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Gloria Tamborini,
Laura Fusini,
Paola Gripari,
Manuela Muratori,
Claudia Cefalù,
Francesco Maffessanti,
Francesco Alamanni, Antonio Bartorelli,
Gianluca Pontone,
Daniele Andreini,
Erika Bertella,
Cesare Fiorentini,
Mauro Pepi
[show abstract]
[hide abstract]
ABSTRACT: The aims of this study were to analyze in a large series of patients undergoing transcatheter aortic valve implantation (TAVI): 1) the accuracy of 3-dimensional transesophageal echocardiographic (3DTEE) measurement of left coronary cusp (LCC) length and of the distances from left main coronary ostium (LM) to the aortic annulus (AA) pre-operatively and to the aortic prosthesis post-operatively; and 2) the role of the 3DTEE measurements in predicting the prosthetic deployment and the association between prosthesis position and aortic regurgitation (AR) and/or prosthesis-patient mismatch (PPM).
Coronary ostia occlusion is a possible complication in TAVI; therefore, the careful pre-operative evaluation of AA-LM and LCC length, and the post-operative analysis of the relationship between the prosthesis and LM, may influence the procedural outcomes. Even though multidetector computed tomography (MDCT) is the gold standard pre-operatively, sometimes it cannot be performed and it is rarely repeated post-operatively.
In 122 patients undergoing TAVI, pre-operative AA-LM and LCC measurements obtained by 3DTEE and MDCT were compared. Post-operatively, the feasibility of 3DTEE evaluation of the prosthesis-LM distance was performed. The relationship between 3DTEE overlap of the prosthesis with the anterior mitral leaflet and AR/PPM was assessed.
Pre-operatively, 3DTEE AA-LM (r = 0.83) and LCC (r = 0.69) significantly correlated with MDCT. Post-operatively, 3DTEE prosthesis-LM distance was 2.1 ± 1.9 mm. The prosthesis reached or exceeded LM in 6 and 10 cases, respectively. Prosthesis overlap with mitral leaflet was 4.7 ± 1.8 mm. Significant correlation between the 3DTEE computed and nominal length of the prosthesis was found (r = 0.61). No correlations were found between prosthesis-mitral leaflet overlap and aortic regurgitation or PPM.
AA-LM distance and LCC length may be accurately estimated by 3DTEE, which may represent a valid alternative to MDCT. Pre- and post-3DTEE data concerning the aortic root, such as LM, aortic valve, and prosthetic morphology, give new insights into TAVI and its complications.
JACC. Cardiovascular imaging 06/2012; 5(6):579-88. · 14.29 Impact Factor
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Norma Maugeri,
Patrizia Rovere-Querini,
Virgilio Evangelista,
Cosmo Godino,
Monica Demetrio,
Mattia Baldini,
Filippo Figini,
Giovanni Coppi,
Massimo Slavich,
Marina Camera, Antonio Bartorelli,
Giancarlo Marenzi,
Lara Campana,
Elena Baldissera,
Maria Grazia Sabbadini,
Domenico Cianflone,
Elena Tremoli,
Armando D'Angelo,
Angelo A Manfredi,
Attilio Maseri
[show abstract]
[hide abstract]
ABSTRACT: Neutrophils are involved in thrombus formation. We investigated whether specific features of neutrophil activation characterize patients with acute coronary syndromes (ACS) compared to stable angina and to systemic inflammatory diseases.
The myeloperoxidase (MPO) content of circulating neutrophils was determined by flow cytometry in 330 subjects: 69 consecutive patients with acute coronary syndromes (ACS), 69 with chronic stable angina (CSA), 50 with inflammation due to either non-infectious (acute bone fracture), infectious (sepsis) or autoimmune diseases (small and large vessel systemic vasculitis, rheumatoid arthritis). Four patients have also been studied before and after sterile acute injury of the myocardium (septal alcoholization). One hundred thirty-eight healthy donors were studied in parallel. Neutrophils with normal MPO content were 96% in controls, >92% in patients undergoing septal alcoholization, 91% in CSA patients, but only 35 and 30% in unstable angina and AMI (STEMI and NSTEMI) patients, compared to 80%, 75% and 2% of patients with giant cell arteritis, acute bone fracture and severe sepsis. In addition, in 32/33 STEMI and 9/21 NSTEMI patients respectively, 20% and 12% of neutrophils had complete MPO depletion during the first 4 hours after the onset of symptoms, a feature not observed in any other group of patients. MPO depletion was associated with platelet activation, indicated by P-selectin expression, activation and transactivation of leukocyte β2-integrins and formation of platelet neutrophil and -monocyte aggregates. The injection of activated platelets in mice produced transient, P-selectin dependent, complete MPO depletion in about 50% of neutrophils.
ACS are characterized by intense neutrophil activation, like other systemic inflammatory syndromes. In the very early phase of acute myocardial infarction only a subpopulation of neutrophils is massively activated, possibly via platelet-P selectin interactions. This paroxysmal activation could contribute to occlusive thrombosis.
