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Corcione N, Ferraro P, Finizio F, Cimmino M, Albanese M, Biondi-Zoccai G, Denti P, Rubbio AP, Bartorelli AL, Mongiardo A, Giordano S, De Felice F, Adamo M, Montorfano M, Baldi C, Tarantini G, Giannini F, Ronco F, Monteforte I, Villa E, Ferrario M, Fiocca L, Castriota F, Squeri A, Tamburino C, Bedogni F, Giordano A. Transcatheter mitral valve repair with MitraClip: comparison of NT, NTr, and XTr Devices. J Invasive Cardiol 2024. [PMID: 38598251 DOI: 10.25270/jic/24.00020] [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] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
OBJECTIVES Transcatheter edge-to-edge repair (TEER) has become an established minimally invasive treatment for significant mitral regurgitation. Ongoing refinements and the availability of different clipping devices have expanded the indications for and effectiveness of TEER, but comprehensive comparative data on this issue are lacking. In this study, we compared NT, NTr, and XTr MitraClip devices (Abbot) for TEER. METHODS Details on patient, imaging, and procedural details, as well as short- and long-term outcomes, were sought from a national prospective clinical registry on TEER with MitraClip. The primary outcome of interest was discharge after procedural success without major clinical complications. RESULTS A total of 2236 patients were included, 1228 (54.9%) in whom NT implantation only was attempted, 233 (10.4%) in whom NTr but not XTr implantation was attempted, and 775 (34.7%) in whom XTr implantation was attempted. Clinical and imaging features differed substantially across the groups, reflecting expanding indications with NTr and XTr devices. In-hospital outcomes were largely similar among the 3 groups, including death. Long-term unadjusted estimates of effect showed significant differences in several outcomes, including death, rehospitalization, and their composite, which demonstrated that NT was associated with more unfavorable outcomes compared with the other devices (all P less than .05). However, most differences depended on baseline features, as adjusted analysis showed no significant differences for early as well as long-term outcomes, including long-term death, rehospitalization, and their composite (all P greater than .05). CONCLUSIONS New-generation MitraClip devices are associated with favorable procedural and clinical outcomes, despite being used in patients with more adverse features, when compared with patients treated with previous devices.
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Affiliation(s)
- Nicola Corcione
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
| | - Paolo Ferraro
- Unità Operativa di Emodinamica, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Filippo Finizio
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
| | - Michele Cimmino
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
| | - Michele Albanese
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Cardiology Unit, Santa Maria Goretti Hospital, Latina, Italy.
| | - Paolo Denti
- Department of Cardiac Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Popolo Rubbio
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy, and Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Annalisa Mongiardo
- Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University
| | - Salvatore Giordano
- Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University
| | - Francesco De Felice
- Division of Interventional Cardiology, Azienda Ospedaliera S. Camillo Forlanini, Rome, 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, both in Brescia, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Cesare Baldi
- Heart Department, University Hospital 'Scuola Medica Salernitana', Salerno, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Science, Interventional Cardiology Unit, University of Padua, Padua, Italy
| | - Francesco Giannini
- Division of Cardiology, IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy
| | - Federico Ronco
- Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, AULSS3 Serenissima, Mestre, Venezia, Italy
| | - Ida Monteforte
- Divisione di Cardiologia, A.O. dei Colli, Ospedale Monaldi, Napoli
| | - Emmanuel Villa
- Cardiac Surgery Unit and Valve Center, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Maurizio Ferrario
- Division of Cardiology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Luigi Fiocca
- Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Fausto Castriota
- Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Angelo Squeri
- Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Corrado Tamburino
- Division of Cardiology, Centro Alte Specialità e Trapianti (CAST), Azienda Ospedaliero-Universitaria Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Arturo Giordano
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
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2
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Maurina M, Chiarito M, Leone PP, Testa L, Montorfano M, Reimers B, Esposito G, Monti F, Ferrario M, Latib A, Colombo A. Randomized clinical trial of abluminus DES+ sirolimus-eluting stent versus everolimus-eluting DES for percutaneous coronary intervention in patients with diabetes mellitus: An optical coherence tomography study. Catheter Cardiovasc Interv 2023; 102:1020-1033. [PMID: 37855169 DOI: 10.1002/ccd.30853] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/30/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Diabetic patients are at higher risk of recurrent adverse events following percutaneous coronary intervention (PCI) than the nondiabetics. Despite the introduction of new generation drug-eluting stents, their efficacy in the diabetics is still limited. AIMS To evaluate the efficacy of the Abluminus DES+ biodegradable polymer sirolimus-eluting stent in reducing neointimal hyperplasia in diabetic patients, compared to a durable polymer everolimus-eluting stent (DP-EES). METHODS A total of 131 patients with diabetes and coronary artery disease were enrolled in six Italian centers and randomized in a 2:1 fashion to PCI with Abluminus DES+ or DP-EES: 85 were assigned to Abluminus DES+ and 46 to DP-EES. The primary endpoint was optimal coherence tomography (OCT)-derived neointimal volume at 9-12 months. Secondary endpoints included OCT-derived neointimal area, neointimal volume obstruction and adverse clinical events. RESULTS The primary endpoint, neointimal volume, did not differ between Abluminus DES+ and DP-EES (29.11 ± 18.90 mm3 vs. 25.48 ± 17.04 mm3 , p = 0.40) at 9-12-month follow-up. This finding remained consistent after weighing for the sum of stents lengths (1.14 ± 0.68 mm3 vs. 0.99 ± 0.74 mm3 for Abluminus DES+ and DP-EES, respectively, p = 0.38). Similarly, other OCT-derived and clinical secondary endpoints did not significantly differ between the two groups. Rate of target lesion failure was high in both groups (21.2% for Abluminus DES+ and 19.6% for DP-EES). CONCLUSIONS This preliminary study failed to demonstrate the superiority of the Abluminus DES+ over the DP-EES in diabetic patients in terms of neointimal proliferation.
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Affiliation(s)
- Matteo Maurina
- Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
- Cardio Center, IRCCS Humanitas Research Hospital, Milan, Rozzano, Italy
| | - Mauro Chiarito
- Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
- Cardio Center, IRCCS Humanitas Research Hospital, Milan, Rozzano, Italy
| | - Pier Pasquale Leone
- Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
- Cardio Center, IRCCS Humanitas Research Hospital, Milan, Rozzano, Italy
| | - Luca Testa
- Department of Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Bernhard Reimers
- Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
- Cardio Center, IRCCS Humanitas Research Hospital, Milan, Rozzano, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Division of Cardiology, University of Naples Federico II, Naples, Italy
- UNESCO Chair on Health Education and Sustainable Development, University of Naples Federico II, Naples, Italy
| | - Francesco Monti
- Department of Cardiology, Ospedale San Pietro Fatebenefratelli, Rome, Italy
| | - Maurizio Ferrario
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, New York, Bronx, USA
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
- Cardio Center, IRCCS Humanitas Research Hospital, Milan, Rozzano, Italy
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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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4
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Arzuffi L, Mandurino-Mirizzi A, Magrini G, Frassica R, Disabato G, Ferlini M, Gazzoli F, Scelsi L, Turco A, Munafò A, Ghio S, Ferrario M, Oltrona-Visconti L, Crimi G. Impact of mitral transcatheter edge-to-edge repair on pulmonary vein flow in patients with functional mitral regurgitation. J Cardiovasc Med (Hagerstown) 2023; 24:206-208. [PMID: 36729687 DOI: 10.2459/jcm.0000000000001417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Luca Arzuffi
- Division of Cardiology
- University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia
| | | | | | | | - Giandomenico Disabato
- Division of Cardiology
- University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia
| | | | | | | | | | - Andrea Munafò
- Division of Cardiology
- University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia
| | | | | | | | - Gabriele Crimi
- Division of Cardiology
- Interventional Cardiology Unit, Cardio-Thoraco Vascular Department (DICATOV), IRCCS Ospedale Policlinico San Martino, Genova, Italy - IRCCS Italian Cardiovascular Network & Department of Internal Medicine, University of Genova, Genova, Italy
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5
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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. 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; 369:5-11. [PMID: 35907504 DOI: 10.1016/j.ijcard.2022.07.033] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 07/13/2022] [Accepted: 07/17/2022] [Indexed: 11/15/2022]
Abstract
Hemoglobin (Hb) levels have emerged as a useful tool for risk stratification and the prediction of outcome after myocardial infarction. We aimed at evaluating the prognostic impact of this parameter among patients in advanced age, where the larger prevalence of anemia and the higher rate of comorbidities could directly impact on the cardiovascular risk. METHODS All the patients in the ELDERLY-2 trial, were included in this analysis and stratified according to the values of hemoglobin at admission. The primary endpoint of this study was cardiovascular mortality within one year. The secondary endpoints were all-cause mortality, MI, Bleeding Academic Research Consortium (BARC) type 2-3 or 5 bleeding, any stroke, re-hospitalization for cardiovascular event or stent thrombosis (probable or definite) within 12 months after index admission. RESULTS We included in our analysis 1364 patients, divided in quartiles of Hb values (<12.2; 12.2-13.39; 13.44-14.49; ≥ 4.5 g/dl). At a mean follow- up of 330.4 ± 99.9 days cardiovascular mortality was increased in patients with lower Hb (HR[95%CI] = 0.76 [0.59-0.97], p = 0.03). Results were no more significant after correction for baseline differences (adjusted HR[95%CI] = 1.22 [0.41-3.6], p = 0.16). Similar results were observed for overall mortality. At subgroup analysis, (according to Hb median values) a significant interaction was observed only with the type of antiplatelet therapy, but not with major high-risk subsets of patients. CONCLUSIONS Among elderly patients with acute coronary syndrome managed invasively, lower hemoglobin at admission is associated with higher cardiovascular and all-cause mortality and major ischemic events, mainly explained by the higher risk profile.
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Affiliation(s)
- Giuseppe De Luca
- Clinical and Experimental Cardiology Unit, Azienda Ospedaliera-Universitaria "Sassari", University of Sassari, Sassari, Italy.
| | - Monica Verdoia
- Division of Cardiology, Ospedale degli Infermi, Biella, Italy
| | - Nuccia Morici
- IRCCSS. Maria Nascente Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | | | | | | | - Irene Bossi
- IRCCSS. Maria Nascente Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | | | | | | | | | | | | | | | | | | | - Elena Corrada
- Humanitas Clinical and Research Center, Rozzano, Italy
| | | | | | | | | | | | | | - Bruno M Cesana
- Statistics and Biomathematics Unit, Department of Molecular and Transactional Medicine, University of Brescia, Brescia, Italy
| | - Leonardo De Luca
- Department of Cardiosciences, AO San Camillo-Forlanini, Roma, Italy
| | | | | | | | - Stefano De Servi
- Department of Molecular Medicine, University of Pavia Medical School, Pavia, Italy
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6
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Galletti M, Alesini D, Anania MP, Arjmand S, Behtouei M, Bellaveglia M, Biagioni A, Buonomo B, Cardelli F, Carpanese M, Chiadroni E, Cianchi A, Costa G, Del Dotto A, Del Giorno M, Dipace F, Doria A, Filippi F, Franzini G, Giannessi L, Giribono A, Iovine P, Lollo V, Mostacci A, Nguyen F, Opromolla M, Pellegrino L, Petralia A, Petrillo V, Piersanti L, Di Pirro G, Pompili R, Romeo S, Rossi AR, Selce A, Shpakov V, Stella A, Vaccarezza C, Villa F, Zigler A, Ferrario M. Stable Operation of a Free-Electron Laser Driven by a Plasma Accelerator. Phys Rev Lett 2022; 129:234801. [PMID: 36563228 DOI: 10.1103/physrevlett.129.234801] [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] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/25/2022] [Accepted: 11/08/2022] [Indexed: 06/17/2023]
Abstract
The breakthrough provided by plasma-based accelerators enabled unprecedented accelerating fields by boosting electron beams to gigaelectronvolt energies within a few centimeters [1-4]. This, in turn, allows the realization of ultracompact light sources based on free-electron lasers (FELs) [5], as demonstrated by two pioneering experiments that reported the observation of self-amplified spontaneous emission (SASE) driven by plasma-accelerated beams [6,7]. However, the lack of stability and reproducibility due to the intrinsic nature of the SASE process (whose amplification starts from the shot noise of the electron beam) may hinder their effective implementation for user purposes. Here, we report a proof-of-principle experiment using plasma-accelerated beams to generate stable and reproducible FEL light seeded by an external laser. FEL radiation is emitted in the infrared range, showing the typical exponential growth of its energy over six consecutive undulators. Compared to SASE, the seeded FEL pulses have energies 2 orders of magnitude larger and stability that is 3 times higher.
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Affiliation(s)
- M Galletti
- Department of Physics, Università di Roma Tor Vergata, Via Ricerca Scientifica 1, 00133 Rome, Italy
- INFN-Tor Vergata, Via Ricerca Scientifica 1, 00133 Rome, Italy
- NAST Center, Via Ricerca Scientifica 1, 00133 Rome, Italy
| | - D Alesini
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - M P Anania
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - S Arjmand
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - M Behtouei
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - M Bellaveglia
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - A Biagioni
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - B Buonomo
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - F Cardelli
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - M Carpanese
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, via Enrico Fermi 45, 00044 Frascati, Italy
| | - E Chiadroni
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
- Sapienza University, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - A Cianchi
- Department of Physics, Università di Roma Tor Vergata, Via Ricerca Scientifica 1, 00133 Rome, Italy
- INFN-Tor Vergata, Via Ricerca Scientifica 1, 00133 Rome, Italy
- NAST Center, Via Ricerca Scientifica 1, 00133 Rome, Italy
| | - G Costa
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - A Del Dotto
- ENEA, C.R. Brasimone, 40032, Camugnano, Bologna, Italy
| | - M Del Giorno
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - F Dipace
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - A Doria
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, via Enrico Fermi 45, 00044 Frascati, Italy
| | - F Filippi
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, via Enrico Fermi 45, 00044 Frascati, Italy
| | - G Franzini
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - L Giannessi
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - A Giribono
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - P Iovine
- INFN-Napoli, Via Cintia, 80126 Naples, Italy
| | - V Lollo
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - A Mostacci
- Sapienza University, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - F Nguyen
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, via Enrico Fermi 45, 00044 Frascati, Italy
| | - M Opromolla
- Università degli Studi di Milano, Via Celoria 16 20133 Milano Italy
- INFN-Milano, Via Celoria 16, 20133 Milan, Italy
| | - L Pellegrino
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - A Petralia
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, via Enrico Fermi 45, 00044 Frascati, Italy
| | - V Petrillo
- Università degli Studi di Milano, Via Celoria 16 20133 Milano Italy
- INFN-Milano, Via Celoria 16, 20133 Milan, Italy
| | - L Piersanti
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - G Di Pirro
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - R Pompili
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - S Romeo
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - A R Rossi
- INFN-Milano, Via Celoria 16, 20133 Milan, Italy
| | - A Selce
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, via Enrico Fermi 45, 00044 Frascati, Italy
- INFN-Roma Tre, Via della Vasca Navale 84, 00146 Roma RM, Italy
| | - V Shpakov
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - A Stella
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - C Vaccarezza
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - F Villa
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
| | - A Zigler
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
- Racah Institute of Physics, Hebrew University, 91904 Jerusalem, Israel
| | - M Ferrario
- Laboratori Nazionali di Frascati, Via Enrico Fermi 54, 00044 Frascati, Italy
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Ardissino M, Nelson AJ, Maglietta G, Malagoli Tagliazucchi G, Disisto C, Celli P, Ferrario M, Canosi U, Cernetti C, Negri F, Merlini PA, Tubaro M, Berzuini C, Manzalini C, Ignone G, Campana C, Moschini L, Ponte E, Pozzi R, Fetiveau R, Buratti S, Paraboschi EM, Asselta R, Botti A, Tuttolomondo D, Barocelli F, Bricoli S, Biagi A, Bonura R, Moccetti T, Crocamo A, Benatti G, Paoli G, Solinas E, Notarangelo MF, Moscarella E, Calabrò P, Duga S, Magnani G, Ardissino D. Sex-Related Differences in Long-Term Outcomes After Early-Onset Myocardial Infarction. Front Cardiovasc Med 2022; 9:863811. [PMID: 35859592 PMCID: PMC9289186 DOI: 10.3389/fcvm.2022.863811] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/25/2022] [Indexed: 11/30/2022] Open
Abstract
Importance There is growing awareness of sex-related differences in cardiovascular risk profiles, but less is known about whether these extend to pre-menopausal females experiencing an early-onset myocardial infarction (MI), who may benefit from the protective effects of estrogen exposure. Methods A nationwide study involving 125 Italian Coronary Care Units recruited 2,000 patients between 1998 and 2002 hospitalized for a type I myocardial infarction before the age of 45 years (male, n = 1,778 (88.9%). Patients were followed up for a median of 19.9 years (IQR 18.1–22.6). The primary composite endpoint was the occurrence of cardiovascular death, non-fatal myocardial re-infarction or non-fatal stroke, and the secondary endpoint of hospitalization for revascularisation by means of a percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG). Results ST-elevation MI was the most frequent presentation among both men and women (85.1 vs. 87.4%, p = ns), but the men had a greater baseline coronary atherosclerotic burden (median Duke Coronary Artery Disease Index: 48 vs. 23; median Syntax score 9 vs. 7; both p < 0.001). The primary composite endpoint occurred less frequently among women (25.7% vs. 37.0%; adjusted hazard ratio: 0.69, 95% CI 0.52–0.91; p = 0.01) despite being less likely to receive treatment with most secondary prevention medications during follow up. Conclusions There are significant sex-related differences in baseline risk factors and outcomes among patients with early-onset MI: women present with a lower atherosclerotic disease burden and, although they are less frequently prescribed secondary prevention measures, experience better long-term outcomes. Trial Registration 4272/98 Ospedale Niguarda, Ca' Granda 03/09/1998.
