1
|
Ugursu B, Sah A, Sartori S, Popp O, Mertins P, Dunay IR, Kettenmann H, Singewald N, Wolf SA. Microglial sex differences in innate high anxiety and modulatory effects of minocycline. Brain Behav Immun 2024; 119:465-481. [PMID: 38552926 DOI: 10.1016/j.bbi.2024.03.035] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 02/08/2024] [Accepted: 03/26/2024] [Indexed: 04/18/2024] Open
Abstract
Microglia modulate synaptic refinement in the central nervous system (CNS). We have previously shown that a mouse model with innate high anxiety-related behavior (HAB) displays higher CD68+ microglia density in the key regions of anxiety circuits compared to mice with normal anxiety-related behavior (NAB) in males, and that minocycline treatment attenuated the enhanced anxiety of HAB male. Given that a higher prevalence of anxiety is widely reported in females compared to males, little is known concerning sex differences at the cellular level. Herein, we address this by analyzing microglia heterogeneity and function in the HAB and NAB brains of both sexes. Single-cell RNA sequencing revealed ten distinct microglia clusters varied by their frequency and gene expression profile. We report striking sex differences, especially in the major microglia clusters of HABs, indicating a higher expression of genes associated with phagocytosis and synaptic engulfment in the female compared to the male. On a functional level, we show that female HAB microglia engulfed a greater amount of hippocampal vGLUT1+ excitatory synapses compared to the male. We moreover show that female HAB microglia engulfed more synaptosomes compared to the male HAB in vitro. Due to previously reported effects of minocycline on microglia, we finally administered oral minocycline to HABs of both sexes and showed a significant reduction in the engulfment of synapses by female HAB microglia. In parallel to our microglia-specific findings, we further showed an anxiolytic effect of minocycline on female HABs, which is complementary to our previous findings in the male HABs. Our study, therefore, identifies the altered function of synaptic engulfment by microglia as a potential avenue to target and resolve microglia heterogeneity in mice with innate high anxiety.
Collapse
Affiliation(s)
- Bilge Ugursu
- Psychoneuroimmunology, Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany; Experimental Ophthalmology, ChariteUniversitätsmedizin Berlin, Germany
| | - Anupam Sah
- Pharmacology and Toxicology, Institute of Pharmacy and CMBI, University of Innsbruck, Austria
| | - Simone Sartori
- Pharmacology and Toxicology, Institute of Pharmacy and CMBI, University of Innsbruck, Austria
| | - Oliver Popp
- Proteomics Platform, Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association, Berlin Institute of Health, Berlin, Germany
| | - Philip Mertins
- Proteomics Platform, Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association, Berlin Institute of Health, Berlin, Germany
| | - Ildiko R Dunay
- Institute of Inflammation and Neurodegeneration, Otto-von-Guericke-University Magdeburg, Germany
| | - Helmut Kettenmann
- Shenzhen Key Laboratory of Immunomodulation for Neurological Diseases, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China; Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Nicolas Singewald
- Pharmacology and Toxicology, Institute of Pharmacy and CMBI, University of Innsbruck, Austria
| | - Susanne A Wolf
- Psychoneuroimmunology, Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany; Experimental Ophthalmology, ChariteUniversitätsmedizin Berlin, Germany.
| |
Collapse
|
2
|
Sorcini D, Stella A, Scialdone A, Sartori S, Marra A, Rossi R, De Falco F, Adamo FM, Dorillo E, Geraci C, Arcaleni R, Rompietti C, Esposito A, Moretti L, Mameli MG, Martelli MP, Falini B, Sportoletti P. FLT3-targeted therapy restores GATA1 pathway function in NPM1/FLT3-ITD mutated acute myeloid leukaemia. EJHaem 2023; 4:1100-1104. [PMID: 38024637 PMCID: PMC10660397 DOI: 10.1002/jha2.738] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/05/2023] [Accepted: 06/09/2023] [Indexed: 12/01/2023]
Abstract
One-third of newly diagnosed adult acute myeloid leukaemia (AML) carry FLT3 mutations, which frequently occur together with nucleophosmin (NPM1) mutations and are associated with worse prognosis. FLT3 inhibitors are widely used in clinics with limitations due to drug resistance. AML cells carrying FLT3 mutations in both mouse models and patients present low expression of GATA1, a gene involved in haematopoietic changes preceding AML. Here, we show that FLT3 inhibition induces cellular responses and restores the GATA1 pathway and functions in NPM1/FLT3-ITD mutated AML, thus providing a new mechanism of action for this drug.
Collapse
Affiliation(s)
- D Sorcini
- Department of Medicine and SurgeryCentro di Ricerca Emato‐OncologicheUniversity of PerugiaPerugiaItaly
| | - A Stella
- Department of Medicine and SurgeryCentro di Ricerca Emato‐OncologicheUniversity of PerugiaPerugiaItaly
| | - A Scialdone
- Department of Medicine and SurgeryCentro di Ricerca Emato‐OncologicheUniversity of PerugiaPerugiaItaly
| | - S Sartori
- Department of Medicine and SurgeryCentro di Ricerca Emato‐OncologicheUniversity of PerugiaPerugiaItaly
| | - A Marra
- Department of Medicine and SurgeryCentro di Ricerca Emato‐OncologicheUniversity of PerugiaPerugiaItaly
| | - R Rossi
- Department of Medicine and SurgeryCentro di Ricerca Emato‐OncologicheUniversity of PerugiaPerugiaItaly
| | - F De Falco
- Department of Medicine and SurgeryCentro di Ricerca Emato‐OncologicheUniversity of PerugiaPerugiaItaly
| | - FM Adamo
- Department of Medicine and SurgeryCentro di Ricerca Emato‐OncologicheUniversity of PerugiaPerugiaItaly
| | - E Dorillo
- Department of Medicine and SurgeryCentro di Ricerca Emato‐OncologicheUniversity of PerugiaPerugiaItaly
| | - C Geraci
- Department of Medicine and SurgeryCentro di Ricerca Emato‐OncologicheUniversity of PerugiaPerugiaItaly
| | - R Arcaleni
- Department of Medicine and SurgeryCentro di Ricerca Emato‐OncologicheUniversity of PerugiaPerugiaItaly
| | - C Rompietti
- Department of Medicine and SurgeryCentro di Ricerca Emato‐OncologicheUniversity of PerugiaPerugiaItaly
| | - A Esposito
- Department of Medicine and SurgeryCentro di Ricerca Emato‐OncologicheUniversity of PerugiaPerugiaItaly
| | - L Moretti
- Department of Medicine and SurgeryCentro di Ricerca Emato‐OncologicheUniversity of PerugiaPerugiaItaly
| | - MG Mameli
- Department of Medicine and SurgeryCentro di Ricerca Emato‐OncologicheUniversity of PerugiaPerugiaItaly
| | - MP Martelli
- Department of Medicine and SurgeryCentro di Ricerca Emato‐OncologicheUniversity of PerugiaPerugiaItaly
| | - B Falini
- Department of Medicine and SurgeryCentro di Ricerca Emato‐OncologicheUniversity of PerugiaPerugiaItaly
| | - P Sportoletti
- Department of Medicine and SurgeryCentro di Ricerca Emato‐OncologicheUniversity of PerugiaPerugiaItaly
| |
Collapse
|
3
|
Spirito A, Koh WJ, Sartori S, Snyder C, Nicholas J, Cao D, Vogel B, Rezvanizadeh V, Jones D, Baber U, Sweeny J, Sharma S, Kini A, Dangas G, Mehran R. Prevalence and impact of TWILIGHT criteria in all-comer patients undergoing percutaneous coronary intervention. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The Ticagrelor with Aspirin or Alone in High-Risk Patients after Coronary Intervention (TWILIGHT) randomized clinical trial demonstrated that in selected high risk patients who took ticagrelor and aspirin for 3 months after percutaneous coronary intervention (PCI), continuing ticagrelor alone was associated with significantly less bleeding events than ticagrelor plus aspirin and did not lead to ischemic harm over a period of 1 year (1).
The prevalence and risk of adverse events of patients fulfilling the TWILIGHT inclusion criteria in real-world setting is unclear.
Purpose
To elucidate the prevalence and prognosis of patients fulfilling the TWILIGHT inclusion criteria.
Methods
Patients that received at least one drug eluting stent in a coronary artery at a large tertiary center (Mount Sinai Hospital, New York) were considered for inclusion. As in the TWILIGHT trial, individuals on chronic oral anticoagulation treatment, with STEMI, cardiogenic shock, on dialysis, with prior stroke, or platelet count <100,000 were excluded. Patients were stratified in two groups: 1) TWILIGHT-like patients, who met at least one clinical (age ≥65 years, female sex, established vascular disease, diabetes mellitus, estimated glomerular fraction rate <60mL/min, acute coronary syndrome with troponin increase) and one angiographic (multivessel coronary artery disease [CAD], stent length >30mm, thrombotic target lesion, bifurcation requiring 2 stents, left main or proximal left anterior descending artery lesion, atherectomy device use, SYNTAX score ≥23) TWILIGHT inclusion criterion; 2) Non-TWILIGHT-like patients, who did not fulfil at least one clinical and one angiographic TWILIGHT inclusion criterion.
The primary outcome was a composite of death, myocardial infarction (MI), stroke. Secondary outcomes included bleeding, components of the primary outcome, target vessel and target lesion revascularization, stent thrombosis. All events were assessed at 1 year after PCI.
Results
Out of 30,470 patients undergoing PCI between 2012 and 2019, 13,236 were included in the current analysis. TWILIGHT criteria were met in 11,018 (83%) patients. Established vascular disease and multivessel CAD were the most frequently fulfilled criteria. At 1 year, TWILIGHT-like patients were at higher risk for the primary outcome (3.2% vs 1.1%, HR 2.85, 95% CI 1.83–4.44), severe bleeding (3.3% vs 1.8%, HR 1.86, 95% CI 1.32–2.62), all-cause death (1.4% vs 0.4%, HR 3.63, 95% CI 1.70–7.77), myocardial infarction (1.8% vs 0.6%, HR 2.81 95% CI 1.56–5.04), TVR (7.8% vs 4.1%, HR 1.94, 95% CI 1.53–2.47), TLR (5.1% vs 1.7%, HR 2.98 95% CI 2.07–4.29). Stent thrombosis and stroke rate were generally low and did not differ between patients meeting or not the TWILIGHT inclusion criteria.
Conclusion
Among all-comer patients undergoing PCI, the fulfillment of the TWILIGHT inclusion criteria is frequent and is associated with a higher risk of death, ischemic and bleeding complications
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- A Spirito
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| | - W J Koh
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| | - S Sartori
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| | - C Snyder
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| | - J Nicholas
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| | - D Cao
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| | - B Vogel
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| | - V Rezvanizadeh
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| | - D Jones
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| | - U Baber
- University of Oklahoma Health Sciences Center , Oklahoma City , United States of America
| | - J Sweeny
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| | - S Sharma
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| | - A Kini
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| | - G Dangas
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| | - R Mehran
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| |
Collapse
|
4
|
Spirito A, Kastrati A, Moliterno DJ, Baber U, Cao D, Sartori S, Collier T, Gibson CM, Angiolillo DJ, Pocock SJ, Cohen DJ, Escaned J, Sardella G, Dangas G, Mehran R. Impact of different antiplatelet therapy cessation modes on outcomes in patients treated with ticagrelor with or without aspirin after PCI: the twilight-antiplatelet cessation study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention (TWILIGHT) trial showed that a regimen consisting of a 3-month dual antiplatelet therapy (DAPT) followed by ticagrelor monotherapy reduces the rate of bleeding events without increasing ischemic complications compared with standard DAPT [1]. Previous studies, such as Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients (PARIS) demonstrated how deviation or cessation of the prescribed antiplatelet regimen might negatively affect clinical outcomes [2].
Purpose
The proposed analysis aims to assess the impact of different antiplatelet therapy cessation patterns on ischemic and bleeding outcomes in patients treated with ticagrelor with or without aspirin after percutaneous coronary intervention (PCI).
Methods
All 7,119 patients randomized at 3 months post-PCI in the TWILIGHT study will be included. The analyses will be conducted separately in the two treatment arms (ticagrelor plus placebo and ticagrelor plus aspirin). According to the PARIS study definitions and as prespecified in the TWILIGHT trial protocol, the occurrence of the three following antiplatelet cessation modes will be assessed: 1) discontinuation (e.g., caused by intolerable side effects or because of a safety concern); 2) interruption (temporary, <14 days, because of surgical or other invasive procedures); 3) disruption (due to non-compliance or bleeding).