PLoS ONE 01/2012; 7(6):e39484. · 4.09 Impact Factor
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Scot Garg,
Patrick W Serruys,
Sigmund Silber,
Joanna Wykrzykowska,
Robert Jan van Geuns,
Gert Richardt,
Pawel E Buszman,
Henning Kelbæk,
Adrianus Johannes van Boven,
Sjoerd H Hofma, [......],
Carlos Macaya,
Philippe Garot,
Carlo DiMario,
Ganesh Manoharan,
Ran Kornowski,
Thomas Ischinger, Antonio Bartorelli,
Eric Van Remortel,
Jacintha Ronden,
Stephan Windecker
[show abstract]
[hide abstract]
ABSTRACT: This study assessed the ability of the SYNTAX score (SXscore) to stratify risk in patients treated with percutaneous coronary intervention (PCI) using zotarolimus-eluting or everolimus-eluting stents.
The SXscore can identify patients treated with PCI who are at highest risk of adverse events.
The SXscore was calculated prospectively in 2,033 of the 2,292 patients enrolled in the RESOLUTE All Comers study (RESOLUTE III All Comers Trial: A Randomized Comparison of a Zotarolimus-Eluting Stent With an Everolimus-Eluting Stent for Percutaneous Coronary Intervention). Clinical outcomes in terms of a patient-oriented composite endpoint (POCE) of all-cause death, myocardial infarction (MI), and repeat revascularization; the individual components of POCE; target lesion failure (TLF) (a composite of cardiac death, target-vessel MI, and clinically driven target lesion revascularization); and stent thrombosis were subsequently stratified according to SXscore tertiles: SXscore(LOW) ≤ 9 (n = 698), 9 <SXscore(MID) ≤ 17 (n = 676); SXscore(HIGH) >17 (n = 659).
At 12-month follow-up, rates of POCE, MI, repeat revascularization, TLF, and the composite of death/MI were all significantly higher in patients in the highest SXscore tercile. Rates of stent thrombosis were all highest in the SXscore(HIGH) tertile (p > 0.05). After multivariate adjustment, the SXscore was identified as an independent predictor of POCE, MI, repeat revascularization, and TLF (p < 0.05 for all). At 12-month follow-up, the SXscore, ACEF score, and Clinical SXscore had C-statistics of 0.57, 0.78, and 0.67, respectively, for mortality and of 0.62, 0.56, 0.63, respectively, for POCE. No significant between-stent differences were observed for TLF or POCE in any of the SXscore tertiles.
The SYNTAX score is able to stratify risk amongst an all-comers population treated with PCI with second-generation drug-eluting stents (DES); however, improvements can be made with the inclusion of clinical variables. (RESOLUTE III All Comers Trial: A Randomized Comparison of a Zotarolimus-Eluting Stent With an Everolimus-Eluting Stent for Percutaneous Coronary Intervention; NCT00617084).
04/2011; 4(4):432-41. · 1.07 Impact Factor
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Daniele Andreini,
Gianluca Pontone,
Saima Mushtaq,
Andrea Annoni,
Alberto Formenti,
Erika Bertella,
Alessandro Parolari,
Piergiuseppe Agostoni, Antonio Bartorelli,
Giovanni Ballerini,
Cesare Fiorentini,
Mauro Pepi
[show abstract]
[hide abstract]
ABSTRACT: Multidetector computed tomography (MDCT) is useful in evaluation of coronary artery bypass graft (CABG). However, radiation exposure is a reason for concern. We compared diagnostic performance and effective dose of a new dedicated post-processing reconstruction algorithm with BMI-adapted scanning protocol (MDCT-XTe) vs. standard prospective ECG-triggering protocol (MDCT-XT) and retrospective ECG-triggering (MDCT-Helical), compared to invasive coronary angiography (ICA), in the assessment of grafts and nongrafted or distal runoff coronary arteries.
One hundred and nineteen patients with 277 grafts were randomized to Group 1 based on BMI-adapted scanning protocol with prospective ECG-triggering (40 patients), Group 2 with prospective ECG-triggering (39 patients) and Group 3 (40 patients) with retrospective ECG-triggering. Data were acquired using 64-slice MDCT.
MDCT correctly assessed the patency of all CABG in 3 groups. After comparison with ICA, MDCT was able to correctly detect the occlusion or stenosis of CABG in all groups, with the exception of one case of Group 3. In Group 3 sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CABG evaluation were 100%, 98.4%, 96.7%, 100% and 98.9%, respectively. In Groups 1 and 2 the diagnostic accuracy of CABG evaluation was 100%. Effective radiation dose was 3.5±1.4mSv in Group 1 vs. 7.4±2.6mSv in Group 2 vs. 27.8±9.4mSv in Group 3.
Our results indicated that MDCT-XTe and MDCT-XT have a diagnostic performance in the evaluation of CABG similar to MDCT-Helical, with a significant reduction of radiation exposure, specially for MDCT-XTe.
International journal of cardiology 12/2010; 157(1):63-9. · 7.08 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: We describe a case of a very anomalous origin of the left main coronary artery, misdiagnosed as occluded at previous invasive coronary angiography. Multidetector computed tomography coronary angiography demonstrated the vessel to be patent, with an anomalous origin from the commissural region between the right sinus of Valsalva and posterior sinus of Valsalva. A large coronary fistula between proximal left anterior descending coronary artery and the right sinus of Valsalva was also demonstrated. This is an example of the additional clinical role of multidetector computed tomography coronary angiography in comparison to conventional coronary angiography in this clinical field.
