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Trabattoni D, Galli S, Rogacka R, Teruzzi G, Montorsi P. Resistant Hypertension in a Patient With Chronic Type B Aortic Dissection. A Selective Indication for Renal Artery Denervation Treatment. Am J Hypertens 2020; 33:784-787. [PMID: 32307546 DOI: 10.1093/ajh/hpaa059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/02/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Daniela Trabattoni
- Department of Invasive Cardiology, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Stefano Galli
- Department of Invasive Cardiology, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Renata Rogacka
- Divisione di cardiologia, Ospedale di Desio, Milan, Italy
| | - Giovanni Teruzzi
- Department of Invasive Cardiology, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Piero Montorsi
- Department of Invasive Cardiology, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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De Luca G, Verdoia M, Savonitto S, Piatti L, Grosseto D, Morici N, Bossi I, Sganzerla P, Tortorella G, Cacucci M, Murena E, Toso A, Bongioanni S, Ravera A, Corrada E, Mariani M, Di Ascenzo L, Petronio AS, Cavallini C, Vitrella G, Antonicelli R, Rogacka R, De Servi S. Impact of diabetes on clinical outcome among elderly patients with acute coronary syndrome treated with percutaneous coronary intervention: insights from the ELDERLY ACS 2 trial. J Cardiovasc Med (Hagerstown) 2020; 21:453-459. [PMID: 32355067 DOI: 10.2459/jcm.0000000000000978] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Despite recent improvements in percutaneous coronary revascularization and antithrombotic therapies for the treatment of acute coronary syndromes, the outcome is still unsatisfactory in high-risk patients, such as the elderly and patients with diabetes. The aim of the current study was to investigate the prognostic impact of diabetes on clinical outcome among patients included in the Elderly-ACS 2 trial, a randomized, open-label, blinded endpoint study carried out at 32 centers in Italy. METHODS Our population is represented by 1443 patients included in the Elderly-ACS 2 trial. Diabetes was defined as known history of diabetes at admission. The primary endpoint of this analysis was cardiovascular mortality, while secondary endpoints were all-cause death, recurrent myocardial infarction, Bleeding Academic Research Consortium type 2 or 3 bleeding, and rehospitalization for cardiovascular event or stent thrombosis within 12 months after index admission. RESULTS Diabetes was present in 419 (29%) out of 1443 patients. Diabetic status was significantly associated with major cardiovascular risk factors and history of previous coronary disease, presentation with non-ST segment elevation myocardial infarction (P = 0.01) more extensive coronary disease (P = 0.02), more advanced Killip class at presentation (P = 0.003), use at admission of statins (P = 0.004) and diuretics at discharge (P < 0.001). Median follow-up was 367 days (interquartile range: 337-378 days). Diabetic status was associated with an absolute increase in the rate of cardiovascular mortality as compared with patients without diabetes [5.5 vs. 3.3%, hazard ratio (HR) 1.7 (0.99-2.8), P = 0.054], particularly among those treated with clopidogrel [HR (95% confidence interval (CI)) = 1.89 (0.93-3.87), P = 0.08]. However, this difference disappeared after correction for baseline differences [Adjusted HR (95% CI) 1.1(0.4-2.9), P = 0.86]. Similar findings were observed for other secondary endpoints, except for bleeding complications, significantly more frequent in diabetic patients [HR (95% CI) 2.02 (1.14-3.6), P = 0.02; adjusted HR (95% CI) = 2.1 (1.01-4.3), P = 0.05]. No significant interaction was observed between type of dual antiplatelet therapy, diabetic status and outcome. CONCLUSION Among elderly patients with acute coronary syndromes, diabetic status was associated with higher rates of comorbidities, more severe cardiovascular risk profile and major bleeding complications fully accounting for the absolute increase in mortality. In fact, diabetes mellitus did not emerge as an independent predictor of survival in advanced age.
