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Kotanidis CP, Mills GB, Bendz B, Berg ES, Hildick-Smith D, Hirlekar G, Milasinovic D, Morici N, Myat A, Tegn N, Sanchis J, Savonitto S, De Servi S, Fox KAA, Pocock S, Kunadian V. Invasive vs. conservative management of older patients with non-ST-elevation acute coronary syndrome: individual patient data meta-analysis. Eur Heart J 2024:ehae151. [PMID: 38596853 DOI: 10.1093/eurheartj/ehae151] [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: 09/18/2023] [Revised: 01/30/2024] [Accepted: 02/28/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND AND AIMS Older patients with non-ST-elevation acute coronary syndrome (NSTEACS) are less likely to receive guideline-recommended care including coronary angiography and revascularization. Evidence-based recommendations regarding interventional management strategies in this patient cohort are scarce. This meta-analysis aimed to assess the impact of routine invasive vs. conservative management of NSTEACS by using individual patient data (IPD) from all available randomized controlled trials (RCTs) including older patients. METHODS MEDLINE, Web of Science and Scopus were searched between 1 January 2010 and 11 September 2023. RCTs investigating routine invasive and conservative strategies in persons >70 years old with NSTEACS were included. Observational studies or trials involving populations outside the target range were excluded. The primary endpoint was a composite of all-cause mortality and myocardial infarction (MI) at 1 year. One-stage IPD meta-analyses were adopted by use of random-effects and fixed-effect Cox models. This meta-analysis is registered with PROSPERO (CRD42023379819). RESULTS Six eligible studies were identified including 1479 participants. The primary endpoint occurred in 181 of 736 (24.5%) participants in the invasive management group compared with 215 of 743 (28.9%) participants in the conservative management group with a hazard ratio (HR) from random-effects model of 0.87 (95% CI 0.63-1.22; P = .43). The hazard for MI at 1 year was significantly lower in the invasive group compared with the conservative group (HR from random-effects model 0.62, 95% CI 0.44-0.87; P = .006). Similar results were seen for urgent revascularization (HR from random-effects model 0.41, 95% CI 0.18-0.95; P = .037). There was no significant difference in mortality. CONCLUSIONS No evidence was found that routine invasive treatment for NSTEACS in older patients reduces the risk of a composite of all-cause mortality and MI within 1 year compared with conservative management. However, there is convincing evidence that invasive treatment significantly lowers the risk of repeat MI or urgent revascularisation. Further evidence is needed from ongoing larger clinical trials.
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Affiliation(s)
- Christos P Kotanidis
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, 4th Floor William Leech Building, Newcastle upon Tyne NE2 4HH, UK
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, High Heaton NE7 7DN, United Kingdom
| | - Gregory B Mills
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, 4th Floor William Leech Building, Newcastle upon Tyne NE2 4HH, UK
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, High Heaton NE7 7DN, United Kingdom
| | - Bjørn Bendz
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Erlend S Berg
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - David Hildick-Smith
- Sussex Cardiac Centre, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Geir Hirlekar
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Dejan Milasinovic
- Department of Cardiology, University Clinical Center of Serbia, Belgrade, Serbia
- Medical Faculty, University of Belgrade, Belgrade, Serbia
| | | | | | - Nicolai Tegn
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Juan Sanchis
- Department of Cardiology, Hospital Clinico Universitario, INCLIVA, Universitat de Valencia, CIBER-Cardiovascular, Valencia, Spain
| | | | - Stefano De Servi
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Keith A A Fox
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Stuart Pocock
- London School of Hygiene and Tropical Medicine, London, UK
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, 4th Floor William Leech Building, Newcastle upon Tyne NE2 4HH, UK
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, High Heaton NE7 7DN, United Kingdom
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De Servi S, Landi A, Savonitto S. Clopidogrel induced reduction in neutrophil count: An overlooked beneficial effect? Eur J Intern Med 2024:S0953-6205(24)00135-3. [PMID: 38582734 DOI: 10.1016/j.ejim.2024.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/02/2024] [Accepted: 03/25/2024] [Indexed: 04/08/2024]
Abstract
Complement-stimulated neutrophils are able to adhere to the endothelium and damage endothelial cells both in vitro and in vivo. These blood cells participate in the early stages, growth and complications of atherosclerotic plaques. Recent findings, based on mendelian randomization analysis, support the concept that high neutrophil counts are a causal risk factor for ischemic heart disease and myocardial infarction . Clopidogrel decreases leukocyte count and inflammatory markers in patients with acute coronary syndromes; this off-target effect, which is independent of the antiplatelet action, may help explaining secondary prevention data showing a superiority of clopidogrel over aspirin in reducing new cardiovascular events.
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Affiliation(s)
- Stefano De Servi
- Department of Molecular Medicine, University of Pavia, Pavia, Italy.
| | - Antonio Landi
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), University of Italian Switzerland, CH-6900, Lugano, Switzerland
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Savonitto S, Morici N, Pancani S, Nozza A, Cosentino F, Perrone Filardi P, Cavallini C, Angeli F, Stähli BE, Heerspink HJL, Mannini A, Schwartz GG, Lincoff AM, Tardif JC, Grobbee DE. Impact of age on the predictive value of NT-proBNP in patients with diabetes mellitus stabilised after an acute coronary syndrome. Diabetes Res Clin Pract 2024; 208:111112. [PMID: 38278494 DOI: 10.1016/j.diabres.2024.111112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/04/2024] [Accepted: 01/21/2024] [Indexed: 01/28/2024]
Abstract
AIMS To assess the impact of age on the prognostic value of NT-proBNP concentration in patients with type-2 diabetes mellitus (T2DM) stabilised after an Acute Coronary Syndrome (ACS). METHODS The AleCardio study compared aleglitazar with placebo in 7226 patients with T2DM and recent ACS. Patients with heart failure were excluded. Median follow-up was 104 weeks. Baseline NT-proBNP plasma concentration was measured centrally. Multivariable Cox regression was used to determine the mortality predictive information provided by NT-proBNP across age groups. RESULTS Median age was 61y (IQR 54, 67). NT-proBNP concentration increased by quartile (Q) of age (median 264, 318, 391, and 588 pg/ml). Compared to Q1, patients in Q4 of NT-proBNP had higher (p < 0.001) adjusted HR for all-cause (aHR 6.9; 95 % CI 4.0-12) and cardiovascular (11; 5.4-23) death. Within each age Q, baseline NT-proBNP in patients who died was 3 times higher than in survivors (all p < 0.001). When age and NT-proBNP levels were modeled as continuous variables, their interaction term was nonsignificant. The relative prognostic information provided by NT-proBNP (percent of total X2) increased from 38 % in age Q1 to 75 % in age Q4 for mortality, and from 50 % to 88 % for CV death. CONCLUSIONS Among patients with T2DM stabilised after an ACS, NT-proBNP level predicts death irrespective of age.
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Affiliation(s)
| | - Nuccia Morici
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Silvia Pancani
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence, Italy
| | - Anna Nozza
- Montreal Health Innovations Coordinating Center (MHICC), Montreal, QC, Canada
| | - Francesco Cosentino
- Cardiology Unit, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
| | | | - Claudio Cavallini
- Division of Cardiology, Ospedale Santa Maria della Misericordia, Perugia, Italy
| | - Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, Varese and Department of Medicine and Cardiopulmonary Rehabilitation Maugeri Care and Research Institutes IRCCS Tradate, Italy
| | - Barbara E Stähli
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Hiddo J L Heerspink
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, University Medical Center Groningen, the Netherlands, and The George Institute for Global Health, Sydney, NSW, Australia
| | - Andrea Mannini
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence, Italy
| | - Gregory G Schwartz
- Rocky Mountain Regional VA Medical Center and University of Colorado School of Medicine, Aurora, CO, USA
| | - A Michael Lincoff
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | | | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care and Julius Clinical, University Medical Center Utrecht, Utrecht, the Netherlands
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Savonitto S, Piatti L, Tiberti G. Two Myocardial Infarctions and Five 8,000-m Peaks. Am J Cardiol 2023; 209:8-9. [PMID: 37856916 DOI: 10.1016/j.amjcard.2023.09.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 10/21/2023]
Abstract
We report the case of a male smoker who is overweight and has no leisure time physical activity until a first acute inferolateral myocardial infarction at the age of 44 years, which was treated using coronary stenting of the left circumflex artery. He was discharged with an ejection fraction of 0.45 and the indication to quit smoking and initiate regular aerobic physical activity. After that episode, he started regular mountain hiking in the Alps, Andes, and, finally, in the Himalayas and Karakorum, where, up to the age of 65 years, he climbed 5 peaks of altitude >8,000 m, always solo and without oxygen, despite a recurrent myocardial infarction because of occlusion at the distal edge of the previously implanted stent. This case supports the indication that high-altitude per se is not contraindicated in patients with well-compensated coronary artery disease, even after an acute MI.
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Affiliation(s)
| | - Luigi Piatti
- Cardiovascular Department, Manzoni Hospital, Lecco, Italy
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Colombo C, Rebora P, Montalto C, Cantoni S, Sacco A, Mauri M, Andreano A, Russo AG, De Servi S, Savonitto S, Morici N. Hospital-Acquired Anemia in Patients with Acute Coronary Syndrome: Epidemiology and Potential Impact on Long-Term Outcome. Am J Med 2023; 136:1203-1210.e4. [PMID: 37704074 DOI: 10.1016/j.amjmed.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/04/2023] [Accepted: 08/21/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Anemia (either pre-existing or hospital-acquired) is considered an independent predictor of mortality in acute coronary syndromes. However, it is still not clear whether anemia should be considered as a marker of worse health status or a therapeutic target. We sought to investigate the relationship between hospital-acquired anemia and clinical and laboratory findings and to assess the association with mortality and major cardiovascular events at long-term follow-up. METHODS Patients consecutively admitted at Niguarda Hospital between February 2014 and November 2020 for an acute coronary syndrome were included in this cohort analysis and classified as anemic at admission (group A), with normal hemoglobin at admission but developing anemia during hospitalization (hospital-acquired anemia) (group B); and with normal hemoglobin levels throughout admission (group C). RESULTS Among 1294 patients included, group A included 353 (27%) patients, group B 468 (36%), and group C 473 patients (37%). In terms of cardiovascular burden and incidence of death, major cardiovascular events and bleeding at 4.9-year median follow-up, group B had an intermediate risk profile as compared with A and C. Baseline anemia was an independent predictor of death (hazard ratio 1.51; 95% confidence interval, 1.02-2.25; P = .04) along with frailty, Charlson comorbidity Index, estimated glomerular filtration rate, previous myocardial infarction, and left ventricular ejection fraction. Conversely, hospital-acquired anemia was not associated with increased mortality (hazard ratio 1.18; 95% confidence interval, 0.8-1.75; P = .4). CONCLUSIONS Hospital-acquired anemia affects one-third of patients hospitalized for acute coronary syndrome and is associated with age, frailty, and comorbidity burden, but was not found to be an independent predictor of long-term mortality.
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Affiliation(s)
- Claudia Colombo
- 1st Division of Cardiology, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Paola Rebora
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging (B4 Center), School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Claudio Montalto
- 1st Division of Cardiology, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Silvia Cantoni
- Division of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alice Sacco
- 1st Division of Cardiology, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marco Mauri
- School of Medicine, University of Milano-Bicocca, Monza, Italy
| | - Anita Andreano
- Epidemiology Unit, Agency for Health Protection of Milan, Italy
| | | | - Stefano De Servi
- Department of Molecular Medicine, University of Pavia Medical School, Italy
| | | | - Nuccia Morici
- IRCSS S. Maria Nascente, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy.
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Savonitto S, De Luca G. Prehospital Care for ST-Segment Elevation Myocardial Infarction in Remote Areas: Lost in Translation. Am J Cardiol 2023; 207:509-510. [PMID: 37802699 DOI: 10.1016/j.amjcard.2023.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/06/2023] [Indexed: 10/08/2023]
Affiliation(s)
| | - Giuseppe De Luca
- Service of Cardiology, AOU "Policlinico G. Martino", University of Messina, Messina, Italy; Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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7
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De Luca G, Algowhary M, Uguz B, Oliveira DC, Ganyukov V, Zimbakov Z, Cercek M, Okkels Jensen L, Loh PH, Calmac L, Roura I Ferrer G, Quadros A, Milewski M, Scotto Di Uccio F, von Birgelen C, Versaci F, Ten Berg J, Casella G, Wong Sung Lung A, Kala P, Díez Gil JL, Carrillo X, Dirksen M, Becerra-Munoz VM, Kang-Yin Lee M, Juzar DA, de Moura Joaquim R, De Simone C, Milicic D, Davlouros P, Bakraceski N, Zilio F, Donazzan L, Kraaijeveld A, Galasso G, Arpad L, Marinucci L, Guiducci V, Menichelli M, Scoccia A, Yamac AH, Ugur Mert K, Flores Rios X, Kovarnik T, Kidawa M, Moreu J, Flavien V, Fabris E, Lozano Martínez-Luengas I, Boccalatte M, Bosa Ojeda F, Arellano-Serrano C, Caiazzo G, Cirrincione G, Kao HL, Sanchis Forés J, Vignali L, Pereira H, Manzo-Silbermann S, Ordoñez S, Arat Özkan A, Scheller B, Lehtola H, Teles R, Mantis C, Antti Y, Brum Silveira JA, Bessonov I, Zoni R, Savonitto S, Kochiadakis G, Alexopoulos D, Uribe CE, Kanakakis J, Faurie B, Gabrielli G, Gutierrez Barrios A, Bachini JP, Rocha A, Tam FCC, Rodriguez A, Lukito AA, Bellemain-Appaix A, Pessah G, Cortese G, Parodi G, Burgadha MA, Kedhi E, Lamelas P, Suryapranata H, Nardin M, Verdoia M. SARS-CoV-2 Positivity, Stent Thrombosis, and 30-day Mortality in STEMI Patients Undergoing Mechanical Reperfusion. Angiology 2023; 74:987-996. [PMID: 36222189 DOI: 10.1177/00033197221129351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
SARS-Cov-2 has been suggested to promote thrombotic complications and higher mortality. The aim of the present study was to evaluate the impact of SARS-CoV-2 positivity on in-hospital outcome and 30-day mortality in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) enrolled in the International Survey on Acute Coronary Syndromes ST-segment elevation Myocardial Infarction (ISACS-STEMI COVID-19 registry. The 109 SARS-CoV-2 positive patients were compared with 2005 SARS-CoV-2 negative patients. Positive patients were older (P = .002), less often active smokers (P = .002), and hypercholesterolemic (P = .006), they presented more often later than 12 h (P = .037), more often to the hub and were more often in cardiogenic shock (P = .02), or requiring rescue percutaneous coronary intervention after failed thrombolysis (P < .0001). Lower postprocedural Thrombolysis in Myocardial Infarction 3 flow (P = .029) and more thrombectomy (P = .046) were observed. SARS-CoV-2 was associated with a significantly higher in-hospital mortality (25.7 vs 7%, adjusted Odds Ratio (OR) [95% Confidence Interval] = 3.2 [1.71-5.99], P < .001) in-hospital definite in-stent thrombosis (6.4 vs 1.1%, adjusted Odds Ratio [95% CI] = 6.26 [2.41-16.25], P < .001) and 30-day mortality (34.4 vs 8.5%, adjusted Hazard Ratio [95% CI] = 2.16 [1.45-3.23], P < .001), confirming that SARS-CoV-2 positivity is associated with impaired reperfusion, with negative prognostic consequences.