Journal of Cardiovascular Medicine 11/2010; 11(11):848-9. · 1.51 Impact Factor
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Alessandro Politi,
Alessandro Martinoni,
Silvio Klugmann,
Roberto Zanini,
Marco Onofri,
Giulio Guagliumi,
Cesare Fiorentini,
Corrado Lettieri,
Guido Belli,
Emanuela Piccaluga, [......],
Battistina Castiglioni,
Paola Colombo,
Enrico Passamonti,
Ezio Bramucci,
Laura Cattaneo,
Giovanni Ferrari,
Sergio Repetto, Antonio Bartorelli,
Salvatore Pirelli,
Stefano De Servi
[show abstract]
[hide abstract]
ABSTRACT: Percutaneous coronary intervention (PCI) has been shown to be the best reperfusion therapy for acute myocardial infarction with ST-elevation (STEMI), but data from registries show differences in patient populations and outcomes between randomized trials and real life.
We sought to provide information about the current status of this treatment with a registry collecting data in Lombardy, the most densely populated region in Italy, with widespread availability of cathlabs and a well-established network for the treatment of STEMI.
Patient enrollment was performed by 32 hub centres recruiting 3901 STEMI patients who underwent PCI procedures within 12 h of the onset of symptoms, of whom 3317 patients underwent primary PCI, 376 'facilitated' PCI, and 208 rescue PCI in cathlabs located, in 77% of cases, in the same hospital of admission. In-hospital and 30-day total death were 4.4 and 6.6%, respectively. At multivariate analysis independent negative predictors of 30-day mortality were Killip class 3-4, number of involved ECG leads, chronic renal failure and age, whereas positive predictors were ST resolution more than 50% and postprocedural grade 3 thrombolysis in myocardial infarction flow.
LombardIMA PCI registry enrolled STEMI patients representing a real-world population treated with PCI. Findings presented in this study may provide a benchmark for similar registries undertaken in other Italian regions and may be helpful to assess future possible developments of care for STEMI patients.
Journal of Cardiovascular Medicine 10/2010; 12(1):43-50. · 1.51 Impact Factor
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Patrick W Serruys,
Sigmund Silber,
Scot Garg,
Robert Jan van Geuns,
Gert Richardt,
Pawel E Buszman,
Henning Kelbaek,
Adrianus Johannes van Boven,
Sjoerd H Hofma,
Axel Linke, [......],
Ganesh Manoharan,
Ran Kornowski,
Thomas Ischinger, Antonio Bartorelli,
Jacintha Ronden,
Marco Bressers,
Pierre Gobbens,
Manuela Negoita,
Frank van Leeuwen,
Stephan Windecker
[show abstract]
[hide abstract]
ABSTRACT: New-generation coronary stents that release zotarolimus or everolimus have been shown to reduce the risk of restenosis. However, it is unclear whether there are differences in efficacy and safety between the two types of stents on the basis of prospectively adjudicated end points endorsed by the Food and Drug Administration.
In this multicenter, noninferiority trial with minimal exclusion criteria, we randomly assigned 2292 patients to undergo treatment with coronary stents releasing either zotarolimus or everolimus. Twenty percent of patients were randomly selected for repeat angiography at 13 months. The primary end point was target-lesion failure, defined as a composite of death from cardiac causes, any myocardial infarction (not clearly attributable to a nontarget vessel), or clinically indicated target-lesion revascularization within 12 months. The secondary angiographic end point was the extent of in-stent stenosis at 13 months.
At least one off-label criterion for stent placement was present in 66% of patients. The zotarolimus-eluting stent was noninferior to the everolimus-eluting stent with respect to the primary end point, which occurred in 8.2% and 8.3% of patients, respectively (P<0.001 for noninferiority). There were no significant between-group differences in the rate of death from cardiac causes, any myocardial infarction, or revascularization. The rate of stent thrombosis was 2.3% in the zotarolimus-stent group and 1.5% in the everolimus-stent group (P=0.17). The zotarolimus-eluting stent was also noninferior regarding the degree (+/-SD) of in-stent stenosis (21.65+/-14.42% for zotarolimus vs. 19.76+/-14.64% for everolimus, P=0.04 for noninferiority). In-stent late lumen loss was 0.27+/-0.43 mm in the zotarolimus-stent group versus 0.19+/-0.40 mm in the everolimus-stent group (P=0.08). There were no significant between-group differences in the rate of adverse events.
At 13 months, the new-generation zotarolimus-eluting stent was found to be noninferior to the everolimus-eluting stent in a population of patients who had minimal exclusion criteria. (ClinicalTrials.gov number, NCT00617084.)
New England Journal of Medicine 07/2010; 363(2):136-46. · 53.30 Impact Factor
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Yves-Laurent Bayard,
Heyder Omran,
Petr Neuzil,
Leif Thuesen,
Maximilian Pichler,
Edward Rowland,
Angelo Ramondo,
Witold Ruzyllo,
Werner Budts,
Gilles Montalescot, [......],
Jean-François Piéchaud, Antonio Bartorelli,
Jean Marco,
Peter Probst,
Karl-Heinz Kuck,
Stefan H Ostermayer,
Franziska Büscheck,
Evelyn Fischer,
Michaela Leetz,
Horst Sievert
[show abstract]
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ABSTRACT: The European PLAATO (Percutaneous Left Atrial Appendage Transcatheter Occlusion) study was performed to determine the safety and efficacy of left atrial appendage occlusion by catheter technique. Embolic stroke due to atrial fibrillation is a common observation, especially in the elderly. Most thrombi in atrial fibrillation form in the left atrial appendage (LAA), its occlusion may therefore reduce the incidence of stroke in these patients.