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Affiliation(s)
- Giuseppe De Luca
- Azienda Ospedaliera-Universitaria 'Maggiore della Carità', Eastern Piedmont University, Novara
| | - Monica Verdoia
- Azienda Ospedaliera-Universitaria 'Maggiore della Carità', Eastern Piedmont University, Novara
| | | | | | | | | | - Irene Bossi
- ASST Grande Ospedale Metropolitano Niguarda, Milano
| | | | | | | | | | | | | | | | - Elena Corrada
- Humanitas Clinical and Research Center, Rozzano, Italy
| | | | | | | | | | | | | | - Renata Rogacka
- Statistics and Biomathematics Unit, Department of Molecular and Transactional Medicine, University of Brescia, Brescia
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De Luca G, Verdoia M, Savonitto S, Ferri LA, Piatti L, Grosseto D, Morici N, Bossi I, Sganzerla P, Tortorella G, Cacucci M, Ferrario M, Murena E, Sibilio G, Tondi S, Toso A, Bongioanni S, Ravera A, Corrada E, Mariani M, Di Ascenzo L, Petronio AS, Cavallini C, Vitrella G, Antonicelli R, Rogacka R, De Servi S. Impact of body mass index on clinical outcome among elderly patients with acute coronary syndrome treated with percutaneous coronary intervention: Insights from the ELDERLY ACS 2 trial. Nutr Metab Cardiovasc Dis 2020; 30:730-737. [PMID: 32127336 DOI: 10.1016/j.numecd.2020.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 12/26/2019] [Accepted: 01/12/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIM Elderly patients are at increased risk of hemorrhagic and thrombotic complications after an acute coronary syndrome (ACS). Frailty, comorbidities and low body weight have emerged as conditioning the prognostic impact of dual antiplatelet therapy (DAPT). The aim of the present study was to investigate the prognostic impact of body mass index (BMI) on clinical outcome among patients included in the Elderly-ACS 2 trial, a randomized, open-label, blinded endpoint study comparing low-dose (5 mg) prasugrel vs clopidogrel among elderly patients with ACS. METHODS AND RESULTS Our population is represented by 1408 patients enrolled in the Elderly-ACS 2 trial. BMI was calculated at admission. The primary endpoint of this analysis was cardiovascular (CV) mortality. Secondary endpoints were all-cause death, recurrent MI, Bleeding Academic Research Consortium (BARC) type 2 or 3 bleeding, and re-hospitalization for cardiovascular reasons or stent thrombosis within 12 months after index admission. Patients were grouped according to median values of BMI (<or ≥ 25.7 kg/m2). BMI was associated with hypertension, diabetes, hypercholesterolemia, estimated glomerular filtration rate and hemoglobin (p < 0.001), and inversely with age (p = 0.005). Overweight patients displayed larger use of diuretics at admission (p = 0.03), aspirin pre-randomization (p = 0.01) and radial access (p = 0.04). At a median follow-up of 367 [337-378] days, BMI did not affect CV mortality in the overall population 4% vs 3.8%; adjusted HR [95%CI] = 2.3 [0.8-6.5], p = 0.12. Similar findings were observed for our secondary efficacy and safety endpoints. Results did not change when considering separately higher risk subsets of patients, (female gender, diabetics, ST-segment elevation myocardial infarction or the type of DAPT treatment allocation), with no significant interaction between these population characteristics and BMI. CONCLUSIONS Among elderly patients with ACS, BMI did not condition the survival or the risk of major cardiovascular and bleeding complications. The results were consistent across several patient risk categories.
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Affiliation(s)
- Giuseppe De Luca
- Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, Novara, Italy.
| | - Monica Verdoia
- Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, Novara, Italy
| | | | | | | | | | - Nuccia Morici
- ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Irene Bossi
- ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | | | | | | | | | | | | | | | | | | | - Elena Corrada
- HumanitasClinical and Research Center, Rozzano, Italy
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Morici N, Savonitto S, Ferri LA, Grosseto D, Bossi I, Sganzerla P, Tortorella G, Cacucci M, Ferrario M, Crimi G, Murena E, Tondi S, Toso A, Gandolfo N, Ravera A, Corrada E, Mariani M, Di Ascenzo L, Petronio AS, Cavallini C, Vitrella G, Antonicelli R, Piscione F, Rogacka R, Antolini L, Alicandro G, La Vecchia C, Piatti L, De Servi S. Outcomes of Elderly Patients with ST-Elevation or Non-ST-Elevation Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention. Am J Med 2019; 132:209-216. [PMID: 30447205 DOI: 10.1016/j.amjmed.2018.10.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 10/24/2018] [Revised: 10/27/2018] [Accepted: 10/29/2018] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Acute coronary syndromes (ACS) have been classified according to the finding of ST-segment elevation on the presenting electrocardiogram, with different treatment strategies and practice guidelines. However, a comparative description of the clinical characteristics and outcomes of acute coronary syndrome elderly patients undergoing percutaneous coronary intervention during index admission has not been published so far. METHODS Retrospective cohort study of patients enrolled in the Elderly ACS-2 multicenter randomized trial. Main outcome measures were crude cumulative incidence and cause-specific hazard ratio (cHR) of cardiovascular death, noncardiovascular death, reinfarction, and stroke. RESULTS Of 1443 ACS patients aged >75 years (median age 80 years, interquartile range 77-84), 41% were classified as ST-elevation myocardial infarction (STEMI), and 59% had non-ST-elevation ACS (NSTEACS) (48% NSTEMI and 11% unstable angina). As compared with those with NSTEACS, STEMI patients had more favorable baseline risk factors, fewer prior cardiovascular events, and less severe coronary disease, but lower ejection fraction (45% vs 50%, P < .001). At a median follow-up of 12 months, 51 (8.6%) STEMI patients had died, vs 39 (4.6%) NSTEACS patients. After adjusting for sex, age, and previous myocardial infarction, the hazard among the STEMI group was significantly higher for cardiovascular death (cHR 1.85; 95% confidence interval [CI], 1.02-3.36), noncardiovascular death (cHR 2.10; 95% CI, 1.01-4.38), and stroke (cHR 4.8; 95% CI, 1.7-13.7). CONCLUSIONS Despite more favorable baseline characteristics, elderly STEMI patients have worse survival and a higher risk of stroke compared with NSTEACS patients after percutaneous coronary intervention.
