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Araki M, Park SJ, Dauerman HL, Uemura S, Kim JS, Di Mario C, Johnson TW, Guagliumi G, Kastrati A, Joner M, Holm NR, Alfonso F, Wijns W, Adriaenssens T, Nef H, Rioufol G, Amabile N, Souteyrand G, Meneveau N, Gerbaud E, Opolski MP, Gonzalo N, Tearney GJ, Bouma B, Aguirre AD, Mintz GS, Stone GW, Bourantas CV, Räber L, Gili S, Mizuno K, Kimura S, Shinke T, Hong MK, Jang Y, Cho JM, Yan BP, Porto I, Niccoli G, Montone RA, Thondapu V, Papafaklis MI, Michalis LK, Reynolds H, Saw J, Libby P, Weisz G, Iannaccone M, Gori T, Toutouzas K, Yonetsu T, Minami Y, Takano M, Raffel OC, Kurihara O, Soeda T, Sugiyama T, Kim HO, Lee T, Higuma T, Nakajima A, Yamamoto E, Bryniarski KL, Di Vito L, Vergallo R, Fracassi F, Russo M, Seegers LM, McNulty I, Park S, Feldman M, Escaned J, Prati F, Arbustini E, Pinto FJ, Waksman R, Garcia-Garcia HM, Maehara A, Ali Z, Finn AV, Virmani R, Kini AS, Daemen J, Kume T, Hibi K, Tanaka A, Akasaka T, Kubo T, Yasuda S, Croce K, Granada JF, Lerman A, Prasad A, Regar E, Saito Y, Sankardas MA, Subban V, Weissman NJ, Chen Y, Yu B, Nicholls SJ, Barlis P, West NEJ, Arbab-Zadeh A, Ye JC, Dijkstra J, Lee H, Narula J, Crea F, Nakamura S, Kakuta T, Fujimoto J, Fuster V, Jang IK. Author Correction: Optical coherence tomography in coronary atherosclerosis assessment and intervention. Nat Rev Cardiol 2024; 21:348. [PMID: 38110566 DOI: 10.1038/s41569-023-00982-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Affiliation(s)
| | | | | | | | - Jung-Sun Kim
- Yonsei University College of Medicine, Seoul, South Korea
| | | | - Thomas W Johnson
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Adnan Kastrati
- Technische Universität München and Munich Heart Alliance, Munich, Germany
| | | | | | | | - William Wijns
- National University of Ireland Galway and Saolta University Healthcare Group, Galway, Ireland
| | | | | | - Gilles Rioufol
- Hospices Civils de Lyon and Claude Bernard University, Lyon, France
| | | | | | | | | | | | - Nieves Gonzalo
- Hospital Clinico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | | | - Brett Bouma
- Massachusetts General Hospital, Boston, MA, USA
| | | | - Gary S Mintz
- Cardiovascular Research Foundation, New York, NY, USA
| | - Gregg W Stone
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christos V Bourantas
- Barts Health NHS Trust, University College London and Queen Mary University London, London, UK
| | - Lorenz Räber
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | | | | | - Myeong-Ki Hong
- Yonsei University College of Medicine, Seoul, South Korea
| | - Yangsoo Jang
- Yonsei University College of Medicine, Seoul, South Korea
| | | | - Bryan P Yan
- Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Italo Porto
- University of Genoa, Genoa, Italy, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | | | - Rocco A Montone
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | | | - Harmony Reynolds
- New York University Grossman School of Medicine, New York, NY, USA
| | - Jacqueline Saw
- Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter Libby
- Brigham and Women's Hospital, Boston, MA, USA
| | - Giora Weisz
- New York Presbyterian Hospital, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY, USA
| | | | - Tommaso Gori
- Universitäts medizin Mainz and DZHK Rhein-Main, Mainz, Germany
| | | | | | | | | | | | - Osamu Kurihara
- Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | | | | | | | - Tetsumin Lee
- Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Takumi Higuma
- Kawasaki Municipal Tama Hospital, St. Marianna University School of Medicine, Kanagawa, Japan
| | | | - Erika Yamamoto
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Krzysztof L Bryniarski
- Jagiellonian University Medical College, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, Krakow, Poland
| | | | | | | | - Michele Russo
- Catholic University of the Sacred Heart, Rome, Italy
| | | | | | - Sangjoon Park
- Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Marc Feldman
- University of Texas Health, San Antonio, TX, USA
| | | | - Francesco Prati
- UniCamillus - Saint Camillus International University of Health Sciences, Rome, Italy
| | - Eloisa Arbustini
- IRCCS Foundation University Hospital Policlinico San Matteo, Pavia, Italy
| | - Fausto J Pinto
- Santa Maria University Hospital, CHULN Center of Cardiology of the University of Lisbon, Lisbon School of Medicine, Lisbon Academic Medical Center, Lisbon, Portugal
| | - Ron Waksman
- MedStar Washington Hospital Center, Washington, DC, USA
| | | | - Akiko Maehara
- Cardiovascular Research Foundation, New York, NY, USA
| | - Ziad Ali
- Cardiovascular Research Foundation, New York, NY, USA
| | | | | | | | - Joost Daemen
- Erasmus University Medical Centre, Rotterdam, Netherlands
| | | | - Kiyoshi Hibi
- Yokohama City University Medical Center, Kanagawa, Japan
| | | | | | | | - Satoshi Yasuda
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kevin Croce
- Brigham and Women's Hospital, Boston, MA, USA
| | | | | | | | | | | | | | | | | | - Yundai Chen
- Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Bo Yu
- The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | | | - Peter Barlis
- University of Melbourne, Melbourne, Victoria, Australia
| | | | | | - Jong Chul Ye
- Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | | | - Hang Lee
- Massachusetts General Hospital, Boston, MA, USA
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Filippo Crea
- Catholic University of the Sacred Heart, Rome, Italy
| | | | | | - James Fujimoto
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Ik-Kyung Jang
- Massachusetts General Hospital, Boston, MA, USA.
- Kyung Hee University, Seoul, South Korea.
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De Filippo O, Cammann VL, Pancotti C, Di Vece D, Silverio A, Schweiger V, Niederseer D, Szawan KA, Würdinger M, Koleva I, Dusi V, Bellino M, Vecchione C, Parodi G, Bossone E, Gili S, Neuhaus M, Franke J, Meder B, Jaguszewski M, Noutsias M, Knorr M, Jansen T, Dichtl W, von Lewinski D, Burgdorf C, Kherad B, Tschöpe C, Sarcon A, Shinbane J, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Karakas M, Koenig W, Pott A, Meyer P, Roffi M, Banning A, Wolfrum M, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KEJ, Napp LC, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Chan C, Bridgman P, Beug D, Delmas C, Lairez O, Gilyarova E, Shilova A, Gilyarov M, El-Battrawy I, Akin I, Poledniková K, Toušek P, Winchester DE, Massoomi M, Galuszka J, Ukena C, Poglajen G, Carrilho-Ferreira P, Hauck C, Paolini C, Bilato C, Kobayashi Y, Kato K, Ishibashi I, Himi T, Din J, Al-Shammari A, Prasad A, Rihal CS, Liu K, Schulze PC, Bianco M, Jörg L, Rickli H, Pestana G, Nguyen TH, Böhm M, Maier LS, Pinto FJ, Widimský P, Felix SB, Braun-Dullaeus RC, Rottbauer W, Hasenfuß G, Pieske BM, Schunkert H, Budnik M, Opolski G, Thiele H, Bauersachs J, Horowitz JD, Di Mario C, Bruno F, Kong W, Dalakoti M, Imori Y, Münzel T, Crea F, Lüscher TF, Bax JJ, Ruschitzka F, De Ferrari GM, Fariselli P, Ghadri JR, Citro R, D'Ascenzo F, Templin C. Machine learning-based prediction of in-hospital death for patients with takotsubo syndrome: The InterTAK-ML model. Eur J Heart Fail 2023; 25:2299-2311. [PMID: 37522520 DOI: 10.1002/ejhf.2983] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/01/2023] [Accepted: 07/26/2023] [Indexed: 08/01/2023] Open
Abstract
AIMS Takotsubo syndrome (TTS) is associated with a substantial rate of adverse events. We sought to design a machine learning (ML)-based model to predict the risk of in-hospital death and to perform a clustering of TTS patients to identify different risk profiles. METHODS AND RESULTS A ridge logistic regression-based ML model for predicting in-hospital death was developed on 3482 TTS patients from the International Takotsubo (InterTAK) Registry, randomly split in a train and an internal validation cohort (75% and 25% of the sample size, respectively) and evaluated in an external validation cohort (1037 patients). Thirty-one clinically relevant variables were included in the prediction model. Model performance represented the primary endpoint and was assessed according to area under the curve (AUC), sensitivity and specificity. As secondary endpoint, a K-medoids clustering algorithm was designed to stratify patients into phenotypic groups based on the 10 most relevant features emerging from the main model. The overall incidence of in-hospital death was 5.2%. The InterTAK-ML model showed an AUC of 0.89 (0.85-0.92), a sensitivity of 0.85 (0.78-0.95) and a specificity of 0.76 (0.74-0.79) in the internal validation cohort and an AUC of 0.82 (0.73-0.91), a sensitivity of 0.74 (0.61-0.87) and a specificity of 0.79 (0.77-0.81) in the external cohort for in-hospital death prediction. By exploiting the 10 variables showing the highest feature importance, TTS patients were clustered into six groups associated with different risks of in-hospital death (28.8% vs. 15.5% vs. 5.4% vs. 1.0.8% vs. 0.5%) which were consistent also in the external cohort. CONCLUSION A ML-based approach for the identification of TTS patients at risk of adverse short-term prognosis is feasible and effective. The InterTAK-ML model showed unprecedented discriminative capability for the prediction of in-hospital death.
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Affiliation(s)
- Ovidio De Filippo
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Victoria L Cammann
- Department of Cardiology, University Heart Center, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Corrado Pancotti
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Davide Di Vece
- Department of Cardiology, University Heart Center, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Angelo Silverio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - Victor Schweiger
- Department of Cardiology, University Heart Center, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - David Niederseer
- Department of Cardiology, University Heart Center, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Konrad A Szawan
- Department of Cardiology, University Heart Center, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Michael Würdinger
- Department of Cardiology, University Heart Center, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Iva Koleva
- Department of Cardiology, University Heart Center, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Veronica Dusi
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Michele Bellino
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
- Department of Vascular Physiopathology, IRCCS Neuromed, Pozzilli, Italy
| | - Guido Parodi
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Eduardo Bossone
- Division of Cardiology, 'Antonio Cardarelli' Hospital, Naples, Italy
| | | | - Michael Neuhaus
- Department of Cardiology, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
| | - Jennifer Franke
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Benjamin Meder
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Miłosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Michel Noutsias
- Division of Cardiology, Angiology and Intensive Medical Care, Department of Internal Medicine III, Mid-German Heart Center, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Maike Knorr
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Thomas Jansen
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Wolfgang Dichtl
- University Hospital for Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Innsbruck, Austria
| | | | | | - Behrouz Kherad
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Carsten Tschöpe
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Annahita Sarcon
- Section of Cardiac Electrophysiology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Jerold Shinbane
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Guido Michels
- Klinik für Akut- und Notfallmedizin, St.-Antonius-Hospital gGmbH, Akademisches Lehrkrankenhaus der RWTH Aachen, Eschweiler, Germany
| | - Roman Pfister
- Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
| | - Alessandro Cuneo
- Krankenhaus 'Maria Hilf' Medizinische Klinik, Stadtlohn, Germany
| | - Claudius Jacobshagen
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany
- Vincentius-Diakonissen Hospital, Karlsruhe, Germany
| | - Mahir Karakas
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Alexander Pott
- Department of Internal Medicine II-Cardiology, Medical Center, University of Ulm, Ulm, Germany
| | - Philippe Meyer
- Service de Cardiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Marco Roffi
- Service de Cardiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Adrian Banning
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Mathias Wolfrum
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Florim Cuculi
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Richard Kobza
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Thomas A Fischer
- Department of Cardiology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Tuija Vasankari
- Heart Center, Turku University Hospital, University of Turku, Turku, Finland
| | | | - L Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | | | | | - Christoph Kaiser
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Leonarda Galiuto
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Christina Chan
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Paul Bridgman
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Daniel Beug
- Department of Cardiology and Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Clément Delmas
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Olivier Lairez
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Ekaterina Gilyarova
- Intensive Coronary Care Unit, Moscow City Hospital No 1 named after N. Pirogov, Moscow, Russia
| | - Alexandra Shilova
- Intensive Coronary Care Unit, Moscow City Hospital No 1 named after N. Pirogov, Moscow, Russia
| | - Mikhail Gilyarov
- Intensive Coronary Care Unit, Moscow City Hospital No 1 named after N. Pirogov, Moscow, Russia
| | - Ibrahim El-Battrawy
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Karolina Poledniková
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague and University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Petr Toušek
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague and University Hospital Královské Vinohrady, Prague, Czech Republic
| | - David E Winchester
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Michael Massoomi
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jan Galuszka
- Department of Internal Medicine I-Cardiology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Christian Ukena
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Gregor Poglajen
- Advanced Heart Failure and Transplantation Center, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Pedro Carrilho-Ferreira
- CHULN, Center of Cardiology of the University of Lisbon, Lisbon School of Medicine, Lisbon Academic Medical Center, Santa Maria University Hospital, Lisbon, Portugal
| | - Christian Hauck
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Carla Paolini
- Local Health Unit n. 8, Cardiology Unit, Vicenza, Italy
| | | | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Ken Kato
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Iwao Ishibashi
- Department of Cardiology, Chiba Emergency Medical Center, Chiba, Japan
| | - Toshiharu Himi
- Division of Cardiology, Kimitsu Central Hospital, Kisarazu, Japan
| | - Jehangir Din
- Dorset Heart Centre, Royal Bournemouth Hospital, Bournemouth, UK
| | - Ali Al-Shammari
- Dorset Heart Centre, Royal Bournemouth Hospital, Bournemouth, UK
| | - Abhiram Prasad
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Charanjit S Rihal
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Kan Liu
- Division of Cardiology, Heart and Vascular Center, University of Iowa, Iowa City, IA, USA
| | - P Christian Schulze
- Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - Matteo Bianco
- Division of Cardiology, A.O.U. San Luigi Gonzaga, Turin, Italy
| | - Lucas Jörg
- Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Hans Rickli
- Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Gonçalo Pestana
- Department of Cardiology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Thanh H Nguyen
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, Adelaide, SA, Australia
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Lars S Maier
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Fausto J Pinto
- CHULN, Center of Cardiology of the University of Lisbon, Lisbon School of Medicine, Lisbon Academic Medical Center, Santa Maria University Hospital, Lisbon, Portugal
| | - Petr Widimský
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague and University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Stephan B Felix
- Department of Cardiology and Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | | | - Wolfgang Rottbauer
- Department of Internal Medicine II-Cardiology, Medical Center, University of Ulm, Ulm, Germany
| | - Gerd Hasenfuß
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany
| | - Burkert M Pieske
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Monika Budnik
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz Opolski
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig, University Hospital, Leipzig, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - John D Horowitz
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, Adelaide, SA, Australia
| | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Francesco Bruno
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - William Kong
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Mayank Dalakoti
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Yoichi Imori
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Thomas Münzel
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Filippo Crea
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Thomas F Lüscher
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Zurich, Switzerland
- Royal Brompton and Harefield Hospitals Trust and Imperial College and Kings College, London, UK
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Piero Fariselli
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Jelena R Ghadri
- Department of Cardiology, University Heart Center, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Rodolfo Citro
- Department of Vascular Physiopathology, IRCCS Neuromed, Pozzilli, Italy
- Department of Cardio-Thoracic-Vascular, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
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3
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Angelini F, Franchin L, Bocchino PP, Morici N, Wańha W, Savonitto S, Trabattoni D, Cerrato E, Barbieri L, Fortuni F, DE Luca L, Greco A, DE Filippo O, Montefusco A, Montabone A, Rubino AE, Gili S, Quadri G, Somaschini A, Cornara S, Carugo S, Capodanno D, Wojakowski W, Dusi V, D'Ascenzo F, DE Ferrari GM. In-hospital outcomes in nonagenarian patients undergoing primary percutaneous coronary intervention. Minerva Cardiol Angiol 2023; 71:590-598. [PMID: 36475546 DOI: 10.23736/s2724-5683.22.06167-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 09/16/2023]
Abstract
BACKGROUND The aim of the present analysis was to evaluate the incidence and predictors of in-hospital adverse outcomes in nonagenarian patients undergoing primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI). METHODS Consecutive nonagenarian patients undergoing pPCI for STEMI from 2009 to 2019 were retrospectively included in an international multicenter registry. In-hospital all-cause death was the primary outcome. RESULTS A total of 308 patients were included (mean age 92.5±2.5 years, 65.6% female). Mean systolic blood pressure (SBP) at hospital admission was 130.7±33.5 mmHg, 46 (17%) patients presented with a Killip class III-IV, mean left ventricle ejection fraction (LVEF) was 40.0±11.5% and 147 (58%) patients were independent in everyday activities. In-hospital death occurred in 99 patients (32%). After multivariate adjustment, lower LVEF (OR per unit reduction 1.08, 95% CI: 1.03-1.11, P value <0.001), lower SBP (OR 1.02 per mmHg reduction, 95% CI: 1.01-1.03, P value 0.001) and being not independent at home (OR 2.56, 95% CI: 1.25-5.26, P value 0.01) resulted independent predictors of in-hospital mortality. A sensitivity analysis performed in final TIMI 3 flow population confirmed the prognostic role of LVEF and independency on in-hospital mortality. CONCLUSIONS Nonagenarian patients presenting with STEMI and undergoing pPCI have high in-hospital mortality. Independency in everyday life is a strong independent predictor of survival to hospital discharge.
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Affiliation(s)
- Filippo Angelini
- Division of Cardiology, Department of Cardiovascular and Thoracic Surgery, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy -
| | - Luca Franchin
- Division of Cardiology, Department of Cardiovascular and Thoracic Surgery, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Pier P Bocchino
- Division of Cardiology, Department of Cardiovascular and Thoracic Surgery, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Nuccia Morici
- Intensive Cardiac Care Unit, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Wojciech Wańha
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | - Daniela Trabattoni
- Department of Invasive Cardiology, IRCCS Monzino Cardiologic Centre, Milan, Italy
| | - Enrico Cerrato
- Interventional Cardiology Unit, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
- Infermi Hospital, Rivoli, Turin, Italy
| | - Lucia Barbieri
- Division of Cardiology, ASST Santi Paolo e Carlo, Milan, Italy
| | - Federico Fortuni
- Coronary Care Unit, Laboratory of Clinical and Experimental Cardiology, IRCCS San Matteo Polyclinic Foundation, Pavia, Italy
| | | | - Antonio Greco
- AOU Policlinico G. Rodolico-S. Marco, University of Catania, Catania, Italy
| | - Ovidio DE Filippo
- Division of Cardiology, Department of Cardiovascular and Thoracic Surgery, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Antonio Montefusco
- Division of Cardiology, Department of Cardiovascular and Thoracic Surgery, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Andrea Montabone
- Division of Cardiology, Department of Cardiovascular and Thoracic Surgery, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Anna E Rubino
- Division of Cardiology, Department of Cardiovascular and Thoracic Surgery, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Sebastiano Gili
- Department of Invasive Cardiology, IRCCS Monzino Cardiologic Centre, Milan, Italy
| | - Giorgio Quadri
- Interventional Cardiology Unit, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
- Infermi Hospital, Rivoli, Turin, Italy
| | - Alberto Somaschini
- Coronary Care Unit, Laboratory of Clinical and Experimental Cardiology, IRCCS San Matteo Polyclinic Foundation, Pavia, Italy
| | - Stefano Cornara
- Coronary Care Unit, Laboratory of Clinical and Experimental Cardiology, IRCCS San Matteo Polyclinic Foundation, Pavia, Italy
| | - Stefano Carugo
- Unit of Cardiology, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Davide Capodanno
- AOU Policlinico G. Rodolico-S. Marco, University of Catania, Catania, Italy
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Veronica Dusi
- Division of Cardiology, Department of Cardiovascular and Thoracic Surgery, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Cardiovascular and Thoracic Surgery, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Gaetano M DE Ferrari
- Division of Cardiology, Department of Cardiovascular and Thoracic Surgery, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
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4
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Zarà M, Baggiano A, Amadio P, Campodonico J, Gili S, Annoni A, De Dona G, Carerj ML, Cilia F, Formenti A, Fusini L, Banfi C, Gripari P, Tedesco CC, Mancini ME, Chiesa M, Maragna R, Marchetti F, Penso M, Tassetti L, Volpe A, Bonomi A, Marenzi G, Pontone G, Barbieri SS. Circulating Small Extracellular Vesicles Reflect the Severity of Myocardial Damage in STEMI Patients. Biomolecules 2023; 13:1470. [PMID: 37892152 PMCID: PMC10605123 DOI: 10.3390/biom13101470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/15/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023] Open
Abstract
Circulating small extracellular vesicles (sEVs) contribute to inflammation, coagulation and vascular injury, and have great potential as diagnostic markers of disease. The ability of sEVs to reflect myocardial damage assessed by Cardiac Magnetic Resonance (CMR) in ST-segment elevation myocardial infarction (STEMI) is unknown. To fill this gap, plasma sEVs were isolated from 42 STEMI patients treated by primary percutaneous coronary intervention (pPCI) and evaluated by CMR between days 3 and 6. Nanoparticle tracking analysis showed that sEVs were greater in patients with anterior STEMI (p = 0.0001), with the culprit lesion located in LAD (p = 0.045), and in those who underwent late revascularization (p = 0.038). A smaller sEV size was observed in patients with a low myocardial salvage index (MSI, p = 0.014). Patients with microvascular obstruction (MVO) had smaller sEVs (p < 0.002) and lower expression of the platelet marker CD41-CD61 (p = 0.039). sEV size and CD41-CD61 expression were independent predictors of MVO/MSI (OR [95% CI]: 0.93 [0.87-0.98] and 0.04 [0-0.61], respectively). In conclusion, we provide evidence that the CD41-CD61 expression in sEVs reflects the CMR-assessed ischemic damage after STEMI. This finding paves the way for the development of a new strategy for the timely identification of high-risk patients and their treatment optimization.
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Affiliation(s)
- Marta Zarà
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.Z.); (A.B.); (G.M.)
| | - Andrea Baggiano
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.Z.); (A.B.); (G.M.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Patrizia Amadio
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.Z.); (A.B.); (G.M.)
| | - Jeness Campodonico
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.Z.); (A.B.); (G.M.)
| | - Sebastiano Gili
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.Z.); (A.B.); (G.M.)
| | - Andrea Annoni
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.Z.); (A.B.); (G.M.)
| | - Gianluca De Dona
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.Z.); (A.B.); (G.M.)
| | | | - Francesco Cilia
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.Z.); (A.B.); (G.M.)
| | - Alberto Formenti
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.Z.); (A.B.); (G.M.)
| | - Laura Fusini
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.Z.); (A.B.); (G.M.)
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20156 Milan, Italy
| | - Cristina Banfi
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.Z.); (A.B.); (G.M.)
| | - Paola Gripari
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.Z.); (A.B.); (G.M.)
| | | | | | - Mattia Chiesa
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.Z.); (A.B.); (G.M.)
| | - Riccardo Maragna
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.Z.); (A.B.); (G.M.)
| | - Francesca Marchetti
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.Z.); (A.B.); (G.M.)
| | - Marco Penso
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.Z.); (A.B.); (G.M.)
| | - Luigi Tassetti
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.Z.); (A.B.); (G.M.)
| | - Alessandra Volpe
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.Z.); (A.B.); (G.M.)
| | - Alice Bonomi
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.Z.); (A.B.); (G.M.)
| | - Giancarlo Marenzi
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.Z.); (A.B.); (G.M.)
| | - Gianluca Pontone
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.Z.); (A.B.); (G.M.)
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
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5
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Trabattoni D, Gili S, Calligaris G, Teruzzi G, Troiano S, Ravagnani P, Santagostino Baldi G, Montorsi P. Patent foramen ovale closure with the Occlutech Figulla flex II device: A long-term (up to 10-years) follow-up. Int J Cardiol 2023; 387:131116. [PMID: 37301447 DOI: 10.1016/j.ijcard.2023.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 06/07/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Percutaneous closure represents the first line of treatment in patients with cryptogenic stroke and documented patent foramen ovale (PFO). Scarce data report the long-term outcomes of patients undergoing PFO closure with the Figulla Flex II device (Occlutech, Germany). METHODS Consecutive patients undergoing PFO closure with a Figulla Flex II device at a single, high-volume Institution were included. Baseline clinical and procedural features were collected and patients were followed up for up to 10 years. The device's long-term safety was assessed, as well as mortality, recurrent cerebrovascular events, new-onset atrial fibrillation (AF) and residual shunt. RESULTS Overall, 442 patients were included. The main indication for PFO closure was cryptogenic stroke/transitory ischemic attack (65.5%), followed by migraine (21.7%), silent lesions at MRI (10.8%), and decompression disease (2.0%). Atrial septal aneurysm was present in 20.8% of cases, Eustachian valve in 9.0%, Chiari network in 19.9%. The most frequently implanted device was the 23/25 mm (49.5% of cases). One procedural failure due to device embolization; in-hospital complications occurred in 15 cases (3.4%; 4 minor access site complications, 11 transient supraventricular tachycardias (SVT)/AF). After a follow-up of 9.2 years, 2 patients suffered recurrent TIA (with no residual R-L shunt detected). A moderate or severe residual shunt was observed in 3 patients after discharge. CONCLUSIONS Figulla Flex II devices for PFO closure are associated with high procedural success and low incidence of adverse events even at long-term follow-up.
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Affiliation(s)
- Daniela Trabattoni
- Centro Cardiologico "Monzino", IRCCS, Department of Cardiovascular Sciences, University of Milan, Italy.
| | - Sebastiano Gili
- Centro Cardiologico "Monzino", IRCCS, Department of Cardiovascular Sciences, University of Milan, Italy
| | - Giuseppe Calligaris
- Centro Cardiologico "Monzino", IRCCS, Department of Cardiovascular Sciences, University of Milan, Italy
| | - Giovanni Teruzzi
- Centro Cardiologico "Monzino", IRCCS, Department of Cardiovascular Sciences, University of Milan, Italy
| | - Sarah Troiano
- Centro Cardiologico "Monzino", IRCCS, Department of Cardiovascular Sciences, University of Milan, Italy
| | - Paolo Ravagnani
- Centro Cardiologico "Monzino", IRCCS, Department of Cardiovascular Sciences, University of Milan, Italy
| | - Giulia Santagostino Baldi
- Centro Cardiologico "Monzino", IRCCS, Department of Cardiovascular Sciences, University of Milan, Italy
| | - Piero Montorsi
- Centro Cardiologico "Monzino", IRCCS, Department of Cardiovascular Sciences, University of Milan, Italy
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6
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Choi KH, Bruno F, Cho YK, De Luca L, Song YB, Kang J, Mattesini A, Gwon HC, Truffa A, Kim HS, Wańha W, Chun WJ, Gili S, Hur SH, Helft G, Han SH, Cortese B, Lee CH, Escaned J, Yoon HJ, Chieffo A, Hahn JY, Gallone G, Choi SH, De Ferrari G, Koo BK, Quadri G, D'Ascenzo F, Nam CW, de Filippo O. Comparison of Outcomes Between 1- and 2-Stent Techniques for Medina Classification 0.0.1 Coronary Bifurcation Lesions. JACC Cardiovasc Interv 2023; 16:2083-2093. [PMID: 37565964 DOI: 10.1016/j.jcin.2023.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/09/2023] [Accepted: 06/11/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Although Medina 0.0.1 bifurcation lesions are often treated by percutaneous coronary intervention (PCI) in real-world practice, the optimal revascularization strategy for this lesion is uncertain. OBJECTIVES The current study aimed to compare the clinical outcomes between 1- and 2-stent strategies in patients treated with PCI for Medina 0.0.1 bifurcation lesions. METHODS The extended BIFURCAT (Combined Insights From the Unified RAIN [Very Thin Stents for Patients with Left Main or Bifurcation in Real Life] and COBIS [Coronary Bifurcation Stenting] Bifurcation Registries) registry was obtained by patient-level merging the dedicated bifurcation COBIS II, III, and RAIN registries. Among 8,434 patients with bifurcation lesions undergoing PCI, 345 (4.1%) with Medina 0.0.1 lesions were selected for the current analysis. The primary endpoint was major adverse cardiac event (MACE, a composite of all-cause death, myocardial infarction, target vessel revascularization, and stent thrombosis) at 800 days. RESULTS In the total population, 209 patients (60.6%) received PCI with a 1-stent strategy and the remaining 136 patients (39.4%) with a 2-stent strategy. There was a tendency for higher use of a 1-stent strategy over time (36.0%, 47.4%, and 90.4% in 2003-2009, 2010-2014, and 2015-2017, respectively; P for trend < 0.001). For the treatment of Medina 0.0.1 lesions, there was no significant difference in the risk of MACE between 1- and 2-stent strategies (1 stent vs 2 stent, 14.3% vs 13.9%; HR: 1.034; 95% CI: 0.541-1.977; P = 0.92). The risk of MACE was also not significantly different when stratifying into 3 groups (1-stent crossover only, 1-stent with strut opening, and 2-stent strategy). CONCLUSIONS In patients with a Medina 0.0.1 type bifurcation lesion, PCI with a 1-stent strategy showed comparable outcomes to that of a 2-stent strategy. (Coronary Bifurcation Stenting II [COBIS II]; NCT01642992; Coronary Bifurcation Stenting III [COBIS III]; NCT03068494; Very Thin Stents for Patients with Left Main or Bifurcation in Real Life [RAIN]; NCT03544294).
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Affiliation(s)
- Ki Hong Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Francesco Bruno
- Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Yun-Kyeong Cho
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | - Leonardo De Luca
- Department of Cardiosciences, San Camillo-Forlanini Hospital, Roma, Italy
| | - Young Bin Song
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeehoon Kang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Alessio Mattesini
- Cardiologia Interventistica Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Wojciech Wańha
- Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Woo Jung Chun
- Department of Internal Medicine, Samsung Changwon Hospital, Changwon, Republic of Korea
| | | | - Seung-Ho Hur
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | - Gerard Helft
- Sorbonne Université, INSERM UMRS1166, Hôpital Pitié-Salpêtrière, Paris, France
| | - Seung Hwan Han
- Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Republic of Korea
| | | | - Cheol Hyun Lee
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | | | - Hyuck-Jun Yoon
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | - Alaide Chieffo
- Division of Cardiology, Ospedale San Raffaele, Milan, Italy
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Guglielmo Gallone
- Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gaetano De Ferrari
- Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Giorgio Quadri
- Division of Cardiology, Ospedale di Rivoli, Rivoli, Italy
| | - Fabrizio D'Ascenzo
- Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Chang-Wook Nam
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea.
| | - Ovidio de Filippo
- Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
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7
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Montorsi P, Galli S, Teruzzi G, Gili S, Trabattoni D. The 'Trawl Fishing' Technique: A Quick Engagement of the Left Common Carotid Artery With the Simmons Catheter During Carotid Artery Stenting From the Right Radial Approach. Cardiovasc Revasc Med 2023; 54:57-60. [PMID: 37085354 DOI: 10.1016/j.carrev.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/11/2023] [Accepted: 04/11/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Transradial approach for carotid artery stenting (TRCAS) is an established technique in specific anatomies potentially associated with high periprocedural event rate from femoral catheterization. The engagement of left common carotid artery originating from the aortic arch is the most challenging scenario requiring specific catheters and techniques. METHODS Among 542 consecutive TRCAS 66 had left, non-bovine carotid stenosis as the target vessel. We retrospectively compared the feasibility, safety, efficacy, fluoroscopy time and radiation exposure of two different techniques, the standard (ST) and the 'trawl-fishing' (TFT), to engage the LCCA with the 5F, 125 cm-long Simmons-2 catheter. RESULTS The ST was initially used in 20 patients with a technical success of 85 % (17/20). In the following 46 patients, the TFT was successfully tested first as bailout after ST failure in 12 cases and as first option in the remaining 34 patients. Full technical success was obtained in all patients at the first attempt. No MACCEs or vascular complications occurred in all patients. Fluoroscopy time and radiation exposure were significantly lower with the TFT vs. ST (p < 0.001). CONCLUSIONS TFT represents a definite improvement in the technique of LCCA engagement during TRCAS.
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Affiliation(s)
- Piero Montorsi
- Department of Clinical Sciences and Community Health, University of Milan, Italy; Centro Cardiologico Monzino, IRCCS, Milan, Italy.
