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Dal Passo B, Cardelli L, Perugini E, Bugani G, Canovi L, Frascaro F, Zanarelli L, Piscitelli L, Colletta M, Casella G. P411 MINOCA OR NOT MINOCA? THE DECISIVE ROLE OF CARDIAC MAGNETIC RESONANCE IN THE DIFFERENTIAL DIAGNOSIS OF MYOCARDIAL DAMAGE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Cardiac MRI can facilitate the differential diagnosis of myocardial damage in patients without coronary artery disease. Our case report is about a 50–year–old man who was admitted to the Emergency Department of the Maggiore Hospital in Bologna in October 2021 for oppressive chest pain at rest; previously he had experienced a similar episode but of minor intensity. He had not previous medical records. When the patient arrived at the emergency department chest pain had regressed, blood pressure was elevated (170/110 mmHg). The ECG showed sinus tachycardia at 100 bpm without electrocardiographic abnormalities suggestive of acute ischemia. Cardiac biomarkers were elevated (hsTnI 312 ng / L –> 975 ng / L – n.v. <19.8 ng / L); blood gas analysis showed pH 7.42, pO2 47 mmHg and pCO2 33 mmHg. Chest CT scan excluded pulmonary embolism and acute aortic syndrome. The patient was transferred to Cardiology Ward in the suspicion of acute coronary syndrome, where echocardiogram showed normal biventricular volumes, mild wall hypertrophy and hypokinesia of the lower middle wall (EF 52%). Coronary angiography didn’t showed any obstructive stenosis in any epicardial vessels. In consideration of the clinical presentation and instrumental evidences, the patient was discharged with a diagnosis of myocardial infarction with non–obstructive coronary arteries (MINOCA), but a cardiac MRI was scheduled in the post–discharge to clarify its genesis. MRI didn’t showed any areas of signal hyperintensity, any perfusion deficits in the first pass study and any areas of late gadolinium enhancement (LGE). Those images permitted to exclude areas of necrosis or inflammation, orienting the diagnosis to myocardial damage during hypertensive crisis. Therefore, the antiplatelet therapy recommended at discharge was suspended. In this case report, cardiac magnetic resonance showed that it can improve the etiological diagnosis of MINOCA, allowing for better clinical and therapeutic management.
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Affiliation(s)
- B Dal Passo
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE BOLOGNA, BOLOGNA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI
| | - L Cardelli
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE BOLOGNA, BOLOGNA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI
| | - E Perugini
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE BOLOGNA, BOLOGNA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI
| | - G Bugani
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE BOLOGNA, BOLOGNA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI
| | - L Canovi
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE BOLOGNA, BOLOGNA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI
| | - F Frascaro
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE BOLOGNA, BOLOGNA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI
| | - L Zanarelli
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE BOLOGNA, BOLOGNA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI
| | - L Piscitelli
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE BOLOGNA, BOLOGNA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI
| | - M Colletta
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE BOLOGNA, BOLOGNA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI
| | - G Casella
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE BOLOGNA, BOLOGNA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI
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Leci E, Carinci V, Bugani G, Greco C, D‘Angelo C, Pecoraro A, Casella G. P23 TIMING OF EJECTION FRACTION REASSESSMENT AFTER SACUBITRIL–VALSARTAN INITIATION FOR INDICATION TO DEFIBRILLATOR IMPLANTATION. A SINGLE CENTER EXPERIENCE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Background
Sacubitril/Valsartan (SV) has been validated for heart failure (HF) with reduced ejection fraction (EF) treatment. SV is effective on hard end–points as well as symptoms and heart remodeling. Present guidelines reccomend at least 3 month of optimized medical therapy (OMT). However, the best timing of EF assessment after SV initiation in order to proceed with defibrillator (ICD) implantation, is still unknown.
Purpose
Evaluate timing of improvement of EF after SV initiation in patients (pts) with systolic HF, candidates to primary prevention ICD implantation.
Methods
From 1 of february 2018, we evaluated retrospectively clinical and echocardiographic data of all consecutive pts with EF < 35% treated with SV and candidates to primary prevention ICD implantation. We evaluated clinical and echo follow up (Fup). Results have been analyzed with paired T–test.