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Affiliation(s)
- Nuccia Morici
- Unità di Cure Intensive Cardiologiche; ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy; Department of Clinical Sciences and Community Health Università degli Studi di Milano, Milano, Italy
| | | | - Luca A Ferri
- Division of Cardiology, Ospedale Manzoni, Lecco, Italy
| | | | - Irene Bossi
- Unità di Cure Intensive Cardiologiche; ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Paolo Sganzerla
- Division of Cardiology, ASST Bergamo ovest-ospedale di Treviglio, Treviglio, Italy
| | - Giovanni Tortorella
- Division of Cardiology, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | | | - Maurizio Ferrario
- Division of Cardiology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Gabriele Crimi
- Division of Cardiology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Ernesto Murena
- Division of Cardiology, Ospedale S. Maria delle Grazie, Pozzuoli, Italy
| | - Stefano Tondi
- Division of Cardiology, Ospedale Baggiovara, Modena, Italy
| | - Anna Toso
- Division of Cardiology, Ospedale S. Stefano, Prato, Italy
| | | | - Amelia Ravera
- Division of Cardiology, Ospedale Ruggi D' Aragona, Salerno, Italy
| | - Elena Corrada
- Cardiovascular Department, Humanitas Research Hospital, Rozzano, Italy
| | | | - Leonardo Di Ascenzo
- Division of Cardiology, Ospedale di San Donà di Piave-Portogruaro, Portogruaro, Italy
| | - A Sonia Petronio
- Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Claudio Cavallini
- Division of Cardiology, Ospedale S. Maria della Misericordia, Perugia, Italy
| | | | | | - Federico Piscione
- Department of Medicine, Surgery and Dentistry, University of Salerno, Schola Medica Salernitana, Salerno, Italy
| | | | - Laura Antolini
- School of Medicine, Center of Biostatistics for Clinical Epidemiology, University Milano Bicocca, Monza, Italy
| | - Gianfranco Alicandro
- Department of Clinical Sciences and Community Health Università degli Studi di Milano, Milano, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health Università degli Studi di Milano, Milano, Italy
| | - Luigi Piatti
- Division of Cardiology, Ospedale Manzoni, Lecco, Italy
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5
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Savonitto S, Ferri LA, Piatti L, Grosseto D, Piovaccari G, Morici N, Bossi I, Sganzerla P, Tortorella G, Cacucci M, Ferrario M, Murena E, Sibilio G, Tondi S, Toso A, Bongioanni S, Ravera A, Corrada E, Mariani M, Di Ascenzo L, Petronio AS, Cavallini C, Vitrella G, Rogacka R, Antonicelli R, Cesana BM, De Luca L, Ottani F, De Luca G, Piscione F, Moffa N, De Servi S, Bolognese L, Bovenzi F, Steffenino G, Santilli I, Bassanelli G, Sacco A, Canziani F, Ferri M, Lo Jacono E, Canosi U, Fornaro G, Leoncini M, Rosa Conte M, Farina R, Stefanin C, Di Pede F, Chella P, Chiara Nardoni M, Tamburrini P, Trimarco B, Galasso G, Elia R, Bolognese L, Grotti S, Bovenzi F, Borrelli L, Tamburino C, Capranzano P, Francaviglia B, Campana C, Bonatti R, Martinoni A, Abate F, Coscarelli S, Rubartelli P, Villani GQ, Rossini R. Comparison of Reduced-Dose Prasugrel and Standard-Dose Clopidogrel in Elderly Patients With Acute Coronary Syndromes Undergoing Early Percutaneous Revascularization. Circulation 2018; 137:2435-2445. [DOI: 10.1161/circulationaha.117.032180] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [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: 10/10/2017] [Accepted: 02/02/2018] [Indexed: 11/16/2022]
Abstract
Background:
Elderly patients are at elevated risk of both ischemic and bleeding complications after an acute coronary syndrome and display higher on-clopidogrel platelet reactivity compared with younger patients. Prasugrel 5 mg provides more predictable platelet inhibition compared with clopidogrel in the elderly, suggesting the possibility of reducing ischemic events without increasing bleeding.
Methods:
In a multicenter, randomized, open-label, blinded end point trial, we compared a once-daily maintenance dose of prasugrel 5 mg with the standard clopidogrel 75 mg in patients >74 years of age with acute coronary syndrome undergoing percutaneous coronary intervention. The primary end point was the composite of mortality, myocardial infarction, disabling stroke, and rehospitalization for cardiovascular causes or bleeding within 1 year. The study was designed to demonstrate superiority of prasugrel 5 mg over clopidogrel 75 mg.