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8
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Mushtaq S, Pontone G, Conte E, Trabattoni D, Galli S, Gili S, Troiano S, Teruzzi G, Baggiano A, Bonomi A, Mallia V, Marchetti D, Schillaci M, Melotti E, Belmonte M, Guaricci AI, Gigante C, Pepi M, Bartorelli AL, Andreini D. Diagnostic accuracy of subendocardial vs. transmural myocardial perfusion defect for the detection of in-stent restenosis or progression of coronary artery disease after percutaneous coronary intervention. J Cardiovasc Comput Tomogr 2023; 17:277-280. [PMID: 37248106 DOI: 10.1016/j.jcct.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/03/2023] [Accepted: 05/17/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND The ADVANTAGE study demonstrated in a cohort of stented patients a diagnostic accuracy of stress myocardial CT perfusion (CTP) significantly higher than that of coronary CT angiography (CCTA) for the detection of in-stent restenosis (ISR) or CAD progression vs. quantitative coronary angiography (QCA). This is a pre-defined subanalysis of the ADVANTAGE aimed at assessing the difference in terms of diagnostic accuracy vs. QCA of a subendocardial vs. a transmural perfusion defect using static stress CTP. METHODS We enrolled consecutive patients who previously underwent coronary stenting and were referred for QCA. All patients underwent stress CTP and rest CTP + CCTA. The diagnostic accuracy of CCTA and CTP were evaluated in territory-based and patient-based analyses. We compared the diagnostic accuracy of "subendocardial" perfusion defect, defined as hypo-enhancement encompassing >25% but <50% of the transmural myocardial thickness within a specific coronary territory vs. "transmural" perfusion defect, defined as hypo-enhancement encompassing >50% of the transmural thickness. RESULTS In 150 patients (132 men, mean age 65.1 ± 9.1 years), the diagnostic accuracy of subendocardial vs. transmural perfusion defect in a vessel-based analysis was 93.5% vs. 87.7%, respectively (p < 0.0001). The sensitivity and specificity of subendocardial vs. transmural defect were 87.9% vs. 46.9% (p < 0.001) and 94.9% vs. 97.9% (p = 0.004), respectively. In a patient-based analysis, the diagnostic accuracy of the subendocardial vs. transmural approach was 86.6% vs. 68% (p < 0.0001). CONCLUSIONS This study shows that detection of a subendocardial perfusion defect as compared to a transmural defect is significantly more accurate to identify coronary territories with ISR or CAD progression.
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Affiliation(s)
| | - Gianluca Pontone
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Edoardo Conte
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Division of Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | | | | | | | | | | | | | - Alice Bonomi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Vincenzo Mallia
- Division of Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Davide Marchetti
- Division of Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Matteo Schillaci
- Division of Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Eleonora Melotti
- Division of Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Marta Belmonte
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Andrea Igoren Guaricci
- University Cardiology Unit, Interdisciplinary Department of Medicine, University Aldo Moro of Bari, Bari, Italy
| | | | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Antonio L Bartorelli
- Division of Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.
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9
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De Filippo O, Pancotti C, Camman VL, Bianco M, Gili S, Di Mario C, Luescher T, Crea F, Templin C, De Ferrari GM, D´ascenzo F. 1149 MACHINE-LEARNING BASED PREDICTION OF IN-HOSPITAL DEATH FOR PATIENTS WITH TAKOTSUBO SYNDROME: THE INTERTAK-ML MODEL. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.714] [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
Background
Takotsubo syndrome (TTS) is burdened by a not negligible rate of an impaired short-term prognosis. Current existing models, based on classical statistical methods, showed only moderate accuracy to predict the risk of in-hospital adverse events following admission for TTS. We sought to design a machine-learning (ML) based model to predict the risk of in-hospital death among patients admitted for TTS, and to provide clusters of TTS patients associated with different risks of adverse short-term prognosis.
Methods
A Penalized Logistic Regression-based ML model for predicting in-hospital death was trained and tested on a cohort of 3482 patients with TTS from the international, multicenter, InterTAK Registry. 33 clinically relevant variables were selected to be included in the prediction model. Model performance was assessed according to area under the receiver operating characteristic curve (AUC). A K-Means clustering algorithm was designed to stratify patients into phenotypic groups based on the most relevant features emerging from the main model.
Results
The overall incidence of in-hospital death was 5.2%. The InterTAK-ML model showed an AUC of 0.88 (95%CI 0.87-0.90) and 0.87 (95%CI 0.83-0.91) with respect to in-hospital death prediction in the train and test cohorts, respectively. By exploiting the 5 variables showing the highest feature importance (use of catecholamines, type of triggering factor, left ventricular ejection fraction, white blood cell count, heart rate), TTS patients were clustered into five groups associated with different risks of in-hospital death (29.4% vs 3.9% vs 1.6% vs 1.3% vs 0.7%).
Conclusion
A ML-based approach for the identification of TTS patients at risk of adverse short-term prognosis is feasible and effective. The InterTAK-ML model showed accurate discriminative capability for the prediction of in-hospital death. To support clinical decision-making, TTS patients can be clustered into groups entailing different risks of death based on routinely collected variables.
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Affiliation(s)
- Ovidio De Filippo
- Division Of Cardiology, Cardiovascular And Thoracic Department, Città Della Salute E Della Scienza Hospital , Turin , Italy
| | - Corrado Pancotti
- Department Of Medical Sciences, University Of Turin , Turin , Italy
| | - Victoria Lucia Camman
- University Heart Center, Department Of Cardiology, University Hospital Zurich , Zurich , Switzerland
| | - Matteo Bianco
- Division Of Cardiology , Aou San Luigi Gonzaga, Orbassano, Turin , Italy
| | | | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital , Firenze , Italy
| | - Thomas Luescher
- Royal Brompton And Harefield Hospitals Trust And Imperial College , London , UK
| | - Filippo Crea
- Università Cattolica Del Sacro Cuore, Policlinico Universitario Agostino Gemelli , Roma , Italy
| | - Christian Templin
- University Heart Center, Department Of Cardiology, University Hospital Zurich , Zurich , Switzerland
| | - Gaetano Maria De Ferrari
- Department Of Medical Sciences, University Of Turin , Turin , Italy
- Division Of Cardiology, Cardiovascular And Thoracic Department, Città Della Salute E Della Scienza Hospital , Turin , Italy
| | - Fabrizio D´ascenzo
- Department Of Medical Sciences, University Of Turin , Turin , Italy
- Division Of Cardiology, Cardiovascular And Thoracic Department, Città Della Salute E Della Scienza Hospital , Turin , Italy
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10
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Gili S, Galli S, Teruzzi G, Baldi GS, Ravagnani P, Calligaris G, Montorsi P, Trabattoni D. 967 THIRD GENERATION, ULTRATHIN STRUTS STENT IN WOMEN COMPARED TO MEN: A GENDER-RELATED ANALYSIS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.334] [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
Introduction
Female patients underrepresentation in clinical trials is a well known issue in clinical research, especially harming the assessment of interventional cardiovascular devices. Limited inclusion of women in such studies might lead to suboptimal care, as results derived from predominantly male populations might not hold true for female patients. In recent years, third generation drug-eluting stents have become the standard of care for percutaneous coronary interventions (PCI). Among them, the Orsiro sirolimus-eluting stent carries some promising features such some of the thinnest struts among commercially available devices (60-80 µm), a bioresorbable-polymer and an amorphous silicon carbide coating. We performed the presents study with the aim to assess if use of this stent in a real-world setting might lead to differential clinical outcomes in women compared to men.
Methods
This is a retrospective study conducted at a single, high-volume center, including all patients undergoing PCI with the implantation of at least one Orsiro for acute or chronic coronary syndromes between January 2017 and December 2019. Main clinical and procedural features were collected, as well as in hospital outcomes. Follow-up data were collected by outpatient visit or by telephone interview. Target lesion failure (TLF), a composite of cardiovascular death, target vessel myocardial infarction or target lesion revascularization, was the main outcome.
Results
Out of a total of 416 patients treated with at least an Orsiro stent, 66 (15.9%) were women and 349 (84.1%) men. No significant differences were observed at baseline, excepted for a higher age (median age 70 vs. 66, P=0.003) and a lower BMI (25.0 vs. 26.1, P=0.010) in women compared to men. No gender-related differences were observed in the indication for PCI, with most of the patients presenting with chronic coronary syndrome (329, 79.3%), rather than acute coronary syndrome in (86, 20.7%). The global number of treated lesions was 558 (90 in women, 468 in men); frequency of left main (5.3% vs. 3.0%) and left anterior descending (34.9% vs. 42.4%) PCI was similar (P=0.28). Treated vessels number of treated lesion per patients (1.36 vs. 1.34, P=0.83), cumulative stent length (33.6 mm vs. 38.4, P=0.078) and mean stent diameter (2.92 vs. 3.0 mm, P=0.39) was not different between men and women. Technical and clinical success was achieved in all cases. Two cases (0.5%) of stent thrombosis, one early and one late, were documented, all in men. After a median follow-up of 402 days, the main outcome of TLF was observed in 10 (2.9%) men and 2 (3.0%) women, with no significant differences at log-rank analysis (2.34 events per 100 patient-years in males, 2.53 in females; P=0.80). In the subgroup of patients undergoing small-vessel PCI (stent diameter ≤ 2.5 mm) no differences were observed in terms of TLF at follow-up between women and men (3.2% vs. 4.9%; P = 0.68). Similar findings emerged in the subgroup of patients presenting with acute coronary syndrome (6.3% vs. 4.3%, P = 0.74)
Conclusions
Ultrathin struts Orsiro stent did not show significant differences in terms of procedural, short-term and long-term outcomes in women compared to men in a real-world setting. This device may represent a viable option for female and male patients undergoing PCI.
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Affiliation(s)
| | | | | | | | | | | | - Piero Montorsi
- Centro Cardiologico Monzino , IRCCS, Milano
- Dipartimento Di Scienze Cliniche E Di Comunità, Università Degli Studi Di Milano , Milano
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11
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Baggiano A, Zarà M, Banfi C, Campodonico J, Tedesco C, Amadio P, Gili S, Dona GD, Sandrini L, Maragna R, Marenzi G, Pontone G, Barbieri SS. 611 PLASMA EXOSOMES REFLECT MYOCARDIAL INJURY DETECTED BY CARDIAC MAGNETIC RESONANCE IN STEMI PATIENTS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.158] [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
Background
CMR is the gold standard technique to detect microvascular obstruction (MVO) and myocardial salvage index (MSI) in patients with ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (pPCI). Exosomes are lipid vesicles released by all cells that reflect the metabolic status of the releasing cells, thus representing potential biomarkers of disease.
Objectives
To evaluate the correlation between exosome profile and myocardial infarction characteristics as detected by CMR in patients after STEMI.
Methods
exosomes were isolated from plasma of 42 patients by different commercial kits, their concentration and size distribution determined by Nanoparticle Tracking Analysis, exosomal surface epitopes by the MACSPlex Exosome Kit and GPIIb-IIIa expression by ELISA kit. Data obtained were correlated with parameters of myocardial damage (STEMI location, culprit lesion, time to revascularization, MVO and MSI).
Results
Levels of circulating plasma exosomes were higher in patients with anterior STEMI (p = 0.0002) and when the culprit lesion was located in LAD (p = 0.045). In addition, a high number of exosomes was measured in the subset of patients who underwent a late revascularization (> 3 h from onset of symptoms; p = 0.038). Patients with MVO and low MSI (< 0.5) have smaller exosome (p = 0.0015 and p = 0.014, respectively). By analysing the expression of 37 surface protein markers, the strongest signals are platelet specific markers (CD41b and CD42a) followed by endothelial and immune cells markers. Interestingly, a lower expression of platelet marker GPIIb-IIIa was detected in both patients with MVO and anterior STEMI (p = 0.039 and p = 0.0038, respectively). Univariate analysis demonstrated that exosome size and GPIIb-IIIa were independent predictors of MVO/MSI and ROC analysis demonstrated that dimension and GPIIb-IIIa can identify patients with MVO/MSI (AUC 0.75 and 0.71, respectively).
Conclusions
The plasma exosome profile well reflects CMR-assessed myocardial injury after STEMI. In particular, the exosome dimension and the expression of platelet marker GPIIb-IIIa are independently associated with MVO. Future studies with larger populations are required to confirm the role of platelet-derived exosomes in risk stratification after STEMI.
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12
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Montorsi P, Galli S, Ravagnani MP, Teruzzi G, Calligaris G, Gili S, Caputi L, Troiano S, Del Maso R, Trabattoni D. Transradial/brachial carotid artery stenting with proximal protection: technical instructions, acute results and long-term outcomes. Minerva Cardiol Angiol 2022; 70:765-777. [PMID: 36519647 DOI: 10.23736/s2724-5683.22.06223-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the feasibility, safety and efficacy of transradial/brachial (TR/TB) carotid artery stenting (CAS) with proximal cerebral protection (PCP) as a first line of treatment of carotid artery stenosis. METHODS Among 556 patients with significant (>50% if symptomatic or >70% if asymptomatic by Doppler US) unilateral, lipid-rich carotid artery stenosis undergoing TR/TB CAS, 137 (24.5%) deemed at high-risk for periprocedural cerebral embolization were scheduled for PCP with Mo.MA Ultra or Mo.MA mono-balloon. In patients with very complex anatomy the standard technique was modified loading the Mo.MA catheter without mandrel on two-wire system (so called 'No MAndrel 2 wire' technique, No.MA2) to increase support and deliverability. Device, technical and procedural successes both acute and at follow-up were the main outcomes. RESULTS Mean patients' age was 74±7 years (93% male), 15% were symptomatic and 59.6% owned 'high-surgical-risk' features. Stenosis degree was 85±7% with soft composition in all (by CT-angiography). TR and TB approach were selected in 92 (67%) and 45 (33%) patients, respectively. Target carotid axes were right, left bovine and left non bovine in 55%, 38% and 7% of patients. Procedures were successfully completed in all patients (intention-to-treat basis) with the standard Mo.MA Ultra system in 129 patients and the Mo.MA mono-balloon in 8 patients. No.MA2 technique was succesfully used in 16 patients as 'bailout' and in 27 patients as 'first line'). Device and technical success was 97% (133/137 patients) due to crossover to femoral access in 3 cases, and Mo.MA too short to engage the ECA in 1 patient. The procedural success was 96.7% (131/137, two minor strokes). Procedural time and fluoroscopy time were increased with No.MA2 technique. One major vascular complication occurred, in the TB group, while chronic radial occlusion was detected by Doppler ultrasound in 7/92 patients (7.1%) at 372±163 days of follow-up. The event-free survival was 91% and the stroke rate was 0%. CONCLUSIONS TR/TB CAS with proximal protection is a feasible, safe and effective strategy and may be considered a first line strategy in all comer patients.
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Affiliation(s)
- Piero Montorsi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy - .,Centro Cardiologico Monzino IRCCS, Milan, Italy -
| | | | | | | | | | | | - Luigi Caputi
- Division of Neurology, ASST Crema, Crema, Cremona, Italy
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13
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Araki M, Park SJ, Dauerman HL, Uemura S, Kim JS, Di Mario C, Johnson TW, Guagliumi G, Kastrati A, Joner M, Holm NR, Alfonso F, Wijns W, Adriaenssens T, Nef H, Rioufol G, Amabile N, Souteyrand G, Meneveau N, Gerbaud E, Opolski MP, Gonzalo N, Tearney GJ, Bouma B, Aguirre AD, Mintz GS, Stone GW, Bourantas CV, Räber L, Gili S, Mizuno K, Kimura S, Shinke T, Hong MK, Jang Y, Cho JM, Yan BP, Porto I, Niccoli G, Montone RA, Thondapu V, Papafaklis MI, Michalis LK, Reynolds H, Saw J, Libby P, Weisz G, Iannaccone M, Gori T, Toutouzas K, Yonetsu T, Minami Y, Takano M, Raffel OC, Kurihara O, Soeda T, Sugiyama T, Kim HO, Lee T, Higuma T, Nakajima A, Yamamoto E, Bryniarski KL, Di Vito L, Vergallo R, Fracassi F, Russo M, Seegers LM, McNulty I, Park S, Feldman M, Escaned J, Prati F, Arbustini E, Pinto FJ, Waksman R, Garcia-Garcia HM, Maehara A, Ali Z, Finn AV, Virmani R, Kini AS, Daemen J, Kume T, Hibi K, Tanaka A, Akasaka T, Kubo T, Yasuda S, Croce K, Granada JF, Lerman A, Prasad A, Regar E, Saito Y, Sankardas MA, Subban V, Weissman NJ, Chen Y, Yu B, Nicholls SJ, Barlis P, West NEJ, Arbab-Zadeh A, Ye JC, Dijkstra J, Lee H, Narula J, Crea F, Nakamura S, Kakuta T, Fujimoto J, Fuster V, Jang IK. Optical coherence tomography in coronary atherosclerosis assessment and intervention. Nat Rev Cardiol 2022; 19:684-703. [PMID: 35449407 PMCID: PMC9982688 DOI: 10.1038/s41569-022-00687-9] [Citation(s) in RCA: 93] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 02/07/2023]
Abstract
Since optical coherence tomography (OCT) was first performed in humans two decades ago, this imaging modality has been widely adopted in research on coronary atherosclerosis and adopted clinically for the optimization of percutaneous coronary intervention. In the past 10 years, substantial advances have been made in the understanding of in vivo vascular biology using OCT. Identification by OCT of culprit plaque pathology could potentially lead to a major shift in the management of patients with acute coronary syndromes. Detection by OCT of healed coronary plaque has been important in our understanding of the mechanisms involved in plaque destabilization and healing with the rapid progression of atherosclerosis. Accurate detection by OCT of sequelae from percutaneous coronary interventions that might be missed by angiography could improve clinical outcomes. In addition, OCT has become an essential diagnostic modality for myocardial infarction with non-obstructive coronary arteries. Insight into neoatherosclerosis from OCT could improve our understanding of the mechanisms of very late stent thrombosis. The appropriate use of OCT depends on accurate interpretation and understanding of the clinical significance of OCT findings. In this Review, we summarize the state of the art in cardiac OCT and facilitate the uniform use of this modality in coronary atherosclerosis. Contributions have been made by clinicians and investigators worldwide with extensive experience in OCT, with the aim that this document will serve as a standard reference for future research and clinical application.
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Affiliation(s)
| | | | | | | | - Jung-Sun Kim
- Yonsei University College of Medicine, Seoul, South Korea
| | | | - Thomas W Johnson
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Adnan Kastrati
- Technische Universität München and Munich Heart Alliance, Munich, Germany
| | | | | | | | - William Wijns
- National University of Ireland Galway and Saolta University Healthcare Group, Galway, Ireland
| | | | | | - Gilles Rioufol
- Hospices Civils de Lyon and Claude Bernard University, Lyon, France
| | | | | | | | | | | | - Nieves Gonzalo
- Hospital Clinico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | | | - Brett Bouma
- Massachusetts General Hospital, Boston, MA, USA
| | | | - Gary S Mintz
- Cardiovascular Research Foundation, New York, NY, USA
| | - Gregg W Stone
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christos V Bourantas
- Barts Health NHS Trust, University College London and Queen Mary University London, London, UK
| | - Lorenz Räber
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | | | | | - Myeong-Ki Hong
- Yonsei University College of Medicine, Seoul, South Korea
| | - Yangsoo Jang
- Yonsei University College of Medicine, Seoul, South Korea
| | | | - Bryan P Yan
- Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Italo Porto
- University of Genoa, Genoa, Italy, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | | | - Rocco A Montone
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | | | - Harmony Reynolds
- New York University Grossman School of Medicine, New York, NY, USA
| | - Jacqueline Saw
- Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter Libby
- Brigham and Women's Hospital, Boston, MA, USA
| | - Giora Weisz
- New York Presbyterian Hospital, Columbia University Medical Center and Cardiovascular Research Foundation, New York, NY, USA
| | | | - Tommaso Gori
- Universitäts medizin Mainz and DZHK Rhein-Main, Mainz, Germany
| | | | | | | | | | | | - Osamu Kurihara
- Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | | | | | | | - Tetsumin Lee
- Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Takumi Higuma
- Kawasaki Municipal Tama Hospital, St. Marianna University School of Medicine, Kanagawa, Japan
| | | | - Erika Yamamoto
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Krzysztof L Bryniarski
- Jagiellonian University Medical College, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, Krakow, Poland
| | | | | | | | - Michele Russo
- Catholic University of the Sacred Heart, Rome, Italy
| | | | | | - Sangjoon Park
- Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Marc Feldman
- University of Texas Health, San Antonio, TX, USA
| | | | - Francesco Prati
- UniCamillus - Saint Camillus International University of Health Sciences, Rome, Italy
| | - Eloisa Arbustini
- IRCCS Foundation University Hospital Policlinico San Matteo, Pavia, Italy
| | - Fausto J Pinto
- Santa Maria University Hospital, CHULN Center of Cardiology of the University of Lisbon, Lisbon School of Medicine, Lisbon Academic Medical Center, Lisbon, Portugal
| | - Ron Waksman
- MedStar Washington Hospital Center, Washington, DC, USA
| | | | - Akiko Maehara
- Cardiovascular Research Foundation, New York, NY, USA
| | - Ziad Ali
- Cardiovascular Research Foundation, New York, NY, USA
| | | | | | | | - Joost Daemen
- Erasmus University Medical Centre, Rotterdam, Netherlands
| | | | - Kiyoshi Hibi
- Yokohama City University Medical Center, Kanagawa, Japan
| | | | | | | | - Satoshi Yasuda
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kevin Croce
- Brigham and Women's Hospital, Boston, MA, USA
| | | | | | | | | | | | | | | | | | - Yundai Chen
- Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Bo Yu
- The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | | | - Peter Barlis
- University of Melbourne, Melbourne, Victoria, Australia
| | | | | | - Jong Chul Ye
- Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | | | - Hang Lee
- Massachusetts General Hospital, Boston, MA, USA
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Filippo Crea
- Catholic University of the Sacred Heart, Rome, Italy
| | | | | | - James Fujimoto
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Ik-Kyung Jang
- Massachusetts General Hospital, Boston, MA, USA.
- Kyung Hee University, Seoul, South Korea.
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Kang J, Bruno F, Rhee TM, De Luca L, Han JK, de Filippo O, Yang HM, Mattesini A, Park KW, Truffa A, Kim HS, Wojciech W, Gwon HC, Gili S, Chun WJ, Helft G, Hur SH, Cortese B, Han SH, Escaned J, Song YB, Chieffo A, Choi KH, Gallone G, Doh JH, De Ferrari G, Hong SJ, Quadri G, Nam CW, Koo BK, D’Ascenzo F. Impact of Clinical and Lesion Features on Outcomes After Percutaneous Coronary Intervention in Bifurcation Lesions. JACC Asia 2022; 2:607-618. [PMID: 36518719 PMCID: PMC9743454 DOI: 10.1016/j.jacasi.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/19/2022] [Accepted: 05/29/2022] [Indexed: 01/11/2023]
Abstract
Background Bifurcation percutaneous coronary intervention (PCI) is associated with higher risk of clinical events. Objectives This study aimed to determine clinical and lesion features that predict adverse outcomes, and to evaluate the differential prognostic impact of these features in patients undergoing PCI for bifurcation lesions. Methods We analyzed 5,537 patients from the BIFURCAT (comBined Insights From the Unified RAIN and COBIS bifurcAtion regisTries) registry. The primary outcome was major adverse cardiac events (MACE) at 2-year follow-up; secondary outcomes included hard endpoints (all-cause death, myocardial infarction) and lesion-oriented clinical outcomes (LOCO) (target-vessel myocardial infarction, target lesion revascularization). The least absolute shrinkage and selection operator (LASSO) model was used for feature selection. Results During the 2-year follow-up period, MACE occurred in 492 patients (8.9%). The LASSO model identified 5 clinical features (old age, chronic renal disease, diabetes mellitus, current smoking, and left ventricular dysfunction) and 4 lesion features (left main disease, proximal main branch disease, side branch disease, and a small main branch diameter) as significant features that predict MACE. A combination of all 9 features improved the predictive value for MACE compared with clinical and lesion features (area under the receiver-operating characteristics curve: 0.657 vs 0.636 vs 0.581; P < 0.001). For secondary endpoints, the clinical features had a higher impact than lesion features on hard endpoints, whereas lesion features had a higher impact than clinical features on LOCO. Conclusions In bifurcation PCI, 9 features were associated with MACE. Clinical features were predominant predictors for hard endpoints, and lesion features were predominant for predicting LOCO. Clinical and lesion features have distinct values, and both should be considered in bifurcation PCI.
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Affiliation(s)
- Jeehoon Kang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Francesco Bruno
- Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Tae-min Rhee
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Leonardo De Luca
- Department of Cardiosciences, San Camillo-Forlanini Hospital, Roma, Italy
| | - Jung-Kyu Han
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ovidio de Filippo
- Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Han-Mo Yang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | | | - Kyung Woo Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | | | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Wanha Wojciech
- Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Hyeon-Cheol Gwon
- Department of Cardiology Sungkyunkwan University, Samsung Medical Center, Seoul, Republic of Korea
| | | | - Woo Jung Chun
- Department of Internal Medicine, Samsung Changwon Hospital, Changwon, Republic of Korea
| | - Gerard Helft
- Pierre and Marie Curie University, Paris, France
| | - Seung-Ho Hur
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Bernardo Cortese
- Interventional Cardiology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Seung Hwan Han
- Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Republic of Korea
| | - Javier Escaned
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Young Bin Song
- Department of Cardiology Sungkyunkwan University, Samsung Medical Center, Seoul, Republic of Korea
| | - Alaide Chieffo
- Division of Cardiology, Ospedale San Raffaele, Milan, Italy
| | - Ki Hong Choi
- Department of Cardiology Sungkyunkwan University, Samsung Medical Center, Seoul, Republic of Korea
| | - Guglielmo Gallone
- Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Joon-Hyung Doh
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Gaetano De Ferrari
- Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Soon-Jun Hong
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Giorgio Quadri
- Division of Cardiology, Ospedale di Rivoli, Rivoli, Italy
| | - Chang-Wook Nam
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea,Address for correspondence: Dr Bon-Kwon Koo, Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 03080, Republic of Korea.
| | - Fabrizio D’Ascenzo
- Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
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15
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Gili S, Giuliani M, Santagostino Baldi G, Teruzzi G, Pravettoni G, Montorsi P, Trabattoni D. Early Detection of Cardiovascular Risk Factors and Definition of Psychosocial Profile in Women Through a Systematic Approach: The Monzino Women Heart Center's Experience. Front Cardiovasc Med 2022; 9:844563. [PMID: 35345485 PMCID: PMC8957226 DOI: 10.3389/fcvm.2022.844563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 01/31/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Cardiovascular (CV) disease is the leading mortality cause among women, yet an alarming misrepresentation of women in CV studies and a low awareness of the impact of CV among women still persist to date. The Monzino Women Heart Center has been established as a clinical and research program dedicated to primary prevention of CV disease in women. Methods Patients aged between 35 and 60 years and with no history of CV disease underwent a comprehensive evaluation including a cardiologic outpatient visit with electrocardiogram, individual CV risk calculation, first-level cardiovascular examinations and a psychological assessment. Results A total of 635 women, with a mean age of 52.2 ± 6.4 participated to the project on a voluntary basis during the period January 2017–August 2021. Included patients had a high level of education (40.4% with a graduate or postgraduate university degree), the majority of them, in a stable couple and with children, were actively working. More than half of the patients performed physical activity on a regular basis. Prevalence of traditional CV risk factors were family history (70.2%), hypertension (46%), hypercholesterolemia (22%) and diabetes (14%). Early or premature menopause was reported by 17.7% of the patients, gestational hypertension and diabetes by 4.96 and 1.7%, respectively. Symptoms of depression were reported by 27%; nearly 36% of the participants rated high score of state anxiety and 41% of trait anxiety. Nearly 69% of the participants showed moderate-to-high perceived stress. The mean value of perceived general self-efficacy was moderate (mean = 28.78, SD = 4.69). Conclusion A CV prevention program dedicated to women can help identifying a considerable number of patients with risk factors for whom early interventions can help reducing the risk of developing CV disease. Psychological assessment might unmask depression or anxiety disorders, which might have a potential long-terme detrimental effect on CV health.
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Affiliation(s)
- Sebastiano Gili
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Mattia Giuliani
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Giulia Santagostino Baldi
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Giovanni Teruzzi
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, Istituto Europeo di Oncologia (IEO), European Institute of Oncology IRCCS, Milan, Italy
| | - Piero Montorsi
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Daniela Trabattoni
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- *Correspondence: Daniela Trabattoni
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16
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Gili S, Galli S, Teruzzi G, Santagostino Baldi G, Ravagnani P, Fabbiocchi F, Bartorelli A, Montorsi P, Trabattoni D. Gender-Associated Outcomes Following Percutaneous Coronary Intervention With a Third-Generation, Ultrathin-Strut Drug-Eluting Stent: A Real-World, Single-Center Experience. Front Cardiovasc Med 2022; 8:796604. [PMID: 35224025 PMCID: PMC8873376 DOI: 10.3389/fcvm.2021.796604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 12/30/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction In recent years, the new third-generation ultrathin bioresorbable-polymer sirolimus-eluting stent (BP-SES), characterized by some of the thinnest struts among commercially available devices (60–80 μm) and an amorphous silicon carbide coating, has been introduced for the treatment of coronary artery disease (CAD). The present study aimed to assess different clinical outcomes and safety of this drug-eluting stent in male and female patients in a real-world setting. Methods The present study is a retrospective analysis including all patients treated with BP-SES between January 2017 and December 2019 at a single high-volume center. Follow-up data, including stress test results and clinical setting, were collected during outpatient visits or by telephone contact. Patients symptomatic for angina or with a positive stress test were addressed to CT scan/coronary angiogram. The main study outcome was target lesion failure (TLF), defined as a composite of cardiovascular death, target vessel myocardial infarction, or target lesion revascularization. Results Overall, 66 (15.9%) female and 349 (84.1%) male patients were included; women were older (median age 70 vs. 66, P = 0.003) and with a lower body mass index (BMI) (25.0 vs. 26.1, P = 0.010) compared to men, with no other relevant differences in baseline characteristics. Indication for percutaneous coronary intervention (PCI) was acute coronary syndrome in 86 (20.7%) of the cases, with no significant differences between male and female patients. A total of 558 lesions were treated with BP-SES stents, 90 in women and 468 in men (1.36 vs. 1.34 lesions per patient, P = 0.83); cumulative stent length (33.6 vs. 38.4 mm, P = 0.078), and mean stent diameter (2.92 vs. 3.0 mm, P = 0.39) did not differ in women compared to men. Technical and clinical successes were achieved in all patients. Stent thrombosis (ST) occurred in 2 (0.5%) patients, both men. TLF occurred in 10 (2.9%) men and 2 (3.0%) women after a median follow-up of 402 days, without significant differences at log-rank analysis (2.34 events per 100 patient-years in men, 2.53 in women; P = 0.80). Conclusion Ultrathin struts BP-SES showed to be a safe and effective option for the treatment of CAD in both women and men, with a very low ST rate and favorable long-term outcomes.
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Affiliation(s)
- Sebastiano Gili
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Stefano Galli
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Giovanni Teruzzi
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Giulia Santagostino Baldi
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Paolo Ravagnani
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Franco Fabbiocchi
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Antonio Bartorelli
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Department of Biomedical and Clinical Sciences, “Luigi Sacco”, University of Milan, Milan, Italy
| | - Piero Montorsi
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Daniela Trabattoni
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- *Correspondence: Daniela Trabattoni
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17
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Teruzzi G, Santagostino Baldi G, Gili S, Guarnieri G, Montorsi P, Trabattoni D. Spontaneous Coronary Artery Dissections: A Systematic Review. J Clin Med 2021; 10:jcm10245925. [PMID: 34945221 PMCID: PMC8706333 DOI: 10.3390/jcm10245925] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 12/12/2021] [Accepted: 12/15/2021] [Indexed: 01/17/2023] Open
Abstract
Myocardial infarction with nonobstructive coronary artery disease due to spontaneous coronary artery dissection (SCAD) accounts for 5–8% of acute coronary syndrome (ACS) presentations. The demographic characteristics, risk factors, and management of patients with SCAD differ from those with atherosclerotic disease. The objective of this review is to provide a contemporary understanding of the epidemiology, pathophysiology, clinical presentation, and management of SCAD.
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Affiliation(s)
- Giovanni Teruzzi
- Centro Cardiologico Monzino, IRCCS, Invasive Cardiology Department, 20138 Milan, Italy; (G.T.); (G.S.B.); (S.G.); (G.G.); (P.M.)
| | - Giulia Santagostino Baldi
- Centro Cardiologico Monzino, IRCCS, Invasive Cardiology Department, 20138 Milan, Italy; (G.T.); (G.S.B.); (S.G.); (G.G.); (P.M.)
| | - Sebastiano Gili
- Centro Cardiologico Monzino, IRCCS, Invasive Cardiology Department, 20138 Milan, Italy; (G.T.); (G.S.B.); (S.G.); (G.G.); (P.M.)
| | - Gianluca Guarnieri
- Centro Cardiologico Monzino, IRCCS, Invasive Cardiology Department, 20138 Milan, Italy; (G.T.); (G.S.B.); (S.G.); (G.G.); (P.M.)
| | - Piero Montorsi
- Centro Cardiologico Monzino, IRCCS, Invasive Cardiology Department, 20138 Milan, Italy; (G.T.); (G.S.B.); (S.G.); (G.G.); (P.M.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Daniela Trabattoni
- Centro Cardiologico Monzino, IRCCS, Invasive Cardiology Department, 20138 Milan, Italy; (G.T.); (G.S.B.); (S.G.); (G.G.); (P.M.)
