1
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De Luca G, Verdoia M, Morici N, Ferri LA, Piatti L, Grosseto D, Bossi I, Sganzerla P, Tortorella G, Cacucci M, Ferrario M, Murena E, Tondi S, Toso A, Bongioanni S, Ravera A, Corrada E, Mariani M, Di Ascenzo L, Petronio AS, Cavallini C, Vitrella G, Antonicelli R, Cesana BM, De Luca L, Ottani F, Moffa N, Savonitto S, De Servi S. Corrigendum to "Impact of hemoglobin levels at admission on outcomes among elderly patients with acute coronary syndrome treated with low-dose Prasugrel or clopidogrel: A sub-study of the ELDERLY ACS 2 trial" [Int J Cardiol. 2022 Dec 15;369:5-11]. Int J Cardiol 2023; 377:133. [PMID: 36774304 DOI: 10.1016/j.ijcard.2023.01.021] [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: 02/12/2023]
Affiliation(s)
- G De Luca
- Clinical and Experimental Cardiology Unit, Azienda Ospedaliera-Universitaria "Sassari", University of Sassari, Sassari, Italy.
| | - M Verdoia
- Division of Cardiology, Ospedale degli Infermi, Biella, Italy
| | - N Morici
- IRCCSS. Maria Nascente Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - L A Ferri
- IRCCS Ospedale San Raffaele, Milan, Italy
| | - L Piatti
- IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - I Bossi
- IRCCSS. Maria Nascente Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | | | | | | | - M Ferrario
- IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy
| | - E Murena
- Ospedale S. Maria delle Grazie, Pozzuoli, Italy
| | - S Tondi
- Ospedale Baggiovara, Modena, Italy
| | - A Toso
- Ospedale S. Stefano, Prato, Italy
| | | | - A Ravera
- Ospedale Ruggi D'Aragona, Salerno, Italy
| | - E Corrada
- Humanitas Clinical and Research Center, Rozzano, Italy
| | | | - L Di Ascenzo
- Ospedale di San Donà di Piave-Portogruaro, Portogruaro, Italy
| | - A S Petronio
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - C Cavallini
- Ospedale S. Maria della Misericordia, Perugia, Italy
| | - G Vitrella
- Ospedali Riuniti di Trieste, Trieste, Italy
| | - R Antonicelli
- Istituto Nazionale di Ricerca e Cura per l' Anziano, Ancona, Italy
| | - B M Cesana
- Statistics and Biomathematics Unit, Department of Molecular and Transactional Medicine, University of Brescia, Brescia, Italy
| | - L De Luca
- Department of Cardiosciences, AO San Camillo-Forlanini, Roma, Italy
| | - F Ottani
- Ospedale Treviglio-Caravaggio, Treviglio, Italy
| | - N Moffa
- IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - S De Servi
- Department of Molecular Medicine, University of Pavia Medical School, Pavia, Italy
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Beneduce A, Ancona MB, Russo F, Ferri LA, Bellini B, Vella C, Romano V, Ancona F, Agricola E, Montorfano M. Transcatheter Mitral Paravalvular Leak Closure Using Arteriovenous Rail Across Aortic Bileaflet Mechanical Prosthesis: Multimodality Imaging Approach. Circ Cardiovasc Imaging 2023; 16:e014267. [PMID: 36330808 DOI: 10.1161/circimaging.122.014267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Alessandro Beneduce
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy (A.B., M.B.A., F.R., L.A.F., B.B., C.V., V.R., M.M.)
| | - Marco Bruno Ancona
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy (A.B., M.B.A., F.R., L.A.F., B.B., C.V., V.R., M.M.)
| | - Filippo Russo
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy (A.B., M.B.A., F.R., L.A.F., B.B., C.V., V.R., M.M.)
| | - Luca Angelo Ferri
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy (A.B., M.B.A., F.R., L.A.F., B.B., C.V., V.R., M.M.)
| | - Barbara Bellini
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy (A.B., M.B.A., F.R., L.A.F., B.B., C.V., V.R., M.M.)
| | - Ciro Vella
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy (A.B., M.B.A., F.R., L.A.F., B.B., C.V., V.R., M.M.)
| | - Vittorio Romano
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy (A.B., M.B.A., F.R., L.A.F., B.B., C.V., V.R., M.M.)
| | - Francesco Ancona
- Echocardiography Laboratory, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy (F.A., E.A.)
| | - Eustachio Agricola
- Echocardiography Laboratory, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy (F.A., E.A.)
| | - Matteo Montorfano
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy (A.B., M.B.A., F.R., L.A.F., B.B., C.V., V.R., M.M.)