One hundred and eighty patients with non-rheumatic atrial fibrillation and contraindication to warfarin therapy were enrolled in the PLAATO study. Patients were eligible if they had a?history of transient ischaemic attack (TIA) or stroke or at least two independent risk factors for stroke such as age > or =75 years, hypertension, congestive heart failure or diabetes. The primary endpoint was LAA closure as determined by transesophageal echocardiography (TEE) two months after the procedure and stroke rate at 150 patient years. Left atrial appendage occlusion was successful in 162/180 patients (90%, 95% CI 83.1% to 92.9%). Two patients died within 24 hours of the procedure (1.1%, 95% CI 0.3% to 4%). Six cardiac tamponades were observed (3.3%, 95% CI 1.5% to 7.1%). In two cases, surgical drainage of the tamponade was necessary (1.1%, 95% CI 0.3% to 4%). In one patient, the device that was chosen was too small and embolised into the aorta after its release (0.6%, 95% CI 0.1% to 3.1%). It was snared and replaced without further complications. Successful occlusion of the LAA was achieved in 126/ 140 (90%, 95% CI 83.5% to 94.2%) of patients as noted by TEE at the two months follow-up. In a follow-up time of 129 documented patient years, three strokes occurred (2.3% per year). The expected incidence of stroke according to the CHADS2-Score was 6.6% per year. The trial was halted prematurely during the follow-up phase for financial considerations.
Left atrial appendage closure is relatively safe and effective. However, severe complications can occur. It might become an alternative for atrial fibrillation patients who are ineligible for long-term anticoagulation therapy.
EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 06/2010; 6(2):220-6. · 3.29 Impact Factor
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Flavio Ribichini,
Gerardo Ansalone, Antonio Bartorelli,
Federico Beqaraj,
Andrea Berni,
Salvatore Colangelo,
Maurizio D'Amico,
Francesco Della Rovere,
Antonio Fiscella,
Gabriele Gabrielli, [......],
Diego Milazzo,
Michele Romano,
Pietro Sangiorgio,
Imad Sheiban,
Corrado Tamburino,
Bernardino Tuccillo,
Rosvaldo Villani,
Barbara Cappi,
Maria Josè Lopera Quijada,
Corrado Vassanelli
[show abstract]
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ABSTRACT: Myocardial revascularization with drug-eluting stents (DESs) is emerging as an alternative to conventional coronary artery bypass surgery in patients with multivessel coronary artery disease (MV-CAD). First-generation DESs have yielded equivalent safety results at mid-term compared with surgery, but inferior efficacy in preventing the recurrence of ischemic symptoms. The outcome of percutaneous coronary intervention with a second-generation everolimus DES as compared with a paclitaxel DES in patients with MV-CAD has not been established.
The aim of the study is the assessment of the efficacy and performance of the XIENCE V everolimus-eluting stent in the treatment of de-novo coronary artery lesions in patients with MV-CAD.
The study is composed of two parts: a prospective, double arm, randomized multicenter trial to assess the angiographic efficacy of the XIENCE V everolimus-eluting coronary stent system (EECSS) compared with the Taxus Liberté Paclitaxel Eluting Coronary Stent System (Taxus Liberté Stent) and a prospective, open-label, single arm, controlled registry to analyze the clinical efficacy and safety of XIENCE V EECSS at mid-term and long-term follow-up in patients treated for MV-CAD.
For the EXECUTIVE randomized trial, the primary endpoint is in-stent late lumen loss at 9 months. For the EXECUTIVE registry, the primary endpoint is a composite of all death, myocardial infarction (Q-wave and non-Q-wave), and ischemia-driven target vessel revascularization at 12 months. The study will be conducted at 30 study centers in Italy and 600 patients will be enrolled in total: 200 patients will be enrolled (1: 1) in the randomized trial and 400 patients will enter the registry.
It was calculated that, assuming a mean in-stent late lumen loss of 0.20 +/- 0.41 mm in the XIENCE V EECSS arm and 0.30 +/- 0.53 mm in the Taxus Liberté stent arm, and a noninferiority margin delta of 0.12 (according to the SPIRIT III results), the analysis of 81 lesions per arm would provide over 90% power. Therefore, 200 patients will be enrolled to account for dropouts.
The present study is expected to provide as yet unavailable information about the performance of second-generation stents in the specific setting of patients with MV-CAD.
