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Gorla R, Tua L, D'Errigo P, Barbanti M, Biancari F, Tarantini G, Badoni G, Ussia GP, Ranucci M, Bedogni F, Baglio G, Rosato S. Incidence and predictors of 30-day and 6-month stroke after TAVR: Insights from the multicenter OBSERVANT II study. Catheter Cardiovasc Interv 2023; 102:1122-1131. [PMID: 37794734 DOI: 10.1002/ccd.30848] [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: 05/21/2023] [Revised: 09/13/2023] [Accepted: 09/17/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND The incidence and predictors of 30-day stroke after transcatheter aortic valve replacement (TAVR) were derived from early studies investigating first-generation devices. The incidence of 6-month stroke and its related predictors are unknown. AIMS To investigate the incidence and to identify procedural and patient-related predictors of 30-day and 6-month stroke after TAVR. METHODS Data from 2753 consecutive patients with severe aortic stenosis undergoing TAVR were obtained from the OBSERVANT-II study, an observational, prospective, multicenter cohort study. The study endpoints were symptomatic 30-day and 6-month stroke after TAVR. RESULTS The occurrence of a 30-day and 6-month stroke was low (1.3% and 2.4%, respectively) but with significant impact on survival. Aortic valve predilatation (odds ratio [OR]: 2.28, 95% confidence interval [CI]: 1.12-4.65, p = 0.023), diabetes (OR: 3.10, 95% CI: 1.56-6.18, p = 0.001), and left ventricle ejection fraction < 50% (OR: 2.15, 95% CI: 1.04-4.47, p = 0.04) were independent predictors of 30-day stroke, whereas diabetes (sub-distribution hazard ratio [SHR]: 2.07, 95% CI: 1.25-3.42, p = 0.004), pre-existing neurological dysfunction (SHR: 3.92, 95% CI: 1.54-10, p = 0.004), bicuspid valve (SHR: 4.75, 95% CI: 1.44-15.7, p = 0.011), and critical status (SHR: 3.05, 95% CI: 1.21-7.72, p = 0.018) were predictive of 6-month stroke. Conversely, antiplatelet therapy and anticoagulation were protective factors at both 30 days and 6 months. CONCLUSIONS Stroke after TAVR was rare. Predilatation was the only procedural factor predictive of 30-day stroke, whereas the remaining were patient-related risk factors, suggesting appropriate risk stratification preoperatively.
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Affiliation(s)
- Riccardo Gorla
- Department of Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Lorenzo Tua
- Department of Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
- Department of Cardiology, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Paola D'Errigo
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", University of Catania, Catania, Italy
| | - Fausto Biancari
- Department of Medicine, South Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland
| | - Giuseppe Tarantini
- Interventional Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Gabriella Badoni
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | | | - Marco Ranucci
- Department of Cardiothoracic and Vascular Anesthesia and ICU, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Francesco Bedogni
- Department of Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Giovanni Baglio
- Italian National Agency for Regional Healthcare Services, Rome, Italy
| | - Stefano Rosato
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
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D'Errigo P, Marcellusi A, Biancari F, Barbanti M, Cerza F, Tarantini G, Ranucci M, Ussia GP, Costa G, Badoni G, Fraccaro C, Meucci F, Baglio G, Seccareccia F, Tamburino C, Rosato S. Financial Burden of Transcatheter Aortic Valve Implantation. Am J Cardiol 2023; 203:1-8. [PMID: 37478636 DOI: 10.1016/j.amjcard.2023.06.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/11/2023] [Accepted: 06/16/2023] [Indexed: 07/23/2023]
Abstract
Given the increasing population eligible for transcatheter aortic valve implantation (TAVI), resource utilization has become an important focus in this setting. We aimed to estimate the change in the financial burden of TAVI therapy over 2 different periods. A probabilistic Markov model was developed to estimate the cost consequences of increased center experience and the introduction of newer-generation TAVI devices compared with an earlier TAVI period in a cohort of 6,000 patients. The transition probabilities and hospitalization costs were retrieved from the OBSERVANT (Observational Study of Effectiveness of AVR-TAVI procedures for severe Aortic steNosis Treatment) and OBSERVANT II (Observational Study of Effectiveness of TAVI with new generation deVices for severe Aortic stenosis Treatment) studies, including 1,898 patients treated with old-generation devices and 1,417 patients treated with new-generation devices. The propensity score matching resulted in 853 pairs, with well-balanced baseline risk factors. The mean EuroSCORE II (6.6% vs 6.8%, p = 0.76) and the mean age (82.0 vs 82.1 y, p = 0.62) of the early TAVI period and new TAVI period were comparable. The new TAVI period was associated with a significant reduction in rehospitalizations (-30.5% reintervention, -25.2% rehospitalization for major events, and -30.8% rehospitalization for minor events) and a 20% reduction in 1-year mortality. These reductions resulted in significant cost savings over a 1-year period (-€4.1 million in terms of direct costs and -€19.7 million considering the additional cost of the devices). The main cost reduction was estimated for rehospitalization, accounting for 79% of the overall cost reduction (not considering the costs of the devices). In conclusion, the introduction of new-generation TAVI devices, along with increased center experience, led to significant cost savings at 1-year compared with an earlier TAVI period, mainly because of the reduction in rehospitalization costs.
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Affiliation(s)
- Paola D'Errigo
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Andrea Marcellusi
- Economic Evaluation and HTA (EEHTA-CEIS), Faculty of Economics, University of Rome "Tor Vergata", Rome, Italy
| | - Fausto Biancari
- Clinica Montevergine, GVM Care & Research, Mercogliano, Italy; Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | | - Francesco Cerza
- Italian National Agency for Regional Healthcare Services, Rome, Italy
| | - Giuseppe Tarantini
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Marco Ranucci
- Department of Cardiothoracic and Vascular Anesthesia and ICU, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | | | - Gabriella Badoni
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Chiara Fraccaro
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | | | - Giovanni Baglio
- Italian National Agency for Regional Healthcare Services, Rome, Italy
| | - Fulvia Seccareccia
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Corrado Tamburino
- A.O.U. Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Stefano Rosato
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
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De Luca L, D'Errigo P, Rosato S, Badoni G, Giordani B, Mureddu GF, Tavilla A, Seccareccia F, Baglio G. Impact of COVID-19 Diagnosis on Mortality in Patients with Ischemic Stroke Admitted during the 2020 Pandemic in Italy. J Clin Med 2023; 12:4560. [PMID: 37510675 PMCID: PMC10380878 DOI: 10.3390/jcm12144560] [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: 05/23/2023] [Revised: 06/29/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
AIMS The impact of the COVID-19 pandemic on the event rate of patients with ischemic stroke has been poorly investigated. We sought to evaluate the impact of the COVID-19 infection on mortality in patients with ischemic stroke admitted during the 2020 pandemic in Italy. METHODS We analyzed a nationwide, comprehensive, and universal administrative database of patients who were admitted for ischemic stroke during and after the national lockdown for the COVID-19 infection in 2020, and the equivalent periods over the previous 5 years in Italy. The 2020 observed hospitalization and mortality rates of stroke patients with and without COVID-19 infection were compared with the expected rates, in accordance with the trend of the previous 5 years. RESULTS During the period of observation, 300,890 hospitalizations for ischemic stroke occurred in Italy. In 2020, 41,302 stroke patients (1102 with concomitant COVID-19 infection) were admitted at 771 centers. The rate of admissions for ischemic stroke during the 2020 pandemic was markedly reduced compared with previous years (percentage change vs. 2015: -23.5). Based on the 5 year trend, the 2020 expected 30 day and 1 year mortality rates were 9.8% and 23.9%, respectively, and the observed incidence of death rates were 12.2% and 26.7%, respectively (both p < 0.001). After multiple corrections, higher rates of mortality were observed among patients admitted for stroke with a concomitant COVID-19 diagnosis. CONCLUSIONS During the COVID-19 pandemic in 2020 in Italy, the rate of hospitalizations for ischemic stroke was dramatically reduced, although both the 30 day and 1 year mortality rates increased compared with the previous 5 year trend.
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Affiliation(s)
- Leonardo De Luca
- Department of Cardio-Thoracic and Vascular Medicine and Surgery, Division of Cardiology, A.O. San Camillo-Forlanini, 00152 Rome, Italy
- Faculty of Medicine and Dentistry, UniCamillus-Saint Camillus International University of Health Sciences, 00131 Rome, Italy
| | - Paola D'Errigo
- National Centre for Global Health, Italian National Institute of Health, 00161 Rome, Italy
| | - Stefano Rosato
- National Centre for Global Health, Italian National Institute of Health, 00161 Rome, Italy
| | - Gabriella Badoni
- National Centre for Global Health, Italian National Institute of Health, 00161 Rome, Italy
| | - Barbara Giordani
- Italian National Agency for Regional Healthcare Services, 00187 Rome, Italy
| | | | - Andrea Tavilla
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, 00161 Rome, Italy
| | - Fulvia Seccareccia
- National Centre for Global Health, Italian National Institute of Health, 00161 Rome, Italy
| | - Giovanni Baglio
- Italian National Agency for Regional Healthcare Services, 00187 Rome, Italy
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Barili F, Onorati F, D'Errigo P, Rosato S, Biancari F, Baglio G, Badoni G, Parolari A, Seccareccia F. Bilateral Internal Thoracic Arteries Improve 10-Year Outcomes of Coronary Artery Bypass Grafting. Ann Thorac Surg 2023; 116:52-60. [PMID: 36822528 DOI: 10.1016/j.athoracsur.2023.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 01/14/2023] [Accepted: 02/06/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND This observational cohort study was designed by the PRIORITY (PRedictIng long-term Outcomes afteR Isolated coronary arTery bypass surgery) steering committee to evaluate the 10-year follow-up outcome of bilateral internal thoracic arteries (BITA) versus single internal thoracic artery. METHODS The PRIORITY project was designed to evaluate long-term outcome of 2 large prospective multicenter cohort studies of coronary artery bypass grafting. Clinical data on isolated coronary artery bypass grafting were merged with administrative data to collect follow-up information. The primary endpoint was the composite outcome of major adverse cardiac and cerebrovascular events at 10-year follow-up. Secondary endpoints were individual components of major adverse cardiac and cerebrovascular events at 10 years and surgical site complications or infections. A propensity score-based inverse probability treatment weighting (IPTW) was used to overcome the selection bias related to the observational nature of the study. RESULTS The study population consisted of 10,988 patients who underwent isolated coronary artery bypass grafting. BITA was used in 23.5%. The use of BITA is related to lower incidence of major adverse cardiac and cerebrovascular events at 10 years (adjusted hazard ratio [HR] 0.88, 95% CI 0.79-0.98, P < .001). BITA correlated with better 10-year survival (IPTW adjusted HR 0.87, 95% CI 0.78-1.00, P = .05), re-revascularization (IPTW adjusted HR 0.83, 95% CI 0.74-0.92, P < .001), and myocardial infarction (IPTW adjusted HR 0.86, 95% CI 0.77-0.95, P = .005) but to increased incidence of surgical site complications or infections (HR 2.12, 95% CI 1.39-3.24, P < .001). CONCLUSIONS In propensity-matched patients, use of BITA was associated with improved 10-year survival, freedom from repeat revascularization, and myocardial infarction but also higher incidence of surgical site complications.