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Beneduce A, Russo F, Ancona MB, Ferri LA, Bellini B, Vella C, Di Maio S, Carlino M, Chieffo A, Montorfano M. Real-Time Intravascular Ultrasound Guidance for Ultra-Low Contrast Complex Bifurcation Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2022; 15:e151-e154. [PMID: 35643762 DOI: 10.1016/j.jcin.2022.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/19/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Alessandro Beneduce
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.
| | - Filippo Russo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Marco Bruno Ancona
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Luca Angelo Ferri
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Barbara Bellini
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Ciro Vella
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Silvana Di Maio
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Mauro Carlino
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
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Russo F, Chieffo A, Carlino M, Ancona MB, Bellini B, Ferri LA, Beneduce A, Vella C, Algethami A, Montorfano M. Intravascular Ultrasound-Guided Coronary Lithotripsy Treatment of In-Stent Restenosis in Saphenous Venous Graft. J Invasive Cardiol 2021; 33:E141-E142. [PMID: 33531446] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
To the best of our knowledge, this is the first description of intravascular-ultrasound guided coronary lithotripsy on saphenous vein graft because of severely calcific in-stent restenosis, showing good result without procedural complications.
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Affiliation(s)
- Filippo Russo
- Interventional Cardiology Unit, IRCCS San Raffaele Hospital, Milan, Italy.
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5
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Ancona MB, Beneduce A, Romano V, Buzzatti N, Russo F, Bellini B, Ferri LA, Agricola E, Landoni G, Scandroglio AM, Chieffo A, Montorfano M. Self-expanding transcatheter aortic valve infolding: Current evidence, diagnosis, and management. Catheter Cardiovasc Interv 2020; 98:E299-E305. [PMID: 33315300 DOI: 10.1002/ccd.29432] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/10/2020] [Accepted: 11/30/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Prosthetic valve infolding is a rare but severe complication of transcatheter aortic valve implantation (TAVI) with self-expanding valves. However, currently available clinical data are limited and fragmented. OBJECTIVES This report aims to provide a comprehensive overview of this complication focusing on predisposing factors, clinical presentation, diagnostic findings, treatment and clinical outcomes. METHODS A systematic review of the literature was performed to identify cases of infolding occurring during TAVI with self-expanding valves published until August 2020. These data were pooled with all the retrospectively identified infolding cases occurred at San Raffaele Scientific Institute between December 2014 and August 2020. RESULTS A total of 34 cases were included. Among patients with available data, 38% received a first-generation CoreValve, and 62% a second-generation Evolut R (82%) or Evolut PRO (18%). Infolding occurred mostly with ≥29-mm valves (94%). Predisposing factors included resheathing of a second-generation valve (82%), heavy calcification of the native valve (65%), lack of predilatation (16%), Sievers type-1 bicuspid aortic valve (11%), and improper valve loading (5%). Infolding resulted in severe PVL causing hemodynamic instability (29%) or cardiac arrest (12%). Postdilatation was the treatment strategy in 68%, while prosthesis replacement with a new device in 23% of cases. Device success rate was 82%. Death and stroke occurred in 3% and 12% of cases. CONCLUSIONS Prosthetic valve infolding is typically observed after resheathing of a large-size self-expanding TAVI. When infolding is timely diagnosed, prosthesis removal and replacement should be pursued. Further studies are required to precisely define predisposing factors to prevent this complication.