Journal of Cardiovascular Medicine 04/2010; 11(4):299-309. · 1.51 Impact Factor
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Tullio Palmerini,
Diego Sangiorgi,
Antonio Marzocchi,
Corrado Tamburino,
Imad Sheiban,
Massimo Margheri,
Giuseppe Vecchi,
Giuseppe Sangiorgi,
Nicoletta Franco, Antonio Bartorelli, [......],
Francesco Di Pede,
Angelo Ramondo,
Massimo Medda,
Marco De Carlo,
Leonardo Bolognese,
Alberto Benassi,
Cataldo Palmieri,
Vincenzo Filippone,
Giulia Lauria,
Stefano De Servi
[show abstract]
[hide abstract]
ABSTRACT: In this study we investigated the impact of acute coronary syndromes (ACSs) on clinical outcomes in patients with unprotected left main coronary artery (ULMCA) stenosis treated with drug-eluting stents (DESs). In this multicenter, retrospective, observational study we enrolled 1,101 patients with ULMCA stenosis treated with DESs. Six hundred eleven patients presented with ACS and 490 had stable coronary artery disease. ACS was defined as the presence of unstable angina or non-ST-segment elevation myocardial infarction (MI). During 2-year follow-up, the adjusted hazard ratio of cardiac mortality and MI of patients with ACS versus stable patients was 2.42 (95% confidence interval 1.37 to 4.28, p = 0.002). We observed a stepwise risk increase, namely patients with stable coronary disease had the lowest risk, patients with unstable angina an intermediate risk, and patients with non-ST-segment elevation MI the highest risk. The increased risk of cardiac mortality and MI of patients with ACS was concentrated in the first year after DES implantation. In conclusion, patients with ULMCA stenosis and ACS treated with DESs have an increased risk of cardiac mortality and MI during the first year after the intervention compared to stable patients.
The American journal of cardiology 01/2010; 105(2):174-8. · 3.58 Impact Factor
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Corrado Carbucicchio,
Paolo Della Bella,
Gaetano Fassini,
Nicola Trevisi,
Stefania Riva,
Francesco Giraldi,
Francesca Baratto,
Giancarlo Marenzi,
Erminio Sisillo, Antonio Bartorelli,
Francesco Alamanni
[show abstract]
[hide abstract]
ABSTRACT: In patients with severe cardiomyopathy, recurrent episodes of nontolerated ventricular tachycardia (VT) or electrical storm (ES) frequently cause acute heart failure and cardiac death; the suppression of the arrhythmia is therefore lifesaving, but feasibility of catheter ablation (CA) is precluded by the adverse hemodynamic conditions together with the characteristics of the arrhythmia that interdicts efficacious mapping. The use of the percutaneous cardiopulmonary support (CPS) for circulatory assistance may allow patient's stabilization and enhance efficacy and safety of CA in this emergency setting.
19 patients (19 males; mean age 61 +/- 6 years; chronic ischemic cardiomyopathy, eleven patients; primary dilated cardiomyopathy, six patients; arrhythmogenic right ventricular dysplasia/ cardiomyopathy, two patients) with recurrent nontolerated VT episodes undergoing CPS-assisted CA were retrospectively evaluated. Twelve patients had acute hemodynamic failure refractory to inotropic agents and ventilatory assistance, seven patients had undergone a failing nonconventional CA procedure. 14 patients presented with ES, and in twelve the procedure was undertaken under emergency conditions within 24 h from admission. Patients were ventilated under general anesthesia and assisted by a multidisciplinary team. The CPS system consisted in a Medtronic Bio-Medicus centrifugal pump and in a Maxima Plus oxygenator, a 15-F arterial cannula, and a 17-F venous cannula.
Flows between 2 and 3 l/min were activated after induction of 56/62 forms of nontolerated VT, achieving hemodynamic stabilization in all patients. CA was mainly guided by conventional activation mapping and was effective in abolishing 45/56 supported VTs; in 10/19 patients all clinical VTs were suppressed by CA. Mean procedural time was 4 h and 20 min. Complete stabilization was achieved in 13 patients (68%) without VT recurrence during a 7-day in-hospital monitoring. A significant clinical improvement was observed in two patients (11%); one patient (5%) with persistent VT episodes acutely died after heart transplant. At a mean follow-up of 42 months (range 15-60 months), 5/18 patients (28%) were free from VT recurrence, 7/18 (39%) had a clear clinical improvement with reduced implantable cardioverter defibrillator interventions. 5/14 patients (36%) had ES recurrence; among them, three died because of acute heart failure. No serious CPS-related complications were observed.
The CPS warrants acceptable hemodynamic stabilization and efficacious mapping in high-risk patients undergoing CA for unstable VT in the emergency setting. Safety and efficacy of this technique translate into significant clinical improvement in the majority of patients. Even if only relatively invasive, CPS should be reserved to patients with ES or intractable arrhythmia causing acute heart failure; moreover, the need for an experienced team of multidisciplinary operators implies that its use is restricted to selected high-competency institutions.
Herz 11/2009; 34(7):545-52. · 0.92 Impact Factor
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Giancarlo Marenzi,
Emilio Assanelli,
Jeness Campodonico,
Monica De Metrio,
Gianfranco Lauri,
Ivana Marana,
Marco Moltrasio,
Mara Rubino,
Fabrizio Veglia,
Piero Montorsi, Antonio L Bartorelli
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the clinical and prognostic relevance of acute kidney injury (AKI) in the setting of ST-elevation acute myocardial infarction (STEMI) complicated by cardiogenic shock (CS).
Prospective study.
Single-center study, 13-bed intensive cardiac care unit at a University Cardiological Center.
Ninety-seven consecutive STEMI patients with CS at admission, undergoing intra-aortic balloon pump (IABP) support and primary percutaneous coronary intervention (PCI).
None.