- Correspondence: ; Tel.: +39-025-800-2546
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18
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Mushtaq S, Zanotto L, Conte E, Pontone G, Guglielmo M, Baggiano A, Trabattoni D, Gili S, Galli S, Troiano S, Monizzi G, Melotti E, Lagrutta L, Randazzo A, Bartorelli A, Andreini D. 185 Diagnostic accuracy of dynamic stress myocardial CT perfusion as compared with invasive coronary physiology metrics in stented patients: preliminary results of the advantage II study. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab132.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
To compare the diagnostic performance of adenosine-stress dynamic myocardial perfusion assessed by CT (CTP) as compared with that of coronary CT angiography (CCTA) alone by using invasive fractional flow reserve (FFR) and index of microvascular resistance (IMR) as standard of reference. Diagnostic performance of CCTA for in-stent restenosis (ISR) detection is still challenging. Recently, CTP demonstrated additional specificity and diagnostic accuracy over CCTA alone in patients with previous stent implantation and suspected IRS or progression of coronary artery disease (CAD). However, no data are available in this clinical setting on the performance of CTP by using a new technique allowing for a non-invasive adjudication of regional myocardial blood flow (dynamic CTP) and to assess both macrovascular and microvascular disease status. Moreover, dynamic CTP was never compared vs. a comprehensive assessment of invasive coronary physiology (FFR and IMR).
Methods and results
We enrolled consecutive stable patients with previous coronary stenting referred for invasive coronary angiography (ICA) for clinical indication. All patients underwent dynamic stress myocardial CTP and rest CTP+CCTA by using a last generation scanner characterized by a 16-cm Z-axis coverage and fast (0.28 s) gantry rotation time. Invasive FFR and IMR were performed during ICA according to the standard practice. The diagnostic rate and diagnostic accuracy of CCTA and CTP were evaluated in a territory-based analyses vs. quantitative coronary angiography (QCA), FFR, and IMR. In 67 enrolled patients (55 men, mean age: 63.1 ± 8.2 years), the diagnostic rate (number of territories interpretable/number of territories evaluated) of CTP was significantly higher than that of CCTA (302/307 = 98.4% vs. 290/307 = 94.4%, P = 0.009). The interpretability of the combined CCTA/CTP approach was 99.7% (306/307 territories). When QCA was used as gold standard, CTP diagnostic accuracy was significantly higher than that of CCTA (84.4% vs. 80.1%, P = 0.01). When coronary physiology metrics were used as gold standard, CTP diagnostic accuracy was significantly higher than that of CCTA vs. both FFR (84.3% vs. 72.2%, P = 0.02) and IMR (83.3% vs. 70.2%, P = 0.02). The radiation exposure of CCTA+CTP was 8.7 ± 2.5 mSv.
Conclusions
In patients with coronary stents, dynamic CTP significantly improves diagnostic rate and accuracy of CCTA alone in comparison with both FFR and IMR. The non-invasive assessment of ISR is still challenging. The comprehensive assessment by cardiac CT provides anatomical combined to functional evaluation of coronary arteries in revascularized patients with good agreement with invasive physiological evaluation.
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Affiliation(s)
- Saima Mushtaq
- Imaging Cardiovascolar Department, Centro Cardiologico Monzino, IRCCS, Milano, Italy
- BIND Department, University of Palermo, Italy
| | | | - Edoardo Conte
- Imaging Cardiovascolar Department, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - Gianluca Pontone
- Imaging Cardiovascolar Department, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - Marco Guglielmo
- Imaging Cardiovascolar Department, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - Andrea Baggiano
- Imaging Cardiovascolar Department, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - Daniela Trabattoni
- Imaging Cardiovascolar Department, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - Sebastiano Gili
- Imaging Cardiovascolar Department, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - Stefano Galli
- Imaging Cardiovascolar Department, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - Sarah Troiano
- Imaging Cardiovascolar Department, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - Giovanni Monizzi
- Imaging Cardiovascolar Department, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - Eleonora Melotti
- Imaging Cardiovascolar Department, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | | | | | - Antonio Bartorelli
- Imaging Cardiovascolar Department, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - Daniele Andreini
- Imaging Cardiovascolar Department, Centro Cardiologico Monzino, IRCCS, Milano, Italy
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19
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D'Ascenzo F, Elia E, Marengo G, Wańha W, González Ferreiro R, Truffa A, Trabattoni D, Figini F, Verardi R, Di Palma G, Infusino F, Pivato C, Ochała A, Omedè P, Milewski M, Estevez R, Raporeiras Roubin S, De Filippo O, Conrotto F, Montefusco A, Gili S, Cortese B, Dusi V, Gallone G, Manfredi R, Mancone M, Biondi Zoccai G, Casella G, Templin C, Stefanini G, Wojakowski W, Sheiban I, De Ferrari GM. Long-term (≥15 years) Follow-up of Percutaneous Coronary Intervention of Unprotected Left Main (From the GRAVITY Registry). Am J Cardiol 2021; 156:72-78. [PMID: 34325877 DOI: 10.1016/j.amjcard.2021.06.008] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/04/2021] [Accepted: 06/14/2021] [Indexed: 02/05/2023]
Abstract
Long term survival and its determinants after Percutaneous Coronary Intervention (PCI) on Unprotected Left Main Coronary Artery (ULMCA) remain to be appraised. In 9 European Centers 470 consecutive patients performing PCI on ULMCA between 2002 and 2005 were retrospectively enrolled. Survival from all cause and cardiovascular (CV) death were the primary end points, while their predictors at multivariate analysis the secondary ones. Among the overall cohort 81.5% of patients were male and mean age was 66 ± 12 years. After 15 years (IQR 13 to 16), 223 patients (47%) died, 81 (17.2%) due to CV etiology. At multivariable analysis, older age (HR 1.06, 95%CI 1.02 to 1.11), LVEF < 35% (HR 2.97, 95%CI 1.24 to 7.15) and number of vessels treated during the index PCI (HR 1.75, 95%CI 1.12 to 2.72) were related to all-cause mortality, while only LVEF <35% (HR 4.71, 95%CI 1.90 to 11.66) to CV death. Repeated PCI on ULMCA occurred in 91 (28%) patients during the course of follow up and did not significantly impact on freedom from all-cause or CV mortality. In conclusion, in a large, unselected population treated with PCI on ULMCA, 47% died after 15 years, 17% due to CV causes. Age, number of vessels treated during index PCI and depressed LVEF increased risk of all cause death, while re-PCI on ULMCA did not impact survival.
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Affiliation(s)
- Fabrizio D'Ascenzo
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy.
| | - Edoardo Elia
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy
| | - Giorgio Marengo
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy
| | - Wojciech Wańha
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | | | | | - Filippo Figini
- Division of Cardiology, Pederzoli Hospital-Peschiera del Garda, Verona, Italy
| | - Roberto Verardi
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy; U.O.C. Cardiologia, Ospedale Maggiore, Bologna, Italy
| | - G Di Palma
- Cardiovascular Research Team, San Carlo Clinic, Milan, Italy
| | - Fabio Infusino
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Carlo Pivato
- Cardio Center, Humanitas Clinical and Research Center IRCCS, Rozzano-Milan, Italy
| | - Andrzej Ochała
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Pierluigi Omedè
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy
| | - Marek Milewski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Roi Estevez
- Department of Cardiology, University Hospital Alvaro Cunqueiro, Vigo, Spain
| | | | - O De Filippo
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy
| | - Federico Conrotto
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy
| | - Antonio Montefusco
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy
| | | | | | - Veronica Dusi
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy
| | - Guglielmo Gallone
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy
| | - Roberto Manfredi
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy
| | - Massimo Mancone
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - G Biondi Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy; Mediterranea Cardiocentro, Naples, Italy
| | | | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Giulio Stefanini
- Cardio Center, Humanitas Clinical and Research Center IRCCS, Rozzano-Milan, Italy
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Imad Sheiban
- Division of Cardiology, Pederzoli Hospital-Peschiera del Garda, Verona, Italy
| | - G M De Ferrari
- Department of Medical Science, Città Della Salute e della Scienza, Division of Cardiology, Turin, Italy
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20
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Montorsi P, Galli S, Teruzzi G, Troiano S, Caputi L, Gili S, Trabattoni D. Case Report: A Cluster of Complications During Carotid Artery Stenting Managed With Peripheral, Coronary, and Imaging Techniques. Front Cardiovasc Med 2021; 8:712963. [PMID: 34568455 PMCID: PMC8458646 DOI: 10.3389/fcvm.2021.712963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/28/2021] [Indexed: 11/18/2022] Open
Abstract
We describe the case of a 72-year-old man with severe, asymptomatic in-stent restenosis detected 4 years after index carotid artery stenting (CAS). The patient was deemed at low risk and scheduled for re-angioplasty with a drug-coated balloon as per institution protocol. What at first seemed a simple case suddenly turned into a series of cerebral and vascular complications that were successfully managed with a mix of peripheral, coronary, and imaging techniques.
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Affiliation(s)
- Piero Montorsi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Centro Cardiologico Monzino, Istituto Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Stefano Galli
- Centro Cardiologico Monzino, Istituto Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Giovanni Teruzzi
- Centro Cardiologico Monzino, Istituto Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Sarah Troiano
- Centro Cardiologico Monzino, Istituto Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Luigi Caputi
- Neurology Unit, Department of Cerebrovascular Diseases, ASST Hospital of Crema, Crema, Italy
| | - Sebastiano Gili
- Centro Cardiologico Monzino, Istituto Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Daniela Trabattoni
- Centro Cardiologico Monzino, Istituto Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
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21
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Bulluck H, Paradies V, Barbato E, Baumbach A, Bøtker HE, Capodanno D, De Caterina R, Cavallini C, Davidson SM, Feldman DN, Ferdinandy P, Gili S, Gyöngyösi M, Kunadian V, Ooi SY, Madonna R, Marber M, Mehran R, Ndrepepa G, Perrino C, Schüpke S, Silvain J, Sluijter JPG, Tarantini G, Toth GG, Van Laake LW, von Birgelen C, Zeitouni M, Jaffe AS, Thygesen K, Hausenloy DJ. Prognostically relevant periprocedural myocardial injury and infarction associated with percutaneous coronary interventions: a Consensus Document of the ESC Working Group on Cellular Biology of the Heart and European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2021; 42:2630-2642. [PMID: 34059914 PMCID: PMC8282317 DOI: 10.1093/eurheartj/ehab271] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 10/19/2020] [Accepted: 04/26/2021] [Indexed: 12/17/2022] Open
Abstract
A substantial number of chronic coronary syndrome (CCS) patients undergoing percutaneous coronary intervention (PCI) experience periprocedural myocardial injury or infarction. Accurate diagnosis of these PCI-related complications is required to guide further management given that their occurrence may be associated with increased risk of major adverse cardiac events (MACE). Due to lack of scientific data, the cut-off thresholds of post-PCI cardiac troponin (cTn) elevation used for defining periprocedural myocardial injury and infarction, have been selected based on expert consensus opinions, and their prognostic relevance remains unclear. In this Consensus Document from the ESC Working Group on Cellular Biology of the Heart and European Association of Percutaneous Cardiovascular Interventions (EAPCI), we recommend, whenever possible, the measurement of baseline (pre-PCI) cTn and post-PCI cTn values in all CCS patients undergoing PCI. We confirm the prognostic relevance of the post-PCI cTn elevation >5× 99th percentile URL threshold used to define type 4a myocardial infarction (MI). In the absence of periprocedural angiographic flow-limiting complications or electrocardiogram (ECG) and imaging evidence of new myocardial ischaemia, we propose the same post-PCI cTn cut-off threshold (>5× 99th percentile URL) be used to define prognostically relevant ‘major’ periprocedural myocardial injury. As both type 4a MI and major periprocedural myocardial injury are strong independent predictors of all-cause mortality at 1 year post-PCI, they may be used as quality metrics and surrogate endpoints for clinical trials. Further research is needed to evaluate treatment strategies for reducing the risk of major periprocedural myocardial injury, type 4a MI, and MACE in CCS patients undergoing PCI.
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Affiliation(s)
- Heerajnarain Bulluck
- Department of Cardiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, Norfolk, NR4 7UY, UK.,Norwich Medical School, Bob Champion Research and Educational Building, Rosalind Franklin Road, University of East Anglia, Norwich Research Park. Norwich, Norfolk, NR4 7UQ, United Kingdom
| | - Valeria Paradies
- Cardiology Department, Maasstad Hospital, Maasstadweg 21, 3079 DZ Rotterdam, The Netherlands
| | - Emanuele Barbato
- Department of Advanced Biomedical Sciences, Federico II University, Via Pansini 5, 8013, Naples, Italy.,Cardiovascular Center Aalst OLV Hospital, Moorselbaan n. 164, 9300 Aalst, Belgium
| | - Andreas Baumbach
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, Barts Heart Centre, Charterhouse Square, London, EC1M 6BQ, UK.,Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510, USA
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - Davide Capodanno
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico-San Marco", University of Catania, Via Santa Sofia 78, 95100 Catania, Italy
| | - Raffaele De Caterina
- Department of Pathology, Cardiology Division, University of Pisa, Lungarno Antonio Pacinotti, 43, 56124 Pisa, Italy.,University of Pisa, and Cardiology Division, Pisa University Hospital AND Fondazione VillaSerena per la Ricerca, Città Sant'Angelo, Pescara, Italy
| | - Claudio Cavallini
- Department of Cardiology, Santa Maria della Misericordia Hospital, Piazzale Giorgio Menghini, 1, 06129 Perugia, Italy
| | - Sean M Davidson
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews London, WC1E 6HX, UK
| | - Dmitriy N Feldman
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, 1414 York Ave, New York, NY 10021, USA
| | - Péter Ferdinandy
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Nagyvarad tér 4, Budapest, 1089 Hungary.,Pharmahungary Group, Hajnóczy u. 6, Szeged, 6722 Hungary
| | - Sebastiano Gili
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Via Carlo Parea, 4, 20138 Milano MI, Italy
| | - Mariann Gyöngyösi
- Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna A-1090, Austria
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, M4:146 4th Floor William Leech Building, Newcastle University Medical School, Newcastle upon Tyne, NE2 4HH, UK.,Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Cardiothoracic centre, High Heaton, Newcastle upon Tyne, NE7 7DN, UK
| | - Sze-Yuan Ooi
- Eastern Heart Clinic, Prince of Wales Hospital, Barker St, Randwick NSW 2031, Australia
| | - Rosalinda Madonna
- Department of Pathology, Cardiology Division, University of Pisa, Lungarno Antonio Pacinotti, 43, 56124 Pisa, Italy.,Department of Internal Medicine, University of Texas Medical School, Houston, 77060 Houston, TX, USA
| | - Michael Marber
- School of Cardiovascular Medicine and Sciences, British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, St. Thomas' Hospital Campus, King's College London, Westminster Bridge Rd, London SE1 7EH, UK
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, USA.,Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway, New York, NY 10019, USA
| | - Gjin Ndrepepa
- Deutsches Herzzentrum München, Technische Universität, Lazarettstraße 36, 80636 München, Germany
| | - Cinzia Perrino
- Department of Advanced Biomedical Sciences, Federico II University, Via Pansini 5, 8013, Naples, Italy
| | - Stefanie Schüpke
- Deutsches Herzzentrum München, Lazarettstr. 36, 80636 Munich, Germany
| | - Johanne Silvain
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), INSERM UMRS, Paris 1166, France
| | - Joost P G Sluijter
- Laboratory of Experimental Cardiology, Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.,Regenerative Medicine Center Utrecht, Circulatory Health Laboratory, University Utrecht, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Giuseppe Tarantini
- Interventional Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via Giustiniani, 2 - 35128 Padova, Italy
| | - Gabor G Toth
- University Heart Center Graz, Division of Cardiology, Department of Medicine, Medical University Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Linda W Van Laake
- Division Heart and Lungs, Department of Cardiology and Regenerative Medicine Center, University Medical Center Utrecht, Heidelberglaan 100, 3574 CX Utrecht, The Netherlands
| | - Clemens von Birgelen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectum Twente, Koningstraat 1, 7512 KZ Enschede, The Netherlands.,Department of Health Technology and Services Research, Faculty BMS, Technical Medical Centre, University of Twente, Hallenweg 5, 7522 NH Enschede, The Netherlands
| | - Michel Zeitouni
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), INSERM UMRS, Paris 1166, France
| | - Allan S Jaffe
- Departments of Cardiology and Laboratory Medicine and Pathology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Kristian Thygesen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - Derek J Hausenloy
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews London, WC1E 6HX, UK.,Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, 8 College Road, Singapore 169857, Singapore.,National Heart Research Institute Singapore, National Heart Centre, 5 Hospital Drive, Singapore 169609, Singapore.,Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, Singapore 119228, Singapore.,Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, 500, Lioufeng Rd., Wufeng, Taichung 41354, Taiwan
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22
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El-Battrawy I, Cammann VL, Kato K, Szawan KA, Di Vece D, Rossi A, Wischnewsky M, Hermes-Laufer J, Gili S, Citro R, Bossone E, Neuhaus M, Franke J, Meder B, Jaguszewski M, Noutsias M, Knorr M, Heiner S, D'Ascenzo F, Dichtl W, Burgdorf C, Kherad B, Tschöpe C, Sarcon A, Shinbane J, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Karakas M, Koenig W, Pott A, Meyer P, David Arroja J, Banning A, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KEJ, Napp LC, Budnik M, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Chan C, Bridgman P, Beug D, Delmas C, Lairez O, Gilyarova E, Shilova A, Gilyarov M, Kozel M, Tousek P, Winchester DE, Galuszka J, Ukena C, Poglajen G, Carrilho-Ferreira P, Hauck C, Paolini C, Bilato C, Kobayashi Y, Prasad A, Rihal CS, Liu K, Schulze PC, Bianco M, Jörg L, Rickli H, Pestana G, Nguyen TH, Böhm M, Maier LS, Pinto FJ, Widimský P, Felix SB, Opolski G, Braun-Dullaeus RC, Rottbauer W, Hasenfuß G, Pieske BM, Schunkert H, Thiele H, Bauersachs J, Katus HA, Horowitz JD, Di Mario C, Münzel T, Crea F, Bax JJ, Lüscher TF, Ruschitzka F, Duru F, Borggrefe M, Ghadri JR, Akin I, Templin C. Impact of Atrial Fibrillation on Outcome in Takotsubo Syndrome: Data From the International Takotsubo Registry. J Am Heart Assoc 2021; 10:e014059. [PMID: 34315238 PMCID: PMC8475688 DOI: 10.1161/jaha.119.014059] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Atrial fibrillation (AF) is a major risk factor for mortality. The prevalence, clinical correlates, and prognostic impact of AF in Takotsubo syndrome (TTS) have not yet been investigated in a large patient cohort. This study aimed to investigate the prevalence, clinical correlates, and prognostic impact of AF in patients with TTS. Methods and Results Patients with TTS were enrolled from the International Takotsubo Registry, which is a multinational network with 26 participating centers in Europe and the United States. Patients were dichotomized according to the presence or absence of AF at the time of admission. Of 1584 patients with TTS, 112 (7.1%) had AF. The mean age was higher (P<0.001), and there were fewer women (P=0.046) in the AF than in the non‐AF group. Left ventricular ejection fraction was significantly lower (P=0.001), and cardiogenic shock was more often observed (P<0.001) in the AF group. Both in‐hospital (P<0.001) and long‐term mortality (P<0.001) were higher in the AF group. Multivariable Cox regression analysis revealed that AF was independently associated with higher long‐term mortality (hazard ratio, 2.31; 95% CI, 1.50–3.55; P<0.001). Among patients with AF on admission, 42% had no known history of AF before the acute TTS event, and such patients had comparable in‐hospital and long‐term outcomes compared with those with a history of AF. Conclusions In patients presenting with TTS, AF on admission is significantly associated with increased in‐hospital and long‐term mortality rates. Whether antiarrhythmics and/or cardioversion are beneficial in TTS with AF should thus be tested in a future trial. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01947621.
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Affiliation(s)
- Ibrahim El-Battrawy
- First Department of Medicine Faculty of Medicine University Medical Centre Mannheim University of Heidelberg Mannheim Germany.,German Center for Cardiovascular Researchpartner site Heidelberg-Mannheim Mannheim Germany
| | - Victoria L Cammann
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Ken Kato
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Konrad A Szawan
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Davide Di Vece
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Aurelio Rossi
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | | | - Julia Hermes-Laufer
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | | | - Rodolfo Citro
- Heart Department University Hospital "San Giovanni di Dio e Ruggi d'Aragona" Salerno Italy
| | - Eduardo Bossone
- Division of Cardiology "Antonio Cardarelli" Hospital Naples Italy
| | - Michael Neuhaus
- Department of Cardiology Kantonsspital Frauenfeld Frauenfeld Switzerland
| | - Jennifer Franke
- Department of Cardiology Heidelberg University Hospital Heidelberg Germany
| | - Benjamin Meder
- Department of Cardiology Heidelberg University Hospital Heidelberg Germany
| | - Milosz Jaguszewski
- First Department of Cardiology Medical University of Gdansk Gdansk Poland
| | - Michel Noutsias
- Mid-German Heart Center Department of Internal Medicine III Division of Cardiology, Angiology and Intensive Medical Care University Hospital HalleMartin-Luther-University Halle-Wittenberg Halle (Saale) Germany
| | - Maike Knorr
- Center for Cardiology Cardiology 1 University Medical Center Mainz Mainz Germany
| | - Susanne Heiner
- Center for Cardiology Cardiology 1 University Medical Center Mainz Mainz Germany
| | - Fabrizio D'Ascenzo
- Division of Cardiology Department of Medical Sciences AOU Città della Salute e della ScienzaUniversity of Turin Turin Italy
| | - Wolfgang Dichtl
- University Hospital for Internal Medicine III (Cardiology and Angiology) Medical University Innsbruck Innsbruck Austria
| | | | - Behrouz Kherad
- Department of Cardiology CharitéCampus Rudolf Virchow Berlin Germany
| | - Carsten Tschöpe
- Department of Cardiology CharitéCampus Rudolf Virchow Berlin Germany
| | - Annahita Sarcon
- Section of Cardiac Electrophysiology Department of Medicine University of California-San Francisco San Francisco CA
| | - Jerold Shinbane
- Keck School of Medicine University of Southern California Los Angeles CA
| | | | - Guido Michels
- Department of Internal Medicine III Heart Center University of Cologne Cologne Germany
| | - Roman Pfister
- Department of Internal Medicine III Heart Center University of Cologne Cologne Germany
| | | | - Claudius Jacobshagen
- Department of Cardiology Intensive Care Medicine and Angiology Vincentius-Diakonissen-Hospital Karlsruhe Germany
| | - Mahir Karakas
- Department of General and Interventional Cardiology University Heart Center Hamburg Hamburg Germany.,German Centre for Cardiovascular Research partner site Hamburg/Kiel/Luebeck Hamburg Germany
| | - Wolfgang Koenig
- Deutsches Herzzentrum MünchenTechnische Universität München Munich Germany.,German Centre for Cardiovascular Research partner site Munich Heart Alliance Munich Germany
| | - Alexander Pott
- Department of Internal Medicine II-Cardiology University of UlmMedical Center Ulm Germany
| | - Philippe Meyer
- Service de Cardiologie Hôpitaux Universitaires de Genève Geneva Switzerland
| | - Jose David Arroja
- Service de Cardiologie Hôpitaux Universitaires de Genève Geneva Switzerland
| | - Adrian Banning
- Department of Cardiology John Radcliffe HospitalOxford University Hospitals Oxford United Kingdom
| | - Florim Cuculi
- Department of Cardiology Kantonsspital Lucerne Lucerne Switzerland
| | - Richard Kobza
- Department of Cardiology Kantonsspital Lucerne Lucerne Switzerland
| | - Thomas A Fischer
- Department of Cardiology Kantonsspital Winterthur Winterthur Switzerland
| | - Tuija Vasankari
- Heart Center Turku University Hospital and University of Turku Turku Finland
| | | | - L Christian Napp
- Department of Cardiology and Angiology Hannover Medical School Hannover Germany
| | - Monika Budnik
- Department of Cardiology Medical University of Warsaw Warsaw Poland
| | - Rafal Dworakowski
- Department of Cardiology King's College Hospital London United Kingdom
| | - Philip MacCarthy
- Department of Cardiology King's College Hospital London United Kingdom
| | - Christoph Kaiser
- Department of Cardiology University Hospital Basel Basel Switzerland
| | - Stefan Osswald
- Department of Cardiology University Hospital Basel Basel Switzerland
| | - Leonarda Galiuto
- Fondazione Policlinico Universitario A. Gemelli IRCCSUniversità Cattolica del Sacro Cuore Rome Italy
| | - Christina Chan
- Department of Cardiology Christchurch Hospital Christchurch New Zealand
| | - Paul Bridgman
- Department of Cardiology Christchurch Hospital Christchurch New Zealand
| | - Daniel Beug
- Department of Cardiology and Internal Medicine B University Medicine Greifswald Greifswald Germany.,German Centre for Cardiovascular Researchpartner site Greifswald Greifswald Germany
| | - Clément Delmas
- Department of Cardiology and Cardiac Imaging Center University Hospital of Rangueil Toulouse France
| | - Olivier Lairez
- Department of Cardiology and Cardiac Imaging Center University Hospital of Rangueil Toulouse France
| | - Ekaterina Gilyarova
- Intensive Coronary Care Unit Moscow City Hospital # 1 named after N. Pirogov Moscow Russia
| | - Alexandra Shilova
- Intensive Coronary Care Unit Moscow City Hospital # 1 named after N. Pirogov Moscow Russia
| | - Mikhail Gilyarov
- Intensive Coronary Care Unit Moscow City Hospital # 1 named after N. Pirogov Moscow Russia
| | - Martin Kozel
- Cardiocenter Third Faculty of Medicine Charles University in Prague and University Hospital Královské Vinohrady Prague Czech Republic
| | - Petr Tousek
- Cardiocenter Third Faculty of Medicine Charles University in Prague and University Hospital Královské Vinohrady Prague Czech Republic
| | - David E Winchester
- Division of Cardiovascular Medicine Department of Medicine College of Medicine University of Florida Gainesville FL
| | - Jan Galuszka
- Department of Internal Medicine I-Cardiology University Hospital Olomouc Olomouc Czech Republic
| | - Christian Ukena
- Klinik für Innere Medizin IIIUniversitätsklinikum des Saarlandes Homburg Germany
| | - Gregor Poglajen
- Advanced Heart Failure and Transplantation Center University Medical Center Ljubljana Ljubljana Slovenia
| | - Pedro Carrilho-Ferreira
- Cardiology Department Santa Maria University HospitalCHLNCAMLCCULFaculty of MedicineUniversity of Lisbon Lisbon Portugal
| | - Christian Hauck
- Klinik und Poliklinik für Innere Medizin II Universitätsklinikum Regensburg Regensburg Germany
| | | | | | - Yoshio Kobayashi
- Department of Cardiovascular Medicine Chiba University Graduate School of Medicine Chiba Japan
| | - Abhiram Prasad
- Department of Cardiovascular Diseases Mayo Clinic Rochester MN
| | | | - Kan Liu
- Division of Cardiology, Heart and Vascular Center University of Iowa Iowa City IA
| | - P Christian Schulze
- Department of Internal Medicine I University Hospital JenaFriedrich-Schiller-University Jena Jena Germany
| | - Matteo Bianco
- Division of Cardiology A.O.U. San Luigi Gonzaga Orbassano, Turin Italy
| | - Lucas Jörg
- Department of Cardiology Kantonsspital St. Gallen St. Gallen Switzerland
| | - Hans Rickli
- Department of Cardiology Kantonsspital St. Gallen St. Gallen Switzerland
| | - Gonçalo Pestana
- Department of Cardiology Centro Hospitalar Universitário de São JoãoE.P.E. Porto Portugal
| | - Thanh H Nguyen
- Department of Cardiology Basil Hetzel InstituteQueen Elizabeth HospitalUniversity of Adelaide Adelaide Australia
| | - Michael Böhm
- Klinik für Innere Medizin IIIUniversitätsklinikum des Saarlandes Homburg Germany
| | - Lars S Maier
- Klinik und Poliklinik für Innere Medizin II Universitätsklinikum Regensburg Regensburg Germany
| | - Fausto J Pinto
- Cardiology Department Santa Maria University HospitalCHLNCAMLCCULFaculty of MedicineUniversity of Lisbon Lisbon Portugal
| | - Petr Widimský
- Cardiocenter Third Faculty of Medicine Charles University in Prague and University Hospital Královské Vinohrady Prague Czech Republic
| | - Stephan B Felix
- Department of Cardiology and Internal Medicine B University Medicine Greifswald Greifswald Germany.,German Centre for Cardiovascular Researchpartner site Greifswald Greifswald Germany
| | - Grzegorz Opolski
- Department of Cardiology Medical University of Warsaw Warsaw Poland
| | | | - Wolfgang Rottbauer
- Department of Internal Medicine II-Cardiology University of UlmMedical Center Ulm Germany
| | - Gerd Hasenfuß
- Clinic for Cardiology and Pneumology Georg August University Goettingen Goettingen Germany
| | - Burkert M Pieske
- Department of Cardiology CharitéCampus Rudolf Virchow Berlin Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum MünchenTechnische Universität München Munich Germany.,German Centre for Cardiovascular Research partner site Munich Heart Alliance Munich Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology Heart Center Leipzig-University Hospital Leipzig Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology Hannover Medical School Hannover Germany
| | - Hugo A Katus
- Department of Cardiology Heidelberg University Hospital Heidelberg Germany
| | - John D Horowitz
- Department of Cardiology Basil Hetzel InstituteQueen Elizabeth HospitalUniversity of Adelaide Adelaide Australia
| | - Carlo Di Mario
- Structural Interventional Cardiology Careggi University Hospital Florence Italy
| | - Thomas Münzel
- Center for Cardiology Cardiology 1 University Medical Center Mainz Mainz Germany
| | - Filippo Crea
- Fondazione Policlinico Universitario A. Gemelli IRCCSUniversità Cattolica del Sacro Cuore Rome Italy
| | - Jeroen J Bax
- Department of Cardiology Leiden University Medical Centre Leiden The Netherlands
| | - Thomas F Lüscher
- Center for Molecular Cardiology Schlieren Campus University of Zurich Zurich Switzerland.,Royal Brompton and Harefield Hospitals Trust and Imperial College London United Kingdom
| | - Frank Ruschitzka
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Firat Duru
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Martin Borggrefe
- First Department of Medicine Faculty of Medicine University Medical Centre Mannheim University of Heidelberg Mannheim Germany.,German Center for Cardiovascular Researchpartner site Heidelberg-Mannheim Mannheim Germany
| | - Jelena R Ghadri
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Ibrahim Akin
- First Department of Medicine Faculty of Medicine University Medical Centre Mannheim University of Heidelberg Mannheim Germany.,German Center for Cardiovascular Researchpartner site Heidelberg-Mannheim Mannheim Germany
| | - Christian Templin
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
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23
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Al Raisi S, Protty M, Raposeiras-Roubín S, D'Ascenzo F, Abu-Assi E, Ariza-Solé A, Manzano-Fernández S, Templin C, Velicki L, Xanthopoulou I, Cerrato E, Quadri G, Rognoni A, Boccuzzi G, Montabone A, Taha S, Durante A, Gili S, Magnani G, Autelli M, Grosso A, Flores-Blanco P, Varbella F, Cespón-Fernández M, Gallo D, Morbiducci U, Domínguez-Rodríguez A, Cequier Á, Gaita F, Alexopoulos D, Valgimigli M, Íñiguez-Romo A, Kinnaird T. Ticagrelor versus prasugrel in acute coronary syndrome: sex-specific analysis from the RENAMI Registry. Minerva Cardiol Angiol 2021; 69:408-416. [PMID: 34137238 DOI: 10.23736/s2724-5683.21.05591-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The use of potent P2Y12 inhibitors (ticagrelor & prasugrel) in acute coronary syndrome (ACS) patients undergoing percutaneous coronary interventions (PCI) is a class I recommendation. We performed a sex-specific analysis comparing the difference in efficacy and safety outcomes between ticagrelor and prasugrel in a real-world ACS population. METHODS Data from the multicenter REgistry of New Antiplatelets in patients with Myocardial Infarction (RENAMI) for 4424 ACS patients who underwent PCI and were treated with ticagrelor or prasugrel between 2012 to 2016 were analyzed. Mean follow-up was 17±9 months. RESULTS After propensity score matching, there was no significant difference in the occurrence of primary endpoint of net adverse cardiac events between ticagrelor and prasugrel in men (HR: 0.94; 95% CI: 0.69-1.29; P=0.71), or women (HR: 1.17; 95% CI: 0.63-2.20; P=0.62; P interaction [sex] = 0.40). Similarly, no differences were found in the occurrence of any of the secondary endpoints (MACE, all cause death, re-infarction, stent thrombosis, BARC major bleeding and BARC any bleeding) between the two P2Y12 groups between men and women. CONCLUSIONS In this real-world ACS population, no relative difference in efficacy or safety outcomes were found between ticagrelor and prasugrel between sexes.