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Affiliation(s)
- Marco Bruno Ancona
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Beneduce
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vittorio Romano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Buzzatti
- Cardiac Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Filippo Russo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Barbara Bellini
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Angelo Ferri
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eustachio Agricola
- Echocardiography Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Anna Mara Scandroglio
- Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Beneduce A, Pagnesi M, Ancona MB, Ferri LA, Montorfano M. Transcatheter Aortic Valve Replacement in Bicuspid Aortic Valve Stenosis: Implications for Long-Term Outcomes. JACC Cardiovasc Interv 2020; 13:1833-1834. [PMID: 32763075 DOI: 10.1016/j.jcin.2020.05.034] [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] [Received: 05/13/2020] [Accepted: 05/19/2020] [Indexed: 10/23/2022]
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Crimi G, Montalto C, Ferri LA, Piatti L, Bossi I, Morici N, Mandurino-Mirizzi A, Grosseto D, Tortorella G, Savonitto S, De Servi S. Clinical Impact of Valvular Heart Disease in Elderly Patients Admitted for Acute Coronary Syndrome: Insights From the Elderly-ACS 2 Study. Can J Cardiol 2020; 36:1104-1111. [DOI: 10.1016/j.cjca.2019.11.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/05/2019] [Accepted: 11/15/2019] [Indexed: 11/16/2022] Open
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Montorfano M, Beneduce A, Ancona MB, Ancona F, Sgura F, Romano V, Ferri LA, Bellini B, Khawaja SA, Moroni F, Chieffo A, Carlino M, Agricola E. Tricento Transcatheter Heart Valve for Severe Tricuspid Regurgitation: Procedural Planning and Technical Aspects. JACC Cardiovasc Interv 2019; 12:e189-e191. [PMID: 31629754 DOI: 10.1016/j.jcin.2019.07.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 06/23/2019] [Accepted: 07/09/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Matteo Montorfano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.
| | - Alessandro Beneduce
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Marco Bruno Ancona
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Ancona
- Echocardiography Laboratory, San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Sgura
- Institute of Cardiology, Policlinico Hospital, University of Modena and Reggio Emilia, Italy
| | - Vittorio Romano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Luca Angelo Ferri
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Barbara Bellini
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Saud Ahmed Khawaja
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Moroni
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Mauro Carlino
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Eustachio Agricola
- Echocardiography Laboratory, San Raffaele Scientific Institute, Milan, Italy
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Cantù E, Ferri LA, Tiberti G, Pera I, Piatti L, Galli G, Savonitto S. [Acute coronary syndrome with unusual finding of double coronary occlusion, acute and chronic, of the left anterior descending coronary artery]. G Ital Cardiol (Rome) 2019; 20:584-586. [PMID: 31593162 DOI: 10.1714/3228.32057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In patients with acute coronary syndrome, total chronic occlusion of a non-culprit vessel is a frequent angiographic finding (10-30%) and it is associated with increased mortality. The effective treatment of these lesions results in better outcomes, and procedural success depends partly on the anatomical features of the lesion. As indicated by current guidelines, the treatment of non-infarct-related artery lesions is not recommended in the acute setting, even in case of hemodynamic instability. We here report the case of a 57-year-old patient suffering from an acute coronary syndrome with double occlusion, acute and chronic, of the left anterior descending artery, both treated in the acute setting with good angiographic and clinical results.
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Affiliation(s)
- Edoardo Cantù
- Dipartimento Cardiovascolare, Ospedale San Leopoldo Mandic, Merate (LC) e Ospedale Alessandro Manzoni, Azienda Socio-Sanitaria Territoriale di Lecco
| | - Luca Angelo Ferri
- Dipartimento Cardiovascolare, Ospedale San Leopoldo Mandic, Merate (LC) e Ospedale Alessandro Manzoni, Azienda Socio-Sanitaria Territoriale di Lecco
| | - Gianluca Tiberti
- Dipartimento Cardiovascolare, Ospedale San Leopoldo Mandic, Merate (LC) e Ospedale Alessandro Manzoni, Azienda Socio-Sanitaria Territoriale di Lecco
| | - Isidoro Pera
- Dipartimento Cardiovascolare, Ospedale San Leopoldo Mandic, Merate (LC) e Ospedale Alessandro Manzoni, Azienda Socio-Sanitaria Territoriale di Lecco
| | - Luigi Piatti
- Dipartimento Cardiovascolare, Ospedale San Leopoldo Mandic, Merate (LC) e Ospedale Alessandro Manzoni, Azienda Socio-Sanitaria Territoriale di Lecco
| | - Giorgia Galli
- Dipartimento Cardiovascolare, Ospedale San Leopoldo Mandic, Merate (LC) e Ospedale Alessandro Manzoni, Azienda Socio-Sanitaria Territoriale di Lecco
| | - Stefano Savonitto
- Dipartimento Cardiovascolare, Ospedale San Leopoldo Mandic, Merate (LC) e Ospedale Alessandro Manzoni, Azienda Socio-Sanitaria Territoriale di Lecco
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Montalto C, Crimi G, Fortuni F, Mandurino Mirizzi A, Ferri LA, Morici N, Tortorella G, Grosseto D, Sganzerla P, Ferrario M, Savonitto S, De Servi S. P1781Burden of significant valvular heart disease in elderly patients presenting with acute coronary syndromes. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Elderly patients with acute coronary syndromes (ACS) represent a group seldom included in clinical trials and in whom robust data regarding mid-term impact of significant concomitant valvular heart disease are lacking.