Results:
Enrollment was interrupted, according to prespecified criteria, after a planned interim analysis, when 1443 patients (40% women; mean age, 80 years) had been enrolled with a median follow-up of 12 months, because of futility for efficacy. The primary end point occurred in 121 patients (17%) with prasugrel and 121 (16.6%) with clopidogrel (hazard ratio, 1.007; 95% confidence interval, 0.78–1.30;
P
=0.955). Definite/probable stent thrombosis rates were 0.7% with prasugrel versus 1.9% with clopidogrel (odds ratio, 0.36; 95% confidence interval, 0.13–1.00;
P
=0.06). Bleeding Academic Research Consortium types 2 and greater rates were 4.1% with prasugrel versus 2.7% with clopidogrel (odds ratio, 1.52; 95% confidence interval, 0.85–3.16;
P
=0.18).
Conclusions:
The present study in elderly patients with acute coronary syndromes showed no difference in the primary end point between reduced-dose prasugrel and standard-dose clopidogrel. However, the study should be interpreted in light of the premature termination of the trial.
Clinical Trial Registration:
URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT01777503.
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Affiliation(s)
| | | | - Luigi Piatti
- Ospedale Manzoni, Lecco, Italy (S.S., L.A.F., L.P.)
| | | | | | - Nuccia Morici
- Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milano, Italy (N. Morici, I.B.)
| | - Irene Bossi
- Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milano, Italy (N. Morici, I.B.)
| | | | - Giovanni Tortorella
- Istituto di Ricerca e Cura a Carattere Scientifico Arcispedale S. Maria Nuova, Reggio Emilia, Italy (G.T.)
| | | | | | - Ernesto Murena
- Ospedale S. Maria delle Grazie, Pozzuoli, Italy (E.M., G.S.)
| | | | | | - Anna Toso
- Ospedale S. Stefano, Prato, Italy (A.T.)
| | | | | | - Elena Corrada
- Humanitas Clinical and Research Center, Rozzano, Italy (E.C.)
| | | | | | | | | | | | - Renata Rogacka
- Azienda Ospedaliera di Desio e Vimercate, Desio, Italy (R.R.)
| | | | - Bruno M. Cesana
- Statistics and Biomathematics Unit, Department of Molecular and Transactional Medicine, University of Brescia, Italy (B.M.C.)
| | | | | | - Giuseppe De Luca
- Azienda Ospedaliera-Universitaria “Maggiore della Carità,” Eastern Piedmont University, Novara, Italy (G.D.L.)
| | - Federico Piscione
- Department of Medicine, Surgery and Dentistry–Schola Medica Salernitana, University of Salerno, Italy (F.P.)
| | - Nadia Moffa
- Mediolanum Cardio Research, Milan, Italy (N. Moffa)
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Cortese B, D’Ascenzo F, Fetiveau R, Balian V, Blengino S, Fineschi M, Rogacka R, Lettieri C, Pavei A, D’Amico M, Poli A, Di Palma G, Latini RA, Orrego PS, Seregni R. Treatment of coronary artery disease with a new-generation drug-coated balloon. J Cardiovasc Med (Hagerstown) 2018; 19:247-252. [DOI: 10.2459/jcm.0000000000000632] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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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Cortese B, di Palma G, Blengino S, Fineschi M, Rogacka R, Lettieri C, Pavei A, Silva P. TCT-209 Clinical outcome of a new generation drug-coated balloon for treatment of de novo coronary lesions and in-stent restenosis: an insight from the DCB-RISE registry. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.284] [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: 10/18/2022]
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Rogacka R, Latib A, Colombo A. IVUS-Guided Stent Implantation to Improve Outcome: A Promise Waiting to be Fulfilled. Curr Cardiol Rev 2011; 5:78-86. [PMID: 20436848 PMCID: PMC2805818 DOI: 10.2174/157340309788166697] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Revised: 11/10/2008] [Accepted: 11/10/2008] [Indexed: 02/04/2023] Open
Abstract
The use of intravascular ultrasound (IVUS) to improve acute angiographic results was already shown in the prestent era. Various studies demonstrated the efficacy of IVUS in balloon sizing and estimating the extent of positive remodeling. With the introduction of drug-eluting stents (DES) the rate of restenosis has been significantly reduced but a new concern, the risk of stent thrombosis, has emerged. The association of stent underexpansion with stent thrombosis was observed for bare metal stents (BMS) and DES. Until now, the criteria for IVUS optimization used in different studies have relied on distal reference or on mean reference vessel for stent or postdilatation balloon sizing. Furthermore, an important recent innovation not available in previous studies is the use of noncompliant balloons to perform high pressure post-dilatation. Universal and easily applicable IVUS criteria for optimization of stent implantation as well as randomized studies on IVUS-guided DES implantation are necessary to minimize stent malapposition and underexpansion, which in turn can positively influence the rates of stent restenosis and thrombosis.