Results
The study involved 95 pts (mean age 67±10 years, 70% male, ischaemic etiology 48%). Mean EF at enrollment was 30 ± 5% (ED vol 90 ±23 ml/m2; ES vol 62 ± 19 ml/m2, severe MR 23%) and NYHA III–IV 50%. In 58% pts reached the target dose of SV (97/103 mg bid). After a mean Fup of 6 months, mean EF of the study population increased to 37±7% (ED vol 80±19 ml/m2, ES vol 51±17 ml/m2, severe MR 5%, p < 0.001), and NYHA III–IV decreased to 8% (p = 0.01). Interestingly, thirty–one pts (32%) had their first Fup within 3 months and showed already an improvement [meanEF 28±5% to 35±6%; ΔEF 7±6%; NYHA III–IV 10 %]. Moreover, 49 pts (51%) had last Fup echo after 1 year (mean 13±6 months) and showed a further EF improvement (meanEF 41±8%; ΔEF 12±9%; p < 0.001).Sixteen pt (16%) underwent ICD (62%) or CRT–D (38%) implantation after 3±2 months of treatment and excluded from further FUP analysis. More favorable effects of treatment with SV were more evident in patient with non–ischaemic etiology of heart failure.
Conclusions
After SV initiation in systolic HF, favourable heart remodeling is clearly evident at 6 months FUP, but could be already observed after 3 months . These findings need to be validated from larger trials but suggest that the best timing of EF reassessment to decide for primary prevention ICD is likely between 3 and 6 months after SV initiation. However decision must be taken following close and individualized FUP for every patient, based on clinical characteristics and response to OMT.
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Affiliation(s)
- E Leci
- U.O CARDIOLOGIA; OSPEDALE MAGGIORE BOLOGNA, BOLOGNA
| | - V Carinci
- U.O CARDIOLOGIA; OSPEDALE MAGGIORE BOLOGNA, BOLOGNA
| | - G Bugani
- U.O CARDIOLOGIA; OSPEDALE MAGGIORE BOLOGNA, BOLOGNA
| | - C Greco
- U.O CARDIOLOGIA; OSPEDALE MAGGIORE BOLOGNA, BOLOGNA
| | - C D‘Angelo
- U.O CARDIOLOGIA; OSPEDALE MAGGIORE BOLOGNA, BOLOGNA
| | - A Pecoraro
- U.O CARDIOLOGIA; OSPEDALE MAGGIORE BOLOGNA, BOLOGNA
| | - G Casella
- U.O CARDIOLOGIA; OSPEDALE MAGGIORE BOLOGNA, BOLOGNA
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Frascaro F, Cardelli SL, Bugani G, Sciarra F, Zagnoni S, Canovi L, Dal Passo B, De Carolis B, Zanarelli L, Piscitelli L, Colletta M, Casella G. P354 GENDER DIFFERENCES IN EPIDEMIOLOGY OF A CORONARY CARE UNIT HUB IN COVID ERA. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
The attention about sex disparities in Cardiology has grown in the last few years. Women are still often under–represented in cardiovascular randomised clinical trials (RCTs) and several studies have shown later diagnosis, less aggressive treatments and poor prognosis among women, even though hospitalized in the coronary care unit (CCU).
Objective
To analyze gender–related differences and their relationships with prognosis among patients admitted to a contemporary CCU Hub.
Methods
Between 1st March 2021 and 30th November 2021, we prospectively collected the data of patients admitted to the II level CCU of Maggiore Hospital in Bologna.
Results
The clinical characteristics of 458 enrolled patients are shown in Table 1. Women represent 32% of the population, are older (p < 0.001) and have been admitted to the CCU mainly for acute coronary syndrome (ACS) (43%) or bradyarrhythmias (23%); men for ACS (57.5%) or heart failure (11.3%). Among patients with ACS, 82% of women underwent coronary angioplasty – both primary and non–primary– versus 88.1% of men (p = 0.276). Females have fewer cardiovascular risk factors and comorbidities than their male counterparts. In CCU, women received similar treatments to men (except for increased use of parenteral nutrition). Similarly, the prevalence of ischemic, haemorrhagic and septic complications was the same between the sexes. The rate of women‘s mortality in CCU was 1.4%, which increases to 4.8% at 30 days, similar to men’s mortality (1.9% versus 3%, respectively).
Conclusions
The study demonstrates that one third of the population of a CCU Hub is represented by women, older and more often hospitalized for ACS. These women receive the same treatments as men, including coronary revascularization. There were no differences about gender prognosis, despite a higher trend towards mortality in females after discharge from the CCU. Therefore, studies where women are more represented are needed, in order to obtain precise indications on how to modulate clinical management according to gender.
