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Cava F, Cosentino N, Lauri G, De Metrio M, Marenzi G. 1056 AN OUT OF ORDINARY CASE OF ACUTE SEVERE AORTIC REGURGITATION IN SPONTANEOUS AORTIC VALVE LACERATION. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.755] [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: 12/23/2022]
Abstract
Abstract
A 77-year-old male presenting with acute chest pain and syncope was sent to our emergency room by ambulance. An echocardiogram revealed severe pericardial effusion, thoracic aortic ectasia, and mild aortic regurgitation (AR). Computed tomography (CT) scan did not demonstrate aortic dissection. He underwent emergency pericardiocentesis for acute cardiac tamponade. After three hours of clinical monitoring, the transthoracic echocardiogram revealed de-novo severe AR, and CT scan showed a probable laceration of left ventricular wall at the level of left sinus of Valsalva. The lesion was confirmed during urgent cardiac surgery and it was successfully repaired using stitches intertwined with double pledglet and aortic bioprosthesis implant.
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Cosentino N, Campodonico J, Milazzo V, De Metrio M, Brambilla M, Camera M, Marenzi G. Vitamin D and Cardiovascular Disease: Current Evidence and Future Perspectives. Nutrients 2021; 13:nu13103603. [PMID: 34684604 PMCID: PMC8541123 DOI: 10.3390/nu13103603] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/28/2021] [Accepted: 10/11/2021] [Indexed: 12/14/2022] Open
Abstract
Vitamin D deficiency is a prevalent condition, occurring in about 30–50% of the population, observed across all ethnicities and among all age groups. Besides the established role of vitamin D in calcium homeostasis, its deficiency is emerging as a new risk factor for cardiovascular disease (CVD). In particular, several epidemiological and clinical studies have reported a close association between low vitamin D levels and major CVDs, such as coronary artery disease, heart failure, and atrial fibrillation. Moreover, in all these clinical settings, vitamin deficiency seems to predispose to increased morbidity, mortality, and recurrent cardiovascular events. Despite this growing evidence, interventional trials with supplementation of vitamin D in patients at risk of or with established CVD are still controversial. In this review, we aimed to summarize the currently available evidence supporting the link between vitamin D deficiency and major CVDs in terms of its prevalence, clinical relevance, prognostic impact, and potential therapeutic implications.
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Affiliation(s)
- Nicola Cosentino
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (N.C.); (J.C.); (V.M.); (M.D.M.); (M.B.); (M.C.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Jeness Campodonico
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (N.C.); (J.C.); (V.M.); (M.D.M.); (M.B.); (M.C.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Valentina Milazzo
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (N.C.); (J.C.); (V.M.); (M.D.M.); (M.B.); (M.C.)
| | - Monica De Metrio
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (N.C.); (J.C.); (V.M.); (M.D.M.); (M.B.); (M.C.)
| | - Marta Brambilla
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (N.C.); (J.C.); (V.M.); (M.D.M.); (M.B.); (M.C.)
| | - Marina Camera
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (N.C.); (J.C.); (V.M.); (M.D.M.); (M.B.); (M.C.)
- Department of Pharmaceutical Sciences, University of Milan, 20133 Milan, Italy
| | - Giancarlo Marenzi
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (N.C.); (J.C.); (V.M.); (M.D.M.); (M.B.); (M.C.)
- Correspondence: ; Tel.: +39-02-580-021
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Buratti S, Crimi G, Somaschini A, Cornara S, Camporotondo R, Cosentino N, Moltrasio M, Rubino M, De Metrio M, Marana I, De Servi S, Marenzi G, De Ferrari GM. A preprocedural risk score predicts acute kidney injury following primary percutaneous coronary intervention. Catheter Cardiovasc Interv 2021; 98:197-205. [PMID: 32797716 DOI: 10.1002/ccd.29176] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/23/2020] [Accepted: 07/19/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Reliable preprocedural risk scores for the prediction of Contrast-Induced Acute Kidney Injury (CI-AKI) following Percutaneous Coronary Intervention (pPCI) in patients with ST-elevation myocardial infarction (STEMI) are lacking. Aim of this study was to derive and validate a preprocedural Risk Score in this setting. METHODS Two prospectively enrolled patient cohorts were used for derivation and validation (n = 3,736). CI-AKI was defined as creatinine increase ≥0.5 mg/dl <72 h postpPCI. Odds ratios from multivariable logistic regression model were converted to an integer, whose sum represented the Risk Score. RESULTS Independent CI-AKI predictors were: diabetes, Killip class II-III (2 points each), age > 75 years, anterior MI (3 points), Killip class IV (4 points), estimated GFR < 60 ml/min/1.73m2 (5 points). The Risk Score c-statistic was 0.84 in both cohorts. Compared with patients with Risk Score ≤ 4, the relative risks of CI-AKI among patients scoring 5-9 were 6.2 (derivation cohort) and 7.1 (validation cohort); among patients scoring ≥10, 19.8, and 21.4, respectively. CONCLUSIONS Among STEMI patients, a simple preprocedural Risk Score accurately and reproducibly predicted the risk of CI-AKI, identifying ¼ of patients with a seven-fold risk and 1/10 of patients with a 20-fold risk. This knowledge may help tailored strategies, including delaying revascularization of nonculprit vessels in patients at high risk of CI-AKI.
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Affiliation(s)
- Stefano Buratti
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Molecular Medicine, Unit of Cardiology, University of Pavia, Pavia, Italy
| | - Gabriele Crimi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,IRCCS Italian Cardiovascular Network & Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Interventional Cardiology Unit, Cardio-Thoraco Vascular Department (DICATOV) Genova, Genoa, Italy
| | - Alberto Somaschini
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Molecular Medicine, Unit of Cardiology, University of Pavia, Pavia, Italy
| | - Stefano Cornara
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Molecular Medicine, Unit of Cardiology, University of Pavia, Pavia, Italy
| | - Rita Camporotondo
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | | | - Mara Rubino
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | - Ivana Marana
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Stefano De Servi
- Department of Molecular Medicine, Unit of Cardiology, University of Pavia, Pavia, Italy.,Division of Cardiology, IRCCS Multimedica, Sesto San Giovanni (MI), Milan, Italy
| | | | - Gaetano M De Ferrari
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Facoltà di Medicina e Chirurgia, Cardiology, Università degli Studi di Torino, Torino, Italy
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Cosentino N, Campodonico J, Moltrasio M, Lucci C, Milazzo V, Rubino M, De Metrio M, Marana I, Grazi M, Bonomi A, Veglia F, Lauri G, Bartorelli AL, Marenzi G. Mitochondrial Biomarkers in Patients with ST-Elevation Myocardial Infarction and Their Potential Prognostic Implications: A Prospective Observational Study. J Clin Med 2021; 10:jcm10020275. [PMID: 33451159 PMCID: PMC7828727 DOI: 10.3390/jcm10020275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/05/2021] [Accepted: 01/08/2021] [Indexed: 12/27/2022] Open
Abstract
Background: Mitochondrial biomarkers have been investigated in different critical settings, including ST-elevation myocardial infarction (STEMI). Whether they provide prognostic information in STEMI, complementary to troponins, has not been fully elucidated. We prospectively explored the in-hospital and long-term prognostic implications of cytochrome c and cell-free mitochondrial DNA (mtDNA) in STEMI patients undergoing primary percutaneous coronary intervention. Methods: We measured cytochrome c and mtDNA at admission in 466 patients. Patients were grouped according to mitochondrial biomarkers detection: group 1 (−/−; no biomarker detected; n = 28); group 2 (−/+; only one biomarker detected; n = 283); group 3 (+/+; both biomarkers detected; n = 155). A composite of in-hospital mortality, cardiogenic shock, and acute pulmonary edema was the primary endpoint. Four-year all-cause mortality was the secondary endpoint. Results: Progressively lower left ventricular ejection fractions (52 ± 8%, 49 ± 8%, 47 ± 9%; p = 0.006) and higher troponin I peaks (54 ± 44, 73 ± 66, 106 ± 81 ng/mL; p = 0.001) were found across the groups. An increase in primary (4%, 14%, 19%; p = 0.03) and secondary (10%, 15%, 23%; p = 0.02) endpoint rate was observed going from group 1 to group 3. The adjusted odds ratio increment of the primary endpoint from one group to the next was 1.65 (95% CI 1.04–2.61; p = 0.03), while the adjusted hazard ratio increment of the secondary endpoint was 1.55 (95% CI 1.12–2.52; p = 0.03). The addition of study group allocation to admission troponin I reclassified 12% and 22% of patients for the primary and secondary endpoint, respectively. Conclusions: Detection of mitochondrial biomarkers is common in STEMI and seems to be associated with in-hospital and long-term outcome independently of troponin.
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Affiliation(s)
- Nicola Cosentino
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (J.C.); (M.M.); (C.L.); (V.M.); (M.R.); (M.D.M.); (I.M.); (M.G.); (A.B.); (F.V.); (G.L.); (A.L.B.); (G.M.)
- Correspondence: ; Tel.: +39-0258-0021
| | - Jeness Campodonico
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (J.C.); (M.M.); (C.L.); (V.M.); (M.R.); (M.D.M.); (I.M.); (M.G.); (A.B.); (F.V.); (G.L.); (A.L.B.); (G.M.)
| | - Marco Moltrasio
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (J.C.); (M.M.); (C.L.); (V.M.); (M.R.); (M.D.M.); (I.M.); (M.G.); (A.B.); (F.V.); (G.L.); (A.L.B.); (G.M.)
| | - Claudia Lucci
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (J.C.); (M.M.); (C.L.); (V.M.); (M.R.); (M.D.M.); (I.M.); (M.G.); (A.B.); (F.V.); (G.L.); (A.L.B.); (G.M.)
| | - Valentina Milazzo
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (J.C.); (M.M.); (C.L.); (V.M.); (M.R.); (M.D.M.); (I.M.); (M.G.); (A.B.); (F.V.); (G.L.); (A.L.B.); (G.M.)
| | - Mara Rubino
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (J.C.); (M.M.); (C.L.); (V.M.); (M.R.); (M.D.M.); (I.M.); (M.G.); (A.B.); (F.V.); (G.L.); (A.L.B.); (G.M.)
| | - Monica De Metrio
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (J.C.); (M.M.); (C.L.); (V.M.); (M.R.); (M.D.M.); (I.M.); (M.G.); (A.B.); (F.V.); (G.L.); (A.L.B.); (G.M.)
| | - Ivana Marana
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (J.C.); (M.M.); (C.L.); (V.M.); (M.R.); (M.D.M.); (I.M.); (M.G.); (A.B.); (F.V.); (G.L.); (A.L.B.); (G.M.)
| | - Marco Grazi
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (J.C.); (M.M.); (C.L.); (V.M.); (M.R.); (M.D.M.); (I.M.); (M.G.); (A.B.); (F.V.); (G.L.); (A.L.B.); (G.M.)
| | - Alice Bonomi
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (J.C.); (M.M.); (C.L.); (V.M.); (M.R.); (M.D.M.); (I.M.); (M.G.); (A.B.); (F.V.); (G.L.); (A.L.B.); (G.M.)
| | - Fabrizio Veglia
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (J.C.); (M.M.); (C.L.); (V.M.); (M.R.); (M.D.M.); (I.M.); (M.G.); (A.B.); (F.V.); (G.L.); (A.L.B.); (G.M.)
| | - Gianfranco Lauri
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (J.C.); (M.M.); (C.L.); (V.M.); (M.R.); (M.D.M.); (I.M.); (M.G.); (A.B.); (F.V.); (G.L.); (A.L.B.); (G.M.)
| | - Antonio L. Bartorelli
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (J.C.); (M.M.); (C.L.); (V.M.); (M.R.); (M.D.M.); (I.M.); (M.G.); (A.B.); (F.V.); (G.L.); (A.L.B.); (G.M.)