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Affiliation(s)
- Sara Al Raisi
- Department of Cardiology, University Hospital of Wales, Cardiff, Wales, UK
| | - Majd Protty
- Department of Cardiology, University Hospital of Wales, Cardiff, Wales, UK.,Systems Immunity University Research Institute, Cardiff University, Cardiff, UK
| | | | - Fabrizio D'Ascenzo
- Service of Cardiology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Emad Abu-Assi
- Department of Cardiology, Álvaro Cunqueiro University Hospital, Vigo, Pontevedra, Spain
| | | | | | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Lazar Velicki
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.,Institute of Cardiovascular Diseases Voivodina, Sremska Kamenica, Serbia
| | | | - Enrico Cerrato
- Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Giorgio Quadri
- Department of Cardiology, Infermi Hospital, Rivoli, Turin, Italy
| | - Andrea Rognoni
- Coronary Care Unit and Catheterization Laboratory, Maggiore della Carità University Hospital, Novara, Italy
| | | | | | - Salma Taha
- Department of Cardiology, Faculty of Medicine, Assiut University, Asiut, Egypt
| | | | - Sebastiano Gili
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Giulia Magnani
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Michele Autelli
- Service of Cardiology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Alberto Grosso
- Service of Cardiology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Pedro Flores-Blanco
- Department of Cardiology, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | | | | | - Diego Gallo
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Polytechnical University of Turin, Turin, Italy
| | - Umberto Morbiducci
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Polytechnical University of Turin, Turin, Italy
| | | | - Ángel Cequier
- Department of Cardiology, Bellvitge Hospital, Barcelona, Spain
| | - Fiorenzo Gaita
- Service of Cardiology, Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Marco Valgimigli
- Service of Cardiology, University Hospital of the Canary Islands, Santa Cruz de Tenerife, Spain
| | - Andrés Íñiguez-Romo
- Coronary Care Unit and Catheterization Laboratory, Maggiore della Carità University Hospital, Novara, Italy
| | - Tim Kinnaird
- Department of Cardiology, University Hospital of Wales, Cardiff, Wales, UK -
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24
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Pristipino C, Germonpré P, Toni D, Sievert H, Meier B, D'Ascenzo F, Berti S, Onorato EM, Bedogni F, Mas JL, Scacciatella P, Hildick-Smith D, Gaita F, Kyrle PA, Thomson J, Derumeaux G, Sibbing D, Chessa M, Hornung M, Zamorano J, Dudek D, D'Ascenzo F, Omedè P, Ballocca F, Barbero U, Giordana F, Gili S, Iannaccone M, Akagi T, Anzola G, Carroll J, Dalvi B, Angelis CD, Junbo G, Kasner SE, Michel-Behnke I, Musumeci G, Søndergaard L, Tarantini G, Biondi-Zoccai GGL, Capodanno D, Valgimigli M, Byrne R, Kunadian V. European position paper on the management of patients with patent foramen ovale. Part II - Decompression sickness, migraine, arterial deoxygenation syndromes and select high-risk clinical conditions. Eur Heart J 2021; 42:1545-1553. [PMID: 33507260 DOI: 10.1093/eurheartj/ehaa1070] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 06/13/2020] [Revised: 10/07/2020] [Accepted: 11/17/2020] [Indexed: 02/05/2023] Open
Abstract
Patent foramen ovale (PFO) is implicated in the pathogenesis of a number of medical conditions but to date only one official position paper related to left circulation thromboembolism has been published. This interdisciplinary paper, prepared with the involvement of eight European scientific societies, reviews the available evidence and proposes a rationale for decision making for other PFO-related clinical conditions. In order to guarantee a strict evidence-based process, we used a modified grading of recommendations, assessment, development, and evaluation (GRADE) methodology. A critical qualitative and quantitative evaluation of diagnostic and therapeutic procedures was performed, including assessment of the risk/benefit ratio. The level of evidence and the strength of the position statements were weighed and graded according to predefined scales. Despite being based on limited and observational or low-certainty randomised data, a number of position statements were made to frame PFO management in different clinical settings, along with suggestions for new research avenues. This interdisciplinary position paper, recognising the low or very low certainty of existing evidence, provides the first approach to several PFO-related clinical scenarios beyond left circulation thromboembolism and strongly stresses the need for fresh high-quality evidence on these topics.
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Affiliation(s)
| | | | - Danilo Toni
- Hospital Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Horst Sievert
- CardioVascular Center Frankfurt (CVC Frankfurt), Frankfurt, Germany.,Anglia Ruskin University, Chelmsford, United Kingdom.,University California San Francisco (UCSF), San Francisco, CA, USA
| | | | - Fabrizio D'Ascenzo
- Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | | | | | | | - Jean-Louis Mas
- Hôpital Sainte-Anne, Université Paris Descartes, Paris, France
| | | | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom
| | - Fiorenzo Gaita
- Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | | | | | | | - Dirk Sibbing
- Privatklinik Lauterbacher Mühle am Ostersee, Iffeldorf and Ludwig-Maximilians-Universität (LMU) München, Munich, Germany
| | - Massimo Chessa
- IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Marius Hornung
- CardioVascular Center Frankfurt (CVC Frankfurt), Frankfurt, Germany
| | | | - Dariusz Dudek
- Jagiellonian University Medical College, Krakow, Poland.,Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy
| | | | - Fabrizio D'Ascenzo
- Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Pierluigi Omedè
- Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | | | | | | | | | | | | | | | | | - John Carroll
- University of Colorado Hospital, Denver, CO, USA
| | | | | | - Ge Junbo
- Shanghai Institute of Cardiovascular Disease, Shanghai, China
| | | | - Ina Michel-Behnke
- University Hospital for Children and Adolescents, Medical University Vienna, Vienna, Austria
| | | | | | | | | | | | | | - Davide Capodanno
- Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | | | - Robert Byrne
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Vijay Kunadian
- Newcastle University and Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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25
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Napp LC, Cammann VL, Jaguszewski M, Szawan KA, Wischnewsky M, Gili S, Knorr M, Heiner S, Citro R, Bossone E, D'Ascenzo F, Neuhaus M, Franke J, Sorici-Barb I, Noutsias M, Burgdorf C, Koenig W, Kherad B, Sarcon A, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Karakas M, Pott A, Meyer P, Arroja JD, Banning A, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KEJ, Hauck C, Paolini C, Bilato C, Imori Y, Kato K, Kobayashi Y, Opolski G, Budnik M, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Dichtl W, Chan C, Bridgman P, Beug D, Delmas C, Lairez O, El-Battrawy I, Akin I, Gilyarova E, Shilova A, Gilyarov M, Horowitz JD, Polednikova K, Tousek P, Widimský P, Winchester DE, Galuszka J, Ukena C, Poglajen G, Carrilho-Ferreira P, Di Mario C, Prasad A, Rihal CS, Schulze PC, Bianco M, Crea F, Borggrefe M, Maier LS, Pinto FJ, Braun-Dullaeus RC, Rottbauer W, Katus HA, Hasenfuß G, Tschöpe C, Pieske BM, Thiele H, Schunkert H, Böhm M, Felix SB, Münzel T, Bax JJ, Bauersachs J, Braunwald E, Lüscher TF, Ruschitzka F, Ghadri JR, Templin C. Coexistence and outcome of coronary artery disease in Takotsubo syndrome. Eur Heart J 2021; 41:3255-3268. [PMID: 32484517 DOI: 10.1093/eurheartj/ehaa210] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 02/09/2020] [Accepted: 03/16/2020] [Indexed: 01/08/2023] Open
Abstract
AIMS Takotsubo syndrome (TTS) is an acute heart failure syndrome, which shares many features with acute coronary syndrome (ACS). Although TTS was initially described with angiographically normal coronary arteries, smaller studies recently indicated a potential coexistence of coronary artery disease (CAD) in TTS patients. This study aimed to determine the coexistence, features, and prognostic role of CAD in a large cohort of patients with TTS. METHODS AND RESULTS Coronary anatomy and CAD were studied in patients diagnosed with TTS. Inclusion criteria were compliance with the International Takotsubo Diagnostic Criteria for TTS, and availability of original coronary angiographies with ventriculography performed during the acute phase. Exclusion criteria were missing views, poor quality of angiography loops, and angiography without ventriculography. A total of 1016 TTS patients were studied. Of those, 23.0% had obstructive CAD, 41.2% had non-obstructive CAD, and 35.7% had angiographically normal coronary arteries. A total of 47 patients (4.6%) underwent percutaneous coronary intervention, and 3 patients had acute and 8 had chronic coronary artery occlusion concomitant with TTS, respectively. The presence of CAD was associated with increased incidence of shock, ventilation, and death from any cause. After adjusting for confounders, the presence of obstructive CAD was associated with mortality at 30 days. Takotsubo syndrome patients with obstructive CAD were at comparable risk for shock and death and nearly at twice the risk for ventilation compared to an age- and sex-matched ACS cohort. CONCLUSIONS Coronary artery disease frequently coexists in TTS patients, presents with the whole spectrum of coronary pathology including acute coronary occlusion, and is associated with adverse outcome. TRIAL REGISTRATION ClinicalTrials.gov number: NCT01947621.
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Affiliation(s)
- L Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Victoria L Cammann
- University Heart Center, Department of Cardiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Milosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Konrad A Szawan
- University Heart Center, Department of Cardiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | | | | | - Maike Knorr
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Susanne Heiner
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Rodolfo Citro
- Heart Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Eduardo Bossone
- Division of Cardiology, "Antonio Cardarelli" Hospital, Naples, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Michael Neuhaus
- Department of Cardiology, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
| | - Jennifer Franke
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Ioana Sorici-Barb
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Michel Noutsias
- Mid-German Heart Center, Division of Cardiology, Angiology and Intensive Medical Care, Department of Internal Medicine III, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | | | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Behrouz Kherad
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Annahita Sarcon
- Section of Cardiac Electrophysiology, Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | | | - Guido Michels
- Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
| | - Roman Pfister
- Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
| | - Alessandro Cuneo
- Krankenhaus "Maria Hilf" Medizinische Klinik, Stadtlohn, Germany
| | - Claudius Jacobshagen
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany
| | - Mahir Karakas
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Germany, Hamburg
| | - Alexander Pott
- Department of Internal Medicine II - Cardiology, University of Ulm, Medical Center, Ulm, Germany
| | - Philippe Meyer
- Service de cardiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Jose D Arroja
- Service de cardiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Adrian Banning
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Florim Cuculi
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Richard Kobza
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Thomas A Fischer
- Department of Cardiology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Tuija Vasankari
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Christian Hauck
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Carla Paolini
- Local Health Unit no. 8, Cardiology Unit, Arzignano, Vicenza, Italy
| | - Claudio Bilato
- Local Health Unit no. 8, Cardiology Unit, Arzignano, Vicenza, Italy
| | - Yoichi Imori
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Ken Kato
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Grzegorz Opolski
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Monika Budnik
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | | | - Christoph Kaiser
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Leonarda Galiuto
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Wolfgang Dichtl
- University Hospital for Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Innsbruck, Austria
| | - Christina Chan
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Paul Bridgman
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Daniel Beug
- Department of Cardiology and Internal Medicine B, University Medicine Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Clément Delmas
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Olivier Lairez
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Ibrahim El-Battrawy
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), partner site, Heidelberg-Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), partner site, Heidelberg-Mannheim, Mannheim, Germany
| | - Ekaterina Gilyarova
- Intensive Coronary Care Unit, Moscow City Hospital # 1 named after N. Pirogov, Moscow, Russia
| | - Alexandra Shilova
- Intensive Coronary Care Unit, Moscow City Hospital # 1 named after N. Pirogov, Moscow, Russia
| | - Mikhail Gilyarov
- Intensive Coronary Care Unit, Moscow City Hospital # 1 named after N. Pirogov, Moscow, Russia
| | - John D Horowitz
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia
| | - Karolina Polednikova
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague, University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Petr Tousek
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague, University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Petr Widimský
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague, University Hospital Královské Vinohrady, Prague, Czech Republic
| | - David E Winchester
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jan Galuszka
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Christian Ukena
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Gregor Poglajen
- Advanced Heart Failure and Transplantation Center, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Pedro Carrilho-Ferreira
- Cardiology Department, Faculty of Medicine, Santa Maria University Hospital, CHLN, CAML, CCUL, University of Lisbon, Lisbon, Portugal
| | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Abhiram Prasad
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Charanjit S Rihal
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - P Christian Schulze
- Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - Matteo Bianco
- Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Turin, Italy
| | - Filippo Crea
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Martin Borggrefe
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), partner site, Heidelberg-Mannheim, Mannheim, Germany
| | - Lars S Maier
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Fausto J Pinto
- Cardiology Department, Faculty of Medicine, Santa Maria University Hospital, CHLN, CAML, CCUL, University of Lisbon, Lisbon, Portugal
| | | | - Wolfgang Rottbauer
- Department of Internal Medicine II - Cardiology, University of Ulm, Medical Center, Ulm, Germany
| | - Hugo A Katus
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Gerd Hasenfuß
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany
| | - Carsten Tschöpe
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Burkert M Pieske
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin Institute of Health (BIH), Berlin, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig - University Hospital, Germany, Leipzig
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Stephan B Felix
- Department of Cardiology and Internal Medicine B, University Medicine Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Thomas Münzel
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Eugene Braunwald
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Thomas F Lüscher
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Zurich, Switzerland.,Royal Brompton and Harefield Hospitals Trust and Imperial College, London, UK
| | - Frank Ruschitzka
- University Heart Center, Department of Cardiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Jelena R Ghadri
- University Heart Center, Department of Cardiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
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26
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D'Ascenzo F, De Filippo O, Borin A, Barbieri L, Adamo M, Morici N, Truffa Giachet A, Iannaccone M, Crimi G, Gaido L, Bocchino PP, Pivato CA, Campo G, Trabattoni D, Chieffo A, Gaibazzi N, Angelini F, Rubboli A, Rognoni A, Musumeci G, Ugo F, Gili S, Cortese B, Vadalà P, Dusi V, Gallone G, Patti G, de Ferrari GM. Impact of COVID-19 pandemic and infection on in hospital survival for patients presenting with acute coronary syndromes: A multicenter registry. Int J Cardiol 2021; 332:227-234. [PMID: 33794235 PMCID: PMC8006512 DOI: 10.1016/j.ijcard.2021.03.063] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/04/2021] [Accepted: 03/22/2021] [Indexed: 12/22/2022]
Abstract
Introduction The impact of Covid-19 on the survival of patients presenting with acute coronary syndrome (ACS) remains to be defined. Methods Consecutive patients presenting with ACS at 18 Centers in Northern-Italy during the Covid-19 outbreak were included. In-hospital all-cause death was the primary outcome. In-hospital cardiovascular death along with mechanical and electrical complications were the secondary ones. A case period (February 20, 2020-May 3, 2020) was compared vs. same-year (January 1–February 19, 2020) and previous-year control periods (February 20–May 3, 2019). ACS patients with Covid-19 were further compared with those without. Results Among 779 ACS patients admitted during the case period, 67 (8.6%) tested positive for Covid-19. In-hospital all-cause mortality was significantly higher during the case period compared to the control periods (6.4% vs. 3.5% vs. 4.4% respectively; p 0.026), but similar after excluding patients with COVID-19 (4.5% vs. 3.5% vs. 4.4%; p 0.73). Cardiovascular mortality was similar between the study groups. After multivariable adjustment, admission for ACS during the COVID-19 outbreak had no impact on in-hospital mortality. In the case period, patients with concomitant ACS and Covid-19 experienced significantly higher in-hospital mortality (25% vs. 5%, p < 0.001) compared to patients without. Moreover, higher rates of cardiovascular death, cardiogenic shock and sustained ventricular tachycardia were found in Covid-19 patients. Conclusion ACS patients presenting during the Covid-19 pandemic experienced increased all-cause mortality, driven by Covid-19 positive status due to higher rates of cardiogenic shock and sustained ventricular tachycardia. No differences in cardiovascular mortality compared to non-pandemic scenarios were reported.
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Affiliation(s)
- Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Ovidio De Filippo
- Division of Cardiology, Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy.
| | - Andrea Borin
- Division of Cardiology, Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Lucia Barbieri
- Division of Cardiology, ASST Santi Paolo e Carlo, 20142 Milan, Italy
| | - Marianna Adamo
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Nuccia Morici
- Intensive Cardiac Care Unit and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Italy
| | | | | | - Gabriele Crimi
- Cardiovascular Disease Unit, Istituto di Ricerca e Cura a Carattere Scientifico Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genova, Italy
| | - Luca Gaido
- Division of Cardiology, Ospedale Maria Vittoria, Torino, Italy
| | - Pier Paolo Bocchino
- Division of Cardiology, Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Carlo Andrea Pivato
- Humanitas Clinical and Research Center IRCCS - Rozzano, Milan, Italy.; Department of Biomedical Sciences - Pieve Emanuele, Humanitas University, Milano, Italy
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Italy
| | - Daniela Trabattoni
- Invasive Cardiology Unit 3, Centro Cardiologico Monzino, IRCCS, Via Parea, 4 - 20138 Milan, Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Gaibazzi
- Cardiology Department, Parma University Hospital, Parma, Italy
| | - Filippo Angelini
- Division of Cardiology, Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Andrea Rubboli
- Division of Cardiology, S Maria delle Croci Hospital, Ravenna, Italy
| | - Andrea Rognoni
- Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Novara, Italy
| | - Giuseppe Musumeci
- Cardiology Department, Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Italy
| | - Fabrizio Ugo
- Division of Cardiology, Presidio Ospedaliero Sant'Andrea di Vercelli, Vercelli, Italy
| | - Sebastiano Gili
- Invasive Cardiology Unit 3, Centro Cardiologico Monzino, IRCCS, Via Parea, 4 - 20138 Milan, Italy
| | - Bernardo Cortese
- San Carlo Clinic, Milan, Italy; Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy
| | - Paolo Vadalà
- Division of Cardiology, Ospedale Michele e Pietro Ferrero, Verduno, Italy
| | - Veronica Dusi
- Division of Cardiology, Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Guglielmo Gallone
- Division of Cardiology, Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Giuseppe Patti
- Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Novara, Italy
| | - Gaetano Maria de Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
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27
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Kato K, Cammann VL, Napp LC, Szawan KA, Micek J, Dreiding S, Levinson RA, Petkova V, Würdinger M, Patrascu A, Sumalinog R, Gili S, Clarenbach CF, Kohler M, Wischnewsky M, Citro R, Vecchione C, Bossone E, Neuhaus M, Franke J, Meder B, Jaguszewski M, Noutsias M, Knorr M, Heiner S, D'Ascenzo F, Dichtl W, Burgdorf C, Kherad B, Tschöpe C, Sarcon A, Shinbane J, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Karakas M, Koenig W, Pott A, Meyer P, Roffi M, Banning A, Wolfrum M, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KEJ, Budnik M, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Chan C, Bridgman P, Beug D, Delmas C, Lairez O, Gilyarova E, Shilova A, Gilyarov M, El-Battrawy I, Akin I, Kozel M, Tousek P, Winchester DE, Galuszka J, Ukena C, Poglajen G, Carrilho-Ferreira P, Hauck C, Paolini C, Bilato C, Sano M, Ishibashi I, Takahara M, Himi T, Kobayashi Y, Prasad A, Rihal CS, Liu K, Schulze PC, Bianco M, Jörg L, Rickli H, Pestana G, Nguyen TH, Böhm M, Maier LS, Pinto FJ, Widimský P, Felix SB, Opolski G, Braun-Dullaeus RC, Rottbauer W, Hasenfuß G, Pieske BM, Schunkert H, Borggrefe M, Thiele H, Bauersachs J, Katus HA, Horowitz JD, Di Mario C, Münzel T, Crea F, Bax JJ, Lüscher TF, Ruschitzka F, Ghadri JR, Templin C. Prognostic impact of acute pulmonary triggers in patients with takotsubo syndrome: new insights from the International Takotsubo Registry. ESC Heart Fail 2021; 8:1924-1932. [PMID: 33713566 PMCID: PMC8120351 DOI: 10.1002/ehf2.13165] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/20/2020] [Accepted: 11/24/2020] [Indexed: 02/01/2023] Open
Abstract
AIMS Acute pulmonary disorders are known physical triggers of takotsubo syndrome (TTS). This study aimed to investigate prevalence of acute pulmonary triggers in patients with TTS and their impact on outcomes. METHODS AND RESULTS Patients with TTS were enrolled from the International Takotsubo Registry and screened for triggering factors and comorbidities. Patients were categorized into three groups (acute pulmonary trigger, chronic lung disease, and no lung disease) to compare clinical characteristics and outcomes. Of the 1670 included patients with TTS, 123 (7%) were identified with an acute pulmonary trigger, and 194 (12%) had a known history of chronic lung disease. The incidence of cardiogenic shock was highest in patients with an acute pulmonary trigger compared with those with chronic lung disease or without lung disease (17% vs. 10% vs. 9%, P = 0.017). In-hospital mortality was also higher in patients with an acute pulmonary trigger than in the other two groups, although not significantly (5.7% vs. 1.5% vs. 4.2%, P = 0.13). Survival analysis demonstrated that patients with an acute pulmonary trigger had the worst long-term outcome (P = 0.002). The presence of an acute pulmonary trigger was independently associated with worse long-term mortality (hazard ratio 2.12, 95% confidence interval 1.33-3.38; P = 0.002). CONCLUSIONS The present study demonstrates that TTS is related to acute pulmonary triggers in 7% of all TTS patients, which accounts for 21% of patients with physical triggers. The presence of acute pulmonary trigger is associated with a severe in-hospital course and a worse long-term outcome.
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Affiliation(s)
- Ken Kato
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Victoria L Cammann
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - L Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Konrad A Szawan
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Jozef Micek
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Sara Dreiding
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Rena A Levinson
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Vanya Petkova
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Michael Würdinger
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Alexandru Patrascu
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Rafael Sumalinog
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | | | | | - Malcolm Kohler
- Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland
| | | | - Rodolfo Citro
- Heart Department, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Carmine Vecchione
- Heart Department, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Eduardo Bossone
- Division of Cardiology, Antonio Cardarelli Hospital, Naples, Italy
| | - Michael Neuhaus
- Department of Cardiology, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
| | - Jennifer Franke
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Benjamin Meder
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Milosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Michel Noutsias
- Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Maike Knorr
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Susanne Heiner
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Wolfgang Dichtl
- University Hospital for Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Innsbruck, Austria
| | | | - Behrouz Kherad
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Carsten Tschöpe
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Annahita Sarcon
- Section of Cardiac Electrophysiology, Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Jerold Shinbane
- Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Guido Michels
- Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
| | - Roman Pfister
- Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
| | - Alessandro Cuneo
- Krankenhaus 'Maria Hilf' Medizinische Klinik, Stadtlohn, Germany
| | - Claudius Jacobshagen
- Clinic for Cardiology and Pneumology, Georg August University of Goettingen, Goettingen, Germany
| | - Mahir Karakas
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Alexander Pott
- Department of Internal Medicine II - Cardiology, University of Ulm, Medical Center, Ulm, Germany
| | - Philippe Meyer
- Service de Cardiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Marco Roffi
- Service de Cardiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Adrian Banning
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Mathias Wolfrum
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Florim Cuculi
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Richard Kobza
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Thomas A Fischer
- Department of Cardiology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Tuija Vasankari
- Heart Center, Turku University Hospital, University of Turku, Turku, Finland
| | | | - Monika Budnik
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | | | - Christoph Kaiser
- Department of Cardiology, University Hospital of Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital of Basel, Basel, Switzerland
| | - Leonarda Galiuto
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Christina Chan
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Paul Bridgman
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Daniel Beug
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Clément Delmas
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Olivier Lairez
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Ekaterina Gilyarova
- Intensive Coronary Care Unit, Moscow City Hospital # 1 named after N. Pirogov, Moscow, Russia
| | - Alexandra Shilova
- Intensive Coronary Care Unit, Moscow City Hospital # 1 named after N. Pirogov, Moscow, Russia
| | - Mikhail Gilyarov
- Intensive Coronary Care Unit, Moscow City Hospital # 1 named after N. Pirogov, Moscow, Russia
| | - Ibrahim El-Battrawy
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Martin Kozel
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Tousek
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - David E Winchester
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jan Galuszka
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Christian Ukena
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Gregor Poglajen
- Advanced Heart Failure and Transplantation Center, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Pedro Carrilho-Ferreira
- Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre and Cardiovascular Centre of the University of Lisbon (CCUL), Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - Christian Hauck
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Carla Paolini
- Local Health Unit n.8, Cardiology Unit, Arzignano, Vicenza, Italy
| | - Claudio Bilato
- Local Health Unit n.8, Cardiology Unit, Arzignano, Vicenza, Italy
| | - Masanori Sano
- Department of Cardiology, Chiba Emergency Medical Center, Chiba, Japan
| | - Iwao Ishibashi
- Department of Cardiology, Chiba Emergency Medical Center, Chiba, Japan
| | | | - Toshiharu Himi
- Division of Cardiology, Kimitsu Central Hospital, Kisarazu, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Abhiram Prasad
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Charanjit S Rihal
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Kan Liu
- Division of Cardiology, Heart and Vascular Center, University of Iowa, Iowa City, Iowa, USA
| | - P Christian Schulze
- Department of Internal Medicine I, JenaUniversity Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Matteo Bianco
- Division of Cardiology, A.O.U San Luigi Gonzaga, Turin, Italy
| | - Lucas Jörg
- Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Hans Rickli
- Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Gonçalo Pestana
- Department of Cardiology, Centro Hospitalar Universitário de São João, E.P.E, Porto, Portugal
| | - Thanh H Nguyen
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Fausto J Pinto
- Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre and Cardiovascular Centre of the University of Lisbon (CCUL), Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - Petr Widimský
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Stephan B Felix
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Grzegorz Opolski
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | - Wolfgang Rottbauer
- Department of Internal Medicine II - Cardiology, University of Ulm, Medical Center, Ulm, Germany
| | - Gerd Hasenfuß
- Clinic for Cardiology and Pneumology, Georg August University of Goettingen, Goettingen, Germany
| | - Burkert M Pieske
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Martin Borggrefe
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig - University Hospital, Leipzig, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Hugo A Katus
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - John D Horowitz
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia
| | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Thomas Münzel
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Filippo Crea
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Thomas F Lüscher
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Zurich, Switzerland.,Royal Brompton and Harefield Hospitals Trust and Imperial College, London, UK
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Jelena R Ghadri
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
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28
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Silvain J, Zeitouni M, Paradies V, Zheng HL, Ndrepepa G, Cavallini C, Feldman DN, Sharma SK, Mehilli J, Gili S, Barbato E, Tarantini G, Ooi SY, von Birgelen C, Jaffe AS, Thygesen K, Montalescot G, Bulluck H, Hausenloy DJ. Procedural myocardial injury, infarction and mortality in patients undergoing elective PCI: a pooled analysis of patient-level data. Eur Heart J 2021; 42:323-334. [PMID: 33257958 PMCID: PMC7850039 DOI: 10.1093/eurheartj/ehaa885] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/10/2020] [Accepted: 10/14/2020] [Indexed: 12/28/2022] Open
Abstract
AIMS The prognostic importance of cardiac procedural myocardial injury and myocardial infarction (MI) in chronic coronary syndrome (CCS) patients undergoing elective percutaneous coronary intervention (PCI) is still debated. METHODS AND RESULTS We analysed individual data of 9081 patients undergoing elective PCI with normal pre-PCI baseline cardiac troponin (cTn) levels. Multivariate models evaluated the association between post-PCI elevations in cTn and 1-year mortality, while an interval analysis evaluated the impact of the size of the myocardial injury on mortality. Our analysis was performed in the overall population and also according to the type of cTn used [52.0% had high-sensitivity cTn (hs-cTn)]. Procedural myocardial injury, as defined by the Fourth Universal Definition of MI (UDMI) [post-PCI cTn elevation ≥1 × 99th percentile upper reference limit (URL)], occurred in 52.8% of patients and was not associated with 1-year mortality [adj odds ratio (OR), 1.35, 95% confidence interval (CI) (0.84-1.77), P = 0.21]. The association between post-PCI cTn elevation and 1-year mortality was significant starting ≥3 × 99th percentile URL. Major myocardial injury defined by post-PCI ≥5 × 99th percentile URL occurred in 18.2% of patients and was associated with a two-fold increase in the adjusted odds of 1-year mortality [2.29, 95% CI (1.32-3.97), P = 0.004]. In the subset of patients for whom periprocedural evidence of ischaemia was collected (n = 2316), Type 4a MI defined by the Fourth UDMI occurred in 12.7% of patients and was strongly associated with 1-year mortality [adj OR 3.21, 95% CI (1.42-7.27), P = 0.005]. We also present our results according to the type of troponin used (hs-cTn or conventional troponin). CONCLUSION Our analysis has demonstrated that in CCS patients with normal baseline cTn levels, the post-PCI cTn elevation of ≥5 × 99th percentile URL used to define Type 4a MI is associated with 1-year mortality and could be used to detect 'major' procedural myocardial injury in the absence of procedural complications or evidence of new myocardial ischaemia.
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Affiliation(s)
- Johanne Silvain
- Corresponding author. Tel: +33 142162961, Fax: +33 142162931,
| | - Michel Zeitouni
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, 47-83 bld de l’Hôpital, 75013 Paris, France
| | - Valeria Paradies
- Cardiology Department, Maasstad Hospital, Rotterdam, Netherlands
| | - Huili L Zheng
- Health Promotion Board, National Registry of Diseases Office, Singapore, Singapore
| | - Gjin Ndrepepa
- Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany
| | - Claudio Cavallini
- Division of Cardiology, Ospedale S Maria della Misericordia, Piazzale Meneghini 1, Perugia 06100, Italy
| | - Dimitri N Feldman
- Division of Cardiology, Weill Cornell Medical College, New York, NY, USA
| | - Samin K Sharma
- Cardiac Catheterization Laboratory, Cardiovascular Institute, Mount Sinai Hospital, New York, NY, USA
| | - Julinda Mehilli
- Munich University Clinic, Ludwig-Maximilians University, Munich, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | | | - Emanuele Barbato
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Napoli, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Sze Y Ooi
- Eastern Heart Clinic, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Clemens von Birgelen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, Netherlands
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Allan S Jaffe
- Department of Cardiology, Mayo Clinic, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Kristian Thygesen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Gilles Montalescot
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, 47-83 bld de l’Hôpital, 75013 Paris, France
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29
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Cammann VL, Szawan KA, Stähli BE, Kato K, Budnik M, Wischnewsky M, Dreiding S, Levinson RA, Di Vece D, Gili S, Citro R, Bossone E, Neuhaus M, Franke J, Meder B, Jaguszewski M, Noutsias M, Knorr M, Heiner S, D'Ascenzo F, Dichtl W, Burgdorf C, Kherad B, Tschöpe C, Sarcon A, Shinbane J, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Karakas M, Koenig W, Pott A, Meyer P, Roffi M, Banning A, Wolfrum M, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KEJ, Napp LC, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Chan C, Bridgman P, Beug D, Delmas C, Lairez O, Gilyarova E, Shilova A, Gilyarov M, El-Battrawy I, Akin I, Poledniková K, Toušek P, Winchester DE, Galuszka J, Ukena C, Poglajen G, Carrilho-Ferreira P, Hauck C, Paolini C, Bilato C, Kobayashi Y, Shoji T, Ishibashi I, Takahara M, Himi T, Din J, Al-Shammari A, Prasad A, Rihal CS, Liu K, Schulze PC, Bianco M, Jörg L, Rickli H, Pestana G, Nguyen TH, Böhm M, Maier LS, Pinto FJ, Widimský P, Felix SB, Braun-Dullaeus RC, Rottbauer W, Hasenfuß G, Pieske BM, Schunkert H, Borggrefe M, Thiele H, Bauersachs J, Katus HA, Horowitz JD, Di Mario C, Münzel T, Crea F, Bax JJ, Lüscher TF, Ruschitzka F, Ghadri JR, Opolski G, Templin C. Age-Related Variations in Takotsubo Syndrome. J Am Coll Cardiol 2021; 75:1869-1877. [PMID: 32327096 DOI: 10.1016/j.jacc.2020.02.057] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [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: 09/26/2019] [Revised: 02/06/2020] [Accepted: 02/28/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Takotsubo syndrome (TTS) occurs predominantly in post-menopausal women but is also found in younger patients. OBJECTIVES This study aimed to investigate age-related differences in TTS. METHODS Patients diagnosed with TTS and enrolled in the International Takotsubo Registry between January 2011 and February 2017 were included in this analysis and were stratified by age (younger: ≤50 years, middle-age: 51 to 74 years, elderly: ≥75 years). Baseline characteristics, hospital course, as well as short- and long-term mortality were compared among groups. RESULTS Of 2,098 TTS patients, 242 (11.5%) patients were ≤50 years of age, 1,194 (56.9%) were 51 to 74 years of age, and 662 (31.6%) were ≥75 years of age. Younger patients were more often men (12.4% vs. 10.9% vs. 6.3%; p = 0.002) and had an increased prevalence of acute neurological (16.3% vs. 8.4% vs. 8.8%; p = 0.001) or psychiatric disorders (14.1% vs. 10.3% vs. 5.6%; p < 0.001) compared with middle-aged and elderly TTS patients. Furthermore, younger patients had more often cardiogenic shock (15.3% vs. 9.1% vs. 8.1%; p = 0.004) and had a numerically higher in-hospital mortality (6.6% vs. 3.6% vs. 5.1%; p = 0.07). At multivariable analysis, younger (odds ratio: 1.60; 95% confidence interval: 0.86 to 3.01; p = 0.14) and older age (odds ratio: 1.09; 95% confidence interval: 0.66 to 1.80; p = 0.75) were not independently associated with in-hospital mortality using the middle-aged group as a reference. There were no differences in 60-day mortality rates among groups. CONCLUSIONS A substantial proportion of TTS patients are younger than 50 years of age. TTS is associated with severe complications requiring intensive care, particularly in younger patients.
