Paola Mantovani

Ospedali Riuniti di Bergamo, Bérgamo, Lombardy, Italy

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Publications (5)19.78 Total impact

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    ABSTRACT: Introduction. Cardiac arrhythmias represent one of the main and most dangerous complications of acute myocardial infarction. The aim of our study is the recording of arrhythmias in elderly patients affected by acute myocardial infarction over a period of 5 years. Methods. A data-base for collecting data on arrhythmias during hospitalization has been active for 5 years. The difference of the frequencies among variables were analyzed with the Fisher exact test, while the difference among continuous variables were analyzed with the Student T test. Results. 1.963 consecutive patients affected by myocardial infarction were analyzed from 2004 to 2008. The arrhythmias were: atrial fibrillation/flutter (8.54%), ventricular fibrillation (5.08%), third-degree atrioventricular block (3.61%), non-sustained ventricular tachycardia (2.59%). The patients with ventricular fibrillation were younger than average (4 years younger than the median age), while those with atrial fibrillation or a third-degree atrioventricular block were considerably older (8 years older than the median age). Discussion. Ventricular fibrillation is associated with a poor prognosis, especially in younger patients. Elderly patients develop atrial fibrillation and third-degree atrioventricular block more frequently. Third-degree atrioventricular block occurs most frequently in the first 24 hour, while atrial fibrillation is equally divided into precocious and late. The presence of a third-degree atrioventricular block which, most likely, is indicative of a wider acute ischemic damage, greatly impact on the mortality rate, which is higher than 20%. The presence of third-degree atrioventricular block retains its predictive value even when corrected by age and gender. Conclusions. The study shows that, despite timely treatment of myocardial infarction, ventricular fibrillation retains a poor prognosis, especially in younger patients, while atrial fibrillation and third-degree atrioventricular block occur more frequently in elderly patients.
    No preview · Article · Jan 2014
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    Full-text · Article · Apr 2011 · Journal of the American College of Cardiology
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    ABSTRACT: In patients undergoing coronary stenting, long-term dual antiplatelet therapy with aspirin and clopidogrel reduces atherothrombotic events but also increases the risk of bleeding. The potential for developing bleeding complications is further enhanced in patients also requiring oral anticoagulant treatment ("triple therapy"). The aim of the study is to assess long-term outcomes associated with the use of triple-therapy in patients undergoing coronary stenting and evaluate how these may be affected by targeting international normalized ratio (INR) values to the lower therapeutic range. We prospectively studied 102 consecutive patients undergoing coronary stenting treated with dual antiplatelet therapy also requiring oral anticoagulation. INR was targeted to the lower therapeutic range (2.0 to 2.5). Patients requiring oral anticoagulant therapy because of mechanical valve prosthesis were excluded. Patients were followed for 18 months, and bleeding, defined according to Thrombolysis in Myocardial Infarction criteria, and major adverse cardiac events were recorded. Outcomes were compared with a control group (n = 102) treated only with dual antiplatelet therapy. The mean duration of triple therapy was 157 +/- 134 days. At 18 months, a nonsignificant increase in bleeding was observed in the triple versus dual therapy group (10.8% vs 4.9%, p = 0.1). INR values were higher in patients with bleeding (2.8 +/- 1.1 vs 2.3 +/- 0.2, p = 0.0001). In patients who had INR values within the recommended target (79.4%), the risk of bleeding was significantly lower compared with patients who did not (4.9 vs 33%, p = 0.00019) and with that observed in the control group (4.9%). An INR >2.6 was the only independent predictor of bleeding. There were no significant differences in major adverse cardiac events between groups (5.8% vs 4.9%, p = 0.7). In conclusion, in patients undergoing coronary stenting on triple therapy, targeting lower therapeutic INR values reduces the risk of bleeding complications.
    Full-text · Article · Jan 2009 · The American journal of cardiology
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    ABSTRACT: In the context of an operative network for acute coronary syndrome consisting in telemedicine equipment and 24-h catheter facility availability, a database was worked out to verify clinical pathways, timeline, prevalence of cardiovascular risk factors, diagnostic and therapeutic choices, and clinical results. The aim of this study was to evaluate the adherence to guidelines in the real world in order to assess quality of care. We implemented a database in the preexisting hospital intranet due to open source interactive pages. From international guidelines we obtained performance measures for each step of the care process, in order to have a continuous and updated evaluation of our healthcare performance. After an accurate analysis of the results of the first 2-year data collection, we modified the performance measurement set to optimize our database. All data were analyzed with statistical program SPSS. A total of 1066 patient characteristics within a period of 5 semesters were analyzed: trends for each of the 11 performance measures were evaluated. In 852 patients clinical and angiographic characteristics were analyzed: cardiovascular risk factors and TIMI risk score for ST-elevation myocardial infarction patients, different pathways and first-aid timeline. Data about pharmacological therapy on admission, during intensive care unit stay and at discharge were also collected. The present study assesses the utility of continuous monitoring and of verifying quality of care with a dedicated database in order to evaluate adherence to guidelines and to promote optimization of clinical practice.
    No preview · Article · Apr 2008 · Giornale italiano di cardiologia (2006)

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Publication Stats

88 Citations
19.78 Total Impact Points

Institutions

  • 2011
    • Ospedali Riuniti di Bergamo
      • Department of Hematology
      Bérgamo, Lombardy, Italy
  • 2009
    • Azienda Ospedaliera Carlo Poma Mantova
      Mantoue, Lombardy, Italy