Publications (14) View all
-
Article: [Role of clopidogrel in acute coronary syndromes without ST-segment elevation].
[show abstract] [hide abstract]
ABSTRACT: Unstable angina and no ST-segment elevation myocardial infarction are acute coronary syndromes (ACS) typically characterized by minimal or little myocardial damage, but often heralding "classical" infarction or coronary death in the short or medium term. Coronary thrombi, mainly composed by platelets, are the major pathogenetic component of ACS and an effective therapeutic target. The hemostatic balance can be shifted towards an antithrombotic state in the clinical setting. Although the thrombogenic stimuli acting in each individual patient, their intensity as well as the prothrombotic factors that may contribute to an inappropriate thrombus growth, remain largely unknown. To this purpose the modulation of platelet aggregation is a particularly effective and practical therapeutic target. The availability of a new antiplatelet agent, clopidogrel, with a proven efficacy in the prevention of cardiovascular events, suggests the opportunity of reviewing the mechanisms of instability and the therapeutic strategies in patients with ACS. In this review we analyze: 1) the composition of coronary thrombi in patients with ACS, 2) the mechanisms of thrombus development and growth, 3) the mechanisms of platelet adhesion and aggregation, 4) the characteristics of clopidogrel, 5) the efficacy of the various therapeutic strategies, 6) the possible implications of the adjunctive therapy with clopidogrel for the treatment and prevention of cardiovascular events in ACS with no ST-segment elevation.Italian heart journal. Supplement: official journal of the Italian Federation of Cardiology 03/2002; 3(2):187-97. -
Article: Beneficial effects of diltiazem during myocardial reperfusion: a randomized trial in acute myocardial infarction.
[show abstract] [hide abstract]
ABSTRACT: Although in experimental models of coronary occlusion diltiazem administration has been shown to reduce the degree of stunning and of reperfusion injury, the majority of clinical trials has failed to demonstrate significant benefits. The aim of this study was to evaluate the effect of diltiazem, administered before coronary reperfusion, on infarct size, residual myocardial viability and recovery of left ventricular function. We studied 90 patients admitted within 3 hours of the onset of symptoms of acute myocardial infarction. They were immediately randomized to either intravenous diltiazem (10 mg bolus + 10 mg/hour for 3 days) (group 1, n = 43) or placebo (group 2, n = 47) and subsequently treated with recombinant tissue-type plasminogen activator. All underwent serial echocardiograms upon admission, 4 days post-admission during low-dose dobutamine stress echo, at discharge and after 6 months. We calculated the dysfunction score (1 = hypokinesia, 2 = akinesia, 3 = dyskinesia) on admission and its percent reduction after dobutamine (viability) and at follow-up (recovery). The 12-lead electrocardiograms were continuously monitored for 3 days and coronary angioplasty was performed whenever the residual stenosis was > 60%. Upon admission, there were no differences in age, sex, infarct location and size, degree of ST-segment elevation, time from onset of symptoms and dysfunction score. Creatine kinase peaked early in 70% of patients in both groups; the incidences of recurrent ischemia, infarct-related vessel patency and the need for coronary angioplasty were also similar. The creatine kinase peak was significantly higher in group 2 (2931 +/- 2456 vs 1726 +/- 1004 IU/l, p < 0.05). Conversely, in group 1 the residual viability was significantly higher (51 +/- 23 vs 36 +/- 30% improvement in dysfunction score, p < 0.05) and the early recovery of regional function was significantly greater (35 +/- 34 vs 18 +/- 22% at discharge, p < 0.05). On the other hand, the delayed recovery was not significantly different (15 +/- 29 vs 21 +/- 32% from the time of discharge to 6 months of follow-up). Intravenous diltiazem, started before coronary reperfusion, has beneficial effects on the infarct size, residual viability and recovery of regional function. If confirmed by larger trials, these preliminary results suggest the use of diltiazem as adjunctive therapy in patients with acute myocardial infarction and undergoing reperfusion.Italian heart journal: official journal of the Italian Federation of Cardiology 10/2001; 2(10):757-65. -
Article: Exercise-induced T-wave normalization predicts recovery of regional contractile function after anterior myocardial infarction.