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Affiliation(s)
| | - Adam J. Nelson
- Duke Clinical Research Institute, Durham, NC, United States
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Giuseppe Maglietta
- Clinical and Epidemiological Research Unit, University Hospital of Parma, Parma, Italy
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | | | - Caterina Disisto
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Patrizia Celli
- Division of Cardiology, Ospedale San Camillo, Rome, Italy
| | - Maurizio Ferrario
- Division of Cardiology, Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy
| | - Umberto Canosi
- Division of Cardiology, Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy
- Associazione per lo Studio della Trombosi in Cardiologia, Pavia, Italy
| | - Carlo Cernetti
- Cardiothoracic Department, University Hospital “Santa Maria della Miserciordia”, Udine, Italy
| | - Francesco Negri
- Cardiothoracic Department, University Hospital “Santa Maria della Miserciordia”, Udine, Italy
| | - Piera Angelica Merlini
- Associazione per lo Studio della Trombosi in Cardiologia, Pavia, Italy
- Division of Cardiology, Azienda Ospedaliera, Ospedale Niguarda Cà Granda, Milan, Italy
| | - Marco Tubaro
- ICCU, Intensive and Interventional Cardiology, San Filippo Neri Hospital, Rome, Italy
| | - Carlo Berzuini
- Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Chiara Manzalini
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Gianfranco Ignone
- Department of Cardiology, Antonio Perrino Hospital, Azienda Sanitaria Locale di Brindisi, Brindisi, Italy
| | - Carlo Campana
- Department of Cardiology, Sant'Anna Hospital, Como, Italy
| | - Luigi Moschini
- Division of Cardiology, Istituti Ospitalieri, Cremona, Italy
| | - Elisabetta Ponte
- Hospital Universitario de Toledo, Servizio di Radiologia, Toledo, Spain
| | - Roberto Pozzi
- Division of Cardiology, San Luigi Gonzaga University Hospital, Turin, Italy
| | | | - Silvia Buratti
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Elvezia Maria Paraboschi
- Department of Biomedical Sciences, Humanitas Clinical and Research Center IRCCS, Humanitas University, Milan, Italy
| | - Rosanna Asselta
- Department of Biomedical Sciences, Humanitas Clinical and Research Center IRCCS, Humanitas University, Milan, Italy
| | - Andrea Botti
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | | | - Federico Barocelli
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Serena Bricoli
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Andrea Biagi
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Rosario Bonura
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Tiziano Moccetti
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Antonio Crocamo
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Giorgio Benatti
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Giorgia Paoli
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Emilia Solinas
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | | | - Elisabetta Moscarella
- University Division of Clinical Cardiology, AORN Sant'Anna e San Sebastiano, Caserta, Department of Translational Medical Sciences, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Paolo Calabrò
- University Division of Clinical Cardiology, AORN Sant'Anna e San Sebastiano, Caserta, Department of Translational Medical Sciences, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Stefano Duga
- Department of Biomedical Sciences, Humanitas Clinical and Research Center IRCCS, Humanitas University, Milan, Italy
| | - Giulia Magnani
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
- *Correspondence: Giulia Magnani ;
| | - Diego Ardissino
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
- Associazione per lo Studio della Trombosi in Cardiologia, Pavia, Italy
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8
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Mandurino-Mirizzi A, Munafò A, Raineri C, Magrini G, Frassica R, Arzuffi L, Scelsi L, Turco A, Ferlini M, Gazzoli F, Ferrario M, Ghio S, Oltrona-Visconti L, Crimi G. Response to acute vasodilator challenge and haemodynamic modifications after MitraClip in patients with functional mitral regurgitation and pulmonary hypertension. European Heart Journal. Acute Cardiovascular Care 2022; 11:464-469. [PMID: 35524735 PMCID: PMC9459870 DOI: 10.1093/ehjacc/zuac053] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/17/2022]
Abstract
The effectiveness of transcatheter edge-to-edge repair (TEER) in patients with functional mitral regurgitation (FMR) and pulmonary hypertension (PH) is still debated and pre-procedural predictors of haemodynamic improvement after TEER in this setting are currently unknown. We investigated whether normalization of pulmonary artery wedge pressure (PAWP) in response to sodium nitroprusside (SNP) during baseline right heart catheterization might be predictive of a favourable haemodynamic response to MitraClip in patients with FMR and PH. Among 22 patients enrolled, 13 had a positive response to SNP (responders), nine were non-responders. At 6-months follow-up, responders showed a 33% reduction in PAWP and a 25% reduction in mean pulmonary artery pressure (PAP) (P = 0.002 and 0.004, respectively); no significant change occurred in non-responders. In patients with FMR and PH, pre-procedural vasodilator challenge with SNP may help define patients who may have haemodynamic improvement after TEER.
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Affiliation(s)
| | - Andrea Munafò
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 1, 27100 Pavia, Italy
- University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Claudia Raineri
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 1, 27100 Pavia, Italy
| | - Giulia Magrini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 1, 27100 Pavia, Italy
| | - Romina Frassica
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 1, 27100 Pavia, Italy
| | - Luca Arzuffi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 1, 27100 Pavia, Italy
- University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Laura Scelsi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 1, 27100 Pavia, Italy
| | - Annalisa Turco
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 1, 27100 Pavia, Italy
| | - Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 1, 27100 Pavia, Italy
| | - Fabrizio Gazzoli
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 1, 27100 Pavia, Italy
| | - Maurizio Ferrario
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 1, 27100 Pavia, Italy
| | - Stefano Ghio
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 1, 27100 Pavia, Italy
| | - Luigi Oltrona-Visconti
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 1, 27100 Pavia, Italy
| | - Gabriele Crimi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 1, 27100 Pavia, Italy
- Interventional Cardiology Unit, Cardio-Thoraco Vascular Department (DICATOV), IRCCS Ospedale Policlinico San Martino, Genova, Italy
- IRCCS Italian Cardiovascular Network & Department of Internal Medicine, University of Genova, Genova, Italy
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9
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Toso A, Morici N, Leoncini M, Villani S, Ferri LA, Piatti L, Grosseto D, Bossi I, Sganzerla P, Tortorella G, Cacucci M, Ferrario M, Tondi S, Ravera A, Bellandi F, Cavallini C, Antonicelli R, De Servi S, Savonitto S. Association of statin pretreatment with presentation characteristics, infarct size and outcome in older patients with acute coronary syndrome: the Elderly ACS-2 trial. Age Ageing 2022; 51:6610925. [PMID: 35716046 DOI: 10.1093/ageing/afac121] [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: 12/09/2021] [Revised: 03/28/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND prior statin treatment has been shown to have favourable effects on short- and long-term prognosis in patients with acute coronary syndrome (ACS). There are limited data in older patients. The aim of this study was to investigate the association of previous statin therapy and presentation characteristics, infarct size and clinical outcome in older patients, with or without atherosclerotic cardiovascular disease (ASCVD), included in the Elderly-ACS 2 trial. METHODS data on statin use pre-admission were available for 1,192 of the 1,443 patients enrolled in the original trial. Of these, 531 (44.5%) were already taking statins. Patients were stratified based on established ASCVD and statin therapy. ACS was classified as non-ST elevation or ST elevation myocardial infarction (STEMI). Infarct size was measured by peak creatine kinase MB (CK-MB). All-cause death in-hospital and within 1 year were the major end points. RESULTS there was a significantly lower frequency of STEMI in statin patients, in both ASCVD and No-ASCVD groups. Peak CK-MB levels were lower in statin users (10 versus 25 ng/ml, P < 0.0001). There was lower all-cause death in-hospital and within 1 year for subjects with ASCVD already on statins independent of other baseline variables. There were no differences in all-cause death for No-ASCVD patients whether or not on statins. CONCLUSIONS statin pretreatment was associated with more favourable ACS presentation and lower myocardial damage in older ACS patients both ASCVD and No-ASCVD. The incidence of all-cause death (in-hospital and within 1 year) was significantly lower in the statin treated ASCVD patients.
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Affiliation(s)
- Anna Toso
- Ospedale S. Stefano, Division of Cardiology, Prato, Italy
| | - Nuccia Morici
- IRCCS S. Maria Nascente - Fondazione Don Carlo Gnocchi ONLUS, Cardiology Rehabilitation Unit, Milan, Italy
| | - Mario Leoncini
- Ospedale S. Stefano, Division of Cardiology, Prato, Italy
| | - Simona Villani
- Biostatistica ed Epidemiologia Clinica, Department of Public Health, Neurosciences, Experimental and Forensic Medicine, Università di Pavia, Pavia, Italy
| | - Luca A Ferri
- San Raffaele Scientific Institute, Operative Unit of Hemodynamics and Interventional Cardiology, Milan, Italy
| | - Luigi Piatti
- Ospedale Manzoni, Cardiovascular Department, Lecco, Italy
| | | | - Irene Bossi
- ASST Grande Ospedale Metropolitano Niguarda, Division of Cardiology, Milano, Italy
| | - Paolo Sganzerla
- IRCCS Auxologico San Luca, Laboratory of Catheterization, Milan, Italy
| | | | | | - Maurizio Ferrario
- IRCCS Fondazione Policlinico S. Matteo, Cardiothoracovascular Department and Molecular Medicine, Pavia, Italy
| | | | - Amelia Ravera
- Ospedale Ruggi D' Aragona, Cardiology Intensive Care Unit, Salerno, Italy
| | | | - Claudio Cavallini
- Ospedale S. Maria della Misericordia, Cardiothoracovascular Department, Perugia, Italy
| | - Roberto Antonicelli
- Istituto Nazionale di Ricerca e Cura per l' Anziano, Cardiology Complex Operating Unit, Ancona, Italy
| | - Stefano De Servi
- IRCCS Fondazione Policlinico S. Matteo, Cardiothoracovascular Department and Molecular Medicine, Pavia, Italy
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10
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Pompili R, Alesini D, Anania MP, Arjmand S, Behtouei M, Bellaveglia M, Biagioni A, Buonomo B, Cardelli F, Carpanese M, Chiadroni E, Cianchi A, Costa G, Del Dotto A, Del Giorno M, Dipace F, Doria A, Filippi F, Galletti M, Giannessi L, Giribono A, Iovine P, Lollo V, Mostacci A, Nguyen F, Opromolla M, Di Palma E, Pellegrino L, Petralia A, Petrillo V, Piersanti L, Di Pirro G, Romeo S, Rossi AR, Scifo J, Selce A, Shpakov V, Stella A, Vaccarezza C, Villa F, Zigler A, Ferrario M. Free-electron lasing with compact beam-driven plasma wakefield accelerator. Nature 2022; 605:659-662. [PMID: 35614244 DOI: 10.1038/s41586-022-04589-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 02/25/2022] [Indexed: 11/09/2022]
Abstract
The possibility to accelerate electron beams to ultra-relativistic velocities over short distances by using plasma-based technology holds the potential for a revolution in the field of particle accelerators1-4. The compact nature of plasma-based accelerators would allow the realization of table-top machines capable of driving a free-electron laser (FEL)5, a formidable tool to investigate matter at the sub-atomic level by generating coherent light pulses with sub-ångström wavelengths and sub-femtosecond durations6,7. So far, however, the high-energy electron beams required to operate FELs had to be obtained through the use of conventional large-size radio-frequency (RF) accelerators, bound to a sizeable footprint as a result of their limited accelerating fields. Here we report the experimental evidence of FEL lasing by a compact (3-cm) particle-beam-driven plasma accelerator. The accelerated beams are completely characterized in the six-dimensional phase space and have high quality, comparable with state-of-the-art accelerators8. This allowed the observation of narrow-band amplified radiation in the infrared range with typical exponential growth of its intensity over six consecutive undulators. This proof-of-principle experiment represents a fundamental milestone in the use of plasma-based accelerators, contributing to the development of next-generation compact facilities for user-oriented applications9.
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Affiliation(s)
- R Pompili
- Laboratori Nazionali di Frascati, Frascati, Italy.
| | - D Alesini
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - M P Anania
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - S Arjmand
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - M Behtouei
- Laboratori Nazionali di Frascati, Frascati, Italy
| | | | - A Biagioni
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - B Buonomo
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - F Cardelli
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - M Carpanese
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, Frascati, Italy
| | - E Chiadroni
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - A Cianchi
- University of Rome Tor Vergata, Rome, Italy.,INFN Tor Vergata, Rome, Italy.,NAST Center, Rome, Italy
| | - G Costa
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - A Del Dotto
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - M Del Giorno
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - F Dipace
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - A Doria
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, Frascati, Italy
| | - F Filippi
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, Frascati, Italy
| | - M Galletti
- University of Rome Tor Vergata, Rome, Italy.,INFN Tor Vergata, Rome, Italy.,NAST Center, Rome, Italy
| | - L Giannessi
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - A Giribono
- Laboratori Nazionali di Frascati, Frascati, Italy
| | | | - V Lollo
- Laboratori Nazionali di Frascati, Frascati, Italy
| | | | - F Nguyen
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, Frascati, Italy
| | | | - E Di Palma
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, Frascati, Italy
| | - L Pellegrino
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - A Petralia
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, Frascati, Italy
| | | | - L Piersanti
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - G Di Pirro
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - S Romeo
- Laboratori Nazionali di Frascati, Frascati, Italy
| | | | - J Scifo
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - A Selce
- ENEA Fusion and Technology for Nuclear Safety and Security Department (FSN), C.R. Frascati, Frascati, Italy
| | - V Shpakov
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - A Stella
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - C Vaccarezza
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - F Villa
- Laboratori Nazionali di Frascati, Frascati, Italy
| | - A Zigler
- Laboratori Nazionali di Frascati, Frascati, Italy.,Racah Institute of Physics, Hebrew University, Jerusalem, Israel
| | - M Ferrario
- Laboratori Nazionali di Frascati, Frascati, Italy
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11
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Kajana V, Primi R, Gentile F, Compagnoni S, Baldi E, Mandurino Mirizzi A, Repetto A, Ferrario M, Ferlini M, Marinoni B, Bendotti S, Currao A, Oltrona Visconti L, Savastano S. C26 COMPLETE REVASCULARISATION IMPROVES SURVIVAL OF PATIENTS RESUSCITATED AFTER AN OUT–OF–HOSPITAL CARDIAC ARREST. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Sudden cardiac death is a major issue in industrialised countries and survival of patients after out–of–hospital cardiac arrest (OHCA) remains low. Acute myocardial infarction (AMI) is the principal cause of OHCA and myocardial revascularisation plays a positive role on survival. In this setting little is known about the role of complete (CR) versus culprit–only revascularisation (IR) on survival.
Purpose
The aim of this study was to assess whether CR could lead to a better one–year survival as compared to IR. Methods. Among patients prospectively enrolled in the Lombardia CARe OHCA registry from January 1 2015 to May 1 2021, who underwent a coronary angiography (CAG) at the Fondazione IRCCS Policlinico San Matteo were enrolled in this study. CAGs were retrospectively reviewed by two interventional cardiologists. Prehospital and survival data were retrieved from the registry.
Results
We enrolled 239 patients [mean age 63.7±12.4 years; male 79.9%; shockable presenting rhythm 84.1%; AMI at post ROSC ECG 67.9%; ejection fraction 37% (30–45), circulatory support with ECMO 10.9%]. Among the 119 (50%) patients with multi–vessel disease, 82 (69%) received IR whereas 37 (31%) received CR [8 during the first procedure, 29 in a second procedure with a median time after OHCA of 5 (2.5–10) days]. This latter group showed significantly higher one–year survival (54.9% vs 16.2%, p < 0.001). At univariable logistic regression only a shockable presenting rhythm and the presence of chronic total occlusion (CTO) were significantly associated with the probability of receiving a CR [OR 5.1 (95%CI 1.1–22), p = 0.03; OR 0.37 (95%CI 0.16–0.85), p = 0.02 respectively]. However, at multivariable regression analysis only CTO was significantly associated with the probability of receiving a CR [OR 0.36 (95%CI 0.15–0.9), p = 0.007]. At Cox multivariable regression model cardiac arrest duration (longer that the median value of 24 min) and CR were independently associated with the probability of death [HR 3.6 (95%CI 1.9–6.9), p < 0.001; HR 0.2 (95%CI 0.1–0.9), p = 0.02]. Similarly, cardiac arrest duration, CR and a shockable presenting rhythm were associated with the probability of death or poor neurologic outcome [HR 3.3 (95%CI 1.8–6), p < 0.001; HR 0.5 (95%CI 0.3–0.9), p = 0.03 and HR 0.2 (95%CI 0.1–0.5), p < 0.001].