We measured serum creatinine at baseline and each day for the following 3 days. Acute kidney injury was defined as a rise in creatinine >25% from baseline. Overall, AKI occurred in 52 (55%) patients, and in 12 of these patients, a renal replacement therapy was required. In multivariate analysis, age >75 yrs (p = .005), left ventricular ejection fraction < or = 40% (p = .009), and use of mechanical ventilation (p = .01) were independent predictors of AKI. Patients developing AKI had a longer hospital stay, a more complicated clinical course, and significantly higher mortality rate (50% vs. 2.2%; p <.001) than patients without AKI. In our population, AKI was the strongest independent predictor of in-hospital mortality (relative risk 12.3, 95% confidence intervals 1.78 to 84.9; p <.001).
In patients with STEMI complicated by CS, AKI represents a frequent clinical complication associated with a poor prognosis.
Critical care medicine 09/2009; 38(2):438-44. · 6.37 Impact Factor
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Giampaolo Niccoli,
Domenico D'amario,
Cristina Spaziani,
Nicola Cosentino,
Marcello Marino,
Stefano Rigattieri,
Paolo Lo Schiavo,
Maria Rosaria De Vita,
Fabio Tarantino, Antonio Bartorelli,
Franco Fabbiocchi,
Francesco Prati,
Fabrizio Imola,
Marco Valgimigli,
Roberto Ferrari,
Filippo Crea
[show abstract]
[hide abstract]
ABSTRACT: Thrombus aspiration improves microvascular obstruction in patients with acute myocardial infarction treated by percutaneous coronary intervention. However, drugs such as nitroprusside and adenosine have not yet been tested as adjuncts to thrombus aspiration. Therefore, we designed a placebo-controlled, randomized, open-label, blind-examination, multicenter trial assessing the effects of intracoronary nitroprusside or adenosine on microvascular obstruction in patients undergoing primary or rescue percutaneous coronary intervention and thrombus aspiration.
Six hospitals in Italy participate in the REOPEN-AMI study. Two hundred and forty consecutive patients with acute myocardial infarction undergoing primary or rescue percutaneous coronary intervention and thrombus aspiration are randomly allocated 1: 1: 1 to receive either intracoronary nitroprusside, adenosine or placebo. The primary end-point is the incidence of ST resolution greater than 70% on surface ECG at 90 min after the procedure. Secondary end-points are: incidence of angiographic no-reflow (thrombolysis in myocardial infarction flow < or =2 or 3 with a myocardial blush grade <2); changes of left ventricular volumes at follow-up (at bidimensional echocardiography); rate of major adverse cardiac events (cardiac death, myocardial infarction, target lesion revascularization and heart failure requiring hospitalization).
REOPEN-AMI will provide important data on the efficacy and safety of intracoronary nitroprusside and adenosine as an adjunctive treatment to percutaneous coronary intervention after thrombus aspiration for patients with acute myocardial infarction.
Journal of Cardiovascular Medicine 05/2009; 10(7):585-92. · 1.51 Impact Factor
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Corrado Tamburino,
Maria Elena Di Salvo,
Davide Capodanno,
Antonio Marzocchi,
Imad Sheiban,
Massimo Margheri,
Aleardo Maresta,
Fabio Barlocco,
Giuseppe Sangiorgi,
Giancarlo Piovaccari, [......],
Diego Ardissino,
Francesco Di Pede,
Angelo Ramondo,
Luigi Inglese,
Anna Sonia Petronio,
Leonardo Bolognese,
Alberto Benassi,
Cataldo Palmieri,
Aldo Patti,
Stefano De Servi
[show abstract]
[hide abstract]
ABSTRACT: To compare long-term clinical outcome following drug-eluting stents (DES) or bare-metal stents (BMS) implantation on lesions located at the ostium or the shaft of the left main in a large real-world population. The advent of DES decreased the risk of unprotected left main coronary artery (ULMCA) restenosis when compared with BMS, but it is unclear if this advantage continues when non-bifurcational lesions are considered.
The GISE-SICI registry is a retrospective, observational multicentre registry promoted by the Italian Society of Invasive Cardiology in which 19 high-volume participating centres enrolled 1453 consecutive patients who underwent percutaneous coronary intervention on ULMCA between January 2002 and December 2006. From the registry, a total of 479 consecutive patients with ostial and shaft lesions who underwent DES (n = 334) or BMS (n = 145) implantation were analysed with extensive multivariable and propensity score adjustments. At 3-year follow-up, risk-adjusted survival rates were higher in patients treated with DES than in those treated with BMS. The adjusted hazard ratio (HR) for the risk of mortality after DES implantation relative to BMS implantation was 0.37 (95% CI: 0.15-0.96, P = 0.04). The adjusted HR for the risk of cardiac mortality was 0.31 (95% CI: 0.09-1.04, P = 0.06). The adjusted 3-year rates of target lesion revascularization (TLR) were not significantly lower in the DES group than in the BMS group (P = 0.60).
In a large population of patients with lesions located at the ostium or the shaft of the left main in a real-world setting, DES were associated with favourable clinical outcomes when compared with BMS, although there was no evidence of a significant reduction in TLR with DES vs. BMS.
European Heart Journal 04/2009; 30(10):1171-9. · 10.48 Impact Factor
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Piero Montorsi,
Stefano Galli,
Paolo Ravagnani,
Sarah Ghulam Ali,
Daniela Trabattoni,
Franco Fabbiocchi,
Alessandro Lualdi,
Giovanni Ballerini,
Daniele Andreini,
Gianluca Pontone,
Andrea Annoni, Antonio L Bartorelli
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ABSTRACT: Unfavorable complex anatomy or congenital anomalies of supra-aortic vessel take-off may increase carotid artery stenting (CAS) procedural difficulties and complications through the femoral route. We assessed the feasibility, safety, and efficacy of CAS through the right brachial approach in patients in whom left internal carotid artery stenosis and bovine aortic arch configuration were identified with computed tomography (CT) angiography. Bovine configuration of the aortic arch and left carotid artery stenosis were easily identified by CT angiography and successfully treated through the right brachial approach technique.