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Affiliation(s)
- Victoria L Cammann
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Konrad A Szawan
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Barbara E Stähli
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Ken Kato
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Monika Budnik
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | - Sara Dreiding
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Rena A Levinson
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Davide Di Vece
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Rodolfo Citro
- Heart Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy
| | - Eduardo Bossone
- Division of Cardiology, "Antonio Cardarelli" Hospital, Naples, Italy
| | - Michael Neuhaus
- Department of Cardiology, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
| | - Jennifer Franke
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Benjamin Meder
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Miłosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Michel Noutsias
- Mid-German Heart Center, Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Maike Knorr
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Susanne Heiner
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Wolfgang Dichtl
- University Hospital for Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Innsbruck, Austria
| | | | - Behrouz Kherad
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Carsten Tschöpe
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Annahita Sarcon
- Section of Cardiac Electrophysiology, Department of Medicine, University of California-San Francisco, San Francisco, California
| | - Jerold Shinbane
- University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Lawrence Rajan
- TJ Health Partners Heart and Vascular, Glasgow, Kentucky
| | - Guido Michels
- Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
| | - Roman Pfister
- Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
| | - Alessandro Cuneo
- Krankenhaus "Maria Hilf" Medizinische Klinik, Stadtlohn, Germany
| | - Claudius Jacobshagen
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany
| | - Mahir Karakas
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Alexander Pott
- Department of Internal Medicine II-Cardiology, University of Ulm, Medical Center, Ulm, Germany
| | - Philippe Meyer
- Service de cardiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Marco Roffi
- Service de cardiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Adrian Banning
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, United Kingdom
| | - Mathias Wolfrum
- Department of Internal Medicine, Cardiology and Angiology, Magdeburg University, Magdeburg, Germany
| | - Florim Cuculi
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Richard Kobza
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Thomas A Fischer
- Department of Cardiology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Tuija Vasankari
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | | | - L Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Rafal Dworakowski
- Department of Cardiology, King's College Hospital, London, United Kingdom
| | - Philip MacCarthy
- Department of Cardiology, King's College Hospital, London, United Kingdom
| | - Christoph Kaiser
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Leonarda Galiuto
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Christina Chan
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Paul Bridgman
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Daniel Beug
- Department of Cardiology and Internal Medicine B, University Medicine Greifswald, Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Clément Delmas
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Olivier Lairez
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Ekaterina Gilyarova
- Intensive Coronary Care Unit, Moscow City Hospital #1 named after N. Pirogov, Moscow, Russia
| | - Alexandra Shilova
- Intensive Coronary Care Unit, Moscow City Hospital #1 named after N. Pirogov, Moscow, Russia
| | - Mikhail Gilyarov
- Intensive Coronary Care Unit, Moscow City Hospital #1 named after N. Pirogov, Moscow, Russia
| | - Ibrahim El-Battrawy
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany; DZHK (German Center for Cardiovascular Research), partner site, Heidelberg-Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany; DZHK (German Center for Cardiovascular Research), partner site, Heidelberg-Mannheim, Mannheim, Germany
| | - Karolina Poledniková
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague and University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Petr Toušek
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague and University Hospital Královské Vinohrady, Prague, Czech Republic
| | - David E Winchester
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida
| | - Jan Galuszka
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Christian Ukena
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Gregor Poglajen
- Advanced Heart Failure and Transplantation Center, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Pedro Carrilho-Ferreira
- Santa Maria University Hospital, CHULN, Center of Cardiology of the University of Lisbon, Lisbon School of Medicine, Lisbon Academic Medical Center, Lisboa, Portugal
| | - Christian Hauck
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Carla Paolini
- Local Health Unit n.8, Cardiology Unit, Arzignano, Vicenza, Italy
| | - Claudio Bilato
- Local Health Unit n.8, Cardiology Unit, Arzignano, Vicenza, Italy
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Toshihiro Shoji
- Department of Cardiology, Chiba Emergency Medical Center, Chiba, Japan
| | - Iwao Ishibashi
- Department of Cardiology, Chiba Emergency Medical Center, Chiba, Japan
| | | | - Toshiharu Himi
- Division of Cardiology, Kimitsu Central Hospital, Kisarazu, Japan
| | - Jehangir Din
- Dorset Heart Centre, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Ali Al-Shammari
- Dorset Heart Centre, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Abhiram Prasad
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Charanjit S Rihal
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Kan Liu
- Division of Cardiology, Heart and Vascular Center, University of Iowa, Iowa City, Iowa
| | - P Christian Schulze
- Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - Matteo Bianco
- Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Turin, Italy
| | - Lucas Jörg
- Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Hans Rickli
- Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Gonçalo Pestana
- Department of Cardiology, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Thanh H Nguyen
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Lars S Maier
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Fausto J Pinto
- Santa Maria University Hospital, CHULN, Center of Cardiology of the University of Lisbon, Lisbon School of Medicine, Lisbon Academic Medical Center, Lisboa, Portugal
| | - Petr Widimský
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague and University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Stephan B Felix
- Department of Cardiology and Internal Medicine B, University Medicine Greifswald, Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | | | - Wolfgang Rottbauer
- Department of Internal Medicine II-Cardiology, University of Ulm, Medical Center, Ulm, Germany
| | - Gerd Hasenfuß
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany
| | - Burkert M Pieske
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany; DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin Institute of Health (BIH), Berlin, Germany
| | - Heribert Schunkert
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany; Local Health Unit n.8, Cardiology Unit, Arzignano, Vicenza, Italy
| | - Martin Borggrefe
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany; DZHK (German Center for Cardiovascular Research), partner site, Heidelberg-Mannheim, Mannheim, Germany
| | - Holger Thiele
- Heart Center Leipzig - University Hospital, Department of Internal Medicine/Cardiology, Leipzig, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Hugo A Katus
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - John D Horowitz
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Thomas Münzel
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Filippo Crea
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Thomas F Lüscher
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Zurich, Switzerland; Royal Brompton and Harefield Hospitals Trust and Imperial College, London, United Kingdom
| | - Frank Ruschitzka
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Jelena R Ghadri
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Grzegorz Opolski
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Christian Templin
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
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Barbero U, Moncalvo C, Trabattoni D, Pavani M, Amoroso GR, Bocchino PP, Truffa Giachet A, Saglietto A, Monticone S, Secco GG, Campo G, Verardi R, Iannaccone M, Galvani M, Ugo F, Infantino V, Olivotti L, Mennuni M, Vercellino M, Gili S, Zucchetti O, Casella G, Giammaria M, De Benedictis M, Tolomeo P, Doronzo B, Grosso Marra W, Rognoni A, Montefusco A, Patti G, Mancone M, De Ferrari GM, D’Ascenzo F. Gender differences in acute coronary syndromes patterns during the COVID-19 outbreak. Am J Cardiovasc Dis 2020; 10:506-513. [PMID: 33224602 PMCID: PMC7675165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/29/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Mortality from acute coronary syndromes (ACS) is strictly related to early management. As female patients usually experience longer delays before diagnosis and treatment, we assessed whether women were more affected by the dramatic drop in hospital admissions for ACS during the Covid-19 pandemic. METHODS We performed a retrospective analysis of clinical and angiographic characteristics of consecutive patients who were admitted for ACS at 15 hospitals in Northern Italy comparing men and women data. The study period was defined as the time between the first confirmed case of Covid-19 in Italy (February 20, 2020) and March 31, 2020. We compared hospitalization rates between the study period and two control periods: the corresponding period during the previous year (February 20 to March 31, 2019) and the earlier period during the same year (January 1 to February 19, 2020). Incidence rate ratios comparing the study period with each of the control periods were calculated with the use of Poisson regression. RESULTS Of the 547 patients who were hospitalized for ACS during the study period, only 127 (23%) were females, accounting for a mean of 3.1 admissions per day, while ACS hospitalized males were 420, with a mean of 10.2 admissions per day. There was a significant decrease driven by a similar reduction in ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) diagnosis in both sexes compared to the control periods. A trend toward a greater reduction in admitted females was shown in the intra-year control period (46% admission reduction in females vs 37% in males, with females accounting for 26% of ACS, P=0.10) and a significant reduction when compared to the previous year control period (40% admission reduction in females vs 23% in males, with females accounting for 28% of ACS, P=0.03), mainly related to Unstable Angina diagnosis. CONCLUSION The Covid-19 pandemic period closed the gap between men and women in ACS, with similar rates of reduction of hospitalized STEMI and NSTEMI and a trend toward greater reduction in UA admission among women. Furthermore, many typical differences between males and females regarding ischemic heart disease presentations and vessel distribution were leveled.
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Affiliation(s)
| | | | - Daniela Trabattoni
- Department of Cardiovascular Sciences, IRCCS Centro Cardiologico Monzino, University of MilanItaly
| | | | | | - Pier Paolo Bocchino
- Division of Cardiology, A.O.U Città della Salute e della Scienza di TorinoTurin, Italy
| | | | - Andrea Saglietto
- Division of Cardiology, A.O.U Città della Salute e della Scienza di TorinoTurin, Italy
| | - Silvia Monticone
- Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences, University of TurinTorino, Italy
| | - Gioel Gabrio Secco
- Department of Cardiology, Interventional Cardiology and Cardiac Surgery Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare ArrigoAlessandria, Italy
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliera Universitaria di FerraraFerrara, Italy
- Maria Cecilia Hospital, GVM Care & ResearchCotignola, Ravenna Italy
| | - Roberto Verardi
- Division of Cardiology, A.O.U Città della Salute e della Scienza di TorinoTurin, Italy
- Department of Cardiology, Maggiore Hospital Carlo Alberto PizzardiBologna, Italy
| | | | - Marcello Galvani
- U.O.C. Cardiologia, Dipartimento Cardiovascolare AUSL Romagna, Ospedale Morgagni, Forlì, e Unità di Ricerca Cardiovascolare, Fondazione Cardiologica SaccoForlì, Italy
| | - Fabrizio Ugo
- Division of Cardiology, Presidio Ospedaliero Sant’Andrea di VercelliVercelli, Italy
| | | | - Luca Olivotti
- Division of Cardiology, Ospedale Santa CoronaPietra Ligure, Italy
| | - Marco Mennuni
- Coronary Care Unit and Catheterization laboratory, A.O.U. Maggiore della CaritàNovara, Italy
| | - Matteo Vercellino
- Department of Cardiology, Interventional Cardiology and Cardiac Surgery Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare ArrigoAlessandria, Italy
| | - Sebastiano Gili
- Department of Cardiovascular Sciences, IRCCS Centro Cardiologico Monzino, University of MilanItaly
| | - Ottavio Zucchetti
- Cardiology Unit, Azienda Ospedaliera Universitaria di FerraraFerrara, Italy
| | - Gianni Casella
- Department of Cardiology, Maggiore Hospital Carlo Alberto PizzardiBologna, Italy
| | | | | | - Paolo Tolomeo
- Cardiology Unit, Azienda Ospedaliera Universitaria di FerraraFerrara, Italy
| | | | | | - Andrea Rognoni
- Coronary Care Unit and Catheterization laboratory, A.O.U. Maggiore della CaritàNovara, Italy
| | - Antonio Montefusco
- Division of Cardiology, A.O.U Città della Salute e della Scienza di TorinoTurin, Italy
| | - Giuseppe Patti
- Coronary Care Unit and Catheterization laboratory, A.O.U. Maggiore della CaritàNovara, Italy
| | - Massimo Mancone
- Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of RomeRome, Italy
| | | | - Fabrizio D’Ascenzo
- Division of Cardiology, A.O.U Città della Salute e della Scienza di TorinoTurin, Italy
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31
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Gili S, Cammann VL, Schlossbauer SA, Kato K, D'Ascenzo F, Di Vece D, Jurisic S, Micek J, Obeid S, Bacchi B, Szawan KA, Famos F, Sarcon A, Levinson R, Ding KJ, Seifert B, Lenoir O, Bossone E, Citro R, Franke J, Napp LC, Jaguszewski M, Noutsias M, Münzel T, Knorr M, Heiner S, Katus HA, Burgdorf C, Schunkert H, Thiele H, Bauersachs J, Tschöpe C, Pieske BM, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Hasenfuß G, Karakas M, Koenig W, Rottbauer W, Said SM, Braun-Dullaeus RC, Banning A, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KEJ, Opolski G, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Crea F, Dichtl W, Empen K, Felix SB, Delmas C, Lairez O, El-Battrawy I, Akin I, Borggrefe M, Gilyarova E, Shilova A, Gilyarov M, Horowitz JD, Kozel M, Tousek P, Widimský P, Winchester DE, Ukena C, Gaita F, Di Mario C, Wischnewsky MB, Bax JJ, Prasad A, Böhm M, Ruschitzka F, Lüscher TF, Ghadri JR, Templin C. Cardiac arrest in takotsubo syndrome: results from the InterTAK Registry. Eur Heart J 2020; 40:2142-2151. [PMID: 31098611 PMCID: PMC6612368 DOI: 10.1093/eurheartj/ehz170] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 09/11/2018] [Accepted: 03/12/2019] [Indexed: 12/27/2022] Open
Abstract
AIMS We aimed to evaluate the frequency, clinical features, and prognostic implications of cardiac arrest (CA) in takotsubo syndrome (TTS). METHODS AND RESULTS We reviewed the records of patients with CA and known heart rhythm from the International Takotsubo Registry. The main outcomes were 60-day and 5-year mortality. In addition, predictors of mortality and predictors of CA during the acute TTS phase were assessed. Of 2098 patients, 103 patients with CA and known heart rhythm during CA were included. Compared with patients without CA, CA patients were more likely to be younger, male, and have apical TTS, atrial fibrillation (AF), neurologic comorbidities, physical triggers, and longer corrected QT-interval and lower left ventricular ejection fraction on admission. In all, 57.1% of patients with CA at admission had ventricular fibrillation/tachycardia, while 73.7% of patients with CA in the acute phase had asystole/pulseless electrical activity. Patients with CA showed higher 60-day (40.3% vs. 4.0%, P < 0.001) and 5-year mortality (68.9% vs. 16.7%, P < 0.001) than patients without CA. T-wave inversion and intracranial haemorrhage were independently associated with higher 60-day mortality after CA, whereas female gender was associated with lower 60-day mortality. In the acute phase, CA occurred less frequently in females and more frequently in patients with AF, ST-segment elevation, and higher C-reactive protein on admission. CONCLUSIONS Cardiac arrest is relatively frequent in TTS and is associated with higher short- and long-term mortality. Clinical and electrocardiographic parameters independently predicted mortality after CA.
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Affiliation(s)
- Sebastiano Gili
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland.,Division of Cardiology, Department of Medical Sciences, AOU Citta della Salute e della Scienza, University of Turin, Turin, Italy
| | - Victoria L Cammann
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Susanne A Schlossbauer
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Ken Kato
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, AOU Citta della Salute e della Scienza, University of Turin, Turin, Italy
| | - Davide Di Vece
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Stjepan Jurisic
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Jozef Micek
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Slayman Obeid
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Beatrice Bacchi
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Konrad A Szawan
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Flurina Famos
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Annahita Sarcon
- Keck School of Medicine, University of Southern California, Los Angeles CA, USA
| | - Rena Levinson
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland.,Division of Biological Sciences, University of California San Diego, San Diego, CA, USA
| | - Katharina J Ding
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Burkhardt Seifert
- Division of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Olivia Lenoir
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Eduardo Bossone
- Division of Cardiology 'Antonio Cardarelli' Hospital, Naples, Italy
| | - Rodolfo Citro
- Heart Department, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Jennifer Franke
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - L Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Milosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Michel Noutsias
- Division of Cardiology, Department of Internal Medicine III, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Halle (Saale), Germany
| | - Thomas Münzel
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Maike Knorr
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Susanne Heiner
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Hugo A Katus
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Carsten Tschöpe
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Burkert M Pieske
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | | | - Guido Michels
- Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
| | - Roman Pfister
- Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
| | - Alessandro Cuneo
- Krankenhaus 'Maria Hilf' Medizinische Klinik, Stadtlohn, Germany
| | - Claudius Jacobshagen
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany
| | - Gerd Hasenfuß
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Mahir Karakas
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Wolfgang Rottbauer
- Department of Internal Medicine II-Cardiology, University of Ulm, Medical Center, Ulm, Germany
| | - Samir M Said
- Internal Medicine/Cardiology, Angiology, and Pneumology, Magdeburg University, Magdeburg, Germany
| | | | - Adrian Banning
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Florim Cuculi
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Richard Kobza
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Thomas A Fischer
- Department of Cardiology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Tuija Vasankari
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Grzegorz Opolski
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Rafal Dworakowski
- Department of Cardiology, Kings College Hospital, Kings Health Partners, London, UK
| | - Philip MacCarthy
- Department of Cardiology, Kings College Hospital, Kings Health Partners, London, UK
| | - Christoph Kaiser
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Leonarda Galiuto
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart Rome, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart Rome, Rome, Italy
| | - Wolfgang Dichtl
- University Hospital for Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Innsbruck, Austria
| | - Klaus Empen
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Stephan B Felix
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Clément Delmas
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Olivier Lairez
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Ibrahim El-Battrawy
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Ekaterina Gilyarova
- Intensive coronary care Unit, Moscow City Hospital # 1 named after N. Pirogov, Moscow, Russia
| | - Alexandra Shilova
- Intensive coronary care Unit, Moscow City Hospital # 1 named after N. Pirogov, Moscow, Russia
| | - Mikhail Gilyarov
- Intensive coronary care Unit, Moscow City Hospital # 1 named after N. Pirogov, Moscow, Russia
| | - John D Horowitz
- Discipline of Medicine, Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia
| | - Martin Kozel
- Third Medical Faculty, Charles University in Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Tousek
- Third Medical Faculty, Charles University in Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Widimský
- Third Medical Faculty, Charles University in Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - David E Winchester
- Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Christian Ukena
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Fiorenzo Gaita
- Division of Cardiology, Department of Medical Sciences, AOU Citta della Salute e della Scienza, University of Turin, Turin, Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy
| | | | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Abhiram Prasad
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Thomas F Lüscher
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Zurich, Switzerland.,Royal Brompton and Harefield Hospitals Trust and Imperial College, London, UK
| | - Jelena R Ghadri
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
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Trabattoni D, Gili S, Teruzzi G, Tamborini G. A severe right-to-left intracardiac shunt after NobleStitch failure: when a device is needed. Eur Heart J Case Rep 2020; 4:1-4. [PMID: 33204941 PMCID: PMC7649439 DOI: 10.1093/ehjcr/ytaa162] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 02/24/2020] [Accepted: 05/19/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Transcatheter closure of patent foramen ovale (PFO) has been demonstrated to be superior to medical therapy in stroke prevention in selected patients. Beyond traditional permanent metallic devices, NobleStitch EL, a suture-based system, has been developed as a potential alternative. CASE SUMMARY A 50-year-old man underwent transcatheter closure of PFO with mild interatrial septal bulging and tunnel-like morphology with a NobleStitch device. A transthoracic echocardiography performed immediately after PFO closure showed residual shunt (RS), which persisted unchanged at staged controls, due to the inability of the delivery system to capture both the septum primum and the septum secundum. A second procedure was performed with the implantation of a Figulla Flex II 27/30 mm device, with no RS detectable at control echocardiography. DISCUSSION The NobleStitch device is interesting in its concept, but several pitfalls may be encountered during its deployment. Opposite to permanent metallic devices, RSs after the procedure are not expected to decrease over time and should be managed with a different approach.
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Affiliation(s)
| | - Sebastiano Gili
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea 4, Milan, Italy
| | - Giovanni Teruzzi
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea 4, Milan, Italy
| | - Gloria Tamborini
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea 4, Milan, Italy
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33
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Trabattoni D, Gili S, Teruzzi G, Omedè P, Cerrato E, Templin C, Capodanno D, Lüscher T, Ryan N, Venuti G, Montabone A, Wojakowski W, Rognoni A, Helft G, Gallo D, Biolè CA, Parma R, De Luca L, Figini F, Mitomo S, Mattesini A, Boccuzzi G, Quadri G, Wańha W, Smolka G, Huczek Z, Chieffo A, Nuñez-Gil I, Morbiducci U, Iannaccone M, di Mario C, Moretti C, D'Amico M, Sheiban I, Escaned J, D'Ascenzo F. A Sex-Based Analysis From the RAIN-CARDIOGROUP VII Study (VeRy Thin Stents for Patients With Left MAIn or BifurcatioN in Real Life) on Left Main Stenting. J Invasive Cardiol 2020; 32:342-346. [PMID: 32568097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION There is a lack of data on clinical outcomes of percutaneous coronary intervention (PCI) with ultrathin stents on unprotected left main (ULM) coronary artery comparing women and men. METHODS All patients treated with ULM-PCI with ultrathin stents (struts ≤81 μm) enrolled in the RAIN-CARDIOGROUP VII study were analyzed according to a sex-assessment evaluation. Major adverse cardiovascular event (MACE, a composite of all-cause death, myocardial infarction, target-lesion revascularization [TLR], and stent thrombosis) was the primary endpoint, whereas single components of MACE were the secondary endpoints. RESULTS Out of a cohort of 793 patients, a total of 172 women (21.7%) and 621 men (78.3%) were included. Compared with men, women were older and less frequently smokers, had more frequently a history of previous PCI, and presented more frequently with an acute coronary syndrome. Among women, ostial lesions were more prevalent and mean stent diameter was lower compared with men. After 13.4 months (range, 8.4-21.6 months), 32 women (18.6%) and 106 men (17.1%) experienced MACE (P=.64). Censoring follow-up data at 3 years, no differences were observed in MACE (16.9 vs 14.7 per 100•patient-years; log-rank P=.61) and their single components between women and men. At multivariate analysis, chronic kidney disease (hazard ratio [HR], 1.91: 95% confidence interval [CI], 1.23 to -2.95; P<.01) and acute coronary syndrome presentation (HR, 1.84; 95% CI, 1.22-2.77; P=.01) were independent predictors of MACE overall. Larger stent size (HR, 0.65; 95% CI, 0.48-0.89; P<.01) and longer dual-antiplatelet therapy duration (HR, 0.95; 95% CI, 0.90-0.99; P=.03) were associated with a reduced risk of MACE during the subsequent follow-up. CONCLUSION Ultrathin stents offer low rates of MACE and TLR in the overall population without significant differences between sexes.
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Affiliation(s)
- Daniela Trabattoni
- Invasive Cardiology Unit 3, Centro Cardiologico Monzino, IRCCS, Via Parea, 4 - 20138 Milan, Italy.
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Anselmino M, Frea S, Gili S, Rovera C, Morello M, Jorfida M, Teodori J, Perversi J, Salvetti I, Grosso Marra W, Faletti R, Righi D, Gaita F, DE Ferrari GM. Left atrial appendage morphology at transesophageal echocardiography: how to improve reproducibility? Minerva Cardiol Angiol 2020; 69:178-184. [PMID: 32657552 DOI: 10.23736/s2724-5683.20.05215-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Left atrial appendage (LAA) morphology, investigated by computed tomography and magnetic resonance imaging, has proved to relate to the risk of cerebrovascular events in patients with atrial fibrillation (AF). The aim of the present study was to assess reproducibility of transesophageal echocardiography (TEE) imaging in describing LAA morphology. METHODS Two-hundred consecutive patients referred for TEE were enrolled. In the first group of 47 (23.5%) patients LAA morphology was analyzed by conventional TEE and described as ChickenWing, Windsock, Cactus or Cauliflower. In the second group of 153 (76.5%) patients, instead, a 3D-Xplane diagnostic algorithm was performed to stratify LAA morphology as linear (ChickenWing) or complex (Windsock/Cactus and Cauliflower). Interobserver variability within three independent readers was assessed in both groups of patients and stratified by operator's experience and training. In a subgroup of 19 (12.4%) patients, the agreement of LAA morphology description by 3D-Xplane diagnostic algorithm was compared to cardiac magnetic resonance. RESULTS By conventional TEE the agreement among operators on LAA morphology classification was poor (ρ<0.13). The 3D-XPlane diagnostic algorithm, significantly increased interobserver agreement up to ρ=0.32 within all readers and up to ρ=0.82 among the experienced and specifically trained operators. LAA morphology description in this latter group provided strong agreement with cardiac magnetic resonance (up to ρ=0.77). CONCLUSIONS LAA morphology assessment is challenging by conventional TEE. To improve reproducibility, the use of the 3D-Xplane technique combined with a specific diagnostic algorithm and training of the operators is fundamental.
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Affiliation(s)
- Matteo Anselmino
- Division of Cardiology, Department of Medical Sciences, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Simone Frea
- Division of Cardiology, Department of Medical Sciences, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Sebastiano Gili
- Interventional Cardiology Unit 3, IRCCS Monzino Cardiac Center, Milan, Italy
| | - Chiara Rovera
- Division of Cardiology, Hospital of Chivasso, Chivasso, Turin, Italy -
| | - Mara Morello
- Division of Cardiology, Department of Medical Sciences, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Marcella Jorfida
- Division of Cardiology, Department of Medical Sciences, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Julien Teodori
- Division of Cardiology, Department of Medical Sciences, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Jacopo Perversi
- Division of Cardiology, Cardinal Massaia Hospital, Asti, Italy
| | - Ilaria Salvetti
- Division of Cardiology, Department of Medical Sciences, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | | | - Riccardo Faletti
- Division of Radiology, Department of Diagnostic Imaging and Radiotherapy, University of Turin, Turin, Italy
| | - Dorico Righi
- Division of Radiology, Department of Diagnostic Imaging and Radiotherapy, University of Turin, Turin, Italy
| | - Fiorenzo Gaita
- Division of Cardiology, Department of Medical Sciences, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Gaetano M DE Ferrari
- Division of Cardiology, Department of Medical Sciences, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
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De Filippo O, D'Ascenzo F, Angelini F, Bocchino PP, Conrotto F, Saglietto A, Secco GG, Campo G, Gallone G, Verardi R, Gaido L, Iannaccone M, Galvani M, Ugo F, Barbero U, Infantino V, Olivotti L, Mennuni M, Gili S, Infusino F, Vercellino M, Zucchetti O, Casella G, Giammaria M, Boccuzzi G, Tolomeo P, Doronzo B, Senatore G, Grosso Marra W, Rognoni A, Trabattoni D, Franchin L, Borin A, Bruno F, Galluzzo A, Gambino A, Nicolino A, Truffa Giachet A, Sardella G, Fedele F, Monticone S, Montefusco A, Omedè P, Pennone M, Patti G, Mancone M, De Ferrari GM. Reduced Rate of Hospital Admissions for ACS during Covid-19 Outbreak in Northern Italy. N Engl J Med 2020; 383:88-89. [PMID: 32343497 PMCID: PMC7224608 DOI: 10.1056/nejmc2009166] [Citation(s) in RCA: 742] [Impact Index Per Article: 185.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Ovidio De Filippo
- Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Fabrizio D'Ascenzo
- Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Filippo Angelini
- Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Pier Paolo Bocchino
- Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Federico Conrotto
- Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Andrea Saglietto
- Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Gioel Gabrio Secco
- Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Gianluca Campo
- Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy
| | - Guglielmo Gallone
- Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Roberto Verardi
- Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | | | - Fabrizio Ugo
- Presidio Ospedaliero Sant'Andrea di Vercelli, Vercelli, Italy
| | | | | | | | - Marco Mennuni
- Azienda Ospedaliera Universitaria Maggiore della Carità, Novara, Italy
| | | | | | - Matteo Vercellino
- Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | - Gianni Casella
- Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | | | | | - Paolo Tolomeo
- Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy
| | | | | | | | - Andrea Rognoni
- Azienda Ospedaliera Universitaria Maggiore della Carità, Novara, Italy
| | | | - Luca Franchin
- Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Andrea Borin
- Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Francesco Bruno
- Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | | | | | | | | | | | - Antonio Montefusco
- Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Pierluigi Omedè
- Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Mauro Pennone
- Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
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Peyracchia M, Saglietto A, Biolè C, Raposeiras-Roubin S, Abu-Assi E, Kinnaird T, Ariza-Solé A, Liebetrau C, Manzano-Fernández S, Boccuzzi G, Henriques JPS, Wilton SB, Velicki L, Xanthopoulou I, Correia L, Rognoni A, Fabrizio U, Nuñez-Gil I, Montabone A, Taha S, Fujii T, Durante A, Gili S, Magnani G, Autelli M, Grosso A, Kawaji T, Blanco PF, Garay A, Quadri G, Queija BC, Huczek Z, Paz RC, González-Juanatey JR, Fernández MC, Nie SP, D’Amico M, Pousa IM, Kawashiri MA, Gallo D, Morbiducci U, Dominguez-Rodriguez A, Lopez-Cuenca A, Cequier A, Alexopoulos D, Iñiguez-Romo A, Grossomarra W, Usmiani T, Rinaldi M, D’Ascenzo F. Efficacy and Safety of Clopidogrel, Prasugrel and Ticagrelor in ACS Patients Treated with PCI: A Propensity Score Analysis of the RENAMI and BleeMACS Registries. Am J Cardiovasc Drugs 2020; 20:259-269. [PMID: 31586336 DOI: 10.1007/s40256-019-00373-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Real-life data comparing clopidogrel, prasugrel, and ticagrelor for unselected patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) are lacking, as are data for the temporal distribution of ischemic and bleeding risks. METHODS A total of 19,825 patients were enrolled from the RENAMI and BleeMACS registries. Both were multicenter, retrospective, observational registries including the data and outcomes of consecutive patients with ACS who underwent primary PCI and were discharged with dual antiplatelet therapy (DAPT). We evaluated the long-term outcome stratified by the different antiplatelet agents. RESULTS A total of 14,105 patients (71.2%) were treated with clopidogrel, 2364 patients (11.9%) with prasugrel and 3356 patients (16.9%) with ticagrelor. After propensity score matching, at 1 year, prasugrel reduced the incidence of net adverse clinical events (NACE; a composite endpoint of all-cause death, myocardial infarction [MI] and Bleeding Academic Research Consortium [BARC] 3-5 bleeding) (4.2% vs.7.6%, p = 0.002) and of major adverse cardiovascular events (MACE; a composite endpoint of death and MI) compared with clopidogrel (2.6% vs. 5.2%, p = 0.007). Ticagrelor decreased rates of MACE compared with clopidogrel (2.7% vs. 6.2%, p < 0.001), but not of NACE (6.6% vs. 8.7%, p = 0.07). Ticagrelor presented similar performance in terms of MACE compared with prasugrel (2.8% vs. 2.4%, p = 0.56), with a trend towards a reduction in MI (0.2% vs. 0.4%, p = 0.56), but with higher risk of BARC 3-5 bleedings (3.8% vs. 1.7%, p = 0.04). In the daily risk analysis, clopidogrel presented a binomial distribution with a peak of ischemic risk at 3 months, which decreased towards bleedings; prasugrel had a constant equivalence between opposite risks; and ticagrelor constantly reduced recurrent MIs despite higher risk of BARC 3-5 events. CONCLUSION In real life, ticagrelor is more effective in reducing ischemic events during the first year after ACS, despite an increased risk of major bleedings, while prasugrel assures a better balance between ischemic and bleeding recurrent events.