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Affiliation(s)
- Renata Rogacka
- Interventional Cardiology Unit, Desio Hospital, Milan, Italy
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9
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Rogacka R, Chieffo A, Latib A, Colombo A. Bioabsorbable and biocompatible stents. Is a new revolution coming? Minerva Cardioangiol 2008; 56:483-491. [PMID: 18813184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
With the introduction of drug-eluting stents (DES) the problem of restenosis after percutaneous stent implantation was partially resolved. In the first generation of DES a stainless steel platform was coated with a durable polymer eluting and controlling the release of an active restenotic drug. The impairment of re-endothelization after DES implantation, one of the causes of late stent thrombosis, was to some extent attributed to the properties of the durable polymer and/or drug that it eluted. The introduction of biodegradable platforms and biocompatible polymers may potentially address this issue. Modern technologies are being applied to improve the characteristics of biodegradable stents and find new active pharmacological agents or combinations of standard antirestenotic and antithrombotic drugs that can be eluted from the stents, in order to improve their safety profile and clinical utility.
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Chieffo A, Park SJ, Meliga E, Sheiban I, Lee MS, Latib A, Kim YH, Valgimigli M, Sillano D, Magni V, Biondi-Zoccai G, Montorfano M, Airoldi F, Rogacka R, Carlino M, Michev I, Lee CW, Hong MK, Park SW, Moretti C, Bonizzoni E, Sangiorgi GM, Tobis J, Serruys PW, Colombo A. Late and very late stent thrombosis following drug-eluting stent implantation in unprotected left main coronary artery: a multicentre registry. Eur Heart J 2008; 29:2108-15. [PMID: 18565967 DOI: 10.1093/eurheartj/ehn270] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Alaide Chieffo
- San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
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Rogacka R, Chieffo A, Michev I, Airoldi F, Latib A, Cosgrave J, Montorfano M, Carlino M, Sangiorgi GM, Castelli A, Godino C, Magni V, Aranzulla TC, Romagnoli E, Colombo A. Dual Antiplatelet Therapy After Percutaneous Coronary Intervention With Stent Implantation in Patients Taking Chronic Oral Anticoagulation. JACC Cardiovasc Interv 2008; 1:56-61. [PMID: 19393145 DOI: 10.1016/j.jcin.2007.11.004] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2007] [Revised: 10/31/2007] [Accepted: 11/20/2007] [Indexed: 01/21/2023]
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12
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Chieffo A, Park SJ, Valgimigli M, Kim YH, Daemen J, Sheiban I, Truffa A, Montorfano M, Airoldi F, Sangiorgi G, Carlino M, Michev I, Lee CW, Hong MK, Park SW, Moretti C, Bonizzoni E, Rogacka R, Serruys PW, Colombo A. Favorable Long-Term Outcome After Drug-Eluting Stent Implantation in Nonbifurcation Lesions That Involve Unprotected Left Main Coronary Artery. Circulation 2007; 116:158-62. [PMID: 17576862 DOI: 10.1161/circulationaha.107.692178] [Citation(s) in RCA: 163] [Impact Index Per Article: 9.6] [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: 11/16/2022]
Abstract
Background—
The presence of a lumen narrowing at the ostium and the body of an unprotected left main coronary artery but does not require bifurcation treatment is a class I indication of surgical revascularization.
Methods and Results—
A total of 147 consecutive patients who had a stenosis in the ostium and/or the midshaft of an unprotected left main coronary artery (treatment of the bifurcation not required) and were electively treated with percutaneous coronary intervention and sirolimus-eluting stents (n=107) or paclitaxel-eluting stents (n=40) in 5 centres were included in this registry. In 72 patients (almost 50%), intravascular ultrasound guidance was performed. Procedural success was achieved in 99% of the patients; in 1 patient with stenosis in the left main coronary artery ostium, a >30% residual stenosis persisted at the end of the procedure, and the patient was referred for coronary artery bypass graft surgery. During hospitalization, no patients experienced a Q-wave myocardial infarction or died. One patient died 19 days after the procedure because of pulmonary infection. At long-term clinical follow-up (886±308 days), 5 patients had died; 7 patients had target vessel revascularization (5 repeat percutaneous coronary interventions and 2 coronary artery bypass graft surgeries), and of these only 1 patient had a target lesion revascularization. Angiographic follow-up was performed in 106 patients (72%) with a late loss of −0.01 mm. Restenosis in the left main trunk occurred only in 1 patient (0.9%).
Conclusions—
Percutaneous coronary intervention with sirolimus-eluting stents or paclitaxel-eluting stents implantation in nonbifurcation left main coronary artery lesions appears safe with a long-term major adverse clinical event rate of 7.4% and a restenosis rate of 0.9%.