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Affiliation(s)
- Giuseppe De Luca
- Division of Clinical and Experimental Cardiology, AOU Sassari, Sassari, Italy Division of Cardiology, Ospedale Nuovo Galeazzi, Milan, Italy
| | - Magdy Algowhary
- Division of Cardiology, Assiut University Heart Hospital, Assiut University, Asyut, Egypt
| | - Berat Uguz
- Division of Cardiology, Bursa City Hospital, Bursa, Turkey
| | - Dinaldo C Oliveira
- Pronto de Socorro Cardiologico Prof. Luis Tavares, Centro PROCAPE, Federal University of Pernambuco, Recife, Brasil
| | - Vladimir Ganyukov
- Department of Heart and Vascular Surgery, State Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - Zan Zimbakov
- University Clinic for Cardiology, Medical Faculty, Ss' Cyril and Methodius University, Skopje, North Macedonia
| | - Miha Cercek
- Centre for Intensive Internal Medicine, University Medical Centre, Ljubljana, Slovenia
| | | | - Poay Huan Loh
- Department of Cardiology, National University Hospital, Singapore
| | | | - Gerard Roura I Ferrer
- Interventional Cardiology Unit, Heart Disease Institute. Hospital Universitari de Bellvitge, Spain
| | | | - Marek Milewski
- Division of Cardiology, Medical University of Silezia, Katowice, Poland
| | | | - Clemens von Birgelen
- Department of Cardiology, Medisch Spectrum Twente, Thoraxcentrum Twente, Enschede, The Netherlands
- Technical Medical Centre, Health Technologies and Services Research, University of Twente, Enschede, Netherlands
| | | | - Jurrien Ten Berg
- Division of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Gianni Casella
- Division of Cardiology, Ospedale Maggiore Bologna, Italy
| | | | - Petr Kala
- University Hospital Brno, Medical Faculty of Masaryk University Brno, Czech Republic
| | | | | | - Maurits Dirksen
- Division of Cardiology, Northwest Clinics Alkmaar, The Netherlands
| | | | - Michael Kang-Yin Lee
- Department of Cardiology, Queen Elizabeth Hospital, University of Hong Kong, Hong Kong
| | - Dafsah Arifa Juzar
- Department of Cardiology and Vascular Medicine, University of Indonesia National Cardiovascular Center "Harapan Kita", Jakarta
| | | | - Ciro De Simone
- Division of Cardiology, Clinica Villa Dei Fiori, Acerra, Italy
| | - Davor Milicic
- Department of Cardiology, University Hospital Centre, University of Zagreb, Zagreb, Croatia
| | - Periklis Davlouros
- Invasive Cardiology and Congenital Heart Disease, Patras University Hospital, Patras, Greece
| | | | - Filippo Zilio
- Division of Cardiology, Ospedale Santa Chiara di Trento, Italy
| | - Luca Donazzan
- Division of Cardiology, Ospedale "S. Maurizio", Bolzano, Italy
| | | | - Gennaro Galasso
- Division of Cardiology, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Lux Arpad
- Maastricht University Medical Center, Utrecht, Netherlands
| | - Lucia Marinucci
- Division of Cardiology, Azienda Ospedaliera "Ospedali Riuniti Marche Nord", Pesaro, Italy
| | | | | | | | - Aylin Hatice Yamac
- Department of Cardiology, Hospital Bezmialem Vakıf University İstanbul, Istanbul, Turkey
| | - Kadir Ugur Mert
- Division of Cardiology, Eskisehir Osmangazi University, Faculty of Medicine, Eskisehir, Turkey
| | | | | | - Michal Kidawa
- Central Hospital of Medical University of Lodz, Poland
| | - Josè Moreu
- Division of Cardiology, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Vincent Flavien
- Division of Cardiology, Center Hospitalier Universitaire de Lille, Lille, France
| | - Enrico Fabris
- Azienda Ospedaliero - Universitaria Ospedali Riuniti Trieste, Italy
| | | | - Marco Boccalatte
- Division of Cardiology, Ospedale Santa Maria Delle Grazie, Pozzuoli, Italy
| | - Francisco Bosa Ojeda
- Division of Cardiology, Hospital Universitario de Canarias, Santa Cruz de Tenerife
| | | | | | | | - Hsien-Li Kao
- Cardiology Division, Department of Internal Medicine, National Taiwan University Hospital, Tapei, Taiwan
| | - Juan Sanchis Forés
- Division of Cardiology, Hospital Clinico Universitario de Valencia, Spain
| | - Luigi Vignali
- Interventional Cardiology Unit, Azienda Ospedaliera Sanitaria, Parma, Italy
| | - Helder Pereira
- Hospital Garcia de Orta, Cardiology Department, Pragal, Almada, Portugal
| | | | - Santiago Ordoñez
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Alev Arat Özkan
- Cardiology Institute, Instanbul University, Instanbul, Turkey
| | - Bruno Scheller
- Division of Cardiology, Clinical and Experimental Interventional Cardiology, University of Saarland, Germany
| | - Heidi Lehtola
- Division of Cardiology, Oulu University Hospital, Finland
| | - Rui Teles
- Division of Cardiology, Hospital de Santa Cruz, CHLO - Nova Medical School, CEDOC, Lisbon, Portugal
| | - Christos Mantis
- Division of Cardiology, Konstantopoulion Hospital, Athens, Greece
| | | | | | | | - Rodrigo Zoni
- Department of Teaching and Research, Instituto de Cardiología de Corrientes "Juana F. Cabral", Argentina
| | | | | | | | - Carlos E Uribe
- Carlos E Uribe, Division of Cardiology, Universidad UPB, Universidad CES, Medellin, Colombia
| | - John Kanakakis
- Division of Cardiology, Alexandra Hospital, Athens, Greece
| | - Benjamin Faurie
- Division of Cardiology, Groupe Hospitalier Mutualiste de Grenoble, France
| | - Gabriele Gabrielli
- Interventional Cardiology Unit, Azienda Ospedaliero Universitaria "Ospedali Riuniti", Ancona, Italy
| | | | | | - Alex Rocha
- Department of Cardiology and Cardiovascular Interventions, Instituto Nacional de Cirugía Cardíaca, Montevideo, Uruguay
| | | | | | - Antonia Anna Lukito
- Cardiovascular Department Pelita Harapan University/Heart Center Siloam Lippo Village Hospital, Tangerang, Banten, Indonesia
| | | | - Gustavo Pessah
- Division of Cardiology, Hospiatl Cordoba, Cordoba, Argentina
| | | | - Guido Parodi
- Division of Cardiology, Ospedale di Lavagna, Italy
| | | | - Elvin Kedhi
- Division of Cardiology, Hopital Erasmus, Universitè Libre de Bruxelles, Belgium
| | | | - Harry Suryapranata
- Division of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Matteo Nardin
- Department of Internal Medicine, Ospedale Riuniti, Brescia, Italy
| | - Monica Verdoia
- Division of Cardiology, Ospedale Degli Infermi, ASL Biella, Italy
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Savonitto S, Piatti L. [The heart patient at high altitude: not just thin air]. G Ital Cardiol (Rome) 2023; 24:872-879. [PMID: 37901978 DOI: 10.1714/4129.41230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
The exposure to high altitude, with its inherent hypobaric hypoxia, elicits transient compensatory physiological responses of the cardiovascular and respiratory system which, however, do not preclude a safe sojourn at least up to 3500 m to the vast majority of well compensated patients with heart disease on stable drug therapy. Existing scientific statements of the European and American Societies of Cardiovascular and High-Mountain Medicine have released specific and helpful recommendations, though mostly based on expert consensus rather than solid evidence. The risk of cardiac events has been recorded only during sports activities, does not seem to depend on altitude and is similar to what is observed during intense exercise at sea level. Besides altitude itself, other aspects of the mountain environment should be considered, such as lower temperature, wind and dehydration which all require careful planning and equipment typical of the alpine sports. The distance of most mountain areas from medical centers able to provide effective care in time-dependent emergencies, and the lack in most cases of dedicated protocols, should also be considered as an important, most likely the most important limiting factor in high-risk patients.
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Savonitto S, Morici N, Farina A. Exercise Training Effective for Refractory Angina, Likely for Multiple Combined Mechanisms. Am J Cardiol 2023; 205:502-503. [PMID: 37661557 DOI: 10.1016/j.amjcard.2023.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 09/05/2023]
Affiliation(s)
| | - Nuccia Morici
- IRCCS S. Maria Nascente, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Andrea Farina
- Division of Cardiology, Manzoni Hospital, Lecco, Italy
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10
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Savonitto S, Montalto C, De Servi S. Gastrointestinal bleeding, a preventable cause of hospital admission: Time for specific studies in patients on antithrombotic therapy. Eur J Intern Med 2023; 116:38-40. [PMID: 37517937 DOI: 10.1016/j.ejim.2023.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 07/26/2023] [Indexed: 08/01/2023]
Affiliation(s)
| | - Claudio Montalto
- De Gasperis Cardio Center, Interventional Cardiology Unit, Niguarda Hospital, Milan, Italy
| | - Stefano De Servi
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
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11
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Angelini F, Franchin L, Bocchino PP, Morici N, Wańha W, Savonitto S, Trabattoni D, Cerrato E, Barbieri L, Fortuni F, DE Luca L, Greco A, DE Filippo O, Montefusco A, Montabone A, Rubino AE, Gili S, Quadri G, Somaschini A, Cornara S, Carugo S, Capodanno D, Wojakowski W, Dusi V, D'Ascenzo F, DE Ferrari GM. In-hospital outcomes in nonagenarian patients undergoing primary percutaneous coronary intervention. Minerva Cardiol Angiol 2023; 71:590-598. [PMID: 36475546 DOI: 10.23736/s2724-5683.22.06167-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
BACKGROUND The aim of the present analysis was to evaluate the incidence and predictors of in-hospital adverse outcomes in nonagenarian patients undergoing primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI). METHODS Consecutive nonagenarian patients undergoing pPCI for STEMI from 2009 to 2019 were retrospectively included in an international multicenter registry. In-hospital all-cause death was the primary outcome. RESULTS A total of 308 patients were included (mean age 92.5±2.5 years, 65.6% female). Mean systolic blood pressure (SBP) at hospital admission was 130.7±33.5 mmHg, 46 (17%) patients presented with a Killip class III-IV, mean left ventricle ejection fraction (LVEF) was 40.0±11.5% and 147 (58%) patients were independent in everyday activities. In-hospital death occurred in 99 patients (32%). After multivariate adjustment, lower LVEF (OR per unit reduction 1.08, 95% CI: 1.03-1.11, P value <0.001), lower SBP (OR 1.02 per mmHg reduction, 95% CI: 1.01-1.03, P value 0.001) and being not independent at home (OR 2.56, 95% CI: 1.25-5.26, P value 0.01) resulted independent predictors of in-hospital mortality. A sensitivity analysis performed in final TIMI 3 flow population confirmed the prognostic role of LVEF and independency on in-hospital mortality. CONCLUSIONS Nonagenarian patients presenting with STEMI and undergoing pPCI have high in-hospital mortality. Independency in everyday life is a strong independent predictor of survival to hospital discharge.
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Affiliation(s)
- Filippo Angelini
- Division of Cardiology, Department of Cardiovascular and Thoracic Surgery, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy -
| | - Luca Franchin
- Division of Cardiology, Department of Cardiovascular and Thoracic Surgery, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Pier P Bocchino
- Division of Cardiology, Department of Cardiovascular and Thoracic Surgery, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Nuccia Morici
- Intensive Cardiac Care Unit, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Wojciech Wańha
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | - Daniela Trabattoni
- Department of Invasive Cardiology, IRCCS Monzino Cardiologic Centre, Milan, Italy
| | - Enrico Cerrato
- Interventional Cardiology Unit, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
- Infermi Hospital, Rivoli, Turin, Italy
| | - Lucia Barbieri
- Division of Cardiology, ASST Santi Paolo e Carlo, Milan, Italy
| | - Federico Fortuni
- Coronary Care Unit, Laboratory of Clinical and Experimental Cardiology, IRCCS San Matteo Polyclinic Foundation, Pavia, Italy
| | | | - Antonio Greco
- AOU Policlinico G. Rodolico-S. Marco, University of Catania, Catania, Italy
| | - Ovidio DE Filippo
- Division of Cardiology, Department of Cardiovascular and Thoracic Surgery, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Antonio Montefusco
- Division of Cardiology, Department of Cardiovascular and Thoracic Surgery, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Andrea Montabone
- Division of Cardiology, Department of Cardiovascular and Thoracic Surgery, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Anna E Rubino
- Division of Cardiology, Department of Cardiovascular and Thoracic Surgery, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Sebastiano Gili
- Department of Invasive Cardiology, IRCCS Monzino Cardiologic Centre, Milan, Italy
| | - Giorgio Quadri
- Interventional Cardiology Unit, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
- Infermi Hospital, Rivoli, Turin, Italy
| | - Alberto Somaschini
- Coronary Care Unit, Laboratory of Clinical and Experimental Cardiology, IRCCS San Matteo Polyclinic Foundation, Pavia, Italy
| | - Stefano Cornara
- Coronary Care Unit, Laboratory of Clinical and Experimental Cardiology, IRCCS San Matteo Polyclinic Foundation, Pavia, Italy
| | - Stefano Carugo
- Unit of Cardiology, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Davide Capodanno
- AOU Policlinico G. Rodolico-S. Marco, University of Catania, Catania, Italy
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Veronica Dusi
- Division of Cardiology, Department of Cardiovascular and Thoracic Surgery, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Cardiovascular and Thoracic Surgery, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Gaetano M DE Ferrari
- Division of Cardiology, Department of Cardiovascular and Thoracic Surgery, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
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12
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Marenzi G, Cosentino N, Resta M, Lucci C, Bonomi A, Trombara F, Della Rocca M, Poggio P, Leoni O, Bortolan F, Savonitto S, Agostoni P. Prognostic Impact of Percutaneous Coronary Intervention in Older Patients Hospitalized with Acute Myocardial Infarction: Real-World Findings from the Lombardy Health Database. J Clin Med 2023; 12:5629. [PMID: 37685696 PMCID: PMC10488530 DOI: 10.3390/jcm12175629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Older patients are less likely to receive percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) compared to younger patients. We investigated the prognostic impact of PCI in a large population of patients hospitalized with AMI in the period 2003-2018 by using the administrative Lombardy Health Database (Italy). METHODS We considered all patients aged ≥75 years hospitalized with AMI (either STEMI or NSTEMI) from 2003 to 2018 in Lombardy. Patients were grouped according to whether they were treated or not with PCI during the index hospitalization. The primary outcome was in-hospital mortality. The secondary endpoints were 1-year mortality and 1-year re-hospitalization for acute heart failure (AHF) or AMI. RESULTS 116,063 patients aged ≥75 years (mean age 83 ± 6; 48% males; 46% STEMI) were hospitalized with a primary diagnosis of AMI. Thirty-seven percent of them (n = 42,912) underwent PCI. The in-hospital mortality rate was significantly lower in PCI-treated patients (6% vs. 15%; p < 0.0001). One-year mortality and 1-year re-hospitalization for AHF/AMI were less frequent in PCI-treated patients (16% vs. 41% and 15% vs. 21%, respectively; p < 0.0001). The adjusted risks of the study endpoints were lower in PCI-treated patients: OR 0.37 (95% CI 0.36-0.39) for in-hospital mortality; HR 0.37 (95% CI 0.36-0.38) for 1-year mortality; HR 0.74 (95% CI 0.71-0.77) for 1-year re-hospitalization for AHF/AMI. Similar results were found in STEMI and NSTEMI patients considered separately. CONCLUSIONS Our real-world data showed that in patients with AMI ≥ 75 years of age, PCI use is associated with lower in-hospital and 1-year mortality.
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Affiliation(s)
- Giancarlo Marenzi
- Centro Cardiologico Monzino, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), 20138 Milan, Italy; (N.C.); (M.R.); (C.L.); (A.B.); (F.T.); (M.D.R.); (P.P.); (P.A.)
| | - Nicola Cosentino
- Centro Cardiologico Monzino, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), 20138 Milan, Italy; (N.C.); (M.R.); (C.L.); (A.B.); (F.T.); (M.D.R.); (P.P.); (P.A.)
| | - Marta Resta
- Centro Cardiologico Monzino, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), 20138 Milan, Italy; (N.C.); (M.R.); (C.L.); (A.B.); (F.T.); (M.D.R.); (P.P.); (P.A.)
| | - Claudia Lucci
- Centro Cardiologico Monzino, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), 20138 Milan, Italy; (N.C.); (M.R.); (C.L.); (A.B.); (F.T.); (M.D.R.); (P.P.); (P.A.)
| | - Alice Bonomi
- Centro Cardiologico Monzino, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), 20138 Milan, Italy; (N.C.); (M.R.); (C.L.); (A.B.); (F.T.); (M.D.R.); (P.P.); (P.A.)
| | - Filippo Trombara
- Centro Cardiologico Monzino, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), 20138 Milan, Italy; (N.C.); (M.R.); (C.L.); (A.B.); (F.T.); (M.D.R.); (P.P.); (P.A.)
| | - Michele Della Rocca
- Centro Cardiologico Monzino, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), 20138 Milan, Italy; (N.C.); (M.R.); (C.L.); (A.B.); (F.T.); (M.D.R.); (P.P.); (P.A.)
| | - Paolo Poggio
- Centro Cardiologico Monzino, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), 20138 Milan, Italy; (N.C.); (M.R.); (C.L.); (A.B.); (F.T.); (M.D.R.); (P.P.); (P.A.)
| | - Olivia Leoni
- Regional Epidemiological Observatory, Lombardy Region, 20138 Milan, Italy; (O.L.); (F.B.)
| | - Francesco Bortolan
- Regional Epidemiological Observatory, Lombardy Region, 20138 Milan, Italy; (O.L.); (F.B.)
| | | | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), 20138 Milan, Italy; (N.C.); (M.R.); (C.L.); (A.B.); (F.T.); (M.D.R.); (P.P.); (P.A.)
- Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, 20138 Milan, Italy
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13
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Spoladore R, Daus F, Pezzini S, Napoli F, Cante L, Savonitto S. [The fact about e-cigarettes and cardiovascular risk]. G Ital Cardiol (Rome) 2023; 24:466-474. [PMID: 37227206 DOI: 10.1714/4041.40206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Electronic cigarettes (e-cigarettes) are battery-powered devices containing a liquid based on propylene glycol or vegetable glycerin. These compounds, when vaporized, act as a vehicle for nicotine, flavors, and other chemical components. These devices have been marketed without clear evidence of risks, long-term safety, and efficacy. Toxicological data show lower plasma concentrations of carbon monoxide and other cancer-inducing substances as compared to traditional smoking. However, several studies have highlighted an increase in sympathetic tone, vascular stiffness, and endothelial dysfunction, all factors associated with cardiovascular risk that, however, is largely inferior to the cardiovascular risk related to traditional smoking. Recent clinical studies have shown how the use of e-cigarettes, combined with adequate psychological support, can be effective in reducing traditional smoking but not nicotine addiction. New policy directives are focusing on the possibility to ban some deleterious products in favor of the use of low-nicotine devices able to promote smoking cessation and reducing the risk of addiction, especially in young people. The use of e-cigarettes among smokers might be promoted with the specific aim of facilitating smoke cessation, but non-smokers and adolescents should be warned against using such devices. Finally, particular attention should be paid to smokers so that the combined use of electronic and traditional cigarettes can be limited as much as possible.
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Affiliation(s)
| | - Francesca Daus
- Scuola di Specializzazione in Malattie dell'Apparato Cardiovascolare, Università degli Studi Milano-Bicocca, Milano
| | - Sara Pezzini
- Scuola di Specializzazione in Malattie dell'Apparato Cardiovascolare, Università degli Studi Milano-Bicocca, Milano
| | - Francesca Napoli
- Scuola di Specializzazione in Malattie dell'Apparato Cardiovascolare, Università degli Studi Milano-Bicocca, Milano
| | - Luigi Cante
- Unità di Cardiologia, Dipartimento di Scienze Mediche Traslazionali, Università della Campania "Luigi Vanvitelli", Napoli
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14
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Savonitto S. [The power of data to support political decision making in health care]. G Ital Cardiol (Rome) 2023; 24:380-382. [PMID: 37102351 DOI: 10.1714/4026.40012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
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15
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De Luca G, Verdoia M, Morici N, Ferri LA, Piatti L, Grosseto D, Bossi I, Sganzerla P, Tortorella G, Cacucci M, Ferrario M, Murena E, Tondi S, Toso A, Bongioanni S, Ravera A, Corrada E, Mariani M, Di Ascenzo L, Petronio AS, Cavallini C, Vitrella G, Antonicelli R, Cesana BM, De Luca L, Ottani F, Moffa N, Savonitto S, De Servi S. Corrigendum to "Impact of hemoglobin levels at admission on outcomes among elderly patients with acute coronary syndrome treated with low-dose Prasugrel or clopidogrel: A sub-study of the ELDERLY ACS 2 trial" [Int J Cardiol. 2022 Dec 15;369:5-11]. Int J Cardiol 2023; 377:133. [PMID: 36774304 DOI: 10.1016/j.ijcard.2023.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Affiliation(s)
- G De Luca
- Clinical and Experimental Cardiology Unit, Azienda Ospedaliera-Universitaria "Sassari", University of Sassari, Sassari, Italy.
| | - M Verdoia
- Division of Cardiology, Ospedale degli Infermi, Biella, Italy
| | - N Morici
- IRCCSS. Maria Nascente Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - L A Ferri
- IRCCS Ospedale San Raffaele, Milan, Italy
| | - L Piatti
- IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - I Bossi
- IRCCSS. Maria Nascente Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | | | | | | | - M Ferrario
- IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy
| | - E Murena
- Ospedale S. Maria delle Grazie, Pozzuoli, Italy
| | - S Tondi
- Ospedale Baggiovara, Modena, Italy
| | - A Toso
- Ospedale S. Stefano, Prato, Italy
| | | | - A Ravera
- Ospedale Ruggi D'Aragona, Salerno, Italy
| | - E Corrada
- Humanitas Clinical and Research Center, Rozzano, Italy
| | | | - L Di Ascenzo
- Ospedale di San Donà di Piave-Portogruaro, Portogruaro, Italy
| | - A S Petronio
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - C Cavallini
- Ospedale S. Maria della Misericordia, Perugia, Italy
| | - G Vitrella
- Ospedali Riuniti di Trieste, Trieste, Italy
| | - R Antonicelli
- Istituto Nazionale di Ricerca e Cura per l' Anziano, Ancona, Italy
| | - B M Cesana
- Statistics and Biomathematics Unit, Department of Molecular and Transactional Medicine, University of Brescia, Brescia, Italy
| | - L De Luca
- Department of Cardiosciences, AO San Camillo-Forlanini, Roma, Italy
| | - F Ottani
- Ospedale Treviglio-Caravaggio, Treviglio, Italy
| | - N Moffa
- IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - S De Servi
- Department of Molecular Medicine, University of Pavia Medical School, Pavia, Italy
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16
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De Servi S, Landi A, Savonitto S, Morici N, De Luca L, Montalto C, Crimi G, De Rosa R, De Luca G. Antiplatelet Strategies for Older Patients with Acute Coronary Syndromes: Finding Directions in a Low-Evidence Field. J Clin Med 2023; 12:2082. [PMID: 36902869 PMCID: PMC10003933 DOI: 10.3390/jcm12052082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/23/2023] [Accepted: 03/04/2023] [Indexed: 03/09/2023] Open
Abstract
Patients ≥ 75 years of age account for about one third of hospitalizations for acute coronary syndromes (ACS). Since the latest European Society of Cardiology guidelines recommend that older ACS patients use the same diagnostic and interventional strategies used by the younger ones, most elderly patients are currently treated invasively. Therefore, an appropriate dual antiplatelet therapy (DAPT) is indicated as part of the secondary prevention strategy to be implemented in such patients. The choice of the composition and duration of DAPT should be tailored on an individual basis, after careful assessment of the thrombotic and bleeding risk of each patient. Advanced age is a main risk factor for bleeding. Recent data show that in patients of high bleeding risk short DAPT (1 to 3 months) is associated with decreased bleeding complications and similar thrombotic events, as compared to standard 12-month DAPT. Clopidogrel seems the preferable P2Y12 inhibitor, due to a better safety profile than ticagrelor. When the bleeding risk is associated with a high thrombotic risk (a circumstance present in about two thirds of older ACS patients) it is important to tailor the treatment by taking into account the fact that the thrombotic risk is high during the first months after the index event and then wanes gradually over time, whereas the bleeding risk remains constant. Under these circumstances, a de-escalation strategy seems reasonable, starting with DAPT that includes aspirin and low-dose prasugrel (a more potent and reliable P2Y12 inhibitor than clopidogrel) then switching after 2-3 months to DAPT with aspirin and clopidogrel for up to 12 months.
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Affiliation(s)
- Stefano De Servi
- Department of Molecular Medicine, University of Pavia Medical School, 27100 Pavia, Italy
| | - Antonio Landi
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland
| | | | - Nuccia Morici
- IRCCS S. Maria Nascente—Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy
| | - Leonardo De Luca
- Department of Cardiovascular Sciences, A.O. San Camillo-Forlanini, 00152 Roma, Italy
| | - Claudio Montalto
- Interventional Cardiology, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy
- Clinical and Interventional Cardiology, Istituto Clinico Sant’Ambrogio, Gruppo San Donato, 20122 Milan, Italy
| | - Gabriele Crimi
- Interventional Cardiology Unit, Cardio-Thoraco Vascular Department (DICATOV), IRCCS, Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Roberta De Rosa
- University Hospital San Giovanni di Dio e Ruggi d’Aragona, 84131 Salerno, Italy
- Goethe University Hospital Frankfurt, 60528 Frankfurt am Main, Germany
| | - Giuseppe De Luca
- Division of Cardiology, AOU “Policlinico G. Martino”, Department of Clinical and Experimental Medicine, University of Messina, 98039 Messina, Italy
- Division of Cardiology, Nuovo Galeazzi-Sant’Ambrogio Hospital, 20161 Milan, Italy
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17
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Sacco A, Montalto C, Bravi F, Ruzzenenti G, Garatti L, Oreglia JA, Bartorelli AL, Crimi G, LA Vecchia C, Savonitto S, Leonardi S, Oliva FG, Morici N. Non-ST-elevation acute coronary syndrome in chronic kidney disease: prognostic implication of an early invasive strategy. Minerva Cardiol Angiol 2023; 71:44-50. [PMID: 35212503 DOI: 10.23736/s2724-5683.21.05839-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The optimal timing of PCI for NSTE-ACS with CKD is unclear. The aim of our study was to assess whether early percutaneous coronary intervention (PCI) (within 24 hours from admission) is associated with improved in-hospital (mortality or acute kidney injury) and long-term events (composite of mortality, myocardial infarction, stroke and bleeding events) in patients with non-ST-elevation acute coronary syndromes (NSTE-ACS) with chronic kidney disease (CKD). METHODS We retrospectively studied NSTE-ACS patients who underwent PCI in large tertiary centers. CKD was defined as estimated glomerular filtration rate (eGFR)<60 mL/min/1.73 m2. A propensity score for the likelihood of an early invasive strategy was calculated. Relative risks (RR) and adjusted hazard ratios (HR) were estimated for in-hospital and follow-up events. RESULTS We included 821 patients, mean age was 69±12 years; 492 (60%) received an early PCI, and 273 (33%) had an eGFR <60. Median follow-up was 391 days. At univariate analysis, early treatment was associated with significantly lower in-hospital and follow-up events. However, after adjustment for major prognostic factors, there was no significant association with both in-hospital (RR=1.06; 95% CI 0.83-1.36) and follow-up events (RR=1.07; 95% CI 0.83-1.37). When the association was assessed in strata of CKD, lack of statistically significant association was confirmed, even if a trend emerged in patients with preserved renal function both on primary outcome (RR=0.47, 95% 0.18-1.22) and time to secondary outcome (HR=0.62, 95% CI 0.36-1.08). CONCLUSIONS In conclusion in a cohort of NSTE-ACS patients, an early invasive strategy does not independently affect prognosis.
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Affiliation(s)
- Alice Sacco
- Intensive Cardiac Care Unit, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy -
| | - Claudio Montalto
- University of Pavia and Coronary Care Unit, IRCCS San Matteo Polyclinic Foundation, Pavia, Italy
| | - Francesca Bravi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giacomo Ruzzenenti
- Intensive Cardiac Care Unit, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Laura Garatti
- Intensive Cardiac Care Unit, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Jacopo A Oreglia
- Interventional Cardiology Division, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Antonio L Bartorelli
- Centro Cardiologico Monzino IRCCS, Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Gabriele Crimi
- Division of Cardiology, San Martino Hospital, Genoa, Italy
| | | | | | - Sergio Leonardi
- University of Pavia and Coronary Care Unit, IRCCS San Matteo Polyclinic Foundation, Pavia, Italy
| | - Fabrizio G Oliva
- Intensive Cardiac Care Unit, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Nuccia Morici
- Intensive Cardiac Care Unit, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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18
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De Servi S, Landi A, Savonitto S, De Luca L, De Luca G, Morici N, Montalto C, Crimi G, Cattaneo M. Tailoring oral antiplatelet therapy in acute coronary syndromes: from guidelines to clinical practice. J Cardiovasc Med (Hagerstown) 2023; 24:77-86. [PMID: 36583976 DOI: 10.2459/jcm.0000000000001399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The assessment of bleeding and ischemic risk is a crucial step in establishing appropriate composition and duration of dual antiplatelet therapy (DAPT) in patients with acute coronary syndrome (ACS) treated with percutaneous coronary angioplasty. Evidence from recent randomized clinical trials led to some paradigm shifts in current guidelines recommendations. Options alternative to the standard 12-month DAPT duration include shorter periods of DAPT followed by single antiplatelet treatment with either aspirin or P2Y12 monotherapy, guided or unguided de-escalation DAPT, prolonged DAPT beyond the 12-month treatment period. Although DAPT composition and duration should be selected for each ACS patient on an individual basis weighing clinical and procedural variables, data from latest trials and meta-analyses may permit suggesting the most appropriate DAPT strategy according to the ischemic and bleeding risk assessed using validated tools and scores.
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Affiliation(s)
- Stefano De Servi
- Department of Molecular Medicine, University of Pavia Medical School, Pavia, Italy
| | - Antonio Landi
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | | | - Leonardo De Luca
- Department of Cardiovascular Sciences, A.O. San Camillo-Forlanini, Roma
| | - Giuseppe De Luca
- Clinical and Experimental Cardiology Unit, Azienda Ospedaliera-Universitaria di Sassari, University of Sassari, Sassari.,Clinical and Interventional Cardiology, Istituto Clinico Sant'Ambrogio, Gruppo San Donato
| | - Nuccia Morici
- IRCCS S. Maria Nascente - Fondazione Don Carlo Gnocchi ONLUS
| | - Claudio Montalto
- Interventional Cardiology, De Gasperis Cardio Center, Niguarda Hospital, Milan
| | - Gabriele Crimi
- Interventional Cardiology Unit, Cardio-Thoraco Vascular Department (DICATOV), IRCCS Ospedale Policlinico San Martino, Genova
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Savonitto S, Angelini G, Farina A. Acute, Prolonged, and Extensive Myocardial Ischemia in a Patient With Colorectal Cancer. JAMA Intern Med 2023; 183:156-157. [PMID: 36534380 DOI: 10.1001/jamainternmed.2022.5065] [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: 12/23/2022]
Abstract
This case report describes a patient in their 60s with spontaneously subsiding and reoccurring severe acute chest pain that lasted for about 30 minutes as well as a recent diagnosis of colorectal cancer.
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Affiliation(s)
| | | | - Andrea Farina
- Division of Cardiology, Manzoni Hospital, Lecco, Italy
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Farina A, Daus F, Savonitto S, Giannattasio C, Pezzini S. 602 CRITICAL AORTIC STENOSIS IN PROFOUND CARDIOGENIC SHOCH: BRIDGE TO TAVI WITH LEVOSIMENDAN. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Cardiogenic shock (CS) in severe aortic stenosis (AS) is associated with high mortality. Percutaneous aortic valve implantation (TAVI) is a possible definite solution, but generally it cannot be performed on an emergency base. In patients with severe systolic dysfunction an augmentation of cardiac index (CI) during dobutamine and nitroprusside infusion can demonstrate contractile and afterload reserve. Invasive hemodynamic monitoring is necessary to keep optimal filling pressure and verify arterial pressure stability. If the hemodynamic response is positive we administer levosimendan to bridge the patient to decision and/or to TAVI. In our small experience this strategy is efficacy and well tolerated.
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Affiliation(s)
| | | | | | | | - Sara Pezzini
- Asst Lecco
- Universita’ Degli Studi Milano Bicocca
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21
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De Luca G, Verdoia M, Morici N, Ferri LA, Piatti L, Grosseto D, Bossi I, Sganzerla P, Tortorella G, Cacucci M, Ferrario M, Murena E, Tondi S, Toso A, Bongioanni S, Ravera A, Corrada E, Mariani M, Di Ascenzo L, Petronio AS, Cavallini C, Vitrella G, Antonicelli R, Cesana BM, De Luca L, Ottani F, Moffa N, Savonitto S, De Servi S. Impact of hemoglobin levels at admission on outcomes among elderly patients with acute coronary syndrome treated with low-dose Prasugrel or clopidogrel: A sub-study of the ELDERLY ACS 2 trial. Int J Cardiol 2022; 369:5-11. [PMID: 35907504 DOI: 10.1016/j.ijcard.2022.07.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 07/13/2022] [Accepted: 07/17/2022] [Indexed: 11/15/2022]
Abstract
Hemoglobin (Hb) levels have emerged as a useful tool for risk stratification and the prediction of outcome after myocardial infarction. We aimed at evaluating the prognostic impact of this parameter among patients in advanced age, where the larger prevalence of anemia and the higher rate of comorbidities could directly impact on the cardiovascular risk. METHODS All the patients in the ELDERLY-2 trial, were included in this analysis and stratified according to the values of hemoglobin at admission. The primary endpoint of this study was cardiovascular mortality within one year. The secondary endpoints were all-cause mortality, MI, Bleeding Academic Research Consortium (BARC) type 2-3 or 5 bleeding, any stroke, re-hospitalization for cardiovascular event or stent thrombosis (probable or definite) within 12 months after index admission. RESULTS We included in our analysis 1364 patients, divided in quartiles of Hb values (<12.2; 12.2-13.39; 13.44-14.49; ≥ 4.5 g/dl). At a mean follow- up of 330.4 ± 99.9 days cardiovascular mortality was increased in patients with lower Hb (HR[95%CI] = 0.76 [0.59-0.97], p = 0.03). Results were no more significant after correction for baseline differences (adjusted HR[95%CI] = 1.22 [0.41-3.6], p = 0.16). Similar results were observed for overall mortality. At subgroup analysis, (according to Hb median values) a significant interaction was observed only with the type of antiplatelet therapy, but not with major high-risk subsets of patients. CONCLUSIONS Among elderly patients with acute coronary syndrome managed invasively, lower hemoglobin at admission is associated with higher cardiovascular and all-cause mortality and major ischemic events, mainly explained by the higher risk profile.