[show abstract] [hide abstract]
ABSTRACT: We investigated the ability of T-wave pseudonormalization and ST-segment elevation, which are demonstrated in infarct-related leads during submaximal exercise testing, to predict late recovery of contractile function. We studied 88 consecutive patients (73 males, mean age 59 +/- 8 years) with anterior infarction, persistent T-wave inversion and a documented lesion of the proximal segment of the left anterior descending coronary artery. They all underwent 2D-echocardiography on admission, 4 weeks as well as 6 months after myocardial infarction to evaluate the dysfunction score and the ejection fraction. Submaximal (75% of maximal predicted heart rate) exercise testing was performed in 80 patients 2 weeks after myocardial infarction following discontinuation of treatment. During exercise testing, 59 of the 88 patients showing negative T-waves on the resting electrocardiogram exhibited pseudonormalization (group A) in at least three adjacent precordial leads, whilst 29 (group B) did not. Patients of group A more frequently exhibited an early creatine kinase peak (41% vs 24%, P < 0.05) and residual angiographic perfusion (97% vs 69%, P < 0.05). The dysfunction score did not change in group B (from 19 +/- 7 to 22 +/- 4), but decreased in group A (from 18 +/- 4 to 11 +/- 6 P < 0.05). The ejection fraction was similar in the two groups on admission (group A: 48 +/- 7%, group B: 45 +/- 10%), but was significantly different at 4-week (52 +/- 99 vs 42 +/- 11%, P < 0.05) and 6-month follow-up (58 +/- 9 vs 44 +/- 10%, P < 0.01). The concomitant presence of ST-segment elevation and T-wave normalization showed the highest positive predictive value for left ventricular function recovery (100%). T-wave normalization induced by submaximal exercise test is frequently associated with residual perfusion to the infarct area and predicts progressive improvement in regional wall motion, especially if associated with ST-segment elevation. Therefore, these electrocardiographic findings may be used as easily obtainable markers of residual viability that predict late recovery in contractile function.European Heart Journal 03/1998; 19(3):420-8. · 10.48 Impact Factor -
Article: Successful thrombolysis for acute myocardial infarction in Type I von Willebrand's disease (vWD)
American Journal of Hematology 03/1998; 57(2):180. · 4.67 Impact Factor -
Article: Soluble E-selectin and intercellular adhesion molecule-1 plasma levels increase during acute myocardial infarction.
[show abstract] [hide abstract]
ABSTRACT: Previous studies have shown that adhesion molecules play a crucial role in leukocyte-endothelium interactions that occur during myocardial ischemia and reperfusion. We assessed the plasma levels of the soluble form of E-selectin (sE-selectin) and intercellular adhesion molecule-1 (sICAM-1) in 15 patients with acute myocardial infarction (AMI) and in 15 controls with chronic stable angina. In patients with AMI, the levels of sE-selectin and sICAM-1 increased significantly during the first 8 h after infarction and subsequently decreased. Soluble E-selectin levels were inversely related to the peak plasma levels of creatine kinase-MB (CK-MB), and the time course of their appearance in plasma correlated with that of neutrophil count and plasma D-dimer. In individual patients, peak and mean sICAM-1 levels correlated respectively with plasma D-dimer concentrations and monocyte count, but no correlation were found when their time courses were analyzed. Eight hours after symptom onset, the mean plasma sE-selectin levels were higher in patients with AMI than in those with stable angina, whereas no significant differences were found in mean plasma sICAM-1 levels between the two groups at every time analyzed. In the acute phase of MI (a) sE-selectin and sICAM-1 levels increase during the first 8 h and subsequently decrease; (b) the increase in sE-selectin probably reflects activation of endothelial cells, correlates with other inflammatory and coagulation parameters, and is inversely related to the degree of myocardial damage; and (c) sICAM-1 plasma levels do not represent a good marker of "cell activation" because they reflect activation of different cells and may be affected by different conditions.Journal of Cardiovascular Pharmacology 11/1997; 30(4):455-60. · 2.29 Impact Factor