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Affiliation(s)
- Alaide Chieffo
- San Raffaele Scientific Institute and Emo Centro Cuore Columbus, Via Olgettina 60, 20132 Milan, Italy
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13
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Airoldi F, Briguori C, Iakovou I, Stankovic G, Biondi-Zoccai G, Carlino M, Chieffo A, Montorfano M, Cosgrave J, Michev I, Rogacka R, Sangiorgi GM, Colombo A. Comparison of sirolimus versus paclitaxel eluting stents for treatment of coronary in-stent restenosis. Am J Cardiol 2006; 97:1182-7. [PMID: 16616023 DOI: 10.1016/j.amjcard.2005.11.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [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: 07/24/2005] [Revised: 11/08/2005] [Accepted: 11/08/2005] [Indexed: 02/08/2023]
Abstract
In patients with in-stent restenosis (ISR) inside bare metal stents, drug-eluting stents reduce the recurrence of restenosis compared with balloon angioplasty. However, few data are available about this therapeutic modality in the case of diffuse restenosis. The aim of this study was to evaluate the immediate and mid-term outcome of sirolimus- and paclitaxel-eluting stent implantation in diffuse ISR and determine the predictors of clinical and angiographic restenosis recurrence. A series of 161 consecutive patients with 194 diffuse ISR lesions (>10 mm) treated with drug-eluting stent implantation were evaluated. Major adverse cardiac events were defined as death, myocardial infarction, and the need for target lesion revascularization. During a mean follow-up of 8.2 +/- 3.4 months, the cumulative incidence of major adverse cardiac events was 19% in the SES group and 24% in the PES group (p = 0.56). Angiographic follow-up was performed in 80% of the lesions. The overall restenosis rate was 22% and was not significantly different between lesions treated with sirolimus-eluting (20%) or paclitaxel-eluting (25%, p = 0.55) stents. The incidence of restenosis was higher in diabetics (32%) than in nondiabetics (16%, odds ratio 2.5, 95% confidence interval 1.1 to 5.5, p = 0.02). By multivariate analysis, diabetes was confirmed to be the only independent predictor of recurrent restenosis (odds ratio 3.53, 95% confidence interval 1.39 to 9.02, p = 0.008). In conclusion, drug-eluting stent implantation for diffuse ISR is associated with acceptable clinical and angiographic results. The association of diffuse restenosis and diabetes mellitus is an unfavorable condition leading to a high risk of recurrence.
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Iakovou I, Stankovic G, Montorfano M, Airoldi F, Chieffo A, Sangiorgi GM, Carlino M, Corvaja N, Iassen M, Rogacka R, Vitrella G, Colombo A. Is overdilatation of 3.0 mm sirolimus-eluting stent associated with a higher restenosis rate? Catheter Cardiovasc Interv 2005; 64:129-33. [PMID: 15678464 DOI: 10.1002/ccd.20276] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [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] [Indexed: 11/10/2022]
Abstract
We evaluated the safety and effectiveness of postdilating a 3.0 mm sirolimus-eluting stents (SESs; six cells) with a 3.5-4.0 mm balloon. We identified 254 consecutive patients who underwent percutaneous coronary interventions using SESs with a nominal diameter of 3.0 mm (six cells). Patients were divided into two groups based on whether they were subsequently postdilated with a 3.0 mm (group 1: 168 patients, 251 lesions) or a 3.5-4 mm balloon (group 2: 86 patients, 102 lesions). There were no significant differences regarding the incidence of in-hospital and long-term follow-up. Angiographic follow-up was available in 72% and 74% of groups 1 and 2, respectively. The two groups had no significant differences regarding late lumen loss (0.51 +/- 0.36 vs. 0.52 +/- 0.33; P = 0.3) and binary restenosis rates (10.7% vs. 8.8%; P = 0.1). Six-month clinical follow-up was available in all patients. At long-term follow-up (mean: 10.6 +/- 3.7 for group 1 and 11.3 +/- 3.9 months for group 2), there were no significant differences between the two groups regarding major adverse cardiac events (8.9% vs. 9.2%; P = 0.9). Implantation of a 3.0 mm SES with postdilation with a 3.5-4 mm balloon did not result in any significant difference in complications, in-hospital non-Q-wave myocardial infarction, binary restenosis, or target lesion revascularization. These data should lessen concern that overdilation may dilute the beneficial effects of SESs.