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Affiliation(s)
- Giuseppe De Luca
- Clinical and Experimental Cardiology Unit, Azienda Ospedaliera-Universitaria "Sassari", University of Sassari, Sassari, Italy.
| | - Monica Verdoia
- Division of Cardiology, Ospedale degli Infermi, Biella, Italy
| | - Nuccia Morici
- IRCCSS. Maria Nascente Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | | | | | | | - Irene Bossi
- IRCCSS. Maria Nascente Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | | | | | | | | | | | | | | | | | | | - Elena Corrada
- Humanitas Clinical and Research Center, Rozzano, Italy
| | | | | | | | | | | | | | - Bruno M Cesana
- Statistics and Biomathematics Unit, Department of Molecular and Transactional Medicine, University of Brescia, Brescia, Italy
| | - Leonardo De Luca
- Department of Cardiosciences, AO San Camillo-Forlanini, Roma, Italy
| | | | | | | | - Stefano De Servi
- Department of Molecular Medicine, University of Pavia Medical School, Pavia, Italy
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Pezzini S, Daus F, Lobiati E, Giannattasio C, Savonitto S. 758 CASE REPORT OF A CATHETER-RELATED THROMBOSIS IN THE RIGHT HEART. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Introduction
Central venous catheters (CVCs) are commonly used in clinical practice. Their use may be associated to complications like catheter-related thrombosis, that may not only result in vascular and catheter occlusion but also infection, pulmonary embolism, and formation of right heart thromboemboli. Patients who develop catheter-related thrombosis have an increased risk of mortality due to the potential risk of embolization to the pulmonary vasculature.
Case presentation
We describe the case of a 76-year-old man with multiple cardiovascular risk factors, admitted to the Nephrology Department for a suspected UTI. The patient develops a central venous catheter-related thrombosis on the CVC placed in the right jugular vein. The finding of the thrombus was accidental and happened during a transthoracic echocardiography performed to exclude endocarditis. The thrombus was successfully treated with LMWH infusion, preventing complications like pulmonary embolism.
Conclusion
Although generally considered safe, central venous catheters can be associated with complications such as catheter-related venous thrombosis. Intensivists who use these devices should be aware of this possible complication and may use strategies to prevent them in order to improve patient outcome. The present case highlights the importance of maintaining a high index of suspicion for thromboembolic complications in patients with CVCs.
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23
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Montalto C, Morici N, Myat A, Crimi G, De Luca G, Bossi I, de Belder A, Savonitto S, De Servi S. Multivessel vs. culprit-only percutaneous coronary intervention strategy in older adults with acute myocardial infarction. Eur J Intern Med 2022; 105:82-88. [PMID: 36109262 DOI: 10.1016/j.ejim.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 08/16/2022] [Accepted: 09/07/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The optima revascularization strategy for senior patients admitted with acute myocardial infarction (AMI) in the context of multivessel coronary artery disease (MVCAD) remains unclear. We aimed to compare a strategy of culprit-vessel (CV) vs. multi-vessel percutaneous coronary intervention (MV-PCI) in older adults (≥75 years) with AMI. METHODS We analyzed four randomized controlled trials designed to include older adults with AMI. The primary endpoint was all-cause death. The secondary endpoint was the composite of all-cause death, myocardial infarction, stroke and major bleeding (Net Adverse Clinical Events, NACE). A non-parsimonious propensity score and nearest-neighbor matching was performed to account for bias. RESULTS A total of 1,334 trial participants were included; of them, 770 (57.7%) underwent CV-PCI and 564 (42.3%) a MV-PCI strategy. After a median follow-up of 365 days, patients treated with MV-PCI experienced a lower rate of death (6.0% vs. 9.9%; p = 0.01) and of NACE (11.2% vs. 15.5%; p = 0.016). After multivariable analysis, MV-PCI was independently associated with a lower hazard of death (hazard ratio [HR]: 0.65; 95% confidence interval [CI]: 0.42-0.96; p = 0.03) and NACE (NACE 0.72[0.53-0.98]; p = 0.04). These results were confirmed in a matched propensity analysis, were consistent throughout the spectrum of older age and when analyzed by subgroups and when immortal-time bias was considered. CONCLUSIONS In the setting of older adults with MVCAD who were managed invasively for AMI, a MV-PCI strategy to pursue complete revascularization was associated with better survival and lower risk of NACE compared to a CV-PCI. Adequately sized RCTs are required to confirm these findings.
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Affiliation(s)
- Claudio Montalto
- Department of Molecular Medicine, University of Pavia, Pavia, Italy; Interventional Cardiology Unit, De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy.
| | - Nuccia Morici
- IRCCS S. Maria Nascente - Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Aung Myat
- Sussex Cardiac Center, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Gabriele Crimi
- Interventional Cardiology Unit, Cardio-Thoraco-Vascular Department, Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Giuseppe De Luca
- Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Novara, Italy
| | - Irene Bossi
- Interventional Cardiology Unit, De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | - Adam de Belder
- Sussex Cardiac Center, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Stefano Savonitto
- Division of Cardiology, Manzoni Hospital, Via dell'Eremo, 9, Lecco 23900, Italy
| | - Stefano De Servi
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
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24
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De Luca G, Nardin M, Algowhary M, Uguz B, Oliveira DC, Ganyukov V, Zimbakov Z, Cercek M, Okkels Jensen L, Loh PH, Calmac L, Roura Ferrer G, Quadros A, Milewski M, Scotto di Uccio F, von Birgelen C, Versaci F, Ten Berg J, Casella G, Wong Sung Lung A, Kala P, Díez Gil JL, Carrillo X, Dirksen M, Becerra-Munoz VM, Lee MKY, Arifa Juzar D, de Moura Joaquim R, Paladino R, Milicic D, Davlouros P, Bakraceski N, Zilio F, Donazzan L, Kraaijeveld A, Galasso G, Lux A, Marinucci L, Guiducci V, Menichelli M, Scoccia A, Yamac AH, Ugur Mert K, Flores Rios X, Kovarnik T, Kidawa M, Moreu J, Flavien V, Fabris E, Martínez-Luengas IL, Boccalatte M, Bosa Ojeda F, Arellano-Serrano C, Caiazzo G, Cirrincione G, Kao HL, Sanchis Forés J, Vignali L, Pereira H, Manzo S, Ordoñez S, Özkan AA, Scheller B, Lehtola H, Teles R, Mantis C, Antti Y, Brum Silveira JA, Zoni R, Bessonov I, Savonitto S, Kochiadakis G, Alexopoulos D, Uribe CE, Kanakakis J, Faurie B, Gabrielli G, Gutierrez Barrios A, Bachini JP, Rocha A, Tam FCC, Rodriguez A, Lukito AA, Saint-Joy V, Pessah G, Tuccillo A, Cortese G, Parodi G, Bouraghda MA, Kedhi E, Lamelas P, Suryapranata H, Verdoia M. Impact of chronic obstructive pulmonary disease on short-term outcome in patients with ST-elevation myocardial infarction during COVID-19 pandemic: insights from the international multicenter ISACS-STEMI registry. Respir Res 2022; 23:207. [PMID: 35971173 PMCID: PMC9376902 DOI: 10.1186/s12931-022-02128-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 05/02/2022] [Indexed: 11/10/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is projected to become the third cause of mortality worldwide. COPD shares several pathophysiological mechanisms with cardiovascular disease, especially atherosclerosis. However, no definite answers are available on the prognostic role of COPD in the setting of ST elevation myocardial infarction (STEMI), especially during COVID-19 pandemic, among patients undergoing primary angioplasty, that is therefore the aim of the current study. Methods In the ISACS-STEMI COVID-19 registry we included retrospectively patients with STEMI treated with primary percutaneous coronary intervention (PCI) between March and June of 2019 and 2020 from 109 high-volume primary PCI centers in 4 continents. Results A total of 15,686 patients were included in this analysis. Of them, 810 (5.2%) subjects had a COPD diagnosis. They were more often elderly and with a more pronounced cardiovascular risk profile. No preminent procedural dissimilarities were noticed except for a lower proportion of dual antiplatelet therapy at discharge among COPD patients (98.9% vs. 98.1%, P = 0.038). With regards to short-term fatal outcomes, both in-hospital and 30-days mortality occurred more frequently among COPD patients, similarly in pre-COVID-19 and COVID-19 era. However, after adjustment for main baseline differences, COPD did not result as independent predictor for in-hospital death (adjusted OR [95% CI] = 0.913[0.658–1.266], P = 0.585) nor for 30-days mortality (adjusted OR [95% CI] = 0.850 [0.620–1.164], P = 0.310). No significant differences were detected in terms of SARS-CoV-2 positivity between the two groups. Conclusion This is one of the largest studies investigating characteristics and outcome of COPD patients with STEMI undergoing primary angioplasty, especially during COVID pandemic. COPD was associated with significantly higher rates of in-hospital and 30-days mortality. However, this association disappeared after adjustment for baseline characteristics. Furthermore, COPD did not significantly affect SARS-CoV-2 positivity. Trial registration number: NCT 04412655 (2nd June 2020).
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Affiliation(s)
- Giuseppe De Luca
- Division of Clinical and Experimental Cardiology, AOU Sassari, Sassari, Italy. .,University of Sassari, Sassari, Italy.
| | - Matteo Nardin
- Third Medicine Division, ASST Spedali Civili, Brescia, Italy
| | - Magdy Algowhary
- Division of Cardiology, Assiut University Heart Hospital, Assiut University, Asyut, Egypt
| | - Berat Uguz
- Division of Cardiology, Bursa City Hospital, Bursa, Turkey
| | - Dinaldo C Oliveira
- Pronto de Socorro Cardiologico Prof. Luis Tavares, Centro PROCAPE, Federal University of Pernambuco, Recife, Brazil
| | - Vladimir Ganyukov
- Department of Heart and Vascular Surgery, State Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - Zan Zimbakov
- Medical Faculty, University Clinic for Cardiology, Ss' Cyril and Methodius University, Skopje, North Macedonia
| | - Miha Cercek
- Centre for Intensive Internal Medicine, University Medical Centre, Ljubljana, Slovenia
| | | | - Poay Huan Loh
- Department of Cardiology, National University Hospital, Singapore, Singapore
| | - Lucian Calmac
- Clinic Emergency Hospital of Bucharest, Bucharest, Romania
| | - Gerard Roura Ferrer
- Interventional Cardiology Unit, Heart Disease Institute, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | - Marek Milewski
- Division of Cardiology, Medical University of Silezia, Katowice, Poland
| | | | - Clemens von Birgelen
- Department of Cardiology, Medisch Spectrum Twente, Thoraxcentrum Twente, Enschede, The Netherlands
| | - Francesco Versaci
- Division of Cardiology, Ospedale Santa Maria Goretti Latina, Latina, Italy
| | - Jurrien Ten Berg
- Division of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Gianni Casella
- Division of Cardiology, Ospedale Maggiore Bologna, Bologna, Italy
| | | | - Petr Kala
- University Hospital Brno, Medical Faculty of Masaryk University, Brno, Czech Republic
| | | | | | - Maurits Dirksen
- Division of Cardiology, Northwest Clinics, Alkmaar, The Netherlands
| | | | - Michael Kang-Yin Lee
- Department of Cardiology, Queen Elizabeth Hospital, University of Hong Kong, Yau Ma Tei, Hong Kong
| | - Dafsah Arifa Juzar
- Department of Cardiology and Vascular Medicine, University of Indonesia National Cardiovascular Center "Harapan Kita", Jakarta, Indonesia
| | | | | | - Davor Milicic
- Department of Cardiology, University Hospital Centre, University of Zagreb, Zagreb, Croatia
| | - Periklis Davlouros
- Invasive Cardiology and Congenital Heart Disease, Patras University Hospital, Patras, Greece
| | | | - Filippo Zilio
- Division of Cardiology, Ospedale Santa Chiara di Trento, Trento, Italy
| | - Luca Donazzan
- Division of Cardiology, Ospedale "S. Maurizio" Bolzano, Bolzano, Italy
| | | | - Gennaro Galasso
- Division of Cardiology, Ospedale San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Arpad Lux
- Maastricht University Medical Center, Maastricht, The Netherlands
| | - Lucia Marinucci
- Division of Cardiology, Azienda Ospedaliera "Ospedali Riuniti Marche Nord", Pesaro, Italy
| | - Vincenzo Guiducci
- Division of Cardiology, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | | | | | - Aylin Hatice Yamac
- Department of Cardiology, Hospital Bezmialem Vakıf University, İstanbul, Turkey
| | - Kadir Ugur Mert
- Division of Cardiology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | | | | | - Michal Kidawa
- Central Hospital of Medical University of Lodz, Lodz, Poland
| | - Josè Moreu
- Division of Cardiology, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Vincent Flavien
- Division of Cardiology, Center Hospitalier Universitaire de Lille, Lille, France
| | - Enrico Fabris
- Azienda Ospedaliero-Universitaria Ospedali Riuniti Trieste, Trieste, Italy
| | | | - Marco Boccalatte
- Division of Cardiology, Ospedale Santa Maria delle Grazie, Pozzuoli, Italy
| | - Francisco Bosa Ojeda
- Division of Cardiology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | | | | | | | - Hsien-Li Kao
- Cardiology Division, Department of Internal Medicine, National Taiwan University Hospital, Tapei, Taiwan
| | - Juan Sanchis Forés
- Division of Cardiology, Hospital Clinico Universitario de Valencia, Valencia, Spain
| | - Luigi Vignali
- Interventional Cardiology Unit, Azienda Ospedaliera Sanitaria, Parma, Italy
| | - Helder Pereira
- Cardiology Department, Hospital Garcia de Orta, Pragal, Almada, Portugal
| | - Stephane Manzo
- Division of Cardiology, CHU Lariboisière, AP-HP, Paris VII University, INSERM UMRS 942, Paris, France
| | - Santiago Ordoñez
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | | | - Bruno Scheller
- Division of Cardiology Clinical and Experimental Interventional Cardiology, University of Saarland, Saarbrücken, Germany
| | - Heidi Lehtola
- Division of Cardiology, Oulu University Hospital, Oulu, Finland
| | - Rui Teles
- Division of Cardiology, Hospital de Santa Cruz, CHLO-Nova Medical School, CEDOC, Lisbon, Portugal
| | - Christos Mantis
- Division of Cardiology, Kontantopoulion Hospital, Athens, Greece
| | - Ylitalo Antti
- Division of Cardiology, Heart Centre Turku, Turku, Finland
| | | | - Rodrigo Zoni
- Department of Teaching and Research, Instituto de Cardiología de Corrientes "Juana F. Cabral", Corrientes, Argentina
| | | | | | | | | | - Carlos E Uribe
- Division of Cardiology, Universidad UPB, Universidad CES, Medellin, Colombia
| | - John Kanakakis
- Division of Cardiology, Alexandra Hospital, Athens, Greece
| | - Benjamin Faurie
- Division of Cardiology, Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France
| | - Gabriele Gabrielli
- Interventional Cardiology Unit, Azienda Ospedaliero Universitaria"Ospedali Riuniti", Ancona, Italy
| | | | | | - Alex Rocha
- Department of Cardiology and Cardiovascular Interventions, Instituto Nacional de Cirugía Cardíaca, Montevideo, Uruguay
| | - Frankie Chor-Cheung Tam
- Department of Cardiology, Queen Mary Hospital, University of Hong Kong, Pok Fu Lam, Hong Kong
| | | | - Antonia Anna Lukito
- Cardiovascular Department Pelita, Harapan University/Heart Center Siloam Lippo Village Hospital, Tangerang, Banten, Indonesia
| | | | - Gustavo Pessah
- Division of Cardiology, Hospiatl Cordoba, Cordoba, Argentina
| | | | - Giuliana Cortese
- Department of Statistical Sciences, University of Padova, Padua, Italy
| | - Guido Parodi
- Department of Cardiology, ASL 4 Liguria, Lavagna, Italy
| | | | - Elvin Kedhi
- Division of Cardiology, Hopital Erasmus, Universitè Libre de Bruxelles, Brussels, Belgium
| | - Pablo Lamelas
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Harry Suryapranata
- Division of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Monica Verdoia
- Division of Cardiology, Ospedale degli Infermi, ASL Biella, Ponderano, Italy
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Affiliation(s)
| | - Nuccia Morici
- Cardio-Respiratory Department, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
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26
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Pappalardo F, Tavazzi G, Savonitto S, Moricci N. "Enrolling patients in Cardiogenic shock Trials: are we missing someone? Insights from Italian Alt Shock-2 Registry". Eur J Heart Fail 2022; 24:1748-1750. [PMID: 35932214 DOI: 10.1002/ejhf.2640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/19/2022] [Accepted: 07/24/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Federico Pappalardo
- Azienda Ospedaliera Nazionale Santi Antonio e Biagio e Cesare Arrigo Alessandria, Alessandria, ITALY
| | - Guido Tavazzi
- Universita degli Studi di Pavia Facolta di Medicina e Chirurgia Clinical, Surgical and Pediatric sciences Anesthesia and Intensive care PAVIA, ITALY
| | | | - Nuccia Moricci
- Istituto Clinico Sant'Ambrogio Via Faravelli, 16 - 20100, Milano, MI
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Ferlini M, Castini D, Ferrante G, Marenzi G, Montorfano M, Savonitto S, D’Urbano M, Lettieri C, Cuccia C, Marino M, Visconti LO, Carugo S. Acute Coronary Syndromes and SARS-CoV-2 Infection: Results From an Observational Multicenter Registry During the Second Pandemic Spread in Lombardy. Front Cardiovasc Med 2022; 9:912815. [PMID: 35783857 PMCID: PMC9243433 DOI: 10.3389/fcvm.2022.912815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/24/2022] [Indexed: 12/29/2022] Open
Abstract
Background COVID-19 had an adverse impact on the management and outcome of acute coronary syndromes (ACS), but most available data refer to March-April 2020. Aim This study aims to investigate the clinical characteristics, time of treatment, and clinical outcome of patients at hospitals serving as macro-hubs during the second pandemic wave of SARS-CoV-2 (November 2020-January 2021). Methods and Results Nine out of thirteen “macro-hubs” agreed to participate in the registry with a total of 941 patients included. The median age was 67 years (IQR 58-77) and ST-elevation myocardial infarction (STEMI) was the clinical presentation in 54% of cases. Almost all patients (97%) underwent coronary angiography, with more than 60% of patients transported to a macro-hub by the Emergency Medical Service (EMS). In the whole population of STEMI patients, the median time from symptom onset to First Medical Contact (FMC) was 64 min (IQR 30-180). The median time from FMC to CathLab was 69 min (IQR 39-105). A total of 59 patients (6.3%) presented a concomitant confirmed SARS-CoV-2 infection, and pneumonia was present in 42.4% of these cases. No significant differences were found between STEMI patients with and without SARS-CoV-2 infection in treatment time intervals. Patients with concomitant SARS-CoV-2 infection had a significantly higher in-hospital mortality compared to those without (16.9% vs. 3.6%, P < 0.0001). However, post-discharge mortality was similar to 6-month mortality (4.2% vs. 4.1%, P = 0.98). In the multivariate analysis, SARS-CoV-2 infection did not show an independent association with in-hospital mortality, whereas pneumonia had higher mortality (OR 5.65, P = 0.05). Conclusion During the second wave of SARS-CoV-2 infection, almost all patients with ACS received coronary angiography for STEMI with an acceptable time delay. Patients with concomitant infection presented a lower in-hospital survival with no difference in post-discharge mortality; infection by itself was not an independent predictor of mortality but pneumonia was.