Conclusions
Complete revascularisation is independently associated with a better one–year survival in patients resuscitated from an out–of–hospital cardiac arrest.
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Affiliation(s)
- V Kajana
- FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA
| | - R Primi
- FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA
| | - F Gentile
- FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA
| | | | - E Baldi
- FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA
| | | | - A Repetto
- FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA
| | - M Ferrario
- FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA
| | - M Ferlini
- FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA
| | - B Marinoni
- FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA
| | - S Bendotti
- FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA
| | - A Currao
- FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA
| | | | - S Savastano
- FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA
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12
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Ono M, Onuma Y, Kawashima H, Hara H, Gao C, Wang R, O'Leary N, Benit E, Janssens L, Ferrario M, Żurakowski A, Dominici M, Huber K, Buszman P, Garg S, Wykrzykowska JJ, Piek JJ, Jüni P, Hamm C, Windecker S, Vranckx P, Deliargyris EN, Bhatt DL, Storey RF, Valgimigli M, Serruys PW. Impact of proton pump inhibitors on efficacy of antiplatelet strategies with ticagrelor or aspirin after percutaneous coronary intervention: Insights from the GLOBAL LEADERS trial. Catheter Cardiovasc Interv 2022; 100:72-82. [PMID: 35500171 PMCID: PMC9541955 DOI: 10.1002/ccd.30217] [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: 01/31/2022] [Revised: 03/16/2022] [Accepted: 04/14/2022] [Indexed: 11/13/2022]
Abstract
Background Several studies have suggested that proton pump inhibitors (PPIs) may reduce the antiplatelet effects of clopidogrel and/or aspirin, possibly leading to cardiovascular events. Aims We aimed to investigate the association between PPI and clinical outcomes in patients treated with ticagrelor monotherapy or conventional antiplatelet therapy after percutaneous coronary intervention (PCI). Methods This is a subanalysis of the randomized GLOBAL LEADERS trial, comparing the experimental antiplatelet arm (23‐month ticagrelor monotherapy following 1‐month dual antiplatelet therapy [DAPT]) with the reference arm (12‐month aspirin monotherapy following 12‐month DAPT) after PCI. Patient‐oriented composite endpoints (POCEs: all‐cause mortality, myocardial infarction, stroke, or repeat revascularization) and its components were assessed stratified by PPI use as a time‐dependent covariate in patients with the experiment or reference antiplatelet arm. Results Among 15,839 patients, 2115 patients (13.5%) experienced POCE at 2 years. In the reference arm, the use of PPIs was independently associated with POCE (hazard ratio [HR]: 1.27; 95% confidence interval [CI]: 1.12–1.44) and its individual components, whereas it was not in the experimental arm (HR: 1.04; 95% CI: 0.92–1.19; pinteraction = 0.035). During the second‐year follow‐up, patients taking aspirin with PPIs had a significantly higher risk of POCE compared to those on aspirin without PPIs (HR: 1.57; 95% CI: 1.27–1.94), whereas the risk did not differ significantly irrespective of PPI in ticagrelor monotherapy group (HR: 1.03; 95% CI: 0.83–1.28; pinteraction = 0.008). Conclusions In contrast to conventional antiplatelet strategy, there were no evidence suggesting the interaction between ticagrelor monotherapy and PPIs on increased cardiovascular events, which should be confirmed in further studies. Clinical Trial Registration URL: https://clinicaltrials.gov
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Affiliation(s)
- Masafumi Ono
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Heart Center, University of Amsterdam, Amsterdam, The Netherlands.,Interventional Medicine and Innovation, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Yoshinobu Onuma
- Interventional Medicine and Innovation, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Hideyuki Kawashima
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Heart Center, University of Amsterdam, Amsterdam, The Netherlands.,Interventional Medicine and Innovation, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Hironori Hara
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Heart Center, University of Amsterdam, Amsterdam, The Netherlands.,Interventional Medicine and Innovation, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Chao Gao
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Cardiology, Xijing Hospital, Xi'an, China
| | - Rutao Wang
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Cardiology, Xijing Hospital, Xi'an, China
| | - Neil O'Leary
- Interventional Medicine and Innovation, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Edouard Benit
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, Belgium.,Faculty of Medicine and Life Sciences, University of Hasselt, Hasselt, Belgium
| | | | | | | | | | | | - Paweł Buszman
- Department of Epidemiology, Silesian Medical School, Katowice, Poland
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, UK
| | - Joanna J Wykrzykowska
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Heart Center, University of Amsterdam, Amsterdam, The Netherlands.,University Medical Center Groningen, Groningen, The Netherlands
| | - Jan J Piek
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Heart Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter Jüni
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Christian Hamm
- University of Giessen and Kerckhoff Heartand Thorax Center, University of Giessen, Bad Nauheim, Germany
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Pascal Vranckx
- Jessa Ziekenhuis, Faculty of Medicine and Life Sciences at the Hasselt University, Hasselt, Belgium
| | | | - Deepak L Bhatt
- Harvard Medical School, Brigham and Women's Hospital Heart & Vascular Center, Boston, Massachusetts, USA
| | - Robert F Storey
- Cardiovascular Research Unit, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Marco Valgimigli
- Cardiocentro Ticino Institute, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Patrick W Serruys
- Interventional Medicine and Innovation, National University of Ireland Galway (NUIG), Galway, Ireland.,NHLI, Imperial College London, London, UK
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13
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Magnani G, Bricoli S, Ardissino M, Maglietta G, Nelson A, Tagliazucchi GM, Disisto C, Celli P, Ferrario M, Canosi U, Cernetti C, Negri F, Merlini PA, Tubaro M, Berzuini C, Manzalini C, Ignone G, Campana C, Moschini L, Ponte E, Pozzi R, Fetiveau R, Buratti S, Paraboschi E, Asselta R, Botti A, Tuttolomondo D, Barocelli F, Biagi A, Bonura R, Moccetti T, Crocamo A, Benatti G, Paoli G, Solinas E, Notarangelo MF, Moscarella E, Calabrò P, Duga S, Niccoli G, Ardissino D. Long-term outcomes of early-onset myocardial infarction with non-obstructive coronary artery disease (MINOCA). Int J Cardiol 2022; 354:7-13. [PMID: 35176406 DOI: 10.1016/j.ijcard.2022.02.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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: 01/12/2022] [Revised: 02/07/2022] [Accepted: 02/10/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND Acute myocardial infarction with non-obstructive coronary artery disease (MINOCA) is frequent in patients experiencing an early-onset MI, but data concerning its long-term prognosis are limited and conflicting. METHODS The Italian Genetic Study on Early-onset MI enrolled 2000 patients experiencing a first MI before the age of 45 years, and had a median follow-up of 19.9 years. The composite primary endpoint was cardiovascular (CV) death, non-fatal MI, and non-fatal stroke (MACE); the secondary endpoint was rehospitalisation for coronary revascularisation. RESULTS MINOCA occurred in 317 patients (15.9%) and, during the follow-up, there was no significant difference in MACE rates between them and the patients with obstructive coronary artery disease (MICAD: 27.8% vs 37.5%; adjusted hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.57-1.09;p = 0.15). The CV death rate was lower in the MINOCA group (4.2% vs 8.4%, HR 0.26, 95%CI 0.08-0.86;p = 0.03), whereas the rates of non-fatal reinfarction (17.3% vs 25.4%; HR 0.76, 95%CI 0.52-1.13;p = 0.18), non-fatal ischemic stroke (9.5% vs 3.7%; HR 1.79, 95%CI 0.87-3.70;p = 0.12), and all-cause mortality (14.1% vs 20.7%, HR 0.73, 95%CI 0.43-1.25;p = 0.26) were not significantly different in the two groups. The rate of rehospitalisation for coronary revascularisation was lower among the MINOCA patients (6.7% vs 27.7%; HR 0.27, 95% CI 0.15-0.47;p < 0.001). CONCLUSIONS MINOCA is frequent and not benign in patients with early-onset MI. Although there is a lower likelihood of CV death,the long-term risk of MACE and overall mortality is not significantly different from that of MICAD patients.
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Affiliation(s)
- Giulia Magnani
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
| | - Serena Bricoli
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | | | - Giuseppe Maglietta
- Division of Research and Innovation, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Department of Statistics, Computer Science, Applications, University of Florence, Florence, Italy
| | - Adam Nelson
- Duke Clinical Research Institute, Durham, NC, USA; South Australian Health & Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | | | - Caterina Disisto
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Patrizia Celli
- Division of Cardiology, Ospedale San Camillo, Rome, Italy
| | - Maurizio Ferrario
- Division of Cardiology, Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy
| | - Umberto Canosi
- Division of Cardiology, Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy; Associazione per lo Studio della Trombosi in Cardiologia, Pavia, Italy
| | - Carlo Cernetti
- Cardio-neurovascular Department, Cà Foncello and San Giacomo Hospital Azienda No. 2, Marca Trevigiana Treviso, Treviso, Italy
| | - Francesco Negri
- Cardio-neurovascular Department, Cà Foncello and San Giacomo Hospital Azienda No. 2, Marca Trevigiana Treviso, Treviso, Italy
| | - Piera Angelica Merlini
- Associazione per lo Studio della Trombosi in Cardiologia, Pavia, Italy; Division of Cardiology, Azienda Ospedaliera, Ospedale Niguarda Cà Granda, Milan, Italy
| | - Marco Tubaro
- Division of Cardiology, San Filippo Neri Hospital, ASL, Roma 1, Rome, Italy
| | - Carlo Berzuini
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Chiara Manzalini
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Giancarlo Ignone
- Department of Cardiology, Antonio Perrino Hospital, Azienda Sanitaria Locale di Brindisi, Brindisi, Italy
| | - Carlo Campana
- Department of Cardiology, Sant'Anna Hospital, Como, Italy
| | - Luigi Moschini
- Division of Cardiology, Istituti Ospitalieri, Cremona, Italy
| | | | - Roberto Pozzi
- Division of Cardiology, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | | | - Silvia Buratti
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Elvezia Paraboschi
- Department of Biomedical Sciences, Humanitas University, and Humanitas Clinical and Research Center IRCCS, Milan, Italy
| | - Rosanna Asselta
- Department of Biomedical Sciences, Humanitas University, and Humanitas Clinical and Research Center IRCCS, Milan, Italy
| | - Andrea Botti
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | | | - Federico Barocelli
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Andrea Biagi
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Rosario Bonura
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Tiziano Moccetti
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Antonio Crocamo
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Giorgio Benatti
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Giorgia Paoli
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Emilia Solinas
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | | | - Elisabetta Moscarella
- University Division of Clinical Cardiology, AORN Sant'Anna e San Sebastiano, Caserta, and Department of Translational Medical Sciences, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Paolo Calabrò
- University Division of Clinical Cardiology, AORN Sant'Anna e San Sebastiano, Caserta, and Department of Translational Medical Sciences, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Stefano Duga
- Department of Biomedical Sciences, Humanitas University, and Humanitas Clinical and Research Center IRCCS, Milan, Italy
| | - Giampaolo Niccoli
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Diego Ardissino
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Associazione per lo Studio della Trombosi in Cardiologia, Pavia, Italy
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Andreone A, Schenk M, Ferrario M, Guerrero S. Development of sweet confectioneries produced from pilot‐scale UV‐C treated orange juice, low‐methoxyl pectin and different sugar‐substitute blends. Impact on physicochemical, rheological and sensory properties. J FOOD PROCESS PRES 2022. [DOI: 10.1111/jfpp.16403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Antonella Andreone
- Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Departamento de Industrias
- Scholar of CONICET ‐ Universidad de Buenos Aires, Instituto de Tecnología de Alimentos y Procesos Químicos (ITAPROQ). Buenos Aires Argentina
| | - M. Schenk
- Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Departamento de Industrias
- CONICET ‐ Universidad de Buenos Aires, Instituto de Tecnología de Alimentos y Procesos Químicos (ITAPROQ)
| | - M. Ferrario
- Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Departamento de Industrias
- CONICET ‐ Universidad de Buenos Aires, Instituto de Tecnología de Alimentos y Procesos Químicos (ITAPROQ)
| | - S. Guerrero
- Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Departamento de Industrias
- CONICET ‐ Universidad de Buenos Aires, Instituto de Tecnología de Alimentos y Procesos Químicos (ITAPROQ)
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15
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Munafò AR, Turco A, Benzoni G, Cattadori B, Pellegrini C, Pelenghi S, Ghio S, Ferrario M, Visconti LO, Ferlini M. 631 First vs. second generation drug-eluting STNET in heart transplant patients with cardiac allograft vasculopathy: a single centre experience. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab134.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
Cardiac allograft vasculopathy (CAV) remains the ‘Achilles’ heel’ of successful long-term outcome after heart transplantation (HTx). Percutaneous coronary intervention (PCI) with bare-metal stents (BMS) and first (I) generation drug-eluting stents (DES) has been previously considered as a palliative treatment option in this setting, for the higher rate of restenosis and the lack of a survival benefit over medical therapy. Few data on the performance of second (II) generation DES in CAV are currently available. Our study aims to compare the efficacy and safety of PCI with I and II generation DES in patients with CAV.
Methods and results
All consecutive heart transplant patients who underwent urgent or elective PCI with I or II generation DES between 2003 and 2020 at Foundation IRCCS Polyclinic San Matteo (Pavia) were enrolled. The extent of revascularization for each patient was assessed calculating the post-procedural residual SYNTAX score. The primary endpoint was a composite of MACE [any myocardial infarction, cardiovascular death and target vessel revascularization (TVR)] at 3-year. The secondary endpoint was target lesion failure (TLF) at 3-year—composite of cardiovascular death, target vessel myocardial infarction (TV-MI) and target lesion revascularization (TLR). A total of 90 transplant patients (113 coronary lesions) were included: 28 patients (32 lesions) were treated with I generation DES and 62 patients (81 lesions) with II generation DES. No differences between the two study groups were identified in term of number of stents per patient implanted (overall 1.63 ± 0.87, P-value = 0.628), total stent length per patient [overall 26 (25th–75th : 18–44) mm, P-value = 0.486], pre-PCI [overall 8 (25th–75th: 5–15), P-value = 0.286], and post-PCI residual [overall 1.5 (25th–75th: 0–4), P-value = 0.187] SYNTAX score. In the whole study population, the primary and secondary endpoints occurred in 28 (33%) and 23 (27%) cases respectively, with a 3-year Kaplan–Meier estimate of freedom from MACE of 64%, and from TLF of 71%. No statistical differences between the two study arms were found (MACE log-rank test P-value = 0.269, TLF log-rank test P-value = 0.260). At multivariate Cox regression analysis, while treatment with II generation DES was confirmed to not predict the risk of MACE (HR: 0.70, CI: 0.32–1.5, P-value = 0.368), a borderline significant higher rate of events was found in patients with a post-PCI residual SYNTAX score >8 (HR: 2.37, CI: 0.98–5.73, P-value = 0.054). However, patients treated with II generation DES experienced a lower rate of TVR (3-year Kaplan-Meier estimate of freedom from TVR I generation DES 69% vs. II generation DES 85%, log-rank test P-value = 0.058, univariate Cox regression analysis HR: 0.4, CI: 0.13–1.07, P-value = 0.069).
Conclusions
In heart transplant patients with CAV, compared with I generation DES, PCI with II generation DES did not show to reduce the risk of MACE and TLF, guaranteeing however a lower rate of TVR. In this complex clinical scenario, incomplete revascularization (defined as a residual post-PCI SYNTAX score > 8) was associated with worse outcome at 3-year follow-up.
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Affiliation(s)
| | - Annalisa Turco
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giorgia Benzoni
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Barbara Cattadori
- Division of Cardiac Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carlo Pellegrini
- Division of Cardiac Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Stefano Pelenghi
- Division of Cardiac Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Stafano Ghio
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Maurizio Ferrario
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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16
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Magnani G, Bricoli S, Ardissino M, Maglietta G, Nelson A, Tagliazzuccchi GM, Disisto C, Celli P, Ferrario M, Canosi U, Cernetti C, Negri F, Merlini PA, Tubaro M, Berzuini C, Manzalini C, Ignone G, Campana C, Moschini L, Ponte E, Pozzi R, Fetiveau R, Buratti S, Paraboschi E, Asselta R, Botti A, Tuttolomondo D, Barocelli F, Biagi A, Bonura R, Moccetti T, Crocamo A, Benatti G, Paoli G, Solinas E, Notarangelo MF, Moscarella E, Calabrò P, Duga S, Niccoli G, Ardissino D. 189 Long-term outcomes of early-onset myocardial infarction with non-obstructive coronary artery disease. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab140.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
Data regarding long-term prognosis of MINOCA are very limited and conflicting.