The primary endpoint will be the composite of all-cause death, myocardial infarction (MI), or stroke at 12 months after randomization. The key secondary endpoint will be BARC type 2, 3 or 5 bleeding. Other secondary endpoints will include the components of the primary endpoint, cardiovascular death, definite or probable stent thrombosis and BARC types 3 or 5 bleeding. The number of events will be estimated according to the antiplatelet cessation status before the clinical event. Hazard ratios and 95% confidence intervals will be generated using Cox proportional hazards models including antiplatelet therapy cessation as a time-updated variable. If more than one cessation event occurred during follow-up, the antiplatelet therapy cessation category will change only if the more recent mode is worse than the previous: disruption will have priority over interruption, which in turn will have priority over discontinuation. Patients without cessation events will represent the reference group. All adverse events and episodes of antiplatelet cessation were independently adjudicated.
Results
The results of this analysis will be presented for the first time at ESC 2022.
Conclusion
This prespecified analysis of the TWILIGHT study will show for the first time the impact on clinical outcomes of different antiplatelet therapy cessation modes when a regimen of Ticagrelor with our without aspirin is prescribed after PCI.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Astra Zeneca, United Kingdom
Collapse
Affiliation(s)
- A Spirito
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| | - A Kastrati
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
| | - D J Moliterno
- University of Kentucky, Division of Cardiovascular Medicine, Gill Heart Institute , Lexington , United States of America
| | - U Baber
- University of Oklahoma Health Sciences Center , Oklahoma City , United States of America
| | - D Cao
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| | - S Sartori
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| | - T Collier
- London School of Hygiene and Tropical Medicine, Department of Medical Statistics , London , United Kingdom
| | - C M Gibson
- Beth Israel Deaconess Medical Center , Boston , United States of America
| | - D J Angiolillo
- University of Florida College of Medicine , Jacksonville , United States of America
| | - S J Pocock
- London School of Hygiene and Tropical Medicine, Department of Medical Statistics , London , United Kingdom
| | - D J Cohen
- St. Francis Hospital, Department of Cardiology , Roslyn , United States of America
| | - J Escaned
- Complutense University of Madrid, Hospital Clínico San Carlos IDISCC , Madrid , Spain
| | - G Sardella
- Polyclinic Umberto I, Department of Cardiovascular Sciences , Rome , Italy
| | - G Dangas
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| | - R Mehran
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| |
Collapse
|
5
|
Mehran R, Spirito A, Cao D, Sartori S, Baber U, Dangas G, Gibson CM, Steg PG, Pocock SJ, Valgimigli M. Safety and efficacy of biodegradable polymer biolimus-eluting stents in patients with non-ST-elevation acute coronary syndrome: a pooled analysis of GLASSY and TWILIGHT. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Biodegradable polymer (BP) drug-eluting stents (DES) have shown similar safety and efficacy compared with second-generation durable polymer (DP)-DES in several randomized trials and meta-analyses. However, study participants were generally maintained on a standard dual antiplatelet therapy (DAPT) for at least 6 months after percutaneous coronary intervention (PCI). Therefore, the differences in thrombogenicity between these two stent technologies may have been unappreciated, especially among patients with acute coronary syndrome (ACS).
Purpose
We aimed to compare the safety and efficacy of BP Biolimus-Eluting Stent (BP-BES) versus 2nd generation DP-DES among ACS patients undergoing PCI and receiving ticagrelor alone or in combination with aspirin.
Methods
We pooled individual patient-level data from two randomized controlled trials, the Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention (TWILIGHT, n=9,006) (1) and the GLOBAL LEADERS Adjudication Sub-Study (GLASSY, n=7,585) (2). In order to reduce biases related to trial design differences, only NST-ACS patients not fulfilling any exclusion criterion of both studies were included and 2 separate analysis for short (0 to 3 months after PCI) and long-term (3 to 12 months after PCI) outcomes were performed. Patients were stratified according to the stent used at index PCI (BP-BES vs 2nd generation DP-DES). In both analysis, the primary outcome was major adverse cardiovascular events (MACE, a composite of cardiovascular death, myocardial infarction and definite or probable stent thrombosis); the key secondary outcomes were target-vessel failure (TVF) and BARC 2, 3 or 5 bleeding. Events rate and risk were assessed separately for the two study periods and subsequently 12-months risk estimates were derived by pooling the results of the two analysis.
Results
Out of 7,729 and 6,572 NST-ACS patients included in the two analysis, 2,321 (30%) and 2,211 (33.6%) received a BP-BES, respectively. Among patients treated with BP-BES versus DP-DES, the occurrence of MACE was similar at 3 months after PCI (1.1% vs 1.4%, adjusted HR 0.81, 95% CI 0.51–1.29), while it was significantly lower in the former group between 3 and 12 months (1.7% vs 3.1%, adj. HR 0.46, 95% CI 0.32–0.67) and in the overall period (pooled adjusted HR estimate 0.58, 95% CI 0.43–0.77).
Similarly, significant differences were observed for TVF and BARC 2, 3, or 5 bleeding, whose risk at 12 months was lower among BP-BES than DP-DES patients (pooled adj. HR estimate 0.49, 95% CI 0.38–0.63 and 0.79, 95% CI 0.79, 95% CI 0.65–0.97, respectively).
Conclusion
As compared to 2nd generation DP-DES, BP-BES was associated with a lower risk of MACE, TVF and bleeding among NST-ACS patients undergoing PCI and treated with ticagrelor with or without aspirin. The findings of this analysis are exploratory and need further confirmation.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Biosensors (Singapore)
Collapse
Affiliation(s)
- R Mehran
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| | - A Spirito
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| | - D Cao
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| | - S Sartori
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| | - U Baber
- University of Oklahoma Health Sciences Center , Oklahoma City , United States of America
| | - G Dangas
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| | - C M Gibson
- Beth Israel Deaconess Medical Center , Boston , United States of America
| | - P G Steg
- Bichat APHP Site of Paris Nord University Hospital , Paris , France
| | - S J Pocock
- London School of Hygiene and Tropical Medicine, Department of Medical Statistics , London , United Kingdom
| | - M Valgimigli
- Cardiocentro Ticino Institute , Lugano , Switzerland
| |
Collapse
|
6
|
Jones D, Sartori S, Cao D, Nicolas J, Spirito A, Beerkens F, Edens M, Synder C, Dangas G, Mehran R. Impact of body mass index on outcomes in patients undergoing percutaneous coronary intervention for in-stent restenosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Recent advances in drug eluting stents (DES) design have significantly decreased the rates of in-stent restenosis (ISR). Nonetheless, ISR remains a major problem, affecting 5–10% of patients undergoing percutaneous coronary intervention (PCI). Furthermore, PCI for ISR is often a poor prognostic factor for outcomes after the procedure. Historically, obese patients tended to have better outcomes when undergoing PCI, however it is unclear if this trend continues for the same population undergoing PCI for ISR.
Purpose
Investigate the outcomes of patients undergoing PCI for ISR in the overweight and normal weight population.
Methods
All patients undergoing PCI with DES implantation at a tertiary care center from January 2012 to December 2019 were included. Normal weight was defined as a body mass index (BMI) greater than or equal to 18.5 kg/m2 and less than 25 kg/m2, while overweight was defined as a BMI greater than or equal to 25 kg/m2. Patients with BMI <18.5 kg/m2, underwent PCI for acute myocardial infarction (MI), or received a bare metal stent (BMS) were excluded. The primary outcome was major events (MACE), a composite of all-cause mortality, myocardial infarction (MI), and target vessel revascularization (TVR) up to one year after PCI. Secondary outcomes included individual components of the primary endpoint.
Results
Out of 16,234 patients with available data on BMI, 12,444 (76.7%) were overweight and 3,790 (23.3%) were normal weight. Among overweight patients, 2,879 (23.1%) underwent PCI for ISR versus 815 (21.5%) of normal weight patients. Regardless of BMI status, patients undergoing PCI for ISR had higher rates of co-morbidities such as hypertension, hyperlipidemia, and diabetes mellitus than non-ISR counterparts. At one year post PCI, both overweight and normal weight patients undergoing PCI for ISR had increased risk of MACE (overweight: 18.4% vs. 6.7%; HR 2.83; 95% CI 2.50–3.20; normal weight: 18.8% vs. 7.8%, HR 2.43, 95% CI 1.95–3.04) when compared to non-ISR counterparts, mostly driven by TVR (overweight: 16% vs. 4.6%; HR 3.58; 95% CI 3.11–4.13; normal weight: 15.2% vs. 4.1%; HR 3.69; 95% CI 2.80–4.86). However, only overweight patients undergoing PCI for ISR had higher risk of all cause mortality (2.2% vs. 1.5%; HR 1.42; 95% CI 1.03–1.95) and MI (3.0% vs. 1.3%, HR 2.22; 95% CI 1.64–2.99) when compared to non-ISR counterparts (Figure 1).
Conclusions
PCI for ISR was associated with increased risk of MACE, irrespective of body weight. The risks of all-cause mortality and MI in ISR vs non-ISR patients only reached statistical significance in overweight patients.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- D Jones
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| | - S Sartori
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| | - D Cao
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| | - J Nicolas
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| | - A Spirito
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| | - F Beerkens
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| | - M Edens
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| | - C Synder
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| | - G Dangas
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| | - R Mehran
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| |
Collapse
|
7
|
Cao D, Valgimigli M, Sartori S, Spirito A, Snyder C, Mehran R. Short dual antiplatelet therapy duration in high bleeding risk patients undergoing PCI for non-ST-elevation acute coronary syndrome. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) remain at increased risk of recurrent ischemic events. An abbreviated dual antiplatelet therapy (DAPT) duration as short as 1 month has been suggested for those at high bleeding risk (HBR). Whether the benefits of 1-month DAPT are preserved in HBR patients presenting with non-ST-elevation ACS (NSTE-ACS) is subject of debate.
Purpose
To assess the impact of NSTE-ACS presentation on the ischemic and bleeding outcomes of HBR patients undergoing PCI with a cobalt-chromium everolimus-eluting stent followed by a 1-month versus 3-month DAPT.
Methods
The XIENCE Short DAPT Program encompasses three prospective, international, single-arm studies evaluating the safety and efficacy of a 1-month (XIENCE 28 USA and Global) or 3-month (XIENCE 90) DAPT duration. The program enrolled HBR patients who had undergone successful XIENCE stent implantation for acute or chronic coronary syndrome (excluding ST-elevation ACS). Event-free subjects discontinued DAPT at 1 or 3 months post-PCI. The primary endpoint was the composite of all-cause death or myocardial infarction (MI), while the key secondary endpoint was Bleeding Academic Research Consortium (BARC) type 2–5 bleeding between 1 and 12 months post-PCI. Ischemic and bleeding events associated with 1-month versus 3-month DAPT were assessed according to clinical presentation using propensity-score (PS) adjustment.
Results
Out of 3,364 HBR patients (n=1,392 on 1-month DAPT and n=1,972 on 3-month DAPT), 1164 (34.6%) underwent PCI for NSTE-ACS. At 12 months, the risk of death or MI was similar between 1- and 3-month DAPT in patients with (adjHR 1.12, 95% CI 0.73–1.70) and without NSTE-ACS (adjHR 0.92, 95% CI 0.65–1.29; p-interaction = 0.33). Landmark analysis between 1 and 3 months post-PCI showed significant treatment effect modification according to clinical presentation (p-interaction = 0.03) with greater benefit of 1-month DAPT in stable patients. BARC 2–5 bleeding was consistently reduced in both NSTE-ACS (adjHR 0.58, 95% CI 0.38–0.90) and stable patients (adjHR 0.86, 95% CI 0.63–1.18; p-interaction = 0.15).
Conclusions
Among HBR patients undergoing PCI with an everolimus-eluting stent, 1-month compared with 3-month DAPT was associated with similar 1-year risk of ischemic events and reduced bleeding, irrespective of clinical presentation. Between 1 and 3 months post-PCI, however, stable patients seemed to derive greater net benefit from 1-month DAPT compared to those with NSTE-ACS.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Abbott
Collapse
Affiliation(s)
- D Cao
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| | | | - S Sartori
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| | - A Spirito
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| | - C Snyder
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| | - R Mehran
- Icahn School of Medicine at Mount Sinai , New York , United States of America
| |
Collapse
|
8
|
Sartori S, Crescioli G, Brilli V, Traversoni S, Lanzi C, Vannacci A, Mannaioni G, Lombardi N. Phenobarbital use in benzodiazepine and z-drug detoxification: a single-centre 15-year observational retrospective study in clinical practice. Intern Emerg Med 2022; 17:1631-1640. [PMID: 35412225 PMCID: PMC9001824 DOI: 10.1007/s11739-022-02976-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/16/2022] [Indexed: 11/25/2022]
Abstract
Given the increase in benzodiazepine (BZD) and Z-drug (ZD) use disorder, this study described the use of phenobarbital (PHB) as detoxification in clinical practice. A 15-year observational retrospective study was performed on medical records of BZD-ZD use disorder patients detoxified with PHB at the Toxicology Unit and Poison Centre, Careggi University Hospital, Florence (Italy). A multivariate logistic regression was used to estimate odd ratios (ORs) and related 95% confidence intervals (CI) of "treatment failure" considering demographic and pharmacological characteristics. "Hospitalisation length", "PHB discharge dose", and "BZD-ZD free status" at discharge were also calculated. During detoxification, out of 355 patients (57% of men), with a mean age of 42.92 years, only 20 (5.6%) treatment failures were recorded: 19 were discharged against medical advice or due to misbehaviour, and only one for PHB-related non-serious skin rash. Analysis showed a higher probability to be BZD-ZD free at discharge for subjects who reported to be employed (OR 2.29; CI 95% 1.00-5.24), for those who abused oral drops of BZD-ZD (OR 2.16, CI 1.30-3.59), and for those treated with trazodone (OR 2.86, CI 1.14-7.17) during hospital stay. A hospitalisation length of > 7 days was observed for patients with opioid maintenance therapy (OR 2.07, CI 1.20-3.58) for substance use disorder, and for those treated with more than 300 mg/day of PHB equivalents at hospital admission (OR 1.68, CI 1.03-2.72). Our results suggested that PHB can be considered a valuable detoxification option for different types of BZD and ZD use disorder patients.