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Affiliation(s)
- Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Diego Castini
- Cardiology Department, ASST Santi Paolo e Carlo, Milan, Italy
| | - Giulia Ferrante
- Department of Clinical Sciences and Community Health, Division of Cardiology, University of Milan, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giancarlo Marenzi
- IRCCS Centro Cardiologico Monzino, University of Milan, Milan, Italy
| | | | | | - Maurizio D’Urbano
- Cardiology Department, Legnano Hospital, ASST Ovest Milanese, Legnano, Italy
| | - Corrado Lettieri
- Cardiology Department, Carlo Poma Hospital, ASST Mantova, Mantua, Italy
| | - Claudio Cuccia
- Cardiology Department, Poliambulanza Hospital, Brescia, Italy
| | - Marcello Marino
- Cardiology Department, Ospedale Maggiore di Crema, ASST Crema, Crema, Italy
| | | | - Stefano Carugo
- Department of Clinical Sciences and Community Health, Division of Cardiology, University of Milan, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- *Correspondence: Stefano Carugo,
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Pina A, Farina A, Savonitto S. Immunomediated Sequential Dissection of Visceral Arteries: Dramatic Improvement After Steroid Therapy. Am J Med 2022; 135:e130-e131. [PMID: 35217014 PMCID: PMC8863431 DOI: 10.1016/j.amjmed.2022.01.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Alessandra Pina
- Cardiovascular Department, "A. Manzoni" Hospital - Lecco (LC), Lecco, Italy
| | - Andrea Farina
- Cardiovascular Department, "A. Manzoni" Hospital - Lecco (LC), Lecco, Italy
| | - Stefano Savonitto
- Cardiovascular Department, "A. Manzoni" Hospital - Lecco (LC), Lecco, Italy.
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Toso A, Morici N, Leoncini M, Villani S, Ferri LA, Piatti L, Grosseto D, Bossi I, Sganzerla P, Tortorella G, Cacucci M, Ferrario M, Tondi S, Ravera A, Bellandi F, Cavallini C, Antonicelli R, De Servi S, Savonitto S. Association of statin pretreatment with presentation characteristics, infarct size and outcome in older patients with acute coronary syndrome: the Elderly ACS-2 trial. Age Ageing 2022; 51:6610925. [PMID: 35716046 DOI: 10.1093/ageing/afac121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/28/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND prior statin treatment has been shown to have favourable effects on short- and long-term prognosis in patients with acute coronary syndrome (ACS). There are limited data in older patients. The aim of this study was to investigate the association of previous statin therapy and presentation characteristics, infarct size and clinical outcome in older patients, with or without atherosclerotic cardiovascular disease (ASCVD), included in the Elderly-ACS 2 trial. METHODS data on statin use pre-admission were available for 1,192 of the 1,443 patients enrolled in the original trial. Of these, 531 (44.5%) were already taking statins. Patients were stratified based on established ASCVD and statin therapy. ACS was classified as non-ST elevation or ST elevation myocardial infarction (STEMI). Infarct size was measured by peak creatine kinase MB (CK-MB). All-cause death in-hospital and within 1 year were the major end points. RESULTS there was a significantly lower frequency of STEMI in statin patients, in both ASCVD and No-ASCVD groups. Peak CK-MB levels were lower in statin users (10 versus 25 ng/ml, P < 0.0001). There was lower all-cause death in-hospital and within 1 year for subjects with ASCVD already on statins independent of other baseline variables. There were no differences in all-cause death for No-ASCVD patients whether or not on statins. CONCLUSIONS statin pretreatment was associated with more favourable ACS presentation and lower myocardial damage in older ACS patients both ASCVD and No-ASCVD. The incidence of all-cause death (in-hospital and within 1 year) was significantly lower in the statin treated ASCVD patients.
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Affiliation(s)
- Anna Toso
- Ospedale S. Stefano, Division of Cardiology, Prato, Italy
| | - Nuccia Morici
- IRCCS S. Maria Nascente - Fondazione Don Carlo Gnocchi ONLUS, Cardiology Rehabilitation Unit, Milan, Italy
| | - Mario Leoncini
- Ospedale S. Stefano, Division of Cardiology, Prato, Italy
| | - Simona Villani
- Biostatistica ed Epidemiologia Clinica, Department of Public Health, Neurosciences, Experimental and Forensic Medicine, Università di Pavia, Pavia, Italy
| | - Luca A Ferri
- San Raffaele Scientific Institute, Operative Unit of Hemodynamics and Interventional Cardiology, Milan, Italy
| | - Luigi Piatti
- Ospedale Manzoni, Cardiovascular Department, Lecco, Italy
| | | | - Irene Bossi
- ASST Grande Ospedale Metropolitano Niguarda, Division of Cardiology, Milano, Italy
| | - Paolo Sganzerla
- IRCCS Auxologico San Luca, Laboratory of Catheterization, Milan, Italy
| | | | | | - Maurizio Ferrario
- IRCCS Fondazione Policlinico S. Matteo, Cardiothoracovascular Department and Molecular Medicine, Pavia, Italy
| | | | - Amelia Ravera
- Ospedale Ruggi D' Aragona, Cardiology Intensive Care Unit, Salerno, Italy
| | | | - Claudio Cavallini
- Ospedale S. Maria della Misericordia, Cardiothoracovascular Department, Perugia, Italy
| | - Roberto Antonicelli
- Istituto Nazionale di Ricerca e Cura per l' Anziano, Cardiology Complex Operating Unit, Ancona, Italy
| | - Stefano De Servi
- IRCCS Fondazione Policlinico S. Matteo, Cardiothoracovascular Department and Molecular Medicine, Pavia, Italy
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Golino M, Angelini G, Errigo V, Farina A, Savonitto S. Chest pain in a Ukrainian woman living in Italy immediately after news of homeland Russian invasion. Eur J Intern Med 2022; 99:93-95. [PMID: 35256207 DOI: 10.1016/j.ejim.2022.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 02/27/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Michele Golino
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | - Vittoria Errigo
- ASST Lecco, "A. Manzoni" Hospital, Lecco, Italy; University of Campania "Luigi Vanvitelli", AORN dei Colli/Monaldi Hospital, Naples, Italy
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Savonitto S, Damiani G, Colombo D. Psoriasis and risk of myocardial infarction: Uncertain link, costly implications. Eur J Intern Med 2022; 98:12-14. [PMID: 35177306 DOI: 10.1016/j.ejim.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 02/08/2022] [Indexed: 11/03/2022]
Affiliation(s)
| | - Giovanni Damiani
- Department of Dermatology, Case Western Reserve University, Cleveland, OH, United States; Clinical Dermatology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Galeazzi, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Delia Colombo
- Dermatologist and Clinical Pharmacologist, Milan, Italy
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32
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De Luca G, Algowhary M, Uguz B, Oliveira DC, Ganyukov V, Zimbakov Z, Cercek M, Jensen LO, Loh PH, Calmac L, Roura-Ferrer G, Quadros A, Milewski M, Scotto di Uccio F, von Birgelen C, Versaci F, Ten Berg J, Casella G, Wong ASL, Kala P, Diez Gil JL, Carrillo X, Dirksen MT, Becerra-Muñoz VM, Kang-Yin Lee M, Juzar DA, de Moura Joaquim R, Paladino R, Milicic D, Davlouros P, Bakraceski N, Zilio F, Donazzan L, Kraaijeveld AO, Galasso G, Lux A, Marinucci L, Guiducci V, Menichelli M, Scoccia A, Yamac A, Ugur Mert K, Flores Rios X, Kovarnik T, Kidawa M, Moreu J, Flavien V, Fabris E, Lozano Martìnez-Luengas I, Boccalatte M, Bosa Ojeda F, Arellano-Serrano C, Caiazzo G, Cirrincione G, Kao HL, Sanchis Fores J, Vignali L, Pereira H, Manzo-Silberman S, Ordonez S, Özkan AA, Scheller B, Lehtola H, Teles R, Mantis C, Ylitalo A, Brum Silveira JA, Zoni R, Bessonov I, Savonitto S, Kochiadakis G, Alexopoulos D, Uribe C, Kanakakis J, Faurie B, Gabrielli G, Gutiérrez A, Bachini JP, Rocha A, Tam FC, Rodriguez A, Lukito A, Saint-Joy V, Pessah G, Tuccillo B, Cortese G, Parodi G, Bouraghda MA, Kedhi E, Lamelas P, Suryapranata H, Nardin M, Verdoia M. COVID-19 pandemic, mechanical reperfusion and 30-day mortality in ST elevation myocardial infarction. Heart 2022; 108:458-466. [PMID: 34711661 PMCID: PMC8561823 DOI: 10.1136/heartjnl-2021-319750] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 09/27/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The initial data of the International Study on Acute Coronary Syndromes - ST Elevation Myocardial Infarction COVID-19 showed in Europe a remarkable reduction in primary percutaneous coronary intervention procedures and higher in-hospital mortality during the initial phase of the pandemic as compared with the prepandemic period. The aim of the current study was to provide the final results of the registry, subsequently extended outside Europe with a larger inclusion period (up to June 2020) and longer follow-up (up to 30 days). METHODS This is a retrospective multicentre registry in 109 high-volume primary percutaneous coronary intervention (PPCI) centres from Europe, Latin America, South-East Asia and North Africa, enrolling 16 674 patients with ST segment elevation myocardial infarction (STEMI) undergoing PPPCI in March/June 2019 and 2020. The main study outcomes were the incidence of PPCI, delayed treatment (ischaemia time >12 hours and door-to-balloon >30 min), in-hospital and 30-day mortality. RESULTS In 2020, during the pandemic, there was a significant reduction in PPCI as compared with 2019 (incidence rate ratio 0.843, 95% CI 0.825 to 0.861, p<0.0001). This reduction was significantly associated with age, being higher in older adults (>75 years) (p=0.015), and was not related to the peak of cases or deaths due to COVID-19. The heterogeneity among centres was high (p<0.001). Furthermore, the pandemic was associated with a significant increase in door-to-balloon time (40 (25-70) min vs 40 (25-64) min, p=0.01) and total ischaemia time (225 (135-410) min vs 196 (120-355) min, p<0.001), which may have contributed to the higher in-hospital (6.5% vs 5.3%, p<0.001) and 30-day (8% vs 6.5%, p=0.001) mortality observed during the pandemic. CONCLUSION Percutaneous revascularisation for STEMI was significantly affected by the COVID-19 pandemic, with a 16% reduction in PPCI procedures, especially among older patients (about 20%), and longer delays to treatment, which may have contributed to the increased in-hospital and 30-day mortality during the pandemic. TRIAL REGISTRATION NUMBER NCT04412655.