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, 20122 Milan, Italy
| | - Giancarlo Marenzi
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (J.C.); (M.M.); (C.L.); (V.M.); (M.R.); (M.D.M.); (I.M.); (M.G.); (A.B.); (F.V.); (G.L.); (A.L.B.); (G.M.)
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Lucci C, Cosentino N, Genovese S, Campodonico J, Milazzo V, De Metrio M, Rondinelli M, Riggio D, Biondi ML, Rubino M, Celentano K, Bonomi A, Capra N, Veglia F, Agostoni P, Bartorelli AL, Marenzi G. Prognostic impact of admission high-sensitivity C-reactive protein in acute myocardial infarction patients with and without diabetes mellitus. Cardiovasc Diabetol 2020; 19:183. [PMID: 33081810 PMCID: PMC7576820 DOI: 10.1186/s12933-020-01157-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/10/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND High-sensitivity C-reactive protein (hs-CRP) elevation frequently occurs in acute myocardial infarction (AMI) and is associated with adverse outcomes. Since diabetes mellitus (DM) is characterized by an underlying chronic inflammation, hs-CRP may have a different prognostic power in AMI patients with and without DM. METHODS We prospectively included 2064 AMI patients; hs-CRP was measured at hospital admission. Patients were grouped according to hs-CRP quartiles and DM status. The primary endpoint was a composite of in-hospital mortality, cardiogenic shock, and acute pulmonary edema. Two-year all-cause mortality was the secondary endpoint. RESULTS Twenty-six percent (n = 548) of patients had DM and they had higher hs-CRP levels than non-DM patients (5.32 vs. 3.24 mg/L; P < 0.0001). The primary endpoint incidence in the overall population (7%, 9%, 13%, 22%; P for trend < 0.0001), in DM (14%, 9%, 21%, 27%; P = 0.0001), and non-DM (5%, 8%, 10%, 19%; P < 0.0001) patients increased in parallel with hs-CRP quartiles. The adjusted risk of the primary endpoint increased in parallel with hs-CRP quartiles in DM and non-DM patients but this relationship was less evident in DM patients. In the overall population, the adjusted OR of the primary endpoint associated with an hs-CRP value ≥ 2 mg/L was 2.10 (95% CI 1.46-3.00). For the same risk, hs-CRP was 7 and 2 mg/L in patients with and without DM. A similar behavior was observed for the secondary endpoint when the HR associated with an hs-CRP value ≥ 2 mg/L found in the overall population was 2.25 (95% CI 1.57-3.22). For the same risk, hs-CRP was 8 and 1.5 mg/L in DM and non-DM patients. CONCLUSIONS This study shows that hs-CRP predicts in-hospital outcome and two-year mortality in AMI patients with and without DM. However, in DM patients, the same risk of developing events as in non-DM patients is associated to higher hs-CRP levels.
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Affiliation(s)
- Claudia Lucci
- Centro Cardiologico Monzino IRCCS, Via Parea 4, Milan, 20138, Italy
| | - Nicola Cosentino
- Centro Cardiologico Monzino IRCCS, Via Parea 4, Milan, 20138, Italy
| | - Stefano Genovese
- Centro Cardiologico Monzino IRCCS, Via Parea 4, Milan, 20138, Italy
| | | | | | - Monica De Metrio
- Centro Cardiologico Monzino IRCCS, Via Parea 4, Milan, 20138, Italy
| | | | - Daniela Riggio
- Centro Cardiologico Monzino IRCCS, Via Parea 4, Milan, 20138, Italy
| | | | - Mara Rubino
- Centro Cardiologico Monzino IRCCS, Via Parea 4, Milan, 20138, Italy
| | - Katia Celentano
- Centro Cardiologico Monzino IRCCS, Via Parea 4, Milan, 20138, Italy
| | - Alice Bonomi
- Centro Cardiologico Monzino IRCCS, Via Parea 4, Milan, 20138, Italy
| | - Nicolò Capra
- Centro Cardiologico Monzino IRCCS, Via Parea 4, Milan, 20138, Italy
| | - Fabrizio Veglia
- Centro Cardiologico Monzino IRCCS, Via Parea 4, Milan, 20138, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino IRCCS, Via Parea 4, Milan, 20138, Italy
- Department of Clinical Sciences and Community Health - Cardiovascular Section, University of Milan, Milan, Italy
| | - Antonio L Bartorelli
- Centro Cardiologico Monzino IRCCS, Via Parea 4, Milan, 20138, Italy
- Department of Biomedical and Clinical Sciences, "Luigi Sacco", University of Milan, Milan, Italy
| | - Giancarlo Marenzi
- Centro Cardiologico Monzino IRCCS, Via Parea 4, Milan, 20138, Italy.
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Marenzi GS, Campodonico J, Cosentino N, Lucci C, Milazzo V, Moltrasio M, Celentano K, Biondi ML, De Metrio M, Rubino M, Marana I, Grazi M, Lauri G. HIGH-SENSITIVITY C-REACTIVE PROTEIN AND ACUTE KIDNEY INJURY IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)30790-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Marenzi GS, Lucci C, Cosentino N, Campodonico J, Biondi ML, Milazzo V, De Metrio M, Celentano K, Moltrasio M, Rubino M, Marana I, Grazi M, Lauri G, Genovese S. DIFFERENT PROGNOSTIC IMPACT OF HIGH-SENSITIVITY C-REACTIVE PROTEIN IN ACUTE MYOCARDIAL INFARCTION PATIENTS WITH AND WITHOUT TYPE 2 DIABETES MELLITUS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)30791-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Cosentino N, Genovese S, Campodonico J, Bonomi A, Lucci C, Milazzo V, Moltrasio M, Biondi ML, Riggio D, Veglia F, Ceriani R, Celentano K, De Metrio M, Rubino M, Bartorelli AL, Marenzi G. High-Sensitivity C-Reactive Protein and Acute Kidney Injury in Patients with Acute Myocardial Infarction: A Prospective Observational Study. J Clin Med 2019; 8:jcm8122192. [PMID: 31842300 PMCID: PMC6947188 DOI: 10.3390/jcm8122192] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/06/2019] [Accepted: 12/09/2019] [Indexed: 01/08/2023] Open
Abstract
Background. Accumulating evidence suggests that inflammation plays a key role in acute kidney injury (AKI) pathogenesis. We explored the relationship between high-sensitivity C-reactive protein (hs-CRP) and AKI in acute myocardial infarction (AMI). Methods. We prospectively included 2,063 AMI patients in whom hs-CRP was measured at admission. AKI incidence and a clinical composite of in-hospital death, cardiogenic shock, and acute pulmonary edema were the study endpoints. Results. Two-hundred-thirty-four (11%) patients developed AKI. hs-CRP levels were higher in AKI patients (45 ± 87 vs. 16 ± 41 mg/L; p < 0.0001). The incidence and severity of AKI, as well as the rate of the composite endpoint, increased in parallel with hs-CRP quartiles (p for trend <0.0001 for all comparisons). A significant correlation was found between hs-CRP and the maximal increase of serum creatinine (R = 0.23; p < 0.0001). The AUC of hs-CRP for AKI prediction was 0.69 (p < 0.001). At reclassification analysis, addition of hs-CRP allowed to properly reclassify 14% of patients when added to creatinine and 8% of patients when added to a clinical model. Conclusions. In AMI, admission hs-CRP is closely associated with AKI development and severity, and with in-hospital outcomes. Future research should focus on whether prophylactic renal strategies in patients with high hs-CRP might prevent AKI and improve outcome.
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Affiliation(s)
- Nicola Cosentino
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (N.C.); (S.G.); (J.C.); (A.B.); (C.L.); (V.M.); (M.M.); (M.L.B.); (D.R.); (F.V.); (R.C.); (K.C.); (M.D.M.); (M.R.); (A.L.B.)
| | - Stefano Genovese
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (N.C.); (S.G.); (J.C.); (A.B.); (C.L.); (V.M.); (M.M.); (M.L.B.); (D.R.); (F.V.); (R.C.); (K.C.); (M.D.M.); (M.R.); (A.L.B.)
| | - Jeness Campodonico
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (N.C.); (S.G.); (J.C.); (A.B.); (C.L.); (V.M.); (M.M.); (M.L.B.); (D.R.); (F.V.); (R.C.); (K.C.); (M.D.M.); (M.R.); (A.L.B.)
| | - Alice Bonomi
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (N.C.); (S.G.); (J.C.); (A.B.); (C.L.); (V.M.); (M.M.); (M.L.B.); (D.R.); (F.V.); (R.C.); (K.C.); (M.D.M.); (M.R.); (A.L.B.)
| | - Claudia Lucci
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (N.C.); (S.G.); (J.C.); (A.B.); (C.L.); (V.M.); (M.M.); (M.L.B.); (D.R.); (F.V.); (R.C.); (K.C.); (M.D.M.); (M.R.); (A.L.B.)
| | - Valentina Milazzo
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (N.C.); (S.G.); (J.C.); (A.B.); (C.L.); (V.M.); (M.M.); (M.L.B.); (D.R.); (F.V.); (R.C.); (K.C.); (M.D.M.); (M.R.); (A.L.B.)
| | - Marco Moltrasio
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (N.C.); (S.G.); (J.C.); (A.B.); (C.L.); (V.M.); (M.M.); (M.L.B.); (D.R.); (F.V.); (R.C.); (K.C.); (M.D.M.); (M.R.); (A.L.B.)
| | - Maria Luisa Biondi
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (N.C.); (S.G.); (J.C.); (A.B.); (C.L.); (V.M.); (M.M.); (M.L.B.); (D.R.); (F.V.); (R.C.); (K.C.); (M.D.M.); (M.R.); (A.L.B.)
| | - Daniela Riggio
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (N.C.); (S.G.); (J.C.); (A.B.); (C.L.); (V.M.); (M.M.); (M.L.B.); (D.R.); (F.V.); (R.C.); (K.C.); (M.D.M.); (M.R.); (A.L.B.)
| | - Fabrizio Veglia
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (N.C.); (S.G.); (J.C.); (A.B.); (C.L.); (V.M.); (M.M.); (M.L.B.); (D.R.); (F.V.); (R.C.); (K.C.); (M.D.M.); (M.R.); (A.L.B.)
| | - Roberto Ceriani
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (N.C.); (S.G.); (J.C.); (A.B.); (C.L.); (V.M.); (M.M.); (M.L.B.); (D.R.); (F.V.); (R.C.); (K.C.); (M.D.M.); (M.R.); (A.L.B.)
| | - Katia Celentano
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (N.C.); (S.G.); (J.C.); (A.B.); (C.L.); (V.M.); (M.M.); (M.L.B.); (D.R.); (F.V.); (R.C.); (K.C.); (M.D.M.); (M.R.); (A.L.B.)
| | - Monica De Metrio
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (N.C.); (S.G.); (J.C.); (A.B.); (C.L.); (V.M.); (M.M.); (M.L.B.); (D.R.); (F.V.); (R.C.); (K.C.); (M.D.M.); (M.R.); (A.L.B.)
| | - Mara Rubino
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (N.C.); (S.G.); (J.C.); (A.B.); (C.L.); (V.M.); (M.M.); (M.L.B.); (D.R.); (F.V.); (R.C.); (K.C.); (M.D.M.); (M.R.); (A.L.B.)
| | - Antonio L. Bartorelli
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (N.C.); (S.G.); (J.C.); (A.B.); (C.L.); (V.M.); (M.M.); (M.L.B.); (D.R.); (F.V.); (R.C.); (K.C.); (M.D.M.); (M.R.); (A.L.B.)