Collapse
Affiliation(s)
- Simone Sartori
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139, Florence, Italy
- Medical Toxicology Unit and Poison Control Centre, Careggi University Hospital, Florence, Italy
| | - Giada Crescioli
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139, Florence, Italy
- Tuscan Regional Centre of Pharmacovigilance, Florence, Italy
| | - Valentina Brilli
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139, Florence, Italy
- Medical Toxicology Unit and Poison Control Centre, Careggi University Hospital, Florence, Italy
| | - Sara Traversoni
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139, Florence, Italy
- Medical Toxicology Unit and Poison Control Centre, Careggi University Hospital, Florence, Italy
| | - Cecilia Lanzi
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139, Florence, Italy
- Medical Toxicology Unit and Poison Control Centre, Careggi University Hospital, Florence, Italy
| | - Alfredo Vannacci
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139, Florence, Italy.
- Tuscan Regional Centre of Pharmacovigilance, Florence, Italy.
| | - Guido Mannaioni
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139, Florence, Italy
- Medical Toxicology Unit and Poison Control Centre, Careggi University Hospital, Florence, Italy
| | - Niccolò Lombardi
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139, Florence, Italy
- Tuscan Regional Centre of Pharmacovigilance, Florence, Italy
| |
Collapse
|
9
|
Campello E, Francavilla A, Pelizza M, Sebellin S, Nosadini M, Pin J, Lorenzoni G, Biffi A, Gregori D, Forestan C, Martinato M, Sartori S, Simioni P. PO-59: Dealing with pediatric cancer associated thrombosis: a case report and a monocentric cohort study. Thromb Res 2022. [DOI: 10.1016/s0049-3848(22)00249-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
10
|
De Iaco F, Mannaioni G, Serra S, Finco G, Sartori S, Gandolfo E, Sansone P, Marinangeli F. Equianalgesia, opioid switch and opioid association in different clinical settings: a narrative review. Eur Rev Med Pharmacol Sci 2022; 26:2000-2017. [PMID: 35363351 DOI: 10.26355/eurrev_202203_28349] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Emergency or postoperative pain often represents an authentic challenge in patients who were already on opioid treatment for chronic pain. Thus, their management requires not only the physician's ability to treat acute pain, but also competence in switching the opioid that lost efficacy. Different aspects should be considered, such as opioids titration, switching, association and equianalgesia. The objective of this paper is to provide a narrative review, which has been elaborated and discussed among clinicians through an iterative process involving development and review of the draft during two web-based meetings and via email. This expert opinion aims to facilitate the correct opioid use through appropriate practices with a focus on pain treatment in emergency and postoperative pain. Equianalgesia tables were reviewed and integrated by clinicians and researchers with expertise in anesthesia, postoperative medicine, intensive care, emergency medicine pharmacology and addiction medicine. Special populations (liver/kidney failure, elder, pediatric, pregnancy/lactation) are discussed in detail along with other critical scenarios, such as: (i) rapid pain worsening in chronic pain (aggravating pain due to disease progression or tolerance development to analgesic therapy); (ii) acute pain on maintenance treatment; and (iii) pain management of complicated patients in emergency care. Extended and updated equianalgesia tables and conversion rates for 17 different opioid formulations (of 9 different molecules) are presented as follows. Opioids remain the class that best suits clinical needs of emergency and post-operative medicine. However, it should be stressed that equianalgesia can be affected by drug-to-drug interactions and pharmacological imprecision, in a complex field where clinical experience may be the main guiding principle.
Collapse
Affiliation(s)
- F De Iaco
- Emergency Department, Martini Hospital, ASL Città di Torino, Torino, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Sartori S, Brilli V, Lanzi C, Pratticò L, Sarcoli E, Di Milia MG, Gambassi F, Mannaioni G. Acute intoxication following massive bupropion sniffing: A case report. Emer Care J 2021. [DOI: 10.4081/ecj.2021.10037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Bupropion intranasal misuse potential should be considered in the suspect of sympathomimetic syndrome for illicit drug or medication intoxication. A 31-year-old man was admitted for intranasal misuse of 30 crushed tablets of bupropion with adrenergic mild presentation. Lorazepam infusion was started with complete clinical resolution. Further forensic investigations detected a bupropion serum and urine concentration levels at 18 hours from intake of 1905.26 ng/mL and 2001.57 ng/mL, respectively. This case of intranasal bupropion misuse shared only some features with oral overdose, despite a plasma concentration five times higher than the lowest toxic level. Nasal bupropion snorting in chronic users could have lower toxicity compared to other snorted stimulants but symptomatic treatment remains the gold standard for preventing complications. Bupropion misuse might rapidly become a concerning issue and monitoring by healthcare professionals is needed.
Collapse
|
12
|
Chiarito M, Cao D, Zhongjie Z, Sartori S, Nicolas J, Nardin M, Pivato CA, Tavenier A, Rao SV, Henry TD, Pocock S, Dangas G, Baber U, Kini A, Mehran R. Prasugrel or clopidogrel in patients with acute coronary syndromes at high thrombotic risk: results from the PROMETHEUS study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Potent P2Y12 inhibitors are recommended on top of aspirin in patients presenting with acute coronary syndrome (ACS). However, guideline recommendations suggest that the optimal antithrombotic strategy should be tailored based on patients thrombotic and hemorrhagic risk profile.
Purpose
It is poorly investigated if the benefits derived from potent P2Y12 inhibition in patients with ACS depend on the individual thrombotic risk profile. Our aim was to evaluate if the benefits associated with prasugrel vs. clopidogrel in patients with ACS undergoing percutaneous coronary intervention (PCI) are similar in case of different thrombotic risk profiles.
Methods
PROMETHEUS was a multicenter observational study comparing prasugrel vs. clopidogrel in ACS patients undergoing PCI. According to the 2020 ESC guidelines for non-ST elevation-ACS, patients are defined at high thrombotic risk if presenting with a clinical (diabetes mellitus requiring medication, history of recurrent myocardial infarction [MI], multivessel coronary artery disease [CAD], polyvascular [coronary and peripheral] disease, premature (<45 years) CAD, and chronic kidney disease [estimated glomerular filtration rate <60 ml/min/1.73m2]) and procedural (≥3 stents implanted, ≥3 lesions treated, total stent length >60 mm, complex revascularization [left main PCI, bifurcation or chronic total occlusion]) risk features. The primary endpoint was major adverse cardiac events (MACE), a composite of death, MI, stroke or unplanned revascularization. Hazard ratio (HR) and 95% confidence intervals (CI) were calculated using propensity-stratified analysis to assess the effect of prasugrel vs. clopidogrel and with multivariable Cox regression to evaluate the impact of thrombotic risk.
Results
Among 16065 patients, 4293 were defined at high thrombotic risk and 11772 at low-to-moderate thrombotic risk. Patients treated with prasugrel had less comorbidities and risk factors than those treated with clopidogrel, both in the high and low-to-moderate thrombotic risk strata. Patients at high thrombotic risk had higher rates of both ischemic and bleeding events at 90 days and at 1 year. Patients treated with prasugrel had a lower adjusted risk of MACE at 1 year (HR 0.86, 95% CI 0.77–0.96), with no significant interaction between effect estimates and thrombotic risk. However, after stratifying the study population by the number of risk factors, there was a significant interaction for a greater reduction in MACE with prasugrel in patients with ≤1 thrombotic risk factor. Conversely, there were no differences in major bleeding among patients treated with prasugrel and clopidogrel.
Conclusions
Patients with ACS at high thrombotic risk who undergo PCI are at increased risk of adverse events. Prasugrel, although mainly reserved to patients with lower burden of comorbidities, reduced the risk of ischemic events both in patients at high and low-to-moderate thrombotic risk as compared with clopidogrel.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Daiichi Sankyo and Eli Lilly and Company Clinical outcomes at 1 year.Impact of number of risk factors
Collapse
Affiliation(s)
- M Chiarito
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - D Cao
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - Z Zhongjie
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - S Sartori
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - J Nicolas
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - M Nardin
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - C A Pivato
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - A Tavenier
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - S V Rao
- Duke University Medical Center, Durham, United States of America
| | - T D Henry
- Cedars-Sinai Medical Center, Los Angeles, United States of America
| | - S Pocock
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - G Dangas
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - U Baber
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - A Kini
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - R Mehran
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | | |
Collapse
|
13
|
Tavenier AH, Chiarito M, Cao D, Pivato CA, Nicolas J, Nardin M, Sartori S, Baber U, Angiolillo DJ, Capodanno D, Kini AS, Sharma SK, Dangas G, Mehran R. Guided and unguided de-escalation from potent P2Y12 inhibitors among patients with ACS: a meta-analysis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Dual antiplatelet therapy (DAPT) with a potent P2Y12 inhibitor is recommended in patients with acute coronary syndrome (ACS) and should be tailored according to ischemic and bleeding risks, which are highest in the acute phase, and gradually attenuate overtime. De-escalation strategies of DAPT aim to optimize this balance of risks.
Purpose
We compared guided or unguided DAPT de-escalation strategies from potent P2Y12 inhibitors to either clopidogrel or lower doses of potent P2Y12 inhibitors versus standard DAPT with potent P2Y12 inhibitors among patients with ACS.
Methods
PubMed, Google Scholar and Cochrane Central Register of Controlled Trials were searched from inception till March 10th 2021. 1633 records were screened on DAPT de-escalation strategies after ACS for inclusion. Aspirin monotherapy and non-randomized trials were excluded.
The primary endpoint was BARC ≥2 bleeding. Other endpoints included MACE (defined according to the definitions reported in the original study protocols), all-cause death, cardiovascular death, myocardial infarction, stent thrombosis, and stroke. Hazard ratios (HRs) and 95% CIs were used as metric of choice for treatment effects with random-effects models. Heterogeneity was assessed with the I2 index. We assessed the interaction between de-escalation strategy (guided vs. unguided) and treatment with a random-effects meta-regression analysis with the empirical Bayes method. This study has been submitted to PROSPERO for registration.
Preliminary findings
Four randomised trials and a total of 8,082 patients randomly allocated to a de-escalation strategy (genetic guided to clopidogrel, n=1,242; platelet function guided to clopidogrel, n=1,304; unguided to clopidogrel (n=323); unguided to lower dose, n=1,170) or standard DAPT (n=4,043) were included in our analysis. De-escalation strategy had a reduction in BARC ≥2 bleeding (HR 0.57, 95% CI 0.37–0.89; I2=81%). MACE (HR 0.79, 95% CI 0.62–1.02; I2=0%), all-cause death (HR 0.89, 95% CI 0.58–1.36), cardiovascular death (HR 0.63, 95% CI 0.36–1.10; I2=0%), myocardial infarction (HR 0.81, 95% CI 0.56–1.17; I2=0%), stent thrombosis (HR 0.57, 95% CI 0.19–1.74; I2=0%) and stroke (HR 0.73, 95% CI 0.39–1.35; I2=0%) did not differ between patients with a de-escalation strategy and those without. Meta-regression analysis did not show any significant interaction between de-escalation method (guided vs. unguided) and treatment effects, except for BARC ≥2 bleeding (P interaction = 0.070), suggesting a greater reduction with unguided de-escalation.
Conclusion
A de-escalation strategy of DAPT after ACS was associated with a lower number of clinically relevant bleeding events, mostly in patients who underwent unguided de-escalation, while no association with increased ischemic events was found. However, the observed broad confidence intervals limit the certainty of our findings.