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Affiliation(s)
- Fabio Barili
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | | | - Paola D'Errigo
- National Centre for Global Health, Italian Health Institute, Rome, Italy
| | - Stefano Rosato
- National Centre for Global Health, Italian Health Institute, Rome, Italy
| | - Fausto Biancari
- Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Research Unit of Surgery, Anesthesiology, and Critical Care, University of Oulu, Oulu, Finland
| | | | - Gabriella Badoni
- National Centre for Global Health, Italian Health Institute, Rome, Italy
| | - Alessandro Parolari
- University Unit of Cardiac Surgery, IRCCS Policlinico S. Donato, S. Donato Milanese, Italy
| | - Fulvia Seccareccia
- National Centre for Global Health, Italian Health Institute, Rome, Italy
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De Luca L, Rosato S, D'Errigo P, Giordani B, Mureddu GF, Badoni G, Seccareccia F, Baglio G. Covid-19 diagnosis and mortality in patients with non-ST-elevation myocardial infarction admitted in Italy during the national outbreak. Int J Cardiol 2023; 370:447-453. [PMID: 36356695 PMCID: PMC9639414 DOI: 10.1016/j.ijcard.2022.11.008] [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: 09/22/2022] [Revised: 10/26/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION We sought to assess the clinical impact of Covid-19 infection on mortality in patients with Non-ST elevation myocardial infarction (NSTEMI) admitted during the national outbreak in Italy. METHODS We analysed a nationwide, comprehensive, and universal administrative database of consecutive NSTEMI patients admitted during lockdown for Covid-19 infection (March,11st - May 3rd, 2020) and the equivalent periods of the previous 5 years in Italy. The observed rate of 30-day and 6-month all-cause mortality of NSTEMI patients with and without Covid-19 infection during the lockdown was compared with the expected rate of death according to the trend of the previous 5 years. RESULTS During the period of observation, 48.447 NSTEMI hospitalizations occurred in Italy. Among these, 4981 NSTEMI patients were admitted during the 2020 outbreak: 173 (3.5%) with and 4808 (96.5%) without a Covid-19 diagnosis. According to the 5-year trend, the 2020 expected rate of 30-day and 6-month all-cause mortality was 6.5% and 12.2%, while the observed incidence of death was 8.3% (p = 0.001) and 13.6% (p = 0.041), respectively. Excluding NSTEMI patients with a Covid-19 diagnosis, the 6-month mortality rate resulted in accordance with the prior 5-year trend. After multiple corrections, the presence of Covid-19 diagnosis resulted one of the independent predictors of all-cause mortality at 30 days [adjusted odds ratio (OR) 4.3; 95% confidence intervals (CI) 2.90-6.23; p < 0.0001] and 6 months (adjusted OR 3.5; 95% CI: 2.43-5.03; p < 0.0001). CONCLUSIONS During the 2020 national outbreak in Italy, a concomitant diagnosis of Covid-19 in NSTEMI was associated with a significantly higher rate of mortality.
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Affiliation(s)
- Leonardo De Luca
- Department of Cardio-Thoracic and Vascular Medicine and Surgery, Division of Cardiology, A.O. San Camillo-Forlanini, Rome, Italy; UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy.
| | - Stefano Rosato
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Paola D'Errigo
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Barbara Giordani
- Italian National Agency for Regional Healthcare Services, Rome, Italy
| | | | - Gabriella Badoni
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Fulvia Seccareccia
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Giovanni Baglio
- Italian National Agency for Regional Healthcare Services, Rome, Italy
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Massussi M, Adamo M, Rosato S, Seccareccia F, Barbanti M, Biancari F, Tarantini G, Immè S, Vignali L, Badoni G, Ussia GP, Costa G, Baiocchi M, Metra M, Baglio G, D'Errigo P. Functional and metabolic frailty predicts mortality in patients undergoing TAVI: Insights from the OBSERVANT II study. Eur J Intern Med 2022; 106:90-96. [PMID: 36202717 DOI: 10.1016/j.ejim.2022.09.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIM Despite the prognostic role of frailty among elderly patients undergoing transcatheter aortic valve implantation (TAVI) is known, its assessment still represents a challenge due to the multitude of scales proposed in literature. The aim of this study was to define the prognostic impact of a simple combined frailty model including both functional and metabolic parameters in a large cohort of patients undergoing TAVI with new generation devices. METHODS AND RESULTS We examined 1-year survival of patients affected by aortic valve stenosis treated with new generation TAVI devices from the OBSERVANT II study. Frailty of patients undergoing TAVI was stratified in four groups according to a combination of functional (geriatric status scale - GSS) and metabolic (global nutritional risk index - GNRI) assessment. Among 1985 patients included in the analysis, 1008 (51%) had no significant frailty, 246 (12%) had only functional impairment, 522 (26%) had only metabolic impairment and 209 (11%) had both functional and metabolic impairment. The presence of combined functional and metabolic frailty was associated with a two-fold increased risk of 1-year all-cause mortality (HR 2.06 [95% CI 1.35-3.14]; p = 0.001). GNRI as a single parameter had a lower impact on mortality (HR 1.48 [95% CI 1.05 - 2.09]; p = 0.027), whereas GSS did not impact on mortality (HR 1.23 [95% CI 0.77-1.97]; p = 0.386). CONCLUSIONS In a large real-world cohort of patients undergoing TAVI with new generation devices, combined functional and metabolic frailty had a significant and incremental impact on 1-year mortality.
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Affiliation(s)
- Mauro Massussi
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili, 1, Brescia 25123, Italy
| | - Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili, 1, Brescia 25123, Italy.
| | - Stefano Rosato
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Fulvia Seccareccia
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Fausto Biancari
- Clinica Montevergine, GVM Care & Research, Mercogliano, Italy; Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Giuseppe Tarantini
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Sebastiano Immè
- Division of Cardiology, Centro Cuore Morgagni, Catania, Italy
| | - Luigi Vignali
- Division of Cardiology, University of Parma, Parma, Italy
| | - Gabriella Badoni
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | | | - Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Massimo Baiocchi
- Anestesia e Rianimazione Dipartimento Cardiotoracovascolare, IRCSS Policlinico S.Orsola, Università degli Studi di Bologna, Bologna, Italy
| | - Marco Metra
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili, 1, Brescia 25123, Italy
| | - Giovanni Baglio
- Italian National Agency for Regional Healthcare Services, Rome, Italy
| | - Paola D'Errigo
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
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Barili F, D'Errigo P, Rosato S, Biancari F, Forti M, Pagano E, Baglio G, Badoni G, Parolari A, Seccareccia F. Ten-year outcomes after off-pump and on-pump coronary artery bypass grafting: an inverse probability of treatment weighting comparative study. J Cardiovasc Med (Hagerstown) 2022; 23:371-378. [PMID: 35645027 DOI: 10.2459/jcm.0000000000001323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIMS The debate on the advantages and limitations of off-pump myocardial revascularization (OPCAB) on long-term outcomes has not still arrived to a conclusion. This study was designed to compare the impact of OPCAB vs, on-pump coronary artery bypass grafting (CABG) on long-term mortality and major adverse cardiac and cerebrovascular events (MACCEs). METHODS The PRIORITY project was designed to evaluate the long-term outcomes of two large prospective multicenter cohort studies on CABG. Data on isolated CABG were linked to two administrative datasets. The inverse probability of treatment weight was employed to balance the treatment groups. Time-to-event methods were employed to analyze endpoints. RESULTS The cohort consisted of 10 988 patients who underwent isolated CABG (27.2% OPCAB). The median follow-up time was 7.9 years and was 100% complete. Unadjusted long-term survival was significantly worst for OPCAB, confirmed by weighted models (hazard ratio 1.08, 95% confidence interval (CI) 1.01-1.14, P = 0.01). OPCAB was associated to an increased risk of MACCE at 10 years (weighted hazard ratio 1.18, 95% CI 1.12-1.23, P < 0.001). Inside the MACCEs, OPCAB was significantly related to increased incidence of repeat revascularization (hazard ratio 2.27, 95% CI 1.39-3.85, P < 0.001, in the first 6 months, hazard ratio 1.19, 95% CI 1.09-1.32, P < 0.001 afterward) and stroke (hazard ratio 1.22, 95% CI 1.10-1.35, P < 0.001). CONCLUSION The results of this study suggest that OPCAB was associated with an increased risk of mortality, repeat myocardial revascularization and stroke at 10 years compared with on-pump CABG.
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Affiliation(s)
- Fabio Barili
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Department of Cardiac Surgery, S. Croce Hospital, Cuneo
| | - Paola D'Errigo
- National Centre for Global Health, Italian Health Institute, Rome, Italy
| | - Stefano Rosato
- National Centre for Global Health, Italian Health Institute, Rome, Italy
| | - Fausto Biancari
- Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki.,Research Unit of Surgery, Anesthesiology and Critical Care, University of Oulu, Oulu, Finland
| | - Marco Forti
- National Agency for Regional Health Services, Rome
| | - Eva Pagano
- Department of Epidemiology, Città della Salute e della Scienza, University of Turin, Turin
| | | | - Gabriella Badoni
- National Centre for Global Health, Italian Health Institute, Rome, Italy
| | - Alessandro Parolari
- Universitary Unit of Cardiac Surgery, IRCCS Policlinico S. Donato, S.Donato Milanese, Italy
| | - Fulvia Seccareccia
- National Centre for Global Health, Italian Health Institute, Rome, Italy
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De Luca L, D‘Errigo P, Mureddu G, Rosato S, Badoni G, Seccareccia F, Baglio G. C58 LONG–TERM SURVIVAL OF PATIENTS ADMITTED FOR A FIRST AMI EVENT AND MANAGED WITH MYOCARDIAL REVASCULARIZATION OR CONSERVATIVE APPROACH IN ITALY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.057] [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
The long–term clinical benefits of myocardial revascularization in a contemporary cohort of patients with acute myocardial infarction (AMI) are unclear. We aimed to compare the overall mortality rates at 8 years of patients admitted in Italian hospitals with a first AMI managed with or without myocardial revascularization during the index event.
Methods
This is a national retrospective cohort study that enrolled patients admitted with a first AMI in 2012 in all Italian hospitals. The outcome of interest was all–cause mortality at 8 years. Time to events was analyzed using a Cox multivariate regression model.