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, 20138 Milan, Italy
| | - Giancarlo Marenzi
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (N.C.); (S.G.); (J.C.); (A.B.); (C.L.); (V.M.); (M.M.); (M.L.B.); (D.R.); (F.V.); (R.C.); (K.C.); (M.D.M.); (M.R.); (A.L.B.)
- Correspondence: ; Tel.: +39-02-580021; Fax: +39-02-58002287
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Marenzi G, Cosentino N, Genovese S, Campodonico J, De Metrio M, Rondinelli M, Cornara S, Somaschini A, Camporotondo R, Demarchi A, Milazzo V, Moltrasio M, Rubino M, Marana I, Grazi M, Lauri G, Bonomi A, Veglia F, De Ferrari GM, Bartorelli AL. Reduced Cardio-Renal Function Accounts for Most of the In-Hospital Morbidity and Mortality Risk Among Patients With Type 2 Diabetes Undergoing Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction. Diabetes Care 2019; 42:1305-1311. [PMID: 31048409 DOI: 10.2337/dc19-0047] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 04/08/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE ST-segment elevation myocardial infarction (STEMI) patients with type 2 diabetes mellitus (DM) have higher in-hospital mortality than those without. Since cardiac and renal functions are the main variables associated with outcome in STEMI, we hypothesized that this prognostic disparity may depend on a higher rate of cardiac and renal dysfunction in DM patients. RESEARCH DESIGN AND METHODS We retrospectively analyzed 5,152 STEMI patients treated with primary angioplasty. Left ventricular ejection fraction (LVEF) and estimated glomerular filtration rate (eGFR) were evaluated at hospital admission. The primary end point was in-hospital mortality. A composite of in-hospital mortality, cardiogenic shock, and acute kidney injury was the secondary end point. RESULTS There were 879 patients (17%) with DM. The incidence of LVEF ≤40% (30% vs. 22%), eGFR ≤60 mL/min/1.73 m2 (27% vs. 18%), or both (12% vs. 6%) was higher (P < 0.001 for all comparisons) in DM patients. In-hospital mortality was higher in DM patients than in non-DM patients (6.1% vs. 3.5%; P = 0.002), with an unadjusted odds ratio (OR) of 1.81 (95% CI 1.31-2.49; P < 0.001). However, DM was no longer associated with an increased mortality risk after adjustment for cardiac and renal function (OR 1.03, 95% CI 0.68-1.56; P = 0.89). A similar behavior was observed for the secondary end point, with an unadjusted OR for DM of 1.52 (95% CI 1.25-1.85; P < 0.001) and an OR after adjustment for cardiac and renal function of 1.07 (95% CI 0.85-1.36; P = 0.53). CONCLUSIONS The study indicates that the increased in-hospital mortality and morbidity of DM patients with STEMI is mainly driven by their underlying cardio-renal dysfunction.
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Affiliation(s)
- Giancarlo Marenzi
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Nicola Cosentino
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Stefano Genovese
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Jeness Campodonico
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Monica De Metrio
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Maurizio Rondinelli
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Stefano Cornara
- Department of Cardiology and Cardiovascular Clinical Research Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
| | - Alberto Somaschini
- Department of Cardiology and Cardiovascular Clinical Research Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
| | - Rita Camporotondo
- Department of Cardiology and Cardiovascular Clinical Research Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
| | - Andrea Demarchi
- Department of Cardiology and Cardiovascular Clinical Research Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
| | - Valentina Milazzo
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Marco Moltrasio
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Mara Rubino
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Ivana Marana
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Marco Grazi
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Gianfranco Lauri
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Alice Bonomi
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Fabrizio Veglia
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Gaetano M De Ferrari
- Department of Cardiology and Cardiovascular Clinical Research Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
| | - Antonio L Bartorelli
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy.,Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Milan, Italy
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Cosentino N, Campodonico J, Faggiano P, De Metrio M, Rubino M, Milazzo V, Sbolli M, Perego C, Provini M, Bonomi A, Veglia F, Bartorelli AL, Marenzi G. A new score based on the PEGASUS-TIMI 54 criteria for risk stratification of patients with acute myocardial infarction. Int J Cardiol 2019; 278:1-6. [DOI: 10.1016/j.ijcard.2018.11.142] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 11/06/2018] [Accepted: 11/30/2018] [Indexed: 12/22/2022]
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Campodonico J, Cosentino N, Milazzo V, Rubino M, De Metrio M, Marana I, Moltrasio M, Grazi M, Lauri G, Bonomi A, Veglia F, Chiorino E, Assanelli E, Bartorelli AL, Marenzi G. Impact of Chronic Antiplatelet Therapy on Infarct Size and Bleeding in Patients With Acute Myocardial Infarction. J Cardiovasc Pharmacol Ther 2018; 23:407-413. [PMID: 29669424 DOI: 10.1177/1074248418769636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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 Patients hospitalized with acute myocardial infarction (AMI) are often on prior single antiplatelet therapy (SAPT) or a dual antiplatelet therapy (DAPT). Whether chronic SAPT or DAPT is beneficial or associated with an increased risk in AMI is still controversial. METHODS AND RESULTS We prospectively enrolled 1718 consecutive patients with AMI (798 ST-segment elevation myocardial infarction and 920 non-ST-segment elevation myocardial infarction) who were divided according to their chronic APT (no APT, SAPT, or DAPT). The study primary end point was the infarct size, as estimated by troponin I peak. Incidence of major bleeding was also evaluated. Five hundred thirty-six (31%) patients were on chronic SAPT and 215 (13%) on DAPT. A graded increase in Global Registry of Acute Coronary Events (GRACE) and Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines (CRUSADE) risk scores was found going from patients without APT to those with DAPT, while a progressive smaller troponin I peak was observed with the increasing number of chronic antiplatelet agents (11.2 [interquartile range: 2-45] ng/mL, 6.6 [1-33] ng/mL, and 4.1 [1-24] ng/mL; P < .001 for trend). This result was maintained after adjustment for baseline ischemic risk profile (GRACE score) and other major confounders ( P < .001). The incidence of bleeding was higher in patients on chronic APT than in those without APT (5.2% vs 2.4%; P = .002). However, when the bleeding risk was adjusted for the CRUSADE risk score, chronic SAPT (odds ratio [OR]: 1.40, 95% confidence interval [CI]: 0.77-2.53) and DAPT (OR: 0.70, 95% CI: 0.29-1.70) were not associated with an increased bleeding risk. CONCLUSION In patients with AMI, chronic APT is associated with higher baseline ischemic and bleeding risks. Despite this and unexpectedly, they have a smaller infarct size and similar adjusted bleeding risk.
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Affiliation(s)
| | | | | | - Mara Rubino
- 1 Centro Cardiologico Monzino, I.R.C.C.S, Milan, Italy
| | | | - Ivana Marana
- 1 Centro Cardiologico Monzino, I.R.C.C.S, Milan, Italy
| | | | - Marco Grazi
- 1 Centro Cardiologico Monzino, I.R.C.C.S, Milan, Italy
| | | | - Alice Bonomi
- 1 Centro Cardiologico Monzino, I.R.C.C.S, Milan, Italy
| | | | | | | | - Antonio L Bartorelli
- 1 Centro Cardiologico Monzino, I.R.C.C.S, Milan, Italy.,2 Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Milan, Italy
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Marenzi G, Cosentino N, Milazzo V, De Metrio M, Rubino M, Campodonico J, Moltrasio M, Marana I, Grazi M, Lauri G, Bonomi A, Barbieri S, Assanelli E, Dalla Cia A, Manfrini R, Ceriani R, Bartorelli A. Acute Kidney Injury in Diabetic Patients With Acute Myocardial Infarction: Role of Acute and Chronic Glycemia. J Am Heart Assoc 2018; 7:JAHA.117.008122. [PMID: 29654205 PMCID: PMC6015410 DOI: 10.1161/jaha.117.008122] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 01/08/2023]
Abstract
Background In acute myocardial infarction, acute hyperglycemia is a predictor of acute kidney injury (AKI), particularly in patients without diabetes mellitus. This emphasizes the importance of an acute glycemic rise rather than glycemia level at admission. We investigated whether, in diabetic patients with acute myocardial infarction, the combined evaluation of acute and chronic glycemic levels may have better prognostic value for AKI than admission glycemia. Methods and Results At admission, we prospectively measured glycemia and estimated average chronic glucose levels (mg/dL) using glycosylated hemoglobin (HbA1c), according to the following formula: 28.7×HbA1c (%)−46.7. We evaluated the association with AKI of the acute/chronic glycemic ratio and of the difference between acute and chronic glycemia (ΔA−C). We enrolled 474 diabetic patients with acute myocardial infarction. Of them, 77 (16%) experienced AKI. The incidence of AKI increased in parallel with the acute/chronic glycemic ratio (12%, 14%, 22%; P=0.02 for trend) and ΔA−C (13%, 13%, 23%; P=0.01) but not with admission glycemic tertiles (P=0.22). At receiver operating characteristic analysis, the acute/chronic glycemic ratio (area under the curve: 0.62 [95% confidence interval, 0.55–0.69]; P=0.001) and ΔA−C (area under the curve: 0.62 [95% confidence interval, 0.54–0.69]; P=0.002) accurately predicted AKI, without difference in the area under the curve between them (P=0.53). At reclassification analysis, the addition of the acute/chronic glycemic ratio and ΔA−C to acute glycemia allowed proper AKI risk prediction in 16% of patients. Conclusions In diabetic patients with acute myocardial infarction, AKI is better predicted by the combined evaluation of acute and chronic glycemic values than by assessment of admission glycemia alone.
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Affiliation(s)
| | | | | | | | - Mara Rubino
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | | | | | - Marco Grazi
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | | | | | | | | | | | | | - Antonio Bartorelli
- Centro Cardiologico Monzino IRCCS, Milan, Italy.,Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Italy
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13
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Marenzi G, Cosentino N, Milazzo V, De Metrio M, Cecere M, Mosca S, Rubino M, Campodonico J, Moltrasio M, Marana I, Grazi M, Lauri G, Bonomi A, Veglia F, Manfrini R, Bartorelli AL. Prognostic Value of the Acute-to-Chronic Glycemic Ratio at Admission in Acute Myocardial Infarction: A Prospective Study. Diabetes Care 2018; 41:847-853. [PMID: 29382659 DOI: 10.2337/dc17-1732] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 12/19/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Acute hyperglycemia is a powerful predictor of poor prognosis in acute myocardial infarction (AMI), particularly in patients without diabetes. This emphasizes the importance of an acute glycemic rise rather than glycemia level at admission alone. We investigated in AMI whether the combined evaluation of acute and chronic glycemic levels, as compared with admission glycemia alone, may have a better prognostic value. RESEARCH DESIGN AND METHODS We prospectively measured admission glycemia and estimated average chronic glucose levels (mg/dL) by the following formula: [(28.7 × glycosylated hemoglobin %) - 46.7], and calculated the acute-to-chronic (A/C) glycemic ratio in 1,553 consecutive AMI patients (mean ± SD age 67 ± 13 years). The primary end point was the combination of in-hospital mortality, acute pulmonary edema, and cardiogenic shock. RESULTS The primary end point rate increased in parallel with A/C glycemic ratio tertiles (5%, 8%, and 20%, respectively; P for trend <0.0001). A parallel increase was observed in troponin I peak value (15 ± 34 ng/mL, 34 ± 66 ng/mL, and 68 ± 131 ng/mL; P < 0.0001). At multivariable analysis, A/C glycemic ratio remained an independent predictor of the primary end point and of troponin I peak value, even after adjustment for major confounders. At reclassification analyses, A/C glycemic ratio showed the best prognostic power in predicting the primary end point as compared with glycemia at admission in the entire population (net reclassification improvement 12% [95% CI 4-20]; P = 0.003) and, particularly, in patients with diabetes (27% [95% CI 14-40]; P < 0.0001). CONCLUSIONS In AMI patients with diabetes, A/C glycemic ratio is a better predictor of in-hospital morbidity and mortality than glycemia at admission.