Funding Acknowledgement
Type of funding sources: None. BARC ≥2 bleedingMACE
Collapse
Affiliation(s)
- A H Tavenier
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - M Chiarito
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - D Cao
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - C A Pivato
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - J Nicolas
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - M Nardin
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - S Sartori
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - U Baber
- University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
| | - D J Angiolillo
- University of Florida College of Medicine, Jacksonville, United States of America
| | | | - A S Kini
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - S K Sharma
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - G Dangas
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - R Mehran
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| |
Collapse
|
14
|
Nicolas J, Cao D, Giustino G, Sartori S, Snyder C, Tavenier A, Chiarito M, Nardin M, Pivato C, Razuk V, Baber U, Windecker S, Stone G, Dangas G, Mehran R. Impact of left ventricular ejection fraction on clinical outcomes in females undergoing percutaneous coronary intervention with drug-eluting stents. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Reduced left ventricular ejection fraction (LVEF) is associated with increased risk of adverse events among patients undergoing percutaneous coronary intervention (PCI). Due to under-enrollment of females in randomized trials, there is limited data on the impact of LVEF on post-PCI outcomes in female patients.
Purpose
To evaluate the impact of varying degrees of LVEF impairment on 3-year outcomes in female patients undergoing PCI with drug-eluting stents (DES).
Methods
We pooled patient-level data of female patients from 26 randomized trials of coronary stents. The study population was stratified into three groups according to the 2016 European Society of Cardiology Heart Failure guidelines: LVEF ≥50% (normal), LVEF 40–49% (mid-range), and LVEF <40% (reduced). The primary outcome was major adverse cardiac events (MACE), a composite of cardiac death, myocardial infarction (MI), or stent thrombosis (ST) at 3-year follow-up. The Kaplan-Meier method was used for time-to-event analyses, with comparative risks being assessed using Cox regression.
Results
Out of 5672 female patients with available LVEF values at baseline, 4427 (78.1%) had normal LVEF, 602 (10.6%) had mid-range LVEF, and 643 (11.3%) had reduced LVEF. Patients with reduced LVEF were older and had a higher prevalence of smoking, prior MI, and multi-vessel disease. There was a stepwise increase in 3-year event rates moving from normal, to mid-range and reduced LVEF (Figure 1). After multivariable adjustment, hazard ratio (HR) for MACE was 1.45 (95% CI: 1.10–1.92) in patients with mid-range LVEF and 2.43 (95% CI: 1.84–3.22) in patients with reduced LVEF (trend p-value <0.0001). The risk of ST was more than doubled in both mid-range LVEF (HR 2.30, 95% CI: 1.30–4.06, p=0.004) and reduced LVEF patients (HR 2.18, 95% CI: 1.11–4.28, p=0.02), as compared with normal LVEF.
Conclusion
The presence of an even mild degree of LVEF impairment confers an increased risk of ischemic events, including ST, among females undergoing PCI with DES.
Funding Acknowledgement
Type of funding sources: None. Figure 1
Collapse
Affiliation(s)
- J Nicolas
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - D Cao
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - G Giustino
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - S Sartori
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - C Snyder
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - A Tavenier
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - M Chiarito
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - M Nardin
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - C Pivato
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - V Razuk
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - U Baber
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - S Windecker
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - G Stone
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - G Dangas
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - R Mehran
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | | |
Collapse
|
15
|
Kumar S, Kyaw H, Giustino G, Sartori S, Sharma S, Kini A, Mehran R. Sex-differences in outcomes after percutaneous coronary intervention of chronic total occlusions: insights from a large single-center registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Patients undergoing PCI of chronic total occlusions (CTO) are at high risk of both periprocedural and post-procedural adverse events. Whether sex-differences in outcomes exist after PCI of CTO remains unclear.
Purpose
We sought to investigate sex-differences in outcomes after CTO-PCI among an unselected real-world cohort of patients.
Methods
In our single-center retrospective study, patients who underwent elective CTO intervention from January 2000 to December 2019 were included. The primary endpoint of interest was major adverse cardiac events (MACE) defined as the composite of death, myocardial infarction (MI), and target vessel revascularization (TVR) at 1 year of follow-up.
Results
A total 1897 patients were included of which 368 were women (19.4%). Women were older (67±11.3 years vs. 62.6±10.9 years) and had a higher prevalence of comorbidities including diabetes and chronic kidney disease. Women had higher rates of procedure-related complications including increased risk of post-procedural bleeding requiring blood transfusion (3.0% vs 1.1%; p=0.007), and acute vessel closure (1.36% vs 0.2%; p=0.009). In multivariable-adjusted models for baseline confounders, female sex was associated with higher risk of MACE and TVR (Table 1).
Conclusion
Gender differences in CTO management are observed, with fewer females going for CTO revascularization in contemporary practice. Female sex is associated with procedural-related complications, higher MACE, and TVR even after successful CTO intervention.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- S Kumar
- Mount Sinai Medical Center, New York, United States of America
| | - H Kyaw
- Mount Sinai Medical Center, New York, United States of America
| | - G Giustino
- Mount Sinai Medical Center, New York, United States of America
| | - S Sartori
- Mount Sinai Medical Center, New York, United States of America
| | - S Sharma
- Mount Sinai Medical Center, New York, United States of America
| | - A Kini
- Mount Sinai Medical Center, New York, United States of America
| | - R Mehran
- Mount Sinai Medical Center, New York, United States of America
| |
Collapse
|
16
|
Cao D, Baber U, Dangas G, Sartori S, Zhongjie Z, Giustino G, Angiolillo DJ, Mehta S, Gibson CM, Sardella G, Sharma SK, Shlofmitz R, Collier T, Pocock S, Mehran R. Ticagrelor monotherapy after percutaneous coronary intervention in patients with concomitant diabetes mellitus and chronic kidney disease: a TWILIGHT substudy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Diabetes mellitus (DM) and chronic kidney disease (CKD) are established risk factors for cardiovascular events, with patients presenting both conditions being at extremely high risk. P2Y12 inhibitor monotherapy with ticagrelor after a short course of dual antiplatelet therapy has emerged as a bleeding avoidance strategy for high-risk patients undergoing percutaneous coronary intervention (PCI).
Purpose
To investigate ischemic and bleeding outcomes associated with ticagrelor monotherapy versus ticagrelor plus aspirin according to the presence or absence of CKD and DM.
Methods
The TWILIGHT trial enrolled patients undergoing PCI with a drug-eluting stent who fulfilled at least one clinical and one angiographic high-risk criterion. Both DM and CKD (estimated glomerular filtration rate <60 mL/min/1.73m2) were clinical study entry criteria. Following 3 months of ticagrelor plus aspirin, patients who had been adherent to treatment and free from major adverse events were randomly assigned to either aspirin or placebo in addition to ticagrelor for 1 year. The primary endpoint was Bleeding Academic Research Consortium (BARC) type 2, 3 or 5 bleeding. The key secondary endpoint was the composite of all-cause death, myocardial infarction, or stroke. Net adverse clinical events (NACE) were defined as BARC type 3 or 5 bleeding, all-cause death, myocardial infarction, or stroke.
Results
Of the 6273 patients included in the analysis, 8.0% had both CKD and DM (DM+/CKD+), 8.9% had CKD only (DM-/CKD+), 29.0% had DM only (DM+/CKD-), and 52.1% had neither CKD nor DM (DM-/CKD-). At 1-year follow-up, there was a progressive increase in the rates of bleeding and ischemic events according to DM and CKD status (Figure 1). Ticagrelor plus placebo reduced the primary bleeding endpoint as compared with ticagrelor plus aspirin across all study groups, including DM+/CKD+ patients (4.7% vs. 8.7%; HR 0.52, 95% CI 0.25–1.07), with no evidence of heterogeneity (p-interaction=0.68). Similar treatment effects of ticagrelor monotherapy were observed for major BARC type 3 or 5 bleeding (p-interaction=0.17), with DM+/CKD+ patients showing the greatest absolute risk reduction (0.9% vs. 5.1%; HR 0.16, 95% CI 0.04–0.72). The key secondary endpoint was not significantly different between treatment arms across study groups, with the exception of a reduced risk in DM+/CKD- patients receiving ticagrelor monotherapy (p-interaction=0.033). A similar pattern in the DM+/CKD- group was observed for NACE (p-interaction=0.030) (Figure 2).
Conclusions
Among high-risk patients undergoing PCI, ticagrelor monotherapy reduced the risk of clinically relevant and major bleeding without a significant increase in ischemic events as compared with ticagrelor plus aspirin, irrespective of the presence of DM and CKD. Furthermore, ticagrelor monotherapy seemed to be associated with a more favourable net benefit in patients with DM without CKD.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Investigator-initiated grant from AstraZeneca Figure 1. Event rates according to DM/CKD statusFigure 2. Effects of ticagrelor monotherapy
Collapse
Affiliation(s)
- D Cao
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - U Baber
- University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
| | - G Dangas
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - S Sartori
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - Z Zhongjie
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - G Giustino
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - D J Angiolillo
- University of Florida College of Medicine, Jacksonville, United States of America
| | - S Mehta
- McMaster University, Hamilton, Canada
| | - C M Gibson
- Beth Israel Deaconess Medical Center, Boston, United States of America
| | - G Sardella
- Umberto I Polyclinic of Rome, Rome, Italy
| | - S K Sharma
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - R Shlofmitz
- St. Francis Hospital, Roslyn, United States of America
| | - T Collier
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - S Pocock
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - R Mehran
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | | |
Collapse
|
17
|
Nicolas J, Cao D, Claessen B, Sartori S, Roumeliotis A, Goel R, Chandiramani R, Stefanini G, Turfah A, Chen S, Dangas G, Baber U, Sharma S, Kini A, Mehran R. Intersection of the Academic Research Consortium – high bleeding risk criteria in patients undergoing PCI for acute coronary syndromes: insights from a high-volume single centre registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2494] [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
Patients presenting for percutaneous coronary intervention (PCI) with acute coronary syndromes (ACS) often have overlapping bleeding and ischaemic risk factors that offset the long-term success of PCI and limit the post stenting therapeutic options. Aiming at improving outcomes following PCI, the Academic Research Consortium (ARC) recently published a set of major and minor criteria that identify, a priori, patients at high bleeding risk (HBR). Indeed, knowledge of these risk factors will help in optimization of pre-procedural therapy and minimization of post intervention complications. Nonetheless, the actual prevalence of these criteria among patients undergoing PCI for ACS is not well known.
Purpose
To determine the intersection and distribution of ARC-HBR major and minor criteria in a real-world ACS population presenting for PCI.
Methods
In this analysis, we included all patients who presented with ACS to a high-volume PCI centre from 2012 to 2017 and underwent PCI with 2nd generation drug-eluting stent (DES) implantation. Patients were then classified as HBR if they met ≥1 major or ≥2 minor criteria according to the ARC-HBR definition. Baseline clinical and procedural characteristics were extracted from each patient electronic health records. The most common exclusive intersections of ARC-HBR major and minor criteria were quantitatively visualized using an Upset Plot.
Results
Only 44.6% (n=2,717) of ACS patients (n=6,097) fulfilled the ARC-HBR definition. There were significant differences in baseline clinical characteristics between HBR and non-HBR groups: age (71.4±11.5 vs. 60.9±10.3 years, p<0.001), females (40.7% vs. 25.5%, p<0.001), cerebrovascular disease (19.5% vs. 3.9%, p<0.001), and diabetes (55.4% vs. 42.1%, p<0.001). The prevalence of active smoking, a major risk factor for bleeding, was higher in the non-HBR group (20.6% vs. 9.9%, p<0.001). The most frequent major and minor criteria were severe anemia (n=1,072) and age ≥75 (n=1,264), respectively. The top five criteria intersections were: severe anemia (n=215), age ≥75 and moderate chronic kidney disease (CKD) (n=145); moderate CKD and mild anemia (n=142); age ≥75 and mild anemia (n=140); age ≥75, moderate CKD, and mild anemia (n=130) (Figure 1).
Conclusion
Among patients who have undergone PCI for ACS, a significant proportion of individuals fulfilled the ARC-HBR definition. Severe anemia was the most prevalent major criteria. Different combinations of minor criteria, mainly age ≥75, moderate CKD and mild anemia, represented the most common intersections.
Figure 1
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- J Nicolas
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - D Cao
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - B Claessen
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - S Sartori
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - A Roumeliotis
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - R Goel
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - R Chandiramani
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - G Stefanini
- UOS of Milan and Humanitas Clinical and Research Center, Cardiology, Milan, Italy
| | - A Turfah
- UOS of Milan and Humanitas Clinical and Research Center, Cardiology, Milan, Italy
| | - S Chen
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - G Dangas
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - U Baber
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - S Sharma
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - A Kini
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - R Mehran
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| |
Collapse
|
18
|
Chandiramani R, Cao D, Claessen B, Sartori S, Nicolas J, Roumeliotis A, Goel R, Chiarito M, Power D, Camaj A, Dangas G, Baber U, Sharma S, Kini A, Mehran R. Are the minor high bleeding risk criteria of the academic research consortium truly minor? Insights from a high-volume tertiary care pci centre. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The Academic Research Consortium (ARC) has recently published a consensus-based definition to identify patients at high bleeding risk (HBR), reflected by a BARC 3 or 5 bleeding rate of ≥4% at 1 year after percutaneous coronary intervention (PCI). The HBR criteria included in the definition are divided into minor and major categories, with patients deemed to be at HBR if they fulfill at least one major or two minor criteria. As a result, patients who present with only one minor criterion are categorized as non-HBR.