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Chieffo A, Melzi G, Rogacka R, Ferrari A, Airoldi F, Cosgrave J, Michev I, Montorfano M, Carlino M, Vitrella G, Biondi Zoccai G, Colombo A. Safety and feasibility of Bivalirudin with either Cypher and Taxus drug-eluting stent during percutaneous coronary intervention. EUROINTERVENTION 2005; 1:70-74. [PMID: 19758880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE This open label, prospective, non-comparative trial is the first to evaluate the safety and feasibility of bivalirudin (Angiomax(R), the Medicines Company, Parsippany, NJ), during PCI with implantation of the sirolimus eluting stent (Cypher, Cordis a J & J, Warren, NJ) or the paclitaxel eluting stent (Taxus, Boston Scientific, Natick, MA). METHODS Patients who were referred for elective PCI suitable for stent implantation were recruited. Bivalirudin was administrated as a bolus of 1.0 mg/kg followed by 2.5 mg/kg/hour infusion for up to 4 hours in the first 68 patients. Following REPLACE 2 study, patients were treated with a lower dose of bivalirudin (0.75 mg/kg followed by 1.75 mg/kg/hour infusion). RESULTS 111 patients with 139 lesions were included in the study. Thirty-one (27.9%) were diabetics, 14 (12.6%) had unstable angina and 79 (66.6%) had multivessel disease. Complex lesion morphology was present in 65 (46.7%), in-stent restenosis in 32 (23%), total occlusion 7 (5%) and bifurcations 22 (15.8%). Activated clotting time (ACT) was verified to be therapeutic following bivalirudin administration. During the index procedure no patients required provisional use of glycoprotein (GP) IIb/IIIa inhibitors. One patient had intracoronary thrombosis which resolved after stenting. An additional 2 patients had non-Q wave myocardial infarction (MI). No patients died, had major bleeding, required transfusions or sustained vascular complications. 1 patient developed thrombosis at 4 months with a documented MI. At 6 month follow-up, 3 (2.7%) patients died and 12 (10.8%) patients had target lesion revascularization (1 CABG and 11 re-PCI). Angiographic follow-up was achieved in 98 patients (89.9%). CONCLUSIONS This study indicates the safety and feasibility of Cypher or Taxus stent implantation in conjunction with bivalirudin administration, with no elective use of GP IIb/IIIa inhibitors.
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Colombo A, Mikhail GW, Michev I, Iakovou I, Airoldi F, Chieffo A, Rogacka R, Carlino M, Montorfano M, Sangiorgi GM, Corvaja N, Stankovic G. Treating chronic total occlusions using subintimal tracking and reentry: The STAR Technique. Catheter Cardiovasc Interv 2005; 64:407-11; discussion 412. [PMID: 15789384 DOI: 10.1002/ccd.20307] [Citation(s) in RCA: 180] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Successful recanalization of coronary total occlusions (CTOs) remains an area where improvements are needed. We propose an approach similar to the one utilized in treating some peripheral artery occlusions and aimed to create a subintimal dissection with distal reentry. A 0.014' hydrophilic wire with a J-configuration is utilized for this purpose. We applied this technique to CTO of native coronaries in 31 patients where previous attempts failed in 21 of them (67%). The right coronary artery (RCA) was the index vessel in 87% of patients. Recanalization of the vessel and of most of distal branches was achieved in 21 patients; patency of at least one major distal branch was achieved in 9 patients. Drug-eluting stents (DESs) were implanted in 53% of patients. Three patients had intraprocedural vessel perforation without consequences. Five patients (16%) had in-hospital non-Q-wave myocardial infarction. No other adverse events occurred at a mean follow-up of 5.1 +/- 3.7 months except for one noncardiac death. Angiographic follow-up was performed in 21 (67%) patients and 53% of them developed restenosis. Reintervention on the target vessel was performed in 11 patients (52%). Complete success with the procedure was originally obtained in 8 of the 10 patients who did not develop restenosis and in 8 of them DESs were originally implanted. This technique appears a promising approach to recanalize difficult total occlusions, particularly the ones localize on the RCA, which has the most important side branches located distally.
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Affiliation(s)
- Antonio Colombo
- Catheterization Laboratory, San Raffaele Hospital, Milan, Italy
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Airoldi F, Rogacka R, Briguori C, Chieffo A, Carlino M, Montorfano M, Mikhail G, Iakovou I, Michev I, Vitrella G, Albiero R, Colombo A. Comparison of clinical and angiographic outcome of sirolimus-eluting stent implantation versus cutting balloon angioplasty for coronary in-stent restenosis. Am J Cardiol 2004; 94:1297-300. [PMID: 15541251 DOI: 10.1016/j.amjcard.2004.07.118] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [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: 04/01/2004] [Accepted: 07/21/2004] [Indexed: 11/18/2022]
Abstract
Sixty in-stent restenotic lesions were treated with sirolimus-eluting stent implantation and retrospectively compared with a group of matched lesions treated with cutting balloon angioplasty. The results indicate a good safety profile of the procedure and a 57% reduction in the incidence of recurrent restenosis in comparison with cutting balloon angioplasty.