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Iannaccone M, Barbero U, De Benedictis M, Imori Y, Quadri G, Trabattoni D, Ryan N, Venuti G, Montabone A, Wojakowski W, Rognoni A, Helft G, Parma R, De Luca L, Autelli M, Boccuzzi G, Mattesini A, Templin C, Cerrato E, Wańha W, Smolka G, Huczek Z, Tomassini F, Cortese B, Capodanno D, Chieffo A, Nuñez-Gil I, Gili S, Bassignana A, di Mario C, Doronzo B, Omedè P, D'Amico M, Tedeschi D, Varbella F, Luscher T, Sheiban I, Escaned J, Rinaldi M, D'Ascenzo F. Comparison of bioresorbable vs durable polymer drug-eluting stents in unprotected left main (from the RAIN-CARDIOGROUP VII Study). BMC Cardiovasc Disord 2020; 20:225. [PMID: 32414330 PMCID: PMC7227223 DOI: 10.1186/s12872-020-01420-5] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 03/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are limited data regarding the impact of bioresorbable polymer drug eluting stent (BP-DES) compared to durable polymer drug eluting stent (DP-DES) in patients treated with percutaneous coronary intervention using ultrathin stents in left main or bifurcations. METHODS In the RAIN registry (ClinicalTrials NCT03544294, june 2018 retrospectively registered) patients with a ULM or bifurcation stenosis treated with PCI using ultrathin stents (struts thinner than 81 μm) were enrolled. The primary endpoint was the rate of target lesion revascularization (TLR); major adverse cardiovascular events (MACE, a composite of all-cause death, myocardial infarction, TLR and stent thrombosis) and its components, along with target vessel revascularization (TVR) were the secondary ones. A propensity score with matching analysis to compare patients treated with BP-DES versus DP-DES was also assessed. RESULTS From 3001 enrolled patients, after propensity score analysis 1400 patients (700 for each group) were selected. Among them, 352 had ULM disease and 1048 had non-LM bifurcations. At 16 months (12-22), rates of TLR (3.7% vs 2.9%, p = 0.22) and MACE were similar (12.3% vs. 11.6%, p = 0.74) as well as for the other endpoints. Sensitivity analysis of outcomes after a two-stents strategy, showed better outcome in term of MACE (20.4% vs 10%, p = 0.03) and TVR (12% vs 4.6%, p = 0.05) and a trend towards lower TLR in patients treated with BP-DES. CONCLUSION In patients with bifurcations or ULM treated with ultrathin stents BP-DES seems to perform similarly to DP-DES: the trends toward improved clinical outcomes in patients treated with the BP-DES might potentially be of value for speculating the stent choice in selected high-risk subgroups of patients at increased risk of ischemic events. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03544294. Retrospectively registered June 1, 2018.
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Affiliation(s)
- Mario Iannaccone
- Division of Cardiology, SS. Annunziata Hospital, ASL CN1, Savigliano, Italy
| | - Umberto Barbero
- Division of Cardiology, SS. Annunziata Hospital, ASL CN1, Savigliano, Italy.
| | | | - Yoichi Imori
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, Japan
| | - Giorgio Quadri
- Department of Cardiology, Infermi Hospital, Rivoli, Italy.,Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Daniela Trabattoni
- Department of Cardiovascular Sciences, IRCCS Centro Cardiologico Monzino, Milan, Italy.,University of Milan, Milan, Italy
| | - Nicola Ryan
- Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | - Giuseppe Venuti
- Division of Cardiology, Cardio-Thoracic-Vascular Department, Azienda Ospedaliero Universitaria "Policlinico-Vittorio Emanuele,", Catania, Italy
| | - Andrea Montabone
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | | | - Andrea Rognoni
- Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Novara, Italy
| | - Gerard Helft
- Division of Cardiology, Pierre and Marie Curie University, Paris, France
| | | | | | - Michele Autelli
- Cardiology Department, Ospedale San Giovanni Bosco, Turin, Italy
| | - Giacomo Boccuzzi
- Cardiology Department, Ospedale San Giovanni Bosco, Turin, Italy
| | - Alessio Mattesini
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Christian Templin
- Division of Cardiology, Universityspirtal of Zurich, Zürich, Switzerland
| | - Enrico Cerrato
- Department of Cardiology, Infermi Hospital, Rivoli, Italy.,Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Wojciech Wańha
- Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Grzegorz Smolka
- Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | | | - Francesco Tomassini
- Department of Cardiology, Infermi Hospital, Rivoli, Italy.,Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Bernardo Cortese
- Interventional Cardiology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Davide Capodanno
- Division of Cardiology, Cardio-Thoracic-Vascular Department, Azienda Ospedaliero Universitaria "Policlinico-Vittorio Emanuele,", Catania, Italy
| | | | - Ivan Nuñez-Gil
- Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | - Sebastiano Gili
- Department of Cardiovascular Sciences, IRCCS Centro Cardiologico Monzino, Milan, Italy.,University of Milan, Milan, Italy
| | - Antonia Bassignana
- Division of Cardiology, SS. Annunziata Hospital, ASL CN1, Savigliano, Italy
| | - Carlo di Mario
- Division of Cardiology, Cardio-Thoracic-Vascular Department, Azienda Ospedaliero Universitaria "Policlinico-Vittorio Emanuele,", Catania, Italy
| | | | - Pierluigi Omedè
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Maurizio D'Amico
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Delio Tedeschi
- Interventional Cardiology, Istituto clinico Sant'anna, Brescia, Italy
| | - Ferdinando Varbella
- Department of Cardiology, Infermi Hospital, Rivoli, Italy.,Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Thomas Luscher
- Division of Cardiology, Universityspirtal of Zurich, Zürich, Switzerland
| | - Imad Sheiban
- Interventional Cardiology, Pederzoli Hospital Peschiera del Garda, Verona, Italy
| | - Javier Escaned
- Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | - Mauro Rinaldi
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
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D'Ascenzo F, Bertaina M, Fioravanti F, Bongiovanni F, Raposeiras-Roubin S, Abu-Assi E, Kinnaird T, Ariza-Solé A, Manzano-Fernández S, Templin C, Velicki L, Xanthopoulou I, Cerrato E, Rognoni A, Boccuzzi G, Omedè P, Montabone A, Taha S, Durante A, Gili S, Magnani G, Autelli M, Grosso A, Blanco PF, Garay A, Quadri G, Varbella F, Queija BC, Paz RC, Fernández MC, Pousa IM, Gallo D, Morbiducci U, Dominguez-Rodriguez A, Valdés M, Cequier A, Alexopoulos D, Iñiguez-Romo A, Gaita F, Rinaldi M, Lüscher TF. Long versus short dual antiplatelet therapy in acute coronary syndrome patients treated with prasugrel or ticagrelor and coronary revascularization: Insights from the RENAMI registry. Eur J Prev Cardiol 2020; 27:696-705. [DOI: 10.1177/2047487319836327] [Citation(s) in RCA: 23] [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] [Indexed: 08/30/2023]
Abstract
Introduction The benefits of short versus long-term dual antiplatelet therapy (DAPT) based on the third generation P2Y12 antagonists prasugrel or ticagrelor, in patients with acute coronary syndromes treated with percutaneous coronary intervention remain to be clearly defined due to current evidences limited to patients treated with clopidogrel. Methods All acute coronary syndrome patients from the REgistry of New Antiplatelets in patients with Myocardial Infarction (RENAMI) undergoing percutaneous coronary intervention and treated with aspirin, prasugrel or ticagrelor were stratified according to DAPT duration, that is, shorter than 12 months (D1 group), 12 months (D2 group) and longer than 12 months (D3 group). The three groups were compared before and after propensity score matching. Net adverse clinical events (NACEs), defined as a combination of major adverse cardiac events (MACEs) and major bleedings (including therefore all cause death, myocardial infarction and Bleeding Academic Research Consortium (BARC) 3–5 bleeding), were the primary end points, MACEs (a composite of all cause death and myocardial infarction) the secondary one. Single components of NACEs were co-secondary end points, along with BARC 2–5 bleeding, cardiovascular death and stent thrombosis. Results A total of 4424 patients from the RENAMI registry with available data on DAPT duration were included in the model. After propensity score matching, 628 patients from each group were selected. After 20 months of follow up, DAPT for 12 months and DAPT for longer than 12 months significantly reduced the risk of NACE (D1 11.6% vs. D2 6.7% vs. D3 7.2%, p = 0.003) and MACE (10% vs. 6.2% vs. 2.4%, p < 0.001) compared with DAPT for less than 12 months. These differences were driven by a reduced risk of all cause death (7.8% vs. 1.3% vs. 1.6%, p < 0.001), cardiovascular death (5.1% vs. 1.0% vs. 1.2%, p < 0.0001) and recurrent myocardial infarction (8.3% vs. 5.2% vs. 3.5%, p = 0.002). NACEs were lower with longer DAPT despite a higher risk of BARC 2–5 bleedings (4.6% vs. 5.7% vs. 6.2%, p = 0.04) and a trend towards a higher risk of BARC 3–5 bleedings (2.4% vs. 3.3% vs. 3.9%, p = 0.06). These results were not consistent for female patients and those older than 75 years old, due to an increased risk of bleedings which exceeded the reduction in myocardial infarction. Conclusion In unselected real world acute coronary syndrome patients treated with percutaneous coronary intervention, DAPT with prasugrel or ticagrelor prolonged beyond 12 months markedly reduces fatal and non-fatal ischaemic events, offsetting the increased risk deriving from the higher bleeding risk. On the contrary, patients >75 years old and female ones showed a less favourable risk–benefit ratio for longer DAPT due to excess of bleedings.
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Affiliation(s)
- Fabrizio D'Ascenzo
- Department of Cardiology, Department of Medical Sciences, University of Torino, Italy
| | - Maurizio Bertaina
- Department of Cardiology, Department of Medical Sciences, University of Torino, Italy
| | - Francesco Fioravanti
- Department of Cardiology, Department of Medical Sciences, University of Torino, Italy
| | - Federica Bongiovanni
- Department of Cardiology, Department of Medical Sciences, University of Torino, Italy
| | | | - Emad Abu-Assi
- Department of Cardiology, University Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Tim Kinnaird
- Cardiology Department, University Hospital of Wales, Cardiff, UK
| | - Albert Ariza-Solé
- Department of Cardiology, University Hospital de Bellvitge, Barcelona, Spain
| | | | - Christian Templin
- University Heart Centre, Department of Cardiology, University Hospital Zurich, Switzerland
| | - Lazar Velicki
- Medical faculty, University of Novi Sad, Novi Sad, Serbia and Institute of cardiovascular diseases Vojvodina, Sremska Kamenica, Serbia
| | | | - Enrico Cerrato
- Interventional Unit, San Luigi Gonzaga University Hospital, Orbassano and Infermi Hospital, Rivoli (Torino), Italy
| | - Andrea Rognoni
- Catheterization Laboratory, Maggiore della Carità Hospital, Novara, Italy
| | | | - Pierluigi Omedè
- Department of Cardiology, Department of Medical Sciences, University of Torino, Italy
| | | | - Salma Taha
- Department of Cardiology, Faculty of Medicine, Assiut University, Egypt
| | | | - Sebastiano Gili
- University Heart Centre, Department of Cardiology, University Hospital Zurich, Switzerland
| | - Giulia Magnani
- University Heart Centre, Department of Cardiology, University Hospital Zurich, Switzerland
| | - Michele Autelli
- Department of Cardiology, Department of Medical Sciences, University of Torino, Italy
| | - Alberto Grosso
- Department of Cardiology, Department of Medical Sciences, University of Torino, Italy
| | - Pedro Flores Blanco
- Department of Cardiology, University Hospital Virgen Arrtixaca, Murcia, Spain
| | - Alberto Garay
- Department of Cardiology, University Hospital de Bellvitge, Barcelona, Spain
| | - Giorgio Quadri
- Interventional Unit, San Luigi Gonzaga University Hospital, Orbassano and Infermi Hospital, Rivoli (Torino), Italy
| | - Ferdinando Varbella
- Interventional Unit, San Luigi Gonzaga University Hospital, Orbassano and Infermi Hospital, Rivoli (Torino), Italy
| | | | - Rafael Cobas Paz
- Department of Cardiology, University Hospital Álvaro Cunqueiro, Vigo, Spain
| | | | - Isabel Muñoz Pousa
- Department of Cardiology, University Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Diego Gallo
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Italy
| | - Umberto Morbiducci
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Italy
| | | | - Mariano Valdés
- Department of Cardiology, University Hospital Virgen Arrtixaca, Murcia, Spain
| | - Angel Cequier
- Department of Cardiology, University Hospital de Bellvitge, Barcelona, Spain
| | | | | | - Fiorenzo Gaita
- Department of Cardiology, Department of Medical Sciences, University of Torino, Italy
| | - Mauro Rinaldi
- Department of Cardiology, Department of Medical Sciences, University of Torino, Italy
| | - Thomas F Lüscher
- Royal Brompton and Harefield Hospitals Trust and Imperial College, London, UK
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D'Ascenzo F, Gili S, Bertaina M, Iannaccone M, Cammann VL, Di Vece D, Kato K, Saglietto A, Szawan KA, Frangieh AH, Boffini B, Annaratone M, Sarcon A, Levinson RA, Franke J, Napp LC, Jaguszewski M, Noutsias M, Münzel T, Knorr M, Heiner S, Katus HA, Burgdorf C, Schunkert H, Thiele H, Bauersachs J, Tschöpe C, Pieske BM, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Hasenfuß G, Karakas M, Koenig W, Rottbauer W, Said SM, Braun‐Dullaeus RC, Banning A, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KJ, Opolski G, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Crea F, Dichtl W, Franz WM, Empen K, Felix SB, Delmas C, Lairez O, El‐Battrawy I, Akin I, Borggrefe M, Horowitz JD, Kozel M, Tousek P, Widimský P, Gilyarova E, Shilova A, Gilyarov M, Biondi‐Zoccai G, Winchester DE, Ukena C, Neuhaus M, Bax JJ, Prasad A, Di Mario C, Böhm M, Gasparini M, Ruschitzka F, Bossone E, Citro R, Rinaldi M, De Ferrari GM, Lüscher T, Ghadri JR, Templin C. Impact of aspirin on takotsubo syndrome: a propensity score‐based analysis of the InterTAK Registry. Eur J Heart Fail 2020; 22:330-337. [PMID: 31863563 DOI: 10.1002/ejhf.1698] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 11/04/2019] [Accepted: 11/07/2019] [Indexed: 02/05/2023] Open
Affiliation(s)
- Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della ScienzaUniversity of Turin Turin Italy
| | | | - Maurizio Bertaina
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della ScienzaUniversity of Turin Turin Italy
| | - Mario Iannaccone
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della ScienzaUniversity of Turin Turin Italy
| | - Victoria L. Cammann
- Department of Cardiology, University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Davide Di Vece
- Department of Cardiology, University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Ken Kato
- Department of Cardiology, University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Andrea Saglietto
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della ScienzaUniversity of Turin Turin Italy
| | - Konrad A. Szawan
- Department of Cardiology, University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Antonio H. Frangieh
- Deutsches Herzzentrum MünchenTechnische Universität München Munich Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance Munich Germany
| | | | | | - Annahita Sarcon
- Section of Cardiac Electrophysiology, Department of MedicineUniversity of California‐San Francisco San Francisco CA USA
| | - Rena A. Levinson
- Department of Cardiology, University Heart CenterUniversity Hospital Zurich Zurich Switzerland
- Division of Biological SciencesUniversity of California San Diego San Diego CA USA
| | - Jennifer Franke
- Department of CardiologyHeidelberg University Hospital Heidelberg Germany
| | - L. Christian Napp
- Department of Cardiology and AngiologyHannover Medical School Hannover Germany
| | - Milosz Jaguszewski
- First Department of CardiologyMedical University of Gdansk Gdansk Poland
| | - Michel Noutsias
- Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical CareUniversity Hospital Halle, Martin‐Luther‐University Halle Halle Germany
| | - Thomas Münzel
- Center for Cardiology, Cardiology 1University Medical Center Mainz Mainz Germany
| | - Maike Knorr
- Center for Cardiology, Cardiology 1University Medical Center Mainz Mainz Germany
| | - Susanne Heiner
- Center for Cardiology, Cardiology 1University Medical Center Mainz Mainz Germany
| | - Hugo A. Katus
- Department of CardiologyHeidelberg University Hospital Heidelberg Germany
| | | | - Heribert Schunkert
- Deutsches Herzzentrum MünchenTechnische Universität München Munich Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance Munich Germany
| | - Holger Thiele
- Department of Internal Medicine/CardiologyHeart Center Leipzig – University Hospital Leipzig Germany
| | - Johann Bauersachs
- Department of Cardiology and AngiologyHannover Medical School Hannover Germany
| | - Carsten Tschöpe
- Department of CardiologyCharité, Campus Rudolf Virchow Berlin Germany
| | - Burkert M. Pieske
- Department of CardiologyCharité, Campus Rudolf Virchow Berlin Germany
| | | | - Guido Michels
- Department of Internal Medicine IIIHeart Center University of Cologne Cologne Germany
| | - Roman Pfister
- Department of Internal Medicine IIIHeart Center University of Cologne Cologne Germany
| | | | - Claudius Jacobshagen
- Clinic for Cardiology and PneumologyGeorg August University Goettingen Goettingen Germany
| | - Gerd Hasenfuß
- Clinic for Cardiology and PneumologyGeorg August University Goettingen Goettingen Germany
| | - Mahir Karakas
- Department of General and Interventional CardiologyUniversity Heart Center Hamburg Hamburg Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck Hamburg Germany
| | - Wolfgang Koenig
- Deutsches Herzzentrum MünchenTechnische Universität München Munich Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance Munich Germany
| | - Wolfgang Rottbauer
- Department of Internal Medicine II – CardiologyUniversity of Ulm, Medical Center Ulm Germany
| | - Samir M. Said
- Internal Medicine/Cardiology, Angiology, and PneumologyMagdeburg University Magdeburg Germany
| | | | - Adrian Banning
- Department of Cardiology, John Radcliffe HospitalOxford University Hospitals Oxford UK
| | - Florim Cuculi
- Department of CardiologyKantonsspital Lucerne Lucerne Switzerland
| | - Richard Kobza
- Department of CardiologyKantonsspital Lucerne Lucerne Switzerland
| | - Thomas A. Fischer
- Department of CardiologyKantonsspital Winterthur Winterthur Switzerland
| | - Tuija Vasankari
- Heart CenterTurku University Hospital and University of Turku Turku Finland
| | | | - Grzegorz Opolski
- Department of CardiologyMedical University of Warsaw Warsaw Poland
| | - Rafal Dworakowski
- Department of Cardiology, Kings College HospitalKings Health Partners London UK
| | - Philip MacCarthy
- Department of Cardiology, Kings College HospitalKings Health Partners London UK
| | - Christoph Kaiser
- Department of CardiologyUniversity Hospital Basel Basel Switzerland
| | - Stefan Osswald
- Department of CardiologyUniversity Hospital Basel Basel Switzerland
| | - Leonarda Galiuto
- Fondazione Policlinico Universitario A. Gemelli, IRCCSUniversità Cattolica del Sacro Cuore Rome Italy
| | - Filippo Crea
- Fondazione Policlinico Universitario A. Gemelli, IRCCSUniversità Cattolica del Sacro Cuore Rome Italy
| | - Wolfgang Dichtl
- University Hospital for Internal Medicine III (Cardiology and Angiology)Medical University Innsbruck Innsbruck Austria
| | - Wolfgang M. Franz
- University Hospital for Internal Medicine III (Cardiology and Angiology)Medical University Innsbruck Innsbruck Austria
| | - Klaus Empen
- Department of Internal Medicine BUniversity Medicine Greifswald Greifswald Germany
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald Greifswald Germany
| | - Stephan B. Felix
- Department of Internal Medicine BUniversity Medicine Greifswald Greifswald Germany
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald Greifswald Germany
| | - Clément Delmas
- Department of Cardiology and Cardiac Imaging CenterUniversity Hospital of Rangueil Toulouse France
| | - Olivier Lairez
- Department of Cardiology and Cardiac Imaging CenterUniversity Hospital of Rangueil Toulouse France
| | - Ibrahim El‐Battrawy
- First Department of Medicine, Faculty of MedicineUniversity Medical Centre Mannheim (UMM) University of Heidelberg Mannheim Germany
- DZHK (German Center for Cardiovascular Research), partner site, Heidelberg‐Mannheim Mannheim Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of MedicineUniversity Medical Centre Mannheim (UMM) University of Heidelberg Mannheim Germany
- DZHK (German Center for Cardiovascular Research), partner site, Heidelberg‐Mannheim Mannheim Germany
| | - Martin Borggrefe
- First Department of Medicine, Faculty of MedicineUniversity Medical Centre Mannheim (UMM) University of Heidelberg Mannheim Germany
- DZHK (German Center for Cardiovascular Research), partner site, Heidelberg‐Mannheim Mannheim Germany
| | - John D. Horowitz
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth HospitalUniversity of Adelaide Adelaide Australia
| | - Martin Kozel
- Cardiocenter, Third Faculty of MedicineCharles University in Prague and University Hospital Královské Vinohrady Prague Czech Republic
| | - Petr Tousek
- Cardiocenter, Third Faculty of MedicineCharles University in Prague and University Hospital Královské Vinohrady Prague Czech Republic
| | - Petr Widimský
- Cardiocenter, Third Faculty of MedicineCharles University in Prague and University Hospital Královské Vinohrady Prague Czech Republic
| | - Ekaterina Gilyarova
- Intensive Coronary Care Unit, Moscow City Hospital # 1 named after N. Pirogov Moscow Russia
| | - Alexandra Shilova
- Intensive Coronary Care Unit, Moscow City Hospital # 1 named after N. Pirogov Moscow Russia
| | - Mikhail Gilyarov
- Intensive Coronary Care Unit, Moscow City Hospital # 1 named after N. Pirogov Moscow Russia
| | - Giuseppe Biondi‐Zoccai
- Department of Medico‐Surgical Sciences and BiotechnologiesSapienza University of Rome Latina Italy
| | - David E. Winchester
- Department of Medicine, College of MedicineUniversity of Florida Gainesville FL USA
| | - Christian Ukena
- Klinik für Innere Medizin IIIUniversitätsklinikum des Saarlandes Homburg Germany
| | - Michael Neuhaus
- Department of CardiologyKantonsspital Frauenfeld Frauenfeld Switzerland
| | - Jeroen J. Bax
- Department of CardiologyLeiden University Medical Centre Leiden The Netherlands
| | - Abhiram Prasad
- Division of Cardiovascular Diseases Mayo Clinic Rochester MN USA
| | - Carlo Di Mario
- Structural Interventional CardiologyUniversity Hospital Careggi Florence Italy
| | - Michael Böhm
- Klinik für Innere Medizin IIIUniversitätsklinikum des Saarlandes Homburg Germany
| | - Mauro Gasparini
- Department of Mathematical SciencesPolitecnico di Torino Turin Italy
| | - Frank Ruschitzka
- Department of Cardiology, University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Eduardo Bossone
- Division of Cardiology‘Antonio Cardarelli’ Hospital Naples Italy
| | - Rodolfo Citro
- Heart DepartmentUniversity Hospital ‘San Giovanni di Dio e Ruggi d'Aragona’ Salerno Italy
| | - Mauro Rinaldi
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della ScienzaUniversity of Turin Turin Italy
| | - Gaetano Maria De Ferrari
- Department of Molecular Medicine University of Pavia, and Cardiac Intensive Care Unit and Laboratories for Experimental CardiologyIRCCS Fondazione Policlinico San Matteo Pavia Italy
| | - Thomas Lüscher
- Center for Molecular Cardiology, Schlieren CampusUniversity of Zurich Zurich Switzerland
- Royal Brompton and Harefield Hospitals Trust and Imperial College London UK
| | - Jelena R. Ghadri
- Department of Cardiology, University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Christian Templin
- Department of Cardiology, University Heart CenterUniversity Hospital Zurich Zurich Switzerland
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Bianco M, D'ascenzo F, Raposeiras Roubin S, Kinnaird T, Peyracchia M, Ariza-Solé A, Cerrato E, Manzano-Fernández S, Gravinese C, Templin C, Destefanis P, Velicki L, Luciano A, Xanthopoulou I, Rinaldi M, Rognoni A, Varbella F, Boccuzzi G, Omedè P, Montabone A, Bernardi A, Taha S, Rossini R, Durante A, Gili S, Magnani G, Autelli M, Grosso A, Blanco PF, Giustetto C, Garay A, Quadri G, Queija BC, Srdanovic I, Paz RC, Fernández MC, Pousa IM, Gallo D, Morbiducci U, Dominguez-Rodriguez A, Lopez-Cuenca Á, Cequier A, Alexopoulos D, Iñiguez-Romo A, Pozzi R, Assi EA, Valgimigli M. Comparative external validation of the PRECISE-DAPT and PARIS risk scores in 4424 acute coronary syndrome patients treated with prasugrel or ticagrelor. Int J Cardiol 2020; 301:200-206. [DOI: 10.1016/j.ijcard.2019.11.132] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 09/01/2019] [Accepted: 11/21/2019] [Indexed: 12/30/2022]
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Ding KJ, Cammann VL, Szawan KA, Stähli BE, Wischnewsky M, Di Vece D, Citro R, Jaguszewski M, Seifert B, Sarcon A, Knorr M, Heiner S, Gili S, D’Ascenzo F, Neuhaus M, Napp LC, Franke J, Noutsias M, Burgdorf C, Koenig W, Kherad B, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Karakas M, Pott A, Meyer P, Arroja JD, Banning A, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KJ, Paolini C, Bilato C, Carrilho-Ferreira P, Opolski G, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Dichtl W, Chan C, Bridgman P, Delmas C, Lairez O, El-Battrawy I, Akin I, Gilyarova E, Shilova A, Gilyarov M, Kozel M, Tousek P, Widimský P, Winchester DE, Galuszka J, Ukena C, Horowitz JD, Di Mario C, Prasad A, Rihal CS, Pinto FJ, Crea F, Borggrefe M, Braun-Dullaeus RC, Rottbauer W, Bauersachs J, Katus HA, Hasenfuß G, Tschöpe C, Pieske BM, Thiele H, Schunkert H, Böhm M, Felix SB, Münzel T, Bax JJ, Lüscher TF, Ruschitzka F, Ghadri JR, Bossone E, Templin C. Intraventricular Thrombus Formation and Embolism in Takotsubo Syndrome. Arterioscler Thromb Vasc Biol 2020; 40:279-287. [DOI: 10.1161/atvbaha.119.313491] [Citation(s) in RCA: 23] [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] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objective:
Takotsubo syndrome (TTS) is characterized by acute left ventricular dysfunction, which can contribute to intraventricular thrombus and embolism. Still, prevalence and clinical impact of thrombus formation and embolic events on outcome of TTS patients remain unclear. This study aimed to investigate clinical features and outcomes of patients with and without intraventricular thrombus or embolism. Additionally, factors associated with thrombus formation or embolism, as well as predictors for mortality, were identified.
Approach and Results:
TTS patients enrolled in the International Takotsubo Registry at 28 centers in Australia, Europe, and the United States were dichotomized according to the occurrence/absence of intraventricular thrombus or embolism. Patients with intraventricular thrombus or embolism were defined as the ThrombEmb group. Of 1676 TTS patients, 56 (3.3%) patients developed intraventricular thrombus and/or embolism following TTS diagnosis (median time interval, 2.0 days [range, 0–38 days]). Patients in the ThrombEmb group had a different clinical profile including lower left ventricular ejection fraction, higher prevalence of the apical type, elevated levels of troponin and inflammatory markers, and higher prevalence of vascular disease. In a Firth bias-reduced penalized-likelihood logistic regression model apical type, left ventricular ejection fraction ≤30%, previous vascular disease, and a white blood cell count on admission >10×10
3
cells/μL emerged as independent predictors for thrombus formation or embolism.
Conclusions:
Intraventricular thrombus or embolism occur in 3.3% of patients in the acute phase of TTS. A simple risk score including clinical parameters associated with intraventricular thrombus formation or embolism identifies patients at increased risk.
Clinical Trial Registration:
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01947621.
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Affiliation(s)
- Katharina J. Ding
- From the Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (K.J.D., V.L.C., K.A.S., B.E.S., D.D.V., F.R., J.R.G., C. Templin)
| | - Victoria L. Cammann
- From the Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (K.J.D., V.L.C., K.A.S., B.E.S., D.D.V., F.R., J.R.G., C. Templin)
| | - Konrad A. Szawan
- From the Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (K.J.D., V.L.C., K.A.S., B.E.S., D.D.V., F.R., J.R.G., C. Templin)
| | - Barbara E. Stähli
- From the Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (K.J.D., V.L.C., K.A.S., B.E.S., D.D.V., F.R., J.R.G., C. Templin)
| | - Manfred Wischnewsky
- Department of Mathematics and Computer Science, University of Bremen, Germany (M.W.)
| | - Davide Di Vece
- From the Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (K.J.D., V.L.C., K.A.S., B.E.S., D.D.V., F.R., J.R.G., C. Templin)
| | - Rodolfo Citro
- Heart Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy (R.C.)
| | - Milosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Poland (M.J.)
| | - Burkhardt Seifert
- Division of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland (B.S.)
| | - Annahita Sarcon
- Section of Cardiac Electrophysiology, Department of Medicine, University of California-San Francisco (A. Sarcon)
| | - Maike Knorr
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Germany (M. Knorr, S.H., T.M.)
| | - Susanne Heiner
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Germany (M. Knorr, S.H., T.M.)
| | | | - Fabrizio D’Ascenzo
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Italy (F.D.)
| | - Michael Neuhaus
- Department of Cardiology, Kantonsspital Frauenfeld, Switzerland (M. Neuhaus)
| | - L. Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Germany (L.C.N., J.B.)
| | - Jennifer Franke
- Department of Cardiology, Heidelberg University Hospital, Germany (J.F., H.A.K.)
| | - Michel Noutsias
- Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Germany (M. Noutsias)
| | | | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (W.K., H.S.)
- German center for Cardiovascular Research, Partner Site Munich Heart Alliance (W.K., H.S.)
| | - Behrouz Kherad
- Department of Internal Medicine and Cardiology, Charité University Medicine Berlin, Campus Virchow Klinikum, Germany (B.K., C. Tschöpe, B.M.P.)
- Department of Internal Medicine and Cardiology, German Heart Center Berlin, Germany (B.K., C. Tschöpe, B.M.P.)
| | - Lawrence Rajan
- T.J. Health Partners Heart and Vascular, Glasgow, KY (L.R.)
| | - Guido Michels
- Department of Internal Medicine III, Heart Center University of Cologne, Germany (G.M., R.P.)
| | - Roman Pfister
- Department of Internal Medicine III, Heart Center University of Cologne, Germany (G.M., R.P.)
| | - Alessandro Cuneo
- Krankenhaus “Maria Hilf” Medizinische Klinik, Stadtlohn, Germany (A.C.)
| | - Claudius Jacobshagen
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Germany (C.J., G.H.)
| | - Mahir Karakas
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (M. Karakas)
- German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Luebeck (M. Karakas)
| | - Alexander Pott
- Department of Internal Medicine II–Cardiology, University of Ulm, Medical Center, Germany (A. Pott, W.R.)
| | - Philippe Meyer
- Service de cardiologie, Hôpitaux Universitaires de Genève, Switzerland (P. Meyer, J.D.A.)
| | - Jose D. Arroja
- Service de cardiologie, Hôpitaux Universitaires de Genève, Switzerland (P. Meyer, J.D.A.)
| | - Adrian Banning
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals, United Kingdom (A.B.)
| | - Florim Cuculi
- Department of Cardiology, Kantonsspital Lucerne, Switzerland (F. Cuculi, R.K.)
| | - Richard Kobza
- Department of Cardiology, Kantonsspital Lucerne, Switzerland (F. Cuculi, R.K.)
| | - Thomas A. Fischer
- Department of Cardiology, Kantonsspital Winterthur, Switzerland (T.A.F.)
| | - Tuija Vasankari
- Heart Center, Turku University Hospital and University of Turku, Finland (T.V., K.E.J.A.)
| | - K.E. Juhani Airaksinen
- Heart Center, Turku University Hospital and University of Turku, Finland (T.V., K.E.J.A.)
| | - Carla Paolini
- Local Health Unit No. 8, Cardiology Unit, Arzignano, Vicenza, Italy (C.P., C. Bilato)
| | - Claudio Bilato
- Local Health Unit No. 8, Cardiology Unit, Arzignano, Vicenza, Italy (C.P., C. Bilato)
| | - Pedro Carrilho-Ferreira
- Cardiology Department, Santa Maria University Hospital, Lisbon Academic Medical Centre and Cardiovascular Centre of the University of Lisbon, Lisbon School of Medicine, Universidade de Lisboa, Portugal (P.C.-F., F.J.P.)
| | - Grzegorz Opolski
- Department of Cardiology, Medical University of Warsaw, Poland (G.O.)
| | - Rafal Dworakowski
- Department of Cardiology, King’s College Hospital, London, United Kingdom (R.D., P. MacCarthy)
| | - Philip MacCarthy
- Department of Cardiology, King’s College Hospital, London, United Kingdom (R.D., P. MacCarthy)
| | - Christoph Kaiser
- Department of Cardiology, University Hospital Basel, Switzerland (C.K., S.O.)