Purpose
To compare the differences in baseline characteristics and 1-year bleeding and ischaemic outcomes between non-HBR patients undergoing PCI that present with only one minor HBR criterion versus those that do not fulfill any HBR criteria.
Methods
The study population consisted of all consecutive patients who underwent PCI with stent implantation in a single high-volume centre from January 2014 to December 2017. Patients were classified as non-HBR if they did not fulfill at least one major or two minor ARC-HBR criteria. The outcomes of interest were major bleeding (composite of peri-procedural and post-discharge bleeding), all-cause death, and myocardial infarction (MI) at 1 year. The Kaplan-Meier method was used for time-to-event analyses, with comparative risks being assessed using Cox regression.
Results
Of the 9,623 patients included in the analysis, 5,345 were classified as non-HBR. Within the non-HBR patients, 2,078 (38.9%) presented with only one minor HBR criterion and 3,267 (61.1%) presented with no HBR criteria. Non-HBR patients with one minor criterion were more often female, significantly older, with a higher burden of comorbidities such as diabetes mellitus, hypertension and hyperlipidaemia, and more likely to have multivessel disease as well as a history of prior MI and revascularisation, while non-HBR patients with no criteria were more likely to be smokers and have a higher BMI. Distribution of the minor HBR criteria within the group presenting with one minor criterion are illustrated in the figure. Non-HBR patients with only one minor criterion had a numerically higher rate of major bleeding compared to non-HBR patients with no criteria (3.6% vs. 2.9%, p=0.09). While the rate of all-cause death was significantly higher in the group with only one minor criterion (1.2% vs. 0.4%, p=0.004), there was no difference in the rate of MI between the two groups (2.1% vs. 1.9%, p=0.83). Hazard ratios comparing the two groups are presented in the figure.
Conclusions
Non-HBR patients presenting with only one minor criterion had a numerically higher rate of post-PCI bleeding and significantly higher mortality compared to those without any criteria. Nonetheless, the major bleeding rates of both groups at 1 year were less than the 4% cutoff to qualify as HBR according to the ARC definition, thereby supporting their inclusion as “minor” criteria in the recent ARC-HBR definition.
Figure 1
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- R Chandiramani
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - D Cao
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - B Claessen
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - S Sartori
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - J Nicolas
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - A Roumeliotis
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - R Goel
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - M Chiarito
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - D Power
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - A Camaj
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - G Dangas
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - U Baber
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - S Sharma
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - A Kini
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - R Mehran
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| |
Collapse
|
19
|
Roumeliotis A, Mehran R, Claessen B, Sartori S, Cao D, Chandiramani R, Nicolas J, Goel R, Reisman A, Baber U, Sweeny J, Barman N, Dangas G, Sharma S, Kini A. Impact of high-density lipoprotein levels in males and females undergoing percutaneous coronary intervention with drug eluting stents. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Low levels of high-density lipoprotein (HDL) have been associated with adverse cardiovascular events in multiple epidemiological studies. Evidence regarding the role of HDL in males and females with established coronary artery disease undergoing percutaneous coronary intervention (PCI) with drug eluting stents (DES) is scarce.
Purpose
We sought to investigate the impact of low HDL levels on 1-year cardiovascular outcomes in males and females undergoing PCI with DES.
Methods
We screened all patients undergoing PCI in our center from 2012 to 2017. Exclusion criteria were: unavailable baseline HDL measurement, age <18 years, presentation with ST-segment elevation myocardial infarction (MI) or shock, coexisting neoplastic disease and treatment without a stent or with a bare metal stent. The final population was divided by gender and further stratified to the high or low HDL group according to baseline HDL levels. Cut-offs were 40mg/dL in males and 50mg/dL in females, per the most recent ACC/AHA guideline recommendations. The primary endpoint of the analysis was major adverse cardiovascular events (MACE) at 1 year, defined as death, MI or target vessel revascularization (TVR). To account for potential clinical and anatomical confounders the outcomes were also adjusted for age, Caucasian ethnicity, hypertension, diabetes mellitus (DM), body mass index, smoking, prior MI, multi-vessel disease and type B2/C lesions.
Results
Out of the 10,843 patients included, 7,718 (71.2%) were male and 3,125 (28.8%) were female. Low HDL was noted in 58.5% of males and 63.8% of females. Patients with low HDL were younger and had a higher prevalence of DM, prior MI, smoking and multi-vessel disease. When comparing low to high HDL groups in terms of 1-year MACE a borderline significant difference was shown in males (7.4% vs. 6.0%; p-value=0.08) but not in females (7.7% vs 8.1%; p-value=0.90) [Panel A]. The numerically higher incidence of MACE in males with low HDL was primarily driven by TVR (5.4% vs 3.7%; p-value=0.005) while the rates of Death (1.4% vs. 1.3%; p=0.96) and MI (2.0% vs. 1.8%; p-value=0.89) were similar between the two groups. After adjustment the male low HDL subgroup remained at a higher risk for 1-year TVR but not 1-year MACE compared to the male high HDL subgroup [Panel B]. No difference for any individual component of MACE was shown between low and high HDL subgroups in females [Panel C].
Conclusion(s)
High HDL levels were associated with a lower incidence of TVR and borderline reduction of MACE in male but not female patients undergoing PCI with DES. No difference was demonstrated in terms of death or MI between the high and low HDL subgroups at 1-year follow-up.
Impact of HDL levels according to gender
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- A Roumeliotis
- Mount Sinai Hospital, New York, United States of America
| | - R Mehran
- Mount Sinai Hospital, New York, United States of America
| | - B Claessen
- Mount Sinai Hospital, New York, United States of America
| | - S Sartori
- Mount Sinai Hospital, New York, United States of America
| | - D Cao
- Mount Sinai Hospital, New York, United States of America
| | - R Chandiramani
- Mount Sinai Hospital, New York, United States of America
| | - J Nicolas
- Mount Sinai Hospital, New York, United States of America
| | - R Goel
- Mount Sinai Hospital, New York, United States of America
| | - A Reisman
- Mount Sinai Hospital, New York, United States of America
| | - U Baber
- Mount Sinai Hospital, New York, United States of America
| | - J Sweeny
- Mount Sinai Hospital, New York, United States of America
| | - N Barman
- Mount Sinai Hospital, New York, United States of America
| | - G Dangas
- Mount Sinai Hospital, New York, United States of America
| | - S Sharma
- Mount Sinai Hospital, New York, United States of America
| | - A Kini
- Mount Sinai Hospital, New York, United States of America
| |
Collapse
|
20
|
Nicolas J, Cao D, Claessen B, Sartori S, Chandiramani R, Roumeliotis A, Goel R, Camaj A, Beerkens F, Turfah A, Dangas G, Baber U, Sharma S, Kini A, Mehran R. Long-term outcomes in high-bleeding risk patients undergoing PCI for acute coronary syndromes: results from a large single-center pci registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Current clinical guidelines recommend prolonged dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI) in patients presenting with acute coronary syndromes (ACS). However, an extended DAPT duration in high-bleeding risk (HBR) patients amplifies the risk of post procedural complications. Hence, clinicians often face the dilemma of prolonging DAPT duration to prevent recurrent ischaemic events at the expense of increasing the incidence of bleeding in high-risk patients. The actual incidence of ischaemic and bleeding events in this particular population is not well elucidated.
Purpose
To evaluate one-year ischemic and bleeding outcomes following PCI for ACS in a real-world HBR population as defined by the Academic Research Consortium (ARC) consensus document.
Methods
We included all patients who presented with ACS to a high-volume single PCI centre from 2012 to 2017 and underwent PCI with 2nd generation drug-eluting stent implantation. Patients were classified as HBR if they met ≥1 major or ≥2 minor criteria according to the recent ARC-HBR consensus. The outcomes of interest were major adverse cardiovascular events (MACE), a composite of all-cause death, myocardial infarction (MI), and target lesion revascularization (TLR), and major bleeding events, including both peri-procedural and post-discharge bleeding. All outcomes were assessed at 1-year follow-up. The Kaplan-Meier method was used for time-to-event analyses.
Results
Out of 6,097 ACS patients included in this analysis, 2,717 (44.6%) fulfilled the ARC-HBR definition. Compared to non-HBR group, HBR patients were more frequently female, older, more likely to have cardiovascular risk factors (e.g., diabetes, hypertension, and hyperlipidemia) and complex coronary artery disease (e.g., multi-vessel disease, bifurcation lesions, and calcification). The 1-year incidence of MACE was significantly higher in HBR patients (16.3% vs. 8.1%, HR 2.16, 95% CI [1.81–2.59], p<0.001) (Figure 1A). This finding was driven by higher rates of all-cause death and MI (Figure 1B). The 1-year incidence of major bleeding was also significantly higher in HBR patients compared to non-HBR (11.1% vs. 3.1%, HR: 3.92, 95% CI 3.10–4.95; p<0.001).
Conclusions
HBR patients undergoing PCI for ACS are not only subject to bleeding complications but are also at an increased risk for ischemic events and all-cause mortality.
Figure 1
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- J Nicolas
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - D Cao
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - B Claessen
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - S Sartori
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - R Chandiramani
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - A Roumeliotis
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - R Goel
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - A Camaj
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - F Beerkens
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - A Turfah
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - G Dangas
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - U Baber
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - S Sharma
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - A Kini
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - R Mehran
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| |
Collapse
|
21
|
Pistelli A, Sartori S. Cancer and pregnancy: management of acute myeloid leukemia in a 23 wks pregnant woman. The experience of Florence Teratology Information Service. Reprod Toxicol 2020. [DOI: 10.1016/j.reprotox.2020.04.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
22
|
Gastaldi M, Mariotto S, Giannoccaro MP, Iorio R, Zoccarato M, Nosadini M, Benedetti L, Casagrande S, Di Filippo M, Valeriani M, Ricci S, Bova S, Arbasino C, Mauri M, Versino M, Vigevano F, Papetti L, Romoli M, Lapucci C, Massa F, Sartori S, Zuliani L, Barilaro A, De Gaspari P, Spagni G, Evoli A, Liguori R, Ferrari S, Marchioni E, Giometto B, Massacesi L, Franciotta D. Subgroup comparison according to clinical phenotype and serostatus in autoimmune encephalitis: a multicenter retrospective study. Eur J Neurol 2020; 27:633-643. [PMID: 31814224 DOI: 10.1111/ene.14139] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/03/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Autoimmune encephalitides (AE) include a spectrum of neurological disorders whose diagnosis revolves around the detection of neuronal antibodies (Abs). Consensus-based diagnostic criteria (AE-DC) allow clinic-serological subgrouping of AE, with unclear prognostic implications. The impact of AE-DC on patients' management was studied, focusing on the subgroup of Ab-negative-AE. METHODS This was a retrospective multicenter study on patients fulfilling AE-DC. All patients underwent Ab testing with commercial cell-based assays (CBAs) and, when available, in-house assays (immunohistochemistry, live/fixed CBAs, neuronal cultures) that contributed to defining final categories. Patients were classified as Ab-positive-AE [N-methyl-d-aspartate-receptor encephalitis (NMDAR-E), Ab-positive limbic encephalitis (LE), definite-AE] or Ab-negative-AE (Ab-negative-LE, probable-AE, possible-AE). RESULTS Commercial CBAs detected neuronal Abs in 70/118 (59.3%) patients. Testing 37/48 Ab-negative cases, in-house assays identified Abs in 11 patients (29.7%). A hundred and eighteen patients fulfilled the AE-DC, 81 (68.6%) with Ab-positive-AE (Ab-positive-LE, 40; NMDAR-E, 32; definite-AE, nine) and 37 (31.4%) with Ab-negative-AE (Ab-negative-LE, 17; probable/possible-AE, 20). Clinical phenotypes were similar in Ab-positive-LE versus Ab-negative-LE. Twenty-four/118 (20.3%) patients had tumors, and 19/118 (16.1%) relapsed, regardless of being Ab-positive or Ab-negative. Ab-positive-AE patients were treated earlier than Ab-negative-AE patients (P = 0.045), responded more frequently to treatments (92.3% vs. 65.6%, P < 0.001) and received second-line therapies more often (33.3% vs. 10.8%, P = 0.01). Delays in first-line therapy initiation were associated with poor response (P = 0.022; odds ratio 1.02; confidence interval 1.00-1.04). CONCLUSIONS In-house diagnostics improved Ab detection allowing better patient management but was available in a patient subgroup only, implying possible Ab-positive-AE underestimation. Notwithstanding this limitation, our findings suggest that Ab-negative-AE and Ab-positive-AE patients share similar oncological profiles, warranting appropriate tumor screening. Ab-negative-AE patients risk worse responses due to delayed and less aggressive treatments.