Results
A total of 97,271 patients with AMI were admitted to an Italian hospital in 2012. Patients with a previous AMI or myocardial revascularization (n = 27,350) have been excluded from this analysis. Among the remaining 69,921 AMI events, 56.6% underwent a percutaneous coronary intervention (PCI) or a coronary artery by–pass grafting (CABG) during the index admission. The crude 8–year survival was 0.76% for patients treated with PCI or CABG in the index admission and 0.34% for patients managed with a conservative approach (Figure 1). Considering the differences in risk factors, the invasive approach showed a significantly lower risk of long–term mortality compared to the conservative management (hazard ratio=0.55; 95% confidence intervals 0.53–0.56) (Figure 2).
Conclusions
In a contemporary nationwide cohort of patients at their first AMI episode, those who underwent a myocardial revascularization during the index event presented an adjusted 45% relative risk reduction in overall mortality at 8–year follow–up compared with those treated only medically.
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Affiliation(s)
- L De Luca
- OSPEDALE SAN CAMILLO, ROMA; NATIONAL CENTRE FOR GLOBAL HEALTH, ISTITUTO SUPERIORE DI SANITÀ, ROMA; AO SAN GIOVANNI ADDOLORATA, ROMA; ITALIAN NATIONAL AGENCY FOR REGIONAL HEALTHCARE SERVICES, ROMA
| | - P D‘Errigo
- OSPEDALE SAN CAMILLO, ROMA; NATIONAL CENTRE FOR GLOBAL HEALTH, ISTITUTO SUPERIORE DI SANITÀ, ROMA; AO SAN GIOVANNI ADDOLORATA, ROMA; ITALIAN NATIONAL AGENCY FOR REGIONAL HEALTHCARE SERVICES, ROMA
| | - G Mureddu
- OSPEDALE SAN CAMILLO, ROMA; NATIONAL CENTRE FOR GLOBAL HEALTH, ISTITUTO SUPERIORE DI SANITÀ, ROMA; AO SAN GIOVANNI ADDOLORATA, ROMA; ITALIAN NATIONAL AGENCY FOR REGIONAL HEALTHCARE SERVICES, ROMA
| | - S Rosato
- OSPEDALE SAN CAMILLO, ROMA; NATIONAL CENTRE FOR GLOBAL HEALTH, ISTITUTO SUPERIORE DI SANITÀ, ROMA; AO SAN GIOVANNI ADDOLORATA, ROMA; ITALIAN NATIONAL AGENCY FOR REGIONAL HEALTHCARE SERVICES, ROMA
| | - G Badoni
- OSPEDALE SAN CAMILLO, ROMA; NATIONAL CENTRE FOR GLOBAL HEALTH, ISTITUTO SUPERIORE DI SANITÀ, ROMA; AO SAN GIOVANNI ADDOLORATA, ROMA; ITALIAN NATIONAL AGENCY FOR REGIONAL HEALTHCARE SERVICES, ROMA
| | - F Seccareccia
- OSPEDALE SAN CAMILLO, ROMA; NATIONAL CENTRE FOR GLOBAL HEALTH, ISTITUTO SUPERIORE DI SANITÀ, ROMA; AO SAN GIOVANNI ADDOLORATA, ROMA; ITALIAN NATIONAL AGENCY FOR REGIONAL HEALTHCARE SERVICES, ROMA
| | - G Baglio
- OSPEDALE SAN CAMILLO, ROMA; NATIONAL CENTRE FOR GLOBAL HEALTH, ISTITUTO SUPERIORE DI SANITÀ, ROMA; AO SAN GIOVANNI ADDOLORATA, ROMA; ITALIAN NATIONAL AGENCY FOR REGIONAL HEALTHCARE SERVICES, ROMA
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9
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De Luca L, Cicala S, D’Errigo P, Cerza F, Mureddu G, Rosato S, Badoni G, Seccareccia F, Baglio G. P206 IMPACT OF AGE, GENDER AND HEART FAILURE ON MORTALITY TRENDS AFTER ACUTE MYOCARDIAL INFARCTION IN ITALY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.198] [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
The outcome of patients with acute myocardial infarction (AMI) may vary substantially based on baseline risk. We aimed at analyzing the impact of gender, age and heart failure (HF) on mortality trends, based on a nationwide, comprehensive and universal administrative database of AMI.
Methods
This is a nationwide cohort study of patients admitted with AMI from 2009 to 2018 in all Italian hospitals. In–hospital mortality rate (I–MR) and 1–year post–discharge mortality rate (1–Y–MR) were assessed.
Results
Among the 1,000,965 AMI events included in the analysis, 43.6% occurred in patients aged ≥75 years, 34.7% in females and 21.8% in AMI complicated by HF at the index hospitalization (Figure 1). Both I–MR and 1–Y–MR significantly decreased over time (from 8.87% to 6.72%; mean annual change − 0.23%; confidence intervals (CI): − 0.26% to − 0.20% and from 12.24% to 10.59%; mean annual change − 0.18%; CI: − 0.24% to − 0.13%, respectively). This trend was confirmed in younger and elderly AMI patients, in both sexes (Figure 2). In AMI patients complicated by HF, both I–MR and 1–Y–MR were markedly high, regardless of age and gender.
Conclusions
This contemporary, nationwide study suggests that I–MR and 1–Y–MR are still elevated, albeit decreasing over time. Elderly patients and those with HF at the time of index admission, present a particularly high risk of fatal events, regardless of gender.
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Affiliation(s)
- L De Luca
- OSPEDALE SAN CAMILLO, ROMA; ITALIAN NATIONAL AGENCY FOR REGIONAL HEALTHCARE SERVICES, ROMA; NATIONAL CENTRE FOR GLOBAL HEALTH, ISTITUTO SUPERIORE DI SANITÀ, ROMA; AO SAN GIOVANNI ADDOLORATA, ROMA
| | - S Cicala
- OSPEDALE SAN CAMILLO, ROMA; ITALIAN NATIONAL AGENCY FOR REGIONAL HEALTHCARE SERVICES, ROMA; NATIONAL CENTRE FOR GLOBAL HEALTH, ISTITUTO SUPERIORE DI SANITÀ, ROMA; AO SAN GIOVANNI ADDOLORATA, ROMA
| | - P D’Errigo
- OSPEDALE SAN CAMILLO, ROMA; ITALIAN NATIONAL AGENCY FOR REGIONAL HEALTHCARE SERVICES, ROMA; NATIONAL CENTRE FOR GLOBAL HEALTH, ISTITUTO SUPERIORE DI SANITÀ, ROMA; AO SAN GIOVANNI ADDOLORATA, ROMA
| | - F Cerza
- OSPEDALE SAN CAMILLO, ROMA; ITALIAN NATIONAL AGENCY FOR REGIONAL HEALTHCARE SERVICES, ROMA; NATIONAL CENTRE FOR GLOBAL HEALTH, ISTITUTO SUPERIORE DI SANITÀ, ROMA; AO SAN GIOVANNI ADDOLORATA, ROMA
| | - G Mureddu
- OSPEDALE SAN CAMILLO, ROMA; ITALIAN NATIONAL AGENCY FOR REGIONAL HEALTHCARE SERVICES, ROMA; NATIONAL CENTRE FOR GLOBAL HEALTH, ISTITUTO SUPERIORE DI SANITÀ, ROMA; AO SAN GIOVANNI ADDOLORATA, ROMA
| | - S Rosato
- OSPEDALE SAN CAMILLO, ROMA; ITALIAN NATIONAL AGENCY FOR REGIONAL HEALTHCARE SERVICES, ROMA; NATIONAL CENTRE FOR GLOBAL HEALTH, ISTITUTO SUPERIORE DI SANITÀ, ROMA; AO SAN GIOVANNI ADDOLORATA, ROMA
| | - G Badoni
- OSPEDALE SAN CAMILLO, ROMA; ITALIAN NATIONAL AGENCY FOR REGIONAL HEALTHCARE SERVICES, ROMA; NATIONAL CENTRE FOR GLOBAL HEALTH, ISTITUTO SUPERIORE DI SANITÀ, ROMA; AO SAN GIOVANNI ADDOLORATA, ROMA
| | - F Seccareccia
- OSPEDALE SAN CAMILLO, ROMA; ITALIAN NATIONAL AGENCY FOR REGIONAL HEALTHCARE SERVICES, ROMA; NATIONAL CENTRE FOR GLOBAL HEALTH, ISTITUTO SUPERIORE DI SANITÀ, ROMA; AO SAN GIOVANNI ADDOLORATA, ROMA
| | - G Baglio
- OSPEDALE SAN CAMILLO, ROMA; ITALIAN NATIONAL AGENCY FOR REGIONAL HEALTHCARE SERVICES, ROMA; NATIONAL CENTRE FOR GLOBAL HEALTH, ISTITUTO SUPERIORE DI SANITÀ, ROMA; AO SAN GIOVANNI ADDOLORATA, ROMA
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10
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De Luca L, D’Errigo P, Rosato S, Mureddu GF, Badoni G, Seccareccia F, Baglio G. Impact of myocardial revascularization on long-term outcomes in a nationwide cohort of first acute myocardial infarction survivors. Eur Heart J Suppl 2022; 24:C225-C232. [PMID: 35663587 PMCID: PMC9155238 DOI: 10.1093/eurheartj/suac013] [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] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The long-term clinical benefits of myocardial revascularization in a contemporary, nationwide cohort of acute myocardial infarction (AMI) survivors are unclear. We aimed to compare the mortality rates and clinical outcomes at 8 years of patients admitted in Italy for a first AMI managed with or without myocardial revascularization during the index event. This is a national retrospective cohort study that enrolled patients admitted for a first AMI in 2012 in all Italian hospitals who survived at 30 days. The outcomes of interest were all-cause mortality, major cardio-cerebrovascular events (MACCE), and re-hospitalization for heart failure (HF) at 8 years. Time to events was analysed using a Cox and Fine and Gray multivariate regression model. A total of 127 431 patients with AMI were admitted to Italian hospitals in 2012. The study cohort consisted of 62 336 AMI events, of whom 63.8% underwent percutaneous or surgical revascularization ≤30 days of the index hospital admission. At 8 years, the cumulative incidence of all-cause death was 36.5% (24.6% in revascularized and 57.6% in not revascularized patients). After multiple corrections, the hazard ratio (HR) for all-cause mortality in revascularized vs. not revascularized patients was 0.61 (P < 0.0001). The rate of MACCE was 45.7% and 65.8% (adjusted HR 0.83; P < 0.0001), while re-hospitalizations for HF occurred in 17.6% and 29.8% (adjusted HR 0.97; P = 0.16) in AMI survivors revascularized and not revascularized, respectively. In our contemporary nationwide cohort of patients at their first AMI episode, those who underwent myocardial revascularization within 1 month from the index event compared to those not revascularized presented an adjusted 39% risk reduction in all-cause mortality and 17% in MACCE at 8-year follow-up.