European Radiology 04/2009; 19(8):2009-15. · 3.22 Impact Factor
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Davide Capodanno,
Maria Elena Di Salvo,
Tullio Palmerini,
Imad Sheiban,
Massimo Margheri,
Giuseppe Vecchi,
Giuseppe Sangiorgi,
Giancarlo Piovaccari, Antonio Bartorelli,
Carlo Briguori, [......],
Francesco Di Pede,
Angelo Ramondo,
Luigi Inglese,
Anna Sonia Petronio,
Leonardo Bolognese,
Alberto Benassi,
Cataldo Palmieri,
Vincenzo Filippone,
Stefano De Servi,
Corrado Tamburino
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ABSTRACT: Few data are available on diabetic patients undergoing percutaneous coronary intervention (PCI) in the context of unprotected left main coronary artery (ULMCA) disease. The main goal of this study was to present the long-term relative benefits of using drug-eluting stent (DES) instead of bare-metal stent (BMS) for diabetic patients submitted to percutaneous ULMCA treatment in a large real world multicenter registry.
The GISE-SICI registry is a retrospective, observational multicenter registry promoted by the Italian Society of Invasive Cardiology in which 19 high-volume participating centers enrolled 1,453 consecutive patients who underwent PCI on ULMCA between January 2002 and December 2006. From the registry, a total of 398 consecutive patients with diabetes mellitus who underwent DES (n = 321) or BMS (n = 77) implantation were analyzed, with extensive multivariable adjustments.
At 3-years, use of DES in diabetic patients resulted in no significant differences with respect to death (HR 0.56, 95% CIs 0.24-1.28), myocardial infarction (HR 0.82, 95% CIs 0.21-3.26), and the composite end-point of death or myocardial infarction (HR 0.56, 95% CIs 0.27-1.20). Conversely, DES were associated with significant reduction of target lesion revascularization (TLR, HR 0.33; 95% CIs 0.14-0.80, P = 0.001) rates.
Patients presenting with ULMCA disease in the context of diabetes mellitus who are treated with stent-supported PCI have a significant reduction in the rate of TLR with no increased risk of death or myocardial infarction.
Catheterization and Cardiovascular Interventions 03/2009; 73(3):310-6. · 2.29 Impact Factor
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Corrado Tamburino,
Maria Elena Di Salvo,
Davide Capodanno,
Tullio Palmerini,
Imad Sheiban,
Massimo Margheri,
Giuseppe Vecchi,
Giuseppe Sangiorgi,
Giancarlo Piovaccari, Antonio Bartorelli, [......],
Diego Ardissino,
Francesco Di Pede,
Angelo Ramondo,
Luigi Inglese,
Anna Sonia Petronio,
Leonardo Bolognese,
Alberto Benassi,
Cataldo Palmieri,
Vincenzo Filippone,
Stefano De Servi
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ABSTRACT: The aim of this study was to compare long term clinical outcome after left main stenting in a large real world population of patients treated with drug-eluting stents (DES) or bare-metal stents (BMS) in the setting of acute coronary syndromes. The advent of DES decreased the risk of unprotected left main coronary artery restenosis as compared with BMS, but safety concerns still exist, especially when high-risk patients presenting with acute coronary syndromes are considered. The Gruppo Italiano Studi Emodinamici-Societa' Italiana di Cardiologia Invasiva (GISE-SICI) registry is a retrospective, observational multicenter registry promoted by the Italian Society of Invasive Cardiology in which 19 high-volume participating centers enrolled 1,453 consecutive patients who underwent percutaneous coronary intervention on unprotected left main coronary artery between January 2002 and December 2006. From the registry, a total of 849 consecutive patients presenting with unstable angina or non-ST-segment elevation myocardial infarction who underwent DES (n=611) or BMS (n=238) implantation were analyzed with extensive multivariable and propensity-score adjustments. At 3-year follow-up, the adjusted hazard ratio for the risk of mortality after DES implantation relative to BMS implantation was 0.90 (95% confidence intervals [CI] 0.59 to 1.38, p=0.617), and the adjusted hazard ratio for the risk of cardiac mortality was 0.75 (95% CI 0.45 to 1.27, p=0.287). DES were associated with significant reduction of myocardial infarction (hazard ratio 0.37, 95% CI 0.17 to 0.81, p=0.009) and target lesion revascularization rates (hazard ratio 0.38, 95% CI 0.21 to 0.69, p=0.001). Younger age, low ejection fraction, an increase in the cardiac biomarkers, absence of diabetes, and bifurcations showed a significant interaction with assigned treatment regarding myocardial infarction. The treatment effects on target lesion revascularization were consistent across multiple subgroups, with the possible exception of patients with nonbifurcational lesions. In conclusion, in a large population of patients with acute coronary syndromes and unprotected left main coronary artery disease DES were more effective than BMS in reducing myocardial infarction and target lesion revascularization. There was no evidence of a significant reduction in mortality with DES versus BMS.