Collapse
Affiliation(s)
- M Gastaldi
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
| | - S Mariotto
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - M P Giannoccaro
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,UOC Clinica Neurologica, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - R Iorio
- Istituto di Neurologia, Fondazione Policlinico Universitario 'Agostino Gemelli' IRCCS, Rome, Italy.,Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - M Zoccarato
- Ospedale S. Antonio, AULSS Euganea, Padua, Italy.,Neuroimmunology Group, Paediatric Research Institute "Città della Speranza", Padua, Italy
| | - M Nosadini
- Neuroimmunology Group, Paediatric Research Institute "Città della Speranza", Padua, Italy.,Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - L Benedetti
- IRCCS Ospedale Policlinico S. Martino, Genoa, Italy
| | - S Casagrande
- Neurosciences Department, Florence University, Italy.,Careggi University Hospital, Florence, Italy
| | - M Di Filippo
- Neurology Clinic, S. Maria della Misericordia Hospital, Perugia University, Perugia, Italy
| | - M Valeriani
- Neurology Unit, Bambino Gesù Children Hospital, Rome, Italy
| | - S Ricci
- Ospedale 'Città-di-Castello-e-Branca', Italy
| | - S Bova
- Pediatric Neurology Unit, ASST Fatebenefratelli Sacco, Children Hospital Vittore Buzzi, Milan, Italy
| | | | - M Mauri
- Neurology and Stroke Unit, Insubria University, Varese, Italy
| | - M Versino
- Neurology and Stroke Unit, Insubria University, Varese, Italy
| | - F Vigevano
- Neurology Unit, Bambino Gesù Children Hospital, Rome, Italy
| | - L Papetti
- Neurology Unit, Bambino Gesù Children Hospital, Rome, Italy
| | - M Romoli
- Neurology Clinic, S. Maria della Misericordia Hospital, Perugia University, Perugia, Italy.,Neurology Unit, Rimini "Infermi" Hospital - AUSL Romagna, Rimini, Italy
| | - C Lapucci
- IRCCS Ospedale Policlinico S. Martino, Genoa, Italy
| | - F Massa
- IRCCS Ospedale Policlinico S. Martino, Genoa, Italy
| | - S Sartori
- Neuroimmunology Group, Paediatric Research Institute "Città della Speranza", Padua, Italy.,Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - L Zuliani
- Neuroimmunology Group, Paediatric Research Institute "Città della Speranza", Padua, Italy.,Neurology Department, Ospedale S. Bortolo, Vicenza, Italy
| | - A Barilaro
- Careggi University Hospital, Florence, Italy
| | - P De Gaspari
- Neuroimmunology Group, Paediatric Research Institute "Città della Speranza", Padua, Italy
| | - G Spagni
- Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - A Evoli
- Istituto di Neurologia, Fondazione Policlinico Universitario 'Agostino Gemelli' IRCCS, Rome, Italy.,Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - R Liguori
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,UOC Clinica Neurologica, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - S Ferrari
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - E Marchioni
- Neuroncology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | | | - L Massacesi
- Neurosciences Department, Florence University, Italy.,Careggi University Hospital, Florence, Italy
| | - D Franciotta
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
| |
Collapse
|
23
|
Díaz M, Morita L, Ferrari B, Sartori S, Greco M, Sobrevias Bonells L, González-Enseñat M, Vicente Villa M, Larralde M. Dermatosis ampollar IgA lineal: serie de 17 casos. Actas Dermo-Sifiliográficas 2019; 110:673-680. [DOI: 10.1016/j.ad.2018.06.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 02/05/2018] [Accepted: 06/03/2018] [Indexed: 10/27/2022] Open
|
24
|
Chandiramani R, Chen H, Cao D, Claessen B, Blum M, Goel R, Sartori S, Aquino M, Guedeney P, Effron M, Keller S, Baker B, Pocock S, Baber U, Mehran R. P1760Incidence and effects of stroke, MI and bleeding on mortality among patients with ACS undergoing PCI: a comparative analysis from the PROMETHEUS registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Stroke represents a potentially calamitous complication among patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) even though its rates are relatively low. Data on the distribution of stroke occurrence over time and its overlap with myocardial infarction (MI) and bleeding after PCI is scarce.
Purpose
We sought to compare the occurrence and impacts of stroke, MI and bleeding on subsequent mortality in ACS patients undergoing PCI in contemporary clinical practice.
Methods
A total of 19,914 ACS patients who underwent PCI in the PROMETHEUS multi-center observational study were analyzed. We calculated the cumulative stroke incidence at 30 days and 1 year using Kaplan Meier (KM) method. We also compared the distribution of stroke, myocardial infarction (MI) and bleeding across time and evaluated the overlap between their occurrences. Predictors of 1 year stroke occurrence were identified through multivariable Cox-regression and stroke, MI and bleeding were entered as time-updated covariates to estimate their individual effects on subsequent mortality.
Results
Of the total number of patients, 244 patients (1.5%) had a stroke within 1 year. 48 of these patients also experienced an MI while another 48 patients experienced a bleeding event. Furthermore, 14 of these overlapping patients experienced a stroke, MI and bleeding event, all within the 1-year follow-up. Patients who sustained a stroke were more likely to have a prior history of cerebrovascular disease, peripheral artery disease, MI and heart failure compared to those who did not have a stroke. Mortality risk was significantly higher among those with stroke versus those without stroke (adjusted HR 4.84, p<0.0001). However, the association attenuated over time with a much larger effect in the first 30 days of its occurrence (adjusted HR 17.7, p<0.0001) versus beyond 30 days (adjusted HR 1.22; 95% CI: 0.6–2.46, p=0.58). Although the effects of MI and bleeding on subsequent mortality within 30 days of occurrence were significantly lower than stroke (adjusted HR 6.22, p<0.0001; adjusted HR 7.30, p<0.0001, respectively), their effects were more sustained on mortality beyond 30 days (adjusted HR 2.89, p<0.0001; adjusted HR 3.05, p<0.0001, respectively).
Conclusion
When compared with MI and bleeding, stroke had a substantially stronger impact on mortality that attenuated rapidly over time among ACS patients undergoing PCI. Optimization of modifiable risk factors and medication adherence are essential parts of management of stroke following PCI for ACS.
Collapse
Affiliation(s)
- R Chandiramani
- The Zena and Michael A. Wiener Cardiovascular Institute, New York, United States of America
| | - H Chen
- The Zena and Michael A. Wiener Cardiovascular Institute, New York, United States of America
| | - D Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, New York, United States of America
| | - B Claessen
- The Zena and Michael A. Wiener Cardiovascular Institute, New York, United States of America
| | - M Blum
- The Zena and Michael A. Wiener Cardiovascular Institute, New York, United States of America
| | - R Goel
- The Zena and Michael A. Wiener Cardiovascular Institute, New York, United States of America
| | - S Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, New York, United States of America
| | - M Aquino
- The Zena and Michael A. Wiener Cardiovascular Institute, New York, United States of America
| | - P Guedeney
- The Zena and Michael A. Wiener Cardiovascular Institute, New York, United States of America
| | - M Effron
- Eli Lilly and Company, Indianapolis, United States of America
| | - S Keller
- Eli Lilly and Company, Indianapolis, United States of America
| | - B Baker
- Daiichi-Sankyo, Inc, Parsippany, United States of America
| | - S Pocock
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - U Baber
- The Zena and Michael A. Wiener Cardiovascular Institute, New York, United States of America
| | - R Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, New York, United States of America
| |
Collapse
|
25
|
Díaz M, Morita L, Ferrari B, Sartori S, Greco M, Sobrevias Bonells L, González-Enseñat M, Vicente Villa M, Larralde M. Linear IgA Bullous Dermatosis: A Series of 17 Cases. Actas Dermo-Sifiliográficas (English Edition) 2019. [DOI: 10.1016/j.adengl.2019.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
|
26
|
Kalkman DN, Chandrasekhar J, Aquino M, Woudstra P, Beijk MA, Sartori S, Baber U, Tijssen J, Koch KT, Dangas GD, Colombo A, De Winter RJ, Mehran R. P1661Evaluation of transradial versus transfemoral procedures in all-comers patients treated with the dual-therapy stent. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1661] [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: 11/14/2022] Open
Affiliation(s)
- D N Kalkman
- Mount Sinai Medical Center, New York, United States of America
| | - J Chandrasekhar
- Mount Sinai Medical Center, New York, United States of America
| | - M Aquino
- Mount Sinai Medical Center, New York, United States of America
| | - P Woudstra
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands
| | - M A Beijk
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands
| | - S Sartori
- Mount Sinai Medical Center, New York, United States of America
| | - U Baber
- Mount Sinai Medical Center, New York, United States of America
| | - J Tijssen
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands
| | - K T Koch
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands
| | - G D Dangas
- Mount Sinai Medical Center, New York, United States of America
| | - A Colombo
- San Raffaele Hospital of Milan (IRCCS), Milan, Italy
| | - R J De Winter
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands
| | - R Mehran
- Mount Sinai Medical Center, New York, United States of America
| | | |
Collapse
|
27
|
Chandrasekhar J, Kalkman DN, Aquino M, Baber U, Sartori S, Woudstra P, Beijk MA, Tijssen J, Koch KT, Dangas GD, Colombo A, De Winter RJ, Mehran R. P1664Clinical outcomes by potency of P2Y12 inhibitor following COMBO DTS PCI: From the COMBO collaboration. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1664] [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: 11/14/2022] Open
Affiliation(s)
- J Chandrasekhar
- Mount Sinai Medical Center, New York, United States of America
| | - D N Kalkman
- Mount Sinai Medical Center, New York, United States of America
| | - M Aquino
- Mount Sinai Medical Center, New York, United States of America
| | - U Baber
- Mount Sinai Medical Center, New York, United States of America
| | - S Sartori
- Mount Sinai Medical Center, New York, United States of America
| | - P Woudstra
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands
| | - M A Beijk
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands
| | - J Tijssen
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands
| | - K T Koch
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands
| | - G D Dangas
- Mount Sinai Medical Center, New York, United States of America
| | - A Colombo
- San Raffaele Hospital of Milan (IRCCS), Milan, Italy
| | - R J De Winter
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands
| | - R Mehran
- Mount Sinai Medical Center, New York, United States of America
| | | |
Collapse
|
28
|
Kalkman DN, Chandrasekhar J, Aquino M, Woudstra P, Beijk MA, Sartori S, Baber U, Tijssen J, Koch KT, Dangas GD, Colombo A, De Winter RJ, Mehran R. P4554Impact of the presence of chronic kidney disease on 1-year target lesion failure in patients treated with a dual-therapy stent. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4554] [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: 11/13/2022] Open
Affiliation(s)
- D N Kalkman
- Mount Sinai Medical Center, New York, United States of America
| | - J Chandrasekhar
- Mount Sinai Medical Center, New York, United States of America
| | - M Aquino
- Mount Sinai Medical Center, New York, United States of America
| | - P Woudstra
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands
| | - M A Beijk
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands
| | - S Sartori
- Mount Sinai Medical Center, New York, United States of America
| | - U Baber
- Mount Sinai Medical Center, New York, United States of America
| | - J Tijssen
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands
| | - K T Koch
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands
| | - G D Dangas
- Mount Sinai Medical Center, New York, United States of America
| | - A Colombo
- San Raffaele Hospital of Milan (IRCCS), Milan, Italy
| | - R J De Winter
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands
| | - R Mehran
- Mount Sinai Medical Center, New York, United States of America
| | | |
Collapse
|
29
|
Chandrasekhar J, Aquino M, Sartori S, Baber U, Kalkman DN, Dangas GD, De Winter RJ, Mehran R, Colombo A. P1663COMBO stent PCI for elderly patients: one year clinical outcomes and DAPT cessation patterns from the global MASCOT registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1663] [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: 11/13/2022] Open
Affiliation(s)
- J Chandrasekhar
- Mount Sinai Medical Center, New York, United States of America
| | - M Aquino
- Mount Sinai Medical Center, New York, United States of America
| | - S Sartori
- Mount Sinai Medical Center, New York, United States of America
| | - U Baber
- Mount Sinai Medical Center, New York, United States of America
| | - D N Kalkman
- Mount Sinai Medical Center, New York, United States of America
| | - G D Dangas
- Mount Sinai Medical Center, New York, United States of America
| | - R J De Winter
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands
| | - R Mehran
- Mount Sinai Medical Center, New York, United States of America
| | - A Colombo
- San Raffaele Hospital of Milan (IRCCS), Milan, Italy
| | | |
Collapse
|
30
|
Chandrasekhar J, Aquino M, Sartori S, Baber U, Sorrentino S, Kalkman DN, Dangas GD, De Winter RJ, Mehran R, Colombo A. P2646COMBO PCI outcomes in patients categorized by baseline PARIS bleeding risk score: from the global MASCOT registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2646] [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: 11/12/2022] Open
Affiliation(s)
- J Chandrasekhar
- Mount Sinai Medical Center, New York, United States of America
| | - M Aquino
- Mount Sinai Medical Center, New York, United States of America
| | - S Sartori
- Mount Sinai Medical Center, New York, United States of America
| | - U Baber
- Mount Sinai Medical Center, New York, United States of America
| | - S Sorrentino
- Mount Sinai Medical Center, New York, United States of America
| | - D N Kalkman
- Mount Sinai Medical Center, New York, United States of America
| | - G D Dangas
- Mount Sinai Medical Center, New York, United States of America
| | - R J De Winter
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands
| | - R Mehran
- Mount Sinai Medical Center, New York, United States of America
| | - A Colombo
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands
| | | |
Collapse
|
31
|
Manara R, Rocco MC, D'agata L, Cusmai R, Freri E, Giordano L, Darra F, Procopio E, Toldo I, Peruzzi C, Vittorini R, Spalice A, Fusco C, Nosadini M, Longo D, Sartori S. Neuroimaging Changes in Menkes Disease, Part 2. AJNR Am J Neuroradiol 2017; 38:1858-1865. [PMID: 28495940 DOI: 10.3174/ajnr.a5192] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 01/19/2023]
Abstract
This is the second part of a retrospective and review MR imaging study aiming to define the frequency rate, timing, imaging features, and evolution of gray matter changes in Menkes disease, a rare multisystem X-linked disorder of copper metabolism characterized by early, severe, and progressive neurologic involvement. According to our analysis, neurodegenerative changes and focal basal ganglia lesions already appear in the early phases of the disease. Subdural collections are less common than generally thought; however, their presence remains important because they might challenge the differential diagnosis with child abuse and might precipitate the clinical deterioration. Anecdotal findings in our large sample seem to provide interesting clues about the protean mechanisms of brain injury in this rare disease and further highlight the broad spectrum of MR imaging findings that might be expected while imaging a child with the suspicion of or a known diagnosis of Menkes disease.