Methods and results
The Italian Genetic Study on early-onset MI enrolled 2000 patients who had a first MI before they were 45. The median follow-up was 19.9 years, the equivalent of 39 535 person-years. The composite primary endpoint was cardiovascular (CV) death, non-fatal MI, and non-fatal stroke (MACE); the secondary endpoint was rehospitalization for coronary revascularization. MINOCA was experienced by 317 patients (15.9%). The risk of MACE was not significantly different between MINOCA patients and those with obstructive coronary artery disease (MICAD, 27.8% vs. 37.5%; adj. HR: 0.79, 95% CI: 0.57–1.09; P = 0.15, Figure 1). There was no between-group difference in the rate of non-fatal MI (17.3% vs. 25.4%; adj. HR: 0.76, 95% CI: 0.52–1.13; P = 0.18), non-fatal ischaemic stroke (9.5% vs. 3.7%; adj. HR: 1.79, 95% CI: 0.87–3.70; P = 0.12), or all-cause mortality (14.1% vs. 20.7%; adj. HR: 0.73, 95% CI: 0.43–1.25; P = 0.26), but the rates of CV death (6.2% vs. 8.4%; adj. HR: 0.26, 95% CI: 0.08–0.86; P = 0.03) and coronary revascularization (6.7% vs. 27.7%; HR: 0.27, 95% CI: 0.15–0.47; P < 0.001) were lower in the MINOCA group.
Conclusions
MINOCA is frequent in early-onset MI patients and is not benign with a long-term risk of MACE and overall mortality not significantly different from that of the MICAD patients.
189 Figure 1 Composite primary endpoint of CV death, non-fatal MI, and non-fatal stroke
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Giancarlo Ignone
- Antonio Perrino Hospital, Azienda Sanitaria Locale di Brindisi, Italy
| | | | | | | | | | | | | | - Elvezia Paraboschi
- Humanitas University and Humanitas Clinical and Research Center IRCCS, Italy
| | - Rosanna Asselta
- Humanitas University and Humanitas Clinical and Research Center IRCCS, Italy
| | - Andrea Botti
- Azienda Ospedaliero Universitaria di Parma, Italy
| | | | | | - Andrea Biagi
- Azienda Ospedaliero Universitaria di Parma, Italy
| | | | | | | | | | | | | | | | | | - Paolo Calabrò
- AORN Sant’Anna e San Sebastiano Caserta, University of Campania, Italy
| | - Stefano Duga
- Humanitas University and Humanitas Clinical and Research Center IRCCS, Italy
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Schirinzi S, Camporotondo R, Ferlini M, Ferrario M, Ghio S. Effects of intra-aortic balloon pump on myocardial efficiency in a patient with advanced heart failure: non-invasive assessment with pressure-strain analysis. Eur Heart J Cardiovasc Imaging 2021; 23:e88. [PMID: 34864968 DOI: 10.1093/ehjci/jeab260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 11/20/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sandra Schirinzi
- Divisione di Cardiologia, Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Rita Camporotondo
- Divisione di Cardiologia, Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Marco Ferlini
- Divisione di Cardiologia, Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Maurizio Ferrario
- Divisione di Cardiologia, Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Stefano Ghio
- Divisione di Cardiologia, Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
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18
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Mandurino-Mirizzi A, Crimi G, Raineri C, Magrini G, Gazzoli F, Frassica R, Gritti V, Montalto C, Scelsi L, Turco A, Ameri P, Ghio S, Ferrario M, Oltrona-Visconti L. Haemodynamic impact of MitraClip in patients with functional mitral regurgitation and pulmonary hypertension. Eur J Clin Invest 2021; 51:e13676. [PMID: 34487548 DOI: 10.1111/eci.13676] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 07/16/2021] [Revised: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 12/14/2022]
Affiliation(s)
- Alessandro Mandurino-Mirizzi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gabriele Crimi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Interventional Cardiology Unit, Cardio-Thoraco Vascular Department (DICATOV), IRCCS Ospedale Policlinico San Martino, Genova, Italy.,IRCCS Italian Cardiovascular Network & Department of Internal Medicine, University of Genova, Genova, Italy
| | - Claudia Raineri
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giulia Magrini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Fabrizio Gazzoli
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Romina Frassica
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valeria Gritti
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Claudio Montalto
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Laura Scelsi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Annalisa Turco
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Pietro Ameri
- Interventional Cardiology Unit, Cardio-Thoraco Vascular Department (DICATOV), IRCCS Ospedale Policlinico San Martino, Genova, Italy.,IRCCS Italian Cardiovascular Network & Department of Internal Medicine, University of Genova, Genova, Italy
| | - Stefano Ghio
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Maurizio Ferrario
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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19
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Affiliation(s)
- C. Templeton
- Department of Chemical Engineering, University of Texas at Austin, Austin, TX, USA
| | - R. Elber
- Department of Chemistry, University of Texas at Austin, Austin, TX, USA
- Oden Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, TX, USA
| | - M. Ferrario
- Dipartimento di Scienze Fisiche, Informatiche e Matematiche, Università di Modena e Reggio E, Modena, Italy
| | - G. Ciccotti
- Dipartimento di Fisica, Università di Roma La Sapienza, Roma, Italy
- IAC-CNR, Roma, Italy
- School of Physics-UCD, Dublin, Ireland
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20
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Vranckx P, Valgimigli M, Odutayo A, Serruys PW, Hamm C, Steg PG, Heg D, Mc Fadden EP, Onuma Y, Benit E, Janssens L, Diletti R, Ferrario M, Huber K, Räber L, Windecker S, Jüni P. Efficacy and Safety of Ticagrelor Monotherapy by Clinical Presentation: Pre-Specified Analysis of the GLOBAL LEADERS Trial. J Am Heart Assoc 2021; 10:e015560. [PMID: 34533034 PMCID: PMC8649516 DOI: 10.1161/jaha.119.015560] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background The optimal duration of dual antiplatelet therapy after coronary drug‐eluting stent placement in adults with stable coronary artery disease (SCAD) versus acute coronary syndromes (ACS) remains uncertain. Methods and Results This was a prespecified subgroup analysis of the GLOBAL LEADERS trial. Participants were randomly assigned 1:1 to the experimental or reference strategy, stratified by ACS (experimental, n=3750; reference, n=3737) versus SCAD (experimental, n=4230; reference, n=4251). The experimental strategy was 75 to 100 mg aspirin daily plus 90 mg ticagrelor twice daily for 1 month, followed by 23 months of ticagrelor monotherapy. The reference strategy was 75 to 100 mg aspirin daily plus either 75 mg clopidogrel daily (for SCAD) or 90 mg ticagrelor twice daily (for ACS) for 12 months, followed by aspirin monotherapy for 12 months. The primary end point at 2 years was a composite of all‐cause mortality or non‐fatal centrally adjudicated new Q‐wave myocardial infarction. The key secondary safety end point was site‐reported Bleeding Academic Research Consortium grade 3 or 5 bleeding. The primary end point occurred in 147 (3.92%) versus 169 (4.52%) patients with ACS (rate ratio [RR], 0.86; 95% CI, 0.69–1.08; P=0.189), and in 157 (3.71%) versus 180 (4.23%) patients with SCAD (RR, 0.87; 95% CI, 0.71–1.08; P=0.221) with experimental and reference strategy, respectively (P‐interaction=0.926). Bleeding Academic Research Consortium grade 3 or 5 bleeding occurred in 73 (1.95%) versus 100 (2.68%) patients with ACS (RR, 0.73; 95% CI, 0.54–0.98; P=0.037), and in 90 (2.13%) versus 69 (1.62%) patients with SCAD (RR, 1.32; 95% CI, 0.97–1.81; P=0.081; P‐interaction=0.007). Conclusions While there was no evidence for differences in efficacy between treatment strategies by subgroup, the experimental strategy appeared to reduce bleeding risk in patients with ACS but not in patients with SCAD. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01813435.
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Affiliation(s)
- Pascal Vranckx
- Jessa Ziekenhuis Faculty of Medicine and Life Sciences at the Hasselt University Hasselt Belgium
| | - Marco Valgimigli
- Department of Cardiology University of BernInselspital Bern Switzerland
| | - Ayodele Odutayo
- Department of Medicine and Institute of Health Policy, Management and Evaluation Applied Health Research CentreLi Ka Shing Knowledge Institute of St. Michael's HospitalUniversity of Toronto Canada
| | | | | | - Philippe Gabriel Steg
- INSERM U-1148 FACT (French Alliance for Cardiovascular Trials) Hôpital BichatAssistance Publique-Hôpitaux de ParisUniversité de Paris France.,National Heart and Lung InstituteRoyal Brompton HospitalImperial College London United Kingdom
| | - Dik Heg
- Clinical Trials Unit University of Bern Switzerland
| | - Eugene P Mc Fadden
- Cork University Hospital Cork Ireland.,Cork University Hospital Wilton, Cork Ireland
| | - Yoshinobu Onuma
- Cardialysis Rotterdam The Netherlands.,Erasmus Medical Center Rotterdam The Netherlands
| | - Edouard Benit
- Jessa Ziekenhuis Faculty of Medicine and Life Sciences at the Hasselt University Hasselt Belgium
| | | | | | | | - Kurt Huber
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine Medical Faculty Wilhelminen Hospital and Sigmund Freud University Vienna Austria
| | - Lorenz Räber
- Department of Cardiology University of BernInselspital Bern Switzerland
| | - Stephan Windecker
- Department of Cardiology University of BernInselspital Bern Switzerland
| | - Peter Jüni
- Department of Medicine and Institute of Health Policy, Management and Evaluation Applied Health Research CentreLi Ka Shing Knowledge Institute of St. Michael's HospitalUniversity of Toronto Canada
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21
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De Rosa R, Morici N, De Luca G, De Luca L, Ferri LA, Piatti L, Tortorella G, Grosseto D, Franco N, Misuraca L, Sganzerla P, Cacucci M, Antonicelli R, Cavallini C, Lenatti L, Leuzzi C, Murena E, Ravera A, Ferrario M, Corrada E, Colombo D, Prati F, Piscione F, Petronio AS, Galasso G, De Servi S, Savonitto S. Association of Sex with Outcome in Elderly Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention. Am J Med 2021; 134:1135-1141.e1. [PMID: 33971166 DOI: 10.1016/j.amjmed.2021.03.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 03/07/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Worse outcomes have been reported for women, compared with men, after an acute coronary syndrome (ACS). Whether this difference persists in elderly patients undergoing similar invasive treatment has not been studied. We investigated sex-related differences in 1-year outcome of elderly acute coronary syndrome patients treated by percutaneous coronary intervention (PCI). METHODS Patients 75 years and older successfully treated with PCI were selected among those enrolled in 3 Italian multicenter studies. Cox regression analysis was used to assess the independent predictive value of sex on outcome at 12-month follow-up. RESULTS A total of 2035 patients (44% women) were included. Women were older and most likely to present with ST-elevation myocardial infarction (STEMI), diabetes, hypertension, and renal dysfunction; men were more frequently overweight, with multivessel coronary disease, prior myocardial infarction, and revascularizations. Overall, no sex disparity was found about all-cause (8.3% vs 7%, P = .305) and cardiovascular mortality (5.7% vs 4.1%, P = .113). Higher cardiovascular mortality was observed in women after STEMI (8.8%) vs 5%, P = .041), but not after non ST-elevation-ACS (3.5% vs 3.7%, P = .999). A sensitivity analysis excluding patients with prior coronary events (N = 1324, 48% women) showed a significantly higher cardiovascular death in women (5.4% vs 2.9%, P = .025). After adjustment for baseline clinical variables, female sex did not predict adverse outcome. CONCLUSIONS Elderly men and women with ACS show different clinical presentation and baseline risk profile. After successful PCI, unadjusted 1-year cardiovascular mortality was significantly higher in women with STEMI and in those with a first coronary event. However, female sex did not predict cardiovascular mortality after adjustment for the different baseline variables.
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Affiliation(s)
- Roberta De Rosa
- University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy; Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Nuccia Morici
- ASST Grande Ospedale Metropolitano Niguarda, Milan; Department of Clinical Sciences and Community Health, Università degli Studi di Milo, Milan, Italy
| | - Giuseppe De Luca
- Azienda Ospedaliera Universitaria Maggiore della Carità, Eastern Piedmont University, Novara, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Amelia Ravera
- University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy
| | | | - Elena Corrada
- Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | | | | | - Federico Piscione
- University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy
| | | | - Gennaro Galasso
- University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy
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22
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Valgimigli M, Mehran R, Franzone A, da Costa BR, Baber U, Piccolo R, McFadden EP, Vranckx P, Angiolillo DJ, Leonardi S, Cao D, Dangas GD, Mehta SR, Serruys PW, Gibson CM, Steg GP, Sharma SK, Hamm C, Shlofmitz R, Liebetrau C, Briguori C, Janssens L, Huber K, Ferrario M, Kunadian V, Cohen DJ, Zurakowski A, Oldroyd KG, Yaling H, Dudek D, Sartori S, Kirkham B, Escaned J, Heg D, Windecker S, Pocock S, Jüni P. Ticagrelor Monotherapy Versus Dual-Antiplatelet Therapy After PCI: An Individual Patient-Level Meta-Analysis. JACC Cardiovasc Interv 2021; 14:444-456. [PMID: 33602441 DOI: 10.1016/j.jcin.2020.11.046] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 08/20/2020] [Revised: 11/04/2020] [Accepted: 11/30/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The aim of this study was to compare ticagrelor monotherapy with dual-antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) with drug-eluting stents. BACKGROUND The role of abbreviated DAPT followed by an oral P2Y12 inhibitor after PCI remains uncertain. METHODS Two randomized trials, including 14,628 patients undergoing PCI, comparing ticagrelor monotherapy with standard DAPT on centrally adjudicated endpoints were identified, and individual patient data were analyzed using 1-step fixed-effect models. The protocol was registered in PROSPERO (CRD42019143120). The primary outcomes were the composite of Bleeding Academic Research Consortium type 3 or 5 bleeding tested for superiority and, if met, the composite of all-cause death, myocardial infarction, or stroke at 1 year, tested for noninferiority against a margin of 1.25 on a hazard ratio (HR) scale. RESULTS Bleeding Academic Research Consortium type 3 or 5 bleeding occurred in fewer patients with ticagrelor than DAPT (0.9% vs. 1.7%, respectively; HR: 0.56; 95% confidence interval [CI]: 0.41 to 0.75; p < 0.001). The composite of all-cause death, myocardial infarction, or stroke occurred in 231 patients (3.2%) with ticagrelor and in 254 patients (3.5%) with DAPT (HR: 0.92; 95% CI: 0.76 to 1.10; p < 0.001 for noninferiority). Ticagrelor was associated with lower risk for all-cause (HR: 0.71; 95% CI: 0.52 to 0.96; p = 0.027) and cardiovascular (HR: 0.68; 95% CI: 0.47 to 0.99; p = 0.044) mortality. Rates of myocardial infarction (2.01% vs. 2.05%; p = 0.88), stent thrombosis (0.29% vs. 0.38%; p = 0.32), and stroke (0.47% vs. 0.36%; p = 0.30) were similar. CONCLUSIONS Ticagrelor monotherapy was associated with a lower risk for major bleeding compared with standard DAPT, without a concomitant increase in ischemic events.
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Affiliation(s)
- Marco Valgimigli
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland; Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland.