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Affiliation(s)
- Leonardo De Luca
- Department of Cardiosciences, A.O. San Camillo-Forlanini, Circonvallazione Gianicolense 87, 00152 Rome, Italy
- UniCamillus-Saint Camillus International, University of Health Sciences, Rome, Italy
| | - Paola D’Errigo
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Stefano Rosato
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | | | - Gabriella Badoni
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Fulvia Seccareccia
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Giovanni Baglio
- Italian National Agency for Regional Healthcare Services, Rome, Italy
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Costa G, D’Errigo P, Rosato S, Biancari F, Marcellusi A, Tarantini G, Santoro G, Baiocchi M, Maffeo D, Fiorina C, Cerza F, Baglio G, Juvonen T, Badoni G, Valvo R, Seccareccia F, Barbanti M, Tamburino C. One-Year Outcomes and Trends over Two Eras of Transcatheter Aortic Valve Implantation in Real-World Practice. J Clin Med 2022; 11:jcm11051164. [PMID: 35268255 PMCID: PMC8911125 DOI: 10.3390/jcm11051164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 12/02/2022] Open
Abstract
Background: Data reflecting the benefit of procedural improvements in real-world transcatheter aortic valve implantation (TAVI) practice are sparse. Aims: To compare outcomes and trends of two TAVI eras from real Italian practice. Methods: A total of 1811 and 2939 TAVI patients enrolled in the national, prospective OBSERVANT and OBSERVANT II studies in 2010–2012 and 2016–2018, respectively, were compared in a cohort study. Outcomes were adjusted using inverse propensity of treatment weighting and propensity score matching. Results: The median age (83.0 (79.0–86.0) vs. 83.0 (79.0–86.0)) and EuroSCORE II (5.2 (3.2–7.7) vs. 5.1 (3.1–8.1)) of OBSERVANT and OBSERVANT II patients were similar. At 1 year, patients of the OBSERVANT II study had a significantly lower risk of all-cause death (10.6% vs. 16.3%, Hazard Ratio (HR) 0.63 (95% Confidence Interval (CI) 0.52–0.76)) and rehospitalization for heart failure (HF) (14.3% vs. 19.5%, Sub-distribution HR 0.71 (95%CI 0.60–0.84)), whereas rates of stroke (3.1% vs. 3.6%) and permanent pacemaker implantation (PPI) (16.6% vs. 18.0%) were comparable between study groups. Conclusions: Age and risk profile among patients undergoing TAVI in Italy remained substantially unchanged between the 2010–2012 and 2016–2018 time periods. After adjustment, patients undergoing TAVI in the most recent era had lower risk of all-cause death and rehospitalization for HF at 1 year, whereas rates of stroke and PPI did not differ significantly.
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Affiliation(s)
- Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (G.C.); (R.V.); (C.T.)
| | - Paola D’Errigo
- National Centre for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy; (P.D.); (S.R.); (G.B.); (F.S.)
| | - Stefano Rosato
- National Centre for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy; (P.D.); (S.R.); (G.B.); (F.S.)
| | - Fausto Biancari
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00029 Helsinki, Finland; (F.B.); (T.J.)
- Research Unit of Surgery, Anesthesiology and Critical Care, University of Oulu, 90570 Oulu, Finland
| | - Andrea Marcellusi
- Centre for Economic Evaluation and HTA (EEHTA), Centre for Economic and International Studies (CEIS), Faculty of Economics, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Giuseppe Tarantini
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, 35122 Padova, Italy;
| | - Gennaro Santoro
- Division of Diagnostic and Interventional Cardiology, Fondazione “G. Monasterio” CNR—Tuscany Region for the Medical Research and Public Health, 94100 Massa, Italy;
| | - Massimo Baiocchi
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Diseases, Policlinico Sant’Orsola, 40138 Bologna, Italy;
| | - Diego Maffeo
- Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza, 25124 Brescia, Italy;
| | - Claudia Fiorina
- Division of Cardiology, Cardiothoracic Department, Spedali Civili, 25123 Brescia, Italy;
| | - Francesco Cerza
- Department of Epidemiology, Italian National Agency for Regional Healthcare Services, 00147 Rome, Italy; (F.C.); (G.B.)
| | - Giovanni Baglio
- Department of Epidemiology, Italian National Agency for Regional Healthcare Services, 00147 Rome, Italy; (F.C.); (G.B.)
| | - Tatu Juvonen
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00029 Helsinki, Finland; (F.B.); (T.J.)
- Research Unit of Surgery, Anesthesiology and Critical Care, University of Oulu, 90570 Oulu, Finland
| | - Gabriella Badoni
- National Centre for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy; (P.D.); (S.R.); (G.B.); (F.S.)
| | - Roberto Valvo
- Division of Cardiology, A.O.U. Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (G.C.); (R.V.); (C.T.)
| | - Fulvia Seccareccia
- National Centre for Global Health, Istituto Superiore di Sanità, 00161 Rome, Italy; (P.D.); (S.R.); (G.B.); (F.S.)
| | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (G.C.); (R.V.); (C.T.)
- Correspondence:
| | - Corrado Tamburino
- Division of Cardiology, A.O.U. Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (G.C.); (R.V.); (C.T.)
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12
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De Luca L, Cicala SD, D'Errigo P, Cerza F, Mureddu GF, Rosato S, Badoni G, Seccareccia F, Baglio G. Impact of age, gender and heart failure on mortality trends after acute myocardial infarction in Italy. Int J Cardiol 2021; 348:147-151. [PMID: 34921898 DOI: 10.1016/j.ijcard.2021.12.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/09/2021] [Accepted: 12/13/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND The outcome of patients with acute myocardial infarction (AMI) may vary substantially based on baseline risk. We aimed at analyzing the impact of gender, age and heart failure (HF) on mortality trends, based on a nationwide, comprehensive and universal administrative database of AMI. METHODS This is a nationwide cohort study of patients admitted with AMI from 2009 to 2018 in all Italian hospitals. In-hospital mortality rate (I-MR) and 1-year post-discharge mortality rate (1-Y-MR) were assessed. RESULTS Among the 1,000,965 AMI events included in the analysis, 43.6% occurred in patients aged ≥75 years, 34.7% in females and 21.8% in AMI complicated by HF at the index hospitalization. Both I-MR and 1-Y-MR significantly decreased over time (from 8.87% to 6.72%; mean annual change -0.23%; confidence intervals (CI): - 0.26% to -0.20% and from 12.24% to 10.59%; mean annual change -0.18%; CI: - 0.24% to -0.13%, respectively). This trend was confirmed in younger and elderly AMI patients, in both sexes. In AMI patients complicated by HF, both I-MR and 1-Y-MR were markedly high, regardless of age and gender. CONCLUSIONS This contemporary, nationwide study suggests that I-MR and 1-Y-MR are still elevated, albeit decreasing over time. Elderly patients and those with HF at the time of index admission, present a particularly high risk of fatal events, regardless of gender.
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Affiliation(s)
- Leonardo De Luca
- Department of Cardiosciences, A.O. San Camillo-Forlanini, Rome, Italy; UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy.
| | | | - Paola D'Errigo
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Francesco Cerza
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | | | - Stefano Rosato
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Gabriella Badoni
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Fulvia Seccareccia
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Giovanni Baglio
- Italian National Agency for Regional Healthcare Services, Rome, Italy
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13
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Barili F, D'Errigo P, Rosato S, Biancari F, Forti M, Pagano E, Parolari A, Gellini M, Badoni G, Seccareccia F. Impact of gender on 10-year outcome after coronary artery bypass grafting. Interact Cardiovasc Thorac Surg 2021; 33:510-517. [PMID: 34000041 DOI: 10.1093/icvts/ivab125] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/15/2021] [Accepted: 03/22/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Our goal was to evaluate the impact of gender on the 10-year outcome of patients after isolated coronary artery bypass grafting (CABG) included in the Italian nationwide PRedictIng long-term Outcomes afteR Isolated coronary arTery bypass surgery (PRIORITY) study. METHODS The PRIORITY project was designed to evaluate the long-term outcomes of patients who underwent CABG and were included in 2 prospective multicentre cohort studies. The primary end point of this analysis was major adverse cardiac and cerebrovascular events. Baseline differences between the study groups were balanced with propensity score matching and inverse probability of treatment. Time to events was analysed using Cox regression and competing risk analysis. RESULTS The study population comprised 10 989 patients who underwent isolated CABG (women 19.6%). Propensity score matching produced 1898 well-balanced pairs. The hazard of major adverse cardiac and cerebrovascular event was higher in women compared to men [adjusted hazard ratio (HR) 1.13, 95% confidence interval (CI) 1.03-1.23; P = 0.009]. The incidence of major adverse cardiac and cerebrovascular event in women was significantly higher at 1 year (HR 1.31, 95% CI 1.11-1.55; P < 0.001) and after 1 year (HR 1.11, 95% CI 1.00-1.24; P = 0.05). Mortality at 10 years in the matched groups was comparable (HR 1.04, 95% CI 0.93-1.16; P = 0.531). Women have significantly a higher 10-year risk of myocardial infarction (adjusted HR 1.40, 95% CI 1.17-1.68; P = 0.002) and percutaneous coronary intervention (adjusted HR 1.32, 95% CI 1.10-1.59; P = 0.003). CONCLUSIONS The present study documented an excess of non-fatal cardiac events after CABG among women despite comparable 10-year survival with men. These findings suggest that studies investigating measures of tertiary prevention are needed to decrease the risk of adverse cardiovascular events among women.
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Affiliation(s)
- Fabio Barili
- Department of Cardiac Surgery, S. Croce Hospital, Cuneo, Italy
| | - Paola D'Errigo
- National Centre for Global Health, Italian Health Institute, Rome, Italy
| | - Stefano Rosato
- National Centre for Global Health, Italian Health Institute, Rome, Italy
| | - Fausto Biancari
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.,Research Unit of Surgery, Anesthesiology and Critical Care, University of Oulu, Oulu, Finland.,Department of Surgery, University of Turku, Turku, Finland
| | - Marco Forti
- Agenzia Regionale per i Servizi Sanitari Regionali, Rome, Italy
| | - Eva Pagano
- Department of Epidemiology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Alessandro Parolari
- Unit of Cardiac Surgery, IRCCS Policlinico S. Donato, University of Milan, S. Donato Milanese, Italy
| | - Mara Gellini
- National Centre for Global Health, Italian Health Institute, Rome, Italy
| | - Gabriella Badoni
- National Centre for Global Health, Italian Health Institute, Rome, Italy
| | - Fulvia Seccareccia
- National Centre for Global Health, Italian Health Institute, Rome, Italy
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Rosato S, Barili F, D'Errigo P, Biancari F, Forti M, Cerza F, Cicala SD, Badoni G, Seccareccia F. Long-term outcome after off-pump coronary artery bypass grafting: implication for public health. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1097] [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] Open
Abstract
Abstract
Background
The debate on the benefits and limitations of off-pump (OPCAB) coronary artery bypass grafting (CABG) on long-term outcomes is not yet settled. This study aimed to compare the impact of OPCAB vs on-pump CABG on long-term outcomes and to evaluate possible public health implications linked to their use.