Collapse
Affiliation(s)
- R Manara
- From the Neuroradiology (R.M., M.C.R.), Sezione di Neuroscienze, Medicine and Surgery Department, University of Salerno, Salerno, Italy
| | - M C Rocco
- From the Neuroradiology (R.M., M.C.R.), Sezione di Neuroscienze, Medicine and Surgery Department, University of Salerno, Salerno, Italy
| | - L D'agata
- Department of Neuroscience (L.D.), University of Padova, Padova, Italy
| | - R Cusmai
- Neurology Unit (R.C., D.L.), Bambino Gesù Children's Hospital IRCCS, Roma, Italy
| | - E Freri
- Department of Pediatric Neuroscience (E.F.), Foundation IRCCS, Neurological Institute "C. Besta," Milano, Italy
| | - L Giordano
- Child Neuropsychiatry Unit (L.G.), "Spedali Civili," Brescia, Italy
| | - F Darra
- Child Neuropsychiatry Unit (F.D.), Department of Life and Reproduction Sciences, University of Verona, Verona, Italy
| | - E Procopio
- Metabolic and Neuromuscular Unit (E.P.), Department of Neuroscience, Meyer Children Hospital, Firenze, Italy
| | - I Toldo
- Pediatric Neurology and Neurophysiology Unit (I.T., M.N., S.S.), Department of Woman and Child Health, University Hospital of Padova, Padova, Italy
| | - C Peruzzi
- Child Neuropsychiatry (C.P.), Ospedale Maggiore, Novara, Italy
| | - R Vittorini
- Child Neurology and Psychiatry (R.V.), Department of Pediatrics and Pediatric Specialties, AOU Città della Salute e della Scienza, Torino, Italy
| | - A Spalice
- Children Neurology Division (A.S.), University La Sapienza Roma, Roma, Italy
| | - C Fusco
- Child Neurology and Psychiatry Unit, (C.F.), Department of Pediatrics, ASMN-IRCCS, Reggio Emilia, Italy
| | - M Nosadini
- Pediatric Neurology and Neurophysiology Unit (I.T., M.N., S.S.), Department of Woman and Child Health, University Hospital of Padova, Padova, Italy
| | - D Longo
- Neurology Unit (R.C., D.L.), Bambino Gesù Children's Hospital IRCCS, Roma, Italy
| | - S Sartori
- Pediatric Neurology and Neurophysiology Unit (I.T., M.N., S.S.), Department of Woman and Child Health, University Hospital of Padova, Padova, Italy
| |
Collapse
|
32
|
Manara R, D'Agata L, Rocco MC, Cusmai R, Freri E, Pinelli L, Darra F, Procopio E, Mardari R, Zanus C, Di Rosa G, Soddu C, Severino M, Ermani M, Longo D, Sartori S. Neuroimaging Changes in Menkes Disease, Part 1. AJNR Am J Neuroradiol 2017; 38:1850-1857. [PMID: 28495946 DOI: 10.3174/ajnr.a5186] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 11/07/2022]
Abstract
Menkes disease is a rare multisystem X-linked disorder of copper metabolism. Despite an early, severe, and progressive neurologic involvement, our knowledge of brain involvement remains unsatisfactory. The first part of this retrospective and review MR imaging study aims to define the frequency rate, timing, imaging features, and evolution of intracranial vascular and white matter changes. According to our analysis, striking but also poorly evolutive vascular abnormalities characterize the very early phases of disease. After the first months, myelination delay becomes evident, often in association with protean focal white matter lesions, some of which reveal an age-specific brain vulnerability. In later phases of the disease, concomitant progressive neurodegeneration might hinder the myelination progression. The currently enriched knowledge of neuroradiologic finding evolution provides valuable clues for early diagnosis, identifies possible MR imaging biomarkers of new treatment efficacy, and improves our comprehension of possible mechanisms of brain injury in Menkes disease.
Collapse
Affiliation(s)
- R Manara
- From the Neuroradiology (R. Manara, M.C.R.), Sezione di Neuroscienze, Medicine and Surgery Department, University of Salerno, Salerno, Italy
| | - L D'Agata
- Department of Neuroscience (L.D.), University of Padova, Padova, Italy
| | - M C Rocco
- From the Neuroradiology (R. Manara, M.C.R.), Sezione di Neuroscienze, Medicine and Surgery Department, University of Salerno, Salerno, Italy
| | - R Cusmai
- Neurology Unit (R.C., D.L.), Department of Imaging, Bambino Gesù Children's Hospital IRCCS, Roma, Italy
| | - E Freri
- Department of Pediatric Neuroscience (E.F.), Foundation I.R.C.C.S., Neurological Institute "C. Besta," Milano, Italy
| | - L Pinelli
- Neuroradiology (L.P.), Section of Pediatric Neuroradiology, Department of Diagnostic Imaging ASST Spedali Civili, Brescia, Italy
| | - F Darra
- Child Neuropsychiatry Unit (F.D.), Department of Life and Reproduction Sciences, University of Verona, Verona, Italy
| | - E Procopio
- Metabolic and Neuromuscular Unit (E.P.), Department of Neuroscience, Meyer Children Hospital, Firenze, Italy
| | - R Mardari
- Department of Neuroscience (R. Mardari, M.E.)
| | - C Zanus
- Institute for Maternal and Child Health (C.Z.), IRCCS "Burlo Garofolo," Trieste, Italy
| | - G Di Rosa
- Unit of Child Neurology and Psychiatry (G.D.R.), Department of Human Pathology of the Adult and Developmental Age, University Hospital of Messina, Messina, Italy
| | - C Soddu
- Ospedale Pediatrico Microcitemico "A. Cao" (C.S.), AOB Cagliari, Italy
| | - M Severino
- Neuroradiology Unit (M.S.), Istituto Giannina Gaslini, Genova, Italy
| | - M Ermani
- Department of Neuroscience (R. Mardari, M.E.)
| | - D Longo
- Neurology Unit (R.C., D.L.), Department of Imaging, Bambino Gesù Children's Hospital IRCCS, Roma, Italy
| | - S Sartori
- Pediatric Neurology and Neurophysiology Unit, Department of Woman and Child Health (S.S.), University Hospital of Padova, Padova, Italy
| |
Collapse
|
33
|
Vogel B, Chandrasekhar J, Farhan S, Sartori S, Giustino G, Snyder C, Kovacic J, Moreno P, Barman N, Sweeny J, Vijay P, Dangas G, Mehran R, Kini A, Sharma S. 2927Sex-related differences in patients undergoing complex coronary interventions in the era of 2nd generation DES. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.2927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
34
|
Mehilli J, Chieffo A, Petronio A, Lefevre T, Presbitero P, Capranzano P, Tchetche D, Iadanza A, Sardella G, Mikhail G, Sartori S, Snyder C, Chandrasekhar J, Morice M, Mehran R. P3283Predictors of pacemaker implantation in women undergoing contemporary transcatheter aortic valve replacement: Results from the WIN-TAVI registry. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3283] [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: 11/13/2022] Open
Affiliation(s)
- J. Mehilli
- Ludwig-Maximilians University, Munich, Germany
| | - A. Chieffo
- San Raffaele Hospital of Milan (IRCCS), Milan, Italy
| | | | - T. Lefevre
- Institut Hospitalier Jacques Cartier, Massy, France
| | - P. Presbitero
- UOS of Milan and Humanitas Clinical and Research Center, Milan, Italy
| | | | - D. Tchetche
- Clinic Pasteur of Toulouse, Toulouse, France
| | - A. Iadanza
- Polyclinic Santa Maria alle Scotte, Siena, Italy
| | | | - G. Mikhail
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - S. Sartori
- Mount Sinai School of Medicine, Cardiology, New York, United States of America
| | - C. Snyder
- Mount Sinai School of Medicine, Cardiology, New York, United States of America
| | - J. Chandrasekhar
- Mount Sinai School of Medicine, Cardiology, New York, United States of America
| | - M. Morice
- Institut Hospitalier Jacques Cartier, Massy, France
| | - R. Mehran
- Mount Sinai School of Medicine, Cardiology, New York, United States of America
| | | |
Collapse
|
35
|
Sorrentino S, Snyder C, Baber U, Sartori S, Cohen D, Cono A, Gibson M, Krucoff M, Moliterno D, Chieffo A, Kini A, Witzenbichler B, Steng F, Pocock S, Mehran R. P511Incidence and patterns of dual antiplatelet therapy cessation among patients with peripheral arterial disease after percutaneous coronary intervention: insights the PARIS registry. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
36
|
Kerkmeijer L, Claessen B, Baber U, Sartori S, Stefanini G, Stone G, Steg P, Chieffo A, Weisz G, Windecker S, Mikhail G, Kastrati A, Morice M, De Winter R, Mehran R. P2068Incidence, determinant and temporal impact of definite stent thrombosis on mortality in women: from the WIN-DES collaborative patient-level pooled analysis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2068] [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: 11/14/2022] Open
Affiliation(s)
- L.S.M. Kerkmeijer
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands
| | - B.E.M. Claessen
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands
| | - U. Baber
- Mount Sinai Medical Center, Cardiology, New York, United States of America
| | - S. Sartori
- Mount Sinai Medical Center, Cardiology, New York, United States of America
| | - G.G. Stefanini
- Clinical Institute Humanitas IRCCS, Cardiology, Rozzano, Italy
| | - G.W. Stone
- Columbia University Medical Center, Cardiology, New York, United States of America
| | - P.G. Steg
- University Paris Diderot, Cardiology, Paris, France
| | - A. Chieffo
- San Raffaele Scientific Institute, Cardiology, Milan, Italy
| | - G. Weisz
- Columbia University Medical Center, Cardiology, New York, United States of America
| | - S. Windecker
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - G.W. Mikhail
- Imperial College Healthcare NHS Trust, Cardiology, London, United Kingdom
| | - A. Kastrati
- Deutsches Herzzentrum Technische Universitat, Cardiology, Munich, Germany
| | - M.C. Morice
- Institut Cardiovasculaire Paris Sud, Cardiology, Paris, France
| | - R.J. De Winter
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands
| | - R. Mehran
- Mount Sinai Medical Center, Cardiology, New York, United States of America
| | | |
Collapse
|
37
|
Sharma M, Baber U, Sorrentino S, Chandrasekhar J, Sartori S, Kovacic J, Moreno P, Barman N, Sweeny J, Vijay P, Giustino G, Dangas G, Mehran R, Kini A, Sharma S. P6114Characteristics and clinical outcomes in patients undergoing PCI by levels of high-density lipoproteins. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
38
|
Vogel B, Baber U, Chandrasekhar J, Sartori S, Farhan S, Sorrentino S, Kovacic J, Moreno P, Barman N, Sweeny J, Shah S, Dangas G, Mehran R, Kini A, Sharma S. P2069Multivessel PCI versus culprit-vessel only PCI in patients with acute myocardial infarction and multivessel disease. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
39
|
Farhan S, Vogel B, Baber U, Sartori S, Sorrentino S, Nitin B, Vijay P, Kovacic J, Sweeny J, Moreno P, Giustino G, Dangas G, Mehran R, Kini A, Sharma S. P2331Association between serum osmolality and acute kidney injury after percutaneous coronary intervention: a simple tool for acute kidney injury prediction. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
40
|
Faggioni M, Baber U, Sartori S, Kini A, Rao S, Weintraub W, Henry T, Kapadia S, Muhlestein J, Toma C, Effron M, Defranco A, Baker B, Pocock S, Mehran R. P493Impact of prior cerebrovascular diseases on treatment strategies and clinical outcomes after percutaneous coronary interventions. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
41
|
Sorrentino S, Baber U, Chandrasekhar Y, Zhen G, Sartori S, Kovacic J, Moreno P, Barman N, Sweeney J, Vijay P, Giustino G, Dangas G, Mehran R, Kini A, Sharma S. P1389Impact of peripheral arterial disease on provision of discharge pharmacotherapy and longitudinal outcomes in patients with stable angina undergoing percutaneous coronary interventions. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
42
|
Hashim D, Sartori S, Brennan P, Curado MP, Wünsch-Filho V, Divaris K, Olshan AF, Zevallos JP, Winn DM, Franceschi S, Castellsagué X, Lissowska J, Rudnai P, Matsuo K, Morgenstern H, Chen C, Vaughan TL, Hofmann JN, D'Souza G, Haddad RI, Wu H, Lee YC, Hashibe M, Vecchia CL, Boffetta P. The role of oral hygiene in head and neck cancer: results from International Head and Neck Cancer Epidemiology (INHANCE) consortium. Ann Oncol 2016; 27:1619-25. [PMID: 27234641 PMCID: PMC4959929 DOI: 10.1093/annonc/mdw224] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 05/22/2016] [Accepted: 05/23/2016] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Poor oral hygiene has been proposed to contribute to head and neck cancer (HNC) risk, although causality and independency of some indicators are uncertain. This study investigates the relationship of five oral hygiene indicators with incident HNCs. METHODS In a pooled analysis of 8925 HNC cases and 12 527 controls from 13 studies participating in the International Head and Neck Cancer Epidemiology Consortium, comparable data on good oral hygiene indicators were harmonized. These included: no denture wear, no gum disease (or bleeding), <5 missing teeth, tooth brushing at least daily, and visiting a dentist ≥once a year. Logistic regression was used to estimate the effects of each oral hygiene indicator and cumulative score on HNC risk, adjusting for tobacco smoking and alcohol consumption. RESULTS Inverse associations with any HNC, in the hypothesized direction, were observed for <5 missing teeth [odds ratio (OR) = 0.78; 95% confidence interval (CI) 0.74, 0.82], annual dentist visit (OR = 0.82; 95% CI 0.78, 0.87), daily tooth brushing (OR = 0.83, 95% CI 0.79, 0.88), and no gum disease (OR = 0.94; 95% CI 0.89, 0.99), and no association was observed for wearing dentures. These associations were relatively consistent across specific cancer sites, especially for tooth brushing and dentist visits. The population attributable fraction for ≤ 2 out of 5 good oral hygiene indicators was 8.9% (95% CI 3.3%, 14%) for oral cavity cancer. CONCLUSION Good oral hygiene, as characterized by few missing teeth, annual dentist visits, and daily tooth brushing, may modestly reduce the risk of HNC.