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Bruno R da Costa
- Applied Health Research Centre of the Li Ka Shing Knowledge Institute, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Usman Baber
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Eùgene P McFadden
- Cardialysis Core Laboratories and Clinical Trial Management, Rotterdam, the Netherlands; Department of Cardiology, Cork University Hospital, Cork, Ireland
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, Belgium
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Sergio Leonardi
- University of Pavia and Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Davide Cao
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - George D Dangas
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Shamir R Mehta
- McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Patrick W Serruys
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - C Michael Gibson
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Gabriel P Steg
- Université de Paris and Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Samin K Sharma
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Christian Hamm
- German Center for Cardiovascular Research, partner site RheinMain, Frankfurt am Main, Germany; Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Richard Shlofmitz
- Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - Christoph Liebetrau
- German Center for Cardiovascular Research, partner site RheinMain, Frankfurt am Main, Germany; Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | | | | | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, and Sigmund Freud University Medical School, Vienna, Austria
| | - Maurizio Ferrario
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - David J Cohen
- Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Aleksander Zurakowski
- Department of Interventional Cardiology Chrzanów, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | - Keith G Oldroyd
- The West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Han Yaling
- General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Dariuz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland; Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Samantha Sartori
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brian Kirkham
- Applied Health Research Centre of the Li Ka Shing Knowledge Institute, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Javier Escaned
- Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos and Complutense University, Madrid, Spain
| | - Dik Heg
- Clinical Trials Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stuart Pocock
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Peter Jüni
- Applied Health Research Centre of the Li Ka Shing Knowledge Institute, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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23
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Giordano A, Ferraro P, Finizio F, Biondi-Zoccai G, Denti P, Bedogni F, Rubbio AP, Petronio AS, Bartorelli AL, Mongiardo A, Giordano S, DE Felice F, Adamo M, Montorfano M, Baldi C, Tarantini G, Giannini F, Ronco F, Monteforte I, Villa E, Ferrario M, Fiocca L, Castriota F, Tamburino C. Implantation of one, two or multiple MitraClips for transcatheter mitral valve repair: insights from a 1824-patient multicenter study. Panminerva Med 2021; 64:1-8. [PMID: 34309332 DOI: 10.23736/s0031-0808.21.04497-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Transcatheter mitral valve repair (TMVR) with the MitraClip device is an established treatment for mitral regurgitation (MR). More than one MitraClip may be implanted if a single one does not reduce MR adequately. We aimed at appraising the outlook of patients undergoing implantation of one, two or multiple MitraClips for TMVR. METHODS Exploiting the ongoing prospective GIse registry Of Transcatheter treatment of mitral valve regurgitaTiOn (GIOTTO) Study dataset, we compared patients, procedural details and outcomes distinguishing those receiving one, two or multiple MitraClips. The primary endpoint was the composite of 1-year cardiac death or rehospitalization for heart failure. Additional endpoints included all cause death, surgical mitral repair, and functional class. Multivariable adjusted Cox proportional hazard analysis was used for confirmatory purposes. RESULTS As many as 1824 patients were included: 718 (39.4%) treated with a single MitraClip, and 940 (51.5%) receiving two MitraClips, and 166 (9.1%) receiving three or more. Significant differences were found for baseline features, including age, female gender, diabetes mellitus, hypertension, chronic obstructive pulmonary disease, prior myocardial infarction, atrial fibrillation, permanent pacemaker, cardiac resynchronization therapy, implantable cardioverter defibrillator, and prior mitral valve repair (all p<0.05). Several imaging features were also different, including left ventricular dimensions, MR severity and proportionality, mitral valve area, flail leaflet, and pulmonary vein flow (all p<0.05). Among procedural features, significant differences were found for anesthesia type, MitraClip type, fluoroscopy, device, and operating room times, postprocedural mitral gradient, residual MR, smoke-like effect, device success partial detachment and surgical conversion (all p<0.05). In-hospital death occurred more frequently in patients receiving multiple MitraClips, and the same applied severe residual MR (all p<0.05). Mid-term follow-up (15±13 months) showed significant difference in the risk of death, cardiac death, rehospitalization for heart failure, and their composites, mainly, but not solely, associated with multiple MitraClips (all p<0.05). Adjusted analysis confirmed the significantly increased risk of composite adverse events when comparing the multiple vs single MitraClip groups (p=0.014 for death and rehospitalization, p=0.013 for cardiac death or rehospitalization). CONCLUSIONS Implantation of one or two MitraClips is associated with favorable clinical outcomes. Conversely, bail-out implantation of three or more MitraClips may portend a worse long-term prognosis.
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Affiliation(s)
- Arturo Giordano
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Paolo Ferraro
- Unità Operativa di Emodinamica, Santa Lucia Hospital, San Giuseppe Vesuviano, Napoli, Italy
| | - Filippo Finizio
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy - .,Mediterranea Cardiocentro, Naples, Italy
| | - Paolo Denti
- Department of Cardiac Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Antonio P Rubbio
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Anna S Petronio
- Cardiothoracic and Vascular Department, University Hospital Pisa, Pisa, Italy
| | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | - Annalisa Mongiardo
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Salvatore Giordano
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Francesco DE Felice
- Division of Interventional Cardiology, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
| | - Marianna Adamo
- Cardiothoracic Department, Spedali Civili Brescia, Brescia, Italy
| | - Matteo Montorfano
- Cardio-Thoracic-Vascular Department, San Raffaele University Hospital, Milan, Italy
| | - Cesare Baldi
- Heart Department, University Hospital Scuola Medica Salernitana, Salerno, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Science, Interventional Cardiology Unit, University of Padua, Padua, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Federico Ronco
- Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, AULSS3 Serenissima, Mestre, Venezia, Italy
| | - Ida Monteforte
- Divisione di Cardiologia, A.O. dei Colli, Ospedale Monaldi, Napoli, Italy
| | - Emmanuel Villa
- Department of Cardiac Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Maurizio Ferrario
- Division of Cardiology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Luigi Fiocca
- Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Fausto Castriota
- Cardiovascular Department of Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Corrado Tamburino
- Division of Cardiology, Centro Alte Specialità e Trapianti (CAST), Azienda Ospedaliero-Universitaria Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
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24
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Mandurino-Mirizzi A, Kajana V, Cornara S, Somaschini A, Demarchi A, Galazzi M, Crimi G, Ferlini M, Camporotondo R, Gnecchi M, Ferrario M, Oltrona-Visconti L, De Ferrari GM. Elevated serum uric acid is a predictor of contrast associated acute kidney injury in patient with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Nutr Metab Cardiovasc Dis 2021; 31:2140-2143. [PMID: 34039505 DOI: 10.1016/j.numecd.2021.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 02/03/2021] [Revised: 04/02/2021] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Contrast associated-acute kidney injury (CA-AKI) has been associated with adverse outcomes after ST-segment elevation myocardial infarction (STEMI). However, early markers of CA-AKI are still needed to improve risk stratification. We investigated the association between elevated serum uric acid (eSUA) and CA-AKI in patients with STEMI treated with primary percutaneous coronary intervention (pPCI). METHODS AND RESULTS Serum creatinine (Scr) was measured at admission and 24, 48 and 72 h after pPCI. CA-AKI was defined as an increase of 25% (CA-AKI 25%) or 0.5 mg/dl (CA-AKI 0.5) of Scr level above the baseline after 48 h following contrast administration. Multivariable analyses to investigate CA-AKI predictors were performed by binary logistic regression and multivariable backward logistic regression model. In the 3023 patients considered, CA-AKI was more frequent among patients with eSUA as compared with patients with normal SUA levels, considering both CA-AKI definitions (CA-AKI25%: 20.8% vs 16.2%, p < 0.012; CA-AKI 0.5: 10.1% vs 5.8%, p < 0.001). The association between eSUA and CA-AKI was confirmed at multivariable analyses (CA-AKI 25%: odd ratio 1.32, 95% CI 1.03-1.69, p = 0.027; CA-AKI 0.5: odd ratio 1.76, 95% CI 1.11-2.79, p = 0.016). CONCLUSION Elevated serum uric acid is associated with CA-AKI after reperfusion in patients with STEMI treated with pPCI.
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Affiliation(s)
- Alessandro Mandurino-Mirizzi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Vilma Kajana
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Stefano Cornara
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alberto Somaschini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Demarchi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marco Galazzi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gabriele Crimi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Cardio-Thoraco-Vascular Department, Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Rita Camporotondo
- Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Massimiliano Gnecchi
- University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Maurizio Ferrario
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Gaetano M De Ferrari
- University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Cardio-Thoraco-Vascular Department, Ospedale Policlinico San Martino IRCCS, Genova, Italy
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25
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Pompili R, Chiadroni E, Cianchi A, Curcio A, Del Dotto A, Ferrario M, Galletti M, Romeo S, Scifo J, Shpakov V, Villa F, Zigler A. Time-resolved study of nonlinear photoemission in radio-frequency photoinjectors. Opt Lett 2021; 46:2844-2847. [PMID: 34129555 DOI: 10.1364/ol.423880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/16/2021] [Indexed: 06/12/2023]
Abstract
Photoemission is one of the fundamental processes that describes the generation of charged particles from materials irradiated by photons. The continuous progress in the development of ultrashort lasers allows investigation into the dynamics of the process at the femtosecond timescale. Here we report about experimental measurements using two ultrashort ultraviolet laser pulses to temporally probe the electrons release from a copper cathode in a radio-frequency photoinjector. By changing their relative delay, we studied how the release mechanism is affected by two-photon photoemission when tens of GW/cm2 intensities are employed. We evaluated the limits it poses on the achievable beam brightness and analyzed the resulting emission yield in terms of the electronic temperature by modeling the cathode as a two-temperature system.
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26
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Moschella MM, Turco A, Ferlini M, Ghio S, Pellegrini C, Cattadori B, Ferrario M, Pelenghi S, Visconti LO. [Early diagnosis and management of cardiac allograft vasculopathy: is it time for a standardized approach?]. G Ital Cardiol (Rome) 2021; 22:377-385. [PMID: 33960981 DOI: 10.1714/3592.35747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Cardiac allograft vasculopathy (CAV) still represents the main cause of long-term graft loss after heart transplantation. Its silent clinical presentation makes an early identification difficult, with relevant implications for a standardized follow-up. Although technological advances have provided sophisticated non-invasive techniques for CAV assessment, intravascular ultrasound in conjunction with coronary angiography is still the gold standard to detect rapidly progressive CAV and to provide prognostic information during follow-up. Current guidelines recommend annual coronary angiography during the first 5 years and every 2 years thereafter. Although commonly performed, coronary angiography has multiple limitations, especially in young patients and in case of chronic kidney disease. This article aims to review the literature about the monitoring of CAV and to propose an ideal and individualized pathway for early diagnosis of CAV in transplanted patients, based on their cardiovascular risk.
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Affiliation(s)
- Martina M Moschella
- U.O.C. Cardiologia, Fondazione IRCCS Policlinico San Matteo, Pavia - Dipartimento di Medicina Molecolare, Università degli Studi, Pavia
| | - Annalisa Turco
- U.O.C. Cardiologia, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Marco Ferlini
- U.O.C. Cardiologia, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Stefano Ghio
- U.O.C. Cardiologia, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Carlo Pellegrini
- U.O.C. Cardiochirurgia, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Barbara Cattadori
- U.O.C. Cardiochirurgia, Fondazione IRCCS Policlinico San Matteo, Pavia
| | | | - Stefano Pelenghi
- U.O.C. Cardiochirurgia, Fondazione IRCCS Policlinico San Matteo, Pavia
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Ferlini M, Leonardi S, Mandurino Mirizzi A, Montalto C, Crimi G, Repetto A, Marinoni B, Somaschini A, Ferrario M, Klersy C, Oltrona Visconti L. Oral aspirin or low dose of intravenous lysine acetylsalicylate in ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. J Cardiovasc Med (Hagerstown) 2021; 22:539-545. [PMID: 34076601 DOI: 10.2459/jcm.0000000000001174] [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: 11/05/2022]
Abstract
AIM To compare the pharmacodynamic effect of an oral loading dose of 'noncoated' ASA 300 mg vs. an intravenous bolus injection of lysine acetylsalicylate 150 mg in patients with STEMI undergoing pPCI. METHODS This was a prospective single-center, open label, pharmacodynamic study, including nonconsecutive patients presenting at our catheterization laboratory with STEMI undergoing pPCI and not receiving ASA within the previous 7 days. Pharmacodynamic analyses were performed at five time points: baseline, and 1, 2, 4 and 12 h after the loading dose, and measured as ASA reaction units (ARU) by the Verify Now System. An ARU more than 550 was considered as nonresponsiveness to study drugs. The primary end point was the different rate of patients with ARU more than 550 at 2 h after the loading dose of oral vs. intravenous ASA. Secondary end points included the comparison of ARU more than 550 at the other time points and the comparison of continuous ARU at each time point. RESULTS The study was planned with a sample size of 68 patients, but it was prematurely stopped due to slow enrollment after the inclusion of 23 patients, 12 randomized to oral ASA and 11 to intravenous lysine acetylsalicylate. At 2 h the rate of patients with ARU more than 550 was numerically but not significantly higher in patients receiving oral ASA as compared with intravenous lysine acetylsalicylate (33 vs. 14.2%; Δ -0.19, 95% confidence interval -0.59-0.21, P = 0.58). The difference over time was NS (P = 0.98), though the prevalence of ARU more than 550 was higher at the other time points. Both routes of administration reduced ARU values over time, though with no overall significant difference between profiles (P overall = 0.48). CONCLUSION In patients with STEMI undergoing pPCI the rate of nonresponsiveness to ASA was not different comparing an oral 'noncoated' loading dose of ASA with an intravenous bolus injection of lysine acetylsalicylate. However, as patient enrollment was prematurely terminated, this study is underpowered to draw a definite conclusion.
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Affiliation(s)
| | - Sergio Leonardi
- Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo.,Department of Molecular Medicine, University of Pavia
| | | | - Claudio Montalto
- Division of Cardiology.,Department of Molecular Medicine, University of Pavia
| | | | | | | | - Alberto Somaschini
- Division of Cardiology.,Department of Molecular Medicine, University of Pavia
| | | | - Catherine Klersy
- Clinical Epidemiology & Biometry Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Mandurino-Mirizzi A, Cornara S, Somaschini A, Demarchi A, Galazzi M, Puccio S, Montalto C, Crimi G, Ferlini M, Camporotondo R, Gnecchi M, Ferrario M, Oltrona-Visconti L, De Ferrari GM. Elevated serum uric acid is associated with a greater inflammatory response and with short- and long-term mortality in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Nutr Metab Cardiovasc Dis 2021; 31:608-614. [PMID: 33358717 DOI: 10.1016/j.numecd.2020.10.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 09/18/2020] [Accepted: 10/23/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND AIMS Despite elevated serum uric acid (eSUA) has been identified as independent risk factor for cardiovascular diseases, its prognostic value in the setting of ST-segment elevation myocardial infarction (STEMI) is still controversial. Although the mechanisms of this possible relationship are unsettled it has been suggested that eSUA could trigger the inflammatory response. This study sought to investigate the association between eSUA with short- and long-term mortality and with inflammatory response in patients with STEMI treated with primary percutaneous coronary intervention (pPCI). METHODS AND RESULTS Blood samples were collected on admission and at 24 and 48 h after pPCI: the inflammatory biomarkers C-reactive protein (CRP), neutrophil count and neutrophil to lymphocytes ratio (NLR) were considered. Baseline eSUA was defined as ≥6.8 mg/dl. Cumulative 30-days and 1-year mortalities were estimated using the Kaplan-Meyer analysis. Multivariable analyses were performed by Cox proportional hazard models. In the 2369 patients with STEMI considered, 30-day mortality was 5.8% among patients with eSUA and 2% among patient with normal SUA level (p < 0.001); 1-year mortality was 8.5% vs 4%, respectively (p < 0.001). At multivariable analyses eSUA was an independent predictor of 30-day mortality (HR 1.196, 95%CI 1.006-1.321, p = 0.042) and 1-year mortality (HR 1.178, 95%CI 1.052-1.320, p = 0.005). eSUA patients presented higher values in on admission CRP (p < 0.001) and in neutrophil count and NLR at 24 h (respectively, p = 0.020 and p < 0.001) and at 48 h (p = 0.018 and p < 0.001) compared to patients with normal SUA levels. CONCLUSIONS Elevated serum uric acid is associated with higher short- and long-term mortality and with a greater inflammatory response after reperfusion in patients with STEMI treated with primary PCI.
