzerland; Gippsland Medical School, Monash University, Victoria, Australia
| | - K Schaller
- Department of Neurosurgery, Geneva University Medical Center, Faculty of Medicine, University of Geneva, Switzerland
| | - E Tessitore
- Department of Neurosurgery, Geneva University Medical Center, Faculty of Medicine, University of Geneva, Switzerland
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Tessitore E, Corniola MV, Gallay M, Schaller K. Grade I lumbar degenerative spondylolisthesis: do we always need fusion with bilateral screws and rods? J Neurosurg Sci 2014; 58:65-71. [PMID: 25371951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Molliqaj G, Payer M, Schaller K, Tessitore E. Acute traumatic central cord syndrome: A comprehensive review. Neurochirurgie 2014; 60:5-11. [DOI: 10.1016/j.neuchi.2013.12.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 12/02/2013] [Accepted: 12/08/2013] [Indexed: 11/15/2022]
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Haemmerli J, Rilliet B, Momjian S, Bijlenga P, Tessitore E, Schaller K, Boëx C. Intraoperative Neuromonitoring in Neurosurgery: Analysis of 307 Consecutive Cases. J Neurol Surg A Cent Eur Neurosurg 2012. [DOI: 10.1055/s-0032-1316193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Tessitore E, Schatlo B, Schaller C, Schonauer C. Fibrillary structure is key for hemostasis: a similar effect of collagen fleece and oxidized cellulose on experimental hemorrhagic brain injury. J Neurol Surg A Cent Eur Neurosurg 2012; 73:89-92. [PMID: 22467482 DOI: 10.1055/s-0032-1309064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The choice of the ideal hemostatic agent for intraoperative cerebral bleeding is under continuous debate. Our aim was to assess the influence of such materials on bleeding time in hemorrhagic cerebral contusions. We compared oxidized regenerated cellulose in fibrillar form (ORC) to microfibrillar collagen fleece (CF) in an experimental study. METHODS N=50 Sprague Dawley rats underwent a bilateral craniectomy. 3 separate standardized superficial cortical impacts were inflicted using a high-speed drill. Immediately after lesion placement, each of the 3 lesions was covered with (a) nothing (control), (b) ORC, or (c) CF. We observed the 3 lesions with a surgical microscope. The bleeding times were recorded for each cerebral lesion and compared using ANOVA test. RESULTS All traumatic lesions produced significant bleeding. The statistical analysis showed a clear reduction in bleeding time for groups treated with either ORC or CF compared to the control group. Lesions covered with ORC and CF showed no significant difference with regard to bleeding time. CONCLUSIONS ORC and CF significantly reduce blood loss from hemorrhagic contusions. Our data suggest that they effectively reduce bleeding time. We advocate the use of hemostatic material for limiting bleeding from superficial cortical lesions.
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Affiliation(s)
- E Tessitore
- Department of Neurosurgery, Geneva University Medical Center, Faculty of Medicine, University of Geneva, Switzerland.
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Temes RE, Tessitore E, Schmidt JM, Naidech AM, Fernandez A, Ostapkovich ND, Frontera JA, Wartenberg KE, Di Tullio MR, Badjatia N, Connolly ES, Mayer SA, Parra A. Left ventricular dysfunction and cerebral infarction from vasospasm after subarachnoid hemorrhage. Neurocrit Care 2011; 13:359-65. [PMID: 20945116 DOI: 10.1007/s12028-010-9447-x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Although neurogenic stunned myocardium (NSM) after aneurysmal subarachnoid hemorrhage (SAH) is well described, its clinical significance remains poorly defined. We investigated the influence of left ventricular (LV) dysfunction and cerebral vasospasm on cerebral infarction, serious cardiovascular events, and functional outcome after SAH. METHODS Of the 481 patients enrolled in the University Columbia SAH Outcomes Project between 10/96 and 05/02, we analyzed a subset of 119 patients with at least one echocardiogram, serial transcranial Doppler (TCD) data, and with no prior history of cardiac disease. LV dysfunction was defined as an ejection fraction <40% on echocardiography. Infarction from vasospasm was adjudicated by the study team after comprehensive review of all clinical and imaging data. Functional outcome was assessed at 15 and 90 days with the modified Rankin Scale (mRS). RESULTS Eleven percent of patients had LV dysfunction (N = 13). Younger age, hydrocephalus, and complete filling of the quadrigeminal and fourth ventricles were associated with LV dysfunction (all P < 0.05). Despite a similar frequency of pre-existing hypertension, 0% of patients with LV dysfunction reported taking antihypertensive medication, compared to 35% of those without (P = 0.009). There was a significant association between LV dysfunction and infarction from vasospasm after adjusting for clinical grade, age, and peak TCD flow velocity (P = 0.03). Patients with LV dysfunction also had higher rates of hypotension requiring vasopressors (P = 0.001) and pulmonary edema (P = 0.002). However, there was no association between LV dysfunction and outcome at 14 days after adjustment for established prognostic variables. CONCLUSIONS LV dysfunction after SAH increases the risk of cerebral infarction from vasospasm, hypotension, and pulmonary edema, but with aggressive ICU support does not affect short-term survival or functional outcome. Antihypertensive medication may confer cardioprotection and reduce the risk of catecholamine-mediated injury after SAH.