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Affiliation(s)
- Giancarlo Marenzi
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Nicola Cosentino
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Valentina Milazzo
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Monica De Metrio
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Milena Cecere
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Susanna Mosca
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Mara Rubino
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Jeness Campodonico
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Marco Moltrasio
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Ivana Marana
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Marco Grazi
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Gianfranco Lauri
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Alice Bonomi
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Fabrizio Veglia
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Roberto Manfrini
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Antonio L Bartorelli
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy.,Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Milan, Italy
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Marenzi GS, Cosentino N, Campodonico J, Milazzo V, Metrio MD, Rubino M, Faggiano P. A NEW SCORE FOR RISK STRATIFICATION OF PATIENTS WITH ACUTE MYOCARDIAL INFARCTION BASED ON THE PEGASUS-TIMI 54 CRITERIA. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)33403-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Marenzi GS, Cosentino N, Campodonico J, Moltrasio M, Milazzo V, Rubino M, Cecere M, Mosca S, Metrio MD, Marana I, Grazi M, Lauri G, Bartorelli A. RENAL REPLACEMENT THERAPY IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION: RATE OF USE, CLINICAL PREDICTORS AND RELATIONSHIP WITH IN-HOSPITAL MORTALITY. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)33623-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Marenzi G, Cosentino N, Marinetti A, Leone AM, Milazzo V, Rubino M, De Metrio M, Cabiati A, Campodonico J, Moltrasio M, Bertoli S, Cecere M, Mosca S, Marana I, Grazi M, Lauri G, Bonomi A, Veglia F, Bartorelli AL. Renal replacement therapy in patients with acute myocardial infarction: Rate of use, clinical predictors and relationship with in-hospital mortality. Int J Cardiol 2017; 230:255-261. [DOI: 10.1016/j.ijcard.2016.12.130] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 11/21/2016] [Accepted: 12/16/2016] [Indexed: 11/25/2022]
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Milazzo V, De Metrio M, Cosentino N, Marenzi G, Tremoli E. Vitamin D and acute myocardial infarction. World J Cardiol 2017; 9:14-20. [PMID: 28163832 PMCID: PMC5253190 DOI: 10.4330/wjc.v9.i1.14] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 09/21/2016] [Accepted: 11/29/2016] [Indexed: 02/06/2023] Open
Abstract
Vitamin D deficiency is a prevalent condition, cutting across all ethnicities and among all age groups, and occurring in about 30%-50% of the population. Besides vitamin D established role in calcium homeostasis, its deficiency is emerging as a new risk factor for coronary artery disease. Notably, clinical investigations have suggested that there is an association between hypovitaminosis D and acute myocardial infarction (AMI). Not only has it been linked to incident AMI, but also to increased morbidity and mortality in this clinical setting. Moreover, vitamin D deficiency seems to predispose to recurrent adverse cardiovascular events, as it is associated with post-infarction complications and cardiac remodeling in patients with AMI. Several mechanisms underlying the association between vitamin D and AMI risk can be involved. Despite these observational and mechanistic data, interventional trials with supplementation of vitamin D are controversial. In this review, we will discuss the evidence on the association between vitamin D deficiency and AMI, in terms of prevalence and prognostic impact, and the possible mechanisms mediating it. Further research in this direction is warranted and it is likely to open up new avenues for reducing the risk of AMI.
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Moltrasio M, Cosentino N, De Metrio M, Rubino M, Cabiati A, Milazzo V, Discacciati A, Marana I, Bonomi A, Veglia F, Lauri G, Marenzi G. Brain natriuretic peptide in acute myocardial infarction. J Cardiovasc Med (Hagerstown) 2016; 17:803-9. [DOI: 10.2459/jcm.0000000000000353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Marenzi G, Cosentino N, Moltrasio M, Rubino M, Crimi G, Buratti S, Grazi M, Milazzo V, Somaschini A, Camporotondo R, Cornara S, De Metrio M, Bonomi A, Veglia F, De Ferrari GM, Bartorelli AL. Acute Kidney Injury Definition and In-Hospital Mortality in Patients Undergoing Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction. J Am Heart Assoc 2016; 5:JAHA.116.003522. [PMID: 27385429 PMCID: PMC5015390 DOI: 10.1161/jaha.116.003522] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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] [Indexed: 12/20/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) has been associated with increased mortality in ST-segment elevation myocardial infarction. We compared the mortality predictive accuracy of the 3 AKI definitions used most widely for patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. METHODS AND RESULTS We included 3771 patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention at 2 Italian hospitals. AKI incidence was evaluated according to creatinine increases of ≥25% (AKI-25), ≥0.3 mg/dL (AKI-0.3), and ≥0.5 mg/dL (AKI-0.5). The primary end point was in-hospital mortality. Overall, 557 (15%), 522 (14%), and 270 (7%) patients developed AKI-25, AKI-0.3, and AKI-0.5, respectively (P<0.01). All AKI definitions independently predicted in-hospital mortality (adjusted odds ratio 4.9 [95% CI 3.1-7.8], 5.4 [95% CI 3.3-8.6], and 8.3 [95% CI 5.1-13.3], respectively; P<0.01 for all). At receiver operating characteristic analysis, the addition of each AKI definition to combined clinical predictors of mortality (age, sex, left ventricular ejection fraction, admission creatinine, creatine kinase-MB peak) found at stepwise analysis significantly improved mortality prognostication (area under the curve increased from 0.89 for clinical predictor combination alone to 0.92 for AKI-25, 0.92 for AKI-0.3, and 0.93 for AKI-0.5; P<0.01 for all). At reclassification analysis, AKI-0.5 added to clinical predictors, provided the highest score in mortality (net reclassification improvement +10% versus AKI-0.3 [P=0.01] and +8% versus AKI-25 [P=0.05]). CONCLUSIONS Each AKI definition significantly improved the mortality prediction beyond major clinical variables. AKI-0.5 showed a mortality discrimination advantage, suggesting it should be the preferred definition in studies addressing ST-segment elevation myocardial infarction and focusing on short-term mortality.
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Affiliation(s)
| | - Nicola Cosentino
- Centro Cardiologico Monzino, I.R.C.C.S., University of Milan, Italy
| | - Marco Moltrasio
- Centro Cardiologico Monzino, I.R.C.C.S., University of Milan, Italy
| | - Mara Rubino
- Centro Cardiologico Monzino, I.R.C.C.S., University of Milan, Italy
| | - Gabriele Crimi
- Department of Cardiology and Cardiovascular Clinical Research Center, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Stefano Buratti
- Department of Cardiology and Cardiovascular Clinical Research Center, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Marco Grazi
- Centro Cardiologico Monzino, I.R.C.C.S., University of Milan, Italy
| | | | - Alberto Somaschini
- Department of Cardiology and Cardiovascular Clinical Research Center, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy Department of Molecular Medicine, University of Pavia, Italy
| | - Rita Camporotondo
- Department of Cardiology and Cardiovascular Clinical Research Center, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Stefano Cornara
- Department of Cardiology and Cardiovascular Clinical Research Center, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy Department of Molecular Medicine, University of Pavia, Italy
| | - Monica De Metrio
- Centro Cardiologico Monzino, I.R.C.C.S., University of Milan, Italy
| | - Alice Bonomi
- Centro Cardiologico Monzino, I.R.C.C.S., University of Milan, Italy
| | - Fabrizio Veglia
- Centro Cardiologico Monzino, I.R.C.C.S., University of Milan, Italy
| | - Gaetano M De Ferrari
- Department of Cardiology and Cardiovascular Clinical Research Center, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy Department of Molecular Medicine, University of Pavia, Italy
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Lauri G, Rossi C, Rubino M, Cosentino N, Milazzo V, Marana I, Cabiati A, Moltrasio M, De Metrio M, Grazi M, Campodonico J, Assanelli E, Riggio D, Sandri MT, Bonomi A, Veglia F, Marenzi G. B-type natriuretic peptide levels in patients with pericardial effusion undergoing pericardiocentesis. Int J Cardiol 2016; 212:318-23. [DOI: 10.1016/j.ijcard.2016.03.075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 02/29/2016] [Accepted: 03/19/2016] [Indexed: 10/22/2022]
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Cosentino N, Lauri G, Rossi C, Rubino M, Milazzo V, Marana I, Moltrasio M, De Metrio M, Grazi M, Campodonico J, Marenzi G. B-TYPE NATRIURETIC PEPTIDE LEVELS IN PATIENTS WITH PERICARDIAL EFFUSION UNDERGOING PERICARDIOCENTESIS. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)31664-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Marenzi G, Cosentino N, Cortinovis S, Milazzo V, Rubino M, Cabiati A, De Metrio M, Moltrasio M, Lauri G, Campodonico J, Pontone G, Andreini D, Bonomi A, Veglia F, Bartorelli A. Myocardial Infarct Size in Patients on Long-Term Statin Therapy Undergoing Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction. Am J Cardiol 2015; 116:1791-7. [PMID: 26602070 DOI: 10.1016/j.amjcard.2015.09.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 09/22/2015] [Accepted: 09/22/2015] [Indexed: 01/19/2023]
Abstract
Statin pretreatment has been reported to have a cardioprotective effect in patients undergoing elective or urgent percutaneous coronary intervention (PCI). However, data on patients with ST-elevation myocardial infarction (STEMI) undergoing primary PCI are still controversial. We prospectively evaluated the effect of long-term statin therapy on infarct size (IS), myocardial salvage index (MSI), and microvascular obstruction (MVO) in consecutive patients with STEMI who underwent primary PCI. Two-hundred thirty patients with STEMI (mean age 61 ± 11 years, 183 men) who underwent primary PCI were evaluated with cardiac magnetic resonance (CMR) imaging during hospitalization (median 4 days after primary PCI). In all patients, we measured peak troponin I level, whereas IS, MSI, and MVO were determined by CMR. Fifty patients (22%) were on long-term statin therapy and showed a significantly lower troponin I peak value compared to patients without previous statins (54 ± 47 vs 88 ± 106 ng/ml; p = 0.02). At CMR evaluation, IS related to the index event was significantly smaller (12.5 ± 11.5 vs 18.5 ± 18.5 g, p = 0.05), and MSI was higher (0.68 ± 0.25 vs 0.52 ± 0.30; p <0.01) in patients with previous statin therapy. MVO was also less frequent (10% vs 20%; p = 0.14) in this group. At multivariate analysis, previous statin therapy remained significantly associated with IS and MSI (p = 0.05 and 0.02, respectively). In conclusion, this study suggests that long-term statin therapy before primary PCI in patients with STEMI is associated with smaller IS and higher MSI. Future studies are warranted to confirm these findings and to investigate potential clinical implications.