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Affiliation(s)
- Alessandro Mandurino-Mirizzi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Stefano Cornara
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alberto Somaschini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Demarchi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marco Galazzi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sebastiano Puccio
- University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Claudio Montalto
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gabriele Crimi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Rita Camporotondo
- Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Massimiliano Gnecchi
- University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Maurizio Ferrario
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Gaetano M De Ferrari
- University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Leonardi S, Branca M, Franzone A, McFadden E, Piccolo R, Jüni P, Vranckx P, Steg PG, Serruys PW, Benit E, Liebetrau C, Janssens L, Ferrario M, Zurakowski A, Diletti R, Dominici M, Huber K, Slagboom T, Buszman P, Bolognese L, Tumscitz C, Bryniarski K, Aminian A, Vrolix M, Petrov I, Garg S, Naber C, Prokopczuk J, Hamm C, Heg D, Windecker S, Valgimigli M. Comparison of Investigator-Reported and Clinical Event Committee-Adjudicated Outcome Events in GLASSY. Circ Cardiovasc Qual Outcomes 2021; 14:e006581. [PMID: 33535773 DOI: 10.1161/circoutcomes.120.006581] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Event adjudication by a clinical event committee (CEC) provides a standardized, independent outcome assessment. However, the added value of CEC to investigators reporting remains debated. GLASSY (GLOBAL LEADERS Adjudication Sub-Study) implemented, in a subset of the open-label, investigator-reported (IR) GLOBAL LEADERS trial, an independent adjudication process of reported and unreported potential outcome events (triggers). We describe metrics of GLASSY feasibility and efficiency, diagnostic accuracy of IR events, and their concordance with corresponding CEC-adjudicated events. METHODS We report the proportion of myocardial infarction, bleeding, stroke, and stent thrombosis triggers with sufficient evidence for assessment (feasibility) that were adjudicated as outcome events (efficiency), stratified by source (IR or non-IR). Using CEC-adjudicated events as criterion standard, we describe sensitivity, specificity, positive and negative predictive value, and global diagnostic accuracy of IR events. Using Gwet AC coefficient, we examine the concordance between IR- and corresponding CEC-adjudicated triggers. There was sufficient evidence for assessment for 2592 (98.3%) of 2636 triggers. RESULTS Overall, the adjudicated end point-to-trigger ratio was high and similar between IR- (88%) and non-IR-reported (87%) triggers. The global diagnostic accuracy and concordance between IR-reported and CEC-adjudicated outcome events was 0.70 (95% CI, 0.65-0.74) and 0.54 (95% CI, 0.45-0.62), respectively, for myocardial infarction; 0.77 (95% CI, 0.75-0.79) and 0.71 (95% CI, 0.68-0.74) for bleeding; 0.70 (95% CI, 0.62-0.79) and 0.59 (95% CI, 0.43-0.74) for stroke; 0.59 (95% CI, 0.52-0.66) and 0.39 (95% CI, 0.25-0.53) for stent thrombosis. For IR bleedings, the concordance with the CEC on type of events was generally weak. CONCLUSIONS Implementing CEC adjudication in a pragmatic open-label trial with IR events is feasible and efficient. Our findings of modest global diagnostic accuracy for IR events and generally weak concordance between investigators and CEC support the role for CEC adjudication in such settings. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03231059.
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Affiliation(s)
- Sergio Leonardi
- Department of Molecular Medicine, Cardiology Unit, University of Pavia, Italy (S.L.).,Coronary Care Unit (S.L.), Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Mattia Branca
- Clinical Trials Unit Bern (M.B.), University of Bern, Switzerland
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (A.F., R.P.)
| | - Eugene McFadden
- Cardialysis Core Laboratories and Clinical Trial Management, Rotterdam, the Netherlands (E.M.).,Department of Cardiology, Cork University Hospital, Ireland (E.M.)
| | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (A.F., R.P.)
| | - Peter Jüni
- Department of Medicine, Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Ontario, Canada (P.J.)
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Belgium (P.V.)
| | | | - Patrick W Serruys
- Department of Cardiology, Imperial College of London, United Kingdom (P.W.S.)
| | - Edouard Benit
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium (E.B.)
| | - Christoph Liebetrau
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany (C.L., C.H.)
| | - Luc Janssens
- German Center for Cardiovascular Research, Partner Site RheinMain, Frankfurt am Main, Germany (C.L., C.H.)
| | - Maurizio Ferrario
- Division of Cardiology (M.F.), Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Aleksander Zurakowski
- Department of Interventional Cardiology, American Heart of Poland SA, Chrzanów (A.Z.)
| | - Roberto Diletti
- Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands (R.D.)
| | | | - Kurt Huber
- 3rd Medical Department, Cardiology, Wilhelminen Hospital, Vienna, Austria (K.H.)
| | - Ton Slagboom
- Sigmund Freud University Medical School, Vienna, Austria (K.H.)
| | - Pawel Buszman
- Center for Cardiovascular Research and Development, American Heart of Poland, Ustroń (P.B.).,Department of Epidemiology and Statistics, Medical University of Silesia, Katowice, Poland (P.B.)
| | | | - Carlo Tumscitz
- Cardiology Unit Sant'Anna Hospital, Ferrara, Italy (C.T.)
| | - Krzysztof Bryniarski
- Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland (K.B.)
| | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Belgium (A.A.)
| | | | - Ivo Petrov
- Acibadem City Clinic Cardiovascular Center, Sofia, Bulgaria (I.P.)
| | - Scot Garg
- East Lancashire Hospitals NHS Trust, Blackburn, United Kingdom (S.G.)
| | - Cristoph Naber
- Contilia Heart and Vascular Centre, Stadtspital Triemli, Zürich, Switzerland (C.N.)
| | | | - Christian Hamm
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany (C.L., C.H.).,German Center for Cardiovascular Research, Partner Site RheinMain, Frankfurt am Main, Germany (C.L., C.H.)
| | - Dik Heg
- Institute of Social and Preventive Medicine and Clinical Trials Unit (D.H.), University of Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital (S.W.), University of Bern, Switzerland
| | - Marco Valgimigli
- Department of Cardiology, Cardiocentro Ticino, Lugano, Switzerland (M. Valgimigli)
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Casula M, Fortuni F, Ferlini M, Mauri S, Rebuffi C, Rossini R, Ferrario M, Oltrona Visconti L. Subclinical leaflet thrombosis after transcatheter aortic valve replacement: a meaningless finding? A systematic review and meta-analysis. Eur Heart J Qual Care Clin Outcomes 2021; 7:107-108. [PMID: 32479593 DOI: 10.1093/ehjqcco/qcaa047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 05/26/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Matteo Casula
- Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, 27100 Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Via Forlanini 6, 27100, Pavia, Italy
| | - Federico Fortuni
- Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, 27100 Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Via Forlanini 6, 27100, Pavia, Italy
| | - Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, 27100, Pavia, Italy
| | - Silvia Mauri
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, 27100, Pavia, Italy
| | - Chiara Rebuffi
- Scientific Documentation Center, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi, 27100, Pavia, Italy
| | - Roberta Rossini
- Cardiologia, Ospedale Santa Croce e Carle, Via Michele Coppino 26, 12100, Cuneo, Italy
| | - Maurizio Ferrario
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, 27100, Pavia, Italy
| | - Luigi Oltrona Visconti
- Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, 27100 Pavia, Italy
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, 27100, Pavia, Italy
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Mandurino-Mirizzi A, Demarchi A, Ruffinazzi M, Cornara S, Somaschini A, Crimi G, Ferlini M, Camporotondo R, Gnecchi M, Ferrario M, Oltrona Visconti L, De Ferrari GM. Serum uric acid may modulate the inflammatory response after primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction. J Cardiovasc Med (Hagerstown) 2020; 21:337-339. [PMID: 31977536 DOI: 10.2459/jcm.0000000000000926] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
| | - Andrea Demarchi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo.,University of Pavia
| | - Marta Ruffinazzi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo.,University of Pavia
| | - Stefano Cornara
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo.,University of Pavia
| | - Alberto Somaschini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo.,University of Pavia
| | - Gabriele Crimi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo
| | - Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo
| | - Rita Camporotondo
- Coronary care unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Massimiliano Gnecchi
- University of Pavia.,Coronary care unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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García Carrillo M, Ferrario M, Schenk M, Guerrero S. Effect of an UV-C Light-Based Hurdle Strategy for Carrot-Orange Juice Processing on Candida parapsilosis Inactivation and Physiological State: Impact on Juice Sensory and Physicochemical Quality Parameters. FOOD BIOPROCESS TECH 2020. [DOI: 10.1007/s11947-020-02540-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bisesto FG, Galletti M, Anania MP, Costa G, Ferrario M, Pompili R, Poyé A, Consoli F, Salvadori M, Cipriani M, Verona C, Zigler A. Ultrafast electron and proton bunches correlation in laser-solid matter experiments. Opt Lett 2020; 45:5575-5578. [PMID: 33001957 DOI: 10.1364/ol.402938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 08/17/2020] [Indexed: 06/11/2023]
Abstract
The interaction of an ultra-intense laser with a solid state target allows the production of multi-MeV proton and ion beams. This process is explained by the target normal sheath acceleration (TNSA) model, predicting the creation of an electric field on the target rear side, due to an unbalanced positive charge. This process is related to the emission of relativistic ultrafast electrons, occurring at an earlier time. In this work, we highlight the correlations between the ultrafast electron component and the protons by their simultaneous detection by means of an electro-optical sampling and a time-of-flight diagnostics, respectively, supported by numerical simulations showing an excellent agreement.
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Gragnano F, Heg D, Franzone A, McFadden EP, Leonardi S, Piccolo R, Vranckx P, Branca M, Serruys PW, Benit E, Liebetrau C, Janssens L, Ferrario M, Zurakowski A, Diletti R, Dominici M, Huber K, Slagboom T, Buszman P, Bolognese L, Tumscitz C, Bryniarski K, Aminian A, Vrolix M, Petrov I, Garg S, Naber C, Prokopczuk J, Hamm C, Steg PG, Jüni P, Windecker S, Valgimigli M. PRECISE-DAPT score for bleeding risk prediction in patients on dual or single antiplatelet regimens: insights from the GLOBAL LEADERS and GLASSY. Eur Heart J Cardiovasc Pharmacother 2020; 8:28-38. [PMID: 32941620 DOI: 10.1093/ehjcvp/pvaa106] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/21/2020] [Accepted: 09/03/2020] [Indexed: 12/23/2022]
Abstract
AIMS The 5-item PRECISE-DAPT, integrating age, haemoglobin, white-blood-cell count, creatinine clearance, and prior bleeding, predicts bleeding risk in patients on dual antiplatelet therapy (DAPT) after stent implantation. We sought to assess whether the bleeding risk prediction offered by the PRECISE-DAPT remains valid among patients receiving ticagrelor monotherapy from 1 month onwards after coronary stenting instead of standard DAPT and having or not having centrally-adjudicated bleeding endpoints. METHODS AND RESULTS The PRECISE-DAPT was calculated in 14,928 and 7,134 patients from GLOBAL LEADERS and GLASSY trials, respectively. The ability of the score to predict BARC 3 or 5 bleeding was assessed and compared among patients on ticagrelor monotherapy (experimental strategy) or standard DAPT (reference strategy) from 1 month after drug-eluting stent implantation. Bleeding endpoints were investigator-reported or centrally-adjudicated in GLOBAL LEADERS and GLASSY, respectively.At 2 years, the c-indexes for the score among patients treated with the experimental or reference strategy were 0.67 (95% confidence interval [CI]:0.63-0.71) vs. 0.63 (95% CI:0.59-0.67) in GLOBAL LEADERS (p = 0.27), and 0.67 (95% CI:0.61-0.73) vs. 0.66 (95% CI:0.61-0.72) in GLASSY (p = 0.88). Decision curve analysis showed net benefit using the PRECISE-DAPT to guide bleeding risk assessment under both treatment strategies. Results were consistent between investigator-reported and adjudicated endpoints and using the simplified 4-item PRECISE-DAPT. CONCLUSIONS The PRECISE-DAPT offers a prediction model that proved similarly effective to predict clinically-relevant bleeding among patients on ticagrelor monotherapy from 1 month after coronary stenting compared with standard DAPT and appears to be unaffected by the presence or absence of adjudicated bleeding endpoints.
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Affiliation(s)
| | - Dik Heg
- Institute of Social and Preventive Medicine and Clinical Trials Unit, University of Bern, Bern, Switzerland
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Eugène P McFadden
- Cardialysis Core Laboratories and Clinical Trial Management, Rotterdam, the Netherlands and Department of Cardiology, Cork University Hospital, Cork, Ireland
| | - Sergio Leonardi
- University of Pavia and Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Belgium
| | - Mattia Branca
- Institute of Social and Preventive Medicine and Clinical Trials Unit, University of Bern, Bern, Switzerland
| | - Patrick W Serruys
- Department of Cardiology, Imperial College of London, London, United Kingdom
| | - Edouard Benit
- Jessa Hospital, Department of Cardiology, Hasselt, Belgium
| | - Christoph Liebetrau
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany and German Center for Cardiovascular Research (DZHK), partner site RheinMain, Frankfurt am Main, Germany
| | | | - Maurizio Ferrario
- University of Pavia and Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Aleksander Zurakowski
- Center of Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
| | - Roberto Diletti
- Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Kurt Huber
- 3rd Medical Department, Cardiology, Wilhelminenhospital, and Sigmund Freud University Medical School, Vienna, Austria
| | | | - Paweł Buszman
- Center for Cardiovascular Research and Development American Heart of Poland, and Department of Epidemiology, Medical University of Silesia, Katowice, Poland
| | | | | | - Krzysztof Bryniarski
- Jagiellonian University Medical College, The John Paul II Hospital, Krakow, Poland
| | - Adel Aminian
- Department of cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | | | - Ivo Petrov
- Acibadem City Clinic Cardiovascular Center, Sofia, Bulgaria
| | - Scot Garg
- East Lancashire Hospitals NHS Trust, Blackburn, UK
| | | | | | - Christian Hamm
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany and German Center for Cardiovascular Research (DZHK); Partner site RheinMain, Frankfurt am Main, Germany
| | | | - Peter Jüni
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Department of Medicine, University of Toronto, Ontario, Canada
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Hicks B, Veronesi G, Ferrario M, Cesana G, Iacoviello L, Palmieri L, Kuulasmaa K, Soderberg S, Sans S, Kee F. Differential susceptibility to allostatic load and educational inequalities in coronary heart disease. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.192] [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
Differential exposure to lifestyle factors may mediate the association between education and cardiovascular disease (CVD). However, differential susceptibility (the effect of exposure to the same “dose” of risk factors differs across groups) may also elevate CVD risk but the causal pathways remain unclear. Allostatic Load (AL) is a marker of cumulative biological burden resulting from mal-adaptation to chronic stressors. We aimed to examine the role of differential exposure and susceptibility to AL and other factors in coronary heart disease (CHD) educational gradients in Europe.
Methods
51,328 35-74-year-old participants originally free of CVD from 21 European cohorts in the BiomarCaRE consortium were identified and followed for a median of 10 years to their first CHD event. We defined an AL score as the sum of z-scores of 8 markers from the cardiovascular, metabolic, and inflammatory systems. To investigate the mediating role of AL (and smoking, alcohol and BMI) on educational differences in CHD incidence we applied marginal structural models and three-way decomposition on gender-specific additive hazards models.
Results
AL was a significant mediator of the association between educational status and CHD. The highest proportion mediated was observed in women, with 28% (95%CI 20% to 44%) attributable to differential exposure and 8% (95%CI 0% to 16%) to differential susceptibility. In men, AL mediated 16% of the increased CHD risk in the less educated, with 2% (95%CI 0%-6%) attributable to differential susceptibility. The effects of smoking, alcohol and BMI were relatively small for men and women, with a limited role of differential susceptibility.
Conclusions
While we found evidence of differential susceptibility to AL on CHD, effects were modest and the mediating effect of AL (and other lifestyle factors) was predominately via differential exposure. Controlling disproportionate exposure to AL may help reduce CHD morbidity among those with lower education.
Key messages
Educational inequalities in coronary heart disease in Europe were predominantly driven by differential exposure rather than susceptibility to allostatic load and other lifestyle factors. Controlling disproportionate exposure to AL may help reduce coronary heart disease morbidity among those with lower education.
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Affiliation(s)
- B Hicks
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - G Veronesi
- Research Center in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - M Ferrario
- Research Center in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - G Cesana
- Research Centre on Public Health, Department of Medicine, University of Milano Bicocca, Monza, Italy
| | - L Iacoviello
- Research Center in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Varese, Italy
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
| | - L Palmieri
- Department of Cardiovascular, Endocrine-metabolic Disease, National Institutes of Health-ISS, Rome, Italy
| | - K Kuulasmaa
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - S Soderberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - S Sans
- Catalan Department of Health, Catalan Department of Health, Barcelona, Spain
| | - F Kee
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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Galletti M, Bisesto FG, Anania MP, Ferrario M, Pompili R, Poyé A, Zigler A. Time-resolved characterization of ultrafast electrons in intense laser and metallic-dielectric target interaction. Opt Lett 2020; 45:4420-4423. [PMID: 32796973 DOI: 10.1364/ol.393503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/21/2020] [Indexed: 06/11/2023]
Abstract
High-intensity ultrashort laser pulses interacting with thin solid targets are able to produce energetic ion beams by means of extremely large accelerating fields set by the energetic ejected electrons. The characterization of such electrons is thus important in view of a complete understanding of the acceleration process. Here, we present a complete temporal-resolved characterization of the fastest escaping hot electron component for different target materials and thicknesses, using temporal diagnostics based on electro-optical sampling with 100 fs temporal resolution. Experimental evidence of scaling laws for ultrafast electron beam parameters have been retrieved with respect to the impinging laser energy (0.4-4 J range) and to the target material, and an empirical law determining the beam parameters as a function of the target thickness is presented.