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Affiliation(s)
- Richard E Temes
- Neurological Intensive Care Unit, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Tessitore E, Rundek T, Jin Z, Homma S, Sacco RL, Di Tullio MR. Association between carotid intima-media thickness and aortic arch plaques. J Am Soc Echocardiogr 2010; 23:772-7. [PMID: 20510582 DOI: 10.1016/j.echo.2010.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND Large aortic arch plaques are associated with ischemic stroke. Carotid intima-media thickness (CIMT) is a marker of subclinical atherosclerosis and a strong predictor of cardiovascular disease and stroke. The association between CIMT and aortic arch plaques has been studied in patients with strokes, but not in the general population. The aim of this study was to investigate this association in an elderly asymptomatic cohort and to assess the possibility of using CIMT to predict the presence or absence of large aortic arch plaques. METHODS Stroke-free control subjects from the Aortic Plaque and Risk of Ischemic Stroke (APRIS) study underwent transesophageal echocardiography and high-resolution B-mode ultrasound of the carotid arteries. CIMT was measured at the common carotid artery, bifurcation, and internal carotid artery. The association between CIMT and aortic arch plaques was analyzed using multivariate regression models. The positive and negative predictive values of CIMT for large (>or=4 mm) aortic arch plaques were calculated. RESULTS Among 138 subjects, large aortic arch plaques were present in 35 (25.4%). Only CIMT at the bifurcation was associated with large aortic arch plaques after adjustment for atherosclerotic risk factors (P=.007). The positive and negative predictive values of CIMT for aortic arch plaque>or=4 mm at the bifurcation above the 75th percentile (>or=0.95 mm) were 42% and 80%, respectively. The negative predictive value increased to 87% when the median CIMT value (0.82 mm) was used. CONCLUSIONS CIMT at the bifurcation is independently associated with aortic arch plaque>or=4 mm. Its strong negative predictive value for large plaques indicates that CIMT may be used as an initial screening test to exclude severe arch atherosclerosis in the general population.
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Affiliation(s)
- Elena Tessitore
- Department of Medicine, Columbia University, New York, New York 10032, USA
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Schizas C, Duff JM, Tessitore E, Faundez A. [Non fusion techniques in spinal surgery]. Rev Med Suisse 2009; 5:2574-2577. [PMID: 20085207] [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: 05/28/2023]
Abstract
In order to prevent adjacent segment degeneration following spinal fusion new techniques are being used. Lumbar disc arthroplasty yields mid term results equivalent to those of spinal fusion. Cervical disc arthroplasty is indicated in the treatment of cervicobrachialgia with encouraging initial results. The ability of arthroplasty to prevent adjacent segment degeneration has yet to be proven. Although dynamic stabilization had not been proven effective in treating chronic low back pain, it might be useful following decompression of lumbar spinal stenosis in degenerative spondylolisthesis. Interspinal devices are useful in mild lumbar spinal stenosis but their efficacy in treating low back pain is yet to be proven. Confronted with a growing number of new technologies clinicians should remain critical while awaiting long term results.
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Affiliation(s)
- C Schizas
- Département de l'appareil locomoteur, Site Hôpital orthopédique, CHUV, Lusanne.
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Pucci A, Brscic E, Tessitore E, Celeste A, Crudelini M, De Bernardi A, Alberti A, Biondi-Zoccai G, Sheiban I. C-reactive protein and coronary composition in patients with percutaneous revascularization. Eur J Clin Invest 2008; 38:281-9. [PMID: 18363718 DOI: 10.1111/j.1365-2362.2008.01944.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND C-Reactive Protein (CRP) is considered a predictive factor for cardiovascular events and its serum levels have been shown to correlate with thin cap coronary plaques in sudden coronary death. Whether serum CRP levels are associated with in vivo atherothrombotic features is unclear. We thus analysed samples from coronary atherectomy specimens obtained during percutaneous coronary intervention. MATERIALS AND METHODS Patients with coronary artery disease undergoing directional atherectomy, distinguished by unstable versus stable coronary syndrome diagnosis, provided coronary specimens from culprit lesions. Assessment was conducted by means of conventional histology, morphometry and immunohistochemistry. Specific antibodies against erythrocyte-specific protein glycophorin A, endothelial and macrophage antigens were also used. RESULTS There were 51 patients with unstable coronary disease and 47 patients with stable angina. Serum CRP levels >/= 1 mg L(-1) were detected in 24/98 patients, and were significantly associated with hypercellularity, macrophage infiltrates, neoangiogenesis and intraplaque haemorrhage (all P < 0.05). Furthermore, coronary plaques from patients with unstable angina contained larger atheromas, more hypercellular plaques, with abundant macrophages, neoangiogenesis and intraplaque haemorrhages and lesser fibrous tissue (all P < 0.05). CONCLUSIONS We observed a positive correlation between increased serum CRP levels and typical pathological features of complex atherothrombotic coronary disease, confirming in vivo the mechanistic role of CRP in coronary atherothrombosis.
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Affiliation(s)
- A Pucci
- Regina Margherita Hospital, ASO OIRM-S.Anna, Turin, Italy.
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Payer M, Tessitore E. Delayed surgical management of a traumatic bilateral cervical facet dislocation by an anterior–posterior–anterior approach. J Clin Neurosci 2007; 14:782-6. [PMID: 17531492 DOI: 10.1016/j.jocn.2006.04.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2006] [Accepted: 04/05/2006] [Indexed: 11/23/2022]
Abstract
Delayed diagnosis (more than one month after injury) of a bilateral cervical facet dislocation is exceptional, and delayed treatment is different from treatment in the acute stage. We describe a neurologically intact 51-year-old patient, in whom the diagnosis of bilateral cervical facet dislocation at C5/6 was made 10 weeks after the trauma. An anterior-posterior-anterior approach was performed, with repositioning during the posterior approach, and with anterior and posterior C5/6 fixation. The patient remained neurologically intact, and radiographic fusion was observed 3, 6, and 12 months postoperatively. Additionally, the (English) literature is reviewed and discussed.
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Affiliation(s)
- M Payer
- Department of Neurosurgery, University Hospital of Geneva, Rue Micheli-du-Crest 24, 1211 Geneva 14, Switzerland.
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