Methods
The PRIORITY project was planned to evaluate the long-term outcomes of two prospective multicenter studies on CABG conducted between 2002-2004 and 2007-2008. Data on isolated CABG were linked to administrative data in order to retrieve patients' late outcome. Time-to-event distributions were analyzed accordingly to primary event-type (death, major adverse cardiac events (MACEs)) using the Kaplan-Meier and the Cox proportional hazards methods.
Results
The study population consisted of 11 021 patients who underwent isolated CABG (27.2% OPCAB). The median follow-up time was 8.0 years (interquartile range 7.6-10.0 years). OPCAB had comparable late all-cause mortality to on-pump CABG (HR 0.94, 95%CI 0.85-1.03, p = 0.19), but it was associated to an increased risk of MACE (adjusted HR 1.14, 95%CI 1.06-1.23, p = 0.001). In particular, OPCAB had an increased risk of repeated revascularization with percutaneous cardiac intervention (PCI) (adjusted HR 1.33, 95%CI 1.16-1.53, p < 0.001) compared to on-pump CABG.
Conclusions
OPCAB does not affect long-term mortality, but it significantly increases the risk of MACEs. In particular, OPCAB had an increased risk of repeated revascularization with PCI. These findings may have important implications towards health resources allocation.
Key messages
Off-pump coronary artery bypass grafting strategy is associated with an increased long-term risk of MACE and repeated PCI. Off-pump strategy is mainly based on operator preferences and can have important implications in terms of healthcare costs.
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Affiliation(s)
- S Rosato
- National Centre for Global Health, Italian National Institute of Health, Rome, Italy
| | - F Barili
- Department of Cardiac Surgery, S. Croce Hospital, Cuneo, Italy
| | - P D'Errigo
- National Centre for Global Health, Italian National Institute of Health, Rome, Italy
| | - F Biancari
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - M Forti
- National Outcomes Program, Italian National Agency for Regional Healthcare Services, Rome, Italy
| | - F Cerza
- National Outcomes Program, Italian National Agency for Regional Healthcare Services, Rome, Italy
| | - S D Cicala
- National Outcomes Program, Italian National Agency for Regional Healthcare Services, Rome, Italy
| | - G Badoni
- National Centre for Global Health, Italian National Institute of Health, Rome, Italy
| | - F Seccareccia
- National Centre for Global Health, Italian National Institute of Health, Rome, Italy
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15
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Rosato S, D'Errigo P, Manno V, Maraschini A, Cerza F, Cicala SD, Forti M, Mureddu GF, Badoni G, Sferrazza A. Trends in mortality and heart failure after acute myocardial infarction in Italy from 2007 to 2017. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1419] [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: 11/14/2022] Open
Abstract
Abstract
Background
Uncertainties on long-term outcomes after acute myocardial infarction (AMI) still exist, despite the ongoing progresses in the management of patients with AMI. This study aims to appraise early and 1-year outcome of patients hospitalized due to AMI and to describe the role of heart failure (HF) as complication affecting prognoses.
Methods
Retrospective nationwide cohort study based on administrative data on patients with AMI admitted in all Italian hospitals from 2007 to 2017. Index admission mortality rate (I-MR), 30-day and 1-year post-discharge mortality rate (PD-MR), and 30-day and 1-year total mortality rate (T-MR) were analysed; mortality average annual changes (AC) and their 95% CI were calculated; the Cox model, adjusting for age, sex, comorbidities and length of stay, was used to analyse 1-year PD-MR
Results
1,148,820 patients were considered. From 2007 to 2017, both I-MR and T-MR up to 1 year decreased significantly (from 10.9 to 8.4%; AC: -0.28%; CI: -0.31 to -0.25 and from 20.2% to 17.1%: AC: -0.33%; CI: -0.39 to -0.28, respectively). From 2010, also the rate of PD-MR decreased significantly from 11.7% to 10.4%, with such favourable trend confirmed at multivariable analyses. The HF diagnosis at the index admission is always associated with a significant increase in the risk of death (1-year T-MR average: 43% and 12% in patients with or without HF, respectively; both patients with and without HF show a constant improvement in I-MR, T-MR and PD-MR over time.
Conclusions
In the last decade, the remarkable improvements in the in-hospital treatment of patients with AMI and in the overall prognosis up to 1 year are confirmed by a constant decrease in both early and long-term mortality. Since complication from HF remains a dangerous condition that significantly worsens the prognosis of the AMI patient, appropriate management strategies must be identified and implemented to guarantee best results from both clinic and public health perspective.
Key messages
Remarkable improvements achieved in overall prognosis after AMI over the past 10 years. HF confirms to be a condition able to worsen AMI patients’ prognosis.
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Affiliation(s)
- S Rosato
- National Centre for Global Health, Italian National Institute of Health, Rome, Italy
| | - P D'Errigo
- National Centre for Global Health, Italian National Institute of Health, Rome, Italy
| | - V Manno
- Technical-Scientific Service of Statistics, Italian National Institute of Health, Rome, Italy
| | - A Maraschini
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - F Cerza
- National Outcomes Program, Italian National Agency for Regional Healthcare Services, Rome, Italy
| | - S D Cicala
- National Outcomes Program, Italian National Agency for Regional Healthcare Services, Rome, Italy
| | - M Forti
- National Outcomes Program, Italian National Agency for Regional Healthcare Services, Rome, Italy
| | - G F Mureddu
- Cardiology and Cardiovascular Rehabilitation Unit, S. Giovanni-Addolorata Hospital, Rome, Italy
| | - G Badoni
- National Centre for Global Health, Italian National Institute of Health, Rome, Italy
| | - A Sferrazza
- National Outcomes Program, Italian National Agency for Regional Healthcare Services, Rome, Italy
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Pagano E, Evangelista A, D'Errigo P, Rosato S, Seccareccia F, Biancari F, Badoni G, Forti M, Barili F. Hospitalization costs related to long-term management of patients undergoing CABG (PRIORITY project). Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1109] [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: 11/14/2022] Open
Abstract
Abstract
Background
Identifying potential tools that could help improving the standard of care and lead to a better allocation of economic resources represents a main objective of research in public health. Using data from the PRIORITY cohort, this study aims to describe inpatients costs after a discharge for isolated coronary artery bypass surgery (CABG).
Methods
The PRIORITY project was designed to evaluate the long-term outcomes of 2 large multicenter cohort studies on CABG conducted between 2002-04 and 2007-08. For each patient discharged alive after a CABG intervention, costs of hospitalizations were estimated as the sum of costs of all the admissions occurred during 3 years of follow-up. NHS reimbursement rates were used as standard costs (in Euros). Inpatients costs were analysed according to their baseline risk factors.
Results
Among the 7363 patients included in this analysis, the median 3-year hospitalization costs were 4341€ (IQR: 1865-11699). Median costs were around 4.000€ for subjects alive at the end of follow up but higher for patients dying within 1 (about 8.600€) and 2-3 years of follow up (about 20.000€). The presence of comorbidities (such as diabetes and cancer) lead to higher median hospitalization costs while the on-pump approach was associated to lower median cost. Sixteen per cent of patients were at zero cost having no re-hospitalizations during the 3 years of follow-up (97% alive). Subjects at zero cost received more frequently on-pump approach, had a lower frequency of cancer, arteriopathy and ictus, but a higher frequency of angina and infarction.
Conclusions
Inpatient costs after isolated CABG are affected by preoperative comorbidities and by operative variables that could be removed or managed. Identifying independent risk factors for re-hospitalization will lead to the definition of a preoperative clinical and decision-making path that will bring both a clinical advantage for the patient and an optimization of costs for the NHS.
Key messages
Inpatient costs after isolated CABG are affected by preoperative comorbidities and operative characteristics like the on-pump approach. Appropriate management of operative approaches mainly based on operator preferences can have important implications in terms of healthcare costs.
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Affiliation(s)
- E Pagano
- Unit of Clinical Epidemiology, Turin, Italy
| | | | - P D'Errigo
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - S Rosato
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - F Seccareccia
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - F Biancari
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - G Badoni
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - M Forti
- National Outcomes Program, Italian National Agency for Regional Healthcare Services, Rome, Italy
| | - F Barili
- Department of Cardiac Surgery, S. Croce Hospital, Cuneo, Italy
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D'Errigo P, Barili F, Rosato S, Biancari F, Cerza F, Cicala SD, Forti M, Badoni G, Seccareccia F. Bilateral internal thoracic artery grafting in coronary surgery: 10-year outcomes. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1420] [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] Open
Abstract
Abstract
Background
The advantages to use the bilateral internal thoracic artery grafting (BITA) technique for coronary artery bypass grafting (CABG) have been recently questioned, but data on long-term follow-up is limited. Using data from the PRIORITY project, this study aims to assess the outcome with the use of BITA grafting and its implications for public health.
Methods
The PRIORITY project was planned to evaluate the long-term outcomes of two prospective multicenter studies on CABG conducted between 2002-2004 and 2007-2008. Data on isolated CABG were linked to administrative data in order to retrieve patients' late outcome. Time-to-event distributions were analyzed accordingly to primary event-type (death, major adverse cardiac events (MACEs)) using the Kaplan-Meier and the Cox proportional hazards methods.
Results
The study population consisted of 11021 patients who underwent isolated CABG. BITA grafting was employed in 24.6% of patients. The median follow-up time was 8.0 years (interquartile range 7.6-10.0 years). After adjustment for potential confounding factors, BITA grafting was significantly associated with better survival (HR 0.85, 95%CI 0.76-0.95, p = 0.003). Moreover, using BITA grafting reduced the incidence of MACE (HR 0.87, 95%CI 0.80-0.94, p = 0.001), showing to be a protective factor for recurrent acute myocardial infarction (HR 0.84, 95%CI 0.71-0.99, p = 0.05) and for rehospitalization for percutaneous cardiac intervention (HR 0.82, 95%CI 0.70-0.96, p = 0.013).
Conclusions
BITA grafting during isolated CABG is associated with survival advantage at 10-year with a significantly reduced incidence of MACE. Being the choice to perform isolated CABG with or without BITA based mainly on operator personal preferences, these findings may have important implications from a public health perspective.
Key messages
The choice to perform CABG with or without BITA grafting is associated to different outcomes. The choice to perform CABG with or without BITA grafting is mainly based on operator preferences and may have important implications in terms of healthcare expenditures.