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Affiliation(s)
- Giuseppe De Luca
- Department of Cardiology, AOU Maggiore della Carità, Eastern Piedmont University, Novara, Italy
- Department of Translational Medicine, Eastern Piedmont University, Novara, Italy
| | | | - Berat Uguz
- Division of Cardiology, Bursa City Hospital, Bursa, Turkey
| | - Dinaldo C Oliveira
- Pronto de Socorro Cardiologico, Centro PROCAPE Prof. Tavares, Recife, Brazil
| | - Vladimir Ganyukov
- Department of Heart and Vascular Surgery, Kemerovo Cardiology Center, Кемерово, Russia
| | - Zan Zimbakov
- University Clinic for Cardiology, Ss Cyril and Methodius University in Skopje, Skopje, Macedonia
| | - Miha Cercek
- Centre for Intensive Internal Medicine, University Medical Centre, Ljubljana, Slovenia
| | | | - Poay Huan Loh
- Department of Cardiology, Singapore Health Service, Singapore
| | - Lucian Calmac
- Clinic Emergency Hospital, University of Bucharest, Bucuresti, Romania
| | - Gerard Roura-Ferrer
- Interventional Cardiology Unit, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - Alexandre Quadros
- Instituto de Cardiologia, Rio Grande do Sul State Department of Health, Porto Alegre, Brazil
| | - Marek Milewski
- Division of Cardiology, Medical University of Silesia in Katowice, Katowice, Poland
| | | | - Clemens von Birgelen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Academisch Medisch Centrum, Twente, The Netherlands
| | | | - Jurriën Ten Berg
- Department of Cardiology, Sint Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | | | | | - Petr Kala
- University Hospital Brno, Masaryk University, Brno, Czech Republic
| | - Jose Luis Diez Gil
- Department of Cardiology, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | - Xavier Carrillo
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | - Michael Kang-Yin Lee
- Department of Cardiology, Queen ElizabethHospital University of Hong Kong, Hong Kong, Hong Kong
| | - Dafsah A Juzar
- Department of cardiology and Vascular Medicine, National Cardiovascular Center 'Harapan Kita', Jakarta, Indonesia
| | | | | | - Davor Milicic
- Department of Cardiology, University of Zagreb, Zagreb, Croatia
| | | | - Nikola Bakraceski
- Center for Cardiovascular Diseases, Ohrid University Hospital, Ohrid, Macedonia
| | - Filippo Zilio
- Division of Cardiology, Ospedale Santa Chiara di Trento, Trento, Italy
| | | | | | - Gennaro Galasso
- Division of Cardiology, University of Salerno, Salerno, Italy
| | - Arpad Lux
- Cardiology, Maastricht University Hospital, Maastricht, The Netherlands
| | - Lucia Marinucci
- Division of Cardiology, Azienda Ospedaliera "Ospedali Riuniti Marche Nord", Ancona, Italy
| | | | - Maurizio Menichelli
- Cardiology Division, Ospedale Fabrizio Spaziani, Roma, Italy
- Cardiology Division, Ospedale "F. Spaziani", Frosinone, Italy
| | | | - Aylin Yamac
- Department of Cardiology, Bezmialem Vakıf University İstanbul, Istanbul, Turkey
| | - Kadir Ugur Mert
- Division of Cardiology, Eskisehir Osmangazi Universitesi, Eskisehir, Turkey
| | | | - Tomas Kovarnik
- Department of Cardiovascular Medicine, University Hospital Prague, Prague, Czech Republic
| | - Michal Kidawa
- Central Hospital, Medical University of Lodz, Lodz, Poland
| | - Jose Moreu
- Division of Cardiology, Hospital Complex of Toledo, Toledo, Spain
| | - Vincent Flavien
- Division of Cardiology, Lille University Hospital Center, Lille, France
| | - Enrico Fabris
- Department of Cardiology, Universita degli Studi di Trieste Dipartimento di Scienze Mediche Chirurgiche e della Salute, Trieste, Italy
| | | | - Marco Boccalatte
- Division of Cardiology, Ospedale Santa Maria delle Grazie, Pozzuoli, Naples, Italy
| | - Francisco Bosa Ojeda
- Division of Cardiology, Consorcio Sanitario de Tenerife, Santa Cruz de Tenerife, Spain
| | | | - Gianluca Caiazzo
- Division of Cardiology, Ospedale "G Moscati", Aversa, Aversa, Italy
| | | | - Hsien-Li Kao
- Cardiology Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Juan Sanchis Fores
- Department of Cardiology, Hospital Clinico Universitario, Universidad de Valencia, Valencia, Spain
| | - Luigi Vignali
- Interventional Cardiology Unit, Azienda Ospedaliera Sanitaria, Parma, Parma, Italy
| | - Helder Pereira
- Cardiology Department, Garcia de Orta Hospital, Almada, Portugal
| | | | - Santiago Ordonez
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | | | - Bruno Scheller
- Clinical and Experimental Interventional Cardiology, Saarland University, Saarbrucken, Germany
| | - Heidi Lehtola
- Division of Cardiology, Oulu University Hospital, Oulu, Finland
| | - Rui Teles
- Department of Cardiology, Hospital de Santa Cruz, CHLO - Nova Medical School,CEDOC, Carnaxide, Portugal
| | - Christos Mantis
- Division of Cardiology, Kontantopoulion Hospital, Athens, Athens, Greece
| | - Antti Ylitalo
- Division of Cardiology, Heart Centre Turku, Turku, Finland
| | | | - Rodrigo Zoni
- Instituto de Cardiología de Corrientes Juana Francisca Cabral, Corrientes, Argentina
| | | | | | | | | | - Carlos Uribe
- Division of Cardiology, Medellin Clinic Universidad UPB, Medellin, Colombia
| | - John Kanakakis
- Division of Cardiology, General Hospital of Athens Alexandra, Athens, Greece
| | - Benjamin Faurie
- Division of Cardiology, Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France
| | - Gabriele Gabrielli
- SOD Cardiologia-Emodinamica-UTIC, Azienda Ospedali Riuniti - Presidio 'GM Lancisi', Ancona, Italy
| | | | | | - Alex Rocha
- Department of Cardiology and Cardiovascular Interventions, Instituto Nacional de Cirugía Cardíaca, Montevideo, Uruguay
| | - Franckie Cc Tam
- Department of Cardiology, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Alfredo Rodriguez
- Department of Cardiology, Otamendi Hospital, Buenos Aires, Argentina
| | - Antonia Lukito
- Cardiovascular Department, Pelita Harapan University, Tangerang, Indonesia
| | | | - Gustavo Pessah
- Division of Cardiology, Cordoba Hospital, Cordoba, Argentina
| | | | - Giuliana Cortese
- Department of Statistical Sciences, University of Padova, Padova, Italy
| | - Guido Parodi
- Division of cardiology, Sassari University Hospital, Sassari, Italy
| | | | - Elvin Kedhi
- Cardiology, Hopital Erasmus, Universitè Libre de Bruxelles, Bruxelles, Belgium
| | - Pablo Lamelas
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | | | - Matteo Nardin
- Department of Translational Medicine, Eastern Piedmont University, Novara, Italy
- Ospedali Riuniti, Brescia, Italy
| | - Monica Verdoia
- Department of Translational Medicine, Eastern Piedmont University, Novara, Italy
- Cardiology, Nuovo Ospedale degli Infermi ASL Biella, Biella, italy
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Angeli F, Verdecchia P, Savonitto S, Cavallini S, Santucci A, Coiro S, Sclafani R, Riccini C, De Servi S, Cavallini C. Soluble CD40 ligand and outcome in patients with coronary artery disease undergoing percutaneous coronary intervention. Clin Chem Lab Med 2022; 60:118-126. [PMID: 34714987 DOI: 10.1515/cclm-2021-0817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/18/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES CD40 ligand (CD40L), a transmembrane glycoprotein belonging to the tumor necrosis factor family and expressed by a variety of cells, is involved in the basic mechanisms of inflammation, atherosclerosis and thrombosis. Some studies suggest that the soluble form of CD40L (sCD40L) is a predictor of major cardiovascular events and mortality in a variety of clinical settings, but data from literature are conflicting. METHODS We studied consecutive patients with acute (ACS) or chronic (CCS) coronary syndrome who underwent percutaneous coronary artery intervention (PCI). Blood samples for sCD40L dosage were taken at baseline immediately before PCI. We tested the relation between sCD40L and pre-specified outcome measures consisting of new ACS, clinical restenosis and all-cause mortality. We recruited 3,841 patients (mean age 64 ± 11 years, 79% men) with ACS (n=2,383) or CCS (n=1,458). RESULTS During a mean follow-up of two years (±0.6 years), 642 patients developed ACS, 409 developed restenosis (≥70% of at least one of the previously treated coronary segments) and 175 died. For each 1-standard deviation increase in sCD40L (0.80 ng/mL), the hazard ratios (HRs) for ACS, restenosis, and mortality were 1.11 (95% confidence interval [CI]: 1.05 to 1.18, p<0.0001), 1.10 (95% CI: 1.02 to 1.19, p=0.010), and 1.00 (95% CI: 0.86 to 1.16, p=0.983), respectively. In multivariable Cox regression models with adjustment for several potential confounders including age, acute or chronic coronary syndrome, multi-vessel disease, stent placement, diabetes, previous coronary events and dyslipidemia, sCD40L remained an independent predictor of ACS and coronary restenosis. There were no interactions between sCD40L and acute or chronic coronary syndrome or stent placement. CONCLUSIONS Among patients with ACS or CCS who undergo PCI, higher levels of sCD40L predict an increased risk of acute coronary events and coronary restenosis, but not of mortality.
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Affiliation(s)
- Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, Varese, Italy.,Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS Tradate, Varese, Italy
| | | | | | - Sara Cavallini
- Department of Cardiology, Hospital of Perugia, Perugia, Italy
| | - Andrea Santucci
- Department of Cardiology, Hospital of Perugia, Perugia, Italy
| | - Stefano Coiro
- Department of Cardiology, Hospital of Perugia, Perugia, Italy
| | - Rocco Sclafani
- Department of Cardiology, Hospital of Perugia, Perugia, Italy
| | - Clara Riccini
- Department of Cardiology, Hospital of Perugia, Perugia, Italy
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Murtas R, Morici N, Cogliati C, Puoti M, Omazzi B, Bergamaschi W, Voza A, Rovere Querini P, Stefanini G, Manfredi MG, Zocchi MT, Mangiagalli A, Brambilla CV, Bosio M, Corradin M, Cortellaro F, Trivelli M, Savonitto S, Russo AG. Algorithm for Individual Prediction of COVID-19-Related Hospitalization Based on Symptoms: Development and Implementation Study. JMIR Public Health Surveill 2021; 7:e29504. [PMID: 34543227 PMCID: PMC8594734 DOI: 10.2196/29504] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/23/2021] [Accepted: 09/14/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has placed a huge strain on the health care system globally. The metropolitan area of Milan, Italy, was one of the regions most impacted by the COVID-19 pandemic worldwide. Risk prediction models developed by combining administrative databases and basic clinical data are needed to stratify individual patient risk for public health purposes. OBJECTIVE This study aims to develop a stratification tool aimed at improving COVID-19 patient management and health care organization. METHODS A predictive algorithm was developed and applied to 36,834 patients with COVID-19 in Italy between March 8 and the October 9, 2020, in order to foresee their risk of hospitalization. Exposures considered were age, sex, comorbidities, and symptoms associated with COVID-19 (eg, vomiting, cough, fever, diarrhea, myalgia, asthenia, headache, anosmia, ageusia, and dyspnea). The outcome was hospitalizations and emergency department admissions for COVID-19. Discrimination and calibration of the model were also assessed. RESULTS The predictive model showed a good fit for predicting COVID-19 hospitalization (C-index 0.79) and a good overall prediction accuracy (Brier score 0.14). The model was well calibrated (intercept -0.0028, slope 0.9970). Based on these results, 118,804 patients diagnosed with COVID-19 from October 25 to December 11, 2020, were stratified into low, medium, and high risk for COVID-19 severity. Among the overall study population, 67,030 (56.42%) were classified as low-risk patients; 43,886 (36.94%), as medium-risk patients; and 7888 (6.64%), as high-risk patients. In all, 89.37% (106,179/118,804) of the overall study population was being assisted at home, 9% (10,695/118,804) was hospitalized, and 1.62% (1930/118,804) died. Among those assisted at home, most people (63,983/106,179, 60.26%) were classified as low risk, whereas only 3.63% (3858/106,179) were classified at high risk. According to ordinal logistic regression, the odds ratio (OR) of being hospitalized or dead was 5.0 (95% CI 4.6-5.4) among high-risk patients and 2.7 (95% CI 2.6-2.9) among medium-risk patients, as compared to low-risk patients. CONCLUSIONS A simple monitoring system, based on primary care data sets linked to COVID-19 testing results, hospital admissions data, and death records may assist in the proper planning and allocation of patients and resources during the ongoing COVID-19 pandemic.
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Affiliation(s)
- Rossella Murtas
- Epidemiology Unit, Agency for the Protection of Health of the Metropolitan Area of Milan, Milan, Italy
| | - Nuccia Morici
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Chiara Cogliati
- ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Massimo Puoti
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Università degli Studi Milano Bicocca, School of Medicine, Milan, Italy
| | | | - Walter Bergamaschi
- Agency for the Protection of Health of the Metropolitan Area of Milan, Milan, Italy
| | | | | | | | - Maria Grazia Manfredi
- General Practitioners Group, Azienda Territoriale della Salute, Milan Metropolitan Area, Milan, Italy.,Ordine dei Medici Chirurghi e degli Odontoiatri di Milano, Milan, Italy
| | - Maria Teresa Zocchi
- General Practitioners Group, Azienda Territoriale della Salute, Milan Metropolitan Area, Milan, Italy.,Ordine dei Medici Chirurghi e degli Odontoiatri di Milano, Milan, Italy
| | - Andrea Mangiagalli
- General Practitioners Group, Azienda Territoriale della Salute, Milan Metropolitan Area, Milan, Italy.,Ordine dei Medici Chirurghi e degli Odontoiatri di Milano, Milan, Italy
| | - Carla Vittoria Brambilla
- General Practitioners Group, Azienda Territoriale della Salute, Milan Metropolitan Area, Milan, Italy.,Ordine dei Medici Chirurghi e degli Odontoiatri di Milano, Milan, Italy
| | - Marco Bosio
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | | | | | | | - Antonio Giampiero Russo
- Epidemiology Unit, Agency for the Protection of Health of the Metropolitan Area of Milan, Milan, Italy
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Slavich M, Falasconi G, Guarnaccia A, Pannone L, Rampa L, Fragasso G, Granata A, Savonitto S, Spoladore R. Hyperhidrosis: the neglected sign in heart failure patients. Am J Cardiovasc Dis 2021; 11:635-641. [PMID: 34849296 PMCID: PMC8611272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 10/15/2021] [Indexed: 06/13/2023]
Abstract
Profuse sweating is a symptom often reported by cardiological patients and could be also an early phenomenon of adaptation or rather cardiac maladaptation in the context of incipient heart failure (HF). By definition, in HF patients the low cardiac output causing reduced renal blood supply and reduced pressure in the arterial baroreceptors activate compensatory mechanisms such as the RAAS and the adrenergic autonomic nervous system. The retention of fluids caused by the decompensation of heart-kidney system could generate a reactive hyperhidrosis and even anticipate an incipient decompensation and might prevent manifest volume overload. Moreover, in HF patients the overactive sympathetic nervous system generates an increase in the reabsorption of fluids in the kidney, on the other hand it generates a signaling to the sweat glands to induce a dispersion of fluids, with loss of sodium and chlorine at the glandular ductal level. Finally sweat gland production physiology during physical activity is also altered in HF patients. This review is focused on sweating and its pathophysiological role in heart failure. Although all the mechanisms underlying this phenomenon are not fully understood, there are interesting connections that might explain this fluid elimination as a wise and sophisticated way to prevent incipient heart failure crisis. Future research could be focused on studying new drugs that selectively would be able to promote fluid elimination by this specific way in patients suffering from heart failure.
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Affiliation(s)
- Massimo Slavich
- Clinical Cardiology Unit, IRCCS San Raffaele University HospitalMilan, Italy
| | - Giulio Falasconi
- Clinical Cardiology Unit, IRCCS San Raffaele University HospitalMilan, Italy
- Vita-Salute San Raffaele UniversityMilan, Italy
| | | | - Luigi Pannone
- Clinical Cardiology Unit, IRCCS San Raffaele University HospitalMilan, Italy
- Vita-Salute San Raffaele UniversityMilan, Italy
| | - Lorenzo Rampa
- Clinical Cardiology Unit, IRCCS San Raffaele University HospitalMilan, Italy
- Vita-Salute San Raffaele UniversityMilan, Italy
| | - Gabriele Fragasso
- Head of Heart Failure Ambulatory, IRCCS San Raffaele University HospitalMilan, Italy
| | - Andrea Granata
- Clinical Cardiology Unit, Alessandro Manzoni HospitalLecco, Italy
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36
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Schrage B, Zeymer U, Montalescot G, Windecker S, Serpytis P, Vrints C, Stepinska J, Savonitto S, Oldroyd KG, Desch S, Fuernau G, Huber K, Noc M, Schneider S, Ouarrak T, Blankenberg S, Thiele H, Clemmensen P. Impact of Center Volume on Outcomes in Myocardial Infarction Complicated by Cardiogenic Shock: A CULPRIT-SHOCK Substudy. J Am Heart Assoc 2021; 10:e021150. [PMID: 34622680 PMCID: PMC8751884 DOI: 10.1161/jaha.120.021150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background Little is known about the impact of center volume on outcomes in acute myocardial infarction complicated by cardiogenic shock. The aim of this study was to investigate the association between center volume, treatment strategies, and subsequent outcome in patients with acute myocardial infarction complicated by cardiogenic shock. Methods and Results In this subanalysis of the randomized CULPRIT‐SHOCK (Culprit Lesion Only PCI Versus Multivessel PCI in Cardiogenic Shock) trial, study sites were categorized based on the annual volume of acute myocardial infarction complicated by cardiogenic shock into low‐/intermediate‐/high‐volume centers (<50; 50–100; and >100 cases/y). Subjects from the study/compulsory registry with available volume data were included. Baseline/procedural characteristics, overall treatment, and 1‐year all‐cause mortality were compared across categories. n=1032 patients were included in this study (537 treated at low‐volume, 240 at intermediate‐volume, and 255 at high‐volume centers). Baseline risk profile of patients across the volume categories was similar, although high‐volume centers included a larger number of older patients. Low‐/intermediate‐volume centers had more resuscitated patients (57.5%/58.8% versus 42.2%; P<0.01), and more patients on mechanical ventilation in comparison to high‐volume centers. There were no differences in reperfusion success despite considerable differences in adjunctive pharmacological/device therapies. There was no difference in 1‐year all‐cause mortality across volume categories (51.1% versus 56.5% versus 54.4%; P=0.34). Conclusions In this study of patients with acute myocardial infarction complicated by cardiogenic shock, considerable differences in adjunctive medical and mechanical support therapies were observed. However, we could not detect an impact of center volume on reperfusion success or mortality.
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Affiliation(s)
- Benedikt Schrage
- Department of Cardiology University Heart and Vascular Centre Hamburg Hamburg Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck Hamburg Germany
| | - Uwe Zeymer
- Department of Cardiology Klinikum der Stadt Ludwigshafen Ludwigshafen am Rhein Germany
| | - Gilles Montalescot
- Sorbonne UniversityACTION Study GroupINSERM UMRS 1166Institut de CardiologieHôpital Pitié-Salpêtrière (AP-HP) Paris France
| | - Stephan Windecker
- Department of Cardiology Bern University HospitalInselspitalUniversity of Bern Bern Switzerland
| | - Pranas Serpytis
- Clinic of Emergency Medicine Faculty of Medicine VIilnius University Lithuania
| | | | - Janina Stepinska
- Department of the Intensive Cardiac Therapy National Institute of Cardiology Warsaw Poland
| | | | - Keith G Oldroyd
- West of Scotland Regional Heart and Lung Centre Golden Jubilee National Hospital Glasgow United Kingdom
| | - Steffen Desch
- Department of Internal Medicine/Cardiology Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute Leipzig Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck Luebeck Germany
| | - Georg Fuernau
- Medical Clinic II (Cardiology, Angiology Intensive Care Medicine) University Heart Center Luebeck Luebeck Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck Luebeck Germany
| | - Kurt Huber
- 3rd Department of Medicine Cardiology and Intensive Care Medicine Wilhelminenhospital and Sigmund Freud UniversityMedical Faculty Vienna Austria
| | - Marko Noc
- Center for Intensive Internal MedicineUniversity Medical Center Ljubljana Slovenia
| | - Steffen Schneider
- Stiftung Institut für Herzinfarktforschung Ludwigshafen am Rhein Germany
| | - Taoufik Ouarrak
- Stiftung Institut für Herzinfarktforschung Ludwigshafen am Rhein Germany
| | - Stefan Blankenberg
- Department of Cardiology University Heart and Vascular Centre Hamburg Hamburg Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck Hamburg Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute Leipzig Germany
| | - Peter Clemmensen
- Department of Cardiology University Heart and Vascular Centre Hamburg Hamburg Germany.,Department of Regional Research and Department of Medicine Faculty of Health Sciences Nykoebing F HospitalUniversity of Southern Denmark Odense Denmark
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37
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Angelini F, Franchin L, Bocchino PP, De Filippo O, Morici N, Wanha W, Savonitto S, Trabattoni D, Cerrato E, Barbieri L, De Luca L, Fortuni F, Capodanno D, D'Ascenzo F, De Ferrari GM. In-hospital outcomes in nonagenarian patients undergoing primary percutaneous coronary intervention. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
The aim of the present analysis was to evaluate the incidence and predictors of in-hospital adverse outcomes in nonagenarian patients undergoing primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI).