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Switzerland (C.K., S.O.)
| | - Leonarda Galiuto
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart Rome, Italy (L.G., F. Crea)
| | - Wolfgang Dichtl
- University Hospital for Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Austria (W.D.)
| | - Christina Chan
- Department of Cardiology, Christchurch Hospital, New Zealand (C.C., P.B.)
| | - Paul Bridgman
- Department of Cardiology, Christchurch Hospital, New Zealand (C.C., P.B.)
| | - Clément Delmas
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France (C.D., O.L.)
| | - Olivier Lairez
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France (C.D., O.L.)
| | - Ibrahim El-Battrawy
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim, University of Heidelberg, Germany (I.E.-B., I.A., M. Borggrefe)
- German Center for Cardiovascular Research, Partner Site, Heidelberg-Mannheim (I.E.-B., I.A., M. Borggrefe)
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim, University of Heidelberg, Germany (I.E.-B., I.A., M. Borggrefe)
- German Center for Cardiovascular Research, Partner Site, Heidelberg-Mannheim (I.E.-B., I.A., M. Borggrefe)
| | - Ekaterina Gilyarova
- Intensive Coronary Care Unit, Moscow City Hospital No. 1 named after N. Pirogov, Moscow, Russia (E.G., A. Shilova, M.G.)
| | - Alexandra Shilova
- Intensive Coronary Care Unit, Moscow City Hospital No. 1 named after N. Pirogov, Moscow, Russia (E.G., A. Shilova, M.G.)
| | - Mikhail Gilyarov
- Intensive Coronary Care Unit, Moscow City Hospital No. 1 named after N. Pirogov, Moscow, Russia (E.G., A. Shilova, M.G.)
| | - Martin Kozel
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague and University Hospital Kralovske Vinohrady, Czech Republic (M. Kozel, P.T., P.W.)
| | - Petr Tousek
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague and University Hospital Kralovske Vinohrady, Czech Republic (M. Kozel, P.T., P.W.)
| | - Petr Widimský
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague and University Hospital Kralovske Vinohrady, Czech Republic (M. Kozel, P.T., P.W.)
| | - David E. Winchester
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville (D.E.W.)
| | - Jan Galuszka
- Department of Internal Medicine I–Cardiology, University Hospital Olomouc, Czech Republic (J.G.)
| | - Christian Ukena
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (C.U., M. Böhm)
| | - John D. Horowitz
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, Australia (J.D.H.)
| | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy (C.D.M.)
| | - Abhiram Prasad
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester MN (A. Prasad, C.S.R.)
| | - Charanjit S. Rihal
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester MN (A. Prasad, C.S.R.)
| | - Fausto J. Pinto
- Cardiology Department, Santa Maria University Hospital, Lisbon Academic Medical Centre and Cardiovascular Centre of the University of Lisbon, Lisbon School of Medicine, Universidade de Lisboa, Portugal (P.C.-F., F.J.P.)
| | - Filippo Crea
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart Rome, Italy (L.G., F. Crea)
| | - Martin Borggrefe
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim, University of Heidelberg, Germany (I.E.-B., I.A., M. Borggrefe)
- German Center for Cardiovascular Research, Partner Site, Heidelberg-Mannheim (I.E.-B., I.A., M. Borggrefe)
| | | | - Wolfgang Rottbauer
- Department of Internal Medicine II–Cardiology, University of Ulm, Medical Center, Germany (A. Pott, W.R.)
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Germany (L.C.N., J.B.)
| | - Hugo A. Katus
- Department of Cardiology, Heidelberg University Hospital, Germany (J.F., H.A.K.)
| | - Gerd Hasenfuß
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Germany (C.J., G.H.)
| | - Carsten Tschöpe
- Department of Internal Medicine and Cardiology, Charité University Medicine Berlin, Campus Virchow Klinikum, Germany (B.K., C. Tschöpe, B.M.P.)
- Department of Internal Medicine and Cardiology, German Heart Center Berlin, Germany (B.K., C. Tschöpe, B.M.P.)
| | - Burkert M. Pieske
- Department of Internal Medicine and Cardiology, Charité University Medicine Berlin, Campus Virchow Klinikum, Germany (B.K., C. Tschöpe, B.M.P.)
- Department of Internal Medicine and Cardiology, German Heart Center Berlin, Germany (B.K., C. Tschöpe, B.M.P.)
- German Center for Cardiovascular Research, Partner Site Berlin (B.M.P.)
- Berlin Institute of Health, Germany (B.M.P.)
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig–University Hospital, Germany (H.T.)
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (W.K., H.S.)
- German center for Cardiovascular Research, Partner Site Munich Heart Alliance (W.K., H.S.)
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (C.U., M. Böhm)
| | - Stephan B. Felix
- Department of Internal Medicine B, University Medicine Greifswald, Germany (S.B.F.)
- German Centre for Cardiovascular Research, Partner Site Greifswald (S.B.F.)
| | - Thomas Münzel
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Germany (M. Knorr, S.H., T.M.)
| | - Jeroen J. Bax
- Department of Cardiology, Leiden University Medical Centre, the Netherlands (J.J.B.)
| | - Thomas F. Lüscher
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Switzerland (T.F.L.)
- Royal Brompton and Harefield Hospitals Trust and Imperial College, London, United Kingdom (T.F.L.)
| | - Frank Ruschitzka
- From the Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (K.J.D., V.L.C., K.A.S., B.E.S., D.D.V., F.R., J.R.G., C. Templin)
| | - Jelena R. Ghadri
- From the Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (K.J.D., V.L.C., K.A.S., B.E.S., D.D.V., F.R., J.R.G., C. Templin)
| | | | - Christian Templin
- From the Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (K.J.D., V.L.C., K.A.S., B.E.S., D.D.V., F.R., J.R.G., C. Templin)
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Trabattoni D, Teruzzi G, Montorsi P, Fabbiocchi F, Gili S, Calligaris G, Grancini L, Galli S, Ravagnani P, Bartorelli A. Comparison of the Effectiveness of Percutaneous Intervention of the Left-Main Coronary Artery With Everolimus-Eluting Stents in Women -Vs- Men. Am J Cardiol 2019; 124:1357-1362. [PMID: 31493828 DOI: 10.1016/j.amjcard.2019.07.060] [Citation(s) in RCA: 4] [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: 05/26/2019] [Revised: 07/24/2019] [Accepted: 07/25/2019] [Indexed: 01/31/2023]
Abstract
Everolimus-eluting stents are largely used for left main (LM) percutaneous coronary interventions (PCI). Long-term follow-up of patients who underwent LM PCI in a real world clinical setting, in particular women, have been scarcely reported. Consecutive patients who underwent unprotected LM PCI with EES at a single Institution from December 2006 to April 2016 were included. Main outcome assessed was the occurrence of major adverse cardiovascular events (MACE) as a composite of death, myocardial infarction or target lesion revascularization at follow-up. Overall, 589 patients (20.8% women) were included in the present analysis. Women were older, had lower body mass index and more frequently hypertensive compared with men. Main clinical presentation was stable coronary artery disease (CAD); unstable angina was more frequently observed in women compared with men, whereas ST-elevation myocardial infarction was less frequent. After 69.7 ± 28.3 months of follow-up, 47 patients overall experienced MACE (1.43 per 100*patients/year). MACE rate was higher in women compared with male patients, with a rate of 2.49 and 1.17 per 100*patients/year, respectively (p = 0.015). The difference was driven mainly by higher mortality in women (0.89 vs 0.15 per 100*patients/years, p = 0.002). At multivariable Cox regression, female gender was independently associated with an increased risk of MACE at follow-up (hazard ratio 2.21, 95% confidence interval 1.20 to 4.08, p = 0.011). In conclusion, EES can be safely and effectively adopted for LM PCI.
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Jurisic S, Gili S, Cammann VL, Kato K, Szawan KA, D'Ascenzo F, Jaguszewski M, Bossone E, Citro R, Sarcon A, Napp LC, Franke J, Noutsias M, Knorr M, Heiner S, Burgdorf C, Koenig W, Pott A, Kherad B, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Karakas M, Meyer P, Arroja JD, Banning A, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KEJ, Dworakowski R, Kaiser C, Osswald S, Galiuto L, Dichtl W, Chan C, Bridgman P, Beug D, Delmas C, Lairez O, Kozel M, Tousek P, Winchester DE, Gilyarova E, Shilova A, Gilyarov M, El-Battrawy I, Akin I, Galuszka J, Ukena C, Poglajen G, Paolini C, Bilato C, Carrilho-Ferreira P, Pinto FJ, Opolski G, MacCarthy P, Kobayashi Y, Prasad A, Rihal CS, Widimský P, Horowitz JD, Di Mario C, Crea F, Tschöpe C, Pieske BM, Hasenfuß G, Rottbauer W, Braun-Dullaeus RC, Felix SB, Borggrefe M, Thiele H, Bauersachs J, Katus HA, Schunkert H, Münzel T, Böhm M, Bax JJ, Lüscher TF, Ruschitzka F, Ghadri JR, Templin C. Clinical Predictors and Prognostic Impact of Recovery of Wall Motion Abnormalities in Takotsubo Syndrome: Results From the International Takotsubo Registry. J Am Heart Assoc 2019; 8:e011194. [PMID: 31672100 PMCID: PMC6898832 DOI: 10.1161/jaha.118.011194] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Left ventricular (LV) recovery in takotsubo syndrome (TTS) occurs over a wide‐ranging interval, varying from hours to weeks. We sought to investigate the clinical predictors and prognostic impact of recovery time for TTS patients. Methods and Results TTS patients from the International Takotsubo Registry were included in this study. Cut‐off for early LV recovery was determined to be 10 days after the acute event. Multivariable logistic regression was used to assess factors associated with the absence of early recovery. In‐hospital outcomes and 1‐year mortality were compared for patients with versus without early recovery. We analyzed 406 patients with comprehensive and serial imaging data regarding time to recovery. Of these, 191 (47.0%) had early LV recovery and 215 (53.0%) demonstrated late LV improvement. Patients without early recovery were more often male (12.6% versus 5.2%; P=0.011) and presented more frequently with typical TTS (76.3% versus 67.0%, P=0.040). Cardiac and inflammatory markers were higher in patients without early recovery than in those with early recovery. Patients without early recovery showed unfavorable 1‐year outcome compared with patients with early recovery (P=0.003). On multiple logistic regression, male sex, LV ejection fraction <45%, and acute neurologic disorders were associated with the absence of early recovery. Conclusions TTS patients without early LV recovery have different clinical characteristics and less favorable 1‐year outcome compared with patients with early recovery. The factors associated with the absence of early recovery included male sex, reduced LV ejection fraction, and acute neurologic events. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01947621.
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Affiliation(s)
- Stjepan Jurisic
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland
| | - Sebastiano Gili
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland.,Centro Cardiologico Monzino IRCCS Milan Italy
| | - Victoria L Cammann
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland
| | - Ken Kato
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland.,Department of Cardiovascular Medicine Chiba University Graduate School of Medicine Chiba Japan
| | - Konrad A Szawan
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland
| | - Fabrizio D'Ascenzo
- Division of Cardiology Department of Medical Sciences AOU Città della Salute e della Scienza University of Turin Italy
| | | | - Eduardo Bossone
- Heart Department University Hospital "San Giovanni di Dio e Ruggi d'Aragona" Salerno Italy
| | - Rodolfo Citro
- Heart Department University Hospital "San Giovanni di Dio e Ruggi d'Aragona" Salerno Italy
| | - Annahita Sarcon
- University of Southern California, Keck School of Medicine Los Angeles CA
| | - L Christian Napp
- Department of Cardiology and Angiology Hannover Medical School Hannover Germany
| | - Jennifer Franke
- Department of Cardiology Heidelberg University Hospital Heidelberg Germany
| | - Michel Noutsias
- Division of Cardiology, Angiology and Intensive Medical Care Department of Internal Medicine III University Hospital Halle Martin-Luther-University Halle Halle (Saale) Germany
| | - Maike Knorr
- Center for Cardiology Cardiology 1 University Medical Center Mainz Mainz Germany
| | - Susanne Heiner
- Center for Cardiology Cardiology 1 University Medical Center Mainz Mainz Germany
| | | | - Wolfgang Koenig
- Deutsches Herzzentrum München Technische Universität München Munich Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance Munich Germany
| | - Alexander Pott
- Department of Internal Medicine II-Cardiology University of Ulm, Medical Center Ulm Germany
| | - Behrouz Kherad
- Department of Cardiology Charité, Campus Rudolf Virchow Berlin Germany
| | | | - Guido Michels
- Department of Internal Medicine III Heart Center University of Cologne Germany
| | - Roman Pfister
- Department of Internal Medicine III Heart Center University of Cologne Germany
| | | | - Claudius Jacobshagen
- Clinic for Cardiology and Pneumology Georg August University Goettingen Goettingen Germany
| | - Mahir Karakas
- Department of General and Interventional Cardiology University Heart Center Hamburg Hamburg Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck Hamburg Germany
| | - Philippe Meyer
- Service de cardiologie Hôpitaux Universitaires de Genève Geneva Switzerland
| | - Jose David Arroja
- Service de cardiologie Hôpitaux Universitaires de Genève Geneva Switzerland
| | - Adrian Banning
- Department of Cardiology John Radcliffe Hospital Oxford University Hospitals Oxford United Kingdom
| | - Florim Cuculi
- Department of Cardiology Kantonsspital Lucerne Lucerne Switzerland
| | - Richard Kobza
- Department of Cardiology Kantonsspital Lucerne Lucerne Switzerland
| | - Thomas A Fischer
- Department of Cardiology Kantonsspital Winterthur Winterthur Switzerland
| | - Tuija Vasankari
- Heart Center Turku University Hospital and University of Turku Turku Finland
| | | | - Rafal Dworakowski
- Department of Cardiology Kings College Hospital Kings Health Partners London United Kingdom
| | - Christoph Kaiser
- Department of Cardiology University Hospital Basel Basel Switzerland
| | - Stefan Osswald
- Department of Cardiology University Hospital Basel Basel Switzerland
| | - Leonarda Galiuto
- Department of Cardiovascular Sciences Catholic University of the Sacred Heart Rome Rome Italy
| | - Wolfgang Dichtl
- University Hospital for Internal Medicine III (Cardiology and Angiology) Medical University Innsbruck Innsbruck Austria
| | - Christina Chan
- Department of Cardiology Christchurch Hospital Christchurch New Zealand
| | - Paul Bridgman
- Department of Cardiology Christchurch Hospital Christchurch New Zealand
| | - Daniel Beug
- Department of Internal Medicine B University Medicine Greifswald Greifswald Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald Greifswald Germany
| | - Clément Delmas
- Department of Cardiology and Cardiac Imaging Center University Hospital of Rangueil Toulouse France
| | - Olivier Lairez
- Department of Cardiology and Cardiac Imaging Center University Hospital of Rangueil Toulouse France
| | - Martin Kozel
- Charles University in Prague and University Hospital Kralovske Vinohrady Prague Czech Republic
| | - Petr Tousek
- Charles University in Prague and University Hospital Kralovske Vinohrady Prague Czech Republic
| | - David E Winchester
- Department of Medicine College of Medicine University of Florida Gainesville FL
| | - Ekaterina Gilyarova
- Intensive Coronary Care Unit Moscow City Hospital # 1 named after N. Pirogov Moscow Russia
| | - Alexandra Shilova
- Intensive Coronary Care Unit Moscow City Hospital # 1 named after N. Pirogov Moscow Russia
| | - Mikhail Gilyarov
- Intensive Coronary Care Unit Moscow City Hospital # 1 named after N. Pirogov Moscow Russia
| | - Ibrahim El-Battrawy
- First Department of Medicine Faculty of Medicine University Medical Centre Mannheim (UMM) University of Heidelberg Mannheim Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim Mannheim Germany
| | - Ibrahim Akin
- First Department of Medicine Faculty of Medicine University Medical Centre Mannheim (UMM) University of Heidelberg Mannheim Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim Mannheim Germany
| | - Jan Galuszka
- Department of Internal Medicine I - Cardiology University Hospital Olomouc Olomouc Czech Republic
| | - Christian Ukena
- Klinik für Innere Medizin III Universitätsklinikum des Saarlandes Homburg/Saar Germany
| | - Gregor Poglajen
- Advanced Heart Failure and Transplantation Center University Medical Center Ljubljana Ljubljana Slovenia
| | - Carla Paolini
- Local Health Unit n.8, Cardiology Unit Arzignano Vicenza Italy
| | - Claudio Bilato
- Local Health Unit n.8, Cardiology Unit Arzignano Vicenza Italy
| | - Pedro Carrilho-Ferreira
- Cardiology Department Santa Maria University Hospital (CHLN) Lisbon Academic Medical Centre and Cardiovascular Centre of the University of Lisbon (CCUL) Lisbon School of Medicine Universidade de Lisboa Portugal
| | - Fausto J Pinto
- Cardiology Department Santa Maria University Hospital (CHLN) Lisbon Academic Medical Centre and Cardiovascular Centre of the University of Lisbon (CCUL) Lisbon School of Medicine Universidade de Lisboa Portugal
| | | | - Philip MacCarthy
- Department of Cardiology Kings College Hospital Kings Health Partners London United Kingdom
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine Chiba University Graduate School of Medicine Chiba Japan
| | - Abhiram Prasad
- Division of Cardiovascular Diseases Mayo Clinic Rochester MN
| | | | - Petr Widimský
- Charles University in Prague and University Hospital Kralovske Vinohrady Prague Czech Republic
| | - John D Horowitz
- Department of Cardiology Basil Hetzel Institute Queen Elizabeth Hospital University of Adelaide Australia
| | | | - Filippo Crea
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italy
| | - Carsten Tschöpe
- Department of Cardiology Charité, Campus Rudolf Virchow Berlin Germany
| | - Burkert M Pieske
- Department of Cardiology Charité, Campus Rudolf Virchow Berlin Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Berlin Berlin Germany.,Berlin Institute of Health (BIH) Berlin Germany
| | - Gerd Hasenfuß
- Clinic for Cardiology and Pneumology Georg August University Goettingen Goettingen Germany
| | - Wolfgang Rottbauer
- Department of Internal Medicine II-Cardiology University of Ulm, Medical Center Ulm Germany
| | | | - Stephan B Felix
- Department of Internal Medicine B University Medicine Greifswald Greifswald Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald Greifswald Germany
| | - Martin Borggrefe
- First Department of Medicine Faculty of Medicine University Medical Centre Mannheim (UMM) University of Heidelberg Mannheim Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim Mannheim Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology Heart Center Leipzig-University Hospital Leipzig Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology Hannover Medical School Hannover Germany
| | - Hugo A Katus
- Department of Cardiology Heidelberg University Hospital Heidelberg Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum München Technische Universität München Munich Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance Munich Germany
| | - Thomas Münzel
- Center for Cardiology Cardiology 1 University Medical Center Mainz Mainz Germany
| | - Michael Böhm
- Klinik für Innere Medizin III Universitätsklinikum des Saarlandes Homburg/Saar Germany
| | - Jeroen J Bax
- Department of Cardiology Leiden University Medical Centre Leiden The Netherlands
| | - Thomas F Lüscher
- Center for Molecular Cardiology Schlieren Campus University of Zurich Switzerland.,Cardiology Royal Brompton and Harefield Hospitals Trust and Imperial College London United Kingdom
| | - Frank Ruschitzka
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland
| | - Jelena R Ghadri
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland
| | - Christian Templin
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland
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Montefusco A, De Filippo O, Gili S, Mancone M, Calcagno S, Cirillo P, Esposito G, Poli A, Ferrara E, Smolka G, Wanha W, Palmieri C, Pastormerlo LE, Baumbach A, Sganzerla P, Tamburino C, Bruno F, Secco GG, Nicolino A, Yew KL, di Palma G, Wojakowski W, Sardella G, Rinaldi M, Cortese B, D'Ascenzo F. Safety and effectiveness of the self-aPposing, bAlloon-delivered, siRolimus-eluting stent for the Treatment of the coronary Artery disease: SPARTA, a multicenter experience. Coron Artery Dis 2019; 31:27-34. [PMID: 31658146 DOI: 10.1097/mca.0000000000000790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIMS To assess the long-term outcomes of patients treated with sirolimus-eluting Stentys stent in a real-life setting. BACKGROUND Few data regarding the safety and effectiveness of self-apposing sirolimus-eluting Stentys stent are available. METHODS 278 patients (30% stable coronary artery disease, 70% acute coronary syndromes, and 54% on unprotected left main) treated with sirolimus eluting Stentys stent were retrospectively included in the self-aPposing, bAlloon-delivered, siRolimus-eluting stent for the Treatment of the coronary Artery disease multicenter registry. Major adverse cardiovascular events (MACE, a composite of cardiac death, myocardial infarction, target lesion revascularization, stent thrombosis) were the primary end-point, single components of MACE were the secondary ones. RESULTS After 13 months (interquartile range 5-32), MACE was 14%. Stent thrombosis occurred in 3.9% of the patients (2.5% definite stent thrombosis and 1.4% probable stent thrombosis), 66% of them presenting with ST-segment elevation myocardial infarction (STEMI) at admission. Cardiovascular death, target lesion revascularization and myocardial infarction was 4.7%, 8.3%, and 7.2%, respectively. At multivariate analysis, risk of MACE was increased by diabetes (hazard ratios 4.76; P = 0.002) but was not affected by the indication leading to sirolimus-eluting Stentys stent implantation (marked vessel tapering vs. coronary ecstasies, hazard ratios 0.74, P = 0.71). CONCLUSION Sirolimus-eluting Stentys stent may represent a potential solution for specific coronary anatomies such as bifurcation, ectasic, or tapered vessels. Risk of stent thrombosis appears related to clinical presentation with STEMI and to anatomic features, stressing the importance of the use of intracoronary imaging for self-expandable stents implantation.
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Affiliation(s)
- Antonio Montefusco
- Department of Medical Sciences, Division of Cardiology, AOU Città della Salute e della Scienza, University of Turin, Turin
| | - Ovidio De Filippo
- Department of Medical Sciences, Division of Cardiology, AOU Città della Salute e della Scienza, University of Turin, Turin
| | - Sebastiano Gili
- Department of Medical Sciences, Division of Cardiology, AOU Città della Salute e della Scienza, University of Turin, Turin
| | - Massimo Mancone
- Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiological and Geriatric Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome
| | - Simone Calcagno
- Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiological and Geriatric Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome
| | - Plinio Cirillo
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples
| | - Giovanni Esposito
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples
| | - Arnaldo Poli
- Division of Cardiology, Ospedale Civile di Legnano - ASST Ovest Mi, Legnano, Italy
| | - Erika Ferrara
- Division of Cardiology, Ospedale Civile di Legnano - ASST Ovest Mi, Legnano, Italy
| | - Grzegorz Smolka
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Wojciech Wanha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | | | | | - Paolo Sganzerla
- Division of Cardiology, AO Ospedale Treviglio-Caravaggio, Treviglio
| | - Corrado Tamburino
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania
| | - Francesco Bruno
- Department of Medical Sciences, Division of Cardiology, AOU Città della Salute e della Scienza, University of Turin, Turin
| | - Gioel Gabrio Secco
- Interventional Cardiology, Santi Antonio, Biagio e Cesare Arrigo Hospital, Alessandria
| | | | - Kuang Leon Yew
- Cardiology Department, Manipal Hospital, Klang, Selangor, Malaysia
| | - Gaetano di Palma
- Department of Interventional Cardiology, ASST Fatebenefratelli-Sacco, Milano, Italy
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Gennaro Sardella
- Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiological and Geriatric Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome
| | - Mauro Rinaldi
- Department of Medical Sciences, Division of Cardiology, AOU Città della Salute e della Scienza, University of Turin, Turin
| | - Bernardo Cortese
- Fondazione Monasterio CNR-Regione Toscana, Massa, Italy.,Department of Interventional Cardiology, ASST Fatebenefratelli-Sacco, Milano, Italy
| | - Fabrizio D'Ascenzo
- Department of Medical Sciences, Division of Cardiology, AOU Città della Salute e della Scienza, University of Turin, Turin
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45
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Di Vece D, Citro R, Cammann VL, Kato K, Gili S, Szawan KA, Micek J, Jurisic S, Ding KJ, Bacchi B, Schwyzer M, Candreva A, Bossone E, D'Ascenzo F, Sarcon A, Franke J, Napp LC, Jaguszewski M, Noutsias M, Münzel T, Knorr M, Heiner S, Katus HA, Burgdorf C, Schunkert H, Thiele H, Bauersachs J, Tschöpe C, Pieske BM, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Hasenfuβ G, Karakas M, Koenig W, Rottbauer W, Said SM, Braun-Dullaeus RC, Banning A, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KEJ, Opolski G, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Crea F, Dichtl W, Empen K, Felix SB, Delmas C, Lairez O, El-Battrawy I, Akin I, Borggrefe M, Gilyarova E, Shilova A, Gilyarov M, Horowitz J, Kozel M, Tousek P, Widimský P, Winchester DE, Ukena C, Di Mario C, Prasad A, Böhm M, Bax JJ, Lüscher TF, Ruschitzka F, Ghadri JR, Templin C. Outcomes Associated With Cardiogenic Shock in Takotsubo Syndrome. Circulation 2019; 139:413-415. [PMID: 30586690 DOI: 10.1161/circulationaha.118.036164] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Davide Di Vece
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (D.D.V., V.L.C., K.K., S.G., K.A.S., J.M., S.J., K.J.D., B.B., M.S., A.C., F.R., J.R.G., C.T.)
| | - Rodolfo Citro
- Heart Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy (R.C., E.B.)
| | - Victoria L Cammann
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (D.D.V., V.L.C., K.K., S.G., K.A.S., J.M., S.J., K.J.D., B.B., M.S., A.C., F.R., J.R.G., C.T.)
| | - Ken Kato
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (D.D.V., V.L.C., K.K., S.G., K.A.S., J.M., S.J., K.J.D., B.B., M.S., A.C., F.R., J.R.G., C.T.)
| | - Sebastiano Gili
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (D.D.V., V.L.C., K.K., S.G., K.A.S., J.M., S.J., K.J.D., B.B., M.S., A.C., F.R., J.R.G., C.T.)
| | - Konrad A Szawan
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (D.D.V., V.L.C., K.K., S.G., K.A.S., J.M., S.J., K.J.D., B.B., M.S., A.C., F.R., J.R.G., C.T.)
| | - Jozef Micek
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (D.D.V., V.L.C., K.K., S.G., K.A.S., J.M., S.J., K.J.D., B.B., M.S., A.C., F.R., J.R.G., C.T.)
| | - Stjepan Jurisic
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (D.D.V., V.L.C., K.K., S.G., K.A.S., J.M., S.J., K.J.D., B.B., M.S., A.C., F.R., J.R.G., C.T.)
| | - Katharina J Ding
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (D.D.V., V.L.C., K.K., S.G., K.A.S., J.M., S.J., K.J.D., B.B., M.S., A.C., F.R., J.R.G., C.T.)
| | - Beatrice Bacchi
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (D.D.V., V.L.C., K.K., S.G., K.A.S., J.M., S.J., K.J.D., B.B., M.S., A.C., F.R., J.R.G., C.T.)
| | - Moritz Schwyzer
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (D.D.V., V.L.C., K.K., S.G., K.A.S., J.M., S.J., K.J.D., B.B., M.S., A.C., F.R., J.R.G., C.T.)
| | - Alessandro Candreva
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (D.D.V., V.L.C., K.K., S.G., K.A.S., J.M., S.J., K.J.D., B.B., M.S., A.C., F.R., J.R.G., C.T.)
| | - Eduardo Bossone
- Heart Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy (R.C., E.B.)
| | - Fabrizio D'Ascenzo
- Department of Medical Sciences, Division of Cardiology, AOU Città della Salute e della Scienza, University of Turin, Italy (F.D.A.)
| | - Annahita Sarcon
- Keck School of Medicine, University of Southern California, Los Angeles (A.S.)
| | - Jennifer Franke
- Department of Cardiology, Heidelberg University Hospital, Germany (J.F., H.A.K.)
| | - L Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Germany (L.C.N., J.B.)
| | - Milosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Poland (M.J.)
| | - Michel Noutsias
- Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Germany (M.N.)
| | - Thomas Münzel
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Germany (T.M., M.K., S.H.)
| | - Maike Knorr
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Germany (T.M., M.K., S.H.)
| | - Susanne Heiner
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Germany (T.M., M.K., S.H.)
| | - Hugo A Katus
- Department of Cardiology, Heidelberg University Hospital, Germany (J.F., H.A.K.)
| | | | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Germany (H.S., W.K.).,German Centre for Cardiovascular Research, Munich Heart Alliance, Germany (H.S., W.K.)
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig, University Hospital, Germany (H.T.)
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Germany (L.C.N., J.B.)
| | - Carsten Tschöpe
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany (C.T., B.M.P.)
| | - Burkert M Pieske
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany (C.T., B.M.P.)
| | - Lawrence Rajan
- TJ Health Partners Heart and Vascular, Glasgow, Kentucky (L.R.)
| | - Guido Michels
- Department of Internal Medicine III, Heart Center University of Cologne, Germany (G.M., R.P.)
| | - Roman Pfister
- Department of Internal Medicine III, Heart Center University of Cologne, Germany (G.M., R.P.)
| | - Alessandro Cuneo
- Krankenhaus "Maria Hilf" Medizinsche Klinik, Stadtlohn, Germany (A.C.)
| | - Claudius Jacobshagen
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany (C.J., G.H.)
| | - Gerd Hasenfuβ
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany (C.J., G.H.)
| | - Mahir Karakas
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (M.K.)
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Germany (H.S., W.K.).,German Centre for Cardiovascular Research, Munich Heart Alliance, Germany (H.S., W.K.)
| | - Wolfgang Rottbauer
- Department of Internal Medicine II-Cardiology, University of Ulm, Medical Center, Germany (W.R.)
| | - Samir M Said
- Department of Cardiac Electrophysiology, Helios St Marienberg, Hospital Helmstedt, Germany (S.M.S.)
| | | | - Adrian Banning
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals, United Kingdom (A.B.)
| | - Florim Cuculi
- Department of Cardiology, Kantonsspital Lucerne, Switzerland (F.C., R.K.)
| | - Richard Kobza
- Department of Cardiology, Kantonsspital Lucerne, Switzerland (F.C., R.K.)
| | - Thomas A Fischer
- Department of Cardiology, Kantonsspital Winterthur, Switzerland (T.A.F.)
| | - Tuija Vasankari
- Heart Center, Turku University Hospital and University of Turku, Finland (T.V., K.E.J.A.)
| | - K E Juhani Airaksinen
- Heart Center, Turku University Hospital and University of Turku, Finland (T.V., K.E.J.A.)
| | - Grzegorz Opolski
- Department of Cardiology, Medical University of Warsaw, Poland (G.O.)
| | - Rafal Dworakowski
- Department of Cardiology, Kings College Hospital, Kings Health Partners, London, United Kingdom (R.D., P.M.)
| | - Philip MacCarthy
- Department of Cardiology, Kings College Hospital, Kings Health Partners, London, United Kingdom (R.D., P.M.)
| | - Christoph Kaiser
- Department of Cardiology, University Hospital Basel, Switzerland (C.K., S.O.)
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Switzerland (C.K., S.O.)
| | - Leonarda Galiuto
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart Rome, Italy (L.G., F.C.)
| | - Filippo Crea
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart Rome, Italy (L.G., F.C.)
| | - Wolfgang Dichtl
- University Hospital for Internal Medicine III, Cardiology and Angiology, Medical University Innsbruck, Austria (W.D.)
| | - Klaus Empen
- Department of Internal Medicine, Kreiskrankenhaus Wolgast, Germany (K.E.)
| | - Stephan B Felix
- Department of Internal Medicine B, University Medicine Greifswald, Germany (S.B.F.).,German Centre for Cardiovascular Research, Greifswald, Germany (S.B.F.)
| | - Clément Delmas
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France (C.D., O.L.)
| | - Olivier Lairez
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France (C.D., O.L.)
| | - Ibrahim El-Battrawy
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany (I.E, I.A., M.B).,German Center for Cardiovascular Research, Heidelberg-Mannheim, Germany (I.E, I.A., M.B.)