Collapse
Affiliation(s)
- D Hashim
- The Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - S Sartori
- The Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - P Brennan
- International Agency for Research on Cancer, Lyon, France
| | | | - V Wünsch-Filho
- School of Public Health, University of São Paulo, São Paulo, Brazil
| | | | - A F Olshan
- Department of Epidemiology, University of North Carolina School of Public Health, Chapel Hill
| | - J P Zevallos
- Department of Otolaryntology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill
| | - D M Winn
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, USA
| | - S Franceschi
- International Agency for Research on Cancer, Lyon, France
| | - X Castellsagué
- Catalan Institute of Oncology (ICO)-IDIBELL, L'Hospitalet de Llobregat, Catalonia CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - J Lissowska
- Department of Cancer Epidemiology and Prevention, The M. Sklasodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - P Rudnai
- National Public Health Center, Budapest, Hungary
| | - K Matsuo
- Division of Molecular Medicine, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - H Morgenstern
- Department of Epidemiology Department of Environmental Health Sciences, School of Public Health and Comprehensive Cancer Center, University of Michigan, Ann Arbor
| | - C Chen
- Fred Hutchinson Cancer Research Center, Seattle
| | - T L Vaughan
- Fred Hutchinson Cancer Research Center, Seattle
| | - J N Hofmann
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda
| | - G D'Souza
- Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - R I Haddad
- Dana Farber Cancer Institute, Harvard Medical School, Boston
| | - H Wu
- The Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Y-C Lee
- Division of Public Health, Department of Family and Preventive Medicine and Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, USA
| | - M Hashibe
- Division of Public Health, Department of Family and Preventive Medicine and Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, USA
| | - C La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - P Boffetta
- The Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, USA The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| |
Collapse
|
43
|
Meelu O, Theodoropoulos K, Mennuni M, Sartori S, Baber U, Mehran R, Dangas G, Sharma S, Kini A. OC10_02 Impact of Diabetes Mellitus on Patients With Human Immunodeficiency Virus Undergoing Percutaneous Coronary Intervention: Results From a Large, Single Center Registry. Glob Heart 2016. [DOI: 10.1016/j.gheart.2016.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
44
|
Santangelo L, Cainelli E, Nosadini M, Sartori S, Sole M, Suppiej A. 3. Evaluation of long term cognitive risks associated with the presence of seizure during acute disseminated encephalomyelitis. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2015.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
45
|
Cainelli E, de Palma L, Nosadini M, Sartori S, Boniver C, Suppiej A. 20. Spectral analysis of the eeg in paediatric anti-NMDAR encephalitis. Clin Neurophysiol 2015. [DOI: 10.1016/j.clinph.2014.10.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
46
|
Griesauer I, Diao W, Ronovsky M, Elbau I, Sartori S, Singewald N, Pollak DD. Circadian abnormalities in a mouse model of high trait anxiety and depression. Ann Med 2014; 46:148-54. [PMID: 24405329 PMCID: PMC4025598 DOI: 10.3109/07853890.2013.866440] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 11/04/2013] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Dysregulation of circadian rhythms is a key symptom of mood disorders, including anxiety disorders and depression. Whether the circadian abnormalities observed in depressed patients are cause or consequence of the disease remains elusive. Here we aimed to explore potential disturbances of circadian rhythms in a validated genetic animal model of high trait anxiety and co-morbid depression and examine its molecular correlates. MATERIALS AND METHODS Mice selectively bred for high (HAB) and normal (NAB) anxiety- and co-segregating depression-like behavior were subjected to analysis of circadian wheel-running activity to determine light-entrained (LD) and free-running circadian (DD) rhythms and a light-induced phase shift. Clock gene expression in HAB/NAB hippocampal tissue was analyzed by qRT-PCR and verified by Western blotting. RESULTS Compared to NABs, HAB mice were found to present with altered DD length of daily cycle, fragmented ultradiem rhythms, and a blunted phase shift response. Clock gene expression analysis revealed a selective reduction of Cry2 expression in hippocampal tissue of HAB mice. DISCUSSION We provide first evidence for a dysregulation of circadian rhythms in a mouse model of anxiety and co-morbid depression which suggests an association between depression and altered circadian rhythms at the genetic level and points towards a role for Cry2.
Collapse
Affiliation(s)
- Irene Griesauer
- Department of Neurophysiology and Neuropharmacology, Medical University of Vienna, Austria
| | - Weifei Diao
- Department of Neurophysiology and Neuropharmacology, Medical University of Vienna, Austria
| | - Marianne Ronovsky
- Department of Neurophysiology and Neuropharmacology, Medical University of Vienna, Austria
| | - Immanuel Elbau
- Department of Neurophysiology and Neuropharmacology, Medical University of Vienna, Austria
| | - Simone Sartori
- Department of Pharmacology and Toxicology, Institute of Pharmacy and CMBI, Leopold-Franzens-University of Innsbruck, Innsbruck, Austria
| | - Nicolas Singewald
- Department of Pharmacology and Toxicology, Institute of Pharmacy and CMBI, Leopold-Franzens-University of Innsbruck, Innsbruck, Austria
| | - Daniela D. Pollak
- Department of Neurophysiology and Neuropharmacology, Medical University of Vienna, Austria
| |
Collapse
|
47
|
Sartori S, Ensslin L, Campos LMDS, Ensslin SR. Mapeamento do estado da arte do tema sustentabilidade ambiental direcionado para a tecnologia de informação. Transinformação 2014. [DOI: 10.1590/s0103-37862014000100008] [Citation(s) in RCA: 3] [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: 11/22/2022] Open
Abstract
Este artigo tem por objetivo realizar um mapeamento das publicações sobre o tema Avaliação da Sustentabilidade Ambiental para a Tecnologia de Informação e, a partir desse, selecionar um portfólio bibliográfico das publicações mais relevantes e alinhadas segundo a percepção dos autores dessa pesquisa. Para este portfólio, fez-se uma análise bibliométrica visando construir o conhecimento sobre os assuntos mais frequentes: autores, artigos, periódicos e palavras-chave no tema. Caracteriza-se este trabalho pelo caráter exploratório-descritivo; além disso, apresenta-se abordagens quantitativas e qualitativas, por meio do uso do instrumento de intervenção Knowledge Development Process - Constructivist. Nesse sentido, foram selecionados 25 artigos relevantes e 416 artigos de referências, que passaram a representar o Portfólio Bibliográfico. Na análise bibliométrica dos artigos do Portfólio Bibliográfico e suas referências evidenciam-se: os periódicos "Association for Computing Machinery Computing Surveys" e "Management Information Systems Quarterly"; os artigos "Information Technology and Organizational Performance: An integrative model of Information Technology business value" e "Beyond the Business Case for Corporate Sustainability"; as palavras-chaves "Information Technology" e "Sustainability"; e os autores mais citados Marie-Claude Boudreau, Tom Butler, Adela Chen, Jason Dedrick, Robert Sroufe, Richard Watson, e Nigel Melville. Esses resultados são singulares devido às delimitações postas pelos autores dessa pesquisa e o processo empregado em sua abordagem é ampla, podendo ser utilizada por outros pesquisadores relacionados a esse tema ou não.
Collapse
|
48
|
Tassinari D, Genestreti G, Pasquini E, Papi M, Fantini M, Tamburini E, Fochessati F, Poggi B, Imola M, Mianulli AM, Fattori PP, Lazzari-Agli L, Ioli G, Sartori S, Ravaioli A. Efficacy of Two Different Platinum- or Anthracycline- Containing Chemotherapy Regimens for the Treatment of Small Cell Lung Cancer. J Chemother 2013; 17:228-36. [PMID: 15920911 DOI: 10.1179/joc.2005.17.2.228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/31/2022]
Abstract
The records of 190 consecutive patients referred to our department to be treated for small cell lung cancer were retrospectively evaluated, and the outcomes were compared on the basis of their first-line treatment. 113 patients were treated with 4-6 courses of cyclophosphamide, epidoxorubicin and etoposide (CEVP16), 77 with 4-6 courses of carboplatin and etoposide (CBE). 72 patients had limited disease and 118 extensive disease. Response rates were 58.4% for CEVP16 and 28.6% for CBE (p=0.0001), with no significant difference in the time to progression (255 vs 246 days, p=0.21). Overall survival was 334 days and 212 days, and the 1-year survival rate was 46% and 22.1%, respectively (p=0.0018). In patients with limited disease, overall survival was 434 days and 249 days (p=0.08) in both treatment group respectively and 281 and 208 days in those with extensive disease, respectively (p=0.02). No difference in side effects was observed between the two groups of patients. Our data suggest a role for anthracycline-containing regimens as first-line treatment of small cell lung cancer.
Collapse
Affiliation(s)
- D Tassinari
- Department of Oncology, City Hospital, viale Settembrini n. 2, 47900, Rimini, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Nosadini M, Sartori S, Toldo I, Cappellari A, de Palma L, Cainelli E, Zuliani L, Giometto B, Boniver C, Suppiej A. 114. Movement disorder and EEG patterns in anti-NMDAr antibodies encephalitis. Clin Neurophysiol 2013. [DOI: 10.1016/j.clinph.2013.06.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
50
|
Zuliani L, Zoccarato M, Sartori S, Pelizza M, Rosellini I, Argentiero V, Marson P, Suppiej A, Giometto B. Anti-NMDAR encephalitis: Clinical and immunological characterization of a case series. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.2312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|