Methods
Consecutive nonagenarian patients undergoing pPCI for STEMI from 2009 to 2019 were retrospectively included in an international multicenter registry. In-hospital all-cause death was the primary outcome.
Results
A total of 308 patients were included (mean age 92.5±2.5 years, 65.6% female). Mean systolic blood pressure (SBP) at hospital admission was 130.7±33.5 mmHg, 46 (17%) patients presented with a Killip class III-IV, mean left ventricle ejection fraction (LVEF) was 40.0±11.5% and 147 (58%) patients were independent in everyday activities. In-hospital death occurred in 99 patients (32%). [Figure 1] After multivariate adjustment, lower LVEF (OR per unit reduction 1.08, 95% CI 1.03–1.11, p-value <0.001), lower SBP (OR 0.98 per mmHg reduction, 95% CI 1.01–1.03, p-value 0.001) and being not independent at home (OR 2.56, 95% CI 1.25–5.26, p-value 0.01) resulted independent predictors of in-hospital mortality. [Figure 2] A sensitivity analysis performed in final TIMI 3 flow population confirmed the prognostic role of LVEF and independency on in-hospital mortality.
Conclusion
Nonagenarian patients presenting with STEMI and undergoing pPCI have high in-hospital mortality. Independency in everyday life is a strong independent predictor of survival to hospital discharge.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Affiliation(s)
- F Angelini
- A.O.U. Citta della Salute e della Scienza di Torino, Division of Cardiology, Turin, Italy
| | - L Franchin
- A.O.U. Citta della Salute e della Scienza di Torino, Division of Cardiology, Turin, Italy
| | - P P Bocchino
- A.O.U. Citta della Salute e della Scienza di Torino, Division of Cardiology, Turin, Italy
| | - O De Filippo
- A.O.U. Citta della Salute e della Scienza di Torino, Division of Cardiology, Turin, Italy
| | - N Morici
- Niguarda hospital, Cardiology, Milan, Italy
| | - W Wanha
- University of Silesia, Cardiology, Katowice, Poland
| | - S Savonitto
- Alessandro Manzoni Hospital, Cardiology, Lecco, Italy
| | - D Trabattoni
- Monzino Cardiology Center, IRCCS, Cardiology, Milan, Italy
| | - E Cerrato
- Degli Infermi Hospital, Cardiology, Rivoli, Italy
| | | | - L De Luca
- S. Camillo-Forlanini Hospital, Cardiology, Rome, Italy
| | - F Fortuni
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | | | - F D'Ascenzo
- A.O.U. Citta della Salute e della Scienza di Torino, Division of Cardiology, Turin, Italy
| | - G M De Ferrari
- A.O.U. Citta della Salute e della Scienza di Torino, Division of Cardiology, Turin, Italy
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38
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Clemmensen P, Schrage BN, Zeymer U, Montalecot G, Windecker S, Serpytis P, Stepinska J, Savonitto S, Desch S, Fuernau G, Huber K, Noc M, Ouarrak T, Blankenberg S, Thiele H. Impact of center-volume on outcomes in myocardial infarction complicated by cardiogenic shock – a CULPRIT-SHOCK sub-study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1479] [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
Little is known about the impact of center-volume on outcomes in acute myocardial infarction complicated by cardiogenic shock (AMI-CS). The aim of this study was to investigate the association between center-volume, treatment strategies and subsequent outcome in patients with AMI-CS.
Methods
In this subanalysis of the randomized CULPRIT-SHOCK trial, study sites were categorized based on the annual volume of AMI-CS into low/intermediate/high volume centers (<50; 50–100;>100 cases/year). Subjects from the study/compulsory registry with available volume data were included. Baseline/procedural characteristics, overall treatment and 1-year all-cause mortality were compared across categories.
Results
N=1032 patients were included in this study (537 treated at low-volume, 240 at intermediate-volume and 255 at high volume centers). Baseline risk profile of patients across the volume categories was similar, although high volume centers included more older patients. Low/intermediate-volume centers had more resuscitated patients (57.5%/58.8% vs. 42.2%; p<0.01), and more patients on mechanical ventilation in comparison to high volume centers. Mechanical circulatory support differed with more use in low/intermediate-volume centers and overall lower use in high-volume centers (30.7%/36.7% vs. 19.2%; p<0.001). There were no differences in reperfusion success despite considerable differences in adjunctive pharmacological/device therapies (figure 1). There was no difference in 1-year all-cause mortality across volume categories (51.1% vs. 56.5% vs. 54.4%; p=0.34).
Conclusion
In this study of patients with AMI-CS, considerable differences in adjunctive medical and mechanical support therapies was observed. However, we could not detect an impact of center volume on reperfusion success or mortality.
Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): The CULPRIT-SHOCK trial was funded by European Union, Seventh Framework Programme (FP7/2007-2013) Grant agreement n°602202, German Heart Research Foundation Treatment according to center volumeLong-term survival
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Affiliation(s)
- P Clemmensen
- University Heart Center Hamburg, Hamburg, Germany
| | - B N Schrage
- University Heart Center Hamburg, Hamburg, Germany
| | - U Zeymer
- IHF Gmbh - Institut Fuer Herzinfarktforschung, Ludwigshafen, Germany
| | - G Montalecot
- Pitié-Salpêtrière APHP University Hospital, Paris, France
| | - S Windecker
- Bern University Hospital, Inselspital, Bern, Switzerland
| | | | - J Stepinska
- National Institute of Cardiology, Warsaw, Poland
| | | | - S Desch
- Heart Center at University of Leipzig, Leipzig, Germany
| | - G Fuernau
- University Heart Center, Luebeck, Germany
| | - K Huber
- Wilhelminen Hospital, Vienna, Austria
| | - M Noc
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - T Ouarrak
- IHF Gmbh - Institut Fuer Herzinfarktforschung, Ludwigshafen, Germany
| | | | - H Thiele
- Heart Center at University of Leipzig, Leipzig, Germany
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39
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De Rosa R, Morici N, De Luca G, De Luca L, Ferri LA, Piatti L, Tortorella G, Grosseto D, Franco N, Misuraca L, Sganzerla P, Cacucci M, Antonicelli R, Cavallini C, Lenatti L, Leuzzi C, Murena E, Ravera A, Ferrario M, Corrada E, Colombo D, Prati F, Piscione F, Petronio AS, Galasso G, De Servi S, Savonitto S. Association of Sex with Outcome in Elderly Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention. Am J Med 2021; 134:1135-1141.e1. [PMID: 33971166 DOI: 10.1016/j.amjmed.2021.03.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 03/07/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Worse outcomes have been reported for women, compared with men, after an acute coronary syndrome (ACS). Whether this difference persists in elderly patients undergoing similar invasive treatment has not been studied. We investigated sex-related differences in 1-year outcome of elderly acute coronary syndrome patients treated by percutaneous coronary intervention (PCI). METHODS Patients 75 years and older successfully treated with PCI were selected among those enrolled in 3 Italian multicenter studies. Cox regression analysis was used to assess the independent predictive value of sex on outcome at 12-month follow-up. RESULTS A total of 2035 patients (44% women) were included. Women were older and most likely to present with ST-elevation myocardial infarction (STEMI), diabetes, hypertension, and renal dysfunction; men were more frequently overweight, with multivessel coronary disease, prior myocardial infarction, and revascularizations. Overall, no sex disparity was found about all-cause (8.3% vs 7%, P = .305) and cardiovascular mortality (5.7% vs 4.1%, P = .113). Higher cardiovascular mortality was observed in women after STEMI (8.8%) vs 5%, P = .041), but not after non ST-elevation-ACS (3.5% vs 3.7%, P = .999). A sensitivity analysis excluding patients with prior coronary events (N = 1324, 48% women) showed a significantly higher cardiovascular death in women (5.4% vs 2.9%, P = .025). After adjustment for baseline clinical variables, female sex did not predict adverse outcome. CONCLUSIONS Elderly men and women with ACS show different clinical presentation and baseline risk profile. After successful PCI, unadjusted 1-year cardiovascular mortality was significantly higher in women with STEMI and in those with a first coronary event. However, female sex did not predict cardiovascular mortality after adjustment for the different baseline variables.
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Affiliation(s)
- Roberta De Rosa
- University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy; Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Nuccia Morici
- ASST Grande Ospedale Metropolitano Niguarda, Milan; Department of Clinical Sciences and Community Health, Università degli Studi di Milo, Milan, Italy
| | - Giuseppe De Luca
- Azienda Ospedaliera Universitaria Maggiore della Carità, Eastern Piedmont University, Novara, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Amelia Ravera
- University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy
| | | | - Elena Corrada
- Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | | | | | - Federico Piscione
- University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy
| | | | - Gennaro Galasso
- University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy
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40
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Morici N, De Servi S, De Luca L, Crimi G, Montalto C, De Rosa R, De Luca G, Rubboli A, Valgimigli M, Savonitto S. Management of acute coronary syndromes in older adults. Eur Heart J 2021; 43:1542-1553. [PMID: 34347065 DOI: 10.1093/eurheartj/ehab391] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/03/2021] [Accepted: 06/03/2021] [Indexed: 12/22/2022] Open
Abstract
Older patients are underrepresented in prospective studies and randomized clinical trials of acute coronary syndromes (ACS). Over the last decade, a few specific trials have been conducted in this population, allowing more evidence-based management. Older adults are a heterogeneous, complex, and high-risk group whose management requires a multidimensional clinical approach beyond coronary anatomic variables. This review focuses on available data informing evidence-based interventional and pharmacological approaches for older adults with ACS, including guideline-directed management. Overall, an invasive approach appears to demonstrate a better benefit-risk ratio compared to a conservative one across the ACS spectrum, even considering patients' clinical complexity and multiple comorbidities. Conversely, more powerful strategies of antithrombotic therapy for secondary prevention have been associated with increased bleeding events and no benefit in terms of mortality reduction. An interdisciplinary evaluation with geriatric assessment should always be considered to achieve a holistic approach and optimize any treatment on the basis of the underlying biological vulnerability.
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Affiliation(s)
- Nuccia Morici
- Unità di Cure Intensive Cardiologiche, and De Gasperis Cardio-Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy
| | | | - Leonardo De Luca
- Department of Cardiosciences, Azienda Ospedaliera San Camillo-Forlanini, Roma, Italy
| | - Gabriele Crimi
- Cardio Thoraco Vascular Department (DICATOV), Interventional Cardiology Unit, IRCCS Policlinico San Martino, Genova, Italy
| | | | - Roberta De Rosa
- Department of Cardiology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Giuseppe De Luca
- Division of Cardiology, AOU Maggiore della Carità, Università del Piemonte Orientale, Novara, Italy
| | - Andrea Rubboli
- Division of Cardiology, Department of Cardiovascular Disease-AUSL Romagna, Ospedale S. Maria delle Croci, Ravenna, Italy
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41
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Kite TA, Ludman PF, Gale CP, Wu J, Caixeta A, Mansourati J, Sabate M, Jimenez-Quevedo P, Candilio L, Sadeghipour P, Iniesta AM, Hoole SP, Palmer N, Ariza-Solé A, Namitokov A, Escutia-Cuevas HH, Vincent F, Tica O, Ngunga M, Meray I, Morrow A, Arefin MM, Lindsay S, Kazamel G, Sharma V, Saad A, Sinagra G, Sanchez FA, Roik M, Savonitto S, Vavlukis M, Sangaraju S, Malik IS, Kean S, Curzen N, Berry C, Stone GW, Gersh BJ, Gershlick AH. International Prospective Registry of Acute Coronary Syndromes in Patients With COVID-19. J Am Coll Cardiol 2021; 77:2466-2476. [PMID: 34016259 PMCID: PMC8128002 DOI: 10.1016/j.jacc.2021.03.309] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/11/2021] [Accepted: 03/23/2021] [Indexed: 02/07/2023]
Abstract
Background Published data suggest worse outcomes in acute coronary syndrome (ACS) patients and concurrent coronavirus disease 2019 (COVID-19) infection. Mechanisms remain unclear. Objectives The purpose of this study was to report the demographics, angiographic findings, and in-hospital outcomes of COVID-19 ACS patients and compare these with pre–COVID-19 cohorts. Methods From March 1, 2020 to July 31, 2020, data from 55 international centers were entered into a prospective, COVID-ACS Registry. Patients were COVID-19 positive (or had a high index of clinical suspicion) and underwent invasive coronary angiography for suspected ACS. Outcomes were in-hospital major cardiovascular events (all-cause mortality, re–myocardial infarction, heart failure, stroke, unplanned revascularization, or stent thrombosis). Results were compared with national pre–COVID-19 databases (MINAP [Myocardial Ischaemia National Audit Project] 2019 and BCIS [British Cardiovascular Intervention Society] 2018 to 2019). Results In 144 ST-segment elevation myocardial infarction (STEMI) and 121 non–ST-segment elevation acute coronary syndrome (NSTE-ACS) patients, symptom-to-admission times were significantly prolonged (COVID-STEMI vs. BCIS: median 339.0 min vs. 173.0 min; p < 0.001; COVID NSTE-ACS vs. MINAP: 417.0 min vs. 295.0 min; p = 0.012). Mortality in COVID-ACS patients was significantly higher than BCIS/MINAP control subjects in both subgroups (COVID-STEMI: 22.9% vs. 5.7%; p < 0.001; COVID NSTE-ACS: 6.6% vs. 1.2%; p < 0.001), which remained following multivariate propensity analysis adjusting for comorbidities (STEMI subgroup odds ratio: 3.33 [95% confidence interval: 2.04 to 5.42]). Cardiogenic shock occurred in 20.1% of COVID-STEMI patients versus 8.7% of BCIS patients (p < 0.001). Conclusions In this multicenter international registry, COVID-19–positive ACS patients presented later and had increased in-hospital mortality compared with a pre–COVID-19 ACS population. Excessive rates of and mortality from cardiogenic shock were major contributors to the worse outcomes in COVID-19 positive STEMI patients.