Purpose
Our aim was to evaluate the impact of moderate-to-severe mitral regurgitation (MR), moderate-to-severe aortic stenosis (AS), or both conditions combined on a primary composite endpoint of mortality, myocardial infarction, disabling stroke and re-hospitalization for cardiovascular causes or bleeding within one year in a population of ACS patients included in the Elderly ACS 2 trial.
Methods
In the multicenter Elderly II ACS Study, 1,443 patients aged >74 y undergoing percutaneous coronary intervention (PCI) for ACS, were randomly assigned to receive prasugrel (5 mg) or clopidogrel (75 mg) and were prospectively followed for 1 year. Amongst these, 1,102 patients received full echocardiographic assessment and were included in the post-hoc analysis (Table 1).
Results
Survival analysis showed that patients presenting with moderate-to-severe MR, AS or both (Figure 1A), had worse outcome in terms of primary endpoint (p<0.001) as compared to no valve disease. A multivariable Cox regression model revealed that the presence of moderate-to-severe MR, AS or both were independent predictors of primary endpoint (HR 1.84; HR 2.8; HR 2.9 and p<0.001; p=0.004; p=0.01, respectively), regardless of age, gender, left ventricular ejection fraction, diabetes mellitus, history of cancer and total number of diseased vessels (Figure 1B).
Table 1 Overall No residual valvular heart disease Moderate-to-severe MR Moderate-to-severe AS Both Age (y) 80.68±4.50 80.40±4.42 81.47±4.45 82.92±5.42 83.23±5.42 Male gender 652 (59.2) 538 (61.6) 92 (48.4) 19 (73.1) 3 (23.1) STE-ACS 420 (38.1) 319 (36.5) 91 (47.9) 6 (23.1) 4 (30.8) Diabetes mellitus 203 (18.4) 158 (18.1) 35 (18.4) 5 (19.2) 5 (38.5) LVEF (%) 48.30±9.58 49.26±9.27 44.61±9.45 48.50±11.22 38.31±10.87 History of cancer 32 (2.9) 26 (3.0) 3 (1.6) 2 (7.7) 1 (7.7) Tot number of diseased vessel 2.31±1.05 2.28±1.04 2.49±1.05 2.04±0.87 2.54±1.13 Data are expressed as mean ± SD or count (valid %).
Figure 1
Conclusions
Moderate-to-severe MR and AS represent significant predictors of 1-year outcome in elderly patients hospitalized for ACS, even when other well-established prognostic factors are taken into account and after revascularization with PCI. Therefore, these patients should be carefully screened for the presence of valvular heart disease at the time of presentation and the need for surgical or percutaneous correction should be assessed accordingly.