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Affiliation(s)
- Giancarlo Marenzi
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCSS), Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - Nicola Cosentino
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCSS), Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Sarah Cortinovis
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCSS), Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Valentina Milazzo
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCSS), Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Mara Rubino
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCSS), Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Angelo Cabiati
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCSS), Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Monica De Metrio
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCSS), Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Marco Moltrasio
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCSS), Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Gianfranco Lauri
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCSS), Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Jeness Campodonico
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCSS), Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Gianluca Pontone
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCSS), Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCSS), Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Alice Bonomi
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCSS), Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Fabrizio Veglia
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCSS), Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Antonio Bartorelli
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico (IRCSS), Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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De Metrio M, Milazzo V, Rubino M, Cabiati A, Moltrasio M, Marana I, Campodonico J, Cosentino N, Veglia F, Bonomi A, Camera M, Tremoli E, Marenzi G. Vitamin D plasma levels and in-hospital and 1-year outcomes in acute coronary syndromes: a prospective study. Medicine (Baltimore) 2015; 94:e857. [PMID: 25984675 PMCID: PMC4602571 DOI: 10.1097/md.0000000000000857] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Deficiency in 25-hydroxyvitamin D (25[OH]D), the main circulating form of vitamin D in blood, could be involved in the pathogenesis of acute coronary syndromes (ACS). To date, however, the possible prognostic relevance of 25 (OH)D deficiency in ACS patients remains poorly defined. The purpose of this prospective study was to assess the association between 25 (OH)D levels, at hospital admission, with in-hospital and 1-year morbidity and mortality in an unselected cohort of ACS patients.We measured 25 (OH)D in 814 ACS patients at hospital presentation. Vitamin D serum levels >30 ng/mL were considered as normal; levels between 29 and 21 ng/mL were classified as insufficiency, and levels < 20 ng/mL as deficiency. In-hospital and 1-year outcomes were evaluated according to 25 (OH)D level quartiles, using the lowest quartile as a reference.Ninety-three (11%) patients had normal 25 (OH)D levels, whereas 155 (19%) and 566 (70%) had vitamin D insufficiency and deficiency, respectively. The median 25 (OH)D level was similar in ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) patients (14.1 [IQR 9.0-21.9] ng/mL and 14.05 [IQR 9.1-22.05] ng/mL, respectively; P = .88). The lowest quartile of 25 (OH)D was associated with a higher risk for several in-hospital complications, including mortality. At a median follow-up of 366 (IQR 364-379) days, the lowest quartile of 25 (OH)D, after adjustment for the main confounding factors, remained significantly associated to 1-year mortality (P < .01). Similar results were obtained when STEMI and NSTEMI patients were considered separately.In ACS patients, severe vitamin D deficiency is independently associated with poor in-hospital and 1-year outcomes. Whether low vitamin D levels represent a risk marker or a risk factor in ACS remains to be elucidated.
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Affiliation(s)
- Monica De Metrio
- From the Centro Cardiologico Monzino, I.R.C.C.S., Milan, Italy (MD, VM, MR, AC, MM, IM, JC, NC, FV, AB, MC, ET, GM); and Dipartimento di Scienze Farmacologiche e Biomolecolari, University of Milan, Italy (MC, ET)
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Marenzi G, Cabiati A, Cosentino N, Assanelli E, Milazzo V, Rubino M, Lauri G, Morpurgo M, Moltrasio M, Marana I, De Metrio M, Bonomi A, Veglia F, Bartorelli A. Prognostic significance of serum creatinine and its change patterns in patients with acute coronary syndromes. Am Heart J 2015; 169:363-70. [PMID: 25728726 DOI: 10.1016/j.ahj.2014.11.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 11/21/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND In acute coronary syndromes (ACS), serum creatinine (sCr) levels have short- and long-term prognostic value. However, it is possible that repeated evaluations of sCr during hospitalization, rather than measuring sCr value at admission only, might improve risk assessment. We investigated the relationship between sCr baseline value, its changes, and in-hospital mortality in patients hospitalized with ACS. METHODS In 2,756 ACS patients, sCr was measured at hospital admission and then daily, until discharge from coronary care unit. Patients were grouped according to the maximum sCr change observed: <0.3 mg/dL change from baseline (stable renal function [SRF] group), ≥0.3 mg/dL decrease (improved renal function [IRF] group), and ≥0.3 mg/dL increase (worsening renal function [WRF] group). RESULTS Of the 2,756 patients, 2,163 (78%) had SRF, 292 (11%) had IRF, and 301 (11%) had WRF. In-hospital mortality in the 3 groups was 0.5%, 2%, and 14% (P < .001), respectively. Peak sCr value was a more powerful predictor of mortality (area under the curve 0.86, 95% CI 0.81-0.92) than the initial sCr value (area under the curve 0.69, 95% CI 0.63-0.77; P < .001). When sCr and its change patterns during coronary care unit stay were evaluated together, improved mortality risk stratification was found. CONCLUSIONS In ACS patients, daily sCr value and its change pattern are stronger predictors of in-hospital mortality than the initial sCr value only; thus, their combined evaluation provides a more accurate and dynamic stratification of patients' risk. Finally, the intermediate mortality risk of IRF patients possibly reflects acute kidney injury started before hospitalization.
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Ammirati E, Cristell N, Cianflone D, Vermi AC, Marenzi G, De Metrio M, Uren NG, Hu D, Ravasi T, Maseri A, Cannistraci CV. Questing for Circadian Dependence in ST-Segment–Elevation Acute Myocardial Infarction. Circ Res 2013; 112:e110-4. [DOI: 10.1161/circresaha.112.300778] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [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: 01/12/2023]
Abstract
Rationale:
Four monocentric studies reported that circadian rhythms can affect left ventricular infarct size after ST-segment–elevation acute myocardial infarction (STEMI).
Objective:
To further validate the circadian dependence of infarct size after STEMI in a multicentric and multiethnic population.
Methods and Results:
We analyzed a prospective cohort of subjects with first STEMI from the First Acute Myocardial Infarction study that enrolled 1099 patients (ischemic time <6 hours) in Italy, Scotland, and China. We confirmed a circadian variation of STEMI incidence with an increased morning incidence (from 6:00 am till noon). We investigated the presence of circadian dependence of infarct size plotting the peak creatine kinase against time onset of ischemia. In addition, we studied the patients from the 3 countries separately, including 624 Italians; all patients were treated with percutaneous coronary intervention. We adopted several levels of analysis with different inclusion criteria consistent with previous studies. In all the analyses, we did not find a clear-cut circadian dependence of infarct size after STEMI.
Conclusions:
Although the circadian dependence of infarct size supported by previous studies poses an intriguing hypothesis, we were unable to converge toward their conclusions in a multicentric and multiethnic setting. Parameters that vary as a function of latitude could potentially obscure the circadian variations observed in monocentric studies. We believe that, to assess whether circadian rhythms can affect the infarct size, future study design should not only include larger samples but also aim to untangle the molecular time–dynamic mechanisms underlying such a relation.
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Affiliation(s)
- Enrico Ammirati
- From the San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy (E.A., N.C., D.C., A.C.V.); Heart Transplantation Division, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan, Italy (E.A.); Heart Care Foundation, Florence, Italy (A.M.); Centro Cardiologico Monzino, IRCCS and University of Milan, Milan, Italy (G.M., M.D.M.); Department of Cardiology, Royal Infirmary of Edinburgh, United Kingdom (N.G.U.); The Heart Center, People’s Hospital of Peking University, Beijing, China
| | - Nicole Cristell
- From the San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy (E.A., N.C., D.C., A.C.V.); Heart Transplantation Division, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan, Italy (E.A.); Heart Care Foundation, Florence, Italy (A.M.); Centro Cardiologico Monzino, IRCCS and University of Milan, Milan, Italy (G.M., M.D.M.); Department of Cardiology, Royal Infirmary of Edinburgh, United Kingdom (N.G.U.); The Heart Center, People’s Hospital of Peking University, Beijing, China
| | - Domenico Cianflone
- From the San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy (E.A., N.C., D.C., A.C.V.); Heart Transplantation Division, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan, Italy (E.A.); Heart Care Foundation, Florence, Italy (A.M.); Centro Cardiologico Monzino, IRCCS and University of Milan, Milan, Italy (G.M., M.D.M.); Department of Cardiology, Royal Infirmary of Edinburgh, United Kingdom (N.G.U.); The Heart Center, People’s Hospital of Peking University, Beijing, China
| | - Anna-Chiara Vermi
- From the San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy (E.A., N.C., D.C., A.C.V.); Heart Transplantation Division, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan, Italy (E.A.); Heart Care Foundation, Florence, Italy (A.M.); Centro Cardiologico Monzino, IRCCS and University of Milan, Milan, Italy (G.M., M.D.M.); Department of Cardiology, Royal Infirmary of Edinburgh, United Kingdom (N.G.U.); The Heart Center, People’s Hospital of Peking University, Beijing, China
| | - Giancarlo Marenzi
- From the San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy (E.A., N.C., D.C., A.C.V.); Heart Transplantation Division, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan, Italy (E.A.); Heart Care Foundation, Florence, Italy (A.M.); Centro Cardiologico Monzino, IRCCS and University of Milan, Milan, Italy (G.M., M.D.M.); Department of Cardiology, Royal Infirmary of Edinburgh, United Kingdom (N.G.U.); The Heart Center, People’s Hospital of Peking University, Beijing, China
| | - Monica De Metrio
- From the San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy (E.A., N.C., D.C., A.C.V.); Heart Transplantation Division, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan, Italy (E.A.); Heart Care Foundation, Florence, Italy (A.M.); Centro Cardiologico Monzino, IRCCS and University of Milan, Milan, Italy (G.M., M.D.M.); Department of Cardiology, Royal Infirmary of Edinburgh, United Kingdom (N.G.U.); The Heart Center, People’s Hospital of Peking University, Beijing, China
| | - Neal G. Uren
- From the San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy (E.A., N.C., D.C., A.C.V.); Heart Transplantation Division, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan, Italy (E.A.); Heart Care Foundation, Florence, Italy (A.M.); Centro Cardiologico Monzino, IRCCS and University of Milan, Milan, Italy (G.M., M.D.M.); Department of Cardiology, Royal Infirmary of Edinburgh, United Kingdom (N.G.U.); The Heart Center, People’s Hospital of Peking University, Beijing, China
| | - Dayi Hu
- From the San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy (E.A., N.C., D.C., A.C.V.); Heart Transplantation Division, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan, Italy (E.A.); Heart Care Foundation, Florence, Italy (A.M.); Centro Cardiologico Monzino, IRCCS and University of Milan, Milan, Italy (G.M., M.D.M.); Department of Cardiology, Royal Infirmary of Edinburgh, United Kingdom (N.G.U.); The Heart Center, People’s Hospital of Peking University, Beijing, China
| | - Timothy Ravasi
- From the San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy (E.A., N.C., D.C., A.C.V.); Heart Transplantation Division, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan, Italy (E.A.); Heart Care Foundation, Florence, Italy (A.M.); Centro Cardiologico Monzino, IRCCS and University of Milan, Milan, Italy (G.M., M.D.M.); Department of Cardiology, Royal Infirmary of Edinburgh, United Kingdom (N.G.U.); The Heart Center, People’s Hospital of Peking University, Beijing, China
| | - Attilio Maseri
- From the San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy (E.A., N.C., D.C., A.C.V.); Heart Transplantation Division, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan, Italy (E.A.); Heart Care Foundation, Florence, Italy (A.M.); Centro Cardiologico Monzino, IRCCS and University of Milan, Milan, Italy (G.M., M.D.M.); Department of Cardiology, Royal Infirmary of Edinburgh, United Kingdom (N.G.U.); The Heart Center, People’s Hospital of Peking University, Beijing, China
| | - Carlo V. Cannistraci
- From the San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy (E.A., N.C., D.C., A.C.V.); Heart Transplantation Division, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan, Italy (E.A.); Heart Care Foundation, Florence, Italy (A.M.); Centro Cardiologico Monzino, IRCCS and University of Milan, Milan, Italy (G.M., M.D.M.); Department of Cardiology, Royal Infirmary of Edinburgh, United Kingdom (N.G.U.); The Heart Center, People’s Hospital of Peking University, Beijing, China
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Marenzi G, Cabiati A, Bertoli SV, Assanelli E, Marana I, De Metrio M, Rubino M, Moltrasio M, Grazi M, Campodonico J, Milazzo V, Veglia F, Lauri G, Bartorelli AL. Incidence and relevance of acute kidney injury in patients hospitalized with acute coronary syndromes. Am J Cardiol 2013; 111:816-22. [PMID: 23273525 DOI: 10.1016/j.amjcard.2012.11.046] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 11/27/2012] [Accepted: 11/27/2012] [Indexed: 10/27/2022]
Abstract
Acute kidney injury (AKI) occurs frequently in patients with acute coronary syndromes (ACS) and is associated with adverse short- and long-term outcomes. To date, however, no standardized definition of AKI has been used for patients with ACS. As a result, information on its true incidence and the clinical and prognostic relevance according to the severity of renal function deterioration are still lacking. We retrospectively studied 3,210 patients with ACS. AKI was identified on the basis of the changes in serum creatinine during hospitalization according to the AKI Network criteria. Overall, 409 patients (13%) developed AKI: 262 (64%) had stage 1, 25 (6%) stage 2, and 122 (30%) stage 3 AKI. In-hospital mortality was greater in patients with AKI than in those without AKI (21% vs 1%; p <0.001). The adjusted risk of death increased with increasing AKI severity. Compared to no AKI, the adjusted odds ratio for death was 3.5 (95% confidence interval 1.79 to 6.83) with stage 1 AKI and 31.2 (95% confidence interval 16.96 to 57.45) with stage 2 to 3 AKI. A significant parallel increase in major adverse cardiac events was also observed comparing patients without AKI and those with stage 2 to 3 AKI. In conclusion, in patients with ACS, AKI is a frequent complication, and the graded increase of its severity, as assessed using the AKI Network classification, is associated with a progressive increased risk of in-hospital morbidity and mortality.