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Affiliation(s)
- P D'Errigo
- National Centre for Global Health, Italian National Institute of Health, Rome, Italy
| | - F Barili
- Department of Cardiac Surgery, S. Croce Hospital, Cuneo, Italy
| | - S Rosato
- National Centre for Global Health, Italian National Institute of Health, Rome, Italy
| | - F Biancari
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - F Cerza
- National Outcomes Program, Italian National Agency for Regional Healthcare Services, Rome, Italy
| | - S D Cicala
- National Outcomes Program, Italian National Agency for Regional Healthcare Services, Rome, Italy
| | - M Forti
- National Outcomes Program, Italian National Agency for Regional Healthcare Services, Rome, Italy
| | - G Badoni
- National Centre for Global Health, Italian National Institute of Health, Rome, Italy
| | - F Seccareccia
- National Centre for Global Health, Italian National Institute of Health, Rome, Italy
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D'Errigo P, Rosato S, Mureddu GF, Badoni G, Cerza F, Cicala SD, Forti M, Seccareccia F. Hospital management of patients with acute coronary syndrome: influence of age and gender. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1124] [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] Open
Abstract
Abstract
Background
Although the improvement of therapeutic strategies is leading to a dramatic decline of in-hospital acute coronary syndrome (ACS) death rates, differences in care and prognosis of ACS patients exist when age, gender and admission department are considered.
Methods
The national administrative hospital discharge record (HDR) system was used. Only data recorded from January 1, 2017 to Dicember 31, 2018 were analyzed. This approach allowed to identify 205775 patients reporting ACS as primary or secondary diagnosis: 122812 with non-ST-elevation ACS (NSTE-ACS) and 82963 with ST-elevation ACS (STEMI). The ACS cohort was stratified by age (<75 and ≥75 years) and gender. The proportion of STEMI patients treated in general medicine or cardiology departments requiring a coronary procedure or extensive investigations were analyzed.
Results
Among the 205775 patients hospitalized for ACS, 6% of STEMI and 8.3% of NSTE-ACS patients have been treated only in a general medicine ward and have never passed through a specific cardiology ward. For STEMI patients, the proportion becomes 4% when males are considered, increases up to 10% for females and up to 13% for elderly patients (≥75 years). During the index hospitalization, about 25% of female and more than 30% of elderly patients with STEMI do not undergo a coronary procedure or other extensive investigations; the same happens only in about 10% of male and 6% of younger patients. The proportion of improperly managed patients reaches 35% for women aged ≥75 years.
Conclusions
In-hospital management of women and elderly patients with ST-elevation ACS does not completely comply with the recommended guidelines and exposes them to unfavourable prognosis.
Key messages
Women and elderly STEMI patients are markedly less intensively investigated and treated in cardiologic departments. This medical policy could lead to unfavourable prognosis.
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Affiliation(s)
- P D'Errigo
- National Centre for Global Health, Italian National Institute of Health, Rome, Italy
| | - S Rosato
- National Centre for Global Health, Italian National Institute of Health, Rome, Italy
| | - G F Mureddu
- Cardiology and Cardiovascular Rehabilitation Unit, S. Giovanni-Addolorata Hospital, Rome, Italy
| | - G Badoni
- National Centre for Global Health, Italian National Institute of Health, Rome, Italy
| | - F Cerza
- National Outcomes Program, Italian National Agency for Regional Healthcare Services, Rome, Italy
| | - S D Cicala
- National Outcomes Program, Italian National Agency for Regional Healthcare Services, Rome, Italy
| | - M Forti
- National Outcomes Program, Italian National Agency for Regional Healthcare Services, Rome, Italy
| | - F Seccareccia
- National Centre for Global Health, Italian National Institute of Health, Rome, Italy
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Seccareccia F, D'Errigo P, Tarantini G, Barbanti M, Tamburino C, Musumeci G, Bedogni F, Berti S, Rosato S, Santoro G, Ussia GP, Baiocchi M, Ranucci M, Corti MC, Badoni G. [First results from the OBSERVANT II study: clinical characteristics of patients with aortic stenosis undergoing transcatheter treatment with new generation devices]. G Ital Cardiol (Rome) 2020; 21:469-477. [PMID: 32425193 DOI: 10.1714/3359.33331] [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: 06/11/2023]
Abstract
BACKGROUND The OBSERVANT study evaluated the medium and long-term outcomes in patients undergoing transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement obtaining comparative effectiveness results at least for the first-generation devices. The OBSERVANT II study enrolled a new series of TAVI procedures to evaluate whether the use of new-generation devices has modified outcome differences recorded in the OBSERVANT study. The aim of this paper is to describe the clinical characteristics of the OBSERVANT II population and compare them with those of the OBSERVANT population. METHODS OBSERVANT II is a prospective multicenter observational study, which enrolled patients with severe aortic stenosis, who underwent a TAVI procedure in 30 Italian centers from December 2016 to September 2018. Clinical, anatomical and procedural information was recorded for each patient as well as procedure characteristics and any periprocedural outcomes. An administrative follow-up will allow to obtain information on medium and long-term outcomes. RESULTS The enrolled population consists of 3001 patients with a mean age similar to that recorded in OBSERVANT (81.7 ± 6.3 vs 81.9 ± 6.2 years; p=0.336). OBSERVANT II patients show a lower prevalence of several morbid conditions than OBSERVANT patients (i.e. chronic obstructive pulmonary disease, coronary artery disease, peripheral arterial disease, etc.), though having very similar mean values of EuroSCORE II (7.2 ± 7.6% vs 7.4 ± 7.9%; p=0.558). According to three EuroSCORE II risk classes (≤3; 3-7; ≥7), the in-hospital mortality rates for patients enrolled in the two studies are 1.0% vs 2.0% (p≤0.000), 1.4% vs 4.1% (p<0.000) and 2.4% vs 7.7% (p<0.000), respectively. CONCLUSIONS The first results of the OBSERVANT II study show that patients undergoing TAVI with new-generation devices are elderly, have a lower risk profile than patients enrolled in the OBSERVANT study but comparable mean values of EuroSCORE II. The in-hospital mortality rate for patients enrolled in the OBSERVANT II study is lower than that recorded in the OBSERVANT study across all the EuroSCORE II risk classes.
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Affiliation(s)
- Fulvia Seccareccia
- Centro Nazionale per la Salute Globale, Istituto Superiore di Sanità, Roma
| | - Paola D'Errigo
- Centro Nazionale per la Salute Globale, Istituto Superiore di Sanità, Roma
| | - Giuseppe Tarantini
- Dipartimento di Scienze Cardiologiche, Toraciche e Vascolari, Policlinico Universitario, Padova
| | - Marco Barbanti
- U.O. Cardiologia, AOU Policlinico Vittorio Emanuele, Università degli Studi di Catania, Catania
| | - Corrado Tamburino
- U.O. Cardiologia, AOU Policlinico Vittorio Emanuele, Università degli Studi di Catania, Catania
| | | | - Francesco Bedogni
- Cardiologia Interventistica, IRCCS Policlinico San Donato, San Donato Milanese (MI)
| | - Sergio Berti
- U.O. Cardiologia Diagnostica ed Interventistica, Fondazione CNR Regione Toscana G. Monasterio - Ospedale del Cuore, Massa
| | - Stefano Rosato
- Centro Nazionale per la Salute Globale, Istituto Superiore di Sanità, Roma
| | - Gennaro Santoro
- U.O. Cardiologia Diagnostica ed Interventistica, Fondazione CNR Regione Toscana G. Monasterio - Ospedale del Cuore, Massa
| | - Gian Paolo Ussia
- Dipartimento Medicina dei Sistemi, Università degli Studi "Tor Vergata", Roma
| | - Massimo Baiocchi
- U.O. Anestesiologia e Rianimazione, Policlinico S. Orsola-Malpighi, Bologna
| | - Marco Ranucci
- Cardiologia Interventistica, IRCCS Policlinico San Donato, San Donato Milanese (MI)
| | | | - Gabriella Badoni
- Centro Nazionale per la Salute Globale, Istituto Superiore di Sanità, Roma
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Mariscalco G, D’Errigo P, Biancari F, Rosato S, Musumeci F, Barbanti M, Ranucci M, Santoro G, Badoni G, Fusco D, Ventura M, Tamburino C, Seccareccia F. Early and late outcomes after transcatheter versus surgical aortic valve replacement in obese patients. Arch Med Sci 2020; 16:796-801. [PMID: 32542080 PMCID: PMC7286321 DOI: 10.5114/aoms.2019.85253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 12/12/2018] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Data on the early and late outcome following transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) in obese patients are limited. We investigated whether TAVI may be superior to SAVR in obese patients. MATERIAL AND METHODS Obese patients (body mass index ≥ 30 kg/m2) who underwent either SAVR or TAVI were identified from the nationwide OBSERVANT registry, and their in-hospital and long-term outcomes were analysed. Propensity score matching was employed to identify two cohorts with similar baseline characteristics. RESULTS The propensity score matching provided 142 pairs balanced in terms of baseline risk factors. In-hospital and 30-day mortality did not differ between SAVR and TAVI obese patients (4.6% vs. 3.3%, p = 0.56, and 5.2% vs. 3.2%, p = 0.41, respectively). Obese SAVR patients experienced a higher rate of renal failure (12.4% vs. 3.6%, p = 0.0105) and blood transfusion requirement (60.3% vs. 25.7%, p < 0.0001) in comparison with TAVI patients. A higher rate of permanent pacemaker implantation (14.4% vs. 3.6%, p = 0.0018), and major vascular injuries (7.4% vs. 0%, p = 0.0044) occurred in the TAVI group. Five-year survival was higher in the SAVR group compared to the TAVI patient cohort (p = 0.0046), with survival estimates at 1, 3 and 5 years of 88.0%, 80.3%, 71.8% for patients undergoing SAVR, and 85.2%, 69.0%, 52.8% for those subjected to TAVI procedures. CONCLUSIONS In obese patients, both SAVR and TAVI are valid treatment options, although in the long term SAVR exhibited higher survival rates.