The American journal of cardiology 02/2009; 103(2):187-93. · 3.58 Impact Factor
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Tullio Palmerini,
Antonio Marzocchi,
Corrado Tamburino,
Imad Sheiban,
Massimo Margheri,
Giuseppe Vecchi,
Giuseppe Sangiorgi,
Andrea Santarelli, Antonio Bartorelli,
Carlo Briguori, [......],
Francesco Di Pede,
Angelo Ramondo,
Luigi Inglese,
Marco De Carlo,
Leonardo Bolognese,
Alberto Benassi,
Cataldo Palmieri,
Vincenzo Filippone,
Diego Sangiorgi,
Stefano De Servi
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ABSTRACT: Data are limited about the relative efficacy of drug-eluting stents (DESs) versus bare-metal stents (BMSs) for the treatment of unprotected left main coronary artery (ULMCA) stenosis. The survey promoted by the Italian Society of Invasive Cardiology on ULMCA stenosis was an observational study involving 19 high-volume Italian centers of patients with ULMCA stenosis treated using percutaneous coronary intervention (PCI). From January 2002 to December 2006, of 1,453 patients identified with ULMCA stenosis treated with PCI, 1,111 were treated with DESs and 342 were treated with BMSs. During a 2-year follow-up, risk-adjusted survival free from cardiac death was significantly higher in patients treated with DESs than in those treated with BMSs. The propensity-adjusted hazard ratio for risk of 2-year cardiac mortality after DES versus BMS implantation was 0.49 (95% confidence interval 0.32 to 0.77). The benefit of DESs in reducing cardiac mortality was obtained in the period from 3 to 6 months and maintained up to 2 years. In conclusion, for patients with ULMCA stenosis undergoing PCI, DES implantation was associated with higher adjusted rates of 2-year survival free from cardiac death. The benefit of DESs in reducing cardiac mortality was obtained in the period in which clinical manifestations of restenosis usually peak.
The American journal of cardiology 01/2009; 102(11):1463-8. · 3.58 Impact Factor
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Tullio Palmerini,
Antonio Marzocchi,
Corrado Tamburino,
Imad Sheiban,
Massimo Margheri,
Giuseppe Vecchi,
Giuseppe Sangiorgi,
Andrea Santarelli, Antonio Bartorelli,
Carlo Briguori, [......],
Angelo Ramondo,
Luigi Inglese,
Marco De Carlo,
Giovanni Falsini,
Alberto Benassi,
Cataldo Palmieri,
Vincenzo Filippone,
Diego Sangiorgi,
Fabio Barlocco,
Stefano De Servi
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ABSTRACT: Distal unprotected left main coronary artery (ULMCA) stenosis represents a technical challenge for interventional cardiologists. In this study, we compared 2-year clinical outcomes of different stenting strategies in patients with distal ULMCA stenosis treated with drug-eluting stents.
The survey promoted by the Italian Society of Invasive Cardiology on ULMCA stenosis was an observational study on patients with ULMCA stenosis treated with percutaneous coronary intervention. In this study, we selected patients with distal ULMCA stenosis treated with drug-eluting stents. Seven hundred seventy-three patients were eligible for this study: 456 were treated with 1 stent (group 1) and 317 with 2 stents (group 2). The primary end point of the study was the incidence of major adverse cardiac events (MACEs), defined as the occurrence of mortality, myocardial infarction, and target lesion revascularization. During a 2-year follow-up, risk-adjusted survival free from MACE was significantly higher in patients in group 1 than in patients in group 2. The propensity-adjusted hazard ratio for the risk of 2-year MACE in patients in group 1 versus group 2 was 0.53 (95% CI, 0.37 to 0.76). The propensity-adjusted hazard ratio for the risk of 2-year cardiac mortality and myocardial infarction in patients in group 1 versus group 2 was 0.38 (95% CI, 0.17 to 0.85).
Compared with the 2-stent technique, the 1-stent technique is associated with a better 2-year MACE-free survival. The stenting strategy is a prognostic factor that should be taken into account when deciding the optimal revascularization treatment.
Circulation Cardiovascular Interventions 12/2008; 1(3):185-92. · 6.06 Impact Factor
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ABSTRACT: To describe the impact of a steerable device on procedural success and times. The Venture wire control catheter (VWC-St. Jude Medical, Maple Grove, MN, U.S.A.), facilitates wire orientation providing excellent backup support and may therefore assist in cases in which conventional approaches have failed.
We describe all cases in which the VWC catheter was used at our institutions. The device was employed after prolonged attempts with standard wires had failed. We analysed procedural success and complication rates, as well as the impact of this device on procedural times. We evaluated 18 cases. The mean time from the first wire attempt to the end of the procedure was 58 minutes. Lesion crossing attempts with standard wires were performed for a mean time of 23 minutes (range 10-45 minutes). The VWC catheter was employed as the last resort, leading to procedural success in 14 cases. Lesion crossing with the VWC catheter was achieved in a mean time of four minutes (range one to 15 minutes). There were no device-related complications.
Our experience shows how the VWC catheter can turn procedural failures into successes, significantly impacting procedural times in different challenging scenarios. This device may represent an extremely useful addition to the interventionalist's armamentarium.
EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 09/2008; 4(2):277-84. · 3.29 Impact Factor