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Cavalca V, Veglia F, Squellerio I, De Metrio M, Rubino M, Porro B, Moltrasio M, Tremoli E, Marenzi G. Circulating levels of dimethylarginines, chronic kidney disease and long-term clinical outcome in non-ST-elevation myocardial infarction. PLoS One 2012. [PMID: 23185262 PMCID: PMC3501498 DOI: 10.1371/journal.pone.0048499] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Mechanisms linking chronic kidney disease (CKD) and adverse outcomes in acute coronary syndromes (ACS) are not fully understood. Among potential key players, reduced nitric oxide (NO) synthesis due to its endogenous inhibitors, asymmetric (ADMA) and symmetric (SDMA) dimethylarginine could be involved. We measured plasma concentration of arginine, ADMA and SDMA and investigated their relationship with CKD and long-term outcome in non-ST-elevation myocardial infarction (NSTEMI). METHODOLOGY/PRINCIPAL FINDINGS We prospectively measured arginine, ADMA, and SDMA at hospital admission in 104 NSTEMI patients. CKD was defined as an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m(2). We considered a primary end point of combined cardiac death and re-infarction at a median follow-up of 21 months. In CKD (n = 33) and no-CKD (n = 71) patients, arginine and ADMA were similar, whereas SDMA was significantly higher in CKD patients (0.65±0.23 vs. 0.42±0.12 µmol/L; P<0.0001). Twenty-four (23%) patients had an adverse cardiac event during follow-up: 12 (36%) were CKD and 12 (17%) no-CKD patients (P = 0.02). When study population was stratified according to arginine, ADMA and SDMA median values, only SDMA (median 0.46 µmol/L) was associated with the primary end-point (P = 0.0016). In models adjusted for age, hemoglobin and left ventricular ejection fraction, the hazard ratio (HR) for CKD and SDMA were high (HR 2.93, interquartile range [IQR] 1.15-7.53; P = 0.02 and HR 6.80, IQR 2.09-22.2; P = 0.001, respectively) but, after mutual adjustment, only SDMA remained significantly associated with the primary end point (HR 5.73, IQR 1.55-21.2; P = 0.009). CONCLUSIONS/SIGNIFICANCE In NSTEMI patients, elevated SDMA plasma levels are associated with CKD and worse long-term prognosis.
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Marenzi G, Ferrari C, Marana I, Assanelli E, De Metrio M, Teruzzi G, Veglia F, Fabbiocchi F, Montorsi P, Bartorelli AL. Prevention of contrast nephropathy by furosemide with matched hydration: the MYTHOS (Induced Diuresis With Matched Hydration Compared to Standard Hydration for Contrast Induced Nephropathy Prevention) trial. JACC Cardiovasc Interv 2012; 5:90-7. [PMID: 22230154 DOI: 10.1016/j.jcin.2011.08.017] [Citation(s) in RCA: 169] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Accepted: 08/18/2011] [Indexed: 01/03/2023]
Abstract
OBJECTIVES This study investigated the effect of furosemide-forced diuresis and intravenous saline infusion matched with urine output, using a novel dedicated device designed for contrast-induced nephropathy (CIN) prevention. BACKGROUND CIN is a frequent cause of acute kidney injury associated with increased morbidity and mortality. METHODS A total of 170 consecutive patients with chronic kidney disease (CKD) undergoing coronary procedures were randomized to either furosemide with matched hydration (FMH group, n = 87) or to standard intravenous isotonic saline hydration (control group; n = 83). The FMH group received an initial 250-ml intravenous bolus of normal saline over 30 min followed by an intravenous bolus (0.5 mg/kg) of furosemide. Hydration infusion rate was automatically adjusted to precisely replace the patient's urine output. When a urine output rate >300 ml/h was obtained, patients underwent the coronary procedure. Matched fluid replacement was maintained during the procedure and for 4 h post-treatment. The definition of CIN was a ≥25% or ≥0.5 mg/dl rise in serum creatinine over baseline. RESULTS In the FMH group, no device- or therapy-related complications were observed. Four (4.6%) patients in the FMH group developed CIN versus 15 (18%) controls (p = 0.005). A lower incidence of cumulative in-hospital clinical complications was also observed in FMH-treated patients than in controls (8% vs. 18%; p = 0.052). CONCLUSIONS In patients with CKD undergoing coronary procedures, furosemide-induced high urine output with matched hydration significantly reduces the risk of CIN and may be associated with improved in-hospital outcome. (Induced Diuresis With Matched Hydration Compared to Standard Hydration for Contrast Induced Nephropathy Prevention [MYTHOS]; NCT00702728).
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Affiliation(s)
- Giancarlo Marenzi
- Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy.
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Ammirati E, Cianflone D, Vecchio V, Banfi M, Vermi AC, De Metrio M, Grigore L, Pellegatta F, Pirillo A, Garlaschelli K, Manfredi AA, Catapano AL, Maseri A, Palini AG, Norata GD. Effector Memory T cells Are Associated With Atherosclerosis in Humans and Animal Models. J Am Heart Assoc 2012; 1:27-41. [PMID: 23130116 PMCID: PMC3487313 DOI: 10.1161/jaha.111.000125] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [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: 12/07/2011] [Accepted: 12/21/2011] [Indexed: 12/30/2022]
Abstract
BACKGROUND#ENTITYSTARTX02014;: Adaptive T-cell response is promoted during atherogenesis and results in the differentiation of naïve CD4(+)T cells to effector and/or memory cells of specialized T-cell subsets. Aim of this work was to investigate the relationship between circulating CD4(+)T-cell subsets and atherosclerosis. METHODS AND RESULTS#ENTITYSTARTX02014;: We analyzed 57 subsets of circulating CD4(+)T cells by 10-parameter/8-color polychromatic flow cytometry (markers: CD3/CD4/CD45RO/CD45RA/CCR7/CCR5/CXCR3/HLA-DR) in peripheral blood from 313 subjects derived from 2 independent cohorts. In the first cohort of subjects from a free-living population (n=183), effector memory T cells (T(EM): CD3(+)CD4(+)CD45RA(-)CD45RO(+)CCR7(-) cells) were strongly related with intima-media thickness of the common carotid artery, even after adjustment for age (r=0.27; P<0.001). Of note, a significant correlation between T(EM) and low-density lipoproteins was observed. In the second cohort (n=130), T(EM) levels were significantly increased in patients with chronic stable angina or acute myocardial infarction compared with controls. HLA-DR(+)T(EM) were the T(EM) subpopulation with the strongest association with the atherosclerotic process (r=0.37; P<0.01). Finally, in animal models of atherosclerosis, T(EM) (identified as CD4(+)CD44(+)CD62L(-)) were significantly increased in low-density lipoprotein receptor and apolipoprotein E deficient mice compared with controls and were correlated with the extent of atherosclerotic lesions in the aortic root (r=0.56; P<0.01). CONCLUSIONS#ENTITYSTARTX02014;: Circulating T(EM) cells are associated with increased atherosclerosis and coronary artery disease in humans and in animal models and could represent a key CD4(+)T-cell subset related to the atherosclerotic process. (J Am Heart Assoc. 2012;1:27-41.).
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Affiliation(s)
- Enrico Ammirati
- Clinical Cardiovascular Biology Centre, San Raffaele Scientific Institute and the Università Vita-Salute San Raffaele , Milan, Italy (E.A., D.C., M.B.) ; Heart Transplantation Division, Ospedale Niguarda Ca' Granda , Milan, Italy (E.A.) ; Heart Care Foundation , Florence, Italy (E.A., A.M.)
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Colombo G, Gertow K, Marenzi G, Brambilla M, De Metrio M, Tremoli E, Camera M. Gene expression profiling reveals multiple differences in platelets from patients with stable angina or non-ST elevation acute coronary syndrome. Thromb Res 2011; 128:161-8. [PMID: 21420725 DOI: 10.1016/j.thromres.2011.02.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 02/16/2011] [Accepted: 02/21/2011] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Platelets play a key role in coronary artery disease. They have the capacity of protein synthesis through translation of megakaryocyte-derived mRNAs, which may influence pathophysiological functions. The present study aimed to prove the concept that platelets from patients with non-ST elevation acute coronary syndrome (NSTE-ACS) have differential mRNA expression profiles, in the hypothesis that this may influence their thrombogenicity. MATERIALS AND METHODS Gene expression profiles were determined in RNA pools from resting platelets of patients with stable angina (SA, n = 14) or NSTE-ACS (n = 15) using a glass microarray platform. Validation was done by real-time PCR and immunoblot analyses in independent sets of individual samples (26 SA and 17 NSTE-ACS patients, in total). Parallel comparison with healthy subjects was performed to relate the relative abundance of validated genes in CAD patients to a control expression level. RESULTS Microarray analysis identified 45 transcripts with a significant ≥ ± 2.0-fold difference in expression between NSTE-ACS and SA platelet pools. Thus, gene expression profiles at least partially discriminate unstable from stable CAD. Validation confirmed a significant over-expression of 3 genes in NSTE-ACS at both mRNA and protein level. In particular, the glycoprotein Ib β-polypeptide (GP1BB) was increased in NSTE-ACS also in comparison with healthy subjects. CONCLUSION This study provides evidence that NSTE-ACS platelets are potentially preconditioned to a higher degree of reactivity on the transcriptional level. Our data suggest that a different composition of the mRNA pool might mediate an increased platelet prothrombotic potential in NSTE-ACS patients.