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Affiliation(s)
- F Frascaro
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; U.O.C DI CARDIOLOGIA UNIVERSITARIA– POLICLINICO DI BARI, BARI
| | - SL Cardelli
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; U.O.C DI CARDIOLOGIA UNIVERSITARIA– POLICLINICO DI BARI, BARI
| | - G Bugani
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; U.O.C DI CARDIOLOGIA UNIVERSITARIA– POLICLINICO DI BARI, BARI
| | - F Sciarra
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; U.O.C DI CARDIOLOGIA UNIVERSITARIA– POLICLINICO DI BARI, BARI
| | - S Zagnoni
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; U.O.C DI CARDIOLOGIA UNIVERSITARIA– POLICLINICO DI BARI, BARI
| | - L Canovi
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; U.O.C DI CARDIOLOGIA UNIVERSITARIA– POLICLINICO DI BARI, BARI
| | - B Dal Passo
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; U.O.C DI CARDIOLOGIA UNIVERSITARIA– POLICLINICO DI BARI, BARI
| | - B De Carolis
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; U.O.C DI CARDIOLOGIA UNIVERSITARIA– POLICLINICO DI BARI, BARI
| | - L Zanarelli
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; U.O.C DI CARDIOLOGIA UNIVERSITARIA– POLICLINICO DI BARI, BARI
| | - L Piscitelli
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; U.O.C DI CARDIOLOGIA UNIVERSITARIA– POLICLINICO DI BARI, BARI
| | - M Colletta
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; U.O.C DI CARDIOLOGIA UNIVERSITARIA– POLICLINICO DI BARI, BARI
| | - G Casella
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; AZIENDA USL DI BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA; U.O.C DI CARDIOLOGIA UNIVERSITARIA– POLICLINICO DI BARI, BARI
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Carinci V, Leci E, Bugani G, Greco C, D'Angelo C, Pecoraro A, Casella G. Timing of ejection fraction reassessment after sacubitril-valsartan initiation for indication to defibrillator implantation. A single center experience. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0699] [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
Sacubitril/Valsartan (SV) has recently been validated in the therapy of heart failure (HF) with reduced ejection fraction (EF). SV is effective on symptoms and heart remodeling. At the moment the best timing to EF assessment after SV initiation in order to proceed with defibrillator (ICD) implantation, it's unknown.
Purpose
Evaluate the timing of improvement of EF after SV initiation in patients (pts) with systolic HF, candidates to primary prevention ICD implantation.
Methods
We enrolled all consecutive pts candidates to primary prevention ICD implantation that underwent SV initiation from February 2018. We evaluated clinical and echo follow up (Fup). Results have been analyzed with paired T-test).
Results
The study involved 61 pts (mean age 67±10 years, 71% male, ischemic cardiopathy 44%, mean time from diagnosis 31 months) with mean EF at enrollment 30±5% (ED vol 94 ml/m2, ES vol 64 ml/m2, severe MR 21%) and mean NYHA 3±0.6. After a mean Fup of 6 months mean EF increased to 37±7% (ED vol 80 ml/m2, ES vol 51 ml/m2, severe MR 8%, p<0.004), NYHA decreased to 2±0.6 (p<0.04). In 69% pts SV dosage reached 97/103 mg bid. 28 pts (45%) had first Fup at 3 months and showed already mean EF 34±6% and mean NYHA 1.6±0.6 (p<0.04). 26 pts (43%) had last Fup echo after 1 year (mean 17±10 months) and showed further EF little improvement (38.3±8%, p 0.05).
Conclusions
After SV initiation in systolic HF, heart remodeling is already evident at 3 months Fup and better appreciable at 6 months Fup. Little non significant further EF improvement could be seen later. In our study best timing to decide for primary prevention ICD is likely between 3 and 6 months after SV initiation.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- V Carinci
- Maggiore Hospital, Department of Cardiology, Bologna, Italy
| | - E Leci
- Maggiore Hospital, Department of Cardiology, Bologna, Italy
| | - G Bugani
- Maggiore Hospital, Department of Cardiology, Bologna, Italy
| | - C Greco
- Maggiore Hospital, Department of Cardiology, Bologna, Italy
| | - C D'Angelo
- Maggiore Hospital, Department of Cardiology, Bologna, Italy
| | - A Pecoraro
- Maggiore Hospital, Department of Cardiology, Bologna, Italy
| | - G Casella
- Maggiore Hospital, Department of Cardiology, Bologna, Italy
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Bugani G, Tonet E, Pavasini R, Serenelli M, Mele D, Caglioni S, Vitali F, Zucchetti O, Verardi F, Biscaglia S, Ferrari R, Campo G. Predictors and outcome of contrast-induced acute kidney injury in older patients presenting with acute coronary syndrome. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3234] [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
The number of older patients presenting with acute coronary syndrome (ACS) is increasing. Routine percutaneous coronary intervention (PCI) is performed in order to improve outcome, but comorbidities associated with aging lead to a higher risk of treatment complications. Contrast-induced acute kidney injury (CI-AKI) represents potential harm in older and frail patients, but its impact on long term prognosis is not clear.