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De Luca G, Verdoia M, Savonitto S, Ferri LA, Piatti L, Grosseto D, Morici N, Bossi I, Sganzerla P, Tortorella G, Cacucci M, Ferrario M, Murena E, Sibilio G, Tondi S, Toso A, Bongioanni S, Ravera A, Corrada E, Mariani M, Di Ascenzo L, Petronio AS, Cavallini C, Vitrella G, Antonicelli R, Rogacka R, De Servi S. Impact of body mass index on clinical outcome among elderly patients with acute coronary syndrome treated with percutaneous coronary intervention: Insights from the ELDERLY ACS 2 trial. Nutr Metab Cardiovasc Dis 2020; 30:730-737. [PMID: 32127336 DOI: 10.1016/j.numecd.2020.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/07/2019] [Revised: 12/26/2019] [Accepted: 01/12/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIM Elderly patients are at increased risk of hemorrhagic and thrombotic complications after an acute coronary syndrome (ACS). Frailty, comorbidities and low body weight have emerged as conditioning the prognostic impact of dual antiplatelet therapy (DAPT). The aim of the present study was to investigate the prognostic impact of body mass index (BMI) on clinical outcome among patients included in the Elderly-ACS 2 trial, a randomized, open-label, blinded endpoint study comparing low-dose (5 mg) prasugrel vs clopidogrel among elderly patients with ACS. METHODS AND RESULTS Our population is represented by 1408 patients enrolled in the Elderly-ACS 2 trial. BMI was calculated at admission. The primary endpoint of this analysis was cardiovascular (CV) mortality. Secondary endpoints were all-cause death, recurrent MI, Bleeding Academic Research Consortium (BARC) type 2 or 3 bleeding, and re-hospitalization for cardiovascular reasons or stent thrombosis within 12 months after index admission. Patients were grouped according to median values of BMI (<or ≥ 25.7 kg/m2). BMI was associated with hypertension, diabetes, hypercholesterolemia, estimated glomerular filtration rate and hemoglobin (p < 0.001), and inversely with age (p = 0.005). Overweight patients displayed larger use of diuretics at admission (p = 0.03), aspirin pre-randomization (p = 0.01) and radial access (p = 0.04). At a median follow-up of 367 [337-378] days, BMI did not affect CV mortality in the overall population 4% vs 3.8%; adjusted HR [95%CI] = 2.3 [0.8-6.5], p = 0.12. Similar findings were observed for our secondary efficacy and safety endpoints. Results did not change when considering separately higher risk subsets of patients, (female gender, diabetics, ST-segment elevation myocardial infarction or the type of DAPT treatment allocation), with no significant interaction between these population characteristics and BMI. CONCLUSIONS Among elderly patients with ACS, BMI did not condition the survival or the risk of major cardiovascular and bleeding complications. The results were consistent across several patient risk categories.
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Affiliation(s)
- Giuseppe De Luca
- Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, Novara, Italy.
| | - Monica Verdoia
- Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, Novara, Italy
| | | | | | | | | | - Nuccia Morici
- ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Irene Bossi
- ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | | | | | | | | | | | | | | | | | | | - Elena Corrada
- HumanitasClinical and Research Center, Rozzano, Italy
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De Rosa R, Morici N, De Servi S, De Luca G, Galasso G, Piscione F, Ferri LA, Piatti L, Grosseto D, Tortorella G, Franco N, Lenatti L, Misuraca L, Leuzzi C, Verdoia M, Sganzerla P, Cacucci M, Ferrario M, Murena E, Sibilio G, Toso A, Savonitto S. Impact of renal dysfunction and acute kidney injury on outcome in elderly patients with acute coronary syndrome undergoing percutaneous coronary intervention. Eur Heart J Acute Cardiovasc Care 2020; 10:2048872620920475. [PMID: 32374175 DOI: 10.1177/2048872620920475] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/30/2020] [Indexed: 02/24/2024]
Abstract
BACKGROUND Chronic kidney disease is common in patients admitted with acute coronary syndrome and its prevalence dramatically increases with age. Understanding the determinants of adverse outcomes in this extremely high-risk population may be useful for the development of specific treatment strategies and planning of secondary prevention modalities. AIM The aim of this study was to assess the impact of baseline renal function and acute kidney injury on one-year outcome of elderly patients with acute coronary syndrome treated with percutaneous coronary intervention. METHODS Patients aged 75 years and older with acute coronary syndrome undergoing successful percutaneous coronary intervention were selected among those enrolled in three Italian multicentre studies. Based on the baseline estimated glomerular filtration rate (eGFR) calculated using the Cockcroft-Gault formula ([(140-age) × body weight × 0.85 if female]/(72 × serum creatinine)* 1.73 m2 of body surface area), patients were classified as having none or mild (eGFR ≥60 ml/min/1.73 m2), moderate (eGFR 30-59 ml/min/1.73 m2) or severe (eGFR <30 ml/min/1.73 m2) renal dysfunction. Acute kidney injury was defined according to the Acute Kidney Injury Network classification. All-cause and cardiovascular mortality, non-fatal myocardial infarction, rehospitalisation for cardiovascular causes, stroke and type 2, 3 and 5 Bleeding Academic Research Consortium bleedings were analysed up to 12 months. RESULTS A total of 1904 patients were included. Of these, 57% had moderate and 11% severe renal dysfunction. At 12 months, patients with renal dysfunction had higher rates (P < 0.001) of all-cause (4.5%, 7.5% and 17.8% in patients with none or mild, moderate and severe renal dysfunction, respectively) and cardiovascular mortality (2.8%, 5.2% and 10.2%, respectively). After multivariable adjustment, severe renal dysfunction was associated with a higher risk of all-cause (hazard ratio (HR) 2.86, 95% confidence interval (CI) 1.52-5.37, P = 0.001) and cardiovascular death (HR 3.11, 95% CI 1.41-6.83, P = 0.005), whereas non-fatal events were unaffected. Acute kidney injury incidence was significantly higher in ST-elevation myocardial infarction versus non-ST-elevation acute coronary syndrome patients (11.7% vs. 7.8%, P = 0.036) and in those with reduced baseline renal function (P < 0.001), and it was associated with increased mortality independently from baseline renal function and clinical presentation. CONCLUSIONS Baseline renal dysfunction is highly prevalent and is associated with higher mortality in elderly acute coronary syndrome patients undergoing percutaneous coronary intervention. Acute kidney injury occurs more frequently among ST-elevation myocardial infarction patients and those with pre-existing renal dysfunction and is independently associated with one-year mortality.
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Affiliation(s)
- Roberta De Rosa
- Cardiovascular and Thoracic Department, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Italy
| | - Nuccia Morici
- Intensive Cardiac Care Unit and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Italy
| | | | - Giuseppe De Luca
- Azienda Ospedaliera Universitaria Maggiore della Carità, Eastern Piedmont University, Italy
| | - Gennaro Galasso
- Cardiovascular and Thoracic Department, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Italy
| | - Federico Piscione
- Cardiovascular and Thoracic Department, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Italy
| | - Luca A Ferri
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Italy
| | | | | | | | | | | | | | - Chiara Leuzzi
- Division of Cardiology, IRCCS Arcispedale S. Maria Nuova, Italy
| | - Monica Verdoia
- Azienda Ospedaliera Universitaria Maggiore della Carità, Eastern Piedmont University, Italy
| | - Paolo Sganzerla
- Division of Cardiology, ASST Bergamo ovest-ospedale di Treviglio, Italy
| | | | - Maurizio Ferrario
- Division of Cardiology, IRCCS Fondazione Policlinico S Matteo, Italy
| | - Ernesto Murena
- Division of Cardiology, Ospedale S Maria delle Grazie, Italy
| | | | - Anna Toso
- Division of Cardiology, Ospedale S Stefano, Italy
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Ghio S, Ferlini M, Scelsi L, Ferrario M, Camporotondo R, Vicentini A, Magrini G, Visconti LO. [COVID-19 pandemic: the need to reorganize a Cardiology Department in a hospital of the Lombardy Region, Italy]. G Ital Cardiol (Rome) 2020; 21:358-359. [PMID: 32310923 DOI: 10.1714/3343.33134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
| | | | | | | | - Rita Camporotondo
- U.O.C Unità Coronarica - Ricerca e Sperimentazione Cardiologica, Dipartimento Scienze Mediche e Malattie Infettive, Fondazione IRCCS Policlinico San Matteo, Pavia
| | | | | | - Luigi Oltrona Visconti
- U.O.C. Cardiologia - U.O.C Unità Coronarica - Ricerca e Sperimentazione Cardiologica, Dipartimento Scienze Mediche e Malattie Infettive, Fondazione IRCCS Policlinico San Matteo, Pavia
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Crimi G, Morici N, Ferrario M, Ferri LA, Piatti L, Grosseto D, Cacucci M, Mandurino Mirizzi A, Toso A, Piscione F, De Carlo M, Elia LR, Trimarco B, Bolognese L, Bovenzi FM, De Luca G, Savonitto S, De Servi S. Time Course of Ischemic and Bleeding Burden in Elderly Patients With Acute Coronary Syndromes Randomized to Low-Dose Prasugrel or Clopidogrel. J Am Heart Assoc 2020; 8:e010956. [PMID: 30636561 PMCID: PMC6497351 DOI: 10.1161/jaha.118.010956] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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] [Indexed: 12/13/2022]
Abstract
Background Elderly patients have high ischemic and bleeding rates after acute coronary syndrome; however, the occurrence of these complications over time has never been studied. This study sought to characterize average daily ischemic rates ( ADIRs ) and average daily bleeding rates ( ADBRs ) over 1 year in patients aged >74 years with acute coronary syndrome undergoing percutaneous coronary intervention who were randomized in the Elderly ACS 2 trial, comparing low-dose prasugrel (5 mg daily) with clopidogrel (75 mg daily). Methods and Results ADIRs and ADBRs were calculated as the total number of events, including recurrent events, divided by the number of patient-days of follow-up and assessed within different clinical phases: acute (0-3 days), subacute (4-30 days), and late (31-365 days). Generalized estimating equations were used to test the least squares mean differences for the pairwise comparisons of ADIRs and ADBRs and the pairwise comparison of clopidogrel versus prasugrel effects. Globally, ADIRs were 2.6 times (95% CI, 2.4-2.9) higher than ADBRs . ADIRs were significantly higher in the clopidogrel arm than in the low-dose prasugrel arm in the subacute phase ( Padj<0.001) without a difference in ADBRs ( Padj=0.35). In the late phase, ADIRs remained significantly higher with clopidogrel ( Padj<0.001), whereas ADBRs were significantly higher with low-dose prasugrel ( Padj<0.001). Conclusions Ischemic burden was greater than bleeding burden in all clinical phases of 1-year follow-up of elderly patients with acute coronary syndrome treated with percutaneous coronary intervention. Low-dose prasugrel reduced ischemic events in the subacute and chronic phases compared with clopidogrel, whereas bleeding burden was lower with clopidogrel in the late phase. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 01777503.
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Affiliation(s)
- Gabriele Crimi
- 1 Division of Cardiology IRCCS Fondazione Policlinico S. Matteo Pavia Italy
| | - Nuccia Morici
- 2 First Division of Cardiology Ospedale Niguarda Milano Italy
| | - Maurizio Ferrario
- 1 Division of Cardiology IRCCS Fondazione Policlinico S. Matteo Pavia Italy
| | - Luca A Ferri
- 3 Division of Cardiology Ospedale Manzoni Lecco Italy
| | - Luigi Piatti
- 3 Division of Cardiology Ospedale Manzoni Lecco Italy
| | | | | | | | - Anna Toso
- 6 Division of Cardiology Ospedale S. Stefano Prato Italy
| | - Federico Piscione
- 7 Department of Medicine, Surgery and Dentistry-Schola Medica Salernitana University of Salerno Italy
| | - Marco De Carlo
- 8 Cardiac Catheterization Laboratory Cardiothoracic and Vascular Department Azienda Ospedaliero-Universitaria Pisana Pisa Italy
| | - Luigi Raffaele Elia
- 9 Division of Cardiology and Intensive Care Unit Ospedale Cardarelli Napoli Italy
| | - Bruno Trimarco
- 10 Division of Cardiology Policlinico Universitario Federico II Napoli Italy
| | | | | | - Giuseppe De Luca
- 13 Division of Cardiology Azienda Ospedaliera-Universitaria "Maggiore della Carità" Eastern Piedmont University Novara Italy
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Curcio A, Bisesto F, Costa G, Biagioni A, Anania MP, Pompili R, Ferrario M, Petrarca M. Modeling and diagnostics for plasma discharge capillaries. Phys Rev E 2019; 100:053202. [PMID: 31869917 DOI: 10.1103/physreve.100.053202] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Indexed: 11/07/2022]
Abstract
In this paper, we show how plasma discharge capillaries can be numerically modeled as resistors within an RLC-series discharge circuit, allowing for a simple description of these systems, while taking into account heat and radiation losses. An analytic radial model is also provided and compared to the numerical model for plasma discharge capillaries at thermal equilibrium, with corrections due to radiation losses. Finally, diagnostic techniques based on visible spectroscopy of plasma emission lines are discussed both for atomic and molecular gases, comparing experimental results with numerical simulations and theoretical calculations.
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Affiliation(s)
| | | | - G Costa
- INFN LNF, Frascati (Rome), Italy
| | | | | | | | | | - M Petrarca
- S.B.A.I. Department of the Roma University "La Sapienza," Rome, Italy and INFN Roma1, Rome, Italy
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Takahashi K, Kogame N, Tomaniak M, Chichareon P, Chang CC, Modolo R, Benit E, Liebetrau C, Janssens L, Ferrario M, Zurakowski A, van Geuns RJ, Dominici M, Huber K, Buszman P, Bolognese L, Tumscitz C, Żmudka K, Aminian A, Vrolix M, Petrov I, Wykrzykowska JJ, de Winter RJ, Hamm C, Steg PG, Onuma Y, Valgimigli M, Windecker S, Vranckx P, Garg S, Serruys PW. Impact of recruitment and retention on all-cause mortality in a large all-comers randomised controlled trial: insights from the GLOBAL LEADERS trial. Clin Res Cardiol 2019; 109:918-929. [PMID: 31828504 DOI: 10.1007/s00392-019-01585-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 08/29/2019] [Accepted: 11/28/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Recruitment and retention in trials may bias the results and subsequently complicate their interpretation and validity. The aim of this study is to evaluate the impact of recruitment and retention on all-cause mortality in a large all-comers trial. METHODS The recruitment rate in each investigating center of the GLOBAL LEADERS trial was assessed and the 130 centers were subdivided into low and high recruiters according to the median, with all-cause mortality then compared between the two groups. Vital status was obtained from public records in patients with incomplete follow-up. RESULTS The trial randomized 15,991 (7.86%) of 203,483 eligible patients with percutaneous coronary intervention during the recruitment period, of whom 15,267 (95.47%) completed follow-up, 23 (0.14%) patients withdrew consent and formally requested to be deleted from the database; 183 (1.14%) withdrew consent but only objected to future data collection; 303 (1.89%) discontinued the study; and 215 (1.34%) were lost to follow-up. Vital status was finally obtained in all but 31 patients (99.81%). Patients from low recruiters had a significantly lower all-cause mortality than high ones (2.26% vs. 3.24%; hazard ratio: 0.69; 95% confidence interval: 0.55-0.87; p = 0.002). There was a significant difference in all-cause mortality among the incomplete follow-up groups (log-rank p < 0.001) with a significantly higher mortality in the 183 patients who withdrew consent than those who completed follow-up (7.38% vs. 2.99%, p = 0.002). CONCLUSIONS Recruitment and retention significantly impacted all-cause mortality. Search for vital status through public domains is of paramount importance in the interpretation and validity of large clinical trials.
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Affiliation(s)
- Kuniaki Takahashi
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Norihiro Kogame
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Mariusz Tomaniak
- Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Ply Chichareon
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Chun-Chin Chang
- Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Rodrigo Modolo
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Cardiology Division, Department of Internal Medicine, University of Campinas (UNICAMP), Campinas, Brazil
| | - Edouard Benit
- Faculty of Medicine and Life Sciences, Jessa Ziekenhuis, Hasselt University, Hasselt, Belgium
| | | | | | - Maurizio Ferrario
- UOC Cardiologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Robert Jan van Geuns
- Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Kurt Huber
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Medical School, Wilhelminen Hospital, and Sigmund Freud University, Vienna, Austria
| | - Pawel Buszman
- American Heart of Poland, Ustroń, Poland
- Department of Epidemiology and Statistics, Medical University of Silesia, Katowice, Poland
| | | | | | - Krzysztof Żmudka
- Department of Interventional Cardiology, Faculty of Medicine, Jagiellonian University, Kraków, Poland
| | - Adel Aminian
- Centre Hospitalier Universitaire Charleroi, Charleroi, Belgium
| | | | | | - Joanna J Wykrzykowska
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Robbert J de Winter
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Christian Hamm
- Kerckhoff Heartand, Thorax Center, University of Giessen, Bad Nauheim, Germany
| | - Philippe Gabriel Steg
- FACT (French Alliance for Cardiovascular Trials), Université Paris-Diderot, Paris, France
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), University Road, Galway, H91 TK33, Ireland
| | - Marco Valgimigli
- Department of Cardiology, University of Bern, Inselspital, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, University of Bern, Inselspital, Bern, Switzerland
| | - Pascal Vranckx
- Faculty of Medicine and Life Sciences, Jessa Ziekenhuis, Hasselt University, Hasselt, Belgium
| | - Scot Garg
- Royal Blackburn Hospital, Blackburn, UK
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), University Road, Galway, H91 TK33, Ireland.