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Affiliation(s)
- Thomas A Kite
- Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester; University Hospitals of Leicester NHS Trust, Leicester, United Kingdom.
| | - Peter F Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine and Leeds Institute for Data Analytics, University of Leeds, and the Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Jianhua Wu
- Leeds Institute of Cardiovascular and Metabolic Medicine and Leeds Institute for Data Analytics, University of Leeds, and the Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Adriano Caixeta
- Division of Cardiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Jacques Mansourati
- Department of Cardiology, University Hospital of Brest and University of Western Brittany, Orphy, France
| | - Manel Sabate
- Cardiovascular Institute, Interventional Cardiology Department, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Pilar Jimenez-Quevedo
- Interventional Cardiology Department, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | | | - Parham Sadeghipour
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Angel M Iniesta
- Department of Cardiology, Hospital Universitario La Paz, Madrid, Spain
| | - Stephen P Hoole
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Nick Palmer
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Albert Ariza-Solé
- Intensive Cardiac Care Unit, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Alim Namitokov
- Scientific Research Institute-Regional Clinical Hospital #1 NA Prof. S.V. Ochapovsky, Krasnodar, Russia
| | | | - Flavien Vincent
- CHU Lille, Institut Cœur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Inserm U1011, Institut Pasteur de Lille, EGID, Université de Lille, Lille, France
| | - Otilia Tica
- University of Oradea, Faculty of Medicine and Pharmacy, Department of Medical disciplines, Oradea, Romania
| | - Mzee Ngunga
- Department of Medicine, Aga Khan University Hospital, Nairobi, Kenya
| | - Imad Meray
- Peoples Friendship University of Russia, Hospital n∖a V.V.Vinogradov, Moscow, Russia
| | - Andrew Morrow
- Department of Cardiology, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Md Minhaj Arefin
- Department of Cardiology, National Institute of Cardiovascular Diseases & Hospital (NICVD), Dhaka, Bangladesh
| | - Steven Lindsay
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Ghada Kazamel
- Cardiology Department, National Heart Institute, Cairo, Egypt
| | - Vinoda Sharma
- Birmingham City Hospital, SWBH NHS Trust, Birmingham, United Kingdom
| | - Aly Saad
- Department of Cardiovascular Medicine, Zagazig University, Zagazig, Egypt
| | | | | | - Marek Roik
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | - Marija Vavlukis
- University Clinic for Cardiology, Medical Faculty, Ss' Cyrial and Methodius University, Skopje, Macedonia
| | | | - Iqbal S Malik
- Cardiology Department, Imperial College Healthcare Trust, London, United Kingdom
| | - Sharon Kean
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Nick Curzen
- Faculty of Medicine, University of Southampton, and University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - Colin Berry
- Department of Cardiology, Golden Jubilee National Hospital, Clydebank, United Kingdom; British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bernard J Gersh
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Anthony H Gershlick
- Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester; University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
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42
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Savonitto S, De Servi S. Early invasive approach and outcome in elderly patients with NSTEACS: randomised trials, real-world data and guideline recommendations. EUROINTERVENTION 2021; 17:20-21. [PMID: 33998526 PMCID: PMC9707460 DOI: 10.4244/eijv17i1a4] [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: 11/23/2022]
Affiliation(s)
- Stefano Savonitto
- Dipartimento Cardiovascolare, Ospedale A. Manzoni, Via dell’Eremo, 9, 23900 Lecco, Italy
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43
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Morici N, Sacco A, Forleo G, Brunelli D, De Luca G, Savonitto S. The other side of the coin: 'centralization' against 'optimization' in COVID-19 pandemic. ESC Heart Fail 2021; 8:2354-2356. [PMID: 33830668 PMCID: PMC8120368 DOI: 10.1002/ehf2.13289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/16/2021] [Accepted: 02/19/2021] [Indexed: 12/20/2022] Open
Affiliation(s)
- Nuccia Morici
- Dipartimento Cardiotoracovascolare, Intensive Coronary Care Unit and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alice Sacco
- Dipartimento Cardiotoracovascolare, Intensive Coronary Care Unit and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giovanni Forleo
- Department of Cardiology, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Dario Brunelli
- Dipartimento Cardiotoracovascolare, Intensive Coronary Care Unit and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giuseppe De Luca
- Division of Cardiology, Azienda Ospedaliero-Universitaria Maggiore della Carità, Università del Piemonte Orientale, Novara, Italy
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Verdoia M, Savonitto S, Dudek D, Kedhi E, De Luca G. Ticagrelor as compared to conventional antiplatelet agents in coronary artery disease: A comprehensive meta-analysis of 15 randomized trials. Vascul Pharmacol 2021; 137:106828. [DOI: 10.1016/j.vph.2020.106828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/11/2020] [Accepted: 12/28/2020] [Indexed: 01/11/2023]
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Morici N, Puoti M, Zocchi MT, Brambilla C, Mangiagalli A, Savonitto S. Home-based COVID 19 management: A consensus document from Italian general medical practitioners and hospital consultants in the Lombardy region (Italy). Eur J Intern Med 2021; 84:94-96. [PMID: 33293151 PMCID: PMC7709719 DOI: 10.1016/j.ejim.2020.11.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 11/28/2020] [Indexed: 01/20/2023]
Affiliation(s)
- Nuccia Morici
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
| | - Massimo Puoti
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Maria Teresa Zocchi
- General Practitioners Group, Azienda Territoriale della Salute, Milan Metropolitan Area, Italy; Ordine dei Medici Chirurghi e degli Odontoiatri di Milano, Milan, Italy
| | - Carla Brambilla
- General Practitioners Group, Azienda Territoriale della Salute, Milan Metropolitan Area, Italy
| | - Andrea Mangiagalli
- General Practitioners Group, Azienda Territoriale della Salute, Milan Metropolitan Area, Italy
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46
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Montalto C, Crimi G, Morici N, Palmerini T, Valgimigli M, Savonitto S, De Servi S. Validation and Additive Predictive Value of the Academic Research Consortium-High Bleeding Risk Criteria in Older Adults. Thromb Haemost 2020; 121:1255-1257. [PMID: 33352592 DOI: 10.1055/a-1342-3750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Claudio Montalto
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Molecular Cardiology, University of Pavia, Pavia, Italy
| | - Gabriele Crimi
- Cardio-Thoraco-Vascular Department, Interventional Cardiology Unit, Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Nuccia Morici
- First Division of Cardiology, Niguarda Ca'Grande Hospital, Milano, Italy
| | | | - Marco Valgimigli
- Department of Cardiology, CardioCentro Ticino, Lugano, Switzerland.,Department of Cardiology, University of Bern, Bern, Switzerland
| | | | - Stefano De Servi
- Department of Molecular Cardiology, University of Pavia, Pavia, Italy
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47
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Montalto C, Crimi G, Morici N, Piatti L, Grosseto D, Sganzerla P, Tortorella G, De Rosa R, De Luca L, De Luca G, Palmerini T, Valgimigli M, Savonitto S, De Servi S. Bleeding risk prediction in elderly patients managed invasively for acute coronary syndromes: External validation of the PRECISE-DAPT and PARIS scores. Int J Cardiol 2020; 328:22-28. [PMID: 33279593 DOI: 10.1016/j.ijcard.2020.11.065] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND We sought to assess and compare the prediction power of the PRECISE-DAPT and PARIS risk scores with regards to bleeding events in elderly patients suffering from acute coronary syndromes (ACS) and undergoing invasive management. METHODS Our external validation cohort included 1883 patients older >74 years admitted for ACS and treated with PCI from 3 prospective, multicenter trials. RESULTS After a median follow-up of 365 days, patients in the high-risk categories according to the PRECISE-DAPT score experienced a higher rate of BARC 3-5 bleedings (p = 0.002) while this was not observed for those in the high-risk category according to the PARIS risk score (p = 0.3). Both scores had a moderate discriminative power (c-statistics 0.70 and 0.64, respectively) and calibration was accurate for both risk scores (all χ2 > 0.05), but PARIS risk score was associated to a greater overestimation of the risk (p = 0.02). Decision curve analysis was in favor of the PRECISE-DAPT score up to a risk threshold of 2%. CONCLUSIONS In the setting of older adults managed invasively for ACS both the PARIS and the PRECISE-DAPT scores were moderately accurate in predicting bleeding risk. However, the use of the PRECISE-DAPT is associated with better performance.
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Affiliation(s)
- Claudio Montalto
- Division of Cardiology, Fondazione IRCCS Policinico San Matteo, Pavia, Italy
| | - Gabriele Crimi
- Division of Cardiology, Fondazione IRCCS Policinico San Matteo, Pavia, Italy; Interventional Cardiology Unit, Cardio-Thoraco-Vascular Department, Ospedale Policlinico San Martino IRCCS, Genova, Italy.
| | - Nuccia Morici
- First Division of Cardiology, Niguarda Ca'Grande Hospital, Milano, Italy
| | - Luigi Piatti
- Division of Cardiology, Ospedale Manzoni, Lecco, Italy
| | | | - Paolo Sganzerla
- Division of Cardiology, Ospedale Treviglio-Caravaggio, Treviglio, Italy
| | - Giovanni Tortorella
- Division of Cardiology, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Roberta De Rosa
- Department of Cardiology, San Giovanni di Dio e Ruggi d'Aragona Hospital, Salerno, Italy; Department of Cardiology, Goethe University Hospital, Frankfurt am Main, Germany
| | - Leonardo De Luca
- Division of Cardiology, Department of Cardiosciences, Roma, Italy
| | - Giuseppe De Luca
- Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Novara, Italy
| | - Tullio Palmerini
- Cardiovascular Department, Policlinico S. Orsola, Bologna, Italy
| | - Marco Valgimigli
- Cardiocentro Ticino, Lugano, University of Bern, Inselspital, Bern, Switzerland
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48
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Carugo S, Ferlini M, Castini D, Andreassi A, Guagliumi G, Metra M, Lombardi C, Cuccia C, Savonitto S, Piatti L, D'Urbano M, Lettieri C, Vandoni P, Lettino M, Marenzi G, Montorfano M, Zangrillo A, Castiglioni B, De Ponti R, Oltrona Visconti L. Management of acute coronary syndromes during the COVID-19 outbreak in Lombardy: The "macro-hub" experience. Int J Cardiol Heart Vasc 2020; 31:100662. [PMID: 33173807 PMCID: PMC7609053 DOI: 10.1016/j.ijcha.2020.100662] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/06/2020] [Accepted: 10/08/2020] [Indexed: 01/22/2023]
Abstract
Background During the COVID-19 outbreak, healthcare Authorities of Lombardy modified the regional network concerning time-dependent emergencies. Specifically, 13 Macro-Hubs were identified to deliver timely optimal care to patients with acute coronary syndromes (ACS). Aim of this paper is to present the results of this experience. Methods and Results This is a multicenter, observational study. A total of 953 patients were included, presenting with STEMI in 57.7% of the cases. About 98% of patients received coronary angiography with a median since first medical contact to angiography of 79 (IQR 45–124) minutes for STEMI and 1262 (IQR 643–2481) minutes for NSTEMI. A total of 107 patients (11.2%) had SARS-CoV2 infection, mostly with STEMI (74.8%). The time interval from first medical contact to cath-lab was significant shorter in patients with COVID-19, both in the overall population and in STEMI patients (87 (IQR 41–310) versus 160 (IQR 67–1220) minutes, P = 0.001, and 61 (IQR 23–98) versus 80 (IQR 47–126) minutes, P = 0.01, respectively). In-hospital mortality and cardiogenic shock rates were higher among patients with COVID-19 compared to patients without (32% vs 6%, P < 0.0001, and 16.8% vs 6.7%, P < 0.0003, respectively). Conclusions During the COVID-19 outbreak in Lombardy, the redefinition of ACS network according to enlarged Macro-Hubs allowed to continue with timely ACS management, while reserving a high number of intensive care beds for the pandemic. Patients with ACS and COVID-19 presented a worst outcome, particularly in case of STEMI.
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Affiliation(s)
- Stefano Carugo
- Cardiology Department, University of Milan, ASST Santi Paolo e Carlo, Milano, Italy
| | - Marco Ferlini
- Cardiology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Diego Castini
- Cardiology Department, University of Milan, ASST Santi Paolo e Carlo, Milano, Italy
| | | | - Giulio Guagliumi
- Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Marco Metra
- Cardiology Department, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Carlo Lombardi
- Cardiology Department, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Claudio Cuccia
- Cardiology Department, Poliambulanza Hospital, Brescia, Italy
| | | | - Luigi Piatti
- Cardiology Department, Manzoni Hospital, ASST Lecco, Italy
| | | | | | - Pietro Vandoni
- Cardiology Department, San Gerardo Hospital, ASST Monza, Italy
| | | | - Giancarlo Marenzi
- IRCCS Centro Cardiologico Monzino, University of Milan, Milano, Italy
| | | | | | | | - Roberto De Ponti
- Cardiology Department, Tradate Hospital, ASST Settelaghi Varese, Italy
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49
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Montalto C, Crimi G, Morici N, Piatti L, Grosseto D, Sganzerla P, Tortorella G, De Rosa R, De Luca L, De Luca G, Palmerini T, Valgimigli M, Savonitto S, De Servi S. Bleeding risk prediction in elderly patients managed invasively for Acute Coronary Syndromes: external validation of the PRECISE-DAPT and PARIS risk scores. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1723] [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: 11/15/2022] Open
Abstract
Abstract
Background
Tailoring Dual Antiplatelet Therapy (DAPT) to each patient bleeding and ischemic risk profile is a majopr challenge in everyday clinical practice. As the elderlies were underrepresented in validation cohorts of bleeding risk scores, their generalizability in this context is uncertain.
Purpose
We sought to assess the clinical utility of the PRECISE-DAPT and PARIS bleeding risk scores to elderly patients suffering from ACS and undergoing invasive management.
Methods
Our external validation cohort included 1,883 patients older >74 years admitted for ACS and treated with PCI from 3 multicenter, randomized trials. Bleeding risk scores were calculated on a patient-level and subjects were stratified into risk categories according to each risk score definition.
Results
After a median follow-up of 365 days, patients in the high-risk categories according to the PRECISE-DAPT score experienced a higher rate of BARC 3–5 bleedings (log rank p=0.002) while this was not observed for those in the high-risk category according to the PARIS risk score (log rank p=0.3). Both scores had a moderate discriminative power (c-statistics 0.70 and 0.64, respectively) and calibration was accurate for both risk scores (all χ2>0.05), but PARIS risk score was associated to a greater overestimation of the risk (mean D observed-predicted probability = −0.65 for PRECISE DAPT and −4.62 for PARIS, p=0.02; Figure 1). Decision curve analysis was in favor of the PRECISE-DAPT score up to a risk threshold of 2%. A sensitivity showed that calibration and discrimination power was moderate for both risk scores also after including BARC 2 events.
Conclusion
In the setting of older adults managed invasively for ACS both the PARIS and the PRECISE-DAPT scores were moderately accurate in predicting bleeding risk. However, the use of the PRECISE-DAPT is associated with better performance and a higher net benefit.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - G Crimi
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy
| | - N Morici
- ASST Great Metropolitan Niguarda, First Division of Cardiology, Milan, Italy
| | - L Piatti
- Alessandro Manzoni Hospital, Division of Cardiology, Lecco, Italy
| | - D Grosseto
- Infermi Hospital of Rimini, Division of Cardiology, Rimini, Italy
| | - P Sganzerla
- AO Ospedale Treviglio, Division of Cardiology, Treviglio, Italy
| | - G Tortorella
- Santa Maria Nuova Hospital, Division of Cardiology, Reggio Emilia, Italy
| | - R De Rosa
- AOU S. Giovanni di Dio e Ruggi d'Aragona, Division of Cardiology, Salerno, Italy
| | - L De Luca
- San Giovanni Evangelista Hospital, Division of Cardiology, Tivoli, Italy
| | - G De Luca
- Hospital Maggiore Della Carita, Division of Cardiology, Novara, Italy
| | - T Palmerini
- Policlinico S. Orsola-Malpighi, Division of Cardiology, Bologna, Italy
| | - M Valgimigli
- Bern University Hospital, Inselspital, Department of Cardiology, Bern, Switzerland
| | - S Savonitto
- Alessandro Manzoni Hospital, Division of Cardiology, Lecco, Italy
| | - S De Servi
- IRCCS - MultiMedica, Department of Cardiology, Milano, Italy
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De Luca L, Di Pasquale G, Gonzini L, Uguccioni M, Olivari Z, Casella G, Boccanelli A, De Servi S, Urbinati S, Colivicchi F, Gabrielli D, Savonitto S. Temporal Trends in Invasive Management and In-Hospital Mortality of Patients With Non-ST Elevation Acute Coronary Syndromes and Chronic Kidney Disease. Angiology 2020; 72:236-243. [PMID: 33021092 DOI: 10.1177/0003319720962676] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We analyzed data from 4 nationwide prospective registries of consecutive patients with acute coronary syndromes (ACS) admitted to the Italian Intensive Cardiac Care Unit network between 2005 and 2014. Out of 26 315 patients with ACS enrolled, 13 073 (49.7%) presented a diagnosis of non-ST elevation (NSTE)-ACS and had creatinine levels available at hospital admission: 1207 (9.2%) had severe chronic kidney disease (CKD) (estimated glomerular filtration rate [eGFR] <30), 3803 (29.1%) mild to moderate CKD (eGFR 31-59), and 8063 (61.7%) no CKD (eGFR > 60 mL/min/1.73 m2). Patients with severe CKD had worse clinical characteristics compared with those with mild-moderate or no kidney dysfunction, including all the key predictors of mortality (P < .0001) which became worse over time (all P < .0001). Over the decade of observation, a significant increase in percutaneous coronary intervention rates was observed in patients without CKD (P for trend = .0001), but not in those with any level of CKD. After corrections for significant mortality predictors, severe CKD (odds ratio, OR: 5.49; 95% CI: 3.24-9.29; P < .0001) and mild-moderate CKD (OR: 2.33; 95% CI: 1.52-3.59; P < .0001) remained strongly associated with higher in-hospital mortality. The clinical characteristics of patients with NSTE-ACS and CKD remain challenging and their mortality rate is still higher compared with patients without CKD.
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Affiliation(s)
- Leonardo De Luca
- Department of Cardiosciences, 220420A.O. San Camillo-Forlanini, Roma, Italy
| | | | | | - Massimo Uguccioni
- Department of Cardiosciences, 220420A.O. San Camillo-Forlanini, Roma, Italy
| | - Zoran Olivari
- Division of Cardiology, Ospedale Cà Foncello, Treviso, Italy
| | - Gianni Casella
- Department of Cardiology, Maggiore Hospital, Bologna, Italy
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