Purpose
To evaluate occurrence, predictors, and impact on long term outcome of CI-AKI in elderly patients presenting with ACS.
Methods
A prospective cohort of 392 older (≥70 years) ACS patients who underwent coronary angiography was enrolled. CI-AKI was defined as a serum creatinine increase at least ≥0.3 mg/dl in 48 h or at least ≥50% in 7 days. According to our department protocol, prophylactic hydration was performed to all patients with isotonic saline, given intravenously at a rate of 1 ml/kg body weight/h (0.5 ml/kg for patients with left ventricular ejection fraction <35%) for 12 h before (unless for emergent patients) and 24 h after PCI. Median follow up was 4 [3.0–4.1] years. Long term adverse outcomes include all-cause mortality and any hospitalization for cardiovascular causes (ACS, heart failure, arrhythmia, cerebrovascular accident).
Results
CI-AKI was observed in 72 patients (18.4%). Among patients who developed or not CI-AKI, no difference was found between clinical presentation (Non-ST segment elevation myocardial infarction (NSTEMI) vs. STEMI), left ventricular ejection fraction and multivessel coronary disease. Estimated glomerular filtration rate (odd ratio (OR) 3.59, confidence interval (CI) 1.79–7.20, p<0.001), contrast media volume (OR 1.006, CI 1.002–1.009, P=0.001), white blood cells (OR 1.18, CI 1.10–1.27, p<0.001), haemoglobin level (OR 0.81, CI 0.70–0.94, p=0.005) and chronic obstructive pulmonary disease (OR=5.37, CI 2.24–12.90, p<0.001) were independent predictors for CI-AKI. Patients with CI-AKI presented increased mortality rate both at 30-days (2.7% vs 0%, p=0.038) and at 4-years follow-up (all cause death 23.6 vs. 11.6%, p=0.013) (Figure 1: long term adverse outcomes). Multivariable Cox proportional hazards analysis revealed that diabetes (hazard ratio, HR 1.99, CI 1.33–2.97, p=0.001), atrial fibrillation (HR 2.49, CI 1.59–3.91, p<0.001), Killip class >1 (HR 2.20, CI 1.32–3.67, p=0.003) and haemoglobin level (HR 0.84, CI 0.76–0.92, p<0.001) were independently associated with adverse outcome, while CI-AKI represent a risk factor only at univariate analysis.
Conclusions
CI-AKI is a common complication among older adults undergoing coronary angiography for ACS. Patients who developed CI-AKI had worse outcome at long term follow-up. Actually, the occurrence of CI-AKI was not identified as an independent predictor for long-term adverse outcome, while it may represent a marker of severity of comorbidity and consequent poor prognosis, rather than a causal agent itself.
Figure 1. Kaplan-Maier Curve
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- G Bugani
- Ferrara University Hospital- Arcispedale S. Anna, Ferrara, Italy
| | - E Tonet
- Ferrara University Hospital- Arcispedale S. Anna, Ferrara, Italy
| | - R Pavasini
- Ferrara University Hospital- Arcispedale S. Anna, Ferrara, Italy
| | - M Serenelli
- Ferrara University Hospital- Arcispedale S. Anna, Ferrara, Italy
| | - D Mele
- Ferrara University Hospital- Arcispedale S. Anna, Ferrara, Italy
| | - S Caglioni
- Ferrara University Hospital- Arcispedale S. Anna, Ferrara, Italy
| | - F Vitali
- Ferrara University Hospital- Arcispedale S. Anna, Ferrara, Italy
| | - O Zucchetti
- Ferrara University Hospital- Arcispedale S. Anna, Ferrara, Italy
| | - F.M Verardi
- Ferrara University Hospital- Arcispedale S. Anna, Ferrara, Italy
| | - S Biscaglia
- Ferrara University Hospital- Arcispedale S. Anna, Ferrara, Italy
| | - R Ferrari
- Ferrara University Hospital- Arcispedale S. Anna, Ferrara, Italy
| | - G Campo
- Ferrara University Hospital- Arcispedale S. Anna, Ferrara, Italy
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Norscini G, Vagnarelli F, Taglieri N, Cinti L, Semprini F, Nanni S, Bugani G, Corsini A, Branzi A, Melandri G. Mid-term and long-term mortality associated with heart failure in patients hospitalized for acute coronary syndromes. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1342] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Vagnarelli F, Taglieri N, Norscini G, Cinti L, Bacchi Reggiani ML, Corsini A, Bugani G, Rapezzi C, Melandri G, Branzi A. Effect of cerebrovascular disease on long-term outcome of patients with acute coronary syndromes: findings from a large cohort of unselected patients. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.2784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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