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Affiliation(s)
- Flavio Airoldi
- Emo Centro Cuore, Columbus Clinic, Interventional Cardiology Unit, San Raffaele Hospital IRCCS, Milan, Italy
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Mikhail GW, Airoldi F, Tavano D, Chieffo A, Rogacka R, Carlino M, Montorfano M, Sangiorgi G, Corvaja N, Michev I, Orlic D, Di Mario C, Colombo A. The use of drug eluting stents in single and multivessel disease: results from a single centre experience. Heart 2004; 90:990-4. [PMID: 15310680 PMCID: PMC1768404 DOI: 10.1136/hrt.2003.028795] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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: 01/23/2023] Open
Abstract
OBJECTIVE Drug eluting stents have been shown to reduce the rate of in-stent restenosis in cases where single lesions are treated. The performance of these stents, in patients with multivessel disease and complex lesions, however, remains unknown. Our experience with sirolimus eluting stents in such patients is presented. DESIGN AND PATIENTS This study includes all consecutive patients treated at San Raffaele Hospital and EMO Centro Cuore Columbus, Milan, Italy treated with sirolimus eluting stents. RESULTS Between April 2002 and March 2003, 486 patients with 1027 lesions were treated (437 males, 49 females) with a mean (SD) age of 62.2 (10.5) years. Of all patients studied, 19.1% had single vessel disease, 33.8% had two vessel disease, and 47.1% had three vessel disease. Of the whole study group, 20.3% of patients had diabetes mellitus. A mean (SD) of 2.3 (0.4) stents per patient and 1.1 (0.2) stents per lesion were implanted. The baseline mean reference diameter was 2.7 (0.6) mm with a mean minimal luminal diameter of 0.9 (0.5) mm. Post-stenting, the acute gain was 1.8 (0.6) mm. During hospital stay one patient died (0.2%) and 13 (2.7%) patients had in-hospital myocardial infarction (MI). One patient required urgent repeat percutaneous coronary intervention. Six months clinical follow up was performed in all 347 eligible patients. Six months mortality was 2.0% (n = 7) and acute MI occurred in 0.3% (n = 1). Target lesion revascularisation occurred in 9.5% (n = 33) of the patients and target vessel revascularisation (TVR) in 11.5% (n = 40) of the patients. Major adverse cardiac event rate was 13.8% (n = 48). TVR was 4.5% for single vessel disease and 13.2% for multivessel disease. Diabetes mellitus was the only significant predictor for TVR. CONCLUSION The use of drug eluting stents in single and multivessel coronary disease produces good short and medium term results with a low rate of revascularisation. Longer term follow-up is required to confirm these observations.
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Affiliation(s)
- G W Mikhail
- San Raffaele Hospital and EMO Centro Cuore Columbus, Milan, Italy
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Iakovou I, Sangiorgi GM, Stankovic G, Corvaja N, Michev I, Chieffo A, Rogacka R, Vitrella G, Airoldi F, Colombo A. Effectiveness of sirolimus-eluting stent implantation for treatment of in-stent restenosis after brachytherapy failure. Am J Cardiol 2004; 94:351-4. [PMID: 15276103 DOI: 10.1016/j.amjcard.2004.04.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [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: 01/21/2004] [Revised: 04/15/2004] [Accepted: 04/15/2004] [Indexed: 10/26/2022]
Abstract
The impact of the use of sirolimus-eluting stents (SESs) in the treatment of in-stent restenosis in previously irradiated sites has not been adequately evaluated. Fifteen consecutive patients who underwent percutaneous coronary interventions using SESs in lesion sites previously intervened with intracoronary radiation therapy were identified. All stents were implanted successfully, and there were no major in-hospital complications. At 30-day follow-up, there was 1 case of subacute thrombosis that led to target lesion revascularization (TLR). At 6 months, 2 patients underwent TLR because of recurrent angina with angiographic restenosis, and 1 patient underwent target vessel revascularization distally to the SES site; no other major adverse cardiac events occurred at long-term follow-up (mean 17 +/- 8 months).
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Chieffo A, Bonizzoni E, Orlic D, Stankovic G, Rogacka R, Airoldi F, Mikhail GW, Montorfano M, Michev I, Carlino M, Colombo A. Intraprocedural Stent Thrombosis During Implantation of Sirolimus-Eluting Stents. Circulation 2004; 109:2732-6. [PMID: 15148281 DOI: 10.1161/01.cir.0000131890.83839.5b] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.7] [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] [Indexed: 11/16/2022]
Abstract
Background—
Intraprocedural stent thrombosis (IPST) is a rare event (<0.01% in our experience with bare metal stents), with the exception of specific settings such as acute myocardial infarction, thrombus-containing lesions, and dissections. We report the occurrence of this event during elective implantation of sirolimus-eluting stents.
Methods and Results—
Between April 2002 and August 2003, 670 patients with 1362 lesions were treated with Cypher (Cordis, Johnson and Johnson Co) sirolimus-eluting stent implantation in San Raffaele Hospital and EMO Centro Cuore Columbus. Diabetes mellitus was present in 142 patients (21%), and 164 (24.5%) had unstable angina. Pretreatment with glycoprotein IIb/IIIa (GP IIb/IIIa) inhibitors was carried out in 235 patients (35%). Total stent length per vessel was 42.9±28.3 mm. IPST occurred in 5 patients (0.7%). None of the patients with IPST were pretreated with GP IIb/IIIa inhibitors. Using univariate exact logistic regression, only total stent length per vessel, in millimeters (exact OR, 1.03; 95% CI, 1.011 to 1.046;
P
=0.0028), was associated with the occurrence of IPST.
Conclusions—
Stent length was associated with the occurrence of IPST. Particular attention will need to be directed to this potential complication when long sirolimus-eluting stents are being used.
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