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Marenzi G, De Metrio M, Rubino M, Lauri G, Cavallero A, Assanelli E, Grazi M, Moltrasio M, Marana I, Campodonico J, Discacciati A, Veglia F, Bartorelli AL. Acute hyperglycemia and contrast-induced nephropathy in primary percutaneous coronary intervention. Am Heart J 2010; 160:1170-7. [PMID: 21146674 DOI: 10.1016/j.ahj.2010.09.022] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Accepted: 09/26/2010] [Indexed: 01/08/2023]
Abstract
BACKGROUND Acute hyperglycemia and contrast-induced nephropathy (CIN) are frequently observed in ST-elevation acute myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI), and both are associated with an increased mortality rate. We investigated the possible association between acute hyperglycemia and CIN in patients undergoing primary PCI. METHODS We prospectively enrolled 780 STEMI patients undergoing primary PCI. For each patient, plasma glucose levels were assessed at hospital admission. Acute hyperglycemia was defined as glucose levels>198 mg/dL (11 mmol/L). Contrast-induced nephropathy was defined as an increase in serum creatinine>25% from baseline in the first 72 hours. RESULTS Overall, 148 (19%) patients had acute hyperglycemia; and 113 (14.5%) patients developed CIN. Patients with acute hyperglycemia had a 2-fold higher incidence of CIN than those without acute hyperglycemia (27% vs 12%, P<.001). In-hospital mortality was higher in patients with acute hyperglycemia than in those without acute hyperglycemia (12% vs 3%, P<.001). Mortality rate was also higher in patients developing CIN than in those without this renal complication (27% vs 0.9%, P<.001). Patients with acute hyperglycemia that developed CIN had the highest mortality rate (38%). Acute hyperglycemia was an independent predictor of CIN and in-hospital mortality. CONCLUSIONS In STEMI patients undergoing primary PCI, acute hyperglycemia is associated with an increased risk for CIN and with increased in-hospital mortality.
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Ammirati E, Cianflone D, Banfi M, Vecchio V, Palini A, De Metrio M, Marenzi G, Panciroli C, Tumminello G, Anzuini A, Palloshi A, Grigore L, Garlaschelli K, Tramontana S, Tavano D, Airoldi F, Manfredi AA, Catapano AL, Norata GD. Circulating CD4+CD25hiCD127lo regulatory T-Cell levels do not reflect the extent or severity of carotid and coronary atherosclerosis. Arterioscler Thromb Vasc Biol 2010; 30:1832-41. [PMID: 20539016 DOI: 10.1161/atvbaha.110.206813] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Regulatory T (Treg) cells play a protective role in experimental atherosclerosis. In the present study, we investigated whether the levels of circulating Treg cells relate to the degree of atherosclerosis in carotid and coronary arteries. METHODS AND RESULTS We studied 2 distinct populations: (1) 113 subjects, selected from a free-living population (carotid study), in which we measured the intima-media thickness of the common carotid artery, as a surrogate marker of initial atherosclerosis; and (2) 75 controls and 125 patients with coronary artery disease (coronary study): 36 with chronic stable angina, 50 with non-ST-elevation acute coronary syndrome, 39 with ST-elevation acute myocardial infarction. Treg-cell levels were evaluated by flow cytometry (Treg cells identified as CD3(+)CD4(+)CD25(high)CD127(low)) and by mRNA expression of forkhead box P3 or of Treg-associated cytokine interleukin 10. In the carotid study, no correlation was observed between Treg-cell levels and intima-media thickness. No differences in Treg-cell levels were observed comparing rapid versus slow intima-media thickness progressors from a subgroup of patients (n=65), in which prospective data on 6-year intima-media thickness progression were available. In the coronary group, Treg-cell levels were not altered in chronic stable angina patients. In contrast, nonunivocal variations were observed in patients suffering an acute coronary syndrome (with a Treg-cell increase in ST-elevation acute myocardial infarction and a Treg-cell decrease in non-ST-elevation acute coronary syndrome patients). CONCLUSIONS The results suggest that determination of circulating Treg-cell levels based on flow cytometry or mRNA assessment is not a useful indicator of the extent or severity of atherosclerosis.
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Affiliation(s)
- Enrico Ammirati
- Clinical Cardiovascular Biology Research Centre, San Raffaele Scientific Institute and the Università Vita-Salute San Raffaele, Via Olgettina 58, 20132 Milan, Italy.
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Marenzi G, Assanelli E, Campodonico J, Lauri G, Marana I, De Metrio M, Moltrasio M, Grazi M, Rubino M, Veglia F, Fabbiocchi F, Bartorelli AL. Contrast volume during primary percutaneous coronary intervention and subsequent contrast-induced nephropathy and mortality. Ann Intern Med 2009; 150:170-7. [PMID: 19189906 DOI: 10.7326/0003-4819-150-3-200902030-00006] [Citation(s) in RCA: 246] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Contrast-induced nephropathy (CIN) frequently occurs in patients with acute ST-segment elevation myocardial infarction (STEMI) who are undergoing primary percutaneous coronary intervention, and CIN is associated with a more complicated clinical course and increased mortality. OBJECTIVE To investigate the association between absolute and weight- and creatinine-adjusted contrast volume, CIN incidence, and clinical outcome in the era of mechanical reperfusion of STEMI. DESIGN Prospective, observational study. SETTING A university cardiology center in Milan, Italy. PATIENTS 561 consecutive patients with STEMI who were undergoing primary percutaneous coronary intervention. MEASUREMENTS For each patient, the maximum contrast dose was calculated, according to the formula (5 x body weight [kg])/serum creatinine, and the contrast ratio, defined as the ratio between the contrast volume administered and the maximum dose calculated, was assessed. An increase in serum creatinine of more than 25% from baseline was defined as CIN. RESULTS 115 (20.5%) patients developed CIN. In-hospital mortality was higher among patients with CIN than those without CIN (21.4% vs. 0.9%; P < 0.001). The maximum contrast dose was exceeded in 130 (23%) patients. Patients who received more than the maximum contrast dose (contrast ratio >1) had a more complicated in-hospital clinical course and higher mortality rate (13% vs. 2.8%; P < 0.001) than did patients with a contrast ratio less than 1. Development of CIN was associated with both contrast volume and contrast ratio. LIMITATION The association between contrast volume and outcomes was observed in a single center and could be due to comorbid conditions, disease severity, or an unknown factor. CONCLUSION During primary percutaneous coronary intervention for STEMI, higher contrast volume is associated with higher rates of CIN and mortality; however, further study is needed to determine whether limiting contrast volume would improve patient outcome. FUNDING Centro Cardiologico Monzino, Institute of Cardiology, University of Milan.
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Brambilla M, Camera M, Colnago D, Marenzi G, De Metrio M, Giesen PL, Balduini A, Veglia F, Gertow K, Biglioli P, Tremoli E. Tissue Factor in Patients With Acute Coronary Syndromes. Arterioscler Thromb Vasc Biol 2008; 28:947-53. [DOI: 10.1161/atvbaha.107.161471] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective—
Activated platelets and circulating platelet-leukocyte aggregates (PLA) are significantly higher in patients with unstable angina than in those with stable angina (SA). Platelets from healthy subjects express TF on activation. The aim of this study was to investigate the expression of TF in PLA, in platelets, and in monocytes of acute coronary syndrome (ACS) patients compared to SA patients and healthy subjects (Controls).
Methods and Results—
We enrolled 26 consecutive patients with ACS, 29 patients with SA, and 25 Controls. A significantly greater number of total and TF positive platelet-monocyte aggregates was found by flow cytometry in blood of ACS patients than in either SA patients (3-fold) or Controls (5-fold). ACS patients also had a significantly higher amount of TF-positive platelets than SA or Controls (>3-fold) and significantly higher thrombin generation capacity. TF mRNA expression in platelets was significantly higher in ACS patients than in SA or Controls.
Conclusions—
In ACS patients the greater expression of TF in platelets and PLA strengthens the link between platelet activation, blood coagulation, and thrombus formation and may further contribute to the hypercoagulability associated with the disease.