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Affiliation(s)
- Giovanni Mariscalco
- Department of Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- Corresponding author: Prof. Giovanni Mariscalco MD, PhD, Department of Heart and Vessels, Cardiac Surgery Unit, Varese University Hospital, 7 Via Guicciardini St, 21100 Varese, Italy, E-mail:
| | - Paola D’Errigo
- Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Fausto Biancari
- Heart Center, Turku University Hospital, Turku, Finland
- Department of Surgery, University of Turku, Turku, Finland
- Department of Surgery, University of Oulu, Oulu, Finland
| | - Stefano Rosato
- Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Francesco Musumeci
- Department of Cardiovascular Sciences, Cardiac Surgery Unit, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Marco Barbanti
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Marco Ranucci
- Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Gabriella Badoni
- Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Danilo Fusco
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Martina Ventura
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Corrado Tamburino
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
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Mureddu GF, Greco C, Rosato S, D'Errigo P, De Luca L, Badoni G, Faggiano P, Seccareccia F. High thrombotic risk increases adverse clinical events up to 5 years after acute myocardial infarction. A nationwide retrospective cohort study. Monaldi Arch Chest Dis 2019; 89. [DOI: 10.4081/monaldi.2019.1166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 10/10/2019] [Indexed: 11/23/2022] Open
Abstract
The risk of recurrent events among survivors of acute myocardial infarction (AMI) is understudied. The aim of this analysis was to investigate the role of residual high thrombotic risk (HTR) as a predictor of recurrent in-hospital events after AMI. This retrospective cohort study included 186,646 patients admitted with AMI from 2009 to 2010 in all Italian hospitals who were alive 30 days after the index event. HTR was defined as at least one of the following in the 5 years preceding AMI: previous myocardial infarction, ischemic stroke/other vascular disease, type 2 diabetes mellitus, renal failure. Risk adjustment was performed in all multivariate survival analyses. Rates of major cardiac and cerebrovascular events (MACCE) within the following 5 years were calculated in both patients without fatal readmissions at 30 days and in those free from in-hospital MACCE at 1 year from the index hospitalization. The overall 5-year risk of MACCE was higher in patients with HTR than in those without HTR, in both survivors at 30 days [hazard ratio (HR), 1.49; 95% confidence interval (CI), 1.45-1.52; p<0.0001] and in those free from MACCE at 1 year (HR, 1.46; 95% CI, 1.41-1.51; p<0.0001). The risk of recurrent MACCE increased in the first 18 months after AMI (HR, 1.49) and then remained stable over 5 years. The risk of MACCE after an AMI endures over 5 years in patients with HTR. This is also true for patients who did not have any new cardiovascular event in the first year after an AMI. All patients with HTR should be identified and addressed to intensive preventive care strategies.
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Tarantini G, Nai Fovino L, D'Errigo P, Rosato S, Barbanti M, Tamburino C, Ranucci M, Santoro G, Badoni G, Seccareccia F. Factors influencing the choice between transcatheter and surgical treatment of severe aortic stenosis in patients younger than 80 years: Results from the OBSERVANT study. Catheter Cardiovasc Interv 2019; 95:E186-E195. [PMID: 31423704 DOI: 10.1002/ccd.28447] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/01/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES We aimed to analyze the baseline features and clinical outcomes of patients younger than 80 years undergoing transfemoral transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR) enrolled in the OBservational Study of Effectiveness of SAVR-TAVR procedures for severe Aortic steNosis Treatment (OBSERVANT) real-world study, focusing on variables guiding Heart Team decision toward TAVI. BACKGROUND Patients treated with TAVI, independently of surgical risk score, are mostly older than 80 years. METHODS OBSERVANT is a multicenter, observational, prospective cohort study that enrolled patients with symptomatic severe aortic stenosis (AS) who underwent SAVR or TAVI from December 2010 to June 2012 in 93 Italian participating hospitals. For this analysis, baseline characteristics, therapeutic approach and outcomes up to 5 years of follow-up of 4,801 patients under 80 years of age were collected. Patients were stratified by age classes (<65, 65-74, and 75-79 years). RESULTS Patients <80 years of age with severe symptomatic AS undergoing TAVI (n = 483) had significantly higher Logistic EuroSCORE (10.84% vs. 5.22%, p < .001) and prevalence of comorbidities compared to subjects undergoing SAVR (n = 4,318). The decision to perform TAVI over SAVR was driven by anatomical factors, mainly previous cardiac surgery (odds ratio [OR] 24.73, confidence interval [CI] 12.71-48.10, p < .001) and the presence of porcelain aorta (OR 17.44, CI 6.67-45.55, p < .001), and clinical factors, mainly moderate-severe frailty score (OR 5.49, CI 3.33-9.07, p < .001), oxygen dependency (OR 7.42, CI 2.75-20.04, p < .001) and need for dialytic treatment (OR 5.24, CI 1.54-17.80, p < .008). Among patients undergoing TAVI, those under 65 years had the highest baseline risk profile (despite a low Logistic EuroSCORE) and the highest 5-year mortality compared to those 65-74 and 75-79-year-old (65.22% vs. 48.54% vs. 55.24%, log-rank p = .061). CONCLUSION Among patients under 80 years of age with symptomatic severe AS, only 10% underwent TAVI. These patients were at higher baseline risk compared to those undergoing SAVR. The decision to perform TAVI was driven by the presence of both anatomical and clinical factors beyond surgical risk scores. Patients under 65 years of age, despite the low Logistic EuroSCORE, had the highest preoperative risk profile and carried the worse outcome.
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Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Luca Nai Fovino
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | | | | | - Marco Barbanti
- Ferrarotto Hospital, University of Catania, Catania, Italy
| | | | - Marco Ranucci
- Department of Cardiothoracic and Vascular Anesthesia and ICU, IRCCS Policlinico San Donato, Milan, Italy
| | - Gennaro Santoro
- Fondazione "G.Monasterio" CNR/Regione Toscana per la Ricerca Medica e la Sanità Pubblica, Florence, Italy
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D'Errigo P, Tamburino C, Barbanti M, Ranucci M, Rosato S, Santoro G, Badoni G, Fusco D, Seccareccia F. P755Long-term comparative effectiveness of Transfemoral Transcatheter vs Surgical Aortic Valve Replacement: Results from the Italian OBSERVANT Study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p755] [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] [Indexed: 11/12/2022] Open
Affiliation(s)
- P. D'Errigo
- Istituto Superiore di Sanità, National Center for Epidemiology, Surveillance and Health Promotion, Rome, Italy
| | - C. Tamburino
- Ferrarotto Hospital - Institute for Cardiology, Department of Cardiovascular, Catania, Italy
| | - M. Barbanti
- Ferrarotto Hospital - Institute for Cardiology, Department of Cardiovascular, Catania, Italy
| | - M. Ranucci
- IRCCS, Policlinico San Donato, Department of Cardiothoracic and Vascular Anesthesia and ICU, San Donato Milanese, Italy
| | - S. Rosato
- Istituto Superiore di Sanità, National Center for Epidemiology, Surveillance and Health Promotion, Rome, Italy
| | - G. Santoro
- Careggi Hospital, Department of Cardiology, Florence, Italy
| | - G. Badoni
- Istituto Superiore di Sanità, National Center for Epidemiology, Surveillance and Health Promotion, Rome, Italy
| | - D. Fusco
- Health Authority Roma E, Lazio Regional Health Service, Rome, Italy
| | - F. Seccareccia
- Istituto Superiore di Sanità, National Center for Epidemiology, Surveillance and Health Promotion, Rome, Italy
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Maraschini A, Greco C, Seccareccia F, Rosato S, D'Errigo P, Badoni G. Evolving mortality trends after acute myocardial infarction: evidence from a cohort of more than 800,000 Italian patients. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1305] [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: 11/12/2022] Open
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D'Errigo P, Biancari F, Maraschini A, Rosato S, Badoni G, Seccareccia F. Thirty-Day Mortality After Coronary Artery Bypass Surgery in Patients Aged <50 Years: Results of a Multicenter Study and Meta-Analysis of the Literature. J Card Surg 2013; 28:207-11. [DOI: 10.1111/jocs.12091] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Paola D'Errigo
- National Centre for Epidemiology, Surveillance and Health Promotion; Istituto Superiore di Sanità; Rome Italy
| | - Fausto Biancari
- Department of Surgery; Oulu University Hospital; Oulu Finland
| | - Alice Maraschini
- National Centre for Epidemiology, Surveillance and Health Promotion; Istituto Superiore di Sanità; Rome Italy
| | - Stefano Rosato
- National Centre for Epidemiology, Surveillance and Health Promotion; Istituto Superiore di Sanità; Rome Italy
| | - Gabriella Badoni
- National Centre for Epidemiology, Surveillance and Health Promotion; Istituto Superiore di Sanità; Rome Italy
| | - Fulvia Seccareccia
- National Centre for Epidemiology, Surveillance and Health Promotion; Istituto Superiore di Sanità; Rome Italy
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Maraschini A, D'Errigo P, Casali G, Rosato S, Badoni G, Seccareccia F. Risk stratification models in elderly patients: recalibrating or remodeling? Acta Cardiol 2013; 68:11-8. [PMID: 23457904 DOI: 10.1080/ac.68.1.2959626] [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: 10/19/2022]
Abstract
OBJECTIVE Risk stratification models perform poorly regarding elderly patients. This study aims to evaluate the performance of the Italian Coronary Artery Bypass Graft Outcome Project (ItCABG) model and the logistic European System for Cardiac Operative Risk Evaluation (LogEuroSCORE) model by age group to build a model specifically for elderly patients. METHODS AND RESULTS Data from the ItCABG and Mattone Outcome-BYPASS study (MO-BYPASS) have been used. ItCABG and LogEuroSCORE models were applied to the ItCABG population (n = 34,310) stratified by four age classes: < 60, 60-69, 70-79, > or = 80 years. Each model's ability to predict 30-day mortality was assessed for accuracy (Brier score and pseudo-R2), calibration (Hosmer-Lemeshow test, X(H-L)) and discrimination (area under the receiver operating characteristic curve, AUC) in age classes. To estimate the elderly risk function a logistic regression was performed on 2,255 octogenarian patients from ItCABG and MO-BYPASS. Elderly model's performance was tested. Model accuracy is fair in all age classes although the explained variance is poor. ItCABG and LogEuroSCORE models revealed good discrimination power in patients aged < (60, 60-69, and 70-79 years, but not in patients aged > or = 80 years (AUCs: 0.82, 0.77, 0.76, 0.64, and 0.78, 0.75, 0.74, 0.65, respectively). Calibration of both models is poor in patients 80 years (ItCABG: X(H-L) = 18.1, P = 0.05; LogEuroSCORE: X(H-L) = 129.7, P < 0.001). When a new model specific to octogenarian patients was built, discrimination power remained poor (AUC = 0.66), although calibration power improved (X(H-L) = 3.93, P = 0.86). CONCLUSIONS ItCABG and LogEuroSCORE models were poor predictors of mortality in octogenarian patients. Elderly-specific risk factors must be assessed to improve risk stratification in patients aged 80 years and older.
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Affiliation(s)
- Alice Maraschini
- National Centre of Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy.