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany (I.E, I.A., M.B).,German Center for Cardiovascular Research, Heidelberg-Mannheim, Germany (I.E, I.A., M.B.)
| | - Martin Borggrefe
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany (I.E, I.A., M.B).,German Center for Cardiovascular Research, Heidelberg-Mannheim, Germany (I.E, I.A., M.B.)
| | - Ekaterina Gilyarova
- Intensive Coronary Care Unit, Moscow City Hospital, Russia (E.G., A.S., M.G.)
| | - Alexandra Shilova
- Intensive Coronary Care Unit, Moscow City Hospital, Russia (E.G., A.S., M.G.)
| | - Mikhail Gilyarov
- Intensive Coronary Care Unit, Moscow City Hospital, Russia (E.G., A.S., M.G.)
| | - John Horowitz
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, Australia (J.H.)
| | - Martin Kozel
- German Centre for Cardiovascular Research, Hamburg/Kiel/Luebeck, Germany (M.K.).,Charles University, University Hospital Kralovske Vinohrady, Czech Republic (M.K., P.T., P.W.)
| | - Petr Tousek
- Charles University, University Hospital Kralovske Vinohrady, Czech Republic (M.K., P.T., P.W.)
| | - Petr Widimský
- Charles University, University Hospital Kralovske Vinohrady, Czech Republic (M.K., P.T., P.W.)
| | - David E Winchester
- Department of Medicine, College of Medicine, University of Florida, Gainesville (D.E.W.)
| | - Christian Ukena
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (C.U., M.B.)
| | - Carlo Di Mario
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy (C.D.M.)
| | - Abhiram Prasad
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester MN (A.P.)
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (C.U., M.B.)
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, The Netherlands (J.J.B.)
| | - Thomas F Lüscher
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Switzerland (T.F.L.).,Royal Brompton and Harefield Hospitals Trust and Imperial College, London, United Kingdom (T.F.L)
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (D.D.V., V.L.C., K.K., S.G., K.A.S., J.M., S.J., K.J.D., B.B., M.S., A.C., F.R., J.R.G., C.T.)
| | - Jelena R Ghadri
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (D.D.V., V.L.C., K.K., S.G., K.A.S., J.M., S.J., K.J.D., B.B., M.S., A.C., F.R., J.R.G., C.T.)
| | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (D.D.V., V.L.C., K.K., S.G., K.A.S., J.M., S.J., K.J.D., B.B., M.S., A.C., F.R., J.R.G., C.T.)
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De Filippo O, D'Ascenzo F, Raposeiras-Roubin S, Peyracchia M, Gili S, Iannaccone M, Ariza-Sole A, Abu-Assi E, Liebetrau C, Manzano-Fernandez S, Montabone A, Henriques JPS, Quadri G, Giustetto C, Rinaldi M. P6409Ticagrelor and prasugrel versus clopidogrel in patients with acute coronary syndromes and chronic renal dysfunction: safety and efficacy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Safety and efficacy of prasugrel and ticagrelor in real-life ACS (Acute Coronary Syndrome) with renal dysfunction remain to be established.
Methods
Consecutive patients from RENAMI and BLEEMACS were stratified according to renal function and estimated glomerular filtration rate (eGFR<60 mL/min/1.73 m2). Myocardial infarction (MI) and BARC major bleedings (MB; BARC type 3 or 5) were the primary end-point. Independent impact of clopidogrel, prasugrel and ticagrelor were evaluated with Cox multivariate analysis.
Results
19255 patients were enrolled (mean eGFR: 90±39 ml/min/1.73m2). Patients with eGFR<60 mL/min/1.73m2, constituted the 12.9% of the population (2490 pts). After a mean follow up of 13±5 months, the global incidence of re-AMI was of 5.8% and 2.9% in patients with and in those without eGFR<60 mL/min/1.73m2 (p<0.0001) respectively. MB occurred in 5.7% and 3% (p<0.0001). At Cox multivariate analysis, clopidogrel compared to prasugrel and ticagrelor was associated with increased risk of MI both in those with eGFR>60 mL/min/1.73m2 (HR=3.3: 2.4–4.4, p<0.0001) as well as in patients with eGFR<60 mL/min/1.73m2 (HR=10.04: 3.1–32.3, p<0.0001). In contrast, both prasugrel (HR=0.07: 0.01–0.54, p=0.01) and Ticagrelor (HR=0.36: 0.16–0.81, p=0.01) were associated with decreased risk of MI in the latters. DAPT with ticagrelor or prasugrel did not increased risk of MB in patients with eGFR<60 mL/min/1.73m2, while in patients with eGFR>60 mL/min/1.73m2, ticagrelor was associated to a slightly higher risk of MB (HR=1.43: 1.09–1.89, p=0.009).
Conclusion
In ACS patients with eGFR<60 mL/min/1.73m2, prasugrel and ticagrelor are associated with lower risk of recurrent MI without significant increase in the risk of MB.
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Affiliation(s)
- O De Filippo
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Turin, Italy
| | - F D'Ascenzo
- City of Health and Science of Turin, Turin, Italy
| | | | - M Peyracchia
- City of Health and Science of Turin, Turin, Italy
| | - S Gili
- Cardiology Center Monzino IRCCS, Milan, Italy
| | | | - A Ariza-Sole
- University Hospital of Bellvitge, Barcelona, Spain
| | - E Abu-Assi
- University Hospital Άlvaro Cunqueiro, vigo, Spain
| | - C Liebetrau
- Kerckhoff Heart and Thorax Center, Frankfurt, Germany
| | | | - A Montabone
- San Giovanni Bosco Hospital of Turino, Turin, Italy
| | - J P S Henriques
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands (The)
| | - G Quadri
- Degli Infermi Hospital, Rivoli, Italy
| | - C Giustetto
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Turin, Italy
| | - M Rinaldi
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Turin, Italy
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47
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De Filippo O, D’Ascenzo F, Raposeiras-Roubin S, Abu-Assi E, Peyracchia M, Bocchino PP, Kinnaird T, Ariza-Solé A, Liebetrau C, Manzano-Fernández S, Boccuzzi G, Henriques JPS, Templin C, Wilton SB, Omedè P, Velicki L, Xanthopoulou I, Correia L, Cerrato E, Rognoni A, Fabrizio U, Nuñez-Gil I, Iannaccone M, Montabone A, Taha S, Fujii T, Durante A, Song X, Gili S, Magnani G, Varbella F, Kawaji T, Blanco PF, Garay A, Quadri G, Alexopoulos D, Caneiro Queija B, Huczek Z, Cobas Paz R, González Juanatey JR, Cespón Fernández M, Nie SP, Muñoz Pousa I, Kawashiri MA, Gallo D, Morbiducci U, Conrotto F, Montefusco A, Dominguez-Rodriguez A, López-Cuenca A, Cequier A, Iñiguez-Romo A, Usmiani T, Rinaldi M, De Ferrari GM. P2Y12 inhibitors in acute coronary syndrome patients with renal dysfunction: an analysis from the RENAMI and BleeMACS projects. European Heart Journal - Cardiovascular Pharmacotherapy 2019; 6:31-42. [DOI: 10.1093/ehjcvp/pvz048] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 07/05/2019] [Accepted: 09/09/2019] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
The aim of the present study was to establish the safety and efficacy profile of prasugrel and ticagrelor in real-life acute coronary syndrome (ACS) patients with renal dysfunction.
Methods and results
All consecutive patients from RENAMI (REgistry of New Antiplatelets in patients with Myocardial Infarction) and BLEEMACS (Bleeding complications in a Multicenter registry of patients discharged with diagnosis of Acute Coronary Syndrome) registries were stratified according to estimated glomerular filtration rate (eGFR) lower or greater than 60 mL/min/1.73 m2. Death and myocardial infarction (MI) were the primary efficacy endpoints. Major bleedings (MBs), defined as Bleeding Academic Research Consortium bleeding types 3 to 5, constituted the safety endpoint. A total of 19 255 patients were enrolled. Mean age was 63 ± 12; 14 892 (77.3%) were males. A total of 2490 (12.9%) patients had chronic kidney disease (CKD), defined as eGFR <60 mL/min/1.73 m2. Mean follow-up was 13 ± 5 months. Mortality was significantly higher in CKD patients (9.4% vs. 2.6%, P < 0.0001), as well as the incidence of reinfarction (5.8% vs. 2.9%, P < 0.0001) and MB (5.7% vs. 3%, P < 0.0001). At Cox multivariable analysis, potent P2Y12 inhibitors significantly reduced the mortality rate [hazard ratio (HR) 0.82, 95% confidence interval (CI) 0.54–0.96; P = 0.006] and the risk of reinfarction (HR 0.53, 95% CI 0.30–0.95; P = 0.033) in CKD patients as compared to clopidogrel. The reduction of risk of reinfarction was confirmed in patients with preserved renal function. Potent P2Y12 inhibitors did not increase the risk of MB in CKD patients (HR 1.00, 95% CI 0.59–1.68; P = 0.985).
Conclusion
In ACS patients with CKD, prasugrel and ticagrelor are associated with lower risk of death and recurrent MI without increasing the risk of MB.
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Affiliation(s)
- Ovidio De Filippo
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, Turin, Italy
| | - Fabrizio D’Ascenzo
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, Turin, Italy
| | - Sergio Raposeiras-Roubin
- Department of Cardiology, University Hospital Alvaro Cunqueiro, Estrada de Clara Campoamor, 341, Vigo, Pontevedra, Spain
| | - Emad Abu-Assi
- Department of Cardiology, University Hospital Alvaro Cunqueiro, Estrada de Clara Campoamor, 341, Vigo, Pontevedra, Spain
| | - Mattia Peyracchia
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, Turin, Italy
| | - Pier Paolo Bocchino
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, Turin, Italy
| | - Tim Kinnaird
- Cardiology Department, University Hospital of Wales, Heath Park Way, Cardiff, UK
| | - Albert Ariza-Solé
- Department of Cardiology, University Hospital de Bellvitge, Av. Mare de Déu de Bellvitge, 3, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Christoph Liebetrau
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestr. 2-8 61231, Bad Nauheim, Germany
| | - Sergio Manzano-Fernández
- Department of Cardiology, University Hospital Virgen Arrtixaca, Ctra. Madrid-Cartagena, s/n, Murcia, Spain
| | - Giacomo Boccuzzi
- Department of Cardiology, S.G. Bosco Hospital, Piazza del Donatore di Sangue, 3, Torino, Italy
| | - Jose Paulo Simao Henriques
- Department of Cardiology, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Stephen B Wilton
- Libin Cardiovascular Institute of Alberta, GE64 3280 Hospital Drive NW, Calgary, Alberta, Canada
| | - Pierluigi Omedè
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, Turin, Italy
| | - Lazar Velicki
- Medical Faculty, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, and Institute of Cardiovascular Diseases Vojvodina, Put doktora Goldmana 4, 21204 Sremska Kamenica, Serbia
| | - Ioanna Xanthopoulou
- Department of Cardiology, Patras University Hospital, Rion, 265 04 Patras, Greece
| | - Luis Correia
- Department of Cardiology, Hospital São Rafael - Avenida São Rafael, 2152 - São Marcos, 41253-196 Salvador, Bahia, Brazil
| | - Enrico Cerrato
- Interventional Cardiology Unit, Orbassano, and San Luigi Gonzaga University Hospital, Regione Gonzole, 10, 10043 Orbassano Rivoli, Turin, Italy
| | - Andrea Rognoni
- Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Corso Mazzini 18, Novara, Italy
| | - Ugo Fabrizio
- Department of Cardiology, S.G. Bosco Hospital, Piazza del Donatore di Sangue, 3, Torino, Italy
| | - Iván Nuñez-Gil
- Interventional Cardiology, Cardiovascular Institute, Hospital Clínico Universitario San Carlos, Calle del Prof Martín Lagos, s/n, 28040 Madrid, Spain
| | - Mario Iannaccone
- Cardiology Department, “SS. Annunziata” Hospital, Via Ospedali, 9, Savigliano, Cuneo, Italy
| | - Andrea Montabone
- Department of Cardiology, S.G. Bosco Hospital, Piazza del Donatore di Sangue, 3, Torino, Italy
| | - Salma Taha
- Department of Cardiology, Faculty of Medicine, Assiut University, Libraries Street, Assiut, Egypt
| | - Toshiharu Fujii
- Division of Cardiovascular Medicine, Department of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Japan
| | - Alessandro Durante
- U.O. Cardiologia, Ospedale Valduce, Via Dante Alighieri, 11, 22100 Como, Italy
| | - Xiantao Song
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Sebastiano Gili
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Giulia Magnani
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Ferdinando Varbella
- Interventional Cardiology Unit, Orbassano, and San Luigi Gonzaga University Hospital, Regione Gonzole, 10, 10043 Orbassano Rivoli, Turin, Italy
| | - Tetsuma Kawaji
- Department of Cardiology, Mitsubishi Kyoto Hospital, 1 Katsura Gosho-cho, Nishikyo-ku, Kyoto, Japan
| | - Pedro Flores Blanco
- Department of Cardiology, University Hospital Virgen Arrtixaca, Ctra. Madrid-Cartagena, s/n, Murcia, Spain
| | - Alberto Garay
- Department of Cardiology, University Hospital de Bellvitge, Av. Mare de Déu de Bellvitge, 3, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Giorgio Quadri
- Department of Cardiology, Infermi Hospital, Via Rivalta, 29, Rivoli, Torino, Italy
| | | | - Berenice Caneiro Queija
- Department of Cardiology, University Hospital Alvaro Cunqueiro, Estrada de Clara Campoamor, 341, Vigo, Pontevedra, Spain
| | - Zenon Huczek
- Department of Cardiology, Medical University of Warsaw, 1 a Banacha St, Warsaw, Poland
| | - Rafael Cobas Paz
- Department of Cardiology, University Hospital Alvaro Cunqueiro, Estrada de Clara Campoamor, 341, Vigo, Pontevedra, Spain
| | - José Ramón González Juanatey
- Servicio de Hemodinámica, Hospital Clínico Universitario de Santiago de Compostela, Travesía da Choupana s/n 15706, Santiago de Compostela, A Coruña, Spain
| | - María Cespón Fernández
- Department of Cardiology, University Hospital Alvaro Cunqueiro, Estrada de Clara Campoamor, 341, Vigo, Pontevedra, Spain
| | - Shao-Ping Nie
- Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | - Isabel Muñoz Pousa
- Department of Cardiology, University Hospital Alvaro Cunqueiro, Estrada de Clara Campoamor, 341, Vigo, Pontevedra, Spain
| | - Masa-Aki Kawashiri
- Department of Cardiology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, 920-86 Kanazawa, Japan
| | - Diego Gallo
- Department of Mechanical and Aerospace Engineering, PolitoBIOMed Lab, Politecnico di Torino, Corso Duca degli Abruzzi, 24, 10129 Torino, Italy
| | - Umberto Morbiducci
- Department of Mechanical and Aerospace Engineering, PolitoBIOMed Lab, Politecnico di Torino, Corso Duca degli Abruzzi, 24, 10129 Torino, Italy
| | - Federico Conrotto
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, Turin, Italy
| | - Antonio Montefusco
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, Turin, Italy
| | - Alberto Dominguez-Rodriguez
- Department of Cardiology, Hospital Universitario de Canarias, Carretera Cuesta Taco, 0, 38320 Cuesta ( La, Santa Cruz de Tenerife), Spain
| | - Angel López-Cuenca
- Department of Cardiology, University Hospital Virgen Arrtixaca, Ctra. Madrid-Cartagena, s/n, Murcia, Spain
| | - Angel Cequier
- Department of Cardiology, University Hospital de Bellvitge, Av. Mare de Déu de Bellvitge, 3, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Andrés Iñiguez-Romo
- Department of Cardiology, University Hospital Alvaro Cunqueiro, Estrada de Clara Campoamor, 341, Vigo, Pontevedra, Spain
| | - Tullio Usmiani
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, Turin, Italy
| | - Mauro Rinaldi
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, Turin, Italy
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Ghadri JR, Kato K, Cammann VL, Gili S, Jurisic S, Di Vece D, Candreva A, Ding KJ, Micek J, Szawan KA, Bacchi B, Bianchi R, Levinson RA, Wischnewsky M, Seifert B, Schlossbauer SA, Citro R, Bossone E, Münzel T, Knorr M, Heiner S, D'Ascenzo F, Franke J, Sarcon A, Napp LC, Jaguszewski M, Noutsias M, Katus HA, Burgdorf C, Schunkert H, Thiele H, Bauersachs J, Tschöpe C, Pieske BM, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Hasenfuß G, Karakas M, Koenig W, Rottbauer W, Said SM, Braun-Dullaeus RC, Banning A, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KEJ, Opolski G, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Crea F, Dichtl W, Empen K, Felix SB, Delmas C, Lairez O, El-Battrawy I, Akin I, Borggrefe M, Horowitz J, Kozel M, Tousek P, Widimský P, Gilyarova E, Shilova A, Gilyarov M, Winchester DE, Ukena C, Bax JJ, Prasad A, Böhm M, Lüscher TF, Ruschitzka F, Templin C. Long-Term Prognosis of Patients With Takotsubo Syndrome. J Am Coll Cardiol 2019; 72:874-882. [PMID: 30115226 DOI: 10.1016/j.jacc.2018.06.016] [Citation(s) in RCA: 202] [Impact Index Per Article: 40.4] [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: 03/28/2018] [Revised: 06/05/2018] [Accepted: 06/05/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Prognosis of Takotsubo syndrome (TTS) remains controversial due to scarcity of available data. Additionally, the effect of the triggering factors remains elusive. OBJECTIVES This study compared prognosis between TTS and acute coronary syndrome (ACS) patients and investigated short- and long-term outcomes in TTS based on different triggers. METHODS Patients with TTS were enrolled from the International Takotsubo Registry. Long-term mortality of patients with TTS was compared to an age- and sex-matched cohort of patients with ACS. In addition, short- and long-term outcomes were compared between different groups according to triggering conditions. RESULTS Overall, TTS patients had a comparable long-term mortality risk with ACS patients. Of 1,613 TTS patients, an emotional trigger was detected in 485 patients (30%). Of 630 patients (39%) related to physical triggers, 98 patients (6%) had acute neurologic disorders, while in the other 532 patients (33%), physical activities, medical conditions, or procedures were the triggering conditions. The remaining 498 patients (31%) had no identifiable trigger. TTS patients related to physical stress showed higher mortality rates than ACS patients during long-term follow-up, whereas patients related to emotional stress had better outcomes compared with ACS patients. CONCLUSIONS Overall, TTS patients had long-term outcomes comparable to age- and sex-matched ACS patients. Also, we demonstrated that TTS can either be benign or a life-threating condition depending on the inciting stress factor. We propose a new classification based on triggers, which can serve as a clinical tool to predict short- and long-term outcomes of TTS. (International Takotsubo Registry [InterTAK Registry]; NCT01947621).
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Affiliation(s)
- Jelena R Ghadri
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Ken Kato
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Victoria L Cammann
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Sebastiano Gili
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland; Division of Cardiology, Department of Medical Sciences, AOU Citta della Salute e della Scienza, University of Turin, Turin, Italy
| | - Stjepan Jurisic
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Davide Di Vece
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Alessandro Candreva
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Katharina J Ding
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Jozef Micek
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Konrad A Szawan
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Beatrice Bacchi
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Rahel Bianchi
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Rena A Levinson
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland; Division of Biological Sciences, University of California, San Diego, La Jolla, California
| | - Manfred Wischnewsky
- Department of Mathematics and Computer Science, University of Bremen, Bremen, Germany
| | - Burkhardt Seifert
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Susanne A Schlossbauer
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Rodolfo Citro
- Heart Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Eduardo Bossone
- Heart Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Thomas Münzel
- Cardiology 1, Center for Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Maike Knorr
- Cardiology 1, Center for Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Susanne Heiner
- Cardiology 1, Center for Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, AOU Citta della Salute e della Scienza, University of Turin, Turin, Italy
| | - Jennifer Franke
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Annahita Sarcon
- University of Southern California, Keck School of Medicine, Los Angeles, California
| | - L Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Milosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Michel Noutsias
- Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Halle (Saale), Germany
| | - Hugo A Katus
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Holger Thiele
- Heart Center Leipzig, University Hospital, Department of Internal Medicine/Cardiology, Leipzig, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Carsten Tschöpe
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Burkert M Pieske
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Lawrence Rajan
- TJ Health Partners Heart and Vascular, Glasgow, Kentucky
| | - Guido Michels
- Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
| | - Roman Pfister
- Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
| | - Alessandro Cuneo
- Krankenhaus "Maria Hilf" Medizinische Klinik, Stadtlohne, Germany
| | - Claudius Jacobshagen
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany
| | - Gerd Hasenfuß
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany
| | - Mahir Karakas
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Wolfgang Rottbauer
- Department of Internal Medicine II-Cardiology, University of Ulm, Medical Center, Ulm, Germany
| | - Samir M Said
- Internal Medicine/Cardiology, Angiology, and Pneumology, Magdeburg University, Magdeburg, Germany
| | | | - Adrian Banning
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, United Kingdom
| | - Florim Cuculi
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Richard Kobza
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Thomas A Fischer
- Department of Cardiology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Tuija Vasankari
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Grzegorz Opolski
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Rafal Dworakowski
- Department of Cardiology, Kings College Hospital, Kings Health Partners, London, United Kingdom
| | - Philip MacCarthy
- Department of Cardiology, Kings College Hospital, Kings Health Partners, London, United Kingdom
| | - Christoph Kaiser
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Leonarda Galiuto
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart Rome, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart Rome, Rome, Italy
| | - Wolfgang Dichtl
- University Hospital for Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Innsbruck, Austria
| | - Klaus Empen
- University Medicine Greifswald, Department of Internal Medicine B, Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Stephan B Felix
- University Medicine Greifswald, Department of Internal Medicine B, Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Clément Delmas
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Olivier Lairez
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Ibrahim El-Battrawy
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany; DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany; DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany; DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - John Horowitz
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia
| | - Martin Kozel
- Charles University in Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Tousek
- Charles University in Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Widimský
- Charles University in Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Ekaterina Gilyarova
- Intensive Coronary Care Unit, Moscow City Hospital #1 named after N. Pirogov, Moscow, Russia
| | - Alexandra Shilova
- Intensive Coronary Care Unit, Moscow City Hospital #1 named after N. Pirogov, Moscow, Russia
| | - Mikhail Gilyarov
- Intensive Coronary Care Unit, Moscow City Hospital #1 named after N. Pirogov, Moscow, Russia
| | - David E Winchester
- Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida
| | - Christian Ukena
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Abhiram Prasad
- Division of Cardiovascular Diseases Mayo Clinic, Rochester, Minnesota
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Thomas F Lüscher
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Switzerland; Royal Brompton and Harefield Hospitals Trust and Imperial College, London, United Kingdom
| | - Frank Ruschitzka
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Christian Templin
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
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49
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Cerrato E, Barbero U, Quadri G, Ryan N, D'Ascenzo F, Tomassini F, Quirós A, Bellucca S, Conrotto F, Ugo F, Kawamoto H, Rolfo C, Pavani M, Mejia-Renteria H, Gili S, Iannaccone M, Debenedictis M, Baldassarre D, Biondi-Zoccai G, Colombo A, Varbella F, Escaned J. Prediction of long-term patient outcome after contemporary left main stenting using the SYNTAX and SYNTAX II scores: A comparative analysis from the FAIL-II multicenter registry (failure in left main study with 2nd generation stents-Cardiogroup III study). Catheter Cardiovasc Interv 2019; 96:E17-E26. [PMID: 31478334 DOI: 10.1002/ccd.28468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 07/24/2019] [Accepted: 08/17/2019] [Indexed: 02/05/2023]
Abstract
AIMS To establish the value of the SYNTAX Score-II (SS-II) in predicting long-term mortality of patients treated with left main PCI (LM-PCI) using second-generation drug-eluting stents (DES). METHODS AND RESULTS The SYNTAX score (SS) and the SS-II were calculated in 804 patients included in the FAILS-2 registry (failure in left main study with 2nd generation stents). Patients were classified in low (SS-II ≤33; n = 278, 34.6%), intermediate (SS-II 34-43; n = 260, 32.3%) and high (SS-II ≥44; n = 266, 33.1%) SS-II tertiles. Primary endpoint was all-cause mortality. A significant difference in long-term mortality was noted (5.2 ± 3.6 years): 4.1, 7.5, and 16.7% in low, mid and high SS-II tertiles respectively (p < .001). SS-II score was more accurate in predicting mortality than SS (AUC = 0.73; 95%CI: 0.67-0.79 vs. AUC = 0.55; 95%CI: 0.48-0.63, respectively; p < .001). SS-II led to a reclassification in the risk of all-cause mortality re-allocating 73% of patients from the CABG-only indication to PCI or equipoise PCI-or-CABG indication. Using multiple Cox regression analysis, SS-II (HR: 1.07; 95%CI: 1.05-1.09; p < .001), along with Acute coronary syndrome (ACS) (HR: 1.66; 95%CI: 1.03-2.66; p = .07) and Cardiogenic shock (CS) (HR: 2.82 (95%CI: 1.41-5.64; p = .003) were independent predictors of long-term mortality. SS-II (HR: 1.05; 95%CI: 1.04-1.06; p < .001) along with Insulin dependent Type 2 DM (HR: 1.58, 95%CI: 1.09-2.30.; p < .05), ACS (HR: 1.58, 95%CI: 1.16-2.14; p < .001) and CS (HR: 2.02 95%CI 1.16-3.53; p < .05), were independent predictors of long-term MACE. CONCLUSION The SS-II was superior to the SS in predicting outcomes associated with contemporary LM-PCI. In this real-world population, two clinical variables not included in the SS-II, ACS and T2DM, were identified as additional markers of poor outcome.
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Affiliation(s)
- Enrico Cerrato
- Interventional Cardiology, Infermi Hospital, Rivoli and San Luigi Gonzaga, Orbassano, Italy
| | - Umberto Barbero
- Cardiology Department, "SS. Annunziata" Hospital, Savigliano, Italy.,Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Giorgio Quadri
- Interventional Cardiology, Infermi Hospital, Rivoli and San Luigi Gonzaga, Orbassano, Italy
| | - Nicola Ryan
- Department of Cardiology, Hopital Clínico San Carlos, Madrid, Spain
| | - Fabrizio D'Ascenzo
- "Città della Scienza e della Salute", Department of Cardiology, University of Turin, Turin, Italy
| | - Francesco Tomassini
- Interventional Cardiology, Infermi Hospital, Rivoli and San Luigi Gonzaga, Orbassano, Italy
| | | | - Simone Bellucca
- Interventional Cardiology, Infermi Hospital, Rivoli and San Luigi Gonzaga, Orbassano, Italy
| | - Federico Conrotto
- "Città della Scienza e della Salute", Department of Cardiology, University of Turin, Turin, Italy
| | - Fabrizio Ugo
- Department of Cardiology, "S.G. Bosco Hospital", Turin, Italy
| | - Hiroyoshi Kawamoto
- Department of Cardiology, Scientific Institute S. Raffaele, Milan, Italy
| | - Cristina Rolfo
- Interventional Cardiology, Infermi Hospital, Rivoli and San Luigi Gonzaga, Orbassano, Italy
| | - Marco Pavani
- Division of Cardiology, Ospedale Umberto I, Turin, Italy
| | | | | | - Mario Iannaccone
- Cardiology Department, "SS. Annunziata" Hospital, Savigliano, Italy
| | | | | | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | - Antonio Colombo
- Department of Cardiology, Scientific Institute S. Raffaele, Milan, Italy
| | - Ferdinando Varbella
- Interventional Cardiology, Infermi Hospital, Rivoli and San Luigi Gonzaga, Orbassano, Italy
| | - Javier Escaned
- Department of Cardiology, Hopital Clínico San Carlos, Madrid, Spain
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50
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Wischnewsky MB, Candreva A, Bacchi B, Cammann VL, Kato K, Szawan KA, Gili S, D'Ascenzo F, Dichtl W, Citro R, Bossone E, Neuhaus M, Franke J, Sorici-Barb I, Jaguszewski M, Noutsias M, Knorr M, Heiner S, Burgdorf C, Kherad B, Tschöpe C, Sarcon A, Shinbane J, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Karakas M, Koenig W, Pott A, Meyer P, Arroja JD, Banning A, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KEJ, Napp LC, Budnik M, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Chan C, Bridgman P, Beug D, Delmas C, Lairez O, El-Battrawy I, Akin I, Gilyarova E, Shilova A, Gilyarov M, Kozel M, Tousek P, Winchester DE, Galuszka J, Ukena C, Poglajen G, Carrilho-Ferreira P, Hauck C, Paolini C, Bilato C, Prasad A, Rihal CS, Liu K, Schulze PC, Bianco M, Jörg L, Rickli H, Nguyen TH, Kobayashi Y, Böhm M, Maier LS, Pinto FJ, Widimský P, Borggrefe M, Felix SB, Opolski G, Braun-Dullaeus RC, Rottbauer W, Hasenfuß G, Pieske BM, Schunkert H, Thiele H, Bauersachs J, Katus HA, Horowitz J, Di Mario C, Münzel T, Crea F, Bax JJ, Lüscher TF, Ruschitzka F, Ghadri JR, Templin C. Prediction of short- and long-term mortality in takotsubo syndrome: the InterTAK Prognostic Score. Eur J Heart Fail 2019; 21:1469-1472. [PMID: 31452320 DOI: 10.1002/ejhf.1561] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 06/25/2019] [Accepted: 06/25/2019] [Indexed: 01/27/2023] Open
Affiliation(s)
| | - Alessandro Candreva
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Beatrice Bacchi
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Victoria L Cammann
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Ken Kato
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Konrad A Szawan
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | | | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Wolfgang Dichtl
- University Hospital for Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Innsbruck, Austria
| | - Rodolfo Citro
- Heart Department, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Eduardo Bossone
- Division of Cardiology, 'Antonio Cardarelli' Hospital, Naples, Italy
| | - Michael Neuhaus
- Department of Cardiology, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
| | - Jennifer Franke
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Ioana Sorici-Barb
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Milosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Michel Noutsias
- Division of Cardiology, Department of Internal Medicine III, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Halle (Saale), Germany
| | - Maike Knorr
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Susanne Heiner
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | | | - Behrouz Kherad
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Carsten Tschöpe
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Annahita Sarcon
- University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Jerold Shinbane
- University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | | | - Guido Michels
- Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
| | - Roman Pfister
- Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
| | | | - Claudius Jacobshagen
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany
| | - Mahir Karakas
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Alexander Pott
- Department of Internal Medicine II - Cardiology, University of Ulm, Medical Center, Ulm, Germany
| | - Philippe Meyer
- Service de Cardiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Jose David Arroja
- Service de Cardiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Adrian Banning
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Florim Cuculi
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Richard Kobza
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Thomas A Fischer
- Department of Cardiology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Tuija Vasankari
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | | | - L Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Monika Budnik
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | | | - Christoph Kaiser
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Leonarda Galiuto
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Christina Chan
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Paul Bridgman
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Daniel Beug
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Clément Delmas
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Olivier Lairez
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Ibrahim El-Battrawy
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg-Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg-Mannheim, Mannheim, Germany
| | - Ekaterina Gilyarova
- Intensive Coronary Care Unit, Moscow City Hospital No. 1 named after N. Pirogov, Moscow, Russia
| | - Alexandra Shilova
- Intensive Coronary Care Unit, Moscow City Hospital No. 1 named after N. Pirogov, Moscow, Russia
| | - Mikhail Gilyarov
- Intensive Coronary Care Unit, Moscow City Hospital No. 1 named after N. Pirogov, Moscow, Russia
| | - Martin Kozel
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Tousek
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - David E Winchester
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jan Galuszka
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Christian Ukena
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Hamburg/Saar, Germany
| | - Gregor Poglajen
- Advanced Heart Failure and Transplantation Center, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Pedro Carrilho-Ferreira
- Cardiology Department, Santa Maria University Hospital, CHLN, CAML, CCUL, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Christian Hauck
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Carla Paolini
- Division of Cardiology, West Vicenza General Hospitals, Vicenza, Italy
| | - Claudio Bilato
- Division of Cardiology, West Vicenza General Hospitals, Vicenza, Italy
| | - Abhiram Prasad
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Charanjit S Rihal
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Kan Liu
- Division of Cardiology, Heart and Vascular Center, University of Iowa, Iowa City, IA, USA
| | - P Christian Schulze
- Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - Matteo Bianco
- Division of Cardiology, A.O.U San Luigi Gonzaga, Turin, Italy
| | - Lucas Jörg
- Department of Cardiology, Gallen, Switzerland
| | - Hans Rickli
- Department of Cardiology, Gallen, Switzerland
| | - Thanh H Nguyen
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Hamburg/Saar, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Fausto J Pinto
- Cardiology Department, Santa Maria University Hospital, CHLN, CAML, CCUL, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Petr Widimský
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Martin Borggrefe
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg-Mannheim, Mannheim, Germany
| | - Stephan B Felix
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Grzegorz Opolski
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | - Wolfgang Rottbauer
- Department of Internal Medicine II - Cardiology, University of Ulm, Medical Center, Ulm, Germany
| | - Gerd Hasenfuß
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany
| | - Burkert M Pieske
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Berlin; and Berlin Institute of Health (BIH), Berlin, Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig - University Hospital, Leipzig, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Hugo A Katus
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - John Horowitz
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia
| | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Thomas Münzel
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Filippo Crea
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Thomas F Lüscher
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Zurich, Switzerland.,Royal Brompton and Harefield Hospitals Trust and Imperial College, London, UK
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Jelena R Ghadri
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
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