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Affiliation(s)
- Marta Brambilla
- From the Department of Pharmacological Sciences (M.B., M.C., E.T.), University of Milan, Italy; Centro Cardiologico Monzino IRCCS (M.C., D.C., G.M., M.D.M., F.V., K.G., P.B., E.T.), Milan, Italy; the Department of Biochemistry (A.B.), University of Pavia, Italy; and Thrombinoscope CV (P.L.G.), Maastricht, The Netherlands
| | - Marina Camera
- From the Department of Pharmacological Sciences (M.B., M.C., E.T.), University of Milan, Italy; Centro Cardiologico Monzino IRCCS (M.C., D.C., G.M., M.D.M., F.V., K.G., P.B., E.T.), Milan, Italy; the Department of Biochemistry (A.B.), University of Pavia, Italy; and Thrombinoscope CV (P.L.G.), Maastricht, The Netherlands
| | - Deborah Colnago
- From the Department of Pharmacological Sciences (M.B., M.C., E.T.), University of Milan, Italy; Centro Cardiologico Monzino IRCCS (M.C., D.C., G.M., M.D.M., F.V., K.G., P.B., E.T.), Milan, Italy; the Department of Biochemistry (A.B.), University of Pavia, Italy; and Thrombinoscope CV (P.L.G.), Maastricht, The Netherlands
| | - Giancarlo Marenzi
- From the Department of Pharmacological Sciences (M.B., M.C., E.T.), University of Milan, Italy; Centro Cardiologico Monzino IRCCS (M.C., D.C., G.M., M.D.M., F.V., K.G., P.B., E.T.), Milan, Italy; the Department of Biochemistry (A.B.), University of Pavia, Italy; and Thrombinoscope CV (P.L.G.), Maastricht, The Netherlands
| | - Monica De Metrio
- From the Department of Pharmacological Sciences (M.B., M.C., E.T.), University of Milan, Italy; Centro Cardiologico Monzino IRCCS (M.C., D.C., G.M., M.D.M., F.V., K.G., P.B., E.T.), Milan, Italy; the Department of Biochemistry (A.B.), University of Pavia, Italy; and Thrombinoscope CV (P.L.G.), Maastricht, The Netherlands
| | - Peter L. Giesen
- From the Department of Pharmacological Sciences (M.B., M.C., E.T.), University of Milan, Italy; Centro Cardiologico Monzino IRCCS (M.C., D.C., G.M., M.D.M., F.V., K.G., P.B., E.T.), Milan, Italy; the Department of Biochemistry (A.B.), University of Pavia, Italy; and Thrombinoscope CV (P.L.G.), Maastricht, The Netherlands
| | - Alessandra Balduini
- From the Department of Pharmacological Sciences (M.B., M.C., E.T.), University of Milan, Italy; Centro Cardiologico Monzino IRCCS (M.C., D.C., G.M., M.D.M., F.V., K.G., P.B., E.T.), Milan, Italy; the Department of Biochemistry (A.B.), University of Pavia, Italy; and Thrombinoscope CV (P.L.G.), Maastricht, The Netherlands
| | - Fabrizio Veglia
- From the Department of Pharmacological Sciences (M.B., M.C., E.T.), University of Milan, Italy; Centro Cardiologico Monzino IRCCS (M.C., D.C., G.M., M.D.M., F.V., K.G., P.B., E.T.), Milan, Italy; the Department of Biochemistry (A.B.), University of Pavia, Italy; and Thrombinoscope CV (P.L.G.), Maastricht, The Netherlands
| | - Karl Gertow
- From the Department of Pharmacological Sciences (M.B., M.C., E.T.), University of Milan, Italy; Centro Cardiologico Monzino IRCCS (M.C., D.C., G.M., M.D.M., F.V., K.G., P.B., E.T.), Milan, Italy; the Department of Biochemistry (A.B.), University of Pavia, Italy; and Thrombinoscope CV (P.L.G.), Maastricht, The Netherlands
| | - Paolo Biglioli
- From the Department of Pharmacological Sciences (M.B., M.C., E.T.), University of Milan, Italy; Centro Cardiologico Monzino IRCCS (M.C., D.C., G.M., M.D.M., F.V., K.G., P.B., E.T.), Milan, Italy; the Department of Biochemistry (A.B.), University of Pavia, Italy; and Thrombinoscope CV (P.L.G.), Maastricht, The Netherlands
| | - Elena Tremoli
- From the Department of Pharmacological Sciences (M.B., M.C., E.T.), University of Milan, Italy; Centro Cardiologico Monzino IRCCS (M.C., D.C., G.M., M.D.M., F.V., K.G., P.B., E.T.), Milan, Italy; the Department of Biochemistry (A.B.), University of Pavia, Italy; and Thrombinoscope CV (P.L.G.), Maastricht, The Netherlands
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Marenzi G, Moltrasio M, Assanelli E, Lauri G, Marana I, Grazi M, Rubino M, De Metrio M, Veglia F, Bartorelli AL. Impact of cardiac and renal dysfunction on inhospital morbidity and mortality of patients with acute myocardial infarction undergoing primary angioplasty. Am Heart J 2007; 153:755-62. [PMID: 17452149 DOI: 10.1016/j.ahj.2007.02.018] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2006] [Accepted: 02/16/2007] [Indexed: 01/26/2023]
Abstract
BACKGROUND Risk stratification of patients with ST-elevation myocardial infarction (STEMI) undergoing primary angioplasty is important in order to predict outcomes and to delineate targeted therapeutic strategies. Although the prognostic implications of reduced left ventricular ejection fraction (LVEF) and creatinine clearance (CrCl) have been recognized, the clinical and prognostic impact of their combination has never been prospectively evaluated. METHODS We stratified 467 patients with STEMI undergoing primary angioplasty according to LVEF and CrCl values at admission: CrCl > 60 mL/min and LVEF > 40% (group 1, n = 261); CrCl < or = 60 mL/min and LVEF > 40% (group 2, n = 113); CrCl > 60 mL/min and LVEF < or = 40% (group 3, n = 60); CrCl < or = 60 mL/min and LVEF < or = 40% (group 4, n = 33). RESULTS Inhospital mortality was different in the 4 groups (1% in group 1, 3% in group 2, 15% in group 3, 30% in group 4) (P < .001). The incidence of combined end point of death, acute pulmonary edema, cardiogenic shock, and acute renal failure requiring mechanical support increased progressively from group 1 to group 4 (5%, 17%, 33%, and 48%, respectively) (P < .001). We found a significant gradient of risk in terms of inhospital mortality and combined end point when patients outcome was evaluated according to the presence of both normal LVEF and CrCl (group 1), impairment in only 1 of these 2 parameters (group 2 and 3 pooled together), and combined LVEF and CrCl reductions (group 4). CONCLUSIONS Reduced LVEF and CrCl are strong independent predictors of increased inhospital morbidity and mortality, and their combined evaluation provides a simple tool for early risk stratification in patients with STEMI treated with primary angioplasty.
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Affiliation(s)
- Giancarlo Marenzi
- Centro Cardiologico Monzino, I.R.C.C.S, Institute of Cardiology, University of Milan, Milan, Italy.
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Marenzi G, Assanelli E, Marana I, Lauri G, Campodonico J, Grazi M, De Metrio M, Galli S, Fabbiocchi F, Montorsi P, Veglia F, Bartorelli AL. N-acetylcysteine and contrast-induced nephropathy in primary angioplasty. N Engl J Med 2006; 354:2773-82. [PMID: 16807414 DOI: 10.1056/nejmoa054209] [Citation(s) in RCA: 394] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patients with acute myocardial infarction undergoing primary angioplasty are at high risk for contrast-medium-induced nephropathy because of hemodynamic instability, the need for a high volume of contrast medium, and the lack of effective prophylaxis. We investigated the antioxidant N-acetylcysteine for the prevention of contrast-medium-induced nephropathy in patients undergoing primary angioplasty. METHODS We randomly assigned 354 consecutive patients undergoing primary angioplasty to one of three groups: 116 patients were assigned to a standard dose of N-acetylcysteine (a 600-mg intravenous bolus before primary angioplasty and 600 mg orally twice daily for the 48 hours after angioplasty), 119 patients to a double dose of N-acetylcysteine (a 1200-mg intravenous bolus and 1200 mg orally twice daily for the 48 hours after intervention), and 119 patients to placebo. RESULTS The serum creatinine concentration increased 25 percent or more from baseline after primary angioplasty in 39 of the control patients (33 percent), 17 of the patients receiving standard-dose N-acetylcysteine (15 percent), and 10 patients receiving high-dose N-acetylcysteine (8 percent, P<0.001). Overall in-hospital mortality was higher in patients with contrast-medium-induced nephropathy than in those without such nephropathy (26 percent vs. 1 percent, P<0.001). Thirteen patients (11 percent) in the control group died, as did five (4 percent) in the standard-dose N-acetylcysteine group and three (3 percent) in the high-dose N-acetylcysteine group (P=0.02). The rate for the composite end point of death, acute renal failure requiring temporary renal-replacement therapy, or the need for mechanical ventilation was 21 (18 percent), 8 (7 percent), and 6 (5 percent) in the three groups, respectively (P=0.002). CONCLUSIONS Intravenous and oral N-acetylcysteine may prevent contrast-medium-induced nephropathy with a dose-dependent effect in patients treated with primary angioplasty and may improve hospital outcome. (ClinicalTrials.gov number, NCT00237614[ClinicalTrials.gov]).
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Affiliation(s)
- Giancarlo Marenzi
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Institute of Cardiology, University of Milan, Milan, Italy.
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Marenzi G, Lauri G, Campodonico J, Marana I, Assanelli E, De Metrio M, Grazi M, Veglia F, Fabbiocchi F, Montorsi P, Bartorelli AL. Comparison of two hemofiltration protocols for prevention of contrast-induced nephropathy in high-risk patients. Am J Med 2006; 119:155-62. [PMID: 16443418 DOI: 10.1016/j.amjmed.2005.08.002] [Citation(s) in RCA: 141] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2005] [Revised: 08/03/2005] [Accepted: 08/03/2005] [Indexed: 12/26/2022]
Abstract
PURPOSE Contrast-induced nephropathy is a complication of contrast medium administration during diagnostic and interventional procedures, with important prognostic relevance. Patients with chronic kidney disease have a higher risk for contrast-induced nephropathy and poorer outcome. In patients with chronic kidney disease, hemofiltration reduces contrast-induced nephropathy incidence and improves long-term survival. We assessed the mechanisms involved in the prophylactic effect of hemofiltration and of the most effective hemofiltration protocol to prevent contrast-induced nephropathy in patients with chronic kidney disease. SUBJECTS AND METHODS We randomized 92 patients with chronic kidney disease (creatinine clearance < or =30 mL/min) to three different prophylactic treatments: intravenous hydration with isotonic saline (1 mL x kg x h for 12 hours before and after contrast exposure, control group; n = 30); intravenous hydration for 12 hours before contrast exposure, followed by hemofiltration for 18 to 24 hours after contrast exposure (post-hemofiltration group; n = 31), and hemofiltration performed for 6 hours before and for 18 to 24 hours after contrast exposure (pre/post-hemofiltration group; n = 31). The incidence of contrast-induced nephropathy (>25% increase in creatinine) and the in-hospital clinical course were compared in the three groups. RESULTS Twelve patients (40%) in the control group, 8 patients (26%) in the post-hemofiltration group, and 1 patient (3%) in the pre/post-hemofiltration group experienced contrast-induced nephropathy (P = .0013); hemodialysis was required in 9 (30%), three (10%), and zero (0%) patients, respectively (P = .002). In-hospital mortality was 20%, 10%, and 0%, respectively (P = .03). CONCLUSIONS Hemofiltration is an effective strategy for contrast-induced nephropathy prevention in patients with chronic kidney disease who are undergoing cardiovascular procedures. Pre-hemofiltration is required to obtain the full clinical benefit, suggesting that, among different mechanisms possibly involved, high-volume controlled hydration before contrast media exposure plays a major role.
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Affiliation(s)
- Giancarlo Marenzi
- Centro Cardiologico Monzino, I.R.C.C.S., Institute of Cardiology of the University of Milan, Milan, Italy.
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Marenzi G, Lauri G, Assanelli E, Campodonico J, De Metrio M, Marana I, Grazi M, Veglia F, Bartorelli AL. Contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction. J Am Coll Cardiol 2005; 44:1780-5. [PMID: 15519007 DOI: 10.1016/j.jacc.2004.07.043] [Citation(s) in RCA: 495] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2004] [Revised: 07/22/2004] [Accepted: 07/28/2004] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The aim of this research was to assess the incidence, clinical predictors, and outcome of contrast-induced nephropathy (CIN) after primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). BACKGROUND Contrast-induced nephropathy is associated with significant morbidity and mortality after PCI. Patients undergoing primary PCI may be at higher risk of CIN because of hemodynamic instability and unfeasibility of adequate prophylaxis. METHODS In 208 consecutive AMI patients undergoing primary PCI, we measured serum creatinine concentration (Cr) at baseline and each day for the following three days. Contrast-induced nephropathy was defined as a rise in Cr >0.5 mg/dl. RESULTS Overall, CIN occurred in 40 (19%) patients. Of the 160 patients with baseline Cr clearance >/=60 ml/min, only 21 (13%) developed CIN, whereas it occurred in 19 (40%) of those with Cr clearance <60 ml/min (p < 0.0001). In multivariate analysis, age >75 years (odds ratio [OR] 5.28, 95% confidence interval [CI] 1.98 to 14.05; p = 0.0009), anterior infarction (OR 2.17, 95% CI 0.88 to 5.34; p = 0.09), time-to-reperfusion >6 h (OR 2.51, 95% CI 1.01 to 6.16; p = 0.04), contrast agent volume >300 ml (OR 2.80, 95% CI 1.17 to 6.68; p = 0.02) and use of intraaortic balloon (OR 15.51, 95% CI 4.65 to 51.64; p < 0.0001) were independent correlates of CIN. Patients developing CIN had longer hospital stay (13 +/- 7 days vs. 8 +/- 3 days; p < 0.001), more complicated clinical course, and significantly higher mortality rate (31% vs. 0.6%; p < 0.001). CONCLUSIONS Contrast-induced nephropathy frequently complicates primary PCI, even in patients with normal renal function. It is associated with higher in-hospital complication rate and mortality. Thus, preventive strategies are needed, particularly in high-risk patients.
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Affiliation(s)
- Giancarlo Marenzi
- Centro Cardiologico Monzino, I.R.C.C.S., Institute of Cardiology of the University of Milan, Milan, Italy.
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