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Seccareccia F, Rosato S, D'Errigo P, Maraschini A, Manfredi RM, Lombardi M, Badoni G, Greco C. [In-hospital management of acute coronary syndrome patients: influence of age, gender and admission department on medical policy and outcome]. G Ital Cardiol (Rome) 2012; 13:124-131. [PMID: 22322553 DOI: 10.1714/1021.11146] [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: 05/31/2023]
Abstract
BACKGROUND Although the improvement of therapeutic strategies is leading to a dramatic decline of in-hospital acute coronary syndrome (ACS) death rates, differences in care and prognosis of ACS patients exist when age, gender and admission department are considered. METHODS The national hospital informative system was used. Only data recorded in three Italian Regions from December 1, 2005 to November 30, 2007 were analyzed. This approach allowed to identify 70 413 patients reporting ACS as primary or secondary diagnosis. The ACS cohort was stratified by age (≤64, 65-74 and ≥75 years) and gender. ACS events were divided into two groups: 42 503 patients with non-ST-elevation ACS (NSTE-ACS) and 27 910 patients with ST-elevation ACS (STEMI). The proportion of NSTE-ACS and STEMI patients treated in general medicine or cardiology departments requiring a coronary procedure or extensive investigations, and in-hospital 30-day mortality rates adjusted by age and gender were analyzed. RESULTS 19% of STEMI and 15% of NSTE-ACS patients are admitted to a general medicine department. For STEMI patients, the proportion increases up to 37.6% when females aged ≥75 years are considered. Patients undergo a coronary procedure or extensive investigations less commonly in general medicine than in cardiology departments; in-hospital 30-day adjusted mortality rates in general medicine departments are approximately 2-fold higher than those recorded in cardiology departments (STEMI: 26.4 vs 16.7%; NSTE-ACS: 7.7 vs 4.2%). CONCLUSIONS In-hospital mortality rates of ACS patients admitted to cardiology departments are lower than those reported in general medicine departments. Nevertheless, in-hospital management of women and elderly ACS patients does not completely comply with the recommended guidelines and exposes them to unfavorable prognosis.
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D'Errigo P, Seccareccia F, Rosato S, Maraschini A, Badoni G, Perucci CA, Fusco D, D'Ovidio M, Stafoggia M, Barone AP. [Final results from four clinical studies in the field of cardiovascular diseases integrated in the "Mattoni del SSN - Mattone Outcome" Project]. G Ital Cardiol (Rome) 2011; 12:1S-58S. [PMID: 22158390 DOI: 10.1714/976.10617] [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: 05/31/2023]
Abstract
Observational outcome studies represent a valid approach to evaluating comparative treatment effectiveness in real populations. The main objective of outcome research is to underline what works and what does not work in the field of health assistance. In 2004 the Italian Ministry of Health launched the Project "Mattone Misura dell'Outcome" aimed at assessing the introduction of procedures and methods for the systematic evaluation of outcomes in the national health system. A new experience, the PROGRESSI program (PROGRamma ESiti per SIVeAS e LEA), started in 2008 with the aim to further develop the methodologies for outcome evaluation. In this Supplement the final results from four clinical studies named "Sperimentazioni dell'area cardiovascolare del Progetto Mattoni" are presented. These studies started between 2005 and 2007 and their main objectives were to evaluate: --the contribution of information from current informative systems and clinical studies in risk-adjustment methodologies; --the advisability of introducing some clinical items in current informative systems to improve outcome estimates; --the goodness of follow-up procedures from current informative systems; and --the role of disease registries in the validation of comparative evaluation measures. The four studies were designed as voluntary prospective multicentre studies. Results concerning the characteristics of the enrolled populations as well as the risk-adjustment models built using information from current informative systems and/or clinical information are presented. As expected, each study produced specific remarks both in terms of clinical findings and contribution of different informative systems to the risk-adjustment models. In general, models built with information from both current informative systems and clinical information show the best performance. Findings from these analyses will provide the public health system with suitable indications to improve statistical methodologies for outcome estimates.
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Affiliation(s)
- Paola D'Errigo
- Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, lstituto Superiore di Sa nita, Roma
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Seccareccia F, D'Errigo P, Maraschini A, Casali G, Rosato S, Badoni G. [The Mattone Outcome-BYPASS study: short-term outcome in patients undergoing coronary artery bypass graft surgery in Italian hospitals. Final results]. G Ital Cardiol (Rome) 2011; 12:439-49. [PMID: 21691381 DOI: 10.1714/835.9310] [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] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In early 2008, a new national prospective study on short-term outcomes of coronary artery bypass graft (CABG) procedures started in Italy. The aim was to describe short-term results in patients undergoing CABG and improve methodologies for comparative outcome evaluation. METHODS Only 26 Italian cardiac surgery centers participated in this survey. For each patient undergoing a CABG procedure, all centers were requested to provide specific data (type of procedure, hemodynamic conditions, comorbidities, recent myocardial infarction and unstable angina, ventricular function, emergency conditions, vital status at 30 days). Representativeness was tested by comparing characteristics of the enrolled population with information derived from national hospital discharge records. A multiple logistic regression analysis was used to perform indirect standardization; the mortality rate of the whole population was used as a reference standard. Comparison with the CABG model built on 34 310 patients in 2002-2004 was performed as well. RESULTS The analysis of 7436 isolated CABG procedures showed a 30-day mortality of approximately 2%. The study population seemed to be representative of the Italian population of CABG patients. Using the new estimate model, two cardiac surgery centers showed significantly better risk adjusted mortality rates than the national reference standard, and two others showed significantly worse rates. The application of the "CABG model" yielded similar results. CONCLUSIONS Our study shows a high-quality level of Italian cardiac surgery centers and confirms the good applicability of the CABG model to the Italian CABG population. Comparison between results from the two models highlights the usefulness of regular outcome studies either for updating risk adjustment procedures and monitoring quality of care in Italian hospitals.
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Affiliation(s)
- Fulvia Seccareccia
- Centro Nazionale di Epidemiologia, Sorveglianza z Promozione Della Salute, Instituto Superiore de Sanità, Roma.
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Maraschini A, Seccareccia F, D'Errigo P, Rosato S, Badoni G, Casali G, Musumeci F. Role of gender and age on early mortality after coronary artery bypass graft in different hospitals: data from a national administrative database. Interact Cardiovasc Thorac Surg 2010; 11:537-42. [PMID: 20709699 DOI: 10.1510/icvts.2010.233296] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The aim of this study is to evaluate the effect of gender and age on outcome following coronary surgery in several hospitals enrolled in a national quality assessment program. Patients undergoing isolated coronary artery bypass graft (CABG) during 2003-2005 in Italy were included in the study (n=74,577). The outcome measure was 30-day in-hospital mortality. Comorbidities recorded during previous and current hospitalizations were used to define patients' health status and to build the adjustment model. The interaction term (gender*hospital) was introduced into the model to test the effect modification of gender; if present, gender specific models were analyzed to test the effect modification of age. A significant effect modification by gender was found in 39 hospitals; the adjusted odds ratios (AdjORs) showed significant increased risk for females (AdjORs ranging from 3.7 to 21.6). In three of these hospitals a significant increased risk was found for older age (AdjORs for elderly patients ranging from 8.1 to 14.6). Two hospitals showed a significant excess risk for patients ≥75 years (AdjORs=6.6 and 13.8). The technical aspects of surgery could account for the excess risk found in female patients; differences in the entire care process (intraoperative and postoperative management) could explain the variations in outcome among elderly patients.
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Affiliation(s)
- Alice Maraschini
- National Centre of Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Via Giano della Bella, 34, I-00161 Rome, Italy.
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Rosato S, Seccareccia F, D'Errigo P, Fusco D, Maraschini A, Badoni G, Perucci CA. Thirty-day mortality after AMI: effect modification by gender in outcome studies. Eur J Public Health 2009; 20:397-402. [DOI: 10.1093/eurpub/ckp194] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Rosato S, D'Errigo P, Badoni G, Fusco D, Perucci CA, Seccareccia F. [Comparison between administrative and clinical databases in the evaluation of cardiac surgery performance]. G Ital Cardiol (Rome) 2008; 9:569-578. [PMID: 18780554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND The availability of two contemporary sources of information about coronary artery bypass graft (CABG) interventions, allowed 1) to verify the feasibility of performing outcome evaluation studies using administrative data sources, and 2) to compare hospital performance obtainable using the CABG Project clinical database with hospital performance derived from the use of current administrative data. METHODS Interventions recorded in the CABG Project were linked to the hospital discharge record (HDR) administrative database. Only the linked records were considered for subsequent analyses (46% of the total CABG Project). A new selected population "clinical card-HDR" was then defined. Two independent risk-adjustment models were applied, each of them using information derived from one of the two different sources. Then, HDR information was supplemented with some patient preoperative conditions from the CABG clinical database. The two models were compared in terms of their adaptability to data. Hospital performances identified by the two different models and significantly different from the mean was compared. RESULTS In only 4 of the 13 hospitals considered for analysis, the results obtained using the HDR model did not completely overlap with those obtained by the CABG model. When comparing statistical parameters of the HDR model and the HDR model + patient preoperative conditions, the latter showed the best adaptability to data. CONCLUSIONS In this "clinical card-HDR" population, hospital performance assessment obtained using information from the clinical database is similar to that derived from the use of current administrative data. However, when risk-adjustment models built on administrative databases are supplemented with a few clinical variables, their statistical parameters improve and hospital performance assessment becomes more accurate.
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Affiliation(s)
- Stefano Rosato
- Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Roma.
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Vollono C, Badoni G, Petrelli G. [Risk perception and self-assessment of exposure to antineoplastic agents in a group of nurses and pharmacists]. G Ital Med Lav Ergon 2002; 24:49-55. [PMID: 11892417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Many antineoplastic drugs have shown to be carcinogenic, teratogenic and mutagenic to humans and exposure and absorption have been showed to occur during the preparation and administration in health care practise. More recently, in many countries, national health authorities concern has been focused on promoting actions aimed to protect health of the personnel handling these drugs. The present study reports the results of a survey carried out through a questionnaire among the pharmacists and nurses working in the health care settings located in the province of Rome (Italy), with the aim to survey: occupational risk perception of health care workers; their confidence in the safety measures adopted in the work practice; their knowledge of risk factor and the kind of training received regarding these specific agents. Among the respondents, most of the pharmacists (80%) and nurses (90.4%) show a high concern about antineoplastic drugs dangerousness. At the same time, they state not to have a satisfactory level of knowledge regarding the risk factor and, also that their main information source on occupational risk connected to antineoplastic drugs exposure is not the health care structure, where they are employed. Besides, they do not show a high level of confidence in the safety measures adopted in the health care structures with the aim to protect workers' health. The study results suggest the necessity to promote the development of preventive actions aimed to minimise occupational exposure to these substances through the implementation of procedures and controls in the hospitals, as well as the use of work practice and protective equipment, reinforced by workers education and training.
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Affiliation(s)
- C Vollono
- Laboratorio di Igiene Ambientale, Istituto Superiore di Sanità, Roma
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