- Imperial College London, London, UK.
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Franzone A, McFadden E, Leonardi S, Piccolo R, Vranckx P, Serruys PW, Benit E, Liebetrau C, Janssens L, Ferrario M, Zurakowski A, Diletti R, Dominici M, Huber K, Slagboom T, Buszman P, Bolognese L, Tumscitz C, Bryniarski K, Aminian A, Vrolix M, Petrov I, Garg S, Naber C, Prokopczuk J, Hamm C, Steg PG, Heg D, Jüni P, Windecker S, Valgimigli M. Ticagrelor Alone Versus Dual Antiplatelet Therapy From 1 Month After Drug-Eluting Coronary Stenting. J Am Coll Cardiol 2019; 74:2223-2234. [DOI: 10.1016/j.jacc.2019.08.1038] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/08/2019] [Accepted: 08/10/2019] [Indexed: 11/17/2022]
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Montalto C, Crimi G, Fortuni F, Mandurino Mirizzi A, Piatti L, Morici N, Tortorella G, Grosseto D, Sganzerla P, Ferrario M, De Servi S, Savonitto S. 258Use of low-dose prasugrel vs. clopidogrel in elderly patients undergoing complex or non-complex PCI for acute coronary syndromes: insights from the Elderly ACS 2 study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0074] [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
Prasugrel was superior to clopidogrel in the setting of acute coronary syndromes (ACS) and recent data highlighted its possible role in the setting of complex percutaneous coronary intervention (PCI). Nonetheless, evidence supporting its use in high bleeding risk population are lacking.
Purpose
The aim of this post-hoc subgroup analysis was to evaluate the impact of prasugrel administration in elderly patients undergoing complex PCI for ACS. A primary composite endpoint of composite of mortality, myocardial infarction, disabling stroke and re-hospitalization for cardiovascular causes or bleeding within one year and secondary endpoints of all-cause mortality and any bleeding at 1 year were analyzed.
Methods
In the multicenter Elderly ACS 2 Study 1,443 patients aged >74 y were randomly assigned to receive low-dose prasugrel (5 mg) or clopidogrel (75 mg) and were prospectively followed for 1 year (Table 1). Complex PCI was defined if ≥3 lesions were treated, if ≥3 stents were deployed, or if any bifurcation, trifurcation, chronic total obstruction or moderate-to-severe calcified lesions were treated.
Results
Patients undergoing complex PCI (n=607) did not experience worse outcome, as compared to those with simpler PCI, in terms of primary endpoint (p=0.21, Figure 1A). Furthermore, in this subgroup, no significant difference was observed with prasugrel vs clopidogrel with regard to the primary endpoint (HR 1.17; CI 0.819–1.67; p=0.39, Figure 1A), all-cause death and bleeding (Figure 1C and 1D). No significant interaction was observed between treatment and PCI complexity (interaction p=0.34).
Table 1 Overall Non-complex PCI Complex PCI p value Age (y) 80.60±4.46 80.00 [77.00, 84.00] 80.00 [77.00, 83.00] 0.215 STE-ACS 595 (41.2) 272 (32.5) 323 (53.4) <0.001 Diabetes mellitus 253 (17.5) 159 (19.0) 94 (15.5) 0.104 LVEF 48.27±9.59 49.08±9.55 47.26±9.54 0.002 Total number of diseased vessels 2.29±1.06 2.22±1.06 2.38±1.05 0.005 Previous Myocardial Infarction 274 (19.0) 171 (20.4) 103 (17.0) 0.122 Randomized to prasugrel 713 (49.4) 404 (48.2) 404 (48.2) 0.307 Data are expressed as mean ± SD or [IQR] and count/valid %).
Figure 1
Conclusions
In elderly patients presenting with ACS low-dose prasugrel was comparable to clopidogrel in terms of all-cause mortality and any bleeding at 1 year.
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 Piatti
- 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 De Servi
- IRCCS Multimedica of Milan, Department of Cardiology, Milan, Italy
| | - S Savonitto
- Alessandro Manzoni Hospital, Division of Cardiology, Lecco, Italy
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Mauri S, Bozzani A, Ferlini M, Aiello M, Gazzoli F, Pirrelli S, Valsecchi F, Ferrario M. Combined Transcatheter Treatment of Severe Aortic Valve Stenosis and Infrarenal Abdominal Aortic Aneurysm in Increased Surgical Risk Patients. Ann Vasc Surg 2019; 60:480.e1-480.e5. [DOI: 10.1016/j.avsg.2019.03.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 03/21/2019] [Accepted: 03/26/2019] [Indexed: 12/20/2022]
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Mandurino Mirizzi A, Cornara S, Somaschini A, Demarchi A, Galazzi M, Puccio S, Crimi G, Ferlini M, Camporotondo R, Gnecchi M, Ferrario M, De Servi S, Oltrona Visconti L, De Ferrari GM. P6395Elevated serum uric acid is associated with a greater inflammatory response and with short- and long-term mortality in patients with ST-segment elevation myocardial infarction undergoing primary percu. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0991] [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: 11/14/2022] Open
Abstract
Abstract
Introduction
Elevated serum uric acid (eSUA) has been identified as independent risk factors for cardiovascular diseases, including coronary artery disease, and it has been associated with increased mortality in the general population. However, whether eSUA is associated with adverse outcomes in the setting of ST-segment elevation myocardial infarction (STEMI) is still controversial. Although the mechanisms of this possible relationship is similarly unsettled it has been suggested that eSUA could trigger oxidative stress and inflammatory response.
Aim
This study sought to investigate the association between eSUA with short- and long-term mortality and with inflammatory response in patients with STEMI treated with primary percutaneous coronary intervention (pPCI).
Methods
We prospectively enrolled all STEMI patients undergoing pPCI in our hospital between 2005 and 2017. Blood samples were collected on admission and at 24 and 48 hours after pPCI: SUA and the inflammatory biomarkers C-reactive protein (CRP), neutrophil count and neutrophil to lymphocytes ratio (NLR) were parameter of interest. NLR was obtained by dividing the total count of neutrophil by the total count of lymphocyte. eSUA was defined as >6.8 mg/dl. Cumulative 30-days and 1-year mortalities were estimated using the Kaplan-Meyer analysis and compared with the long-rank test. Landmark analysis was set at 365 days. Multivariable analyses were performed by Cox proportional hazard models.
Results
Out of the dataset of 2959 STEMI patients treated with pPCI, we analyzed 2369 patients who had SUA data. Overall age was 63 (p25-p75: 54–73) years, men were 2295 (75.5%), anterior MI 1390 (45.8%). eSUA was present in 563 patients (23.8%). 30-day mortality was 5.8% (n=31) among patients with eSUA and 2% (n=34) among patient with normal SUA level (p<0.001); 1-year mortality was 8.5% (n=46) vs 4% (n=70), respectively (p<0.001). Landmark analysis is shown in Figure 1. At multivariable analyses eSUA was an independent predictor after adjusting for age, female gender, BMI, diabetes, previous MI, serum creatinine, Hb, acute glycemia, Killip class >2 (30-day mortality HR 1.196, 95% CI 1.006–1.321, p=0.042; 1-year mortality HR 1.178, 95% CI 1.052–1.320, p=0.005). On admission CRP was higher in the group with eSUA as compared with the group with normal SUA levels (respectively, 1.27 [0.57–3.37] mg/dl vs 0.72 [0.30–1.8] mg/dl, p<0.001). On admission neutrophil count and NLR did not differ among the groups (respectively, p=0.205 and p=0.399), but eSUA patients presented higher values in neutrophil count and NLR at 24 hours (respectively, p=0.020 and p<0.001) and at 48 hours (p=0.018 and both p<0.001).
Figure 1
Conclusions
Elevated serum uric acid is associated with higher short- and long-term mortality and with a greater inflammatory response after reperfusion in patients with STEMI treated with primary PCI.
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Affiliation(s)
- A Mandurino Mirizzi
- Policlinic Foundation San Matteo IRCCS, Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Pavia, Italy
| | - S Cornara
- Policlinic Foundation San Matteo IRCCS, Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Pavia, Italy
| | - A Somaschini
- Policlinic Foundation San Matteo IRCCS, Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Pavia, Italy
| | - A Demarchi
- Policlinic Foundation San Matteo IRCCS, Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Pavia, Italy
| | - M Galazzi
- Policlinic Foundation San Matteo IRCCS, Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Pavia, Italy
| | - S Puccio
- Policlinic Foundation San Matteo IRCCS, Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Pavia, Italy
| | - G Crimi
- Policlinic Foundation San Matteo IRCCS, Cardiology Department, Pavia, Italy
| | - M Ferlini
- Policlinic Foundation San Matteo IRCCS, Cardiology Department, Pavia, Italy
| | - R Camporotondo
- Policlinic Foundation San Matteo IRCCS, Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Pavia, Italy
| | - M Gnecchi
- Policlinic Foundation San Matteo IRCCS, Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Pavia, Italy
| | - M Ferrario
- Policlinic Foundation San Matteo IRCCS, Cardiology Department, Pavia, Italy
| | - S De Servi
- IRCCS Multimedica of Milan, Milan, Italy
| | - L Oltrona Visconti
- Policlinic Foundation San Matteo IRCCS, Cardiology Department, Pavia, Italy
| | - G M De Ferrari
- Policlinic Foundation San Matteo IRCCS, Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Pavia, Italy
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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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Ferlini M, Fortuni F, Di Giacomo C, Cornara S, Somaschini A, Oltrona Visconti L, Ferrario M. Transcatheter aortic valve replacement versus surgery in low-risk patients: a meta-analysis of randomized studies. J Cardiovasc Med (Hagerstown) 2019; 21:168-170. [PMID: 31568091 DOI: 10.2459/jcm.0000000000000871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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49
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Mandurino Mirizzi A, Crimi G, Gritti V, Scotti V, Strozzi C, Silvestri A, Montalto C, D'Ascenzo F, Repetto A, Ferlini M, Marinoni B, De Servi S, Ferrario M, Klersy C, Oltrona Visconti L. P970DK-crush is the best treatment strategy to reduce stent oriented clinical outcome, results from a network meta-analysis of twenty-six randomized clinical trials comparing different stent techniques. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0564] [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
Coronary bifurcation disease (CBD) accounts for approximately 20% of all and is associated with worse short- and long- term clinical outcomes. Provisional stenting (PS) is the preferred choice, however, this approach may not be suitable in all CBD anatomies, therefore several elective two-stents techniques have been described, however there is lack of randomized evidence to guide interventionalist across different stent techniques. Objectives. To identify the best percutaneous coronary interventions (PCI) technique for CBD.
Methods
We systematically review randomized clinical (RCTs) of patients receiving CBD PCI with either PS or six type of elective two-stent techniques (DK-crush, TAP, culotte, dedicated bifurcation stents, crushing, T-stenting) and compare device oriented clinical events (DOCE) in a network meta-analysis. DOCE was defined as composite of cardiac death, target-vessel myocardial infarction, stent thrombosis, target lesion revascularization OR target vessel revascularisation.
Results
We included 26 RCTs leading to a pooled population of 10339 patients-years with 1229 DOCE. Compared to PS, the DK-crush technique had a lower DOCE with RR=0.62, [0.42–0.92]. Figure. DK-crush had the highest likelihood (model likelihood=90.2%, SUCRA=98.0%) of being the best treatment to reduce DOCE.
Figure 1
Conclusions
In the management CBD, when a two-stent technique is required as upfront strategy, the DK- Crush technique should be privileged as it showed to reduce stent-related clinical outcomes (DOCE) when compared to other bifurcation techniques.
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Affiliation(s)
- A Mandurino Mirizzi
- Policlinic Foundation San Matteo IRCCS, Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Pavia, Italy
| | - G Crimi
- Policlinic Foundation San Matteo IRCCS, Cardiology Department, Pavia, Italy
| | - V Gritti
- Policlinic Foundation San Matteo IRCCS, Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Pavia, Italy
| | - V Scotti
- Policlinic Foundation San Matteo IRCCS, Service of Biometry and Clinical Epidemiology, Pavia, Italy
| | - C Strozzi
- Policlinic Foundation San Matteo IRCCS, Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Pavia, Italy
| | - A Silvestri
- Policlinic Foundation San Matteo IRCCS, Service of Biometry and Clinical Epidemiology, Pavia, Italy
| | - C Montalto
- Policlinic Foundation San Matteo IRCCS, Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Pavia, Italy
| | - F D'Ascenzo
- University of Turin, Department of Cardiology, Turin, Italy
| | - A Repetto
- Policlinic Foundation San Matteo IRCCS, Cardiology Department, Pavia, Italy
| | - M Ferlini
- Policlinic Foundation San Matteo IRCCS, Cardiology Department, Pavia, Italy
| | - B Marinoni
- Policlinic Foundation San Matteo IRCCS, Cardiology Department, Pavia, Italy
| | - S De Servi
- IRCCS Multimedica of Milan, Cardiology Department, Milan, Italy
| | - M Ferrario
- Policlinic Foundation San Matteo IRCCS, Cardiology Department, Pavia, Italy
| | - C Klersy
- Policlinic Foundation San Matteo IRCCS, Service of Biometry and Clinical Epidemiology, Pavia, Italy
| | - L Oltrona Visconti
- Policlinic Foundation San Matteo IRCCS, Cardiology Department, Pavia, Italy
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50
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Montalto C, Crimi G, Mandurino-Mirizzi A, Frassica R, Gazzoli F, Covi R, Moschella M, Ghio S, Magrini G, Raineri C, Pelenghi S, Ferrario M, De Ferrari GM, Oltrona-Visconti L. P1856Percutaneous mitral edge-to-edge valvuloplasty in end-stage heart failure as a bridge to heart transplant: a case series from a single tertiary referral center. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0607] [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
Improved outcomes after percutaneous edge-to-edge mitral valvuloplasthy with MitraClip implantation were recently observed in patients with heart failure (HF) and functional severe mitral regurgitation (MR). Nonetheless, its efficacy in end-stage heart failure (HF) are lacking.
Purpose
Our aim was to investigate feasibility, preliminary efficacy on hemodynamics and follow-up of MitraClip implantation in a cohort of patients with very advanced HF.
Methods
Patients were retrospectively included in the present analysis if already in HT list, unsuitable for HT despite optimal medical and device therapy, or if implantation was a “bridge-to-candidacy”.
Results
Baseline and procedural characteristics are listed in Table 1; MR etiology was predominantly functional (n=7). No major complications were observed in the peri-operative period. At 6-month follow-up, invasive hemodynamics was available for 8 patients. A significant increase in cardiac index was observed (Least Square Mean Difference, LSMD = +0.47 L/min/m2; p=0.03; Figure 1), in conjunction with a numerical reduction in pulmonary vascular resistance (LSMD = −1.02 WU; p=0.3), a trend towards lower mean pulmonary arterial pressure (LSMD = −6.5 mmHg; p=0.053) and lower ejection fraction (LSMD = −6.5%; p=0.053). At a median follow-up of 772 days (IQR 156–1,578), all three patients unsuitable for HT at baseline could be eligible to HT list and one of them received LVAD. Moreover, two patients were transplanted, four experienced unplanned rehospitalization for HF, and one died of non-cardiac cause.
Table 1. Baseline clinical evaluation (n=10) Age (y) 53.67±8.43 HF Etiology – post ischemic 4 (40) Male sex 6 (60) HF Etiology – no CAD 4 (40) Body Surface Area (m2) 1.76±0.22 HF Etiology – other 2 (20) Chronic Resynchronization Therapy 5 (50) Euroscore II 6.00±2.74 Baseline MR grade (+) 4 (40) STS mortality 1.71±2.65 Residual MR grade (+) 1.71±0.49 Clips implanted (number) 1.78±0.67 Data are expressed as mean ± SD or count (valid %). MR scored on a scale from 0+ to 4+. STS, Society of Thoracic Surgeons.
Figure 1
Conclusions
Percutaneous edge-to-edge mitral valvuloplasty with MitraClip appears safe and effective in end-stage patients, impacts on clinical decision-making and therefore might be considered as a “bridge” towards a more definite strategy.
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
| | - A Mandurino-Mirizzi
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - R Frassica
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - F Gazzoli
- Policlinic Foundation San Matteo IRCCS, Division of Cardiac Surgery, Pavia, Italy
| | - R Covi
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - M Moschella
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - S Ghio
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - G Magrini
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - C Raineri
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - S Pelenghi
- Policlinic Foundation San Matteo IRCCS, Division of Cardiac Surgery, Pavia, Italy
| | - M Ferrario
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - G M De Ferrari
- Policlinic Foundation San Matteo IRCCS, Coronary Care Unit, Pavia, Italy
| | - L Oltrona-Visconti
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
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