Acknowledgement/Funding
None
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Affiliation(s)
- C Montalto
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - G Crimi
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - F Fortuni
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - A Mandurino Mirizzi
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - L A Ferri
- Alessandro Manzoni Hospital, Division of Cardiology, Lecco, Italy
| | - N Morici
- Niguarda Ca' Granda Hospital, First Division of Cardiology, Milan, Italy
| | - G Tortorella
- Santa Maria Nuova Hospital, Division of Cardiology, Reggio Emilia, Italy
| | - D Grosseto
- Infermi Hospital of Rimini, Division of Cardiology, Rimini, Italy
| | - P Sganzerla
- AO Ospedale Treviglio, Division of Cardiology, Treviglio, Italy
| | - M Ferrario
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - S Savonitto
- Alessandro Manzoni Hospital, Division of Cardiology, Lecco, Italy
| | - S De Servi
- IRCCS Multimedica of Milan, Department of Cardiology, Milan, Italy
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Ferri LA, Piatti L, Grosseto D, Tortorella G, De Servi S, Savonitto S. [Therapeutic strategies in elderly patients with acute coronary syndromes]. G Ital Cardiol (Rome) 2018; 19:640-647. [PMID: 30425393 DOI: 10.1714/3012.30111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Because of the aging of the population, the proportion of elderly patients admitted to the coronary care unit for an acute coronary syndrome (ACS) is increasing. Until a decade ago, treatment of elderly patients was based on poor scientific evidence, as older patients were commonly excluded from randomized controlled trials. In the last years, real-world registries and randomized controlled trials specifically addressing the older population have been published and provided clear evidence. Primary percutaneous angioplasty has become the standard of care for the treatment of ST-elevation myocardial infarction also in the elderly population, whereas the Italian Elderly ACS and the After Eighty randomized trials have demonstrated the superiority of an invasive strategy over an initial conservative strategy also in elderly patients affected by non-ST-elevation myocardial infarction. Moreover, real-world registries have shown that an increased use of early revascularization was associated with a progressive reduction in mortality after ACS: these findings have been confirmed also in a clinical context characterized by high mortality rates such as that of cardiogenic shock. As 80% of deaths after an ACS have been shown to be due to cardiovascular causes also in the elderly, the focus has been shifted to secondary prevention. Data regarding the use of both ticagrelor or low-dose prasugrel, as compared to clopidogrel, showed that a reduction of ischemic events was counterbalanced by an increase in bleeding events. In perspective, it might be interesting to explore the superiority of a strategy that limits the duration of dual antiplatelet therapy to a short period after an ACS (when the ischemic event rate is higher) in elderly patients, and to explore other endpoints such as mid-term quality of life outcome after ACS in elderly patients.
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Affiliation(s)
| | - Luigi Piatti
- Dipartimento Cardiovascolare, Ospedale Alessandro Manzoni, Lecco
| | | | | | - Stefano De Servi
- Dipartimento Cardiovascolare, IRCCS Multimedica, Sesto San Giovanni (MI)
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Giannini F, Pagnesi M, Campo G, michael donahue, Ferri LA, Briguori C, Stefanini G, Scardala R, Sardella G, De Rosa S, Figini F, Monello A, Pastormerlo LE, Testa L, Nicolino A, Ielasi A, Durante A, Leone A, Ciccarelli G, martina briani, Reimers B, claudio rapetto, Ceccacci A, Indolfi C, Sheiban I, Palmieri C, Bedogni F, Tespili M, Latib A, Colombo A. TCT-273 Italian Multicenter Registry of Bare Metal Stent Use in Modern Percutaneous Coronary Intervention Era: a multicenter observational study. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1407] [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: 10/28/2022]
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13
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Ferri LA, Chieffo A, Giustino G, Frasheri A, Garbo R, Masotti-Centol M, Salvatella N, Oteo Dominguez JF, Steffanon L, Tarantini G, Presbitero P, Menozzi A, Pucci E, Mauri J, Sardella G, Colombo A. TCT-204 Optimal duration of dual antiplatelet therapy (DAPT) after second generation drug-eluting stent (DES) implantation in elderly patients: the SECURITY-ELDERLY substudy. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.255] [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: 10/20/2022]
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14
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Del Furia F, Giustino G, Montorfano M, giannini F, Carlino M, Latib A, Jabbour R, Ferri LA, Benincasa S, Chieffo A, Colombo A. TCT-361 Targeting Transradial Approach: an Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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15
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Ferri LA, Jabbour R, Giannini F, Benincasa S, Regazzoli D, Ancona M, Aurelio A, Mangieri A, Montorfano M, Carlino M, Chieffo A, Colombo A, Latib A. TCT-229 Safety and Efficacy of Rotational Atherectomy for the Treatment of Undilatable Underexpanded Stents Implanted in Calcific Lesions. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.240] [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: 12/01/2022]
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16
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Giannini F, Latib A, Montorfano M, Ruparelia N, Romano V, Longoni M, Aurelio A, Jabbour R, Regazzoli D, Ferri LA, Mangieri A, Ancona M, Tanaka A, Agricola E, Chieffo A, Alfieri O, Colombo A. TCT-698 Comparison of the fully repositionable and retrievable Lotus Valve and Direct Flow Medical Valve for the treatment of severe aortic stenosis: a high-volume single center experience. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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